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1.
Infect Genet Evol ; 82: 104292, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32240798

RESUMO

OBJECTIVE: To investigate the relationship between melanocortin-3 receptor (MC3R) gene polymorphism and tuberculosis (TB) susceptibility in Han population in southern China. METHODS: A total of 341 patients with TB (173 with pulmonary TB and 168 with multifocal TB) and 359 healthy controls were enrolled. Genotyping was performed by PCR and DNA sequencing, and detection of protein was performed by western blot. RESULTS: The distributions of genotype and allele frequencies of rs6127698 differed significantly between the pulmonary and multifocal TB groups, and between the multifocal TB and control groups. The GG genotype was significantly more common among multifocal TB patients than among pulmonary TB patients (P = .009) and those in the control group (P = .001) under the recessive model. GG+GT genotype was more common in multifocal TB than in pulmonary TB (P < .01) and control group (P < .01) under the dominant model. G allele was more common in multifocal TB than in pulmonary TB (P < .0167) and control group (P < .0167). Patients with multifocal TB had an increased expression of MC3R protein than healthy controls (P < .05). CONCLUSIONS: In the southern Chinese Han population, the MC3R rs6127698 polymorphism, which accompanying an increased expression of MC3R protein,was associated with susceptibility to multifocal TB. Presence of the G allele increased the risk of developing multifocal TB.

2.
BMC Musculoskelet Disord ; 21(1): 98, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054465

RESUMO

BACKGROUND: Whether or not, prophylactic neurosurgical interventions of split cord malformation (SCM) before undertaking corrective surgery was the focus of debate. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis (RCS) associated with SCM. METHODS: From 2011 to 2017, 24 patients suffered from RCS associated with SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The apex of the deformity was lumbar (n = 9), thoracic (n = 11), and thoracolumbar (n = 4). There were 13 cases of failure of segmentation; 4 cases of failure of formation and 7 cases of mixed defects. Based on SCM classification, there were 14 patients with SCM type 1 and 10 patients with SCM type 2. The Scoliosis Research Society (SRS)-22 and modified Japanese Orthopaedic Association (mJOA) scores were assessed preoperatively and at the final follow up. RESULTS: The mean duration of surgery was 327.08 ± 43.99 min and the mean blood loss was 1303.33 ± 526.86 ml. The mean follow-up period was 20.75 ± 8.29 months. The preoperative mean coronal Cobb angle was 80.38° ± 13.55°; on the bending radiograph of the convex side, the mean Cobb angle was 68.91° ± 15.48°; the mean flexibility was 15.04% ± 7.11%. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 56.89° ± 13.39°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 32.54° ±11.33°. The postoperative mean correction rate was 60.51% ± 7.79%. At the final follow up, the corrective loss rate of Cobb angle was only 3.17%. The SRS-22 total score improved at the final follow-up evaluation compared with the preoperative SRS-22 total score. The spinal cord function was stable and there were no new neurological symptoms after correction. There were no significant differences between final follow-up and preoperative mJOA total scores. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of RCS associated with SCM.

3.
World Neurosurg ; 127: e407-e415, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910755

RESUMO

OBJECTIVE: We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. METHODS: From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. RESULTS: The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. CONCLUSIONS: Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis.


Assuntos
Transplante Ósseo , Fixadores Internos , Cifose/cirurgia , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Transplante Ósseo/métodos , Feminino , Seguimentos , Humanos , Fixadores Internos/efeitos adversos , Cifose/complicações , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Titânio , Transplante Homólogo , Resultado do Tratamento , Tuberculose da Coluna Vertebral/complicações
4.
Pharmacology ; 103(1-2): 101-109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30522105

RESUMO

It has been reported that taxifolin inhibit osteoclastogenesis in RAW264.7 cells. In our research, the inhibition effects of taxifolin on the osteoclastogenesis of human bone marrow-derived macrophages (BMMs) induced by receptor activator of NF-κB ligand (RANKL) as well as the protection effects in lipopolysaccharide-induced bone lysis mouse model have been demonstrated. In vitro, taxifolin inhibited RANKL-induced osteoclast differentiation of human BMMs without cytotoxicity. Moreover, taxifolin significantly suppressed RANKL-induced gene expression, including tartrate-resistant acid phosphatase, matrix metalloproteinase-9 nuclear factor of activated T cells 1 and cathepsin K, and F-actin ring formation. Further studies showed that taxifolin inhibit osteoclastogenesis via the suppression of the NF-κB signaling pathway. In vivo, taxifolin prevented bone loss in mouse calvarial osteolysis model. In conclusion, the results suggested that taxifolin has a therapeutic potential for osteoclastogenesis-related diseases such as osteoporosis, osteolysis, and rheumatoid arthritis.


