A novel 3D approach for determination of frontal and coronal plane tibial slopes from MR imaging

Background

The proximal tibia is geometrically complex, asymmetrical, and variable, is heavily implicated in arthrokinematics of the knee joint, and thus a contributor to knee pathologies such as non-contact anterior cruciate ligament injury. Medial, lateral, and coronal tibial slopes are anatomic parameters that may increase predisposition to knee injuries, but the extent to which each contributes has yet to be fully realized. Previously, two-dimensional methods have quantified tibial slopes, but more reliable 3D methods may prove advantageous.

Can kinematic tibial templates assist the surgeon locating the flexion and extension plane of the knee?

Purpose

We performed virtual feasibility and in-vivo validation studies to test whether the use of a kinematic tibial template (KTT) assists the surgeon in accurately locating the orientation of the F-E of the knee with low bias and high precision.

Identification of oral cavity biofilm forming bacteria and determination of their growth inhibition by Acacia arabica,Tamarix aphylla L. and Melia azedarach L. medicinal plants

ObjectiveBiofilms are complex, multi-species bacterial communities that colonize the oral cavity in the form of plaque and are known to cause dental caries and periodontal disease. Present study demonstrated the potential of three selected medicinal plants against isolated and identified dental biofilm forming strains.MethodsPathogenic bacteria from dental biofilms were isolated, cultured, identified by phylogenetic analysis using PCR-based 16S ribosomal RNA (or 16S rRNA) nucleotide sequences and were analyzed for their biofilm forming capability. The antimicrobial activity of the three important medicinal plant extracts (Acacia arabica, Tamarix aphylla L. and Melia azadirachta L.) was determined against the highest biofilm forming bacteria.ResultsPhylogenetic analysis revealed that the 19 strains belonged to Proteobacteria, Firmicutes and Actinobacteria. Among the 19 isolates, eleven strains were found to possess high biofilm formation capability comparatively and antimicrobial activity assay showed that the selected plants considerably inhibited their growth. Extract from A. arabica stem had strong effect on the ability of bacteria isolated from dental carries as evident by up to 73% reduction in biofilm formation on surface pre-treated with extract from this plant. The same extract also showed tremendous biofilm cleaning potential up to 87% of the biofilm.ConclusionThe results suggested that the extracts of selected medicinal plants could be used for protection against pathogenic dental biofilm causing bacteria and attempts should be taken by pharmaceutical industries to utilize it in dental caring products.     

Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment

Purpose

Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF.

Materials and Methods

Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values.

Results

Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope.

Conclusion

ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope.     

Fibre‐based scaffolding techniques for tendon tissue engineering

Tendon refers to a band of tough, regularly arranged, and connective tissue connecting muscle and bone, transferring strength from muscle to bone, and enabling articular stability and movement. The limitations of natural tendon grafts motivate the scaffold‐based tissue engineering (TE) approaches, which aim to build patient‐specific biological substitutes that can repair the damaged or diseased tissues. Advances in engineering and knowledge of chemistry and biology have brought forth numerous fibre‐based technologies, including electrospinning, electrohydrodynamic jet printing, electrochemical alignment technique, and other fibre‐assembly technologies, which enable the fabrication of tendon tissue structure in 3‐dimension. Textile techniques such as knitting and braiding have also been performed based on the fibrous materials to produce more complex structure. These scaffolds showed great similarity with native tendons in architectural features, mechanical properties, and facilitate biological functionality such as cellular adhesion, ingrowth, proliferation, and differentiation towards tendon tissue. Herein, we review the techniques that have been used to assemble fibres into scaffolds for tendon TE application. The morphological structures, mechanical properties, materials, degradation characteristics, and biological activities of the induced scaffolds were compared. The existing challenges and future prospects of fibre‐based tendon TE have also been discussed.     

Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

Background

To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options.

Methods

We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores.

Results

A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%).

Conclusions

Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.     

