Application of the cortical bone trajectory technique in posterior lumbar fixation.

The cortical bone trajectory (CBT) is a novel technique in lumbar fixation and fusion. The unique caudocephalad and medial-lateral screw trajectories endow it with excellent screw purchase for vertebral fixation via a minimally invasive method. The combined use of CBT screws with transforaminal or posterior lumbar interbody fusion can treat a variety of lumbar diseases, including spondylolisthesis or stenosis, and can also be used as a remedy for revision surgery when the pedicle screw fails. CBT has obvious advantages in terms of surgical trauma, postoperative recovery, prevention and treatment of adjacent vertebral disease, and the surgical treatment of obese and osteoporosis patients. However, the concept of CBT internal fixation technology appeared relatively recently; consequently, there are few relevant clinical studies, and the long-term clinical efficacy and related complications have not been reported. Therefore, large sample and prospective studies are needed to further reveal the long-term complications and fusion rate. As a supplement to the traditional pedicle trajectory fixation technique, the CBT technique is a good choice for the treatment of lumbar diseases with accurate screw placement and strict indications and is thus deserving of clinical recommendation.

Epidural gas-containing pseudocyst leading to lumbar radiculopathy: A case report.

BACKGROUND: Lumbar radiculopathy is a common symptom in the clinic and is often caused by lumbar disc herniation or osteophytes compressing the nerve root; however, it is rare for nerve roots to be compressed by epidural gas. Few symptomatic epidural gas-containing pseudocyst cases have been reported. Furthermore, the reported cases were due to a mix of gas and obvious osteophytes; therefore, it was hard to rigorously conclude that gas was the factor responsible for radiculopathy. We provide evidence that because no epidural gas accumulated before radiculopathy occurred and the symptoms were relieved after removal of the gas, the epidural gas-containing pseudocyst was the root cause of radiculopathy in this case. CASE SUMMARY: An 87-year-old man with a 3-wk history of right radiating pain was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations showed a vacuum phenomenon and huge lesions with low signal intensity located in the same area where the pain occurred. After carefully checking the images acquired in the last 3 mo, we found an abdominal CT examination performed 40 d prior because of abdominal pain. The CT images showed no gas-containing pseudocyst in the epidural space and notably, he had no leg pain at the time. To ensure a low-intensity intervention and complete decompression of the nerve, percutaneous endoscopic lumbar nerve decompression surgery was advised. A gas-containing pseudocyst was identified under endoscopy. The symptoms were relieved after surgery, and the postoperative images showed total disappearance of the vacuum phenomenon and lesions with low signal intensity on CT and MRI. Histological examination showed that the sampled gas-containing pseudocyst tissue was fibrous connective tissue. CONCLUSION: This case thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain. Percutaneous endoscopic decompression is a minimally invasive and effective treatment method.

Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy.

BACKGROUND: Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. OBJECTIVE: This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. METHODS: In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. RESULTS: All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52-130 min). The fluoroscopy duration was 5.88 ± 1.05 (4-7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively (P < 0.05). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up (P < 0.05). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. CONCLUSIONS: The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.

Isolated talonavicular arthrodesis and talonavicular-cuneiform arthrodesis for the Müller-Weiss disease.

BACKGROUND: The study aimed to introduce the isolated talonavicular and talonavicular-cuneiform arthrodesis for the stage III and IV Müller-Weiss disease and analyze their clinical outcomes. METHODS: Thirty patients of stage III and IV Müller-Weiss disease were divided into the talonavicular (TN) arthrodesis group and the talonavicular-cuneiform (TNC) arthrodesis group according to the perinavicular osteoarthritis by MRI scans. For the isolated talonavicular arthrodesis group, 16 patients underwent talonavicular arthrodesis with two 4.0 mm hollow headless compression screws. For the TNC arthrodesis group, 14 patients were received the TNC arthrodesis with reverse "V" shape osteotomy and autoallergic iliac bone graft. All patients were followed up at 3, 6, 9, and 12 months, and per 6 months after 1 year, by the AOFAS ankle-midfoot scores, and evaluated by radiographic measurements. RESULTS: All of them were followed up in two groups and all patients were satisfied with their clinical results. At the TN arthrodesis group, the patients' mean was 39.8 months (range, 11-66 months) follow-up. The mean AOFAS ankle and hindfoot scores had improved from 38.3 ± 5.1 preoperatively to 88.9 ± 1.9 at the last postoperative assessment. At the TNC arthrodesis group, the mean follow-up was 51.7 months (range, 12-90 months). The mean AOFAS ankle and hindfoot scores were 40.1 ± 7.9 preoperatively to 90.1 ± 2.0 at the last postoperative. All of the cases were solid fusion on the radiograph. CONCLUSIONS: According to MRI evaluation, either TN or TNC arthrodesis for stage III or IV Müller-Weiss disease have the good clinical outcomes with solid fusion rate and obvious improvement of the quality of life of patients.

