Purpose: The aim of this study was to evaluate the degree of Luschka's joint hyperplasia and homolateral longus colli (LC) atrophy and explore their roles in cervical angina (CA) pathogenesis. Methods: After informed consent, 38 patients affected by cervical vertebra disease were included. Of these, 19 CA patients were included as Group CA. As a matched control group (Group C), another 19 patients were included. All patients were maintained under general anesthesia and underwent anterior cervical fusion surgeries. Imaging examination including Cobb's angle, sum range of motion (ROM), segment ROM, area of Luschka's joint osteophyte (LJO) and LC were measured. Results: There were no significant differences in Cobb's angle, sum ROM and segment ROM between two groups. All symptoms were relieved in patients of Group CA and Group C after operation, and there was no recurrence in follow-up period. JOA score increased, while NDI and VAS scores decreased after operation in both two groups (P < 0.05). Conclusion: Anterior cervical surgery could effectively improve the symptoms of CA. Luschka's joint hyperplasia could result in bowstring effect of longus colli, which might be a pathogenic factor of CA. Evaluating the degree of Luschka's joint hyperplasia might assist in the diagnosis of CA.

Study Design. Prospective cohort. Objective. To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM). Summary of Background Data. In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes. Methods. Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts. Results. FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = −0.674, P < 0.001) but not JOA recovery rates (r = −0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = −0.813, P < 0.001) and JOA recovery rate (r = −0.429, P < 0.001). Conclusion. DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients. Level of Evidence: 3

The rabbit annular puncture model of intervertebral disc degeneration (IDD) is among the most widely used models of IDD. We aimed to establish a rabbit model of IDD using a direct, minimally invasive procedure, and to establish a safe approach for disc injection of therapeutic agents. The rabbit model of IDD was established using ultrasound-guided percutaneous annular puncture: 18G to induce disc injury (18G segments), and 27G to evaluate the feasibility and safety of disc injection (27G segments). X-rays, histology and magnetic resonance imaging (MRI) were performed to assess IDD at 4, 8 and 12 weeks after modeling. Disc morphologic changes (by MRI, X-rays and histology), and collagen I and II immunohistochemistry were used to assess IDD. Disc space narrowing was observed as early as 4 weeks and osteophytes were formed at 12 weeks after puncture in the 18G segments, but no such changes occurred in the 27G and control segments. MRI demonstrated a progressive loss of T2WI signal intensity at the 18G segment throughout the 12-week period, while the 27G segment showed only a slight decrease of T2WI signal intensity throughout the 12-week period. Immunohistochemistry showed a progressive loss of the normal architecture and collagens in the 18G segment from 4 to 12 weeks, while the 18G segment showed only a slight change in architecture. These results indicated that using ultrasound-guided percutaneous annular puncture in rabbits; a 27G needle was small enough prevent the induction of IDD and could be a promising method of delivering therapeutic agents into discs.

Objective To develop a MFS (Myelopathy-Hand Function Evaluation System) in combination with computer programming based on the data glove technology. Methods Altogether 20 confirmed CSM (Cervical Spondylotic Myelopathy) patients and 20 healthy volunteers were selected respectively in this study. With deployment of the WiseGlove data glove, motion signals of the metacarpophalangeal joint during 10-s GRT (Grip and Release Test) were acquire dand processed by the computer software based on VC++programming to simulate the angular changes of the metacarpophalangeal joint. Results The average 10-s GRT results of the left and right hands in CSM Group were 15.20 times/10 s and 15.45 times/10 s respectively in contrast with 23.42 times/10 s and 23.63 times/10 s in Control Group. Statistically significant differences existed in the 10-s GRT results of the same-sided hands between two groups (P<0.05). Hand functions were deteriorated to various degrees in patients with CSM. Conclusion With the ifrst ever adoption of the data glove technology, MFS had demonstrated its high-integration, noninvasive, quantitative, reliable and easy-to-operate features in quantitative analysis of myelopathy-hand functions.

