Promotion effect of FGF23 on osteopenia in congenital scoliosis through FGFr3/TNAP/OPN pathway / 中华医学杂志(英文版)

BACKGROUND@#Congenital scoliosis (CS) is a complex spinal malformation of unknown etiology with abnormal bone metabolism. Fibroblast growth factor 23 (FGF23), secreted by osteoblasts and osteocytes, can inhibit bone formation and mineralization. This research aims to investigate the relationship between CS and FGF23.@*METHODS@#We collected peripheral blood from two pairs of identical twins for methylation sequencing of the target region. FGF23 mRNA levels in the peripheral blood of CS patients and age-matched controls were measured. Receiver operator characteristic (ROC) curve analyses were conducted to evaluate the specificity and sensitivity of FGF23. The expression levels of FGF23 and its downstream factors fibroblast growth factor receptor 3 (FGFr3)/tissue non-specific alkaline phosphatase (TNAP)/osteopontin (OPN) in primary osteoblasts from CS patients (CS-Ob) and controls (CT-Ob) were detected. In addition, the osteogenic abilities of FGF23-knockdown or FGF23-overexpressing Ob were examined.@*RESULTS@#DNA methylation of the FGF23 gene in CS patients was decreased compared to that of their identical twins, accompanied by increased mRNA levels. CS patients had increased peripheral blood FGF23 mRNA levels and decreased computed tomography (CT) values compared with controls. The FGF23 mRNA levels were negatively correlated with the CT value of the spine, and ROCs of FGF23 mRNA levels showed high sensitivity and specificity for CS. Additionally, significantly increased levels of FGF23, FGFr3, OPN, impaired osteogenic mineralization and lower TNAP levels were observed in CS-Ob. Moreover, FGF23 overexpression in CT-Ob increased FGFr3 and OPN levels and decreased TNAP levels, while FGF23 knockdown induced downregulation of FGFr3 and OPN but upregulation of TNAP in CS-Ob. Mineralization of CS-Ob was rescued after FGF23 knockdown.@*CONCLUSIONS@#Our results suggested increased peripheral blood FGF23 levels, decreased bone mineral density in CS patients, and a good predictive ability of CS by peripheral blood FGF23 levels. FGF23 may contribute to osteopenia in CS patients through FGFr3/TNAP / OPN pathway.

Construction of recurrence prediction model after radical resection of middle and low rectal cancer based on magnetic resonance imaging measurement of perirectal fat content and its application value / 中华消化外科杂志

Objective:To investigate the influencing factors of recurrence after radical resection of middle and low rectal cancer, and to establish a prediction model based on magnetic resonance imaging (MRI) measurement of perirectal fat content and investigate its application value.Methods:The retrospective cohort study was constructed. The clinicopathological data of 254 patients with middle and low rectal cancer who were admitted to Tianjin Union Medical Center from December 2016 to December 2021 were collected. There were 188 males and 66 females, aged (61±9)years. All patients underwent radical resection of rectal cancer and routine pelvic MRI examina-tion. Observation indicators: (1) follow-up and quantitative measurement of perirectal fat content; (2) factors influencing tumor recurrence after radical resection of middle and low rectal cancer; (3) construction and evaluation of the nomogram prediction model of tumor recurrence after radical resection of middle and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(rang) and M( Q1, Q2). Count data were described as absolute numbers. Univariate and multivariate analyses were conducted using the COX regression model. The rms software package (4.1.3 version) was used to construct the nomogram and calibration curve. The survival software package (4.1.3 version) was used to calculate the C-index. The ggDCA software package (4.1.3 version) was used for decision curve analysis. Results:(1) Follow-up and quantitative measurement of perirectal fat content. All 254 patients were followed up for 41.0(range, 1.0?59.0)months after surgery. During the follow-up period, there were 81 patients undergoing tumor recurrence with the time to tumor recurrence as 15.0(range, 1.0?43.0)months, and there were 173 patients without tumor recurrence. The preoperative rectal mesangial fascia envelope volume, preoperative rectal mesangial fat area, preoperative rectal posterior mesangial thickness were 159.1(68.6,266.5)cm3, 17.0(5.1,34.4)cm2, 1.2(0.4,3.2)cm in the 81 patients with tumor recurrence, and 178.5(100.1,310.1)cm3, 19.8(5.3,40.2)cm2 and 1.6(0.3,3.7)cm in the 173 patients without tumor recurrence. (2) Factors influencing tumor recurrence after radical resection of middle and low rectal cancer. Results of multivariate analysis showed that poorly differentiated tumor, tumor pathological N staging as N1?N2 stage, rectal posterior mesangial thickness ≤1.43 cm, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures were independent risk factors of tumor recurrence after radical resection of middle and low rectal cancer ( hazard ratio=1.64, 2.20, 3.19, 1.69, 4.20, 95% confidence interval as 1.03?2.61, 1.29?3.74, 1.78?5.71, 1.02?2.81, 2.05?8.63, P<0.05). (3) Construction and evaluation of the nomogram prediction model of tumor recurrence after radical resection of middle and low rectal cancer. Based on the results of multivariate analysis, the tumor differentiation, tumor pathological N staging, rectal posterior mesangial thickness, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures were included to construct the nomogram predic-tion model of tumor recurrence after radical resection of middle and low rectal cancer. The total score of these index in the nomogram prediction model corresponded to the probability of post-operative tumor recurrence. The C-index of the nomogram was 0.80, indicating that the prediction model with good prediction accuracy. Results of calibration curve showed that the nomogram prediction model with good prediction ability. Results of decision curve showed that the prediction probability threshold range was wide when the nomogram prediction model had obvious net benefit rate, and the model had good clinical practicability. Conclusions:Poorly differentiated tumor, tumor pathological N staging as N1?N2 stage, rectal posterior mesangial thickness ≤1.43 cm, magnetic resonance extra mural vascular invasion, tumor invasion surrounding structures are independent risk factors of tumor recurrence after radical resection of middle and low rectal cancer. Nomogram prediction model based on MRI measurement of perirectal fat content can effectively predict the probability of postoperative tumor recurrence.

