Comparing effects of cervical anterior approach and laminoplasty in surgical management of cervical ossification of posterior longitudinal ligament by a prospective nonrandomized controlled study

INTRODUCTION

The laminoplasty has been the most widely used surgical method for OPLL. In recent years, increasing attention has been drawn to the anterior operative approaches for surgical treatment of cervical OPLL. However, which method is the optimum selection for therapy of cervical OPLL is still obscure. Therefore, we performed this prospective nonrandomized clinical study in patients with multilevel cervical myelopathy due to OPLL and compare the therapeutic efficiency of laminoplasty and anterior approach (cervical discectomy and/or cervical corpectomy) in the management of multilevel cervical OPLL.

HYPOTHESIS

There is no difference in clinical effects between anterior cervical spine surgery and laminoplasty in the treatment of multilevel cervical OPLL.

MATERIAL AND METHODS

A total of 150 consecutive patients with multilevels of cervical OPLL underwent anterior approaches (ACDF, ACCF and HDF) from July 2010 to June 2014, which were enrolled in this study. During the same period, one hundred and two patients receiving the laminoplasty were enrolled in the study. The clinical effects, alignment and range of motion (ROM) of cervical spine in patients of the anterior group and posterior group were assessed, respectively. The effects of high signals in T2 weighed MRI scans and percentage of spinal canal stenosis in these patients were also evaluated. Finally, postoperative complications regarding each group were analyzed.

RESULTS

Although significant differences in types of OPLL and preoperative sagittal alignment of cervical spine occurred in the two groups (P<0.05), clinical effects of the two groups were similar (P>0.05). The cervical curvature in laminoplasty group showed significant decrease at final follow-up (P<0.05). For ROM of cervical spine, no significant alteration was observed in both groups. The high T2 weighed signals and rate of spinal canal stenosis can influence clinical effects of both anterior group and laminoplasty group. In addition, significantly higher complication rate was observed in laminoplasty group compared with anterior group (P<0.05).

DISCUSSION

Both anterior and laminoplasty approaches can be considered effective and safe procedures in the treatment of the multilevel OPLL. However, the anterior approach with relatively lower incidence of postoperative complications is a better choice for cases with poor cervical curvature and serious spinal canal stenosis.

TYPE OF STUDY AND LEVEL OF PROOF

Level 3 nonrandomized, controlled clinical trials.

[Clinical diagnosis and management of cervical spondylotic amyotrophy]

Objective: To investigate the clinical characteristics and surgical treatment of cervical spondylotic amyotrophy. Methods: Thirteen patients(13 man) with proximal (10) and distal(3) cervical spondylotic amyotrophy between November 2014 and September 2016 were included in this study. The average age of the patients was 55 (range, 47-66) years. The sex, age, clinical course, type of amyotrophy, lesion segment and postdecompression improvement in muscle power were reviewed. Results: Of 13 cervical spondylotic amyotrophy patients, 9 were performed on with cervical disectomy, 2 were performed on with cervical posterior operation, 2 remainding patients received nonoperative treatment. Cervical spondylotic amyotrophy patients were followed up 6-22 (average 10.6) months, muscle power of 4 patients (all proximal-type)were improved completely (the average recovery time were 4.4 months), muscle power of 6 patients were improved uncompletely, 1 patients failed to improve, the 2 remainding patients received nonoperative treatment had no change. Conclusion: Cervical spondylotic amyotrophy as a rare type of cervical spondylotic disorder, It should distinguish cervical spondylotic amyotrophy from amyotrophic lateral sclerosis, especially in the early stage of amyotrophic lateral sclerosis. A surgical treatment is recommended as the first line of proximal-type CSA, especially those with serious compression. It is important that clinicians should be aware that distal-type CSA had a poor results, resulting in a lower lower satisfaction, especially those with no, or insignificant, sensory disturbance.

