Quantitative measurements of hip abduction strength in lumbar surgery patients

BackgroundWe sought to evaluate the hip abduction strength in patients before and after lumbar surgery.Materials and methodsEighty-four patients (51 males and 33 females) undergoing surgery for lumbar disc herniation or lumbar canal stenosis were selected. Mean age was 64.7 ± 13.8 years. Seven patients (8.3%) had surgery at multiple levels, including L2-L3 (group A), 27 (32.1%) patients had surgery at multiple levels including L3-L4 (group B), 32 (38.1%) patients had surgery at the L4-L5 level only (group C), and 18 (21.4%) patients had surgery at the L5-S1 level only (group D). Hip abduction strength was measured in the 84 patients preoperatively and in 49 patients postoperatively.ResultsIn all patients, preoperative mean hip abduction strength on the symptomatic side and the asymptomatic side was 71.4 ± 34.5 N and 90.7 ± 36.5 N, respectively (p = 0.0008). In groups A and B, there were no significant differences between the mean hip abduction strength on the symptomatic and contralateral side. In group C, those on the symptomatic and contralateral side were 68.0 ± 33.5 N and 89.3 ± 34.8 N, respectively (p = 0.0181). In group D, those on the symptomatic and contralateral side were 74.3 ± 42.4 N and 101.7 ± 44.7 N, respectively (p = 0.0314). In the 49 patients of all groups that could be measured postoperatively, there were no significant differences between the mean hip abduction strength on both sides.ConclusionsIt was confirmed that the gluteus medius, which was main hip abductor, was mainly innervated by L5 and its mean strength significantly improved postoperatively. The possibility of improvement of hip abduction strength, especially with unchanged tibialis anterior strength, could be very useful for operative decisions.     

Successful Treatment of Erdheim-Chester Disease With Coronary Artery Involvement

Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis and inflammatory myeloid neoplasm with poor prognosis. Symmetric long bone osteosclerosis occurs in nearly all patients, but other organs are often involved. Coronary artery involvement is rare, but was encountered in a patient who experienced angina. Radiologic presentation and histologic findings were consistent with diagnosis of ECD. A soft-tissue mass was found surrounding the right atrium, ascending aorta, and all branches of coronary artery. Interferon-alfa treatment was successful. In conclusion, we recommend coronary artery computed tomography angiography for cardiovascular evaluation of ECD and interferon-alfa to treat ECD.     

The monoclonal antibody to cytotoxic T lymphocyte antigen 4, ipilimumab (MDX-010), a novel treatment strategy in cancer management

Background: Cytotoxic T lymphocyte antigen 4 (CTLA-4) is an inhibitory regulator of the T cell immune response against tumor cells. Ipilimumab (MDX-010) is a monoclonal antibody directed against CTLA-4. Objective: To describe the basic mechanism of ipilimumab and discuss data available to date with regards to its safety and efficacy profile. Methods: Data from clinical trials including abstracts were reviewed using the PubMed Database as well as the American Society of Clinical Oncology Abstract Database. Conclusions: CTLA-4 inhibition with a monoclonal antibody is usually well tolerated and has efficacy as a therapeutic agent in a variety of cancers. The most clinically important toxicities have been related to autoimmune events, and guidelines for treatment of these effects are now available. Preliminary results indicate that therapy with ipilimumab leads to durable responses. Pharmacokinetics and pharmacodynamics are different from those of traditional chemotherapy agents. Phase III studies are currently underway for melanoma.     

Update on anti-CTLA-4 antibodies in clinical trials

Breaking immune tolerance against tumor self-antigens is presently an area of intense research in the design of cancer therapies. One possible method to enhance immune system activation against tumor antigens is by blocking the inhibitory co-stimulatory signals mediated by cytotoxic T lymphocyte antigen 4, (CTLA-4) expressed on activated T cells. The fully human monoclonal antibodies that are directed against human CTLA-4, ipilimumab (Medarex/Bristol-Myers Squibb) and CP-675,206 (Pfizer/Abgenix, now Amgen), have demonstrated activity against metastatic melanoma, hormone refractory prostate cancer and other malignancies. They have also uncovered unusual immune-related adverse events manifesting as self-limiting inflammatory reactions of the bowel, skin and pituitary. This article reviews preclinical development and data generated from Phase I, II and III studies with regard to the end points reported and immune-related adverse events.     

