PRL2 regulates neutrophil extracellular trap formation which contributes to severe malaria and acute lung injury.

Excessive host immune responses contribute to severe malaria with high mortality. Here, we show that PRL2 in innate immune cells is highly related to experimental malaria disease progression, especially the development of murine severe malaria. In the absence of PRL2 in myeloid cells, Plasmodium berghei infection results in augmented lung injury, leading to significantly increased mortality. Intravital imaging revealed greater neutrophilic inflammation and NET formation in the lungs of PRL2 myeloid conditional knockout mice. Depletion of neutrophils prior to the onset of severe disease protected mice from NETs associated lung injury, and eliminated the difference between WT and PRL2 CKO mice. PRL2 regulates neutrophil activation and NET accumulation via the Rac-ROS pathway, thus contributing to NETs associated ALI. Hydroxychloroquine, an inhibitor of PRL2 degradation alleviates NETs associated tissue damage in vivo. Our findings suggest that PRL2 serves as an indicator of progression to severe malaria and ALI. In addition, our study indicated the importance of PRL2 in NET formation and tissue injury. It might open a promising path for adjunctive treatment of NET-associated disease.

An Electrochemical Perspective of Aqueous Zinc Metal Anode.

Based on the attributes of nonflammability, environmental benignity, and cost-effectiveness of aqueous electrolytes, as well as the favorable compatibility of zinc metal with them, aqueous zinc ions batteries (AZIBs) become the leading energy storage candidate to meet the requirements of safety and low cost. Yet, aqueous electrolytes, acting as a double-edged sword, also play a negative role by directly or indirectly causing various parasitic reactions at the zinc anode side. These reactions include hydrogen evolution reaction, passivation, and dendrites, resulting in poor Coulombic efficiency and short lifespan of AZIBs. A comprehensive review of aqueous electrolytes chemistry, zinc chemistry, mechanism and chemistry of parasitic reactions, and their relationship is lacking. Moreover, the understanding of strategies for suppressing parasitic reactions from an electrochemical perspective is not profound enough. In this review, firstly, the chemistry of electrolytes, zinc anodes, and parasitic reactions and their relationship in AZIBs are deeply disclosed. Subsequently, the strategies for suppressing parasitic reactions from the perspective of enhancing the inherent thermodynamic stability of electrolytes and anodes, and lowering the dynamics of parasitic reactions at Zn/electrolyte interfaces are reviewed. Lastly, the perspectives on the future development direction of aqueous electrolytes, zinc anodes, and Zn/electrolyte interfaces are presented.

Clonorchis sinensis calcium-binding protein Cs16 causes acute hepatic injury possibly by reprogramming the metabolic pathway of bone marrow-derived monocytes.

Introduction: Clonorchis sinensis infection results in various complications in the liver and biliary systems and is a neglected tropical disease in Eastern Asia. In this study, we report that C. sinensis calcium-binding protein Cs16 activates host immune cells and induces immunopathology in liver. Methods: Immunohistochemistry was used to detect the localization of Cs16 in C. sinensis adult worms. ELISA was used to detect the serum levels of anti-Cs16 IgG antibody in infected humans and mice. Bile duct injection model was used to figure out the role of Cs16 in vivo. RT-qPCR and ELISA were used to detect the cytokine production from Cs16-treated BMMs in vitro. Seahorse assay was used to detect the metabolic pathway of Cs16-treated BMMs in vitro. Result: Cs16 localizes in the tegument and gut of C. sinensis. Humans and mice with C. sinensis infection exhibited increased levels of anti-Cs16-specific antibody. Using the bile duct injection technique, we found that Cs16 induced obvious inflammation and hepatic necrosis in vivo. Cs16 treatment caused the upregulation of inflammatory cytokines in innate immune cells. Moreover, Cs16-treated monocytes relied more on the glycolytic metabolic pathway. Discussion: Our findings suggest that Cs16 is a potential pathogenic factor derived from C. sinensis adult worm. By reprogramming the metabolic pathway of innate immune cells, Cs16 triggers pro-inflammatory responses in the liver, and therefore, Cs16 is a potential target for the prevention and treatment of clonorchiasis.

