The proteomic analysis uncovers the cellular responses to the African swine fever virus membrane proteins p54, p17, and pB117L.

African swine fever virus (ASFV) infection causes African swine fever (ASF), a highly contagious and fatal disease that poses severe threat to swine production. To gain insights into the host responses to ASFV, we generated recombinant adenovirus Ad5 expressing viral membrane proteins p54, p17, and pB117L individually and infected an alveolar cell line, 3D4/21, with these recombinant viruses. Then, the cell lysates were analyzed using label-free quantification proteomic analysis method. A total of 2158 differentially expressed proteins (DEPs) were identified, of which 817, 466, and 875 proteins were from Ad5-p54-, Ad5-p17-, Ad5-pB117L-infected 3D4/21 cells, respectively. Gene Ontology (GO) classification and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis revealed distinct yet interconnecting patterns of protein interaction networks. Specifically, the Ad5-p54 virus infection enriched the DEPs primarily involved in the metabolic pathways, endocytosis, adherens junction, and SNARE interactions in vesicular transport. The Ad5-p17 virus infection enriched the DEPs in endocytosis, ubiquitin-mediated proteolysis, N-Glycan biosynthesis, and apoptosis, while the Ad5-pB117L virus infection enriched the DEPs in metabolic pathways, endocytosis, oxidative phosphorylation, and focal adhesion. In summary, these results provide a comprehensive proteinomics analysis of the cellular responses to three ASFV membrane proteins, thus facilitating our understanding of ASFV pathogenesis.

Scalp block for postoperative pain after craniotomy: A meta-analysis of randomized control trials.

Background: Postoperative pain after craniotomy is an important clinical concern because it might lead to brain hyperemia and elevated intracranial pressure. Considering the side effects of opioid, several studies have been conducted to investigate the effect of local anesthetics, especially the scalp block, on postoperative pain. However, the strength of evidence supporting this practice for postoperative pain after craniotomy was unclear and the best occasion of scalp block was also not identified. Therefore, we conducted a meta-analysis to evaluate the efficacy, safety, and the best occasion of scalp block for postoperative pain after craniotomy. Methods: PubMed, Embase, and the Cochrane Library databases from database inception to October 10, 2021 were searched for all randomized controlled trials evaluating the effect of scalp block on postoperative pain after craniotomy. Data were assessed by StataMP 16 software. Results: A total of 12 studies were included. A random-effect model was used to analyze all data. Patients under scalp block earned fewer scores than the non-scalp block group in visual analogue scale at the very early period (MD = -1.97, 95% CI = -3.07 to -0.88), early period (MD = -1.84, 95% CI = -2.95 to -0.73) and intermediate period (MD = -1.16, 95% CI = -1.84 to -0.49). Scalp block could also significantly prolong the time of the first request of rescue analgesia and reduce the use of additional analgesics without a significant difference in the incidence of complications. Subgroup analysis showed there was no significant difference in analgesia effect between pre-incision scalp block and post-incision scalp block in all periods. Conclusion: Scalp block could lead to lower pain intensity scores, more time of the first request of rescue analgesia, and fewer analgesic drugs applied in the first 12 h after craniotomy. There was no significant difference between pre-incision and post-incision scalp block in the occurrence and severity of postoperative pain.

P2X4R Contributes to Central Disinhibition Via TNF-α/TNFR1/GABAaR Pathway in Post-stroke Pain Rats.

Central post-stroke pain (CPSP) is a disabling condition in stroke patients. It is a type of neuropathic pain for which the mechanism and relevant drug pathways remain unknown. Inflammatory response and central disinhibition have been suggested recently. Our previous research has shown targeting P2X4 receptors (P2X4R) may be effective in the treatment of CPSP, but the downstream pathway of the P2X4R has not been studied. In this study, we found the increase in tumor necrosis factor alpha (TNF-α) level and endocytosis of surface gamma-aminobutyric acid a receptors (GABAaR) in CPSP, and these effects were inhibited by blocking P2X4R. Furthermore, antagonizing TNF-α can increase surface GABAaR expression and mechanical pain threshold. Meanwhile, knocking down TNFR1 but not TNFR2 reversed the endocytosis of surface GABAaR and alleviated mechanical allodynia. Thus, the neuropathic pain was mediated, in part, through P2X4R/TNF-α/TNFR1/GABAaR signaling, which was induced after stroke. PERSPECTIVE: P2X4R regulates the pathophysiological mechanism of CPSP through central disinhibition mediated by TNF-α/TNFR1. Our results suggest that modulation of P2X4R-TNF-α/TNFR1-GABAaR signaling could provide a new therapeutic strategy to treat CPSP.

