Is Type 2 Diabetes Mellitus Associated with Spinal Degenerative Disorders?: Evidence from Observational and 2-Sample Mendelian Randomization Analyses.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and spinal degenerative disorders (SDD) are common diseases that frequently coexist. However, both traditional observational studies and recent Mendelian randomization (MR) studies have demonstrated conflicting evidence on the association between T2DM and SDD. This comparative study explored and compared the association between T2DM and SDD using observational and MR analyses. METHODS: For observational analyses, cross-sectional studies (44,972 participants with T2DM and 403,095 participants without T2DM), case-control studies (38,234 participants with SDD and 409,833 participants without SDD), and prospective studies (35,550 participants with T2DM and 392,046 participants without T2DM with follow-up information until 2022) were performed to test the relationship between T2DM and SDD using individual-level data from the U.K. Biobank from 2006 to 2022. For MR analyses, the associations between single-nucleotide polymorphisms with SDD susceptibility obtained using participant data from the U.K. Biobank, which had 407,938 participants from 2006 to 2022, and the FinnGen Consortium, which had 227,388 participants from 2017 to 2022, and genetic predisposition to T2DM obtained using summary statistics from a pooled genome-wide association study involving 1,407,282 individuals were examined. The onset and severity of T2DM are not available in the databases being used. RESULTS: Participants with T2DM were more likely to have SDD than their counterparts. Logistic regression analysis identified T2DM as an independent risk factor for SDD, which was confirmed by the Cox proportional hazard model results. However, using single-nucleotide polymorphisms as instruments, the MR analyses demonstrated no causal relationship between T2DM and SDD. The lack of such an association was robust in the sensitivity analysis, and no pleiotropy was seen. CONCLUSIONS: Our results suggest that the association between T2DM and SDD may be method-dependent. Researchers and clinicians should be cautious in interpreting the association, especially the causal association, between T2DM and SDD. Our findings provide fresh insights into the association between T2DM and SDD by various analysis methods and guide future research and clinical efforts in the effective prevention and management of T2DM and SDD. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Impact of Gender-Role Attitudes and Mental Health on Hostile Sexism and Acceptance of Cosmetic Surgery.

BACKGROUND: Each year, tens of thousands of people worldwide choose to undergo cosmetic surgery in order to alter their appearance. In recent years, young people have gradually emerged to comprise the main driving force behind the increasing demand for cosmetic surgery. Previous studies have found that sexism may motivate young people to undergo such surgeries. However, few studies have been conducted to determine if this psychological mechanism influences the acceptance of cosmetic surgery among Chinese university students. METHODS: A total of 579 Chinese university students (280 girls and 299 boys, 17-20 years) volunteered to participate in the online survey. They completed a questionnaire containing the Ambivalent Sexism Inventory, the 12-item General Health Questionnaire, the Gender-Role Attitudes Questionnaire and the Acceptance of Cosmetic Surgery Scale. We firstly evaluated the underlying factor structure of the Acceptance of Cosmetic Surgery Scale using exploratory and confirmatory factor analyses, and exploring pattern of associations between the constructs was analyzed via path analysis. RESULTS: According to the findings, hostile sexism was associated with greater levels of acceptance toward cosmetic surgery. Moreover, gender-role attitudes mediated the link between hostile sexism and the acceptance of cosmetic surgery, and this mediation was positively influenced by general mental health. CONCLUSION: Our study contributes to a deeper understanding of Chinese university students' attitudes toward cosmetic surgery, hostile sexism may contribute to normalizing traditional gender stereotypes and encourage cosmetic surgery acceptability among Chinese university students. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The benefits of expressive writing among newly diagnosed mainland Chinese breast cancer patients.