Interface Engineering with Quaternary Ammonium-Based Ionic Liquids toward Efficient Blue Perovskite Light-Emitting Diodes.

Perovskite light-emitting diodes (PeLEDs) have become a hot research topic in recent years and can now achieve an external quantum efficiency (EQE) of over 22% for green and red devices. However, the efficiency of blue PeLEDs, which are essential for display applications, lags far behind their green and red counterparts. The interface of the PeLEDs has a critical influence on the carrier transport and exciton recombination dynamics, and interface engineering is considered to be an effective strategy to improve the device performance. Herein, quaternary ammonium-based ionic liquids serve as an interfacial modification layer to significantly improve the device efficiency and stability. The interaction of quaternary ammonium cations with Pb(Br/Cl)6 octahedra promotes nucleation sites, which significantly improves the morphology of perovskite films and reduces the formation of defects in films. In addition, ion migration is also effectively suppressed in the device. As a result, with tributylmethylammonium bromide (TMAB) used as the interface layer, the EQE of the device is successfully increased from 3.5 to 6.7%, and the operational stability with a half-lifetime (T50) is increased by over 12 times. Our work provides a new class of interface modification materials toward high-performance blue PeLEDs.

Lattice strain modulation toward efficient blue perovskite light-emitting diodes.

The successful implementation of perovskite light-emitting diodes (PeLEDs) in advanced displays and lighting has proven to be challenging because of the inferior performance of blue devices. Here, we point out that a strained system would lead to the quasi-degenerate energy state to enhance the excited-state transition due to the formation of double-polarized transition channel. The tensile strained structure also brings about a synergetic control of the carrier dynamics in virtue of lattice structure deformation and reduced dimensional phase regulation to promote carrier population in large bandgap domains and to realize near-unit energy transfer from the large bandgap phases to the emitter phases. Accordingly, high external quantum efficiencies of 14.71 and 10.11% are achieved for the 488- and 483-nanometer PeLEDs. This work represents a versatile strategy using a strained system to achieve enhanced radiative emission for the development of efficient PeLEDs.

Thermodynamics Irreversibilities Analysis of Oxy-Fuel Diffusion Flames: The Effect of Oxygen Concentration.

In studies on the combustion process, thermodynamic analysis can be used to evaluate the irreversibility of the combustion process and improve energy utilization efficiency. In this paper, the combustion process of a laminar oxy-fuel diffusion flame was simulated, and the entropy generation due to the irreversibilities of the radiation process, the heat conduction and heat convection process, the mass diffusion process, and the chemical reaction process was calculated. The effect of the oxygen concentration in the oxidizer on the entropy generation was analyzed. The results indicated that, as the oxygen concentration in the oxidizer increases, the radiative entropy generation first increases and then decreases, and the convective and conductive entropy generation, the mass diffusion entropy generation, the chemical entropy generation, and the total entropy generation gradually increase.

Targeting Filamin A alleviates ovariectomy-induced bone loss in mice via the WNT/ß-catenin signaling pathway.