MiR-145 regulates osteogenic differentiation of human adipose-derived mesenchymal stem cells through targeting FoxO1.

In this study, we aimed to investigate the expression of miR-145 before and after hASCs osteogenic differentiation. We also intended to explore the influence of the target relationship between miR-145 and FoxO1 on osteogenic differentiation. Dual-luciferase reporter gene assay and real-time PCR were used to confirm the target relationship between miR-145 and FoxO1. Furthermore, the modulatory effects of miR-145 and FoxO1 on hASCs osteoinductive differentiation were measured by real-time PCR , Western blot, ALP staining, ARS staining, and cell immunofluorescence assay. After osteogenic differentiation, miR-145 was gradually down-regulated, while FoxO1 was up-regulated in hASCs. MiR-145 could directly target FoxO1 3'UTR. FoxO1 was negatively regulated by miR-145. After osteoinductive differentiation, BSP, Ocn, and OPN expression was lowered with the overexpression of miR-145 or the knockdown of FoxO1. Furthermore, ALP and ARS staining assay results showed weakened ALP activity and extracellular matrix calcification. When overexpressing miR-145 and FoxO1 simultaneously, no obvious change in ALP activity and extracellular matrix calcification was seen. MiR-145 could suppress hASCs osteoinductive differentiation by suppressing FoxO1 directly. Impact statement Researching on ASCs was a promising strategy to study osteogenic differentiation. The regulatory role of miR-145 on hASCs osteogenic differentiation remained partially explored. Our study revealed a novel mechanism of the osteogenic differentiation process and suggested that miR-145 and its target gene FoxO1 may be potential targets for the therapy of human osteogenic-related disorders.

Serotonin type-1D receptor stimulation of A-type K(+) channel decreases membrane excitability through the protein kinase A- and B-Raf-dependent p38 MAPK pathways in mouse trigeminal ganglion neurons.

Although recent studies have implicated serotonin 5-HT1B/D receptors in the nociceptive sensitivity of primary afferent neurons, the underlying molecular and cellular mechanisms remain unclear. In this study, we identified a novel functional role of the 5-HT1D receptor subtype in regulating A-type potassium (K(+)) currents (IA) as well as membrane excitability in small trigeminal ganglion (TG) neurons. We found that the selective activation of 5-HT1D, rather than 5-HT1B, receptors reversibly increased IA, while the sustained delayed rectifier K(+) current was unaffected. The 5-HT1D-mediated IA increase was associated with a depolarizing shift in the voltage dependence of inactivation. Blocking G-protein signaling with pertussis toxin or by intracellular application of a selective antibody raised against Gαo or Gß abolished the 5-HT1D effect on IA. Inhibition of protein kinase A (PKA), but not of phosphatidylinositol 3-kinase or protein kinase C, abolished the 5-HT1D-mediated IA increase. Analysis of phospho-p38 (p-p38) revealed that activation of 5-HT1D, but not 5-HT1B, receptors significantly activated p38, while p-ERK and p-JNK were unaffected. The p38 MAPK inhibitor SB203580, but not its inactive analogue SB202474, and inhibition of B-Raf blocked the 5-HT1D-mediated IA response. Functionally, we observed a significantly decreased action potential firing rate induced by the 5-HT1D receptors; pretreatment with 4-aminopyridine abolished this effect. Taken together, these results suggest that the activation of 5-HT1D receptors selectively enhanced IA via the Gßγ of the Go-protein, PKA, and the sequential B-Raf-dependent p38 MAPK signaling cascade. This 5-HT1D receptor effect may contribute to neuronal hypoexcitability in small TG neurons.

