Non-alcoholic fatty liver disease: pathogenesis and models.

Non-alcoholic fatty liver disease (NAFLD) is a complex disease characterized by a massive accumulation of lipids in the liver, with a continuous progression of simple steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma. Non-alcoholic fatty liver disease is associated with obesity, insulin resistance, and metabolic syndrome; it is a severe public health risk and is currently the most common liver disease of the world. In addition to the fatty infiltration of the liver in non-alcoholic fatty liver disease patients, the field of liver transplantation faces similar obstacles. NAFLD and NASH primarily involve lipotoxicity, inflammation, oxidative stress, and insulin resistance. However, the precise mechanisms and treatments remain unclear. Therapeutic approaches encompass exercise, weight control, as well as treatments targeting antioxidants and anti-inflammatory pathways. The role of animal models in research has become crucial as a key tool to explore the molecular mechanisms and potential treatments for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Here, we summarized the current understanding of the pathogenesis of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis and discussed animal models commonly used in recent years.

Comparing the efficacy and complications of unilateral biportal endoscopic fusion versus minimally invasive fusion for lumbar degenerative diseases: a systematic review and mate-analysis.

BACKGROUND: Unilateral biportal endoscopic (UBE) has been gradually applied in clinical practice. UBE has two channels, with good visual field and operating space, and has achieved good results in the treatment of lumbar spine diseases. Some scholars combine UBE with vertebral body fusion to replace traditional open fusion surgery and minimally invasive fusion surgery. The efficacy of biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is still controversial. In this systematic review and meta-analysis, BE-TLIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) are compared in the efficacy and complications of lumbar degenerative diseases. METHODS: PubMed, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) were used to search literatures related to BE-TLIF before January 2023, to identify relevant studies, and systematically review all literatures. Evaluation indicators mainly include operation time, hospital stay, estimated blood loss, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab. RESULTS: A total of 9 studies were included in this study; a total of 637 patients were collected, and 710 vertebral bodies were treated. Nine studies showed that there was no significant difference in VAS score, ODI, fusion rate, and complication rate between BE-TLIF and MI-TLIF at the final follow-up after surgery. CONCLUSION: This study suggests that BE-TLIF is a safe and effective surgical approach. BE-TLIF surgery has similar good efficacy to MI-TLIF in the treatment of lumbar degenerative diseases. And compared with MI-TLIF, it has the advantages of early postoperative relief of low-back pain, shorter hospital stay, and faster functional recovery. However, high-quality prospective studies are needed to validate this conclusion.

Candidate chemosensory receptors in the antennae and maxillae of Spodoptera frugiperda (J. E. Smith) larvae.

Although most of the damage caused by lepidopteran insects to plants is caused by the larval stage, chemosensory systems have been investigated much more frequently for lepidopteran adults than for larvae. The fall armyworm Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) is a polyphagous and worldwide pest. To understand the larval chemosensory system in S. frugiperda, we sequenced and assembled the antennae and maxillae transcriptome of larvae in the sixth instar (larval a-m) using the Illumina platform. A total of 30 putative chemosensory receptor genes were identified, and these receptors included 11 odorant receptors (ORs), 4 gustatory receptors (GRs), and 15 ionotropic receptors/ionotropic glutamate receptors (IRs/iGluRs). Phylogeny tests with the candidate receptors and homologs from other insect species revealed some specific genes, including a fructose receptor, a pheromone receptor, IR co-receptors, CO2 receptors, and the OR co-receptor. Comparison of the expression of annotated genes between S. frugiperda adults and larvae (larval a-m) using RT-qPCR showed that most of the annotated OR and GR genes were predominantly expressed in the adult stage, but that 2 ORs and 1 GR were highly expressed in both the adult antennae and the larval a-m. Although most of the tested IR/iGluR genes were mainly expressed in adult antennae, transcripts of 3 iGluRs were significantly more abundant in the larval a-m than in the adult antennae of both sexes. Comparison of the expression levels of larval a-m expressed chemosensory receptors among the first, fourth, and sixth instars revealed that the expression of some of the genes varied significantly among different larval stages. These results increase our understanding of the chemosensory systems of S. frugiperda larvae and provide a basis for future functional studies aimed at the development of novel strategies to manage this pest.