Assuntos
Reabsorção Óssea/induzido quimicamente , Reabsorção Óssea/tratamento farmacológico , Lipopolissacarídeos/farmacologia , Macrófagos/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Quercetina/análogos & derivados , Ligante RANK/antagonistas & inibidores , Actinas/metabolismo , Animais , Catepsina K/metabolismo , Diferenciação Celular/efeitos dos fármacos , Modelos Animais de Doenças , Humanos , Quinase I-kappa B/metabolismo , Macrófagos/citologia , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/genética , NF-kappa B/metabolismo , Fatores de Transcrição NFATC/metabolismo , Osteólise/induzido quimicamente , Osteólise/tratamento farmacológico , Osteólise/patologia , Quercetina/farmacologia , Ligante RANK/farmacologia , Células RAW 264.7 , Transdução de Sinais , Fator de Transcrição RelA/metabolismo
5.
Injury ; 48(2): 378-383, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28063678

RESUMO

PURPOSE: To analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. METHODS: From September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60-68 years) at the time of surgery. The mean follow-up time was 40 months(range 26-68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle. RESULTS: The spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8-38°) and decreased to 7.6° (range 1-18°) postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis.


Assuntos
Desbridamento/métodos , Cifose/cirurgia , Fusão Vertebral/métodos , Telas Cirúrgicas , Tuberculose da Coluna Vertebral/complicações , Idoso , China/epidemiologia , Desbridamento/instrumentação , Descompressão Cirúrgica , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/epidemiologia , Cifose/prevenção & controle , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Titânio , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/epidemiologia , Tuberculose da Coluna Vertebral/patologia
6.
J Neurosurg Pediatr ; 19(1): 96-101, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27739946

RESUMO

OBJECTIVE The objective of this study was to evaluate the clinical efficacy of posterior-only surgical correction of dystrophic scoliosis in patients with neurofibromatosis Type 1 (NF1) using a multiple anchor point method (MAPM). METHODS From 2005 to 2014, 31 patients (mean age 13.5 years old, range 10-22 years old) suffering from dystrophic scoliosis associated with NF1 underwent posterior-only surgical correction using a MAPM. The apex of the deformity was thoracic (n = 25), thoracolumbar (n = 4), and lumbar (n = 2). The mean preoperative coronal Cobb angle was 69.1° (range 48.9°-91.4°). The mean Cobb angle on the side-bending radiograph of the convex side was 58.2° (range 40°-79.8°). The mean flexibility and apical vertebral rotation (AVR) were 15.6% (range 8.3%-28.2%) and 2.5° (range 2°-3°), respectively. The mean angle of sagittal kyphosis was 58.3° (range 34.1°-79.6°). RESULTS The mean follow-up period was 53 months (range 12-96 months). The mean postoperative coronal Cobb angle was 27.4° (range 16.3°-46.7°). Postoperatively, the mean AVR and angle of sagittal kyphosis were 1.2° (range 1°-2°) and 22.4° (range 4.2°-36.3°), respectively. All patients showed good correction of all indices postoperatively. The mean postoperative correction rate was 58.7% (range 46.3%-74.1%). At the final follow-up evaluation, the corrective loss rate of the Cobb angle was only 2.3%. Only 1 patient required revision surgery. No severe complications such as spinal cord, neural, or large vascular injury occurred during the operation. CONCLUSIONS Posterior-only surgical correction of dystrophic scoliosis in patients with NF1 using a MAPM could yield satisfactory clinical efficacy of correction and fusion.


