Research progress of measurement tools for health-related quality of life in patients with spinal metastases / 中华骨科杂志

The Health-Related Quality of Life (HRQoL) pertains to patients' subjective contentment concerning their physical, psychological, and social well-being throughout disease treatments. Predominantly employed HRQoL metrics in spinal metastases comprise the 36-item Short-Form Health Survey (SF-36), EuroQoL Five Dimensions Questionnaire (EQ-5D), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and the Functional Assessment of Cancer Therapy-General (FACT-G). In clinical applications, due to their broad application and diverse disease types, combined with the lack of specificity in the scale content and the prolixity of their questionnaires, these tools often fail to capture the nuanced experiences of patients, thereby compromising the reliability and validity of the results. The Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ), developed by the Spine Oncology Study Group, offers a tailored metric for spinal metastases, encapsulating both specificity and inclusivity. Its proven robust reliability and validity make it invaluable for decision-making and therapeutic efficacy appraisals. The Patient-Reported Outcome Measurement Information System (PROMIS), a novel metric suitable across many medical disciplines, facilitates cross-sector data acquisition, substantially augmenting the precision, sensitivity, and credibilityof assessments, and is pivotal in clinical investigations and interventions. As it continually evolves, PROMIS consistently outperforms traditional metrics in evaluative capacities, exhibiting impressive and consistent proficiency in prognostications, preoperative assessments, and therapeutic outcome evaluations within the spinal metastasis domain. Presently, Chinese research on the HRQoL of spinal metastasis patients remains scant, and choosing an apt, precise, and dependable metric holds significant clinical relevance. Drawing upon extant scholarly publications, this review concluded the current global HRQoL tools for spinal metastases, aiming to furnish insights for the clinical management and research pertaining to spinal metastases.

The application and insight of single-stage posterior total en bloc spondylectomy treatment on L 5 vertebrae spine tumors / 中华骨科杂志

Objective:To investigate the feasibility and technical points of single posterior total spine resection for L 5 vertebrae tumors, evaluate the effectiveness and safety of the technique, and propose a comprehensive treatment model for L 5 tumors on this basis. Methods:A retrospective analysis was performed on the data of 13 patients with L 5 vertebrae tumor who were treated by total en bloc spondylectomy (TES) through single-stage posterior approach from January 2014 to September 2021, including 4 males and 9 females. The age range was 21-65 years, with an average age of 33.85±14.24 years. Imaging examination showed isolated tumors of L 5 vertebrae without other metastases. All patients were treated with a single posterior L 5 vertebrae tumor TES by adjusting the curvature of lumbar lordosis, and the lumbar nerve root was fully dissociated. The vertebra with tumor was removed entirely and lumbar stability reconstruction via a pedicle screw system. Various parameters, including operative time, blood loss, complications, preoperative and postoperative spine sagittal parameters, Japanese Orthopaedic Association scores (JOAs), tumor control and outcome, were listed and analyzed. Results:Preoperative pathological diagnosis of 13 patients was mainly primary bone tumor including giant cell tumor in 7 cases, and invasive hemangioma, epithelioid hemangioma, aneurysmal bone cyst, chordoma, plasma cell myeloma and bone metastasis of breast cancer in 1 case. The mean operative time was 333.23±99.48 min (range 175-480 min), and the mean intraoperative blood loss was 1 407.69±676.49 ml (range 300-2 800 ml). There were no serious perioperative complications during the perioperative period. The mean follow-up was 54.92±19.29 months (range 28-84 months). JOAs improved from 13.85±3.86 points before operation to 24.31±2.16 points at 6 months after operation, and the difference was statistically significant ( t=8.19, P<0.001). Postoperative delayed wound healing occurred in 2 case. 2 patients showed numbness of the left lower limb, and 1 patient had slightly reduced plantar flexion movement. Conclusion:Single posterior TES is a good surgical method for the treatment of isolated L 5 vertebrae tumors. Although this technique is difficult, it can reduce surgical wounds and postoperative complications and good functional and oncology prognosis can be achieved.

