A new “de-tension”-guided surgical strategy for multilevel ossification of posterior longitudinal ligament in thoracic spine: a prospective observational study with at least 3-year follow-up

BACKGROUND CONTEXTMultilevel ossification of the posterior longitudinal ligament in thoracic spine (mT-OPLL) is a rare but clinically significant spinal condition. Various surgical methods have been developed to address this disease. However, the outcomes are commonly unfavorable, and no standard surgical strategy has been established. To solve this problem, we introduced a new surgical strategy based on an innovative decompression concept, namely “de-tension.”PURPOSEThis study aimed to investigate the safety and efficacy of this new treatment, and to establish an improved surgical strategy.STUDY DESIGNA prospective observational study with at least 3 years of follow-up.PATIENT SAMPLEFifty-one patients with consecutive mT-OPLL who were treated between August-2012 and June-2018 were enrolled in this study.OUTCOME MEASURESA modified Japanese Orthopedic Association (mJOA) scale assessing thoracic spine, recovery rate (RR), and surgical complications.METHODSAll patients underwent 1-stage thoracic posterior laminectomy, selective OPLL resection, and spinal column shortening with/without reduction of kyphosis (dekyphosis). Initially, we recommended that when thoracic kyphosis of T1-T12 in sagittal reconstruction CT (TK) was less than 20°, no dekyphosis should be performed; when this angle was greater than 20°, dekyphosis could be conducted. Patients’ demographic data, radiological findings, and intra/postoperative complications were recorded and analyzed. Neurological status was evaluated with mJOA score and RR. The correlation of preoperative TK or kyphosis angle in fusion area (FSK) with postoperative dekyphosis angle and spinal column shortening distance (SD) were respectively evaluated by Pearson correlation analysis.RESULTSCerebrospinal fluid leakage (58.8%) and neurological deterioration (15.7%) were the most common complications. Average mJOA score was improved from preoperative 4.0±2.1 to 8.9±2.4 at the last follow-up, and the mean RR was 71.3±33.7%. There was no correlation between preoperative TK and SD (p=.56) or between preoperative FSK and SD (p=.21), but dekyphosis angle was significantly correlated with TK (r=0.504, p<.01) and FSK (r=0.5734, p<.01). TK of 24.6° and FSK of 23.0° were determined as the critical angles for dekyphosis, and a modified surgical strategy was formulated.CONCLUSIONSThis new strategy provided a novel solution for mT-OPLL, and was proved to be safe and effective during long-term follow-up. Further rigorously designed large-scale prospective studies are needed to validate our findings.     

Tako-Tsubo-Kardiomyopathie

Tako-tsubo cardiomyopathy (TK) is an acutely appearing myocardial disease leading to impaired cardiac function, which can barely be distinguished clinically from an acute myocardial infarction. It occurs mainly in postmenopausal women and usually has a good prognosis. The pathophysiology of TK still remains to be elucidated but the favoured hypothesis is myocardial damage induced by catecholamine excess. Various acute diseases, emotional stress, surgical procedures and anaesthesia have been described as possible causes for TK. Little is known about the optimal therapy, however, there might be potential differences in the therapy of TK compared to contemporary therapy algorithms for heart failure. Knowledge of TK as a differential diagnosis for acute myocardial infarction is necessary to avoid incorrect treatment.     

逆转录病毒载体介导HSV—TK基因在膀胱癌细胞的表达和作用

应用基因工程技术构建了带ＨＳＶＴＫ基因的逆转录病毒重组体ｐＬＮＳＸＴＫ，磷酸钙沉淀法转染ＰＡ３１７细胞，建立了重组病毒的载体产生细胞系ＰＡ３１７／ＴＫ细胞。用病毒上清感染人的膀胱癌细胞株ＢＩＵ８７，Ｇ４１８筛选抗性克隆ＢＩＵ８７／ＴＫ细胞。提取ＰＡ３１７／ＴＫ和ＢＩＵ８７／ＴＫ细胞的ＤＮＡ，用ＤＩＧ标记检测证实整合了ＨＳＶＴＫ基因，在病毒上清用ＲＴＰＣＲ检测到目的基因的转录。转导ＨＳＶＴＫ基因的膀胱癌细胞获得对ＡＣＶ的化学敏感性，给予ＡＣＶ可有效地杀伤肿瘤细胞。     

