Extremely severe pancytopenia induced by low dosage of azathioprine in systemic lupus erythematosus patients is rare. A 40-year-old Chinese female was diagnosed with systemic lupus erythematosus. She suffered worse erythema, oral ulceration, raised erythrocyte sedimentation rate and high anti-dsDNA in August 2013. Then she was initiated on oral azathioprine 50mg/d and extremely severe pancytopenia was seen in September 2013. She was recovered by a series of treatments. Regular monitoring of blood counts is highly recommended to reduce the possible serious myelosuppression induced by azathioprine.

AIM: Anterior cervical discectomy and Cage bone graft fusion followed by steel plate internal fixation can decompress the vertebral canal and then spinal cord in patients with multilevel cervical spondylotic myelopathy. Complete decompression is very important for such patients. This study is to investigate the effect of this technique on reconstruction of spinal function.METHODS:①Thirty-eight inpatients with multilevel cervical spondylotic myelopathy admitted to Department of Spine Surgery, Tianjin Hospital between April 2003 and February 2006 were involved in this study. The involved patients, 35 male and 3 female, were aged 43-72 years, with disease course of 0.5 to 5 years. Informed consents of therapeutic regimen were obtained from all the patients.②All the patients underwent anterior cervical discectomy and cage placement operation. The patients with destabilized combination underwent titanium-plate fixation, and those with stabilized combination underwent cage implantation alone. The cage used in the experiment was made of tetragonal polyether ether ketone (Intromed Company), and titatium-plate was Zephir plate (sofarmor Danek Company). The elastic modulus of tetragonal polyether ether ketone Cage was similar to bone tissue and could allow X-ray pass through, which was easy for postoperative fusion of implanted bone. The outer design of Cage bone graft with certain angle could allow cervical physiological antecurvature well recover; Surface radian was the same as end plate, and good fitness contributed to the good fusion rate of bone graft; The sawtooth antiskid design on the surface provided good stability immediately after implantation; Elastic modulus was between os integumentale and cancellous bone that made stress-shielding and subsidence of fusion cage reduced, and had good anticausticity and biocompatibility. ③ The clinical results were evaluated with Japanese Orthopaedic. Association (JOA) scoring system before, 2,8 and 24 weeks after operation: upper limb motor function (4 points), lower limb motor function (4 points), sensation (6 points) and bladder function (3 points). Higher scores indicated better function. Postoperatively, body examination and X-ray and MRI scanning of anteroposterior cervical vertebra were performed.RESULTS: Thirty-eight patients with multilevel cervical spondylotic myelopathy participated in the final analysis. Within postoperative several days, nervous symptoms improved obviously, muscle strength of lower limb was increased, limbs were more flexible after operation than before operation, and paresthesia of two upper limbs recovered in 38 patients. JOA was a score of (9.25±1.85) before operation, and it was (12.4±2.08) at postoperative 2 weeks, (13.2±2.07) at postoperative 8 weeks and (13.8±1.67) at postoperative 24 weeks.CONCLUSION: Multilevel discectomy and Cage implantation obviously improve sensorimotor function and lessen symptoms of patients with multilevel cervical spondylotic myelopathy.

Objective To measure the vertebral rotational centers in sagittal and transverse plane. These data may be quite valuable for the design of artificial disc. Methods Ten healthy volunteers of 40-60 years old were recruited under IRB approval and informed consent. Three-dimension lumbar spine models of L_2, L_3 and L_4 were reconstructed from MR scans. Spine motions were then reproduced using combined dual fluoroscopic imaging system (DFIS) and MR scan technique during flexion-extension and left-right twisting of the body. Based on the geometrical features of the vertebrae, ranges of motion (ROM) of 3 representative lo-cations were measured from anterior to posterior, the vertebral body center, the spinal cord canal center and the spinous process tip. Rotational centers of the vertebral segments were then located by calculating the point of zero ROM. Results Motion patterns: The ROMs of L_2 with respect to L_3 (L_(2,3)) and L_(3,4) increased pro-portionally from anterior to posterior locations. During flexion-extension motion, the vertebral body center moved within a range of 0.6 mm, while the spinous process tip moved within 7.5 mm in the sagittal plane. During left-right twisting, the vertebral body center moved within 1.0 mm, while the tip moved within 1.6 mm in the transverse plane. No statistical differences were found in the ROMs between L_(2,3) and L_(3,4). Rotational centers: the rotational centers of flexion-extension in sagittal plane for both L_(2,3) and L_(3,4) segments were located at posterior one-third of the vertebral body. The rotational centers of both L_(2,3) and L_(3,4) segments were located approximately 30 mm anterior to the front edge of the vertebral body. Conclusion The anterior portion of the vertebrae was found to have smaller ROM than the posterior portion. The vertebra rotates with the center of rotation located at approximately the posterior one-third of the vertebral body in sagittal plane. However, the vertebra rotates in transverse plane with respect to a point about 30 mm in front of the vertebra. The data indicated that the different portions of the vertebra have distinct motion characters during different motions.

