Risk factors and treatment strategies for adjacent segment diseases / 中华骨科杂志

Fusion surgery has been an effective modality for the treatment of spinal disorders for more than 100 years. With the increasing understanding of the disease and the increasing maturity of surgical techniques, lumbar fusion has become more widely performed and its efficacy has been conclusively proven. However, fusion surgery inevitably disrupts the original physiologic motion of the spine and limits segmental motion, resulting in a significant increase in disc and joint protrusion stress in adjacent segments. When a newly identified degenerative change on imaging is present in an adjacent segment or an existing degeneration is more aggravated, this is known as adjacent segment degeneration. When clinical symptoms such as pain and numbness in the lower extremities are present that are consistent with degeneration, this is known as adjacent segment disease. Real world studies (RWS) have become a major focus in medical research in recent years. Since it is closer to clinical practice and more practical for decision-making compared with randomized controlled trail (RCT), it is gaining importance in clinical practice. By searching major national and international databases, this article provides a review of risk factors as well as advances in the treatment of lumbar adjacent segment disease in RWS. According to the retrieved literature, there are many factors that contribute to the development and progression of adjacent segment degeneration and disease, which are mainly divided into patient-related factors and surgery-related factors. In general, patient age, weight, spinal-pelvic sagittal parameters, and internal diseases influence the progression of adjacent segment degeneration. Surgery-related risk factors include the number of segments operated on, the surgical approach, interference with adjacent segments, and whether the spinal-pelvicsagittal imbalance is corrected. To prevent the development of adjacent segment disease, patients can slow the progression of adjacent segment degeneration by reducing their own weight and controlling their internal diseases. The physician can also avoid the influence of surgery-related factors through adequate surgical planning and careful intraoperative management. At the same time, surgeries may be performed in patients who have developed adjacent segmental disease and for whom conservative treatment has failed. The current revision surgical approaches include endoscopic simple decompression and posterior decompression with extended internal fixation.Short-term RWS revealed that the efficacy of endoscopic treatment of adjacent spondylosis might be equivalent to re-fusion internal fixation surgery. Studies with large samples and long-term follow-up are still needed to guide the treatment of adjacent segment disease in the future, in order to improve clinical decision-making.

Correlation between paraspinal muscle atrophy, morphological changes of facet joints and adjacent segment degeneration after lumbar fusion / 中华骨科杂志

