Volume 97  ·  Issue 33  ·  2017

Spinal surgery is an exquisite art. Perfect spinal surgery requires doctors' rich experience and fine hand movements. However, long-term surgery may lead to doctors' operational mistakes. In recent years, medical robots have been applied in the surgical field. Through motion adjustment and tremor filtering functions, robots have perfected the dexterity of doctors' hands. Their high accuracy and almost infinite endurance have been praised by the industry. At present, the application of robot-assisted surgery in spinal surgery includes robot-assisted pedicle screw placement, anterior lumbar intervertebral fusion, thoracolumbar tumor resection, transstomatodontic resection and paravertebral tumor resection, etc. However, the early application effect is not satisfactory. With the development of robot technology, the number of cases using robots in clinical practice gradually increases, and good clinical results have been obtained. But because of its high price and other factors, it has not been widely used at present.

To investigate the correlated factors of height gain (ΔSH) after posterior spinal correction surgery in Lenke 1 adolescent idiopathic scoliosis (AIS), and to propose the predictive model of ΔSH.

From 2013 to 2015, a total of 150 Lenke 1 AIS patients undergoing posterior spinal correction surgery were included in the study, with the age of (14.3±2.9) years. The Cobb angle of major curve, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured on both pre-op and post-op standing whole spine x-rays. The change in Cobb angle, TK and LL were calculated. The difference between pre-operation and post-operation was compared and the linear regression analysis was used for the predictive model of ΔSH.

The pre-op and post-op values were (41.6±3.0)cm and (43.9±2.7)cm for spinal height (SH)[ΔSH=(2.4±0.8)cm,P=0.000]; (50.5±10.4)° and (14.6±6.4)° for Cobb angle (P=0.000). The Pearson correlation analysis showed that ΔSH was significantly correlated with pre-op SH ( P=0.000), pre-op Cobb angle (P=0.000), pre-op TK (P=0.000), post-op SH (P=0.020), post-op Cobb angle (P=0.000), change in Cobb angle (P=0.000) and change in TK (P=0.000). The linear regression model 1 revealed that ΔSH was linearly correlated with change in Cobb angle ( P=0.000) as well as change in TK (P=0.000); the linear regression model 2 showed that the pre-op Cobb angle (P=0.000) and pre-op TK (P=0.020) could be used for the pre-op prediction of ΔSH.

The positively correlated factors of ΔSH include pre-op and post-op Cobb angle, TK, change in Cobb angle and change in TK. High pre-op Cobb angle and TK indicates high height gain in Lenke 1 AIS patients.

To evaluate the efficacy and safety of Vesselplasty in the treatment of osteoporotic vertebral fractures and vertebral metastases.

From June 2010 to December 2016, data of 81 patients with spinal diseases treated with Vesselplasty in Department of Spinal Surgery, Beijing Friendship hospital, Capital Medical University were retrospectively analyzed. There are 49 cases of vertebral fractures with age (70.2±8.2) years. Among them, 16 cases have posterior vertebral wall breakage, but no symptoms of nerve injury. Clinical result were evaluated with Visual Analogue Scale(VAS) , the kyphotic angle(Cobb′s angle) and Oswestry disability index(ODI) was measured preoperatively, postoperatively and follow-up. At the same time, the operation time and cement leakage were recorded. There were 32 patients with vertebral metastases, with age of (69.6±11.1) years old. The posterior wall of the vertebral body was damaged in 22 cases. The VAS scores were recorded and compared preoperatively and postoperatively. The operation time was recorded also.

All patients were completed the operation safely and with no complications. Compared with preoperative VAS, postoperative VAS was significantly decreased in all subjects(P<0.05). The average operation time of each vertebral body was 16.2±4.6 min, and the postoperative VAS score significantly decreased (P<0.05), Cobb ′s angle from preoperative (13.9±6.0) ° to( 5.2±4.0) ° (P<0.05) in 49 cases of vertebral fracture(58 vertebrae). The clinical results were still satisfied in follow-up . In 32 cases of vertebral metastases(38 vertebrae), the average operation time was (17.6±5.4) min. The postoperative VAS score was obviously decreased also(P<0.05). A small amount of bone cement leakage occurred in 4 cases of 4 vertebrae. The rate of bone cement leakage was 4.2%, but there were no clinical symptoms in these cases.

Vesselplasty is a safe and effective treatment of osteoporotic vertebral fractures and vertebral metastases. It can lead to satisfactory clinical effect, partial recovery of vertebral height. Besides, the bone filling mesh can reduce the risk of bone cement leakage, which can provide a new choice for minimally invasive treatment of vertebral fracture and metastases.

To evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures.

From January 2008 to January 2015 , 161 patients with thoracolumbar fractures in Department of Orthopedics, Luohe City Central Hospital, were divided into two groups: 79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015. 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, if the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, the position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups.

In the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset.31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation(χ²=0.268 vs χ ²=1.372, P>0.05). The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle[(40.3±11.8)° vs(82.1±4.2)°, (-10.3±2.6)° vs(6.9±3.3)°,P<0.05], but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group.

Patients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.

To analyse the factors of elder patients with lumbar vertebrae fractures caused by low-energy injury in plateau area.

From March 2013 to September 2016, 124 elder patients with lumbar vertebrae fractures caused by low-energy injury in our hospital were selected as observation group, in the corresponding period, 98 elderly patients who had no fractures were considered as control group .The bone mineral density (BMD) was examined by whole body bone mineral density tester, and univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of lumbar fractures caused by low-energy injury.

BMD and T value of lateral projection of lumbar vertebrae in observation group were significantly lower than those in control group (P<0.05). Single factor analysis showed that the age, body mass index, past history, bone mineral density and calcium supplementation had a significant effect on lumbar fractures caused by low-energy injury. Logistic regression analysis showed that age (OR=1.215), bone mineral density (OR=3.215) and calcium supplementation (OR=4.904) were independent risk factors for lumbar fractures caused by low-energy injury (P<0.05).

Bone mineral density of elderly population in plateau area is lower. Age, bone mineral density and calcium supplementation are independent risk factors of lumbar fractures caused by low-energy injury, and individual medical intervention is needed.

To investigate the gene expression profiles of long non-coding RNAs (lncRNA)in human degenerated intervertebral disc degeneration (IDD).

An lncRNA-mRNA microarray analysis of human nucleus pulposus (NP) was employed. Bioinformatics prediction was also applied to delineate the functional roles of the differentially expressed lncRNAs. Several lncRNAs and mRNAs were chosen for quantitative real-time PCR (qRT-PCR) validation.

A total of 1 570 lncRNAs expressed in degenerate group compared with the nondegenerate group. Of these, the expression level of 428 lncRNAs was upregulated >2-fold compared with nondegenerate group while that of 584 was downregulated. Bioinformatics analysis (GO and pathway analyses) revealed that some classical pathways participating in extracellular matrix (ECM) and cell apoptosis were aberrantly expressed in the intervertebral disc ( P<0.05). Enhancer-like lncRNAs and their nearby coding genes were analyzed. Three lncRNAs were identified as potential enhancers. Several lncRNAs were validated in the intervertebral disc using RT-qPCR.

The lncRNAs express differentially in the intervertebral disc. LncRNAs may therefore be novel candidate biomarkers and potential targets for intervertebral disc degeneration therapy in the future.

To investigate the safety of carotid endarterectomy (CEA) without shunting in carotid artery stenosis (CAS) patients with contralateral carotid occlusion (CAO) under the protection of monitoring of cerebral blood oxygen saturation.

A total of 71 patients with CAS was enrolled in our research during 2013 to 2016. They were divided into two groups which were group A: 20 CAS patients with contralateral CAO, and group B: 51 CAS patients without contralateral CAO. All patients were given CEA without shunting during operation.One and 6 months following up was carried to observe the incidence of newly hemorrhage and infarction on operation side and adverse cardiac events.

There was none adverse cardiac event and newly infarction. But there was 1 (5.00%) newly hemorrhage in group A during the 1 month following up. None adverse event was found in group B. During the 3 months following up, none adverse event was found in group A and 3 (5.88%) newly infarction patients were found in group B. However, there was no significant difference between group A and group B.

CEA without shunting in CAS patients with contralateral carotid occlusion under the protection of monitoring of cerebral blood oxygen saturation is an efficient and safe way to improve the patients, living quality.

To observe the efficacy and safety of the novel oral anticoagulant Rivaroxaban for anticoagulation therapy in patients with nonvalvular atrial fibrillation (AF) during cryoablation.

A total of 137 AF patients from October 2013 to December 2016 underwent cryoablation were divided into two groups according to the application of anticoagulant drugs: Rivaroxaban group (65 cases) and Heparin group (72 cases). Rivaroxaban group: oral administration of Rivaroxaban 20 mg, once a day, was started 3 days before the cryoablation, no anticoagulant was additionally added during cryoablation, the activated clotting time (ACT) was measured, and oral administration of Rivaroxaban was continued for 3 months after cryoablation. Heparin group: oral administration of Rivaroxaban 20 mg, once a day, was stopped 24 hours before the cryoablation, heparin (100 U/kg) anticoagulation was given during cryoablation, ACT was controlled between 250 and 300 seconds, and oral administration of Rivaroxaban was continued for 3 months after cryoablation. The ACT results, the incidence of bleeding and thromboembolic events between the two groups were compared.

