Molecular targeted drugs resistance impairs double-strand break repair and sensitizes ER-positive breast cancer to PARP inhibitors.

BACKGROUND: There are various treatments for estrogen-positive breast cancer, mainly hormone therapy and molecular-targeted drugs. Acquiring resistance to these drugs is a major clinical problem. Additionally, little is known about the effect of drug resistance on the DNA repair mechanism. Poly ADP ribose polymerase (PARP) inhibitors currently used for treating HER2-negative metastatic breast cancer with BRCA mutations have been shown to be effective in BRCA-deficient cells with impaired homologous recombination repair. Here, we investigated the effect of drug resistance acquisition on the DNA repair mechanism and the effect of PARP inhibitors on ER (estrogen receptor) -positive breast cancer. METHODS: We investigated changes in the expression of DNA repair mechanism-related factors and repair ability of double-strand breaks (DSB) in various drug-resistant cell lines established in our laboratory. Additionally, PARP inhibitor susceptibility was investigated using olaparib. RESULTS: DSB repairs in MCF-7 and hormone therapy-resistant model cells were normal, and these cells demonstrated low sensitivity to olaparib. The resistant cell lines against CDK4/6 inhibitors, fulvestrant and mTOR/PI3K inhibitors showed decreased DSB repair ability and high olaparib sensitivity. They showed low sensitivity to CDK4/6 inhibitors, a close link between acquiring resistance to CDK4/6 inhibitors and hypersensitivity to olaparib. CONCLUSIONS: Our study suggests some cases of acquiring drug resistance impairs DSB repair ability and sensitizes ER-positive breast cancer to PARP inhibitors.

Navafenterol, a new drug for the treatment of chronic obstructive airway disease / 中国临床药理学与治疗学

Navafenterol is a new compound with both muscarinic receptor antagonist and β2 receptor agonist effects in a single molecule, who is being developed for the treatment of chronic obstructive airway disease such as chronic obstructive pulmonary disease and asthma. These pilot clinical studies found that it can significantly improve lung function and symptoms, and is safe and well tolerated. Common treatment emergent adverse events include headache, nasopharyngitis, and dizziness. It may become a next-generation bronchodilator for chronic obstructive airway disease. This review introduced the prospective of Navafenterol.

Advances on roles of Th22 cells in human common viral infections / 中华临床感染病杂志

Na?ve CD4 + T cells differentiate into a variety of T helper (Th) subsets that secrete various cytokines to exert biological effects. Th22 cells, a novel identified CD4 + T cell subset, are distinct from Th1, Th2 and Th17 cell subsets. Th22 cells express chemokine receptors CCR4, CCR6 and CCR10, and secrete multiple cytokines such as IL-22, IL-13 and TNF-α, but not IL-17, IL-4 IFN-γ; and IL-22 is considered as major effector cytokine of Th22. The understanding on functions and differentiation mechanisms of Th22 cells have been constantly improved, and Th22 cells play important roles in human common viral infections. The article reviews the current advances about the characteristics, function, differentiation of Th22 cells, the roles of Th22 cells and the key molecules in several human common viral infections, which would provide novel immune strategies for the prevention and treatment of human viral infection.

Study on Preventive Effects and Mechanism of Ginsenoside Rg 1 on Focal Cerebral Ischemia-reperfusion Injury Model Rats / 中国药房

OBJECTIVE：To st udy preventive effect and mec hanism of ginsenoside Rg 1 on focal cerebral ischemia-reperfusion injury（CIRI）model rats. METHODS ：Totally 78 SD rats were randomly divided into sham operation group ，model group ， butylphthalide control group （positive control ，10 mL/kg），ginsenoside Rg 1 low-dose，medium-dose and high-dose groups （10， 20，40 mg/kg），with 13 rats in each group. Administration groups were give relevant medicine intraperitoneally ，sham operation group and model group were given constant volume of normal saline intraperitoneally ，once a day ，for consecutive 7 d. After medication，except for the sham operation group ，focal CIRI model was induced by middle cerebral artery occlusion （MCAO） method in other groups. After modeling ，neurological deficit scoring was performed according to the modified neurological difict scoring standard ； TTC staining was used to detected the percentage of cerebral infarction of rats ；the cerebral water content was measured by dry/wet weight method ；serum contents of IL- 1β and IL-6 were detected by ELISA ；the protein expressions of p-p 38 MAPK and p-NF-κB p65 in cerebral tissue were determined by immunohistochemistry and Western blotting assay. RESULTS ： Compared with sham operation ，neurological deficits score ，percentage of cerebral infarction and cerebral water content ，serum contents of IL- 1β and IL-6，positive expression numbers of cells and protein expressions of p-p 38 MAPK and p-NF-κB p65 in cerebral tissue were increased significantly in model group （P＜0.05 or P＜0.01）. Compared with model group ，above index levels of administration groups were all decreased significantly （P＜0.05 or P＜0.01），and the effect of ginsenoside Rg 1 had a dose-dependent trend ；there was no significant difference of all above indexes between ginsenoside Rg 1 middle-dose，high-dose groups and butylphthalide control group （P＞0.05）. CONCLUSIONS ：Ginsenoside Rg 1 has a certain preventive effect on focal CIRI model rats ，the mechanism of which may be associated with down-regulating the protein expression of p-p 38 MAPK and p-NF-κB p65，inhibiting the release of inflammatory factors such as IL- 1β and IL-6.