Objective:To investigate the correlation between paraspinal muscle atrophy, morphological changes of facet joints and adjacent segment disease (ASDis) after lumbar fusion operation.Methods:A retrospective study was conducted among 195 patients who underwent posterior lumbar fusion again for ASDis at this institution from January 2014 to December 2020, including 29 patients with ASDis whose initial surgical fusion segment was L 4,5. According to Roussouly's staging, there were 5 cases of type I, 9 cases of type II, 10 cases of type III, and 5 cases of type IV. Another 29 cases were selected from patients without ASDis after lumbar fusion as a control group. The control group was paired 1∶1 with the ASDis group according to gender, fusion segment, and Roussouly typing of the lumbar spine. The cross-sectional area (CSA) and fat infiltration (FI) of paravertebral muscle, facet joint angle (F-J) and pedicle facet (P-F) angle before the first (second) operation were measured and compared between the two groups. Then logistic regression analysis was used to determine the predictors of ASDis after posterior lumbar fusion. Finally, the receiver operation characteristic (ROC) curve was described, and the area under the curve (AUC) and cut-off point were calculated. At the same time, the paraspinal muscle atrophy before the second operation in ASDis group was measured. Results:The average follow-up time of 98 patients was 59.25±6.38 months (range, 49-73 months). The average body mass index (BMI) of ASDis group was 24.76±3.64 kg/m 2, which was higher than that in control group (22.24±2.92 kg/m 2) ( t=2.481, P=0.041). The average CSA and relative cross-sectional area (rCSA) of paraspinal muscle in ASDis group were 3 214.32± 421.15 mm 2 and 1.69±0.36 respectively, which were less than 3 978.91±459.87 mm 2 and 2.26±0.29 in control group ( t=10.22, P=0.012; t=9.47, P=0.038). The FI degree of paraspinal muscle in ASDis group (21.95%±5.89%) was significantly higher than that in control group (14.64%±7.11%) ( t=7.32, P=0.002). The F-J angle in ASDis group was 35.06°±3.45°, which was less than 38.39°±4.67° in control group ( t=4.76, P=0.027). The P-F angle in ASDis group was 117.39°±8.13°, which was greater than 111.32°±4.78° in control group ( t=5.25, P=0.031). Multivariate logistic regression analysis showed that higher BMI ( OR=1.34, P=0.038), smaller rCSA of paraspinal muscle ( OR=0.02, P=0.017) and higher FI of paraspinal muscle ( OR=1.58, P=0.032) were the risk factors of postoperative ASDis. The ROC curve showed that the AUC of BMI was 0.680 and the cut-off point was 22.58 kg/m 2; The AUC of the FI of paraspinal muscle was 0.716 and the cut-off point was 15.69%; The AUC of rCSA of paraspinal muscle was 0.227 and the cut-off point was 1.92. For ASDis patients, the paraspinal muscle before the second operation had a higher degree of FI (25.47%±6.59% vs. 21.95%±5.89%, t=3.99, P=0.042) and a smaller rCSA (1.52±0.28 vs. 1.69±0.36, t=3.85, P=0.038) than that before the first operation. The difference between the FI degree of paraspinal muscle before the second operation and the first operation was negatively correlated with the occurrence time of ASDis ( r=-0.53, P=0.039) , and the difference of rCSA was positively correlated with the occurrence time of ASDis ( r=0.64, P=0.043) . Conclusion:When BMI >22.58 kg/m 2, FI of paraspinal muscle >15.69%, and rCSA of paraspinal muscle <1.92, it suggests that ASDis is more likely to occur after operation. And the more obvious paraspinal muscle atrophy after the first operation, the earlier ASDis may occur. Morphological changes of facet joints cannot be used as an index to predict the occurrence of ASDis.

A case report of small cell neuroendocrine carcinoma of prostate / 中华泌尿外科杂志

To study the diagnosis and treatment of small cell neuroendocrine prostatic carcinoma. A 60-year-old patient with pure small cell neuroendocrine carcinoma of prostate was admitted because of dysuria for 1 month. Digital rectal examination showed the prostate was hard. Result of histological biopsy were consistent with a diagnosis of small cell neuroendocrine carcinoma of prostate. Combination chemotherapy with radiotherapy regimen were proved to be effective. The patient′s symptoms were relieved obviously. The patient died about 15 months after admission. Small cell neuroendocrine carcinoma of prostate has a very poor prognosis. Systemic chemotherapy is the most important treatment available.

A case report of small cell neuroendocrine carcinoma of prostate / 中华泌尿外科杂志

To study the diagnosis and treatment of small cell neuroendocrine prostatic carcinoma.A 60-year-old patient with pure small cell neuroendocrine carcinoma of prostate was admitted because of dysuria for 1 month.Digital rectal examination showed the prostate was hard.Result of histological biopsy were consistent with a diagnosis of small cell neuroendocrine carcinoma of prostate.Combination chemotherapy with radiotherapy regimen were proved to be effective.The patient's symptoms were relieved obviously.The patient died about 15 months after admission.Small cell neuroendocrine carcinoma of prostate has a very poor prognosis.Systemic chemotherapy is the most important treatment available.

