Preoperative Range of Motion in Extension May Influence Postoperative Cervical Kyphosis After Laminoplasty.

STUDY DESIGN: Retrospective observational study. OBJECTIVE: The objective of this study was to investigate factors associated with cervical kyphosis after laminoplasty. SUMMARY OF BACKGROUND DATA: Many factors are reportedly associated with the deterioration of cervical curvature after laminoplasty, including cervical lordosis angle, cervical spine range of motion (ROM), T1 slope, and C2-C7 sagittal vertical axis. Postlaminoplasty kyphosis or deterioration of cervical curvature is likely caused by multiple factors. There is currently no consensus on these issues. MATERIALS AND METHODS: Data of patients treated with laminoplasty for degenerative cervical myelopathy at our institution during 2008-2018 were reviewed. The following variables were collected for each patient: age and sex; follow-up time; surgery involving C3 (yes or no); surgery involving C7 (yes or no); distribution of segments operated on; number of laminae operated on; flexion, extension, and total ROM; cervical lordotic angle; longitudinal distance index; curvature index; C2-C7 sagittal vertical axis; and T1 slope. Logistic regression analysis was used to assess possible risk factors for postoperative kyphosis. Receiver operating characteristic curves were constructed to determine the cutoff values of risk factors. RESULTS: The study cohort comprised 151 patients. Logistic regression analysis indicated that sex, number of laminae operated on, and preoperative extension ROM were significantly associated with postoperative cervical kyphosis ( P <0.05). There was significantly greater postoperative kyphosis in women than in men; the more segments operated on, the greater the risk of postoperative kyphosis, and the larger the preoperative extension ROM, the lower the risk of postlaminoplasty kyphosis. Receiver operating characteristic curve analysis showed that the cutoff value for preoperative extension ROM is 22.1°. CONCLUSIONS: Preoperative extension ROM may be associated with the development of postoperative kyphosis. The cutoff value of preoperative extension ROM that suggested the prospect of postoperative kyphosis in our sample was 22.1°.

Tumor length-to-height ratio as a predictor of recurrent laryngeal nerve lymph node metastasis in patients with thoracic esophageal squamous cell carcinoma.

BACKGROUND: The metastasis of laryngeal nerve lymph node is mostly found in the upper-and middle esophageal cancer, the ratio of esophageal length from the upper incisors to the position where the esophageal tumor began to appear as proven via endoscopy to the height (LH) is likely to affect the possibility of detection of recurrent laryngeal nerve(RLN) lymph node (LN) metastasis. The purpose of this study was to evaluate the predictive value of LH for RLN LN metastasis. METHODS: One hundred and eighty-eight patients (mean age: 64.89 years; range: 46-84 years) calculated LH before esophagectomy and LN dissection were retrospective analyzed. The clinicopathological data of the patients, LH calculations were compared with the RLN LN histopathologic results to investigate the effect of LH on the diagnosis of RLN LN metastasis. RESULTS: The LH correlated with that of the RLN LN metastasis in receiver-operating-characteristic (ROC) analysis. Our ROC analyses demonstrated the optimal cut-off value was 16.66 for LH with an area under the curve value of 0.69. Compared with the Height (H) and L, ROC curve for LH have better performance in predicting the RLN LN metastasis. CONCLUSIONS: LH is a useful predictive tool in the evaluation of RLN LN metastasis for esophageal cancer. The present findings support the result that LH can be an indicator of RLN LN dissection.

An Overview of Systematic Reviews of Chinese Herbal Medicine for Parkinson's Disease.

