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@#The microRNAs(miRNAs)is a non-coding small RNA molecule with the function of regulating gene expression, which can be released by cells and tissues in various biological fluids, including serum or plasma. A large number of studies have confirmed that the expression of different miRNAs in diabetic retinopathy(DR)can be specifically increased or decreased. Recently, more and more evidence shows that some miRNAs in serum and plasma are specifically expressed in DR and participate in the occurrence and development of DR, and can become biomarkers for the diagnosis of DR and monitoring of DR progress. In addition, the regulation of these miRNAs levels may delay the progression of DR for early intervention in patients with DR. miRNAs is expected to become a new therapeutic target for DR. This paper mainly reviews the progress of miRNAs in the diagnosis and monitoring of DR and possible new therapeutic targets in recent years.
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@#Brain-derived neurotrophic factor(BDNF)is a basic protein, and a member of neurotrophic factor family, which plays an important role in the development, differentiation and maintenance of neurons. A large number of studies have confirmed that BDNF is involved in the occurrence and development of neurodegenerative diseases such as Parkinson's disease and Alheimer's disease, and has a neuroprotective effect. In the retina, BDNF is mainly produced by retinal ganglion cells, amacrine cells, astrocytes, retinal glial cells(Müller cells)and photoreceptors. In recent years, related studies have found that BDNF is involved in the occurrence and development of glaucoma, diabetic retinopathy(DR)and other ocular diseases, and may have a diagnostic role, which will be beneficial to early intervention of patients to avoid the development of advanced glaucoma or DR. On the other hand, BDNF-based therapies have achieved good results in <i>in vitro</i> and <i>in vivo</i> experiments of glaucoma, DR and amblyopia, which may provide more choices for the treatment of these ocular diseases. In this manuscript, the research progresses of BDNF in ocular diseases in recent years were reviewed.
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OBJECTIVE@#To observe effects of (, TLZT) gel preparation on p53, miR-502-5p, NF-κBp65 in synovial tissue of knee osteoarthritis (KOA), and to explore mechanism of TLZT gel preparation in treating KOA.@*METHODS@#Thirthy-six Wistar rats aged 8 weeks and weighed 200 to 220 g (meaned 208 g) were randomly divided into normal group, model group and traditional Chinese medicine (TCM) group, 12 rats in each group. KOA model was established by modified Hulth method. After 4 weeks of modeling, TCM group treated with TLZT gel preparation for external use, 3 times daily for 2 weeks;normal group and model group were fed normally without intervention. After treatment, morphological changes of specimens in each group were observed, changes of miR-502-5p in synovial tissue were detected by qPCR, and contents of p53, NF-κBp65, IL-1β, TNF-α, MMP-13 in synovial tissue were detected by qPCR and Western Blot respectively.@*RESULTS@#(1)Morphological observation of specimens showed that the articular cartilage in model group was hyaline and uneven, the synovial membranes were hypertrophic and proliferative with a large number of inflammatory cells infiltrating, the joint fluid was thicker in texture;the articular cartilage in TCM group was more transparent and smooth, synovial hyperplasia was mild with a small amount of inflammatory cell infiltration, the texture of articular fluid was clear and sparse. (2) Compared with normal group, content of miR-502-5p of synovial tissue in model and TCM group were increased, mRNA and expression of p53 decreased, expression of NF-κBp65, IL-1β, TNF-α, MMP-13 increased. (3)Compared with model group, content of miR-502-5p in synovial tissue of TCM group decreased (<0.05), mRNA and protein expression of p53 increased (<0.05), mRNA and protein expression of NF-κBp65, IL-1β, TNF-α, MMP-13 decreased (<0.05).@*CONCLUSION@#Expression of p53, miR-502 -5p, NF -κBp65 in synovial tissue is closely related to synovial hyperplasia and inflammatory reaction, TLZT gel preparation may reduce proliferation and inflammatory reaction of KOA synovium by regulating the expression of p53, miR- 502-5p, NF-κBp65 in synovial tissues.