Expert Concensus on Triune Personalized Treatment of Pelvic Tumor Based on Three-Dimensional Printing / 医用生物力学

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Construction of Hsf1 gene-knockout mouse model using CRISPR/Cas9 / 中华骨科杂志

Objective:To explore the efficient construction of HSF1 gene knockout mouse model using CRISPR/Cas9 gene editing technology, and to establish the early basis for the mouse model of primary osteosarcoma.Methods:According to exon 9 of HSF1 gene structure, the corresponding GRNA (guideRNA) was selected and screened. Then the transcription template of sgRNA (small guide RNA) was amplified by PCR, and four up stream primers were obtained. Subsequently, sgRNA was transcribed in vitro and screened by Tube Screen platform to screen the sgRNA with effective cutting, and the sgRNA with the highest cutting efficiency was selected from the screening results for subsequent experiments. The transcription template of SPCas9mRNA was amplified by PCR, and then Cas9mRNA was transcribed in vitro. The sgRNA transcribed in vitro and Cas9mRNA were injected into the fertilized eggs of healthy C57BL/6 mice, and the tissue was extracted from the tail of the born mice and identified by PCR sequencing. Heterozygous female mice of F0 generation were selected to mate with wild-type male mice too btain F1 generation off spring. The mutation of gene bases of F1 generation mice was detected by AGAR gel electrophoresis and gene sequencing. The heterozygous male mice of the F1 generation and female mice of the F0 generation were back crossed to obtain the F2 generation daughter mice. The tail tissues were cut and sequenced to obtain the F2 generation homozygous knockout mice. PCR was used to observe the cutting efficiency of sgRNA and the sequencing of rat tail tissue, and SNAPGene software was used for gene sequence alignment to determine the deletion of base fragments.Results:The up stream primers sgRNA-1 Primer-f, sgRNA-2 Primer-f, sgRNA-3 Primer-f, sgRNA-4 Primer-f and down stream primers sgRNA-4 Primer -r were obtained by PCR amplification. After in vitro tran scription and screening of sgrRNA, sgrRNA-1, sgrRNA-2 and sgrRNA-4 had high cleavage efficiency and were selected for subsequent experiments. T7 promoter was added to the 5 'end of Cas9 mRNA, and Cas9 mRNA was obtained by PCR and in vitro transcription kit. Mixed Cas9-sgRNA solution was injected into the fertilized eggs of mice and cultured. The cultured two-cell fertilized eggs were injected into the ampulla of the pseudo pregnant female mice, and the F0 generation mice were obtained successfully. A total of 8 heterozygous mice of F0 generation were obtained by Agar gel electrophoresis. Three heterozygous knockout mice of F1 generation were obtained by breeding the female heterozygous mice of F0 generation with healthy wild-type male mice and PCR and sequencing. Three heterozygous male mice of F1 generation were back crossed with female mice of F0 generation 3 to obtain F2 generation mice. Through the observation of electrophoresis and sequencing results of F2 generation mice, it was confirmed that 7 mice were missing HSF1 base sequence, and the electrophoresis results showed mutant bands and no wild-type bands, which were identified as homozygous. The F2 generation homozygous mice were able to breed stably. As eries of results proved that the HSF1 gene knockout mouse model was successfully established in this experiment.Conclusion:CRISPR/Cas9 technology was successfully used to construct HSF1 gene knockout mouse model, with strong stability and high reproducibility, which laida foundation for further study of HSF1 gene expression products and establishment of mouse model of primary osteosarcoma.

A surgical classification system for the management of axial primary malignant and aggressive benign tumors and its application in multiple tertiary centers / 中华骨科杂志

Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.