The progression of ossification of the posterior longitudinal ligament of the cervical spine: A follow-up study by CT imaging after laminoplasty / 中华骨科杂志

Objective To evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2011 to June 2016,Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty.There were 21 patients finally enrolled in this study,which consisted of 11 male and 10 female aging from 55-69,mean(61.48±4.29).The preoperative patients all had severe symptoms of spinal compression.Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender,age,preoperative and postoperative follow-up.The length,width and thickness of OPLL were measured by CT scan and two-dimensional reconstruction of cervical spine during preoperative and follow-up,and the average progress rate was calculated.The relationship between OPLL size before surgery and OPLL progress rate after surgery was analyzed.Results A total of 21 patients were included in this study,with an average age of 61.48±4.29 years-old.The mean follow-up time was 3.36± 1.92 years.The JOA score of cervical spine was 11.81 ± 1.75 before operationand 14.43± 1.69 at the last follow-up time (t=3.8,P＜0.01).The progression rate of OPLL length,width and thickness was 3.54± 2.89 mm/year,0.49± 0.52 mm/year and 0.34± 0.21 mm/year,respectively.Compared with the width and thickness,the average progress speed of the length was statistically significant (t=3.6,P=0.003;t=3.8,P=0.002).The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1,P=0.559).Linear regression showed that OPLL length progression speed (mm) =0.05×preoperative length + 1.23,R2=0.26 and P=0.02.Theprogression rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness.The progression rates of local,segmental,continuous,and mixed OPLL were 3.02±0.26 mm,2.97±0.65 mm,3.65± 1.14 mm,and 3.82± 1.27 mm per year.Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved during a short-term follow up.CT imaging follow-up showed there was progression of OPLL in length,width and thickness,and the progression rate of length was faster than width and thickness.However,there was no significant difference between the progression of rostral and caudal of OPLL.In addition,short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of segmental and limited OPLL.

Effects of fufangxuanju capsule combined with tamoxifen citrate tablet on seminal plasma biochemistry in patients with asthenospermia / 中国医师进修杂志

Objective To study the effect of fufangxuanju capsule combined with tamoxifen citrate tablet on seminal plasma biochemistry in patients with asthenospermia.Methods One hundred and fifty patients with asthenospermia were divided into group A(treated with tamoxifen citrate tablet,45 cases),group B(treated with fufangxuanju capsule,45 cases)and group C(treated with tamoxifen citrate tablet and fufangxuanju capsule, 60 cases) according to random digits table method.All patients were treated for 2 months.The semen parameters and semen biochemical parameters were detected, and the pregnancy rate was followed up for 6 months.Results The semen volume,sperm density,sperm survival rate, grade a sperm percentage and grade a+b sperm percentage after treatment in group C were significantly higher than those in group A and group B: (4.41 ± 1.21) ml vs.(4.01 ± 0.87) and(3.97 ± 1.10)ml,(24.63 ± 4.44)×109/L vs.(20.45 ± 4.69)and(18.04 ± 3.05)×109/L,(64.05 ± 7.98)% vs.(45.15 ± 8.87)% and(51.47 ± 10.01)%,(26.05 ± 5.62)% vs.(15.01 ± 3.67)% and(18.31 ± 2.21)%, (55.30 ± 9.65)% vs.(38.07 ± 8.26)% and (44.35 ± 9.03)%, and there were statistical differences (P<0.05).There were no statistical differences between group A and group B (P>0.05).The fructose, a-glucosidase and acid phosphatase levels after treatment in group C were significantly higher than those in group A and group B:(30.36 ± 5.30)mmol/L vs.(24.01 ± 6.32)and(26.03 ± 5.53)mmol/L,(60.61 ± 8.86) U/L vs.(45.46 ± 8.87)and(50.56 ± 5.56)U/L,(140.12 ± 10.25)U/L vs.(98.36 ± 8.36)and(100.36 ± 8.36) U/L,and there were statistical differences(P<0.05);there were no statistical differences between group A and group B(P>0.05).The zinc after treatment in group C was significantly higher than that in group A and group B:(2 406.96 ± 187.60)μmol/L vs.(1 508.30 ± 135.87)and(2 001.30 ± 130.26)μmol/L,the zinc after treatment in group B was significantly higher than that in group A, and there were statistical differences(P<0.05).The pregnancy rate within 6 months in group C was significantly higher than that in group A and group B: 51.6% (31/60) vs.37.8% (17/45) and 33.3% (15/45), and there was statistical difference (P<0.05).There was no statistical difference between group A and group B (P>0.05).Conclusions Fufangxuanju capsule combined with tamoxifen citrate tablet can increase the concentration of fructose, a-glycosidase, zinc and acid phosphatase in seminal plasma, and improve the semen quality of patients with asthenospermia so as to increase the woman pregnancy rate.

