[Effects of preoperative segmental mobility on the clinical and radiographic outcomes following one-level artificial cervical disc replacement].

Objective: To investigate the effects of preoperative segmental range of motion (ROM) on clinical and radiographical outcomes after artificial cervical disc replacement (ACDR) and explore whether ACDR could be indicated for patients with preoperative limited or excessive segmental ROM. Methods: From January 2008 to December 2017, patients who underwent Prestige-LP ACDR in West China Hospital were retrospectively reviewed. The preoperative and postoperative X-rays of the cervical spine were collected to measure the radiographic parameters, including cervical lordosis (CL), C(2-7) ROM, disc height (DH), disc angle (DA) and ROM at the arthroplasty level. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) and the Neck Disability Index (NDI) scores. The correlation between preoperative segmental ROM and postoperative clinical and radiographical outcomes were also analyzed. Results: A total of 161 patients were analyzed, with 73 males and 88 females. The mean age was (44±8) years, and the follow-up period was 34 months (12-120 months). JOA and NDI scores improved after ACDR (P<0.05). However, postoperative C(2-7) ROM and ROM at the arthroplasty level were comparable with preoperative counterparts (both P>0.05). Preoperative segmental ROM positively correlated with C(2-7) ROM and ROM at the arthroplasty segment (r=0.213、0.271, both P<0.05), but was negatively correlated with the change of ROM (r=-0.534, P<0.05). The segmental ROM was 4.0°±1.0° in the limited-ROM group (A) and 14.6°±1.3° in the excessive-ROM group (B), respectively. There were significantly more patients diagnosed with cervical spondylosis in group A than in group B (35.5% vs 10.7%, P<0.05). The level-distribution was statistically different between the two groups. C(5/6) and C(6/7) were prone to limited motion in group A, while C(4/5) and C(5/6) were predisposed to excessive motion in group B (all P<0.05). After surgery, C(2-7) ROM increased for 14.2°±16.8° in group A, while paradoxically decreased for 2.2°±14.4° in group B. However, C(2-7) ROM in group B was still larger than that in group A (P<0.05). Similarly, the ROM at the arthroplasty level increased by 3.1°±3.7° in group A, whereas the values decreased by 4.4°±4.2° in group B postoperatively. In addition, group A still had less segmental ROM than group B (P<0.05). The preoperative DH in group A was less than that in group B (P<0.05). The rates of ASD, HO, and high-grade HO in group A were all higher than those in group B but without significant differences (all P>0.05). Conclusion: Preoperative segmental ROM has no significant effects on clinical outcomes after ACDR; it has a positive correlation with postoperative global and segmental ROM while is negatively correlated with ROM change.

Minimum four-year subsequent surgery rates of cervical disc replacement versus fusion: A meta-analysis of prospective randomized clinical trials.

INSTRUCTION: Anterior cervical discectomy and fusion (ACDF) is a well-accepted surgical management strategy for radiculopathy and/or myelopathy. However, complications sometimes required subsequent surgery at the operated and adjacent levels. Artificial cervical disc replacement (ACDR) has been accepted as the most extensive non-fusion procedure and is designed to preserve motion. However, some specific complications can result in subsequent surgery, thus, attracting the attention of investigators. HYPOTHESIS: Compared with ACDF, ACDR had a lower subsequent surgery rates at both operated and adjacent levels after a minimum of four-years of follow-up. MATERIAL AND METHODS: A meta-analysis was performed with articles published prior to February 2016. Only randomized controlled trials that reported a minimum of 4 years of follow-up with regard to the rates of subsequent surgeries after ACDR compared with ACDF were included in this study. Two reviewers independently screened the articles and data following the PRISMA statement. RESULTS: Our data showed that the pooled overall rate of subsequent surgery at the operated level and adjacent levels was lower in the ACDR group (7.4%) than in the ACDF group (16.8%) (P=0.0006). For subsequent surgery at the operated level, patients who received ACDR had a lower rate of subsequent surgery than patients who received ACDF (P<0.0001). With respect to the adjacent level, ACDR also had fewer subsequent surgeries compared with ACDF (P<0.0001). CONCLUSION: ACDR had significantly fewer subsequent surgical interventions compared with ACDF, However, a review of the literature showed that there were an insufficient number of studies with respect to subsequent surgery with a minimum of 4 years of follow-up. Hence, longer-term, multicenter studies are needed for better evaluation of the rate of subsequent surgery after ACDR. LEVEL OF EVIDENCE: Level I, meta-analysis of high-powered prospective randomized trials.