The ACT result between the two groups were with statistically significance[(110±16) vs (323±61) seconds, P=0.000)]. The bleeding events for Rivaroxaban group were two cases of local hematoma of the femoral vein puncture site, with the incidence rate of 3.1%(2/65); Heparin group were two cases of local hematoma of the femoral vein puncture site, and one case of epistaxis, with the incidence rate of 4.2%(3/72), with no statistical significance(P=0.549) between the two groups. No thromboembolic event occurred in the Rivaroxaban group, one cerebellar thromboembolic event occurred in the Heparin group during anticoagulant bridging phase after cryoablation.

Rivaroxaban is safe and effective for anticoagulation therapy in patients with atrial fibrillation cryoablation.

To evaluate the efficacy of tracheobronchial segmental resection and reconstruction applied to surgical treatment in the patients with esophageal cancer with airway invasion.

From January 2004 to April 2014, 13 patients in our center underwent radical esophagectomy combined with tracheobronchial segmental resection and reconstruction. Patient characteristics, operative procedures, postoperative complications and long-term survival were retrospectively reviewed.

All patients received complete resection (R0) with an average length of resected airway 2.77±0.73 cm. In addition, carinal resection plus lobar resection (including carinal pneumonectomy) was accomplished in 2 patients; 1 patient underwent aortic replacement. Complications were noted in 5 patients (39%) and 2 patients (15.38%) died within 30 days after operation. 4 patients (30.76%) suffered from airway anastomosis stenosis and all 3 of them died within 2 years after operation due to refusing bronchoscopy interventions. The overall 1-, 2-, and 5-year survival rates were 72.7%, 45.5%, and 24.2%, respectively, with a median survival time of 2 years (0.5-10 years).

Tracheobronchial segmental resection and reconstruction can provide an opportunity of complete resection and a survival benefit for patients with esophageal cancer invading airway with acceptable morbidity and mortality. Postoperative airway anastomosis stenosis needs active treatment.

The purpose of the present study was to evaluate the diagnostic performance of preoperative ultrasonography(US), magnetic resonance imaging(MRI) and US combined with MRI in the prediction of extrathyroidal extension(ETE) in patients with papillary thyroid carcinoma(PTC).

Between January 2013 and December 2016, a total of 83 consecutive patients underwent surgery for pathologically confirmed PTCs with ETE. We analyzed all patients with PTC with ETE who received preoperative combination of US and MRI scan to evaluate ETE.

For minimal ETE, the accuracy was 92.2%(47/51) of US, 74.5%(38/51) of MRI, and their combination was 98.0%(50/51). The differences of the three methods for minimal ETE were statistically significantly different(P=0.000). For extensive ETE, the accuracy was 62.5%(20/32) of US, 87.5%(28/32) of MRI, and their combination was 93.8%(30/32). The different of the three methods for extensive ETE was statistically significantly different(P=0.000). For the total accuracy of ETE, US was 80.7%(67/83), MRI was 79.5% (66/83), and their combination was 96.4%(80/83). The difference of the three methods for ETE was statistically significantly different(P=0.001).

The combination of US and MRI can improve the preoperative diagnostic accuracy of ETE for PTC.

To explore the magnetic resonance imaging (MRI) features of the anatomy and injuries of flexor tendon and pulley system of the fingers.

Clinical and imaging data of 20 healthy volunteers without injuries and 36 patients from Beijing Jishuitan Hospital with flexor tendon and pulley system injuries in the fingers between March 2013 and March 2016 were retrospectively analyzed. All subjects underwent magnetic resonance imaging (MRI) examination. The MRI findings of patients were compared with healthy volunteers. In addition, imaging findings of patients were compared with the surgical results and confirmed by double-blinded method.

Twenty volunteers without flexor tendon and pulley system injures showed homogeneous hypointensity on both T1-weighted and Proton Density-weighted images with fat saturation (PD-FS). There were 36 patients with finger injures, including 21 cases of flexor tendon injury, 10 cases of pulley system injury, 5 cases of compound injury, which demonstrated unclear signal, discontinuity on T1-weighted images and heterogeneously increased signal intensity of the involved structures on PD-FS images. Edema was detected in the soft tissues surrounding the injured sites.