Vacuum Sealing Drainage as Treatment of Severe Buttocks and Perianal Infection: A Case Report and Review of the Literature (Care-Compliant).

Vacuum sealing is a therapeutic concept to achieve secure and rapid wound healing in traumatic soft tissue damage. Its application and effect in the treatment of severe buttocks and perianal infection are unclear.We describe a case of buttocks and perianal infection using the vacuum sealing drainage (VSD) technique. A 58-year-old man was admitted with buttocks and perianal severe infection, which was caused by injection. The size of the wounds was 40 × 30 cm. Colostomy was applied prior to the prompt surgical debridement to prevent defecation and keep the perianal region clean. Emergency debridement was then conducted. After the wounds were thoroughly washed with conventional disinfection solution, they were then covered by VSD system.The infection was controlled 9 days after the first surgery by prompt surgical debridement, the application of VSD treatment, and the use of narrow-spectrum antibiotics based on susceptibility result. After 3 applications of VSD treatment, skin grafting harvested from the left leg was conducted. All free skin grafts survived at 8 weeks. Colon was placed back into the abdominal cavity finally.Initial colostomy and debridement, the temporary VSD cover followed after several days by skin grafting is a reliable treatment regimen for severe buttocks and perianal infection.

Anterior Lumbar Interbody Fusion for Degenerative Discogenic Low Back Pain: Evaluation of L4-S1 Fusion.

The treatment of degenerative discogenic pain is controversial, and anterior lumbar fusion for the treatment of degenerative discogenic low back pain has also been a controversial topic for over a generation.The aim of this systematic review was to evaluate the outcome of different anterior lumbar fusion levels for degenerative discogenic low back pain.In this study, we performed a clinical outcome subgroup analysis. The outcomes of 84 consecutive patients who underwent anterior lumbar interbody fusion from 2004 to 2009 were reviewed. The operative time, intraoperative blood loss, hospital stay, Oswestry Disability Index (ODI), visual analog scale (VAS) results, and complication rate were recorded separately.Medical indications were degenerative disc disease (73.8%), postdiscectomy disc disease (16.1%), and disc herniation (9.5%). Patients with severe spondylolysis or disc degeneration, with more than 3 or multilevel lesions, were excluded.The mean operative time was 124.5 ±â€Š10.9 min (range 51-248 min), the mean intraoperative blood loss was 242.1 ±â€Š27.7 mL (range 50-2700 mL), the mean hospital stay was 3.9 ±â€Š1.1 days (range 3-6 days), the mean preoperative VAS score was 7.5 ±â€Š1.4, and the mean preoperative ODI score was 60.0 ±â€Š5.7. At the 1-year follow-up, the mean postoperative VAS score was 3.3 ±â€Š1.3 and the mean postoperative ODI score was 13.6 ±â€Š3.4 (P < 0.05). L4-L5 disc fusion led to better clinical results than 2-level L4-L5/L5-S1 disc fusion. Additionally, the 2-level fusion of L4-L5/L5-S1 had better clinical results than the L5-S1 disc fusion at both the 1 and 2-year postoperative follow-ups regarding the VAS score and the ODI score. The rate of complications was more frequent in the 2-level L4-L5/L5-S1 group (27.3%) (group C) than in the L4-L5 group (9.1%) (group A) and the L5-S1 group (12.5%) (group B). There was no difference between the L4-L5 group (9.1%) and the L5-S1 group (12.5%). A venous tear occurred during surgery and was successfully repaired in 6 of the 84 patients. Also, out of the 84 patients, 6 were found with pseudarthrosis during the follow-up, and these patients underwent a spinal fusion with instrumentation, with a posterior approach after a mean of 1 year. The complications secondary to the surgical approach were persistent abdominal pain (1/84, 1.2%) and wound dehiscence (1/84, 1.2%).Anterior lumbar interbody fusion for L4-L5 had better clinical results than the 2-segmental L4-L5/L5-S1 disc fusion, and the 2-segmental L4-L5/L5-S1 disc fusion had better clinical results than the L5-S1 disc fusion. Also, the 2-segmental L4-L5/L5-S1 disc fusion had a higher complication rate (27.3%), but there was no difference between the L4-L5 group (9.1%) and the L5-S1 group (12.5%).

