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ABSTRACT: Study Design. Retrospective and radiological analysis of spino-pelvic sagittal alignment in Chinese patients with thoracic and thoracolumbar kyphosis.Objective. To determine the impact of thoracic and thoracolumbar kyphosis on pelvic sagittal morphology and the mechanisms of adjusting trunk sagittal balance.Summary of Background Data. Previous studies have reported the normative values of pelvic sagittal parameters and classification of normal patterns of sagittal curvature, but no study has analyzed the impact of thoracic and thoracolumbar kyphosis on pelvic sagittal morphology and the mechanisms of maintaining the sagittal balance.Methods. Whole spine and standing lateral radiographs of 49 Chinese patients with thoracic and thoracolumbar kyphosis were taken before surgery, immediately after surgery and in the final follow-up. The pelvic and spinal parameters were measured and the correlations of all parameters were analyzed. A descriptive analysis characterizing these parameters and a multivariate analysis were performed.Results. The patients had a mean age of 30.3 years, while the mean age at which the patients developed kyphosis was 7.1 years. Preoperative pelvic incidence was significantly less than that of normal subjects, and there was no difference in the preoperative, in the immediate postoperative and in the final follow-up radiographs. The magnitude of kyphosis and the levels involved were independent factors of pelvic incidence. Pelvis anteversion and lumbar hyperlordosis were the mechanisms of adjusting the trunk sagittal balance. Although kyphosis and sagittal imbalance was corrected by surgery, pelvic sagittal morphology remained unchanged.Conclusion. Thoracic and thoracolumbar angular kyphosis occurring during the growth period will lead to abnormal pelvic morphology. Greater the kyphotic angle and lower the kyphotic levels, greater impact it will have on the pelvic morphology during skeletal maturation. The mechanisms of adjusting the trunk sagittal balance include not only pelvis anteverting, but also lumbar hyperlordosis. The latter serves as the main mechanism once skeletal maturation has been established. After skeletal maturation, surgery can reestablish the spinal sagittal balance but not the pelvis morphology.
Spine 03/2013; · 2.08 Impact Factor
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ABSTRACT: PURPOSE: The purpose of this study is to review our operative experience of congenital kyphosis or kyphoscoliosis undergoing either pedicle subtraction osteotomy (PSO) or posterior vertebral column resection (pVCR) according to certain criteria we have established. METHODS: From December 2003 to 2009, 23 consecutive patients of congenital kyphosis or kyphoscoliosis were treated by means of PSO or pVCR procedure in a single institution. The average preoperative kyphosis angle was 74.3º. The C7 plumb line was 12.6 mm posterior to the posterior-superior corner of S1 on average, showing negative imbalance. In the 11 cases who had accompanied scoliosis, the average preoperative scoliosis angle was 42.6º. The average Oswestry Deficiency Index (ODI) for back pain was 14.6 before surgery. Eleven patients had compromise of neurological functions. RESULTS: After PSO or pVCR procedure, the average kyphosis angle decreased to 20.0º, and the accompanied scoliosis also decreased to 15.8º. The average follow-up time after surgery was 34.3 months. At the last follow-up, the average kyphosis corrective rate was 73.7 %, and the average scoliosis corrective rate was 61.7 %. The negative imbalance improved, with the C7 plumb line being 1.5 mm posterior to the posterior-superior corner of S1 on average. After surgery, the average ODI for back pain had 40.6 % improvement, and most patients who had neurological symptoms before surgery had varying degrees of relief. The total satisfactory rate to corrective surgery was 91.3 %. No permanent neurological damage was observed. CONCLUSIONS: If selected appropriately, both PSO and pVCR procedures can achieve compatible and satisfactory correction results in the surgical treatment of congenital kyphosis or kyphoscoliosis.
European Spine Journal 08/2012; · 1.97 Impact Factor
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ABSTRACT: Retrospective review.
To perform a single-institution analysis of incidence, treatment, and clinical outcome in patients with thoracic ossification of the ligamentum flavum (OLF) who experienced dural tears and cerebrospinal fluid (CSF) leakage.