Thymidine kinase in brain-tumor cysts

A recently developed method for deoxythymidine kinase (TK) determination was applied to brain-tumor cyst fluid and fluid from a non-neoplastic intracerebral cyst. The fluid from all tumors tested positive for TK whereas the non-neoplastic cyst lacked TK. Cyst fluid was also analyzed for TK before and after intracystic instillation of BCNU. It is suggested that TK activity in the fluid in cystic brain lesions could prove useful in deciding whether an intracerebral lesion is neoplastic. Also, TK activity can be used to evaluate the effect of topical therapy.     

Thymidine kinase and its isozyme activities in human thyroid diseases

An increase in DNA synthesis runs parallel with an increase in the activity of cytoplasmic thymidine kinase (TK), an enzyme that catalyses the phosphorylation of deoxythymidine via the pyrimidine salvage pathway. In this work, I measured TK and its isozyme activities in normal thyroid tissue, Basedow's disease, adenomatous goiter, adenoma and adenocarcinoma of human thyroid glands. TK activity was assayed by the method of Taylor et al. The average TK activities in Basedow's disease, adenomatous goiter, adenoma and adenocarcinoma were 1.78, 1.75, 2.98 and 3.33 times than that in normal thyroid tissue, respectively. TK isozymes were separated by DEAE cellulose (DE-52, Whatman, Kent, UK) column chromatography (1.5 X 5.0 cm). The activities eluted at NaCl concentrations of 0M, 0.1M and 0. 2 M were named peak A,B and C, respectively. The average activities in peaks A and C were not significantly different from each other in these diseases. But the average activity of peak B in the thyroid adenocarcinoma was significantly higher (2.3 fold) than that in normal thyroid tissue. As the activity of this isozyme was not affected by deoxycytidine triphosphate (dCTP), it may be involved in DNA replication closely.     

逆转录病毒载体介导的HSV1—TK基因在人肾癌GRC—1细胞中 …

探讨ＨＳＶ１－ＴＫ基因在人肾癌ＧＲＣ－１细胞中表达的可能性及意义。方法采用基因工程技术构建带ＨＳＶ１－ＴＫ基因的逆转录病毒重组体Ｇ１Ｎ－ＴＫ、用脂质体法对人肾癌ＧＲＣ－１细胞进行转染及用新霉素筛选。结果成功克隆出ＨＳＶ１－ＴＫ基因的ＧＲＣ－１／ＴＫ细胞,并对无环鸟苷敏感。     

Four types of global spine sagittal alignment and compensation mechanism in adult patients with lumbar degenerative disease

BackgroundThe objective of this study was to describe and classify common variations and compensation mechanisms in the sagittal alignment of the spine with lumbar degenerative disease.MethodsA total of 230 patients over 18 years old who underwent whole-spine X-rays to evaluate lower back pain were enrolled in this study. C7 slope, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), cervical lordosis (CL), thoracolumbar kyphosis (TLK), and sagittal vertical axis (SVA) were measured. Patients were divided into Group A (balance without compensation), B (balance with compensation), C (unbalance with compensation), and D (unbalance without compensation) according to spinopelvic balance and thoracic compensation.ResultsGroup A had the largest LL, smallest PT, largest SS, and best clinical parameters of the four groups (p < 0.001, p < 0.001, p < 0.001, p < 0.001). The age increased gradually from Group B to Group D. Group B had an increased TK compared with Group A (p < 0.001). Group C had an increased TK compared with Group A (p < 0.001). Group D had an increased C7 slope compared with Group A (p = 0.022).ConclusionsThis classification is shown four different regional and global alignments of the spine. Compensation took place to keep the balance of the spine. Classification types were consistent with age, compensation abilities, and clinical parameters. This classification potentially represents a valuable tool for comprehensive analysis of lumbar degenerative before surgical treatment considering sagittal balance.     

The standing and sitting sagittal spinopelvic alignment of Chinese young and elderly population: does age influence the differences between the two positions?

