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Background: Both patients with Chiari-I malformation (CIM) with syringomyelia and those with idiopathic syringomyelia (ISm) have a syrinx and can have scoliosis as well. However, there is no literature regarding differences between CIM and ISm in terms of radiographic outcomes and surgical complications after posterior fusion, to our knowledge. The aim of the present study was to compare radiographic features, clinical outcomes, and surgical complications after posterior spinal fusion between patients with CIM-associated scoliosis and those with ISm-associated scoliosis.Methods: One hundred and twenty patients with syringomyelia-associated scoliosis were retrospectively analyzed. Twenty-one patients with scoliosis secondary to CIM were enrolled and matched by sex, age, and the Cobb angle of the scoliotic curve with 21 patients with scoliosis secondary to ISm. All patients underwent 1-stage posterior fusion surgery. Coronal and sagittal radiographic parameters were evaluated before surgery, immediately after surgery, and at the final follow-up (at least 2 years). We also collected data regarding syringeal features, neurological deficits, intraoperative neuromonitoring, and complications.Results: Sex, age, preoperative coronal/sagittal scoliosis parameters, and neurological deficits were similar between the matched CIM and ISm groups. On average, the CIM group had a longer syrinx (12.3 ± 3.6 versus 8.9 ± 4.5 vertebral levels, p = 0.010) than the ISm group. The CIM and ISm groups showed similar correction rates for primary curves (70.9% ± 10.6% versus 69.5% ± 16.3%, p = 0.739). There were no significant differences in coronal/sagittal correction, intraoperative neuromonitoring abnormalities, surgical complications, or Scoliosis Research Society-22 questionnaire scores between the 2 groups.Conclusions: Despite matched demographic and scoliotic coronal parameters, patients with CIM had longer syrinxes compared with patients with ISm. One-stage posterior fusion achieved comparable clinical and radiographic outcomes for both CIM- and ISm-associated scoliosis without significant differences in neurological complications.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study.Objective: To compare syrinx characteristics, scoliotic parameters, and neurological deficits between Chiari I malformation (CIM) and idiopathic syringomyelia (IS) in the scoliotic population.Summary Of Background Data: CIM and IS are common in neuromuscular scoliosis patients; however, differences in syrinx characteristics, scoliotic parameters, and neurological deficits between CIM and IS are unclear.Methods: Thirty-six patients with scoliosis secondary to CIM were enrolled retrospectively and matched with 36 IS patients for sex, age, scoliosis classification, and Cobb angle. Information on radiographic features of scoliosis and syrinx and neurological deficits was systematically collected.Results: Sex, age, and coronal, and sagittal scoliosis parameters did not differ between the CIM and IS groups. The CIM group had a longer syrinx (12.9 ± 4.0 vertebral levels vs. 8.7 ± 5.5 vertebral levels, P < 0.001), a higher cranial extent (3.6 ± 2.2 vs. 5.2 ± 3.5, P = 0.027), and a lower caudal extent (15.6 ± 2.9 vs. 13.0 ± 4.6, P = 0.006) than the IS group, despite no differences in syrinx/cord (S/C) ratio or syrinx classification. No differences in neurological deficits were identified between the CIM and IS patients.Conclusion: With demographic and scoliotic coronal parameters matched, the CIM patients had a longer syrinx, located at a higher cranial and lower caudal level, compared with the IS group. No significant differences in syrinx S/C ratio, sagittal features of scoliosis, or neurological deficits were detected between the two groups.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background/Aims: Congenital scoliosis (CS) is a result of anomalous development of vertebrae and is frequently associated with somitogenesis malformation. Although noncoding RNAs (ncRNAs) have been recently determined to be involved in the pathogenesis of CS, the competing endogenous RNA (ceRNA) regulatory networks in CS remain largely unknown. Methods: Sequencing was conducted to explore the ncRNA expression profiles in rat embryos (gestation day 9) following vitamin A deficiency (VAD) (n = 9 for the vitamin A deficiencyinduced congenital scoliosis (VAD-CS) group and n = 4 for the control group). Real-time reverse transcriptase polymerase chain reaction (RT-PCR) was conducted to verify the expression levels of selected mRNAs, long noncoding RNAs (lncRNAs), circular RNAs (circRNAs), and microRNAs (miRNAs). Bioinformatics analysis was used to discover the possible relationships and functions of the ceRNAs. Results: A total of 749 mRNAs, 56 miRNAs, 685 lncRNAs, and 70 circRNAs were identified to have significantly different expression levels in the two groups. Wnt, PI3K-ATK, FoxO, EGFR, and mTOR were found to be the most significant pathways involved in VAD-CS pathogenesis. The circRNA/miRNA/mRNA and lncRNA/miRNA/mRNA networks of CS were built, and the gene expression mechanisms regulated by ncRNAs were unveiled via the ceRNA regulatory networks. Conclusion: We comprehensively identified ceRNA regulatory networks of embryonic somite development in VAD-CS as well as revealed the contribution of different ncRNA expression profiles. Our data demonstrate the association between mRNAs and ncRNAs in the pathogenic mechanism of CS. [ABSTRACT FROM AUTHOR]

