[Efficacy evaluation of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in treating lumbar disc herniation with lumbar instability].

OBJECTIVE: To evaluate the clinical effects of modified lamina osteotomy replantation versus traditional lamina osteotomy replantation in the treatment of lumbar disc herniation with lumbar instability. METHODS: The clinical data of 146 patients with unilateral lumbar disc herniation with lumbar instability underwent surgical treatment from March 2008 to March 2013 were retrospectively analyzed. Patients were divided into two groups according to osteotomy replantation pattern. There were 77 patients in the traditional group (underwent traditional lamina osteotomy replantation), including 42 males and 35 females with an average age of (49.4±18.5) years;the lesions occurred on L4,5 in 46 cases, on L55S1 in 31 cases. There were 69 patients in modified group (underwent modified lamina osteotomy replantation), including 37 males and 32 females with an average age of (49.8±17.9) years;the lesions occurred on L4,5 in 40 cases, on L5S1 in 29 cases. The operation time, intraoperative blood loss, complication rate during operation, lamina healing rate, recurrence rate of low back and leg pain were compared between two groups. Visual analogue scales (VAS) and Japanese Orthopadic Association (JOA) scores were used to evaluate the clinical effects. RESULTS: The operation time and intraoperative blood loss were similar between two group (P>0.05). There was significantly different in nerve injury rate(5.80% vs 16.9%) and dural injury rate(1.45% vs 9.09%) between modified group and traditional group(P<0.05). The recurrent rate of low back pain of modified group was higher (91.30%, 63/69) than that of traditional group (76.62%, 59/77), and the intervertebral fusion rate of modified group was lower(8.70%, 6/69) than that of traditional group (29.9%, 23/77) at 3 years after operation. Postoperative VAS scores of all patients were significantly decreased at 6 months, 1, 2, 3 years, and JOA scores were obviously increased (P<0.05). At 1, 2, 3 years after operation, VAS scores of modified group were significantly lower than that of traditional group(P<0.05), and JOA scores of modified group were higher than that of traditional group(P<0.05). CONCLUSIONS: Modified lamina osteotomy replantation has better long-term efficacy(in the aspect of recurrent rate of low back pain, intervertebral fusion rate, VAS and JOA score at three years follow-up) in treating lumbar disc herniation with instability.

[Analysis of clinical effects in the treatment of single-segment lumbar degenerative disease by lamina osteotomy and former vertebral plates regraft].

OBJECTIVE: To compare the clinical effect between the lamina osteotomy and former vertebral plates regraft method and total laminectomy and interbody fusion method in treating single-segment lumbar degenerative disease. METHODS: The clinical data of 167 patients with single-segment lumbar degenerative disease underwent surgical treatment from January 2010 to December 2014 were retrospectively analyzed. There were 92 males and 75 females, aged from 45 to 75 years old with an average of (59.6±12.4) years. The patients were divided into lamina osteotomy and former vertebral plates regraft group(82 cases) and total laminectomy and interbody fusion group(85 cases) according to the different surgical methods used. The general conditions and clinical effects were compared between two groups. General conditions included the operation time, intraoperative blood loss, postoperative drainage, hospitalization time and the clinical effects included the visual analogue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Dability Index(ODI), MacNab results, epidural fibrosis (EF), the incidence of adjacent segment degeneration (ASD). RESULTS: All the patients were followed for 18 to 36 months with an average of (24.8±5.7) months, furthermore, there was no significant difference in the follow-up time between two groups. There was no significant difference in general conditions such as operation time, intraoperative blood loss, postoperative drainage, or hospitalization time between two groups. At final follow-up, the VAS, ODI, JOA, of all patients were significantly improved (P<0.05);and the three factors above in the lamina osteotomy and former vertebral plates regraft group respectively were(2.0±1.1) points, (24.0±1.8) %, (19.8±8.2) point, while the results of total laminectomy and interbody fusion group were(2.5±1.6) points, (23.3±2.0)%, and(22.5±8.5) point;there was statistical difference between two groups(P<0.05). According to the standard of MacNab, 59 cases obtained excellent results, 20 good, 3 fair results in the lamina osteotomy and former vertebral plates regraft group;while 47 cases got excellent results, 26 good, and 12 fair results in the total laminectomy and interbody fusion group;there was significant difference between two groups(P<0.05). Sixteen patients(19.51%) with EF and 20 patients(24.39%) with ASD were found in lamina osteotomy and former vertebral plates regraft group;and 30 patients(35.29%) with EF and 37 patients(43.53%) with ASD were found in total laminectomy and interbody fusion group; there was significant difference between two groups(P<0.05). CONCLUSIONS: Both two methods can achieve the ideal effects for the treatment of single-segment lumbar degenerative disease, but the lamina osteotomy and former vertebral plates regraft method can reserve the integrity of posterior ligamentous complex, reducing the incidence of EF and ASD, and is a better surgical method.