Clinical effect of dual growth rod technique in the treatment of early-onset scoliosis / 中华骨科杂志

Objective:To investigate the clinical efficacy of dual growing rods (DGR) in the treatment of early onset scoliosis (EOS), and to evaluate the safety of its clinical application.Methods:From March 2015 to August 2021, a total of 20 EOS patients with onset age within 10 years old who were treated with dual growth rod technique were retrospectively analyzed, including 8 males and 12 females. The mean age of patients at first surgery was 9.0±1.4 years (range, 6.3-10.8 years); the preoperative Cobb angle was 59.0°±16.8° (range, 41.2°-103°). The Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, T 1-T 12 height, T 1-S 1 height, coronal plane imbalance, sagittal vertical axis (SVA), apical vertebral translation (AVT) and Campbell's space available for lung ratio (SAL) were recorded and analyzed while surgery-related complications were also recorded. Results:The average follow-up time of 20 patients was 28.07±14.30 months. The average initial hospital stay was 20.56±8.28 days, the average initial operation time was 211.70±39.80 min, the average blood loss in the initial operation was 255.00±149.50 ml, and the average surgical distraction was 1.60±0.51 times per person. The Cobb angle of the main curve in the coronal plane decreased from 59.00°±16.80° before operation to 33.40°±11.80° after the initial operation, which was 29.67°±11.67° at 1 year and 29.40°±11.30° at the last follow-up. Preoperative thoracic kyphosis angle was 41.39°±6.06°, decreased to 31.72°±3.56° after the initial operation, was 30.32°±4.26° at 1-year and 30.24°±4.23° at the last follow-up; preoperative lumbar lordosis angle was 45.90°±8.03°, decreased to 42.65°±9.05° after initial operation, 41.55°±7.84° at 1-year follow-up, and 41.53°±8.21° at the last follow-up; preoperative T 1-S 1 height was 31.76±4.42 cm, initial after operation, it increased to 34.64±3.96 cm, 36.73±3.87 cm at 1 year, and 37.28±4.36 cm at the last follow-up; preoperative T 1-T 12 height was 17.38±2.76 cm. increased to 19.39±2.86 cm after the initial operation, 21.77±2.71 cm at 1 year, and 21.91±2.74 cm at the last follow-up; Preoperative coronal balance was 1.52±0.73 cm, and decreased to 0.87±0.38 cm after the initial operation, 0.81±0.38 cm at 1 year, and 0.77±0.37 cm at the last follow-up; preoperative sagittal balance was 1.94±0.78 cm, and 1.42±0.56 cm after operation, 1.28±0.55 cm at 1 year, and 1.26±0.57 cm at the last follow-up; The preoperative apical vertebra offset was 4.33±1.85 cm, and 2.16±1.47 cm after the initial operation, 1.63±1.17 cm at 1 year, and 1.61±1.23 cm at the last follow-up; SAL increased from preoperative 0.88±0.05 to 0.94±0.03 postoperatively, and 0.96±0.01 at 1-year follow-up, and 0.97±0.01 at the last follow-up. The differences between the above indicators before and after surgery were statistically significant ( P<0.05); there was a statistically significant difference in SAL between the 1-year follow-up and the last follow-up ( t=3.80, P=0.001), and other indicators were not statistically significant. Among the 20 cases, there were 5 cases of postoperative complications, including 2 cases of pedicle screw loosening and displacement, 2 cases of transverse process hook decoupling, and 1 case of proximal junctional kyphosis (PJK). The complication rate was 25% (5/20), all of them underwent revision treatment, and the prognosis was good after timely treatment. Conclusion:The dual growth bar technique can effectively control the progression of EOS deformity, preserve the longitudinal growth potential of the spine, and buy time for the development of the thorax in children, which has high safety.

Surgical strategy selection and clinical outcome analysis in treatment of congenital cervicothoracic scoliosis / 中华骨科杂志

