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Objective To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP).Methods From January 2014 to February 2018,243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics,Shanghai Ninth People's Hospital.Their clinical data were retrospectively analyzed.Of them,a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group).In the control group,there were 41 men and 128 women with an age of 71.6 ± 9.5 years,and the fracture was distributed from T5 to T10 in 7 cases,from T11 to L2 in 132 and from L3 to L5 in 30.In the modified group,there were 20 men and 54 women with an age of 73.6 ± 9.3 years,and the fracture was distributed from T5 to T10 in 3 cases,from T11 to L2 in 63 and from L3 to L5 in 8.The 2 groups were compared in terms of postoperative recovery of vertebral height,reduction in visual analogue scale (VAS) and bone cement leakage.Results There were no significant differences between the 2 groups in age,gender,distribution of fractured vertebral bodies,compression degree,condition of vertebral posterior wall,or bone cement volume injected (P ＞ 0.05).There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43％ ± 7.82％ versus 6.20％ ±7.84％) or reduction in VAS score (5.83 ± 0.99 versus 5.81 ± 0.89) (P ＞ 0.05).Bone cement leakage occurred in 93 cases (55.0％) in the control group but in 26 cases (35.1％) in the modified group,showing a significant difference (P ＜ 0.05).The incidences of bone cement leakage in the paravertebral vessels [13.5％(10/74)],paravertebral soft tissue [9.5％ (7/74)] and spinal canal [4.1％ (3/74)] in the modified group were all significantly lower than those in the control group [25.4％ (43/169),20.1％ (34/169) and 15.4％ (26/169)] (P ＜ 0.05).Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP,because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes,especially in the spinal canal,paraspinal vessels and paraspinal soft tissue.
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Objective@#To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP).@*Methods@#From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage.@*Results@#There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05).@*Conclusion@#Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue.
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BACKGROUND:Under hypoxic environment, hypoxia-inducible factor 1α plays a dualregulatory role in cel apoptosis. Severity of hypoxia is the key to determine whether cels appear to have apoptosis or adapt to survive. When the cels are exposed to chronic or extreme hypoxia, a lack of protection mechanisms from hypoxia-inducible factor-1α can induce cel apoptosis. OBJECTIVE: To research the expression of hypoxia-inducible factor 1α in human lumbar nucleus pulposus of different herniated types and its relationships with cel apoptosis. METHODS: The nucleus pulposus was harvested from 60 cases of herniation of lumbar intervertebral discs, L4-5 in 41 cases and L5-S1 in 19 cases. The nucleus pulposus tissues were equaly divided into protruded and sequestered groups. Meanwhile, the nucleus pulposus tissues from another 10 cases of lumbar spine fracture were taken as control group. Expression of hypoxia-inducible factor 1α and apoptosis of lumbar nucleus pulposus cels were observed and detected with immunohistochemical technique and TUNEL method. Correlation of hypoxia-inducible factor 1α and apoptosis in human lumbar nucleus pulposus of different herniated types was analyzed. RESULTS AND CONCLUSION: The expression of hypoxia-inducible factor 1α was visualized in each case, but it was significantly higher in the sequestered group than in the protruded group and control group (P < 0.01). Apoptosis of nucleus pulposus cels were found in al the three groups, but the apoptotic rate was also higher in the sequestered group than in the protruded group and control group (P < 0.01). Expression of hypoxia-inducible factor 1α was positively correlated with cel apoptosis in human lumbar nucleus pulposus (P < 0.01). Overal, the expression of hypoxia-inducible factor1α in degenerative human lumbar nucleus pulposus is associated with herniated types, which is the highest in the sequestered type. The relationship between hypoxia-inducible factor 1α and apoptosis is positive.
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BACKGROUND:Under hypoxic environment, hypoxia inducible factor-1 plays an important role in regulation of hypoxia-induced gene expression in the intervertebral disc. Hypoxia-inducible factor-1 consists of α and βsubunits, and which hypoxia inducible factor-1α determines the stability and activity of hypoxia-inducible factor-1. OBJECTIVE: To observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus of different herniated types and to judge their relationships. METHODS:A total of 60 nucleus pulposus samples were harvested from the lumbar vertebra, including 41 from L4-5 and 19 from L5-S1, and then divided into protruded group and sequestered group, with 30 cases in each group. Meanwhile, another 10 samples of lumbar nucleus pulposus served as controls. Hematoxylin-eosin staining and streptavidin-biotin peroxidase complex immunohistochemical technique were used to observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus in different groups. RESULTS AND CONCLUSION:The expression level of hypoxia inducible factor-1α was (58.2±7.5)% in the sequestered group, (27.3±2.3)% in the protruded group, and (10.5±4.7)% in the control group, which was significantly higher in the sequestered group than the other two groups (P < 0.01). These findings indicate that the expression of hypoxia inducible factor-1α in the lumbarnucleus pulposus is associated with the herniated types, which is the highest in the prolapse sequestered type.
