Mechanism and prevention of structural valve degeneration and Bioprosthetic valve failure / 中华胸心血管外科杂志

Structural valve degeneration (SVD) and bioprosthetic valve failure (BVF) seriously limits the service life of biological valves. Exploring the molecular mechanism and pathological process of SVD and BVF is an important way to improve valve durability and prognosis of patients with biological valves replacement. In this review, we systematically summarized the definition, pathogenesis, related molecular pathways and prevention strategies of SVD and BVF. This review is expected to provide a theoretical basis for the study of the mechanism of SVD and BVF and the development of clinical intervention targets.

[Strategies and ideas of comprehensive development and utilization of medicine and food homologous variety Phyllanthus emblica].

Phyllanthus emblica is a kind of traditional medicine and medicinal and edible plant, with rich variety resources and high development value. It is a key poverty alleviation variety in China at present. As P. emblica processing industry is rising gradually in recent years, in order to fully develop and utilize its industrial resources, this paper systematically introduces current comprehensive development and utilization of P. emblica, discusses the problems in P. emblica processing industry, and puts forward comprehensive development and utilization strategies and industrial models in terms of cultivation, breeding, grading, quality evaluation and waste recycling, so as to provide a certain reference for promoting the high-quality development of P. emblica industry in China.

Strategies and ideas of comprehensive development and utilization of medicine and food homologous variety Phyllanthus emblica / 中国中药杂志

Phyllanthus emblica is a kind of traditional medicine and medicinal and edible plant, with rich variety resources and high development value. It is a key poverty alleviation variety in China at present. As P. emblica processing industry is rising gradually in recent years, in order to fully develop and utilize its industrial resources, this paper systematically introduces current comprehensive development and utilization of P. emblica, discusses the problems in P. emblica processing industry, and puts forward comprehensive development and utilization strategies and industrial models in terms of cultivation, breeding, grading, quality evaluation and waste recycling, so as to provide a certain reference for promoting the high-quality development of P. emblica industry in China.

Identification of aberrantly methylated differentially expressed genes targeted by differentially expressed miRNA in osteosarcoma.

BACKGROUND: Osteosarcoma (OS) is the most common primary bone tumors diagnosed in children and adolescents. Recent studies have shown a prognostic role of DNA methylation in various cancers, including OS. The aim of this study was to identify the aberrantly methylated genes that are prognostically relevant in OS. METHODS: The differentially expressed mRNAs, miRNAs and methylated genes (DEGs, DEMs and DMGs respectively) were screened from various GEO databases, and the potential target genes of the DEMs were predicted by the RNA22 program. The protein-protein interaction (PPI) networks were constructed using the STRING database and visualized by Cytoscape software. The functional enrichment and survival analyses of the screened genes was performed using the R software. RESULTS: Forty-seven downregulated hypermethylated genes and three upregulated hypomethylated genes were identified that were enriched in cell activation, migration and proliferation functions, and were involved in cancer-related pathways like JAK-STAT and PI3K-AKT. Eight downregulated hypermethylated tumor suppressor genes (TSGs) were identified among the screened genes based on the TSGene database. These hub genes are likely involved in OS genesis, progression and metastasis, and are potential prognostic biomarkers and therapeutic targets. CONCLUSIONS: TSGs including PYCARD, STAT5A, CXCL12 and CXCL14 were aberrantly methylated in OS, and are potential prognostic biomarkers and therapeutic targets. Our findings provide new insights into the role of methylation in OS progression.

Amphiphilic Block Copolymers: A Novel Substance for Bitter-Masking in Aqueous Solutions.

It is a challenging task to suppress the bitterness of liquid preparations, especially for children. Bitter molecules are highly dispersible in liquids, leading to a strong and instant stimulation of the bitter receptors. At present, there is no effective way to correct this issue except for adding sweeteners, resulting in an unsatisfying taste. Based on the three-point contact theory, which is a universally accepted mechanism of bitterness formation, a new idea and application of amphiphilic block copolymers (ABCs) for bitterness suppression was proposed for the first time. We found that ABCs could widely inhibit the bitterness of four typical bitter substances. The mechanism is that ABCs self-assemble to form association colloids, which attract bitter components and reduce their distribution in the molecular form in solution. The bitter components were demonstrated to automatically embed in the spiral hydrophobic cavity of the hydrophobic chain of the ABCs, and their special interaction dispersed the positive electrostatic potential of bitter groups. The combination did not affect the pharmacokinetic parameters and pharmacodynamics of bitter drugs. These findings highlight the novel application of ABCs for the inhibition of bitterness and illuminate the underlying inhibition mechanisms.

