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Background: The pathogenesis of multiple sclerosis (MS) is mediated primarily by T cells, but most studies of MS and its animal model, experimental autoimmune encephalomyelitis (EAE), have focused on CD4+ T cells. The aims of the current study were to determine the pathological interrelationship between CD4 and CD8 autoreactive T cells in MS/EAE. Methods: Female C57BL/6 mice (n =20) were induced by myelin oligodendrocyte glycoprotein (MOG) 35-55 peptide. At 14 days after immunization, T cells were isolated from the spleen and purified as CD4+ and CD8 + T cells by using CD4 and CD8 isolation kits, and then the purity was determined by flow cytometric analysis. These cells were stimulated by MOG35–55 peptide and applied to proliferation assays. The interferon-gamma (IFN-γ) and interleukin (IL)-4 secretion of supernatant of cultured CD4 + and CD8 + T cells were measured by enzyme-linked immunosorbent assays (ELISA). For adoptive transfer, recipient mice were injected with MOG35–55-specific CD8+ or CD4+ T cells. EAE clinical course was measured by EAE score at 0–5 scale and spinal cord was examined by staining with hematoxylin and eosin and Luxol fast blue staining. Results: CD8+CD3+ and CD4+CD3 + cells were 86% and 94% pure of total CD3+ cells after CD8/CD4 bead enrichment, respectively. These cells were stimulated by MOG35–55 peptide and applied to proliferation assays. Although the CD8+ T cells had a generally lower response to MOG35–55 than CD4+ T cells, the response of CD8+ T cells was not always dependent on CD4. CD8+ T cell secreted less IFN-γ and IL-4 compared with CD4+ T cells. EAE was induced in wildtype B6 naive mice by adoptive transfer of MOG35–55-specific T cells from B6 active-induced EAE (aEAE) mice. A similar EAE score and slight inflammation and demyelination were found in naive B6 mice after transferring of CD8 + T cells from immunized B6 mice compared with transfer of CD4 + T cells. Conclusion: Our data suggest that CD8+ autoreactive T cells in EAE have a lower encephalitogenic function but are unique and independent on pathogenic of EAE rather than their CD4+ counterparts. Key words: Autoimmune; CD8-Positive T-Lymphocytes; Encephalomyelitis; Experimental; Multiple Sclerosis; Myelin-Oligodendrocyte Glycoprotein

Background: The current pain assessment methods are strongly subjective and easily affected by outside influences, and there is an urgent need to develop a reliable objective and quantitative pain-monitoring indicator. The aim of this study was to evaluate the feasibility of using Pain index (Pi) to assess pain symptoms in pain patients. Methods: Subjects were enrolled from patients seeking treatment at Pain Medicine Center of China Medical University Aviation General Hospital from October 2015 to December 2016, such as postherpetic neuralgia, spinal cord injury, femoral head necrosis, lumbar disc herniation, trigeminal neuralgia, complex regional pain syndrome, perineal pain, phantom limb pain, etc., (pain group, n = 111), as well as healthy volunteers without subjective pain (control group, n = 100). The subjective pain symptoms in pain patients were evaluated by Pi and visual analogue scale/numerical rating scales (VAS/NRS), respectively, and the relationship between them was analyzed using single factor correlation analysis and multiple factor regression analysis. Results: Pi levels in the pain group were significantly higher than those of the control group (t = 6.273, P < 0.001 ), the correlation analysis of Pi and VAS/NRS score in the pain group showed that the Pearson correlation coefficient was 0.797 (P < 0.001); After adjusted for types of pain, pain sites, medication, gender, and age, Pi was found to be independently correlated to VAS/NRS score (P < 0.001). Conclusions: Pi significantly correlates with VAS/NRS score, might be used to evaluate the subjective pain symptoms in patients and has good research and application value as an objective pain assessment tool. Key words: Electroencephalogram; Pain; Wavelet Algorithm

