Correlation between lesion location and dysphagia characteristics in post-stroke patients.

OBJECTIVE: To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients. MATERIALS AND METHODS: We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal-Wallis test analysis to characterize the parameters among the groups. RESULTS: Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level. CONCLUSION: The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.

Inference of relative permeability curves in reservoir rocks with ensemble Kalman method.

Multiphase flows through reservoir rocks are a universal and complex phenomenon. Relative permeability is one of the primary determinants in reservoir performance calculations. Accurate estimation of the relative permeability is crucial for reservoir management and future production. In this paper, we propose inferring relative permeability curves from sparse saturation data with an ensemble Kalman method. We represent these curves through a series of positive increments of relative permeability at specified saturation values, which guarantees monotonicity within, and boundedness between 0 and 1. The proposed method is validated by the inference performances in two synthetic benchmarks designed by SPE and a field-scale model developed by Equinor that includes certain real field features. The results indicate that the relative permeability curves can be accurately estimated within the saturation intervals having available observations and appropriately extrapolated to the remaining saturations by virtue of the embedded constraints. The predicted well responses are comparable to the ground truths, even though they are not included as the observation. The study demonstrates the feasibility of using ensemble Kalman method to infer relative permeability curves from saturation data, which can aid in the predictions of multiphase flow and reservoir production.

Myocardial extracellular volume fraction quantification based on T1 mapping at 3 T: quality optimization by contour-based registration and segmental analysis.

BACKGROUND: Myocardial extracellular volume fraction (ECV) assessment can be affected by various technical and subject-related factors. PURPOSE: To evaluate the role of contour-based registration in quantification of ECV and investigate normal segment-based myocardial ECV values at 3T. MATERIAL AND METHODS: Pre- and post-contrast T1 mapping images of the left ventricular basal, mid-cavity, and apical slices were obtained in 26 healthy volunteers. ECV maps were generated using motion correction with and without contour-based registration. The image quality of all ECV maps was evaluated by a 4-point scale. Slices were dichotomized according to the occurrence of misregistration in the source data. Contour-registered ECVs and standard ECVs were compared within each subgroup using analysis of variance for repeated measurements and generalized linear mixed models. RESULTS: In all three slices, higher quality of ECV maps were found using contour-registered method than using standard method. Standard ECVs were statistically different from contour-registered ECVs in global (26.8% ± 2.8% vs. 25.8% ± 2.4%; P = 0.001), mid-cavity (25.4% ± 3.1% vs. 24.3% ± 2.5%; P = 0.016), and apical slices (28.7% ± 4.1% vs. 27.2% ± 3.4%; P = 0.010). In the misregistration subgroups, contour-registered ECVs were lower with smaller SDs (basal: 25.2% ± 1.8% vs. 26.7% ± 2.6%; P = 0.038; mid-cavity: 24.4% ± 2.3% vs. 26.8% ± 3.1%; P = 0.012; apical: 27.5% ± 3.6% vs. 29.7% ± 4.5%; P = 0.016). Apical (27.2% ± 3.4%) and basal-septal ECVs (25.6% ± 2.6%) were statistically higher than mid-cavity ECV (24.3% ± 2.5%; both P < 0.001). CONCLUSION: Contour-based registration can optimize image quality and improve the precision of ECV quantification in cases demonstrating ventricular misregistration among source images.

External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies.

PURPOSE: Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications. METHODS: A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2. RESULTS: Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002). CONCLUSIONS: We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.

Diffusion-weighted MRI in bladder carcinoma: the differentiation between tumor recurrence and benign changes after resection.

PURPOSE: To investigate the efficacy of diffusion-weighted MRI (DWI) in differentiating recurrent tumor from chronic inflammation and fibrosis after cystectomy or transurethral resection of bladder cancer. METHODS: Eleven patients with suspected tumor recurrence underwent pelvic DWI and dynamic contrast-enhanced (DCE) MRI at 3 months to 7 years following bladder cancer resection. The diagnosis was histologically confirmed in all patients by transurethral or cystoscopic resection of 27 lesions within 2 weeks of MR examinations. RESULTS: The accuracies, sensitivities, specificities, and positive predict values of DWI (92.6%, 100%, 81.8%, and 88.9%) were higher than those of DCE MRI (59.3%, 81.3%, 27.3%, and 54.2%) for detecting recurrent tumors. Using receiver operating characteristic analysis, the accuracy of DWI was significantly higher than that of DCE MRI (P < 0.05). There was no significant difference between DWI diagnosis and histopathology (P > 0.05), whereas the difference between diagnosis of DCE MRI and histopathology was significant (P < 0.05). The normalized apparent diffusion coefficients of recurrent tumors (0.697 ± 0.219) were significantly (P < 0.05) lower than those of postoperative inflammation or fibrosis (1.019 ± 0.143). CONCLUSIONS: DWI is superior to DCE MRI for differentiating recurrent bladder tumors from postoperative inflammation or fibrosis. DWI can be included in the follow-up MRI protocol after bladder cancer surgery.