Effect of CT window settings on size measurements of the solid component in subsolid nodules: evaluation of prediction efficacy of the degree of pathological malignancy in lung adenocarcinoma.

OBJECTIVE: To investigate the predictive value of size measurements of the solid components in pulmonary subsolid nodules with different CT window settings and to evaluate the degree of pathological malignancy in lung adenocarcinoma.  Methods: The preoperative chest CT images and pathological data of 125 patients were retrospectively evaluated. The analysis included 127 surgically resected lung adenocarcinomas that manifested as subsolid nodules. All subsolid nodules were divided into two groups: 69 in group A, including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinomas (MIA); 58 in group B that included invasive pulmonary adenocarcinomas (IPA). The size of the solid component in the pulmonary subsolid nodules were calculated in one dimensional, two dimensional and three dimensional views using lung and mediastinal windows that were recorded as 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW and 3D-SCMW, respectively. Furthermore, the volume of solid component with a threshold of -300HU was measured using lung window (3D-SCT). All the quantitative features were evaluated by the Mann-Whitney U test. Multivariate analysis was used to identify the significant predictor of the degree of pathological malignancy.  Results: The 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW, 3D-SCMW and 3D-SCT views of group B were significantly larger than those of group A (p < 0.001). The multivariate logistic regression analysis indicated that 3D-SCT (OR = 1.018, 95%CI: 1.005 ~ 1.03, p <0.05＝was the independent predictive factor. The larger SCT was significantly associated with IPAs.  Conclusion: 3D-SCT of subsolid nodules during preoperative CT can be used to predict the degree of pathological malignancy in lung adenocarcinoma, which may provide a more objective and convenient selection criterion for clinical application.  Advances in knowledge:  Applying threshold of -300 HU with lung window setting would be better than other window setting for the evaluation of solid component in subsolid nodules. Computer-aided volumetry of the solid component in subsolid nodules can more accurately predict the degree of pathological malignancy than the other dimensional measurements.

NVP-BEZ235 synergizes cisplatin sensitivity in osteosarcoma.

Osteosarcoma(OS) remains a major health concern in childhood and adolescence, although cisplatin is one of the gold standard chemotherapeutic drugs in the treatment of OS, chemoresistant to cisplatin is common. Phosphoinositide 3-kinase (PI3K)-Akt-mammalian target of rapamycin inhibitor (mTOR) pathway and autophagy regulates chemosensitivity incancer cells. In this study, we hypothesized that NVP-BEZ235, a dual inhibitor of PI3K/mTOR, could synergize cisplatin sensitivity in OS. In vitro, NVP-BEZ235 plus cisplatinexerted a synergistic effect on cell proliferation inhibition and apoptosis induction. Cisplatin could activate PI3K-Akt-mTOR pathway activity in early times, whereas, NVP-BEZ235 could inhibit PI3K-Akt -mTOR pathway activity all the times alone or combined with cisplatin. What's more, NVP-BEZ235 could switch function of autophagy induced by cisplatin to synergize cisplatin sensitivity. In vivo, pronounced decrease in tumor cell proliferation and increase in apoptosisin combination-treated mouse xenograft models compared with cisplatin or NVP-BEZ235 treated models. All these results suggest NVP-BEZ235 could synergize cisplatin sensitivity in OS, combination of NVP-BEZ235 with cisplatin could represent a novel therapeutic strategy for treatment of OS.

Overexpression of constitutively active MAP3K7 in ameloblasts causes enamel defects of mouse teeth.