The study aimed to evaluate the effects of an expressive writing intervention on quality of life (QoL) among mainland Chinese breast cancer patients. A total of 118 Chinese breast cancer patients were randomly assigned to one of four groups: a cancer-facts writing condition (CTL group), an emotional disclosure writing condition (EMO group), a self-regulation writing condition (SR group), or a neutral control condition with no writing tasks (CON group). QoL was assessed by FACT-B at baseline, 3-, and 6-month follow-ups. A repeated measure analysis of variance revealed significant effects of time (F = 13.9, P < 0.001, η2 = 0.20) and the time × group interaction (F = 3.5, P < 0.01, η2 = 0.08) on QoL. Residualized change models showed that the CTL, EMO and SR groups reported higher levels of QoL than the CON group at the 6-month follow-up. The EMO group had a higher level of QoL than the SR group. The CTL group had higher level of physical well-being compared to the SR group. Mainland Chinese breast cancer patients shortly after diagnosis benefit from expressive writing. They benefited more from cancer-facts and emotional disclosure compared to self-regulation. The study indicated that the impact of expressive writing may differ due to stage of cancer survivorship, social, and cultural context.

The detrimental effects of ambivalence over emotional expression on well-being among Mainland Chinese breast cancer patients: Mediating role of perceived social support.

OBJECTIVE: Recent research has documented the harmful effects of ambivalence over emotional expression (AEE) on psychological well-being, but few studies to date have examined AEE among Mainland Chinese breast cancer patients, an ethnic group that prioritizes emotion restraint to preserve social harmony. The present study examined the relationship between AEE and well-being (viz, anxious and depressive symptoms and quality of life) and evaluated perceived social support as a potential mediator of this relationship in a sample of Mainland Chinese breast cancer patients. METHODS: Three hundred twenty-seven Chinese breast cancer patients recruited from Weifang, China, completed a self-reported questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Medical Outcomes Study Social Support Scale (MOS-SSS), the Self-rating Anxiety Scale (SAS), the Self-rating Depression Scale (SDS), and the Functional Assessment of Cancer Therapy-Breast (FACT-B). RESULTS: Overall, Mainland Chinese breast cancer patients endorsed high levels of AEE. A series of mediation analyses revealed perceived social support served as a partial mediator of the relationship between AEE and well-being. Specifically, AEE was associated with lower perceived social support (ßs = -.13, P < .001), which in turn, was associated with greater anxious symptoms (ß = .23, P < .001), depressive symptoms (ß = .20, P < .001) and lower quality of life (ß = -.30, P < .001). CONCLUSIONS: The harmful relationship between AEE and well-being is partially explained by reduced social support. Psychosocial interventions that facilitate emotional disclosure without harming social harmony may be culturally effective for mainland Chinese breast cancer patients.

Posterior Distraction and Instrumentation Cannot Always Reduce Displaced and Rotated Posterosuperior Fracture Fragments in Thoracolumbar Burst Fracture.

STUDY DESIGN: A retrospective clinical study. OBJECTIVE: To determine the imaging features that can be used to predict failure of reduction of a retropulsed fracture fragment by posterior ligamentotaxis in thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Posterior instrumentation and distraction with ligamentotaxis has been successfully used to shift retropulsed fragments anteriorly in thoracolumbar burst fractures. However, posterior longitudinal ligament rupture can lead to treatment failure. The exact preoperative radiographical parameters associated with failure of reduction remain unknown. MATERIALS AND METHODS: A total of 85 patients who suffered from thoracolumbar burst fractures with significant retropulsion of fragments into the spinal canal, as confirmed by preoperative computed tomography and followed by postoperative computed tomography, were retrospectively analyzed. Seventy-three patients (85.9%) in whom the fragments were reduced by ligamentotaxis were included in the reduced group. In 12 patients (14.1%), the fracture fragment in the spinal canal was not reduced, and these patients were included in the nonreduced group. Neurologic status was classified according to the scoring system of the American Spinal Injury Association (ASIA). The displaced distance and rotation angle of the fracture fragment were measured at the fractured segment. RESULTS: Preoperatively,the average displacement distances into the spinal canal of rotated posterosuperior fragments was 0.53 cm in the reduced group and 0.94 cm in the nonreduced group (P=0.002). The average rotation angles of the fracture fragments were 43.2 degrees in the reduced group and 61.7 degrees in the nonreduced group (P=0.012). "Double cortical surfaces" of the fragment were observed in the nonreduced patients. Neurological function was evaluated and recorded at the 2-year follow-up examination. There was no significant difference in the ASIA recovery grade between the 2 groups (P=0.668). CONCLUSIONS: Displaced and rotated posterosuperior fracture fragments in thoracolumbar burst fracture cannot always be reduced by posterior ligamentotaxis. The 2 criteria for treatment failure that were most consistently present in our series were a displacement distance greater than 0.85 cm and a rotation angle greater than 55 degrees.

