Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse.

BACKGROUND: The most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon's concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved. AIM: To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse. METHODS: From January 2017 to July 2019, 49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler. RESULTS: Forty-five patients were cured, 4 patients improved, and the cure rate was 92%. The postoperative obstructed defecation syndrome score, the defecation frequency score, time/straining intensity, and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment, and the differences were statistically significant (P < 0.05). The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment, and the differences were statistically significant (P < 0.05). The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment, and the differences were statistically significant (P < 0.05). The postoperative ratings of rectocele, resting phase, and defecation phase in these patients were significantly decreased compared with those before treatment, and the differences were statistically significant (P < 0.05). CONCLUSION: The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.

Identification of a subset of immunosuppressive P2RX1-negative neutrophils in pancreatic cancer liver metastasis.

The immunosuppressive microenvironment that is shaped by hepatic metastatic pancreatic ductal adenocarcinoma (PDAC) is essential for tumor cell evasion of immune destruction. Neutrophils are important components of the metastatic tumor microenvironment and exhibit heterogeneity. However, the specific phenotypes, functions and regulatory mechanisms of neutrophils in PDAC liver metastases remain unknown. Here, we show that a subset of P2RX1-negative neutrophils accumulate in clinical and murine PDAC liver metastases. RNA sequencing of murine PDAC liver metastasis-infiltrated neutrophils show that P2RX1-deficient neutrophils express increased levels of immunosuppressive molecules, including PD-L1, and have enhanced mitochondrial metabolism. Mechanistically, the transcription factor Nrf2 is upregulated in P2RX1-deficient neutrophils and associated with PD-L1 expression and metabolic reprogramming. An anti-PD-1 neutralizing antibody is sufficient to compromise the immunosuppressive effects of P2RX1-deficient neutrophils on OVA-activated OT1 CD8+ T cells. Therefore, our study uncovers a mechanism by which metastatic PDAC tumors evade antitumor immunity by accumulating a subset of immunosuppressive P2RX1-negative neutrophils.

Consensus statement on diagnosis and treatment of cervical ossification of posterior longitudinal ligament from Asia Pacific Spine Society (APSS) 2020.

PURPOSE: The study aimed to develop an evidence-based expert consensus statement on diagnosis and treatment of cervical ossification posterior longitudinal ligament (OPLL). METHOD: Delphi method was used to perform such survey, and the panel members from Asia Pacific Spine Society (APSS) 2020 were invited to answer the open-ended questions in rounds 1 and 2. Then the results were summarized and developed into a Likert-style questionnaire for voting in round 3, and the level of agreement was defined as 80%. In the whole process, we conducted a systematic literature search on evidence for each statement. RESULTS: Cervical OPLL can cause various degrees of neurological symptoms, an it's thought to be more common in Asia population. CT reconstruction is an important imaging examination to assist diagnosis and guide surgical choice. Segmental, continuous, mixed, and focal type is the most widely used classification system. The non-surgical treatment is recommended for patients with no or mild clinical symptoms, or irreversible neurological damage, or failed surgical decompression, or condition cannot tolerant surgery, or refusing surgery. As OPLL may continue to develop gradually, surgical treatment would be considered in their course inevitably. The surgical choice should depend on various conditions, such as involved levels, thickness, and type of OPLL, skill-experiences of surgeons, which are listed and discussed in the article. CONCLUSION: In this statement, we describe the clinical features, classifications, and diagnostic criteria of cervical OPLL, and review various surgical methods (such as their indications, complications), and provide a guideline on their choice strategy.

p53 suppresses 14-3-3γ by stimulating proteasome-mediated 14-3-3γ protein degradation.