Objective To explore the value of the apparent diffusion coefficient(ADC)ratio and fractional anisotropy(FA)ratio of magnetic resonance(MR)diffusion tensor imaging(DTI)in evaluating the clinical symptoms,prognosis of cervical spondylotic myelopathy(CSM).Methods Thirty-six healthy subjects and fifty CSM patients were involved and received MRI examination.Regions of interest(ROIs)were selected in the ventral funiculus(VF),lateral funiculi(LF),dorsal funiculus(DF),and central gray matter(GM)for ADC and FA measurements.In the control group,ADC and FA ratios were calculated using the original values at the C3/4,C4/5,C5/6,and C6/7levels to divide the corresponding values at their C1/2levels.In the CSM group,ADC and FA ratios were calculated using the ADC and FA values at the most compressed levels to divide the corresponding values at their C1/2levels.In the control group,the variances of the two ratios were compared between different cervical levels and ages.CSM patients were divided into mild,moderate,and severe group according to the preoperative Japanese Orthopaedic Association(JOA)scoring system,and were divided into well,moderate,and poor group according to the postoperative JOA recovery rates.Correlations between DTI parameters,DTI ratios of the VF,LF,DF,and GM of the CSM patients and the JOA scores,JOA recovery rates were assessed among different clinical symptom subgroups and prognosis subgroups.Results In control group,DTI ratios(ADC ratios and FA ratios)in VF,LF,DF,and GM were significantly different between C3/4,C4/5,C5/6,and C6/7levels(P0.05),but not found between different age subgroups.Correlations between DTI ratios of the VF,LF,DF,and GM and JOA scores,JOA recovery rates were significantly superior than the correlations between DTI parameters and JOA scores,JOA recovery rates(P0.05 or P0.01),with the FA ratio being superior to the ADC ratio.Compared with normal control group,the ADC ratios increased gradually in order and FA ratios decreased gradually in the mild,moderate,and severe injury subgroups(P0.05).Compared with normal control group,the ADC ratios increased gradually in order and FA ratios decreased gradually in the well,moderate,and poor recovery subgroups(P0.05).Conclusion DTI ratios might eliminate the influence of age in evaluating the clinical symptoms and prognosis of CSM.Therefore DTI ratios,compared with DTI parameters,may better evaluate the clinical symptoms,prognosis of CSM.

To investigate the effect of uric acid on the osteogenic and adipogenic differentiation of human bone mesenchymal stem cells (hBMSCs). The hBMSCs were isolated from bone marrow of six healthy donors. Cell morphology was observed by microscopy and cell surface markers (CD44 and CD34) of hBMSCs were analyzed by immunofluorescence. Cell morphology and immunofluorescence analysis showed that hBMSCs were successfully isolated from bone marrow. The number of hBMSCs in uric acid groups was higher than that in the control group on day 3, 4, and 5. Alizarin red staining showed that number of calcium nodules in uric acid groups was more than that of the control group. Oil red-O staining showed that the number of red fat vacuoles decreased with the increased concentration of uric acid. In summary, uric acid could promote the proliferation and osteogenic differentiation of hBMSCs while inhibit adipogenic differentiation of hBMSCs.

目的 利用CT测量退变颈椎矢状径、横径、椎体高度及螺钉间距,探讨适用于长节段退变颈椎的钢板要求及设计思路.方法 随机选取本院自2013-06-2014-06诊治的颈椎病80例,所有患者术前常规进行CT平扫和三维重建,在PACS系统上测量颈椎CT参数.横断面上,分别测量矢状径、横径,在椎间隙水平测量钩椎关节内径;矢状面上,测量颈椎各椎体和稚间隙高度,测量预期螺钉间距和实际螺钉间距并进行统计比较.结果 颈椎各椎体的矢状径从上缘到正中到下缘逐渐增加,C2-7各椎体相同水平矢状径逐渐增加,C2下缘水平为(16.75±1.16)mm,C6下缘达到(19.28±2.08)mm.颈椎各椎体的横径从上缘到正中变化不大,从中分到下缘逐渐增加,从C2～7各椎体相同水平横径逐渐增加,C7水平横径为(31.01±2.28)mm.钩椎关节内径从C3～7逐渐增加,C3水平为(16.07±1.07)mm,C4水平为(17.42±1.58)mm,C5水平为(18.44±1.37)mm,C6水平为(20.79±1.40)mm,C7水平为(23.22±2.68)mm.颈椎前缘椎间隙和椎体高度无显著的从头段向尾端递增趋势.按照现有钢板设计,头尾两侧的螺钉间距在(16.96±1.95)mm到(17.51±1.59)mm之间,均显著高于实际需要的间距(12.84±1.53)mm到(14.50±1.69)mm.结论退变颈椎虽然存在一定的个体差异,但其横径和矢状径均向尾端逐渐递增,尤其是颈椎横径头尾两端的差异较大.现有的宽度均一、螺钉间距相等的钢板不完全适用于长节段颈椎前路手术,根据CT测量结果,可考虑设计螺钉间距不等的梯形钢板以满足长节段颈椎前路手术.