Advanced progress in classic genomic and non-genomic regulating mechanism mediated by retinoic acids in anti-cancer treatments / 中南大学学报(医学版)

Retinoic acid, an active metabolite of vitamin A, exerts multiple effects on regulating embryonic development and inducing differentiation, proliferation, apoptosis as well as resistance in various cancer cells. Apart from the classic genomic action (binding to the nuclear receptors to regulate the expression of its downstream target genes), retinoic acids also play important roles in anti-cancer effect through non-genomic pathways (via extranuclear and non-transcriptional effects).

Regulation of Wnt/β-catenin signaling in bone development and bone tumor / 中华外科杂志

The Wnt/β-catenin signaling pathway is crucial in bone development and homeostasis.Normally, it has been suggested to play a significant role in regulation of osteogenic differentiation of bone marrow mesenchymal stem cells, osteoclastogenesis and?偅ibone mineral density. Dysregulated Wnt/β-catenin signaling pathway is responsible for bone tumor, metabolic bone disease, degenerative bone disease and it related to development and invasion of osteosarcoma and Ewing′s sarcoma.Studies of the molecular mechanisms of Wnt/β-catenin signaling pathway provide theoretical basis of a potential target for bone diseases.

Total en bloc spondylectomy for spinal tumors of the fourth lumbar spine via a posterior approach: our clinical experience / 中华骨科杂志

Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes.Methods From March 2011 to December 2013,21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed.The patients included 9 males and 12 females,with a mean age of 47.1± 15.6 years old (range,15-71 years old).This series included 12 cases of primary bone tumors and 9 cases of solitary metastases.Preoperative evaluation according to clinical,imaging and pathologic features was performed meticulously to select patients.The length of surgery,estimated blood loss,surgical margins,instrumentation failure,perioperative complications,Frankel scale,visual analogue scale (VAS) for pain,local control rate and overall survival were reviewed and analyzed.Results Total en bloc spondylectomy was performed successfully in all patients.Average operative time and estimated blood loss were 297.6±44.6 min (range,225-420 min) and 2 247.1±904.5 ml (range,900-4100 ml),respectively.The mean follow-up time was 50.4± 17.1 mons (range,24-79 mons).All patients encountered nerve roots stretch and 5 patients (23.8％) showed lower extremeties neurological dysfunction.All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow -up.Cerebrospinal fluid leak was found in 4 patients (19.0％).The VAS score was 1.5±1.4 at post-operation,which was significantly lower than the 6.2± 1.6 in average at operation (P=0.008).Three patients with metastatic tumors died during the follow-up.Titanium mesh cage subsidence was observed in 7 patients (33.3％).No implant failure was occurred during the follow-up.Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible.However,there are many intraoperative neurological complications and the indications for TES are extremely limited.

Research on cancer stem cells in osteosarcoma: current status, controversy and comment / 中华骨科杂志

Osteosarcoma is the most common primary malignant tumor of bone in children and adolescents and advanced osteosarcoma patients with evidence of metastasis share a poor prognosis.Osteosarcoma frequently gains resistance to standard therapies highlighting the need for improved treatment regimens and identification of novel therapeutic targets.The composition of cancer stem cells is one of the attractive theoretical studies in osteosarcoma biology.It has been proposed that osteosarcomas are composed of a group of functionally heterogeneous cells.Only a small number of osteosarcoma cells have stem cell characteristics,with self-renewal and differentiation capacities,which facilitates in the generation of different types of osteosarcoma cells.These osteosarcoma stem cells play a decisive role in maintaining the proliferation,invasion,recurrence,and metastasis of tumors.Previous research suggests that osteosarcoma formation may result from the development of cancer stem cells by the deregulation of normal self-renewal pathways of tissue stem cells.The discovery of cancer stem cells in osteosarcoma offers a new approach to understanding the biology of these conditions.Further study is needed to understand both normal and osteosarcoma stem cell development and various signaling pathways which appear to regulate self-renewal of stem cells and CSCs,with dysregulation of these signaling pathways leading to tumorigenesis.Ultimately,new prognostic and predictive markers,as well as targeted therapeutic strategies,may be developed to force osteosarcoma into better outcome or permanent remission.In this review we will discuss the research advance of cancer stem cells in osteosarcoma such as commonly used isolation techniques for osteosarcoma stem cells as well as the identified biochemical and molecular markers and we share our viewpoints on controversy in research of osteosarcoma stem cells.