Physiological responses of Corythucha ciliata adults to high temperatures under laboratory and field conditions.

Under high temperature conditions, insects can tolerate to survive through various physiological mechanisms, which have been well documented in laboratory studies. However, it is still unclear as to whether these laboratory data can scale up to those in the field. Here we studied dynamics of heat-induced metabolites in Corythucha ciliata adults under both laboratory and field conditions to examine their significance in thermal tolerance of the species. We compared the effects of controlled thermal treatments (2h at 33-43 °C at 2 °C intervals in the laboratory) and naturally increasing thermal conditions (10:00-14:00 at 2-h intervals (33.5-37.2 °C) on a hot summer day in a field in Shanghai, China) on water content and levels of water-soluble protein, triglycerides, mannitol, and sorbitol in the adult bodies. The results showed that water content significantly decreased and all other metabolic parameters significantly increased in response to temperature stresses with similar patterns in both the laboratory and field, although the respective threshold temperatures were different under the two conditions. The close linkage observed in the two conditions suggests that a short period of heat stress induces water loss and accumulation of thermal metabolites in C. ciliata adults. This heat-resistance provides a defense mechanism counteracting thermal damage in C. ciliata.

The effect of multilevel anterior cervical fusion on neck motion.

BACKGROUND: Anterior cervical decompression and fusion (ACDF) procedures are successful in treating multilevel cervical radiculopathy and cervical myelopathy. It was reported that this procedure would result in a loss of cervical range of motion. However, few studies have focused on the exact impact of multilevel (more than 3 levels) ACDF on cervical range of motion. METHODS: 29 patients underwent a 3-level or 4-level ACDF. In all the patients, preoperative active cervical ROM measurement was performed, and postoperative measurement was performed at 1-year follow-up by a CROM device. The pre- and postoperative data were compared to each other using paired t tests (α = 0.05). RESULTS: The patients had significantly less ROM after the surgery in all planes of motion. Major reduction was observed in flexion (39.5%), left and right lateral flexion (25.7 and 25.9%), with relatively minor impact on extension (18.3%), left and right rotation (14.0 and 14.4%) observed. In the three cardinal planes, major reduction was observed in the sagittal plane (28.2%) and coronal plane (25.8%), while minor impact observed in the horizontal plane (14.1%). CONCLUSIONS: The patients of cervical spondylotic myelopathy had an obvious reduction in active cervical ROM following multilevel ACDF. However, patients might not experience great difficulties in performing daily activities with regard to the loss of neck motion after fusion.

[Efficacies of anterior approach for cervical spinal canal stenosis].

OBJECTIVE: To evaluate the therapeutic efficacies and surgical procedures of anterior approach for cervical spinal canal stenosis. METHODS: A total of 162 cases of cervical spinal canal stenosis underwent anterior surgical procedure from March 2007 to March 2010. The operative duration, the volume of blood loss and the days of postoperative hospital stay were recorded and analyzed. The Cobb angle and canal sagittal diameter were measured. The bone graft fusion and nerve functions were evaluated postoperatively. RESULTS: The average operative duration was 86.4 minutes with an intraoperative blood loss of 80.2 ml and a postoperative hospital stay of 5.3 days. A follow-up visit of 9-18 months (average: 12.8) showed that bone graft fusion was achieved in all cases and Cobb angle increased by an average of 7.2 degree. The spinal canal sagittal diameter increased by 4.23 mm. And the JOA (Japanese Orthopedic Association) score increased by an average of 6.1 points at 3 Month post-operation. CONCLUSION: For cervical spinal canal stenosis, the pressure comes mostly from the front part. The anterior surgical procedure can decompress directly with a shorter operative duration, a smaller volume of blood loss, a shorter hospitalization stay and an effective recovery of cervical curvature and canal volume.

[Surgical treatment strategies for severe cervicothoracic kyphosis].