Background: Ambient aerosol fine particulate matter (PM2.5) is associated with male reproductive toxicity in experiments and may have adverse effects in the female. However, studies evaluating the protective effects and precise mechanisms of aspirin, Vitamin C, Vitamin E, or ozone against toxic effects of PM2.5 are sparse. This study was conducted to investigate the possible protective effects and mechanisms of aspirin, Vitamin C, Vitamin E, or ozone on fertility in female mice treated with PM2.5. Methods: Eighty-four ICR mice were divided into six groups: control group, PM2.5 group, PM2.5 + aspirin group, PM2.5 + Vitamin C group, PM2.5 + Vitamin E group, and PM2.5 + ozone group. PM2.5 was given by intratracheal instillation every 2 days for 3 weeks. Aspirin, Vitamin C, and Vitamin E were given once a day by oral gavage for 3 weeks, and ozone was administered by intraperitoneal injection once a day for 3 weeks. The levels of anti-Mullerian hormone (AMH), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and 8-hydroxy-2’-deoxyguanosine (8-OHdG) were measured using enzyme-linked immunosorbent assay.Western blotting analysis was used to analyze the expressions of Bcl-2, Bax, and caspase-3 in ovaries. Changes in histological structure were examined by light microscope and electron microscopy was used to detect ultramicrostructure. Results: The results demonstrated that PM2.5 decreased AMH levels (P < 0.001); however, aspirin (P < 0.001), Vitamin C (P < 0.001), Vitamin E (P = 0.001), and ozone (P = 0.002) alleviated the decrease. Changes of IL-6, TNF-α, 8-OHdG, Bax/Bcl-2, and caspase-3 in PM2.5 group were increased compared to control group (P < 0.001), while in PM2.5 + aspirin, PM2.5 + Vitamin C, PM2.5 + Vitamin E, and PM2.5 + ozone groups, they were statistically decreased compared to PM2.5 group (P < 0.001 or P < 0.05). Conclusions: PM2.5 cause the damage of ovaries, and aspirin, Vitamin C, Vitamin E, and ozone antagonizes the damage. The protective mechanism is probably due to its ability to blunt the inflammatory and oxidative stress caused by PM2.5, which subsequently suppressing the expression of apoptotic regulatory protein and reducing the incidence of ovary apoptosis. Key words: Aspirin; Fine Particulate Matter; Ozone; Reproductive Toxicity; Vitamin C; Vitamin E

To the Editor: A 54-year-old woman with no significant history of a headache or hypertension underwent epidural oxygen-ozone injection at a concentration of 30 µg/ml (3 ml) for cervical disc herniation at cervical vertebra (C6–C7) level. Throughout the procedure, the routine monitorings of blood pressure, heart rate, and blood oxygen saturation were performed. One minute following the end of the injection, the patient developed a high-intensity headache mimicking symptoms of a ruptured cerebral aneurysm. The patient described the location of a headache as present in the frontoparietal and occipital areas accompanied by nausea and vomiting. The presumptive diagnosis of inadvertent epidural puncture was made. The patient was immediately treated oxygen therapy and bed rest. Monitoring showed vital signs of blood pressure (149/83 mmHg), heart rate (86 beats/min), pulse oxygen saturation (SpO2, 96%), blood sugar (6.3 mmol/L), and body temperature (36.6°C). Subsequently, metoclopramide 10 mg and midazolam 1 mg were injected intravenously. Thirty minutes later, the severe headache symptom significantly improved. An immediate brain computed tomography (CT) scan revealed a large air collection in the frontal horns of the lateral ventricles, and a smaller one in the third ventricle region [Figure 1a]. The patient was discharged from the pain treatment clinic after 4 h of observation with a blood pressure of 130/80 mmHg. There were no further symptoms in the following 2 months, and the brain CT scan revealed no significant abnormalities 1 month later [Figure 1b]. Figure 1 Axial view of nonenhanced cranial computed tomography scan. (a) Large air collection in the frontal horns of the lateral ventricles, and a smaller one in the third ventricle region (arrows); (b) No significant abnormalities 1 month later. At present, oxygen-ozone therapy is an alternative option to treat cervical or lumbar disc herniation.[1] Further, randomized controlled studies have documented proven effects.[2] To date, only one case of a thunderclap headache after oxygen-ozone therapy was reported. In 2007, Devetag Chalaupka et al.[3] reported a 27-year-old man as the first case of a severe headache due to pneumocephalus after epidural puncture of oxygen-ozone therapy. In this case, the symptom of a thunderclap headache and the image findings of pneumocephalus were similar to those reported by Devetag Chalaupka et al.[3] Fortunately, both cases of thunderclap headache second to pneumocephalus (oxygen-ozone gas) resolved with no further symptoms. Physicians should be aware of this potential complication of minimally invasive oxygen-ozone therapy and be prepared to diagnose and treat this complication. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