The application of en-bloc resection of primary sacral chordoma based on 3-Dimensional printing technology / 中华骨科杂志

Objective To investigate the safety and feasibility of en-bloc resection of a primary sacral chordona based on a 3-dimensional printing model.Methods 31 patients with primary sacral chordoma underwent en-bloc resection via a onestage posterior approach or combined anterior and posterior approaches in our oncology department from January 2013 to December 2014.They comprised 21 males and 10 females of mean age (49.2±12.5) years (range,26-67 years).Preoperative 3-D printing models were created by 3D printing technology,it included tumor tissue,the around vascular and nerves involved in sacral chordoma.The sacral chordomas were en-bloc resection with decompression and internal fixation.Results With the mean (29.0±6.8)months follow-up (range from 19 to 41),all patients underwent en bloc excision via 26 cases with posterior approach,5 cases combined posterior and anterior approaches in one stage.The mean operative time and estimated blood loss were (275.0±58.1) min and (3 250.0±1 304.4) ml,respectively.The visual analogue scale (VAS) score was (5.6±1.9) in average (range from 3 to 9) at preoperation,and (2.0±1.5) at post-operation,which was significantly lower than that of preoperation,and the pain was relief obviously.There were 13 cases in grade C,11 cases in grade D,7 cases in grade E of American Spinal Injury Association (ASIA) grade neurological function before surgery,compared with the pre-operation,there were 5 cases in grade C,6 cases in grade D,20 cases in grade E of post-operation,which was significantly improved.MSTS (Musculoskeletal Tumor Society) 93 score was 6-29 points (20.0％-96.7％) at the follow-up 3 months after surgery,with the average of (19.8 ± 5.8) points,which excellent in 8 cases,good in 14 cases,general in 5 cases,poor in 4 cases.Two cases of dysporia for the reasons of resecting on one side of the S1,2 nerve roots involved by the sacral chordoma,after sacrificing the nerve root of complete tumor resection,the urine left dysfunctional,while the pain of other 29 patients were thoroughly relief after surgery.The ones were relieved with the disturbance of sensation of the perineum before the operation.2 cases were recovery of leakage of cerebrospinal by the drainage of lumbar cistern with normal temperature.One hypostatic pneumonia patient was cured by anti-inflammatory.One with the urinary infection got better by the effective bladder irrigation,which had diabetics mellitus with the bladder stoma before.1 case of skin necrosis due to vascular thrombosis before operation,recevied flap translocation half month after surgery,got recovery 3 months later.Only one underwent tumor resection for the recurrence at 15 months follow-up.Conclusion It is feasible and safe to perform en bloc resection of primary sacral chordoma.This is the most effective means of managing method of the marginal resection of the tumor.Preoperative 3-D printing modeling enables better anatomical understanding of the relationship between the tumor,and can avoid vascular and nerves tissue injury,which can also assist in planning the surgical procedure,and be worth recommendation.