Radiological evaluation of anterior lumbar fusion using PEEK cages with adjacent vertebral autograft in spinal deformity long fusion surgeries.

PURPOSE: The aim of this study was to evaluate the radiographic characteristics of polyetheretherketone (PEEK) cages packed with adjacent vertebral autograft material in lumbar anterior lumbar interbody fusion (ALIF) in spinal deformity long fusion surgeries. METHODS: This is a retrospective radiographic study. From April 2008 to April 2012, 40 patients (5 males and 35 females, mean age 67 ± 9 years) with coronal and/or sagittal spine deformities underwent staged corrective surgery combined with lumbar ALIF using PEEK cages at the L3-L4, L4-L5 or L5-S1 segment with posterior long (≥ 4 levels) instrumentation. The mean follow-up time was 27.5 months (13-49 months). We examined the interbody fusion rate and cage subsidence at 3 months postoperatively and final follow-up. Additionally, we evaluated the distance of cage migration at final follow-up and the improvement in lumbar lordosis. The rate of "collapse" of the adjacent vertebra where the autograft was harvested was assessed at the final follow-up. Finally, we examined the cage-related postoperative complications in this series. RESULTS: Solid interbody fusion was achieved in 96.4 % (81/84) of the levels at the final follow-up. A mild forward cage migration was observed, and the mean migration distance at final follow-up was 0.83 mm in L3/4, 0.36 mm in L4/5 and 0.55 mm in L5/S1. There was cage subsidence observed in 8.3 % (7/84) of the levels. In all patients, the PEEK cage maintained a significant increase in segmental lordosis at all postoperative visits. However, a mild reduction in segmental lordosis still occurred with time. The adjacent lumbar vertebral bodies where the autografts were harvested appeared to be intact in height radiologically at the final follow-up. There were no postoperative complications due to bone harvesting or cage insertion. Proximal junctional kyphosis was found in one patient who underwent a subsequent revision surgery. CONCLUSIONS: The use of lumbar ALIF with PEEK cages and adjacent vertebral autografts in spinal deformity long fusion surgeries is an effective and safe procedure. The allograft filler is safe and effective in maintaining the shape of harvested vertebrae. Additional long-term follow-up studies are needed to further justify its use.

A functional insertion/deletion polymorphism in the proximal promoter of CD3G is associated with susceptibility for hepatocellular carcinoma in Chinese population.

Hepatocellular carcinoma (HCC) represents the most common primary malignancy of the liver with a worldwide increasing incidence. Although the risk factors for HCC are well characterized, the molecular mechanisms responsible for malignant transformation of hepatocytes are not well understood. In this study, a case-control study including 291 HCC patients and 294 healthy controls was conducted to investigate the association between HCC susceptibility and with a 4-bp insertion/deletion polymorphism (rs66465034) in the proximal promoter of CD3G. Logistic regression analysis showed that the heterozygote and the homozygote 4-bp ins/ins confer a significantly increased risk of HCC after controlling for other covariates (adjusted odds ratio [OR]=1.51, 95% confidence interval [C.I.] 1.01-2.27, p=0.040; OR=1.71, 95% C.I. 1.07-2.89, p=0.025, respectively). Carriage of the 4-bp insertion allele was associated with a greatly increased risk of developing the disease (OR=1.30, 95% C.I. 1.02-1.64, p=0.027). Moreover, hepatitis B virus (HBV) stratification analysis showed that the differences between cases and controls were more obvious in HBV-positive than in the HBV-negative population, suggesting a possible role of this polymorphism in the immune regulation during HBV infection. Further, luciferase-based transient transfection assays revealed that rs66465034 can affect promoter activity of CD3G, indicating its possible functional significance. Our data suggested that common genetic polymorphisms in CD3G may influence HCC risk in Chinese population. Considering the relative small sample size, replication in other populations with larger sample size and further functional analysis are required for fully understanding the roles of CD3G polymorphisms in predisposition for HCC.

