Volume 86  ·   Issue 43  ·  2006

In recent 10 years, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have attracted widespread attention at home and abroad. Because of their small surgical trauma, high safety and good pain relief effect, they have gradually become one of the important methods for treating painful vertebral diseases such as osteoporotic compression fracture, vertebral metastasis and myeloma of thoracolumbar vertebra [1].

Minimally invasive orthopedics is not an independent new discipline or a new branch discipline, but a surgical technique that has smaller surgical incision, better internal environment stability, lighter systemic or local reaction, faster bone tissue healing, shorter functional recovery time and better psychological effect than traditional standard orthopedics surgery. Surgery is the main way of surgical treatment, and all kinds of surgical methods and techniques are condensed with the efforts of surgeons. From the perspective of human wish and the development law of science and technology, surgeons should finally give up all kinds of treatment methods that cause trauma to patients, and reasonably apply minimally invasive techniques to achieve the best curative effect with the least trauma. To develop minimally invasive orthopedics techniques, patients should be maintained to achieve the least tissue damage, the least psychosomatic pain, the fastest functional recovery, the least treatment complications and the cheapest economic expenses. At the same time, we should get social praise, praise medical professional ethics, establish a good social atmosphere, establish a good doctor-patient relationship, and obtain good social benefits [1].

Objective to observe the effects of different ventilation methods on lung and endotoxin receptor CD14 in rats.Methods Adult male SD rats were randomly divided into 4 groups (12 rats in each group): spontaneous breathing group (R group), without mechanical ventilation; In the mechanical ventilation group (group M), tidal volume (Vt) =12 ml/kg, positive end-expiratory pressure (PEEP) =8 mm Hg; In the protective mechanical ventilation group (group P), Vt =6 ml/kg, PEEP =0 mm Hg; In the high tidal volume mechanical ventilation group (group N), Vt =40 ml/kg, PEEP =0 mm Hg. Six rats in each group were injected with 50 mg/kg Evans blue (EB) 2 h after the start of the experiment. Arterial blood gas analysis was performed before mechanical ventilation (basal value) and 1, 2 and 3 h after mechanical ventilation, respectively. At the end of the experiment 3 h, the rats were sacrificed by bleeding. Lung pathomorphological scores, wet/dry weight ratio (W/D) of lung tissue, inflammatory cell count in bronchial lavage fluid (BALF) and vascular wall permeability were measured. Plasma tumor necrosis factor α (TNF-α) and macrophage inflammatory protein 2 (MIP-2) concentrations were measured by enzyme-linked immunoassay (ELISA). The expression of endotoxin receptor CD14 in lung tissue was measured by RT-PCR, and the expression of CD14 in BALF monocytes was measured by immunohistochemistry. Results Lung pathomorphological scores: No change in group R and group P, but slightly increased in group M, and significantly higher in group N than in group M (6.0±1.6, 0.7±0.8, t =8, P =0.000, respectively). Lung W/D: compared with group R Group N was higher than Group R (5.73±0.39, 4.91±0.24, t =4.38, P =0.000, respectively). EB: Compared with Group R, there was no significant difference between Group P and Group M; The WBC in BALF was significantly higher in group N than in group R (84.50±3.01, 32.33±1.75, t =36.63, P =0.000, respectively). TNF-α was not detected in the four groups. MIP-2: The difference between group P (35.4±5.3) and group R (31.5±2.4) was not statistically significant. The difference between group M (44.7±6.9) and group R was significantly higher (t =4.382, P =0.04), and group N (167.7±11.8) was significantly higher (t =27.779, P =0.000). The expression of CD14 protein in monocytes and CD14 gene in lung tissue in BALF was basically the same in group R and group P. The expression of M histone was not statistically significant, but the gene expression was increased; The expression of CD14 protein was significantly increased in group N (P =0.000). Conclusion Conventional mechanical ventilation induced mild lung injury in rats, and the expression of CD14 gene in lung was up-regulated, but the expression of CD14 protein in lung was unchanged; High tidal volume mechanical ventilation caused lung injury in rats, which significantly upregulated the expression of CD14 in the lungs. Protective mechanical ventilation could avoid the above changes in rats' lungs.