Mannose prevents acute lung injury through mannose receptor pathway and contributes to regulate PPARγ and TGF-ß1 level.

Mannose has been reported to prevent acute lung injury (ALI), and mannose receptor (MR) has been demonstrated to have a role. The rationale for this study is to characterize the mechanism by which mannose and MR prevent lipopolysaccharide (LPS)-induced ALI. Male ICR mice were pretreated mannose by intravenous injection 5 min before and 3 h after intratracheal instillation of LPS. Pathological changes, proinflammatory mediator, peroxisome proliferator activated receptor gamma (PPARγ), MR, and transforming growth factor ß1 (TGF-ß1) levels were determined. The RAW264.7 cells were pretreated with mannose and stimulated with LPS for 3 h. Proinflammatory mediator and TGF-ß1 in the culture media, PPARγ, MR, and TGF-ß1 expression in RAW 264.7 cells were measured. Mannose markedly attenuated the LPS-induced histological alterations and inhibited the production of proinflammatory mediator in mice and in RAW 264.7 cells. Mannose increased PPARγ and MR expression, and inhibited TGF-ß1 stimulated by LPS. Interestingly, competitive inhibition of MR with mannan was associated with elimination of the anti-inflammatory effects of mannose, and reversed effects of mannose of regulation to PPARγ and TGF-ß1. MR is important in increasing PPARγ and decreasing TGF-ß1 expression and plays a critical role in mannose's protection against ALI.

Mismatch negativity latency as a biomarker of amnestic mild cognitive impairment in chinese rural elders.

The aim was to evaluate the mismatch negativity (MMN) component, a correlate of the automatic detection of changes in the acoustic environment, in healthy adults, and adults with amnestic mild cognitive impairment (aMCI). Forty-three aMCI subjects and 43 healthy Chinese older adults were arranged into experimental group and control group, respectively. Their MMN amplitude and latency were measured at the FZ, FCZ, and CZ electrode sites under a passive auditory oddball task. The results showed that the latencies obtained from the FZ, FCZ, and CZ electrode sites were significantly longer in the aMCI adults than in the control adults (P < 0.01) while there were no significant differences in MMN amplitude between two groups (P > 0.05). The MMN latency was found to be a sensitive and specific biomarker of aMCI.

[Quantification of Agricultural In-Situ Surface Soil Moisture Content Using Near Infrared Diffuse Reflectance Spectroscopy: A Comparison of Modeling Methods].

At field scale, surface soil had special characteristics of volumetric moisture content (VMC) with a relatively little difference and spatial heterogeneity induced by physical and chemical properties, roughness, straw residues, etc. It has been a great challenge for near infrared diffuse reflectance spectroscopy (NIR-DRS) measurement of surface soil moisture in situ. In this study, exonential decay models based on seven water-related wavelengths (1200, 1400, 1450, 1820, 1940, 2000 and 2250 nm), linear models of normalized difference soil moisture index (NSMI) and relative absorption depth (RAD) based on wave-length combinations, linear or quadratic model of width of the inflection (σ), center amplitude of the function (Rd) and area under the Gaussian curve (A) from soil moisture Gaussian model (SMGM), and partial least square (PLS) regression models based on bands were used to quantify VMC. The results indicated that (1) of all the single wavelengths, 2 000 nm showed the best validation result, indicated by the lowest RMSEp (2.463) and the highest RPD value (1.060). (2) Comparing with RAD, the validation of NSMI was satisfactory with higher R² (0.312), lower RMSEp (2.133) and higher RPD value (1.224). (3) In the validation results of SMGM parameters and PLS fitting, Rd was found to produce the best fitting quality identified by the highest R² (0.253), the lowest RMSEp (2.222), and the highest RPD value (1.175). (4) Comprehensively, a linear model based on NSMI showed the highest validation accuracy of all the methods. What is more, its calculation process is simple and easy to operate, and therefore become the preferred method to quantify surface soil moisture content in situ.

[Comparison of red edge parameters of winter wheat canopy under late frost stress].

