Publications by authors named "Zhen-Zhou Li"

27 Publications

  • Page 1 of 1

The effect of erythrocyte transfusion on macrophage pyroptosis and inflammation in a sepsis model.

Adv Clin Exp Med 2021 May 25. Epub 2021 May 25.

Department of Anesthesiology, Shanghai Gongli Hospital, The Second Military Medical University, China.

Background: Sepsis is one of most common causes of death in the intensive care unit (ICU) due to infection and inflammation. The Duffy antigen receptor for chemokines (DARC) regulates pro-inflammatory cytokines, thus playing an important role in inflammation.

Objectives: This study aimed to elucidate the correlation among erythrocyte transfusion, macrophage pyroptosis and inflammation in the progression of sepsis.

Material And Methods: Alanine aminotransferase (ALT/GPT) activity was measured with the ALT/GPT activity measurement kit (Jiancheng Bio, Nanjing, China) according to the kit manual. The ET-1 concentration was measured with enzyme-linked immunosorbent assay (ELISA) using the endothelin-1 (ET-1) measurement kit (Jiancheng Bio) according to the kit manual. Apoptosis was evaluated using flow cytometry-based Annexin V staining assay. The cells were collected using centrifugation and resuspended in binding buffer. Ultrastructural analysis of pyroptotic body, the levels of interleukin (IL)-1β, IL-18, IL-33, MIP-2, CXCL8, reactive oxygen species (ROS), and LTB4 were measured with ELISA.

Results: Our results showed that septic rats had impaired hepatic function and ET-1 levels. Erythrocyte transfusion upregulated DARC expression in the sepsis model. Erythrocyte transfusion also affected pyroptosis in macrophages, reduced the production of inflammatory cytokines, such as IL-1β, IL-18 and IL-33, and alleviated cytotoxicity in the sepsis model.

Conclusions: Erythrocyte transfusion may function as a therapeutic tool against sepsis by regulating pyroptosis, inflammation and cytotoxicity.
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http://dx.doi.org/10.17219/acem/133490DOI Listing
May 2021

To Research the Effects of Storage Time on Autotransfusion based on Erythrocyte Oxygen-Carrying Capacity and Oxidative Damage Characteristics.

Cell Transplant 2021 Jan-Dec;30:9636897211005683

Department of Anesthesiology, Shanghai Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China.

Autotransfusion refers to a blood transfusion method in which the blood or blood components of the patient are collected under certain conditions, returned to himself when the patient needs surgery or emergency after a series of storing and processing. Although autotransfusion can avoid blood-borne diseases and adverse reactions related to allogeneic blood transfusion, a series of structural and functional changes of erythrocytes will occur during extension of storage time, thus affecting the efficacy of clinical blood transfusion. Our research was aimed to explore the change of erythrocyte oxygen-carrying capacity in different storage time, such as effective oxygen uptake (Q), P50, 2,3-DPG, Na-K-ATPase, to detect membrane potential, the change of Ca, and reactive oxygen species (ROS) change of erythrocytes. At the same time, Western blot was used to detect the expression of Mitofusin 1 (Mfn1) and Mitofusin 2 (Mfn2) proteins on the cytomembrane, from the perspective of oxidative stress to explore the function change of erythrocytes after different storage time. This study is expected to provide experimental data for further clarifying the functional status of erythrocytes with different preservation time in patients with autotransfusion, achieving accurate infusion of erythrocytes and improving the therapeutic effect of autologous blood transfusion, which has important clinical application value.
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http://dx.doi.org/10.1177/09636897211005683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135200PMC
May 2021

Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion: A Technical Note With 1-Year Follow-Up.

Int J Spine Surg 2021 Jun 7;15(3):504-513. Epub 2021 May 7.

Desert Institute for Spine Care, Phoenix, Arizona; Executive Director International Intradiscal Therapy Society, Phoenix, Arizona.

Background: Oblique lateral lumbar interbody fusion (OLLIF) is a minimally invasive lumbar interbody fusion procedure using a bullet-shaped polyetheretherketone (PEEK) nonexpandable fusion cage modified to diminish risk to the exiting nerve root during posterolateral implantation through the Kambin safe zone under fluoroscopic guidance. The objective of this study was to present feasibility of this procedure and 1-year clinical outcome data.

Methods: The authors present a prospective cohort study of 20 patients who underwent fluoroscopy-guided and full-endoscopic OLLIF in 22 segments allowing protection of the exiting nerve root from January 2018 to March 2019. The foraminoplasty, discectomy, endplate preparation, placement of bone graft and insertion of the fusion cage was done under continuous full-endoscopic visualization. The OLLIF fusion was backed up with bilateral percutaneous posterior supplemental pedicle screw fixation. Primary clinical outcome measures were the visual analog scale (VAS) of low back and leg pain, and Oswestry disability index (ODI) at 1 week, 3 months, 6 months, and 1 year after the operation. At final follow-up, the Macnab score was also evaluated. Secondary outcome measures were computed tomography (CT) assessment fusion using the Mannion classification of spinal fusion and adverse events related to the device as well as magnetic resonance imaging (MRI) assessment of nerve root decompression.

Results: All patients had significant relief of low back pain and leg pain, by VAS and ODI scores that improved significantly ( < .01). There were no complications. Postoperative lumbar MRI of all patients showed sufficient direct nerve decompression. At 1-year follow-up, excellent Macnab outcomes were obtained 13 patients, good in six, and fair in one. Impaired sensation and muscle strength of the involved nerve root significantly recovered in all but 2 patients ( < .05). According to the Mannion CT-based classification of spinal fusion, CT showed complete interbody fusion achieved in all 22 segments.