OBJECTIVE: Compelling evidence suggests that mitogen-activated protein kinases (Mapks) play an important role in amelogenesis. However, the role of transforming growth factor (TGF)-ß-activating kinase 1 (Tak1, Map3k7), which is a known upstream kinase of Mapks, during amelogenesis remains to be determined. The aim of this study was to investigate the possible involvement of Map3k7 in amelogenesis. DESIGN: We generated transgenic mice that produced constitutively active human MAP3K7 (caMAP3K7) under the control of amelogenin (Amelx) gene promoter. Radiography and micro-computed tomography (µCT) analysis was used to detect the radio-opacity and density of the teeth. The enamel microstructure was observed with a scanning electron microscope. Histological analysis was used to observe the adhesion between ameloblasts and residual organic matrix of the enamel. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to analyze the expression of enamel matrix protein. RESULTS: The enamel of mandibular molars in caMAP3K7-overexpressing mice displayed pigmentation and a highly irregular structure compared with the wild type littermates. Teeth of transgenic animals underwent rapid attrition due to the brittleness of the enamel layer. The microstructure of enamel, normally a highly ordered arrangement of hydroxyapatite crystals, was completely disorganized. The gross histological appearances of ameloblasts and supporting cellular structures, as well as the expression of the enamel protein amelotin (Amtn) were altered by the overexpression of caMAP3K7. CONCLUSIONS: Our data demonstrated that protein expression, processing and secretion occurred abnormally in transgenic mice overexpressing caMAP3K7. The overexpression of caMAP3K7 had a profound effect on enamel structure by disrupting the orderly growth of enamel prisms.

Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness.

OBJECTIVE: To assess whether quantitative computed tomography (CT) can help predict histological invasiveness of pulmonary adenocarcinoma appearing as pure ground glass nodules (pGGNs). METHODS: A total of 110 pulmonary pGGNs were retrospectively evaluated, and pathologically classified as pre-invasive lesions, minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA). Maximum nodule diameters, largest cross-sectional areas, volumes, mean CT values, weights, and CT attenuation values at the 0th,2th,5th, 25th, 50th,75th, 95th, 98th and100th percentiles on histogram, as well as 2th to 98th, 5th to 95th, 25th to 75th,and 0th to 100thslopes, respectively, were compared among the three groups. RESULTS: Of the 110 pGGNs, 50, 28, and 32 were pre-invasive lesions, MIA, and IPA, respectively. Maximum nodule diameters, largest cross-sectional areas, andmass weights were significantly larger in the IPA group than in pre-invasive lesions. The 95th, 98th, 100th percentiles, and 2th to 98th, 25th to 75th, and 0th to 100thslopes were significantly different between pre-invasive lesions and MIA or IPA. Logistic regression analysis showed that the maximum nodule diameter (OR=1.21, 95%CI: 1.071-1.366, p<0.01) and 100th percentile on histogram (OR=1.02, 95%CI: 1.009-1.032, p<0.001) independently predicted histological invasiveness. CONCLUSIONS: Quantitative analysis of CT imaging can predict histological invasiveness of pGGNs, especiallythe maximum nodule diameter and 100th percentile on CT number histogram; this can instruct the long-term follow-up and selective surgical management.

Optimization and evaluation of intermediate uniformity in Chinese medicine pill powders based on particle design principle:exemplifying by Xiaojin Pills / 药学学报