In the present study, late frost experiments were implemented under a range of subfreezing temperatures (-1 - -9 degrees C) by using a field movable climate chamber (FMCC) and a cold climate chamber, respectively. Based on the spectra of winter wheat canopy measured at noon on the first day after the frost experiments, red edge parameters REP, Dr, SDr, Dr(min), Dr/Dr(min) and Dr/SDr were extracted using maximum first derivative spectrum method (FD), linear four-point interpolation method (FPI), polynomial fitting method (POLY), inverted Gaussian fitting method (IG) and linear extrapolation technique (LE), respectively. The capacity of the red edge parameters to detect late frost stress was explicated from the aspects of the early, sensitivity and stability through correlation analysis, linear regression modeling and fluctuation analysis. The result indicates that except for REP calculated from FPI and IG method in Experiment 1, REP from the other methods was correlated with frost temperatures (P < 0.05). Thereinto, significant levels (P) of POLY and LE methods all reached 0.01. Except for POLY method in Experiment 2, Dr/SDr from the other methods were all significantly correlated with frost temperatures (P < 0.01). REP showed a trend to shift to short-wave band with decreasing temperatures. The lower the temperature, the more obvious the trend is. Of all the REP, REP calculated by LE method had the highest correlation with frost temperatures which indicated that LE method is the best for REP extraction. In Experiment 1 and 2, only Dr(min) and Dr/Dr(min), calculated by FD method simultaneously achieved the requirements for the early (their correlations with frost temperatures showed a significant level P < 0.01), sensitivity (abso- lute value of the slope of fluctuation coefficient is greater than 2.0) and stability (their correlations with frost temperatures al- ways keep a consistent direction). Dr/SDr calculated from FD and IG methods always had a low sensitivity in Experiment 2. In Experiment 1, the sensitivity of Dr/SDr from FD was moderate and IG was high. REP calculated from LE method had a lowest sensitivity in the two experiments. Totally, Dr(min) and Dr/Dr(min) calculated by FD method have the strongest detection capacity for frost temperature, which will be helpful to conducting the research on early diagnosis of late frost injury to winter wheat.

Thoracolumbar fracture dislocations treated by posterior reduction, interbody fusion and segmental instrumentation.

BACKGROUND: Literature describing the application of modern segmental instrumentation to thoracic and lumbar fracture dislocation injuries is limited and the ideal surgical strategy for this severe trauma remains controversial. The purpose of this article was to investigate the feasibility and efficacy of single-stage posterior reduction with segmental instrumentation and interbody fusion to treat this type of injury. MATERIALS AND METHODS: A retrospective review of 30 patients who had sustained fracture dislocation of the spine and underwent single stage posterior surgery between January 2007 and December 2011 was performed. All the patients underwent single stage posterior pedicle screw fixation, decompression and interbody fusion. Demographic data, medical records and radiographic images were reviewed thoroughly. RESULTS: Ten females and 20 males with a mean age of 39.5 years were included in this study. Based on the AO classification, 13 cases were Type B1, 4 cases were B2, 4 were C1, 6 were C2 and 3 cases were C3. The average time of the surgical procedure was 220 min and the average blood loss was 550 mL. All of the patients were followed up for at least 2 years, with an average of 38 months. The mean preoperative kyphosis was 14.4° and reduced to -1.1° postoperatively. At the final followup, the mean kyphosis was 0.2°. The loss of correction was small (1.3°) with no significant difference compared to postoperative kyphotic angle (P = 0.069). Twenty seven patients (90%) achieved definitive bone fusion on X-ray or computed tomography imaging within 1 year followup. The other three patients were suspected possible pseudarthrosis. They remained asymptomatic without hardware failure or local pain at the last followup. CONCLUSION: Single stage posterior reduction using segmental pedicle screw instrumentation, combined with decompression and interbody fusion for the treatment of thoracic or lumbar fracture-dislocations is a safe, less traumatic and reliable technique. This procedure can achieve effective reduction, sagittal angle correction and solid fusion.

Surgical treatment of large abdominally involved primary dumbbell tumor in the lumbar region.

