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Objective To describe spinal osteotomy in lateral position, which might be a new strategy for correcting thoracolumbar kyphotic deformity combined with severe hip flexion contracture, and to present two cases in which this method was successfully performed. Methods Spinal osteotomies in lateral position were performed in two patients with severe thoracolumbar kyphosis combined with hip flexion contracture, which was not suitable for operation in the prone position. Case 1: a 33‐year‐old female AS patient still had severe hip flexion contracture due to poor rehabilitation after total hip replacement (THR). The range of movement of the hip was only about 15° in right and 10° in left. Pre‐operativethoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA) were 52.4°, 49.1°, 42.7°, and 315 mm, respectively. Pedicle subtraction osteotomy (PSO) at L3 was performed in the lateral position. The eggshell procedure was used during osteotomy. Case 2: a 45‐year‐old male AS patient presented coexisting rigid thoracolumbar kyphosis and hip flexion contracture. The range of movement of the hip was only about 20° in right and 25° in left. Pre‐operativeTK, TLK, LL and SVA were 34.9°, 66.8°, 58.8° and 290.8 mm, respectively. PSO at L2 was performed in lateral position. The eggshell procedure was also used. Results Sagittal malalignments of both patients were greatly improved. For case 1, the total operation time was 5.5 h. The blood loss was 1500 mL and the amount of allogeneic blood transfusion was 1580 mL during the operation. SVA was reduced to 127 mm and LL decreased from preoperative 42.7° to −28.4°. The correction angle through L3 was 34.7° and the correction angle through the osteotomy segment was 62.9°. For case 2, the duration of surgery was 6.5 h. The operative blood loss was 2000 mL and the total amount of blood transfusion was 2020 mL. SVA was reduced to 209.8 mm and LL decreased from preoperative 58.8° to 9.2°.The correction angle through L2 was 37.1° and the correction angle through the osteotomy segment was 55°. No intra‐operative or post‐operative complications were observed. Six months after PSO, case 1 had good posture for standing and sitting. The case 2 underwent bilateral THRs nine months after PSO. Conclusion PSO could be performed in the lateral position successfully. For AS patients who cannot be placed in the prone position due to coexisting severe thoracolumbar kyphosis and hip flexion contracture, performing spinal osteotomy in the lateral position as the first step is an alternative., For AS patients who cannot be placed in the prone position due to coexisting severe thoracolumbar kyphosis and hip flexion contracture, performing spinal osteotomy in the lateral position is an alternative and can be performed successfully.

Objective To explore the spine‐pelvis‐hip alignments in degenerative spinal deformity (DSD) patients, and compare the outcomes in the procedure of long‐fusion with posterior lumbar inter‐body fusion (PLIF) or single‐level three‐column osteotomy (STO) at lower lumbar level (LLL, L3‐S1) and thoracolumbar levels (TLL, T10‐L2) for those patients. Methods This is a retrospective study. Following institutional ethics approval, a total of 83 patients (Female, 67; Male, 16) with DSD underwent long‐fusion with PLIF or STO surgery between March 2015 and December 2017 were reviewed. All of those patients were assigned into LLL and TLL groups. The average age at surgery was 65.2 years (SD, 8.1). Demographic (age, gender, BMI, and comorbidities), radiographs (both coronal and sagittal parameters) and health‐related quality of life (HRQOL) assessments were documented. The radiographic parameters and HRQOL‐related measurements at pre‐ and post‐operation were compared with paired‐samples t test, and those variables in the two groups were analyzed using an independent‐sample t test. The relationships between pelvic incidence (PI) and other sagittal parameters were investigated with Pearson correlation analysis. The Pearson χ2 or Fisher's exact was carried out for comparison of gender, incidence of comorbidities and post‐operative complications. Results There were 53 and 30 patients in the LLL and TLL groups respectively. Those spino‐pelvic radiographic parameters had significant improvements after surgeries (P, Degenerative spinal deformity patients with low PI would be vulnerable to thoracolumbar degeneration, and those with high PI would suffer significant lumbar degeneration. Moreover, those radiographic data of hip joints in DSD patients with lower PI would be restored much easier after the procedure of long‐fusion with PLIF or STO.