Factors influencing quality of life in elderly patients with type 2 diabetes in community / 中华全科医师杂志

A survey on the quality of life of diabetic patients was conducted in Shanghai Changqiao community in August 2017.Total 1 002 patients with type 2 diabetes mellitus (T2DM)aged ≥60 years were randomly selected to participant in this face-to-face questionnaire survey,967 participants completed the survey with a effective rate of 96.5％.The Anxiety Self-Rating Scale and Diabetes-Specific Quality of Life Scale (A-DQOL) were applied for evaluation.The results showed that up to 48.9％(473/967) participants had an anxiety state.Multivariate stepwise regression analysis showed that the educational level was the main influencing factor of A-DQOL (P＜0.05).The educational level and fasting blood glucose were the influencing factors of satisfaction degree and impacting degree score;educational level,treatment mode and BMI were the influencing factors of grade Ⅰ anxiety;age and educational level were the influencing factors of grade Ⅱ anxiety (all P＜0.05).The survey demonstrates that age,educational level,treatment,fasting blood glucose and BMI would affect the quality of life of elderly T2DM patients.

Effect of Lycium barbarum polysaccharide on atherosclerosis in mice by up-regulating adiponectin expression / 药物评价研究

Objective To explore the effect of Lycium barbarum polysaccharide (LBP) on adiponectin (APN) expression and the mechanism of lowering blood-lipid and anti-inflammation in atherosclerotic (AS) mice.Methods C57BL/6J mice with normal feed were chosen as control group.Thirty-two ApoE-/-mice with high cholesterol diet were successfully established as AS models,and then the mice were randomly divided into model group and three LBP groups,which were feed with high,medium,and low dose of LBP.After feeding for four weeks,aortic blood and tissues were collected.Blood-lipid,inflammatory factors,endothelin-1 (ET-1),APN,AdipoR1,and AMPK pathway related protein expression were detected.Differentiated 3T3-L1 cells were divided into control group,LBP group,and LBP + BML-275 group.Triglyceride (TG),inflammatory factors,APN,AdipoR1,and AMPK pathway related protein expression was investigated.Results In mice,compared with the control group,typical AS pathomorphologic changes were found in aorta and the levels of TG,total cholesterol (TC),nitric oxide (NO),ET-1,interleukin-6 (IL-6),and tumor necrosis factor (TNF-α) in the model group were significantly increased,while the protein expression of HDL-C,APN,AdipoR1,PPARα,AMPKα,and p-AMPK-α and Acyl-CoA oxidase (ACO) mRNA expression was reduced.Compared with the model group,AS pathomorphologic state was obviously improved in aorta and the amount of TG,TC,NO,ET-1,IL-6,and TNF-α in LBP groups were markedly decreased,while the protein expression of HDL-C,APN,AdipoR1,PPARα,AMPKα,p-AMPKα,and ACO mRNA expression was up-regulated.These changes were all in a dose-dependent manner.In differentiated 3T3-L1 fat cells,compared with control group,LBP enhanced the expression of APN,AdipoR1,PPARα,AMPKα,p-AMPKα,and ACO,but decreased the amount of TG,IL-6,and TNF-α.Compared with LBP group,the levels of TG,IL-6 and TNF-α was notably increased in BML-275 group.Conclusion LBP up-regulates the expression of APN and AdipoR1,activates APN/AMPK pathway,plays a role in lowering blood-lipid and anti-inflammation,and thus relieves AS in mice.