Objective To investigate the progression of idiopathic epiretinal macular membrane(IEMM) and compare the correlation factors of contrast sensitivity function (CSF) such as visual acuity(VA) and central macular thickness. Design Prospective, case-controlled study. Participants 80 normal people (80 eyes) were divided into three groups: old-aged group (60-80 years old, of 26 eyes), middle-aged group (40-59 years old, of 30 eyes) and young-aged group (

Objective To determine the three dimensional motion data of each segment of cervical vertebrae and analyze the characteristics of the intervertebral coupled motion during cervical axial rotation under physiological weight bearing. Methods A total of 16 healthy volunteers (ranging from 22 to 29, median age, 23 years) were recruited to our study. Any cervical spine disorder history, pain or other discomfort and malformations were excluded so as to avoid abnormal neck motion. These subjects underwent CT scans of their cervical segments in a supine position, and 3D models of C1-C7 were constructed. Next, each subject was asked to sit up straight and was positioned in the following sequence:maximal left and right twisting, while double oblique images by DFIS were taken simultaneously at each of the positions. Then, the CT models were matched to the osseous outlines of the images from the two oblique views to quantify the position of cervical vertebraes in 3D at each position. Through local coordinate systems at the center of vertebral bodies, changes of position and angle of each cephalad vertebrae relative to the cauddal one were calculated before and after the axial rotation. Results (1) In the axial rotation of the cervical spine, the contribution of C1/2 accounted for the most of the total cervical rotation range. For the lower levels, axial rotation was found to be maximal at C3/4 and C5/6, minimal at C2/3. (2) In cervical axial motion, C1/2 demonstrated a coupled lateral bending opposite to the axial rotation direction, while each segment of C2-7 demonstrated coupled lateral bending towards the same side of the axial rotation. Among these segments the lateral bending angle of C2/3 was smaller than angles of C3/4, C4/5 and C5/6. Conclusion This study investigated the cervical coupling behavior using the noninvasive 2D-3D matching technique and obtained the motion data at each cervical spinal segment. These findings will help to improve the understanding on physiological cervical spine movement and potential biomechanical mechanism and treatment of cervical spondylosis. Also our data may provide useful reference for the prosthesis design.

BACKGROUND:Epidemiologic reports have indicated that excessive weight-bearing exercise is one of important risk factors for lumbar degeneration, but the effects of weight-bearing activity on normal lumbar motion pattern are stil not clear. OBJECTIVE:To measure the changing characteristics and rules of position at the center of rotation of the lower lumbar spine during a weight-lifting activity of normal person. METHODS: Fourteen asymptomatic subjects with a mean age of (25±5) years were recruited for this study. The L4-5 and L5-S1 segments of each subject were CT-scanned to construct 3D models using dual X-ray imaging system and spiral CT examination combined technology in the aid of computer software. The physiological load and lumbar spinal 3D motion under the loading condition were reproduced when matching the flexion, neutrality and extension in the dual X-ray imaging system and on dual oblique lumbar X-ray image. Coordinate systems were established at the vertebral body of L4-S1 to obtain the center of rotation during flexion-to-neutral, neutral-to-extension and the ful flexion-extension motion. RESULTS AND CONCLUSION: (1) Under physiological load, the center of rotation of L4-5 of normal person was located about 1.0 mm anterior to the central axis of the vertebral body, and the center of rotation of L5-S1 was located about 0.7 mm anterior to the central axis of the vertebral body. (2) With weight loading, the center of rotation of both two segments shifted backward about 0.5 mm. There was no statistical difference between these two loading conditions. (3) When the center of rotation in flexion and extension was calculated respectively, the moving range of the center of rotation at both L4-5and L5-S1 became larger due to taking loads of 10 kg (P < 0.05). In flexion, the center of rotation at L5-S1 significantly shifted forward during a weight-lifting activity (P < 0.05). (4) These results confirm that compared with non-weight-bearing condition, the trajectory of the center of rotation was found to be increased when taking loads, especialy during the flexion-to-neutral motion.

Related literature and studies concerning the kinematics in patients after cervical arthrodesis have extensive?ly reviewed and comprehensively analyzed in 4 terms of changes in adjacent segment range of motion, motion segment per?cent contributions, motion pattern of cervical facet joints, and deviated center of rotation at adjacent segments. These report?ed researches of in-vivo kinematics after cervical arthrodesis are almost on the sagittal plane. Few data have been reported on the 6DOF kinematics under physiological loading conditions. Whether adjacent segment pathology caused by hypermobili?ty remains controversial. Long-term follow-up of large sample randomized controlled studies and obtaining the accurate 6DOF kinematics are the best way to resolve controversy.

