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Antibiotic resistance genes (ARGs) are emerging micropollutants with environmental persistence. Aquaculture environments are considered as potential reservoirs for ARGs pollution and horizontal gene transfer (HGT). This study analyzed water and sediment from eight culture ponds (integrated culture: duck-fish pond; monoculture: duck pond and fish pond) and a control pond (without any aquaculture activity) in Zhongshan, South China. Seventeen types of ARGs were detected in all ponds, which conferring resistance to four classes of antibiotics including tetracycline ( tet A, tet B, tet C, tet E, tet G, tet L, tet A-P, tet M, tet O, tet S, tet W and tet X), AmpC beta-lactamase products ( EBC and FOX ), sulfonamide ( sul 1 and sul 2) and erythromycin ( erm A), with class 1 integron ( intI 1) as motility gene. The total concentrations of detected ARGs in culture pond water were much higher than control (about 1.6–4.0 times). Integrated culture showed lowest absolute abundance of ∑ARGs in water (3.686 × 10 7 copies mL −1 ) and the highest in sediment (4.574 × 10 8 copies g −1 ). Monoculture ponds showed higher relative abundance of ∑ARGs both in water (fish pond: 0.5149) and sediment (duck pond: 0.4919). As the main contributor to the ARGs abundance and significant correlations with ∑ tet , ∑ARGs and intI 1 ( P tet A was suggested to be a potential indicator for the abundance of tetracycline resistance genes in these classes of aquaculture modes in the Pearl River Delta. This study provides a case for the ARGs abundance in aquaculture and as a reference for the upcoming health risk assessment in aquatic environment.

Purpose To evaluate the association of single-nucleotide polymorphisms (SNPs) in the SIX1-SIX6 locus with primary open-angle glaucoma (POAG) through a systematic review and meta-analysis from 22 studies. Methods To our knowledge, all case-control association studies on SNPs in the SIX1-SIX6 locus and POAG reported up to August 30, 2018, in PubMed, Embase, and Web of Science were retrieved. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for each SNP were calculated using a fixed- or random-effect model according to interstudy heterogeneity. Results This meta-analysis involved 12 SNPs in SIX1-SIX6 reported in 22 studies. The association of rs10483727 with POAG has been presented in 16 studies involving 14,402 patients and 27,425 controls, whereas rs33912345 has been investigated in 12 studies involving 10,563 patients and 16,740 controls. Meta-analyses revealed significant associations of these two SNPs with POAG in the pooled populations under all genetic models. Stratified analyses by population detected significant association of both SNPs in the East Asian and Caucasian subgroups, but not in South Asian or African subgroups. Among the other SNPs that were reported by up to four cohorts of East Asian and African ancestries, only rs12436579 showed a significant association in the meta-analysis (OR = 0.79, P = 1.08 × 10-4). Conclusions This meta-analysis confirmed the association of rs10483727 and rs33912345 in SIX1-SIX6 with POAG. The associations of both SNPs were specifically detected in East Asian and Caucasian cohorts, rather than in South Asian and African cohorts, suggesting an ethnic difference. SNP rs12436579 is a candidate variant for the disease that awaits validation in other populations.

This study aimed to investigate the hypoglycemic and hypolipidemic activities of polysaccharides from Grifola frondosa (GFP) in diabetic mice induced by high-fat diet (HFD) and streptozotocin (STZ). Results showed that oral administration of GFP markedly reduced the serum levels of fasting blood glucose (FBG), oral glucose tolerance (OGT), cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), and significantly decreased the hepatic levels of TC, TG and free fatty acids (FFA). Meanwhile, high-dose of GFP supplementation (900 mg/kg day) also showed powerful effects on moderating the composition of intestinal microflora in diabetic mice, especially altering the functionally relevant intestinal microbial phylotypes. Spearman’s correlation network analysis revealed that key microbial phylotypes responding to GFP intervention were strongly correlated with the glucose and lipid metabolic disorders associated parameters. Moreover, GFP treatment regulated mRNA expression levels of the genes responsible for hepatic glucose and lipid metabolism. It is noteworthy that GFP treatment markedly increased mRNA expression of cholesterol 7α-hydroxylase (CYP7A1) and bile salt export pump (BSEP), suggesting an enhancement of bile acids (BAs) synthesis and excretion in liver. These findings demonstrated that GFP could prevent hyperglycemia and hyperlipidemia in diabetic mice by altering gut microbiota and regulating hepatic glycolipid metabolism related genes, and therefore could be used as potential functional food ingredients for the prevention or treatment of hyperglycemia and hyperlipidemia.

The main research in this paper is an ultra-wideband (UWB) three-dimensional (3D) circular antenna array and we highlight the importance of elevation angles and their influence of the system performance. The 3D channel is calculated by 3D shooting and bouncing ray/image techniques which specify multipath elevation angles and azimuth for horizontal plane angles. The capacities of the two-dimensional (2D) and three-dimensional transmitting antenna arrays have been presented. Beam-synthesizing techniques are used at the transmitter to focus the transmitter energy for reducing the multi-path effect and increasing channel capacity. Asynchronous Particle Swarm Optimization (APSO) methods are used to adjust the length of the feed line on each array element for maximizing the capacity. The higher directive gain obtained from the 3D antenna arrays results in high channel capacity compared to 2D azimuth-only antenna arrays. It is found the capacity for the 3D array increases more than 10% compared to that for the 2D array. Our research not only provides qualitative results, but also provides quantitative results.

BACKGROUND AND AIMS: Making an optimal and lasting submucosal cushion is critical for endoscopic submucosal dissection. The thermo-sensitive binary hydrogels system composed of poloxamer 407 and poloxamer 188 might be an excellent submucosal injection solution considering the unique feature that it remains liquid at room temperature and becomes gelatinous after being injected in the submucosa of the digestive tract. The present study focuses on preparing the thermo-sensitive binary hydrogels system and testing its capacity in mucosal lifting and its role in the endoscopic submucosal dissection procedure. METHODS: Various concentrations of poloxamer 407 and poloxamer 188 were added to normal saline. The gelation temperature viscosity of the thermo-sensitive binary hydrogels system was measured to choose the best formula. The thermo-sensitive binary hydrogels system and normal saline were first compared in extracted porcine stomach. For in vivo study, the thermo-sensitive binary hydrogels system and normal saline were compared for facilitating the endoscopic submucosal dissection procedure. RESULTS: Among the 46 kinds of thermo-sensitive binary hydrogels system, gelation temperatures of the thermo-sensitive binary hydrogels system I (poloxamer 407/poloxamer 188, 17%/0.5%, w/w) and the thermo-sensitive binary hydrogels system II (poloxamer 407/poloxamer 188, 18%/2%, w/w) were among the ideal range of gelation temperature. The injecting pressure in vitro study of thermo-sensitive binary hydrogels system II was significantly higher than that of thermo-sensitive binary hydrogels system I and normal saline (p

