Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital / 中华医学杂志(英文版)

BACKGROUND@#Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials.@*METHODS@#This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation.@*RESULTS@#We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population.@*CONCLUSIONS@#The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.

Clinical and genetic features of children with hereditary spherocytosis: an analysis of 4 cases / 中国当代儿科杂志

Four children (two boys and two girls), aged from 3 years and 7 months to 5 years, had mild or moderate anemia, mild hepatosplenomegaly, jaundice (mainly an increase in indirect bilirubin), an increase in the percentages of reticulocytes and spherical erythrocytes in peripheral blood smear and an increase in erythrocyte osmotic brittleness. High-throughput sequencing found two novel mutations in the SLC4A1 gene, c.37G>A and c.340T>C, in case 1 and case 2 respectively, and these two mutations were predicted to be pathogenic by Mutation Taster. The Polyphen2 scores of these two mutations were 0.87 and 0.83 respectively, which suggested that these mutations were probably damaging. The SIFT scores of these two mutations were 0.008 and 0.09 respectively, suggesting that these mutations were probably damaging. No abnormality in this gene was found in their parents. Two reported heterozygous mutations in the ANK1 gene, c.830A>G and c.985G>C, were found in case 3 and case 4 respectively. Gene detection was not performed for the parents of case 3. The mother of case 4 was diagnosed with hereditary spherocytosis and had a heterozygous mutation of c.985G>C in the ANK1 gene. All four children were diagnosed with hereditary spherocytosis. Case 3 had a hemoglobin level of 105 g/L. Hereditary spherocytosis is a hereditary hemolytic disease caused by abnormality in erythrocyte membrane protein, and gene detection helps to make a confirmed diagnosis.

Clinical value of preoperative peripheral blood neutrophil to lymphocyte ratio in predicting lymph node metasta-sis after radical resection of esophageal carcinoma / 局解手术学杂志

Objective To investigate the clinical value of preoperative neutrophil to lymphocyte ratio in predicting lymph node metasta-sis after radical resection of esophageal carcinoma. Methods The clinical data of 110 patients with esophageal carcinoma who underwent radical resection of esophageal carcinoma from February 2015 to March 2017 in our hospital were retrospectively analyzed. NLR≥4 was the critical point,all patients were divided into high NLR group(NLR≥4) in 45 cases,the low NLR group(NLR<4) 65 cases,compared two groups of patients with clinical characteristics,lymph node metastasis,and regression analysis of factors influencing lymph node metastasis af-ter radical resection of esophageal carcinoma by logistic. Results There were 87 patients with lymph node metastasis in 110 cases,among which 43 cases(95. 56％) had lymph node metastasis in 45 cases of high NLR group,and 44 cases(67. 69％) had lymph node metastasis in 65 cases in low NLR group. The number of lymph node metastasis,depth of tumor invasion and distant metastasis in the high NLR group were higher than those in the low NLR group(P<0. 05),which indicated that the preoperative NLR level was related to lymph node metastasis af-ter radical resection of esophageal carcinoma. The number of lymph node metastasis and lymph node metastasis in the high NLR group were higher than those in the low NLR group(P<0. 05). The tumor T stage(OR=1. 898,95％CI:1. 151～3. 130),NLR≥4(OR=1. 919,95％CI:1. 076～3. 422) is the independent risk factors of lymph node metastasis in patients with esophageal cancer(P<0. 05). Conclusion The preoperative NLR was higher in patients with esophageal cancer and its lymph node metastasis,the greater the risk of distant metastasis tumor the deeper the infiltrating,it is more likely,to suggest it should expand the range of lymph node dissection in the operation,the lymph node metastasis,radical dissection has certain value.