Three-Way Laryngeal Mask Reduces Anesthesia-Related Stress Responses in Bronchoalveolar Lavage: An Experimental Canine Study.

OBJECTIVE: To compare the ventilatory effects of the three-way laryngeal mask airway (TLMA) and tracheal tube (TT) on hemodynamics, respiratory function, and stress responses in a canine model during bronchoalveolar lavage (BAL). STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: The 303rd Hospital of the Chinese People&#039;s Liberation Army in May 2013. METHODOLOGY: Sixteen dogs were divided into two groups. MAP, SpO2 and HR were recorded before anesthesia (T0), immediately before intubation (T1), during intubation (T2), at 3 (T3) and 10 (T4) minutes after mechanical ventilation, at 10 (T5), 20 (T6), and 30 (T7) minutes during the course of BAL, during extubation (T8), and 3 minutes after extubation (T9). Tidal volume, peak inspiratory airway pressure, and expiratory CO2 pressure were recorded at time points T2, T5, T6, T7, and T8. Stress responses variables, including epinephrine and norepinephrine levels, were examined at time points T0, T2, T3, T5, T8, and T9. RESULTS: BAL was successfully completed in all animals. In comparison to the TT, the TLMA was capable of maintaining hemodynamic stability and ventilation (p &lt; 0.05), and producing less stress responses (p &lt; 0.05). CONCLUSION: In a canine model, ventilation with the TLMA was better than the TT during BAL in terms of maintaining effective ventilation and stable hemodynamics, and producing less stress responses.

Digital gene expression analysis of transcriptomes in lipopolysaccharide-induced acute respiratory distress syndrome.

BACKGROUND: The mortality from acute respiratory distress syndrome (ARDS) is high, and its exact pathogenesis remains unclear, which forms a major obstacle for prevention and treatment of this disease. In the present study, we used digital gene expression (DGE) to detect the differentially expressed genes of the lung at 4h after lipopolysaccharide (LPS) exposure in a mouse model. METHODS: Mice were treated with LPS or control saline by intratracheal instillation for 4h, and their lung tissues were collected for DGE analysis. We used a false discovery rate ≤0.001 and an absolute value of the log2 ratio≥1 as the thresholds for judging the significance of any difference in gene expression between the two members of each pair of mice. RESULTS: We obtained 3,387,842 clean tags (i.e., after filtering to remove potentially erroneous tags) and about 84,513 corresponding distinct clean tags (i.e., types of tag). Approximately 91.20% of the clean tags could be mapped, and 82.71% could be uniquely mapped, to the reference tags, and 3.82% were unknown tags. At least 2200 differentially expressed genes were identified and analyzed for enrichment of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway. Twenty genes with the greatest difference in expression levels between the two members of every pair of mice were chosen. The majority of these genes are involved in signaling transduction, molecular adhesion, and metabolic pathways. CONCLUSIONS: Using the powerful technology of DGE, we present, to our knowledge, the first in-depth transcriptomic analysis of mouse lungs after LPS exposure. We found some differentially expressed genes that might play important roles in the pathogenesis of ARDS.

Medial displacement calcaneal osteotomy with posterior tibial tendon reconstruction for the flexible flatfoot with symptomatic accessory navicular.

We investigated the clinical outcomes after medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular, in patients with flexible flatfoot with accessory navicular symptoms. From December 2008 to July 2011, 16 patients (21 feet) with a flexible flatfoot, symptomatic accessory navicular, and obvious heel valgus underwent medial displacement calcaneal osteotomy and reconstruction with posterior tibial tendon insertion on the navicular bone. The patients were evaluated preoperatively, 6 weeks and 3, 6, and 12 months postoperatively, and every 6 months thereafter. The clinical examination was undertaken using the American Orthopaedic Foot and Ankle Society ankle and midfoot scores. The radiologic assessments included the arch height, calcaneus inclination angle, talocalcaneal angle, and talar first metatarsal angle on the lateral weightbearing radiograph. The talocalcaneal angle and talar first metatarsal angle was assessed on the anteroposterior view of the weightbearing foot. Heel valgus alignment was assessed on the axial hindfoot radiographs. The mean follow-up duration was 28.5 months (range 18 to 48). All patients were satisfied with the clinical results and were pain free 6 months postoperatively. No cases of wound infection or nerve injury developed. The mean American Orthopaedic Foot and Ankle Society score improved from 53.3 ± 6.5 to 90.8 ± 1.4 at the last follow-up visit (p < .01). The improvements in all radiographic parameters were statistically significant between the preoperative and last follow-up examinations (p < .01). The heel valgus of all patients was corrected. Our results have shown that medial displacement calcaneal osteotomy with reconstruction of the posterior tibial tendon insertion on the navicular bone is an effective treatment of flexible flatfoot with symptomatic accessory navicular, associated with excellent clinical outcomes and correction of the deformity.