Alterations of serum osteocalcin levels in patients with Legg-Calvé-Perthes.

BACKGROUND: Legg-Calvé-Perthes disease (LCPD) is a paediatric form of osteonecrosis that ultimately heals but will cause femoral head and acetabular deformities. The purpose of this study was to investigate the early serum measurement of osteocalcin in children with femoral head necrosis compared with that of healthy children. METHODS: 20 patients with LCPD (4 girls and 16 boys) and 20 healthy volunteers (5 girls and 15 boys) were enrolled. All patients did not have additional treatment. Blood samples were obtained from all patients preoperatively in the morning. All cases had hip radiographs. The serum levels of osteocalcin comparisons between the LCPD patients and the healthy volunteers were performed using Wilcoxon signed-rank test. The Spearman rank correlation was used to assess correlation between LCPD grade and serum osteocalcin levels. Significance was set at p = 0.05. RESULTS: The 20 patients with LCPD (72.75 ± 24.92 ng/ml) had significantly higher serum osteocalcin levels compared with the healthy group (16.80 ± 4.04 ng/ml) (p<0.01). Serum osteocalcin levels of different LCPD grades were significantly different (Spearman's p = 0.540, p = 0.014). CONCLUSIONS: We observed a significant correlation between serum osteocalcin levels and LCPD. These results may be meaningful in clinical practice and to future studies.

Inflammation in low back pain may be detected from the peripheral blood: suggestions for biomarker.

Biomarker for prediction of development of low back pain, and disease progression in chronic conditions are virtually non-existent. In the present study, we examined evidence of inflammation in the peripheral blood and demonstrated significant changes in neuroinflammation markers in subjects with chronic low back pain in comparison with control subjects. The present study was performed using peripheral blood from subjects with chronic low back pain and age-matched control subjects. Western blotting, real-time RT-PCR, cell culture and in vitro assays were incorporated to perform the current study. We obtained evidence that the balance between proinflammatory and anti-inflammatory cytokines is misaligned, with decrease in interleukin-10 (IL-10) expression and increase in interleukin-6 (IL-6) expression. Furthermore, we demonstrated increase in CD16 monocyte expression. Cells were cultured under differential conditions to generate M1/M2 macrophages. In the macrophages, opioid secretory capacity was shown to be diminished. Finally, Dragon (repulsive guidance molecule b, RGMb) expression was shown diminished in M1 macrophages, which serves as a key transcriptional inhibitor of IL-6 expression. These biochemical and cellular alterations in chronic low back pain can serve as potential biomarkers for assessing disease initiation, intensity and progression.

[Correlation between type 2 diabetes and DNA methylation and mRNA expression of APN in abdominal adipose tissues in Xinjiang Uygur population].

To investigate the relationship between type 2 diabetes mellitus (T2DM) onset and development and mRNA expression and promoter methylation of adiponectin (APN) gene in abdominal adipose tissues of Xinjiang Uygur population, abdominal adipose tissues of omentum were collected and divided into control, obesity and T2DM groups. The status of APN promoter methylation was detected by denaturing high performance liquid chromatography (DHPLC), while the mRNA expression level of APN was detected by RT-PCR. Results show that methylation positive rate of APN was at the lowest level in control, middel in obesity and highest in T2DM groups, and the differences are statistically significant. Comparing the APN mRNA relative copy number of adipose tissue in each group, we found that the relative copy number of APN in control group is significantly higher than that of obesity and T2DM groups. There is a negative correlation between the mRNA expression level of APN in abdominal adipose tissue and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and triglyceride (TG) level. There is a negative correlation in DNA promoter methylation and mRNA expression of APN gene. Relative copy number of APN in DNA methylation positive group is significantly lower than that of the negative group. In conclusion, increased APN promoter methylation results in decreased mRNA expression, which induces glucose and lipid metabolic disorder, thus contributing to the initiation and development of T2DM in Xinjiang Uygur population.