MRI is an accurate method for evaluation of the anatomy and pathologic conditions of flexor tendon and pulley system of the fingers and a useful tool for diagnosis and treatment of flexor tendon and pulley system injuries.

To investigate the impact of autoimmune thyroiditis (AIT) on pregnancy outcomes in patients with polycystic ovary syndrome (PCOS) following the in vitro fertilization and embryo transfer (IVF-ET) by analyzing their pregnancy outcomes.

The patients undergoing IVF-ET treatment diagnosed with PCOS in Peking University Third Hospital from May 2010 to December 2014 were investigated. According to the anti-thyroid antibodies (TPOAb or TGAb), patients were divided into AIT group and non-AIT group. The pregnancy outcomes of two groups were analysed for investigate the effect of AIT on pregnancy outcomes.

Four hundred and ninety patients with PCOS were enrolled, 119 (24.3%) of AIT group and 371 (75.7%) of non-AIT group. Patients with PCOS had a higher incidence (24.3%) of AIT. There was no correlation between AIT and the different pregnancy outcomes.TSH was negatively correlated with pregnancy as a risk factor. Hyperandrogenemia was negatively correlated with clinical pregnancy as a risk factor. Hyperprolactinemia was negatively correlated with delivery as a risk factor, while TSH was positively correlated with delivery.

The incidence of AIT was higher in patients with PCOS. AIT was not the risk factor of adverse pregnancy outcomes for PCOS women undergoing IVF. The metabolic disorders (including hyperinsulinemia, hyperandrogenemia and hyperprolactinemia) were the risk factors of adverse pregnancy outcomes. Patients in AIT group had the high TSH level. They should be received more care and monitoring to make it conducive to delivery.

To study the potential of differentiation of menstrual blood-derived mesenchymal stem cells (MenSC) into endometrial epithelial cells (EEC) in vitro.

Endometrial stromal cells (ESC) and MenSC were cultured and identified by certain methods.MenSC were co-cultured with ESC, added 10 ng/ml TGF-β1, 10 ng/ml EGF, 10 ng/ml PDGF-BB and 1×10^-7 mol/L 17-β-estradiol.The expression of cytokeratin, which was marker of EEC, was tested by immunofluorescence in differentiated MenSC.

MenSC proliferated quickly in vitro, and showed fusiform shape and clear structure within 10 generations.The expression rate of superficial markers of MenSC, CD44, CD90, CD73, and CD29, were 98.4%, 90.77%, 94.75% and 97.01% respectively.The expression of vimentin, which was stromal marker, was positive in cultured ESC (P3). After co-cultured with ESC for 3 weeks, MenSC morphology changed from fibroblast-like cells into epithelial-like cells.Immunofluorescence assay showed that the differentiated MenSC expressed cytokeratin.

Under the condition of co-culture with ESC, MenSC has the ability to differentiate into endometrial epithelial cells. Cell growth factor and estrogen play the important roles in this process.

To explore the incidence of carotid atherosclerosis in staffs of Tsinghua university according to the different age groups, the possible risk factors and conduct a follow-up survey.

Detailed information about physical examination and carotid ultrasound from 832 staffs of Tsinghua University between 2014 to 2016 were reviewed to observe the occurrence and development of atherosclerosis according to different age groups; the correlation between conventional risk factors and carotid arteriosclerosis was studied by multivariate Logistic regression analysis.The process of different degrees of arteriosclerosis in the population was observed one year later.

In the past three years, there were 2 024 cases of carotid examination. Among them, there were 832 staffs who had been followed up for more than 6 months. There were 517 cases of carotid atherosclerosis, with 289 males (55.9%) and 228 females (44.1%), and the incidence of atherosclerosis in male was higher than that in female (P<0.05). The 50 to 59 years old, 60 to 69 years old, 70 to79 years old were the age group with high incidence of pure carotid intima-media thickening, atherosclerosis plaque formation and stenosis or occlusion, respectively. After multivariate Logistic regression analysis, hypertension, diabetes and hyperlipidemia were found the independent risk factors for carotid intimal thickening. The follow-up of 832 staffs with ultrasound showed that there was no significant difference in intima-media thickening, plaque formation, stenosis or occlusion after one year (P>0.05).

This research suggests that the incidence of atherosclerosis in male is higher than that in female, and hypertension, diabetes and hyperlipidemia are important influencing factors of arteriosclerosis for staffs of Tsinghua University. Early screening, identification of high-risk patients and comprehensive treatment should be done to delay the process of atherosclerosis.In addition, long-term follow-up is necessary in the context of no significant changes within the short-term.