A derivative of 2-phenylpyridine (Hppy), 5-nitro-2-(3′,5′-di(trifluoromethyl)phenyl)pyridine (HL), is prepared. The L-containing cyclometalated iridium(III) complexes with mono- and bidentate ancillary ligands, [Ir(L)2(PPh3)Cl] (1) and [Ir(L)2(pic)] (2, pic = picolinic acid), are synthesized and characterized. The photoluminescence (PL) spectra of 1 and 2 in CH2Cl2 solutions show emission maxima at 558 and 560 nm, corresponding to yellow light emission with the Commission Internationale de L’eclairage (CIE) coordinates of (0.45, 0.54) and (0.46, 0.52), respectively. However, the luminescence intensity of 2 with PL quantum yield of 0.71 is obviously stronger that of 1 with PLQY of 0.19. The two-band white PL properties of 2 and [Ir(dfppy)2(PPh3)(NCS)] (3, dfppy = 2-(4,6-difluorophenyl)pyridine) with efficient blue light emission are investigated. The CH2Cl2 solutions of 2 and 3 in the molar ratio of 1 : 5 show white light emission with the CIE coordinates of (0.33, 0.41).

The objective of this study is to evaluate the feasibility and efficacy of endoscopic full-thickness resection (EFTR) and fully covered retrievable self-expandable metal stents (SEMSs) placement for this kind of tumors.A total of six consecutive patients, presenting with esophageal and GE junction SMTs, received EFTR and SEMSs placement at the our endoscopic center between January 2015 and June 2015. Their medical records were thoroughly investigated.EFTR was performed successfully in all cases. The en bloc resection rate was 100%. The final pathological diagnoses were leiomyomas in all six cases. No patients developed delayed bleeding. SEMSs were placed immediately after EFTR during the same endoscopic session except patient #1. Complete healing of esophageal leakage after stent placement was achieved for 6/6 patients (100%) without the need for surgical interventions. Stent migration occurred in one patient. No residual tumor or tumor recurrence was observed during the follow-up period.EFTR combined with fully covered retrievable self-expandable metallic stents placement is a feasible and effective new method for providing radical treatments for SMTs from the deep MP layer of esophagus and GE junction. Standardization of the procedure should be studied further.

Gastric schwannoma is not so recognized by clinicians as its counterparts. The efficacy of endoscopic resection has not been described yet. Our aim was to assess the efficacy and safety of endoscopic resection in the management of gastric schwannoma. Retrospective data were reviewed from January 2008 to December 2013 in our center. Fourteen patients who had endoscopic resection with the final pathology result of gastric schwannoma were included in the study. Of the 14 patients, there were 12 females and two males. The median age was 59 years (range 32–83). Thirteen tumors (92.9 %) were from the muscularis propria and one located in the submucosa. Endoscopic en bloc resection was achieved in 12 patients (12/14, 85.7 %), including seven cases of endoscopic full-thickness resection (EFTR). The mean resected tumor size was 1.73 ± 1.10 cm (range 0.3–4.0 cm). In one case, endoscopic resection was suspended due to the limited experience of EFTR during the early period of the study. In another case, due to the difficult tumor location (gastric angle) and extraluminal growth pattern, the patient was referred to laparoscopic surgery. In the 12 successful endoscopic resection cases, during the median follow-up time of 4 years (range 17–77 months, one patient lost), no tumor residue, recurrence or metastasis was found. Endoscopic resection is safe and effective in treating gastric schwannoma with excellent long-term outcomes. However, it should be performed with caution because schwannoma is mainly located in the deep muscular layer, which leads to the full-thickness resection of gastric wall.

A series of cyclometalated Ir(III) complexes [Ir(dFNppy)2(PPh3)L] (PPh3 = triphenylphosphine, L = Cl−, 1; NCS−, 2; NCO−, 3; N3−, 4) in which 5-nitro-2-(2′,4′-difluorophenyl)pyridyl (dFNppy) is used as the main ligand are synthesized and characterized. The crystal structures of 3 and 4 are determined by X-ray diffraction analyses. Photoluminescence spectra of 1–4 in CH2Cl2 solutions at room temperature show the maximum emission wavelengths (λmax) in the range from 586 to 627 nm, corresponding to red-orange luminescence. HOMO–LUMO energy levels of 1–4 are estimated by cyclic voltammetry measurements. Compared with corresponding 2-phenylpyridyl (ppy)-containing Ir(III) complexes having same ancillary ligands, 1–4 have obviously smaller HOMO–LUMO energy gaps (Eg). Simultaneously, 1–4 show relatively bigger Eg compared with 2-phenyl-5-nitropyridyl (5-NO2-ppy)-containing Ir(III) complexes possessing same ancillary ligands. Methods of Eg adjustment are also discussed.

The endoscopic resection of gastrointestinal mesenchymal tumors (GIMTs) is widely accepted because of its minimal invasiveness. However, one major concern is the high rate of positive microscopic margins remaining following endoscopic resection, which was thought to be related to a higher risk of recurrence. This study aimed to determine whether positive margins affect the recurrence rate of gastric GIMTs and the factors associated with positive margins. Patients with gastric GIMTs were recruited retrospectively from January 2008 to December 2013. Clinical and pathological features, endoscopic procedure information, and follow-up data were collected and analyzed. The study included 777 patients. All tumors were removed along with the pseudocapsule without macroscopic residual (ER0), and the median tumor size was 15.2 mm (range 3–100 mm). Pathological evaluation revealed 371(47.7%) GISTs. The rate of microscopic R1 resection rate was 47.0% (443/777). In a stepwise multivariate analysis, a significantly increased incidence of R1 resection was recorded for the GISTs (OR 11.13, 95% CI 3.00–41.37). In a subgroup analysis of GISTs, a univariate analysis revealed that EFTR achieved a higher rate of R0 resection (OR 0.56, 95% CI 0.31–1.00), but it was proven insignificant in a stepwise multivariate analysis. Local recurrence occurred in two patients (0.3%) during a mean follow-up time of 34.2 months. Differences in the recurrence rates between the R0 and R1 groups were statistically insignificant (P = 0.841). R1 resection for gastric GIMTs is not related to a higher recurrence rate than R0 resection, and ER0 resection is sufficient for gastric GIMTs.