Association of TUSC3 gene polymorphisms with non-syndromic mental retardation based on nuclear families in the Qinba mountain area of China

TUSC3 interacts with the protein phosphatase 1 and magnesium ion transport system, which plays an important role in learning and memory. Abnormal conditions of learning and memory are common clinical characteristics of mental retardation (MR). However, the association of TUSC3 genetic polymorphisms with MR remains unknown. A total of 456 DNA samples including 174 nuclear families containing MR were collected in the Qinba mountain area of China. The genotypes of eight tag single nucleotide polymorphisms of TUSC3 were evaluated with traditional genetic methods. Family-based association tests, transmission disequilibrium tests (TDTs), and haplotype relative risk (HRR) analyses were performed to investigate the association between genetic variants of the TUSC3 gene and MR. The genetic polymorphisms rs10093881, rs6530893, and rs6994908 were associated with MR (all P values <0.05) based upon the results of single-site TDT and HRR analyses. The haplotype block consisting of rs6530893 and rs6994908, harboring the sixth exon of TUSC3, was also associated with MR (all P values <0.05). This study demonstrated an association between genetic polymorphisms of the TUSC3 gene and MR in the Qinba mountain area, the sixth exon of which might contribute to the risk of MR. However, further studies are needed on the causal mechanisms in this association.

Predicting drug-drug interactions involving multiple mechanisms using physiologically based pharmacokinetic modeling: a case study with ruxolitinib

Physiologically based pharmacokinetic modeling was applied to characterize the potential drug-drug interactions for ruxolitinib. A ruxolitinib physiologically based pharmacokinetic model was constructed using all baseline PK data in healthy subjects, and verified by retrospective predictions of observed drug-drug interactions with rifampin (a potent CYP3A4 inducer), ketoconazole (a potent CYP3A4 reversible inhibitor) and erythromycin (a moderate time-dependent inhibitor of CYP3A4). The model prospectively predicts that 100-200 mg daily dose of fluconazole, a dual inhibitor of CYP3A4 and 2C9, would increase ruxolitinib plasma concentration area under the curve by ∼two-fold, and that as a perpetrator, ruxolitinib is highly unlikely to have any discernible effect on digoxin, a sensitive P-glycoprotein substrate. The analysis described here illustrates the capability of physiologically based pharmacokinetic modeling to predict drug-drug interactions involving several commonly encountered interaction mechanisms and makes the case for routine use of model-based prediction for clinical drug-drug interactions. A model verification checklist was explored to harmonize the methodology and use of physiologically based pharmacokinetic modeling.

No association between FGD1 gene polymorphisms and intellectual developmental disability in the Qinba mountain area

FGD1 encoding a guanine nucleotide exchange factor, specifically activates Rho GTPase cell division cycle 42 (Cdc42). Dysfunction of FGD1 causes Aarskog-Scott syndrome (MIM #305400), an X-linked disorder that may affect bone and intellectual development. However, the relationship between FGD1 and intellectual developmental disorders (IDD) remains unclear. The purpose of this study was to investigate the genetic association between the FGD1 polymorphism and IDD. Working with families from the Qinba mountain area where the occurrence of IDD is higher than the average in China, we analyzed 456 samples from 130 nuclear families, effectively controlling for stratification and environmental factors. Five SNP loci (rs2230265, rs7881608, rs2239809, rs6614244, and rs2284710) were selected that were well distributed within the FGD1 gene. Genotyping was performed through single-strand conformation polymorphism and restriction fragment length polymorphism. The data were analyzed with transmission disequilibrium tests. In the Qinba mountain area, no significant association was observed between IDD and allele or genotype frequencies, or the haplotype of the 5 SNP loci of the FGD1 gene. The results indicate that FGD1 may not be a monogenetic X-linked factor in IDD. Further studies are required to investigate its role in intellectual development based on its specific interactions with Cdc42 or other partner proteins contributing to IDD.

Differentiation of neonatal dorsal root ganglion-derived neural stem cells into oligodendrocytes after intrathecal transplantation into a cauda equina lesion model

Cauda equina syndrome (CES) is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction. The prognosis for complete recovery of CES is dependent on not only the time before surgical intervention with decompression but also the severity of the nerve damage. Delayed or severe nerve compression impairs the capability of nerve regeneration. Transplantation of neural stem cells (NSCs) may facilitate axon regeneration and functional recovery in a spectrum of neurological disorders. Our study shows that the NSCs derived from early postnatal dorsal root ganglion (DRG) are able to proliferate to form neurospheres and differentiate into O4(+) oligodendrocytes but not glial fibrillary acidic protein (GFAP(+)) astrocytes or βIII-tubulin(+) neurons in vitro. After intrathecal transplantation into the lumbar spinal canal stenosis animal model, most of the GFP-expressing NSCs were induced to differentiate into oligodendrocytes in vivo. Although the recovery of sensorimotor function was not significantly improved in rats with transplantation therapy, our results implied that subarachnoid microinjection of NSCs may promote axon regeneration of DRG neurons in the cauda equina model after nerve injury.