[Selection of upper instrumented vertebra for long-segment fixation in adult degenerative scoliosis].

Objective: To review the research progress of upper instrumented vertebra (UIV) selection strategy for long-segment fixation (LSF) in adult degenerative scoliosis (ADS). Methods: The relevant domestic and foreign literature in recent years was reviewed, and the selection strategy of sagittal and coronal UIV for LSF in ADS patients, the relationship between UIV selection and proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), the impact of minimally invasive spine surgery on the selection strategy of UIV were summarized. Results: LSF can restore the biomechanical balance of the spine and reconstruct the physiological curve of the spine for ADS patients. LSF should be selected for ADS patients with severe scoliosis, vertebral rotation, and severe sagittal imbalance. For patients with poor general condition, UIV can choose the thoracic and lumbar vertebrae to reduce the operation time and intraoperative bleeding, which is conducive to early mobilization and reduce complications; for patients with good general condition, the upper thoracic vertebrae can be considered if necessary, in order to achieve satisfactory long-term effectiveness. However, the lower thoracic vertebra (T 9、10) should be selected as much as possible to reduce postoperative complications such as PJK and PJF. In recent years, a new reference marker, the first coronal reverse vertebra was proposed, to guide the selection of UIV. But a large-sample multicenter randomized controlled study is needed to further verify its reliability. Studies have shown that different races and different living habits would lead to different parameters of the spine and pelvis, which would affect the selection of UIV. Minimally invasive surgeries have achieved satisfactory results in the treatment of ADS, but the UIV selection strategy in specific applications needs to be further studied. Conclusion: The selection strategy of UIV in LSF has not yet been unified. The selection of UIV in the sagittal plane of the upper thoracic spine, the lower thoracic spine, or the thoracolumbar spine should comprehensively consider the biomechanical balance of the spine and the general condition of the patient, as well as the relationship between the upper horizontal vertebra, the upper neutral vertebra, and the upper end vertebra on the coronal plane.

Application and modification of bone cement in vertebroplasty: A literature review.

Vertebral compression fractures are more common in the elderly, particularly in postmenopausal women. Most of these people are accompanied by osteoporosis, which can easily lead to spinal deformities and fractures. Once a fracture occurs, the patient would have severe pain response, limited spinal movement, and need to stay in bed for a long time, resulting in a significant decrease in their quality of life. Percutaneous vertebroplasty (PVP) is a minimally invasive spinal surgery that injects bone cement into the diseased vertebrae for therapeutic purposes. It can quickly relieve pain and stabilize the spine. It is widely used in the treatment of vertebral compression fractures and is currently an ideal treatment method. There are many materials of bone cement used in clinical treatment, and each material has unique characteristics. Many scholars would modify the bone cement according to the advantages and disadvantages to make it more suitable for clinical use. In this review, we discuss the clinical application and modification of bone cement.

Influence of Three-Dimensional Visual Reconstruction Technology Combined with Virtual Surgical Planning of CTA Images on Precise Resection of Liver Cancer in Hepatobiliary Surgery.

Hepatobiliary malignancies, such as hepatocellular carcinoma (HCC) and biliary tract cancers, namely, gallbladder carcinoma and cholangiocarcinoma, are linked to a high rate of morbidity and mortality, depending on the phase of the disease. The intricate hepatobiliary anatomy and the need for accurate peroperative management, especially in patients with advanced liver disease, make these tumors difficult to treat. Surgical resection is a notable therapy for hepatobiliary cancers. Unnecessary or excessive liver excision influences patient rehabilitation, normal liver function, and postoperative complications. Hepatobiliary operations must therefore include accurate liver removal. The present advancements in imaging technology are aimed at improving the diagnostic efficacy of liver injury even more. Three-dimensional visual reconstruction is becoming more important in the diagnosis as well as treatment of a variety of disorders. In this paper, we proposed a novel three-dimensional visual reconstruction technology using enhanced nonuniform rational basis spline (ENURBS) combined with virtual surgical planning of Computed Tomography Angiography (CTA) images for precise liver cancer resection. The purpose of this project is to rebuild 2D CTA scan images of liver cancer into a 3D reconstructed model for efficient visualization and diagnosis of liver cancer and to prepare an effective preoperative surgical plan for precise liver excision based on a 3D recreated liver model. This method's performance is compared to that of 2D planning in terms of accuracy and time taken to complete the plan. It is concluded that our proposed technique outperforms the planning technique based on 2D images.

