Achieving Ideal and Environmentally Stable n-Type Charge Transport in Polymer Field-Effect Transistors.

Realizing ideal charge transport in field-effect transistors (FETs) of conjugated polymers is crucial for evaluating device performance, such as carrier mobility and practical applications of conjugated polymers. However, the current FETs using conjugated polymers as the active layers generally show certain non-ideal transport characteristics and poor stability. Here, ideal charge transport of n-type polymer FETs is achieved on flexible polyimide substrates by using an organic-inorganic hybrid double-layer dielectric. Deposited conjugated polymer films show highly ordered structures and low disorder, which are supported by grazing-incidence wide-angle X-ray scattering, near-edge X-ray absorption fine structure, and molecular dynamics simulations. Furthermore, the organic-inorganic hybrid double-layer dielectric provides low interfacial defects, leading to excellent charge transport in FETs with high electron mobility (1.49 ± 0.46 cm2 V-1 s-1) and ideal reliability factors (102 ± 7%). Fabricated polymer FETs show a self-encapsulation effect, resulting in high stability of the FET charge transport. The polymer FETs still work with high mobility above 1 cm2 V-1 s-1 after storage in air for more than 300 days. Compared with state-of-the-art conjugated polymer FETs, this work simultaneously achieves ideal charge transport and environmental stability in n-type polymer FETs, facilitating rapid device optimization of high-performance polymer electronics.

Controlling Solution-State Aggregation and Solid-State Microstructures of Conjugated Polymers by Tuning Backbone Conformation.

Molecular ordering of conjugated polymers both in solution-state aggregates and in solid-state microstructures is a determining factor of the charge transport properties in optoelectronic devices. However, the effect of backbone conformation in conjugated polymers on assembly structures is still unclear. Herein, to understand such backbone conformation effect, three novel chlorinated benzodifurandionge-based oligo(p-phenylene vinylene) (BDOPV) polymers are systematically developed. These BDOPV-based polymers exhibit significantly twisted backbone conformation (near 90° interunit torsion angle) between conjugated units, which can prevent polymer chains from forming ordered assembly structures by increasing conformational energy penalty in closely packed chains. A higher rotational barrier of the torsion angle would further prevent polymer chains from assembling, finally resulting in nonaggregated chains in solution and highly disordered solid-state packing structures. This work will deepen the understanding of the relationship between polymer backbone conformation and assembly structures, contributing to the exploration of the structure-property relationship of polymers.

Regulation of High Miscibility for Efficient Charge-Transport in n-Doped Conjugated Polymers.

Strong interchain interactions of conjugated polymers usually result in poor miscibility with molecular dopants, limiting the doping efficiency because of uncontrolled phase separation. We have developed a strategy to achieve efficient charge-transport and high doping miscibility in n-doped conjugated polymers. We solve the miscibility issue through disorder side-chains containing dopants better. Systemic structural characterization reveals a farther side-chain branching point will lead to higher disorders, which provides appropriate sites to accommodate extrinsic molecular dopants without harming original chain packings and charge-transport channels. Therefore, better sustainability of solid-state microstructure is obtained, yielding a stable conductivity even when overloading massive dopants. This work highlights the importance of realizing high host-dopant miscibility in molecular doping of conjugated polymers.

Seed oil of Brucea javanica induces apoptosis through the PI3K/Akt signaling pathway in acute lymphocytic leukemia Jurkat cells.

Brucea javanica oil emulsion (BJOE) has been used to treat tumor in China for more than 40 years. However, its components and effectiveness in the treatment of acute lymphocytic leukemia (ALL) and its mechanism of anti-cancer activity remain unknown. In the current study, high-performance liquid chromatography-evaporative light scattering detector (HPLC-ELSD) was used to analyze the components of BJOE. Then, the anti-leukemia effects of BJOE were examined both in vitro and in vivo using ALL Jurkat cells and the p388 mouse leukemia transplant model, respectively. The primary ALL leukemia cells were also used to confirm the anti-leukemia effects of BJOE. The apoptotic-related results indicated that BJOE induced apoptosis in Jurkat cells and were suggestive of intrinsic apoptotic induction. Moreover, BJOE inhibited Akt (protein kinase B) activation and upregulated its downstream targets p53 and FoxO1 (forkhead box gene, group O-1) to initiate apoptosis. The activation of GSK3ß was also involved. Our findings demonstrate that BJOE has anti-leukemia effects on ALL cells and can induce apoptosis in Jurkat cells through the phosphoinositide3-kinase (PI3K) /Akt signaling pathway.