Objective:To investigate the surgical strategy of posterior correction of cervicothoracic scoliosis in children and adolescents, and to analyze the curative effect of surgical correction.Methods:A retrospective study was conducted on 14 patients with cervicothoracic scoliosis who underwent surgical treatment in the department of spine surgery of our hospital from January 2014 to June 2020, including 9 female and 5 male patients. 8 patients were treated with Halo traction before surgery.Among them, 7 patients were treated by posterior column osteotomy and fusion surgery, 7 patients were treated byposterior approach hemivertebra osteotomy. The scoliosis Cobb angle, T 1 tilt angle, clavicle angle, neck tilt angle, shoulder height difference, sagittal balance distance, coronal balance distance and local kyphosis angle were measured compared among before operation, after operation, at 1 year follow-up and at the last follow-up to evaluate the effect of surgical treatment and the correction loss at follow-up. Intraoperative and postoperative complications were recorded, and the Scoliosis Research Society question naires-22 (SRS-22) questionnaire was completed preoperatively and at 24-month follow-up to evaluate the functional status and treatment effect. Results:All 14 patients successfully completed the operation, the operation time was 6.85±1.79 h (range, 5-11 h); the intraoperative blood loss was 685.71±265.61 ml (range, 400-1 200 ml), and the follow-up time was 37.28±13.75 months (range, 24-72 months). The Cobb angle of the main curve was 50.20°±15.19° preoperatively, 10.91°±6.46° postoperatively , 10.53°±6.42° at 1-year follow-up, and 10.14°±5.95° at the last follow-up, and the difference was statistically significant ( F=45.55, P<0.001), the preoperative and postoperative difference was statistically significant ( t=10.62, P<0.001) with a correction rate of 78.32%±11.41%. The T 1 inclination angle was 16.08°±8.06° before operation, 3.71°±2.40° after operation, 4.05°±1.94° at 1-year follow-up, and 3.97°±2.04° at the last follow-up, and the difference was statistically significant ( F=10.55, P=0.001), the preoperative and postoperative difference was statistically significant ( t=6.37, P<0.001) with a correction rate of 69.56%±25.86%. The neck tilt angle was 7.45°±3.72° before operation, 2.45°±1.12° after operation, 2.75°±0.89° at 1-year follow-up, and 3.10°±2.01° at the last follow-up, and the difference was statistically significant ( F=6.65, P=0.008), in which postoperative correction rate was 57.92%±25.41%, and the difference was statistically significant ( t=4.69, P<0.001). The data of shoulder height difference before operation did not conform to normal distribution (Shapiro-Wilk test, P=0.017), it was 0.97 (0.54, 1.32) cm before operation and 0.53±0.40 cm after operation, and the postoperative correction rate was 50.17%±27.38%, the difference was statistically significant ( Z=3.18, P=0.001). The total score of SRS-22 questionnaire was increased from 4.21±0.29 preoperatively to 4.81±0.17 at 24-month follow-up ( t=7.35, P<0.001). Except for one patient with transient upper limb numbness, the other 13 patients showed no obvious intraoperative or postoperative complications. Conclusion:Both posterior column osteotomy with fusion and posterior hemivertebra osteotomy are effective in the treatment of cervicothoracic scoliosis, and the surgeon can make individual treatment plans according to different conditions.

In vitro biomechanical analysis of the second-generation dynamic anterior plate-screw system for quadrilateral area / 中华骨科杂志

Objective:To introduce the standard screw implantation methods and to analyze the biomechanical stability of the second-generation dynamic anterior plate-screw system for quadrilateral area (DAPSQ).Methods:Six adult formalin-preserved corpses were selected to make a complete pelvic specimen. Further, the left high double-column fracture models were made and randomly fixed with second-generation DAPSQ or anterior reconstruction titanium plate and 1/3 tube buttress-plate (ARTPB). The specimens of intact pelvis (IP) group, DAPSQ group and ARTPB group were fixed on a Zwick Z100 material machine and loaded vertically with 200 N, 300 N, 400 N, 500 N, 600 N, 700 N, and 800 N in a simulated sitting position, respectively. The axial displacement and strain changes in the anterior and posterior columns were tested in the three groups. The stiffness was calculated accordingly.Results:The axial compression displacement in the three groups showed an increase trend as well with the vertical load increased from 200 N to 800 N ( F=68.581, P<0.001; F=91.795, P<0.001; F=33.819, P=0.002). The axial displacement in ARTPB group was significantly larger than that in DAPSQ group and IP group ( P<0.05), while the difference between DAPSQ and IP groups was not significant ( P>0.05). Under the vertical load of 600 N, the pelvic axial stiffness of IP group, DAPSQ group, and ARTPB group were 220.72±70.33 N/mm, 185.68±48.49 N/mm and 135.83±60.58 N/mm, respectively. The axial stiffness of ARTPB group was significantly lower than that in DAPSQ group and IP group ( t=5.345, P=0.003; t=6.443, P=0.001), while the difference between DAPSQ and IP groups was not significant ( t=2.138, P=0.086). There were no significant differences of the strain values in anterior column among the three groups during the load increasing from 200 N to 800 N ( P>0.05). With the load increasing from 500 N to 800 N, the strain values of the posterior column in ARTPB group were significantly greater than those of IP and DAPSQ groups ( P<0.05). However, the differences between IP and DAPSQ groups were not statistically significant in strain values of the posterior column ( P>0.05). Conclusion:Compared with anterior reconstruction titanium plate and 1/3 tube buttress-plate, acetabular double-column fracture model fixed with the second-generation DAPSQ has less axial compression displacement but with greater axial stiffness. The stress change in the posterior columns of the acetabulum is like in IP. Therefore, the second-generation DAPSQ has reliable biomechanical stability.

Clinical study of deformed complex vertebral osteotomy (DCVO) in the treatment of angular kyphosis of cured spinal tuberculosis / 中华骨科杂志