Objective to analyze the regulatory effect of benzopyrene (B (a) P) on the catalytic subunit (GCLC) gene of γ-glutamylcysteine synthase (γ-GCS). Methods Supershift was used to confirm that the stimulation of benzopyrene (B (a) P) can induce the binding of ARNT or its complex to E-box element in the upstream regulatory sequence of rat GCLC. Under different concentrations of benzopyrene stimulation, the functional changes of the 5 '-end full-length regulatory sequence of rat GCLC and the 5'-end full-length regulatory sequence with deletion of E-box site were compared by firefly luciferase reporter system in vitro, and the regulatory effect of benzopyrene was preliminarily confirmed. Results B (a) P stimulation can make ARNT or its complex bind to E-box element. The luciferase activity of CCL-149 cells showed little change by different concentrations of B (a) P at different time points (P>0.05). Conclusion B (a) P stimulation can make ARNT bind to E-box on γ-GCS gene, but this binding seems to have a significant effect on γ-GCS gene

Objective to isolate and culture neural stem cells from the hippocampus and epithalamus of embryonic rats, and compare their proliferation ability in vitro.Methods Neural stem cells were obtained from the hippocampus and epithalamus of embryonic rats by mechanical separation and serum-free subculture.The cell growth was dynamically observed and their growth curves were measured in vitro.The cell clones of two sources were identified by immunofluorescence method, and the morphological characteristics of the neural stem cell clones were observed by laser confocal microscope.The surface morphological characteristics of the neural stem cell clones were observed by scanning electron microscope.The neural stem cells were co-incubated with Brdu to observe the proliferation in vitro.Results The growth of hippocampus-derived embryonic neural stem cells was basically the same as that of upper colliculus-derived stem cells, but the proliferation rate of the former was relatively slow.The ultrastructure of the stem cell clones of two sources was similar. Under phase contrast microscope and laser confocal microscope, the morphology of the neural stem cells of two sources was similar. The positive rate of neural stem cells derived from superior colliculus was higher than that of hippocampal stem cells. From the cell growth curves, it can be seen that the proliferation trend of the two stem cells showed the same, but the growth curves were not the same. From the 8th day of culture, the viable cell count of embryonic neural cells derived from superior colliculus was higher than that of hippocampal stem cells. Conclusion Embryonic neural stem cells derived from hippocampus and superior colliculus can be obtained by mechanical separation and serum-free culture. The two stem cells have similar morphological structure, but the proliferation rate of neural stem cells derived from superior colliculus is higher than that of hippocampal stem cells.

Objective to observe the phenomenon of delayed neuronal death in patients with cerebral hemorrhage (ICH), and to understand the apoptosis and related regulatory mechanisms of neurons around hematoma after cerebral hemorrhage. Methods the apoptosis rate of neurons around hematoma in 29 patients with hypertensive cerebral hemorrhage and the brain tissue samples obtained within 3 h of 6 patients with abnormal death were detected by deoxyribonucleotide terminal transferase-mediated nick end labeling (TUNEL) and the expression levels of Bcl-2, Bax, P53 and caspase-3 were detected by immunohistochemistry. Results the apoptosis rates in the cerebral hemorrhage group and the control group were 4.10 ± 0.28 and 0.57 ± 0.43, Bcl-2 were 2.68 ± 0.52 and 1.54 ± 0.56, Bax were 3.49 ± 0.18 and 0.96 ± 0.27, P53 were 4.12 ± 0.63 and 0.96 ± 0.71, and caspase-3 were 3.50 ± 0.25 and 0.74 ± 0.73, respectively. The former was significantly higher than the latter, and the differences were statistically significant (all P<0.01). The expression of Bax, caspase-3 and Bax/Bcl-2 were positively correlated with the apoptosis rate. Conclusion the apoptosis mechanism was involved in the secondary injury of cerebral hemorrhage and was the main cause of delayed neuronal death. Some genes were involved in the regulation of neuronal apoptosis. Bax, caspase-3 promoted apoptosis, while Bcl-2 and P53 inhibited apoptosis.