Correlating Charge Transport Properties of Conjugated Polymers in Solution Aggregates and Thin-Film Aggregates.

The role of solution aggregates on the charge transport process of conjugated polymers in electronic devices has gained increasing attention; however, the correlation of the charge carrier mobilities between the solution aggregates and the solid-state films remains elusive. Herein, three polymers, FBDOPV-2T, FBDOPV-2F2T, and FBDOPV-4F2T, are designed and synthesized with distinct aggregation behavior in solution. By combining contact-free ultrafast terahertz (THz) spectroscopy and field-effect transistor measurements, we track the charge carrier mobility of the aggregates of these polymers from the solution to the thin-film state. Remarkably, the mobility of these three polymers is found to follow nearly the same trend (FBDOPV-2T>FBDOPV-2F2T≫FBDOPV-4F2T) in both solutions and thin-film states. The quantitative mobility correlation indicates that the charge transport properties of solution aggregates play a critical role in determining the thin-film charge transport properties and final device performance. Our results highlight the importance of investigating and controlling solution aggregation structures towards efficient organic electronic devices.

Multi-level aggregation of conjugated small molecules and polymers: from morphology control to physical insights.

Aggregation of molecules is a multi-molecular phenomenon occurring when two or more molecules behave differently from discrete molecules due to their intermolecular interactions. Moving beyond single molecules, aggregation usually demonstrates evolutive or wholly emerging new functionalities relative to the molecular components. Conjugated small molecules and polymers interact with each other, resulting in complex solution-state aggregates and solid-state microstructures. Optoelectronic properties of conjugated small molecules and polymers are sensitively determined by their aggregation states across a broad range of spatial scales. This review focused on the aggregation ranging from molecular structure, intermolecular interactions, solution-state assemblies, and solid-state microstructures of conjugated small molecules and polymers. We addressed the importance of such aggregation in filling the gaps from the molecular level to device functions and highlighted the multi-scale structures and properties at different scales. From the view of multi-level aggregation behaviors, we divided the whole process from the molecule to devices into several parts: molecular design, solvation, solution-state aggregation, crystal engineering, and solid-state microstructures. We summarized the progress and challenges of relationships between optoelectronic properties and multi-level aggregation. We believe aggregation science will become an interdisciplinary research field and serves as a general platform to develop future materials with the desired functions.

Competency Model of Physical Therapists in China: An Exploratory Research / 中国康复理论与实践

Objective:To construct the competency model of physical therapists in China. Methods:A set of physical therapists' competency elements was established based on literature review and expert interviews. A questionnaire was designed based on the set, and 641 rehabilitation practitioners were investigated (521 valid questionnaires returned) with the questionnaire. Exploration factor analysis was used to construct the competency model of physical therapists, and confirmatory factor analysis was used to confirmed. Results:The set of physical therapists' competency elements included 74 elements in four dimensions. There were 44 competency elements in the competency model of physical therapists, including five dimensions that were Professionalism and Moral Conduct, Knowledge and Skills of Evaluation and Intervention, Abilities of Educational-Research and Advocate, Abilities of Cooperation and Management, and Basic Knowledge of Discipline, covering 74.41% of the total variance. The Cronbach's α coefficient of the whole questionnaire and each dimension was more than 0.8. Model fitness indexes of confirmatory factor analysis were as follow: χ2/df = 2.340, Root Mean Square Error of Approximation = 0.060, Goodness of Fit Index = 0.746, Normed Fit Index = 0.811, Incremental Fit Index = 0.850, Comparative Fit Index = 0.850. Conclusion:The competency model can provide a basis for physical therapists to become independent occupation, as well as for the education, selection, evaluation of physical therapists in China.