Hepatic Ischemia-reperfusion Injury in Mice was Alleviated by Rac1 Inhibition - More Than Just ROS-inhibition.

BACKGROUND AND AIMS: Reducing reactive oxygen species (ROS) production has proven an effective way for alleviating oxidative stress during ischemia-reperfusion injury (IRI). Moreover, inhibition of Rac1 could reduce ROS production and prevent oxidative stress injury. Previous studies have suggested a positive interactivation feedback loop between Rac1 and hypoxia-inducible factor (HIF)-1α, the latter being up-regulated early during ischemia. The positive inter-activation between Rac1 and HIF-1α would aggravate ROS production, thereby promoting IRI. This study was designed to verify the effects of Rac1 inhibition on hepatic IRI both at animal and cellular levels and to explore the interaction between Rac1 and HIF-1α during hepatic IRI. METHODS: C57B/6 mice and AML-12 cells were used for the construction of hepatic IRI animal and cell models. Rac1 inhibition was achieved by NSC23766 (a specific Rac1 inhibitor). Lentiviral vectors were used for Rac1 knockdown. At designated time points, serum and liver tissues were collected from the mice and treated cells were collected for further analysis. RESULTS: NSC23766 treatment significantly alleviated the hepatic IRI in mice, manifesting as lower vacuolation score and less apoptosis cells, lower ROS and serum/liver alanine aminotransferase/aspartate aminotransferase levels, and fewer activated inflammatory cells. IRI of AML-12 was also alleviated by 50 µM NSC23766 or Rac1-knockdown, manifesting as reduced cell apoptosis, less extensive interruption of mitochondrial membrane potential, down-regulation of apoptosis, and effects on DNA damage-related proteins. Interestingly, Rac1 knockdown also down-regulated the expression level of HIF-1α. CONCLUSIONS: Our study supports a protective effect of Rac1 inhibition on hepatic IRI. Aside from the classic topics of reducing ROS production and oxidative stress, our study showed an interaction between Rac1 and HIF-1α signaling during hepatic IRI.

Development of machine learning models for mortality risk prediction after cardiac surgery.

Background: We developed machine learning models that combine preoperative and intraoperative risk factors to predict mortality after cardiac surgery. Methods: Machine learning involving random forest, neural network, support vector machine, and gradient boosting machine was developed and compared with the risk scores of EuroSCORE I and II, Society of Thoracic Surgeons (STS), as well as a logistic regression model. Clinical data were collected from patients undergoing adult cardiac surgery at the First Medical Centre of Chinese PLA General Hospital between December 2008 and December 2017. The primary outcome was post-operative mortality. Model performance was estimated using several metrics, including sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). The visualization algorithm was implemented using Shapley's additive explanations. Results: A total of 5,443 patients were enrolled during the study period. The mean EuroSCORE II score was 3.7%, and the actual in-hospital mortality rate was 2.7%. For predicting operative mortality after cardiac surgery, the AUC scores were 0.87, 0.79, 0.81, and 0.82 for random forest, neural network, support vector machine, and gradient boosting machine, compared with 0.70, 0.73, 0.71, and 0.74 for EuroSCORE I and II, STS, and logistic regression model. Shapley's additive explanations analysis of random forest yielded the top-20 predictors and individual-level explanations for each prediction. Conclusions: Machine learning models based on available clinical data may be superior to clinical scoring tools in predicting postoperative mortality in patients following cardiac surgery. Explanatory models show the potential to provide personalized risk profiles for individuals by accounting for the contribution of influencing factors. Additional prospective multicenter studies are warranted to confirm the clinical benefit of these machine learning-driven models.