Objective:To evaluate the feasibility and clinical efficacy of deformed complex vertebral osteotomy (DCVO) technique on the treatment of angular kyphosis of cured spinal tuberculosis.Methods:A retrospective study was performed on patients with angular kyphosis of cured spinal tuberculosis who underwent the DCVO technique or posterior vertebral column resection (PVCR) technique from Jan, 2007 to Jan, 2019. 33 patients were included, 18 males and 15 females, the average age was 39.5±15.0 years old (ranged 9-78 years old). The vertebral deformity in thoracic vertebrae 14 cases, thoracolumbar vertebrae 16 cases, and lumbar vertebrae 3 cases. 20 cases underwent the DCVO technique, while 13 cases underwent PVCR technique. For DCVO group, the multiple malformed vertebrae were considered a malformed complex, and a larger range and angle wedge osteotomy was performed within the complex using the DCVO technique. PVCR technique would resect the whole deformed vertebrae, and subsequently brought the two separated spinal columns together with instruments and titanium mesh. The intro-operative blood loss, operating time and complications were recorded. The radiological measurements included preoperative and postoperative spinopelvic parameters, which including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and segmental kyphosis. The recovery of neurological function was evaluated by Frankle classification.Results:All patients were followed up for 7-72 months. Comparing with the cases underwent PVCR technique, the DCVO group has a significantly lower blood loss (1315.00±462.57 ml), operating time (293.00±83.86 min) and complications rate (1.5%). At the time of preoperation, postoperation and last follow-up, the deformity angle of DCVO group was 96.80°±6.32°, 29.10°±6.96°and 29.05°±6.49°, which gained an average 69.9% correction rate. The statistical analysis suggested that deformity angle was enormously corrected. And there was an insignificant difference between DCVO group and PVCR group. Meanwhile, the preoperative, postoperative and follow-up TK of DCVO group was 96.96°±29.13°, 37.15°±4.88° and 37.00°±3.89°respectively, whosecorrection rate was 67.1%; LL was 66.70°±21.21°, 42.25°±5.53° and 41.90°±4.98°, which have a significant difference between pre-operation and post-operation/follow-up ( F=23.997, P<0.001) ; SVA was 75.95±18.63 mm, 16.30±6.88 mm and 16.55±7.30 mm. PI was 47.50°±6.12°, 47.35°±5.54°and 47.90°±5.93°, PT was 37.25°±9.63°, 18.50°±1.99° and 19.00°±1.65°; SS was 10.25°±8.27°, 29.15°±5.91° and 28.85°±5.77°. The sagittal and spinopelvic parameters of two groups improved significantly at postoperation and follow-up. No obviously difference of spinal parameters was found between two groups at preoperation and postoperation. Both groups have cases with dysneuria. And all of these cases achieved different degrees of recovery at follow-up. Conclusion:The use of DCVO technique for the treatment of post-tubercular angular kyphosis is safe and efficiency. DCVO leads a better clinical outcomes and lower complication rate than VCR technique.

Practice of joint base training of traumatic brain injury in standardized training of neurosurgery specialists / 中华医学教育探索杂志

The diagnosis and treatment of traumatic brain injury (TBI) are basic skills that should be mastered by neurosurgery specialists during the standardized training. In view of the lack of TBI patients in our center, TBI training was entrusted to a joint base with more TBI patients. Based on clinical training and practice experience of the authors in recent years, including joint base introduction, basic requirement, theory and skill training, research training, humanity accomplishment improvement, inter-base communication and evaluation standard, we discuss the appropriate joint base training mode of TBI in standardized training of neurosurgery specialists, so as to provide reference for cultivating qualified and comprehensively developed neurosurgery specialists.

Roles of Pipeline embolization device in combination with coils in the treatment of large and giant unruptured internal carotid artery aneurysms / 中国脑血管病杂志

Objective To investigate the roles of Pipeline embolization device ( PED) in combination with coils in the treatment of large and giant unruptured internal carotid artery aneurysms. Methods From January 2014 to December 2016,51 patients with large (diameter 10-25 mm) and giant (diameter >25 mm) internal carotid artery aneurysms treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively. Among them,35 were females and 16 were males, the average age was 53 ±13 years (range 15-71). They were divided into a PED group (n=31) and a PED combined with coil group (n=20) according to whether using coils for packing aneurysm cavity or not. The treatment of two groups of patients and ≥6 months of imaging follow-up effect were analyzed. The embolic rate was evaluated by Raymond grade. Results Thirty-one patients with 32 aneurysms ( mean diameter 15 ± 3 mm) in the PED group were treated with 33 PEDs,including 15 with cavernous sinus aneurysm and 17 with supraclinoid aneurysm;20 patients with 21 aneurysms ( mean diameter 17 ± 4 mm) were treated with 22 PEDs in the PED combined with coil group,including 10 cavernous sinus aneurysms and 11 supraclinoid carotid aneurysms. Six months after procedure,imaging follow-up revealed that the incidence of residual aneurysm ( Raymond grade Ⅱ-Ⅲ) in the PED group was significantly higher that that in the PED combined with coil group (9. 7% [n =3] and 0％,respectively). The incidence of thrombosis in PED combined with coil group was significantly higher than that in the PED group,there was significant difference between two groups (P<0. 05). Conclusions When using PED to treat large and giant internal carotid artery aneurysms,packing aneurysm cavity in combination with coils can reduce the incidence of residual aneurysm,but it may have a higher risk of thrombotic events. A prospective randomized controlled trial of large samples is still needed to prove it.

Training practice of neurocritical care in standardized training of neurosurgical specialists / 中华医学教育探索杂志

The training of neurocritical care is an important component in standardized training of neurosurgical specialists. As a subspeciality of neurosurgery, as well as with the characteristics of critical care medicine, neurocritical care carries its own discipline features. Based on clinical training and practice experiences, the training mode and practice experience were summarized, including basic requirement, theory training, skill training, research training, humanity accomplishment improvement and evaluation stan-dard, in order to discuss the appropriate training mode of neurocritical care in standardized training of neurosurgical specialists, improve the training methods and advance the training effectiveness, and provide reference for cultivating qualified and comprehensively developed neurosurgical specialists.