Ordered Solid-State Microstructures of Conjugated Polymers Arising from Solution-State Aggregation.

Controlling the solution-state aggregation of conjugated polymers for producing specific microstructures remains challenging. Herein, a practical approach is developed to finely tune the solid-state microstructures through temperature-controlled solution-state aggregation and polymer crystallization. High temperature generates significant conformation fluctuation of conjugated backbones in solution, which facilitates the polymer crystallization from solvated aggregates to orderly packed structures. The polymer films deposited at high temperatures exhibit less structural disorders and higher electron mobilities (up to two orders of magnitude) in field-effect transistors, compared to those deposited at low temperatures. This work provides an effective strategy to tune the solution-state aggregation to reveal the relationship between solution-state aggregation and solid-state microstructures of conjugated polymers.

Wafer-Scale Fabrication of High-Performance n-Type Polymer Monolayer Transistors Using a Multi-Level Self-Assembly Strategy.

Wafer-scale fabrication of high-performance uniform organic electronic materials is of great challenge and has rarely been realized before. Previous large-scale fabrication methods always lead to different layer thickness and thereby poor film and device uniformity. Herein, the first demonstration of 4 in. wafer-scale, uniform, and high-performance n-type polymer monolayer films is reported, enabled by controlling the multi-level self-assembly process of conjugated polymers in solution. Since the self-assembly process happened in solution, the uniform 2D polymer monolayers can be facilely deposited on various substrates, and theoretically without size limitations. Polymer monolayer transistors exhibit high electron mobilities of up to 1.88 cm2 V-1 s-1 , which is among the highest in n-type monolayer organic transistors. This method allows to easily fabricate n-type conjugated polymers with wafer-scale, high uniformity, low contact resistance, and excellent transistor performance (better than the traditional spin-coating method). This work provides an effective strategy to prepare large-scale and uniform 2D polymer monolayers, which could enable the application of conjugated polymers for wafer-scale sophisticated electronics.

Lumbar Scoliosis Induction in Juvenile Dogs by Three-dimensional Modulation of Spinal Growth Using Nickel-Titanium Coil Springs.

BACKGROUND: Current treatments for scoliosis have some defects and complications. To study spinal deformities and test novel scoliosis treatments, many animal models of scoliosis have been developed. These models applied a single load to the spine and could not precisely modulate the spinal growth in different dimensions. In this study, we applied posterior tethering in various directions with the application of nickel-titanium (NT) coil springs in dog's spine to modulate spinal growth in the coronal, sagittal, and transverse planes and create a scoliosis model possess curves that mimic adolescent idiopathic scoliosis (AIS) three dimensionally. METHODS: Scoliosis was surgically induced in eight 8-week-old female dogs (weight: 1.95-2.30 kg) using bone screws and NT coil springs. The deformity was induced through the placement of posterior NT coil springs that tethered the spine by bone screw fixation. All dogs were monitored with serial radiographs to document changes in deformities. RESULTS: All experimental animals developed scoliotic curves convex to the left in the lumbar segment. The mean coronal Cobb angle was 18.0° immediately postoperatively and 54.5° at 22 weeks. The mean lordosis increased from 6.2° postoperatively to 35.0° at final follow-up. Apical axial rotation increased from 4.5° postoperatively to 31.2° at 22 weeks. CONCLUSIONS: With the application of NT springs in dogs that allowed posterior tethering in various directions, lumbar spinal deformity was achieved in three planes: coronal, sagittal, and transverse planes. Notably, the lumbar spine in surgically treated dogs developed lordoscoliosis with obvious rotation and the curves mimic AIS three dimensionally well. This method allows lumbar scoliosis to develop without deep dissection of muscle and maintains the essential anatomical elements along the spinal curve. Moreover, the spinal growth modulation technique could yield information that would provide a basis for developing novel early-stage treatments for children with scoliosis.