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Animals , Rats , Drugs, Chinese Herbal , MicroRNAs , Osteoarthritis, Knee , Rats, Wistar , Synovial Membrane , Tumor Suppressor Protein p53ABSTRACT
OBJECTIVE@#To explore expression of β-catenin and NF-κB signaling pathway in synovial tissue of rats with different degrees of knee osteoarthritis (KOA).@*METHODS@#Forty-eight SPF male rats weighed (200±20) g were randomly divided into three groups, namely model group (32 rats), sham operation group (8 rats) and control group (8 rats). KOA model rats were established by Hulth method, and 8 rats were killed at 2, 4, 8, 12 weeks respectively after modeling, in order to establish KOA model rats with moderate, early, mild and severe degree. Sham operation group was only cut off capsule of knee joint and suture to exclude interference factor, control group was untreated. Behavior, synovial hyperplasia and cartilage degeneration of rats among each group were observed. Expression of NF-κB and signaling pathway and β-catenin in synovial tissue of rats were detected by real-time PCR.@*RESULTS@#KOA rat model was successfully established, and synovial hyperplasia was observed in KOA model at mild and early degree, and then gradually decreased; while cartilage degeneration in the early moderate and severe KOA model was significantly expressed, and gradually aggravated with time. The results of PCR showed that expression of β-catenin in 4-week group (8.57±0.46) and 8-week group (4.23±0.09) were higher than those in control group (<0.05); expression of TLR-2 in 2-week group (12.04±4.02) and 4-week group (8.54±2.13) were higher than those in control group(<0.05), and TLR-4 in 2-week group(5.04±0.93), 4-week group (3.29±0.58) and 8-week group (1.63±0.12) were higher than those in control group; expression of NF-κB was significantly higher in 2-week group (10.15±2.04), 4-week group (15.97±4.17), 8-week group (7.69±1.48) and 12-week group (6.70±1.58) than that in control group (<0.05), and expression of IL-1β was significantly higher in 4-week group (2.79±0.25) and 8-week group (2.46±0.32) than that of control group (<0.05).@*CONCLUSIONS@#On the RNA expression level, both of β-catenin and NF-κB signaling pathways are involved in synovial inflammation in KOA model rats, and they play a regulatory role in expression of IL-1β, degeneration of KOA.
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Animals , Male , Rats , Inflammation , NF-kappa B , Osteoarthritis, Knee , Signal Transduction , beta CateninABSTRACT
Objective To compare the accuracy of three classification systems [determinant based classification (DBC),Revision of the Atlanta classification (RAC),and Atlanta classification (AC)] to stratify severity of acute pancreatitis (AP),and to analyze the association between different severity categories and clinical outcomes.Methods In this retrospective study,we reviewed the clinical data of 458 patients with AP admitted to our unit from January 2015 to December 2017.AP severity was stratified according to the three classification systems (DBC,RAC,and AC) respectively.The classification accuracy of three classification systems was analyzed.Receiver operating characteristic analysis (area under the curve) compared the accuracy of each classification.Multi-factors logistic regression analysis identified the independent risk fators for mortality of AP.Results Among the three classification systems,there were significant differences in the mortality rate,invasive treatment rate,ICU monitoring rate and the average hospitalization time among the three subtypes (P＜0.001).The RAC and DBC were comparable,but performed better than AC in predicting mortality (AUC 0.94 and 0.95 vs.0.63,P＜0.001),ICU admission (AUC 0.90 and 0.88 vs 0.60,P＜0.001).The DBC performed better than the RAC and OAC in predicting the need for intervention (AUC 0.88 vs 0.69 and 0.68,P＜0.001).Persistent organ failure (OR=13.131,P=0.003) and infected necrosis(OR=9.424,P=0.014) were independent risk factors for mortality.Conclusion The accuracy of DBC and RAC to stratify the severity of AP was significantly higher than that of AC.The accuracy of DBC in predicting clinical outcome was genarally higher than that of RAC and AC.Infectious necrosis and persistent organ failure were the independent risk fators for mortality.