A 44-year-old male was admitted to our department on April 20, 2015 due to "fever with fatigue for more than 1 month". The white blood cell count at the initial diagnosis was 49.48×10⁹/L, hemoglobin determination 68 g/L, platelet count 27×10⁹/L, bone marrow morphology, immunotyping, karyotype analysis and other examinations were performed to confirm the diagnosis of acute myeloid leukemia-M4. Physical examination: spleen flat umbilicus, liver 2 fingers under the costs. Hydroxyurea was given first to reduce tumor burden after admission. After chemotherapy with decitabine + homoharringtonine + cytarabine from May 4, 2015, the patient's spleen retracted and white blood cells decreased. On May 21, 2015, on the 12th day after stopping chemotherapy, the patient suddenly suffered from excessive sweating, nausea, and lethargy, and the spleen progressively enlarged from the two fingers under the costs to the flat umbilicus under the costs. Carbon dioxide binding capacity suddenly decreased to 12.0 mmol/L, blood glucose 4.67 mmol/L, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, total bilirubin, and direct bilirubin were all in the normal range. Blood gas analysis showed pH 7.232, lactic acid 18 mmol/L, partial pressure of carbon dioxide 16.6 mmHg (1 mmHg =0.133 kPa) and partial pressure of oxygen 134 mmHg. Consider decompensated metabolic acidosis combined with respiratory alkalosis. The efficacy of 10% glucose instillation and sodium bicarbonate acid correction was not good. May 28, 2015 Bone marrow morphology showed that monocytes occupied 58.5% of nuclear cells, of which 17% were progenital monocytes. On 29 May 2015, the patient was given chemotherapy with decitabine + mitoxantrone + cytarabine regimen. Blood gas analysis showed persistent lactic acidosis. During chemotherapy, white blood cell count, serum lactate level and lactate dehydrogenase quantification all decreased simultaneously, and the condition improved once. The leukocytes doubled and lactic acidosis reappeared during the intermediate period of chemotherapy. He was given decitabine + daunorubicin + cytarabine chemotherapy, and the condition recurred after another brief remission. On July 6, 2015, he was given emergency chemotherapy with decitabine + homoharringtonine + cytarabine regimen. The symptoms persisted and the lactate level continued to increase. At the same time, he was complicated by anal fissure and lung infection, and gradually appeared chest tightness, holding his breath, deep breathing, and entering a state of sleepiness. Died July 25, 2015. We examined the peripheral blood electron microscopy samples of patients with lactic acidosis again, which indicated that the tumor cells were hyperautophagic, and a large number of mitochondria were encapsulated and destroyed by autophagosomes (Figure 1)。

In recent years, it has been found that intestinal flora is closely related to the brain-gut axis, and flora dysbalance is related to a variety of diseases, including irritable bowel syndrome (IBS) and depression, thus giving rise to the concept of "microbiota-gut-brain axis"^[1]。 microglia is a kind of mononuclear macrophage, which is widely distributed in the central nervous system. Previous studies have found that it interacts with various components of the flora-intestine-brain axis. Taking IBS and depression as examples, this paper will introduce the research progress of the interaction between microglia and the flora-intestine-brain axis.

Autophagy is the process by which damaged, denatured, or senescent proteins and various organelles within a cell are transported into lysosomes for digestion and degradation. Under normal conditions, autophagy maintains a dynamic balance between cell self-renewal and apoptosis, but when this balance is disrupted, insufficient or excessive autophagy may lead to the occurrence and development of disease^[1]。 According to different substrates, autophagy can be divided into three types: general autophagy, selective autophagy and mitochondrial autophagy. Autophagy can be divided into macroautophagy, micro-autophagy and chaperone-mediated autophagy according to the different pathways of cellular material transport into lysosomes, among which macroautophagy is the most important and typical form^[2]。 A large number of studies have shown that autophagy plays a particularly important role in the maintenance of central function and intracellular homeostasis of heart diseases. In many kinds of heart diseases, autophagy is accompanied by changes of cardiomyocyte autophagy, and it affects the occurrence and development of diseases. In different pathological models, autophagy plays different roles by influencing different signaling pathways. The purpose of this paper is to review the influence of autophagy on the occurrence and development of various structural heart diseases according to the current research progress at home and abroad.

exosomes (exosomes), as a kind of tiny vesicles with diameters between 30 and 100 nm actively secreted by cells, have become a research focus in recent years. As a carrier of intercellular communication, it plays an important role in regulating the occurrence of central nervous system (CNS) infection, inflammatory response and damage repair.