Based on the principle of particle design, the powder of Xiaojin Pills was prepared, and the quality uniformity was investigated by means of powder characterizations and content uniformity. By studying the mixed crushing rules of the classified materials and the design principle of the powder particles of Chinese medicine, the powder of the Xiaojin Pills was prepared. At the same time, the manmade mixed powder and the control powder prepared by pharmacopoeia were prepared. The mixed homogeneity of the three powders was evaluated by particle size distribution and color difference. The GC-MS and LC-MS/MS were used to study the homogeneity of their contents. The best preparation process of particle design powder is:materials easily crushed are smashed for 50 min in the vibrating ultrafine mill with -15℃, then add the materials difficultly crushed into the mill and let them crushed together for 3 min. The particle size range of manmade mixed powder was the largest with the particle size difference being more than 100 microns, the RSD value being 26.07%. The particle size range was more than 50 microns in the powder prepared by pharmacopoeia, and the RSD was nearly 15%. The difference in particle size was only around 4 μm and the RSD value was 3.18%. The color difference test showed that the composite chromatism (dE*) value of the powder prepared by pharmacopoeia was the largest for the RSD was 84.56%. The RSD of manmade mixed powder and the powder prepared by Pharmacopeia were 53.83% and 32.83%, respectively. The RSD value of the particle designed powder's muscone content is about 50% of the other two kinds of powders. The contents of 10 components in powders were determined by LC-MS/MS. The RSD values of the particle designed powder were much smaller than other two kinds of powders. Results indicate that the uniformity of the particle designed powder is better than other two kinds of powders. Chinese medicine particle design technology can effectively improve the uniformity of traditional Chinese medicine powder.

Endoscopic transmaxillary transMüller's muscle approach for decompression of superior orbital fissure: a cadaveric study with illustrative case.

BACKGROUND: In an effort to avoid the damage and inconvenience associated with transcranial approaches, we developed an endoscopic transmaxillary transMüller's muscle approach for decompression of the superior orbital fissure (SOF). METHODS: The endoscopic transmaxillary transMüller's muscle route was performed in ten cadaveric heads. We measured important anatomic landmarks, and angles radiographically. This approach was initially attempted in one patient with traumatic superior orbital fissure syndrome (tSOFS). RESULTS: A maxillary antrostomy was carried out with a buccal sulcus incision. The sinus ostium and the course of infraorbital nerve were used as endoscopic anatomic landmarks. Then the inferior orbital fissure was drilled out, followed by separating the Müller's muscle. The periorbita were peeled off from the lateral wall, followed by the endoscope going along the periorbital space, until the lateral aspect of the SOF could be visualized. Decompression was successfully performed in all specimens. The initial clinical application justified this approach. The patient had an uneventful postoperative course and satisfactory recovery. CONCLUSION: This approach offers sufficient endoscopic visualization and reliable decompression of SOF. It avoids the need for brain retraction, temporalis muscle manipulation, or any external incision, and appears to be able to deliver satisfying aesthetic results as well as favourable functional recovery.

A review on health inequ ality and related facot rs of the globa l elderly / 中国卫生政策研究

The rapidly aging population has attracted extensive attention to the health of elderly people .The elderly are a vulnerable group in society .Their adverse physical and mental health not only affects their own well-be-ing but also brings a heavy burden on families and society .Numerous studies have found that health inequality of the elderly is a problem throughout the world, and differences in gender, age, marital status, socioeconomic status, and social capital among the elderly are all contributing factors .This paper summarizes these factors through a literature review.We suggest that cross-sectional and longitudinal data should be combined and suitable indicators and mathe -matical models to Chinese conditions should be established in order to analyze the mechanisms of various factors and their effects on health inequality and serve as a reference for promoting the overall health of the elderly .

[Preliminary study for classification of spino-pelvic sagittal alignment in adult volunteers].