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Objective To investigate the clinical features of patients with acute ST-segment elevation myocardial infarction (STEMI) comorbid with diabetes mellitus (DM) and to analyze the prognosis within 12 months after primary percutaneous coronary intervention (pre-PCI). Methods A total of 375 STEMI patients were divided into the diabetes group (n=140) and the normal blood glucose group(n=235) according to whether they met the diagnostic criteria of DH. The clinical data,characteristics of coronary artery lesions,type of stent implant,rate of coronary slow flow or no-reflow after pre-PCI, and the prognosis within 12 months after PCI of the two groups were investigated.Results Patient in the diabetes group presented with higher mean age ,higher comorbid rates of hypertension , hyperlipidemia and heart function of Killip class Ш and above than patients in the normal blood glucose group (all P<0.05). patients in the diabetes group had higher rates of slow reflow /no-reflow after PCI(12.9% vs.5.5%,P=0.013),higher percentages of 3-ressel disease(40.7% vs. 28.9%,P=0.019)and lef t main lesions(13.6% vs. 7.2%,P=0.044). The in-hospital mortality rates(6.4% vs.1.7%,P=0.020),revascularization rates within 12 months(7.9% vs.0.9%,P=0.001)and incidence of heart failure(7.9% vs. 2.6%,P=0.017)were all higher in the diabetes group. Conclusions STEMI patients comorbid with DM were relatively older, had higher comorbidities of hypertension,hyperlipidemia, three-vessel disease, left main coronary lesions and higher mortality during hospitalization. No significant increase in cardiac death and recurrent myocardial infarction were deserved during the follow-up period. These patients may benefit more from early intervention.
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Objective To observe the relationship of IL-17 and arterial blood gas, fibrin fragment D (D-D) in patients with both pulmonary embolism (PE) and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods We collected 20 patients with both PE and OSAHS and 43 patients with only PE who hospitalized in the first ward of pneumology department of the Second Affiliated Hospital of Kunming Medical University, then measured D-D, IL-17 in venous blood and arterial blood gas and recorded them to analysis.Re s ults PO2 in patients with both PE and OSAHS was significantly lower than that in patients with only PE, while D-D and IL-17 of the latter were markedly lesser than the former. Conclus ions The expression of IL-17 between the 2 groups of patients has statistically significant difference. What's more, the expression of IL-17 is positively associated with hypercoagulability and Body Mass Index (BMI), and the result shows a negative relation between arterial blood oxygen partial pressure and IL-17, suggesting that IL-17 may be relate to the common progress of PE and OSASH. Thus, IL-17 can be used in the detection of patients with both PE and OSASH
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Objective To study the effect of lateral wedge insoles with different stiffness on the knee adduction moment (KAM) under walking condition. Methods The gait of 15 healthy males wearing lateral wedge insoles with different stiffness was tested. The kinetics and kinematics data were collected by optical motion capture system and ground reaction force platform. The KAM and its peak values were calculated by Visual 3D software. The differences in peak KAM under 3 walking conditions (shoes only, shoes with softer or harder lateral wedge insoles) were analyzed. Results Compared with walking with the softer lateral wedge insoles, walking with the harder lateral wedge insoles could reduce the 1st and 2nd peak KAM by 9.3% and 9.7%, respectively, with significant statistic differences. Conclusions Increasing some stiffness of lateral wedge insoles can further reduce the pressure and wear on medial compartment of the knee joint, which may relieve the symptom of knee osteoarthritis.
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Objective To study the effect of lateral wedge insoles with different stiffness on the knee adduction moment (KAM) under walking condition.Methods The gait of 15 healthy males wearing lateral wedge insoles with different stiffness was tested.The kinetics and kinematics data were collected by optical motion capture system and ground reaction force platform.The KAM and its peak values were calculated by Visual 3D software.The differences in peak KAM under 3 walking conditions (shoes only,shoes with softer or harder lateral wedge insoles) were analyzed.Results Compared with walking with the softer lateral wedge insoles,walking with the harder lateral wedge insoles could reduce the 1st and 2nd peak KAM by 9.3％ and 9.7％,respectively,with significant statistic differences.Conclusions Increasing some stiffness of lateral wedge insoles can further reduce the pressure and wear on medial compartment of the knee joint,which may relieve the symptom of knee osteoarthritis.