In treating superior laryngeal neuralgia (SLN), superior laryngeal nerve blocks (SLNBs) can provide immediate relief of persistent pain. Although SLNB was effective, the procedure can increase the risks due to the proximity to the carotid artery, external vein, and other vessels. To avoid complications such as advertent intravascular injection, local anesthetic toxicity from intravascular absorption, and intratracheal injection, we successfully blocked the superior laryngeal nerve under ultrasound guidance in three patients suffering from SLN. The written informed consent before treatment was obtained for each patient participating in this study. A 58-year-old male was admitted to our hospital; he had a complaint of a fish bone that had stuck to his throat 6 months ago, and the bone was immediately removed (case 1). Subsequently, he experienced paroxysmal burning and stabbing pain in his left throat. Pain was associated with deep inspiration and coughing. Tenderness over the left thyrohyoid membrane was elicited by light pressure. Neurological examination was negative. The left SLNBs under ultrasound guidance using 3 ml of 2% lidocaine were done for four times, which was completed for every 2 days. The patient experienced no pain when we followed up 6 months following the procedures. A 70-year-old female who developed left-side SLN for 2 years was admitted to our hospital (case 2). She had had a cough for a week just before the onset of the neuralgia. She experienced paroxysmal stabbing pain in the left side of the throat, triggered by swallowing and aspiration. There was tenderness to pressure over the left thyrohyoid membrane. Neurological examination was negative, and 10 trials of SLNB were done. Although the paroxysms occurred once a year for a few months after the last block therapy, she was able to deal with the pain with carbamazepine alone. A 57-year-old male with complaints of right-side throat pain for the previous 5 months was admitted to our hospital (case 3). He had a history of severe smoking for about 20 years. The paroxysmal stabbing pain occurred almost every day. Neurological examination was negative. After 10 trials of SLNB, pain was alleviated. He remained asymptomatic for about 1 year after the last SLNB. A portable ultrasound machine, Venue 50, (GE Healthcare, Chalfont St. Giles, UK) was brought to the operating room, with the patient lying in the supine position with head turned away from the affected side and a pillow placed under the patient's neck. After preparation of the skin with antiseptic solution, ultrasound examination is performed using a high-resolution linear array transducer. The transducer is applied transversely to the middle aspect of the neck to obtain a short axis view of the thyrohyoid membrane. One can easily identify the thyroid cartilage and the common carotid artery. The superior laryngeal nerve is usually found medial to the artery between the hyoid bone and thyroid cartilage, and a block needle is inserted in the plane of the ultrasound beam in a medial to lateral orientation. It is often easy to visualize the needle. The needle was inserted with 35° to the skin and the depth was approximately 2 cm. When the needle located medial to the common carotid artery, with no blood or air of the aspirated, the test dose of 2 ml of 2% lidocaine was injected [Figure 1]. The procedure is completed for every 2 days until the pain disappeared. Figure 1 Transverse sonographic view of the patient's neck at the level of the thyrohyoid membrane. An in-plane method was used to block the superior laryngeal nerve. Arrow indicates the entry of the needle from the 10 o’clock direction. Triangle indicates ... The superior laryngeal nerve arises from the vagus nerve. It runs inferiorly and anteriorly behind the carotid artery to pass the lateral extent of the hyoid bone.[1] It divides into internal and external branches. The internal branch passes immediately inferior to the greater horn of the hyoid bone and approaches the thyrohyoid membrane accompanied by the superior laryngeal artery, a branch of the superior thyroid artery. The superior laryngeal nerve is so located that any regional inflammation or further local trauma,[2] aggravated by normal laryngeal movements, can produce localized neuritis at the thyrohyoid membrane and cause the throat pain. Aydin et al.[3] described a case of SLN after acute laryngitis and treatment with a single injection of a local anesthetic. The patient received a single nerve block near the right hypothyroid membrane and the symptoms decreased dramatically in a few minutes. He had no pain for 1 year following the procedure. Neuropathic pain is derived from abnormal afferent inputs caused by axonal damage, myelin disruption, and inflammatory processes. Local anesthetics can interrupt or alleviate pain and have been shown to suppress ectopic neural discharges from nerve fibers. It was posited that SLNB may be useful in the diagnosis and treatment of SLN.[4] Ultrasound has been used to image the human body for over half a century. The images can be acquired in “real time,” thus providing instantaneous visual guidance for many interventional procedures including those for regional anesthesia and pain management.[5] In these three cases, the use of ultrasound made it possible to perform SLNB in patients suffering from SLN. All of the three patients recovered from SLB without any complications. These cases illustrate a potential clinical application for ultrasound assistance in pain management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

