The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending.

BACKGROUND: Abnormal intervertebral movements of spine have been reported to be associated with trauma and pathological conditions. The importance of objective spinal motion imaging assessment in the frontal plane was frequently underestimated. The clinical evaluation of the segmental motion contribution could be useful for detecting the motion pattern of individual vertebrae. Therefore the purpose of this study was to investigate the shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending to provide additional insights to cervical biomechanics. METHODS: A total of 92 subjects (46 healthy adult subjects and 46 disc-herniated patients) were enrolled in this case-control study. The motion images during cervical lateral bending movements were digitized using a precise image protocol to analyze the intervertebral motion and contribution. RESULTS: Our results showed that the intervertebral angulation during cervical lateral bending for the C2/3 to C6/7 segments were 7.66°±2.37°, 8.37°±2.11°, 8.91°±3.22°, 7.19°±2.29°, 6.31°±2.11°, respectively for the healthy subjects. For the patients with herniated disc, the intervertebral angulation for the C2/3 to C6/7 segments were 6.87°±1.67°, 7.83°±1.79°, 7.73°±2.71°, 5.13°±2.05°, 4.80°±1.93°, respectively. There were significant angulation and translational differences between healthy subjects and the patients with herniated disc in the C5/6 and C6/7 segments (P=0.001-0.029). The segmental contributions of the individual vertebral segments were further analyzed. There was a significant increase in segmental contribution ratio of C3/4 (P=0.048), while a significant decrease in contribution ratio of C5/6 (P=0.037) was observed in the patients with herniated disc. Our results indicated that the segmental contribution shifted toward the middle cervical spine in the patients with herniated disc. CONCLUSIONS: The segmental contributions of cervical spine during lateral bending movement were first described based on the validated radiographic protocol. The detection of the shift of segmental contribution ratio could be helpful for the diagnosis the motion abnormality resulted from the disc or, facet pathologies, and arthritic changes of cervical spine.

Taiwanese Chinese translation and validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis 31 (QUALEFFO-31).

BACKGROUND/PURPOSE: Currently, Taiwanese Chinese version of a disease-specific health-related quality of life questionnaire for osteoporosis is not available. The purpose of this study was to translate and test the reliability and validity of the Taiwanese Chinese version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-31). METHODS: The QUALEFFO-31 was translated from the original English to Taiwanese Chinese. In this study, the translation procedure followed the guidelines described by Beaton et al. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the questionnaire. The internal consistency was assessed with Cronbach's α; Pearson's correlation was used to assess convergent and discriminant validity; the Mann Whitney U test was used to examine known group validity. RESULTS: The ICC for the test-retest reliability ranged from 0.77 to 0.91; Cronbach's α for pain, physical function, and mental function domains were 0.85, 0.74, and 0.79, respectively. For the convergent and discriminant validity, the correlation coefficients of score of each item with score of pain domain and of other domains were 0.72-0.90 and 0.26-0.43, respectively; the physical domain, 0.19-0.68 and 0.00-0.45; the mental domain, 0.53-0.71 and 0.11-0.38. CONCLUSION: The Taiwanese Chinese version of the QUALEFFO-31 is reliable and valid. We recommend this tool for evaluating participants with low bone mass in Taiwan. Further tests should be conducted to confirm the use of this questionnaire in clinical practice.

Integrative taxonomy reveals a new species of the genus Burmoniscus (Isopoda, Philosciidae) from the Xuefeng Mountains, China.

Three species of the genus Burmoniscus are identified from the Xuefeng Mountains, central China, by integrating morphological and molecular approaches. Burmoniscuschuanyanensis Li, sp. nov. is described. Morphological photographs of the new species are provided.

Uncemented total hip arthroplasty in chronic hemodialysis patients.

BACKGROUND AND PURPOSE: Whether or not uncemented total hip arthroplasty (THA) can achieve durable fixation of implants to bone in patients on chronic hemodialysis is unknown. We analyzed the 2-13-year clinical outcomes of cementless THA in patients with end-stage renal diseases who were maintained on long-term hemodialysis. PATIENTS AND METHODS: We reviewed the outcome of 23 consecutive uncemented THAs undertaken between 1993 and 2004, in patients with chronic renal failure who had been on long-term hemodialysis (2-18 years). 1 patient died and 2 patients were lost to follow-up within 2 years, leaving 20 hips (20 patients, median age 66 (38-81) years at the time of THA, 11 females) that were reviewed at median 7 (2-13) years postoperatively. RESULTS: Radiographic bone-ingrowth fixation of the components was found in 19 patients. 1 patient had aseptic loosening requiring revision surgery. The median d'Aubigne and Postel score was 10 (8-14) preoperatively and 15 (12-18) at final review. No prosthetic infections were found in any of the patients. INTERPRETATION: Uncemented THA shows promising medium-term results in patients receiving long-term hemodialysis.