Assuntos
Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Procedimentos Ortopédicos/métodos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Neurofibromatose 1/epidemiologia , Escoliose/epidemiologia , Adulto Jovem
7.
Spine (Phila Pa 1976) ; 42(11): 808-817, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27792109

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To assess the minimum 5-year follow up outcomes of the surgical management of adults with thoracic tuberculosis by comparing posterior only (PO), anterior only (AO), and combined posterior and anterior (AP) surgical approaches. SUMMARY OF BACKGROUND DATA: Surgeons use multiple methods to treat spinal tuberculosis, including an anterior, posterior, and combined anterior and posterior approach. However, there are a few reports comparing the mid- and long-term outcomes of these surgical methods. METHODS: The medical records for 184 patients treated for thoracic tuberculosis between January 2003 and November 2010 were retrospectively reviewed. Among them, 62 patients were treated with a single-stage posterior debridement and interbody fusion with instrumentation (Group A), 65 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 57 patients with anterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale for pain, complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups. RESULTS: Groups A, B, and C were followed for 72.7 ±â€Š3.8 months, 74.3 ±â€Š4.2 months, and 73.6 ±â€Š4.5 months, respectively. The operative time, blood loss, and rate of complications for Group A were significantly less than Groups B and C (P < 0.05). The correction rate and loss angle were superior in Groups A and B compared with C, whereas the Visual Analog Scale for pain and fusion time showed no statistically significant difference among the groups (P > 0.05). CONCLUSION: For patients with thoracic tuberculosis, use of the AO approach should be limited. Although the AP approach produced satisfactory outcomes, it remains more traumatic. Therefore, the PO approach is recommended, not only because it achieves good results, but because it has reduced complications, operative time, and blood loss. LEVEL OF EVIDENCE: 3.


Assuntos
Transplante Ósseo/métodos , Desbridamento/métodos , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Transplante Ósseo/efeitos adversos , Desbridamento/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento , Adulto Jovem
8.
Arch Med Res ; 47(4): 255-61, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27664484

RESUMO

Estrogen receptor plays critical roles in osteogenesis but the underlying mechanism remains unclear. In order to determine the effect of ERα and ERß on several critical factors in regulating osteogenesis in human osteoblasts. Cell based assy, RT-PCR and immunoblot analyses were used in the research. Both RT-PCR and immunoblot showed that gene expression of OPG, MBP2, TGF-ß, RUNX2, IGF-1 was significantly reduced while expression of RANKL was drastically increased after shRNA-based depletion of ERα in MG-63 osteoblasts. Surprisingly, 17ß-estradiol (E2) treatment led to remarkably reduced RANKL compared with that in E2 untreated cells. In contrast, ERß plays an opposite role in regulating gene expression of OPG, MBP2, TGF-ß, RUNX2, IGF-1 and RANKL. However, double depletion of ERα and ERß could not rescue the gene expression of these factors in vitro. Our results provide a novel mechanism of estrogen receptor in controlling osteogenesis in human cells as well as a potential clinic therapeutic target in human osteoporosis.


Assuntos
Estradiol/farmacologia , Receptor alfa de Estrogênio/metabolismo , Receptor beta de Estrogênio/metabolismo , Osteoblastos/efeitos dos fármacos , Proteína Morfogenética Óssea 2/metabolismo , Linhagem Celular , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Receptor alfa de Estrogênio/genética , Receptor beta de Estrogênio/genética , Técnicas de Silenciamento de Genes , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Osteoblastos/fisiologia , Osteogênese/efeitos dos fármacos , Osteoprotegerina/metabolismo , Ligante RANK/metabolismo , Fator de Crescimento Transformador beta/metabolismo
9.
Mol Med Rep ; 14(4): 3662-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27600753

RESUMO

Liraglutide, a synthetic analogue of glucagon-like peptide­1, is utilized in the treatment of type 2 diabetes and obesity. Liraglutide has been previously demonstrated to prevent osteoblastic differentiation of human vascular smooth muscle cells, resulting in the slowing of arterial calcification, however, its effect on bone formation remains unclear. The present study investigated the effect of liraglutide on osteoblastic differentiation using Alizarin Red S staining, and examined the molecular mechanisms underlying the regulatory effect by western blot analysis. The present study demonstrated that protein expression levels of phosphorylated adenosine monophosphate­activated protein kinase (p­AMPK) were downregulated in MC3T3­E1 cells during osteoblastic differentiation in commercial osteogenic differentiation medium, whereas protein expression levels of transforming growth factor­ß (TGF­ß) and phosphorylated mammalian target of rapamycin (p­mTOR) increased. Liraglutide was subsequently demonstrated to dose­dependently attenuate the osteoblastic differentiation of MC3T3­E1 cells, to upregulate p­AMPK, and downregulate p­mTOR and TGF­ß protein expression levels. Treatment with an AMPK­specific inhibitor, Compound C, eradicated the effect of liraglutide on osteoblastic differentiation, and p­mTOR and TGF­ß downregulation. An mTOR activator, MHY1485, also abolished the inhibitory effect of liraglutide on osteoblastic differentiation, and resulted in p­mTOR and TGF­ß downregulation, but did not attenuate the liraglutide­induced increase in p­AMPK protein expression levels. The results of the present study demonstrate that liraglutide attenuates osteoblastic differentiation of MC3T3­E1 cells via modulation of AMPK/mTOR signaling. The present study revealed a novel function of liraglutide, which contributes to the understanding of its pharmacological and physiological effects in clinical settings.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Diferenciação Celular/efeitos dos fármacos , Hipoglicemiantes/farmacologia , Liraglutida/farmacologia , Osteoblastos/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismo , Animais , Linhagem Celular , Camundongos , Osteoblastos/citologia , Osteoblastos/metabolismo , Osteogênese/efeitos dos fármacos
10.
Childs Nerv Syst ; 32(8): 1495-502, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27392447