There is a paucity of clinical reports focusing on dural tears and CSF leakage after thoracic OLF surgery. Because dural adhesion and dural ossification are common features of thoracic OLF, the incidence of CSF leakage in OLF patients is high and represents a significant clinical challenge.
A total of 266 patients with thoracic OLF were admitted to our hospital from 1995 to 2011. Each patient's medical records were reviewed to identify cases of dural tears and CSF leakage. Information on therapeutic strategy used to repair the dural tears and complications related to CSF leakage was extracted.
The incidence of dural tears and CSF leakage in OLF patients was 32% (85/266). The incidence of dural ossification was 25.2%. The dural tears were repaired with a range of materials, including gelatin sponge, muscle/fascia, artificial dura, silk suture, and fibrin glue. The intraoperative repair procedure did not resolve CSF leakage in 65 cases, and 16 of those cases experienced complications related to the continued CSF leakage, including CSF pseudocyst, wound dehiscence, and meningitis. Fifty-eight patients with CSF leakage were eventually cured by a series of comprehensive treatments, which included prone position, continuous pressure by sandbag, ultrasound-guided puncture, and aspiration. Only 7 patients required reoperation.
Dural ossification was the main reason for dural tears. In all, 78 of the 85 patients with CSF leakage or dural tear were successfully cured. The success rate was 91.8%, which indicated that a series of comprehensive treatments was an effective strategy to treat these patients.
Spine 05/2012; 37(12):E702-7. · 2.08 Impact Factor
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ABSTRACT: Tissue transglutaminase (type II, TG2) has long been postulated to directly promote skeletal matrix calcification and play an important role in ossification. However, limited information is available on the expression, function and modulating mechanism of TG2 during osteoblast differentiation and mineralization. To address these issues, we cultured the well-established human osteosarcoma cell line SAOS-2 with osteo-inductive conditioned medium and set up three time points (culture days 4, 7, and 14) to represent different stages of SAOS-2 differentiation. Osteoblast markers, mineralization, as well as TG2 expression and activity, were then assayed in each stage. Furthermore, we inhibited TG activity with cystamine and then checked SAOS-2 differentiation and mineralization in each stage. The results showed that during the progression of osteoblast differentiation SAOS-2 cells presented significantly high levels of osteocalcin (OC) mRNA, bone morphogenetic protein-2 (BMP-2) and collagen I, significantly high alkaline phosphatase (ALP) activity, and the increased formation of calcified matrix. With the same tendency, TG2 expression and activity were up-regulated. Furthermore, inhibition of TG activity resulted in a significant decrease of OC, collagen I, and BMP-2 mRNA and of ALP activity and mineralization. This study demonstrated that TG2 is involved in osteoblast differentiation and may play a role in the initiation and regulation of the mineralization processes. Moreover, the modulating effects of TG2 on osteoblasts may be related to BMP-2.
Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 04/2012; 45(8):693-700. · 1.08 Impact Factor
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ABSTRACT: STUDY DESIGN:: A clinical retrospective study. OBJECTIVE:: To analyze the complications and relevant management of the correction procedure for focal kyphosis. SUMMARY OF BACKGROUND DATA:: The treatment of focal kyphosis is a difficult problem in spine surgery. The potential complications of surgery should be considered cautiously and managed positively. METHODS:: Eighty-one patients with focal kyphosis were treated by posterior osteotomy and correction. The etiology was posttraumatic in 31 cases, healed tuberculosis in 31 cases, congenital in 17 cases, and iatrogenic in 2 cases. The surgical procedures were pedicle subtraction osteotomy in 19 cases, posterior osteotomy with anterior opening-posterior closing correction in 23 cases, and posterior vertebral column resection with dual axial rotation correction in 39 cases. The intraoperative and postoperative complications were summarized, and the corresponding management was described in detail. RESULTS:: The average follow-up time was 31 months. Among patients who underwent pedicle subtraction osteotomy, the intraoperative and postoperative complications included 3 cases of dural tear and 1 case of wound infection. For posterior osteotomy with anterior opening-posterior closing correction, the complications included 4 cases of dural tear, 1 case of wound infection, and 1 case of instrumentation loosening and recurrence of kyphosis . For posterior vertebral column resection with dual axial rotation correction, the complications included 3 cases of dural tear, 5 cases of nerve root injury, 1 case of titanium mesh loosening, 1 case of osteotomy segment migration, 2 cases of transient neurological compromise, and 1 case of instrumentation loosening and kyphosis recurrence. All the complications were treated positively and pertinently. CONCLUSIONS:: During the posterior osteotomy and correction of focal kyphosis, the risk of surgery increases along with the more severe deformity and the more complicated surgical procedure. However, most complications do not significantly affect the outcome if treated appropriately.