Biomechanics characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy:a finite element model study / 中国组织工程研究

BACKGROUND:Surgical treatment is commonly used for decompressing the spinal cord in multilevel cervical spondylotic myelopathy, but the optimum anterior cervical reconstructive method has not been determined. OBJECTIVE:To compare and analyze the biomechanical characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy utilizing the three-dimensional finite element model. METHODS:A three-dimensional finite element model of an intact C2–7 segment was developed and validated based on healthy adult male CT images. Four additional models were developed from the fusion model, including anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical hybrid decompression and fusion and anterior cervical discectomy and fusion with Cage alone. Von Mises stresses on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. RESULTS AND CONCLUSION:(1) The C2/3 disc stress in flexion, extension, lateral bending and rotation condition was significantly higher than the C6/7 disc in 4 anterior cervical reconstructive techniques, and the adjacent disc stress (C2/3, C6/7) was lowest in the anterior cervical discectomy and fusion with Cage alone, and highest in the anterior cervical corpectomy and fusion. (2) The stress at the plate-screw interface was highest in the anterior cervical corpectomy and fusion, and lowest in the anterior cervical discectomy and fusion. (3) In conclusion, among the four anterior cervical reconstructive techniques for multilevel cervical spondylotic myelopathy, the anterior cervical discectomy and fusion with Cage alone makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment disease after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

Qualitative research of stimulative about posttraumatic growth of head-injured patients associated with limb movement disorder / 中国实用护理杂志

Objective To explore stimulative of posttraumatic growth(PTG) of head-injured patients associated with limb movement disorder,in order to provide reference for psychological nursing intervention.Methods Phenomenological methodology was used in the study.A semi-structured interview was conducted on seven head-injured patients with limb movement disorder recruited by purposive sampling method.Data were analyzed by Colaizzi's analysis procedure.Results Through interview,the following four themes were summarized:positive state of mind and coping style of patients; patients' high level of self-efficacy; social support; high quality of medical services.Conclusions In order to promote PTG of head-injured associated with limb movement disorder patients,nurses should strive to adjust the patient mentality and coping strategies,improve their self-efficacy levels,help patients get support from the community,at the same time should also focus on quality of medical services.

Impact of low dietary glycemic index on decreasing of the risk of coronary heart disease: a systematic review / 中国实用护理杂志

Objective To evaluate the impact of low dietary glycemic index on the risk of coronaryheart disease (CHD).Methods We searched the Cochrane Database of Systematic Reviews,JBI Database of Systematic Reviews,MEDLINE,EMbase,CBMdisk,and CNKI to collect cohort studies from 2000 to 2011.The quality of cohort studies was critically appraised and data were extracted by 4 reviewers independently.Meta-analysis were conducted for the eligible cohort studies using RevMan 5.0.Results Five cohort studies were included,and 128 911 samples were researched.The result of meta analysis indicated that low dietary glycemic index was a protective factor of CHD,RR value was 1.25,95％ CI was (1.13,2.15).Further more,the result was only effective to female,RR value was 1.35,95％ CI was (1.16,1.57),but not to male,RR value was 0.96,95％CI was (0.76,1.31).Conclusions Low dietary glycemic index can decrease the risk of CHD,but it is still to be proved whether it is suitable to male.

Design and clinical application of the instrument for percutaneous posterolateral lumbar foraminoplasty / 中华骨科杂志

ObjectiveTo introduce the design of the instrument for percutaneous posterolateral foraminoplasty and analyze long-term outcomes of percutaneous foraminoplasty and transforaminal endoscopic discectomy in the treatment of non-contained lumbar disc herniation.MethodsFifty-six patients with noncontained lumbar disc herniation confirmed by symptom,physical sign and concordant imaging underwent percutaneous foraminoplasty and transforaminal endoscopic discectomy,including 7 cases of L3-4,30 of L4-5 and 19 of L5S1.The visual analogue scales(VAS) of pre- and post-operative low back pain and sciatica were compared,and the Macnab scores were also evaluated.ResultsAll of the procedures were performed successfully,with mean operation time of 60 min(range,40-120 min),and a mean blood loss of 30 ml (range,20-50 ml).The follow-up time was more than 36 months.Postoperative VAS of low back pain and sciatica were significantly decreased compared with preoperative VAS (P＜0.01).There were 44 cases of excellent,10of good,and 2 of fair according to Macnab score system,with total successful rate (excellent and good) up to 96.4％.Only 5 cases with L5S1 disc herniation were found complicated with sun-burn syndrome,which were relieved by pulsed electro-stimulant therapy for 1 week.ConclusionPercutaneous foraminoplasty and transforaminal endoscopic discectomy is an effective and safe minimally invasive treatment alternative for non-contained lumbar disc herniation.