Conclusions: Full-endoscopic OLLIF is a safe, effective, minimally invasive, economical, practical, and widely applicable minimally invasive interbody fusion technique in the lumbar spine.

Level Of Evidence: 3.
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http://dx.doi.org/10.14444/8072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176836PMC
June 2021

The effect of different storage times on the oxygen-carrying capacity of the exosomes of red blood cells.

Adv Clin Exp Med 2021 04;30(4):387-394

Department of Anesthesiology, Shanghai Gongli Hospital, The Second Military Medical University, China.

Background: After storing blood for a period of time, the structure and properties of the red blood cells (RBC) will change, which results in a decrease in the oxygen-carrying capacity, and further has a certain impact on their exosomes.

Objectives: Effective oxygen uptake (Q), P50, 2,3-DPG, and Na+-K+-ATP of RBC after different storage times were detected. Electron microscopy was used to observe the morphology of RBC and the characteristics of secreting exosomes. Western blot was used to detect the expression of phenotypes CD63 and CD81 of exosomes, and the expression of mitochondrial riboprotein MRPS35 of exosomes was also detected to explore the mechanism of decreased function of RBC with the extension of preservation time.

Material And Methods: After the RBC suspension was prepared, the effective oxygen-carrying capacity (Q) and P50, as well as 2,3-DPG and Na+-K+-ATP were prepared. This was followed by morphology observation of erythrocyte exosomes using transmission electron microscope (TEM), and by western blot analysis of exosome phenotypes CD63 and CD81.

Results: Erythrocytes secrete exosomes, which results in abnormal expression of related proteins in mitochondria. This leads to increased ROS production, mitochondrial apoptosis and, finally, changes in or damage to erythrocytes.

Conclusions: Changes in the rheological properties and oxygen-carrying functions of erythrocytes during preservation are all observable manifestations, and underlying these manifestations are mechanisms of damage to erythrocytes at a molecular level. Erythrocytes secrete exosomes, which results in abnormal expression of related proteins in mitochondria, increasing ROS production, mitochondrial apoptosis and, finally, changes or damage to erythrocytes.
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http://dx.doi.org/10.17219/acem/131962DOI Listing
April 2021

Ultrasonic Osteotome Assisted Full-Endoscopic en Block Resection of Thoracic Ossified Ligamentum Flavum: Technical Note and 2 Years Follow-up.

Pain Physician 2021 Mar;24(2):E239-E248

Department of Orthopedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.

Background: Conventional open laminectomy is considered to be the standard procedure for the treatment of thoracic ossified ligamentum flavum, but multi-segment thoracic laminectomy extensively removes the facet joints and ligamentous tissue, destroying the thoracic spine biomechanics and stability, may lead to delayed thoracic spine kyphosis deformities, which in turn can lead to potential neurological deterioration and local intractable pain.

Objective: To introduce the technical notes and clinical outcome of ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum.

Study Design: A prospective cohort study.

Setting: Hospital and outpatient surgery center.

Methods: From January 2017 to March 2018, 15 patients with 1 - 2 segment thoracic ossified ligamentum flavum were treated with ultrasonic osteotome assisted full-endoscopic en block resection of thoracic ossified ligamentum flavum under local anesthesia. The magnetic resonance imaging and computed tomography of the thoracic spine was reexamined after the operation to evaluate the completeness of ossified ligamentum flavum resection and spinal cord decompression. The patients were followed up on the visual analog scale of back pain and radicular pain, Nurick score and mJOA score of neurological function, and Oswestry Disability Index at 1 week, 3 months, 6 months, one year, and 2 years after operation.

Results: All operations of 17 segments thoracic ossified ligamentum flavum in 15 patients were successfully completed without intraoperative conversion to open surgery. There were no intraoperative spinal cord injuries, dura tears, postoperative cerebrospinal fluid leakage, postoperative infections, and postoperative spinal cord injury aggravated symptoms. Postoperative thoracic spine magnetic resonance imaging and computed tomography examinations of all patients showed that the spinal cord was fully decompressed without any residual pressure. Back pain and radicular pain were relieved significantly, and spinal cord function (Nurick, mJOA, and Oswestry Disability Index scores) was obviously restored. The mJOA recovery rate at the 2-year follow-up was 78.3% in average.

Limitations: This is an observational cohort study with relative small sample and short-term follow-up.

Conclusions: Ultrasonic assisted full-endoscopic en block resection of ossified ligamentum flavum is a safe and effective minimally invasive spine surgery for thoracic myelography caused by thoracic ossified ligamentum flavum.
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March 2021

Elevation of plasma tRNA fragments as a promising biomarker for liver fibrosis in nonalcoholic fatty liver disease.

Sci Rep 2021 Mar 15;11(1):5886. Epub 2021 Mar 15.

Emergency Department, Central South University Third Xiangya Hospital, No. 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China.