The objective of this study was to explore the core functional microbiota for the production of volatile flavour during the traditional brewing of Wuyi Hong Qu glutinous rice wine, one of the most typical representatives of rice wine in China. Microbiological analysis based on high-throughput sequencing (HTS) technology demonstrated that bacteria of Lactobacillus, Bacillus, Leuconostoc, Lactococcus, Raoultella, Staphylococcus, Pediococcus, and Weissella, and fungi of Saccharomyces, Saccharomycopsis, Rhizopus, Monascus, Pichia, Wickerhamomyces, Candida, and Aspergillus were the predominant genera during the traditional fermentation process. Principal component analysis (PCA) based on the relative abundance showed that both of bacterial and fungal communities varied significantly in different fermentation phases. Some predominant microbial species or genera (including bacteria of Bacillus spp., Staphylococcus spp., Weissella spp., and P. acidilactici, and fungi of M. purpureus, R. oryzae, R. arrhizus var. arrhizus, and A. niger) were detected at the initial brewing stage, and their populations decreased as the fermentation progressed, while those of Lactobacillus, Gluconacetobacter, Leuconostoc, Pichia, Wickerhamomyces, and Saccharomyces increased to become the predominant genera at the final stage. A total of 79 volatile compounds were identified in traditional fermentation starters and during the traditional brewing process, mainly including esters, alcohols, acids, aldehydes, ketones, and phenols. Heatmaps and PCA also revealed the significant variances in the composition of volatile compounds among different samples. Furthermore, the potential correlations between microbiota succession and volatile flavour dynamics were explored through bidirectional orthogonal partial least squares (O2PLS) based correlation analysis. Three bacterial genera, namely, Gluconacetobacter, Lactobacillus, Lactococcus, and three fungal genera of Pichia, Wickerhamomyces, and Saccharomyces, were determined as the core functional microbiota for production of main volatile compounds in Wuyi Hong Qu glutinous rice wine. To conclude, information provided by this study is valuable to the development of effective strategies for the selection of beneficial bacterial and fungal strains to improve the quality of Wuyi Hong Qu glutinous rice wine.

Binary pollution of both heavy metals and antibiotics has received increasing attentions for their joint effects of eco-toxicity and health hazards. To reveal the effects of mixtures of different pollutants on bacterial antioxidant response system, Pseudomonas fluorescens ZY2, a new strain isolated from swine wastewater, was chosen to determinate growth (bacterial density OD600), reactive oxygen species (ROS) concentration, protein concentration and superoxide dismutase (SOD) activity under exposure treatments of Zn, Cefradine or Zn + Cefradine. Bacterial densities of all the treatment groups increased significantly over the incubation time, but those containing pollutant addition were slightly lower than the control at different times of incubation. Both ROS concentration and SOD activity increased first and then decreased (p < 0.01) over time, which was opposite to the protein concentrations (p < 0.01), showing a much significant increase by Cefradine alone. With Zn concentration increasing from 40 to 160 mg/L, the intracellular SOD activity increased as a response to the improvement of ROS (p < 0.05), while the balance between ROS and SOD was broken down due to the disproportionate change of total SOD activity and ROS concentration, the bacterial densities therefore decreased for the weak resistance. With the combined treatment of Zn (200 mg/L) and Cefradine (1 mg/L), though the toxicity of Zn caused a much significant increase of ROS, the bacterial resistance was further improved showing a more significant increase of total SOD activity and the bacterial densities therefore increased bacterial growth. Zn concentration also affected the protein synthesis. Either single or binary stress induced the bacterial resistance by regulating SOD activity to eliminate ROS. All results of the bacterial oxidant stress, SOD response and protein synthesis in the combined treatment groups were more complicated than those in single treatment groups, which depended on the properties of the single treatment as well as the interaction between the two treatments upon bacterial activity. For P. fluorescens ZY2, the mediation of SOD activity to eliminate ROS in response to the combined exposure to Zn and Cefradine was first revealed as one of the co-resistance mechanisms, which is informative to further understanding the risk of antibiotics resistant bacteria to human and environmental health more accurately.

Land use change ,which has a great influence on the ecological balance, is one of the major driving force in the evolution of regional ecological system. With coal mining and land reclamation for years , Peixian county’s land structure has been changed, which has a big impact on the ecological environment.Based on TM/ETM imagery interpretation data in 1988-2014, with the aid of remote sensing and GIS method, analysis of Peixian county nearly 26 a mining area land use change, and combining the mine actual situation, fix the corresponding ecological service value, calculate the regional ecological service value and its changing trends.

Various modifications have been tested to prevent kyphosis after Bryan cervical disc arthroplasty (CDA). However, the migration of Bryan prostheses has not been systematically studied. This study investigated the cause of anterior migration (AM) and assessed the effect of AM on clinical and radiographic outcomes.We retrospectively reviewed 46 consecutive patients who underwent modified Bryan CDA between August 2006 and December 2010. We measured functional spinal unit, angle of operative disc space, range of motion, and sagittal alignment of cervical spine preoperatively, postoperatively, and at the final follow-up, and compared these values between the AM and non-AM groups. Clinical outcome was evaluated by scores for Japanese Orthopaedic Association, Neck Disability Index, and visual analog scale.AM occurred in 9/46 (19.6%) patients. Clinical outcomes in both groups were significantly improved compared with the preoperative scores (P0.05). However, the postoperative and final follow-up angle of operative disc space was more lordotic and the postoperative functional spinal unit significantly higher in patients in the AM group compared with the non-AM group (P0.05). At the final follow-up, patients with AM had significantly higher Neck Disability Index and neck visual analog scale scores (P0.05), partially restricted range of motion (4.9° vs. 7.4°; P0.05), and adjacent segment degeneration at 6 vertebral levels (46.2%).The intermediate clinical outcomes for patients treated with modified Bryan CDA were satisfactory; however, overcorrection of segmental lordosis may lead to AM of the prosthesis, which could restrict patient range of motion and cause postoperative neck pain.