Osteoporosis (OP) is a worldwide prevalent chronic metabolic bone disease, causing by a disruption of the balance between bone resorption and formation. Estrogen deficiency and aging are the main causes for disturbances in bone remodeling activity and bone loss, however, the mechanisms underlying bone remodeling regulation require clarification if novel targets for OP treatment are to be identified. In this investigation, we showed that filamin A (FLNA) accumulated in osteoblasts (OBs) and osteoclasts (OC) in bone from human OP samples, and mice with age-related and postmenopausal OP. FLNA negatively modulated in vitro osteogenic differentiation and positively promoted RANKL-induced osteoclastic differentiation. Mechanistically, FLNA interacted with low-density lipoprotein receptor-related proteins 6 (LRP6) to inhibit ß-catenin expression, and enhanced nuclear factor of activated T cell c1 (NFATc1)-dependent osteoclastogenic gene expression to inhibit osteogenesis, and promote osteoclastogenesis. Inhibiting FLNA with calpeptin activated WNT/ß-catenin signaling, resulting in prominent protective effects of bone loss in ovariectomy (OVX)-induced postmenopausal OP mice. Our findings revealed that FLNA not only participated in OP pathogenesis, but could be a new target to stimulate bone formation and inhibit bone resorption. Targeting FLNA with calpeptin may be a promising therapeutic approach for postmenopausal OP in the future.

Preliminary outcomes of allograft and hydroxyapatite as substitutes for autograft in anterior cervical discectomy and fusion with self-locking standalone cages.

PURPOSE: To investigate the efficacy and safety of allograft and hydroxyapatite (HA) as substitutes for autograft in anterior cervical discectomy and fusion (ACDF). METHODS: In this study, 49 patients (80 segments) treated with ACDF were included and allocated into three groups [group A, autogenous iliac bone, n = 18; group B, allogeneic bone, n = 16; group C, HA, n = 15]. The clinical efficacy and fusion status were compared among each group. Complications were recorded in detail, and the Bazaz classification and Voice Handicap Index-10 (VHI-10) were used to detect dysphagia and dysphonia. RESULTS: Patients exhibited similar clinical efficacy among the groups during the final follow-up. All patients in groups A and B achieved fusion compared to only 73.3% of patients in group C. Groups A and B had similar fusion score, both of which greater than that of group C. No cage subsidence was observed in group A; however, 6.3% of patients in group B and 53.3% in group C had cage subsidence. Two patients in group A (11.1%) had persistent pain at the donor site. One patient in group B had dysphagia and dysphonia (6.3%), while one patient in group C had dysphonia (6.7%). CONCLUSION: In ACDF, the autogenous iliac bone was the most ideal bone graft. The allogeneic bone was an acceptable substitute but risked cage subsidence and dysphagia. HA had a much lower fusion rate and a high risk of cage subsidence. Better substitutes should be further explored for ACDF.

Luminescent, Wide-Band Gap Solar Cells with a Photovoltage up to 1.75 V through a Heterostructured Light-Absorbing Layer.

The development of photovoltaic devices with a high output voltage offers great opportunities for emerging internet of things (IoT) sensors and low-power-consumption electronics. However, the photovoltage of solar cells is yet to satisfy the requirement of driving voltage for most applications. Here, we demonstrate a wide-band gap CsPbBr3-based solar cell with a heterostructured light absorber based on amino acid-modulated CsPbBr3 and CdSe quantum dots (QDs). Compared with the single absorbing layer device, the heterostructured device exhibits a low nonradiative recombination loss, which is strongly correlated to the high external electroluminescence of the device. In addition, in the heterostructured solar cells, carrier transfer from the perovskite to CdSe QDs induces the conduction band bending of CdSe QDs, leading to a large splitting of the quasi-Fermi levels. As a result, a remarkable photovoltage up to 1.75 V is achieved for the wide-band gap solar cells, representing an extremely low voltage deficit of 250 mV. Furthermore, the CsPbBr3-based solar cells exhibit a weak light intensity dependence, showing a photovoltage of 1.59 V under room light conditions. Our work not only provides an effective approach for the design of high-photovoltage solar cells but also paves the ways of using photovoltaic devices for various applications with low driving voltage schemes.

Increased Osteoblastic Cxcl9 Contributes to the Uncoupled Bone Formation and Resorption in Postmenopausal Osteoporosis.