Journal of spinal disorders & techniques 02/2012; · 1.21 Impact Factor
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ABSTRACT: This is a cohort investigation of 2 categories of patients with adult lumbar scoliosis.
To demonstrate the different surgical strategies between 2 categories of patients with adult lumbar scoliosis based on their symptoms and radiological findings.
It has been hypothesized that patients with adult lumbar scoliosis should be categorized, when possible, into 2 distinct groups on the basis of clinical symptoms and that this categorization can best guide surgical treatment strategy.
Between January 2002 and December 2004, 43 patients with adult lumbar scoliosis underwent surgical treatment. Each patient was categorized into 1 of 2 distinct groups before surgery. Group 1 patients had primary symptoms related to stenosis, and the surgical strategy was posterior local decompression with or without instrumented fusion at the treated levels. Group 2 patients had primary symptoms related to symptomatic or progressive deformity, and the surgical strategy was instrumented fusion, to include at least the end vertebrae, by posterior or by combined anterior/posterior approach, with or without selective decompression. Preoperative and postoperative radiographical evaluation was performed. Preoperative and postoperative clinical outcomes utilized were the Modified Prolo Scale and the Patient Satisfaction Index (PSI).
The average age at the time of treatment was 61 years. The mean follow-up time after surgery was 35 months (range, 24-65 months). A radiographical grade I fusion (definitely fused) was achieved in 65% of cases. Failure of fusion was seen in 9.1% for group 1 and 9.5% for group 2. In group 1, the average Modified Prolo Scale was 9.5 before surgery and 15.9 at follow-up and total satisfaction rate (PSI) was 82%. In group 2, the average Modified Prolo Scale was 10.9 before surgery and 17.0 at follow-up and total satisfaction rate (PSI) was 86%.
Categorization of patients into 2 groups, 1 with primarily stenosis symptoms and 1 with primarily deformity symptoms, may be effective for surgical decision making. These 2 categories of patients may be expected to enjoy similar clinical improvements after surgical treatment.
Spine 01/2012; 37(9):E556-61. · 2.08 Impact Factor
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ABSTRACT: The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy.
Each patient underwent single-stage correction via a posterior surgical approach. A modified pedicle subtraction osteotomy (mPSO) was performed when the kyphotic deformity was less than 70° (7 cases), whereas a posterior vertebral column resection (VCR) was performed when the kyphotic deformity exceeded 70° (29 cases). Full-length standing radiographs were obtained before surgery and at follow-up visits. These images were used to measure the kyphosis angle; sagittal alignment of the lumbar, thoracic, and cervical regions; and sagittal balance of the spine. Back pain was rated using the visual analog scale (VAS), and neurological function was classified based on the American Spinal Injury Association (ASIA) grading system. Each patient's overall satisfaction with surgical treatment was measured with the Patient Satisfaction Index. For purposes of comparison, patients were studied in 2 groups based on the region of their kyphotic apex. Half of the cohort had apical kyphosis in the lower thoracic spine or thoracolumbar junction (TL group). Using both radiographic and clinical assessments, the authors compared this group with the other half of the patients who had apical kyphosis in the upper to mid thoracic spine (MT group).