Effect of Lymphocyte/Monocyte Ratio on Clinical Features and Prognosis of Patients with Primary Gastrointestinal Diffuse Large B Cell Lymphoma / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To analyze the effect of lymphocyte/monocyte ratio(LMR) on clinical features and prognosis of patients with primary gastrointestinal diffuse large B cell lymphoma(PGI-DLBCL).</p><p><b>METHODS</b>The clinical data of 38 PGI-DLBCL patients with complete follow-up data in our hospital were analyzed retrospectively. The absolute lymphocyte count(ALC), absolute monocyte count(AMC) and LMR were counted by automating complete blood cell count statistics in newly diagnosed patients, and then the LMR cut off value was obtained by ROC curve. All patients were divided into ≤3.9 group and >3.9 group according to cut off value.</p><p><b>RESULTS</b>Out of 38 patients 21 male and 17 female with a median age 55 old years (29-73 years), 7 cases died, the clinical B symptom occurred in 7 cases (18.4%); the pathologic type of 13 cases (34.2%) belonged to germinal center B-cell like, the primary gastral and intestinal DLBCL were observed in 18 and 20 cases respectively. The chisquare test showed that the LMR associated with of clinical stage and tumor size of PGI-DLBCL. The median survival time was 44 months (7-100 months), and 5-year overrall survival(OS) rate was 78.3% for 38 PGI-DLBCL cases. The univariate analysis showed that age (P=0.021), stage (P=0.012), IPI score (P=0.001), LDH level (P<0.001), tumor size (P=0.037) and LMR (P=0.026) all associate with the 5 years OS rate(%), and the difference was between them statistically significant, but the multivariate analysis showed that only clinical staging is independent risk factors for the OS.</p><p><b>CONCLUSION</b>LMR shows an important effect on clinical features and prognosis of PGI-DLBCL.</p>

Study on preparation of matrine double-sensitive colon-specific pellets and in vitro release / 中国中药杂志

<p><b>OBJECTIVE</b>To prepare matrine double-sensitive colon-specific pellets and study the factors affecting its quality and evaluateing the colon-specific effects of preparation.</p><p><b>METHOD</b>Matrine enzyme-sensitive pellets core were prepared by carboxymethyl konjac glucomannan as the main carrier material, and coated the core by acrylic resin II and III to prepare matrine double-sensitive colon-specific pellets. The prescription and technology of the matrine colon-specific pellets were studied by the single factor investigation, through the in vitro release test and coating rate determination.</p><p><b>RESULT</b>The optimized process conditions: FeCl3 concentration is 4.0 g x L(-1), chitosan concentration is 3.0 g x L(-1), carboxymethyl konjac glucomannan concentration is 20 g x L(-1), mixed gel solution pH value is 3. The release of matrine is less than 30% in the simulation of the upper gastrointestinal medium. The release of matrine is close to 100% in simulated full gastrointestinal medium, the coating weight is 7%.</p><p><b>CONCLUSION</b>The prepared pellets have good colon positioning effect in vitro.</p>

Effect of environmental factors on photosynthetic physiology and flavonoid constituent of Scutellaria baicalensis / 中国中药杂志

To discuss the effect of environmental factors and photosynthesis on the growing of plant and the content of active components in Scutellaria baicalensis, the photosynthetic physiology index and diurnal changes of flavonoid constituent of S. Baicalensis were observed and tested in flowering and fruiting stages, and in the meantime environmental parameters were recorded. The obtained data were analyzed data by using path analysis and gray correlation analysis. The results showed that PAR and SWC were important environmental factors impacting on photosynthesis of S. baicalensis. SWC, RH and Ca were important environmental factors impacting on baicalin content. PAR, Po and Ta were important environmental factors impacting on baicalein content.

Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Among the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.</p><p><b>METHODS</b>From March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.</p><p><b>RESULTS</b>The mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.</p><p><b>CONCLUSION</b>Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.</p>

A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation.</p><p><b>METHODS</b>From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI).</p><p><b>RESULTS</b>All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000).</p><p><b>CONCLUSION</b>Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.</p>

Physiological ecology responses of Scutellaria baicalensis to drought and rewatering / 中国中药杂志

To study the physiological ecology responses of Scutellaria baicalensis to drought and rewatering of short period, we tested and analyzed photosynthesis and chlorophyll fluorescence parameters of S. baicalensis leaves processed by different ways of water treatment in drought and rewatering period, characteristic indexes of physiology and biochemistry of root SOD, POD, PAL, C4H, etc. and accumulation dynamic change of root baicalin and baicalein. The result showed that along with the worsening drought, P(n), T(r), G(s) and F(v)/F(m) of S. baicalensis declined in different water supply, and F(o) increased. The response of SOD and POD's activity in S. baicalensis root to drought in I and II was earlier than it in III. The response time and increase range of baicalin accumulation existed differences in different water supply, and the indexes regained after rewatering. Therefore, photosynthesis of S. baicalensis changed and it destroyed the antioxidant metabolism balance when soil water content decreased resulting from drought. The synergistic effect of defence mechanism launched by S. baicalensis, SOD, POD, PAL, C4H, baicalin and baicalein reduced active oxygen's damage to the cell.

Preliminary application of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical effects and application value of intraoperative CT in treatment of severe scoliosis with posterior total pedicle screws.</p><p><b>METHODS</b>Thirty-two cases of severe scoliosis were retrospectively analysed in our hospital from June 2009 to June 2011,which were treated by posterior total pedicle screws with intraoperative CT including 12 males and 20 females with an average age of 16.8 years ranging from 10 to 38 years. There were 19 cases combined with thoracic kyphosis among 32 cases. Multiple planar reconstruction technology of intraoperative CT was applied to assess screw position. The numbers (rates) of pedicle screws were calculated and evaluated as different grades in upper thoracic vertebra (T1-T4) ,middle thoracic vertebra (T5-T8), lower thoracic vertebra (T9-T12) and lumbar vertebra. The pedicle screws of 2 grade and 3 grade were defined as malpositioned screws. Times of applicating intraoperative CT were calculated. Cobb angle of all cases and kyphosis angle of the cases combined with thoracic kyphosis were measured before and after surgery. Scoliosis correction rates and kyphosis correction rates were calculated.</p><p><b>RESULTS</b>There were 686 pedicle screws placed in thoracolumbar of 32 patients (including 544 thoracic pedicle screws,142 lumbar pedicle screws) and 14 patients underwent osteotomy. The rate of malpositioned screws in thoracolumbar was 7.3% by evaluating with intraoperative CT,and it respectively was 5.6%,11.1%, 6.7% and 4.3% in upper thoracic vertebra, middle thoracic vertebra,lower thoracic vertebra and lumbar vertebra. The malpositioned screws were amended in surgery. The mean times of intraoperative CT was 2.6 times (ranged from 2 times to 4 times). The mean preoperative Cobb angle was 95 degrees (ranged from 78 degrees to 123 degrees) and the mean postoperative Cobb angle was 340 (ranged from 19 degrees to 53 degrees). The mean correction rate of Cobb angle was 64%. The mean preoperative kyphosis angle of the patients combined with thoracic kyphosis was 69 degrees (ranged from 46 degrees to 82 degrees) and the mean postoperative kyphosis angle was 32 degrees (ranged from 22 degrees to 45 degrees). The mean correction rate of kyphosis angle was 54%. Four patients suffered cerebrospinal fluid leak after surgery. No infection, vascular lesion and nervous lesion were found. All patients had an average 18-month follow-up (ranged from 12 to 26 months). No broken nails, broken rods and pseudarthrosis were founded.</p><p><b>CONCLUSION</b>Application of in traoperative CT in severe scoliosis with posterior total pedicle screws can detect and amend malpositioned screws timely in surgery, to avoid secondary surgery for malpositioned screws and protect the safety of surgery. The effects of surgery is satisfactory.</p>