INTRODUCTION: Estrogen deficiency leads to bone loss in postmenopausal osteoporosis, because bone formation, albeit enhanced, fails to keep pace with the stimulated osteoclastic bone resorption. The mechanism driving this uncoupling is central to the pathogenesis of postmenopausal osteoporosis, which, however, remains poorly understood. We previously found that Cxcl9 secreted by osteoblasts inhibited osteogenesis in bone, while the roles of Cxcl9 on osteoclastic bone resorption and osteoporosis are unclear. MATERIALS AND METHODS: Postmenopausal osteoporosis mouse model was established by bilateral surgical ovariectomy (OVX). In situ hybridization was performed to detect Cxcl9 mRNA expression in bone. ELISA assay was conducted to assess Cxcl9 concentrations in bone and serum. Cxcl9 activity was blocked by its neutralizing antibody. Micro-CT was performed to determine the effects of Cxcl9 neutralization on bone structure. Cell Migration and adhesion assay were conducted to evaluate the effects of Cxcl9 on osteoclast activity. TRAP staining and Western blot were performed to assess osteoclast differentiation. CXCR3 antagonist NBI-74,330 or ERK antagonist SCH772984 was administered to osteoclast to study the effects of Cxcl9 on CXCR3/ERK signaling. RESULTS: Cxcl9 was expressed and secreted increasingly in OVX mice bone. Neutralizing Cxcl9 in bone marrow prevented bone loss in the mice by facilitating bone formation as well as inhibiting bone resorption. In vitro, Cxcl9 secreted from osteoblasts facilitated osteoclast precursors adhesion, migration and their differentiation into mature osteoclasts. The positive role of osteoblastic Cxcl9 on osteoclasts was eliminated by blocking CXCR3/ERK signaling in osteoclasts. Estrogen negatively regulated Cxcl9 expression and secretion in osteoblasts, explaining the increased Cxcl9 concentration in OVX mice bone. CONCLUSION: Our study illustrates the roles of Cxcl9 in inhibiting bone formation and stimulating bone resorption in osteoporotic bone, therefore providing a possible therapeutic target to the treatment of postmenopausal osteoporosis.

Introducing Ion Migration and Light-Induced Secondary Ion Redistribution for Phase-Stable and High-Efficiency Inorganic Perovskite Solar Cells.

Inorganic halide perovskites have been demonstrated as a promising alternative for light absorption because of their improved thermal stability compared with organic-inorganic halide perovskites. However, low power conversion efficiency and phase instability are major hindrances to their application. Here, a straightforward approach, by adding a layer of CsBr on the top of CsPbI3, is reported for high-efficiency and phase-stable CsPbI3-based solar cells. Characterizations demonstrate that the bromide ion can migrate from the surface into the bulk of CsPbI3, mitigating the nonuniform depth distribution of iodide in the CsPbI3 absorber and passivating the bulk defects. Impressively, the light illumination can induce secondary-ion redistribution, which is identified as a crucial process to further enhance the carrier extraction efficiency, strengthen the lattice stability, and improve the film homogenization. Accordingly, a high efficiency of 17% is obtained for the CsPbI3-based solar cell. Moreover, the unencapsulated device exhibits remarkable phase stability, maintaining 93% of its initial efficiency under room temperature after being stored in the nitrogen glovebox for over 5000 h.

The anatomical mechanism of C5 palsy after expansive open-door laminoplasty.