The cohort included 15 males and 21 females, with an average age of 34 years at the time of surgery. The minimum follow-up was 24 months, and the mean follow-up was 31 months. Following surgery, kyphosis across the treated segments was reduced by an average of 60°. Lumbar lordosis also improved by an average of 24°, and thoracic kyphosis improved by an average of 20°. Both back pain and neurological function improved after surgical treatment. There was a 67% improvement in VAS scores, and 13 of the 36 patients had improvement in their ASIA grade. The 2 surgical procedures used for deformity correction (mPSO and VCR) demonstrated comparable radiographic and clinical results. Note, however, that differences were found in both radiographic and clinical outcomes in comparing patients who had lower thoracic or thoracolumbar (TL group) versus upper to midthoracic (MT group) apical kyphosis.
Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.
Journal of neurosurgery. Spine 01/2012; 16(4):351-8. · 1.61 Impact Factor
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ABSTRACT: OBJECTIVES:: To analyze the clinical characteristics and surgical results of posttraumatic kyphosis of the thoracolumbar segment. METHODS:: Thirty-four patients with posttraumatic kyphosis of the thoracolumbar segment underwent posterior osteotomy, kyphosis correction, and fixation at our hospital. The kyphosis apex was from T10 to L2. There were 15 male and 19 female patients. The mean age was 48.9 years. Full-spine standing radiographs were obtained before surgery, after surgery, and at follow-up. The sagittal spine balance status was evaluated, and the kyphotic angle, the lumbar lordotic angle, and the thoracic kyphotic angle were measured. The Frankel grading system for neurological functions and the Visual Analogue Scale for back pain were evaluated before surgery and at follow-up. The Oswestry Disability Index was applied for assessment of life quality and surgical results of patients. The Patient Satisfied Index (PSI) was also used for determination of surgical results. Patients were grouped according to the extent of kyphotic angle and the surgical technique. The difference in kyphosis correction and back pain between groups was observed before and after surgery. Relief from neurological symptoms was also observed. RESULTS:: The average kyphotic angle was 48.5 degrees, the average lumbar lordotic angle was 57.9 degrees, and the average thoracic kyphotic angle was 11.4 degrees before surgery. The sagittal spine balance was well maintained in 14 cases, and negative imbalance and positive imbalance were seen in 13 cases and 7 cases, respectively. There was significant difference in back pain between patients in the abnormal and normal groups of the lumbar lordotic angle. The average follow-up time after surgery was 32.1 months. The average kyphotic angle correction rate was 90.4% after surgery and 87.2% at follow-up. The average Oswestry Disability Index was 50.4% before surgery, which improved to 29.4% at follow-up, with an improvement rate of 41.5%. The Patient Satisfied Index result showed a total satisfactory rate of 94.1%. There were 16 cases of neurological deficit before surgery; 8 of them achieved various degrees of improvement after surgery. CONCLUSIONS:: Surgical correction of posttraumatic kyphosis of the thoracolumbar segment can show good radiologic and clinical results with the appropriate procedure according to the extent of the kyphosis angle. Some patients with neurological deficit are still worthy of surgical treatment.
Journal of spinal disorders & techniques 09/2011; · 1.21 Impact Factor
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ABSTRACT: The aim of this study was to determine the therapeutic efficacy of simvastatin treatment starting 1 day after spinal cord injury (SCI) in rat and to investigate the underlying mechanism. Spinal cord injury was induced in adult female Sprague-Dawley rats after laminectomy at T9-T10. Then additionally with sham group (laminectomy only) the SCI animals were randomly divided into 3 groups: vehicle-treated group; 5-mg/kg simvastatin-treated group; and 10-mg/kg simvastatin-treated group. Simvastatin or vehicle was administered orally at 1 day after SCI and then daily for 5 weeks. Locomotor functional recovery was assessed during 8 weeks postoperation by performing open-field locomotor test and inclined-plane test. At the end of study, motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) were assessed to evaluate the integrity of spinal cord pathways. Then, the animals were killed, and 1-cm segments of spinal cord encompassing the injury site were removed for histopathological analysis. Immunohistochemistry was performed to observe the expression of brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) in the spinal cord. Results show that the simvastatin-treated animals showed significantly better locomotor function recovery, better electrophysiological outcome, less myelin loss, and higher expression of BDNF and GDNF. These findings suggest that simvastatin treatment starting 1 day after SCI can significantly improve locomotor recovery, and this neuroprotective effect may be related to the upregulation of BDNF and GDNF. Therefore, simvastatin may be useful as a promising therapeutic agent for SCI.
