Guidelines for management of pediatric acute hyperextension spinal cord injury.

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19.

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Double PCL sign does not always indicate a bucket-handle tear of medial meniscus.

The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.

The influence of MicroRNA-150 in Osteoblast Matrix Mineralization.

This study investigated the influence of miR-150 expression on osteoblast matrix mineralization and its mechanisms. The mouse osteoblast cell line MC3T3-E1 was used as an in vitro model of bone formation. On the fifth day of mineralization, transfection experiments using agomiR-150, agomiR-NC, antagomiR-150 antagomiR-NC, and mock groups were set up to test the effects of miR-150 in MC3T3-E1 model. The mRNA and protein levels of OC, ALP, type I collagen, and OPN were measured by qRT-PCR and ELISA. Matrix mineralization was detected by alizarin red S (ARS) staining and flow cytometry was employed to quantify apoptosis in each group. RT-PCR and Western blot were applied to detect the expression of target gene MMP14. Our results demonstrated that the endogenous expression levels of miR-150, OC, ALP, type I collagen, and OPN in MC3T3-E1 cells increased steadily. Exogenous expressions of agomiR-150 and antagomiR-150 can significantly up-/down-regulate, respectively, the expression level of miR-150 in MC3T3-E1 cells. Compared with the mock group, higher expression levels of OC, ALP, type I collagen, and OPN mRNA were observed in the agomiR-150 group, while lower mRNA expression levels of OC, ALP, type I collagen, and OPN were found in the antagomiR-150 group. Based on these results, potential miR-150 targeted genes are discussed. Our results showed that miR-150 supports the osteoblastic phenotype related to osteoblast function and bone mineralization. Thus, miR-150 may have potential therapeutic applications in promoting bone formation in certain disease settings, such as in osteoporosis and in elderly patients.

[Retracted] Mitochondrial DNA induces inflammation and increases TLR9/NF­κB expression in lung tissue.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that several of the western blotting images shown in Fig. 4 on p. 822 were strikingly similar to data which had appeared in Fig. 5A of the following paper: Fan J, Frey RS and Malik AB: TLR4 signaling induces TLR2 expression in endothelial cells via neutrophil NADPH oxidase. J Clin Invest 112: 1235­1243, 2003. Owing to the fact that the contentious data in the above article had already been published elsewhere prior to its submission to International Journal of Molecular Medicine, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [International Journal of Molecular Medicine 33: 817­824, 2014; DOI: 10.3892/ijmm.2014.1650].

[Clinical manifestation and treatment strategy of intervertebral space infection after radiofrequency ablation of lumbar nucleus pulposus].

OBJECTIVE: To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus. METHODS: A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days. RESULTS: All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation. CONCLUSION: The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

[Risk factors and prognosis of preoperative herat failure after hip fracture].

OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION: Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.

Risk factor analysis of disc and facet joint degeneration after intersegmental pedicle screw fixation for lumbar spondylolysis.

BACKGROUND: Patients who do not respond to conservative treatment of the isthmus are often treated with surgery. We used direct repair plus intersegment pedicle screw fixation for the treatment of lumbar spondylolysis. The aim of this observational study was to assess the effects of this technique and evaluate various risk factors potentially predicting the probability of disc and facet joint degeneration after instrumentation. METHODS: The study included 54 male L5 spondylolysis patients who underwent pars repair and intersegment fixation using pedicle screws. Bony union was evaluated using reconstruction images of computed tomography. Radiographic changes, including disc height, vertebral slip, facet joint and disc degeneration in the grade of adjacent and fixed segments, were determined from before to final follow-up. Logistic regression analysis was performed to identify factors associated with the incidence of disc and facet joint degeneration. RESULTS: Bony union was achieved in all cases. Logistic regression analysis revealed that instrumentation durations of greater than 15.5 months and 21.0 months were significant risk factors for the incidence of L4/5 and L5S1 facet degeneration, respectively. CONCLUSIONS: Intersegmental pedicle screw fixation provides good surgical outcomes and good isthmic bony union rates in patients with lumbar spondylolysis. The duration of fixation was confirmed as a risk factor for facet joint degeneration. Once bony union is achieved, instrument removal should be recommended.

Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth.

BACKGROUND: When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. METHODS: A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. RESULTS: There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12-36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. CONCLUSIONS: Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.

[Single-segment lumbar microdiscectomy:drainage or not].

OBJECTIVE: To evaluate the safety and feasibility of single-segment lumbar microdiscectomy without drainage. METHODS: The clinical data of 135 patients with single-segment lumbar disc herniation treated by microdiscectomy surgery from January 2018 to August 2019 were retrospectively analyzed. There were 95 males and 40 females, aged from 18 to 40 years old, with a mean of (28.3±5.4) years. They were divided into drainage group (78 cases) and non-drainage group (57 cases) according to whether the drainage tube was placed during operation. The general conditions of patients were recorded such as age, gender, operation segment, body mass index(BMI), symptom duration, follow-up time, operation time, intraoperative blood loss, out-of-bed time, hospital stay, postoperative drainage removal time and drainage volume of drainage group, postoperative body temperature. VAS of incisional pain in supine resting state on the 1 and 3 days after operation, the VAS of low back pain and lower extremity radiating pain during ground exercise before operation, 3 days, 1 month and 3 months after operation were compared. Oswestry Disability Index (ODI) was collected before operation, 1 month and 3 months after operation. The ratio of complications was calculated such as symptomatic incision hematoma, poor incision healing, incision infection, exacerbation and progressive aggravation of neurological dysfunction, and unplanned secondary surgery. RESULTS: There were no significant differences in age, gender, operation segment, BMI, symptom duration, follow-up time, operation time, intraoperative blood loss, and postoperative body temperature between two groups. The average hospital stay and out-of-bed time in non-drainage group were shorter than in drainage group(P=0.0000). VAS of incision pain in non-drainage group was lower than that in control group at 1 and 3 days after surgery (P<0.05). Postoperative low back pain VAS and ODI of all patients were significantly reduced compared with those before surgery. No symptomatic hematoma occurred in two groups. Postoperative neurological dysfunction immediately aggravated each one patient in two groups, and no progressive aggravation of neurological function was found in two groups. Incision infection occurred in one case in each of the two groups, and both were cured by drug treatment; poor incision healing occurred in one case in each of the two groups, and both were healed after repeated dressing changes. There was one case of unplanned second operation in drainage group, the patient received a second operation due to disc protrusion recurrence within 1 month. CONCLUSION: Single-segment lumbar microdiscectomy without drainage can shorten the average hospital stay and promote early exercise out of bed, and reduce the trauma and stress reaction of drainage. No drainage may be an option for patients with enhanced recovery after lumbar microdiscectomy.

[Therapeutic efficacy of augmentative plate fixation in long-bone hypertrophic nonunion subsequent to intramedullary nailing].

OBJECTIVE: To determine the therapeutic efficacy of augmentation plate fixation in nonunion of long-bone fracture after interlocking intramedullary nailing. METHODS: From April 1998 to April 2009, 14 patients with long-bone hypertrophic nonunion after intramedullary nail internal fixation were treated with augmentative plate. There were nine patients with nonunion of femur, three of humerus and two of tibia. After implanting the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A general plate with at least two screws reaching the opposite cortical bone above and below the fracture was fixated to the lateral side of bone shaft. In all patients, the rotational instability of fracture site was verified intra-operatively in all cases. However, motion disappeared after plate augmentation. RESULTS: All patients achieved radiological solid union at an average of 8 months (range: 6 - 11). Hardware was removed in six cases at 6-11 months post-operation. No infection, hardware loosening or rupture was found. CONCLUSION: The augmentative plate fixation can be applied at the fracture site to prevent the rotational instability. Augmentation plate fixation is indicated for femoral and tibial nonunion of proximal or distal metaphyseal-diaphyseal junctional areas, primary comminuted fracture and humeral nonunion after intramedullary nailing.

[Curative effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury].