Objective to summarize the clinicopathological characteristics of familial adenomatous polyposis (FAP) and to explore the reasonable diagnosis and treatment schemes.Methods the clinicopathological data of 51 patients with FAP hospitalized in Cancer Hospital of China Union Medical University from September 1980 to December 2005 were retrospectively analyzed and summarized, including 29 males and 22 females, aged between 17 and 67 years, with an average age of 36.6 years. Results Among the 51 patients in this group, 29 had family history and 7 had suspicious family history. The main clinical manifestations were blood in stool, diarrhea, abdominal pain or discomfort. There were 23 cases without cancer, with an average age of 31.9 years, of which rectal and sigmoid colon cancer accounted for 81.8%. Except for 1 case who could not be resected due to fixed rectal cancer and underwent radiotherapy, the other 50 cases underwent different forms of colorectal resection. There was no surgical death in the whole group, and the complication rate was 8%. Thirty-eight patients were followed up, with a follow-up rate of 74.5% (38/51), and the follow-up time was 6 months to 25 years. 21 cases (41.2%) had no reexamination after the first operation, and 14 cases (27.5%) had regular reexamination. Residual colorectal cancer was found in 8 cases after operation. At present, 17 cases in the whole group died. Conclusion FAP lacks specific clinical manifestations and is prone to cancer. Colonoscopy should be performed for suspicious cases, and treatment should be done as soon as possible after diagnosis. Surgery is the most important treatment method. The surgical method should be individualized according to the specific condition, and strict monitoring and follow-up should be done after operation.

Objective to evaluate the clinical efficacy and adverse reactions of imatinib mesylate in preoperative adjuvant therapy and postoperative recurrent and/or metastatic gastrointestinal stromal tumor (GIST). Methods 51 cases of GIST were confirmed by histopathology, of which 47 cases were positive for CD117 and 4 cases were negative for CD117. 4 cases were treated with preoperative adjuvant chemotherapy, and 47 cases were treated with 300~800 mg/d of imatinib mesylate. Results Among 51 patients, 1 case was lost to follow-up, and 50 cases were able to evaluate the objective efficacy. 3 cases (6.0%) had complete remission (CR), 34 cases (68.0%) had partial remission (PR), 5 cases (10.0%) had stable disease (SD), 8 cases (16.0%) had progressive disease (PD), the benefit rate (CR + PR + SD) was 84%, and the median progression-free survival (TTP) of the beneficiaries was 16 months. Adverse reactions could be evaluated in 50 cases, including 36 cases (72.0%) with mild edema, 23 cases (46%) with Ⅰ ~ Ⅱ leukopenia, 14 cases (28%) with Ⅰ ~ Ⅱ asthenia, 7 cases (14.0%) with mild abdominal pain, 9 cases (18.0%) with Ⅰ ~ Ⅱ nausea and vomiting, 9 cases (18.0%) with mild rash, and 2 cases (4.0%) with tumor hemorrhage.

Objective to investigate the relationship between pepsinogen C (PGC) gene insertion-deletion polymorphism and susceptibility to gastric cancer and its precancerous diseases from the perspective of gastric carcinogenesis and development, and to investigate the influence of the interaction between PGC gene polymorphism and H. pylori infection on the occurrence and development of gastric carcinoma. Methods The genotypes of PGC gene were detected by polymerase chain reaction (PCR) and agarose electrophoresis in 141 patients with gastric cancer and 564 patients without gastric cancer. To compare the relationship between different genotypes and gastric cancer and gastric precancerous diseases.Serum H. pylori-IgG titers were detected by enzyme-linked immunosorbent assay (ELISA), and the interaction between PGC-H. pylori infection was analyzed by effector modification model.Results Compared with non-homozygous carriers of PGC allele 1, the risk of atrophic gastritis increased to 3.103 times (95% CI, 1.440-6.686), the risk of gastric cancer increased to 2.962 times (95% CI, 1.370-6.404), and the risk of intestinal metaplasia increased to 1.659 times (95% CI, 0.998-2.757). The risk of atrophic gastritis and gastric cancer was significantly increased in homozygous carriers of PGC allele 1 and H. pylori-IgG positive (P =0.023 and P =0.005). Conclusion PGC gene polymorphism is related to the genetic susceptibility of atrophic gastritis and gastric cancer