Protective effect of high activity deproteinized extract of calf blood on alcohol liver injury of mice / 吉林大学学报(医学版)

Objective:To observe the protective effect of deproteinized extract of calf blood (DECB)on the ethanol-induced liver injury of the mice,and to preliminaryly discuss its mechanism. Methods:Sixty healthy ICR mice were divided into control group,model group,positive drug group,low,medium and high doses of DECB groups (n=10).By intragastric administration,the mice in control group were given 20 mL·kg-1 saline solution, the mice in low,medium and high doses of DECB groups were administrated with 0.125,0.250,0.500 g·kg -1 DECB,and the mice in positive drug group were administrated with 0.63 g·kg -1 Hugan Tablets;once a day for 30 d. 1 h after the last administration,except control group,the mice in other groups were administrated with one-time grant of 50% ethanol 14 mL·kg -1 ,and fasted for 16 h to establish the models of acute alcohol liver injury.The endurance alcohol time and drunk time of the mice were determined,the activities of aspartate aminotransferase (ALT)and alanine transaminase (AST)activity in serum of the mice were detected,the levels of triglyceride (TG),glutathione (GSH)and malonic dialdehyde (MDA)in liver tissue were determined,and the pathological changes of liver tissue were detected.Results:Compared with model group,the drunk symptoms of the mice in different doses of DECB groups were obviously reduced,the endurance time of the mice in high dose of DECB group and positive drug group was prolonged (P <0.05),and the drinking time was shortened (P <0.05);the ALT and AST activities in serum in mediun and high doses of DECB groups were significantly lower than those in model group (P <0.05).Compared with model group,the MDA and TG levels in liver tissue of the mice in medium and high doses of DECB groups and positive drug group were obviously reduced,and the GSH levels were increased (P <0.05);compared with model group,the pathological damages of liver tissue of the mice in high dose of DECB group caused by ethanol were significantly reduced.Conclusion:DECB can improve ethanol-induced liver injury which may be related to the inhibition of hepatic oxidative stress response.

Transplantation of erythropoietin gene-modified endothelial progenitor cells to treat lower extremity artery occlusion:a magnetically-labeled MRI evaluation / 中国组织工程研究

BACKGROUND:Erythropoietin and progenitor cel transplantation both have therapeutic effects on lower extremity arterial occlusive disease. OBJECTIVE:To investigate the erythropoietin modification effect and magnetic resonance imaging feasibility of superparamagnetic iron oxide (SPIO)-labeled endothelial progenitor cel s in vitro. METHODS:Rat bone marrow-derived endothelial progenitor cel s at logarithmic growth phase were randomized into four groups:endothelial progenitor cel group, SPIO labeled transfection group (pcDNA3-EPO transfection fol owed by SPIO labeling), SPIO labeled empty vector group (empty plasmid transfection fol owed by SPIO labeling), and SPIO labeling group (only SPIO labeling). 4.7T MRI was used to observe SPIO-labeled endothelial progenitor cel s. Cel proliferation, cel cycle distribution, and expression of erythropoietin protein in the four groups were measured. RESULTS AND CONCLUSION:MRI findings showed with the increasing cel number, gradual y lowered signal intensity on T1-weighted imaging (T1WI), T2WI and T2*WI was seen, and the reduction in the signal intensity was the maximum on T2*WI sequence and the minimum on T1WI sequence. For T1WI, T2WI and T2*WI sequences, the minimum number of cel s was 2×104, 1×104 and 0.5×104, respectively. Cel proliferation and cel cycle distribution showed no significant difference among three SPIO labeling groups. In addition, the expression of erythropoietin protein was only found in the SPIO-labeled transfection group. These findings showed that under SPIO labeling, erythropoietin gene-modified endothelial progenitor cel s show no changes in cel proliferation and cel cycle, and the 4.7T MR is capable of imaging SPIO-labeled erythropoietin gene-modified endothelial progenitor cel s in vitro.

