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Objective:To compare the long-term efficacy of two-level cervical artificial disc replacement (CADR) and anterior cervical decompression and fusion (ACDF) in the treatment of cervical degenerative diseases.Methods:A retrospective analysis was performed on patients who had received two-level anterior cervical surgery for cervical degenerative diseases for more than 15 years from December 2003 to December 2007. The patients were divided into two groups: CADR and ACDF according to surgical methods. There were 15 patients in the CADR group, including 7 males and 8 females, with an average age of 49.73±10.26 (range, 32-70) years. Three cases of mixed cervical spondylosis, 5 cases of cervical spondylotic radiculopathy, 7 cases of cervical spondylotic myelopathy, including C 3, 4 and C 4, 5 level 1 case, C 3, 4 and C 5, 6 level 2 cases, C 4, 5 and C 5, 6 level 7 cases, C 5, 6 and C 6, 7 level 5 cases, operative segment range of motion (ROM) was 9.10°±4.00°. The follow-up time in the CADR group was 189.07±13.51 (range, 162-210) months. There were 20 patients in the ACDF group, including 12 males and 8 females, with an average age of 52.60±8.83 (range, 32-68) years. Two cases of mixed cervical spondylosis, 3 cases of cervical spondylotic radiculopathy, 15 cases of cervical spondylotic myelopathy, including C 3, 4 and C 4, 5 level 1 case, C 4, 5 and C 5, 6 level 15 cases, C 5, 6 and C 6, 7 level 4 cases, the ROM of the surgical segment was 8.31±5.23°. The mean follow-up time of ACDF group was 184.20±21.39 (range, 156-222) months. The Japanese Orthopaedic Association (JOA) score and neck disability index (NDI) were evaluated preoperatively and at the last follow-up. The overall ROM of the cervical spine, ROM of the surgical segment, and Miyazaki grading of the adjacent intervertebral disc, Odom score and complications of the two groups were evaluated at the last follow-up. Results:In the CADR group, the JOA score improved from 13.20±2.64 preoperatively to 15.93±1.22 at last follow-up, and NDI improved from 27.60%±6.44% preoperatively to 15.07%±9.71% at last follow-up, JOA improvement rate was 59.44%±60.86%, and NDI decreased by 12.53%±9.64%. In the ACDF group, JOA score improved from 12.93±2.46 preoperatively to 15.65±1.25 at last follow-up, NDI improved from 30.80%±8.11% preoperatively to 12.80%±6.31% at last follow-up, JOA improvement rate was 60.51%±43.17%, NDI decreased by 18.00%±8.34%. There was no significant difference in JOA and NDI between the two groups before surgery and at the last follow-up. At the last follow-up, the overall ROM of the cervical spine in the CADR group was 38.33°±12.31°, the ROM of the surgical segment was 6.51°±4.61°, and the overall ROM of the cervical spine in the ACDF group was 31.11°±8.65°, the ROM of the surgical segment was 0°. There was a significant difference in the overall ROM of the cervical spine between the two groups at the last follow-up ( t=7.22, P=0.049). The incidence of increased Miyazaki grading of the upper and lower adjacent segment of the cervical intervertebral disc in the CADR group were 40% and 47%, and the rate of new intervertebral disc herniation were 20% and 13%. The incidence of increased Miyazaki grading of the upper and lower adjacent segment of the cervical intervertebral disc in the ACDF group were 45% and 50%, and the incidence of new herniated disc were 25% and 40%, there is a significant difference in the degeneration rate of the lower adjacent segments between the two groups (χ 2=4.38, P=0.036). At the last follow-up, the excellent and good rate of Odom in the CADR group was 80%, and 1 case was revised; the excellent and good rate of Odom in the ACDF group was 85%, and 1 case was revised. There was no significant difference in the overall efficacy between the two groups. Conclusion:The long-term clinical efficacy of two-level CADR is comparable to that of traditional ACDF, and it preserved the ROM of the surgical segment, and is superior to ACDF in terms of the overall cervical spine ROM, and the incidence of adjacent segment degeneration.
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Objective To identify the gene mutations of platelet membrane glycoprotein Ⅱ b,Ⅲa(GPⅡb/Ⅲa)in three Chinese pedigrees with Glanzmann thrombastIlenia.Methods All exons and exonintron boundaries of GP Ⅱ b/Ⅲ a gene were amplified by PCR analysis followed by DNA sequencing.DNA sequencing was used to exclude gene polymorphisms.Results The probands in the three pedigrees had a normal platelet count,coagulation profiles,scattered platelets on the blood film,a prolonged cutaneous bleeding time,and impaired or minimal ex vivo platelet aggregation in response to ADP,thrombin,collagen,adrenaline and arachidonic acid,but normal platelet aggregation in response to ristoeetin.Both FACS and Western blotting demonstrated trace content of αⅡb in the platelets from proband 1 and proband 3,who were classified as type Ⅰ GT,and a small amount of αⅡb in the platelets from proband 2,who was classified as type Ⅱ GT.Compound heterozygous mutations,T2255G(Leu721Arg)and C2671T(Gln860Stop)were identified in proband 1.The proband 2 had homozygous A2334C(Gln747Pro)missense mutation.Nonsense mutations C1750T (Arg584Stop)and 69-79 deletion mutation were identified in proband 3. Conclusions Compound heterozygous mutations T2255G and C2671T of αⅡb gene lead to type Ⅰ Glanzmann thrombasthenia for proband 1. Homozygous mutation A2334C of αⅡb gene leads to type Ⅱ Glanzmann thrombasthenia for proband 2. Compound heterozygous mutations C1750T and 69-79del αⅡb gene lead to type Ⅰ Glanzmann thrombasthenia for proband 3. T2255G,C1671T and 69-79del aye novel mutations for αⅡb gene.
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Objective To investigate the expression of DcR3 mRNA in cells of acute leukemia(AL) and its clinical significance.Methods The DcR3 mRNA of bone marrow mononuclear cells(BMNC) in the patients with AL was detected by RTPCR.There were 28 AML cases,and 18 ALL cases.27 cases of non-malignant hematopathy were used as control group.The expression level of DcR3 mRNA in BMNC was detected with RT-PCR.Results The positive rate of DcR3 mRNA was 67.4% and gene expression level was 0.56?0.09 in AL group,while they were 40.7% and 0.39?0.19 in control group,there were significant differences(P0.05).The positive expression level of DcR3 mRNA increased when the white blood cell count was ≥30?109?L-1.Conclusion DcR3 gene might play a role by suppressing apoptosis in leukemogenesis.
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Objective To investigate the effects of methylation of p73 gene on pathogenesis of acute lymphoblastic leukemia.Methods The restriction endonuclease enzyme digestion combined with PCR was used to detect p73 gene and methylation in 42 patients with acute lymphoblastic leukemia.Results Methylation of p73 gene was found in 28.6%(12/42).Patients without methylation of p73 gene had a higher complete remission rate of first chemotherapy and a longer survival time than those with methylation of p73 gene.Conclusion Methylation of p73 gene probably plays a role in the pathogenesis of acute lymphoblastic leukemia and may have clinical significance in predicting prognosis of ALL.