[Retrospective observation of dynamic levels of serum Golgi protein 73 in patients prior to the onset of liver cancer].

OBJECTIVE: To observe the dynamic levels of serum Golgi protein 73(GP73) in patients prior to and after the onset of liver cancer, and to explore the related factors. METHODS: From 2007 to 2012, a periodical screening program was carried out in a group of high risk population with positive Hepatitis B surface antigens (HBsAg) , twice a year. Their serum specimens from every screening time point were kept in Qidong Biobank until liver cancer was diagnosed. Thirty-nine patients with liver cancer were recruited for the study, each of them at least had three times of specimens collected as well as B ultrasound scan (BUS) exam results at onset of disease and within 30 months before diagnosed, amongst 6 time points. In total, there were 162 specimens collected to test GP73 by double-antibody sandwich enzyme-linked immuno-sorbent assay (ELISA). Statistical analyses of time series and differences among groups were performed by stata software 10. RESULTS: The average value of 39 patient's GP73 at the time point of liver cancer onset was (126.77 ± 73.73) µg/L, while the values at the other five time points prior to the onset were (128.32 ± 81.18) , (129.97 ± 83.62) , (127.38 ± 80.10) , (135.52 ± 97.88) and (138.24 ± 93.58) µg/L, respectively, with no significant difference (F = 0.07, P = 0.997). No obvious changing trends of GP73 were observed among the 39 liver cancer cases at the 6 time points. All 162 samples were divided into two groups: without hepatic cirrhosis (63 samples) and with cirrhosis (99 samples) according to findings of B-ultrasonic wave; whose average GP73 values were separately (97.16 ± 51.39) and (151.20 ± 91.68) µg/L. The difference showed statistical significance (F = 18.22, P < 0.01). Furthermore, if we grouped the samples by the average value of GP73 at 130.19 µg/L, then there were only 1/14 of the subjects without hepatic cirrhosis having higher GP73 values, but 12 of the 25 subjects with hepatic cirrhosis having higher GP73 values. The difference showed statistical significance (P = 0.013). The results of Linear regression model also showed that there was no correlation between GP73 and time series (t = 0.75, P = 0.455), but significant correlation between GP73 and hepatic cirrhosis (t = 4.30, P < 0.01). CONCLUSION: No significant changes of the dynamic levels of GP73 could be found among the liver cancer patients within 30 months prior to the onset of disease. GP73 values of the patients with liver cancer may depend on their background of hepatic diseases; and hepatic cirrhosis might be one of the main influencing factors or confounding factors.

[Survey of the serum hepatocellular carcinoma marker Golgi glycoprotein (GP73) among Qidong residents and correlation analysis to outcome at two-year follow-up].

OBJECTIVE: To survey the levels of Golgi glycoprotein (GP73), a hepatocellular carcinoma (HCC) marker, in residents of Qidong and determine the correlation of detected GP73 concentration ranges with outcome at two-year follow-up. METHODS: A total of 12,378 individuals (age range: 35-69 years old) from Qidong were enrolled in the study. All participants were tested for hepatitis B virus (HBV) by detecting hepatitis B surface antigen (HBsAg) in serum. One-tenth of the participants were assigned to a stratified-random sample group (those with identification numbers ending with "0") to represent a "subgroup of the natural population" (HBsAgPop, n = 1227). All HBsAg carriers were stratified as a "subgroup of positivity" (HBsAgPve, n = 1025). One-tenth of all HBsAg-negative individuals were assigned to a stratified-random sample group to represent a "subgroup of negativity" (HBsAgNve, n = 1132). Enzyme-linked immunoassay was used to measure the serum GP73 and alpha-fetoprotein (AFP) levels; the distribution, medians (50th percentile), and 95th percentiles of GP73 were determined for the three subgroups. A two-year follow-up was carried out to observe the differential incidence of HCC between the HBsAgPve and HBsAgNve subgroups. RESULTS: A positively skewed distribution of the GP73 values was observed for all three subgroups. The medians for HBsAgPve, HBsAgNve, and HBsAgPop were 67 mug/L, 54 mug/L, and 55 mug/L; the 95th percentiles were 174 mug/L, 108 mug/L, and 114 mug/L, respectively. The AFP positivity rates were 7.23% (37/512) for carriers whose GP73 values were above the median level and 0.78% (4/513) for carriers with GP73 values below the median level, with a highly significant difference between the two (P less than 0.01). A the two-year follow-up, 23 (4.49%) of the 512 carriers with GP73 more than or equal to 67 mug/L had developed HCC, while only one patient (0.19%) of the 513 carriers with GP73 less than 67 mug/L developed HCC, which yielded a relative risk value of 23.6. In the non-carriers, no HCC cases had occurred, regardless of serum GP73 level. CONCLUSION: Serum GP73 has a higher potential as a diagnostic/prognostic marker of HCC in individuals with HBsAg positivity. In follow-up of HBsAg carriers, GP73 may help in the early detection of liver cancer.