Parkinson's disease (PD) is a high prevalence neurodegenerative disorder without a disease-modifying therapy. Up to now, a number of systematic reviews have been conducted to evaluate efficacy and safety of Chinese herbal Medicine (CHM) for PD patients. Here, we aimed to assess the methodological quality and reporting quality of systematic reviews using an overview, and then synthesize and evaluate the available evidence level of CHM for PD. Six databases were searched from inception to September 2018. The literatures were selected and data were extracted according to prespecified criteria. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to evaluate the quality of methodology, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to determine the evidence quality of the primary outcome measures. A total of 11 systematic reviews with 230 RCTs of CHM for PD were included. AMSTAR scores of the included reviews were range from 4 to 9. Compared with conventional western medicine (WCM), CHM paratherapy showed significant effect in improving UPDRS score, Webster scale score, PDQ-39, NMSQuest, CHM Syndrome Integral Scale, and PDSS. However, CHM monotherapy showed no difference relative to WCM according to various outcome measures. Adverse events were reported in 9 systematic reviews. The side effect in CHM paratherapy group was generally less than or lighter than that in WCM group. The quality of the evidence of primary outcomes was moderate (42%) to high (54%) according to the GRADE profiler. The present finding supported the use of CHM paratherapy for PD patients but we should treat the evidence cautiously because of the methodological flaws, whereas there is insufficient evidence of CHM monotherapy for PD.

BMP-7 improved proliferation and hematopoietic reconstitution potential of ex vivo expanded cord blood-derived CD34(+) cells.

Due to limited availability, ex vivo expansion is essential for clinical applications of hematopoietic stem cells (HSCs). Bone morphogenetic proteins (BMPs) play an important role in regulating hematopoiesis development. In this study, the effects of BMP-2 and BMP-7 at different doses on expansion, clonogenicity and differentiation of cord blood (CB)-derived CD34(+) cells were investigated in serum-free medium supplemented with stem cell factor, thrombopoietin and flt3-ligand (STF). Irradiated non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice were used as an animal model to assess the in vivo hematopoietic reconstitution potential of CB-derived CD34(+) cells treated by BMPs. It was demonstrated that the addition of BMP-7 at 5 ng/mL improved the proliferations of total cells, CD34(+) cells and CD34(+)CD38(-) cells without affecting the colony-forming ability of CD34(+) cells and component of lineage cells, while BMP-2 showed no effect on expanding these cells during the 10-day culture. Moreover, CB-derived CD34(+) cells cultured with STF and 5 ng/mL BMP-7 for 10 days were transplanted into irradiated NOD/SCID mice, and showed better engraftment and multi-lineage reconstitution ability compared with the cells cultured with STF alone. Together, 5 ng/mL BMP-7 was beneficial to ex vivo expansion of CB-derived CD34(+) cells for clinical purposes. The results may help improve the existing culture systems and achieve wider application of HSCs.

[Clinical features and gene mutation analysis in Machado-Joseph disease of spinocerebellar ataxia type 3 in littoral of Zhejiang].

OBJECTIVE: To study the clinical features and gene mutation analysis in Machado-Joseph disease of spinocerebellar ataxia type 3 in littoral of Zhejiang. METHODS: Clinical manifestation and brain MRI data 18 patients with SCA in family were analyzed. The gene mutations of 18 patients and 10 family numbers without abnormal presentation, and 12 healthy persons of controls. RESULTS: The gene mutations of 18 patients is SCA3/MJD, and 2 asymptomatic SCA3/MJD had been detected in SCA family. Normal alleles of SCA3/MJD have CAG repeats ranging from 14 to 27, patients from 67 to 82, asymptomatic and carrier SCA3/MJD from 28 to 45. The main features of 18 patients included gait ataxia, ambiguity in speech and action clumsiness. Brain MRI showed remarkable atrophy on cerebellum and brain stem. CONCLUSION: CAG expansions were related to SCA3/MJD. The clinical manifestations are ataxia and dysarthria. The detection of repeated times CAG can provide an effective way for the genetic and asymptomatic diagnosis.

[Hematopoietic reconstitution of fresh and cultured cord blood CD34+ cells in NOD/SCID mice].