Expression changes and their clinical significance of triggering receptors of myeloid cells-1 after severe thoracic trauma / 中华创伤杂志

Objective To investigate the expression change and their clinical role of triggering receptor expressed on myeloid cells-1 (TREM-1) in patients with severe thoracic trauma.Methods A prospective cohort study was conducted to analyze the clinical data of 52 patients with severe thoracic trauma (trauma group) hospitalized from October 2016 to May 2017.The peripheral anticoagulant blood samples were collected at days 1,3,5,7 and 14 after trauma.Meanwhile,10 healthy volunteers were enrolled in control group and their blood samples were collected once.According to injury severity score (ISS),the patients were divided into ISS low-score group (＜ 20 points,n =15) and high-score group (≥20 points,n =37).The patients were assigned to traumatic non-sepsis group (n =34) and traumatic sepsis group (n =18) by the latest definition and standard of sepsis 3.0 issued by the Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM).The expressions of TREM-1 on neutrophils and monocytes were measured by flow cytometry.Pairwise comparisons were done between trauma group and healthy volunteers,ISS low-score group and ISS high-score group,and traumatic sepsis group and non-sepsis group,respectively.The accuracy of traumatic sepsis prediagnosis by TREM-1 was evaluated by the area under receiver operating characteristic curve (AUC).Results Trauma group had 41 males and 11 females,with age of (45.9 ± 12.4) years,Abbreviated Injury Scale (AIS) of (3.5 ± 0.6) points and Injury Severity Score (ISS) of (23.6 ± 8.5) points.Control group had eight males and two females,with the age of(29.1 ± 2.8) years.Compared to control group,trauma group had slightly lower TREM-1 expressions in neutrophils and significantly higher expressions in monocytes at days 1 to 14 (all P ＜ 0.01).ISS high-score group had slightly lower TREM-1 expressions in neutrophils than ISS low-score group at days 1 to 7,with significant difference at day 1 (P ＜ 0.05).ISS high-score group had slightly higher TREM-1 expressions in monocytes than ISS lowscore group at days 1 to 14,with significant difference at day 14 (P ＜ 0.05).Compared to traumatic non-sepsis group,traumatic sepsis group had significantly lower TREM-1 expressions in neutrophils at days 1 to 14 (all P ＜ 0.05).Traumatic sepsis group had slightly lower expressions in monocytes than traumatic non-sepsis group at days 1 to 7,with significant difference at day 3 (P ＜ 0.05).AUC and 95％ CI evaluating the role of neutrophils TREM-1 in traumatic sepsis prediagnosis were 0.852 (0.738,0.966) at day 1,0.835 (0.721,0.948) at day 3,0.797 (0.654,0.939) at day 5,0.756 (0.599,0.914) at day 7,and 0.707 (0.525,0.888) at day 14,respectively.Conclusions After severe thoracic trauma,the expressions of TREM-1 are decreased in neutrophils but increased in monocytes.TREM-1 might be used to assess the injury severity and has certain value in prediagnosis for traumatic sepsis.

Morphological and Hemodynamic Parameters for Middle Cerebral Artery Bifurcation Aneurysm Rupture Risk Assessment

OBJECTIVE: To investigate the morphological and hemodynamic parameters associated with middle cerebral artery (MCA)bifurcation aneurysm rupture. METHODS: A retrospective study of 67 consecutive patients was carried out based on 3D digital subtraction angiography data. Morphological and hemodynamic parameters including aneurysm size parameters (dome width, height, and perpendicular height), longest dimension from the aneurysm neck to the dome tip, neck width, aneurysm area, aspect ratio, Longest dimension from the aneurysm neck to the dome tip (Dmax) to dome width, and height-width, Bottleneck factor, as well as wall shear stress (WSS), low WSS area (LSA), percentage of LSA (LSA%) and energy loss (EL) were estimated. Parameters between ruptured and un-ruptured groups were analyzed. Receiver operating characteristics were generated to check prediction performance of all significant variables. RESULTS: Sixty-seven patients with MCA bifurcation aneurysm were included (31 unruptured, 36 ruptured). Dmax (p=0.008) was greater in ruptured group than that in un-ruptured group. D/W (p<0.001) and the percentage of the low WSS area (0.09±0.13 vs. 0.01±0.03, p<0.001) were also greater in the ruptured group. Moreover, the EL in ruptured group was higher than that in un-ruptured group (6.39±5.04 vs. 1.53±0.86, p<0.001). Multivariate regression analysis suggested D/W and EL were significant predictors of rupture of MCA bifurcation aneurysms. Correlation analyses revealed the D/W value was positively associated with the EL (R=0.442, p<0.01). CONCLUSION: D/W and EL might be the most two favorable factors to predict rupture risk of MCA bifurcation aneurysms.

Treatment of vertebrobasilar aneurysms using suboccipital muscle stratification via far lateral approach / 中国脑血管病杂志

Objective To discuss the technical essentials of microsurgery using suboccipital muscle stratification for the treatment of complex vertebrobasilar aneurysms via far lateral approach.Methods The clinical data of 8 patients with vertebrobasilar aneurysm underwent suboccipital muscle stratification via far lateral approach at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 5 patients with subarachnoid hemorrhage (Hunt-Hess grade Ⅱ 3 cases;grade Ⅲ 1 case;grade Ⅳ 1 case),and 3 with symptomatic dissecting aneurysm.Six patients underwent occipital artery-posterior inferior cerebellar artery and anterior inferior cerebellar artery bypass grafting,and aneurysm trapping,and the aneurysms of the other 2 cases were clipped directly in the operation.The modified Rankin scale (mRS) was used to evaluate the clinical efficacy.Results Postoperative digital subtraction angiography (DSA) revealed that all the bridge vessels were patent.The obtained length of occipital artery in the actual measurement of the operation was 12.5±1.1 cm.The distance between the anastomosis site and the skin incision in 6 cases was 50±6 mm.They were followed up for 4-21 months after procedure.The mRs score in 7 cases was 0-1.Two patients had new-onset hoarseness and recovered completely within 3 months after procedure.Another patient had postoperative cerebellar hemisphere dominant regional cerebral infarction and the mRs score was 4.None of them had poor wound healing,infection and cerebrospinal fluid leakage after procedure.Conclusion Suboccipital muscle stratification via far lateral approach can effectively obtain a longer occipital artery,reduce the occupation effect of muscle and depth of field.It is beneficial to expose lesions and operation of deep anastomosis.It is a more safe and practical technique in neurosurgery for the treatment of vertebrobasilar artery aneurysms.