One-stage total en bloc spondylectomy and reconstruction via a single posterior approach for thoracic vertebral symptomatic hemangioma associated with spinal cord dysfunction / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the surgical results of one-stage total en bloc spondylectomy (TES) and reconstruction via a single posterior approach for thoracic symptomatic vertebral hemangioma associated with spinal cord dysfunction and evaluate its curative effect.</p><p><b>METHODS</b>A total of 9 patients treated with one-stage TES (7 cases) and total vertebrectomy (2 cases) by posterior approach from March 2006 to January 2010 were retrospectively reviewed. The cases included 2 males and 7 females with a median age of 33.6 years (range 14 to 77 years), and with 1 case of Grade A, 3 cases of Grade B, 3 cases of Grade C, 2 cases of Grade D according to Frankel grade system. All patients suffered from moderate to severe pain and neurological deficit with an average symptom duration of 14.4 months (range 3 - 24 months) MRI revealed severe spinal cord compression. The spinal reconstruction was obtained by titanium mesh filled with autograft and posterior internal fixation with rod-screw system.</p><p><b>RESULTS</b>The operation time was 210 minutes on average (180 - 270 minutes) and the average blood loss was 1800 ml (1000 - 5000 ml). The follow-up period lasted from 18 months to 5 years. All cases with preoperative pain relieved after operation. The visual analogue scale pain scores decreased to 1.1 from 8.3 at 3 months after surgery. No disruption of dural mater, cerebrospinal fluid leakage, iatrogenic spinal cord injury and major vessel damage occurred. Up to now, there was no local recurrence in all cases. Significant neurological function improvement was achieved in all patients with one to three grades in Frankel grade system. Fusion of the autograft was well achieved and no internal fixation failure in all patients.</p><p><b>CONCLUSIONS</b>One-stage TES and spine reconstruction by a single posterior approach is feasible, safe and effective to this disease. It is favourable in decreasing the hemangioma recurrence and improvement of the neurological function.</p>

Animal experiment of memory alloy staples to control the sagittal growth of vertebrates / 中华外科杂志

<p><b>OBJECTIVE</b>To present that Nickel-Titanium (NT) memory alloy staples in fusionless controlling the growth of the vertebrates in the sagittal plane.</p><p><b>METHODS</b>Eighteen infant female goats were selected and equally divided into 3 random groups: long staple group, short staple group and blank control group. Five long staple (the legs' length = 7 mm) and five short staple (the legs' length = 4 mm) were implanted into each goat in long and short staple groups respectively by anterior approach, right on the front of the thoracic vertebrae from T(6) to T(11). The control group was not given any treatment. X-ray examination was performed pre-operatively and post-operatively. Cobb angle of lateral radiograph was measured and the data of Cobb angle were statistically analyzed. At the end of the experiment, whether the staples implanted spinal columns were fused or not were evaluated by gross observation.</p><p><b>RESULTS</b>Finally, all of the goats were included in the final results. Before the operations, T(6-11) sagittal Cobb angle was 7.0° ± 2.3° in short staple group, and 6.2° ± 4.0° in long staple group. And after the operation, the T(6-11) Cobb angle was increased to 12.7° ± 4.7° in short staple group with the increased rate of 81.4%, and 14.0° ± 4.9° in long staple group with the increased rate of 125.8%, respectively. Before and after the surgery, there were no significant differences between long staple group and short staple group in terms of Cobb angle (pre-operation P = 0.655, post-operation P = 0.596). Before the surgery, there were no differences in terms of Cobb angle, between long staple groups and control group (P = 0.929), and short staple groups and control group (P = 0.720). At the end of the experiment, there were significant differences between long staple group and control group in terms of Cobb angle (P = 0.007), and between short staple group and control group (P = 0.021). The staples implanted spinal columns were not fused which was proved by gross observation.</p><p><b>CONCLUSIONS</b>The memory alloy staple implantation by anterior approach, right on the front of the thoracic vertebrae of goats, can control the growth of thoracic vertebrates leading to kyphosis.</p>