AIM: To study the hematopoietic reconstitution ability of fresh and cultured cord blood CD34(+) cells by sublethally irradiated NOD/SCID mice. METHODS: Mononuclear cells (MNC) were separated from cord blood and then cultured with stem cell factor (SCF)+ flt3 ligand (FL)+ thrombopoietin (TPO)+ interleukin-3 (IL-3)+ IL-6 for 14 d. CD34(+) cells were isolated from fresh or cultured MNC using miniMACS magnetic separation system. Then 4x10(5) CD34(+) cells together with 5x10(6) CD34(-) cells were injected into NOD/SCID mice. After transplantation, the dynamics of hematopoieitc recovery in the mice were measured. After 6 weeks, bone marrow (BM) and spleen samples were obtained from mice for detecting human cells. RESULTS: The number of total cells increased 1.78-fold after 14 d of culture. All recipients received fresh and cultured CD34(+) cells survived. Human cells, human lineage cells and human ALU sequence could be detected in BM and spleen. The peripheral blood counts of all transplanted mice recovered. The engraftment levels of cultured CD34(+) cells were similar to those of fresh CD34(+)cells but the percentage of human lineage cells was higher than that of fresh CD34(+) cells. CONCLUSION: CD34(+) cells cultured for 14 d still preserved the hematopoietic reconstitution ability and showed better multilineage reconstitution ability than fresh CD34(+) cells.

[Effect of regulating intracellular ROS with antioxidants on the ex vivo expansion of cord blood CD34+ cells].

AIM: To investigate the effect of regulating intracellular ROS with antioxidants on the ex vivo expansion of cord blood CD34(+) cells. METHODS: The levels of reactive oxygen species (ROS) in cord blood CD34(+) cells were reduced by superoxide dismutase (SOD), catalase (CAT) or N-acetylcysteine (NAC) in ex vivo expansion. The expansion of CD34(+) cells reducing ROS levels with antioxidant was studied. RESULTS: It was observed that the generation of ROS was increased markedly by the cytokine combination. ROS was eliminated by antioxidant effectively. With the addition of antioxidant at different concentration, ROS was reduced to different levels. The percentage of CD34(+) cells and CD34(+)CD38(-) cells, the colony growth of colony-forming cells (CFC) and the re-expansion capability of CD34(+) cells were enhanced by 2 000 U/mL SOD, 200 U/mL CAT or 2 mmol/L NAC. However, its effect on fold expansion of CD34(+) cells was not significant. The expansion of the cells was inhibited by 8 000 U/mL SOD, 1 000 U/mL CAT or 5 mmol/L NAC. CONCLUSION: The proportion of hematopoietic stem and progenitor cells in the culture substance was increased markedly with the addition of low dose antioxidants in ex vivo expansion.

[Perfusion culture of hematopoietic cells in a stirred tank bioreactor].

To optimize the culture environment and protocol of hematopoietic cells' expansion, avoiding the fluctuation caused by medium changing in stirred culture and concentration gradient in static culture, the hematopoietic cells from cord blood (CB) were cultured in a stirred bioreactor connected with a cell retention system, which is a gravity sedimentation settler designed for hematopoietic cell. Total cells expanded 11.5 and 18.6 fold respectively in the twice perfusion stirred cultures, in which CFU-Mix was expanded 23.2 and 20.4 fold, CFU-GM 13.9 fold and 21.5 fold, BFU-E 8.0 fold and 6.9 fold, CD34+ cells 17.1 fold and 15.4 fold. After 12-day culture, it was obtained that 1082 x 10(6) total cells, 6.31 x 10(6) CFU-GM, 6.2 x 10(6) CFU-Mix and 23 x 10(6) CD34+ cells from 267 x 10(6) CB mononuclear cells (MNC) in the first culture, and 1080 x 10(6) total cells, 4.65 x 10(6) CFU-GM, 11.0 x 10(6) CFU-Mix, and 25.0 x 10(6) CD34+ cells from 180 x 10(6) CB MNC. These two cultures met to the clinical scale. Due to the optimized dissolved oxygen (DO) and stable culture environment, the rate of stem/progenitor cells to total cells in the perfusion culture was higher than that in T-flask cell-retention feeding culture. But the cell growth was inhibited in the later phase of perfusion culture, when the cell density is high. The inhibition should be attribute to the high cell density itself. The perfusion culture environment in bioreactor with optimal DO and pH controlling is more favorable for stem/progenitor cells' maintenance and expansion, and the expanded cells' number has reached a clinical scale. But the high cell density in the later phase of perfusion culture caused inhibition to mature hematopoietic cell's growth.