[Open reduction and mini-plate internal fixation for the treatment of fracture and dislocation of coccyx].

OBJECTIVE: To explore the therapeutic methods of fracture and dislocation of coccyx and evaluate its curative effects. METHODS: From May 2002 to March 2010,56 patients with fracture and dislocation of coccyx were divided into surgical treatment group and non-surgical treatment group. There were 7 males and 20 females in surgical treatment group with an average age of (48.1 +/- 0.6) years (ranged, 29 to 62 years), treated with open reduction and mini-plate internal fixation. There were 8 males and 21 females in non-surgical treatment group with an average age of (47.5 +/- 0.9) years (ranged, 19 to 54 years),treated with manipulative reduction. All patients were underwent X-ray examination and were finally diagnosed before treatment. Clinical symptoms and Visual Analogue Scales (VAS) of all patients were statistically analyzed before and after treatment. RESULTS: There was no significant difference between two groups in gender, age, BMI index and VAS evaluation. All patients were followed up from 12 to 25 months with an average of 17.2 months. In surgical treatment group,there were 26 cases with I/a incision and 1 case with II/a incision; the excellent rate of clinical symptom was respectively 92.6% and 100% at leaving hospital and final follow-up; the improvement rate of VAS was 97.6% and was excellent result;internal fixtures were removed at the 1 to 2 years after treatment and no unwell symptoms occurred; VAS of all patients in the group was 0 point. In non-surgical treatment group,the excellent rate of clinical symptom was respectively 72.4% and 82.8% at leaving hospital and final follow-up; the improvement rate of VAS was 72.1% and was good result. There was significant difference in clinical results between two groups (P<0.05). CONCLUSION: The results indicated that fracture and dislocation of coccyx should be treated in time. For the treatment of patients with manipulative reduction failures, instability reduction by X-ray examination and serious rectal irritation, open reduction and mini-plate internal fixation can obtain satisfactory results.

Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation.

BACKGROUND: The traditional lamina osteotomy replantation method is prone to nerve root injury and low back pain recurrence. Our team has proposed a modified approach that improves the osteotomy site and its fixation procedure. The aim of this study was to evaluate the clinical efficacy of traditional and modified lamina replantation methods in treating unstable lumbar disc herniation. METHODS: From March 2008 to August 2011, 124 patients with unstable lumbar disc herniation were enrolled and randomly divided into the following two groups according to random digital table: group A (traditional group) consisting of 61 patients who underwent traditional laminectomy replantation, and group B (modified group) consisting of 63 patients who underwent modified lamina replantation. Both surgeries were performed by the same surgeons. The two groups had no significant difference in gender, age, symptoms, time of onset and the prominent segment. Visual analogue scale (VAS), Oswertry disability index (ODI), and Japanese Orthopaedic Association (JOA) scores, operative time, blood loss, complication rate, radiographic healing rates, and low back pain recurrence rates were compared between the two groups. RESULTS: There were 121 patients followed up for more than one year, and the follow-up rate was 97.6%. Nerve injury occurred in two patients (3.3%) in the modified group and 12 patients (20.0%) in the traditional group. Dural injury occurred in one patient (1.6%) in the modified group and seven patients (11.7%) in the traditional group. Pseudarthrosis occurred in two patients in the modified group and in 18 patients in the traditional group with 1-year fusion rates of 96.7% and 70.0%, respectively. Recurrence of lower back pain after one year was noted in three patients (4.9%) in the modified group, and in 15 (25.0%) in the traditional group. Leg pain recurrence was noted in one patient (1.6%) in the modified group and in three cases (5.0%) in the traditional group. The one-year healing rates of nerve injury, dural injury, replantation lamina and low back pain recurrence rates after one year were significantly different (P < 0.05) between the two groups. At two weeks, three months, six months and one year postoperatively, both groups had significant improvement in VAS, ODI, and JOA scores from their preoperative values (P < 0.05). No significant difference was detected between the short term postoperative scores between groups A and B (P > 0.05). However, a significant difference was found one year later (P < 0.05). CONCLUSIONS: Compared to the traditional approach, the modified technique for lamina replantation showed lower rates of dural and nerve damage, a higher lamina healing rate, a lower back pain recurrence rate, and better clinical scores. It is a safe and effective operation for lumbar spine surgery.