The role of smoking status and collagen IX polymorphisms in the susceptibility to cervical spondylotic myelopathy

We investigated a possible association of collagen IX tryptophan (Trp) alleles (Trp2 and Trp3) and smoking with cervical spondylotic myelopathy (CSM) in 172 Chinese patients and 176 age- and gender-matched controls. The smoking status was evaluated by smoking index (SI). The CSM cases had a significantly higher prevalence of Trp2 alleles (Trp2+) than controls (19.8 vs 6.2%, P = 0.002), but the prevalence of Trp3 alleles (Trp3+) was similar between the two groups (23.3 vs 21.6%, P = 0.713). Logistic regression analyses showed that the subjects with Trp2+ had a higher risk for CSM. We thus analyzed whether smoking status influenced the association between Trp2 alleles and CSM risk. Among Trp2+ subjects with an SI less than 100, the smoking status did not influence the effect of risk for SCM [odds ratio (OR) = 1.34, 95% confidential interval (95%CI) = 0.85-2.18, P > 0.05]. When SI increased from 101 to 300, the OR for CSM reached 3.34 (95%CI = 2.11-5.67, P = 0.011); when SI was more than 300, the OR for CSM reached 5.56 (95%CI = 3.62-7.36, P < 0.001). Among Trp2- subjects with SI more than 300, the OR for CSM increased 2.14 (95%CI = 1.15-4.07, P = 0.024). We found a significant association between the Trp2 alleles and CSM risk and smoking amplifies this risk, suggesting that smoking abstinence is important for reducing CSM occurrence in subjects with high genetic risk.

PTEN deletion prevents ischemic brain injury by activating the mTOR signaling pathway

It is increasingly clear that the tumor suppressor PTEN (phosphatase and tensin homolog deleted on chromosome 10) is a negative regulator of neuronal cell survival. However, its molecular mechanisms remain poorly understood. Here we found that PTEN/mTOR is critical for controlling neuronal cell death after ischemic brain injury. Male rats were subjected to MCAO (middle cerebral artery occlusion) followed by pretreating with bpv (pic), a potent inhibitor for PTEN, or by intra-cerebroventricular infusion of PTEN siRNA. bpv (pic) significantly decreased infarct volume and reduced the number of TUNEL-positive cells. We further demonstrated that although bpv (pic) did not affect brain injury-induced mTOR protein expression, bpv (pic) prevented decrease in phosphorylation of mTOR, and the subsequent decrease in S6. Similarly, down-regulation of PTEN expression also reduced the number of TUNEL-positive cells, and increased phospho-mTOR. These data suggest that PTEN deletion prevents neuronal cell death resulting from ischemic brain injury and that its neuroprotective effects are mediated by increasing the injury-induced mTOR phosphorylation.

A family-based and case-control association study of the NOTCH4 gene and schizophrenia

Recently a strong positive association between schizophrenia and Notch4 has been reported. Both individual markers and haplotypes showed association with the disease, with five markers (three microsatellites and two SNPs) being tested. In order to test this finding we genotyped these markers in the Han Chinese population using a sample of 544 cases and 621 controls as well as >300 trios. Analysis of allele, genotype and haplotype frequencies in both samples showed no association between the markers and the disease. Our results would indicate that a significant role for the Notch4 gene in schizophrenia can be ruled out in the Han Chinese. However, similar studies are necessary in the Caucasian population as linkage disequilibrium arrangements and founder effects may differ between these two populations.

Polyoxygenated bipyridine, pyrrolylpyridine, and bipyrrole alkaloids from Speranskia tuberculata

Five novel polyoxygenated alkaloids, speranculatines A-C (3-5), speranskilatine A (6), and speranberculatine A (7), have been isolated from Speranskia tuberculata. Compounds 3-5, 6, and 7, have bipyridine, pyrrolylpyridine, and bipyrrole skeletons, respectively. This is the first time that these three alkaloid structural types have been reported. The structures of 3-7 were elucidated by spectroscopic methods, including 2D NMR techniques and X-ray crystallographic analysis.