For the three cases listed in this article, difficult airway was anticipated preoperatively. We described how we intubated, but it did not mean what we did was the best choice. For the first case of ankylosing spondylitis, comprehensive airway evaluation was performed the day before surgery including the possibility of mask ventilation. We all considered easy mask ventilation after discussion at morning round. There were no anomalies of his orofacial development, and the patient did not snore at night. In patients with easy mask ventilation, awake intubation is not always the first choice. The second case was a pediatric patient diagnosed with congenital arthrogryposis multiplex. Congenital arthrogryposis multiplex is characterized by congenital, nonprogressive, and symmetrical joint contractures involving at least two different body areas. Patients with congenital arthrogryposis multiplex may have several surgeries for the correction of contracture and spine deformities. The two major challenges for anesthesiologists are as followings. First, the difficult airway is the first concern due to micrognathia, high arched palate, and cervical spine instability.[1] Second, myopathy is one etiology of congenital arthrogryposis multiplex, and the risk of malignant hyperthermia cannot be excluded.[2] It is suggested avoiding the use of succinylcholine and volatile agents. This patient had a history of difficult airway at another hospital before coming to our hospital. Although we did not get detailed information about her last intubation, good mask ventilation and difficult laryngoscopy (Macintosh) were recorded on patient's note. Moreover, we had no reason to doubt about their technique and judgment. For patients with a history of difficult airway and a diagnosis at high risk of difficult airway, it is necessary to prepare for the worst. We did intubate successfully using McGrath video laryngoscope with 2 blades, and Cormack–Lehane classification was 2, and only posterior extremity of glottis was seen. It is true that this patient is not defined as a difficult airway based on the intubation at my hospital, we cannot underestimate the risk of difficult airway in patients with congenital arthrogryposis multiplex. Awake intubation is not always possible in pediatric patients. Moreover, inhalational induction without interrupting spontaneous breathing is not recommended in patients at high risk of malignant hyperthermia. For the third case, it was a lucky case. We did underestimate the difficulty of intubation. Although we had GlideScope as our first choice with fiber-optic bronchoscopy as a backup, the saturation did dropped to 76%. However, the desaturation lasted