Inhibitory effect of miR-199 a on bladder cancer / 中国生化药物杂志

Objective To study the inhibitory effect of miR-199a on bladder cancer.Methods T24 bladder cancer cells were divided into control group, pre-scamble group and pre-miR-199a group according to different treatment.Cell proliferation was assayed by MTT, cell apoptosis and cell cycle by flow cytometry, and cell invasion by Transwell.ResuIts The OD value of pre-miR-199a group (0.436 ±0.042) was significantly lower than that of control group (0.634 ±0.020) and pre-scamble group (0.601 ±0.059)(P<0.05).Cell apoptosis of pre-miR-199a group(19.25 ±1.57)% was higher than that of control group(10.19 ±0.98)% and pre-scamble group(12.27 ±1.38)%(P<0.05).The cell ratio in G1 phase of control group、pre-scamble group and pre-miR-199a group was 45.09%, 47.57%, and 58.62%, respectively.The cell cycle arrested in G1 phase after transfected with pre-miR-199a.The cells migration number of pre-miR-199a group (46.00 ±1.58) was lower than those of control group(67.00 ±1.58) and pre-scamble group(61.20 ±1.30)(P<0.05).ConcIusion MiR-199a could inhibit the growth of bladder cancer cells.

Study on mechanism of active ingredients in Sanhuang Xiexin Decoction on acute kidney injury induced by lipopolysaccharide / 中国生化药物杂志

Objective To research on reversal mechanism of active ingredients of Sanhuang Xiexin Decoction on lipopolysaccharide-induced acute kidney injury.Methods C57BL/6 mice were randomly divided into 6 groups: control group, LPS group, rhein group, berberine group, baicalin group and dexamethasone group.8 mice in each group.Control group were injected intraperitoneally with 0.9%NaCl 0.5 mL, and the remaining groups were injected intraperitoneally with LPS 0.1 mL/g.The mice of rhein group, berberine group, baicalin group and dexamethasone group were respectively injected intraperitoneally rhein, berberine, baicalin ( 0.1 mL/g ) and dexamethasone ( 0.0001 mL/g ) 2 h before LPS injection.One day after LPS treatment, mice were decapitated and blood collected, diagnostic kits and automatic biochemical analyzer were used to detected urea nitrogen and creatinine.TNF-αand IL-6 concentrations in serum were detected by ELISA kit.HE staining and immunohistochemistry were performed in the kidney tissues.expression of apoptosis protein detected by Western blot.ResuIts Compared to control group, the blood urea nitrogen, serum creatnine, TNF-αand IL-6 level were significantly lower ( P<0.05 ) .HE staining found the renal tubular epithelial cell which treated with LPS were swelling, degeneration, loss, narrow lumen and tube type and exudate, renal interstitial edema, inflammatory cells infiltration.And symptoms of the other group were significantly slight.Immunohistochemical results showed that the expression of Bax and Caspase3 in LPS group was obviously increased, while the expression of the others group was decreased, neither did Bcl-2.Western blot results showed that apoptosis proteins Bax, Cleave-caspase3, CytoC expression increased of LPS group, while the other groups were lower than LPS group.But Bcl-2 expression reduced in LPS group and increased in others group.ConcIusion The effective constituent of Sanhuang Xiexin Decoction can reversal of LPS induced acute kidney injury and its mechanism of action is similar to that of dexamethason.