This study investigates the characteristics of core adsorption material (CAM) prepared from corn stalks core (Core) by glycol solvent treatment (high pressure boiling at 120 °C for 30 min using a 50:3 liquor/solid ratio with 2%, w/w sodium hydroxide). The structures of CAM and Core were compared by FT-IR, SEM and XRD. Maltogenic amylase from Aspergillus awamori var., neutral proteins from Source Organism and lipase from Pseudomonas aeruginosa were selected as model enzymes in order to assess their potential applicability for enzyme immobilization. Adsorption characteristics for the different enzymes on CAM were studied and the activity of the immobilized enzymes was evaluated. The results show that CAM has many hydroxyl groups, more flakes, irregular indentations and grooves and a proportionally larger amount of hemi-cellulose than Core, which results in increased numbers of hydroxyl groups in CAM and increased enzyme accessibility into CAM; CAM has the greatest adsorption capacity (9.84 ± 0.32 mg/g) for neutral proteins and the best relative activity (total relative activity of 212.6% after being reused three times) after being immobilized, as well as the lowest adsorption capacity (5.15 ± 0.51 mg/g) for lipase and the lowest relative activity (total relative activity is 78.23%). The isotherms of maltogenic amylase and neutral proteinase were found to be linear using the Langmuir equation (R2 = 0.9974 and 0.9966, respectively, p

Considering the involving stakeholders in public rental housing construction under the CCIT model, which is the basics of constructing the financial structure and analysing the main body involved in the risk, and then construct the assessment system. This paper proposes a model based on the analytic hierarchy process (AHP) and grey clustering risk assessment method. Firstly by analyzing the clustering index in the financing mode of risk subject, we can quantify the weight of indicators of every layers, and then using the gray clustering to get clustering analysis, drawing the value at risk ,finally , this article quantitatively analyses the CCIT mode in public rental housing construction in the use of the degree of risk..

A novel long-term information feature for language identification called shifted cepstra curve (SCC) is presented in this paper. Long-term information consists of information over multiple frames, which are commonly used in language identification systems. For instance, in parallel phone recognition language model (PPRLM), the feature vector contains not only information surpassing multiple frames but also linguistic knowledge [1]. However high computational cost for modeling linguistic gram may preclude their use in tasks which demand low memory. By contrast, experiments have proved that linguistics independent long-term information can also achieve high performance in language identification with much lower computing cost. For instance, Shifted delta cepstra (SDC) is employed as long-term information features to establish GMM based language identification systems, which can achieve comparative or even superior performance to PPRLM [2-4]. While, though SDC feature could model the dynamical information across multiple frames, the approximation is not precise enough for language identification. Thus, this paper further presents a new method for linguistics independent long-term information extraction by curve fitting algorithm. Experiments show that new feature based language identification systems are superior to not only short-term features based but also SDC features based systems.

We have studied the structures and electronic properties of PdCn (n=2-12) using the density functional theory in this paper. Though calculating, we found that the linear isomers are most stable for PdCn(n=2-9) clusters. N=10 is turning point, and the bicyclical structure is most stable for PdC10 cluster. Cyclic structures have the lowest energy for PdC11 and PdC12 clusters.

Bryan cervical disc arthroplasty has been reported with satisfactory short- and medium-term clinical results. However, the long-term clinical and radiographic outcomes are seldom reported. The purpose of this study was to compare the eight-year follow-up results in patients who underwent Bryan disc arthroplasty with patients received ACDF, and assess the incidence of heterotopic ossification (HO) and its effect on clinical outcome and mobility of the device. Thirty-one patients underwent Bryan disc arthroplasty, and 35 patients underwent ACDF were included in the study. The Japanese Orthopedic Association (JOA) scores, neck disability index (NDI), visual analogue scale (VAS) of neck and arm pain, and the radiographs were used to evaluate the outcomes. The heterotopic ossification (HO) was determined by CT scan and was classified into three subgroups to compare the related effect. Adjacent segment degeneration (ASD) was also observed. At final follow-up, there were no significant differences in JOA scores between two groups, but the improvement in NDI and neck or arm VAS were significantly greater in the Bryan disc cohort. The range of motion at the index level was 7.0° in Bryan group, while 100 % bone fusion were achieved in ACDF group. HO was observed in 18 (51.4 %) levels. There were more restricted movement of the prosthesis and slight higher rate of axial pain in patients with severe-HO (grade III and IV). Fourteen (28.6 %) levels developed ASD in Bryan group, which was significantly lower than that (58.6 %) in ACDF group. At eight year follow-up, the clinical and radiographic outcomes of Bryan cervical disc arthroplasty compared favorably to those of ACDF. It avoided accelerated adjacent segment degeneration by preserving motion. However, severe HO restricted the ROM of the index levels and maybe associated with post-operative axial pain.

Aim This study assessed the clinical significance of incidental colorectal 2-fluoro-2-deoxyglucose (FDG) uptake using 18F-FDG positron emission tomography/computed tomography (PET/CT) scans and evaluated the importance of colonoscopy when incidental colorectal FDG uptake was observed. Method A prospective study was designed and conducted at a single institution over a 2-year period. In patients undergoing PET/CT scans, all with FDG uptake in the colorectum were assigned to have colonoscopy and biopsy. The value of PET/CT scanning was studied by comparison with the colonoscopy and biopsy results. Results Among 10 978 PET/CT scans, one or more focal uptakes of FDG in the colorectum were observed in 148 (1.35%) patients. In 136 valid patients, malignant colorectal tumours and polyps were found in 23.5% and 20.5%, respectively,, while the colon in the other 56% was normal. A higher false-positive rate was found in the right colon compared with the distal colorectum (66.2%vs 36.7%, P = 0.004). A significant increase of the maximum standardized uptake (SUVmax) value was found among normal, polyps and cancer groups. Multivariate analysis revealed that SUVmax was the risk factor for predicting colorectal cancer or polyps and FDG uptake in the right colon was a negative predictive factor for finding cancers or polyps. Conclusions Our study proves the necessity of colonoscopy when incidental FDG uptake is found on PET/CT imaging. The false-positive FDG uptake is more commonly observed in the right colon. Although the SUVmax value is higher in cancer patients, a high SUVmax value does not necessarily result in malignancies.

Kyphosis may occur after arthroplasty as the result of the disc insertion angle and overmilling; however, few studies have described techniques to avoid these factors. We investigated whether modified techniques of Bryan cervical disc arthroplasty can prevent adverse outcomes. Twenty patients (control group) underwent surgery using techniques described in the Bryan disc product monograph (Medtronic Sofamor Danek, Minneapolis, MN, USA). Twenty-nine patients (investigation group) underwent surgery using a modified technique which included changes in disc insertion angle, reducing overmilling of the endplates, ensuring the anterior borders of the two halves of the prosthesis were at the same horizontal line, and accurately fitting the prosthesis. Disability and pain were assessed using self-administered questionnaires and the change in functional spinal unit (FSU) angle between the two groups was also compared. Both groups demonstrated statistically significant improvement compared with preoperative values for the following functional outcomes measures. The mean neck pain Visual Analog Scale (VAS) scores before surgery were 73.45 (control) and 74.53 (investigation); at the 2-year follow-up these scores were 22.1 and 14.79 (p = 0.0013), respectively. After surgery, 14 of 20 patients in the control group developed a tendency toward kyphosis of the FSU in the neutral position (range = –9°–13°, mean = –1.1 °± 5.05). Conversely, none of the 29 patients in the investigation group developed kyphosis of the FSU in the neutral position (range = 0–10°, mean = 3.79° ± 2.90) (p = 0.0007). There was no statistically significant difference between the groups regarding preoperative and postoperative scores with the exception of neck pain VAS and FSU angle changes. There were no intraoperative complications, vascular or neurologic complications, spontaneous fusions, or device failures or explantations.

