陈旧性Denis Ⅱ型骶骨骨折合并骶神经损伤的诊断与治疗

目的：探讨陈旧性Denis Ⅱ型骶骨骨折合并骶神经损伤的诊断及手术方法。方法：取60具骶骨干标本及26具完整骨盆标本，测量S1棘突与S1后孔同位置关系、骶前区血管、骶神经及梨状肌之间关系；对14例陈旧性DenisⅡ型骶骨骨折合并骶神经损伤患者，在常规骨盆X线片，CT，螺旋CT三维重建的同时，又采用显示骶神经全长的骶骨斜冠状位MR扫描，观察神经走向及眦领关系。11例行自行设计的后略骶神经管扩大减压术，3例行非手术治疗。结果：S1棘突于S1后孔中上1/3者占90%，骶前区主要血管有骶外侧动静脉和骶外侧血管、骶正中血管及臀上血管进入骶前孔的分支。血管位于骶丛神经腹侧，骶外侧斑管距离S1前孔大于10mm，S2前孔大于5mm。骶骨斜冠状位MR扫描可以显示骶神经全长及周围眦领关系。骶神经损伤时，发现有神经根走行改变(13例），损伤处神经很周围脂肪消失（11例），神经根管狭窄(10例)。14例均获得随访。随访时间6--12个月。平均7.1个月，术后改善情况，优9例，无变化1例。结论螺旋CT三维重建及骶骨斜冠状位MR扫描对于骶神经损伤的定位及定性诊断有重要价值。后路骶神经管扩大减压术是针对骶神经管、骶前孔处神经损伤的较理想手术方法。     

Direct protective effect of interleukin-10 on articular chondrocytes in vitro

Objective To assess whether interleukin-10 (IL-10) is chondroprotective in vitro.Methods Chondrocytes were isolated from femoral cartilage of rats (7-10 days) by digesti on with collagenase Ⅱ.The first passage cells were grown in 24- well plates with DMEM, supplemented with 10% fetal bovine serum, for 2-4 days.The ce lls were then cultured in 0.1% fetal bovine serum DMEM medium, and given respec tively interleu kin-1 (IL-1) 100 μ/ml, IL-1 100 μ/ml+recombinant murine interleukin-10 ( rmIL-10) 20 ng/ml, rmIL-10 20 ng/ml, and cultured for 48 hours.Scanning el ectron morphology and immunohistochemical study of nitric oxide synthase 2 and matric metalloproteinase 3 mRNA in situ hybridization were performe d.Cell proliferation and morphology were observed under inverted microscope fr om the beginning of cell culture for three weeks.Results IL-1 stimulated granule production in the cytoplasma of chondrocytes, and the c ells died in the second and third weeks of culture.IL-10 antagonized IL-1, p rotected the cells from death and maintained chondrocyte proliferation.Scannin g electron morphology showed that IL-1 stimulated the formation of numerous mic rovilli on the cell surface, while thin and less numerous microvilli were found in cultures with IL-10.Immunohistochemical study and in situ hybridization sh owed that IL-10 inhibited NOS2 and MMP3 expression.Conclusion IL-10 not only inhibits the synthesis of inflammatory cytokines, but also direc tly protects chondrocytes by antagonizing IL-1.     

Adriamycin-methotrexate high dose versus adriamycin-methotrexate moderate dose as adjuvant chemotherapy for osteosarcoma of the extremities: a randomized study

Adjuvant chemotherapy comprising Adriamycin (ADM) and Methotrexate (MTX) with Citrovorum Factor (CF) was administered on a randomization basis to 2 groups of patients with osteosarcoma after surgical ablation of the primary tumor. One group received high dose MTX (regimen I) and the other moderate dose MTX (regimen II). In both groups a short period of heparin treatment was also administered to prevent neoplastic emboli during surgery. All patients were free of metastasis at the beginning of therapy. The efficacy of therapy was determined by recording the percentage of continuously disease-free patients. This was compared to the disease-free survival in 132 patients previously treated with other ADM or ADM-MTX regimens and to a group of 39 patients treated during this period with amputation only. The latter did not receive adjuvant chemotherapy for a variety of reasons and are equated to a concurrent control group. Over the ensuing 27–66 months, 31 of 56 patients (55%) treated with regimen I and 25 of 50 (50%) treated with regimen II were disease-free. The overall disease-free survival in both regimens was 53%. This is similar to the 132 patients treated with previous adjuvant chemotherapy protocols (45–50%). However, the percentage of continuously disease-free patients treated with adjuvant chemotherapy was significantly better than the 39 patients (12%) treated contemporaneously with surgery only (P < 0.0005). Survival in the latter is similar to that of historical control patients. These results do not suggest any change in the natural history of osteosarcoma and reveal benefits which may accrue with adjuvant chemotherapy. These results also demonstrate that in adjuvant treatment of osteosarcoma performed with ADM and MTX the high and the moderate doses of MTX are equally efficacious.     