STUDY DESIGN: This was a retrospective clinical study. OBJECTIVE: The aim of this study was to assess the efficacy of a combined anterior and posterior approach, or single-stage posterior extensive approach for resection of large abdominally involved dumbbell tumor in the lumbar region. BACKGROUND: Resection of the large spinal-retroperitoneal involved dumbbell tumor is particularly controversial and challenging because of unique exposure requirements. METHODS: From June 2006 to October 2011, 18 consecutive patients suffering from large dumbbell tumors in the lumbar region were involved. In the initial 8 patients, a combined posterior and anterior surgical approach was applied. The remaining 10 patients were surgically treated with a single posterior extensive approach to excise both the intraspinal and intra-abdominal tumors. Reconstruction with bone or mesh grafts was also performed simultaneously in 3 of the 10 patients in this group. RESULTS: The perioperative period was uneventful for 7 of 8 patients who underwent combined surgery. However, 1 patient encountered right nephrectomy because of a ruptured renal vein and refractory bleeding during anterior tumor exposure. Histopathology revealed the presence of schwannoma (n=4), neurofibroma (n=3), and neuroblastoma (n=1). With the mean of 52 months of follow-up, metastasis occurred in 1 patient with neuroblastoma. In the 10 patients with only the posterior approach, histopathology demonstrated schwannoma (n=5), neurofibroma (n=3), small round cell mesenchymal tumor (n=1), and benign fibrous histiocytoma (n=1). No recurrence was detected at the mean follow-up of 24 months. CONCLUSIONS: The posterior extensive approach is safe and effective to remove the large abdominally involved dumbbell tumors, and also facilitates simultaneously reconstruction of the vertebral body, as compared with the combined posterior and anterior approach.

The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach.

OBJECTIVES: To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. METHODS: This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2-15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively. RESULTS: Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p<0.001 chi-square test). The neurologic recoveries, assessed by the ASIA scoring system, were not satisfactory for the neural deficit patients in either group, indicating there was no significant difference with regard to neurologic recovery between the two groups (p>0.05 Fisher's exact test). CONCLUSION: Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure.

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model.

OBJECTIVE: This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. METHODS: Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85%) of all 20 animals. The positive rate for bacteria presence was 45% by culture and 80% by pyrosequencing method. RESULTS: Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals. CONCLUSION: Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the "culprit" for the persistence or recurrence of infection.

Surgical treatment based on pedicle screw instrumentation for thoracic or lumbar spinal Langerhans cell histiocytosis complicated with neurologic deficit in children.

BACKGROUND CONTEXT: Surgical indications and procedures for spinal Langerhans cell histiocytosis (LCH) in children are still controversial. Reports containing large samples of surgically treated patients are few in the currently available literature, and the reported operative procedures were also somewhat obsolete. So, further investigation based on large-sample cases and using improved surgical techniques is beneficial and helpful to refine the treatment strategy. PURPOSE: To recommend a reasonable treatment strategy for thoracic or lumbar spine LCH in children complicated with neurologic deficit. STUDY DESIGN/SETTING: Retrospective/academic medical center. PATIENT SAMPLE: Twelve children aged from 2 to 16 years old with the diagnosis of thoracic or lumbar spinal LCH accompanied by neurologic deficit received surgical treatment from January 2005 to January 2010. OUTCOME MEASURES: Frankel scale for neurologic function, fusion of the mass, and recurrence of the lesion. METHODS: All 12 patients presented initially with local pain and progressive neurologic detriment. Neurologic evaluation revealed two patients with Frankel Grade B, eight with Grade C, and two with Grade D. Radiographic features were positive for typical vertebra plana, a space-occupying mass in the spinal canal compressing neural elements, and a spinal canal encroachment rate more than 50%. Posterior instrumentation with pedicle screw combined with anterior corpectomy, decompression, and support bone graft was performed in the first seven patients as a one-stage procedure. In the remaining five patients, posterior pedicle screw fixation, laminectomy for decompression (via excision of the tumor-like mass), and repair of laminae with allograft bone block were performed. The collapsed vertebral body was left untouched. No chemotherapy or radiotherapy was administrated postoperatively in any of the cases. RESULTS: The mean follow-up duration was 43.3 months. The mean operation time was 330 minutes with combined procedure and 142 minutes with single posterior approach (p=.000). The average blood loss was 933 mL with combined procedure and 497 mL with single posterior approach (p=.039). Three of seven patients who received combined surgery encountered approach-related complications, that is, one with intercostal neuralgia and two with pleural effusion. No severe neurologic deteriorate, instrumentation failure, or disease recurrence was detected at follow-up. Neurologic function completely recovered in all 12 patients from 2 to 12 weeks after surgery. The anterior bone graft fused and shaped well in all seven patients, and allograft bone block for lamina repair also achieved complete fusion in the remaining five patients. The internal fixator was removed at 3 to 5 years (average 4.1 years) after initial operation in six patients. No deformity, including scoliosis and kyphosis, has been identified during follow-up period in both procedures. CONCLUSIONS: For spinal LCH patients, neurologic deficit is a main indication for operative treatment to prevent permanent and serious consequences. Surgery provides an opportunity for rapid recovery of neurologic function. Both combined and single-stage posterior approaches based on pedicle screw instrumentation techniques are similarly effective in relieving neurologic compression. However, single-stage posterior approach is more favorable with less complications, and preserving involved vertebral body is not a latent hazard of recurrence.