Patients with os odontoideum always present instability in atlantoaxial joint and need atlantoaxial fixation. C2 pedicle or laminar screws fixation has proven to be efficient and reliable for atlantoaxial instability. However, os odontoideum is a congenital or developmental disease, featured with anomalous bony anatomies. The anatomic measurements and guidelines for C2 pedicle screw placement in general population tends to differ with those of os odontoideum patients, for whom C2 pedicle screws are often needed. The option and techniques of C2 fixation are still challenging and yet to be fully explored.We recruited 29 adult patients with os odontoideum and measured the dimension of C2 pedicle and lamina for each patient to examine how well do they match with the screws anatomically. In order to access the intra-observer reliability and inter-observer repeatability of the measurements, the intraclass correlation coefficient (ICC) was also calculated.The results for reliability of the CT measurements showed excellent intraobserver (ICC = 0.95 and 0.96) and interobserver correlation coefficient (ICC = 0.93). The diameter and length of C2 pedicle were found to be 6.06 ± 1.37 and 24.05 ± 2.54 mm, while the corresponding figures of C2 laminar were 6.95 ± 0.82 and 25.60 ± 2.18 mm, respectively. In the measurements, all 29 cases had suitable diameter (larger than 5.5 mm) for C2 laminar screw (the laminar diameters ranged from 5.52 to 8.82 mm). In C2 pedicle measurements, the diameters of the 29 cases were from 3.50 to 9.86 mm, while 20 pedicles (34.5%) in 14 cases were less than 5.5 mm in diameter. Six had bilateral small pedicles where the diameter was less than 5.5 mm.Anatomically, we found laminar screw is a better match in comparison with pedicle screw for C2 fixation in os odontoideum. The options for C2 fixation should be made based on careful preoperative imaging and thorough consideration. Preoperative reconstructive CT scan can offer great assistance for the choice of fixation in os odontoideum by revealing the anatomy of the C2 pedicles in detail.

ObjectThe aim of this study was to investigate the clinical significance of both the signal intensity ratio obtained from MR imaging and clinical manifestations on the prognosis of patients with cervical ossification of the posterior longitudinal ligament.MethodsThe authors retrospectively reviewed the records of 58 patients with cervical ossification of the posterior longitudinal ligament who underwent cervical laminoplasty from February 1999 to July 2007. Magnetic resonance imaging (1.5-T) was performed in all patients before surgery. Sagittal T2-weighted images of the cervical spinal cord compressed by the ossified posterior longitudinal ligament showed increased intramedullary signal intensity, whereas the sagittal images obtained at the C7–T1 disc levels were of normal intensity. The signal intensity ratio between regions of intramedullary increased signal intensity and the normal C7–T1 disc level was calculated based on the signal intensity values generated from the MR imaging workstation. Patients were divided into 3 groups according to their signal intensity ratio (high, intermediate, and low signal intensity groups).ResultsThere were significant differences between the 3 groups regarding recovery rate (p < 0.001), age (p = 0.022), duration of disease (p = 0.001), Babinski sign (p < 0.001), ankle clonus (p < 0.001), and both pre- and postoperative Japanese Orthopaedic Association score (p < 0.001). There was no significant difference in sex among the 3 groups (p = 0.391).ConclusionsPatients with low signal intensity ratios that changed on T2-weighted imaging experienced a good surgical outcome. Low increased signal intensity might reflect mild neuropathological alteration in the spinal cord and greater recuperative potential. An increased signal intensity ratio with positive pyramidal signs indicates less recuperative potential of the spinal cord and a poor surgical outcome.

STUDY DESIGN A retrospective imaging study of 73 patients who underwent surgery for cervical spondylotic myelopathy (CSM) between April 2005 and July 2007. OBJECTIVE To investigate whether magnetic resonance (MR) T2 image signal intensity (SI) ratio and clinical manifestation can assess the prognosis in patients with CSM. SUMMARY OF BACKGROUND DATA The association between intramedullary high SI on T2-weighted MR images and surgical outcome in CSM remains controversial. The means of quantizing SI ratio for the disease has not been discussed. METHODS A total of 73 patients with cervical compressive myelopathy were retrospectively enrolled and were treated with anterior, posterior, and posterior-anterior united decompression. A total of 1.5-T magnetic resonance imaging was performed in all patients before surgery. T2-weighted images of sagittal increased SI on the cervical spinal cord were obtained, and the regions of interest (ROIs) are taken by 0.05 cm. T2-weighted MR images of sagittal normal cord SI on the cervical between C7-T1 disc levels were obtained, and the ROIs are taken by 0.3 cm. SI value is measured by computer, and the SI ratio between the regions 0.05 cm and 0.3 cm has been calculated. If no intramedullary high SI was noted on T2-weighted MR images, the ROIs were taken by 0.05 cm of the severe compression cord. All patients had been divided into 3 groups by hierarchical clustering analysis with SI ratio (Group 1: low SI ratio, Group 2: middle SI ratio, and Group 3: high SI ratio). Statistical analyses were performed with SPSS 11.0. RESULTS There are significant differences between 3 groups by comparing the recovery rate (P < 0.001), age (P = 0.003), duration of disease (P = 0.001), Babinski sign (P < 0.001), preoperative JOA score (P = 0.006), and postoperative JOA score (P < 0.001). There are no significant differences on sex among 3 groups (P = 0.387). By using the multiple comparison analysis, the above results are further shown. CONCLUSION Patients with low SI ratio who were not too old and had a shorter duration of disease experienced a good surgical outcome. However, with the increase of SI ratio and the occurrence of pyramidal sign, a poor prognosis after surgery will show. SI ratio and clinical manifestation can be a predictor of surgical outcome.

