The MRI study of brain functional changes in cervical vertigo patients / 中华骨科杂志

Objective:To explore the brain function changes in patients with cervical vertigo using functional MRI.Methods:Twenty-two patients who were diagnosed with cervical vertigo were recruited in this study for functional MRI (fMRI) analysis, while 25 age- and sex-matched adult healthy individuals were chose forhealthy controls. The Visual Analogue Scale(VAS) and Dizziness Handicap Inventory (DHI) were used to access the severity of cervical vertigo, and the six-point categorical rating scale was used to measure the frequency of vertigo. Functional MRI was used to investigate the regions with brain functional changes between the cervical vertigo group and the control group. All the data was analyzed using low-frequency oscillation amplitude (ALFF) to explore local brain function changes. The ALFF values between the two groups were tested by two independent samples t-tests. Finally, the ALFF values in abnormal brain regions were extracted using the REST software package and correlated with the diseaseduration of cervical vertigo and thevertigo scores (VAS and DHI) using Pearson correlation analysis. P <0.05 was considered statistically significant. Results:Compared to healthy controls, patients with cervical vertigo haddecreased ALFF valuesin the left superior temporal gyrus (voxel=45, t=-3.36), right superior temporal gyrus (voxel=32, t=-2.82) and left supramarginal gyrus (voxel=57, t=-4.85), and increased ALFF values in the left and right cerebellum (voxel=41, t=4.26; voxel=33, t=4.57; respectively)(AlphaSim Rest, all P values >0.05). The ALFF values of left and right superior temporal gyrus were negatively correlated with the disease duration of vertigo (left R2=0.437, right R2==0.259), the VAS score (left R2==0.453, right R2==0.341) and DHI score (left R2=0.553, right R2=0.594), respectively, and there were significant differences (all P values < 0.05). The ALFF values of left and right cerebellum were positively correlated with the disease duration of vertigo (left R2==0.555, right R2=0.490) and the VAS score (left R2=0.307, right R2=0.282) and DHI score (left R2=0.632, right R2=0.591), respectively, and the differences were significant (all P values < 0.05). Conclusion:Patients with cervical vertigo have reduced spontaneous nerve activity in bilateral Vestibular cortex, and increased spontaneous nerve activity in the bilateral cerebellum. The brain functional changes were correlated with the disease duration and the severity of vertigo.

Comprehensive rehabilitation is superior to surgical intervention for many patients with recurrent lumbar disc herniation / 中华物理医学与康复杂志

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation (LDH).Methods A total of 124 LDH patients were recruited antd randomly divided into an experimental group and a control group,each of 62.The experimental group was given comprehensive rehabilitation consisting of medicine,physical therapy,and spinal stabilization exercises,while the control group received lumbar spine surgery.The patients' back and leg pain scores and their Oswestry Disability Index (ODI) scores were compared at admission and discharge,as well as 3 and 12 months after discharge.Anxiety and depression were also assessed at admission and 3 months after discharge.Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admisshin for both groups.There were no significant inter-group differences.In terms of anxiety and depression,however,these had decreased signifieantly in both groups,but the experimental group's average rating was significantly better at diseharge.Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH.Comprehensive rehabilitation should be considered as the first ehoiee for patients with rccurrent LDH,and only supplemented by surgical intervention if it is not effective.

Differentiation of adipose-derived stem cells toward nucleus pulposus-like cells induced by hypoxia and a three-dimensional chitosan-alginate gel scaffold in vitro / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Injectable three-dimensional (3D) scaffolds have the advantages of fluidity and moldability to fill irregular-shaped defects, simple incorporation of bioactive factors, and limited surgical invasiveness. Adipose-derived stem cells (ADSCs) are multipotent and can be differentiated toward nucleus pulposus (NP)-like cells. A hypoxic environment may be important for differentiation to NP-like cells because the intervertebral disc is an avascular tissue. Hence, we investigated the induction effects of hypoxia and an injectable 3D chitosan-alginate (C/A) gel scaffold on ADSCs.</p><p><b>METHODS</b>The C/A gel scaffold consisted of medical-grade chitosan and alginate. Gel porosity was calculated by liquid displacement method. Pore microstructure was analyzed by light and scanning electron microscopy. ADSCs were isolated and cultured by conventional methods. Passage 2 BrdU-labeled ADSCs were co-cultured with the C/A gel. ADSCs were divided into three groups (control, normoxia-induced, and hypoxia-induced groups). In the control group, cells were cultured in 10% FBS/DMEM. Hypoxia-induced and normoxia-induced groups were induced by adding transforming growth factor-β1, dexamethasone, vitamin C, sodium pyruvate, proline, bone morphogenetic protein-7, and 1% ITS-plus to the culture medium and maintaining in 2% and 20% O2, respectively. Histological and morphological changes were observed by light and electron microscopy. ADSCs were characterized by flow cytometry. Cell viability was investigated by BrdU incorporation. Proteoglycan and type II collagen were measured by safranin O staining and the Sircol method, respectively. mRNA expression of hypoxia-inducing factor-1α (HIF-1α), aggrecan, and Type II collagen was determined by reverse transcription-polymerase chain reaction.</p><p><b>RESULTS</b>C/A gels had porous exterior surfaces with 80.57% porosity and 50-200 üm pore size. Flow cytometric analysis of passage 2 rabbit ADSCs showed high CD90 expression, while CD45 expression was very low. The morphology of induced ADSCs resembled that of NP cells. BrdU immunofluorescence showed that most ADSCs survived and proliferated in the C/A gel scaffold. Scanning electron microscopy showed that ADSCs grew well in the C/A gel scaffold. ADSCs in the C/A gel scaffold were positive for safranin O staining. Hypoxia-induced and normoxia-induced groups produced more proteoglycan and Type II collagen than the control group (P < 0.05). Proteoglycan and Type II collagen levels in the hypoxia-induced group were higher than those in the normoxia-induced group (P < 0.05). Compared with the control group, higher mRNA expression of HIF-1α, aggrecan, and Type II collagen was detected in hypoxia-induced and normoxiainduced groups (P < 0.05). Expression of these genes in the hypoxia-induced group was significantly higher than that in the normoxia-induced group (P < 0.05).</p><p><b>CONCLUSION</b>ADSCs grow well in C/A gel scaffolds and differentiate toward NP-like cells that produce the same extracellular matrix as that of NP cells under certain induction conditions, which is promoted in a hypoxic state.</p>