14-3-3 proteins are a family of highly conserved polypeptides that interact with a large number of proteins and play a role in a wide variety of cellular processes. 14-3-3 proteins have been demonstrated overexpressed in several cancers and serving as potential oncogenes. In a previous study we showed one isoform of the 14-3-3 family, 14-3-3γ was negatively regulated by p53 through binding to its promoter and inhibiting its transcription. In the present study we investigated both p53 and 14-3-3γ protein levels in human lung cancerous tissues and normal lung tissues. We found 14-3-3γ expression correlated to p53 overexpression in lung cancer tissues. Ecotopic expression of wild-type p53, but not mutant p53 (R175H) suppressed both endogenous and exogenous 14-3-3γ in colon and lung cancer cell lines. Further examination demonstrated that p53 interacted with C-terminal domain of 14-3-3γ and induced 14-3-3γ ubiquitination. MG132, a specific inhibitor of the 26S proteasome, could block the effect of p53 on 14-3-3γ protein levels, suggesting that p53 suppressed 14-3-3γ by stimulating the process of proteasome-mediated degradation of 14-3-3γ. These results indicate that the inhibitory effect of p53 on 14-3-3γ is mediated also by a post-transcriptional mechanism. Loss of p53 function may result in upregulation of 14-3-3γ in lung cancers.

Correlation between circulating myeloid-derived suppressor cells and Th17 cells in esophageal cancer.

AIM: To perform a comprehensive investigation into the potential correlation between circulating myeloid-derived suppressor cells (MDSCs) and Th17 cells in esophageal cancer (ECA). METHODS: A total of 31 patients newly diagnosed with ECA and 26 healthy subjects were included in the current study. The frequencies of MDSCs and Th17 cells in peripheral blood were determined by flow cytometry. The mRNA expression of cytokines, arginase 1 (Arg1) and inducible NO synthase (iNOS) in peripheral blood mononuclear cells (PBMCs) and plasma Arg1 were assessed by real-time polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. RESULTS: There was an increased prevalence of MDSCs in the peripheral blood from ECA patients (15.21% ± 2.25%) when compared with healthy control (HC) (1.10% ± 0.12%, P < 0.0001). The plasma levels of Arg1 in ECA patients were significantly higher than those in HC (28.28 ± 4.10 ng/mL vs 9.57 ± 1.51 ng/mL, P = 0.0003). iNOS mRNA levels in the peripheral blood of ECA patients also showed a threefold increase compared with HC (P = 0.0162). The frequencies of Th17 cells (CD4⁺IL-17A⁺) were significantly elevated in ECA patients versus HC (3.50% ± 0.33% vs 1.82% ± 0.19%, P = 0.0001). Increased mRNA expression of IL-17 and ROR-γt was also observed in ECA patients compared with HC (P = 0.0041 and P = 0.0004, respectively), while the mRNA expression of IL-6 and tumor necrosis factor-α (TNF-α) showed significant decreases (P = 0.0049 and P < 0.0001, respectively). No obvious correlations were found between the frequencies of MDSCs and Th17 cells in the peripheral blood from ECA patients(r = -0.1725, P = 0.3534). Arg1 mRNA levels were positively correlated with levels of IL-6 (r = 0.6404, P = 0.0031) and TNF-α (r = 0.7646, P = 0.0001). Similarly, iNOS mRNA levels were also positively correlated with levels of IL-6 (r = 0.6782, P = 0.0007) and TNF-α (r = 0.7633, P < 0.0001). CONCLUSION: This study reveals the relationship between circulating MDSCs and Th17 cells, which may lead to new immunotherapy approaches for ECA based on the associated metabolites and cytokines.

[Surgical options and clinical outcomes of cervical ossification of the posterior longitudinal ligament].