A feasibility research of unilateral incision minimally invasive transforaminal lumbar interbody fusion using pedicle screws and a translaminar screw hybrid fixation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of unilateral incision hybrid fixation using pedicle screws and a translaminar screw in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><b>METHODS</b>From January to June 2010, 18 patients with single-level lumbar disc disease were treated with MIS-TLIF under METRx(TM) X-tube. After decompression and fixation using unilateral pedicle screws, a translaminar screw was inserted from the same incision to the other side. The results of perioperative parameters, radiographic images and clinical outcomes were assessed.</p><p><b>RESULTS</b>All patients underwent MIS-TLIF were accomplished unilateral hybrid fixation without any neural complication. The average operative time was (107 ± 19) min, the average operative blood loss was (62 ± 21) ml, and the average postoperative ambulation time was (21 ± 5) h. The average length of translaminar facets screw was (52 ± 2) mm, and the postoperative images showed all screws penetrate through facets joint. During the follow-up the visual analogue scale and Oswestry disability index scores were significant improved compared with preoperative (F = 42.221 - 259.833, P < 0.01).</p><p><b>CONCLUSIONS</b>Bilateral hybrid fixation could be completed through unilateral incision by pedicle screws and a translaminar screw in MIS-TLIF, and the advantage including less invasion, quickly recovery, short operative time, and saving fixation cost.</p>

Complication and treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize and discuss the lapsus and the treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy (PELD).</p><p><b>METHODS</b>Between July 2002 and October 2010, 689 patients with lumbar intervertebral disc herniation treated by PELD were analyzed, including 448 males, and 241 females. Single lumbar intervertebral disc herniation were 669 cases. double lumbar intervertebral disc herniation were 19; three lumbar intervertebral disc herniation were 1. Central type in 66, side central type in 365, lateral type in 242, extreme lateral type in 10, sequestered type in 6. These cases with complications in operation and postoperation were studied retrospectively.</p><p><b>RESULTS</b>There were nucleus pulposus omissions in 5 patients and 2 patients underwent open resection of nucleus pulposus during operation immediately and the second operation was needed in 3 cases, 1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection of nucleus pulposus. Two patients had nerve root injury, but all completely recovered in 3 - 6 months after operation. Spinal dura mater disruption was in 2 patients, recovered after suturing of skin wound. All 689 patients were followed up for 6 - 96 months, mean follow-up time was 33 months. Postoperative spondylodiscitis was in 7 patients, recovery after expectant treatment in 1, percutaneous puncture irrigation and drainage for continued use of local antibiotics in 4, posterior infective lumbar discectomy in 2. Postoperative relapse was in 6 patients, operated secondly by PELD in 4 and by TLIF in 2, recovery after the second operation. Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 19 patients, the symptom was improved by analgesic drug, neurotrophy drug and physiotherapy. The effect of single segment PELD was not good in 10 patients with spinal stenosis, who underwent multiple segment TLIF later.</p><p><b>CONCLUSIONS</b>The complications during operation usually are nucleus pulposus omissions, nerve root injury, spinal dura mater disruption. Accordingly the complications after operation include spondylodiscitis, recurrence, nerve root induced hyperalgesia or burning-like nerve root pain. Strict indication, aseptic technique, skilled operation and proper rehabilitation exercise are effective ways to reduce complications.</p>

Vertebral column decancellation for the management of rigid scoliosis: the effectiveness and safety analysis / 中华外科杂志