Objective to investigate the inhibitory effect of CⅡ allosteric peptide sub268-270, which continuously replaces T cell receptor (TCR) binding amino acids of type Ⅱ collagen (CⅡ) 268-270, on the injury of articular cartilage in collagen arthritis (CIA). Methods CIA was induced by bovine CⅡ in Lewis rats. CIA rats were divided into 30 μ g group, 5 μ g group, 1 μ g group and blank control group. Eight rats in each group received 30 μ g, 5 μ g, 1 μ g of CⅡ allosteric peptide sub268-270 and phosphate buffer intravenously twice a week. The effects of allosteric peptide were evaluated from joint inflammation score, pathological synovial inflammation score, pannus score, articular cartilage injury score and bone destruction score, and the inhibitory effects of allosteric peptide on articular cartilage injury were evaluated by serum cartilage oligomeric matrix protein (COMP) level and cartilage saffron content in joint tissue sections. Results the joint inflammation score of 30 μ g CⅡ allosteric peptide group was 5.6 ± 2.63, which was significantly lower than that of 5 μ g group (9.67 ± 5.61), 1 μ g group (10.02 ± 5.06) and blank control group (11.8 ± 5.34) (P<0.01). Compared with 5 μ g allosteric peptide, 1 μ g allosteric peptide and PBS, 30 μ g allosteric peptide could significantly reduce synovitis score (P<0.01) and pannus score (P<0.01) in CIA rats The content of cartilage proteoglycan (A value) in joint tissue sections was 2.35 ± 0.76 in 30 μ g group, 1.57 ± 0.63 in 5 μ g group, 1.37 ± 0.53 in 1 μ g group and 1.00 ± 0.41 in blank control group. The ratio of 30 μ g group to blank control group was P<0.01. Conclusion 30 μ g CⅡ allosteric peptide sub268-270 can effectively alleviate CIA and significantly inhibit the destruction of articular cartilage in CIA.

Objective to investigate the correlation between the changes of chemokines and receptors and the clinical characteristics of systemic lupus erythematosus (SLE). Methods the serum levels of macrophage inflammatory protein (MIP) -1 α, macrophage inflammatory protein (MIP) -1 β, activated normal T cell expression and secretion factor (RANTES) in 37 patients with initial SLE and 20 normal controls were detected by ELISA. The expressions of chemokine receptors CCR1, CCR3 and CCR5 on CD4+ T cells in peripheral blood of 18 patients with initial SLE and 10 normal controls were detected by flow cytometry, and the correlation between their changes and different clinical characteristics was analyzed. Results the serum concentrations of MIP-1 α in patients with SLE and fever were (52 ± 27) ng/L and (28 ± 19) ng/L in patients with normal body temperature (P<0.01). The serum concentration of MIP-1 β was (221±158) ng/L in patients with SLE with arthritis and (95±83) ng/L in patients without arthritis, the difference was statistically significant (P<0.01). The serum concentration of RANTES was (130±122) ng/L in patients with thrombocytopenia and (212±114) ng/L in patients with normal platelets, the difference was statistically significant (P<0.05). The percentage of CD4+ CCR3+ cell subsets in peripheral blood CD4+ T cells of patients with anti-RNP antibody positive SLE was (14.8±3.0) %, and that of patients with anti-RNP antibody negative was (11.3±2.6) %, the difference was statistically significant (P<0.05). Conclusion The abnormal expression of different chemokines and receptors may be related to different clinical features of systemic lupus erythematosus system.

Since the severe acute respiratory syndrome (SARS) incident in 2003, public health emergencies have become a topic of great concern in our society. SARS, Sudan red additive incident, Anhui meningococcal panic, Sichuan Streptococcus suis infection and avian influenza have come one after another, which has prompted our government to attach great importance to public health emergencies. However, the prevention and treatment of public health emergencies in China is still in a preliminary stage, and it is not very clear how to construct a scientific public health emergency response system that conforms to our national conditions. The evaluation tool of public health emergency response ability plays a vital role in guiding the construction of public health emergency response system in a country and a region.