Isolation, structural characterization, and synthesis of a naturally occurring bisfuranopseudopterane ether: biskallolide A. Evidence for a carbocation intermediate during the facile conversion of kallolide A and isokallolide A into various solvolysis products

The West Indian alcyonacean Pseudopterogorgia bipinnata (Verrill, 1864) is shown to contain a novel bisditerpenoid ether: biskallolide A (2). The structural assignment of 2 was mainly based on 1D and 2D NMR and MS spectral data and was further confirmed by synthesis. The 2-C-alkoxylation of furanopseudopteranes kallolide A (1) and isokallolide A (8) occurs spontaneously in some solvents and involves replacement of the C2 hydroxyl with an alkoxyl group to yield solvolysis products that display net retention of configuration. The facile solvolytic 2-C-acyloxylation of kallolide A was achieved readily under similar circumstances to afford kallolide A acetate (4) as the sole product. Mechanistic details in conversion of alcohols 1 and 8 into various solvolysis products, including dimeric ethers 2 and 9, were investigated in this study. Solvolysis of kallolide A and isokallolide A in [(18)O]-labeled solvent demonstrated that the C2 alkoxyl of the solvolysis products originated from the solvent, suggesting that these conversions may proceed through an S(N)1 mechanism with generation of a carbocation intermediate. The chemical structures of kallolide A derivatives 3-7and those of isokallolide A congeners 9-11 were established by detailed analysis of the spectral data.

[Chemical constituents from Speranskia tuberculata (Bge.) Baill]

OBJECTIVE

To investigate the chemical constituents from the herb Speranskia tuberculata.

METHOD

The chemical constituents were extracted with solvent and separated with column chromatography. The structures were elucidated by spectral analysis.

RESULT

Two compounds were isolated from the plant and identified as 18-hydroxy(-)-manool and beta-sitosterol.

CONCLUSION

Both were separated from this plant first time.

Constituents of Eremurus chinensis

A novel bianthraquinone glycoside, 8-O-beta-D-glucopyranosyl-1,1', 8'-trihydroxy-3,3'-dimethyl-2,7'-bianthraquinone (1); two naphthalene derivatives, 2-acetyl-1-hydroxy-8-methoxy-3-methylnaphthalene (2) and 2-acetyl-1, 8-dimethoxy-3-methylnaphthalene (3); and a novel pre-anthraquinone, 1-oxo-4(S),9-dihydroxy-8-methoxy-6-hydroxymethyl-1,2,3, 4-tetrahydroanthracene (4), were isolated from Eremurus chinensis. Their structures were established by spectroscopic and chemical methods. In addition, the known compounds chrysophanol, chrysophanol 8-methyl ether, aloesaponol III 8-methyl ether (5), and 10-(chrysophanol-7'-yl)-10-hydroxychrysophanol-9-anthrone were also isolated and identified from this plant.

Highly oxygenated pseudopterane and cembranolide diterpenes from the Caribbean sea feather Pseudopterogorgia bipinnata

A chemical study of the sea feather Pseudopterogorgia bipinnata from Colombia has produced four known metabolites, namely, kallolide A (1), bipinnatin A (2), bipinnatin C (3), and bipinnatin J (4), in addition to nine previously undescribed diterpenes possessing an uncommonly high level of oxygenation. One of them, bipinnapterolide A (5), is a new representative of the pseudopterane family of diterpenes possessing the rare 2,3-epoxy-1,4-dione moiety. The other metabolites, bipinnatins G-I (6-8) and bipinnatolides F-J (9-13), are highly oxygenated cembranolide diterpenes. Their chemical structures including relative stereochemistry were established by detailed analysis of the spectral data in addition to X-ray diffraction analysis and NMR spectral comparisons with known pseudopterane and cembranolide models.

Isolation, structure elucidation, and synthesis of bisgersolanolide, a novel heptacyclic bis-diterpenoid from the gorgonian octocoral Pseudopterogorgia bipinnata

[formula: see text] A chemical study of the hexane extracts of the Caribbean gorgonian Pseudopterogorgia bipinnata (Verrill) collected in San Andrés Island, Colombia, has led to the isolation of an unprecedented heptacyclic C40 bis-diterpenoid, bisgersolanolide (1). The structure of this novel secondary metabolite, which was established by spectroscopic studies that included 2D NMR correlation methods, IR, UV, and accurate mass measurements, was confirmed by synthesis.