OBJECTIVE: To analyze the outcomes of surgical treatment for severe cervicothoracic kyphosis. METHODS: A retrospective study was performed for a total of 7 patients with severe cervicothoracic kyphosis. There were congenital malformation (n = 5) and cervicothoracic tuberculosis (n = 2). The mean preoperative Cobb angle of kyphosis was 89.3° (range: 72 - 103°). The average JOA (Japanese Orthopedic Association) score of neurological function was 11.2 ± 1.2 points. Preoperative halo-pelvic traction was performed and maintained for 25 - 40 days according to the patient conditions. Then posterior instrumented fusion was performed. RESULTS: The average postoperative JOA score was 15.4 ± 1.6 points. The mean immediate postoperative Cobb angle was 53.4° (range: 45 - 67°). A mean correction rate of 40.2% was achieved. All patients were followed up for a mean of 18 months (range: 10 - 24). And a mean correction loss of 2.5° was observed at the final follow-up. Two patients had transient upper limb pain during distraction. There were no intra-operative or post-operative occurrences of spinal cord injury and other neurological complications. CONCLUSION: Halo-pelvic traction plus posterior spondylodesis may be a safe and effective therapy of severe cervicothoracic kyphotic deformity.

[Multi-slice spiral CT scan with lower dose for preoperative evaluation: living renal donor kidney morphology and the quantification of unilateral glomerular filtration rate].

OBJECTIVE: To explore the feasibility of multi-slice spiral computed tomography (CT) with a lower dose as one-off examination for the preoperative morphology evaluation and the quantification of unilateral renal glomerular filtration rate of living renal donors. METHODS: A total of 36 living renal donors at our hospital from May 2008 to June 2009 were examined by 64-slice spiral CT and single photon emission computed tomography (SPECT). Living renal donors were examined with a plain scan and three-phase enhancement CT scan. Also there were two inserted dynamic scans, one after the injection of contrast agent and the other between cortex and parenchymal phases. Image reconstructions were performed to observe renal parenchyma, renal vessels and collecting system. Comparisons were made with intra-operative findings. And the known Patlak equation was used simultaneously. The glomerular filtration rate (GFR) in a single kidney was calculated on CT and SPECT respectively. The GFRs of two groups were analyzed to investigate the Pearson correlation and simple linear regression between them. RESULTS: Twenty of 36 renal living donor kidneys underwent the operation, variations of morphology detected by CT were all corresponded with the operation. The GFR values estimated from CT were (42.4 ± 8.9) ml/min (left) and 43.2 ± 8.4) ml/min (right). While GFR of SPECT 47.4 ± 9.3) ml/min (left) and 48.2 ± 8.5) ml/min (right). Linear trend was found between the GFRs of CT and SPECT. Pearson's product-moment correlation coefficient r = 0.753 (left) (P < 0.01), r = 0.709 (right) (P < 0.01). These values indicated that the GFR from CT was positively correlated with the GFR from SPECT. CONCLUSION: During the preoperative evaluation, multi-slice spiral CT may provide both anatomic information and the GFR of living renal donors.

An Optimized Integrin α6-Targeted Magnetic Resonance Probe for Molecular Imaging of Hepatocellular Carcinoma in Mice.

INTRODUCTION: Integrin α6 is an attractive diagnostic biomarker for molecular imaging of hepatocellular carcinoma (HCC) as it has an extremely high positive rate (approximately 94%) in clinical early-stage HCC. In this study, based on our previously identified integrin α6-targeted peptide, we developed an optimized integrin α6-targeted magnetic resonance (MR) probe dubbed DOTA(Gd)-ANADYWR for MR imaging of HCC in mice. MATERIALS AND METHODS: The longitudinal (R1) relaxivity of DOTA(Gd)-ANADYWR was measured on a 3.0 T MR system . The specific tumor enhancement of the agent was investigated in four distinct mouse models, including subcutaneous, orthotopic, genetically engineered and chemically induced HCC mice. RESULTS: The R1 relaxivity value of DOTA(Gd)-ANADYWR is 5.11 mM-1s-1 at 3.0 T, which is similar to that of the nonspecific clinical agent Gadoteridol. DOTA(Gd)-ANADYWR generated superior enhanced MR signal in HCC lesions and provided complementary enhancement MR signals to the clinically available hepatobiliary MR contrast agent gadoxetate disodium (Gd-EOB-DTPA). Importantly, DOTA(Gd)-ANADYWR could efficiently visualize small HCC lesion (approximately 1 mm) which was hardly detected by the clinical Gd-EOB-DTPA. CONCLUSION: These findings suggest the potential application of this integrin α6-targeted MR probe for the detection of HCC, particularly for small HCC.