Objective to investigate the efficacy and complications of percutaneous anterior screw internal fixation in the treatment of odontoid fractures. Methods the clinical data of 28 patients undergoing percutaneous odontoid screw internal fixation were reviewed. Among them, 21 males and 7 females, 12 Anderson type Ⅱ, 16 Anderson type Ⅲ, and 10 superficial type Ⅲ were reviewed. All patients were fixed with one screw. The clinical efficacy and complications were analyzed by summarizing the results of radiology and clinical follow-up. Results After 26~62 months follow-up, 25 of 28 patients obtained bone healing, 2 cases did not heal, and 1 case was changed to posterior fusion. The healing rate of Anderson type Ⅲ fracture was 93.8%, Anderson type Ⅱ fracture healing rate was 83.3%, and the total healing rate was 89.3%. Most of the patients returned to normal cervical vertebral mobility. The complications included 1 case of temporary superior laryngeal nerve paralysis, 5 cases of nail tail indwelling on the upper edge of cervical vertebra, 1 case of screw penetrating the tip of odontoid process, 1 case of thread not completely passing through the fracture end, Conclusion Percutaneous odontoid screw internal fixation is a new minimally invasive surgical procedure. Its cure rate is similar to open anterior surgery, but there are fewer complications, and it has the advantages of simple operation, less intraoperative bleeding, light destruction of surrounding tissue and quick postoperative recovery.

Objective to evaluate the clinical efficacy of thoracoscope-assisted small incision technique for anterior reconstruction of thoracic tuberculosis. Methods 60 cases of thoracic tuberculosis were retrospectively analyzed by thoracoscope-assisted small incision technique. Among them, 38 males and 22 females, aged 19-68 years, with an average of 47.4 years. The lesions involved T4-T12 vertebrae. 50 cases had obvious paravertebral abscess, 17 cases complicated with pleurisy, and 42 cases had compression of dural sac. The average kyphosis angle of pseudo-fusion segment before operation was 29.2° (18° ~42°). Preoperative nervous system function Frankel grade: A grade in 1 case; B Grade 4 cases; Grade C 6; Grade D 19 cases; The average operation time was 230min (180~320), the average bleeding volume was 570 (350~1200) ml, and the average drainage time was 3.6 d (3~5d). The excellent and good rate of clinical efficacy was 91.7%. The average kyphosis angle of the fusion segment was 18.5° (16° ~33°), and the correction rate was 36.6%. The incidence of postoperative complications was 30% in 18 cases. After 2~6 years postoperatively, the average follow-up was 3.4 years, there was no loosening and fracture of internal fixation, no significant loss of correction degree, and all of them obtained good bone grafting fusion. The neurological function of 30 cases was improved by grade 1~3 after the last follow-up. Conclusion Thoracoscopic assisted small incision technique provides a simple, safe, effective and practical minimally invasive spinal surgery for anterior reconstruction of thoracic tuberculosis.

Objective to investigate the minimally invasive degree of local and systemic trauma in patients with lumbar intervertebral disc herniation treated by posterior microendoscopic nucleus pulposus excision. Methods The operative time, intraoperative blood loss and postoperative hospital stay of 22 patients undergoing microendoscopic nucleus pulposus excision (minimally invasive group) and open interlaminar fenestration nucleus pulposus excision (open group) were recorded respectively. The changes of serum interleukin-6 (IL-6), C-reactive protein (CRP) and creatine kinase (CK) activity levels were compared between the two groups before operation and 24 and 48 h after operation. The postoperative incision pain was evaluated by visual analogy score, and the severity of symptoms and short-term clinical efficacy were evaluated by Chinese Oswestry dysfunction index scale before operation and 6 months after operation, respectively. Results Compared with the open group, the minimally invasive group showed shorter operation time, less intraoperative bleeding, less postoperative incision pain and shorter postoperative hospital stay, but the short-term efficacy was similar between the two groups CK was (167.9±51.9) ~ (401.6±108.9) U/L (P<0.01), which was significantly higher than that before surgery and reached the highest value. The concentration of CRP in the open group was significantly higher than that in the minimally invasive group at 24 hours after surgery, while the concentration of CRP in the open group reached the highest (10.8±5.3) ~ (30.0±14.9) mg/L at 48 hours after surgery (P<0.01), and the concentration of CRP in the minimally invasive group was significantly lower than that in the open group at 24 and 48 hours after surgery. Conclusion Compared with open surgery, the short-term curative effect of posterior microendoscopic nucleus pulposus excision is similar, but the local muscle tissue injury is mild, and the degree of traumatic reaction of whole body surgery is significantly lower than that of open surgery, which is minimally invasive.