Objective The aim of this study was to clarify the usefulness of the management of acute left colon and rectum obstruction because of colorectal carcinoma using a transanal ileus drainage tube before curative surgery. Method Forty-six patients (24 males and 22 females, aged 24-94 years, mean = 56.2) treated between September 2005 and March 2007 for acute left colon and rectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. After a cleaning enema was administered, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a ileus tube was attempted. Results Endoscopic decompression using the ileus tube was technically successful in 45 of 46 patients (97.8%). Perforation occurred in one patient 3 days later and emergent operation was performed. The site of obstruction was the rectum in 15 patients, the sigmoid colon in 18, the descending colon in 13. Following adequate cleansing of the colon, patients' abdominal girth were decreased from 91 +/- 4 cm before drainage to 82 +/- 2 cm 7 days later, and one-stage surgery after 8 +/- 1 days (SD; range 7-10 days) were performed. No anastomotic leakage or postoperative stenosis occurred after operation. Conclusion Management of acute left colon and rectum obstruction because of colorectal carcinoma using the ileus tube was found to be effective and safe, considered as a bridged method before curative surgery.

Study design A prospective, randomized study of the clinical and radiographic outcomes in patients undergoing single- and 2-level cervical arthroplasty with Bryan cervical disc (Medtronic Sofamor Danek, Memphis, TN). Objective This study was designed to investigate the modified techniques of cervical arthroplasty with Bryan disc and analyze the clinical and radiologic effects. Summary of background data Aggravation of kyphosis is the known challenge after arthroplasty. Disc insertion angle and overmilling were reported to be factors causing kyphosis. However, few studies have performed methods to avoid these factors. Additionally, translation and length matching of prosthesis seemed to be ignored. There have been no studies regarding the effects of modified techniques for the prevention of these adverse outcomes. Methods Modified techniques include change in disc insertion, reducing overmilling of endplates, the assurance of the anterior borders at the same horizontal line, and the accurate fitness of prosthesis size. Techniques described in product monograph were applied to 20 patients (control group) and modified techniques were applied to 19 patients (investigational group). Clinical and radiologic (radiograph) follow-ups of all the patients were performed before surgery and after surgery (6 months). Comparisons between the 2 groups in terms of functional spinal unit angle, shell angle, the anteroposterior displacement between the 2 metal shells in the neutral position, and the fitness of prosthesis size were performed. Results Radiologic outcomes in investigational group were significantly superior to those in control group; clinical outcomes were similar in both groups. Conclusion The modified techniques can improve the outcomes of the cervical arthroplasty with Bryan disc and prevent the unexpected imbalance and motion of cervical spine.

Estrogen deprivation is a high risk of cognitive dysfunction in neurodegenerative diseases, and the early used estrogen replacement has been proved effective in many studies. Because of the adverse actions, selective estrogen receptor modulating has been raised to substitute for estrogen replacement. In this study, we observed in hippocampus of bilaterally ovariectomized rats that the level of estrogen receptor α (ERα) was decreased in nuclei with activated glycogen synthase kinase-3β (GSK-3β) in cytoplasm at 8 weeks after operation. The level of nuclear ERα is important for its transcriptional property, and the inhibition of GSK-3β benefits to ERα nuclear translocation. Then, we used 4,4k,4a-(4-propyl-[1H]-pyrazole-1, 3, 5-triyl) trisphenol (PPT) (1 mg/kg/day), an agonist of ERα, combined with LiCl (40 mg/kg/day), an inhibitor of GSK-3β, to treat the ovariectomized rats. After the combination treatment of these two drugs (PPT + LiCl), the improved learning and memory abilities of ovariectomized rats in Morris water maze, increased dendritic spines in CA1 region, and decreased tau phosphorylation at Ser-396 in hippocampus were observed. Furthermore, PPT + LiCl treatment significantly increased ERα level in the nuclear fraction of hippocampus, and in the cytoplasmic fraction, the total level of GSK-3β was declined after treatment with its increased phosphorylation at Ser-9 (inactivation form). This study suggested that PPT + LiCl treatment could inhibit the activation of cytoplasmic GSK-3β and promote the nuclear translocation of ERα, and ERα together with GSK-3β maybe the targets to preserve hippocampus-dependent cognitive ability after long-term ovariectomy.

In military academies, “task-oriented” teaching way should be put into use to make teaching goals well achieved. In this paper, from discussing the connotation of “task-oriented” teaching way as the starting point, the current implement of this kind teaching method in military academies is fully analyzed and some existing problems are pointed out. Finally, the corresponding countermeasures as well as the key points requiring attention are also suggested.

Background: Upper lumbar disc herniation (ULDH) is easy to be misdiagnosed due to its special anatomical and atypical clinical features. Few studies have identified the relationship between ULDH and adjacent wedge-shaped vertebrae (WSV). Hypothesis: WSV may have some indicative relations withULDH. Patients and methods: Between January 2003 and October 2013, 47 patients (27 males and 20 females; mean age, 41.2 years) with single-level ULDH (as study group) and 47 sex- and age-matched healthy volunteers (as control group) were studied by radiograph. The two groups were compared with respect to age, sexual proportion, body mass index (BMI), kyphotic angle, and the proportion of WSV. Also, correlative analyses were conducted in the study group to investigate the relation between the kyphotic angle of target vertebrae and other factors including age, BMI, Cobb angle, JOA score and bone mineral density (BMD). Results: The average kyphotic angle in the study group was 11° (4°-22°), while the average kyphotic angle in the control group was 2° (0°-7°). Obviously, the mean kyphotic angle in the study group was statistically larger than that in the control group (t=13.797, P

To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from L1-L2 to L5-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2: disc collapse with severe lumbar hyperosteogeny; Group B1: Neither disc collapse nor severe lumbar hyperosteogeny; Group B2: severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by χ(2) test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.Four groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208, the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34.8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group B1 was 16.9%. The number of intervertebral discs in the B2 group was 182, the incidence rate of group B2 was 29.7%. There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups(χ(2) = 69.565, P0.05). The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2, B1 and B2 (χ(2) = 12.524, 66.701 and 24.102, P0.00714). There was significant difference of Modic change incidence rate between group A2 and B1(χ(2) = 15.032, P0.00714), but there was no significant difference of Modic change incidence rate between group A2 and B2 (χ(2) = 0.945, P0.00714) . There was significant difference of Modic change incidence rate between group B2 and group B1 (χ(2) = 9.395, P0.00714).The incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain. There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.

Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments. The efficiency of posterior longitudinal ligament (PLL) resection in anterior cervical decompression and fusion has been demonstrated. However, no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty. This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.We performed a prospective investigation of clinical and radiological outcomes in patients after Bryan cervical disc arthroplasty. Sixty patients who underwent Bryan cervical disc arthroplasty were included. The PLL was removed in 35 patients (investigational group) and preserved in 25 patients (control group). All of the patients were followed up for more than 18 months. Clinical (Japanese Orthopedic Association score and Visual Analogue Scale pain score) and radiological (functional spinal unit (FSU) angle, range of movement (ROM), and diameter of the spinal cord) parameters were compared between the two groups before and after surgery (18 months).Clinical outcomes in the investigational group were significantly superior to those in the control group. There were no significant differences in the FSU angle and ROM (P = 0.41 and 0.16, respectively) between the two groups. However, the increase in diameter of the spinal cord in the investigational group was significantly greater than that in the control group (P0.01).Removal of the PLL can improve the clinical outcomes of Bryan cervical disc arthroplasty. This procedure does not have a large effect on imbalance and motion of the cervical spine.

Surgical treatment of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is technically demanding, and the results tend to be unfavorable. Various operative approaches and treatment strategies have been attempted, and posterior decompression with transforaminal thoracic interbody fusion (PTTIF) may be the optimal method with which the anterior-posterior compression was removed in one step. It is comparatively less traumatic with fewer serious complications.Sixteen patients with thoracic myelopathy due to concurrent OLF and OPLL at the same level underwent PTTIF. We investigated clinical outcomes and neurological improvements. Magnetic resonance imaging (MRI) was performed on all patients preoperatively and postoperatively, and intramedullary signal changes were evaluated.The mean operating time was 275 minutes, and the mean operative bleeding amount was 1031 ml. Cerebrospinal fluid leakage occurred in three patients and healed well after repair. Neurological symptom deterioration occurred in one patient, but the patient recovered to nearly the preoperative level after methylprednisolone treatment. The follow-up period ranged from 28 to 47 months. The mean score on the Japanese Orthopedic Association scale improved from 4.3±1.2 preoperatively to 7.3±1.7 at 3 months postoperatively to 8.5±1.5 at the final follow-up (P0.01), with a recovery rate of (63.6±20.0)%. Postoperative images showed a significant improvement in local kyphosis (P0.01). Eleven patients (68.8%) showed increased signal intensity (ISI) on preoperative T2-weighted MRI. At the final follow-up, the intramedullary ISI totally recovered in five patients. Neurological improvement was worse in patients with persistent ISI than in the other patients (P0.05).PTTIF is an effective therapeutic option for combined OPLL and OLF and provides satisfactory neurological recovery and stabilized thoracic fusion through a single posterior approach. Intramedullary signal changes do not always indicate a poor prognosis; only irreversible ISI is correlated with a poor clinical result.

To investigate the radiological change of bilateral paravertebral muscles in degenerative lumbar scoliosis (DLS) and analyze its clinical significance.As a retrospective study, 66 patients with DLS and 66 patients with lumbar spinal stenosis were retrospectively enrolled from April 2004 to August 2011 as scoliosis group and lumbar spinal stenosis group, meanwhile 66 health persons with no lumbar spinal stenosis were selected as control group. No significant differences were found in the gender, age and body mass index among the three groups. The cross-sectional area (CSA) and percentage of fat infiltration area (FIA) of the bilateral paravertebral muscles at the L(1)-S(1) levels were measured using T2-weighted axial MRI and Image J software. The measured data were analyzed with a paired t-test.In the DLS with bilateral symptom group, the mean percentage of FIA of the multifidus muscle on the convex side were 18% ± 4%, 21% ± 4%, 27% ± 4%, 34% ± 6%, 42% ± 10% and on the concave side were 25% ± 8%, 30% ± 7%, 35% ± 7%, 40% ± 10%, 44% ± 8% at L(1-2), L(2-3), L(3-4), L(4-5) and L(5)-S(1) levels, which showed significant differences between the convex side and the concave side (t = 7.95, 9.30, 5.35, 2.78, 2.38, P0.05); the mean percentage of FIA of the longissimus muscle on the convex side were 25% ± 9%, 28% ± 8% and on the concave side were 27% ± 9%, 31% ± 9% at L(3-4), L(4-5) levels, which showed significant differences between the convex side and the concave side (t = 2.52, 3.48, P0.05). There were no significant differences in the CSA of both muscles between the concave and convex sides (P0.05). In the DLS with unilateral symptom group, the mean percentage of FIA of the multifidus muscle on the convex side were 18% ± 5%, 23% ± 5%, 29% ± 5%, 34% ± 6%, 42% ± 9% and on the concave side were 23% ± 6%, 30% ± 7%, 36% ± 7%, 41% ± 10%, 45% ± 8% at L(1-2), L(2-3), L(3-4), L(4-5) and L(5)-S(1) levels, which showed significant differences between the convex side and the concave side (t = 6.67, 7.96, 6.43, 3.86, 2.15, P0.05). There were on significant differences in the CSA of both muscles, and in the percentage of FIA of the longissimus between the concave and convex sides (P0.05).There exist asymmetric degeneration in paravertebral muscle in DLS, which have potential clinical importance on the evaluation of curve progression, and muscle degeneration is more often seen in the concave side. Spinal deformity and radiculopathy may contribute to the paravertebral muscle degeneration.

Aim Safety and survival were investigated in patients treated according to expanded surgical indications for colorectal hepatic metastases. Method A retrospective analysis of all consecutive patients who underwent resection of colorectal hepatic metastases at Zhongshan Hospital from 2000 to 2010 was conducted. The patients were divided into two groups based on a change in the surgical indications introduced in 2005. Patients in Group I underwent hepatic surgery between 2000 and 2004 and those in Group II between 2005 and 2010. The clinicopathological data and survival rates of both groups were analysed. Results There were 530 patients who underwent hepatic surgery between 2000 and 2010. After the expansion of surgical indications, the rate of surgical resection rose from 25.1 to 35.1% (P

Methods The expression levels of 754 known human microRNA were quantified in whole peripheral blood by TaqMan low density array for 23 chronically HIV-infected subjects. Significance analyses of miRNA expression profiles were performed on groups with varied levels of CD4+ T cell counts or viral loads. The identified prognostic miRNA signature was further validated in a 51 HIV+ patient cohort naive to ART with following up for 2 years. In addition, we assessed their association with progression-free rate. For the latter, various prediction algorithms were computed on the basis of weighted levels of the miRNAs forming the outcome signature. Results Of the 10 differentially expressed miRNAs (p

Background Epitope based vaccines are widely used in vaccine development against HIV-1, cancer and other diseases. One of the key components is how to enhance its immunogenicity. Previous studies suggested that the magnitudes of both T cell and antibody responses could be improved through repeating epitope in design, however, it remains unknown how this could influence the functional features of T cell responses and its optimization.