[The clinical features and surgical treatment strategies of cervical kyphosis].

OBJECTIVE: To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. METHODS: From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. RESULTS: In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. CONCLUSIONS: In the early period of cervical kyphosis, adopt postural therapy, plaster braces to correct an imbalance in cervical spine biomechanics can prevent deformity development. According to patients' clinical characteristics, choosing individual treatment programs can correct the severe cervical kyphosis and achieve good outcome.

[The surgical treatment of severe adolescent idiopathic cervical kyphosis].

OBJECTIVE: To summarize the clinical characteristics of severe adolescent idiopathic cervical kyphosis and the operation method. METHODS: A retrospective study was performed in 12 adolescent patients with severe cervical kyphosis treated from July 2003 to January 2007. Preoperative the Cobb angle of kyphosis range from 55 degrees to 73 degrees (average 61 degrees ). According to the angles between the posterior vertebral body tangents at every involved level on lateral cervical radiograph in extension, the osteotomy angles and range of lamina and facet were decided. The anterior release and posterior osteotomy were performed firstly. Then skull traction was maintained in order to correct the deformity as long as possible, fusion and internal fixation was completed after 7-10 days. The cervical coronal and sagittal planes X-rays and the MR were hold after operation 3 days, 3 months, 6 months, 1 year and 2 years. At the same time the treatment result, bone fusion and the instrumentation were followed up, and the symptoms were compared between pre-operation and post-operation. RESULTS: The defect appearance of the patients was improved significantly, with the total disappearance of neck pain and improvement of nerve function. Post-operational cervical spine MR showed that the physiological curve of cervical spine was restored, cerebral spinal fluid line was clear in the kyphosis area and no spinal cord compression was found. X-ray imaging of post-operation 3 d showed that Cobb angle ranged from -12.3 degrees to 11.2 degrees with an average of -2.0 degrees . Beside one patient's AISA score was D, other patient's AISA score was E. CONCLUSIONS: The severe adolescent idiopathic cervical kyphosis has its own clinical manifestation. It is an ideal treatment to completely assess the deformity, have staging operation and skull traction between two operations.

[Anatomic research on the transposition of accessory nerve to phrenic nerve].

OBJECTIVE: To comprehend the anatomic characteristics and correlations between the accessory nerve and the phrenic nerve in the adult corpses. METHODS: The bilateral accessory nerves, phrenic nerves, and their branches of 20 adult corpses (38 sides) were underwent exposure. The morphologic data of the accessory nerves and the phrenic nerves above clavicle were measured. In addition, the minimal and maximal distances from several points on the accessory nerve to the full length of the phrenic nerve above clavicle were measured. Then, the number of motor nerve fibers on different locations of the nerves utilizing the method of immunohistochemistry were counted and compared. RESULT: The accessory nerves after sending out the sternocleido-mastoid muscular branches were similar in the morphologic data with the phrenic nerves. Meanwhile, the accessory nerve had a coiled appearance within this geometrical area. The possibly minimal distance between the accessory nerve and phrenic nerve was (3.19 ± 1.23) cm, and the possibly maximal distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle was (8.71 ± 0.75) cm. CONCLUSIONS: The accessory nerve and the phrenic nerve are similar in the anatomic evidences and the number of motor nerve fibers. And the length of accessory nerve is sufficiently long to connect with phrenic nerve as needed. It is possible to suture them without strain directly.

Neuregulin-1ß Protects the Rat Diaphragm during Sepsis against Oxidative Stress and Inflammation by Activating the PI3K/Akt Pathway.