An ISDN-based telemedicine system.

Our preliminary results show the telemedicine system is successful. It does fulfill the 3 goals we set earlier. However, for such a system to be cost effective, the communication cost need to be cut further. In fact, video is not required at all time. We are hoping to establish criteria and operational procedure for use of video. Also some sort of standard should be set up for evaluation of the quality of telemedicine.

Neuronal intestinal dysplasia presenting as an abdominal mass: report of a case.

An unusual clinical presentation of a patient with neuronal intestinal dysplasia is presented. A 46-year-old male noted a palpable mass in the right lower quadrant of his abdomen for two months. A computed axial tomographic scan showed a thickened wall of the cecum with a tumor-like appearance. The excised specimen consisted of a mass caused by the thickened, edematous wall of the dilated cecum and appendix. The wall of the cecum and appendix measured up to 2.5 and 0.8 cm, respectively, in thickness. Microscopic studies showed extensive hyperplasia and hypertrophy of the ganglia and nerve plexuses and hypertrophy of the muscularis propria, consistent with neuronal intestinal dysplasia.

Identification, cloning, sequencing, and overexpression of the gene encoding proclavaminate amidino hydrolase and characterization of protein function in clavulanic acid biosynthesis.

Proclavaminate amidino hydrolase (PAH) catalyzes the reaction of guanidinoproclavaminic acid to proclavaminic acid and urea, a central step in the biosynthesis of the beta-lactamase inhibitor clavulanic acid. The gene encoding this enzyme (pah) was tentatively identified within the clavulanic acid biosynthetic cluster in Streptomyces clavuligerus by translation to a protein of the correct molecular mass (33 kDa) and appreciable sequence homology to agmatine ureohydrolase (M.B.W. Szumanski and S.M. Boyle, J. Bacteriol. 172:538-547, 1990) and several arginases, a correlation similarly recognized by Aidoo et al. (K. A. Aidoo, A. Wong, D. C. Alexander, R. A. R. Rittammer, and S. E. Jensen, Gene 147:41-46, 1994). Overexpression of the putative open reading frame as a 76-kDa fusion to the maltose-binding protein gave a protein having the catalytic activity sought. Cleavage of this protein with factor Xa gave PAH whose N terminus was slightly modified by the addition of four amino acids but exhibited unchanged substrate specificity and kinetic properties. Directly downstream of pah lies the gene encoding clavaminate synthase 2, an enzyme that carries out three distinct oxidative transformations in the in vivo formation of clavulanic acid. After the first of these oxidations, however, no further reaction was found to occur in vitro without the intervention of PAH. We have demonstrated that concurrent use of recombinant clavaminate synthase 2 and PAH results in the successful conversion of deoxyguanidinoproclavaminic acid to clavaminic acid, a four-step transformation. PAH has a divalent metal requirement, pH activity profile, and kinetic properties similar to those of other proteins of the broader arginase class.

New method of percutaneous gastrostomy using anchoring devices.

We used an anchoring device to secure the stomach to the abdominal wall when performing percutaneous endoscopic gastrostomy. This method avoids many of the disadvantages of the technique currently used. The procedure is easy to perform, allows insertion of a proper size of gastrostomy tube, ensures fixation of the stomach to the abdominal wall, and facilitates changing of the feeding tube.

Prophylaxis of deep venous thrombosis by hydroxychloroquine sulfate and heparin.

A double blind study of 134 patients was undertaken to compare the effectiveness of hydroxychloroquine sulfate, Plaquenil, and heparin in the prophylaxis of deep venous thrombosis. By the 125I fibrinogen scanning technique, deep venous thrombosis was detected in six patients in the placebo group, in one patient in the Plaquenil group and none in the heparin group. These results indicate that both heparin and Plaquenil do diminish the incidence of thrombosis.

Spontaneous hemorrhage due to pseudocysts of the pancreas.

Spontaneous hemorrhage caused by erosion of major arteries by a pseudocyst of the pancreas is a rare condition. We have encountered three cases, one involving the abdominal aorta and two the superior pancreaticoduodenal artery. It is important to keep in mind that pseudocyst of the pancreas may cause massive gastrointestinal or intraabdominal bleeding. Operative treatment offers a better chance of survival than more conservative management.