Study Design: A prospective study.Objective: To investigate the incidence and risk factors of acute pancreatitis after scoliosis surgery.Summary Of Background Data: Pancreatitis has been recognized as a possible complication of extra-abdominal surgeries. However, there were few reports on the incidence and risk factors of acute pancreatitis after scoliosis surgery.Methods: A prospective clinical study was performed at our center from September 2014 to October 2015. One hundred seventy-six patients undergoing posterior spinal correction surgery were enrolled. The diagnosis of acute pancreatitis was based on their clinical manifestations combined with laboratory examination. Demographic, intraoperative, and radiological parameters were evaluated to identify the risk factors of acute pancreatitis after scoliosis surgery.Results: Thirteen patients (7.4%) were diagnosed with acute pancreatitis. Compared with patients without pancreatitis, pancreatitis patients had lower body mass index (BMI) (15.5 vs. 19.5, P = 0.001), larger preoperative Cobb angle of major curve (87.5° vs. 59.2°, P < 0.001), lower correction rate (57.4% vs. 69.0%, P = 0.045), lower intraoperative mean arterial pressure (57.9 mmHg vs. 66.1 mmHg, P < 0.001), and longer fusion levels (13.3 vs. 10.1, P < 0.001). No significant differences were noted with respect to operation time, intraoperative blood loss, or the amount of sagittal profile correction. Furthermore, multivariate logistic analysis revealed that BMI (odds ratio [OR] = 1.542, P = 0.009), lowest intraoperative mean arterial pressure (OR = 1.126, P = 0.039), and segments of fusion (OR = 0.551, P = 0.025) were independent risk factors for postoperative acute pancreatitis. All cases were treated with bowel rest, intravenous fluids, and fasting and completely recovered with 3.3 (2-5) days.Conclusion: The incidence of postoperative acute pancreatitis after scoliosis surgery was 7.4%. The low BMI, lowest intraoperative mean arterial pressure, and long segments of fusion were independent risk factors for acute pancreatitis after scoliosis surgery.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Vertebrae, ribs, and spinal cord are anatomically adjacent structures, and their close relationships are clinically important for planning better corrective surgical approach. The objective is to identify the radiographic characteristics in surgical patients with congenital scoliosis (CS) and coexisting split cord malformation (SCM).Methods: A total of 266 patients with CS and SCM underwent surgical treatment at our hospital between May 2000 and December 2015 was retrospectively identified. The demographic distribution and radiographic data were collected to investigate the characteristics of spine curve, vertebral, rib, and intraspinal anomalies. According to Pang's classification, all patients were divided into two groups: type I group is defined as two hemicords, each within a separate dural tube separated by a bony or cartilaginous medial spur, while type II group is defined as two hemicords within a single dural tube separated by a nonrigid fibrous septum.Results: There were 104 patients (39.1%) in Type I group and 162 patients (60.9%) in Type II group. SCM was most commonly found in the lower thoracic and lumbar regions. The mean length of the septum in Type I SCM was significantly shorter than Type II SCM (2.7 vs. 5.2 segments). Patients in Type I group had a higher proportion of kyphotic deformity (22.1%). The vertebral deformities were simple in only 16.5% and multiple in 83.5% of 266 cases. Patients in Type I group presented higher prevalence of multiple (90.4%) and extensive (5.1 segments) malformation of vertebrae. In addition, hypertrophic lamina and bulbous spinous processes were more frequent in Type I group (29.7%), even developing into the "volcano-shape" deformities. Rib anomalies occurred in 62.8% of all patients and 46.1% of them were complex anomalies. The overall prevalence of other intraspinal anomalies was 42.9%. The most common coexisting intraspinal anomalies was syringomyelia (30.5%).Conclusion: The current study, with the largest cohort to date, demonstrated that patients with CS and coexisting SCM presented high prevalence of multiple vertebral deformities, rib and intraspinal anomalies. The length of the split segment in Type I SCM was shorter than that in Type II SCM. Compared with Type II SCM, patients with Type I SCM presented with higher incidence of kyphotic deformity, more extensive and complicated vertebral anomalies, and more complex rib anomalies. [ABSTRACT FROM AUTHOR]

Endostatin (ES), as an angiogenesis inhibitor, has been approved by the State Food and Drug Administration (SFDA) in China for the treatment of patients with non-small-cell lung cancer. However, as a protein drug, there are a lot of obstacles on its clinical application, such as need of high dose to maintain its efficacy, expensive and poor stability, etc and limits its clinical use. In order to overcome these shortcomings, we chemically modified ES by polyethylene glycol and low molecular weight heparin (LMWH), respectively. The changes of the secondary structure of the modified products were studied by Fourier transform infrared spectroscopy and Circular dichroism spectra to obtain better ES derivatives. Our study demonstrated that the modified products have a better heat tolerance than ES towards. The result of secondary structure analysis suggests the percentage of β-turn in whole protein is an important factor on the activity and heat stability and ES modified by LMWH can maintain higher activity and its secondary structure. [ABSTRACT FROM PUBLISHER]