Fibrotic tissue remodelling in nonalcoholic fatty liver disease (NAFLD) will probably emerge as the leading cause of end-stage liver disease in the coming decades, but the ability to diagnose liver fibrosis in NAFLD patients noninvasively is limited. The abnormal expression of tRNA-derived small RNA (tsRNA) in plasma provides a novel idea for noninvasive diagnosis of various diseases, however, the relationship between tsRNAs and NAFLD is still unknown. Here, we took advantage of small RNA-Seq technology to profile tsRNAs in NAFLD patients and found the ubiquitous presence of hepatic tsRNAs secreted into circulating blood. Verification in a cohort of 114 patients with NAFLD and 42 patients without NAFLD revealed that three tsRNAs (tRF-Val-CAC-005, tiRNA-His-GTG-001, and tRF-Ala-CGC-006) were significantly elevated in the plasma of NAFLD patients, and the expression level are associated with NAFLD activity score (calculated from 0 to 8) and fibrosis stage (scored from 0 to 4). In mouse models, we further found that increased plasma levels of these three tsRNAs were positively correlated with the degree of liver fibrosis. Our study potentially identifies a new class of NAFLD biomarkers and reveal the possible existence of tsRNAs in the blood that can be used to predict fibrogenesis risk in patients diagnosed with NAFLD.
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http://dx.doi.org/10.1038/s41598-021-85421-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961013PMC
March 2021

The effect of pre-operative autologous blood donation on bone marrow hematopoietic functions in rabbits after hepatectomy.

Curr Pharm Biotechnol 2021 Feb 22. Epub 2021 Feb 22.

Department of Anesthesiology, Shanghai Gongli Hospital, the Second Military Medical University, Shanghai 200135. China.

Background: Pre-operative autologous blood donation (PABD) is one of the most widely distributed autologous blood donation means, which has positive effect on erythropoiesis. However, whether PABD can stimulate the bone marrow hematopoiesis after hepatectomy have not been reported.

Methods: Totally 80 New Zealand rabbits were randomly divided into 4 groups that included control group, surgery group, hemodilutional autotransfusion (HA) group and PABD group. Automatic reticulocyte examination was performed to detect the content of reticulocyte and immature reticulocyte fractions (IRF). Flow cytometric analysis was employed to monitor the level of CD34+ cells and the cell cycle status. Southern blotting was conducted to determine the telomere length of CD34+ cells.

Results: The content of high fluorescence reticulocytes (HFR) and IRF was decreased at 6 h and 24 h after autotransfusion. However, the level of CD34+ cells was upregulated after PABD. Cell cycle status analysis revealed that majority of the CD34+ cells in HA and PABD group were maintained in G0/G1 phase. The telomere length in HA and PABD group was shorten than that of control group and surgery group.

Conclusion: PABD could promote the bone marrow hematopoietic functions in rabbits after hepatectomy via stimulating proliferation of CD34+ cells and shortening the telomere length of CD34+ cells, but the content of HFR was not increased immediately because of the stuck of CD34+ cells in G0/G1 phase.
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http://dx.doi.org/10.2174/1389201022666210222162311DOI Listing
February 2021

Exploration on the effect of predeposit autotransfusion on bone marrow hematopoiesis after femoral shaft fracture.

Transfus Clin Biol 2021 Feb 20;28(1):25-29. Epub 2020 Nov 20.

Ningxia Medical University, Gongli Hospital of Shanghai Pudong New Area Training Base, Shanghai 200135, PR China; Department of Anesthesiology, Shanghai Gongli Hospital, the Naval Military Medical University, Shanghai 200135, PR China. Electronic address:

Objective: By observing the changes in the number and activity of CD34+ cells in bone marrow after predeposit autotransfusion (PAT) to patients with femoral shaft fracture (FSF), to evaluate the effects of PAT on hematopoietic function and hematopoietic stem cells in bone marrow.

Methods: Selected FSF patients were randomly divided into 2 groups: the control group (patients did not receive blood transfusion after surgery) and PAT group (patients received PAT after surgery). The content of RBC and Plt in blood samples were counted by blood routine. The cell cycle and proportion of CD34+ myelinated cells in blood samples was analyzed by flow cytometry. The telomere DNA length of hematopoietic stem cells (HSCs) in the control groups and PAT group at postoperation 24 was analyzed by southern blot.

Results: The content of RBC and Plt in postoperation 6h and 24h in the control group was evidently higher compared to that in PAT group, while Hb content in control group was significantly lower compared to that in PAT group. The proportion of CD34+ myelinated cells in post-transfusion 6h and postoperation 24h in PAT group was evidently higher compared to that in the control group. In PAT group, S phase at postoperation 24h was significantly larger compared to that at post-transfusion 6h. The telomere DNA length of HSCs in PAT group was longer than that in the control group.

Conclusion: PAT can increase the number of HSC, while does not cause the abnormal aging of HSCs. PAT is suitable for postoperative blood transfusion of patients with FSF.
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http://dx.doi.org/10.1016/j.tracli.2020.10.013DOI Listing
February 2021

Antishock Characteristics of Erythrocyte-mediated Endoplasmic Reticulum Stress in Macrophages in Severe Hemorrhagic Shock Environment Based on TLR9-cGAS-STING-IFN Signal Axis.

Cell Transplant 2020 Jan-Dec;29:963689720950218

Department of Anesthesiology, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, P.R. China.