Neuroscience Letters 01/2011; 487(3):255-9. · 2.11 Impact Factor
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ABSTRACT: in this paper, the authors' goal was to evaluate the feasibility, safety, and efficacy of apical segment resection osteotomy with dual axial rotation correction for severe focal kyphosis by examining outcomes.
between May 2004 and December 2006, the authors treated 23 patients with severe focal kyphosis (average Cobb angle 86.9°, range 50°-130°) using apical segmental resection osteotomy with dual axial rotation correction and instrumented anterior column reconstruction and fusion. Radiographic assessment of sagittal plane balance and kyphotic Cobb angle (including a scoliosis Cobb angle in 9 cases) was performed in each patient before and immediately after surgery and at the last follow-up (minimum 2 years). The Frankel grading system for neurological function and Oswestry Disability Index for quality of life were evaluated before surgery and at the last follow-up. The patient satisfaction index was also used for clinical evaluation at the last follow-up.
the mean surgical time was 6.7 hours. The average blood loss was 2960 ml. All patients underwent follow-up for 2 or more years after surgery. The fusion rate was 95.65%. The average kyphotic angle improved from 86.9° preoperatively to 25.6° immediately postoperatively, with an average correction rate of 72.17%. At the last follow-up, the average kyphotic angle was 27.4°, making the final correction rate 69.87%. The sagittal plane balance was significantly improved at the last follow-up. Preoperatively, 15 patients had neurological deficits, and the Frankel grade was E in 8 cases, D in 8 cases, C in 6 cases, and B in 1 case. At the last follow-up, 15 cases were Grade E, 5 were Grade D, and 3 were Grade C. The average improvement in the Oswestry Disability Index score was 43.30%. The patient satisfaction index result showed a total satisfaction rate of 91.30%. Complications included 1 case of late neurological deficit due to shifting of an expandable artificial vertebra, 5 cases of nerve root injury, 3 cases of dural tear, and 1 case of transient lower-extremity weakness due to insufficient blood supply to the spinal cord during surgery.
apical segmental resection osteotomy with dual axial rotation correction and instrumented fusion is an effective and safe way to treat severe focal kyphosis of the thoracolumbar spine.
Journal of neurosurgery. Spine 01/2011; 14(1):106-13. · 1.61 Impact Factor
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Qingquan Kong,
Li Zhang,
Limin Liu,
Tao Li,
Quan Gong,
Jiancheng Zeng,
Yueming Song,
Hao Liu,
Shaobo Wang,
Yu Sun,
Fengshan Zhang,
Mai Li, Zhongqiang Chen
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ABSTRACT: A retrospective study to analyze the effect of decompressive extent on the posterior shift of spinal cord after expansive open-door laminoplasty (ELAP).
To investigate the effect of decompressive extent on cord shift distance after ELAP, and determine the morphologic limitations of posterior approach when the cervical alignment is lordotic or straight.
It is still controversial on the effect of space available for spinal cord at the level cephalad to the decompression with cord shift. Moreover, there is less understanding regarding the significance of decompressive extent of laminoplasty in relation to spinal cord shift and clinical outcome.
Preoperative and postoperative MRIs of 76 patients with a straight or lordotic cervical spine who had undergone cervical laminoplasty were reviewed and evaluated retrospectively. Radiographic parameters including cervical sagittal alignment, space available at the level cephalad, the thickness of compressive mass, and the average anterior subarachnoid space were measured. Laminoplasty was performed from C1 to C7 in 11 cases (CI group), C2 to C7 in 30 cases (CII group), and C3 to C7 in 35 cases (CIII group). According to whether the anterior indirect decompression was adequate or not, CII and CIII groups were further divided into two subgroups, the noncontact group in which the spinal cord was completely separated from the anterior compressive mass after laminoplasty, and the contact group in which there was residual cord compression after laminoplasty. The recovery rate that based on the Japanese Orthopedic Association score was calculated for each patient.