[Inhibitory effect of human mitochondria-targeted MPG recombinant on proliferation of human non-small cell lung cancer multidrug-resistant cell line A549/DDP].

BACKGROUND & OBJECTIVE: Multidrug resistance is the key obstacle to the improvement of chemotherapy effect of lung cancer. This study was to construct eukaryotic expression vector of human mitochondria-targeted N-methylpurine DNA glycosylase (MPG), and explore its inhibitory effect on proliferation of human non-small cell lung cancer multidrug-resistant cell line A549/DDP. METHODS: Manganese-superoxide dismutase mitochondria-targeted sequence-MPG fusion gene (mito-MPG) was constructed through splicing by overlap extension (SOE). Recombinant eukaryotic expression vector pCMV-Script/mito-MPG was constructed by molecule-cloning technique, and then transfected into A549/DDP cells. In the stably transfected cells which were screened out by G418, the expression of mito-MPG mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR); its expression in separated and purified mitochondria was detected by Western blot. The proliferation of A549/DDP cells was detected by trypan blue exclusion trial. Cell cycle distribution was analyzed by flow cytometry. RESULTS: The mito-MPG fusion gene was confirmed by DNA sequencing,the recombinant pCMV-Script/mito-MPG was confirmed by restrictive endonuclease digestion and DNA sequencing. mito-MPG mRNA and protein were detected in the cells transfected with pCMV-Script/mito-MPG (MPG group), but not in the cells transfected with pCMV-Script (P group) and untransfected cells (C group). The cell double time were 72.6 h in C group, 73.5 h in P group, and 98.9 h in MPG group. Cell cycle blockage and subdiploid peak were found in MPG group. The proliferation indexes were 51.3% in C group, 54.3% in P group, and 26.1% in MPG group. CONCLUSION: pCMV-Script/mito-MPG could be constructed and transfected into mitochondria of A549/DDP cells successfully, and inhibit proliferation and induce apoptosis of A549/DDP cells.

[Analysis of major QTL for Fusarium head blight resistance on the short arm of chromosome 3B in wheat].

Three recombinant inbred populations, Ning894037/Alondra, Wangshuibai/Alondra and Sumai3/Alondra, were analyzed for QTLs associated with Fusarium head blight resistance by interval mapping and composite interval mapping in this study. The result showed that the major QTLs were detected on the short arm of chromosome 3B of all three resistant parents using the data of FHB resistance evaluated in greenhouse or field. They were located in the interval of 5.0 cM between BARC133 and Xgwm493 in Ning894037, 11.5 cM between BARC147 and Xgwm493 in Wangshuibai, and 13.0 cM between Xgwm533a and Xgwm493 in Sumai3, explaining 42.8%, 15.1% and 10.6% of the phenotypic variance for Type II resistance (spread within the spike), respectively. Some of the SSR markers linking to the major QTLs tightly can be used directly in marker-assisted breeding to improve FHB resistance in wheat.

[Effects of bone morphogenetic protein and transforming growth fractor-beta on biomechanical property for fracture healing in rabbit ulna].

OBJECTIVE: To investigate the effects of exogenous bone morphogenetic protein (BMP) and transforming growth factor-beta (TGF-beta) on biomechanical property for ulna of fracture healing. METHODS: Thirty-six adult rabbits were made the model of right ulnar fracture and treated locally with TGF-beta/PLA, BMP/PLA, TGF-beta + BMP/PLA or PLA (as control group). Fracture healing was evaluated by measurement of the mechanical parameters and geometric parameters. RESULTS: As compared with control group, the geometric parameters, the bending broken load, the ultimate bending strength, the bending elastic modulus, the ultimate flexural strength, the flexural elastic modulus, the ultimate compressing strength, the compressing elastic modulus, and the ultimate tensile strength for ulna of fracture healing increased significantly in the treatment groups(P < 0.01). These parameters were higher in TGF-beta + BMP/PLA group than in TGF-beta/PLA group or in BMP/PLA group and in TGF-beta/PLA group than in BMP/PLA group(P < 0.05). There was no significant difference in bone density between the treatment groups and control group. CONCLUSION: Local application of exogenous TGF-beta and BMP can increase the callus formation and enhance biomechanical strength of bone after fracture healing. A combination of TGF-beta and BMP has synergetic effect in enhancing fracture healing.