Machine learning approach to predict acute kidney injury after liver surgery.

BACKGROUND: Acute kidney injury (AKI) after surgery appears to increase the risk of death in patients with liver cancer. In recent years, machine learning algorithms have been shown to offer higher discriminative efficiency than classical statistical analysis. AIM: To develop prediction models for AKI after liver cancer resection using machine learning techniques. METHODS: We screened a total of 2450 patients who had undergone primary hepatocellular carcinoma resection at Changzheng Hospital, Shanghai City, China, from January 1, 2015 to August 31, 2020. The AKI definition used was consistent with the Kidney Disease: Improving Global Outcomes. We included in our analysis preoperative data such as demographic characteristics, laboratory findings, comorbidities, and medication, as well as perioperative data such as duration of surgery. Computerized algorithms used for model development included logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGboost), and decision tree (DT). Feature importance was also ranked according to its contribution to model development. RESULTS: AKI events occurred in 296 patients (12.1%) within 7 d after surgery. Among the original models based on machine learning techniques, the RF algorithm had optimal discrimination with an area under the curve value of 0.92, compared to 0.87 for XGBoost, 0.90 for DT, 0.90 for SVM, and 0.85 for LR. The RF algorithm also had the highest concordance-index (0.86) and the lowest Brier score (0.076). The variable that contributed the most in the RF algorithm was age, followed by cholesterol, and surgery time. CONCLUSION: Machine learning algorithms are highly effective in discriminating patients at high risk of developing AKI. The successful application of machine learning models may help guide clinical decisions and help improve the long-term prognosis of patients.

microRNA-29a regulates liver tumor-initiating cells expansion via Bcl-2 pathway.

MicroRNAs (miRNAs) participate in tumorigenesis, progression, recurrence and drug resistance of hepatocellular carcinoma (HCC). However, few miRNAs have been identified and entered clinical practice. Herein, we report that miR-29a is downregulated in tumor-initiating cells (T-ICs) and has an important function in liver T-ICs. Functional studies revealed that miR-29a knockdown promotes liver T-ICs self-renewal and tumorigenesis. Conversely, a forced miR-29a expression inhibits liver T-ICs self-renewal and tumorigenesis. Mechanistically, we find that miR-29a downregulates Bcl-2 via binding its mRNA 3'UTR in liver T-ICs. The correlation between miR-29a and Bcl-2 is validated in human HCC tissues. Furthermore, the miR-29a expression determines the responses of hepatoma cells to sorafenib treatment. Analysis of patient-derived xenografts (PDXs) further demonstrated that the miR-29a high patients are more sensitive to sorafenib treatment. In conclusion, our findings revealed the crucial role of the miR-29a in liver T-ICs expansion and sorafenib response, rendering miR-29a as an optimal target for the prevention and intervention of HCC.

Association of total cholesterol with severe acute pancreatitis: A U-shaped relationship.

BACKGROUND & AIMS: There is no consensus on relationship between total cholesterol levels and incidence of severe acute pancreatitis (SAP). The aim of this study was to investigate the relation between total cholesterol (TC) and the disease severity of acute pancreatitis. METHODS: We conducted a cross-sectional study on patients with acute pancreatitis between April 2012 and December 2015 in a university hospital. Fasting blood total cholesterol (TC) was assayed within 24 h of admission, as well as 3-5 days, 7-9 days and 13-15 days during hospitalization. Time interval before admission, age, gender, Body Mass Index, hypertension, diabetes mellitus, alcohol consumption, smoking, etiology and albumin were recorded as potential confounding factors. To assess the pattern of relationship of TC and SAP, we used restricted cubic spline analysis with multivariable logistic regression analysis. We also compared total cholesterol concentrations between patients with or without SAP at different time points. RESULTS: 648 patients (median age: 47.5 years; 62.4% man) were enrolled. The incidence of SAP was 10%. A U-shaped association of TC level within 24 h of admission with severity was observed in acute pancreatitis. Patients with low TC levels (<160 mg/dL) and high TC levels (>240 mg/dL) had a significantly higher incidence of SAP and protracted hospital stays when compared to moderate TC levels (160-240 mg/dL). Low total cholesterol levels (OR 2.72; 95 %eCI 1.27-5.83; P = 0.01) and high total cholesterol levels (OR 2.54; 95 %eCI 1.09-5.89; P = 0.03), were still independently associated with development of SAP after adjusting for potential confounding factors. Longitudinal cohort study indicated that patients with SAP had lower total cholesterol concentrations among 3-15 days after admission compared to patients without SAP (P < 0.001). CONCLUSIONS: Both low TC level (<160 mg/dL) and high TC (>240 mg/dL) within 24 h of admission is independently associated with an increased risk of SAP.