<p><b>OBJECTIVE</b>to explore the effectiveness and safety of vertebral column decancellation (VCD) for the management of rigid scoliosis.</p><p><b>METHODS</b>from May 2004 to February 2008, 32 patients with rigid scoliosis underwent VCD were reviewed. There were 12 males and 20 females with an average age of 18 years (range, 10 - 56 years). The operation techniques included multilevel vertebral body decancellation and residual intervertebral disc resection, followed by realignment and posterior correction with pedicle screws. The effectiveness was evaluated by preoperative and postoperative radiography and three-dimensional CT scan reconstruction at final follow-up. The intraoperative and postoperative complications of all patients were recorded.</p><p><b>RESULTS</b>a mean of 2.1 vertebrae were performed with VCD and a mean of 10.6 vertebral levels were instrumented and fused (range, 8 - 13 vertebrae). The mean duration of surgery was 270 minutes (range, 215 - 380 minutes). The average intraoperative blood loss was 1560 ml (range, 900 - 4800 ml). Complications were encountered in 4 patients. There were 2 cases with transient neurological deficits, 1 case with CSF leak, 1 case with epidural hematoma. The average time of follow-up was 31 months (range, 24 - 48 months). The correction rate was 61% on the coronal plane (from 108° to 42°), and the correction rate was 65% on the sagittal plane (from 82.0° to 28.7°). All patients had solid fusion at osteotomy site, and no instrumentational failure and loosening were found over the follow up.</p><p><b>CONCLUSION</b>single stage posterior VCD is an effective option to manage rigid scoliosis.</p>

The clinical outcomes of surgical treatment for adult idiopathic scoliosis using pedicle subtraction osteotomy / 中华外科杂志

<p><b>OBJECTIVE</b>to evaluate the clinical outcomes of transpedicular lumbar wedge resection osteotomy in treating adult idiopathic scoliosis.</p><p><b>METHODS</b>twenty-five adult idiopathic scoliosis patients treated with transpedicular lumbar wedge resection osteotomy from July 2001 to November 2007 were included, among whom 18 were female and 7 were male. Nine of 25 were with double major curve in thoracic and thoracolumbar/lumbar spine, and 16 were with single curve in thoracolumbar/lumbar spine. The average age was 35 years (29 - 48 years) at operation. Osteotomy were performed at T(11), T(12), L(1) or L(2). The motion evoked potential monitoring system and awaking test were used during surgery. The preoperative, postoperative immediately and latest standing posteroanterior and lateral radiographs were reviewed.</p><p><b>RESULTS</b>all patients were operated successfully. The average operation time was 274 min (range, 220 - 380 min) and the average blood loss were 2328 ml (range, 1500 - 5000 ml). The average coronal Cobb angle of all patients in thoracolumbar/lumbar curves was 88° (range, 70° - 121°) before operation, which was corrected to 43° (range, 35° - 70°). The coronal correction rate was 44%. The average kyphosis angle of all in thoracolumbar/lumbar curves was 63° (range, 50° - 90°) before operation, which was corrected to 10° (range, -40° - 21°). The sagittal correction rate was 86%. Nerve root injury occurred in 3 of all patients who complained about postoperative radicular pain. No spine cord injury, delayed paralysis, infection and instrumentation failure were found. With a follow-up of 2 - 4 years, no correction loss or decompensation happened. The back pain existing before operation was relieved in large measure. The cosmetic appearance were all promoted significantly.</p><p><b>CONCLUSIONS</b>the transpedicular thoracolumbar/lumbar wedge osteotomy is efficient and safe in the correction of adult idiopathic scoliosis. The correction is much better on the sagittal plane than that on the coronal plane.</p>

