Association between TNF-α polymorphisms and the risk of upper gastrointestinal bleeding induced by aspirin in patients with coronary heart disease.

OBJECTIVE: To investigate the correlation of tumor necrosis factor α (TNF-α) polymorphisms with upper gastrointestinal bleeding (UGIB) induced by enteric-coated aspirin in coronary heart disease (CHD) patients. METHODS: In total, 154 CHD patients taking enteric-coated aspirin were enrolled in this study. Patients were divided into the UGIB group (n = 57) and non-UGIB group (n = 97) based on the presence or absence of signs of UGIB, respectively. TNF-α polymorphism (-857C > T, -863C > A, and -1031T > C) genotyping was performed using polymerase chain reaction (PCR) amplification with sequence-specific primers (PCR-SSP). RESULTS: Patients who had the CC genotype and C allele of -1031T > C exhibited a significantly increase risk of UGIB after receiving enteric-coated aspirin (CC vs. TT: odds (OR) (95% confidence interval (CI)): 7.568 (1.527-37.49), P = 0.005; C vs. T: OR (95% CI): 1.852 (1.036-3.312), P = 0.036). Patients who had CA and CA + AA genotypes and the A allele of -863C > A also exhibited an increased risk of aspirin-induced UGIB (CA vs. CC: OR (95% CI): 2.415 (1.143-5.101), P = 0.019: CA + AA vs. CC: OR (95% CI): 2.218 (1.123-4.381), P = 0.021; A vs. C: OR (95% CI): 1.788 (1.039-3.078), P = 0.035). However, the TNF-α -857 C > T polymorphism was unrelated to the induction of UGIB by enteric-coated aspirin in CHD patients (P > 0.05). In addition, the haplotypes of CCC (-1031T > C, -863C > A, and -857C > T) markedly reduced the risk of aspirin-induced UGIB in CHD patients. CONCLUSION: TNF-α -863A and -1031C increased the risk of UGIB induction by enteric-coated aspirin in CHD patients, whereas TNF-α -857C > T was not correlated with the UGIB risk.

[Correlation of lumbar disc degeneration and spinal-pelvic sagittal balance].

OBJECTIVE: To elucidate the relationship between spino-pelvic sagittal balance parameters and lumbar intervertebral disc degeneration of each segment through retrospective analysis in lumbar degeneration patients. METHODS: Retrospective analysis was conducted for the follow-up data in 126 patients with lumbar degenerative disease from July 2009 to June 2012. There were 38 cases with whole spine plates and 88 cases with lumbar plates. All of them received magnetic resonance imaging (MRI) scans. Through software Image J, the following spino-pelvic sagittal balance parameters were measured: sagittal vertical axis (SVA, distance between C7 plumb line and posterior upper corner of S1 endplate), thoracic kyphosis (TK, T5-T12 Cobb angle), thoracolumbar kyphosis (TLK, T10-L2 Cobb angle), lumbar lordosis (LL, L1-L5 Cobb angle), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 spino-pelvic inclination (T1-SPI), T9 spino-pelvic inclination (T9-SPI), spino-sacral angle (SSA), spino-pelvic angle (SPA) and C7 tilt (C7T). Based on the grading system of Pfirrmann et al, the intervertebral disc degeneration grades were acquired for each lumbar segment. According to the normal range of previous studies, each spino-pelvic sagittal balance parameter was classified into 3 groups, i.e. Group A (less than normal), Group B (normal) and Group C (more than normal). All statistical analyses were performed to compare the differences of each lumbar segment/intervertebral disc degeneration among groups by one-way ANOVA test via SPSS 18.0. And P-value < 0.05 was deemed significant. RESULTS: PI had a significant impact on the L5/S1 disc degeneration. And L5/S1 disc degeneration had a significant impact on sagittal balance. Among 57 cases of large PI, LL, PT, SS, SVA, C7T, SPA in L5/S1 of mild-to-moderate and severe degeneration groups was 36.91 ± 14.93 and 29.71 ± 11.30 (P = 0.045), 18.82 ± 8.27 and 25.18 ± 10.19 (P = 0.012), 39.45 ± 8.82 and 34.57 ± 8.88 (P = 0.042), 23.04 ± 26.63 and 62.15 ± 33.82 (P = 0.002), 88.85 ± 3.13 and 83.98 ± 4.62 (P = 0.003), 157.88 ± 11.20 and 147.75 ± 13.98 (P = 0.043) respectively. TLK in L1/L2 with mild-to-moderate and severe degeneration groups was 4.59 ± 7.81 and 14.91 ± 14.75 (P = 0.026). All of L1/L2, L2/L3 and L3/L4 disc degeneration had a significant impact on SPA. SPA in L1/L2, L2/L3, and L3/L4 with mild-to-moderate and severe degeneration groups was 158.47 ± 11.97 and 147.84 ± 12.72 (P = 0.031), 159.91 ± 10.78 and 148.75 ± 13.17 (P = 0.024), 158.46 ± 10.86 and 148.61 ± 13.93 (P = 0.047) respectively. CONCLUSION: With an important impact on lumbar disc degeneration, PI, either too big or too small, may predispose to the occurrences of lumbar disc degeneration. L5/S1 disc degeneration has a significant impact on pelvis postural parameters (PT, SS). L5/S1 degeneration is a key causative factor of pelvic posterior rotation and compensatory process. L5/S1 disc degeneration has an important impact on pelvis overall parameters (SVA, SPA, C7T). And the degeneration of L5/S1 is a key cause of trunk imbalance.