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Objective To establish a Daphnia model of alloxan-induced diabetes. Methods Daphnia were exposed to three different concentrations of alloxan (3, 5, and 10 mmol/L) for 30 minutes. Blood glucose and survival rate were recorded for 72 hours after alloxan insult. Sequence analysis and phylogenetic inference for glucose transporters (GLUT) were clustered with the maximum-likelihood method. Using reverse transcription and quantitative polymerase chain reaction techniques, we investigated the transcriptional changes of GLUT at 12 hours after alloxan (5 mmol/L) exposure. Results Compared with control, 3 mmol/L, and 5 mmol/L as well as 10 mmol/L alloxan initially induced transient blood glucose decline by 15% for 2 hours and 12 hours respectively. In Daphnia with 5 and 10 mmol/L alloxan, their blood glucose was persistently raised by about 150% since after 24-hour insult. Survival rate of Daphnia exposure to alloxan with concentrations of 3, 5, and 10 mmol/L were 90%, 75%, and 25% respectively. We predicted seven GLUT genes in the Daphnia genome and successfully amplified them using real-time polymerase chain reaction. Two of seven GLUT transcripts were down-regulated in Daphnia with 5 mmol/L alloxan-induced diabetes. Conclusion Alloxan-induced diabetes model was successfully established in the Daphnia pulex, suggesting diabetes-relevant experiments can be conducted using Daphnia.
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Animals , Alloxan , Blood Glucose , Daphnia , Diabetes Mellitus, Experimental , Disease Models, Animal , Gene Expression Regulation , Glucose Transport Proteins, Facilitative , Genetics , Metabolism , Likelihood Functions , Phylogeny , Real-Time Polymerase Chain ReactionABSTRACT
This study employed a Bac-to-Bac/Bombyx mori bioreactor to mass-produce immunogenic urease subunit B (UreB) from Helicobacter pylori. The signal peptide bombyxin from B. mori was used to promote secretory expression to improve expression levels and was designed and integrated into the UreB gene to generate the Bacmid/BmNPV/(signal peptide)-UreB baculovirus expression system. To determine whether the bombyxin signal peptide resulted in secretory expression of recombinant UreB (rUreB) and to determine the secretory efficiency, we tested the secretory expression level of rUreB in Bm5 cells using ELISA. To further investigate whether secretory expression affected cell viability, cells were evaluated using 0.4% trypan blue staining, and Bacmid/BmNPV/UreB without the signal peptide served as a control. The above recombinant bacmid constructs were injected to silkworm larvae, and the secretory expression level of rUreB was detected using SDS-PAGE and semi-quantitative western blot analysis. The results indicated that the bombyxin signal peptide directed the secretory expression of rUreB and that this expression improved the viability of Bm5 cells. Moreover, the results showed that the expression level of rUreB was 1.5 times higher with the Bacmid/BmNPV constructs containing the bombyxin signal sequence than those without the signal sequence. These results demonstrate that secretory expression can enhance rUreB expression levels and is likely to aid in the large-scale expression and yield of rUreB in silkworm larvae.
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Objective To compare biomechanical characteristics of the knee joint during forward walking and backward walking. Methods Temporal-spatial, kinematics, kinetics parameters of 13 healthy young male volunteers were collected and compared by 3D motion capture system Vicon T40 and force platforms AMTI OR6-7. Results Compared with forward walking, the speed, cadence and stride length significantly decreased, while the gait cycle and stance phase percentage in gait cycle significantly increased during backward walking. In the sagittal plane, the range of motion (ROM), the maximum flexion/extension moment of the knee were smaller during backward walking. In the frontal plane, the ROM of knee varus/valgus during backward walking decreased, and the peak value of knee adduction moment significantly reduced in the early stance phase while significantly increased in the late stance phase of backward walking. The peak value of ground reaction force (GRF) was significantly larger in the early stance phase while smaller in the late stance phase during backward walking than that during forward walking. Conclusions The biomechanical characteristics of the knee joint during forward walking and backward walking are significantly different. Compared with forward walking, backward walking is helpful to reduce the medial compartment load in the early stance phase. Further study will be needed to investigate the effects of backward walking on knee joint loading in the late stance phase.