Objective To assess the effect that correction of lower lumbar lordosis (3L) has on global spine realignment due to the key role of 3L for scoliosis surgery in patients with degenerative lumbar scoliosis (DLS). Methods This study is a retrospective review performed between June 2018 and January 2020, including consecutive patients with DLS. Only patients age ≥ 45 years who had already undergone a selective root block operation and had the procedure of long‐fusion extending to pelvis and posterior lumbar interbody fusion (PLIF) at lower lumbar spine (L4‐S1) were retained for analysis. Spinopelvic parameters measured included thoracic kyphosis (TK), lumbar lordosis (LL), 3L, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) at pre‐operation and the third month follow‐up. The mismatch (PI‐LL) was calculated subsequently. Pearson correlation and linear regression analysis were performed to explore the association of the changes in global spinopelvic parameters with 3L correction. Results Thirty‐nine patients (five males, 34 females) with the average age of 63.84 years (SD 7.53; range, 45–75 years) at the time of surgery were identified. All patients had the surgical procedure of long‐fusion (≥4 vertebras) with PLIF at lower lumbar spine between L4 and S1 spine. Lower instrumented vertebras (LIV) fused to pelvis (S1, 14; S2, 18; ilium, 7) were operated in all patients. Seventeen patients were with upper instrumented vertebras (UIV) at thoracolumbar spine (L2‐T11), and 22 patients at thoracic spine (T10 and above). The median of instrumented segments was 10 (5–14). 3L significantly increased (P = 0.02) after surgical treatment by mean change of 4.21° (range, −19.7° to +22.2°). Perioperatively, all spinopelvic parameters regarding to TK, LL, SS, PT, TPA, SVA, and mismatch (PI‐LL) had significant changes (P, Scatterplots showing the change in lumbar lordosis correlated with changes in spinopelvic parameters. The linear regression formulas are as follows: d‐LL = 14.977+ 0.636*d‐3L, (R 2 = 0.596); d‐(PI‐LL) = 16.575 + 0.62*d‐3L, (R 2 = 0.183); d‐TPA = −7.284 to 0.358*d‐3L, (R 2 = 0.193); d‐SVA = −30.556 to 2.639*d‐3L, (R 2 = 0.347).

Objectives To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment. Methods This is a retrospective study. Following institutional ethics approval, a total of 57 patients (49 Female, eight Male) with ASD underwent surgery fused to sacroiliac bone (S1, S2, or ilium) from March 2014 to January 2019 were included. All of those patients were followed up for at least 2 years. Demographic, radiographic and surgical data were recorded. The maximum range of flexion motion (F‐ROM) and extension motion (E‐ROM) actively of hip joints was measured and recorded at pre‐ and postoperation. The sum of F‐ROM and E‐ROM was defined as the range of hip motion (H‐ROM). Receiver operating characteristic (ROC) curve analysis was used to obtain the cut off value of parameters for PJF. A Kaplan–Meier curve and log‐rank test were used to analyze the differences in PJF‐free survival. Results In all, 14 patients developed PJF during follow‐up. Comparisons between patients with and without PJF showed significant differences in immediate TK (P 13° were being as the control group. Patients in the observational group had smaller H‐ROM (P = 0.016) and F‐ROM (P, Adult spinal deformity (ASD) patients underwent the procedure of scoliosis surgery with pelvic fixation, the restricted hip motion resulted by smaller acetabular anteversion (AA ≤13°) postoperatively would be a risk factor for the mechanical complications of proximal junctional failure (PJF). Furthermore, large thoracic kyphosis postoperatively (≥28.1°) increased the incidence of PJF in those patients.