To investigate the characteristics of standing and sitting spinopelvic sagittal alignment among Chinese healthy population with different age groups. This cross-sectional, prospective study included a total of 235 volunteers aged 19 to 71 years. Volunteers were divided into two groups: group A (age ≤ 40 years; n = 140) and group B (age > 40 years, n = 95). Student’s t test was performed to compare the sagittal parameters including sagittal vertical axis (SVA), T1 pelvic angle (TPA), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL) and pelvic tilt (PT) between standing and sitting positions of two groups. Multiple regression was performed to explore the influence factors of differences between two positions. In the standing position, group B had larger SVA, TK, PT and TPA than group A. When moving from standing to sitting position, increased SVA and PT were found in both groups, accompanied by decreased LL and TK. However, despite similar change in SVA, group B presented with lesser changes in LL, PT and TPA than group A in sitting position. Age and gender independently influenced the difference in PT and LL. In the standing position, the older volunteers showed larger SVA, TPA, TK, CL and PT than young population. Both groups showed similar changes when moving from standing to sitting, but the differences between the positions were smaller in older population. These characteristics in the standing and sitting positions of different age groups should be considered when planning surgical reconstruction of sagittal alignment. These slides can be retrieved under Electronic Supplementary Material.     

Importance of sagittal alignment in spinal deformity

To maintain proper function and an erect posture, the spine compensates by changing the amount of kyphosis or lordosis at each region. However, in the setting of severe spinal malalignment, the compensatory motion of the spine may be inadequate, and may lead to compensatory spinopelvic and postural changes, which increase energy for standing and ambulation. Sagittal alignment has been shown through numerous studies to affect patient reported outcome scores. The goals of sagittal alignment are SVA < 50 mm, PI –LL < 20°, with various other equations (PI − LL < 10°, PI + LL + TK ≤ 45°, LL = [(PI + TK)/2] + 10) described to optimize surgical outcomes following correction. This review will look at the importance of sagittal alignment, how to measure spinopelvic alignment parameters, contributing variables to spinal alignment, and the clinical importance when spinal malalignment causes imbalance.     

Immunomodulation of glioma cells after gene therapy: induction of major histocompatibility complex class I but not class II antigen in vitro

OBJECTIVE: Acquired immunity has been demonstrated in Fischer rats bearing syngeneic 9L tumors after herpes simplex virus (HSV) thymidine kinase (TK) gene transfection and ganciclovir treatment. The nature of this immunity in rats and its relevance to the HSV TK/ganciclovir protocol for human subjects remain to be determined. In this study, levels of major histocompatibility complex (MHC) Class I and II antigen expression were measured before and after HSV TK transfection, in an effort to document immunomodulatory changes caused by gene therapy. METHODS: Tumor cells from the 9L gliosarcoma cell line, three primary human glioma cultures, and the human glioma cell line U87 MG were transduced with HSV TK vector-containing supernatant from fibroblast-producing cells (titer of 5 x 10(6) colony-forming units/ml) and selected in G418 medium for neomycin resistance. Clones were pooled or individually selected for cell-killing assays with ganciclovir, to confirm TK expression (10(3) cells/well in a 96-well dish). Northern analyses using MHC Class I and Class II complementary deoxyribonucleic acid probes were performed on blots containing total ribonucleic acid from wild-type tumor cells and HSV TK transfectants. A beta-actin complementary deoxyribonucleic acid probe served as an internal control. Cell surface expression was confirmed with flow cytometry. The induction of MHC Class I was tested for cycloheximide and genistein sensitivity. RESULTS: All cell cultures exhibited increases in MHC Class I but not MHC Class II expression, as determined by Northern analysis densitometry and flow cytometry. Cycloheximide treatment did not diminish the up-regulation of MHC Class I after retroviral transfection, implicating a signal transduction pathway that does not require ongoing protein synthesis. Genistein pretreatment of cell cultures did diminish the up-regulation of MHC Class I, implicating a tyrosine kinase in the signaling cascade. CONCLUSION: Induction of MHC Class I in rat and human glioma cells after HSV TK retroviral gene therapy is a primary effect that is dependent on tyrosine kinase activity. Specific immune responses generated after transfection may represent an important general side effect of gene therapy protocols. Elucidation of the mechanism of immunomodulation after gene therapy will likely yield safer and more effective clinical protocols.     