Anatomic and clinical study of minimally invasive total hip arthroplasty through anterolateral intermuscular approach / 中华创伤杂志

Objective To investigate the anatomic structure of the Chinese people,develop the procedure of minimally invasive total hip arthroplasty through the anterolateral intermuscular approach and investigate its clinical outcome.Methods Three fresh adult cadavers(6 hips)were used for study of the anatomic construction of the anterolateral intermuscular approach in Chinese people.Sixteen patients were treated with minimally invasive total hip arthroplasty through anterolateral intermuscular approach.The clinical results and operation technique were recorded.Results The anterolateral intermuscular approach was a triangle muscular interval slightly parallel to the femur.The medial-superior angle of the triangle muscular interval consists of the anterior border of gluteus medius and tensor fascia lata muscle with juncture of muscles,where the inferior branch of superior gluteal nerve entered into tensor fascia lata muscle.The average incision length was 8.8 cm(7-10 cm),with mean blood loss of 350 ml(250-550 ml).The patients took out-of-bed activity 3-5 days after operations.During operations,anterior border injury in deep portion of the gluteus medius muscle was observed in seven patients and the injured muscles were trimed or repaired.All patients were followed up for 18-39 months(averaged 27.7 months).Most of the patients had excellent location of the phantoms,except that one acetabulum had a little pitch angle and two acetabulums had a little abduction angle.No complication was observed.The mean Harris scores of hip for all patients was increased from preoperative(39.1±6.7)points to(80.6±11.3)points on six month,(88.7±9.6)points on 12 month and(91.4±13.5)points on 24 months(11 patients).No patient suffered from gluteus medius muscle weakness during the follow-up.ConclusionAnterolateral intermuscular approach has the advantages of simple anatomic construction,small incision,little operative injury,muscle sparing and fast recovery without separate muscle or tendon and is suitable for the Chinese patients.Exact incision and special operative instruments should be emphasized to avoid the increase of acetabular pitch angle and abduction angle.

T lymphocyte subsets and intracellular cytokines after transfer of chemical acellular nerve allograft / 中华创伤骨科杂志

Objective To provide immunological evidence for clinical transfer of chemical extracted acellular nerve allografL Methods One hundred and twenty-eight BALB/C mice were randomly divided into 4 groups of equal size according to their different treatments:negative contrast group(NC),fresh autograft group(AG),fresh allogeneic nerve group(FN)and chemical extracted aceflular allogeneic nerve group(CEN).Then we implanted various kinds of nerve grafts into the thigh muscle of BALB/C mice in corresponding groups.At 3,7,14,28 days postoperatively,8 mice from each group were killed each time to harvest their spleens,from which T lymphocytes were collected.Theu monoclonal antibodies(CD3,CD4 CD8 CD25,IL-2,IFN-γ, TNF-α)were added into the suspension.Then fluorescence.activated cell sorting(FACS)was used to determine the positive rates of cells combined with the above monoclonal antibodies. Results There were no statistically significant differences between CEN group,NC group,and AG group,but indexes of FN group were significantly higher than those of the other 3 groups at corresponding time points. Conclusion There is no obvious immune reiection of chemical extracted acellular nerve allograft when compared with fresh nerve autograft.

Treatment of cervical disc herniation using coblation technology / 中国矫形外科杂志

[Objective]To retrospectively analyze the results of plasma-mediated coblation in treating cervical disc herniation.[Method]From January 2003 to April 2006,127 symptomatic cases(197 disc levels)with cervical contained disc herniation were treated with plasma-mediated coblation technology,including 81 males and 46 females,their average age was 49 years,the treated disc levels were 17 in C3、4,61 in C4、5,90 in C5、6 and 29 in C6、7 ,respectively.All patients were reported to have persistent cervical or unilateral arm pain for a minimum of three months and failed previous conservative treatment.MRI showed herniated cervical disc causing focal compression of the nerve root.An average percentage of symptom relief(VAS score)and subjective satisfaction were administered to measure symptoms at all visits.[Result]In the immediate post-operative period,124 patients reported significant amelioration of symptoms,3 patients complained of arm numbness did not change clinical status,one week after operation,percentage of symptom relief was 64%,perfect rate of subjective satisfaction was 91%.Patients were followed up for average 18 months(range 6～31 months)postoperatively.Percentage of symptom relief was 47%,perfect rate of subjective satisfaction was 62%.In the last follow-up,7 patients were observed a stabilization of clinical status over 2 years and in 15 patients the status was similar to preoperation.The other patients referred some residual symptoms and were still under follow-up.There were no complications observed such as hemorrhages,infections and nerve root injurys due to the procedure.[Conclusion]Our data indicate coblation procedure appearing to be less injury,safety,is a promising treatment option for patients with contained cervical disc herniation who have failed conservative therapies and are not considered candidates for open surgery,also supplementary therapy perioperatively in patients treated with cervical open surgery.