Background: The mechanism of coronal imbalance is still unclear. The relationships among CBD and major curve, L4 and L5 tilt have been reported, which were not explicit although. The aim of this retrospective study was to explore and examine the association between spinopelvic parameters and coronal balance distance (CBD) in degenerative lumbar scoliosis (DLS) patients.Methods Following institutional ethics approval, the radiographs of 161 DLS patients were retrospectively reviewed. The coronal measurements involving CBD, L4 coronal tilt, L5 coronal tilt, fractional curve, pelvic coronal tilt, the Cobb angle and included vertebras of major curve were documented. All of those participants were divided into group A (CBD≥30mm) and group B (CBD < 30mm). Statistical analysis was performed to compare the difference of continuous and categorical variables. Pearson-Correlation, and Multiple-Regression Analysis were performed to explore the related parameter with CBD.Results The CBD in 31 (19.25%) DLS patients at pre-operation was over 30mm. With similar major Cobb angle, main curve of patients in the group A had less involving vertebras (P=0.009), but more rotation of the apical vertebra (PP=0.02). Pearson-correlation analysis showed that CBD had significant relationship with L4/L5 coronal tilt(PP=0.027), but linearly independent with pelvic tilt and major Cobb. Stepwise Multiple- regression analysis revealed that only L4 tilt was the independent predictor for major Cobb and CBD.Conclusions The prevalence of coronal imbalance at pre-operation in DLS patients is about 20%. With similar major Cobb, the less the number of involving vertebra, the higher the incidence of coronal imbalance in DLS patients. L4 coronal tilt would be the predictive variable for progression of scoliosis and global coronal malalignment. Pelvis, the foundation of spine, had less effect on full-spine coronal balance.

Spirometra erinaceieuropaei is an important diphyllobothriid cestode whose larval plerocercoid (sparganum) can parasitise humans, causing sparganosis. In China, sparganosis is an important foodborne parasitic zoonosis and poses a serious threat to human health. However, our knowledge of the taxonomic classification of S. erinaceieuropaei and its relationship with other diphyllobothriid cestodes, such as Diphyllobothrium, remains fragmentary. In this study, we determined the complete sequences of cytochrome b (cytb) and cytochrome c oxidase subunit I (cox1) genes from 61 isolates of S. erinaceieuropaei collected from 11 geographical locations in eastern China and compared them to the sequences of Diphyllobothrium species from the GenBank database. Then, we evaluated the genetic variation of S. erinaceieuropaei and the phylogenetic relationship between S. erinaceieuropaei and Diphyllobothrium. Both negative Tajima's D and Fu's FS values of neutrality tests and unimodal curve of mismatch distribution analyses supported demographic population expansion. Bayesian skyline plot (BSP) analyses indicated that a population expansion occurred in the Pleistocene. Phylogenetic analysis based on cytb, cox1, and cytb+cox1 under all three methods tested (neighbour-joining, maximum parsimony, and maximum likelihood) suggested that the S. erinaceieuropaei isolates from eastern China and the genus Diphyllobothrium are separate monophyletic groups. Furthermore, the uncorrelated log-normal relaxed molecular-clock model suggested that divergence between Spirometra and Diphyllobothrium began in the late Miocene.

The Spirometra mansoni antigenic polypeptide (SmAP) gene was expressed in Escherichia coli, and its characteristics and value as an antigen for the serodiagnosis of sparganosis were investigated. The recombinant SmAP protein (rSmAP) has the molecular weight of 28.7 kDa. On Western blotting analysis, the rSmAP strongly reacted with the sera of mice infected with spargana, but not with normal sera; the anti-rSmAP serum obviously recognized the 28.7-kDa band in the crude antigens and excretory–secretory (ES) antigens of spargana. The immunofluorescence test (IFT) results showed that the positive staining was observed at different stages of spargana from the infected frogs and mice, but not adult worm of S. mansoni. An immunolocalization analysis identified SmAP in the teguments and parenchymal tissues of spargana. ELISA with rSmAP antigen or sparganum ES antigens were evaluated for the serodiagnosis of sparganosis. The results showed that the sensitivity of rSmAP-ELISA and ES-ELISA was 83.3 % (25/30) and 100 % (30/30), respectively, for the detection of anti-sparganum IgG antibodies in sera of the experimentally infected mice (P > 0.05), the specificities of both ELISA were 100 % (67/67). It is suggested that the rSmAP might be a potential candidate antigen for serodiagnosis of sparganosis.