OBJECTIVE: To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury. METHODS: From January 2016 to June 2018, 16 patients with severe thoracolumbar burst fractures (more than 50% of ratio of spinal canal encroachment, reverse fragment at the posterior edge of the vertebral body) with spinal cord injury were retrospectively analyzed, including 10 males and 6 females, ranging in age from 19 to 57 years old. Causes of injury:8 cases of fall injury, 6 cases of traffic accident injury and 2 cases of other injuries. Fracture site:T11 in 4 cases, T12 in 5 cases, L1 in 5 cases, L2 in 2 cases. All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach. The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra, Cobb angle of the adjacent segment of the injured vertebra, and ratio of spinal canal encroachment. The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale (VAS). RESULTS: All 16 patients were followed up, and the average follow up time was (15.9±5.4) months. The average operation time was (234±41) minutes and the average amount of bleeding was (431±93) ml. The loss of anterior height of injured vertebrae was (52.25±10.10)% before operation, (8.93± 3.61)% at 3 days after operation, and (9.25±2.88)% at the latest follow up. The results of 3 days after operation and the latest follow up were better than that before operation, and there was no significant differencesbetween results at the latest follow up and 3 days after operation (P<0.01). Cobb angle of adjacent segment of injured vertebrae was (28.19±10.89)°before operation, (5.31±5.14)° 3 days after operation, and (6.81±4.59)°at the latest follow-up. The ratio of spinal canal encroachment was (67.68±12.45)% before operation, (7.69±4.46)% at 3 days after operation, and (4.75±1.63)% at the latest follow-up. At 3 days and the latest follow-up, the rate recovered to a certain extent (P<0.05). At the latest follow up, spinal nerve function was improved in 12 patients, no improvement in 4 patients and no deterioration in nerve function. VSA score was improved from preoperative 7.8±0.9 to final follow-up 1.8±0.7. CONCLUSION: For severe thoracolumbar burst fracture and spinal cord injury, with more than 50% of ratio of spinal canal encroachment and reverse fragment at the posterior edge of the vertebral body, the anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach has the characteristics of accurate reduction, complete decompression and firm fixation, and the clinical effect is satisfactory.

[The application of computer aided design and computer aided engineering technique in separation of Pygopagus conjoined twins].

OBJECTIVES: To explore the effect of CAD and CAE related technique in separation of Pygopagus Conjoined Twins. METHODS: CT images of Pygopagus conjoined twins were obtained and reconstructed in three-dimensional by Mimics software. 3D entity model of skin and spine of conjoined twins were made by fast plastic technique and equipment according to 3D data model. The circumference and area of fused and independent dural sac were measured by software of AutoCAD. RESULTS: The entity model is real reflection of skin and spine of Pygopagus. It was used in the procedures of discussion, sham operation, skin flap design and informed consent. In the measure of MRI, the circumference and area of fused dural sac was more than of independent dural sac, that is to say, the defect of dural sac can be repaired by direct suture. The intraoperative finding match with imaging measure results. CONCLUSIONS: The application of CAD and CAE in the procedure of preoperative plan have gave big help to successful separation of Pygopagus Conjoined Twins.

[Biomechanical study and clinical application of cannulated compression screws with across solid frame for intertrochanteric fractures].

OBJECTIVE: To evaluate the safety and efficiency of treating the senile intertrochanteric fractures with cannulated compression screws (CCS) with across solid frame in femur head via biomechanical tests and clinical application. METHODS: Biomechanical tests: the fracture model was made in 31-A1.3 style, 6 pairs of flesh and embalmed cadaveric femurs were mechanically tested in a single-limb stance configuration. A material testing machine was used to apply vertical loads onto the femoral head. Both stiffness and reverse turn were recorded. Clinical application: from 1998 to 2006, According to damage control orthopedics (DCO) and American Society of Anesthesiologists (ASA) and the Evans classification, 51 patients received treatment with CCS with across solid flame in femur head. All the cases were followed up for 12 to 36 months (mean: 18 months). RESULTS: the differences between two groups in BMD (bone mineral density) were of statistical significance. And tensile rigidity and torsional rigidity of CCS were strong enough to bear weight. The CCS group had a lesser amount of blood loss or transfusion and lower treatment expenses. CONCLUSION: Cannulated compression screw with across solid flame is strong enough to be employed as an effective method to treat aged intertrochanteric hip fractures with the advantages of simple procedure, minimal invasion, stable fixation and weight bearing.