脊柱侧凸患者站立位与平卧位脊柱骨盆矢状面序列差异

目的 比较不同体位和不同病因分型对脊柱骨盆矢状面序列的影响.方法 选取我科2010年2月- 2014年6月110例脊柱侧凸患者,按病因分为特发性脊柱侧凸(31例)、先天性脊柱侧凸(36例)、神经肌肉型脊柱侧凸(32例)、退行性脊柱侧凸(11例)4组.分别行自然站立位全脊柱骨盆侧位X线和平卧位低剂量三维CT重建检查,分别测量脊柱侧凸患者矢状面平衡距离(sagittal vertical axis,SVA)、胸后凸角(Cobb T5-T12,TK)、胸腰段后凸角(Cobb T11-L2,TLK)、腰前凸角(Cobb L1-S1,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS),比较各组站立位与平卧位参数差异.结果 从站立位到平卧位,4组TK和PT均减小(P<0.05),SS均增大(P<0.05).退行性脊柱侧凸组SVA、LL、PI和PT与其他3组差异均有统计学意义.当从站立位变换为平卧位时,退行性脊柱侧凸组LL增大(P<0.05),而特发性脊柱侧凸组和神经肌肉型脊柱侧凸组LL均减小(P<0.05);先天性脊柱侧凸组LL差异无统计学意义.结论 脊柱侧凸患者的站立位与平卧位的脊柱骨盆矢状面序列存在差异.无论站立位还是平卧位,退行性脊柱侧凸患者与特发性、先天性和神经肌肉型脊柱侧凸患者的脊柱骨盆矢状面序列明显不同.     

Heterogeneity found in the cagA gene of Helicobacter pylori from Japanese and non-Japanese isolates

We analyzed cagA genes from Helicobacter pylori strains isolated from Japanese and non-Japanese individuals for differences that could be associated with variations in virulence. The cagA genes from Japanese isolates (n = 12) and non-Japanese American Type Culture Collection (ATCC) strains (n = 4) were sequenced and compared with three published sequences. Phylogenetic analysis resolved two distinct clusters with a genetic distance of 0.1602. Similarity plot analysis of the amino acid sequences identified two highly variable regions of which each was unique to the Japanese and non-Japanese isolates, respectively. Furthermore, nucleic acid sequence analysis revealed that the multiple repeated sequences present in cagA may have been generated by homologous recombination and/or misaligned replication to promote variation in the cagA gene products. Our data indicate that alleic variations in the H. pylori genome exist between isolates from Japanese and non-Japanese subjects and that distinct H. pylori populations may be circulating in different geographical regions. Phylogenetic analysis did not reveal any association of a specific CagA type with a particular disease. Although extensive alterations were found in the cagA gene, none of the isolates contained a prematurely terminated CagA protein. The cagA gene may be advantageous to H. pylori, possibly by aiding its escape from host immune recognition by antigen modulation. Thus, this ability to elude the host immune system may contribute to an increased risk for gastric disease. Received: March 2, 2000 / Accepted: July 7, 2000     

Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis?

Background and Aim: Many technical developments of computed tomography (CT) made in recent years have improved imaging quality. However, the diagnostic efficacy of CT with coronal reconstruction for choledocholithiasis remains uncertain. This study aimed to investigate if CT with coronal reconstruction can aid in the diagnosis of choledocholithiasis. Methods: Two hundred and sixty‐six patients with clinically suspected choledocholithiasis undergoing abdominal CT before endoscopic retrograde cholangiopancreatography were recruited. Among them, 163 patients confirmed with choledocholithiasis were divided into three groups: group 1, 92 patients undergoing CT using 5‐mm thick sections with coronal reconstruction; group 2, 32 patients undergoing CT using 5‐mm thick sections without coronal reconstruction; and group 3, 39 patients undergoing CT using 7‐mm thick sections without coronal reconstruction. The diagnostic rate of CT for choledocholithiasis, the stone size and biochemical data among the three groups were analyzed. Results: The sensitivity and specificity of CT in diagnosing choledocholithiasis were 77.3% and 72.8%. There was no significant difference of CT diagnostic rate among the three groups (75.0%, 81.2% and 79.5%, respectively). The diameter of common bile duct (CBD), size of CBD stones and white cell count showed significant differences between CT true‐positive and false‐negative cases in group 1 patients. The CT diagnostic rate was significantly lower in patients with choledocholithiasis of less than 5 mm than in patients with choledocholithiasis of 5 mm or more (56.5% vs 81.2%). Conclusion: The coronal reconstruction of CT imaging did not increase its diagnostic efficacy on choledocholithiasis. The stone size affects the diagnostic rate of abdominal CT for detecting choledocholithiasis.