Efficacy analysis of intravenous thrombolysis bridging intra-arterial thrombectomy for the treatment of acute intracranial large-vessel occlusion / 中国脑血管病杂志

Objective To investigate the safety and effectiveness of intravenous thrombolysis bridging intra-arterial thrombectomy for opening the acute occlusion of intracranial large artery.Methods Theclinical data of 63 patients with acute intracranial large artery occlusion treated with intravenous thrombolysis bridging intra-arterial thrombectomy in Beijing Xuanwu Hospital,Capital Medical University from January to September 2016 were analyzed retrospectively. The initiation time of intravenous thrombolysis was within 4. 5 h after onset. The initiation time of endovascular therapy (femoral artery puncture)was within 6 h after onset. They were divided into either a simple stent mechanical thrombectomy group (n=41)or a stent mechanical thrombectomy combined with catheter suction group (n=22)according to the ways of thrombectomy. There were no significant differences in the gender composition,average age,occlusion site and National Institutes of Health Stroke Scale (NIHSS)score on admission between the two groups of patients (all P <0. 05). The modified Thrombolysis in Cerebral Infarction (mTICI)was used evaluate the effect of vascular patency. The vascular recanalization time,number of thrombectomy,NIHSS scores on admission,at 72 h after procedure and at day 90,and intraoperative and postoperative complications treated with two kinds of intra-arterial treatment under the intravenous thrombolysis bridging were analyzed. Results (1)In the simple stent mechanical thrombectomy group,there were 37 patients with anterior circulation occlusion (90. 2%)and 4 with posterior circulation occlusion (9. 8%). In the stent mechanical thrombectomy combined with catheter suction group, there are 20 patients with anterior circulation occlusion (90. 9%)and 2 with posterior circulation occlusion (9. 1%). There were no significant differences between the two groups of patients (P<0. 05). After treatment, the large vessels achieved good recanaliazation (mTICI grade:Ⅱb-Ⅲ). (2)The mean recanalization time of the simple stent mechanical thrombectomy group was 86 ± 11 min and the mean number of arterial embolectomy was 2. 8 ± 0. 9 times. The complication rate after procedure was 14. 6%(5 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 51. 2%(21/41)at 90 days of follow-up. The mean recanalization time of the stent mechanical thrombectomy combined with catheter suction group was 83 ± 11 min and the mean number of arterial embolectomy was 2. 2 ± 0. 8 times. The compli-cation rate after procedure was 13. 6%(2 symptomatic intracranial hemorrhages and 1 cardiac death). The patients of mRS 0-2 accounted for 59. 1%(13/22)at 90 days of follow-up. There were significant differ-ences in the above indices between the two groups(all P<0.05).Conclusion Both intravenous throm-bolysis bridging simple stent mechanical thrombectomy and stent mechanical thrombectomy combined with catheter suction can quickly make the recanalization of intracranial occlusion of large artery,and the stent mechanical thrombectomy combined with catheter suction has a better recanalization rate. However, both techniques need to be further studied in improving the clinical prognosis of patients.

Preliminary application of multiple angiographic patterns in the hybrid surgery of cerebral and spinal arteriovenous malformations / 中国脑血管病杂志

Objectives To investigate the application modes of indocyanine green (ICG) angiography,digital subtraction angiography (DSA) and methylene blue angiography in the hybrid surgery of cerebral and spinal arteriovenous malformations (AVMs) and to compare the application value of different intraoperative angiographic methods.Methods From July 2013 to December 2015,55 patients treated with hybrid surgery of cerebral and spinal AVMs in Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 8 patients with cerebral AVM(Spetzler-Martin grade ≥Ⅲ) and 47 with spinal AVM.Their mean age was 33.8±15.6 years.Intraoperative DSA was performed in a hybrid operation room and methylene blue angiography was performed via the feeding artery.ICG angiography was performed in 4 cases in the initial stage as a comparison.Anatomic cure was confirmed by DSA at 3 months after surgery and the results were assessed.Results All 55 patients performed intraoperative DSA,32 underwent methylene blue angiography and 4 performed intraoperative ICG angiography.The frequency of intraoperative DSA was 3.6±1.3 times for each case.After the resection of the first lesion,the residual lesions revealed by DSA accounted for 27.3% (15/55).85.5% (47/55) patients achieved anatomic cure,in which the patients with midbrain AVM (8/8) and spinal AVM 83.0% (39/47) achieved anatomic cure.Three patients were lost to follow up at 1 year after procedure.The median modified Rankin scale (mRS) score of the cerebral AVMs was 2.0 (0.0-3.8).Compared with 3.5 (2.0-4.0) before procedure,there was significant difference (Z=-2.264,P0.05).The patients with function preservation (function score equal or better than pre-operation) accounted for 88.5% (46/52).Conclusions Intraoperative DSA could precisely localize the nidi and verify the complete resection.Intraoperative methylene blue angiography could selectively reveal the feeding artery supplied nidi in the operative field and identify the angioarchitecture.ICG angiography could reveal the structures of nidi on the surface of the operation area.The intraoperative methylene blue angiography could replace ICG angiography and achieve the treatment target of anatomical cure of the hybrid surgery of the cerebral and spinal cord vascular malformations.