The effects of heparin-superoxide dismutase (SOD) conjugate (heparin-SOD) on γ-radiation induced DNA damage in vivo and in vitro were evaluated. Plasmid pcDNA3.0 solution was mixed with heparin-SOD, SOD, and a mixture of heparin and SOD (heparin + SOD), respectively, and irradiated with 60Co at a dosage of 120 Gy. DNA injury was analyzed using agarose gel electrophoresis. The results showed that the degree of injury of pcDNA3.0 mixed with heparin-SOD, SOD, or heparin + SOD was less than that of untreated pcDNA3.0, and among them the degree of injury of pcDNA3.0 mixed with heparin-SOD was the least. It also showed that the protective effect increased with an increase of heparin-SOD concentration. The effects of SOD and heparin-SOD on the DNA damage and tumor inhibition rate of 60Co γ-radiation exposure on tumor-bearing mice were also studied. Agarose gel electrophoresis showed that, when different SOD samples were administered before irradiation, the thymus DNA injuries of heparin-SOD, SOD, or heparin + SOD groups were more serious than that of the control group, and the DNA injuries of heparin-SOD or heparin + SOD groups were the most serious, which contradicted the above in vitro experiments. However, when heparin-SOD was administered post irradiation, it showed a repairing effect on the injured DNA. [ABSTRACT FROM AUTHOR]

Background: The natural history of split spinal cord malformation (SCM) is still unclear. Knowledge of the characteristics of the osseous spur and its relationship with the spinal deformity may allow early identification of patients with a higher risk of a neurological deficit and enhance surgical decision-making.Methods: Eighty-five consecutive patients with congenital scoliosis and type-I SCM who had undergone surgical treatment at our hospital from May 2000 to December 2013 were identified retrospectively. There were 22 male and 63 female patients with an average age of 13.9 years at the time of surgery. Preoperative clinical and radiographic data were collected to investigate the characteristics of the scoliosis and the osseous spur. Two groups were identified on the basis of whether the patients had intact neurological function (Group A) or a neurological deficit (Group B).Results: There were 52 patients (61%) in Group A (intact neurological function) and 33 patients (39%) in Group B (neurological deficit). There were no significant differences in the demographic distribution, curve magnitude, or length and thickness of the osseous spur between the 2 groups. In Group A, the location of the osseous spur relative to the apex of the major curve was proximal in 13 patients (25%), distal in 28 (54%), and central in 11 (21%). In Group B, the osseous spur was proximal in 7 (21%), distal in 8 (24%), and central in 18 (55%). The 2 groups differed significantly with respect to the location of the osseous spur (chi square = 10.898, p = 0.004). Group-B patients had a higher proportion of patients with kyphotic deformity (42%) than Group A (10%). The ratio of the diameters of the hemicords (concave side divided by convex side) differed significantly between the 2 groups (0.98 for Group A versus 0.89 for Group B, p = 0.030).Conclusions: The neurological status in patients with congenital scoliosis and type-I SCM appears to be closely related to the location of the osseous spur relative to the congenital scoliosis. An osseous spur at the apex of the scoliosis may be related to a higher risk of developing a neurological deficit, especially in patients with kyphotic deformity. Asymmetric splitting of the spinal cord may contribute to neurological deficits.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Human serum albumin (HSA) is used as an important plasma volume expander in clinical practice. In the present study, HSA was N-terminally PEGylated and a PEGylated HSA (PEG-HSA) carrying one chain of PEG (20 kDa) per HSA molecule was obtained. The purity, secondary structure and hydrodynamic radius of the modified protein were characterized using sodium dodecyl sulfate polyacrylamide gel electrophoresis, circular dichroism measurements, and dynamic light scattering, respectively. The pharmacokinetics in normal mice and vascular permeability of the PEG-HSA in a lipopolysaccharideinduced acute lung injury mice model were evaluated. The results showed that the biological half-life of the modified HSA was approximately 2.2 times of that of native HSA, and PEG-HSA had a lower vascular permeability which suggested that PEGylation of HSA could reduce extravasation into interstitial space. It can be inferred that due to the prolonged half-life time and enhanced vascular retention, the molecularly homogeneous PEG-HSA may be a superior candidate as a plasma volume expander in treating capillary permeability increase related illness. [ABSTRACT FROM AUTHOR]