Intervertebral disc degeneration(IVDD)is characterized by the excessive degradation of extracellular matrix(ECM),which underlies many spine-related disorders.Matrix metalloproteinases(MMPs)and a disintegrin metalloproteinases with thrombospondin motifs(ADAMTSs)are believed to be the major proteolytic enzymes responsible for ECM degradation.This review summarizes the current literatures on gene expression and regulation of MMPs,ADAMTSs,and tissue inhibitors of metalloproteinases(TIMPs)in IVDD.Reports have showen that specific MMPs(MMP-1,-2,-3,-7,-8,-10,and-13)and ADAMTS(ADAMTS-1,-4,and-15)are upregulated in human degenerated intervertebral discs.Tissue inhibitor of metalloproteinase-3is downregulated and TIMP-1 is upregulated in human degenerated intervertebral discs relative to nondegenerated intervertebral discs.Regulation of the MMP and ADAMTS expression is affected by many factors including mechanical,inflammatory,oxidative stress,and so on.Genetic predisposition also plays an important role in expression of MMP-1,-2,-3,and-9.Upregulation of MMP and ADAMTS expression is implicated in ECM destruction,which can lead to the development of IVDD.Future IVDD therapeutics may target specific MMPs and ADAMTSs which is essential in the pathological proteolysis of ECM.

A potential bone tissue engineering material was produced from a biodegradable polymer, poly(lactic-co-glycolic acid) (PLGA), loaded with nanodiamond phospholipid compound (NDPC) via physical mixing. On the basis of hydrophobic effects and physical absorption, we modified the original hydrophilic surface of the nanodiamond (NDs) with phospholipids to be amphipathic, forming a typical core-shell structure. The ND-phospholipid weight ratio was optimized to generate sample NDPC50 (i.e., ND-phospholipid weight ratio of 100:50), and NDPC50 was able to be dispersed in a PLGA matrix at up to 20 wt %. Compared to a pure PLGA matrix, the introduction of 10 wt % of NDPC (i.e., sample NDPC50-PF10) resulted in a significant improvement in the material's mechanical and surface properties, including a decrease in the water contact angle from 80 to 55°, an approximately 100% increase in the Young's modulus, and an approximate 550% increase in hardness, thus closely resembling that of human cortical bone. As a novel matrix supporting human osteoblast (hFOB1.19) growth, NDPC50-PFs with different amounts of NDPC50 demonstrated no negative effects on cell proliferation and osteogenic differentiation. Furthermore, we focused on the behaviors of NDPC-PFs implanted into mice for 8 weeks and found that NDPC-PFs induced acceptable immune response and can reduce the rapid biodegradation of PLGA matrix. Our results represent the first in vivo research on ND (or NDPC) as nanofillers in a polymer matrix for bone tissue engineering. The high mechanical properties, good in vitro and in vivo biocompatibility, and increased mineralization capability suggest that biodegradable PLGA composite matrices loaded with NDPC may potentially be useful for a variety of biomedical applications, especially bone tissue engineering.

Cullin 4B (CUL4B) is a component of the Cullin4B-Ring E3 ligase complex (CRL4B) that functions in proteolysis and is implicated in tumorigenesis. Here, we report that CUL4B is associated with tumorigenesis by promoting proliferation and inhibiting apoptosis of human osteosarcoma cells. We performed RNA interference (RNAi) with a lentiviral vector system to silence the CUL4B gene using osteosarcoma SAOS-2 cells. The negative control included the normal target cells infected with the negative control virus whereas the knockdown cells included the normal target cells transfected with the RNAi target virus. We assessed the inhibition resulting from the decreased expression of the CUL4B gene on the proliferation rate of SAOS-2 cells, and also evaluated the cell cycle distribution, apoptosis and clonability. Compared with the negative control, the CUL4B gene expression was significantly inhibited in the SAOS-2 cells at the mRNA and protein levels in the knockdown group (P<0.01). Furthermore, in the knockdown group, the cell proliferation rate and clonability were also significantly inhibited (P<0.01). The apoptosis rate increased significantly (P<0.05). A significant decrease in the number of cells in the G1 phase (P<0.01) and significant increases in the S (P<0.01) and G2 phases (P<0.05) were observed. The silencing of CUL4B gene expression can effectively inhibit osteosarcoma cell proliferation and induce apoptosis. These findings may provide a novel biomarker for the treatment of osteosarcoma.