First record of the genus Tetracona Meyrick (Lepidoptera, Crambidae) from China, with description of a new species.

The genus Tetracona has two species with an Australian distribution. The present study aims to record the genus from China for the first time and to add a third species, T. multispina Jie & Li, sp. nov. to the genus. The new species can be distinguished from the congeners by the antemedial line connecting the postmedial line near the dorsum in the hindwing, and the phallus with a cluster of spine-like cornuti in the male genitalia. Images of the habitus, tympanal organs and male genitalia are provided for the new species.

Effects of exercise programmes on quality of life in osteoporotic and osteopenic postmenopausal women: a systematic review and meta-analysis.

OBJECTIVE: To examine the effect of exercise therapy on quality of life in postmenopausal women with osteoporosis or osteopenia. METHODS: We searched MEDLINE, CINAHL, PEDro, EMBASE and the Cochrane library from January 1966 to March 2007. Two reviewers independently selected all studies that met predetermined inclusion criteria. Randomized controlled trials that used the Short Form 36 of the Medical Outcome Study (SF-36) questionnaire or the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) as outcome measures were selected. The PEDro Scale was applied to rate the quality of each article. All studies had a quality score above 5/10. Meta-analysis was facilitated by RevMan 4.1. RESULTS: Four randomized controlled trials met the inclusion criteria, involving a total of 256 participants. Results revealed that the exercise groups showed significant improvements in the domains of physical function, pain, role physical and vitality (P<0.05). Furthermore, intervention with combined exercise programmes had better effects on physical function, pain and vitality domains than controls. Group exercise programmes also produced better results in these three domains. A short-duration exercise programme produced more improvement in physical function, role physical and vitality, whereas a long-duration exercise programme resulted in more improvement in physical function and pain domains. CONCLUSIONS: This meta-analysis revealed better improvement in physical function, pain, role physical and vitality in the exercise groups. Combined exercise and group exercise programmes showed better outcomes in the physical function, pain and vitality domains, but different durations of exercise programme showed improvement in different domains.

The geographical distribution patterns of Chrysoteuchia Hübner in China and description of a new species (Lepidoptera, Crambidae).

The geographical distribution patterns of Chrysoteuchia Hübner in China are analysed with MaxEnt and ArcGIS based on known localities and nineteen environmental variables. The results suggest that southeastern China is a highly suitable area, and Bio11 (mean temperature of the coldest quarter), Bio12 (annual precipitation) and Bio18 (precipitation of the warmest quarter) are revealed to be the main variables affecting the present distribution patterns. Among them, Bio18 is the strongest predictor with a 24.3% contribution. Furthermore, a new species from Tibet is added to the genus, Chrysoteuchialandryi sp. nov., and the male of C.curvicavus is described for the first time. Images of adults and their genitalia are illustrated, and two maps showing the geographical distribution patterns of Chrysoteuchia in China are provided.

Notes on Glaucocharis (Lepidoptera, Crambidae) from China, with descriptions of two new species.

Two new species belonging to the genus Glaucocharis Meyrick, 1938 are described from southwest China: Glaucocharissperlingi sp. n. and G.nussi sp. n. The female of G.castaneus Song & Chen, 2002 is described for the first time. The geographical distribution of the genus in China is analysed. The precipitation of the warmest quarter is revealed to be the strongest predictor affecting the present distribution pattern of the genus. A map showing the distribution of the known Chinese localities of Glaucocharis is provided.

Genotyping of five chinese patients with 17alpha-hydroxylase deficiency diagnosed through high-performance liquid chromatography serum adrenal profile: identification of two novel CYP17 mutations.

CONTEXT: 17alpha-Hydroxylase deficiency is a rare form of congenital adrenal hyperplasia caused by CYP17 gene mutations. OBJECTIVE: Five Chinese patients with 17alpha-hydroxylase deficiency were genotyped. PATIENTS: The five patients derived from four families living in Shandong Province, China. The diagnosis of 17alpha-hydroxylase deficiency was initially established through HPLC serum adrenal profiles in Qilu Hospital, China, from 1983-1993. RESULTS: Three CYP17 gene mutations were identified from these patients. Among them, V311fs and Y329fs are two novel frame-shifting mutations. V311fs is an 8-bp nucleotide (TTAAATGG) deletion in exon 5. Y329fs is a deletion-insertion combined mutation (TAC-->AA) at codon 329 in exon 6. Two homozygotes for Y329fs and one compound heterozygote for Y329fs and V311fs were identified from three different families. Two homozygous sisters for the D487_S488_F489 deletion were identified. CONCLUSION: The results confirmed the diagnostic value of the HPLC serum adrenal profile for 17alpha-hydroxylase deficiency. The D487_S488_F489 deletion had been identified in two previously genotyped Chinese families. In our present study, a third Chinese family with this mutation was identified, suggesting that this mutation is a prevalent CYP17 mutation in the Chinese population. The identification of Y329fs mutation in addition to three previously identified mutations at codon 329 suggests that codon 329 is an unstable point of the CYP17 gene. The mutations identified from our five patients appear to be random, but the recurrence of the Y329fs mutation may be attributed to a founder effect. Our studies suggest that 17alpha-hydroxylase deficiency may not be rare in the Chinese population.