Sepsis-induced diaphragm dysfunction (SIDD) which is mainly characterized by decrease in diaphragmatic contractility has been identified to cause great harms to patients. Therefore, there is an important and pressing need to find effective treatments for improving SIDD. In addition, acetylcholinesterase (AChE) activity is a vital property of the diaphragm, so we evaluated both diaphragmatic contractility and AChE activity. Though neuregulin-1ß (NRG-1ß) is known to exert organ-protective effects in some inflammatory diseases, little is known about the potential of NRG-1ß therapy in the diaphragm during sepsis. Our study was aimed at exploring the effects of NRG-1ß application on diaphragmatic contractility and AChE activity during sepsis. Proinflammatory cytokines, muscle injury biomarkers in serum, contractile force, AChE activity, proinflammatory cytokines, oxidative parameters, histological condition, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining, and expression of phosphoinositide 3-kinase (PI3K)/protein kinase B (PKB/Akt) signaling proteins in the diaphragm were measured and compared between nonseptic and septic groups with or without NRG-1ß treatment. In vitro, the effects of NRG-1ß on reactive oxygen species (ROS) production in the lipopolysaccharide- (LPS-) stimulated L6 rat muscle skeletal cells with or without the Akt inhibitor MK-2206 were detected. NRG-1ß inhibited proinflammatory cytokine release and muscle injury biomarkers soaring in serum and improved the sepsis-induced diaphragm dysfunction and AChE activity decrease significantly during sepsis. Meanwhile, the inflammatory response, oxidative stress, pathological impairment, and cell apoptosis in the diaphragm were mitigated by NRG-1ß. And NRG-1ß activated the PI3K/Akt signaling in the diaphragm of septic rats. Elevated ROS production in the LPS-stimulated L6 rat skeletal muscle cells was reduced after treatment with NRG-1ß, while MK-2206 blocked these effects of NRG-1ß. In conclusion, our findings underlined that NRG-1ß could reduce circulating levels of proinflammatory cytokines in rats with sepsis, adjust diaphragmatic proinflammatory cytokine level, mitigate diaphragmatic oxidative injury, and lessen diaphragm cell apoptosis, thereby improving diaphragmatic function, and play a role in diaphragmatic protection by activating PI3K/Akt signaling.

miR-122 Exerts Inhibitory Effects on Osteoblast Proliferation/Differentiation in Osteoporosis by Activating the PCP4-Mediated JNK Pathway.

Osteoporosis is characterized by the reduction of bone mineral density and deterioration of bone quality which leads to high risk of fractures. Some microRNAs (miRNAs) have been confirmed as potential modulators of osteoblast differentiation to maintain bone mass maintenance. We aimed to clarify whether miR-122 could regulate osteoblast differentiation in ovariectomized rats with osteoporosis. miR-122 was upregulated and Purkinje cell protein 4 (PCP4) was downregulated in ovariectomized rats. PCP4 was identified as a target of miR-122 by dual-luciferase reporter gene assay. We transfected isolated osteoblasts from ovariectomized rats with miR-122 mimic or inhibitor or PCP4 overexpression vectors. Proliferation and differentiation of osteoblasts were repressed by the overexpression of miR-122 but enhanced by overexpression of PCP4. miR-122 could induce the activation of the c-Jun NH2-terminal kinase (JNK) signaling pathway, while PCP4 blocked this pathway. Rescue experiments further demonstrated that the inhibiting effects of miR-122 on osteoblast differentiation could be compensated by activation of the PCP4 or inhibition of JNK signaling pathway. Collectively, our data imply that miR-122 inhibits osteoblast proliferation and differentiation in rats with osteoporosis, highlighting a novel therapeutic target for osteoporotic patients.

Retrospective analysis of anterior correction and fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: the relationship between preserving mobile segments and trunk balance.

The objective of this paper was to investigate the surgical strategy of the selection of the lowest instrumented vertebrae (LIV) in anterior correction for adolescent idiopathic scoliosis (AIS) and to discuss the relationship between the LIV and trunk balance. From 1998 to 2004, 28 patients with thoracolumbar/lumbar AIS (Lenke 5 type) were treated by anterior correction and fusion with a mean follow-up of 1.5 years. Specific radiographic parameters were observed respectively and the correlation between disc wedging immediately below the LIV and these parameters was analysed. The mean corrective rate of major curves was 74.84%. The preoperative disc angle distal to LIV was 2.96 +/- 1.43 degrees and postoperatively it was -3.60 +/- 1.75 degrees . The postoperative disc wedging was most correlated with LIV obliquity. The postoperative LIV-CSVL (centre sacral vertical line) distance, which reflects regional balance, was correlated with various preoperative parameters. LIV determination was correlated with multiple preoperative radiographic parameters. Disc wedging distal to LIV occurs most often when a short fusion excluding the lower end vertebra (LEV) and the subjacent disc are nearly parallel.

[Clinical characteristics and diagnosis of rheumatoid arthritis of upper cervical spine: analysis of 71 cases].