[Correlation of adult spinal sagittal imbalance and life quality].

OBJECTIVE: To evaluate the correlation of spinal sagittal imbalance and life quality. METHODS: Radiographic analysis for 48 consecutive symptomatic patients with spinal sagittal imbalance was performed with posteroanterior and lateral standing radiographs. There were 12 males and 36 females with an average age of (66.2 ± 8.5) yrs. The measurement parameters included C7PL, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI) and sacral slope (SS). Life quality was assessed with SF-36 questionnaire. Pearman's method was employed to analyze the correlation. RESULTS: Mean C7PL was (44.7 ± 22.5) mm, TK (26.1 ± 13.1)°, TLK (11.9 ± 10.3)°, LL (23.5 ± 18.2)°, PT (32.1 ± 13.4)°, PI (57.4 ± 10.9)° and SS (22.5 ± 11.5)°. C7PL had a significant correlation with physical functioning (r = -0.428, P < 0.01) and general health (r = -0.428, P < 0.01). PI had a significant correlation with bodily pain (r = -0.374, P < 0.01), vitality (r = -0.303, P < 0.01), social functioning (r = -0.309, P < 0.01) and role emotional (r = -0.429, P < 0.05). TK had a significant correlation with physical functioning (r = -0.292, P < 0.05) and general health (r = -0.389, P < 0.01). LL had a significant correlation with physical functioning (r = 0.428, P < 0.01), general health (r = 0.340, P < 0.05) and vitality (r = 0.373, P < 0.01). PT had significant correlation with vitality (r = -0.385, P < 0.01) and social functioning (r = -0.417, P < 0.05). No significant correlation existed between TLK, SS and SF-36 categories. CONCLUSION: C7PL, TK, LL, PI and PT are significant parameters correlating with quality of life. PI is the most important one affecting bodily pain. TK, LL and C7PL are the main parameters affecting general health. PI, PT and LL affect vitality the most. Correcting these parameters while treating sagittal imbalance is important for a better life quality.

Role of death receptor, mitochondrial and endoplasmic reticulum pathways in different stages of degenerative human lumbar disc.

Intervertebral disc (IVD) cell apoptosis has been suggested to play an important role in promoting the degeneration process. It has been demonstrated that IVD cell apoptosis occurs through either death receptor, mitochondrial or endoplasmic reticulum (ER) pathway. Our study aimed to explore the relationship among these three pathways and grade of IVD degeneration (IVDD). IVDs were collected from patients with lumbar fracture, vertebral tumor, disc herniation or spondylolisthesis. IVDs were distinguished by MRI and histomorphological examination, cell apoptosis was detected by TUNEL staining. Biomarkers of these three apoptosis pathways were detected by RT-PCR and Western blot. Furthermore, the correlation between apoptosis pathways biomarkers and disc pathology were analyzed. Nucleus pulposus cell density decreased with degeneration process, and increased apoptotic ratio. ER pathway was predominant in mild stage of IVDD (GRP78, GADD153 upregulation and caspase-4 activation), death receptor pathway was predominant in mild and moderate stages (Fas, FasL up-regulation and caspase-8 activation) and mitochondrial pathway was predominant in moderate and severe stages (Bcl-2 down-regulation, Bax up-regulation, cytochrome-c accumulation in cytoplasm and caspase-9 activation). There were significant differences in the expressions of Fas, FasL, Bax, GADD153, cytochrome-c and cleaved caspase-8/9/3 between contained and non-contained discs. In conclusion, apoptosis occurs via these three apoptosis pathways together in IVDD. ER pathway plays a more critical role in the mild compared to moderate and severe stages, death receptor pathway in mild and moderate, and mitochondrial pathway in moderate and severe stages of IVDD. Disc cells apoptosis may progress rapidly after herniation, and may depend on the type of herniation.

[Effect of local injection of recombinant hirudin on survival of skin flaps with venous congestion in a rabbit model].