En bloc resection of semi-facet and lamina for thoracic ossification of ligamentum flavum with epidural adhesion / 中华骨科杂志

Objective To explore the strategy and outcomes of surgical treatment of thoracic ossification of ligamentum flavum(OLF),especially combined with ossification of posterior longitudinal ligament,thoracic kyphosis and epidural adhesion.Methods Fifty-three cases of thoracic OLF from January 2003 to December 2009 were reviewed retrospectively.All patients were treated by the methods of en bloc resection of semi-facet and lamina.All patients were followed up for more than half an year,including 32 males and 21 females,aged from 43 to 73 years(average 54.7 years).The lesions located in upper thoracic for 18 patients,and in thoracolumbar for 35 patients.For multi-level or jumping OLF patients,the responsible levels were determined by combination of images and clinical symptoms.For multi-level OLF with ossification of posterior longitudinal ligament(OPLL)or thoracic kyphosis(＞50°),multi-level pedicle screw fixation and correction of kyphosis were performed.For dural adhesion patients,part of cerebrospinal fluid was released with a caudal incision of dural sac resulting in collapse and epidural arachnoid separation.Ossific and adhesion dura mater were removed with integrity of arachnoid.The surgical outcomes were evaluated with preoperative and postoperative thoracic Japanese Orthopaedic Association(JOA)score,Nurick grade and neurologic functional recovery ratio.Results Fifty-three cases were followed up for 6 months to 6 years,with an average of 18 months.The average preoperative JOA score was 4.3±2.3,which significantly increased to 8.3±1.8 after operation.Postoperative neurologic functional recovery rates were 11% to 80%(average 65.8%),including excellent in 18 cases,good in 20,fair in 10,and poor in 5.The excellent or good rate was 71.7%.The mean preoperative Nurick grade was 3.7(2-5 grade)and decreased to 2.3 grade after operation.Conclusion En bloc resection of semi-facet and lamina is a safe and effective method for treatment of thoracic OLF.For the patients with OPLL or kyphosis,pedicle screws fixation and kyphosis correction was beneficial for recovery of neurologic function of thoracic OLF patients.

Experimental study on osteoporosis of ovariectomized rats inhibited by adenovirus-BMP-7 / 中国矫形外科杂志

[Objective]To evaluate the inhibiting affection of Ad-BMP-7 to osteoporosis of ovariectomized rats.[Method]Mice model of osteoporosis was made by surgical ovariectomy,and divided into 4 groups:A.group of vertebral body intramedullary injection of normal saline;B.injection of Adovirus(Ad)-GFp;C.injection of Ad;D.injection of Ad+BMP(bone morphogenetic protein),the bone losing of whole body were monitored by measuring dry bone weight after 1 month,the osteoporosic condition of bone trabecular were observed by histology,and bone histomorphometry of vertebral bodies were carried to quatitatively measure the dynamic and static indexes of osteoporosic bone.[Result]The dry bone weight of AdBMP-7 rats werehigher than that of other groups.Under the microscope,the bone trabecula form of the Ad BMP-7 groups were more integrity,however,the bone trabecular of the other groups showed sharpen and ruptured.In the bone histomorphomitry,the numbers of the osteoblasts,the thickness of osteoid of group D were obviously higher than other groups.[Conclusion]Ad BMP-7 injected into the vertebral bodies of ovariectomized rats may secrete BMP-7,and inhibits the osteoporosis of ovariectomized rats in the early stage.The protective effect of this gene was not restricted to bones receiving intramedullary injection of the vector,but occurred in all bones that were evaluated.This proof of concept encourages further development of gene therapy approaches to the treatment of osteoporosis.