Initial results for the use of single and dual growing rod techniques in the treatment of early onset scoliosis (EOS) has been seldom documented. The aim of this research was to investigate the initial efficacy of single and dual growing rods in treatment of EOS.A retrospective study of 25 early onset scoliosis cases treated with growing rod technique between November 2002 and May 2010 was performed, including six cases in the single growing rod group and 19 cases in the dual growing rod group. Operation time, intra-operative bleeding, correction rate, changes in C7-S1 distance, and incidence of complications of the first operation were compared for the two techniques.The average post-operative follow-up duration was 31.9 months. There was no statistical difference observed between operation time, intra-operative bleeding, and complication incidence between the single and dual growing rod groups. In addition, no statistical difference was observed in the pre-operative coronal Cobb's angle (P0.05), or in the pre-operative sagittal Cobb's angle between both groups (P0.05). The correction rate of the dual growing rod group was significantly superior to that of the single growing rod group in the coronal plane (P0.01), but not in the sagittal plane (P0.05). The C7-S1 distance in the dual growing rod group was significantly larger than that in the single growing rod group (P0.05).The growing rod technique is an effective option for surgical treatment of EOS. The dual growing rod technique shows relative superiority in the correction outcome as compared to the single growing rod technique.

Peripheral nerve injury causes a high rate of disability and a huge economic burden, and is currently one of the serious health problems in the world. The use of nerve grafts plays a vital role in repairing nerve defects. Acellular nerve grafts have been widely used in many experimental models as a peripheral nerve substitute. The purpose of this study was to test the biomechanical properties of acellular nerve grafts.Thirty-four fresh sciatic nerves were obtained from 17 adult male Wistar rats (age of 3 months) and randomly assigned to 3 groups: normal control group, nerve segments underwent no treatment and were put in phosphate buffered saline (pH 7.4) and stored at 4°C until further use; physical method group, nerve segments were frozen at -196°C and then thawed at 37°C; and chemical method group, nerve segments were chemically extracted with the detergents Triton X-200, sulfobetaine-10 (SB-10) and sulfobetaine-16 (SB-16). After the acellularization process was completed, the structural changes of in the sciatic nerves in each group were observed by hematoxylin-eosin staining and field emission scanning electron microscopy, then biomechanical properties were tested using a mechanical apparatus (Endura TEC ELF 3200, Bose, Boston, USA).Hematoxylin-eosin staining and field emission scanning electron microscopy demonstrated that the effects of acellularization, demyelination, and integrity of nerve fiber tube of the chemical method were better than that of the physical method. Biomechanical testing showed that peripheral nerve grafts treated with the chemical method resulted in some decreased biomechanical properties (ultimate load, ultimate stress, ultimate strain, and mechanical work to fracture) compared with normal control nerves, but the differences were not statistically significant (P0.05).Nerve treated with the chemical method may be more appropriate for use in implantation than nerve treated with the physical method.

It has been stated that preoperative pulmonary function tests are essential to assess the surgical risk in patients with scoliosis. Arterial blood gas tests have also been used to evaluate pulmonary function before scoliotic surgery. However, few studies have been reported. The aim of this study was to investigate the roles of preoperative arterial blood gas tests in the surgical treatment of scoliosis with moderate or severe pulmonary dysfunction.This study involved scoliotic patients with moderate or severe pulmonary dysfunction (forced vital capacity60%) who underwent surgical treatment between January 2002 and April 2010. A total of 73 scoliotic patients (23 males and 50 females) with moderate or severe pulmonary dysfunction were included. The average age of the patients was 16.53 years (ranged 10 - 44). The demographic distribution, medical records, and radiographs of all patients were collected. All patients received arterial blood gas tests and pulmonary function tests before surgery. The arterial blood gas tests included five parameters: partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, alveolar-arterial oxygen tension gradient, pH, and standard bases excess. The pulmonary function tests included three parameters: forced expiratory volume in 1 second ratio, forced vital capacity ratio, and peak expiratory flow ratio. All five parameters of the arterial blood gas tests were compared between the two groups with or without postoperative pulmonary complications by variance analysis. Similarly, all three parameters of the pulmonary function tests were compared.The average coronal Cobb angle before surgery was 97.42° (range, 50° - 180°). A total of 15 (20.5%) patients had postoperative pulmonary complications, including hypoxemia in 5 cases (33.3%), increased requirement for postoperative ventilatory support in 4 (26.7%), pneumonia in 2 (13.3%), atelectasis in 2 (13.3%), pneumothorax in 1 (6.7%), and hydrothorax in 1 (6.7%). No significant differences in demographic characteristics or perioperative factors (P0.05) existed between the two groups with or without postoperative pulmonary complications. According to the variance analysis, there were no statistically significant differences in any parameter of the arterial blood gas tests between the two groups.No significant correlation between the results of the preoperative arterial blood gas tests and postoperative pulmonary complications existed in scoliotic patients with moderate or severe pulmonary dysfunction. However, the postoperative complications tended to increase with the decrease of partial pressure of arterial oxygen in the arterial blood gas tests.