OBJECTIVE: To observe the effect of local injection of recombinant hirudin on survival of skin flaps with venous congestion in a rabbit model. METHODS: Eighteen healthy rabbits were enrolled and divided into heparin-treatment (HT), recombinant hirudin treatment (RHT) and control (C) groups according to the random number table, with 6 rabbits in each group. After intravenous anesthesia with 20 g/L pentobarbital sodium, model of skin flaps with venous congestion in the size of 6 cm × 3 cm was reproduced in the dorsal side of left ear of each rabbit, in which central artery of ear served as the only blood supply, and a pedicle of 1 cm in width including central vessel of ear and its accompanying nerves as the only venous return pathway. Each flap in RHT, HT, C groups was respectively given 1 mL recombinant hirudin (1 U), low-molecular-weight heparin (625 U), and isotonic saline via multi-point and homogenous injection, then they were sutured in site. Appearance and survival rate of the flaps were observed after operation. Specimens of the distal part of flaps were harvested for determination of thromboxane B2 (TXB2) on post operation day (POD) 1, 3, 5, 7. Data were processed with one-way analysis of variance and t test. RESULTS: Rabbit model of skin flaps with venous congestion was reproduced successfully. Obvious hair loss was observed in completely necrotic parts of flap in each group. Obvious edema was observed in all flaps with venous congestion at distal site. The color of flaps in HT and RHT groups were lighter as compared with that in C group, and apparent hematoma of flap was observed in 1 rabbit of RHT group, 2 rabbits of HT group, 4 rabbits of C group on POD 1. The survival rate of flap in HT and RHT groups was respectively (92.3 ± 1.7)% and (94.8 ± 1.9)%, both higher than that in C group [(77.9 ± 1.2)%, F = 191.29, P < 0.05]. There was no statistical difference in survival rate of flap between HT group and RHT group (t = 2.75,P > 0.05). The content of TXB2 in HT and RHT groups on POD 3, 5 was respectively lower than that in C group (with t value from 6.68 to 30.55, P values all below 0.01), but there was no statistical difference between HT and RHT groups (with t value respectively 1.22, 6.44, P values all above 0.05). CONCLUSIONS: Local injection of low-molecular-weight heparin or recombinant hirudin can significantly ameliorate venous congestion of skin flap in rabbit ear, and improve its survival rate.

[Experimental study of percutaneous vertebroplasty with a novel bone void filling container system].

OBJECTIVE: To investigate vertebral augmentation with a novel reticulate bone filling container system by polymethyl methacrylate (PMMA) injection in cadaveric simulated vertebral compressive fracture and explore the effect of reticulate bone filling container on cement distribution controlling within vertebral body and the restoration of biomechanical properties after augmentation. METHODS: A total of 28 freshly frozen human vertebrae specimens were randomly divided into 4 groups. After the measurements of bone mineral density (BMD) and vertebral height, each vertebra received an axle load by a MTS (material testing system) machine to test the initial strength and stiffness. Subsequently a simultaneous compressive fracture model was created to measure the stiffness and height of fractured vertebrae. Then the augmentation procedure was performed. Afterward the biomechanical properties and the vertebral height were similarly measured as pre-operatively. The expansion of bone filling container and the distribution of cement within vertebral body were morphologically observed by crossing the specimens in sagittal midline and also integrated with the radiographic results. RESULTS: Stiffness was significantly restored comparing with that of fractured level (P < 0.05). And the bipedicular groups had better restoration results than the unipedicular groups. The strength and height of specimens significantly increased after the augmentation procedure but without difference among groups. In axial radiographic view, the distribution of cement in vertebral body was oval or long oval-shaped in double-layer bone filling container groups while it was irregular in single-layer groups. After crossing, the double-layer version expanded well in vertebral body and could enwrap most of injected cement. There was only a little leakage near the vessel layer. But the single-layer version had a poor expansion and a large amount of cement leakage. CONCLUSION: This novel reticulate bone void filling container system with different layers may restore both the biomechanical properties and the height of fractured vertebrae. But, with the benefit of reducing cement leakage, a double-layer design can enwrap most of injected PMMA and has a brighter prospect of clinical application.

[Effectiveness of 23-valent penumococcal polysaccharide and split-virus influenza vaccines to prevent respiratory diseases for elderly people].

OBJECTIVE: To assess the effectiveness of 23-valent penumococcal polysaccharide vaccine (PenV23) and Split-Virus influenza vaccine (InfV-B) for preventing upper respiratory diseases in the aging population. METHODS: 151 people aged > or =60 years who inoculated the PenV23 and InfV-B vaccines at clinics during 2005 as trial group, and 188 people aged > or =65 years didn't administered as control guoup from some comminity. On base line survey, both guoups were followed up two years after vaccination about incidence, hospitalization rate, treatment and direct medical cost. RESULTS: The vaccine of PenV23 and InfV-B vaccination in upper respiratory tract infection was 60% [(odds ratio OR) = 0.35, 95% CI (0.153-0.794)] and the difference between the 2 groups was significant (P = 0.009). The people had recevied both vaccines, the mean duration of hospitalization in vaccinated vs unvaccinated control peple was 20.00 days: 24.19 days (t = 5.82, P < 0.001). Benefit-cost ratio was 4.03, and the net benefit was Yen 177994.86. CONCLUSION: Incidence of influenza-like illness for the elderly people in the community decreased by administered PenV23 ahd InfV-B vaccine. This vaccines had high cost-benefits.

Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct.

The development of iliac screws has provided a markedly easier way for spino-pelvic instrumentation than the classical Galveston technique. However, high rates of iliac screw loosening and breakage are usually reported, especially in cases where bilateral single iliac screws are used. Therefore, there is a need for exploring more stable iliac fixation techniques. Thus, the objective of this study was to compare the biomechanical effects of bilateral single and dual iliac screws on the stability of L3-iliac fixation construct under total sacrectomy condition. In this study, L2-pelvic specimens were harvested from seven fresh human cadavers. After biomechanically testing the intact state simulated by L3-L5 pedicle screw fixation, destabilization was introduced by total sacrectomy. Upon destabilization, L3-iliac screw-rod reconstructions were performed by four different techniques as follows: (1) bilateral single short iliac screws (Single-Short); (2) bilateral single long iliac screws (Single-Long); (3) bilateral dual short iliac screws, placed in the upper and lower iliac columns (Dual-UL); and (4) bilateral dual short iliac screws, all placed in the lower iliac column (Dual-Lower). These four iliac screw fixation techniques were sequentially preformed in the same specimen, and the lengths of the short and long iliac screws were 70 and 130 mm, respectively. Biomechanical testing was performed on a material testing machine under 800 N compression and 7 Nm torsion loading modes to evaluate the construct stiffness. In compression, the stiffness of the L3-iliac fixation constructs of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 73, 76, 98, and 108% of the intact state, respectively. No significant differences were detected between Single-Short and Single-Long (P = 0.589) techniques. However, the compressive stiffness of these two techniques was significantly lower than the intact state, and the Dual-UL and Dual-Lower techniques (P < 0.05). There was no statistical difference between the intact condition and the Dual-Lower technique (P = 0.109). Interestingly, Dual-Lower exhibited notably higher compressive stiffness than Dual-UL (+10.3%, P = 0.049). In torsion, the stiffness of Single-Short, Single-Long, Dual-UL, and Dual-Lower techniques were 72, 79, 105, and 109% of the intact condition, respectively. No significant differences were detected between Single-Short and Single-Long techniques (P = 0.338), and also among Dual-UL, Dual-lower techniques, and the intact state (P > 0.05). However, Single-Short and Single-Long techniques provided markedly lower construct torsional stiffness than the other three groups (P < 0.05). For lumbo-illiac reconstruction after total sacrectomy, even the use of bilateral single, long iliac screws do not help in restoring the local stability to the intact condition. However, dual iliac screws provide much higher construct stability than single iliac screw techniques. Therefore, dual iliac screw technique should be preferred for treating the unstable situation caused by total sacrectomy.

[Evaluation of the efficacy of phenobarbital in treatment of epilepsy in rural areas: study of 2455 patients in rural China].

OBJECTIVE: To evaluate the efficacy of phenobarbital in treatment of patients with convulsive forms of epilepsy in rural areas and to develop a suitable relevant model for rural China. METHODS: A demonstration protocol was conducted in the rural areas of 8 counties from 6 provinces and municipality in China, Heilongjiang, Ningxia, Henan, Jiangsu, Shanxi, and Shanghai from December 2001 to June 2004. Epidemiological investigation of the prevalence and treatment gap of epilepsy was carried out. Patients with convulsive forms of epilepsy thus screened underwent treatment of phenobarbital. Physicians of township hospitals received short-term training to be in charge of the treatment and regular follow-up of the patients. RESULTS: A total of 2455 patients with generalized tonic-clonic seizures in these 6 rural areas were screened and entered the treatment group. 347 patients (26.2%) had been seizure-free during the period of these 2 years, 415 patients (31.3%) had their seizure frequencies decreased by > 75% as compared with those during the period of 6 months before treatment, and the conditions of 26.1% of the patients did not change or even became worse. About 26.1% of the patients had mild side effects, 3.7% had moderate side effects, and only 0.3% had severe side effects when the dosage of phenobarbital in the first 3 months was increased. 597 patients (24.3%) withdrew from the treatment group because of various reasons. CONCLUSION: This protocol was suitable to the rural areas of China. The trained physicians are capable of fulfilling the task to treat the patients with epilepsy. Phenobarbital is an effective drug for most patients with convulsive seizures and has no severe side effect.