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BACKGROUND:The methylprednisolone pulse therapy in early period of spinal cord injury can attenuate the pathological degree of spinal cord injury, however no breakthrough was found within recent 20 years. OBJECTIVE:To observe the protection effects of sodium aescinate on the nerve cellapoptosis and expression of glial fibrial ary acidic protein (GFAP) in the early spinal cord injured rats. METHODS:Spinal cord injury models were established with the modified Al en’s method in 180 Sprague-Dawley rats, and were randomly divided into three groups, with 60 rats in each group. Immediately after injury, the rats in three groups were intraperitoneal y injected with sodium aescinate (5 mg/kg), methylprednisolone (100 mg/kg) and equal saline, respectively, once per day. At 8 hours, 24 hours, 96 hours and 7 days, 14 days after injury, rats were sacrificed and the injured segments were resected for hematoxylin-eosin staining and immunohistochemical staining, the nerve cellapoptosis and GFAP expression were detected. RESULTS AND CONCLUSION:The apoptotic nerve cells were seen at 8 hours after injury and the number of apoptotic cells reached the peak at 7 days, the edema was attenuated at 14 days without less nerve cellapoptosis in al groups, significantly fewer apoptotic nerve cells can be seen in sodium aescinate and methylprednisolone groups compared with the control group (P0.05), which was lower than methylprednisolone group (P<0.05);after 96 hours, methylprednisolone group and sodium aescinate group were both significantly lower than control group (P<0.05). Furthermore, the decreasing expression was observed in al groups after 7 days. Sodium ascinate has obvious protection effects on nerve cells in spinal cord injured rats and promotes neurological function through decreasing GFAP expression after injury. The efficacy of sodium ascinate is equal to that of methylprednisolone within 2 hours.
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BACKGROUND:Endogenous hydrogen sulfide can be used as a new gaseous signaling molecule, and has important signal transfer function and biological regulation effects. OBJECTIVE:To study the neuroprotective effects of hydrogen sulfide in rats with acute cauda equina syndrome. METHODS: The 72 Sprague-Dawley rats were randomly assigned to three groups. Experimental group, model group: laminectomy was performed at the lumbar 4 (L4) level of the vertebra, and a piece of silicone (10 mm long, 1 mm thick, and 1 mm wide) was placed under the laminae of the L5-6 vertebra to produce the animal model of cauda equina syndrome. Sham surgery group: a simple laminectomy was performed in L4, but silicone was not implanted. In the experimental group, 20 μmol/kg NaHS was injected intraperitonealy at 1 hour before model establishment. Model and sham surgery groups: an equal volume of saline was injected intraperitonealy. At 12, 24, 48 and 72 hours after model establishment, malonaldehyde and glutathione levels in cauda equina nerve tissue were detected. Simultaneously, hematoxylin-eosin staining and TUNEL staining were performed at 48 hours. RESULTS AND CONCLUSION:Hematoxylin-eosin staining demonstrated that cauda equina nerve tissue was dense and regular, with complete myelin sheath, no axon sweling in the sham surgery group. Cauda equina nerve tissue was sparse, with the presence of demyelination, and partial axons and myelin sheath sweling in the model group. Cauda equina nerve tissue was tight, with axonal sweling and demyelination in the experimental group. TUNEL staining demonstrated that the number of positive cels was less in the spinal cord and dorsal root ganglia in the sham surgery group. Abundant positive cels were detected in the spinal cord and dorsal root ganglia in the model group. The number of positive cels was significantly lower in the experimental group than that in the model group. Malonaldehyde levels were lower in the sham surgery and experimental groups than in the model group (P < 0.05, P < 0.01), but glutathione levels were higher than model group (P < 0.05,P < 0.01). These results indicated that hydrogen sulfide could decrease oxidative stress and protect cauda equina nerve in rats with acute cauda equina syndrome.
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A 53-year-old man was admitted to the hospital for verrucous hyperplasia on the circular sulcus for 2 years as well as erythematous painful swelling, ulcer and rupture of inguinal lymph nodes for more than 2 months. Physical examination revealed erythematous, indurated and painful swelling of bilateral inguinal lymph nodes. Fluctuation could be felt at the centre of the right swollen inguinal lymph nodes, where several pores were seen with yellowish-white purulent fluid flowing out, giving the appearance of a watering can. Multiple swollen or ulcerative lymph nodes were separated by the inguinal ligament forming the groove sign.There were irregular, indurated, verrucous, proliferative and keratinized lesions sized 1 cm × 2 cm on both sides of the circular sulcus. The right scrotum was obviously swelling. Erythematous, fluctuating swelling, ulcer and rupture of the glans fraenum were also observed with yellowish-white purulent exudates. Neither the secretion from the skin lesions on the surface of bilateral inguinal lymph nodes nor the puncture sample from the right groin was positive for multiple fungal or bacterial culture, acid-fast stain or first culture of C. trachomatis.However, the endogenous plasmid of Chlamydia was successfully amplified by PCR from these samples, and restriction fragment length polymorphism (RFLP) analysis of the major outer membrane protein (MOMP) suggested that the genotype of the Chlamydia strain was L3. Western blot revealed the presence of anti-MOMP antibodies and anti-Pmp H antibodies (titer: ＞ 1: 800) in serum. Culture of C. trachomatis also gave positive results after multiple passage. Biopsy of the verrucous hyperplasia on the right groin is consistent with well-differentiated squamous cell carcinoma of the skin. A diagnosis of lymphogranuloma venereum complicated by cutaneous squamous cell carcinoma was made.