This study aimed to investigate the protective effects of erythrocyte-mediated endoplasmic reticulum (ER) stress in macrophages in hemorrhagic shock. An hemorrhagic shock model was established in male BALB/c mice. Animals were randomly divided into three groups ( = 8): control group (A), erythrocyte reinfusion group (B), and TLR9 inhibition group (C). Eight healthy BALB/c mice were also included as group N ( = 8). Mice in group A were not treated, while mice in groups B and C were transfused with red blood cells separated from the blood of mice in group N. Flow cytometry was used to detect the expression of erythrocyte surface protein TLR9 in each group. Immunofluorescence assay was used to analyze the distribution and relative expression of protein STING in macrophages. Flow cytometry was used to analyze the expression of STING, ATF6, and IRE1 in macrophages. Enzyme-linked immunosorbent assay was used to analyze the levels of inflammatory signal molecules, including IFN-α, IFN-β, IL-6, CCL4, CCL5, and IL-6. FITC-Annexin V was used to analyze the apoptosis of immune cells (macrophages) in mouse blood samples and to detect the concentration of calcium ions in erythrocyte cytoplasm. The results showed that the expression of erythrocyte surface protein TLR9; the distribution of STING-positive cells in macrophages; the expressions of STING, ATF6, and IRE1 in macrophages; the levels of inflammatory signal molecules; the apoptosis rate of macrophages; and the intracellular calcium concentration in erythrocytes in group B were higher than those in group A, followed by group C. These results suggest that TLR9 regulates ER stress in macrophages of mice with hemorrhagic shock through the TLR9-cGAS-STING-IFN signaling pathway. Increased expression of TLR9 enhanced macrophage activity, reduced apoptosis, enhanced inflammatory response and immune response, and restored electrolyte level, which might be a therapeutic option for the treatment of hemorrhagic shock.
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http://dx.doi.org/10.1177/0963689720950218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784501PMC
November 2020

A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up.

Pain Physician 2020 09;23(5):E497-E506

The First Affiliated Hospital of Chinese PLA's General Hospital, Beijing, China.

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation.

Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture.

Study Design: This study used a prospective cohort design.

Setting: The research was conducted in a hospital and outpatient surgery center.

Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded.

Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the one-year follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05).

Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up.

Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy.
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September 2020

Plasma Transfusion Promoted Reprogramming CD4 T Lymphocytes Immune Response in Severe Sepsis Mice Model Through Modulating the Exosome Protein Galectin 9.

Cell Transplant 2020 Jan-Dec;29:963689720947347

Department of Anesthesiology, Shanghai Gongli Hospital, the Second Military Medical University, Shanghai, P. R. China.

Sepsis is a life-threatening disease that results in excessive stimulation of the host's immune cells. In the animal study, the purpose was to investigate the roles of fresh frozen plasma (FFP) transfusion in shaping the CD4 T lymphocytes immune response through modulating the secreted exosome protein Galectin-9 in mice with severe sepsis. By using Western blot analysis, we first identified that the protein Galectin-9 is highly accumulated in the blood plasma of severe sepsis mice, and with transmission electron microscopy (TEM) and protein analysis, we found that Galectin-9 is a secreted exosome protein. Thereafter, we treated the severe sepsis mice with the antibiotic Cefuroxime Axetil; one group of mice received FFP transfusion and the other group of mice received normal saline. Surprisingly, the FFP transfusion reduced the secretion of exosome protein Galectin-9 and there was crosstalking between the exosome protein Galectin-9 and CD4 T lymphocytes in mice with severe sepsis. Results showed that the proliferation of T helper (Th) cells (Th1 and Th17) was promoted, and regulatory T (Treg) cells' maintenance was inhibited in the sepsis mice after receiving FFP transfusion. Correspondingly, this immune reprogrammed activity shaped the inflammatory cytokine secretion with an increase in the interleukin (IL)-1β, IL-6, and interferon-gamma levels, while it decreased IL-10 levels. Taken together, it was suggested that FFP transfusion promoted reprogramming of CD4 T lymphocytes' immune response through inhibiting the secretion of exosome protein Galectin-9 in mice with severe sepsis to relieve immunosuppression.
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http://dx.doi.org/10.1177/0963689720947347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784505PMC
September 2020

Influence of different erythrocyte storage times on the macrophage response in haemorrhagic shock mice.

J Int Med Res 2020 Aug;48(8):300060520947872

Department of Anaesthesiology, Shanghai Gongli Hospital, the Second Military Medical University, Shanghai, China.

Objective: To investigate the characteristics of the macrophage response to transfusion of erythrocytes kept at different storage times in the mouse model of haemorrhagic shock.

Methods: Erythrocytes were isolated from mice and stored for 7, 21 or 35 days and samples injected intravenously into haemorrhagic shock mice. Changes in macrophages, inflammatory cytokines and T cell differentiation were assessed using flow cytometry or enzyme-linked immunosorbent assay (ELISA). In a second experiment, haemorrhagic shock mice were injected with 21D-erythrocytes and the expression of nuclear factor erythroid 2 p45-related factor 2 (Nrf2), arginine -1 (Arg-1) and inducible nitrous oxide (iNOS) determined.

Results: The proportion of M1-polarized macrophages was greatest in the 21D group while M2 macrophages tended to increase with the erythrocyte storage time. Levels of inflammatory cytokines and T helper 1 (Th1) cells increased in proportion to erythrocytes storage time. Most regulatory T cells (Treg) were found at 21D. Arg-1 expression was significantly increased in a group that received an heme oxygenase 1 (HO-1) agonist and significantly decreased in a group that received an HO-1 inhibitor but there were no differences in the expression of iNOS or Nrf2.

Conclusion: 21D storage time may be an important time point for erythrocyte storage and immunity response and Arg-1 may have a role in the macrophage response to erythrocyte infusion.
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http://dx.doi.org/10.1177/0300060520947872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469737PMC
August 2020

Autologous transfusion of "old" red blood cells-induced M2 macrophage polarization through IL-10-Nrf2-HO-1 signaling complexes.