Biomechanical analysis of spinal reconstruction after total en bloc spondylectomy for lower lumbar spine / 中华骨科杂志

Objective To evaluate the mechanical stability of alternative reconstruction methods after total en bloc spon?dylectomy in the lower lumbar spine. Methods Eight adult fresh cadaveric lumbosacral spines (L1-S1) were adopted. Total en bloc spondylecotmy of the L4 vertebra was performed after intact testing. Four designed reconstruction samples were tested for the range of motion (ROM) of the spine:1) expandable artificial vertebral body and short posterior instrumentation at L3-L5 (SP), 2) ex?pandable artificial vertebral body and short posterior instrumentation with additional anterolateral fixation at L 3-L5 (ASP), 3) ex?pandable artificial vertebral body and multilevel posterior instrumentation at L2-S1 (MP), 4) expandable artificial vertebral body and multilevel posterior instrumentation with additional anterolateral fixation at L2-S1 (AMP). Nondestructive biomechanical test?ing was performed on each construct under loading control. The ROM for each construct was obtained by applying pure moments in flexion, extension, lateral bending, and axial rotation. Results In flexion, extension and lateral bending, the ROM of all the re?constructed constructs significantly decreased compared to the intact. The ROM of specimens with anterolateral fixation was less when compared to the ones without additional fixation. In lateral bending, MP (L:1.87° ± 0.32° , R:1.97° ± 0.33° ), ASP (L:1.89° ± 0.37°, R:2.08°±0.36°) and AMP (L:1.32°±0.29°, R:1.61°±0.33°) provided significantly less ROM than the SP (L:3.14°±0.35°, R:3.44°±0.34°). In axial rotation, the ROM of ASP (L:4.21°±0.58°, R:4.02°±0.59°) and AMP (L:3.56°±0.55°, R:3.52°±0.48°) was significant decreased when compared to the intact state (L: 7.47° ± 1.00° , R:7.57° ± 0.84° ). MP (L:6.33° ± 0.71° , R:5.88° ± 0.62°), ASP and AMP showed significantly less ROM than the short posterior fixation (L:9.28°±1.01°, R:9.48°±0.98°). AMP sig?nificantly decreased the ROM compared to MP. Conclusion After total en bloc spondylectomy of lower lumbar, long segmental fixation provided more stability to the construct than the short one. Compared to posterior fixation, circumferential fixations showed a higher stability. In contrast, multilevel segmental instrumentation with circumferential fixation did not provided more stability than the short constructs.

One-stage foci debridement for cervical tuberculosis / 中华骨科杂志

Objective To evaluate the effectiveness of one-stage debridement for cervical tuberculosis at different segments.Methods Clinical data of 54 patients (male 20,female 34) with cervical tuberculosis treated by one-stage debridement from Jan 1998 to Dec 2011 were reviewed retrospectively.The average age of these patients was 45.4 years (range,26-75 years).Among them,12 cases were involved in single level (C2 1 case,C4 2 cases,C5 3 cases,C6 4 cases,C7 2 cases); 36 cases in the adjacent two levels (C1,2 3 cases,C2,3 2 cases,C3,4 5 cases,C4,5 6 cases,C5,6 14 cases,C6,7 5 cases,C7T1 1 case); 5 cases in three levels(C4 6 2 cases,C5-7 2 cases,C3,5,6 1 case)and 1 case in four levels (C4-7).Five cases were involved in other spinal levels (T6 1 case,T 3 cases,L3,4 1 case).Comorbidity of cervical ossification of the posterior longitudinal ligament was found in 1 case.Before surgery,the mean VAS and JOA scores were 5.9 (range,4-9) and 10.5 (range,7-12) respectively and the mean Cobb angle of lesion segment was 26.7°± 9.1°.All cases underwent regular anti-TB treatment preoperatively,and surgical treatment were performed when blood sedimentation (ESR) was lower than 50 mm/1 h.According to the segmental involvement,different surgical approaches were performed including anterior debridement with anterior or anterior-posterior internal fixation and fusion,submandibular approach debridement with posterior occipital cervical fusion or atlantoaxial fusion.Results Mean follow-up duration was 27.3 months (range,13-52 months).Symptoms were improved significantly in all cases.Mean time of union was 3.2 months (range,2-4 months).At the last follow-up,the mean VAS and JOA scores were 5.9 (range,4-9)and 10.5 (range,7-12) respectively,and the mean Cobb angle of lesion segment was 6.8°.Regular anti-TB treatment was performed postoperatively for 18 to 20 months.Intraoperative esophageal injury was found in one case of upper cervical tuberculosis which was cured uneventfully after gastrointestinal tubation for 1 week.No cervical tuberculosis recurrence,graft loosening or pseudarthrosis was found in follow-up.Conclusion With preoperative anti-TB treatment,cervical tuberculosis can be treated by one-stage foci debridement according to the segmental involvement and deformity.Postoperative regular anti-TB treatment is a crucial factor for the final recovery of cervical tuberculosis.