[The surgical separation of pygopagus conjoined twins].

OBJECTIVE: To explore the program of preoperative evaluation, preoperative preparation and separation operation of pygopagus conjoined twins. METHODS: Clinical data of one case of pygopagus (male, gestational age 37 weeks, uterine-incision delivery, 3.5 months old; twins of triplets; total body weight 8.0 kg. The twins have self-governed extremities, anus, penis. Four limbs can move independently). Separated successfully were analyzed. The auxiliary examination of X-rays, MRI, ultrasound, CT and 3D reconstruction, sensory evoked potential showed that there were process hypoplasia and lamina bifid of lumbosacral vertebrae below L3. Dural sac connected below L3 and conus medullaris located at L3. There were no conjunction of spinal cord and cauda equine. The decision of direct suture of dural sac was made by preoperative evaluation through measurement of circumference and area of conjoined dural sac. The separation surgery program was decided through team debate and sham operation. Separation operation was performed under the general anaesthesia. Crossing V-shaped skin flap was used to cover the wound surface. The dura of conjoined twins were sutured directly. The tension of skin flap was normal postoperative with continuing negative pressure drainage under the flap and pressure sterilized dressing. RESULTS: Successful separation of pygopagus conjoined twins was achieved. Lower extremities movements of separated twins were normal 6 h after operation. The drainage was removed 1 day postoperative, blood supplies of skin flap were normal. There were no complications of infection, cerebrospinal fluid leakage and neurological deficit. The healing of the skin flap was good. With 6 months follow-up, the growth and neurological function were normal. CONCLUSION: Consummate preoperative preparation, accurate preoperative investigations, meticulous operative management, careful postoperative administration and good team cooperation are the keys to successful separation of pygopagus conjoined twins.

[An experimental study on percutaneous autologous bone marrow mesenchymal stem cell grafting for bone defect].

OBJECTIVES: To investigate in vive osteogenic potential in size-critical bone defect after percutaneous autologous grafting of culture-expanded rabbit autologous BMSCs, osteo-induced BMSCs and combination of both. METHODS: BMSCs were cultured and then induced with osteogenic supplement (OS) medium. BMSCs with and without OS induction were collected and percutaneously autologously injected respectively into the 15 mm bone defect of 20 experimental rabbit model. The grafts were BMSCs, osteo-induced BMSCs, BMSCs and osteo-induced BMSCs, BMP combined with fibrin sealant, and 0.9% NaCl solution. Osteogenesis at the defect areas were observed by regular radiography, histology and biomechanics. RESULTS: The group transplanted with BMSCs + osteo-induced BMSCs achieved complete bone healing with medullary cavity united, which showed the largest quantity of new bone measured by X-ray analysis, and also their maximal load were better than those in other groups. CONCLUSION: The bone-forming ability of rabbit osteo-induced BMSCs combined with BMSCs in bone defect is superior to those of BMSCs and osteo-induced BMSCs.

[An epidemiological study on physical and mental health of inhabitants who experienced a catastrophic event of "5.12 serious earthquake in Wenchuan county"].

OBJECTIVE: To investigate the influence of a catastrophic event to the physical and mental health of inhabitants in "5.12 serious earthquake in Wenchuan county". METHODS: The analysis of descriptive epidemiology on the spot was made in 3006 servicemen who were living in the disaster area of Wenchuan county and Dujiangyan city. RESULTS: The diseases were mainly found in both psychological symptoms and respiratory system, and the incidences were 62.16% and 51.78%, respectively. It was obviously showed that these children and juveniles less than 14 years had the most apparent psychological symptoms, and the incidence was 85%. On the contrary, the diseases were testified to be low in the incidence of digestive system, and the incidences were only 31.21%. CONCLUSIONS: The physical and mental health of inhabitants who experienced a catastrophic earthquake disaster was harmed in various degree, and the corresponding measures should be made in the medication or mental intervention.