Significance of Flexion Priority in the Rehabilitation of Posttraumatic Stiffness of Elbow / 中国康复理论与实践

@#ObjectiveTo evaluate the significance of flexion priority strategy and the principle of joint mobilization technique in the rehabilitation of posttraumatic stiffness of the elbow. Methods24 patients with posttraumatic stiffness of the elbow were divided into 2 groups, 12 patients in each group. The treatment group was treated with flexion priority strategy of joint mobilization technique only in the treatment of flexion contracture. In order to decrease the pain caused by joint mobilization training of extension and achieve the restoration of flexion as early as possible, the rehabilitation of extension was altered to self-exercise under the consultation of doctors combined with gentle passive traction by the therapist. The control group was treated with joint mobilization technique of both flexion and extension once a day. All the patients were measured the flexion range, extension range, and flexion-extension arc after 6 weeks of rehabilitation. Results6 weeks after rehabilitation, the treatment group got 124° of flexion (range 95°～135°), much better than the control group of 95° (range 80°～110°) （P<0.01）. There was no significant difference of extension degrees between the treatment group (15°, range 10°～35°) and the control group (16°, range 10°～30°) （P＞0.05）. The final arc of flexion and extension in the treatment group had an increase of 53°, significantly greater than 30° in the control group（P<0.01）. ConclusionFlexion priority strategy of elbow rehabilitation can significantly restore the flexion function of posttraumatic elbow stiffness.

Transforaminal Posterolateral Endoscopic Discectomy and Radiofrequency Annuloplasty for Discogenic Low Back Pain / 中国微创外科杂志

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs (L5-S1) developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation:6.24?0.97,1,3,6 months after the operation:0(0~2); Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%(23/25). Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.

Further knowledge on Schmorl′s node formation:a case report / 第二军医大学学报

Objective:To further study the pathogenesis of classic Schm orl′s nodes based on clinical practice.Methods:A patient with severe low back pain was found that the irregularity of the endplates and the presence of Schm orl′s nodes in L2 - 3 and L3- 4spaces in lumbar radiographs.Two painful intervertebral discs with Schm orl′s nodes in their superior or inferior endplates were identified by discography and pain provocation.Two foci of Schnorl′s nodes were rem oved in en bloc via a retroperitoneal approach for histological examination.Meanwhile,anterior intervetebral body fusion of painful discs were undertaken.Results:The radiographic manifestation of Schmorl′s nodes was the end- plate indentation.Schmorl′s nodes in CT scan was shown as a round- like or multicystic irregular zone of bone density with an indistinct sclerotic margin beneath the cartilaginous endplate,which was sim ilar to the typical CT changes of osteonecrosis.The histological examinations of en bloc slices of Schm orl′s nodes revealed subchondral osteonecrosis.Conclusion:The current study indicate classic Schm orl′s node shown in radiograph is osteonecrosis zone beneath cartilaginous endplate,suggesting the necessity of further study on Schmorl′s node form ation. [