BACKGROUND: Postoperative C5 palsy is not an uncommon complication in patients who undergo expansive open-door laminoplasty. However, the etiology is unclear and likely multifactorial. Nerve root lesions and spinal cord lesions have been previously proposed theories. PURPOSE: To investigate the anatomical mechanism of postoperative C5 palsy after cervical expansive open-door laminoplasty. STUDY DESIGN: A dissection-based study of eight embalmed human cadavers. METHODS: The anatomy was studied in eight whole cervical cadavers (three females, five males), prepared with formaldehyde, whose ages at the time of death ranged from 54 to 78 years. Dissection was performed on the intervertebral foramen and spinal canal. In the C3-C7 of the cervical vertebra, the extraforaminal ligaments and the meningovertebral ligaments were observed. The length, width, and thickness of the ligaments were measured with a Vernier caliper. After an expansive open-door laminoplasty was performed, the shape of the dural sac was changed, and displacement of the nerve root was observed. In addition, the lengths of the anterior rootlets were measured. This study has been supported by grants from Science and Technology Planning Project of Guangdong Province (CN) (Grant No. 2017B020210010) without potential conflict of interest-associated biases in the text of the paper. RESULTS: One hundred seventy-seven extraforaminal ligaments were found to connect the spinal nerve to the surrounding structures. After an expansive open-door laminoplasty was performed, posterior distension of the dural sac and movement of the spinal cord and nerve root were found. The spinal cord was closely attached to the ligamentum flavum by meningovertebral ligaments. In addition, the length of the C5 intradural rootlets (5.81-10.59 mm) was the shortest among the vulnerable segments. CONCLUSION: Traction on and posterior movement of the extradural roots may be the main pathologic mechanism of postoperative C5 palsy when expansive open-door laminoplasty is performed. The meningovertebral ligaments and extraforaminal ligaments might play an important role in the occurrence of postoperative C5 palsy. CLINICAL SIGNIFICANCE: This study provides clinicians with a more detailed understanding of the anatomic structure and potential mechanism of C5 palsy. Consideration of the meningovertebral ligaments and the intervertebral foramen may provide new directions for reducing the incidence of this complication.

The Anatomical Study and Clinical Significance of the Sinuvertebral Nerves at the Lumbar Levels.

STUDY DESIGN: A dissection-based study of 10 embalmed human cadavers. OBJECTIVE: The purpose of this study was to describe the sinuvertebral nerves at the lumbar level and to discuss their possible clinical significance. SUMMARY OF BACKGROUND DATA: Discogenic low-back pain is mediated by the sinuvertebral nerves. However, the detailed descriptions of the sinuvertebral nerves at the lumbar level are lacking. METHODS: One hundred L1-L5 intervertebral foramina from 10 embalmed cadavers were studied. The presence of the sinuvertebral nerves was noted. The quantity, origin, pathway, innervation range, and spatial orientations of the sinuvertebral nerves in the L1-L5 intervertebral foramina were examined. RESULTS: A total of 450 sinuvertebral nerves were identified in the 100 lumbar intervertebral foramina; sinuvertebral nerves were observed in 100.00% of the intervertebral foramina. The sinuvertebral nerves were routinely divided into the following two types: the sinuvertebral nerve deputy branch and sinuvertebral nerve main trunk. Three hundred twelve sinuvertebral nerve deputy branches were found; on average, there were approximately 3.12 (range, 1-8) branches in each intervertebral foramen. One hundred thirty-eight sinuvertebral nerve main trunks were found, and sinuvertebral nerve main trunks were observed in 97.00% of the intervertebral foramina. The initial portion of the sinuvertebral nerve was located along the posterior-lateral edge of the disc to the spinal canal. Sixty-one (44.20%) sinuvertebral nerve main trunks originated from the starting point of the gray ramus communicans of the nerve root; 77 (55.80%) sinuvertebral nerve main trunks originated from the anterior surface of the spinal ganglia of the nerve root. CONCLUSION: This is a systematic anatomy study that describes the sinuvertebral nerve at the lumbar level and may be of clinical importance to spinal surgeons. A comprehensive understanding of the distribution of sinuvertebral nerves may lead to significant benefits for patients undergoing percutaneous endoscopic treatment for discogenic low-back pain. LEVEL OF EVIDENCE: 4.

Normalized Lithium Growth from the Nucleation Stage for Dendrite-Free Lithium Metal Anodes.