Association analysis of TNFRSF1B polymorphism with susceptibility for migraine in the Chinese Han population.

Migraine is a debilitating condition characterized by a multi-factorial and polygenic mode of inheritance. Tumor necrosis factor alpha (TNF-α), a pro-inflammatory cytokine, has been implicated in the pathophysiological mechanisms of migraine. The aim of this study was to investigate whether TNF receptor superfamily member 1b gene (TNFRSF1B) polymorphism affects the occurrence of migraine in the Chinese Han population. We focused on a 15 base pair (bp) insertion/deletion polymorphism (rs5745946) in the 5' promoter region of TNFRSF1B, and investigated whether TNFRSF1B polymorphism is associated with susceptibility to migraine. We studied the genotypic and allelic frequencies of TNFRSF1B polymorphism in 416 patients with migraine and 415 control participants using polymerase chain reaction amplification and polyacrylamide gel electrophoresis analyses. The TNFRSF1B 15 bp insertion allele was associated with an increased risk for migraine (p=0.04, odds ratio=0.79, 95% confidence interval: 0.63-1.00). Our data suggested that individuals in the Chinese Han population with the TNFRSF1B 15 bp insertion allele may be at higher risk for migraine, which warrants further replication association studies and follow-up functional experiments.

Thoracic curve correction after posterior fusion and instrumentation of structural lumbar curves in patients with adolescent idiopathic scoliosis.

INTRODUCTION: Spontaneous thoracic curve correction may occur following selective anterior spinal fusion in patients with adolescent idiopathic scoliosis (AIS). However, a few reports have described outcomes in patients following selective posterior fusion. The aim of this retrospective study was to assess curve correction in AIS patients with major lumbar curves and secondary thoracic curves after selective posterior fusion of the major curve. METHODS: The records of 42 AIS patients with major lumbar and minor thoracic curves who had received selective posterior lumbar fusion with segmental pedicle screw fixation were examined. Preoperative and follow-up radiographs were examined and the following were determined: curve flexibility, Cobb angle measurements of the major and minor curves, thoracolumbar/lumbar and thoracic Cobb measurements. Also, thoracolumbar/lumbar to thoracic Cobb ratios were determined. Minimum follow-up was 2 years. Patients were compared with respect to whether final thoracic curve improvement was (group A) or was not (group B) apparent. Improvement was indicated by a final thoracic curve that was less than the preoperative thoracic curve. RESULTS: Thoracic curve improvement was apparent in 32 of 42 patients after surgery. The mean preoperative thoracic curve in group A was 22.5° and 15.0° at follow-up, while corresponding values in group B were 35.0° and 39.8°. There were no cases in group A and eight cases in group B in which the preoperative thoracic curve was >30°. All patients in group B had preoperative thoracic curves on lateral bending >20°. Thoracic curvature at final follow-up was strongly correlated with preoperative thoracic curvature (r = 0.911) and thoracic curvature on lateral bending (r = 0.948). CONCLUSIONS: Selective posterior fusion with segmental pedicle screw fixation in patients with major lumbar AIS resulted in curve correction in the majority of cases. Preoperative thoracic curvature and thoracic curvature on lateral bending were strongly correlated with the final thoracic curvature.

The epidemic status and genetic diversity of 14 highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) isolates from China in 2009.