Aim The aim of this study was to investigate the potential of sequential positron emission tomography (PET)/CT standardized uptake value (SUV)/metabolic area variation in predicting the pathological response to preoperative chemoradiotherapy (CRT) for rectal cancer. Method Fifty-three patients diagnosed with clinical T3-4 and/or N+ rectal cancer were enrolled. All patients received CRT followed by radical surgery after 6–8 weeks. A PET/CT scan was performed before (PET/CT1) initiation of treatment and a second scan (PET/CT2) was performed within 1 week after the completion of CRT. Thirty-five of 53 patients also underwent a third (PET/CT3) scan within 1 week before surgery. Maximal SUV within the tumour (SUVmax), average SUV within the tumour (SUVmean), metabolic tumour volume (MV), total lesion glycolysis (TLG) and response indices (∆%, i.e. the percentage difference between two different PET/CT scans for SUVmax, SUVmean, MV and TLG) were calculated. The different metabolic parameters were analysed and correlated with the tumour regression grade (TRG) score. Results When patients were regrouped as responders (TRG 3-4) and nonresponders (TRG 0-2), significant differences were observed in the percentage differences between PET/CT1 and PET/CT3 for MV (∆%MV(1-3); 91.08% vs 75.43%) and for TLG (∆%TLG(1-3); 94.00% vs 82.02%). As demonstrated by receiver–operating characteristics analysis, ∆%MV(1-3) and ∆%TLG(1-3) both had a strong capability to discriminate between responders and nonresponders. Patients classified as having a pathological complete response (pCR) and a non-pCR showed significant differences in the percentage difference between PET/CT1 and PET/CT3 in SUVmax (∆% SUVmax(1-3); 69.17% vs 57.77%), SUVmean (∆% SUVmean(1-3); 44.20% vs 30.19%), ∆%MV(1-3) (90.93% vs 80.30%) and ∆%TLG(1-3) (94.22% vs 85.63%). ∆%TLG (1-3) was a more powerful discriminator than the others. Conclusion Differences in the SUV/metabolic area with 18F-fluorodeoxyglucose (18F-FDG) PET/CT have the potential to predict a response to preoperative CRT for rectal cancer.

Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P0.001). The vertebral body height on the convex side was greater than the height on the concave side (P = 0.016). There was a significant difference between the scoliosis group and the control group (P = 0.003), and between T-value and the rate of osteoporosis between the two groups (both P0.001).were verified using multiple linear regression analysis.Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.

Our objective was to evaluate the clinical efficacy and feasibility of posterior decompression with transforaminal thoracic interbody fusion (PTTIF) for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. Between March 2004 and December 2008, 13 patients (five men and eight women, average age: 56years, range: 39-72years) who underwent PTTIF for concurrent OLF and OPLL were studied retrospectively. The clinical efficacy, operative time, blood loss, sagittal alignment and complications were investigated. Cerebrospinal fluid leakage occurred in three patients, all of whom healed well after repair. One patient developed a urinary tract infection and one developed a wound infection, but both were cured with appropriate antibiotic therapy. Neurological symptom deterioration occurred in one patient, but she returned to her preoperative baseline after completing methylprednisolone therapy. After an average 36.8months follow up, the mean Japanese Orthopaedic Association (JOA) score significantly increased from 4.3±1.3 preoperatively to 7.2±1.8 at 3months after the operation and 8.5±1.7 at the final follow-up (P

Objective: To investigate whether the magnetic resonance (MR) T2 image signal intensity ratio and clinical manifestations can predict the prognosis in patients with cervical spondylotic myelopathy (CSM). Methods: A total of 73 patients treated with anterior, posterior, or posterior-anterior combined surgery for compressive cervical myelopathy were enrolled retrospectively in this study. 1.5 T magnetic resonance imaging (MRI) was performed on all patients before surgery. T2-weighted images (T2WI) of sagittal signal intensity were obtained of the cervical spinal cord, and the regions of interest (ROI) were taken by 0.05 cm2. MR T2WI of sagittal normal cord signal at the C7-T1 disc level were also obtained, and the ROI were taken by 0.3 cm2. Signal value was measured by computer and the signal ratio between regions 0.05 cm2 and 0.3 cm2 calculated. Where no intramedullary high signal intensity was noted on MR T2WI, the ROI were taken by 0.05 cm2 of the region of most severe spinal cord compression. The 73 patients were divided into three groups by hierarchical clustering analysis with signal intensity ratio (group 1: low signal intensity ratio; group 2: middle signal intensity ratio; group 3: high signal intensity ratio). Statistical analyses were performed with SPSS 11.0. Results: There were significant differences between the three groups according to the recovery rate (P < 0.001), age (P= 0.003), duration of disease (P= 0.001), Babinski sign (P < 0.001), pre- and postoperative Japanese Orthopaedic Association (JOA) score (P= 0.006). With increases in both signal intensity ratio grade and age, the recovery rate and pre- and postoperative JOA scores gradually decreased, and the incidence of Babinski sign increased. There was no significant difference in sex among the three groups (P= 0.387). Multiple comparison tests further supported the above-mentioned results. Conclusion: Patients with light or no intramedullary signal changes on T2WI had a good surgical outcome. However, increase of signal intensity ratio and occurrence of the pyramidal sign were associated with a poor prognosis after surgery.

To investigate the relationship of dynamic cord impingement of sagittal diameter on flexion-extension cervical magnetic resonance (MR) imaging with disease severity and prognosis in cervical spondylotic myelopathy.A total of 53 patients with cervical degenerative disease were evaluated with regards to the dynamic cord changes of sagittal diameter at neutral and flexion-extension 1.5 T MR imaging from February 2006 to November 2008. The mean follow-up period was 14.6 (11 - 36) months. The factors of age, sex, duration of disease, cervical range of motion and cord signal intensity were considered. The patients were divided into two groups according to the extent of dynamic cord changes of sagittal diameter on MRI (groups of high and low dynamic cord changes). Statistical analyses were performed with SPSS 13.0.The preoperative JOA scores were 9.17 +/- 2.45 and 13.76 +/- 2.81 respectively with a recovery rate of 57.02% +/- 16.23% at the final follow-up. There was no significant difference between the two groups in terms of recovery rate and age. The cervical range of motion and cord signal intensity in group of high dynamic cord changes were higher than those in group of low dynamic cord changes. The preoperative JOA score and duration of disease were lower than those in group of low dynamic cord changes. According to linear regression test between the recovery rate, the preoperative JOA score and the extent of dynamic cord changes, the correlation coefficient were 0.07 (P = 0.643) and -0.27 (P = 0.04) respectively.With the precondition of a short disease duration in cervical spondylotic myelopathy, the extent of dynamic cord changes is correlated with disease severity but shows no relationship with prognosis.