OBJECTIVE: To investigate the feasibility of the classification of the spino-pelvic sagittal alignment in adluts according to lumbar lordosis (LL) and inflection point (IP). METHODS: Whole spine, standing radiographs of 223 adult volunteers were taken from July to August in 2011 .There were 111 cases(56 female and 55 male) enrolled in the study based on the inclusion criteria. The pelvic and spinal parameters, including thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), LL, sacral slope(SS), pelvic tilt(PT), pelvic incidence(PI), intervertebral endplate angle, sagittal vertical axis (SVA), spino-sacral angle (SSA) and IP were measured. The spino-pelvic sagittal alignment were classified in to 3 types according to LL and IP. Type I: LL > -40°, IP located below L2 ∼ 3; Type II: -60° ≤ LL ≤ -40°, IP located in L1 ∼ 2 or T12 ∼ L1; Type III: LL < -60°, P located above T11 ∼ 12. Pearson correlation analysis was used to test the correlation between the variables. The parameters in each type were compared by oneway-ANOVA respectively,then additional multiple comparisons were performed. RESULTS: The mean value of LL was -49° ± 10°, TK was 36° ± 7°, TLK was 6° ± 7°, PT was 11° ± 7°, SS was 34° ± 8°, PI was 45° ± 9°, SSA was 127° ± 9° and SVA was (-2.7 ± 22.8)mm, respectively. Only LL had significant statistical correlation with all the other parameters. Negative correlation presented between LL and TK, PI, SS, SSA (r = -0.387, -0.536, -0.858, -0.801,P < 0.05). Positive correlation presented between LL and TLK, SVA, PT (r = 0.319, 0.296, 0.262, P < 0.05). All the volunteers were classified into the 3 types: Type I1 9 cases, Type II 75 cases,Type III 17 cases. Oneway-ANOVA results showed statistical difference in LL, TK, TLK, PT, SS, PI, SSA, SVA among the 3 types, (F = 164.559, 7.431, 14.099, 4.217, 53.856, 6.252, 35.995, 8.626, P < 0.05 ). Multiple comparisons showed that LL, SS, SSA, PI had statistical difference between each two types comparison (P < 0.05). CONCLUSIONS: LL is the central parameter of the spino-pelvic sagittal balance. The patterns of the spino-pelvic sagittal alignment in adults could be classified into three types, according to LL and IP. The classification could describe the morphological differences and balance of the spino-pelvic sagittal alignment.

Design and performance of tapered cubic anvil used for achieving higher pressure and larger sample cell.

In order to increase the maximum cell pressure of the cubic high pressure apparatus, we have developed a new structure of tungsten carbide cubic anvil (tapered cubic anvil), based on the principle of massive support and lateral support. Our results indicated that the tapered cubic anvil has some advantages. First, tapered cubic anvil can push the transfer rate of pressure well into the range above 36.37% compare to the conventional anvil. Second, the rate of failure crack decreases about 11.20% after the modification of the conventional anvil. Third, the limit of static high-pressure in the sample cell can be extended to 13 GPa, which can increase the maximum cell pressure about 73.3% than that of the conventional anvil. Fourth, the volume of sample cell compressed by tapered cubic anvils can be achieved to 14.13 mm(3) (3 mm diameter × 2 mm long), which is three and six orders of magnitude larger than that of double-stage apparatus and diamond anvil cell, respectively. This work represents a relatively simple method for achieving higher pressures and larger sample cell.

[Preliminary clinical results of endoscopic assisted anterior lumbar interbody fusion].

OBJECTIVE: To summarize the experiences of endoscopic assisted anterior lumbar interbody fusion (ALIF) with self-locking cage via retroperitoneal approach through small incision lateral to abdominal rectus. METHODS: There were 47 cases of endoscopic assisted ALIF from April 2010 to April 2012 were reviewed retrospectively, including 28 male and 19 female patients whose age ranged from 39 to 65 years, averaged of (48 ± 11) years. Of 47 cases, 17 cases were founded instability in lumbar spine, 16 cases of discogenetic low back pain, 7 cases of degenerative spondylolithesis, and 7 cases of recurrent disc herniation. The level involved included 7 cases at L3-4 level, 33 cases at L4-5 level, 7 cases at L5-S1. X-ray and/or 3D CT scan were done in each patient at post-operative day 4, 1 month, 3 months, and 6 months. The height and angle of disc space, angle of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were recorded and measured, as well as length of incision, operation time, blood loss, complications and ratio of bone graft fusion. The clinical outcomes were evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). RESULTS: Average length of incision was (6.2 ± 0.8)cm (5.3-7.8 cm) , average blood loss was (81 ± 20)ml (50-150 ml) , mean operation time was (96 ± 10)minutes (65-122 minutes) . There were significant improvement of ODI(48% ± 10% vs. 14% ± 5%), the VAS of back pain(6.3 ± 1.1 vs.0.7 ± 0.7) and VAS of leg pain(3.4 ± 2.1 vs.0.6 ± 0.6) during preoperative and postoperation last follow-up (t = 20.78, 25.92 and 8.74, P = 0.000). The disc height of operative segments were all recovered significantly (F = 18.971, P = 0.000) postoperatively, from preoperative (10.3 ± 2.4)mm to postoperative (12.6 ± 2.1)mm. For complications, 5 cases had peritoneum tear, 19 cases had bone donor site pain, 14 cases had abdominal distension and 5 cases had lower limb paraesthesia, which were all treated with supportive managements. Bony intervertebral fusion was obtained in all cases in 6 months postoperatively. CONCLUSIONS: The advantages of endoscopic assisted ALIF with self-locking cage via retroperitoneal approach are less damage, rapid recovery, and less blood loss. Comparing with traditional ALIF procedure, the view of operative field is also improved.

