[Clinical diagnosis and management of cervical spondylotic amyotrophy].

Objective: To investigate the clinical characteristics and surgical treatment of cervical spondylotic amyotrophy. Methods: Thirteen patients(13 man) with proximal (10) and distal(3) cervical spondylotic amyotrophy between November 2014 and September 2016 were included in this study. The average age of the patients was 55 (range, 47-66) years. The sex, age, clinical course, type of amyotrophy, lesion segment and postdecompression improvement in muscle power were reviewed. Results: Of 13 cervical spondylotic amyotrophy patients, 9 were performed on with cervical disectomy, 2 were performed on with cervical posterior operation, 2 remainding patients received nonoperative treatment. Cervical spondylotic amyotrophy patients were followed up 6-22 (average 10.6) months, muscle power of 4 patients (all proximal-type)were improved completely (the average recovery time were 4.4 months), muscle power of 6 patients were improved uncompletely, 1 patients failed to improve, the 2 remainding patients received nonoperative treatment had no change. Conclusion: Cervical spondylotic amyotrophy as a rare type of cervical spondylotic disorder, It should distinguish cervical spondylotic amyotrophy from amyotrophic lateral sclerosis, especially in the early stage of amyotrophic lateral sclerosis. A surgical treatment is recommended as the first line of proximal-type CSA, especially those with serious compression. It is important that clinicians should be aware that distal-type CSA had a poor results, resulting in a lower lower satisfaction, especially those with no, or insignificant, sensory disturbance.

[Lumbosacral nerve bowstring disease].

Objective: To define a novel disease-lumbosacral nerve bowstring disease, and propose the diagnostic criteria, while capsule surgery was performed and evaluated in the preliminary study. Methods: From June 2016 to December 2016, a total of 30 patients (22 male and 8 female; mean age of 55.1±9.7 years) with lumbosacral nerve bowstring disease were included in Department of Spine Surgery, Changzheng Hospital, the Second Military Medical University.Lumbosacral nerve bowstring disease was defined as axial hypertension of nerve root and spinal cord caused by congenital anomalies, which could be accompanied by other lesions as lumbar disc herniation, spinal cord stenosis or spondylolisthesis, or aggravated by iatrogenic lesions, resulting in neurological symptoms.This phenomenon is similar to a stretched string, the higher tension on each end the louder sound.Meanwhile, the shape of lumbosacral spine looks like a bow, thus, the disease is nominated as lumbosacral nerve bowstring disease.All the patients underwent capsule surgery and filled out Owestry disability index (ODI) and Tempa scale for kinesiophobia (TSK) before and after surgery. Results: The mean surgery time was (155±36) min, (4.3±0.4) segments were performed surgery.The pre-operative VAS, TSK and ODI scores were (7.6±0.8), (52.0±10.3) and (68.4±12.7), respectively.The post-operative VAS, TSK and ODI scores were (3.3±0.4), ( 24.6±5.2) and (32.1±7.4)(P<0.05, respectively), respectively. Conclusion: The definition and diagnostic criteria of lumbosacral nerve bowstring disease was proposed.Capsule surgery was an effective strategy with most patients acquired excellent outcomes as symptoms relieved and quality of life improved.

Knockdown of AXL receptor tyrosine kinase in osteosarcoma cells leads to decreased proliferation and increased apoptosis.

Dysregulation of the Axl receptor tyrosine kinase (RTK) has been implicated in the development and progression of a variety of malignancies. Axl is known to activate strong anti-apoptotic signaling pathways that promote oncogenesis. However, the role of Axl plays in osteosarcoma (OS) remains elusive. The present study aimed to investigate the clinical significance and function of Axl in human OS. Forty cases of OS and corresponding adjacent non-cancerous tissues (ANCT) were collected. The expression of Axl was assessed using immunohistochemical assay through tissue microarray procedure. A loss-of-function experiment was performed to investigate the effects of small hairpin RNA (shRNA)-mediated knockdown of Axl on the expression of p-AKT, poly ADP-ribose polymerase (PARP) and Ki-67, the proliferative activities, indicated by MTT assay, and the apoptotic index in OS MG-63 cells. As a result, the expression of Axl was found in OS tissues with higher strong reactivity rate, compared with the ANCT (75.0 percent vs 20.0 percent, P=0.000), but it did not associate with the age, gender, tumor size, TNM staging and distant metastases (each Pgreater than0.05). Furthermore, knockdown of Axl inhibited the proliferative activities and induced apoptosis in MG-63 cells with decreased expression of p-AKT, and Ki-67 and increased expression of PARP. In conclusion, our findings suggest that Axl is highly expressed in most of the OS tissues compared with the ANCT, and knockdown of Axl inhibits proliferation and induces apoptosis of OS cells possibly through downregulation of the AKT pathway, suggesting that our findings may provide new insights into the potential therapeutic target for cancer.