Adv Clin Exp Med 2020 Jul;29(7):833-840

Shanghai Pudong New Area Gongli Hospital Training Base, Ningxia Medical University, China.

Background: Red blood cell (RBC) transfusion is associated with systemic inflammation and immune suppression as adverse outcomes.

Objectives: To investigate the immunomodulatory function of the transfused autologous RBC in altering pro-inflammatory and immunosuppressive effects.

Material And Methods: A total of 24 Sprague Dawley male rats were randomly divided into 3 groups (n = 8 in each group). Group 1 did not receive blood transfusions, while the other 2 groups of rats separately received transfusion of RBC stored for 14 days (group 2) and 35 days (group 3). The rats were treated with HO-1 inhibitor, HO-1 inducer and nuclear factor erythroid 2-related factor 2 (Nrf2) activator after they separately received autologous transfusion of RBC that were cryopreserved for 14 days or 35 days. The blood samples of the rats were collected 12 h after the transfusion, and the macrophage phenotype of M1 and M2 were analyzed with flow cytometry (FCM). Also, the surface protein expression of CD68 and CD200R in macrophages were analyzed and the inflammatory signals in the serum were measured with enzyme-linked immunosorbent assay (ELISA). Moreover, the location and expression of proteins heme oxygenase 1 (HO-1), arginine 1 (Arg-1) and nitric oxide synthase 2 (NOS2) in macrophage were detected with immunofluorescence (IF).

Results: Autologous transfusion of long-time stored ("old") RBC promoted macrophage polarization to M2 phenotype and upregulated the expression of its surface proteins CD68 and CD200R. The pro-inflammatory cytokines tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-1β, and IL-18 were inhibited, and the secretion of NOS isoforms (iNOS) in serum was reduced with blood transfusion; contrarily, the production of IL-10 and CCL22 was increased. Additionally, HO-1, Arg-1 and NOS2 proteins were located in the cytoplasm, and HO-1 and Arg-1 proteins were highly expressed in macrophage, while the expression of protein NOS2 was low. Moreover, Nrf2, HO-1 and Arg-1 proteins were upregulated in macrophage after receiving "old" RBC transfusion.

Conclusions: Autologous transfusion of "old" RBC drove the macrophage phenotype toward M2 macrophages and induced immunosuppressive effects through the IL-10-NRF2-HO-1 signals.
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http://dx.doi.org/10.17219/acem/121924DOI Listing
July 2020

[Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture].

Zhongguo Gu Shang 2020 Jun;33(6):498-504

Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.

Objective: To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.

Methods: A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded.

Results: All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L and 19 cases of L), and 23 patients(including 11 cases of L and 12 cases of LS) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(<0.01). At 1 year postoperative follow up, 17 patients got an excellent result, 29 good and 4 fair according to Macnab evaluation system. On the first year after surgery, the sense of damaged nerve roots and muscle strength were significantly restored (<0.01), but tendon reflexes were not significantly restored (>0.05).

Conclusion: Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.
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http://dx.doi.org/10.12200/j.issn.1003-0034.2020.06.002DOI Listing
June 2020

AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures.

Global Spine J 2020 Apr 28;10(2 Suppl):111S-121S. Epub 2020 May 28.

St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.

Study Design: International consensus paper on a unified nomenclature for full-endoscopic spine surgery.

Objectives: Minimally invasive endoscopic spinal procedures have undergone rapid development during the past decade. Evolution of working-channel endoscopes and surgical instruments as well as innovation in surgical techniques have expanded the types of spinal pathology that can be addressed. However, there is in the literature a heterogeneous nomenclature defining approach corridors and procedures, and this lack of common language has hampered communication between endoscopic spine surgeons, patients, hospitals, and insurance providers.

Methods: The current report summarizes the nomenclature reported for working-channel endoscopic procedures that address cervical, thoracic, and lumbar spinal pathology.

Results: We propose a uniform system that defines the working-channel endoscope (full-endoscopic), approach corridor (anterior, posterior, interlaminar, transforaminal), spinal segment (cervical, thoracic, lumbar), and procedure performed (eg, discectomy, foraminotomy). We suggest the following nomenclature for the most common full-endoscopic procedures: posterior endoscopic cervical foraminotomy (PECF), transforaminal endoscopic thoracic discectomy (TETD), transforaminal endoscopic lumbar discectomy (TELD), transforaminal lumbar foraminotomy (TELF), interlaminar endoscopic lumbar discectomy (IELD), interlaminar endoscopic lateral recess decompression (IE-LRD), and lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD).

Conclusions: We believe that it is critical to delineate a consensus nomenclature to facilitate uniformity of working-channel endoscopic procedures within academic scholarship. This will hopefully facilitate development, standardization of procedures, teaching, and widespread acceptance of full-endoscopic spinal procedures.
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http://dx.doi.org/10.1177/2192568219887364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263337PMC
April 2020

To study the effect of oxygen carrying capacity on expressed changes of erythrocyte membrane protein in different storage times.

Biosci Rep 2020 06;40(6)

Department of Anesthesiology, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai 200135, P.R. China.