Effects of tyrosine kinase receptor B-brain-derived neurotrophic factor signal pathway on the secretion of vascular endothelial growth factor and matrix metalloproteinase-9 of neuroblastoma / 中国小儿急救医学

Objective To study the effects of tyrosine kinase receptor B-brain-derived neurotrophic factor (TrkB-BDNF) signal pathway on the secretion of vascular endothelial growth factor (VEGF) and matrix metalloproteinases-9(MMP-9) of neuroblastoma.Methods We used all-trans retinoic acid (ATRA) to induce the high expression of TrkB in the SH-SY5Y cell line,and then added the ectogenid BDNF to activate the TrkB-BDNF and its three downstream signal pathways.TrkB-BDNF signal pathway was inhibited by specific tyrosine kinase inhibitor K252a.The three downstream signal pathway was respectively inhibited by LY294002 (the phosphatidylinositol 3-hydroxy kinase (PI3 K) pathway inhibitor)、U73122 (the phospholipase C pathway inhibitor) 、U0126(the mitogen activated protein kinase pathway inhibitor).Enzyme linked immunosorbent assay was used to detect the concentration of VEGF and MMP-9 protein in the SY5Y cell culture supernatants.Results VEGF [(485.89 ± 109.99) pg/ml] and MMP-9 [(15.73 ± 1.72) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA + BDNF were significantly higher than that of the control group and ATRA alone group(P ＜0.05).VEGF [(272.42 ±86.33) pg/ml]and MMP-9 [(5.25 ± 1.44) pg/ml] protein levels in the group of ATRA + BDNF + K252a were significantly lower than those of the ATRA + BDNF group(P ＜ 0.05) and had no significant difference compared with the control group and the ATRA alone group(P ＞0.05).VEGF [(314.12 ±24.68) pg/ml] and MMP-9 [(4.91 ± 1.08) pg/ml] protein levels in the group of ATRA + BDNF + LY294002 were significantly lower than those of the ATRA + BDNF group(P ＜ 0.05) and had no significant difference compared with the control group and the ATRA alone group(P ＞0.05).VEGF [(444.08 ±64.49) pg/ml] and MMP-9 [(13.28 ±3.38) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA +BDNF + U73122 had no significant difference compared with the ATRA + BDNF group(P ＞ 0.05).VEGF [(429.97 ± 19.95) pg/ml] and MMP-9 [(13.96 ± 4.45) pg/ml] protein levels in neuroblastoma cells cultured in serum-free media in the group of ATRA + BDNF + U0126 had no significant difference compared with the ATRA + BDNF group(P ＞ 0.05).Conclusion Activation of TrkB-BDNF signal pathway can increase the synthesis and secretion of VEGF and MMP-9 in human neuroblastoma cells.TrkB-BDNF signal pathway may be through activating its downstream PI3K pathway to increase the synthesis and secretion of VEGF and MMP-9 in human neuroblastoma cells.The synthesis and secretion of VEGF and MMP-9 can be inhibited by blocking the TrkB-BDNF signal pathway with K252a or blocking its downstream signal pathway PI3 K with LY294002.