Differentiation of neonatal dorsal root ganglion-derived neural stem cells into oligodendrocytes after intrathecal transplantation into a cauda equina lesion model.

Cauda equina syndrome (CES) is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. The prognosis for complete recovery of CES is dependent on not only the time before surgical intervention with decompression but also the severity of the nerve damage. Delayed or severe nerve compression impairs the capability of nerve regeneration. Transplantation of neural stem cells (NSCs) may facilitate axon regeneration and functional recovery in a spectrum of neurological disorders. Our study shows that the NSCs derived from early postnatal dorsal root ganglion (DRG) are able to proliferate to form neurospheres and differentiate into O4(+) oligodendrocytes but not glial fibrillary acidic protein (GFAP(+)) astrocytes or ßIII-tubulin(+) neurons in vitro. After intrathecal transplantation into the lumbar spinal canal stenosis animal model, most of the GFP-expressing NSCs were induced to differentiate into oligodendrocytes in vivo. Although the recovery of sensorimotor function was not significantly improved in rats with transplantation therapy, our results implied that subarachnoid microinjection of NSCs may promote axon regeneration of DRG neurons in the cauda equina model after nerve injury.

The role of smoking status and collagen IX polymorphisms in the susceptibility to cervical spondylotic myelopathy.

We investigated a possible association of collagen IX tryptophan (Trp) alleles (Trp2 and Trp3) and smoking with cervical spondylotic myelopathy (CSM) in 172 Chinese patients and 176 age- and gender-matched controls. The smoking status was evaluated by smoking index (SI). The CSM cases had a significantly higher prevalence of Trp2 alleles (Trp2+) than controls (19.8 vs 6.2%, P = 0.002), but the prevalence of Trp3 alleles (Trp3+) was similar between the two groups (23.3 vs 21.6%, P = 0.713). Logistic regression analyses showed that the subjects with Trp2+ had a higher risk for CSM. We thus analyzed whether smoking status influenced the association between Trp2 alleles and CSM risk. Among Trp2+ subjects with an SI less than 100, the smoking status did not influence the effect of risk for SCM [odds ratio (OR) = 1.34, 95% confidential interval (95%CI) = 0.85-2.18, P > 0.05]. When SI increased from 101 to 300, the OR for CSM reached 3.34 (95%CI = 2.11-5.67, P = 0.011); when SI was more than 300, the OR for CSM reached 5.56 (95%CI = 3.62-7.36, P < 0.001). Among Trp2- subjects with SI more than 300, the OR for CSM increased 2.14 (95%CI = 1.15-4.07, P = 0.024). We found a significant association between the Trp2 alleles and CSM risk and smoking amplifies this risk, suggesting that smoking abstinence is important for reducing CSM occurrence in subjects with high genetic risk.

PTEN deletion prevents ischemic brain injury by activating the mTOR signaling pathway.

It is increasingly clear that the tumor suppressor PTEN (phosphatase and tensin homolog deleted on chromosome 10) is a negative regulator of neuronal cell survival. However, its molecular mechanisms remain poorly understood. Here we found that PTEN/mTOR is critical for controlling neuronal cell death after ischemic brain injury. Male rats were subjected to MCAO (middle cerebral artery occlusion) followed by pretreating with bpv (pic), a potent inhibitor for PTEN, or by intra-cerebroventricular infusion of PTEN siRNA. bpv (pic) significantly decreased infarct volume and reduced the number of TUNEL-positive cells. We further demonstrated that although bpv (pic) did not affect brain injury-induced mTOR protein expression, bpv (pic) prevented decrease in phosphorylation of mTOR, and the subsequent decrease in S6. Similarly, down-regulation of PTEN expression also reduced the number of TUNEL-positive cells, and increased phospho-mTOR. These data suggest that PTEN deletion prevents neuronal cell death resulting from ischemic brain injury and that its neuroprotective effects are mediated by increasing the injury-induced mTOR phosphorylation.

Spinal cord injury blunted effects of endothelin-1 on Ca(2+) transients and calcium current in isolated rat cardiomyocytes.