Inducing uniform deposition of lithium from the stage of metal crystallization nucleation is of vital importance to achieve dendrite-free lithium anodes. Herein, using experiments and simulation, homogenization of Li nucleation and normalization of Li growth can be achieved on PNIPAM polymer brushes with lithiophilic functional groups modified Cu substrates. The lithiophilic functional groups of amide O can homogenize ion mass transfer and induce the uniform distribution of Li nucleation sites. What is more, the ultra-small space between each brush can act as the channels for Li transportation and normalization growth. Owing to the synergistic effect of homogenization and normalization of electrodeposited Li, the obtained planar columnar Li anode exhibits excellent cycle stability at an ultra-high current density of 20 mA cm-2 .

Orcinol glucoside facilitates the shift of MSC fate to osteoblast and prevents adipogenesis via Wnt/ß-catenin signaling pathway.

BACKGROUND: During osteoporosis, bone mesenchymal stem cells (BMSCs) lineage commitment shifts to adipocytes, causing fat accumulation and bone loss in the skeleton. Seeking drugs that could reverse the adipocyte fate determination of BMSCs is critical for osteoporosis therapy. As a traditional Chinese medicine, Rhizoma Curculiginis (Xianmao) has been used to treat bone diseases and promote bone healing, while the effective constituent of it and the underlying mechanisms are unknown. OBJECTIVES: The aim of this study is to unveil the role of orcinol glucoside (OG), one constituent of Rhizoma Curculiginis, in osteoporosis and BMSCs lineage commitment and to explore the underlying mechanisms. METHODS: Micro-CT and three-point bending test were performed to determine the effect of OG on bone structure and strength. qT-PCR and Western blot were performed to determine the expression of osteogenic or adipogenic differentiation markers in BMSCs. Mineralization in differentiated BMSCs was assessed by Alizarin Red staining, and lipid accumulation in the cells was evaluated by Oil Red O staining. All measurements were performed at least three times. RESULTS: OG prevented bone loss by stimulating bone formation and attenuating fat formation in bone. In vitro, OG promoted osteoblastic differentiation and inhibited adipogenic differentiation of BMSCs. Inhibition of Wnt/ß-catenin by ICG-001 significantly reversed the effect of OG on osteogenic and adipogenic differentiation of BMSCs. CONCLUSION: Our study demonstrated the role of OG in alleviating bone loss and fat accumulation in osteoporotic bone, therefore bringing a new therapeutic means to the treatment of osteoporosis.

Li2O-Reinforced Solid Electrolyte Interphase on Three-Dimensional Sponges for Dendrite-Free Lithium Deposition.

Lithium (Li) metal, with ultra-high theoretical capacity and low electrochemical potential, is the ultimate anode for next-generation Li metal batteries. However, the undesirable Li dendrite growth usually results in severe safety hazards and low Coulombic efficiency. In this work, we design a three-dimensional CuO@Cu submicron wire sponge current collector with high mechanical strength SEI layer dominated by Li2O during electrochemical reaction process. The 3D CuO@Cu current collector realizes an enhanced CE of above 91% for an ultrahigh current of 10 mA cm-2 after 100 cycles, and yields decent cycle stability at 5 C for the full cell. The exceptional performances of CuO@Cu submicron wire sponge current collector hold promise for further development of the next-generation metal-based batteries.

Neural stem cell transplantation combined with erythropoietin for the treatment of spinal cord injury in rats.