RESUMO

PURPOSE: The purpose of this study was to determine the efficacy and feasibility of surgical management of children with thoracolumbar spine tuberculosis with kyphosis by using one-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion. METHODS: From October 2010 to September 2013, 21 children with thoracolumbar spinal tuberculosis accompanied by kyphosis were treated with one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. There were 13 males and 8 females, aged from 7 to 13 years old (average age 9.9 years). The mean follow-up was 34 months (range26-48 months). Patients were evaluated before and after surgery in terms of ESR, neurologic status, pain, and kyphotic angle. RESULTS: Spinal tuberculosis was completely cured, and the grafted bones were fused in all 21 patients. There was no recurrent tuberculous infection. ESR got normal within 3 months in all patients. The ASIA neurologic classification improved in all cases. Pain relief was obtained in all patients. The average preoperative kyphosis was 29.7° (range 12-42°) and decreased to 5.5° (range 2-10°), postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS: Our results show that one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion were an effective treatment for children with thoracolumbar spinal tuberculosis. It is characterized as minimum surgical trauma, good neurologic recovery, good correction of kyphosis, and prevention of progressive kyphosis.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Cifose/etiologia , Cifose/cirurgia , Fusão Vertebral/métodos , Tuberculose da Coluna Vertebral/complicações , Adolescente , Sedimentação Sanguínea , Criança , Feminino , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Doenças do Sistema Nervoso/etiologia , Dor/etiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
Int Orthop ; 40(6): 1117-24, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26983410

RESUMO

PURPOSE: Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. METHODS: From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60-71 years). The mean follow-up was 46.5 months (range 38-70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle. RESULTS: Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°-22.5°) and became 29.4° (range 27.1°-32.5°) at final follow-up. CONCLUSIONS: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability.


Assuntos
Desbridamento/métodos , Região Lombossacral/cirurgia , Fusão Vertebral/métodos , Titânio/uso terapêutico , Tuberculose da Coluna Vertebral/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Resultado do Tratamento
12.
Orthop Surg ; 8(1): 89-93, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27028387

RESUMO

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery.


Assuntos
Desbridamento , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Idoso , Terapia Combinada , Humanos , Masculino , Parafusos Pediculares , Fusão Vertebral/instrumentação
13.
Eur Spine J ; 23(1): 234-41, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23771578

RESUMO

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To evaluate the outcomes of two-level (T12 and L3) pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS), and to discuss the surgical strategies of this surgery. BACKGROUND: Cases were limited on the results of two-level PSO for correction of severe kyphosis caused by AS, nor on surgical strategies of this type of surgery. METHODS: From March 2006 to December 2010, nine consecutive AS patients with severe kyphotic deformity, underwent T12 and L3 PSOs. Chin-brow vertical angle (CBVA) and radiographic assessments which contain thoracic kyphosis (TK), lumbar lordosis (LL), global kyphosis (GK), and sagittal vertical axis were carefully recorded pre and postoperatively to evaluate the sagittal balance. Intra and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index before surgery and at the last follow-up visit. RESULTS: All nine patients (8M/1F), averaged 41.4 years old (range 35-51 years), were received two-level (T12 and L3) PSO, and were followed up after surgery for a mean of 39.9 months (range 24-68 months). Good cosmetic results were achieved in all patients. Mean correction at two-level PSO was 67.9 ± 5.5°. All CBVA, TK, LL, and GK were changed significantly after surgery (P < 0.05), the mean amount of correction of which were 59.5 ± 13.8, 34.7 ± 3.8, 33.2 ± 2.4, and 54.0 ± 14.8 degrees, respectively, and with a small loss of correction at the last follow-up visit. Sagittal imbalance was significantly improved from 27.3 ± 4.4 to 3.4 ± 0.7 cm postoperatively. Neither mortalities nor any major neurological complications were found. The mean ODI score was significantly improved from 53.4 ± 15.5 before surgery to 8.2 ± 4.7 at the last visit. CONCLUSION: The outcomes of follow-up showed that two-level (T12 and L3) PSO can effectively and safely correct severe thoracolumbar kyphosis in AS.