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Objective To study dynamic characteristics of the ankle gait simulator, simulate plantar forces in the vertical, anterior-posterior, right-left direction during the stance phase, and validate such forces in the experimental setup. Methods The Adams virtual prototype and ankle model (including tendons, ligaments and soft tissues of foot) were established for dynamic simulation based on the self-developed 5 DOF gait simulator. The dynamic results from both the prototype and gait simulator were compared with the real plantar forces. Results The simulated plantar force could accurately fit the normal in vivo ankle position curves during a stance phase in three directions, and the tendons, ligaments and soft tissues had important influences on the correct gait. The simulated plantar force by the gait simulator could be repeatedly fit for the real stance plantar force. Conclusions The gait simulator was proved to simulate the human gait stance well and can provide a clinical research platform for those experiments which are incapable of in vivo measurement.
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Objective To study the control problem in dynamic foot biomechanical simulator and propose a complete multi-axis control algorithm which could be more competitive than that of current gait simulators in aspects as simulations in degree-of-freedom (DOF), velocity, precision, weight-bearing and trial efficiency. Methods A novel custom-made foot and ankle biomechanical simulator was developed to simulate both motion and force characteristics in a stance phase with 5 DOF. A model of the simulator was built in Matlab based on gait analysis and reasonable simplification. Iteration learning control (ILC) was proposed to control multi-axis forces and was verified in Simulink. Finally, the control strategy was validated in the simulation platform with a prosthetic foot. Results The novel simulator could complete the motion and force loading process within 5 seconds in one stance after 4-5 iterations. All 3D ground reaction forces (Fz, Fy and Fx) had high verified repeatability. The tracking curves of Fz and Fy with 50% of real body weight could converge to the target ones with root mean square (RMS) error of 20 N and 8 N using ILC, respectively, which was smaller than 10% of simulated loads. Conclusions The proposed control strategy greatly improved intelligence of the simulator and provided a good foundation to further improve the simulation speed and accuracy. The development of the simulator is of great significance to the cadaveric experiments on foot and ankle biomechanics.
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OBJECTIVE: To explore a new synthesis method of the saxagliptin intermediate of the dipeptidyl peptidase IV (DPP-IV)inhibitor saxagliptin, N-BOC-3-hydroxy-1-adamantylglycine, to reduce the synthesis cost of saxagliptin. METHODS: The synthesis used 1-adamantane carboxylic acid (1) as the starting material. Through achlorination, substitution, and decarboxylation afford 1-adamantyl methyl ketone (2) was obtained, which was then converted into 2-(3-hydroxy-1-adamantyl)-2-oxoacetic acid (3)by oxidation with potassium permanganate in aqueous NaOH. Compound 3 reacted with hydroxylamine hydrochloride to give the 2-(3-hydrox-1-adamantyl)-2-hydroxyimino acetic acid(4), and then oxime 4 was reduced, and got the amino with BOC2O to afford dipeptidyl peptidase IV (DPP-IV)inhibitor saxagliptin intermediate N-BOC-3-hydroxyadamanty- lglycine(5). RESULTS: We got a new compound 4 which had not been reported. The 36% overall yield was reached. CONCLUSION: This synthetic route is simple, its reaction conditions are mild, and the raw materials are cheap and readily available, so it is suitable for manufacturing purposes.
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The effect and safety of anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach were assessed in the single-level lumbar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients' general information, microbiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association (ASIA) impairment, visual analogue scale (VAS), and Oswestry Disability Index (ODI). Ten patients had undergone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments included L1-2, L2-3, L3-4, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were positive for Staphylococcus aureus (5 cases), Staphylococcus epidermidis (4), Streptococcus (3), and Escherichia coli (1). The operative time was 213.8±45.6 min, and the intraoperative blood loss was 180.6±88.1 mL. Postoperative complications consisted of urinary retention (2 cases), constipation (3), and deep vein thrombosis (2). On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondylodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.