胸弯型青少年特发性脊柱侧凸术前胸椎后凸对术后矢状面代偿模式的影响

目的 探讨胸弯型青少年特发性脊柱侧凸 (AIS) 患者选择性胸椎融合术前胸椎矢状面 形态对术后矢状面代偿模式的影响.方法 回顾性分析1999年2月至2005年12月行前路或后路 选择性胸椎融合术且有完整随访资料的90例 AIS患者的临床资料,其中男性15例,女性75例;年龄 11-18岁,平均(14.5±1.9)岁;前路手术41例,后路手术49例.根据术前胸椎后凸角(TK)大小,再 将前后路手术患者分别分为TK<10°组和TK≥10°组.对这四组患者术前及术后随访的胸弯侧凸 角、腰弯侧凸角、TK、腰椎前凸角(LL)、内固定远端交界性后凸角(DJK)、胸腰段交界性后凸(TJK)及 骶骨后上缘与C_7,铅垂线的距离 (SVA) 等指标进行测昔并进行统计学分析.结果 末次随访时,前路 TK<10°组TK、TJK和 DJK均较术前增大,差异具有统计学意义(P<0.05),总体上由前凸变成后凸; 前路TK≥10°组TK 较术前无明显变化,DJK虽有增大的趋势,但差异无统计学意义(P>0.05),而 TJK 较术前增大,差异有统计学意义(P<0.05);后路TK<10°组TK、TJK均较术前增大,差异有统计 学意义(P<0.05),DJK虽有增大的趋势,但差异无统计学意义(P>0.05)°后路TK≥10°组TK、TJK 和DJK在随访过程中均无明显变化.末次随访时全部TK<10°患者LL与术前相比差异虽无统计学 意义,但总体上呈现逐渐增大的趋势.而四组患者术后的SVA与术前相比无明显变化且均保持在正 常范围.结论 术前TK减少的胸弯型AIS患者行选择性胸椎融合术后,TK、LL均获良好蕈建.但 术后随访过程中DJK和TJK有后凸增大趋势,可能与前路内固定节段短及术后矢状面的重建有关.     

TK基因/9-丙氧鸟苷联合mGM-CSF基因治疗胃癌

目的 观察自杀基因ＴＫ对小鼠胃癌的杀伤作用,并联合ｍＧＭ－ＣＳＦ基因,观察免疫反应在增强ＴＫ杀伤性中的作用。方法 应用逆转录病毒方法转导自杀基因ＴＫ,应用脂质体方法转导细胞因子基因ｍＧＭ－ＣＳＦ。观察ＴＫ基因体外对小鼠胃癌６１５小鼠前胃癌（ＭＦＣ）细胞的杀伤性和旁观者效应;体内实验中将病毒上清注入瘤体内,并结合应用其前药９－丙氧鸟苷（ＧＣＶ）和ｍＧＭ－ＣＳＦ基因,分别观察肿瘤的生长情况。通过病理切     