A high-mortality swine disease, the highly pathogenic porcine reproductive and respiratory syndrome (HP-PRRS), reappeared in some regions of China in 2009. To explore the possible mechanisms underlying the emergence of HP-PRRSV and more fully understand the extent of the genetic diversity of this virus in China, the complete genome of 14 isolates from 10 provinces in China from 2009 were analyzed. Full-length genome sequencing analysis showed that the 14 isolates were closely related to HP-PRRSV, with 98.0-98.9% nucleotide similarity, although 2 of the 14 strains exhibited a new, discontinuous 29-amino acid deletion in the Nsp2 gene. Furthermore, amino acid analysis of the GP5 protein indicated that the 14 isolates had a concurrent mutation in a decoy epitope and different mutations in glycosylation sites. Additionally, the antigenic drift in GP3 and a 1-nucleotide deletion in both the 5'-UTR and 3'-UTR, which are found in almost all highly pathogenic Chinese PRRSV isolates, were examined in all 14 isolates. The phylogenetic analysis showed that the 14 strains belonged to the North American genotype and were clustered in a subgroup with other HP-PRRSV isolates that have been found in China since 2006. However, compared with other Chinese HP-PRRSV isolates collected in 2006-2008, the phylogenetic tree showed that the 14 isolates had a closer relationship with each other. These results indicated that HP-PRRSV remained an extensive pandemic, affecting swine farms in China in 2009 and revealed new genetic diversity.

The vascular endothelial growth factor-2549 insertion/deletion polymorphism is not associated with susceptibility to hepatocellular carcinoma in Chinese.

Vascular endothelial growth factor (VEGF) is a key mediator of angiogenesis, which is crucial for development and metastasis of tumors including hepatocellular carcinoma (HCC), and elevated VEGF levels in serum and tissues have been known to be related with poor prognosis in patients with HCC. Polymorphisms in VEGF may alter VEGF protein concentrations, influence the process of angiogenesis, and may relate to interindividual variation in tumorigenesis. In this study, we carried out a case-control study in a Chinese population (206 cases and 302 controls) to estimate the susceptibility to HCC associated with an 18-bp insertion/deletion polymorphism (rs35569394) in the promoter region of VEGF. After adjusting the data by gender, age, smoking status, drinking status, and hepatitis B virus (HBV) infection using logistic regression model, we found that rs35569394 was not associated with HCC, at both the allele and genotype levels. Thus, rs35569394 should not be viewed as a major contributor to the development of HCC in Chinese.

Coronal and sagittal plane correction in patients with Lenke 1 adolescent idiopathic scoliosis: a comparison of consecutive versus interval pedicle screw placement.

STUDY DESIGN: Prospective clinical study. OBJECTIVE: The aim of this study was to compare postoperative outcome in patients with Lenke 1 adolescent idiopathic scoliosis (AIS) after posterior correction and fusion with consecutive or interval pedicle screw constructs on the correction side. SUMMARY OF BACKGROUND DATA: Despite reports of satisfactory correction and maintenance of scoliotic curves after consecutive pedicle screw instrumentation on the correction side, there has been no comparison of outcome after consecutive versus interval pedicle screw placement. METHODS: Thirty patients with Lenke 1 AIS were randomly divided into 2 groups. In 1 group, posterior fusion was performed using consecutive pedicle screw placement on the correction side, whereas in the other, an interval placement construct was employed. The following variables were assessed preoperatively and postoperatively (between 2 and 4.1 y) to ascertain curve correction: thoracic coronal and sagittal Cobb angle and global coronal and sagittal balance. RESULTS: There were no preoperative or surgical between group differences for any variable. Thoracic coronal Cobb angle significantly decreased from 60.7+/-11.7 to 15.5+/-7.88 and from 61.87+/-9.93 to 15.67+/-7.35 in the consecutive and interval placement groups. Thoracic sagittal Cobb angle significantly decreased from 27.3+/-10.6 to 21.5+/-11.7 and from 27.1+/-9.83 to 22.0+/-11.3 in the consecutive and interval placement groups. Global sagittal balance significantly decreased from -2.33+/-5.05 to 1.33+/-3.22 and from -3.40+/-4.76 to 0.80+/-2.93 in the consecutive and interval placement groups. There were no between group differences for any postoperative measure. No neurologic complications of surgery were apparent in either group. CONCLUSIONS: Interval pedicle screw placement constructs seem to be equally effective as consecutive constructs for facilitating curve correction in patients with Lenke 1 AIS.

Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China.

