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1.  High Glucose Accelerates Autophagy in Adult Rat Intervertebral Disc Cells 
Asian Spine Journal  2014;8(5):543-548.
Study Design
In vitro cell culture.
Purpose
The purpose of this study was to investigate the effect of high glucose on autophagy in adult rat intervertebral disc cells.
Overview of Literature
Diabetes mellitus is considered to be an important etiologic factor for intervertebral disc degeneration, resulting in degenerative disc diseases. A glucose-mediated increase of autophagy is a major causative factor for the development of diseases associated with diabetes mellitus. However, no information is available for the effect of high glucose on autophagy in adult intervertebral disc cells.
Methods
Nucleus pulposus and annulus fibrosus cells were isolated from 24-week-old adult rats, cultured and placed in either 10% fetal bovine serum (normal control) or 10% fetal bovine serum plus two different high glucose concentrations (0.1 M and 0.2 M) (experimental conditions) for one and three days, respectively. The expressions of autophagy markers, such as beclin-1, light chain 3-I (LC3-I) and LC3-II, autophagy-related gene (Atg) 3, 5, 7 and 12, were identified and quantified.
Results
Two high glucoses significantly increased the expressions of beclin-1, LC3-II, Atg3, 5, 7, and 12 in adult rat nucleus pulposus and annulus fibrosus cells in a dose- and time-dependent manner. The ratio of LC3-II/LC3-I expression was also increased in a dose-respectively time-dependent manner.
Conclusions
The results suggest that autophagy of adult nucleus pulposus and annulus fibrosus cells might be a potential mechanism for the intervertebral disc degeneration in adult patients with diabetes mellitus. Thus, the prevention of autophagy in adult intervertebral disc cells might be considered as a novel therapeutic target to prevent or to delay the intervertebral disc degeneration in adult patients with diabetes mellitus.
doi:10.4184/asj.2014.8.5.543
PMCID: PMC4206802  PMID: 25346805
Diabetes mellitus; High glucose; Autophagy; Adult intervertebral disc cells; Intervertebral disc degeneration
2.  Diagnostic Usefulness of White Blood Cell and Absolute Neutrophil Count for Postoperative Infection after Anterior Cervical Discectomy and Fusion Using Allograft and Demineralized Bone Matrix 
Asian Spine Journal  2013;7(3):173-177.
Study Design
Prospective study.
Purpose
We investigated normative temporal levels of white blood cell (WBC) and absolute neutrophil count (ANC) in uncomplicated anterior cervical discectomy and fusion (ACDF) using allograft and demineralized bone matrix (DBM).
Overview of Literature
No study has investigated the diagnostic usefulness of WBC and ANC for postoperative infection following ACDF using allograft and DBM.
Methods
Blood samples of 85 patients, who underwent one or two-level ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, fourteenth, thirtieth, and ninetieth postoperative days. No infection was found in all patients for at least one year follow-up period.
Results
Mean WBC and ANC values increased significantly and reached peak levels on the first postoperative day. The peaked levels rapidly decreased but still remained elevated above the preoperative levels on the third postoperative day. The levels returned close to the preoperative levels on the fifth postoperative day. The mean WBC and ANC values did not get out of their normal reference ranges throughout the follow-up periods. One-level and two-level ACDF exhibited a similar course of postoperative changes in WBC and ANC values and no significant difference in mean levels of WBC and ANC throughout the follow-up periods.
Conclusions
Uncomplicated ACDF using allograft and DBM showed normal values of WBC and ANC during the early postoperative period. Therefore, significant abnormal values of WBC and ANC at an early postoperative period suggest the possibility of the development of acute postoperative infection after ACDF using allograft and DBM.
doi:10.4184/asj.2013.7.3.173
PMCID: PMC3779767  PMID: 24066211
White blood cell; Absolute neutrophil count; Anterior cervical discectomy and fusion; Allograft; Demineralized bone matrix
3.  Sacralization of L5 in Radiological Studies of Degenerative Spondylolisthesis at L4-L5 
Asian Spine Journal  2008;2(1):34-37.
Study Design
Radiological analysis.
Purpose
To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5.
Overview of Literature
Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5.
Methods
Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5).
Results
There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02±6.21 versus 16.65±4.87, p=0.809), facet orientation (54.99±12.18 versus 56.23±4.35, p=0.642), facet osteoarthritis (3.43±0.59 versus 3.53±0.37, p=0.527), or disc degeneration (4.50±0.51 versus 4.35±0.61, p=0.340) between the two groups.
Conclusions
Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5.
doi:10.4184/asj.2008.2.1.34
PMCID: PMC2857485  PMID: 20411140
Degenerative spondylolisthesis; Sacralization; Radiological findings
4.  The Utility of Somatosensory Evoked Potential Monitoring During Cervical Spine Surgery: How Often Does It Prompt Intervention and Affect Outcome? 
Asian Spine Journal  2007;1(1):43-47.
Study Design
Retrospective review of the results of somatosensory evoked potentials (SSEP) performed in cervical spine surgery.