Erythrocyte membrane is crucial to maintain the stability of erythrocyte structure. The membrane protein on the surface of erythrocyte membrane enables erythrocyte to have plasticity and pass through the microcirculation without being blocked or destroyed. Decreased deformability of erythrocyte membrane protein will lead to a series of pathological and physiological changes such as tissue and organ ischemia and hypoxia. Therefore, this research collected 30 cases of healthy blood donors, and explored erythrocyte stored at different times relating indicators including effective oxygen uptake (Q), P50, 2,3-DPG, Na+-k+-ATP. Erythrocyte morphology was observed by electron microscopy. Western blot and immunofluorescence assay were used to detect membrane protein EPB41, S1P, GLTP, SPPL2A expression changes of erythrocyte. To explore the effective carry oxygen capacity of erythrocyte at different storage time resulting in the expression change of erythrocyte surface membrane protein.
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http://dx.doi.org/10.1042/BSR20200799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317602PMC
June 2020

Percutaneous Isthmus Foraminoplasty and Full-Endoscopic Lumbar Discectomy for Very Highly Upmigrated Lumbar Disc Herniation: Technique Notes and 2 Years Follow-Up.

World Neurosurg 2020 09 9;141:e9-e17. Epub 2020 Apr 9.

Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.

Objective: To report the technical notes and clinical outcome of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy (PIF-FELD) for the treatment of very highly upmigrated lumbar disc herniation (VHUM-LDH).

Patients And Methods: From January 2014 to December 2017, 16 patients with VHUM-LDH underwent PIF-FELD surgery. A 10-mm-diameter semi-open foraminoplasty was performed on the dorsal side of the upper intervertebral foramen with lateral isthmus resection by a safe trephine system, in which the facet joint was not injured. Full-endoscopic transforaminal fragmentectomy in the spinal canal and discectomy in the intervertebral space were performed simultaneously. Magnetic resonance imaging of the lumbar spine was reexamined on the second day and 3 months after the operation to evaluate the completeness of the disc fragmentectomy and nerve decompression. The patients were followed up on the visual analog scale (VAS) of lumbar pain and leg pain and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation. The MacNab score and nerve root function recovery were evaluated at 2 years postoperative follow-up.

Results: All operations were successfully completed without any change in the surgical method. During the operation, 5 patients were found to have a single sequestered fragment, and the remaining 11 patients had multiple sequestered fragments. There were no complications (e.g., dural tear and nerve injury) during the operation, and no complications (e.g., infection, cerebrospinal fluid leakage, exacerbation of nerve root function injury, and recurrence of intervertebral disc herniation) occurred. Postoperative reexamination of lumbar magnetic resonance imaging in all patients showed complete disc fragmentectomy and adequate nerve decompression. The postoperative low back pain VAS and leg pain VAS scores and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation were significantly improved compared with preoperatively (P < 0.01). At 2 years follow-up, the sensation and muscular strength of the affected nerve root innervation area were significantly restored (P < 0.05), but tendon reflex function was not significantly restored (P > 0.05). At 2 years follow-up, MacNab scores included 6 excellent, 9 good, and 1 fair.

Conclusions: PIF-FELD is a safe and effective minimally invasive spine surgery technique for VHUM-LDH.
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http://dx.doi.org/10.1016/j.wneu.2020.03.141DOI Listing
September 2020

Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up.

Pain Physician 2017 Jan-Feb;20(1):E85-E98

The First Affiliated Hospital of Chinese PLA's General Hospital, Beijing, China.

Background: Conventional percutaneous endoscopic lumbar discectomy (PELD) with an "inside-outside" technique has 4.3% - 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots.

Study Design: A prospective cohort study.

Setting: Hospital and outpatient surgical center.

Objective: To evaluate the outcome and safety of modified PLF-PELD with a specially designed instrument for complex uncontained lumbar HDs.

Method: From April of 2007 to April of 2009, 148 patients with uncontained lumbar HDs were treated with modified PLF-PELD. Magnetic resonance imaging (MRI) checkup was performed the next morning after the operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, one year, and 5 years after surgery. Low back pain and leg pain were measured by visual analog scale (VAS) score (1 - 100). Functional outcomes were assessed by using the Oswestry Disability Index (ODI) and modified MacNab criteria.

Results: Follow-up data were obtained from 134 cases, including 14 cases on L3-4, 78 cases on L4-5, and 42 cases on L5-S1. One hundred-eight cases were prolapse type, while 26 cases were sequestration type. Pre-operative symptoms and deficits included nerve root dermatome hypoesthesia in 98 patients (73%), nerve root myotome muscle weakness in 32 patients (23%), and weakening or disappearance of tendon reflex in 43 patients (32%). No case required conversion to an open procedure during the surgery. Low back pain and leg pain were significantly relieved immediately after surgery in all patients. MRI examination showed adequate removal of HD in all patients. VAS scores and ODI values were significantly lower at all time points after surgery than before surgery. The percentage of pain relief in leg pain was significantly higher than that in low back pain (P < 0.01). But there was no significant correlation between duration of the preoperative symptoms and the percentage of pain relief. MacNab scores at 5 years after surgery were obtained from 134 patients. Seventy-five cases were rated "excellent"; 49 were rated "good," Five patients experienced heavier low back pain, thus being classified as "fair." Five cases with recurrence were rated "poor." Preoperative and postoperative (5 years follow-up) related nerve root function status was compared. Sensation and muscle strength recovered significantly (P < 0.01), while tendon reflex was not changed (P = 0.782). No patients had infections. Five patients were complicated with dysesthesia in distribution of the exiting nerve that was all operated at L5-S1. Complaints were reduced one week after treatment with medium frequency pulse electrotherapy. Five cases required a revision surgery after recurrence.

Limitations: This is an observational clinical case series study without comparison.