Objective To measure the range of motion (ROM) of the lumbar pedicle screw entrance point (LPSEP) in vivo during unrestricted motion under physiological weight bearing.Methods Eleven healthy volunteers aged 45-60 years underwent MRI scans in a supine position.Three-dimensional (3D) models of L2-5 were constructed.Next,each volunteer was asked to stand and was positioned in the following sequence:standing,45° flexion,maximal extension,maximal left-right twisting,while two orthogonal fluoroscopic images were taken simultaneously at each position.The MRI models were matched to the osseous outlines of the images from the two orthogonal views to determine the position of the vertebrae in 3D at each position.Coordinate systems were established to study the ROM of the LPSEP.Results The predominant translations were along anteroposterior and craniocaudal axis from supine to standing position (average,2.44mm and 2.35 mm).Rotation of the LPSEP occurred mainly around the mediolateral axis(average,3.91 °).During flexion-extension movements of the trunk,the predominant translation were along anteroposterior and craniocaudal axis and rotation were around mediolateral axis.During lateral bending and twisting,ROM of LPSEP did not rotate or translate in one dominant direction.Instead,the resulting motion represented a combination of rotation and translation in different directions.There was no significantly difference in translation and rotation between the three axis in L4,5segment (P＞0.05).Conclusion The kinematic behaviors of the LPSEP of the upper lumbar spine (L2,3 and L3,4) are similar which are different from that of the lower lumbar spine (L4,5).

Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with or without ossification of ligament flavum were surgically treated,including 22 males and 9 females,with a mean age of 54 years(range,24 to 71 years).According to Anand and Regan clinical classification,there was type 2 for 1 case,grade 3a for 2,grade 3b for 3,grade 4 for 6,and grade 5 for 19.The neurological status was Frankel B for 2 cases,C for 6,D for 11,and E for 12.Anterior surgeries were performed for 18 patients without ossification of ligament flavum.Anterior decompression was performed through the resection of posterior part of vertebral body,or subtotal resection of vertebral body,followed by strut graft and internal fixation.Posterior surgeries were performed for 13 patients with disc herniation and ossification of ligament flavum.The resection of hemi-articular process and total laminectomy was performed.Results The complications of 18 patients with anterior surgery included laceration of dura mater in 1 case,nerve root sleeve injury in 1 case,intercostal neuralgia in 3 cases,atelectasis in 1 case,and femoroiliac numbness in 2 cases.The complications of 13 patients with posterior surgery included intra-canal hematoma in 1 cases,leakage of cerebrospinal fluid in 2 cases,infection of incision in 1 cases,and pneumonia in 1 case.The patients were followed for 18 months(range,6 to 48 months).At final follow-up,the neurological status and local symptom improved in all patients,with Frankel C for 3 cases,D for 7,and E for 21;and Anand and Regan type 1 for 2 cases,2 for 1,3a for 1,4 for 2,5 for 10 and no symptom for 15.Conclusion For thoracic and thoracolumbar disc herniation,anterior surgery is suitable for patients mainly suffered anterior cord compression.Resection of posterior part of vertebral body or subtotal resection of vertebral body is often needed for sufficient decompression.Posterior surgery is suitable for patients with anterior and posterior cord compression due to ossification of ligament flavum,and the decompression can be obtained by resection of hemi-articular process and total laminectomy.

Objective To investigate the inhibitory effect of octreotide on transforming growth factor-alpha (TGF-?)-induced cell proliferation of human hepatocellular carcinoma cells and its possible mechanism. Methods The effect of octreotide on TGF-?-induced cell proliferation of the liver cancer cells (LCC) was evaluated by immunohistochemistry method. The effect of octreotide on TGF-? secretion and epidermal growth factor receptor(EGFR) expression in the cells was determined by reverse-transcriptase polymerase chain reaction(RT-PCR). The effect of octreotide on extracellular signal-regulated protein kinase (ERK) expression in the cells was measured by Western-blot and immunohistochemistry method. Results The TGF-?-induced expressions of proliferating cell nuclear antigen (PCNA) in nucleus were obviously increased by TGF-?. TGF-?mRNA index of hepatocellular carcinoma cells was decreased by octreotide. Octreotide inhibited significantly the expressions of EGFR mRNA induced by TGF-?. Octreotide inhibited significantly the expressions of ERK protein induced by TGF-?. There was intense staining in the nucleus of the cells by TGF-? and weak staining in the nucleus of the cells treated simultaneously by octreotide and TGF-?.Conclusions Octreotide can inhibit the secretion of TGF-?, the expression of EGFR, and the signal transduction of EGFR of LCC, and consequently exerts an inhibitory effect on TGF-?-induced hepatocellular carcinoma cells proliferation.