Intimal changes associated with arterial spasm induced by periarterial application of calcium chloride

Arterial spasm was induced by application of calcium chloride to the adventitial surface of the rabbit common carotid artery in vivo. Sodium chloride (NaCl) was applied to the contralateral vessel as control. Vessels were fixed in situ by intravascular perfusion after 15 min, 1 hr, or 24 hr and prepared for light and scanning electron microscopy (SEM). With SEM, the luminal surface at the site of calcium application showed severe longitudinal folding accompanied by endothelial desquamation with extensive platelet deposition on exposed subendothelium. The luminal cross-sectional area was reduced by 53 +/- 19.5% after 15 min and by 44 +/- 12% after 1 hr as compared with the contralateral control. Furthermore, the luminal area at the site of calcium application was found to be reduced by 42 +/- 8% after 1 hr when compared with segments of the same vessel distal to the site of calcium application. Blood flow rate, as measured by electromagnetic flow probe, was not reduced. Vessels examined after 24 hr showed a significant increase in luminal cross-sectional area as compared with contralateral control vessels (136 +/- 70%). Control vessels (NaCl) showed no significant change in luminal cross-sectional area and no endothelial desquamation or platelet deposition after 15 min, 1 hr, or 24 hr. Examination of histologic sections showed calcium precipitation within the attached thrombus after 15 min with calcium deposits also adherent to the adjacent luminal aspect of the internal elastic lamina (IEL). By 24 hr, this precipitation extended throughout the media. Marked deposition of leukocytes was seen after 24 hr which showed a preferential attachment for areas of endothelial damage and discontinuity of IEL.     

一株海洋来源Streptomyces sp. SCSIO 1682中那西肽(nosiheptide)的分离鉴定及其生物合成基因簇分析

目的 对一株海洋来源的菌株SCSIO 1682进行16S rDNA分子生物学鉴定,对发酵产物中的抑菌活性化合物进行分离鉴定,并对抑菌活性化合物的生物合成基因簇进行分析。方法 通过构建基于16S rDNA序列的系统发育树来进行菌株鉴定;通过有机溶剂萃取、正相和反相硅胶层析等化学分离手段对菌株SCSIO 1682的次级代谢产物进行活性追踪分离纯化;运用HR-ESI-MS,₁H和₁₃C NMR等波谱手段对所得化合物进行结构解析;通过对菌株SCSIO 1682进行全基因组扫描测序鉴定所得化合物的生物合成基因簇。结果 该菌株被鉴定为Streptomyces sp. SCSIO 1682,所得抑菌活性化合物为那西肽,鉴定了那西肽的生物合成基因簇并进行生物信息学分析。结论 从海洋链霉菌Streptomyces sp. SCSIO 1682中分离鉴定了那西肽,那西肽生物合成基因簇的鉴定为利用组合生物合成和合成生物学技术对那西肽进行结构改造提供了新的基因资源。     

抗感染海洋天然产物marformycin生物合成基因簇中调控基因及转运基因的功能研究

目的 对海洋放线菌Streptomyces drozdowiczii SCSIO 10141抗感染次级代谢产物marformycins生物合成基因簇中的调控基因mfnM与转运基因mfnR进行生物信息学分析和功能鉴定。方法 利用生物信息学对mfnM与mfnR的功能进行预测,利用PCR-targeting技术对mfnM与mfnR进行体内阻断,构建双交换突变株△mfnM和△mfnR,对突变株进行发酵并利用HPLC对发酵液进行分析。结果 突变株△mfnM和△mfnR丧失了生产marformycins代谢产物的能力。结论 初步阐明了mfnM与mfnR的功能,mfnM编码一个正调控因子,对marformycins的生物合成起正调控作用;而mfnR编码的ABC转运蛋白,负责marformycins的胞外转运。