OBJECTIVE: To discuss the options and clinical outcomes of surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: From January 2006 to December 2010, 63 patients of cervical OPLL treated surgically by same team were retrospectively analyzed. There were 49 males, 14 females, with a mean age of 56.2 years (from 38 to 76 years). The duration of symptoms ranged from 2 months to 20 years (mean 3.2 years). The ossified ligament was classified via sagittal and coronal images on CT scan. The cervical curvature was measured. Choice of surgical methods was determined according to the type of ossified ligament and cervical curvature. All complications occurred was recorded. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurological status. The severity of cervical pain was assessed with visual analogue scale (VAS) method. The results of preoperative, postoperative and follow-up were statistically compared with student t test. RESULTS: The JOA scores of 35 patients performed with anterior approach improved from 9.8 ± 2.3 preoperatively to 11.7 ± 2.1 at final follow-up (t = 3.28, P < 0.05). The VAS sore was significantly decreased at final follow-up compared with preoperative (t = 3.15, P < 0.05). While the JOA scores improved from 10.4 ± 2.7 preoperatively to 12.5 ± 2.3 at final follow-up (t = 3.81, P < 0.05) in 12 patients with laminectomy and from 9.7 ± 2.5 to 11.6 ± 2.6 in 14 patients with laminoplasty (t = 3.56, P < 0.05). The VAS score either in laminectomy or in laminoplasty has not significantly difference between preoperative, 3 month postoperative and final follow-up (P > 0.05). Two patients underwent a combined anterior-posterior approach procedure. Complications in patients included 1 patient of postoperative neurologic deterioration and 2 cases of cerebrospinal fluid leakage in patients with anterior approach, and 2 cases of C(5) nerve palsy in patients with laminectomy. CONCLUSIONS: Surgical options of cervical OPLL should be determined by detailed study of type and range of ossified ligament, as well as the cervical curvature of patients. Good neurological function can be expected in case of appropriate choosing the method for treating the cervical OPLL.

The ATP2A2 gene in patients with Darier's disease: one novel splicing mutation.

BACKGROUND: Darier's disease (DD) is a rare, inherited skin disorder characterized by warty papules and plaques over the seborrheic area, such as central trunk, flexures, scalp, and forehead. Mutations in ATP2A2 gene encoding the enzyme sarco/endoplasmic reticulum Ca(2+) ATPase type 2 are responsible for the disease. Here we report two Chinese families affected by DD with two ATP2A2 mutations. MATERIALS AND METHODS: DNA was extracted from the peripheral blood samples and then subjected to polymerase chain reaction amplification and direct automated DNA sequencing. RESULTS: A heterozygous G to T transition in the first nucleotide of intron 7 (c.630 + 1G>T) and G to A transversion at nucleotide 2898 in exon 20 of the ATP2A2 gene were identified in two pedigrees, respectively. The former mutation in the splice site is a novel mutation and is thought to lead to aberrant splicing and premature protein truncation. The latter has already been described, which leads to premature termination codons (PTC) (W966X). CONCLUSION: The results will contribute to the expanding database of ATP2A2 mutations in patients with DD and be useful for inherited counseling and prenatal examination for affected families.

Single-stage combined decompression for patients with tandem ossification in the cervical and thoracic spine.

STUDY DESIGN: Retrospective study of clinical outcomes of single-staged combined cervical and thoracic decompression for patients with tandem ossification (TO). OBJECTIVE: To describe primary clinical outcomes of this procedure. TO is introduced to described a double ossification lesion of the posterior longitudinal ligament (OPLL) or the ligament flavum (OLF) at the cervical, thoracic and lumbar spine. In clinical practice, cervical OPLL combined with thoracic OPLL or/and OLF are the most common types of TO. However, little is known about the clinical outcomes of surgical treatment and there is no consensus on the optimal treatment to this combined disorder. METHODS: Between January 2005 and December 2008, 15 patients of this complicated phenomenon were treated by single-staged combined cervical and thoracic decompression in conditions where patients' general condition allowed and individuals agreed on. Surgical intervention, perioperative complications, and clinical outcomes were reviewed in these 15 TO patients who were followed up for more than 2 years (range 2-5 years). Clinical symptoms were evaluated using the JOA scoring system and activity of daily life was evaluated by Nurick classification before surgery, at 6 months postoperatively, and at final follow-up. Patient satisfaction was determined at final follow-up. RESULTS: The mean blood loss was 1,553.3 ± 735.7 ml (range 700-2,900 ml) and the mean operation time was 280.7 ± 53.6 min (range 220-370 min). The important intraoperative and postoperative complications recorded in medical documents included CSF leakage, hematoma, C5 palsy and neurological deterioration. The JOA score was significantly higher 6 months after surgery (8.1 ± 1.8 points vs. 11.0 ± 1.6 points, p < 0.0001), and there was no significant change between 6 months after surgery and final follow-up (11.0 ± 1.6 points vs. 11.3 ± 2.1, p = 0.5894). The mean Nurick classification significantly improved from grade 3.6 ± 0.7 before surgery to grade 2.5 ± 0.9 at 6 months after surgery (p < 0.001), and well maintained as grade 2.3 ± 1.0 at final follow-up (p = 0.3343). Three patients had satisfaction scores of 3 points, 5 had scores of 2 or 1 point, and 2 had score of 0 point. Pearson correlation analysis showed a significant positive correlation between satisfaction score and JOA score (r = 0.6493, p = 0.0093), and a significant negative correlation between satisfaction score and Nurick classification (r = -0.5941, p = 0.0195). Besides, perioperative complications and progression of tandem ossification which needed revision surgery had significant adverse effect on patients' satisfaction. CONCLUSIONS: The results showed that single-staged combined decompression could provide comparable clinical outcomes, and patients' satisfaction was significantly related with postoperative neurological function. In addition, satisfaction score could be decreased by perioperative complications and progression of tandem ossification. Thus, this aggressive surgical strategy should be used more carefully with emphasis on preoperative communication with patients.