Patient safety has been gained much more attention in recent years. The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center, USA. The main objectives of the study were to determine the incidence of intraoperative cardiac arrest, to identify possible causes of cardiac arrest and to explore amenable modifications.With approval by the University of Pittsburgh Institutional Review Board, patients experienced cardiac arrest during surgery were retrieved from medical records, surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS), a hospital electronic searching system. Cases of cardiac arrest were collected over a period of thirteen years from the Presbyterian University Hospital (PUH), USA.We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000). Fourteen patients (60.8%) died in the operating room, leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics. Immediate overall survival rate after arrest was 39% (9/23). Half of the patients (12/23) were emergency cases with 41% survival rate (5/12). One fourth of the arrests were trauma patients (6/23). Most arrest patients (87%, 20/23) were American Society of Anesthesiologists Physical Status (ASA PS) IV and V, while only three patients were ASA PS-I, II and III, respectively. One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Most intraoperative cardiac arrests were not due to anesthesia-related causes. Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

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

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

Patients with congenital scoliosis often also have intraspinal abnormalities and other organ defects, and few studies of the effects of congenital scoliosis on cardiac function and structure have been published.A total of 215 adolescent patients with congenital scoliosis (average age, 13.58 years) underwent preoperative echocardiography and were then assigned to subgroups according to apex vertebral rotation, side of convexity, curvature severity in the coronal and sagittal planes, type of deformity, and sex. Differences between the subgroups were compared by independent-samples t test or a one-factor analysis of variance.We observed statistically significant differences between patients with right-sided scoliosis curvature and those with left-sided scoliosis curvature, respectively, in left ventricular inner diameter at end-diastole ((39.39 +/- 4.66) mm vs (41.74 +/- 4.90) mm), left ventricular inner diameter at end-systole ((24.80 +/- 3.45) mm vs (25.92 +/- 3.07) mm), interventricular septum thickness at end-diastole ((5.66 +/- 0.98) mm vs (5.98 +/- 1.03) mm), and posterior wall of left ventricle at end-diastole ((5.61 +/- 0.98) mm vs (6.06 +/- 1.20) mm). When the patients were evaluated by coronal plane Cobb angle, significant differences were found between those with Cobb angle of 40 degrees - 80 degrees and of80 degrees in left ventricular inner diameter at end-diastole ((40.97 +/- 5.06) mm vs (38.98 +/- 4.45) mm) and left ventricular inner diameter at end-systole ((25.53 +/- 3.39) mm vs (24.36 +/- 3.14) mm), respectively. When the patients were evaluated by sagittal plane Cobb angle (20 degrees, group 1; 20 degrees - 40 degrees, group 2;40 degrees, group 3), significant differences were found in right ventricular diameter between those with Cobb angle of20 degrees and of 20 degrees - 40 degrees ((18.27 +/- 3.66) mm vs (16.54 +/- 3.57) mm) and in diameter of aortic root between those with Cobb angle of 20 degrees - 40 degrees and of40 degrees ((23.83 +/- 3.39) mm vs (24.90 +/- 3.30) mm), respectively. No significant differences were found in ejection fraction and fractional shortening between patients according to apex vertebral rotation, side of convexity, coronal plane and sagittal plane Cobb angles, type of deformity, or sex.Congenital scoliosis influences cardiac structure, but not function.