Assuntos
Cifose/etiologia , Cifose/cirurgia , Osteotomia/métodos , Espondilite Anquilosante/complicações , Vértebras Torácicas/cirurgia , Adulto , Feminino , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Complicações Pós-Operatórias/diagnóstico , Radiografia , Estudos Retrospectivos , Espondilite Anquilosante/diagnóstico por imagem , Resultado do Tratamento
14.
Arch Orthop Trauma Surg ; 133(9): 1211-8, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23812354

RESUMO

PURPOSE: We present a retrospective study of 15 cases with severe posttuberculous kyphosis of thoracolumbar region that underwent posterior vertebral column resection. METHODS: From 2004 to 2009, 15 consecutive patients with posttubercular kyphotic deformity underwent posterior vertebral resection osteotomy. Six subjects were females and nine were males with an average age of 35.8 years (range 20-60 years) at the time of surgery. None of the patients had neurological deficits. The mean preoperative visual analogue scale was 8.7 (range 3-9), and the average preoperative Oswestry Disability Index was 46.5 (range 40-56). RESULTS: The average duration of postoperative follow-up was 36.1 ± 10.7 months (range 24-62 months). The number of vertebra resected was 1.3 (range 1-2) on average. There were ten patients with one-level osteotomy and five patients with two-level osteotomy. The average operation time was 446.0 ± 92.5 min (range 300-640 min) with an average blood loss of 1,653.3 ± 777.9 ml (range 800-3000 ml). The focal kyphosis before surgery averaged 92.3 ± 8.9° (range 74-105°), and the kyphotic angle decreased to 34.5 ± 8.7° on average after the surgical correction. The average kyphotic angle at the last follow-up was 36.9 ± 8.5°, loss of correction was 2.4 ± 1.4° on average. All patients postoperatively received bony fusion within 6-9 months. CONCLUSIONS: Our results showed that although posterior vertebral resection is a highly technical procedure, it can be used safely and effectively in the management of severe posttuberculous kyphosis. It is imperative that operations be performed by an experienced surgical team to prevent operation-related complications.


Assuntos
Cifose/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Osteotomia , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
15.
Arch Orthop Trauma Surg ; 133(3): 333-41, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23242452

RESUMO

PURPOSE: The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time. METHODS: Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B. RESULTS: The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients. CONCLUSIONS: Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/instrumentação , Tuberculose da Coluna Vertebral/cirurgia , Adolescente , Adulto , Criança , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Ethn Dis ; 22(1): 38-44, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22774307

RESUMO

OBJECTIVES: We explored whether ethnic differences in type 2 diabetes (T2D) explain ethnic disparities in cognitive impairment. DESIGN: Longitudinal study. SETTING: A cohort study of multiethnic community-dwelling elderly persons in Northern Manhattan, New York. PARTICIPANTS: 941 participants aged > or =65 years without prevalent cognitive impairment or dementia (CID) were followed for a median of 7.1 years. MAIN OUTCOMES MEASURES: CID was defined by a clinical dementia rating > or = .5. CID risk attributable to T2D was estimated for each ethnic group using the hazard ratio (HR) relating T2D and CID and the ethnic prevalence of T2D. RESULTS: 448 participants developed CID; 69 (31.4%) non-Hispanic whites (whites); 152 (48.6%) non-Hispanic-blacks (blacks); 227 (55.6%) Hispanics, P < .001. T2D prevalence was 8.2% in Whites, 20.1% in blacks, and 19.6% in Hispanics, P < .001. Controlling for age, sex, education, and APOE E4, the HR relating T2D and CID was 1.63 (95% CI 1.26, 2.09). CID attributable to T2D was higher in blacks and Hispanics compared to Whites (11.4% vs. 4.9%; P = .06). We estimated that reducing the ethnic disparities in diabetes prevalence could reduce the CID ethnic disparities by 17%. CONCLUSIONS: Reducing ethnic differences in T2D prevalence could partially reduce ethnic differences in incident CID.