Spinal cord injury (SCI) comprises nerve and motor function disorders that may be caused by a variety of damaging factors and is challenging to treat. The aim of the present study was to investigate the regenerative effects of neural stem cell (NSC) transplantation combined with intraperitoneal injection of erythropoietin (EPO) on cross-sectional SCI in rats. A model of SCI was induced in 40 adult Wistar rats via the complete transection of the 10th thoracic vertebra (T10). The rats were allocated at random into 4 groups: Control, NSC, EPO and NSC + EPO groups (n=10 per group). Morphological alterations associated with axonal regeneration were detected using neurofilament (NF)-200 immunohistochemistry and immunofluorescence staining after 8 weeks. Basso, Beattie and Bresnahan (BBB) scoring was used to evaluate the recovery of hindlimb function. A total of 5 rats died following surgery, including 2 control rats and 1 rat each in the EPO, NSC and NSC + EPO groups. NSCs labeled with bromodeoxyuridine were observed to have survived and migrated in the spinal cord tissue after 8 weeks. Significant histomorphological differences were observed in the NSC and NSC + EPO groups compared with the EPO and control groups. Furthermore, the rats of the NSC + EPO group exhibited significantly enhanced axonal regeneration in the SCI area compared with the NSC group rats. The rats of the NSC and NSC + EPO groups exhibited significantly improved BBB scores compared with the EPO and control group rats at 7 days after treatment (P<0.05). In addition, the BBB scores of the NSC + EPO group were significantly improved compared with those of the three other groups at 7 days after surgery (P<0.05). Therefore, the results of the present study suggest that NSC transplantation combined with intraperitoneal injection of EPO may benefit the survival and regeneration of injured axons, and accelerate the repair of injured spinal cord tissue, thus facilitating the functional recovery of hindlimb locomotor function in rats.

[Preliminary study for classification of spino-pelvic sagittal alignment in adult volunteers].

OBJECTIVE: To investigate the feasibility of the classification of the spino-pelvic sagittal alignment in adluts according to lumbar lordosis (LL) and inflection point (IP). METHODS: Whole spine, standing radiographs of 223 adult volunteers were taken from July to August in 2011 .There were 111 cases(56 female and 55 male) enrolled in the study based on the inclusion criteria. The pelvic and spinal parameters, including thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), LL, sacral slope(SS), pelvic tilt(PT), pelvic incidence(PI), intervertebral endplate angle, sagittal vertical axis (SVA), spino-sacral angle (SSA) and IP were measured. The spino-pelvic sagittal alignment were classified in to 3 types according to LL and IP. Type I: LL > -40°, IP located below L2 ∼ 3; Type II: -60° ≤ LL ≤ -40°, IP located in L1 ∼ 2 or T12 ∼ L1; Type III: LL < -60°, P located above T11 ∼ 12. Pearson correlation analysis was used to test the correlation between the variables. The parameters in each type were compared by oneway-ANOVA respectively,then additional multiple comparisons were performed. RESULTS: The mean value of LL was -49° ± 10°, TK was 36° ± 7°, TLK was 6° ± 7°, PT was 11° ± 7°, SS was 34° ± 8°, PI was 45° ± 9°, SSA was 127° ± 9° and SVA was (-2.7 ± 22.8)mm, respectively. Only LL had significant statistical correlation with all the other parameters. Negative correlation presented between LL and TK, PI, SS, SSA (r = -0.387, -0.536, -0.858, -0.801,P < 0.05). Positive correlation presented between LL and TLK, SVA, PT (r = 0.319, 0.296, 0.262, P < 0.05). All the volunteers were classified into the 3 types: Type I1 9 cases, Type II 75 cases,Type III 17 cases. Oneway-ANOVA results showed statistical difference in LL, TK, TLK, PT, SS, PI, SSA, SVA among the 3 types, (F = 164.559, 7.431, 14.099, 4.217, 53.856, 6.252, 35.995, 8.626, P < 0.05 ). Multiple comparisons showed that LL, SS, SSA, PI had statistical difference between each two types comparison (P < 0.05). CONCLUSIONS: LL is the central parameter of the spino-pelvic sagittal balance. The patterns of the spino-pelvic sagittal alignment in adults could be classified into three types, according to LL and IP. The classification could describe the morphological differences and balance of the spino-pelvic sagittal alignment.

[Preliminary clinical results of endoscopic assisted anterior lumbar interbody fusion].