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis.

OBJECTIVE: Conventional open spinal surgery of adult scoliosis can be performed from anterior, posterior, or combined approach. Minimally invasive spine surgery (MISS) was developed for the purpose of reducing the undesirable effects and complications. This review aimed to make a brief summary of recent studies of the approach and clinical outcomes of MISS in adult scoliosis. DATA SOURCES: We conducted a systematic search from PubMed, Medline, EMBASE, and other literature databases to collect reports of surgical methods and clinical outcomes of MISS in treatment of adult scoliosis. Those reports were published up to March 2017 with the following key terms: "minimally invasive," "spine," "surgery," and "scoliosis." STUDY SELECTION: The inclusion criteria of the articles were as followings: diagnosed with adult degenerative scoliosis (DS) or adult idiopathic scoliosis; underwent MISS or open surgery; with follow-up data. The articles involving patients with congenital scoliosis or unknown type were excluded and those without any follow-up data were also excluded from the study. The initial search yielded 233 articles. After title and abstract extraction, 29 English articles were selected for full-text review. Of those, 20 studies with 831 patients diagnosed with adult DS or adult idiopathic scoliosis were reviewed. Seventeen were retrospective studies, and three were prospective studies. RESULTS: The surgical technique reported in these articles was direct or extreme lateral interbody fusion, axial lumbar interbody fusion, and transforaminal lumbar interbody fusion. Among the clinical outcomes of these studies, the operated levels was 3-7, operative time was 2.3-8.5 h. Both the Cobb angle of coronal major curve and evaluation of Oswestry Disability Index and Visual Analog Scale decreased after surgery. There were 323 complications reported in the 831 (38.9%) patients, including 150 (18.1%) motor or sensory deficits, and 111 (13.4%) implant-related complications. CONCLUSIONS: MISS can provide good radiological and self-evaluation improvement in treatment of adult scoliosis. More prospective studies will be needed before it is widely used.

[Advances in minimally invasive spine surgery in treatment of adolescent idiopathic scoliosis and adult scoliosis].

The traditional treatment of scoliosis is mainly based on open surgeries that use the anterior approach, the posterior approach, or both. These surgical procedures often lead to complications including massive blood loss, infections, and pain of incision.The minimally invasive spine surgery (MISS) was introduced in the 1990s and has shown many advantages including less blood loss, less pain, and lower infection incidences.Today MISS is mainly used in the treatment of adolescent idiopathic scoliosis and adult scoliosis. However, due to some inevitable complications, it still can not be routinely applied.This review will briefly summarize the advances in the application of MISS in surgical treatment of adolescent idiopathic scoliosis and adult scoliosis.

Benazepril inhibited the NF-κB and TGF-ß networking on LV hypertrophy in rats.

PURPOSE: Benazepril, an angiotensin-converting enzyme (ACE) inhibitor, has been used to treat hypertension, congestive heart failure, and chronic renal failure. However, its biological activity and mechanism of action in inflammation are not fully identified. The present study was designed to determine the in vivo anti-inflammatory effects of benazepril on LV hypertrophy in rats. METHODS: LV hypertrophy was produced in rats by abdominal aortic coarctation. They were then divided into the following groups: sham operation; LV hypertrophy; LV hypertrophy+benazepril (1mg/kg in a gavage, once a day for 4 weeks). Both morphological assays (hemodynamic and hemorheological measurement; LV hypertrophy assessment), and molecular assays (protein levels of Collagen type I/III, TNF-α and VCAM-1; TGF-ß gene expression; NF-κB or Smad activation; intracellular ROS production) were performed. RESULTS: The following effects were observed in rats treated with benazepril: (1) marked improvements in hemodynamic and hemorheological parameters; (2) significant reductions in LV hypertrophy, dilatation and fibrosis; (3) significantly attenuated protein levels of Collagen type I/III, TGF-ß, TNF-α and VCAM-1, NF-κB or Smad activation, as well as intracellular ROS production. CONCLUSIONS: These results suggest that the anti-inflammatory properties of benazepril may be ascribed to their down-regulation of both NF-κB and TGF-ß signaling pathways by acting on the intracellular ROS production in rats with LV hypertrophy, thus supporting the use of benazepril as an anti-inflammatory agent.