OBJECTIVE: To evaluate the influence of Scoliosis Research Society (SRS)‐Schwab sagittal modifiers of pelvic incidence minus lumbar lordosis mismatch (PI‐LL) on clinical outcomes for adult degenerative scoliosis (ADS) after long posterior instrumentation and fusion. METHODS: This was a single‐institute, retrospective study. From 2012 to 2014, 44 patients with ADS who underwent posterior instrumentation and fusion treatment were reviewed. Radiological evaluations were investigated by standing whole spine (posteroanterior and lateral views) X‐ray and all radiological measurements, including Cobb’s angle, LL, PI, and the grading of vertebral rotation, were performed by two experienced surgeons who were blind to the operations. The patients were divided into three groups based on postoperative PI‐LL and the classification of the SRS‐Schwab: 0 grade PI‐LL (20°, n = 12). The clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Lumbar Stiffness Disability Index (LSDI), and complications. Other characteristic data of patients were also collected, including intraoperative blood loss, operative time, length of hospital stay, complications, number of fusion levels, and number of decompressions. RESULTS: The mean operative time, blood loss, and hospital stay were 284.5 ± 30.2 min, 1040.5 ± 1207.6 mL, and 14.5 ± 1.9 day. At the last follow‐up (2.6 ± 0.6 years), the radiological and functional parameters, except the grading of vertebral rotation, were all significantly improved in comparison with preoperative results (P 0.05). A Pearson correlation analysis further demonstrated that LSDI was negatively associated with PI‐LL. Furthermore, the incidence rate of postoperative complications was lower in patients with + grade PI‐LL (1/19, 5.26%) than that in patients with 0 (2/13, 15.4%) and ++ grade PI‐LL (3/12, 25%). CONCLUSION: Our present study suggest that the ideal PI‐LL may be between 10° and 20° in ADS patients after long posterior instrumentation and fusion.

Background Sparganosis is a neglected but important food-borne parasitic zoonosis. Clinical diagnosis of sparganosis is difficult because there are no specific manifestations. ELISA using plerocercoid crude or excretory–secretory (ES) antigens has high sensitivity but has cross-reactions with other helminthiases. The aim of this study was to characterize Spirometra erinaceieuropaei cysteine protease (SeCP) and to evaluate its potential application for serodiagnosis of sparganosis. Methodology/Principal Findings The full length SeCP gene was cloned, and recombinant SeCP (rSeCP) was expressed and purified. Western blotting showed that rSeCP was recognized by the serum of sparganum-infected mice, and anti-rSeCP serum recognized the native SeCP protein of plerocercoid crude or ES antigens. Expression of SeCP was observed at plerocercoid stages but not at the adult and egg stages. Immunolocalization identified SeCP in plerocercoid tegument and parenchymal tissue. The rSeCP had CP activity, and the optimum pH and temperature were 5.5 and 37°C, respectively. Enzymatic activity was significantly inhibited by E-64. rSeCP functions to degrade different proteins and the function was inhibited by anti-rSeCP serum and E-64. Immunization of mice with rSeCP induced Th2-predominant immune responses and anti-rSeCP antibodies had the potential capabilities to kill plerocercoids in an ADCC assay. The sensitivity of rSeCP-ELISA and ES antigen ELISA was 100% when performed on sera of patients with sparganosis. The specificity of rSeCP-ELISA and ES antigen ELISA was 98.22% (166/169) and 87.57% (148/169), respectively (P, Author Summary Sparganosis is a neglected tropical disease; its diagnosis is difficult and it is often misdiagnosed. ELISA using the crude or ES antigens of plerocercoids cross reacts with other helminthiases. Cysteine protease is a type of hydrolase and plays important roles in the development and survival of parasites; it has been used for diagnostic markers and vaccine targets for some parasitic diseases. In this study, a 36 kDa Spirometra erinaceieuropaei cysteine protease (SeCP) was expressed and purified. The results showed that SeCP was a plerocercoid stage-specific protein located in the teguments and parenchymal tissue. The rSeCP had cysteine protease activity and functioned to degrade host proteins. Vaccination of mice with rSeCP induced high levels of IgG1 and anti-rSeCP antibodies with the ability to kill plerocercoids in an ADCC assay. The rSeCP had a high sensitivity and specificity for detecting anti-plerocercoid antibodies, and could be used as a potential antigen for serodiagnosis of sparganosis.