Related research of the role of Autophagy gene Beclin 1 in osteosarcoma development / 中国综合临床

Objective To investigate the role of Beclin 1 in the genesis and development of osteosarcoma and the effect of Beclin 1 overexpression on the growth of the in vitro osteosarcoma cell line MG63.Methods Real time-polymerase chain reaction (RT-PCR) and Western blot were used to detect the expressions of Beclin 1 in MG63 and hFOB1.19 at mRNA and protein levels ; A eukaryotic clone of plasmid pEGFP/Beclinl fusion with protein EGFP/Beclin 1 was constructed and was transfected into human osteosarcoma cell line MG63 by using lipofectamine 2000.The effect of Beclin1 overexpressions on the proliferation of MG63 cells was evaluated by MTT assay.Cell apoptosis was measured by flow cytomerty(FCM).Results The mRNA and protein expression of Beclin1 in human osteosarcoma cell line MG63 was significantly lower than that in the human osteoblast cell line hFOB1.19(0.17 ±0.06 vs 0.43 ±0.11,t =29.493,P ＜0.01 ; 0.13 ±0.05 vs.0.25 ± 0.08,t =6.325,P ＜ 0.01).The transfection of pEGFP/Beclinl increased the mRNA levels of human osteosarcoma(5.34 ± 0.50) times in transfected tumor cells MG63.The rate of cell apoptosis was low in control or transfected with lipofectamine 2000 only cells at an average of(0.10 ± 0.05) ％.The apoptosis rate was significantly higher in pEGFP/Beclin1 transfected cells than control cells ((4.3 ± 0.8) ％,t =5.752,P ＜ 0.05).Conclusion Compared with control cells,Bedin1 is down-regulated in the human osteosarcoma cell line MG63,which indicate the role of Beclin 1 in regulating the malignant behaviors of osteosarcoma.Beclin1 overexpressions inhibits cell proliferation and induces apoptosis in MG63 cells.

Anterior construction after resection for axis tumors through the sub mandible approach / 中华骨科杂志

Objective To investigate procedure and therapeutic effect of resection and reconstruction for axis tumors through the sub mandible approach. Methods Between December 2004 to June 2010,17 patients with axis neoplasm underwent tumor resection and antero-posterior reconstruction through the combined the sub mandible-inner sternocleidomastoid muscle (SMIS) approach and posterior approach. Tumor lesions involved C2 in 11 cases, C2-3 in 4, C2-4 in 2. Eight cases involved vertebral body, and 9 involved both vertebral body and element. Fourteen primary lesions including 4 giant cell tumors, 4 plasmocytomas, 2 chordomas, 2 eosinophilic granulomas, 1 hemangiopericytomas and 1 lymphoma, and 3 metastatic lesions were involved in this study. Three types of reconstruction in upper cervical spine including titanium mesh plus vertically placed titanium plate, titanium mesh plus obliquely placed titanium plate and trimmed titanium mesh alone, were adopted after anterior tumor resection, and then posterior tumor resection and reconstruction were performed. Results All patients experienced pain relief and neurological improvement after surgery. Except for one incidence of screw pull-out which was corrected by a revision surgery, solid fusion was achieved in all patients. A follow-up period of 6 months to 6 years was available for this study. One patient died of cerebral infarction 9 months postoperative. Two patients with chordoma relapsed 13 months and18 months postoperative, respectively, of whom one died of high plegia and respiratory failure, and the other was alive with disease. Two patients with metastasis died of multiple remote metastases 12 months and 18 months postoperative, respectively. Conclusion Through the SMIS apporach, a satisfactory exposure can be obtained for axis tumor resection and reconstruction. Anterior reconstruction of upper cervical spine after tumor resection can be achieved with internal fixation system of cervical spine, which can improve intraopera-tive safety. The combined anterior reconstruction and posterior occipito-cervcial fixation can provide immediate stability, and benefit maintaining stability of upper cervical spine.