[Effects of guanxinping tablet containing serum on H2O2-induced apoptosis and NF-kappaB expressions in vascular endothelial cells].

OBJECTIVE: To study the effects of Guanxinping Tablet (GT) containing serum on H2O2-induced apoptosis and the nuclear factor kappa B (NF-kappaB) expression in vascular endothelial cells (VECs). METHODS: Rabbits were randomly divided into the normal control group (treated with normal saline, 10 mL/kg), the verapamil group (0. 02 g/kg, 10 mL/kg), the small dose GT group (2; 8 g/kg, 10 mL/kg), the middle dose GT group (5.6 g/kg, 10 mL/kg), and the large dose GT group (11.2 g/kg, 10 mL/kg), 3 in each group. The medication was given to rabbits by gastrogavage for 3 successive days. The gastrogavage was performed twice on the last day with an interval of 2 h. One h after the last medication the peripheral blood was sampled from the vein of the ear edge. The blood was put for 1 h and centrifuged at 2 500 r/min for 30 min. The serum was extracted and deactivated at 56 degrees C for 30 min to prepare the drug containing serum. The apoptosis injury model was established using 100 micromol/L H2O2 induced VECs in the log phase growth. After modeling they were divided into 6 groups, 5 samples in each group, i. e., the normal group (10% vehicle serum culture solution), the model group (10% vehicle serum culture solution +100 micromol/L H2O2), the verapamil group (10% verapamil serum culture solution +100 micromol/L H2O2), the low dose GT group (10% low dose GT culture solution +100 micromol/L H2O2), the middle dose GT group (10% middle dose GT culture solution + 100 micromol/L H2O2), and the high dose GT group (10% high dose GT culture solution + 100 micromol/L H2O2). THE VEC apoptotic rate was detected using flow cytometry. The protein expression of NF-kappaB was detected using Western blot. RESULTS: The VEC apoptosis rate (9.00% +/- 1.18%) and the protein expression of NF-kappaB (0.39% +/- 0.06%) increased more in the model group than in the normal control group (P<0.01). Compared with the model group, the VEC apoptosis rate of the verapamil group (6.00% +/- 0.18%), the large dose GT group (5.30% +/- 0.08%), and the middle dose GT group (6.83% +/- 0.51%) were obviously lower. The expression of NF-kappaB of each treatment group significantly decreased (the verapamil group: 0.28% +/- 0.03%; the small dose GT group: 0.33% +/- 0.03%; the middle dose GT group: 0.30% +/- 0.03%; the large dose GT group: 0.28% +/- 0.04%, P<0.01, P<0.05). CONCLUSIONS: GT could fight against H2O2-induced VEC cell apoptosis. Its mechanism might be correlated with regulating the expression of NF-kappaB protein.

[Treadmill exercise test in patients with coronary artery myocardial bridging].

OBJECTIVE: To observe treadmill exercise test (TET) characteristics in patients with myocardial bridging (MB). METHODS: TET results from January 2003 to December 2010 were retrospectively analyzed in 156 patients with confirmed MB diagnosis. MB patients were divided into smoking group (68 cases) and non-smoking group (88 cases). Coronary angiography results were used to analyze the relations between MB length, myocardial ischemia and exercising duration. RESULTS: (1) MB was documented on two coronary arteries in 2 patients (1%), MB was detected in single artery in 154 patients (99%), of whom 146 cases were located at left anterior descending artery, 8 cases were located at right coronary artery. The degree of narrowing of MB was graded 1 (less than 50%) in 16 patients (10%), grade 2 (50% to 75%) in 108 patients (69%) and grade 3 (greater than 75%) in 32 patients (21%). The length of MB ranged between 4 to 40 mm, MB length was less than 10 mm in 40 patients (26%), between 11 to 20 mm in 48 patients (31%), between 21 to 30 mm in 44 patients (28%), greater than 31 mm in 24 patients (15%). (2) TET positive rate was 41% (64/156) and the TET positive rate was significantly higher in smoking group than in non-smoking group [57% (39/68) vs. 28% (25/88, P < 0.01)]. (3) The length of MB was positively related to the ST-segment depression (r = 0.723, P < 0.01) and negatively related to exercising duration (r = -0.828, P < 0.01). Heart rate was positively related to the ST-segment depression (r = 0.368, P < 0.01). CONCLUSIONS: TET may serve as a good test to assess myocardial ischemia in patients with MB. The length of MB is positively related with myocardial ischemia and negatively related with exercising duration. Smoking might increase myocardial ischemic incidence in MB patients, MB patients should be advised to stop smoking.