There were statistically significant differences in the average anterior subarachnoid space among CI, CII, and CIII groups (P < 0.05);the average anterior subarachnoid space was the largest in CI group, and the smallest in CIII group. The space available at the level cephalad had strong sigmoidal correlation with cord postoperative shift in CIII group (R = 0.91). A higher neurologic recovery rate (69% ± 20% vs. 29% ± 11%; P < 0.05) in the noncontact group after surgery than in the contact group, with a similar follow-up period.
The posterior decompression extent is a main factor affecting cord shift distance after laminoplasty in the context of a straightened or lordotic cervical curvature. The space available at the levels cephalad is a key factor to predict cord shift distance in laminoplasty from C3 to C7. Neurologic recovery rate after ELAP is affected by whether the anterior indirect decompression was adequate or not.
Spine 12/2010; 36(13):1030-6. · 2.08 Impact Factor
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ABSTRACT: The study was undertaken to compare the expression and activity of tissue transglutaminase (TG2) in human ligamentum flavum cells derived from ossification of the ligamentum flavum (OLF) and non-OLF patients.
To determine whether TG2 is involved in the pathologic process of OLF.
OLF is a disease characterized by heterotopic formation of new bone in the flavum ligament. Recently, TG2 is proved to directly promote skeletal matrix mineralization and play an important role in the ossification. TG2 activity is vital to the differentiation of osteoblasts and the formation of mineralization. But whether TG2 is involved in the pathologic process of OLF is unknown. We investigated the relations between TG2 expression and OLF.
OLF and non-OLF cells were cultured and osteocalcin, bone morphogenetic protein-2(BMP-2) and TG2 mRNA expressions were assayed by reverse transcription polymerase chain reaction. Meanwhile, alkaline phosphatase activity and calcified nodules were compared between OLF and non-OLF cells. To detect TG2 expression, Western blot and immunohistochemical analysis were carried out, and TG2 activity was compared between OLF and non-OLF cells.
Our experiments demonstrated that OLF cells showed osteoblast-like activity and increased mRNA expression of BMP-2. More interesting, compared with non-OLF cells, OLF cells showed elevated expression levels of TG2 mRNA and protein, as well as enzyme activity.
TG2 expression and enzyme activity are upregulated in the OLF cells and TG2 may be involved in the pathologic process of OLF.
Spine 09/2010; 35(20):E1018-24. · 2.08 Impact Factor
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ABSTRACT: Simvastatin has been shown to stimulate osteogenesis both in vitro and in vivo. However, the mechanism by which simvastatin exerts its effects is still unclear. We previously reported that simvastatin promotes bone morphogenetic protein 2 (BMP-2) expression, induces osteoblastic differentiation, and inhibits adipocytic differentiation in mouse bone marrow stromal cells (BMSCs), and that this occurs, at least in part, via a BMP-2-dependent pathway. The aim of this study was to investigate further the mechanisms by which simvastatin stimulates osteogenesis in mouse BMSCs. To determine whether simvastatin-mediated osteogenesis was dependent on BMP-2, mouse BMSCs were treated with nonimmune normal mouse IgG or BMP-2 neutralizing antibodies combined with different concentrations of simvastatin. Surprisingly, the stimulatory effect of simvastatin on alkaline phosphatase (ALP) activity was not completely blocked by neutralizing BMP-2 monoclonal antibody treatment. Interestingly, we found that estrogen receptor-alpha (ER-alpha) protein levels increased after mouse BMSCs were treated with simvastatin for 72 h in a concentration-dependent manner. Moreover, the stimulatory effect of simvastatin on ALP activity in BMSCs was blocked by the estrogen receptor agonist ICI 182,780, and cotreatment with 17-beta-estradiol and simvastatin increased ALP activities by two-to threefold in the BMSCs compared with treatment with simvastatin alone. These results suggest that simvastatin-induced in vitro osteogenesis in mouse BMSCs is mediated, at least in part, by induction of ER-alpha and not by BMP-2 alone. These results provide new insight into the mechanisms of simvastatin-induced bone formation in BMSCs.