重度腰椎滑脱术后骨盆一脊柱参数与临床症状的相关分析

目的研究重度峡部裂腰椎滑脱患者手术前后骨盆．脊柱参数的变化与临床症状改善的相关性。方法回顾性分析2000--2013年中南大学湘雅二医院收治的60例L,重度峡部裂滑脱患者的临床资料,根据术后Oswestry评分改善率的不同分为高改善率组（改善率〉50％）和低改善率组（改善率〈50％）,测量分析两组滑脱百分比、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（ss）、髋关节-S,水平距离（SFHD）、髋关节．s,垂直距离（SFVD）、腰椎前凸角（LL）、胸椎后凸角（TK）、C,铅垂线．骶骨后角距离（SC7D）、腰骶角（Dub—LSA）、腰骶关节角（LSJA）等数据。结果高改善率组PT、LL、SFHD、SC7D、LSJA、PT／SS、LL／TK、SFHD／SFVD均低于低改善率组（P〈O．05）,而SS、TK、SFVD、Dub．LSA均高于低改善率组（P〈O．05）。PT、LL、SFHD、SC7D、LSJA与Oswestry评分改善率呈显著负相关,负相关程度依次为SC7D〉LL〉PT〉SFHD〉LSJA（P〈0．05）;SS、TK、SFVD、Dub．LSA与Oswestry评分改善率呈显著正相关,正相关程度依次为：Dub—LSA〉SS〉SFVD〉TK（P〈0．05）：PT／SS、SFHD／SFVD、LL／TK与Oswestry评分改善率呈显著负相关,负相关程度依次为：PT／SS〉LL／TK〉SFHD／SFVD（P〈0．05）,这3个参数比值与术后Oswestry评分改善率的相关性均大于单个参数与术后评分改善率的相关性（P〈0．05）。结论重度腰椎滑脱患者术后临床症状与骨盆．脊柱参数关系密切,临床症状改善率与PT、LL、SFHD、SC7D、LSJA、PT／SS、SFHD／SFVD、LL／TK呈负相关,与SS、TK、SFVD、Dub．LSA呈正相关。提示对于此类患者,术前应充分评估可能影响术后症状改善的因素,优先考虑矫正影响较大的参数,并设计合理军术方寨．以樨高疗前。     

Significance of thymidine kinase activity in renal cell carcinoma

PURPOSE: Thymidine kinase (TK) has a key role in the complementary or alternative salvage pathway of pyrimidine synthesis. Little is known about the significance of TK activity in renal cell carcinoma. We examined the activity of TK in 66 renal cell carcinomas and investigated the association of the level of TK activity with the stage and grade of renal cell carcinoma. MATERIALS AND METHODS: TK activity in nonfixed, fresh frozen renal cell carcinoma and normal kidney was determined by the DEAE cellulose disc method. RESULTS: The activity of TK was approximately 4-fold higher in normal kidney compared with renal cell carcinoma. The higher the stage and grade of renal cell carcinoma, the higher the TK activity. TK activity correlated positively with the activity of thymidine synthase, which is a key enzyme for pyrimidine synthesis in the de novo pathway. TK activity in renal cell carcinoma cells was inversely related to their sensitivity to 5-fluorouracil. CONCLUSIONS: To our knowledge this report represents the first study to demonstrate that the level of TK activity correlates with the stage and grade of renal cell carcinoma, and higher TK activity in renal cell carcinoma predicts lower sensitivity to 5-fluorouracil. These results suggest that high TK activity may be associated with the malignant potential of renal cell carcinoma and TK may be a molecular therapeutic target for this disease. In addition, the combination of TK and thymidylate synthase inhibitors may be beneficial for renal cell carcinoma.     

单纯疱疹病毒胸苷激酶基因和更昔洛韦对膀胱癌细胞的旁观杀伤效应

目的：探讨单纯疮疹病毒胸苷激酶（HSV-tk）基因和更昔洛韦（GCV）对膀胱癌细胞的旁观者效应和机制。方法：将转染HSV-tk基因的膀胱癌细胞HTB9与HTB9细胞混合培养，在GCV作用下，观测细胞的存活率。HTB9-tk细胞条件培养基，经不同孔径的滤膜过滤，将滤液及0.22μm滤膜上的物质重新加入HTB9细胞，观察细胞存活率。结果：当HTB9-tk细胞50％时，共培养细胞对GCV的敏感性近100％，表明每个表达HSV-tk基因的细胞至少杀死1个不含HSV-tk基因的膀胱癌细胞。HTB9-tk细胞的条件培养液过滤后直径大于0.22μm的某种物质对HTB9细胞具有细胞毒性作用。结论：HSV-tk/GCV对膀胱癌细胞具有明显旁观者效应的毒性作用，直径大于0.22μm的某种物质对HTB9细胞具有细胞毒性作用，其旁观杀伤效应机理可能是HTB9对HTB9-tk细胞凋亡囊泡的吞噬。     

Thymic transplantation in miniature swine: III. Induction of tolerance by transplantation of composite thymokidneys across fully major histocompatibility complex-mismatched barriers