[Treatment of unstable lumbar intervertebral disc herniation by modified lamina osteotomy replantation].

OBJECTIVE: To evaluate the clinical effects of the modified lamina replantation for the treatment of unstable lumbar intervertebral disc herniation. METHODS: From March 2009 to August 2011,63 patients with unstable lumbar intervertebral disc herniation were treated by discectomy, interbody fusion, pedicle screw fixation, and modified lamina replantation. There were 33 males and 30 females with an average age of 48.4 years old ranging from 22 to 68 years old. The average duration of disease was 38.8 months ranging from 3 months to 13 years. All patients had lower back and leg pains. X-ray,CT and MR results showed unstable lumbar intervertebral disc herniation. Preoperative and postoperative ODI, JOA scores, complication incident rates,radiographic healing rates,and lower back and leg pain recurrence rates were observed and recorded. RESULTS: Sixty-two incisions were healed at first stage, 1 at second stage. There were no complications such as deep vein thrombosis, intervertebral infection and so on. Sixty-one patients were followed up for more than one year, and the mean duration was 33 months. Nerve and dural injury occurred in 2 patients and 1 patient respectively. One-year fusion happened in 58 patients while the recurrence of lower back pain and leg pain after 1 year were noted in 4 patients and 1 patient respectively. ODI, and JOA scores were respectively re-assessed at 2 weeks, 6 months and 1 year after the operation, and the results showed a significant difference from the preoperative scores (P < 0.05). CONCLUSION: Modified lamina replantation for unstable lumbar intervertebral disc herniation showed lower rates of dural and nerve damage, as well as a higher lamina healing rate, lower back and leg pain recovery rate, and a better clinical score. It is a safe and efficient operation choice for lumbar spine surgery.

[Clinical natural development in human meniscus injury].

OBJECTIVE: To investigate the changes of clinic and wound edge of the meniscus without treatment in order to provide a theoretical basis for clinical treatment. METHODS: From January 2001 to December 2011,68 patients with knee injury without diagnosis and treatment were selected in the study. According to clinical symptoms (pain,interlocking,instability, etc.) and knee MRI,32 patients were diagnosed as meniscus injury and underwent the arthroscopy. Total meniscectomy was performed in 32 cases on account of impossible repair of the meniscus. There were 21 males and 11 females,ranging in age from 15 to 49 years old with an average age of 25 years old,with an average time from diagnosis to arthroscopy for 46 weeks. Observation indexes included 1Preoperative and postoperative Lysholm scores of knee. 2Position,type and status of injury by arthroscopy. 3Observation of histology. With the procedure as follow: tissue samples were taken from different positions of the edge of the meniscus wound,and were divided into two parts. One part of sample was fixed with formalin, sliced with paraffin imbedding,and observed under an electron microscope after HE staining,and the other part of the sample was fixed with glutaraldehyde of 3%,sliced with ethoxyline imbedding ,and observed under an electron microscope after Lead Citrate staining. RESULTS: Thirty-two patients were followed up more than one year. There was significant differences in Lysholm scores bewteen preoperative and postoperative 3 months (t=15.6,P<0.01). Arthroscopy showed typical differences in 28 cases between the middle and the two ends of the wound edge and atypical differences in 4 cases. Light microscope showed typical manifestations in 26 cases, a few epithelioid cells could been seen fat the middle of the wound edge as well as cells tissue healing (such as fibroblasts) at the junction of each end,and atypical manifestations in 2 cases. Electron microscope showed typical manifestation in 25 cases and atypical manifestations in 3 cases. Typical manifestations in electron microscope showed the atrophic state tions in 25 cases and atypical manifestations in 3 cases. Typical manifestations electron microscope showed the atrophic state of nuclei and kytoplasm of cell (isogenous cells and epithelioid cells) at the middle of the wound edge; at the either junction of the wound edge, the fibroblasts exhibited an enlarged volume with many protuberances; the nuclei also increased in size, and the cytoplasm contained major rough endoplasmic reticulum, free ribosomes and Golgi complex; chondrocytes were round or oval with a large,round nucleus ; a large amount of rough endoplasmic reticulum and many free ribosomes could be observed in the cytoplasm;cartilage lacunae were observed surrounding chondrocytes. CONCLUSION: Weight loading activities with meniscus injury without treatment or before healing will increase the length of the wound and aggravate clinical symptoms. These findings indicate that early diagnosis and treatment combined with timely and effective immobilization is a key to the healing of meniscus injury and avoiding further surgery. The recent clinical effect of total meniscectomy is satisfacory in treating impossible repair meniscus.