AIM: Delayed treatment of adolescent idiopathic scoliosis (AIS) is common in Mainland China because of the lack of public education about health care resulting in the reluctance to undergo surgery. This leads to a high incidence of complex cases where surgeons may not be trained in advanced procedures. We report the efficacy of single-staged anterior and posterior spinal fusion for correction of severe AIS in China. METHODS: A retrospective review was performed of 31 consecutive cases in which patients were treated at the Orthopaedic Department of Changhai Hospital in Shanghai between 2001 and 2004 with a combined anterior and posterior spinal fusion with screws, hooks, sublaminar wires or cables. RESULTS: Thirty-one patients with AIS with Lenke type 1, 2, 3 and 4 curves were included for analysis. At least one of the curves was >or=90 degrees in each patient. The mean coronal and sagittal Cobb angles of the main thoracic curve were 98 degrees and 22 degrees before surgery, 50.5 degrees and 21 degrees after surgery, and 53.7 degrees and 24 degrees at follow-up, respectively. No neurological deficits or deaths occurred. Solid arthrodesis with coronal and sagittal balance was achieved in all patients. CONCLUSIONS: A single-stage anterior release and fusion and posterior fusion for treatment of severe AIS is good alternative to pedicle screws/vertebrectomy on the basis of risk-benefit balance, and can be performed by surgeons not experienced in more complex procedures. The risk of pulmonary complications may be preferable to the risk of severe neurological complications when thoracic pedicle screws are applied, especially when surgeons are not adequately trained in their use.

Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective review of anterior and posterior fusions for treatment of Lenke5C adolescent idiopathic scoliosis (AIS). OBJECTIVE: To compare the clinical and radiographic results of anterior versus posterior pedicle screw instrumentation in Lenke5C AIS. SUMMARY OF BACKGROUND DATA: Anterior and posterior pedicle screw instrumentations are 2 established methods of correcting Lenke5C AIS. However, there are few reports that compare the 2 methods. METHODS: Forty-six consecutive patients with Lenke5C AIS curves underwent selective lumbar or thoracolumbar fusion (1999-2005). Twenty-two patients had anterior surgery, and 24 patients had posterior surgery. Patients were evaluated at a minimum 2-year follow-up. RESULTS: No complications occurred in either group. The number of levels involved in the major curve was similar for the anterior and posterior groups (5.5 vs. 5.7). Preoperative thoracic (24.13 degrees +/- 4.9 degrees vs. 22.88 degrees +/- 5.14 degrees) and lumbar/thoracolumbar (50.2 degrees +/- 7.52 degrees vs. 52.2 degrees +/- 6.40 degrees). Cobb values for the 2 groups were also similar. The percent correction of the lumbar curve was similar between the 2 groups at all stages of follow-up (56% vs. 57.7%), as was the percent of spontaneous correction of the unfused thoracic curve (25% vs. 27.2%). However, fusion levels were significantly shorter in the anterior group (mean, 5.09 vs. 6.13), and there were 8 patients (4 in the anterior group and 4 in the posterior group) whose thoracic curve became greater at the latest follow-up. The thoracolumbar/lumbar-thoracic Cobb ratio for these 8 patients was less than that for the other patients (1.34 vs. 2.43), and their curve flexibility was worse. CONCLUSION: Selective anterior and posterior screw instrumentation both achieved good surgical lumbar and subsequent spontaneous thoracic correction. There was no statistically significant difference between the 2 groups in lumbar correction or thoracic correction, but fusion levels were shorter in the anterior group. Patients with late thoracic curve decompensation had smaller thoracolumbar/lumbar-thoracic Cobb ratios and less preoperative flexibility than those who did not decompensate.

Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique.