Paresis associated with aconuresis caused by intervertebral disc calcification at c7-t1: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: To report a case of a 19-year-old boy with intervertebral disc calcification (IDC) at C7-T1, who presented with paresis and aconuresis. Surgical outcome was assessed. SUMMARY OF BACKGROUND DATA: IDC, commonly seen in the cervical spine region in children, is well-known as a self-limiting disorder with no or little symptoms. Surgical intervention is usually not required. METHODS: A 19-year-old boy presented with acute back pain, progressive numbness, and weakness of both lower extremities and aconuresis for 1 week. There was no traumatic history or signs of infection. Radiograph, computed tomography with reconstruction, and magnetic resonance imaging revealed C7-T1 IDC with severe spinal cord compression. Decompression with anterior cervical corpectomy and fusion was performed. RESULTS: Follow-up showed complete resolution of the back pain and complete recovery of motor power and sensory function in both lower extremities and return of normal micturition function. The patient had full recovery with no complications. CONCLUSION: Serious neurologic deficit, especially a bladder dysfunction, caused by calcified intervertebral disc is rare. However, favorable outcome can be achieved in those cases where rapid diagnosis is made and followed by spinal cord decompression.

Combined anterior C2-C3 fusion and C2 pedicle screw fixation for the treatment of unstable hangman's fracture: a contrast to anterior approach only.

STUDY DESIGN: A retrospective clinical study was used to evaluate the effect of a new surgical treatment of the hangman's fractures. OBJECTIVE: To determine the treatment efficacy of combined anterior C2-C3 reduction and fusion and posterior compressive C2 pedicle screw fixation for the management of unstable hangman's fractures. SUMMARY OF BACKGROUND DATA: The classification of hangman's fractures as proposed by Levine-Edwards was used to classify and guide the treatment of these injuries. Most of these fractures respond to a variety of conservative therapies, but recently, earlier surgery has been increasingly advocated by authors from several countries for the rapid stabilization of these fractures. If surgery is indicated, an anterior approach using a C2-C3 reduction and fusion is preferred usually. Another well-accepted surgical method is the direct transpedicular osteosynthesis by the dorsal approach. However, there was rare report of the combined use of these 2 techniques. METHODS: A group of 45 surgical patients were all diagnosed with radiograph, magnetic resonance imaging (MRI), and 3D CT scans. Initial and final radiographs were measured for anterior translation and angulation of the C2-C3 complex. Initial external skull traction with extension was used in all patients after admission to reduce the fracture. Then an anterior C2-C3 discectomy followed by an interbody fusion and locking plate fixation was performed. Intraoperative reduction was confirmed by fluoroscopic control. About 29 patients therefore received anterior surgeries only since satisfactory reduction was achieved during the procedure. For the 16 patients who had persistent large residual gaps after the anterior procedure, additional same stage posterior C2 compressive pedicle screws were placed. Clinical and radiologic comparisons were performed in these 2 groups. RESULTS: The follow-up ranged from 24 to 54 months, with an average 33.6 months. There was radiographic evidence of continuity of the fracture and the bone graft seen at 4.7 months on average. Neck pain and neurologic deficits resolved in nearly all patients after surgery. The anterior translation of anterior-posterior surgery group decreased more significant compared to anterior surgery group, although with no statistical significance. The fractures were closed with a slight gap no more than 2 mm in anterior-posterior surgery group. The residual kyphosis in anterior-posterior surgery group was still a little larger than it in anterior surgery group. No internal fixation failures or infections were observed. CONCLUSION: We believe that the need for single stage 360° fusion of hangman's fractures can be somewhat predicted by a combination of high resolution imaging. For hangman's fractures with significant deformity and gapping, it is our experience that immediate single-stage anterior-posterior reduction, instrumentation, and arthrodesis achieve superior postoperative reduction and long-term functional outcomes.