Background: The diffusion tensor imaging (DTI) parameters of the cervical spinal cord (CSC) changes with age. However, previous studies only examined specific CSC areas. Objectives: To analyze the DTI parameters in all intervertebral space levels of the whole normal CSC and to study the impact of age on these parameters in a Chinese population.Methods: Thirty-six healthy subjects aged 20-77 years were recruited. DTI parameters were calculated for gray matter (GM) and white matter (WM) funiculi in all the CSC intervertebral spaces (C112-C617). Age-related changes of DTI parameters were analyzed for the GM and WM funiculi.Results: Fractional anisotropy (FA) and mean diffusivity (MD) were lower in GM than in WM. MD and FA values were lower in the WM in the lower CSC compared with the upper CSC (all P< 0.05), but no difference was observed in GM. In ventral funiculi, MD increased with age, while FA decreased (all P< 0.001). In lateral and dorsal funiculi, MD and FA decreased with age (all P< 0.001). In GM, MD and FA decreased with age (all P< 0.001). Significant age-related changes were observed in FA and MD from GM and WM funiculi. FA was correlated with age in all funiculi (ventral: r = -0.733; lateral: r = -0.468; dorsal: r = -0.607; GM: r= -0.724; all P < 0.01).Conclusion: Important changes in MD and FA were observed with advancing age at all levels of CSC in Chinese patients. DTI parameters may be useful to assess CSC pathology, but the influence of age and segments need to be taken into account in diagnosis. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVE:To establish a goat model of acute spinal cord compression injury through a modified percutaneous technique with a Foley double-lumen urine catheter and explore the method feasibility and preliminary observation.METHODS:Twelve adult male Chongming goats were randomly divided into 3 groups:control (A, n = 4), 0.5 ml compression (B, n = 4) and 1 ml compression (C, n = 4). After local anesthesia, all animals received epidural balloon catheter (5Fr) insertion via a percutaneous trans-lumbosacral interlaminar space technique that mimicked the method used in vascular access for angiography. The balloon catheter was advanced under fluoroscopic guidance until its distal tip reached the middle of T6 level.One week later, for groups B and C, the balloon was inflated by half-strength contrast material, 0.5 ml and 1 ml, respectively. The balloon was left inflated for 30 min and then deflated. The images of computed tomography (CT) and magnetic resonance (MR) were taken before and after surgical procedures.Quantitative assessment of spine canal occupying rate was accomplished by an off-line software program based on CT results. Motor function was assessed by the modified Tarlov scale. Two animals of each group were sacrificed after a total observation period of 48 h and 72 h respectively.Spinal cords from the injured level were then obtained for pathologic examinations.RESULTS:All animals underwent successful catheterization occupying 6.8%±0.7% (Group A), 6.7%±0.7% (Group B) and 6.6%±0.6% (Group C) of spine canal respectively. After inflation, the occupying rate of groups B and C achieved 43.4%±2.5% and 88.1%±2.3% respectively.Ventral compression of spinal cord was noted on MR images.Hindlimb movement remained normal after catheter insertion in all groups. All animals in group B and C became paraplegic after inflation. And a positive correlation existed between injection volume and Tarlov score. Pathological findings confirmed neuron atrophy, increased gap around neurons, mild demyelination and vacuolar degeneration both in groups B and C at 48 h after injury. Pathological changes deteriorated at 72 h after injury.CONCLUSION:The results of behavioral evaluation, radiographic images and pathological examination reveal an evidence of acute spinal cord injury. Percutaneous epidural balloon catheter insertion differs from previous techniques by avoiding surgical exposure and associated artifacts, yet it offers injury mechanisms similar to those of human spinal cord injury. As a new means of modeling spinal cord injury in animals, this technique has many potential applications.

Objective To establish a new animal model of chronic cervical compressive myelopathy and to assess its feasibility.Methods Eighteen Chongming goats were divided into two groups: control group(n=3) and experimental group(n=15).The balloon was placed into the C3 intervertebral space by anterior approach operation,and the syringe valve was fixed subcutaneously.Contrast agent was injected percutaneously into the valve(0.1 ml/week) to inflate the balloon progressively to produce chronic compression.In the control group,the balloon compression system was placed and immediately removed;percutaneous puncture was performed each week without injecting anything.The Tarlov scores were assessed in each group every four weeks.The goats underwent X-ray,CT and MRI under general anesthesia every four weeks.The spinal cord specimens were pathologically examined at test level at the end of experiment.Results The Tarlov scores were 5(normal) at all time points in the control group.Tarlov scores were not changed in the experimental group four weeks after surgery(n=13);at eight weeks after surgery(n=11) the Tarlov scores were 4 in 2 goats and 5 in 9 goats;and at twelve weeks after surgery(n=9) the Tarlov scores were 2 in 3 goats,3 in 4 goats and 4 in 2 goats.The balloon compression system was stable in the experimental group.Radiological findings showed that the cervical spinal cord compressed progressively in the experimental group as time went by,and those in the control group underwent no noticeable change.Pathological examination showed neuronatrophy,increased gap around the neurons,mild demyelinated and vacuolar degeneration in the experimental group at eight weeks after surgery,and these changes were deteriorated twelve weeks after surgery.There were no noticeable pathological changes in the control group and four weeks after surgery in the experimental group.Conclusion The postoperative behavior,radiological and pathological findings of the animals consist with the character of chronic cervical compressive myelopathy,indicating that the balloon compression system in the present study can be used to establish a reliable and stable animal model of chronic cervical spinal cord compression.