OBJECT: The authors evaluated the effectiveness of Lenke Type 2 criteria in scoliosis correction with the segmental pedicle screw (PS) technique, with emphasis on shoulder balance. METHODS: Twenty-five consecutive patients with Lenke Type 2 scoliosis (structural double thoracic curves, sidebending Cobb angle > 25 degrees , or T2-5 kyphosis > 20 degrees ) who underwent segmental PS instrumentation were included in this study. At surgery, the patients were an average of 14.1 years of age, and the average duration of follow-up was 2.9 years. For radiological evaluation of the patients, preoperative, postoperative, and the latest available follow-up radiographs were used. The difference between right and left shoulder heights was determined to assess shoulder balance. All patients were treated with fusion of both the proximal and distal curves. RESULTS: The mean preoperative proximal thoracic curve of 43 degrees was corrected to 21 degrees postoperatively, a 51.2% correction. The preoperative lower thoracic curve of 61 degrees was corrected to 23 degrees , for a 62.3% correction. The preoperative shoulder height difference of -5.92 +/- 12.52 mm (range: -31 to +14 mm, negative designating a lower left shoulder) was improved to 1.52 +/- 8.12 mm. Postoperatively, no patient had significant or moderate shoulder imbalance, 4 patients had minimal shoulder imbalance, and 21 patients had balanced shoulders. CONCLUSIONS: Although Lenke Type 2 criteria were developed wth Cotrel-Dubousset instrumentation, they are successfully applied to determining thoracic fusion when segmental PS instrumentation is used.

Successful use of posterior instrumented spinal fusion alone for scoliosis in 19 patients with neurofibromatosis type-1 followed up for at least 25 months.

INTRODUCTION: Posterior instrumented fusion alone has been considered inadequate to correct scoliosis in most patients with neurofibromatosis type-1 (NF-1) because of their weak bone structure. This study was undertaken to evaluate whether the extension of fusion one level beyond the conventional fusion level would enable posterior instrumented fusion alone to be as effective as anterior-posterior fusion in treating patients with NF-1 and scoliosis who are more than 10 years old and whose scoliosis is <90 degrees . METHODS: Nineteen patients with NF-1 were treated surgically with long, posterior instrumented fusion for scoliosis from 1998 to 2004. Among the patients, 3 had nondystrophic curves, and 16 had dystrophic curves. Posterior fusions were performed that used abundant bone grafts, and included neutral and stable vertebrae in both the coronal and sagittal planes and any coronal curves of more than 40 degrees . RESULTS: The mean coronal and sagittal Cobb's angles in the nondystrophic curves were 79 degrees and 16 degrees before surgery, 31 degrees and 12 degrees after surgery, and 37 degrees and 15 degrees at follow-up, respectively. In the dystrophic thoracic curves, the Cobb's angles in the coronal and sagittal planes before and after surgery and at follow-up were 68 degrees and 31 degrees , 27 degrees and 28 degrees , and 33 degrees and 30 degrees , respectively. There were no cases of coronal or sagittal decompensation, neurologic complications, or infections. There were eight (42.1%) complications, three intraoperative and five late. Pseudarthrosis with instrumentation failure that required revision surgery occurred in one (5.2%) patient. CONCLUSIONS: These results demonstrate that a satisfactory stabilization of scoliosis can be achieved by posterior fusion with instrumentation alone in patients with NF-1 who are more than 10 years old, and whose scoliosis is <90 degrees .

[Analysis of the parameters about selective anterior fusion of thoracolumbar/lumbar curves in adolescent idiopathic scoliosis].

OBJECTIVE: To establish criteria for AIS of Lenke5 and Lenke6 by an anterior only procedure of the lower curve fusion. METHODS: A retrospective study was conducted between March 1999 and May 2004 to investigate 52 AIS patients of Lenke5 and Lenke6. All the patients were observed 24 years (34 months on average). Many parameters were evaluated. At final assessment, two groups emerged: Group A had satisfactory results (the thoracic curve was reduced) and Group B had just the opposite. RESULTS: Preoperative thoracic curve in group A averaged 33 degrees and 18 degrees after surgery. The lumbar curve averaged 49 degrees before surgery and 21 degrees after surgery. In group B (n = 6), the average thoracic curve was 38 degrees before surgery and 45 degrees after surgery, whereas the lumbar curve averaged 46 degrees before surgery and 25 degrees after surgery. Two of these patients underwent posterior thoracic instrumentation and fusion because of the unreasonable balance. CONCLUSIONS: A successful surgical outcome was dependent on both the flexibility of the thoracic curve and the patients' maturity. The thoracolumbar/lumbar-thoracic (TL/L:T) Cobb ratio in combination with the flexibility of the thoracic curve were the best predictors among the structural indexes.