Assuntos
Transtornos Cognitivos/etnologia , Diabetes Mellitus Tipo 2/etnologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Apolipoproteínas E/genética , Distribuição de Qui-Quadrado , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/genética , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Genótipo , Humanos , Incidência , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , New York/epidemiologia , Prevalência , Estatísticas não Paramétricas
17.
Ying Yong Sheng Tai Xue Bao ; 23(3): 710-6, 2012 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-22720615

RESUMO

Taking the salt-tolerant cotton variety CCRI-44 and salt-sensitive cotton variety Sumian 12 as test materials, a two-year pot experiment was conducted at the Pailou experimental station of Nanjing Agricultural University in 2008 and 2009 to study the relationships of soil electrical conductivity (EC) with the spectral reflectance and hyperspectral indices of cotton functional leaves at different growth stages under five simulated salinity levels (0, 0.35%, 0.60%, 0.85%, and 1.00%) of coastal saline soils, and the quantitative monitoring models on the cotton soil EC were established. With increasing salinity level, the cotton functional leaves had an increased spectral reflectance in near-infrared and middle-infrared regions, and the spectral parameter normalized difference spectrum index (NDSI) based on 1350 nm and 2307 nm, i. e., NDSI (R1350, R2307), correlated well to the soil EC. With the NDSI (R1350, R2307) as independent variable, the soil EC monitoring model was constructed as EC = -42.899 NDSI (R1350, R2307) +27.338. Among the derivative spectral parameters, TM5-SWIR was most correlated to soil EC, and thus, the soil EC monitoring model was constructed as EC = 0.0574TM5-SWIR2-2.5928TM5 -SWIR+30.021. The two models with NDSI (R1350, R2307) and TM5-SWIR as the independent variables respectively all had higher prediction precision, with the determination coefficient being 0. 887 and 0. 814 and the root mean square error being 1.09 and 1.29 dS x m(-1), respectively, suggesting that using the hyperspectral parameters NDSI (R1350, R2307) and TM5-SWIR of cotton functional leaves could effectively monitor the soil EC of saline cotton fields.


Assuntos
Ecossistema , Gossypium/fisiologia , Folhas de Planta/química , Plantas Tolerantes a Sal/fisiologia , Solo/química , Simulação por Computador , Condutividade Elétrica , Gossypium/crescimento & desenvolvimento , Salinidade , Solo/análise , Análise Espectral
18.
Arch Orthop Trauma Surg ; 132(9): 1273-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22622797

RESUMO

PURPOSE: Various surgical methods have been described for the management of lumbar tuberculous spondylitis in the literature. However, there were few reports on the two-stage surgical treatment of lumbar tuberculosis in children of elementary school age. We present a retrospective clinical study of 14 patients with lumbar and lumbosacral tuberculous spondylitis treated by two-stage surgery (first stage: posterior instrumentation; second stage: anterior debridement and allografting). The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis in children. METHOD: Our series was comprised 9 males and 5 females with an average age of 7.5 years treated with the above-mentioned surgical procedure. All patients had lumbar and lumbosacral involvement with one patient having spondylitis at L2-3, three at L3-4, seven at L4-5, and three at L5-S1. All patients had single motion segment involvement. The Frankel scoring system was used to assess the neurological deficits. Frankel's grade B in two patients, grade C in four and grade D in eight. The following data were followed-up for an average period of 50.1 months (42-64 months) in these patients: healing of disease, deformity correction and its maintenance, neurologic function, and spinal bony fusion. RESULTS: The average preoperative local deformity angle was -13.8°, correcting to 3.4° postoperatively and 1.5° at the final follow-up. With the exception of one patient who received a D at the final follow-up, all cases obtained complete neurological recovery. No breakage and looseness of internal fixation was found. Bony fusion was achieved in all cases within 6 months postoperatively. There was no recurrent tuberculous infection. CONCLUSION: Two-stage (posterior and anterior) surgery is a safe and effective procedure for the patient of elementary school age suffering from lumbar and lumbosacral tuberculous spondylitis, especially for the patients in poor general condition. The procedure has the advantage of minor surgical invasion, effective kyphosis correction and less complications.