Transforming growth factor-β1 involved in urotensin II-induced phenotypic differentiation of adventitial fibroblasts from rat aorta / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Urotensin II (UII) is a new vasoconstrictive peptide that may activate the adventitial fibroblasts. Transforming growth factor-β1 (TGF-β1) is an important factor that could induce the phenotypical transdifferentiation of adventitial fibroblasts. This study aimed to explore whether TGF-β1 is involved in UII-induced phenotypic differentiation of adventitial fibroblasts from rat aorta.</p><p><b>METHODS</b>Adventitial fibroblasts were prepared by the explant culture method. TGF-β1 protein secretion from the cells was determined by enzyme-linked immunosorbent assay (ELISA). The mRNA and protein expression of α-smooth nuscle actin (α-SM-actin), the marker of phenotypic differentiation from fibroblasts to myofibroblasts, were determined using real-time quantitative RT-PCR (real-time RT-PCR) and Western blotting, respectively.</p><p><b>RESULTS</b>UII stimulated the secretion of TGF-β1 in cultured adventitial fibroblasts in a time-dependent manner. The secretion reached a peak at 24 hours, was higher by 69.8% (P < 0.01), than the control group. This effect was also concentration dependent. Maximal stimulation was reached at 10(-8) mol/L of UII (P < 0.01), which was increased by 59.9%, compared with in the control group (P < 0.01). The secretion of TGF-β1 induced by UII was significantly blocked by SB-710411 (10(-7) mol/L), a specific antagonist of UII receptor. In addition, both UII (10(-8) mol/L) and TGF-β1 significantly stimulated α-SM-actin mRNA and protein expression. Moreover, the α-SM-actin induced by UII was inhibited by the specific neutralizing antibody (20 µg/ml) of TGF-β1, while the α-SM-actin expression stimulated by TGF-β1 (20 ng/ml) was inhibited by SB-710411 (10(-7) mol/L), the UII receptor antagonist.</p><p><b>CONCLUSION</b>This study suggests that UII could induce TGF-β1 secretion in adventitial fibroblasts via UT activation, and TGF-β1 might be involved in phenotypic differentiation from adventitial fibroblasts into myofibroblasts induced by UII, and TGF-β1 signaling might be one of the important pathways by which UII is involved in vascular fibrosis.</p>

Correction of severe post-traumatic kyphosis by posterior vertebra column resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more important. Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity, no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region. Therefore, the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.</p><p><b>METHODS</b>From May 2004 to May 2006, 53 patients (38 male, 15 female) at an average age of 37.6 years (range, 24 to 66 years), were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital. Among them, 5 consecutive adult patients with severe post-traumatic kyphosis were included in this study. Operation time, blood loss and complications were noted in each case. Radiographic documentation was made on the basis of standing anterior-posterior (AP) and lateral views and three dimensional reconstruction images of computed tomography (CT) scans were used to further identify the apex region of a sharp angular deformity. Sagittal correction was assessed in terms of effective regional deformity (ERD) for the injury level. Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan. Preoperative and postoperative clinical assessments were performed by using Oswestry disability index (ODI), back pain was rated in all patients by the visual analog scale (VAS) preoperatively, postoperatively and at the latest follow-up.</p><p><b>RESULTS</b>The mean operating time was 265 minutes (220 - 408 minutes), with an average blood loss of 1362 ml (870 - 2570 ml). Each patient finished at least two years of follow-up. The average ERD significantly decreased from 69 degrees (58 degrees - 86 degrees ), preoperatively to 4 degrees (1 degrees - 8 degrees ) after surgery (P = 0.017); with a mean correction of 65 degrees . ERD averaged 10.4 degrees (7 degrees - 17 degrees ) at the latest follow-up with a mean loss of 6.4 degrees . VAS and ODI scores improved from preoperative 7.4 (6.0 - 9.0) and 55.2 (48.0 - 60.0) to 2.3 (1.0 - 4.0) and 12.2 (7.0 - 18.0) at the latest follow-up. Full bone fusion was achieved in all patients. Complications occurred in two patients: one had a transient weakness of the left side lower extremity and the symptom improved spontaneously without further treatment within one month; the other patient suffered a deep wound infection three weeks after the operation, and recovered well by additional debridement, continuous perfusion and drainage.</p><p><b>CONCLUSIONS</b>Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region. Nevertheless, this challenging procedure should be performed by experienced spinal surgeon to minimize complications.</p>