Conclusion: Modified PLF-PELD with a specially designed instrument is a less invasive, effective and safe surgery for complex uncontained lumbar DH.Key words: Lumbar disc herniation, minimally invasive treatment, foraminoplasty, percutaneous endoscopic lumbar discectomy.
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July 2017

Speckle noise removal applied to ultrasound image of carotid artery based on total least squares model.

J Xray Sci Technol 2016 10;24(5):749-760

Department of Ultrasound, First Affiliated Hospital of Shenzhen University, Shenzhen No.2 People's Hospital, Shenzhen, China.

An ultrasonic image speckle noise removal method by using total least squares model is proposed and applied onto images of cardiovascular structures such as the carotid artery. On the basis of the least squares principle, the related principle of minimum square method is applied to cardiac ultrasound image speckle noise removal process to establish the model of total least squares, orthogonal projection transformation processing is utilized for the output of the model, and the denoising processing for the cardiac ultrasound image speckle noise is realized. Experimental results show that the improved algorithm can greatly improve the resolution of the image, and meet the needs of clinical medical diagnosis and treatment of the cardiovascular system for the head and neck. Furthermore, the success in imaging of carotid arteries has strong implications in neurological complications such as stroke.
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http://dx.doi.org/10.3233/XST-160570DOI Listing
October 2016

Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up.

Clin Neurol Neurosurg 2016 Apr 10;143:90-4. Epub 2016 Feb 10.

The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.

Objective: To evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs).

Method: From August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1-100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria.

Result: Two years follow-up data were obtained from 85 cases, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5S1, 1 case on bilateral L5S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4-S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46-78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given "excellent"; 48 were given "good". 6 patients experienced heavier low back pain, thus being classified as "fair". 2 cases with recurrence were given "poor".

Conclusions: PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs.
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http://dx.doi.org/10.1016/j.clineuro.2016.02.008DOI Listing
April 2016

The strategy and early clinical outcome of full-endoscopic L5/S1 discectomy through interlaminar approach.

Clin Neurol Neurosurg 2015 Jun 14;133:40-5. Epub 2015 Mar 14.

Department of Orthopaedics, The First Affiliated Hospital of General Hospital of Chinese People's Liberation Army, Beijing 100048, China.

Objective: To analyze the surgical strategy, safety and clinical outcome of full-endoscopic discectomy through interlaminar approach in the case of L5/S1 intervertebral disc excision.

Methods: From April 2011 to December 2011, 72 cases of intracanalicular non-contained disc herniations at L5/S1 level were treated with full-endoscopic discectomy through interlaminar approach. L5/S1 disc herniation was divided into three types according to position of herniated disc related to S1 nerve root: axilla type, ventral type and shoulder type. Axilla approach was selected for axilla type while shoulder approach was selected for ventral type and shoulder type. After operation, MRI was reexamined to evaluate the resection completeness of prolapsed disc material. Visual analog scales (VAS) of low back pain and sciatica, and Oswestry disability index (ODI) were recorded in certain preoperative and postoperative time points. MacNab scores were evaluated at the 12-month follow-up.

Results: All operations were completed without conversion to other surgical techniques. Average operation time was 45 min (20-80 min). Only one reoccurrence was revised with microendoscopic discectomy. No nerve injury and infection were complicated. Postoperative ODI and VAS of low back pain and sciatica were significantly decreased in each time point (P < 0.05). MacNab scores of 12-month follow-up include 44 excellent, 26 good, 1 fair and 1 poor.

Conclusion: With proper selection between axilla approach and shoulder approach according to the sites of prolapsed or sequestered disc materials, full-endoscopic L5/S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2015.03.003DOI Listing
June 2015

Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain.

Clin Neurol Neurosurg 2014 Nov 18;126:11-7. Epub 2014 Aug 18.

Department of Orthopedics Surgery, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China.

Objective: To study the effectiveness of surgical dorsal endoscopic rhizotomy for the treatment of facetogenic chronic low back pain.

Methods: From April 2011 to November 2011, 58 patients who were diagnosed with lumbar facetogenic chronic low back pain (CLBP) and thereafter experienced >80% reliefs of pain with two comparative lumbar medial branch blocks were recruited in the study. Of those 58 patients, 45 cases (the operation group) received dorsal endoscopic rhizotomy, and the remaining 13 cases (the conservative group) received conservative treatment. Patients' preoperative and postoperative VAS score, percentage of pain relief and the MacNab score were analyzed and compared. Anatomic variations and any possible complications were recorded.

Results: In the operation group, VAS scores of pain (low back/referred) at any time point postoperatively were significantly lower than that before MBB (P<0.05), which, however, showed no significant difference as compared to the scores after MBB (P>0.05). In the conservative group, VAS scores of pain (low back/referred) at any time point postoperatively with conservative treatment decreased significantly compared with that before MBB (P<0.05) and were significantly higher than that after MBB (P<0.05). Percentage of pain relief in the operation group at any time point postoperatively were significantly higher than that in the conservative group (P<0.01). The MacNab scores of 1 year follow-up in the operation group were higher than that in the conservative group. In addition, four separate newly identified anatomical variations of medial branch anatomy were observed and reported.

Conclusion: Dorsal endoscopic rhizotomy is safe and effective for the facetogenic CLBP, and can achieve better clinical outcome than the conservative treatment.
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http://dx.doi.org/10.1016/j.clineuro.2014.08.014DOI Listing
November 2014

Papillary thyroid carcinoma on sonography.

Clin Imaging 2010 Mar-Apr;34(2):121-6

Department of Ultrasonography, Shenzhen Second Hospital, Shenzhen, China.