Purpose
To evaluate the utility of spinal cord monitoring during cervical spine surgery in a single surgeon's practice, based on how often it prompted an intraoperative intervention.
Overview of Literature
Intraoperative monitoring during cervical spine surgery is not a universally accepted standard of care. This is due in part to the paucity of literature regarding the impact of monitoring on patient management or outcome.
Methods
SSEP for tibial, median, and ulnar nerves were monitored in 809 consecutive cervical spine operations performed by a single surgeon. The average patient age was 52 years (range, 2 to 88 years), with 472 males and 339 females. Cases were screened for significant degradation or loss of SSEP data. Specific attention was paid to 1) what interventions were performed in response to the SSEP degradation with subsequent improvement, and 2) whether SSEP changes corresponded with postoperative neurological deficits.
Results
Seventeen of 809 patients (2.1%) had SSEP degradation that met warning criteria and therefore prompted intervention. Release of shoulder tape (8) or traction (4) most often resulted in SSEP improvement. Failure of SSEP data to return to within acceptable limits of baseline was associated with neurological deficit (p=0.04). Two patients awoke with new postoperative neurological deficits, which resolved in 6 hours and 2 months respectively. Patients with ossification of the posterior longitudinal ligament (OPLL) were at seven-fold greater risk of intraoperative SSEP degradation.
Conclusions
SSEP monitoring in this surgical population proved sensitive to perioperative factors which may increase the risk of postoperative neurologic deficit, and probably prevented neurological deficits in 15 of 809 patients (1.9%). Improvement in data following intervention appears to correlate well with unchanged neurologic status. Experience with intraoperative monitoring in this patient series has led to incorporation of these techniques as a standard of care in cervical spine surgeries performed by this surgeon.
doi:10.4184/asj.2007.1.1.43
PMCID: PMC2857496  PMID: 20411152
Somatosensory evoked potentials; Cervical spine surgery; Postoperative neurological deficits
5.  Serum Levels of TGF-β1, TIMP-1 and TIMP-2 in Patients with Lumbar Spinal Stenosis and Disc Herniation 
Asian Spine Journal  2007;1(1):8-11.
Study Design
The serum levels of transforming growth factor-beta 1 (TGF-β1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and TIMP-2 were measured by enzyme-linked immunosorbent assay.
Purpose
To compare the serum levels of TGF-β1, TIMP-1 and TIMP-2 between patients with lumbar spinal stenosis and disc herniation.
Overview of Literature
It has been reported that increased concentrations of TGF-β1, TIMP-1 and TIMP-2 in the ligamentum flavum might be a possible pathogenesis for ligamentum flavum hypertrophy in spinal stenosis. However, it is not determined whether this phenomenon in spinal stenosis is a local or systemic problem.
Methods
The concentrations of TGF-β1, TIMP-1 and TIMP-2 were quantitatively analyzed by ELISA in the ligamentum flavum and serum of patients with lumbar spinal stenosis (n=16) and disc herniation (n=16). The thickness of ligamentum flavum was measured on axial T1-weigted magnetic resonance image. The biochemical and radiological results were compared for the two conditions.
Results
The thickness of the ligamentum flavum was larger in patients with spinal stenosis compared with that with disc herniation (p=0.001). The mean concentrations of TGF-β1, TIMP-1, and TIMP-2 in the ligamentum flavum were significantly higher in patients with spinal stenosis than those with disc herniation (all, p < 0.05). However, the difference in serum levels of TGF-β1 (p=0.464), TIMP-1 (p=0.146) and TIMP-2 (p=0.794) was not significant between the lumbar spinal stenosis and disc herniation patients.
Conclusions
Despite increased levels of TGF-β1, TIMP-1, and TIMP-2 in the ligamentum flavum of spinal stenosis patients compared to disc herniation patients, the serum levels of TGF-β1, TIMP-1 and TIMP-2 were very similar in both groups. These results indicate that the role of TGF-β1, TIMP-1 and TIMP-2 on hypertrophy of the ligamentum flavum in spinal stenosis patients is a local phenomenon, not systemic.
doi:10.4184/asj.2007.1.1.8
PMCID: PMC2857497  PMID: 20411146
Spinal stenosis; Hypertrophy of ligamentum flavum; TGF-β1; TIMPs; Local phenomenon
6.  Cervical Myelopathy Secondary to Atlas Hypoplasia - Reports of 3 Adult Cases - 
Asian Spine Journal  2007;1(1):48-52.
There have been paucity of reports on atlas hypoplasia, and as a result this condition is not clearly defined, nor well understood. The authors reported three cases of atlas hypoplasia that were found in adults who presented with myelopathic symptoms. On radiographic examination, it was found that the anterior-posterior diameter of the atlas was remarkably narrower in all three cases in comparison with normal persons. The MRI in all three cases also revealed intramedullary high signal lesions at the levels where severe spinal cord compression was present. This led to our diagnosis of atlas hypoplasia causing myelopathy.
doi:10.4184/asj.2007.1.1.48
PMCID: PMC2857503  PMID: 20411153
Atlas hypoplasia; Cervical myelopathy; Cervical spinal stenosis

Results 1-6 (6)