BACKGROUND: This study determines whether composite thymokidney (TK) grafts, created by implantation of autologous thymic tissue beneath the donor's renal capsule before transplantation, could induce allogeneic transplantation tolerance across two-haplotype fully major histocompatibility complex (MHC)- mismatched barriers in juvenile MGH-miniature swine. METHODS: TK grafts were prepared by implanting autologous thymic tissue under the renal capsule of donor animals 2 to 3 months before transplantation. Four recipients were treated with a T-cell-depleting immunotoxin and received fully MHC-mismatched TK grafts plus a 12-day course of cyclosporine A (CsA). Control animals were treated with CsA alone or both CsA and immunotoxin, but with a normal kidney or a kidney implanted with autologous lymph node rather than thymus. Renal graft function was assessed by plasma creatinine levels and histologic analyses. Immunologic status was monitored by cell-mediated lympholysis assays. RESULTS: All four recipients of fully MHC-mismatched TK transplants treated with immunotoxin and a 12-day course of CsA accepted their composite renal allografts long-term. All control recipients receiving a TK and CsA alone, a normal kidney or a composite kidney containing lymph node tissue acutely rejected their grafts. CONCLUSIONS: To our knowledge, this is the first demonstration that functional vascularized thymic grafts can induce transplantation tolerance across fully MHC-mismatched barriers in a large animal model.     

胸苷激酶1在肌层浸润性膀胱癌组织中表达的特征

目的研究胸苷激酶1(thymidine kinases,TK1)在肌层浸润性膀胱上皮癌中的表达特征。方法选择2010年1月到2012年12月青岛大学附属烟台毓璜顶医院泌尿外科收治的59例肌层浸润性膀胱癌切除术后癌组织及良性组织,甲醛固定后用于做TK1免疫组化(immunohistochemically,IHC)。免疫组化的结果以半定量的方式表达,由2个独立的观察者分别判断。TK1染色的定位分为单纯细胞核染色及细胞核和细胞浆共同染色。研究TK1的表达与肌层浸润性膀胱癌的相关性,并分析TK1 RNA的表达水平。结果相对于良性组织,TK1在浸润性膀胱癌的表达明显升高(P0.05),癌组织中细胞浆染色更多见(P0.05)。TK1在良性尿路上皮基底层组织中表达少见。结论 TK1在浸润性膀胱癌与良性膀胱上皮中的表达有明显差异,表明TK1有作为诊断肌层浸润性膀胱癌标志物的潜能。     

Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults

BackgroundThe precise prediction of ideal lumbar lordosis (LL) has become increasingly important in clinical practice. The aim of this study was to explore the regulatory mechanisms of sagittal spinopelvic alignment and to predict ideal LL based on individual pelvic incidence (PI) and thoracic kyphosis (TK) parameters in asymptomatic adults.MethodsA total of 233 asymptomatic subjects older than 18 years were consecutively enrolled in our study between April 2017 and December 2019. A full-spine, standing X-ray was performed for each subject. The following parameters were measured in the sagittal plane: the apex of lumbar lordosis (LLA), the distance between the plumb line of the lumbar apex (LAPL) and the gravity plumb line, the inflection point (IP), LL, the upper arc and lower arc of lumbar lordosis (LLUA and LLLA, respectively), PI and TK. Stepwise multiple linear regressions were conducted, and the statistical significance level was P < 0.05.ResultsBoth PI and TK were two important predictive variables for LLA, LAPL, IP and LL. In addition, the LLUA was mainly explained by TK, while the LLLA was explained by PI. The corresponding predictive models are listed as follows: LLA = 17.110 ? 0.0401PI + 0.0231TK (R² = 0.380), LAPL = 31.296 + 0.4671PI ? 0.1261TK (R² = 0.309), IP = 10.437 + 0.0911TK ? 0.0291PI (R² = 0.227), LL = 2.035 + 0.6181PI + 0.4301TK (R² = 0.595), LLUA = 0.893 + 0.4181TK (R² = 0.598), LLLA = 3.543 + 0.5761PI (R² = 0.433).ConclusionThe specific sagittal lumbar profile should be regulated by both pelvic and thoracic morphology. Such predictive models for lumbar parameters determined by individual PI and TK parameters have been established, which are meaningful for surgeons to better understand the regulatory mechanisms of sagittal spinopelvic alignment and reconstruct a satisfactory lumbar alignment.     