Preliminary study for classification of spino-pelvic sagittal alignment in adult volunteers / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of the classification of the spino-pelvic sagittal alignment in adluts according to lumbar lordosis (LL) and inflection point (IP).</p><p><b>METHODS</b>Whole spine, standing radiographs of 223 adult volunteers were taken from July to August in 2011 .There were 111 cases(56 female and 55 male) enrolled in the study based on the inclusion criteria. The pelvic and spinal parameters, including thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), LL, sacral slope(SS), pelvic tilt(PT), pelvic incidence(PI), intervertebral endplate angle, sagittal vertical axis (SVA), spino-sacral angle (SSA) and IP were measured. The spino-pelvic sagittal alignment were classified in to 3 types according to LL and IP. Type I: LL > -40°, IP located below L2 ∼ 3; Type II: -60° ≤ LL ≤ -40°, IP located in L1 ∼ 2 or T12 ∼ L1; Type III: LL < -60°, P located above T11 ∼ 12. Pearson correlation analysis was used to test the correlation between the variables. The parameters in each type were compared by oneway-ANOVA respectively,then additional multiple comparisons were performed.</p><p><b>RESULTS</b>The mean value of LL was -49° ± 10°, TK was 36° ± 7°, TLK was 6° ± 7°, PT was 11° ± 7°, SS was 34° ± 8°, PI was 45° ± 9°, SSA was 127° ± 9° and SVA was (-2.7 ± 22.8)mm, respectively. Only LL had significant statistical correlation with all the other parameters. Negative correlation presented between LL and TK, PI, SS, SSA (r = -0.387, -0.536, -0.858, -0.801,P < 0.05). Positive correlation presented between LL and TLK, SVA, PT (r = 0.319, 0.296, 0.262, P < 0.05). All the volunteers were classified into the 3 types: Type I1 9 cases, Type II 75 cases,Type III 17 cases. Oneway-ANOVA results showed statistical difference in LL, TK, TLK, PT, SS, PI, SSA, SVA among the 3 types, (F = 164.559, 7.431, 14.099, 4.217, 53.856, 6.252, 35.995, 8.626, P < 0.05 ). Multiple comparisons showed that LL, SS, SSA, PI had statistical difference between each two types comparison (P < 0.05).</p><p><b>CONCLUSIONS</b>LL is the central parameter of the spino-pelvic sagittal balance. The patterns of the spino-pelvic sagittal alignment in adults could be classified into three types, according to LL and IP. The classification could describe the morphological differences and balance of the spino-pelvic sagittal alignment.</p>

Preliminary clinical results of endoscopic assisted anterior lumbar interbody fusion / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experiences of endoscopic assisted anterior lumbar interbody fusion (ALIF) with self-locking cage via retroperitoneal approach through small incision lateral to abdominal rectus.</p><p><b>METHODS</b>There were 47 cases of endoscopic assisted ALIF from April 2010 to April 2012 were reviewed retrospectively, including 28 male and 19 female patients whose age ranged from 39 to 65 years, averaged of (48 ± 11) years. Of 47 cases, 17 cases were founded instability in lumbar spine, 16 cases of discogenetic low back pain, 7 cases of degenerative spondylolithesis, and 7 cases of recurrent disc herniation. The level involved included 7 cases at L3-4 level, 33 cases at L4-5 level, 7 cases at L5-S1. X-ray and/or 3D CT scan were done in each patient at post-operative day 4, 1 month, 3 months, and 6 months. The height and angle of disc space, angle of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were recorded and measured, as well as length of incision, operation time, blood loss, complications and ratio of bone graft fusion. The clinical outcomes were evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS).</p><p><b>RESULTS</b>Average length of incision was (6.2 ± 0.8)cm (5.3-7.8 cm) , average blood loss was (81 ± 20)ml (50-150 ml) , mean operation time was (96 ± 10)minutes (65-122 minutes) . There were significant improvement of ODI(48% ± 10% vs. 14% ± 5%), the VAS of back pain(6.3 ± 1.1 vs.0.7 ± 0.7) and VAS of leg pain(3.4 ± 2.1 vs.0.6 ± 0.6) during preoperative and postoperation last follow-up (t = 20.78, 25.92 and 8.74, P = 0.000). The disc height of operative segments were all recovered significantly (F = 18.971, P = 0.000) postoperatively, from preoperative (10.3 ± 2.4)mm to postoperative (12.6 ± 2.1)mm. For complications, 5 cases had peritoneum tear, 19 cases had bone donor site pain, 14 cases had abdominal distension and 5 cases had lower limb paraesthesia, which were all treated with supportive managements. Bony intervertebral fusion was obtained in all cases in 6 months postoperatively.</p><p><b>CONCLUSIONS</b>The advantages of endoscopic assisted ALIF with self-locking cage via retroperitoneal approach are less damage, rapid recovery, and less blood loss. Comparing with traditional ALIF procedure, the view of operative field is also improved.</p>

[The use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy].