Polyostotic fibrous dysplasia involving the thoracic spine with myelopathy: case report and review of the literature

Background contextPolyostotic fibrous dysplasia (PFD) seldom involves the thoracic spine and usually presents with back pain.PurposeTo describe an extremely rare presentation of an uncommon disease.Study design/settingWe present a case report from a university hospital.MethodsWe report a case of symptomatic thoracic PFD associated with myelopathy and pathologic fracture. A thorough search of PubMed/MEDLINE was performed for the terms “polyostotic fibrous dysplasia,” “spine,” and “neurological deficit.”ResultsThe patient was treated by posterior laminectomy, vertebroplasty, and pedicle screw fixation and fusion. Satisfactory results were achieved, and there were no complications.ConclusionsIn the spine, PFD may lead to pathologic fracture and myelopathy even after adolescence. Vertebroplasty with or without decompression and fixation may be the appropriate option for cases with myelopathy.     

Preoperative neutrophil-to-lymphocyte ratio is a more valuable prognostic factor than platelet-to-lymphocyte ratio for nonmetastatic rectal cancer

Several combinations of inflammatory factors, including neutrophil-to- lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been reported to be prognostic factors in various malignant tumors, including colorectal cancer (CRC). The aim of this study was to evaluate the prognostic value of NLR and PLR for patients with rectal cancer (RC) who underwent curative surgery. Data from patients who underwent curative resection for RC were retrospectively reviewed. The cutoff for NLR and PLR was defined as 2.3 and 144 by receiver operating characteristic (ROC) curve. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier method. Multivariable Cox regression model was used to evaluate the independent prognostic significance of variables. A total of 140 patients were eligible in the study. High NLR (> 2.3) and high PLR (> 144) both predicted lower OS and DFS according to Kaplan-Meier method. But in the multivariable Cox regression model, only the high NLR retained significance for reduced OS and DFS. According to Chi-square test, patients with higher NLR had larger tumor size and higher pN-stage. While PLR was only associated with the pN-stage. High preoperative NLR was shown to be a negative independent prognostic factor in patients undergoing resection for nonmetastatic RC. It may be helpful as a factor to guide the postoperative therapies.     

Rasch analysis of a Spanish language-screening parent survey

The purpose of this study was to evaluate and refine items from a parent survey designed to screen the language skills of Spanish-speaking preschoolers. This investigation applied Rasch modeling to systematically evaluate and identify items that demonstrated favorable qualities.A set of 124 parent survey items was administered to 107 Spanish-speaking parents of preschool age children. Parents completed survey items intended to provide a global measure of preschool language abilities. Rasch analyses of the survey items were conducted using WINSTEPS.Results indicated that 59 items, all vocabulary items, fit the Rasch model. Sufficient unidimensionality was obtained, with the model accounting for 58% of the variance. Item difficulty estimates ranged from −7.43 to 4.12, with a shortage of items at both the lower ability level and at the higher ability level. Analyses of pruned and remaining items identified the type of items that may be most useful for a refined item bank. These results will inform the development of new items for a Spanish language-screening parent survey for preschool age children.     

ProDisc–C versus anterior cervical discectomy and fusion for the surgical treatment of symptomatic cervical disc disease: two-year outcomes of Asian prospective randomized controlled multicentre study

European Spine Journal - Our study aimed to evaluate non-inferiority of ProDisc-C to anterior cervical discectomy and fusion (ACDF) in terms of clinical outcomes and incidence of adjacent segment...     

Correction to: Correlation between lordosis distribution index,lordosis tilt,and occurrence of proximal junctional kyphosis following surgery for adult degenerative scoliosis

European Spine Journal -