Effect analysis of preoperative embolization combined with microsurgery for the treatment of intracranial arteriovenous malformation / 中国脑血管病杂志

Objective To evaluate the treatment effect of using preoperative embolization combined with microsurgery for the treatment of intracranial arteriovenous malformation.Methods From January 2005 to December 2015,57 consecutive patients with intracranial arteriovenous malformation (AVM ) admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were diagnosed by magnetic resonance imaging (MRI)and digital subtraction angiography (DSA). Glubran and/or Onyx embolization was used before the microsurgery. The clinical features,treatment, and occurrence of complications were recorded.Results In 57 patients,the Spetzler-Martin grade in 35 patients were gradeⅠ-Ⅱ,in 18 were Ⅲ,and in 4 were Ⅳ. The complications occurred in 11 patients (19. 3%),including 5 with Onyx,5 with Glubran,and 1 with Onyx+Glubran. After embilization,4 patients had hemorrhage,2 had intracranial hemorrhage,1 had postoperative intracranial infection,1 had postoperative neuro-logical dysfunction,and 3 had other systemic complications after procedure. The complication rates were 14. 3%(5/35)and 22. 2%(4/18)respectively according to the Spetzler-Martin grade Ⅰ-Ⅱ and Ⅲ. Two patients of Spetzler-Martin gradeⅣhad complications. The incidence of complications in the functional areas was 20. 0%(4/20)and that in non-functional areas was 18. 9%(7/37). One patient died. DSA revealed that 4 patients had residual lesions before discharge. The cure rate was 93. 0%. The mean modified Rankin scale (mRS)score at discharge was 1. 6 ± 1. 0. The patients of mRS 0-1 accounted for 59. 6%(34/57).The mRS scores in 7 patients at discharge were higher than before treatment.Conclusion For the high-grade AVM foci with larger volume and in the deep part of brain,the treatment with microsurgery combined with embolization can be considered.

Diagnostic and treatment analysis of arteriovenous fistula of cauda equina / 中国脑血管病杂志

Objective To investigate the diagnostic and treatment results of arteriovenous fistula of cauda equina.Methods From January 2000 to December 2015,9 Patients with arteriovenous fistula of cauda diagnosed and treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively,including 6 males and 3 females.Their ages were 17-58 (mean 39±14) years.The diagnoses were confirmed by digital subtraction angiography (DSA) or surgery (the lesions were located on the cauda equine,which were fed by the arterial supply of the nerve root,and the drainage vein flowed upward into the perimedullary vein).The clinical data,imaging data,and treatment follow-up results of the patients were analyzed.Results The patients presented with weakness of both lower extremities and disturbances of bowel movement and urination.Aminoff Logue score for spinal function was 7.2±3.2 before procedure.The median course of disease was 6.0 (4.5-18.0) months.Angiography showed that the vascular architecture types of the lesions were divided into simple fistula type and micro-nidus type.The feeding arteries were all the nerve root branches of the internal iliac artery.Three patients complicated with conical part of the intramedullary arteriovenous malformations.Eight patients were treated with endovascular embolization,one was treated by operation.No patients were treated with combined interventional surgery,and no surgery-related complications were observed.The mean follow-up duration was 20.1±6.7 months.Imaging follow-up showed that they all reached anatomic cure.Aminoff Logue score dropped to 4.6±2.8 after treatment.There were significant differences before and after treatment in Aminoff Logue score of the patients (t=4.276,P<0.05).Conclusions The nerve root arteriovenous fistula of the cauda equina can be diagnosed by DSA findings.Symptomatic patients are eligible for the indication of endovascular or surgical treatment.Anatomy and functional prognosis are satisfactory after treatment.

Roles of high-resolution magnetic resonance imaging in the diagnosis and treatment of vertebrobasilar dissecting aneurysms / 中国脑血管病杂志

Objective To investigate the roles of high-resolution magnetic resonance imaging (HR-MRI) in the diagnosis and treatment of vertebrobasilar dissecting aneurysms (VBDA).Methods From January 2016 to December 2016,62 patients with VBDA admitted to Xuanwu Hospital,Capital Medical University using 3.0 T HR-MRI (3D-TOF-MRA,3D-T1WI,and 3D-T1WI+C sequence) and diagnosed by DSA were analyzed retrospectively.They were divided into either an asymptomatic group (n=18) or a symptomatic group (n=44) according to their medical histories.Their clinical features,imaging features,and the relationship with prognosis were analyzed.Results HR-MRI revealed that the double lumen sign/intimal flap accounted for 27.8% (n=5) and 54.5% (n=24) respectively in the asymptomatic group and symptomatic group.The intramural hematoma accounted for 22.2% (n=4) and 43.2% (n=19) respectively in both groups.The enhancement of aneurysmal wall accounted for 33.3% (n=6) and 77.3% (n=34) in the asymptomatic group and symptomatic group.There were significant differences in the above features between the two groups (all P<0.05).In the symptomatic group,18.2% (n=8) of patients had aneurysm recurrence,which was significantly higher than the asymptomatic group (5.6%,n=1).The difference between the two groups was statistically significant (P<0.05).Conclusions HR-MRI can better reveal the lesion characteristics of VBDA.The rates of aneurysmal wall enhancement and recurrence in symptomatic VBDAs are higher,which indicates that HR-MRI can assess the stability of the aneurysmal wall and identify the prognosis to a certain extent.