Clinical value of conditions of radial artery for autogenous arteriovenous fistula ostomy by color Doppler ultra-sound / 局解手术学杂志

Objective To evaluate the clinical value of the condition of radial artery for autogenous arteriovenous fistula ostomy by color Doppler ultrasound. Methods The condition of radial artery of 133 end-stage renal disease( ESRD) patients who received autogenous arteri-ovenous fistula ostomy were detected by color Doppler ultrasound,and compared with the postoperative parameters of fistula vascular. Results Among all 133patients,the preoperative radial artery of 95 cases were normal,abnormal in 38 cases. Ostomy surgery performed on 131 cases. Two cases gave up surgery for the poor condition of radial artery,13 cases with fistula failure. The success rate with normal radial artery (95. 8%) was higher than that with the abnormal radial artery(75%). The blood flow parameters of normal radial artery were significantly better than those of the abnormal radial artery,and 4 weeks after operation,the anastomotic blood flow and blood vessel diameter were better than those 1 week before and after surgery. Conclusion Color Doppler ultrasound that can provide preoperative data of radial artery, predict postoperative the state of fistula vascular,and monitor the conditions of postoperative fistula vascular,with better clinical value.

Evaluation of radiation dose in multislice spiral CT scan for children embedded teeth / 中华放射医学与防护杂志

Objective To evaluate the radiation dose in both low radiation dose and to conventional radiation dose mode in multislice spiral CT scan for children with embedded teeth,and explore the lowest conditions of exposure in multislice spiral CT scan for children embedded teeth.Methods Eighty cases of children with embedded teeth examined by 16 slices spiral CT were divided into 5 ,25,125 and 250 mAs scanning groups.The scanned pictures of four groups were evaluated by two chief physicians and three associate chief physicians in the radiological department with double blind method.The CTDI_w and DLP in different radiation dose mode were recorded and analyzed with statistics.Results All the four groups scanned pictures in different radiation dose mode could accurately show the structure and the adjacency relation of embedded teeth.Even though the resolution of scanned pictures in S mAs group were inferior to the other three groups on bone trabecula,gingiva and their surrounding soft tissue,it still could meet the requirements of examination.The average DLP in 5 mAs group was only 2% of value in 250 mAs group.Conclusions MSCT in 5 mAs group can not only meet the requirements of examination,but also reduce the radiation dose to patients to the greatest extent.

Normal Representations of Permanent Teeth and Alveolar Bone at Multi-slice Spiral CT / 实用放射学杂志

Objective To explore the spiral the normal representations of permanent teeth and alveolar bone of multi-slice spiral(MSCT). Methods 30 adults with normal teeth were studied by multislice spiral CT scanner,window width and window level was 3000~5000 HU and 1200~1500 HU respectively.MSCT findings were analysed using multiplanar reformation,dental panorama and 3D reconstruction were done in all cases.Results The tooth were showed as multilaryer structures with different density at MSCT because of the mineral content of different part of tooth,from high to low density was enamel,circumpulpal dentin,outside dentin,cementum and pulp.The periodontal membrane was low density located beween the cementum and lamina dura and the thickness was homogeneous.The bone cortex of alveolar bone was successive,the bone trabecula appeared as wirelike or reticulate.Conclusion The structures of permanent teeth and alveolar bone can be displayed clearly by MSCT.Multiplanar reformation,dental panorama and 3D reconstruction are helpful to display the structures of teeth and alveolar bone as well as the relationship around structures.

Designation of gACE epitope and preparation of its polgclonal antibody / 中国免疫学杂志

Objective:To prepare gACE polyclonal antibody for functional study of gACE.Methods:According to the bioinformatics analysis and prediction of the possible conformational structure,hydrophobicity and antigenicity of gACE and the principal for antibody production,a partial peptide with 18-amino acid residues of gACE was synthesized after homology search.The synthesized peptide was then used to immunize after coupling with KLH.The properties of anti-gACE were analyzed by ELISA,Western blot and immunohistochemistry.Results:The antigenicity was repredicted by bioinformatics analysis.The polyclonal antibody against gACE was successfully obtained and its specificity and sensitivity we conformed by ELISA,Western blot and immunohistochemistry.Conclusion:By the bioinformatics analysis and prediction,the hydrophilicity and antigenicity of gACE are analyzed.The antibody of gACE is successfully obtained.