Changes in the global spine alignment in the sitting position in an automobile

BACKGROUND CONTEXTStudies of the changes in spine alignment in the sitting position have been limited to specific spine segments. Because there have been few studies of global spinopelvic alignment in the sitting position, it is important to assess the changes associated with this position for such settings as developing future design of seats and achieving appropriate restoration of spine alignment.PURPOSEThis study aimed to measure changes in global spine alignment when people are sitting in car seats and to analyze the characteristics of those changes.STUDY DESIGNThis was a prospective, collaborative study of the radiological evaluation of changes in global spine alignment.PATIENT SAMPLEThe study included 113 asymptomatic adult participants (56 men and 57 women) without a history of spine disease or lower limb surgery, and with no current lower back or leg pain.OUTCOME MEASURESRadiographic findings were assessed by measurement of various angles: cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis (C7-SVA), T1 spinopelvic inclination (T1SPI), and T1 pelvic angle (TPA).METHODSRadiographs were obtained in the standing and sitting positions. The objective variables analyzed statistically were spine alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, PT, and PI) measured in the standing position, body alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, and PT) measured in the sitting position, and stand-to-sit changes (∆CL, ∆TK, ∆TLK, ∆LL, ∆C7-SVA, ∆T1SPI, ∆TPA, ∆SS, and ∆PT). Explanatory variables were sex, age, body height, and body mass index.RESULTSChanging posture from standing to sitting decreased CL by an average of 5.3°, slightly decreased TK by an average of 1.3°, increased TLK by an average of 6.8°, decreased LL by an average of 35°, decreased SS by an average of 49.2°, increased PT by an average of 49.2°, shifted C7-SVA backward by an average of 106.7 mm, decreased T1SPI by an average of 18.8°, and increased TPA by an average of 21.1°. Statistical analysis revealed that ΔLL was significantly decreased in elderly participants. After the stand-to-sit change, ΔTLK and ∆TPA were significantly increased in taller participants and ΔT1SPI was significantly decreased in taller participants.CONCLUSIONSAmong other changes, most notably LL is decreased and the pelvic tilt is increased when a person is sitting in a car seat. However, these changes in spine alignment differ with age and height. These findings may be useful for the development of future design of seats and for achieving appropriate surgical restoration of spine alignment.     

A novel suicide gene therapy targeting the overexpression of eukaryotic initiation factor 4E improves survival in a rat peritoneal carcinomatosis model

BACKGROUND: Eukaryotic Initiation Factor 4E (eIF4E) is pivotal in translating mRNAs with complex 5' un-translated regions (UTRs). A target-specific gene therapy was developed by splicing a complex 5'UTR upstream of the herpes simplex virus thymidine kinase (TK) gene in an adenovirus vector (Ad-HSV-UTK). Translation of the suicide TK gene is restricted to cells that overexpress eIF4E. We investigated the efficacy of this novel therapy in a rat peritoneal carcinomatosis (PC) model. METHODS: A PC model was developed by implanting a syngeneic 0.25 cm(3) tumor into Fisher 344 rats' omentum. Rats were grouped as follow: No surgery (? CS), cytoreductive surgery alone (CS), and CS + Ad-HSV-UTK + gancyclovir (GCV). 10(9) Ad-HSV-UTK was injected intraperitoneally (i.p.) and GCV (50 mg/kg) was administered i.p. every other day, beginning on postoperative day 2. The Kaplan-Meier survival method and log-rank test were statistical tests used. RESULTS: Treated rats had a significantly longer median and overall survival than the ? CS and CS groups (P = .012). The median survivals for the treated rats, ? CS, CS were 18 days, 9 days, and 11 days, respectively. CONCLUSIONS: Treatment with a novel suicide gene therapy following cytoreductive surgery prolonged survival in a rat peritoneal carcinomatosis model.