[Case-control study of the risk factors of lumbar intervertebral disc herniation in 5 northern provinces of China].

OBJECTIVE: To explore the risk factors of lumbar intervertebral disc herniation in the 5 northern provinces of China. METHODS: A total of 2010 patients with established diagnosis of lumbar disc herniation by CT and/or MRI and 2170 control subjects without a history of low back pain or sciatica were randomly selected from the community population and hospitalized patients. The family history of lumbar disc herniation, occupations, smoking status, and occupational psychosocial factors were investigated. RESULTS: The positivity of family history of lumbar disc herniation was the highest risk factor (OR=3.551) followed by lumbar load (OR=2.132) and hard work (OR=1.763). Physical exercises (OR=0.435) were significantly related with the disease, and the OR of the type of bed was 0.364. CONCLUSION: A family history of lumbar disc herniation, lumbar load and hard work are the major risk factors for lumbar disc herniation, and physical exercises and sleeping not in soft bed might be a protective factor against the disease.

The promoter of a rice glycine-rich protein gene, Osgrp-2, confers vascular-specific expression in transgenic plants.

The genomic sequence of a rice (Oryza sativa L.) glycine-rich protein (GRP) gene, designated Osgrp-2, has been previously determined (GenBank U40708). Primer extension analysis indicated that transcription starts 47 bp upstream of the translation start codon. To gain an insight into the transcriptional regulation of this gene, the 2,401-bp promoter sequence and a series of its 5' deletions were transcriptionally fused to the beta-glucuronidase (GUS) gene. GUS activity was subsequently assayed in a transient expression system of tobacco ( Nicotiana tabacum L.) protoplasts, which revealed the presence of a positive regulatory region (-2290 to -1406) and two negative regulatory regions (-2401 to -2291 and -1405 to -1022) in the Osgrp-2 promoter for the promoter activity. The positive regulatory region displayed an enhancer-like activity when fused to the cauliflower mosaic virus (CaMV) 35S minimal promoter (-89 to +6) to drive GUS expression and assayed on tobacco leaves by the Agrobacterium-mediated transient expression technique (agroinfiltration). Histochemical staining for GUS activity on transgenic tobacco plants has further indicated a preferential expression in vascular tissues of stems and leaves conferred by the positive regulatory region. A 1,023-bp fragment of the Osgrp-2 promoter (-1021 to +2) fused with GUS was transformed into tobacco and proved to be capable of conferring vascular-specific expression. Further 5' and 3' deletion analysis of the 1,023-bp promoter revealed that a 99-bp fragment located from -497 to -399 contained cis-elements responsible for vascular-specific expression.

[Agroinfiltration, a useful technique in plant molecular biology research].

Agroinfiltration is a newly developed plant transient gene expression technique, which is simple, rapid and reproducible. It has been widely used in analyses of foreign gene expression, hypersensitive reaction, gene silencing, promoter activity and identification of new disease-resistance genes. In this paper, we describe the principle and the operation procedure of Agroinfiltration and its application in diverse aspects of plant molecular biology research. Our experiences in modification of the Agroinfiltration technique are also provided.