Modified posterior closing wedge osteotomy in patients of posttraumatic thoracic lumbar kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome of posterior trans-pedicle + disc osteotomy in patients with post-traumatic thoracolumbar kyphosis.</p><p><b>METHODS</b>Between June 2000 and June 2003, 26 adult patients, 16 male and 10 female, average 30.6 years old (21 - 42 y), of post-traumatic thoracolumbar kyphosis were corrected by means of single posterior trans-pedicle + disc osteotomy technique. Operation time, blood loss, and surgical complication were counted. Back pain Visual Analog Scale (VAS) Oswestry score and Frankel neurological grade were used to for clinical evaluation. All the radiographic and clinical data were requested at 3 time points (before operation, directly postoperatively, and at final follow-up).</p><p><b>RESULTS</b>No severe complications were found in this group. Local kyphosis (T(10)-L(2) Cobb angle) was corrected from average 22.3 degrees +/- 3.5 degrees to 2.2 degrees +/- 2.1 degrees (corrective rate 90.1%). Intraoperative average blood loss was (680.0 +/- 31.5) ml and average operational time was (186.0 +/- 22.8) min. All the patients finished at least 3 - 5 years follow-up, Neural improvement achieved in this group (before operation Frankel D 12 cases, Frankel C 6 cases and Frankel B2 cases; 3 years postoperation Frankel E 14 cases, Frankel D 2 cases Frankel C1 case and Frankel B 1 case), postoperative back pain was reduced from preoperative 8.6 +/- 1.3 to 2.2 +/- 0.5 in VAS and Oswestry score improved from (62.5 +/- 8.6)% to (16.2 +/- 4.3)% at last follow up.</p><p><b>CONCLUSION</b>Single posterior trans-pedicle + disc osteotomy technique is suitable to thoracolumbar post-traumatic kyphosis.</p>

An experimental study of correction of idiopathic-type scoliosis by staple / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of the correction idiopathic-type scoliosis by implanting the staple in growing animal models.</p><p><b>METHODS</b>Fourteen female goats were performed unilateral pedicle screws asymmetric tethering in left side in combination with right rib resection (age: 5 to 8 weeks, weight: 6 to 8 kg). The observing time was about 8 weeks. Goats that had been created scoliosis model successfully were classified in 2 groups randomly.</p><p><b>CONTROL GROUP</b>just removing the posterior tether, no treatment was offered. Correct group: the removing of posterior tether and the stapling of anterior spinal epiphysis were performed simultaneously. Dorsoventral and lateral plain radiographs were taken preoperatively and postoperatively. Serial X-ray postoperatively were performed every 4 weeks to measure the Cobb angle of the spine and to observe the condition of the insert. The observing time is about 8 weeks.</p><p><b>RESULTS</b>Radiography showed that 12 goats had created scoliosis model successfully. CONTROL GROUP (n = 6): Series X-ray show that the change of the Cobb angle was not obviously. The initial curves after the procedures measured an average of 40.8 degrees (28 degrees-56 degrees), the average Cobb angle was 42.5 degrees (30 degrees-58 degrees) after 8 weeks, no statistics difference are found (P > 0.05). Treatment group (n = 6): no complication such as pedicel screw break, instrument loosen, dislocation, injury of blood vessel, nerve injury and organ injury of thoracic cavity etc, were found during the observing period. The initial curves after the procedures measured an average of 44.5 degrees (36 degrees-57 degrees), to some degree, the Cobb angle decreased and the average was 42.5 degrees (30 degrees-58 degrees) after 8 weeks. There are statistics difference between the initial and final curves (P < 0.05).</p><p><b>CONCLUSION</b>As a means of mechanical modulation, stapling can be manipulate conveniently and safely, and can modulate the spinal growth of the animal model successfully, predicted that it may be a new selection for idiopathic-type scoliosis in growing children.</p>