OBJECTIVE: To study the clinical characteristics and diagnosis of rheumatoid arthritis (RA) in the upper cervical spine. METHODS: The clinical data of 71 patients with RA in the upper cervical spine, 18 males and 53 females, aged 46.2 (23-76), with a mean duration of RA of 18.2 years (2 months-47 years) were retrospectively reviewed. Fifty-three patients received glucocorticoid for more than 3 months. In addition to routine examinations, all patients underwent plain X-ray film taking, CT and MRI scanning, and erythrocyte sedimentation rate, rheumatoid factor (RF) and antistreptolysin O testing. RESULTS: The symptoms of upper cervical spine appeared at 8.3 years (2 months-46 years) after the diagnosis of RA was confirmed. The clinical manifestations of RA in the upper cervical spine were intractable pain in craniocervical junction or radiating pain. Abnormal postures in the neck and Sherp-Purser's sign were positive in some patients. Progressive neurological dysfunction with the involvement of spinal cord, medulla, or some cranial nerves might gradually appear. Irregular destruction of bone with osteoporosis around the lateral and median atlantoaxial joint was a common finding in the X-ray films and CT scans. Instability of the atlantoaxial joint, including anterior atlantoaxial subluxation, posterior atlantoaxial subluxation and anterior-posterior atlantoaxial subluxation were found in 68 cases, while rotation subluxation was presented in 37 cases. Vertical migration of the odontoid was seen in 11 cases. RF was positive in 18 cases. MRI revealed that the cause of spinal cord compression was the bone tissue and soft tissue pannus. CONCLUSIONS: RA in the upper cervical spine is a common situation in the clinical settings. The key point in the diagnosis of this disease is the identification of instability in the atlantoaxial joint and assessment of the spinal neurological deficit. And a careful analysis of the natural history will further help to achieve a better treatment effect.

[Clinical research of delayed hyperextension injury concomitance spinal cord injury of cervical spine].

OBJECTIVE: To discuss Clinic feature and turnover of delayed hyperextension injury concomitance spinal cord injury of cervical spine. METHODS: The clinic data of 30 patients delayed hyperextension injury of cervical spine were reviewed and analyzed. Course of disease was from 3 months to 8 years. Thirty patients were divided into three groups according to course of disease. The first group, 3 - 6 months, 17 cases; the second group, 6 - 12 months, 8 cases; the third group, 12 months-8 years, 5 cases. Neurological function improvement rates were evaluated according to the JOA scores at preoperative, 3 months and 1 year post operation, and complications were observed in three groups. Twenty-six cases were treated with anterior decompression, bone graft and plate fixation. Four cases were treated with posterior decompression, bone graft and plate fixation. RESULTS: The patient number of the three group exist with statistical significance. Thirty patients were followed up for 18 - 39 months, 23 months on average. Neurological function recovery rates were 23.8% in the first group, 53.9% in the second group and 54.3% in the third group at 1 year post operation. JOA scores of the first group and the second group with statistical significance at 3 months and 1 year post operation. JOA scores of the first group and the third group with statistical significance at 3 months and 1 year post operation. JOA scores of the second group and the third group without statistical significance at 3 months and 1 year post operation. CONCLUSIONS: Incidence of hyperextension injury associated with spinal cord injury of cervical spine would degrade along with course of disease prolong. If delayed spinal cord injury occurred earlier, the patient's condition was severer and badly improvement rate.

[Sagittal diameters measurements on MR of the cervical spinal cord in normal subjects].

OBJECTIVE: To offer normal reference of diameter of the cervical spinal cord and available diameter of cervical spinal canal and to screen scientific radiographic criteria to define and quantify cervical spinal cord disease. METHODS: The magnetic resonance images of 120 normal people had been measured. The data of diameters of cervical spinal cord, CSF, M, the ratio of diameters of cord and CSF, and the ratio of diameters of cord and M had been collected and statistical analysis was made. And the relationships between the data above and each of gender, the length of C-spine and age were evaluated. In addition, the ratio of diameters of cord and CSF, and the ratio of diameters of cord and M was evaluated. RESULTS: The study showed that in healthy people, the diameters of cervical spinal cord, CSF and M was larger in the males than in the females, decreased with age, and increased with the length of C-spine but the diameter of CSF. And the ratio of diameters of cord and CSF increased with age and not affected by the length of C-spine. However, the ratio of diameters of cord and M was not affected by age and the length of C-spine. CONCLUSION: The ratio of diameters of cord and M is not affected by individual variation and can be used to evaluate cervical spinal cord atrophy, compression and impaired in patients with cervical myelopathy and can be important information in looking for clinically critical points.