Plasma endothelin-1 (ET-1) levels are elevated in spinal cord injury (SCI), and ET-1 may be involved in the pathophysiology of this condition. However, its effects on contractile function of the heart of SCI rats are still unknown. To define more clearly the possible role of ET-1 following SCI, we investigated the effect of ET-1 on the contraction, calcium transients and L-type calcium current (I(Ca,L)) in the cardiomyocytes of control and SCI rats. Sixteen Sprague-Dawley male rats aged 80-100 days and weighing 250-350 g were randomized into control and SCI groups. Fourteen days following compression injury to the spinal cord, effects of ET-1 on the contraction, calcium transients and I(Ca,L) were studied in the cardiomyocytes of control and SCI rats by the technique of simultaneous measurement of intracellular Ca(2+) and contraction and by whole-cell configuration of the patch-clamp technique. In myocytes from control rats, ET-1 significantly increased contraction, the magnitude of Ca(2+) transients and the peak amplitude of I(Ca,L). However, ET-1 had little effect on the amplitude of contraction, calcium transients and I(Ca,L). in myocytes from SCI rats. These results suggest that the positive inotropic effects of ET-1 on control myocardial contraction may be altered in pathological states such as SCI.

Brown-Séquard syndrome due to penetrating injury by an iron fence point.

STUDY DESIGN: Case report. OBJECTIVES: To present an unusual type of penetrating objects causing Brown-Séquard syndrome (BSS) and its clinical character. SETTING: Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China. METHODS: A 54-year-old man fell from a height of 4 m onto an iron fence, and a sharp iron fence point penetrated the right side of his back. He developed left-sided BSS. Both X-ray film and computed tomography scanning of the thoracic spine showed a right vertebral plate of Th5 fracture and metal fragments inclining through the posterior and left lateral of the spinal canal. Emergency decompressive laminectomy and removal of the foreign metal piece were performed. No improvement in neurological function was observed 10 days after surgery, and thus hyperbaric oxygen treatment was initiated twice a day for the next 1 month. RESULTS: Forty days after surgery, his bladder function returned to normal. The motor deficit had regressed and he could walk without assistance 70 days after the operation. One year later, his lower extremity functions recovered almost completely, except for slight numbness on the right side. CONCLUSION: As far as we know, on the basis of existing literature, the injury mechanism to BSS by a sharp iron fence point has not been reported so far. The satisfactory recovery after injury may in part be attributed to timely surgery and continuing hyperbaric oxygen treatment.

Maximum entropy image deconvolution applied to structure determination for crystal Nd1.85Ce0.15CuO4-delta.

Eight [100] images from a through-focus series of tetragonal crystal Nd1.85Ce0.15CuO4-delta were transformed separately into the structure images by means of maximum entropy image deconvolution. The constructed projected structure model based on the deconvoluted image is confirmed by image simulation. It is demonstrated that the image deconvolution is still successful even when some reflections fall in the vicinity of zero cross of contrast transfer function. The effectiveness and advantages of the technique are discussed.

MRI and myelography in the diagnosis of lumbar canal stenosis and disc herniation. A comparative study.

We studied the diagnostic accuracy of magnetic resonance imaging (MRI) and the possibility of its substitution for myelography in 78 patients with lumbar canal stenosis and/or disc herniation, who had myelography and MRI examination. The diagnostic results of the two methods were compared respectively with those of operation, showing no statistical significance (coincidence rate 88.5% vs 92.3%, P greater than 0.05). We conclude that MRI could clearly reveal the pathological changes and anatomical relations of lumbar structures without invasive and radioactive damages, and that with the improvement of operative technique, better understanding of images, and reduction of cost, MRI is likely to replace myelography in the future.

Radiographic measurement of the prevertebral soft tissue of cervical vertebrae.

The radiographic measurement of the prevertebral soft tissue of cervical vertebrae was performed in 87 normal adults. According to the results of the measurement, 10 mm and 20 mm were used as the upper limit normal values of the retropharyngeal and retrotracheal space respectively. We conclude that although the widened soft tissue space is of diagnostic significance, diagnosis should be made on the basis of analysis of the injury history, clinical manifestation and imaging examination.

Dynamic changes of the cervical ligamental flavum in hyperextension---hyperflexion movement and their measurements.

Ten fresh cadaver cervical spine specimens were frozen and bisected through the median sagittal plane. The length, thickness of the ligamental flavum (LF) and its protruding depth into the cervical canal were measured in hyperextension, hyperflexion and mid-position. The results showed that LF was elongated and became thinner in hyperflexion and shortened, thickened, and protruded into the cervical canal in hyperextension. The protruding depth into the canal was 3.5 +/- 0.35 mm at C 5-6, 3.25 +/- 0.50 mm at C 4-5 and 2.96 +/- 0.35 mm at C 6-7 respectively. Segmental stenosis was observed at the level of intervertebral space in hyperextension.