Implanting pedicle screw in fractured vertebra results in no adverse effect on bone healing in thoracic or lumbar burst fracture.

AIM: To confirm whether implanting pedicle-screw at the level of fractured vertebra increases adverse effects on fracture healing. MATERIAL AND METHODS: CT follow-up was conducted for 28 patients who sustained thoracic or lumbar burst fracture and underwent posterior pedicle-screw instrumentation and reduction including implanting screws into the fractured vertebra at the same time. The time for follow-up CT scan ranged from 1 to 3 years postoperatively. RESULTS: 28 patients underwent final CT scan 1 to 3 years after surgery which revealed good bony fusion within each fractured vertebra and no screw or rod breakage; kyphosis was also not detected. CONCLUSION: Implanting pedicle-screw at the level of fractured vertebra does not have a negative influence on bone healing.

[Relationship between variations of severe isthmic spondylolisthesis spino-pelvic parameters and clinical symptoms].

OBJECTIVE: To explore the relationship between variations of severe isthmic spondylolisthesis spino-pelvic parameters and clinical symptoms. METHODS: A retrospective study of spino-pelvic parameters was conducted for 45 patients with L5 severe isthmic spondylolisthesis. Their spino-pelvic parameters were analyzed on preoperative full spinal radiography: grade of spondylolisthesis, pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), SFHD, SFVD, SC7D and T9 tilting angle. According to the Oswestry score, the patients with low back pain were divided into light and severe groups. T-tests were used to compare their parameters. The analyses of multiple factor correlation, linear regression and stepwise regression were used to examine the associations between all parameters and Oswestry score. RESULTS: Grade of spondylolisthesis, PT, LL, T9 tilting angle, SFHD, SC7D, PT/SS, SFHD/SFVD, LL/TK were significantly greater and SS, SFVD were significantly smaller for patients with severe low back pain versus light low back pain (P < 0.05). PI or TK had no statistically significant difference between two groups. Multiple factor correlation, linear regression and stepwise regression: Grade of spondylolisthesis, PT, SC7D, LL and SFHD had significant positive correlations with Oswestry score. Degree of positive correlation: Grade of spondylolisthesis > SC7D > PT > LL > SFHD. And PI, TK or T9 tilting angle had no significant correlation with Oswestry score. SS and SFVD had significant negative correlations with Oswestry score. Degree of negative correlation: SS > SFVD. PT/SS, SFHD/SFVD and LL/TK had significant positive correlation with Oswestry score. Degree of positive correlation: PT/SS> SFHD/SFVD > LL/TK. CONCLUSION: Clinical symptoms of severe isthmic spondylolisthesis have significant positive correlations with grade of spondylolisthesis, PT, SC7D, LL, SFHD, PT/SS, SFHD/SFVD, LL/TK and significant negative correlations with SS and SFVD. Low back pain symptom has no significant correlation with PI, TK or T9 tilting angle.

Pedicle screw implantation in the thoracic and lumbar spine of 1-4-year-old children: evaluating the safety and accuracy by a computer tomography follow-up.