Identification of Key Transcription Factors AP-1 and AP-1-Dependent miRNAs Forming a Co-Regulatory Network Controlling PTEN in Liver Ischemia/Reperfusion Injury.

Liver ischemia/reperfusion (I/R) injury is a complex and common clinical disease with limited therapeutic options. The aim of our study was to discover the candidate target genes in liver I/R injury and to further elucidate the potential regulatory mechanisms, especially the ones involving transcription factors and miRNAs. The analysis of mouse data set GSE10657 from Gene Expression Omnibus database (GEO) revealed 203 differentially expressed genes (DEGs) including 19 transcription factors (TFs). Functional and pathway enrichment analyses were conducted to explore their biological functions. We further obtained the targets of TFs and miRNAs, to form our TF-mRNA/TF-miRNA-mRNA co-regulatory network. In our network, we found that the important subunits of activator protein 1 (AP-1) including JUN, FOS and ATF3, were hub genes in liver I/R injury. AP-1 target genes were activated in our mouse models. AP-1 could transcriptionally activate phosphatase and tensin homolog (PTEN) while AP-1-dependent miRNAs countered this effect. In conclusion, this study suggested that AP-1, together with AP-1-dependent miRNAs formed a co-regulatory network enabling AP-1 target genes to be tightly controlled, which will complete the mechanism of liver ischemia/reperfusion injury and provide direction for finding potential therapeutic targets.

MiR-942-3p Promotes the Proliferation and Invasion of Hepatocellular Carcinoma Cells by Targeting MBL2.

MicroRNAs (miRNAs), a subgroup of small noncoding RNAs, play critical roles in tumor growth and metastasis. Accumulating evidence shows that the dysregulation of miRNAs is associated with the progression of hepatocellular carcinoma (HCC). However, the molecular mechanism by which miR-942-3p contributes to HCC remains undocumented. The association between miR-942-3p expression and the clinicopathological characteristics in HCC patients was analyzed by The Cancer Genome Atlas data set. The targets of miR-942-3p were identified by bioinformatic analysis and dual luciferase report assay. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and Transwell assays were performed to assess the functional role of miR-942-3p in HCC cells. Consequently, we found that miR-942-3p expression level was elevated in HCC tissues and cell lines as compared with the normal tissues and was associated with the pathological stage and tumor node metastasis (TNM) stage, acting as an independent prognostic factor of poor survival in patients with HCC. Ectopic expression of miR-942-3p enhanced the proliferation and invasive potential of HCC cells, but inhibition of miR-942-3p expression had the opposite effects. Mannose-binding lectin 2 (MBL2) was further identified as a direct target of miR-942-3p and possessed a negative correlation with miR-942-3p expression and unfavorable survival in patients with HCC. Restoration of MBL2 inhibited the progression of HCC cells and attenuated the tumor-promoting effects induced by miR-942-3p. In conclusion, miR-942-3p may act as an oncogenic factor in HCC cells by targeting MBL2 and provide a potential marker for patients with HCC.

Two case reports and literature review for hepatic epithelioid angiomyolipoma: Pitfall of misdiagnosis.

