[Effects of ultrasonic bone curettes combined with high-speed drills in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis].

Objective: To evaluate the safety and efficacy of the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis, and propose the optimal cutting position for ultrasonic bone curette during the laminectomy. Methods: By observing and measuring the parameters of thoracic pedicle, lamina, inner wall of the vertebral canal and their relation with the surrounding structures on cadavers, we provided a morphological marker for laminectomy by an ultrasonic bone curette. Data of 19 patients with severe thoracic spinal stenosis treated by posterior laminectomy and decompression were collected from June 2017 to June 2018 in Shanghai Changzheng Hospital. There were 11 males and 8 females, aged (50±6) years. The patients received laminectomy with the combined use of ultrasonic bone curette and the high-speed drill (Group A, n=10) or the use of ultrasonic bone curette alone (Group B, n=9). Operational time of decompressive laminectomy, blood loss, as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of the nerve root and spinal cord were recorded in these two groups. The improvement of symptoms and the decompression width of the spinal canal were evaluated after operation. Two independent samples t-test was used for the comparison of two sets of continuous normal distribution data. Results: We had done the measurement in 6 cadavers. The mean distance between the boundary of cancellous-cortical bone of lamina and the inner wall of spinal canal was (0.9±0.4) mm, and the distance between the boundary of cancellous-cortical bone of pedicle and the inner wall of the spinal canal was (1.2±0.6) mm. For the surgeries in groups A, the mean laminectomy time for each segment was (4.4±0.5) min, the mean width of posterior laminectomy was (21.8±0.5) mm; and for the surgeries in group B, the mean laminectomy time for each segment was (5.0±0.5) min, the mean width of posterior laminectomy was (19.9±1.0) mm; there were significant differences in laminectomy time for each segment and the width of posterior laminectomy between the two groups (t=-2.391, 3.491, both P<0.05). There was one case of dura injury and one case of thoracic nerve root injury during the operation in group B. Conclusions: It is safer and more reliable for the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for the severe thoracic spinal stenosis. The interface between the cortical bone and the medial edge of cancellous bone of the pedicle could be identified as the cutting mark for ultrasonic bone curette in this procedure.

[Comparison of the pulmonary function between adolescent patients with Chiari malformation associated scoliosis and idiopathic scoliosis].

Objective: To compare the pulmonary function between adolescent patients with Chiari malformation associated scoliosis (CMS) and adolescent idiopathic scoliosis (AIS). Methods: A retrospective analysis was performed on 52 patients with CMS, and 52 patients with AIS were selected as the control group to match the CMS patients by age, sex, and Cobb angle. Preoperative pulmonary function tests were completed by all the patients, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), maximal mid-expiratory flow (MMEF), and ratio of FEV(1) to FVC. The difference of pulmonary function parameters was analyzed between the two groups; Correlation between pulmonary function and radiographic parameters was analyzed in patients with CMS. Results: There were no significant differences in terms of sex, age, and the main coronal Cobb angle between the two groups. There were 42(80.7%) and 44(84.6%) of patients with restrictive ventilatory dysfunction (the percentage of predicted FVC<80%) in CMS and AIS group respectively. 18(42.8%) and 10 (22.7%) out of these patients were also with obstructive ventilation dysfunction (FEV(1)/FVC<92%) in CMS and AIS group respectively. Types of ventilation dysfunction distributed between the two groups had no significant difference (P>0.05). No significant difference was noted between the two groups in the percentage of predicted VC, FVC, FEV(1) and FEV(1)/FVC (P>0.05). The percentage of predicted MMEF in patients with CMS was lower compared to those with AIS[(57.9±13.3)% vs (67.2±23.3)%, P=0.053]. In patients with CMS, the percentage of predicted VC, FVC, FEV(1) and MMEF had significantly negative correlation with the number of vertebrae involved (P<0.01). Main coronal Cobb angle had negative correlation with the percentage of predicted VC, FVC and FEV(1) (P<0.05). The percentage of predicted VC, FVC and FEV(1) had positive correlation with thoracic kyphosis (P<0.05). Conclusions: There are no significant differences in characteristics of the pulmonary dysfunction between patients with AIS and CMS without obviously neural deficit. Both groups mainly present with restrictive ventilation dysfunction.

Screening of polymorphisms located in the FGF20 and TMEM175 genes in North Chinese Parkinson's disease patients.

Genome-wide association studies have reported numerous susceptibility loci for Parkinson's disease (PD). However, there have been few replication studies examining these loci in northern Chinese populations. To evaluate the relationships among 3 polymorphic markers located in the fibroblast growth factor 20 and transmembrane protein 175 genes and the genetic susceptibility to PD in northern Chinese subjects, 2 single nucleotide polymorphisms, and 1 insertion/deletion marker (rs591323 in FGF20; rs6599388 and rs142821586 in transmembrane protein 175 near the G-associated kinase/diacylglycerol kinase theta region) were investigated in 313 PD patients and 318 matched controls. Mismatched multiplex polymerase chain reaction-restriction fragment length polymorphism analysis as well as sequence-specific primer polymerase chain reaction and restriction fragment length polymorphism assays were performed. The genotypic frequency of rs591323 differed significantly between the patient and control groups; however, neither rs6599388 nor rs142821586 was associated with PD. We corrected the Hardy-Weinberg disequilibrium for rs6599388, which was previously reported to be common in 4 Asian descent populations into equilibrium status by simultaneously genotyping rs6599388 and rs142821586. In summary, we found that rs591323 was associated with PD but rs6599388 and rs142821586 were not associated with PD in a northern Chinese population.

Multi-drug resistance (MDR1) gene expression in de novo acute leukemia cells: correlations with CD surface markers and treatment outcome.

One important mechanism of drug resistance in acute leukemia is the overexpression of the multi-drug resistance (MDR1) gene that encodes a 170-kDa membrane protein called P-glycoprotein. To estimate the incidence and role of MDR1 gene expression in patients with acute leukemia, we investigated the expression of MDR1 by using the RT-PCR method in blast cells from 40 cases of de novo acute leukemia. We found a high frequency of MDR1 gene expression: 10 out of 20 with de novo acute myeloid leukemia (AML), 8 out of 17 with de novo acute lymphoblastic leukemia (ALL), and none of the 3 with de novo acute mixed leukemia, were MDR1 mRNA-positive. No correlation between cluster designation (CD) surface markers (CD19, CD7, CD13, CD33, CD34, CD14, HLA-DR) and MDR1 gene expression in AML was found. The complete remission rate was correlated with MDR1 gene expression. Among 40 evaluable patients examined, 17% (3 of 18) with MDR1 mRNA-positive reached complete remission versus 77% (17 of 22) with MDR1 mRNA-negative (p=0.044). These results suggest that MDR1 gene expression can be used as a prognostic factor and may be helpful in determining chemotherapeutic protocol for patients with acute leukemia.