Objective: The purpose of this study is to investigate the characteristics of papillary thyroid carcinomas (PTCs) on color duplex sonography (CDUS).

Methods: We retrospectively reviewed 115 nodules (104 patients) with PTC confirmed by pathology from February 1, 2005, to August 31, 2008. The size, border, calcification, echotexture, hemodynamics (peak systolic velocity and resistance index) of the thyroid nodules and cervical lymph nodes on CDUS were analyzed.

Results: There was a close relationship between the size of the nodule and the vascularity of the thyroid carcinoma (P=.000). Microcalcification increased the suspicion for malignancy of the thyroid nodule. A hypoechoic thyroid nodule with abundant internal vascularity, ill-defined border and microcalcification was highly suggested PTC.

Conclusion: CDUS plays an important role in the early detection of PTC and cervical lymph node metastasis, which would provide surgeons with valuable information for planning surgical intervention. Mastering manifestations of PTC on CDUS will improve the accuracy in the diagnosis of PTC. CDUS-guided fine needle aspiration of the thyroid nodule is the standard in the diagnosis of thyroid carcinoma and metastasis pre- and postthyroidectomy.
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http://dx.doi.org/10.1016/j.clinimag.2009.03.003DOI Listing
June 2010

[Correlation between high intensity zone on MRI and positive pain response on lumbar discography in the diagnosis of discogenic low back pain].

Zhonghua Wai Ke Za Zhi 2008 Jul;46(13):973-6

Department of Orthopaedics, the First Affiliated Hospital of General Hospital of People's Liberation Army, Beijing 100037, China.

Objective: To study correlation between high intensity zone (HIZ) of lumbar disc and positive pain response on lumbar discography for the diagnosis and treatment of discogenic low back pain.

Methods: Thirty-seven cases with chronic low back pain without neurologic symptoms and lumbar disc herniation on CT scan underwent lumbar discography and MRI examination. X-ray and CT after discography with positive pain response were analyzed to correlate with HIZ on MRI.

Results: Ninety-eight discs underwent discography in 37 patients. Twenty-one discs presented positive pain response; including 10 have HIZ (47.6%). Seventy-seven discs presented negative pain response; including 29 had HIZ (37.6%). The higher grade of annular disruption group had the higher proportion of HIZ on lumbar MRI. There was a positive correlation between HIZ and degree of annular disruption. However, there was no correlation between HIZ and positive pain response on lumbar discography.

Conclusions: HIZ on lumbar MRI only can be a filtrated and suggestive image sign and can not replace discography in the diagnosis and treatment of discogenic low back pain.
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July 2008

[Diagnosis and surgical treatment of back pain originating from endplate].

Zhonghua Wai Ke Za Zhi 2007 Oct;45(20):1401-4

Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.

Objective: To explore the methods of diagnosis and surgical treatment for patients with back pain originating from endplate.

Methods: All patients received examinations of radiography, CT, and MR imaging. Pain level of disc was decided by discography in each patient. The principal outcome judgment were pain and disability, and the efficacy of surgical treatment was assessed by visual analog scale (VAS) for pain, and the Oswestry disability index (ODI) for functional recovery.

Results: All patients with a diagnosis of back pain originating from endplate according to discography were treated with anterior or posterior fusion surgery. The mean follow-up period was three years and five months (from 2 to 6 years). Among of the 21 patients, 20 (95%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement on the ODI and the VAS scores were obtained in the patients with chronic low back pain originating from endplate (P = 0.0001) after treatment.

Conclusions: The study suggests that the discography and fusion surgery may be very effective methods for the diagnosis and treatment of chronic back pain originating from endplate respectively.
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October 2007

Unilateral external fixator in the treatment of lower third humeral shaft fractures.

Chin J Traumatol 2005 Aug;8(4):230-5

Department of Orthopedics, The 304th Clinical Branch of the General Hospital of PLA, Beijing, China.

Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.

Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months.

Results: The time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.

Conclusions: Fixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.
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August 2005

[The use of dynamic axial external fixator with modified technique in Pilon fractures of tibial].

Zhonghua Wai Ke Za Zhi 2004 Jun;42(12):733-6

Department of Orthopaedics, the 304th Hospital of People's Liberation Army, Beijing 100037, China.

Objective: To retrospectively analyses the results of dynamic axial external fixator with modified technique in the treatment of severely Pilon fractures.

Methods: From July 2000 to February 2003, 14 patients with severely Pilon fractures were treated with dynamic axial external fixator inserted with modified technique combined with limited open reduction and internal fixation with screws and Kirschner wires, with two distal external pins inserted into talus and calcaneus respectively so that the rotation axis of distal clamp was coincided with that of ankle joint. All patients were young or middle-aged people from 20 y to 52 y (average 38 y). All fractures were Rüedi-Allg were type II or type III. External fixators were removed after bone healing. Duration of follow-up was 5 - 36 m (average 18 m).

Results: The time of bone healing was 12 - 24 weeks (average 14 weeks). At the latest follow-up, results include 5 excellent, 6 good and 3 fair according to ankle scoring system (ASS). There was only one case of superficial pin site infection settled with oral antibiotics and pin site care with mild disinfectants. There was no wound breakdown, superficial and deep infection, osteomyelitis, fracture fragments redisplacement and collapse.

Conclusion: Dynamic axial external fixator with modified technique combined with limited internal fixation is an effective method for the treatment of severely Pilon fractures.
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June 2004