Objective to retrospectively analyze the clinical efficacy and safety of kyphoplasty in the treatment of non-osteoporotic thoracolumbar compression fractures. Methods Seventeen patients with non-osteoporotic thoracolumbar compression fractures were treated with percutaneous kyphoplasty, including 14 males and 3 females, aged 19-51 years, with an average age of 35.2 years. The causes of injury were: fall from height in 10 cases, traffic accident in 4 cases and building crush in 3 cases. All patients in this group were single vertebral compression fractures, and the fracture segments were: T9 in 1 case, T11 in 2 cases, T12 in 7 cases, L1 in 5 cases, L2 in 1 case and L3 in 1 case. All patients in this group complained of severe pain in the lower back, without sensory motor abnormalities of lower limbs, and the diagnosis was confirmed by X-ray plain film and CT. All patients underwent percutaneous kyphoplasty with Kyphon-X balloon dilator under local anesthesia, The changes of VAS pain score, Oswestry function score, vertebral body height and kyphosis angle of injured vertebrae were compared before and after operation and at follow-up. Results All patients completed the operation successfully, except for 2 cases with strong paravertebral cement leakage, there were no serious complications. The average operation time was 55 (40~65) min. All patients were followed up for more than half a year, with an average of 13 (6-24) months. The mean VAS pain scores ranged from 8.7 before surgery to 3.2 at 1 week after surgery, 2.7 at 1 month after surgery and 2.1 at the last follow-up (P<0.05). The mean ODI functional scores ranged from 72.3 before surgery to 48.6 at 1 week after surgery, 28.9 at 1 month after surgery and 22.4 at the last follow-up (P<0.05). The mean anterior vertebral edge height (mm) ranged from 14.3 before surgery to 24.7 at 1 week after surgery, 22.9 at 1 month after surgery and 21.4 at the last follow-up (P<0.05). The mean kyphosis angle ranged from 31.1° before surgery to 9.6° at 1 week after surgery, 10.9° at 1 month after surgery and 12.7° at the last follow-up (P<0.05). All patients in this group returned to their original work or normal life within 2 months after surgery. Conclusion Percutaneous kyphoplasty for the treatment of non-osteoporotic thoracolumbar compression fracture has the advantages of less surgical trauma, good pain relief, It has the advantages of good recovery of vertebral body height and quick recovery after operation, with remarkable clinical effect and good safety.

Proliferation-inducing ligand (APRIL) and B lymphocyte stimulating factor (BAFF) belong to the same tumor necrosis factor superfamily and share two receptors. BAFF can promote B cell differentiation, proliferation and survival of immature lymphocytes, and induce or aggravate the disease of systemic lupus erythematosus (SLE) [1, 2]. However, the role of APRIL in SLE is unclear, and the results are even contradictory [3, 4]. In this study, the role and significance of APRIL in SLE disease activity and system damage were investigated by detecting the serum levels of APRIL in SLE patients, and simultaneously detecting autoantibodies related to disease activity such as anti-dsDNA antibody, anti-nucleosome antibody (AnuA) and anti-C1q antibody.

Our hospital started to use Leksell gamma knife (gamma knife) to treat various intracranial diseases since August 1, 1995, and it has been more than 10 years since now. Among them, 394 cases of cerebral arteriovenous malformations (cAVM) were treated by gamma knife before December 31, 2002, and 341 cases of cerebral arteriovenous malformations (cAVM) with complete follow-up data were statistically analyzed to further explore the efficacy and influencing factors of gamma knife in the treatment of cAVM.

contingent negative variation (CNV) is a classical cognitive potential recorded under specific stimulation conditions. In the past, the analysis method of CNV was complicated, such as measuring the integral area under negative waves, etc. In this study, the improved CNV analysis method-early component M1 and late component M2 technique [1] was used to detect CNV in patients with first-episode schizophrenia.