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Adult , Aged , Female , Humans , Male , Middle Aged , Back Pain , Bacterial Infections , Microbiology , Constipation , Debridement , Methods , Disability Evaluation , Discitis , General Surgery , Escherichia coli , Follow-Up Studies , Lumbar Vertebrae , Microbiology , General Surgery , Minimally Invasive Surgical Procedures , Methods , Pain Measurement , Retrospective Studies , Spinal Fusion , Methods , Staphylococcus aureus , Staphylococcus epidermidis , Streptococcus , Treatment Outcome , Urinary Retention , Venous ThrombosisABSTRACT
Patients with type 2 diabetes mellitus (T2DM) exhibit hyperglycemia and hyperinsulinemia and increased risk of fracture at early stage, but they were found to have normal or even enhanced bone mineral density (BMD). This study was aimed to examine the molecular mechanisms governing changes in bone structure and integrity under both hyperglycemic and hyperinsulinemic conditions. Monocytes were isolated from the bone marrow of the C57BL/6 mice, induced to differentiate into osteoclasts by receptor activator of nuclear factor kappa-B ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) and exposed to high glucose (33.6 mmol/L), high insulin (1 μmol/L), or a combination of high glucose/high insulin (33.6 mmol/L glucose and 1 μmol/L insulin). Cells cultured in α-MEM alone served as control. After four days of incubation, the cells were harvested and stained for tartrate resistant acid phosphatase (TRAP). Osteoclast-related genes including RANK, cathepsin K and TRAP were determined by using real-time PCR. The resorptive activity of osteoclasts was measured by using a pit formation assay. Osteoclasts that were derived from monocytes were of multinucleated nature and positive for TRAP, a characteristic marker of osteoclasts. Cell counting showed that the number of osteoclasts was much less in high glucose and high glucose/high insulin groups than in normal glucose and high insulin groups. The expression levels of RANK and cathepsin K were significantly decreased in high glucose, high insulin and high glucose/high insulin groups as compared with normal glucose group, and the TRAP activity was substantially inhibited in high glucose environment. The pit formation assay revealed that the resorptive activity of osteoclasts was obviously decreased in high glucose group and high glucose/high insulin group as compared with normal group. It was concluded that osteoclastogenesis is suppressed under hyperglycemic and hyperinsulinemic conditions, suggesting a disruption of the bone metabolism in diabetic patients.
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The effect and safety of anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach were assessed in the single-level lumbar pyogenic spondylodiscitis. Seventeen patients from 2007 to 2009 underwent anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach. Postoperative follow-up time was 24-41 months. Data included the patients' general information, microbiology, operative time, intraoperative blood loss, postoperative complications, intervertebral fusion rate, and preoperative and final follow-up scores for American Spinal Injury Association (ASIA) impairment, visual analogue scale (VAS), and Oswestry Disability Index (ODI). Ten patients had undergone a prior spinal invasive procedure, and 7 had hematogenous infection. The infected segments included L1-2, L2-3, L3-4, and L4-5 in 1, 2, 5, and 9 cases, respectively. Thirteen bacterial cultures were positive for Staphylococcus aureus (5 cases), Staphylococcus epidermidis (4), Streptococcus (3), and Escherichia coli (1). The operative time was 213.8±45.6 min, and the intraoperative blood loss was 180.6±88.1 mL. Postoperative complications consisted of urinary retention (2 cases), constipation (3), and deep vein thrombosis (2). On the final follow-up, VAS scores and ODIs were significantly lower than those of preoperation, while the ASIA grades improved. All the cases achieved good intervertebral bony fusion. Anterior debridement and fusion with a minimally invasive approach combined with posterior fixation via the Wiltse approach can successfully treat single-level lumbar pyogenic spondylodiscitis, with less trauma and reliable immobilization. It is a viable option for clinical application.
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As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limitations and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight consecutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mortality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixation failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior reconstruction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.
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As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limitations and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight consecutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mortality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixation failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior reconstruction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.