Journal of Bone and Mineral Metabolism 02/2008; 26(3):213-7. · 2.27 Impact Factor
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ABSTRACT: A case-control association study was conducted to investigate the genetic etiology for ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament of the spine (OPLL).
To determine whether COL6A1 polymorphisms are associated with susceptibility to OLF and OPLL in Chinese Han population.
The COL6A1 has been identified as a susceptibility gene for OPLL in Japanese. The susceptibility gene for OPLL may be different among various populations, so we investigated whether COL6A1 polymorphisms are also associated with OPLL in Chinese Han population. OLF and OPLL are similar in epidemiology, etiology, and pathology, and common coexist. Hereditary factors may be implicated in OLF and COL6A1 may be a potential susceptibility gene for OLF, so we investigated the relations between COL6A1 polymorphisms and OLF.
Four known single nucleotide polymorphisms (SNPs) of COL6A1 were genotyped among 338 Chinese Han subjects by high throughput GenomeLab SNPstream genotyping system. Allele frequency and genotype distribution of each polymorphism were compared using a contingency chi2 test between 183 cases (90 OPLL, 61 OLF, and 32 OPLL coexisting with OLF) and 155 controls.
Among 4 studied SNPs, allele frequency of promoter (-572T) SNP demonstrated the most significant difference not only between OPLL cases and controls (P = 2.65E-4), but also between OLF cases and controls (P =7.38E-4). Moreover, the overall frequency of haplotypes constructed from promoter (-572), intron 32 (-29), and intron 33 (+20) SNPs showed significant difference not only between the patients with OPLL and controls, but also between the patients with OLF and controls (P = 5.86E-3, P = 1.5E-8, respectively).
This is the first report on SNPs of COL6A1 in OLF that suggests polymorphisms may be a risk factor for OLF. Our findings indicate that COL6A1 may be a common susceptibility gene for OLF and OPLL in Chinese Han population.
Spine 01/2008; 32(25):2834-8. · 2.08 Impact Factor
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ABSTRACT: Obesity is a risk factor for thoracic ossification of ligament flavum (TOLF) that is characterized by ectopic bone formation in the spinal ligaments. Hyperleptinemia is a common feature of obese people, and leptin, an adipocyte-derived cytokine with proliferative and osteogenic effects in several cell types, is believed to be an important factor in the pathogenesis of TOLF. However, how leptin might stimulate cell osteogenic differentiation in TOLF is not totally understood. We reported here that leptin-induced osteogenic effect in TOLF cells is associated with activation of signaling molecules STAT3, JNK, and ERK1/2 but not p38. Blocking STAT3 phosphorylation with a selective inhibitor, AG490, significantly abolished leptin-induced osteogenic differentiation of TOLF cells, whereas blocking ERK1/2 and JNK phosphorylation with their selective inhibitors PD98059 and SP600125, respectively, had only marginal effects. In addition, we showed that STAT3 interacted with Runt-related transcription factor 2 (Runx2) in the nucleus, and STAT3, Runx2, and steroid receptor coactivator steroid receptor coactivator-1 were components of the transcription complex recruited on Runx2 target gene promoters in response to leptin treatment. Our experiments identified STAT3, Runx2, and steroid receptor coactivator-1 as critical molecules in mediating leptin-stimulated cell osteogenesis in TOLF.
Journal of Biological Chemistry 11/2007; 282(41):29958-66. · 4.77 Impact Factor
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ABSTRACT: Mechanical stress is considered to be an important factor in the progression of thoracic ossification of the ligament flavum (TOLF). To elucidate the mechanism underlying mechanical stress-induced TOLF, we investigated the effect of stretching on cultured flavum ligament cells derived from TOLF and non-TOLF patients. We found that the mRNA expression of alkaline phosphatase (ALP), osteocalcin, Runx2, and osterix, but not that of Dlx5 and Msx2, was significantly increased by stretching in TOLF cells. In addition, the effect seems to be finely tuned by stretching-triggered activation of distinct mitogen-activated protein kinase cascades. Specifically, a p38 specific inhibitor, SB203580, significantly inhibited stretching-induced osterix expression as well as ALP activity, whereas a specific inhibitor of ERK1/2, U0126, prevented stretching-induced Runx2 expression. We showed that overexpression of osterix resulted in a significant increase of ALP activity in TOLF cells, and osterix-specific RNAi completely abrogated the stretching-induced ALP activity, indicating that osterix plays a key role in stretching-stimulated osteogenic effect in TOLF cells. These results suggest that mechanical stress plays important roles in the progression of TOLF through induction of osteogenic differentiation of TOLF cells, and our findings support that osterix functions as a molecular link between mechanostressing and osteogenic differentiation.