Primary clinical evaluation of the joint replacement for the treatment of the first metatarsophalangeal arthritis.

OBJECTIVE: To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant. METHODS: A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant. There were 2 males and 10 females with a mean age of 61.4 (range, 56-75) years old. Of them, 9 cases (11 feet) were hallux valgus with osteoarthritis; 1 case (2 feet) was rheumatic arthritis; 2 cases (2 feet) were traumatic arthritis. The subjective and objective results were evaluated during follow-up. RESULTS: All of the patients were followed up regularly with an average of 24.7 months, ranging from 12 to 38 months. Ten patients were completely satisfied with the operation; 1 patient showed partial satisfaction, and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation. Osteolysis around the implant occurred in 2 cases without clinical symptoms, and no special treatment was given. CONCLUSION: The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.

Clinical application of reverse radial hypothenar flap for finger soft tissue defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of reverse radial hypothenar flap for finger soft tissue defect.</p><p><b>METHODS</b>From Mar. 2006 to Mar. 2010, 13 cases (14 fingers) with finger soft tissue defects were treated with reverse radial hypothenar flaps pedicled with ulnar palmar digital artery of little finger. The defects were 1.9 cm x 1.5 cm -4.0 cm x 2.0 cm in size. The flap size ranged from 1.5 cm x 2.0 cm to 4.0 cm x 2.0 cm.</p><p><b>RESULTS</b>All the flaps survived completely with primary healing both in donor and recipient area. 12 cases (13 fingers) were followed up for 1-3 years. The flaps color was similar to the unaffected fingers. Cicatricial contracture happened in one case due to contracture of palmar fascia. The two-point discrimination distance on flap was 3.2-5.3mm. The active and passive movement of finger joints was evaluated as excellent in 12 fingers, good in one finger. There was no complaint about the feeling at the donor site. Two months after operation, all patients could go back to work.</p><p><b>CONCLUSIONS</b>The reverse radial hypothenar flap is very suitable for finger soft tissue defect with less morbidity to donor site.</p>

Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients.

BACKGROUND: Selective anterior thoracolumbar/lumbar (TL/L) fusion and instrumentation in adolescent idiopathic scoliosis (AIS) patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients. METHODS: By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/L fusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra (LIV) tilt, coronal disc angle immediately below the LIV (LIVDA) and radiographic shoulder height (RSH) were measured and analyzed. RESULTS: Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rate of 80.2% (P = 0.000). While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% (P = 0.000). At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm, which was much better than that after operation (P = 0.001). The mean LIV tilt was 23.5° before operation, and was significantly improved after operation (8.3°, P = 0.000). At final follow-up, it was well maintained (10.6°). The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation (P = 0.100) and 7.4° at final follow-up (P = 0.012), respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation (P = 0.002). CONCLUSIONS: Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AIS patients, while a larger LIVDA.

Postoperative disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis: a comparison of anterior and posterior approaches.