Functional outcomes after endoprosthetic knee reconstruction following resection of osteosarcoma near the knee.

PURPOSE: The aims of this study were to evaluate outcomes of osteosarcoma patients who underwent wide resection and endoprosthetic knee reconstruction, to compare with their own sound sides and controls, and to assess the interrelationships among these parameters. METHOD: Twenty patients and 20 matched controls were recruited. Strength and range of motion (ROM) of the knee, gait and Enneking functional score were measured. RESULTS: The results revealed the operated knees were significantly weaker than sound knees and controls (p < 0.05). The ROM of operated knees, sound knees and controls were 106.2 degrees +/- 13.0 degrees, 134.1 degrees +/- 7.5 degrees, and 137.7 degrees +/- 7.0 degrees respectively (p < 0.05). Patients' and controls' walking velocity were 54 +/- 12 m/min, and 72 +/- 6 m/min (p < 0.05). Their Enneking score was 21.6 +/- 2.8 (72% of total score, 30). The ratio of extensor strength of operated/sound knee and isometric hamstring/quadriceps ratio of operated knee were significantly correlated to the difference of stance-phase duration of bilateral sides (p < 0.05). In addition, the ratio of isometric flexor strength was significantly correlated to Enneking score (p < 0.05). CONCLUSIONS: The patients achieved an acceptable recovery in strength and gait in spite of some functional limitation.

Knee proprioception in patients with osteosarcoma around the knee after modular endoprosthetic reconstruction.

BACKGROUND: Proprioception as an outcome for patients with osteosarcoma who have undergone modular endoprosthetic knee reconstruction has not been studied, as far as we know. The primary purpose of the present study was to understand the differences in knee proprioception between this patient population and control subjects. We also compared differences in proprioception between patients with tumors at different sites and between patients who had different proportions of bone length excised. METHODS: We evaluated twenty patients who had undergone a wide resection of a tumor about the knee followed by reconstruction with a modular endoprosthesis. The mean age of the patients was 21.7 years. The patients were grouped according to tumor site, i.e., the distal part of the femur or the proximal part of the tibia; they were also grouped according to the length of resected bone (<40% or >or=40% of the length of the bone). Another twenty age-matched control subjects were recruited for this study. Knee proprioception was evaluated by comparing active and passive angular repositioning of the involved limb and the normal limb in the patients and the dominant limb in the central subjects. RESULTS: The absolute matching error of active and passive repositioning was 2.7 degrees +/- 2.1 degrees and 2.9 degrees +/- 2.2 degrees , respectively, for knees treated operatively and 3.2 degrees +/- 2.1 degrees and 2.1 degrees +/- 1.3 degrees , respectively, for the dominant knees in the control subjects. The differences between the operatively treated knees and the control knees were not significant (p > 0.05). There was also no significant difference in proprioception between the patients with a distal femoral tumor and those with a proximal tibial tumor (p > 0.05). The proprioception of the patients with a greater length of bone resected was significantly worse in both lower extremities than that of patients with a shorter resected length (p = 0.016 for the normal side and p = 0.025 for the involved side). CONCLUSIONS: The proprioception of the involved knees in the patients with osteosarcoma who had modular endoprosthetic reconstruction was not found to be different from the normal knees or the knees in the control subjects. On the basis of our data, we found that proprioception is probably not influenced by the tumor site. Conversely, resection length appears to be an important factor. These study findings may be used as a reference for knee proprioception in patients with osteosarcoma who have a modular endoprosthetic knee reconstruction.

A new species of Metaeuchromius (Lepidoptera, Crambidae) from the Tibetan glacier area of China.

Metaeuchromiusglacialis Li, sp. n. is described from the Tibetan glacier area of China. The new species is similar to Metaeuchromiuscirce Bleszynski by the distal projection of costa exceeding the apex of valva, and the phallus with strong spine-like cornuti in the male genitalia. Images of male adult, tympanal and scent organs as well as genitalia of the new species are provided.

Femoral non-elongating rodding in osteogenesis imperfecta - the importance of purchasing epiphyseal plate.