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia.

Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuous-type) were selected via clinical and radiographic features, and intraoperative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.

[Effect of Aidi injection on peripheral blood expression of Th1/Th2 transcription factors and cytokines in patients with esophageal squamous cell carcinoma during radiotherapy].

OBJECTIVE: To investigate the expression of Th1/Th2 transcription factors and cytokines in peripheral blood of patients with esophageal squamous cell carcinoma (ESCC) during radiotherapy to provide an evidence for using traditional Chinese medicine in anti-tumor immunotherapy. METHODS: Sixty patients with ESCC undergoing radiotherapy were randomly and equally assigned to the tested group (treated with combined treatment of Aidi Injection) and the control group (treated with radiotherapy alone). A group consisted of 20 healthy persons was set up meanwhile as the normal control. Patients' expressions of Th1 and Th2 type transcription factors and cytokines were detected before and after radiotherapy, the expression of T-bet and GATA-3 in peripheral blood monoclear cells (PBMCs) were detected by Real-time quantitative PCR (RT-PCR), and plasma expressions of interferon gamma (IFN-gamma), interleukin 2, 4 and 10 (IL-2, IL-4, IL-10) were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared with the healthy control group, the expressions of Th1 type transcription factor T-bet and cytokines IFN-gamma, IL-2 in ESCC patients were significantly lower (P < 0.01), while expressions of Th2 type transcription factor GATA-3 and cytokines IL-4, IL-10 were significantly higher (P < 0.01). These changes were exacerbated significantly after radiotherapy in the control group (P < 0.01), but only showed a slight change in the tested group with statistical insignificance (P > 0.05). CONCLUSIONS: Radiotherapy can not reverse the Th1/Th2 shift presented in ESCC patients, while the combined intravenous dripping of Aidi Injection during radiotherapy can inhibit it effectively. The combined therapy could elevate the immune function in organism, enhance the radiosensitivity, and attenuate the toxic-adverse effect of radiotherapy.

[Expression of transcription factor T-bet and GATA-3 in peripheral blood mononuclear cells and its correlation with immune status in esophageal cancer patients].

OBJECTIVE: To investigate the expression of transcription factors (TF) T-bet and GATA-3 mRNA in peripheral blood mononuclear cells and its correlation with immune status in esophageal cancer patients. METHODS: Sixty patients were divided into two groups according to the clinical data: group A consisting of stage I and II, group B including stage III and IV. The gene expression of T-bet and GATA-3 in 60 esophageal cancer patients and 30 healthy controls was detected by reverse transcription-polymerase chain reaction (RT-PCR). The expression of IFN-gamma and IL-4 was measured by enzyme linked immunosorbent assay (ELISA). RESULTS: Expression of T-bet mRNA in esophageal cancer patients (stage I and II: 0.27 +/- 0.05 ng/L, stage III and IV: 0.12 +/- 0.02 ng/L) was significantly lower than that in the healthy controls (1.35 +/- 0.14 ng/L), but the expression of GATA-3 mRNA in esophageal cancer patients (stage I and II: 0.45 +/- 0.06, stage III and IV: 0.55 +/- 0.03) was significantly higher than that in the healthy controls (0.09 +/- 0.10). The plasma level of Th1 cytokine IFN-gamma in the patients [stage I and II: (12.12 +/- 1.48) ng/L, stage III and IV: (8.44 +/- 0.90) ng/L] was significantly lower than that in the healthy controls, while the level of Th2 cytokine IL-4 in the patients [stage I and II: (18.64 +/- 0.77) ng/L, stage III and IV: (25.28 +/- 2.02) ng/L] was significantly higher than that in the healthy controls. However, neither in the expression of T-bet and GATA-3, nor in the plasma level of IFN-gamma and IL-4, showed a significant difference between group A and B. CONCLUSION: In the peripheral blood of esophageal cancer patients, the expression of T-bet decreased, while GATA-3 increased, Th1/Th2 balance is broken, and the Th2 is dominant. T-bet and GATA-3 play a part role in the regulation of Th1/Th2 balance.

[Anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament].

OBJECTIVE: To study the technique and effect of anterior decompression for the treatment of cervical spondylotic myelopathy associated with ossification of posterior longitudinal ligament (OPLL). METHOD: Sixty-one patients (42 male and 19 female, 45 - 74 years with mean age of 57 years old) underwent anterior decompression for the treatment of cervical spondylotic myelopathy associated with OPLL. Among them, OPLL was definitely diagnosed in 49 patients preoperatively, and was found during the operation in the other 12 patients. The occupying rate of OPLL ranged 32%-70% with an average of 52%. The preoperative JOA scores ranged 4 - 14 points with an average of 9.6 points. In additional to conventional decompression, the ossification was removed completely after discectomy and corpectomy. RESULTS: Corpectomy was performed in 41 cases, discectomy in 6 cases and combination of corpectomy and discectomy in 14 cases. The follow-up of all patients ranged from 6 to 36 months (mean 16 months). The postoperative JOA scores ranged 8-16 points with an average of 12.8 points. The neurological improvement rate ranged from 25.0% to 87.5% with an average of 65.2%. The transient leakage of cerebrospinal fluid (CSF) occurred in 5 cases, and stopped after conservational treatment. No neurological deterioration developed. CONCLUSIONS: The difficulty and risk of anterior decompression are significantly increased in the patients with cervical spondylotic myelopathy associated with OPLL. Remove of ossification after corpectomy and discectomy could provide complete decompression and better results.

[Anterior radical decompression for severe ossification of the posterior longitudinal ligament in the cervical spine].

OBJECTIVE: To report the outcome of anterior radical decompression for the treatment of severe ossification of the posterior longitudinal ligament (OPLL) with an average occupying ratio exceeding 50% in the cervical spine. METHODS: From July 2002 to February 2006, 26 patients with cervical OPLL occupying ratio of the spinal cord exceeding 50% underwent anterior decompression and fusion. There were 18 males and 8 females. The average age was 59 years (ranged from 43 to 73 years) and the mean occupying ratio was (65 +/- 20)%; Before operation, the JOA score was 8.7 +/- 2.8, and the sagittal diameter of spinal cord was (25 +/- 7)%. The ossified ligament was classified into two groups, the base-open group and the base-closed group. The occupying ratio was measured on 3-D CT scans, and the sagittal diameter of the deformed spinal cord was measured at the narrowest level on sagittal T2-weighted MRI. All patients received anterior decompression with the ossified ligament removed completely. Among them, 10 cases underwent one level corpectomy combined with one level diskectomy, 3 cases underwent 2 level corpectomy, and the other 13 patients underwent one level corpectomy. The decompressed segments were reconstructed either with a iliac crest strut or a titanium cage, and an anterior locking plate was implanted to prevent graft extrusion in every patient. All patients were monitored with ECP during decompression. RESULTS: The occupying ratio decreased to (10 +/- 5)%, the sagittal diameter of spinal cord increased to (75 +/- 15)%, and the average diameter of spinal cord at the narrowest site increased 3 times after operation. The JOA score was 14.2 +/- 2.5, with an average improvement ratio of (61 +/- 24)%. Three patients accompanied with diabetes presented with temporarily neurological deterioration. There were two cases complicated with cerebrospinal fluid leaks but cured within 2 weeks after surgery. One case accompanied with diabetes underwent a second emergency reexploration for hematoma in the spinal canal which caused a dyspnea. CONCLUSIONS: Anterior radical decompression is an optimal method for the management of severe OPLL in the cervical spine. Higher rate of neuro-function recovery can be anticipated.

[Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the treatment of unstable Hangman's fractures: 16 cases review].

OBJECTIVE: To determine the outcome of combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation for the management of unstable Hangman's fractures. METHODS: Sixteen cases of unstable Hangman's fractures were retrospectively reviewed through X-ray, MRI and three dimensional CT scans. Pre- and postoperative radiographs were measured for translation and angulation of C2,3. Skull traction under extension poison was conducted in all the patients right after their admission. Then anterior C2,3 discectomy followed by interbody fusion, either with iliac autograft or with box cage, and locking plate fixation were performed in each case. Because dissatisfied reduction, mainly residual large fracture gap or kyphosis, was found by the C-arm fluoroscopy during operations, posterior compressive C2 pedicle screw fixation was performed in one stage. According to the Levine-Edwards classification, there were 12 cases of type II, 2 of type I a and 2 of type III in this group. RESULTS: Follow-up ranged 6-38 months, averaged 26 months. Fracture union and bone graft fusion were completed in an average of 4 months after operation. Complaints of neck pain and numbness of limbs disappeared in all patients after surgery, but range of neck motion decreased compared with normal people. Translation of C2 decreased from (4.2 +/- 1.4) mm preoperatively to (2.3 +/- 1.1) mm postoperatively, while angulation of C2,3 decreased from 8.6 degrees +/- 2.1 degrees preoperatively to 2.6 degrees +/- 1.0 degrees postoperatively. Both have statistical significance (P < 0.05). No implant failure or infection was observed. CONCLUSIONS: The classification of Hangman's fracture should be modified in combination with MRI and CT scans to determine the stability of the fracture. Combined anterior C2,3 reduction and fusion with posterior compressive C2 pedicle screw fixation is the treatment of choice for patients with unstable Hangman's fractures.

Single-chain antibody against human lipocalin-type prostaglandin D synthase: construction, expression, purification, and activity assay.

An active form of single-chain antibody (ScFv) from murine monoclonal antibody 4A7, which is specific for lipocalin-type prostaglandin D synthase (L-PGDS), was produced in Escherichia coli. The complementary DNA fragments encoding the variable regions of heavy chain (VH) and light chain (VL), which amplified from hybridoma 4A7 producing a monoclonal antibody (IgG1) against L-PGDS, were connected by a (Gly4Ser)3 linker using an assembly polymerase chain reaction. The resultant ScFv were cloned into the vector pGEM and expressed in E. coli as inclusion bodies. The expressed ScFv fusion proteins were purified by Ni2+-nitrilotriacetic acid chromatography. The purity and activity of purified ScFv were confirmed by SDS-PAGE and ELISA. The result revealed that 4A7 ScFv conserved the same characteristics of specific recognition and binding to sperm as the parental 4A7 monoclonal antibody.

[Clinical characteristics and results of cervical spinal cord injury in the patients with ossification of the posterior longitudinal ligament].

OBJECTIVE: To investigate the clinical characteristics and results of cervical spinal cord injury (SCI) in the patients with ossification of the posterior longitudinal ligament (OPLL). METHODS: Nineteen patients with cervical SCI associated with OPLL were retrospectively analyzed. Data collection included: pre- and postoperative neurological function, OPLL-type, MRI signal changes and surgical approaches. RESULTS: Spinal cord associated with OPLL was injured severely by mild trauma. Methylprednisolone sodium succinate was used within 8 h after trauma in 12 cases. Two of them died of complications. The neurological functions were markedly improved in the other 10 cases. Seventeen cases had surgical treatment. The neurological functions (Frankel grade) were improved significantly in the operated patients except for one, who died 27 d after operation. CONCLUSIONS: The patients with OPLL are prone to have severe SCI, which directly associates with the preexisting OPLL-type and hyper-intensity signal change in the spinal cord on MRI. Both of using methylprednisolone sodium succinate administration within 8 h after trauma and surgical decompression may improve the neurological outcomes.