Assuntos
Vértebras Lombares , Sacro , Tuberculose da Coluna Vertebral/cirurgia , Transplante Ósseo , Criança , Pré-Escolar , Desbridamento , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Transplante Homólogo
19.
Arch Orthop Trauma Surg ; 132(6): 751-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22350053

RESUMO

PURPOSE: Multilevel noncontiguous thoracic spinal tuberculosis has rarely been reported in the literature. We present a retrospective clinical study of 14 patients with multilevel noncontiguous thoracic spinal tuberculosis treated by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF) and determine the clinical effectiveness of such surgical treatment for MNTST. METHODS: Fourteen patients with multilevel noncontiguous thoracic spinal tuberculosis were treated with modified TTIF. The mean follow-up was 27.36 ± 10.46 months (range 13-42 months). The kyphotic angle ranged from -2° to 47° before operation, with an average of 19.21° ± 12.63°. The erythrocyte sedimentation rate (ESR) of patients upon admission ranged from 30 to 62 mm/h before operation, with an average of 46.43 ± 10.77 mm/h. The Frankel Grade was used to evaluate the neurological deficits. RESULTS: The average ESR got normal (8.14 ± 5.89 mm/h) within 3 months in all patients. The average kyphotic angle decreased to 8.07° ± 6.91° postoperatively. Mean deformity angle was measured as 8.79° ± 7.29° at the last visit. Solid fusion was achieved in all cases. Neurologic status of the 12 patients with preoperative neurologic deficit was 6 with grade D recovered to normal; 2 with grade B, both of them to grade D; 4 with grade C, 2 to grade D, 1 to grade E, and 1 still in grade C. CONCLUSIONS: Modified TTIF can be an effective treatment method of multilevel noncontiguous thoracic spinal tuberculosis.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Vértebras Torácicas/cirurgia , Tuberculose da Coluna Vertebral/cirurgia , Adulto , Idoso , Antituberculosos/uso terapêutico , Diagnóstico por Imagem , Feminino , Humanos , Fixadores Internos , Masculino , Pessoa de Meia-Idade , Paraplegia/etiologia , Paraplegia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento , Tuberculose da Coluna Vertebral/tratamento farmacológico
20.
Ying Yong Sheng Tai Xue Bao ; 22(7): 1771-81, 2011 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-22007454

RESUMO

A two-year (2007-2008) pot experiment with cotton varieties Sumian 12 (salinity-sensitive) and Zhongmiansuo 44 (salinity-tolerance) was conducted at the Pailou experimental station of Nanjing Agricultural University to study the diurnal variation of the gas exchange and chlorophyll fluorescence parameters of cotton functional leaves under five levels (0, 0.35%, 0.60% , 0.85%, and 1.00%) of soil salinity. With the increase of soil salinity, the concentrations of Na+, Cl-, and Mg2+ in functional leaves increased, whereas the concentrations of K+ and Ca2+ decreased. The salinity level <0. 35% had little effects on the gas exchange and chlorophyll fluorescence parameters, but that >0.35% depressed the net photosynthetic rate (Pn) dramatically. At the salinity level >0.35%, the sensitivity of functional leaves to daytime photon flux density (PFD) and air temperature (Ta) enhanced, which in turn resulted in more severe photo- and temperature inhibition, and changed the diurnal variation patterns of Pn and stomatal conductance (Gs) from a one-peak curve to a constantly decreasing one. Along with the variations of daytime PED and Ta, the diurnal variation patterns of the maximum photochemical efficiency (F(v)/F(m)), quantum yield of electron transport (phi(PS II), and photochemical quenching coefficient (q(P)) of functional leaves presented a V-shaped curve, with the minimum value appeared at 12:00-13:00, while the non-photochemical quenching coefficient (q(N)) showed a single-peak curve. Soil salinity decreased the F(v)/F(m), phi(PS II), and q(P) significantly, but increased the q(N) and enlarged its change trend. The comparatively low concentrations of Na+ and Cl- and the relatively high concentrations of K+ and Ca2+ in salt-tolerant Zhongmiansuo 44 functional leaves benefited the relative stability of PS II, and the maintenance of a relatively high thermal dissipation capacity could be one of the reasons for a high level of Pn at high salinity level.


Assuntos
Dióxido de Carbono/metabolismo , Gossypium/fisiologia , Fotossíntese/fisiologia , Salinidade , Solo/química , Clorofila/metabolismo , Ritmo Circadiano , Fluorescência , Gossypium/classificação , Gossypium/metabolismo , Folhas de Planta/metabolismo , Folhas de Planta/fisiologia
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