BACKGROUND: Hepatic epithelioid angiomyolipoma (HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases. CASE SUMMARY: We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years (median 44 years). Among the patients with clinical symptoms mentioned, 61.93% (205/331) were asymptomatic, 34.74% (115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34% (165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin, melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation. CONCLUSION: HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological ,and immunohistochemical findings.

Alsterpaullone induces apoptosis of HepG2 cells via a p38 mitogen-activated protein kinase signaling pathway.

Alsterpaullone (Alp) is a small-molecule inhibitor that targets cyclin-dependent kinases to inhibit tumor cell activity. However, to the best of our knowledge, the effect of Alp on hepatoblastoma has not been investigated. Therefore, the function of Alp in apoptotic induction of hepatoblastoma cells and a potential mechanism of action were investigated. Results indicated that low doses of Alp (1 µM) significantly induced apoptosis in the HepG2 hepatoblastoma cell line. In vivo experiments of tumor suppression further indicated that Alp (3 mg/kg) exerted an inhibitory effect on HepG2 ×enograft tumor growth. Following Alp treatment, the expression level of B-cell lymphoma 2 (Bcl-2)-associated X protein, and cleaved caspase-3 and -9 in HepG2 cells was significantly increased; however, the expression of Bcl-2 was significantly decreased. In addition, phosphorylation of p38 mitogen-activated protein kinase (MAPK) significantly decreased Alp-induced caspase-3 and -9 activation. These results suggested that Alp induces apoptosis and inhibited proliferation via the p38MAPK signaling pathway. Therefore, Alp may be a therapeutic agent for treating hepatoblastoma.

Lethal and sublethal effects of cyantraniliprole on Helicoverpa assulta (Lepidoptera: Noctuidae).

Cyantraniliprole is a novel anthranilic diamide insecticide registered for the control of many sucking and chewing insect pests including the oriental tobacco budworm, Helicoverpa assulta (Guenée), which is an important lepidopteran pest of tobacco in China. This study determined the lethal and sublethal effects of cyantraniliprole on a treated parental generation and on an untreated offspring generation of H. assulta. Cyantraniliprole was incorporated in the diet of 3rd-instar larvae of the parental generation. Cyantraniliprole was highly toxic to the parental generation: after a 72-h feeding period, the LC50 was 0.176mg/L. Cyantraniliprole tended to increase the developmental time of parental larvae, and the LC30 significantly reduced the pupation rate and the pupal weight. Cyantraniliprole also significantly decreased the intrinsic rate of increase (rm) and finite rate of increase (λ), and increased the doubling time (Dt). Treatment of the parental generation with the LC30 decreased the pupal weight and adult fecundity, and increased adult deformity in the parental and offspring generations. Cyantraniliprole did not significantly affect the pupal period, the percentage of females, or adult longevity in either generation. These results suggest that both the lethal and sublethal effects of cyantraniliprole might suppress H. assulta population growth by reducing the insect's survival, development, and reproduction.

Novel alternative therapy for spinal tuberculosis during surgery: reconstructing with anti-tuberculosis bioactivity implants.

Accompanied with the worsening of the pulmonary tuberculosis bacterium (TB) epidemic, the incidence of spinal TB has increased in recent years. Spinal reconstruction and stabilisation, and bone defect repair play a crucial role in the surgical treatment of spinal TB. Unfortunately, the existing materials have not completely met the requirements for spinal TB reconstruction due to their diverse deficiencies. Therefore, there is an urgent need to develop novel reconstructing implants. Poly-DL-lactide (PDLLA) and nano-hydroxyapatite (nHA) are two promising drug delivery systems (DDS) and materials for bone repair, which could help us to overcome the difficulties in spinal TB reconstruction in the future. In this article, we discuss the properties of PDLLA and nHA, two potential drug delivering and bone repair materials for spinal TB reconstruction. We also presented two alternatives for spinal TB in future. Two strategies have the potential for treating spinal TB in the future. One such strategy consists of mixing anti-TB drugs, PDLLA with nHA to fabricate a novel three-dimensional (3D) porous scaffold via 3D printing (3DP) technology. Another is preparing a novel titanium mesh implant coated with drugs/PDLLA/nHA composites by solvent evaporation and low-temperature drying technology. These two hypotheses have recently been tested in a laboratory setting by our team.