OBJECTIVE: To summarize the experiences of endoscopic assisted anterior lumbar interbody fusion (ALIF) with self-locking cage via retroperitoneal approach through small incision lateral to abdominal rectus. METHODS: There were 47 cases of endoscopic assisted ALIF from April 2010 to April 2012 were reviewed retrospectively, including 28 male and 19 female patients whose age ranged from 39 to 65 years, averaged of (48 ± 11) years. Of 47 cases, 17 cases were founded instability in lumbar spine, 16 cases of discogenetic low back pain, 7 cases of degenerative spondylolithesis, and 7 cases of recurrent disc herniation. The level involved included 7 cases at L3-4 level, 33 cases at L4-5 level, 7 cases at L5-S1. X-ray and/or 3D CT scan were done in each patient at post-operative day 4, 1 month, 3 months, and 6 months. The height and angle of disc space, angle of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were recorded and measured, as well as length of incision, operation time, blood loss, complications and ratio of bone graft fusion. The clinical outcomes were evaluated by Oswestry disability index (ODI) and visual analogue scale (VAS). RESULTS: Average length of incision was (6.2 ± 0.8)cm (5.3-7.8 cm) , average blood loss was (81 ± 20)ml (50-150 ml) , mean operation time was (96 ± 10)minutes (65-122 minutes) . There were significant improvement of ODI(48% ± 10% vs. 14% ± 5%), the VAS of back pain(6.3 ± 1.1 vs.0.7 ± 0.7) and VAS of leg pain(3.4 ± 2.1 vs.0.6 ± 0.6) during preoperative and postoperation last follow-up (t = 20.78, 25.92 and 8.74, P = 0.000). The disc height of operative segments were all recovered significantly (F = 18.971, P = 0.000) postoperatively, from preoperative (10.3 ± 2.4)mm to postoperative (12.6 ± 2.1)mm. For complications, 5 cases had peritoneum tear, 19 cases had bone donor site pain, 14 cases had abdominal distension and 5 cases had lower limb paraesthesia, which were all treated with supportive managements. Bony intervertebral fusion was obtained in all cases in 6 months postoperatively. CONCLUSIONS: The advantages of endoscopic assisted ALIF with self-locking cage via retroperitoneal approach are less damage, rapid recovery, and less blood loss. Comparing with traditional ALIF procedure, the view of operative field is also improved.

[The use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy].

OBJECTIVE: To investigate the use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy. METHODS: From April 2008 to March 2010, anterior cervical discectomy and fusion with self-locking cages were performed on 45 patients who suffered from multi-segmental cervical myelopathy, among of them there were 23 male and 22 female, aged from 32 to 67 years (average 53 years). Recording the Japanese Orthopedic Association (JOA) scores and SF-36 scores in the protocol time point, in order to investigate the clinical outcome, meanwhile, accumulating the pre-operation and postoperation X-ray films of cervical spine for measuring the height of intervertebral space, whole curvature of cervical spine and the rate of fusion by repeated measures analysis of variance. RESULTS: The mean follow-up time was 28.4 months (24 - 35 months). JOA scores ascended from preoperative 6.5 ± 3.1 to postoperative 13.4 ± 1.7 (F = 17.84, P = 0.001), the 7 scores of SF-36 improved significantly after operation (t = 1.151 - 12.207, P < 0.05), but mental health not. The fineness rate was 91.1%. Height of disc space ascended from preoperative (5.5 ± 1.8) mm to postoperative (8.3 ± 0.8) mm (F = 11.71, P = 0.043), globle curvature of cervical spine ascended from preoperative 5° ± 7° to postoperative 10° ± 14° (F = 234.53, P = 0.000), the change of the two index was significantly, respectively. Fat necrosis in one case and hematoma in another case at the bone donor-site were found, both of the two cases were cured by physiotherapy. All of the 45 cases (111 segments) achieved bone fusion. CONCLUSION: The use of anterior cervical discectomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy possess many advantages as follows: satisfactory clinical outcome, minimally invasive, higher fusion rate, higher orthopaedic ability.