Trichinellosis is a public health problem and is considered an emerging/re-emerging disease in various countries. The etiological agent of trichinellosis is the nematode Trichinella, which infects humans, domestic animals and wildlife. A veterinary vaccine could be an option to control the disease in domestic animals. Although several vaccine candidates have shown promising results, a vaccine against trichinellosis remains unavailable to date. Phage particles are especially ideal vaccine delivery vehicles because they do not interfere with the immune response against the displayed peptide antigens, and, if anything, are more likely to efficiently direct antigen expression to professional antigen-presenting cells. In this study, Tsp10 polypeptide, which was encoded by a cDNA fragment of Trichinella spiralis intestinal infective larvae and was found to bind to normal mouse intestinal cells, was displayed on the surface of T7 phage. Anti-Tsp10 antibodies were able to recognize the native Tsp10 protein mainly localized to the stichosome of T. spiralis. Mice immunized with the recombinant phage T7-Tsp10 showed a 62.8% reduction in adult worms and a 78.6% reduction in muscle larvae following challenge with T. spiralis muscle larvae. Our results demonstrate that the vaccination with Tsp10 polypeptide displayed by T7 phage elicits the Th2-predominant immune responses and produces a significant protection against T. spiralis infection in mice. These findings suggest that phage display is a simple, efficient, and promising tool to express candidate vaccine antigens for immunization against T. spiralis.

Background: Nudix hydrolases (Nd) is a widespread superfamily, which is found in all classes of organism, hydrolyse a wide range of organic pyrophosphates and has a ‘housecleaning’ function. The previous study showed that Trichinella spiralis Nd (TsNd) bound to intestinal epithelial cells (IECs), and the vaccination of mice with T7 phage-displayed TsNd polypeptides produced protective immunity. The aim of this study was to clone, express and identify the full-length TsNd and to investigate its immune protection against T. spiralis infection. Methods: The full-length cDNA sequence of TsNd gene encoding a 46 kDa protein from T. spiralis intestinal infective larvae (IIL) was cloned and identified. The antigenicity of rTsNd was analyzed by Western blot. Transcription and expression of TsNd at T. spiralis different stages were observed by RT-PCR and IFT. The levels of the specific total IgG, IgG1 and IgG2a antibodies to rTsNd were determined by ELISA. The immune protection of rTsNd against T. spiralis infection was investigated. Results: Sequence and phylogenetic analysis revealed that TsNd had a nudix motif located at 226-244aa, which had high homology and the closest evolutionary status with T. pseudospiralis. The rTsNd was obtained after expression and purification. Western blot analysis showed that anti-rTsNd serum recognized the native TsNd protein in crude antigens of muscle larvae (ML), IIL, adult worms (AW) and newborn larvae (NBL), and ES antigens of ML. Transcription and expression of TsNd gene was observed in all developmental stages of T. spiralis (ML, IIL, AW and NBL), with high level expression in IIL. An immunolocalization analysis identified TsNd in the cuticle, stichocytes and reproductive organs of the parasite. Following immunization, anti-rTsNd IgG levels were increased, and the levels of IgG1 were more significantly higher than that of IgG2a. After a challenge infection with T. spiralis, mice immunized with the rTsNd displayed a 57.7% reduction in adult worms and a 56.9% reduction in muscle larval burden. Conclusions: TsNd induced a partial protective immunity in mice and could be considered as a novel candidate vaccine antigen against trichinellosis.