[Prevention and treatment of leg length discrepancy after total hip arthroplasty].

OBJECTIVE: To explore the prevention and treatment of leg length discrepancy after total hip arthroplasty (THA). METHODS: There were 87 patients who were treated by THA from January 2004 to December 2006, including 36 males and 51 females, with the average age of 60.2 years (ranging from 35 years to 78 years). Among these cases, there were 35 of avascular necrosis of the femoral head, 38 of subcapital femoral neck fracture, 4 of femoral neck tumor, 6 of rheumatoid arthritis and 4 of acetabular dysplasia. In 70 cases, the patients had leg length discrepancy, and the legs shortened from 1 cm to 6 cm. Based on the clinical measurement and radiographic examination, the surgical protocols were designed, the type of the hip prosthesis was chosen, and the neck length of the femoral prosthesis and the position of osteotomy were estimated. By the proper wearing of the acetabula, the best rotation point was found out. The cut plane of the femoral neck was adjusted according to the results of the radiographic and other examinations. The neck length was readjusted after the insertion of the prosthesis so as to achieve intended leg-length equalization. The discrepancy of the leg length was measured and evaluated after operation. RESULTS: Superficial infestation happened in 2 cases 5 days after the operation and was cured by mero-drainage. Luxation happened in 4 cases 4 weeks after the operation, in which 2 cases were cured by operation while the other 2 were cured by manual reduction. All the patients were followed up for 6 months to 36 months, with the average time of 18.3 months. The Harris scores were 34.81 +/- 1.36 preoperatively and 91.50 +/- 1.87 postoperatively (P < 0.05). In the 17 patients with equal legs before the operation, 1 was lengthened 1.5 cm in the leg, while in the 70 patients with shortened legs before the operation, 66 returned to the same length in their legs, and 4 were lengthened or shortened from 1.6 cm to 2.1 cm. The total rate of equal leg length was 94.25%. CONCLUSION: The preoperative measurement, radiographic templating and intraoperative correction, together with postoperative orthopraxy, are effective in prevention and treatment of leg length discrepancy after THA.

[Therapeutic effect of posterior pedicle screw system combined with interbody fusion cage on lumbar spondylolisthesis].

OBJECTIVE: To analyze the therapeutic effect of the posterior pedicle screw system combined with interbody fusion cage on lumbar spondylolisthesis. METHODS: From February 2003 to March 2006, 37 lumbar spondylolisthesis patients were treated with this operation, including 21 males and 16 females and aging 39-69 years. The affected lumbars were L3 (3 cases), L4 (23 cases), and L1 (11 cases). According to the Meyerding-evaluating system, 12 cases were classified as degree I, 20 cases as degree II, and 5 cases as degree III. Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index were measured before operation, and 2 weeks and 3 months after operation. RESULTS: All patients were followed up 3-36 months. There were statistically significant differences in Taillard index, Boxall index, slipping angle, lumbar lordosis angle and intervertebral height index between before operation and 2 weeks after operation (P < 0.05), and no statistically significant differences between 2 weeks and 3 months after operation (P>0.05). According to Dewei Zhou's creterior for scoring, the results were excellent in 27 cases, good in 8 cases,and fair in 2 cases. The excellent and good rate was 94.6%. All of the embedded osseous were fused. The fusing time was from 3 to 8 months (mean 3.9 months). There were no breakage of screw and rod. The position and configuration of the whole cages were good. CONCLUSION: Applying the posterior pedicle screw system combined with interbody fusion cage may achieve synergism in the treatment of lumbar vertebral spondylolisthesis. Above procedure is served as solid internal fixation and offers a satisfactory reduction, and can improve the fusion rate of the spine. So it is an ideal procedure and worthily recommended method for treatment of lumbar vertebral spondylolisthesis.