Chemical radiculitis in lumbar spine / 中华骨科杂志

Objective The theory of chemical radiculitis was put forward about 30 years ago, but it has not been proved by clinical study so for. The current study was initiated to assess whether the annular tear in painful disc was the cause of radiating leg pain (radiculopathy) in patients with discogenic low back pain. Methods Forty-two patients with chronic low back pain in single level and shooting leg pain in unilateral or bilateral lower limbs without lumbar disc herniation on CT and MR imaging were treated (age range, 19-52 years; mean age, 34.9 years; 27 males, 15 females). All patients showed annular disruption and pain reproduction on injection of the contrast during discography at single disc level (not including patients who had two or three levels disc disease). CT scan was performed to identify the location of annular tears after discography. The examinations of electromyography(EMG) and motor nerve conduction velocity (MCV) were performed in all patients, which were used to analyze the degree of nerve root injury and the relation with radiating leg pain. Results The patients with posterolateral annular disruption in single side mainly presented single lower limb radiation pain, in contrast, the patients with posterolateral annular disruption in two sides or posterior midline annular disruption mainly presented dual lower limb radiation pain. There was a significant positive correlation between the site of annular tear and the side of radiation pain. The examinations of EMG in all 42 cases found that there were abnormal insertional activities such as fibrillation potentials and positive sharp waves in 32 cases(76%). Of the 23 patients with unilateral lower limb radiation, nerve root lesions were found on the symptomatic side in 17 cases(74%). Of the 19 cases with bilateral lower limb radiation pain, root lesions were suggested in 15 patients(79%). The conduction velocities of common peroneal nerve and tibial nerve decreased with a statistically significant difference in symptomatic side compared with normal side. Conclusion Inflammatory chemical mediators and cytokines produced in painful disc leaking into epidural space through annular tear could lead to the injury to adjacent nerve roots, which might be primary pathophysiologic mechanism for the production of chemical radiculitis.

Pathologic characteristics and clinical significance of high intensity zone of lumbar intervertebral disc in the patient with discogenic low back pain / 中华骨科杂志

Objective To study the pathologic characteristics and clinical significance of high intensity zone (HIZ) of lumbar intervertebral disc in the patients with discogenic low back pain. Methods 52 patients with low back pain without disc herniation underwent MRI and following discography of lumbar vertebrae. All patients previously were treated conservatively without relief of their symptoms for more than 6 months. Specimens of lumbar intervertebral discs containing HIZ in the posterior annulus from 11 patients with discogenic low back pain during posterior lumbar interbody fusion (PLIF) were collected to investigate the morphologic patterns and clinical significance. Results In all of 142 discs in 52 patients at discography, 17 discs in 17 patients presented HIZ, all showed painful reproduction and abnormal morphology with annular tears extending either well into or through the outer third of the annulus fibrosus. The histologic study of the consecutive sagittal slices in the HIZ lesions revealed that the normal lamellar structure was replaced by disorganized, vascularized granulation tissue that consisted of small round cells, fibroblasts, and newly formed blood vessels around the tears extending from the nucleus pulposus to the outer region of the annulus fibrosus. Blood vessel proliferation and inflammatory cell infiltration were seen extending along the margins of the tears into the middle and inner annulus, and sometimes the tears were bridged with granulation tissue. Ingrowth of vascularized tissue was sometimes observed to end abruptly at the junction between the inner third of the annulus and the nucleus pulposus. There was also matured scarring collagenous tissue. Conclusion The HIZ in the lumbar disc in the patients with symptomatic low back pain can be considered as a reliable marker of painful outer annular disruption.

Evaluation of Different Surgical Procedures for the Treatment of Lumbar Spondylolisthesis: A Clinical Analysis of 202 Cases / 中华骨科杂志

Purpose: Through the analysis of 202 cases of spondylolisthesis treated with surgery, the different types of surgical procedures were reevaluated. Material and Method: Patients with spondylolisthesis were divided into 3 groups based upon their pathology and different surgical procedures were used accordingly. The results were evaluated after follow-up of more than one year. Group Ⅰ consisted of 38 patients with degenerative spondylolisthesis with back pain and isthmic spondylolisthesis of less than 33%; they were treated with anterior intervertebral body fusion. Group Ⅱ consisted of 99 cases of mild isthmic spondylolisthesis with unilateral sciatica, and were treated with semi-laminectomy and decompression of symptomatic side; interlaminar and interspinous process fusion of the opposite side was performed for 99 cases of mild isthmic spondylolisthesis with unilateral sciatica. Group Ⅲ consisted of 65 cases of spondylolisthesis more than 33% with sciatica and they were treated with decompression, reduction of sliding vertebra and posterior intervertebral body fusion. Result: In group Ⅰ, solid fusion was in 20 cases giving a fusion rate of 91%. In group Ⅱ, the satisfactory rate was as high as 91.5%. In group Ⅲ, the satisfactory rate and fusion rate reached 91.8% and 95.9% respectively. Conclusion: Reduction of spondylolisthesis could increase the fusion contact area, restore normal mechanics and saggital curve of the lumbar spine, relieve neural compression and improve the extemal appearance and function. For the surgical treatment of spondylolisthesis, the major goal should toward a solid fusion between the sliding vertebra and its adjacent vertebrae and laminectomy alone is not a procedure of choice.