OBJECTIVE: To investigate the use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy. METHODS: From April 2008 to March 2010, anterior cervical discectomy and fusion with self-locking cages were performed on 45 patients who suffered from multi-segmental cervical myelopathy, among of them there were 23 male and 22 female, aged from 32 to 67 years (average 53 years). Recording the Japanese Orthopedic Association (JOA) scores and SF-36 scores in the protocol time point, in order to investigate the clinical outcome, meanwhile, accumulating the pre-operation and postoperation X-ray films of cervical spine for measuring the height of intervertebral space, whole curvature of cervical spine and the rate of fusion by repeated measures analysis of variance. RESULTS: The mean follow-up time was 28.4 months (24 - 35 months). JOA scores ascended from preoperative 6.5 ± 3.1 to postoperative 13.4 ± 1.7 (F = 17.84, P = 0.001), the 7 scores of SF-36 improved significantly after operation (t = 1.151 - 12.207, P < 0.05), but mental health not. The fineness rate was 91.1%. Height of disc space ascended from preoperative (5.5 ± 1.8) mm to postoperative (8.3 ± 0.8) mm (F = 11.71, P = 0.043), globle curvature of cervical spine ascended from preoperative 5° ± 7° to postoperative 10° ± 14° (F = 234.53, P = 0.000), the change of the two index was significantly, respectively. Fat necrosis in one case and hematoma in another case at the bone donor-site were found, both of the two cases were cured by physiotherapy. All of the 45 cases (111 segments) achieved bone fusion. CONCLUSION: The use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy possess many advantages as follows: satisfactory clinical outcome, minimally invasive, higher fusion rate, higher orthopaedic ability.

Perinatal risk factors associated with neurobehavioral development of full-term small for gestational age newborn infants / 中国小儿急救医学

Objective To explore perinatal risk factors associated with the neurobehavioral development of small for gestational age (SGA) full-term neonates.Methods This prospective cross-sectional study included 111 full-term newborn infants from Apr 2008 to Apr 2010 born in Yan-tai Yuhuangding Hospital.Detailed clinical data in perinatal period of all subjects were recorded.Infants aged 3 ～ 7 days were assessed with neonatal behavioral neurological assessment (NBNA) for neurobehavioral development.Logistic regression analysis was used to explore risk factors associated with the score of NBNA.Results Significant differences (P ＜ 0.05) were found between full-term SGA (10.72 ± 1.41,7.13 ± 0.96,7.32 ± 0.74,37.16 ±1.32) and normal neonates (11.27 ± 1.04,7.89 ± 0.72,7.62 ± 0.64,39.12 ± 0.76) in terms of capacity,active and passive muscle tension and NBNA score.Full-term SGA neonates had lower score than control.Univariate logistic regression showed that delivery,placenta abnormalities,umbilical cord abnormalities,infection in perinatal period,gestational hypertension,twin pregnancy,hyperbilirubinemia affected neurobehavioral development of full-term SGA infants.Multivariate logistic regression showed that mothers' infection in perinatal period (OR =2.175,95 ％ CI 1.981 ～ 2.408,P ＜ 0.05),twin pregnancy (OR =1.936,95％ CI 1.517 ～2.368,P ＜ 0.05) and hyperbilirubinemia (OR =1.518,95％ CI 1.072-2.149,P ＜ 0.05) were risk factors for neurobehavioral delay of full-term SGA infants.Conclusion Full-term SGA neonates showed poorer quality in neurobehavior.Risk factors associated with neurobehavior of full-term SGA infants included mothers' infection in perinatal period,twin pregnancy and hyperbilirubinemia.