Treatment of odontoid fractures with Gallie technique with titanium cable fixation and Harms C1,2 screw fixation: a comparative study / 中华创伤杂志

Objective To compare the dinical outcome of posterior Gallie method with cable fixation and Harms technique with C1,2 pedicle screw fixation in treatment of odontoid fractures. Methods From July 2003 to July 2008, 26 patients with types Ⅱ and Ⅲ odontoid fractures were treated surgically. There were 18 males and 8 femalses, at age range of 22-65 years ( average 43 years). The patients were divided into Gallie titanium cable fixation group (Gallie group, n = 14) and C1 -C2 posterior screw fixation group using Harms technique (Harms group, n = 12) according to treatment methods to compare blood loss, operation duration, costs, hospital stay, bone fusion time, complications and secondary operation. Results The patients were followed up for 18-84 months ( average 37.3 months). The average blood loss and costs in Gallie group were significantly less than that in Harms group (P<0.05), while the time for back to work in Gallie group was significantly longer than that in Harms group ( P < 0. 05 ). There was no statistical difference upon operation duration, hospital stay and bone fusion time in two groups (P > 0. 05 ). There was one patient with nonunion and two with delayed union in Gallie group and one with secondary operation due to implant failure in Gallie group, and one with secondary debridement due to wound infection and one with delayed wound healing in Harms group, with no statistical difference (P > 0. 05). Conclusions Both Gallie technique with titanium cable fixation and Harms C1,2 screw fixation have advantages of early walk and short hospital stay. Compared with the former, the latter technique costs more but can help early back to work.

Influence of different depression status on symptoms and survival status in patients with metastasis tumor in spine / 第二军医大学学报

Objective:To investigate the influence of different depression degree status on the clinic symptoms and survival status in the patients with metastasis tumor in spine (MTS). Methods: By using Zung's self rating depression scale (SDS), we studied 125 patients with MTS between 1999 and 2001. Results: It was found that 44% patients with MTS were affected by depression. The survival period in the negative depression group(NDP) was longer than that in the moderate and the severe groups after a mean of 21 months follow up( P

Strategies of surgical treatment of the spinal metastatic tumors / 中华骨科杂志

Objective To study the clinical features,surgical treatments and the prognosis of the103patients with the metastatic tu mors in the spine.Methods From Jan.1996to Dec.2001,103cases were treated by operation in our department,there were62males and41females,aging from33to79years old(average,59years).The lesions were located at cervical spines in34cases,thoracic spines in39,lumbar spines in25and sacrum in5.The patients underwent anterior,posterior,combined or staged antero-posterior operations based on the location of lesions in the spine.Most of the patients were adopted vertebral recon-struction and internal fixation depending on the conditions.Preoperative clinical evaluation included of gen-eral condi tions,X-ray films,CT scan,MRI and ECT in order to decide the endurance of the patient to the sur gi cal treatment.The operation was only considered when the patient could have the ex pected survival time more than6months.Operative indications,surgical methods and prognosis were analyzed and summa -rized.Re sults The postopera tive follow-up ranged from6months to5years.No death related to the op-eration.Eighty-five of 103cases had partial or even complete relief of local pain and radiculopathy,54cases were im proved in neu rological status caused by spinal cord compression.The postoperative survival rates at6months,one year,two years,three years and four years intervals were97.1%,90.3%,44.7%,29.1%and8.7%respectively,9patients survived more than4years.Conclusion Local pain was the predomi nant symptom in metastatic tu mor of spine,and some of them suffered from spinal cord and nerve compromise.The surgical treatments for the spinal metastatic diseases were indicated depending spinal instability,progressive neurological deteriora tion,in tractable pain,or the need for histological diagnosis.The most im por tant factor being consid-ered was the patient's condition when operative treatment was decided.The anterior,posterior,combined or staged antero-poste rior operations were influenced by location of lesions in the spine,en durance of the patient,life ex pectan cy and so on.Surgical interven tion could stabilize and reconstruct the spine,relieve pain,maintain or improve the neurological status of the patients,thus improve the life qualities in limited life expectancy pa-tients.[