Correlative study on findings of dynamic myelography and surgical operation in non-bony lumbar spinal canal stenosis.

The authors performed dynamic lumbar myelography with Omnipaque on 110 patients from 1990 to 1992, of them, 33 cases were diagnosed as non-bony lumbar spinal canal stenosis according to contrast medium defect seen on the lateral view of the myelogram. All such cases were operated on and their dynamic pathological findings during the operation were recorded to compare with the abnormal findings observed on the myelograms, there was a high coincidence rate of 88.7%. The authors believe that the fibrous degenerative changes make up the basis of dural sac compression and the dynamic compression in the spinal canal plays a very important role in causing the severity of the stenosis. As the dynamic pathological findings on the myelograms can not be well demonstrated on CT scanning and MR imaging, the dynamic lumbar myelography should be the method of choice for use in some cases.

[Magnetic resonance imaging in the diagnosis of protrusion of a lumbar vertebral disc].

Signals of MR images which were done preoperatively on 86 patients with protrusion of lumbar vertebral disc were correlated to operative findings that were grouped, according to condition and position of the nucleus pulposus with relation to its annulus fibrosus, into 3 categories: protrusion, herniation and extrusion. Each of these 3 pathologic conditions was well-reflected on MRI image, a recognizable unique signal, characteristic of each category. Accordingly, the preoperative diagnosis in this series was 96.5% accurate, much better than that with any other methods; better still, MR imaging is non-invasive.

[Dynamic change in the ligmenta flava of the cervical spine in motion].

Cervical spine specimen from fresh cadaver of 10 young persons, 8 males and 2 females, aged from 23 to 32 years, were divided right through the midline after frozen under -30 degrees C. Changes in length and thickness of each ligmenta flava were measured in hyperflexion and hyper extension as well as in neutral position. Being stretched long and thin in flex and contracted short and thick in extension, the ligmenta flava stuck into the spinal canal in position of hyperextension, mostly at C5-6 (3.50 +/- 0.34 mm) and then C4-5 (3.25 +/- 0.50 mm), C6-7 (2.96 +/- 0.61 mm) in descending order. This experiment definitely demonstrated that segmental narrowing of spinal canal , due to sticking in of ligmenta flava at each intravertebral level, was fashioned in hyperextension.

[Isthmic bone grafting in the treatment of lumbar spondylolysis].

Twenty-one patients with lumbar vertebral isthmic spondylolysis were treated by inserting bone graft in the isthmic defect. Grafting should also include the adjacent facet joints, thus after healing of grafted bone lumbar stability could be obtained, all cases were followed up for 10-15 months. Twenty-one patients had 44 isthmic lesions 39 of them revealed bony fusion radiologically (88.7%). On clinical evaluation, the combined excellent and good results reached 90.5%.

[Lumbar discectomy and forominotomy].

17 patients, 11 males and 6 females, aged from 25 to 65 years (41.5 years, on average), suffered from lumbago and/or sciatica in various patterns, were operated upon. Lumbar discectomy and forominotomy were performed on 12 cases, and forominotomy only on 5. Follow-up of all the 17 patients found excellent and good results in 88.3% (15/17). Based on the experience from this small series of patients, we would suggest: forominotomy should be done on cases in whom neither disc protrusion nor yellow ligament thickening nor recess narrowing could be found, or the corresponding nerve root could not get free and still remain tight after discectomy, or the nerve root sustained tenderness on pressure when the operation was carried out under local anesthesia.

[Treatment of lumbar spinal stenosis with partial laminectomy and canal enlargement].

Thirty-eight patients with lumbar spinal stenosis were treated by partial laminectomy, incision of ligmental flava and canal enlargement. According to the pathological characteristic of lumbar spinal stenosis, both decompression and stability of the lumbar spine would be achieved by limited surgical treatment to the pathological segment and removing of any pathological factors. The average time for follow-up is 14 months. The excellent rate is 89.5%. The technique of the operation was also described and discussed.

[Preliminary report on the use of MRI in acute spinal trauma].

Forty three Magnetic Resonance (MR) studies were performed on 28 patients using a 1.5 Tesla magnet and surface coil. Imaging was performed between day 1 and day 16 after suspected cord injury. In several patients, repeat MR studies were performed to evaluate the resolution of the cord lesions. Three types of MR signal patterns were seen in association with the cord injuries. Patients with intraspinal hemorrhage did not have significant neurological recovery while patients with cord edema/contusion recovered significant neurological function. MR imaging would seem extremely useful in the diagnosis of acute cord injury and also appears to demonstrate the potential for predicting neurological recovery.