STUDY DESIGN: This was a retrospective clinical study. OBJECTIVE: To evaluate the safety and accuracy of pedicle screw placement in very young children and to observe its influence on vertebral and spinal canal growth. SUMMARY OF BACKGROUND DATA: Although widely used, it is not known if pedicle screw fixation is safe and effective in very young children. METHODS: Sixteen children, with an average age of 34 months, had received pedicle screw fixation from January 2003 to January 2010. Candidates for surgery were those patients who had hemivertebra deformity (11 patients), eosinophilic granuloma disease with spinal cord compression, and neurological deficit (2 patients), or spinal tuberculosis accompanied with kyphotic deformity (3 patients). The location of involved vertebrae was between T2 and L5. A total of 74 pedicle screws were implanted using a modified free-hand technique. The safety and accuracy of this method, and the influence on vertebral growth, was evaluated using postoperative x-ray and computer tomography scans. RESULT: The average follow-up was 30.6 months. No patient had any neurological or radicular symptoms related to the placement of pedicle screws. Postoperative computer tomography scans demonstrated a malposition of 5 of the 74 pedicle screws (6.8%). Two screws breached the anterolateral cortical bone of the vertebral body. One screw breached the lateral cortical bone of the pedicle, 1 passed through the anterior vertebral margin by 3 threads, and a third was so laterally placed that it entered into disk space. There was no vessel, visceral complications, or any other adverse effects resulting from these misplacements. No screw was placed so medially that injured the spinal cord. No retardation of vertebral growth was observed in 7 patients who were followed up for at least 3 and up to 7 years. CONCLUSIONS: The results indicate that in very young children, pedicle screws can be safely implanted using a modified free-hand implantation technique.

Expression analysis of Cdc42 in lung cancer and modulation of its expression by curcumin in lung cancer cell lines.

Cdc42, a Rho GTPase family member, is involved in cell transformation, proliferation, survival, invasion and metastasis of human cancer cells. Overexpression of Cdc42 has been reported in several types of human cancer. However, the underlying mechanisms are not well understood. The present study showed that Cdc42 was overexpressed in 80 of 110 primary lung cancer patients, and overexpression of Cdc42 was significantly associated with high TNM stage and lymph node metastasis. Moreover, RNAi-mediated suppression of Cdc42 expression reduced actin filopodia formation, migration and invasion potential of a highly metastatic lung cancer cell line, 801D. In parallel, 801D cells were treated with curcumin and the effect on the expression of the Cdc42 gene at the transcriptional and translational levels was analyzed by RT-PCR and Western blotting. Curcumin inhibited cell migration, invasion and downregulated Cdc42 gene and Cdc42-related target gene expression in 801D cells. It also induced rearrangements of the actin cytoskeleton. These effects mimicked those of Cdc42 knockdown. Furthermore, xenograft experiments confirmed the suppression of tumor growth and invasion in vivo, which was due to the effect of curcumin and the inhibition of Cdc42 by curcumin. Our results showing the downregulation of Cdc42 expression by curcumin in lung cancer cells taken together with the clinical data suggest a potential therapeutic role for curcumin in inducing Cdc42-mediated inhibition of invasion of lung cancer cells.

Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity.

OBJECTIVE: The purpose of this study was to validate the efficacy and safety of single-stage posterior instrumentation and anterior debridement for treatment of active spinal tuberculosis with kyphotic deformity. METHOD: From January 2005 to January 2009, 13 males and 24 females were enrolled in this retrospective study. All patients underwent single-stage posterior instrumentation and fusion, combined with anterior radical debridement and bone grafting. Clinical and radiographic results were analysed. RESULTS: Patients were followed-up for 33.6 months on average. Bony fusion was achieved at six- to nine-month follow-up in all patients. The respective average kyphosis at the pre-operative and the last follow-up was 53.5° and 12.6°, with a mean correction of 40.9° (78.5%). Neurologic recovery averaged 1.5 grades on the Frankel scale. No recurrence of tuberculosis or instrumentation failure occurred. CONCLUSION: Single-stage posterior instrumentation and anterior debridement with fusion was demonstrated to be a safe and effective method to achieve spinal decompression and kyphosis correction in patients with Pott's disease.

[Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation].

OBJECTIVE: To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH). METHODS: From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed. RESULTS: All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01). CONCLUSIONS: Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.