Journal of Cellular Physiology 07/2007; 211(3):577-84. · 3.87 Impact Factor
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ABSTRACT: To clarify the mechanism of the stimulatory effect of statins on bone formation, we investigated the effect of simvastatin, a widely used statin, on osteoblastic and adipocytic differentiation in primary cultured mouse bone marrow stromal cells (BMSCs). Simvastatin treatment enhanced the expression level of mRNA for osteocalcin and protein for osteocalcin and osteopontin, and increased alkaline phosphatase activity significantly (p<0.05). After BMSCs were exposed to an adipocyte differentiation agonist, Oil Red O staining, fluorescence activated cell sorting, and decreased expression level of lipoprotein lipase mRNA showed that treatment with simvastatin significantly inhibits adipocytic differentiation compared to controls that did not receive simvastatin (p<0.05). Lastly, we found that simvastatin induces high expression of BMP(2) in BMSCs. These observations suggested that simvastatin acts on BMSCs to enhance osteoblastic differentiation and inhibits adipocytic differentiation; this effect is at least partially mediated by inducing BMP(2) expression in BMSCs.
Biochemical and Biophysical Research Communications 08/2003; 308(3):458-62. · 2.48 Impact Factor
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ABSTRACT: To analyse the reason and countermeasure for the infection of severe acute respiratory syndrome (SARS) in health care workers, to provide reference for the health care workers to control infection of SARS.
To analyse retrospectively the reason and countermeasure 19 infective cases of SARS among the health care workers in our hospital from 16th March, 2003 to 3rd May, 2003.
Except for 4 fellow-doctors were infected by close contact in a same dormitory, all others were infected on work-station of close contact with SARS patients, there were no more cross-infection among the health care workers.
It is important to improve the protection even for the health care workers without contact of SARS patients, and it's necessary to wear mask, goggles, and gloves, health care workers with contact with SARS patients must be separated according the extent of contact separately, and draw guideline in advance.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 06/2003; 35 Suppl:55-8.
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ABSTRACT: To provide reference for correct clinical treatment by summarizing the characteristics and surgical experience in spinal deformity of the upper thoracic (T(1)-T(4)) short angular kyphosis.
Medical history was taken in 15 cases are reviewed. The results of X-ray and MRI examinations were analyzed. The kyphotic angles were measured using the Cobb technique. All cases underwent the anterior spinal cord decompression, by posterolateral approach in 4 cases and posterior in 11 cases.
Kyphosis was congenital in 7 cases and due to tuberculosis approach in 8 was. The average age at deformity was first noted was 3.6 years in 7 congenital cases and 9.0 years in 8 tuberculosis cases. All cases had neurologic deficits. The mean kyphosis was 86.5 degrees (range, 45 - 100 degrees). The delay between first observation of the deformity and subsequent neurologic loss was 16.5 years and 18.1 years respectively. The operation failed in 1 case. 13 cases were followed up, with an average 42 months. Seven cases showed improvement, 2 no change and 4 deterioration in neurologic deficit.
In cases of or tuberculosis kyphosis, the usual time for kyphosis to occur is during the preadolescent growth spurt. Neurologic deficits may occur without treatment and will be always progressive. The result of operation is not satisfactory. Early diagnosis and adequate management of kyphosis will prevent progression and thus any possible spinal cord compression. Early fusion is usually necessary to control the kyphosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2002; 40(1):52-4.