OBJECTIVE: To evaluate the different influences of anterior and posterior correction and fusion approaches upon disc wedging in adolescent idiopathic thoracolumbar/lumbar scoliosis. METHODS: The retrospective study was conducted with the medical records and radiographs of adolescent idiopathic thoracolumbar/lumbar scoliosis patients that underwent anterior (group A) or posterior (group B) correction and fusion surgery from December 1998 to May 2008. The correction of the main curve and changes of the disc wedging were analyzed. RESULTS: Fifty-three patients were included, 26 in group A and 27 in group B. The mean coronal Cobb angles of the main curve in group A and group B were significantly corrected after surgery (P < 0.05), with an average correction rate of 75.2% and 88.2%, respectively. Upon final follow-up, the coronal Cobb angles of the two groups were 18.90 +/- 11.1 degrees and 7.70 +/- 5.6 degrees, respectively, with an average correction loss of 6.8 degrees +/- 6.5 degrees and 2.7 degrees +/- 3.3 degrees, respectively. The coronal Cobb angle after operation and at final follow-up, and the correction rate were significantly better in group B than those in group A (P < 0.05), while the coronal Cobb angle loss in group A was greater than that in group B (P < 0.05). The disc wedging before operation, after operation, and at final follow-up were 3.2 degrees +/- 3.0 degrees, 5.7 degrees +/- 3.0 degrees, and 8.6 degrees +/- 4.4 degrees in group A, and 2.4 degrees +/- 3.2 degrees, 3.3 degrees +/- 3.4 degrees, and 3.7 degrees +/- 3.6 degrees in group B, respectively. Postoperative disc wedging was significantly larger compared with preoperative measurements in group A (P < 0.05), but not in group B (P > 0.05). The difference between disc wedging at final follow-up and that after surgery was significant in group A (P < 0.05), but not in group B (P > 0.05). Between the two groups, group A had larger disc angles after operation and at final follow-up (P < 0.05), and a greater loss of disc angle (P < 0.05). CONCLUSION: For adolescent idiopathic thoracolumbar/lumbar scoliosis, posterior approach using all pedicle screws might produce a better result in terms of disc wedging compared with anterior approach.

Primary effect of dual growing rod technique for the treatment of severe scoliosis in young children.

BACKGROUND: Treatment of rapidly progressing scoliosis in young children is a challenge for spine surgeons. Some surgeons had begun to use dual growing rod technique for treatment of rapidly progressing scoliosis in young children and had achieved acceptable results. The aim of this study was to determine the primary results and complications of this new technique in China. METHODS: Eleven children suffering from rapidly progressing scoliosis were treated with dual growing rod technique between November 2004 and March 2009 at Peking Union Medical College Hospital (PUMCH). There were 10 females and 1 male in the group with Risser sign of 0 grade. The mean age at initial surgery was 6.1 years (range, 2.1-10.9 years). Ten patients were diagnosed as congenital scoliosis and 1 patient neuromuscular scoliosis. All the patients had 1-4 lengthening procedures (mean, 1.8 procedures) after the initial surgeries. The radiographic results of all the patients were investigated. RESULTS: The coronal Cobb angle of scoliosis improved from (67.64+/-11.43) degrees to (34.64+/-8.26) degrees after initial surgery with the correction rate observed at (47.15+/-16.48)%. The coronal trunk shift improved from (2.00+/-1.73) cm to (1.49+/-1.31) cm after initial surgery. The T1-S1 height increased from (25.47+/-6.16) cm to (28.84+/-5.69) cm after initial surgery. The coronal Cobb angle of scoliosis was (36.82+/-11.76) degrees and the coronal trunk shift was (1.11+/-1.29) cm after the most recent lengthening procedure with the most recent correction rate observed at (44.73+/-19.43)%. The T1-S1 height was (31.29+/-4.50) cm after the most recent lengthening procedure with an average T1-S1 length increase of 1.6 (range, 1.0-2.7) cm per year during the lengthening period. The sagittal balance was maintained. Five of the total patients (45.5%) had complications including: hook displacement, pedical screw loosening, and broken rod. We performed revision surgeries with simultaneous lengthening procedures in all 5 cases with satisfactory results. CONCLUSIONS: The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique could control severe scoliosis, allow for spinal growth, and maintain the coronal and sagittal balance. But the technique has high complications requiring strict and regular follow-up.