[The primary evaluation of its safety and immune effect of NogoA vaccination for spinal cord injury].

OBJECTIVES: To prepare and purify NogoA vaccination for treatment of spinal cord injury. To study the safety and immune effect of this vaccination. METHODS: Artificial NogoA-13 polypeptide was coupled with KLH to improve the immunogenicity of vaccination. Sixty three-week-old Wistar female rats were divided into 3 groups randomly. Group A was immunized with NogoA vaccination, group B with incomplete freund's adjuvant + complete freund's adjuvant; group C with KLH. Rats received abdominal cavity immunization. The level of antibody and the binding capability were detected with ELISA. The safety of vaccination was evaluated by the incidence and severity of experimental autoimmune encephalomyelitis (EAE). RESULTS: The IgG antibody against the NogoA-13 polypeptide had been detected with ELISA in group A. A value of serum presented regular gradient during multiple proportion dilution. In group B and C, no antibodies were detected. The statistical significant difference in A value was revealed between group A and B, C group. No statistical significant difference was found in A value between group B and group C and non-immunized negative control serum. The features of EAE were not found in the immunized rats. CONCLUSIONS: NogoA polypeptide vaccination can stimulate the antibody against the polypeptide. The immune effect of this vaccination is confirmed by binding reaction revealed in the ex vivo experiment. The good safety of vaccination is revealed by no features of EAE found in the immunized rats.

[Relationship between the operation time of multiple fractures with system inflammation changes and clinical outcomes].

OBJECTIVE: To investigate the relationship between the operation time of femur shaft fracture with post-operation system inflammation changes and clinical outcomes for those multiple fractures. METHODS: This investigation was designed as a prospective, nonrandomized cohort study. From April 2005 to August 2007, all 78 hospitalized patients were divided into 3 groups by an inclusion criteria: multiple fractures with opened fracture of femur shaft (group A, n = 26), multiple fractures with closed fracture of femur shaft (group B, n = 23), single closed fracture of femur shaft (group C, n = 29). In the group A, damage control orthopaedics (DCO) procedure were performed. In the group B and C, all the femur shaft fractures were performed intramedullary nail fixation early (< 24 h). From serially sampled venous blood, inflammatory reaction index were estimated by measured the concentration of IL-6, TNF-alpha surround the operation, and the conditions of multiple organs were estimated by assayed PaO2/FiO2, total bilirubin (TBIL), creatinine (Cr) levels, the postoperation complication rates were analyzed among each groups. The extent of inflammation changes, multiple organs damage conditions and postoperation complication rates were compared and analyzed among the 3 groups. RESULTS: In the group A, the median increase values of IL-6,TNF-alpha after the secondary surgery were 59 ng/L and 85 ng/L, whereas they were 154 ng/L and 250 ng/L respectively in the group B, there was a significant difference between the 2 groups (P < 0.01). In addition, the median increase values of IL-6, TNF-alpha after the first surgery in group A and in group C were both significantly less than group B (P < 0.01). Correspondingly, the abnormal rates of PaO2/ FiO2, TBIL, Cr levels occurred in the group B were all greater than group A after the 2 surgery procedures (P < 0.05), and in the aspects of average ventilation days, ICU staying days, duration of positive fluid balance (input/output > 500 ml/24 h), the group B were all greater than group A after the second surgery ( P < 0.01). Compared with group A after the first surgery, group B showed a longer average ventilation days, but it had no significant difference in average ICU stay days and duration of positive fluid balance. In addition, for group C, all the aspects above were less than group B (P < 0.01). Concerned with the complications after surgery in each groups, fat embolism and MODS rate between group A and B had no significant difference (11.5% vs 13.0% ,P > 0.05), but higher than which of group C (P < 0.01). CONCLUSIONS: The early intramedullary nail fixation of femur shaft fracture in multiple fractures may lead to a significant system inflammation changes, and may develop the subclinical changes of multiple organs. However, these changes are less in those surgery procedures later performed, namely intramedullary nail fixation of femur shaft fracture in multiple fractures as a primary definitive treatment has a potential risk, and should be carefully evaluated.