Expanding PSO technique for the treatment of congenital severe thoracic angular kyphotic deformity / 中华骨科杂志

Objective To evaluate the clinical efficacy and feasibility of using the expanding pedicle subtraction osteotomy (E-PSO) technique for the treatment of congenital severe thoracic angular kyphotic deformity.Methods We retrospectively reviewed a cohort of 13patients with congenital severe kyphosis admitted to our hospital from January 2010 to June 2015 including 5 males and 8 females,the average age is (34.9±20.5) years old (ranged 15-55 years old).The vertebral deformity in T7～83 cases,T8～93 cases,T9～102 cases,T10～114 cases,T9～111 case.All cases were treated by E-PSO technique.The multi-malformed vertebrae are considered as a complexus.And the osteotomy was performed within the complexus.The superior and inferior endplate of the complexus were reserved.After the osteotomy was completed,alternately pressed tightly closed the upper and lower parts.Results All cases were followed up for 10-42 months,with an average of 32 months.At the time of preoperation,postoperation andthe last follow-up,the deformity angle was 107.0°±3.5°,23.5°± 1.5° and 23.5°±0.2°;TK was 98.1°±7.6°,28.9°±3.0° and 29.5°±0.1 °,LL was 94.1 °± 1.5°,43.7°± 1.3° and 44.1 °±5.3°;SVA was (-0.6±39) mm,(1.6±7.9) mm and (6±0.7) mm,respectively;PI was 28.9°±1.6°,31.7±12.3°and 31.9°±2.1°;PT was 17.7°±1.9°,13.4°±3.4°and 13.1°±4.2°,SS was 11.3°±0.4°,18.2°±1.1° and 18.7°±2.1°,respectively.The sagittal parameters and spinopelvic parameters except SVA were significantly improved in the post-operation and the last follow-up compared with the pre-operation according to the image data.No significant loss of correction occurred during the follow-up,and there was no statistical difference.The preoperative VAS score was (5.7± 1.4) points,ODI score was (19.8±12.7) points.The last follow-up VAS score was (1.9±0.7) points,the ODI score was (9.2±0.7) points.No case of nerve damage,infection and other complications,and no dissection,displacement and rupture of internal fixation were found during the follow-up.Conclusion The use of E-PSO technique for the treatment of congenital severe thoracic kyphotic kyphosis is feasible and can achieve better curative effect.

Effect of selective indocyanine green videoangiography in the operation of craniocervical junction dural arteriovenous fistulas / 中国脑血管病杂志

Objective To investigate the effect of using selective indocyanine green videoangiography in the surgical treatment of craniocervical junction dural arteriovenous fistulas.Methods From June 2014to January 2017,the clinical data of 24 patients (26 sides) with craniocervical junction dural arteriovenous fistula treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 15 with subarachnoid hemorrhage,8 with venous hypertensive myelopathy,and 1 with medullary compression symptom.The selective indocyanine green fluorescence technique was used to temporarily clip the origin of the arterilized draining vein,and the drainage vein was opened after the indocyanine green fluorescent arterial phase,and thus to determine the sites of arteriovenous fistulas.DSA examination was performed again after the operation,and the clinical efficacy was evaluated with the modified Rankin scale (mRS).Results The dural arteriovenous fistulas of 24 patients (26 sides) were separated from the fistulas during the operation.Intraoperative indocyanine green fluorescence development and postoperative DSA follow-up confirmed that the fistulas were separated.The follow-up time was 4-30 months.The mRS score in 21 patients was 0-1,the Hunt-Hess grade Ⅲ subarachnoid hemorrhage in 2 patients was mRS score 2,and mRS score in 1 patients with preoperative brainstem compression symptom was mRS score 3.Conclusion The selective indocyanine green fluorescence technique is a safe,simple,and effective technique for the treatment of dural arteriovenous fistulas at the junction of craniocervical junction.

Posterior only approaches versus anterior only approaches and combined posterior and anterior approaches for thorac-ic tuberculosis in adults:minimum 5-year follow-up / 中华骨科杂志

Objective To compare the minimum 5?year follow?up outcomes of surgical management by posterior only ap?proaches, anterior only approaches and combined posterior and anterior approaches for thoracic tuberculosis in adults, and evalu?ate the mid term follow?up results of posterior only approaches. Methods All of 184 patients with monosegment thoracic tubercu?losis between January 2003 and November 2010 were studied retrospectively. Among these patients, 62 cases were treated with posterior debridement combine with interbody fusion (PO group), 65 cases were treated by posterior instrumentation, anterior de?bridement and bone graft in one or two?stage procedures (AP Group ), and 57 cases were treated by anterior only approach (AO Group). The operation time, blood loss, Visual Analogue Scale, complications, recovery of neurological function, kyphosis angle, correction rate and loss angle were respectively compared between each group. Results Comparison of postoperative curative ef?fects showed:mean operation time and blood loss:PO group (260.05±30.75 min,735.95±161.43 ml) was better than AP group (411.65 ± 55.61 min, 1178.65 ± 184.50 ml)and AO group (343.65 ± 24.74 min, 965.35 ± 122.59 ml);corrective angle and correction rate:PO group (6.78°±1.13°, 72.48%±12.97%) and AP group (6.97°±1.05°, 73.10%±11.42%) were better than AO group (13.98°± 1.73°, 44.95%±16.84%);bed time:PO group and AO group were shorter than AP group. Mid term follow?up outcomes showed:ky?phosis angle and loss angle:PO group (8.56°±1.09°, 1.89°±1.41°) and AP group (8.55°±1.65°, 1.63°±1.11°) were better than AO group (16.39°±1.59°, 2.80°±1.29°);bone fusion time, VAS and recovery of neurological function:there were no statistically differ?ence in all groups. Conclusion The mid term follow?up outcomes of posterior debridement combined with interbody fusion is sat?isfied in the management of monosegment thoracic tuberculosis. It is a safe and effective method.