Effect of Schwann cell-derived neural cell adhesion molecule L_1 on axon regeneration of injured spinal cord / 中华骨科杂志

Objective To study the effect of Schwann cell enclosed by antibody of neural cell adhesion molecule L1 on injured spinal cord. Methods Over 98% of the purity of Schwann cells obtained from bilateral sciatic nerves of 2 days newborn SD rats, the concentration of Schwann cells was about 2.5?104 /?l. The Schwann cells were enclosed by the antibody of neural cell adhesion molecule L1 using co-culture. The adult SD rats (weight 200-250 g) were used to establish the model of spinal cord injury by hemi-transection at the left side of T10 level. The animals were divided into three groups; the SC group was transplanted with 20 ?l suspension Schwann cells; the anti-L1 group with 20 ?l Schwann cells enclosed by antibody of neural cell adhesion molecule L1; and the control group was injected solely with normal saline to the injured cord. Eight weeks later regenerated neural axons were investigated through horseradish peroxiase HRP retrograde trace immunohistochemistry of neurofilament and Western blot. Results Few regenerated neural axons appeared in the control group; some of regenerated neural axons could be observed in anti-L1 group; plentiful and bulky regenerated neural axons were found in SC group. The group with antibody had significant less HRP positive neurons and neural axons than the group without antibody. Western blot showed that the quantity of neurofilament in the anti-L1 group was only two thirds of the SC group. Conclusion Schwann cell-derived neural cell adhesion molecule L1 is able to enhance the neural axon regeneration of injured spinal cord.

Posterior surgical approach for operation of atlantoaxial instability / 中华骨科杂志

Objective To investigate the results of surgical treatment of atlantoaxial instability through posterior approach. Methods Seventy eight patients with atlantoaxial instability were used for this collective review, the patients included 38 with unstable odontoid fractures,15 with os odontoideum,8 with a disrupted transverse ligament, 6 with C1,2 tumor,6 with congenital occipitocervical abnormalities,5 with old Jefferson fractures. There were 57 males and 21 females. The mean age of the patients was 42 years(range, 3-78 years). All patients were treated by operation. Thirty seven patients were operated upon by atlantoaxial arthrodesis using wire fixation with autologous bone grafts. Nine were treated by C1,2 posterior wiring fixation and atlantoaxial facet screw fixation. Nine were operated on by atlantoaxial arthrodesis using Apofix interlaminar clamping with autologous bone grafts. Occipitocervical fusion was performed in 32 patients, arthrodesis simple with autologous bone grafts and external fixation was done in 11 patients. CD-Cervical fixation was used in 11 patients. Cervifix fixation was used in 10 patients. Results The patients were followed up for an average of 38.4 months(range, 6-216 months). Solid arthrodesis was obtained in 75 patients and non union in 3 cases. All the non union cases occurred after occipitocervical fusion. Conclusion Posterior fusion is recommended for atlantoaxial instability due to traumatic fracture or ligament disruption, tumor, inflammatory, skeletal dysplasias, congenital abnormalities. It is emphasized that adequately controlling atlantoaxial motion, meticulously preparing the fusion bed are the important measures for successful operation.