BACKGROUND: Corrective osteotomy and intramedullary rodding are widely used in children with osteogenesis imperfecta (OI), but revision rodding is often required. This study aims to investigate the effect of purchasing distal femoral epiphysis on the longevity of fixation using non-elongating rod. METHODS: We investigated children with Sillence type III or IV OI who received antegrade femoral Rush rod fixations at age between 4 and 10 years in our institution. The fixations were classified into group A in which the rod reached distal femoral epiphysis and group B in which the rod stopped at femoral metaphysis. Failure of fixation is defined as rod cutting out of the cortex or when revision surgery was performed. Calculation of longevity of each rod fixation and Kaplan-Meier survival analysis were performed and compared between the two groups. RESULTS: Eighteen children had the first femoral rodding at a mean age of 6.9 years and received a total of 61 femoral roddings with a mean follow-up of 11.4 years. Group A included 38 roddings performed at a mean age of 7.1 years and group B included 23 roddings performed at a mean age of 6.6 years. Group A had less revision rate (58% vs. 87%), more chance of survival > 3 years (74% vs. 43%), and longer median survival time (80 months vs. 33 months) than group B. CONCLUSIONS: Less revision rate and better 3-year and 5-year survival rate were proved in the roddings that purchased epiphysis. We emphasize on using the precise implant length to purchase distal femoral epiphysis when non-elongating rod is the only available implant for fixation in children with OI.

Treatment of Gartland type III pediatric supracondylar humerus fractures with the Kapandji technique in the prone position.

OBJECTIVE: The purpose of this study was to report the efficacy of the Kapandji technique performed in the prone position for humeral supracondylar fractures in children. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: We retrospectively reviewed 34 children with Gartland type III supracondylar humerus fractures. There were 22 boys and 12 girls with a mean age of 5.2 years (range, 1-12.7 years). INTERVENTION: Closed reduction and the Kapandji technique were performed in the prone position for all patients. The mean follow-up was 17.4 months (range, 13.2-24.8 months). MAIN OUTCOME MEASUREMENTS: We assessed preoperative and postoperative radiographs to evaluate the quality of the reduction. The clinical outcome was assessed according to the criteria of Flynn. RESULTS: All operations were performed in a closed manner, no cases required open reduction. Loss of reduction after K-wire fixation was identified in 2 patients. There were no pin-related nerve injuries. The mean range of elbow motion was 139.6 degrees. The clinical outcome was excellent in 31 patients, good in 2 patients (97% excellent or good), and fair in 1 patient. CONCLUSIONS: This technique is an effective and safe option to treat type III supracondylar humerus fractures in children. In patients with severe soft tissue swelling, unstable fracture reduction, or unable to achieve acceptable reduction, this technique could facilitate fracture reduction and avoid unnecessary open reduction. The disadvantage of this technique is that the prone position is less desirable for airway management. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pten regulates homeostasis and inflammation-induced migration of myelocytes in zebrafish.

BACKGROUND: Loss of the tumor suppressor phosphatase and tensin homolog (PTEN) is frequently observed in hematopoietic malignancies. Although PTEN has been implicated in maintaining the quiescence of hematopoietic stem cells (HSCs), its role in hematopoiesis during ontogeny remains largely unexplored. METHODS: The expression of hematopoietic marker genes was analyzed via whole mount in situ hybridization assay in ptena and ptenb double mutant zebrafish. The embryonic myelopoiesis was characterized by living imaging and whole mount in situ immunofluorescence with confocal microscopy, as well as cell-specific chemical staining for neutrophils and macrophages. Analyses of the involved signaling pathway were carried out by inhibitor treatment and mRNA injection. RESULTS: Pten-deficient zebrafish embryos exhibited a strikingly increased number of myeloid cells, which were further characterized as being immune deficient. In accordance with this finding, the inhibition of phosphoinositide 3-kinase (PI3K) or the mechanistic target of rapamycin (mTOR) corrected the expansive myelopoiesis in the pten-deficient embryos. Further mechanistic studies revealed that the expression of cebpa, a critical transcription factor in myeloid precursor cells, was downregulated in the pten-deficient myeloid cells, whereas the injection of cebpa mRNA markedly ameliorated the dysmyelopoiesis induced by the loss of pten. CONCLUSIONS: Our data provide in vivo evidence that definitive myelopoiesis in zebrafish is critically regulated by pten via the elevation of cebpa expression.

Guided growth by a stainless-steel tubular plate.

Guided growth using titanium tension band plates is an advancement in the correction of angular deformity. We applied two-hole stainless-steel one-third tubular plates for the same purpose. There were 14 deformities around the knees in eight children, mean age 10.8 years at operation. The success rate was 92.9% (13/14). The average correction rate per month was 0.59° in the femur and 0.65° in the tibia. No premature physeal arrest, overcorrection, or rebound phenomenon was observed. A stainless-steel plate is a safe and effective option for guided growth surgery in countries where only stainless-steel plates are available.