This is a case example on the concept of personalized precision medicine in a surgical setting and demonstrates how 3D-printed, patient-specific implants may bring individualized solutions to rare problems wherein restoration of the specific anatomy of each patient is a key prognostic factor.

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On the basis of current evidence, TEP as a modified and more complex laparoscopic procedure than TAPP, did not lead to a significant difference in aspects of clinical outcomes and complications. Therefore, we firstly recommended TAPP for laparoscopic hernia repair, especially for nonexpert surgeons. Further choices would be made according to the specific clinical characteristics of patients and surgeons.

Disc bulging increases with the severity of disc degeneration. Grade I discs demonstrate the expected sagittal migration in response to postural load. However, more degenerative discs behave less predictably, and spine extension may result in significant posterior disc bulging. Degenerative changes in the intervertebral disc significantly affect the kinematic patterns under postural load in vivo. kMRI is a useful tool to quantify the kinematic behavior of degenerative intervertertebral discs.

BACKGROUND AND PURPOSEIL-6 plays crucial roles in cardiac hypertrophy, cardiac fibrosis and heart failure. Activation of b-adrenoceptors induced IL-6 production in neonatal mouse cardiac fibroblasts (NMCFs) through a Gs/adenylate cyclase/cAMP/p38 MAPK pathway but independent of PKA. However, how cAMP activates p38 MAPK is still not defined. In this study, we have assessed the role of the exchange protein directly activated by cAMP (Epac) and PKCd in p38 MAPK activation and IL-6 production by stimulated by the b-adrenoceptor agonist isoprenaline in NMCFs. EXPERIMENTAL APPROACHThe IL-6 concentration in cell culture supernatants was measured by ELISA. The levels of phosphorylated and total p38 MAPK and PKCd were determined by Western blot analysis. The translocation of PKCd was determined by immunoblotting the soluble and particulate fractions. Expression of Epac1 or PKCd was knocked down by the corresponding, adenovirus-mediated, small hairpin RNA (shRNA). RESULTSIn NMCFs, activation of b-adrenoceptors enhanced PKCd phosphorylation and translocation. Furthermore, knock-down of the PKCd isoform using an adenovirus-mediated shRNA markedly down-regulated IL-6 induction by NMCFs stimulated with isoprenaline. Moreover, knock-down of Epac1 confirmed that Epac1 was upstream of PKCd in IL-6 production. Additionally, both Epac1 and PKCd mediated the p38 MAPK activation induced by isoprenaline. CONCLUSIONS AND IMPLICATIONSb-Adrenoceptor agonists activate a cAMP/Epac/PKCd/p38 MAPK pathway to produce IL-6 in NMCFs. This study identifies Epac as the link between cAMP and p38 MAPK signalling pathways and demonstrates that PKCd can function as a novel downstream effector of this b-adrenoceptor/cAMP/Epac pathway. AbbreviationsNMCFs, neonatal mouse cardiac fibroblasts; PKCd, protein kinase Cd; PKI, PKA inhibitor 14-22 amide; shRNA, small hairpin RNA

The cervical alignment correlates with their global spine and pelvic curves. And lordosis is not the only presentation in asymptomatic subjects. The degenerative modification of cervical disc angles was the compensation of global spine degeneration for horizontal gaze. Cervical angles are influenced by their TK angles, occipital-C2 joint and the tilt of T1 vertebral body. The occipital-C2 joint has a compensating mechanism in all Roussouly types in cervical spondylosis.

Background and objectives To summarise our experience treating patients with spinal malignant peripheral nerve sheath tumours (MPNSTs). Methods We retrospectively reviewed the records of patients diagnosed with spinal MPNSTs who received surgical treatment from January 1998 to December 2009. Results Postoperative follow-up data were available for 14/16 patients with spinal MPNSTs (7 men, 7 women; median age = 44 years [range: 23-68 years]). Eight of 14 (57.1%) patients had primary and 6/14 (42.9%) recurrent MPNSTs. A total of 12/14 (85.7%) patients underwent total tumour resection, whereas 2/14 (14.3%) patients underwent subtotal tumour resection. Malignancies were graded low in 4 (28.6%) and high in 10 (71.1%) cases. A total of 12/14 (85.7%) patients experienced tumour recurrence and 10/14 (71.4%) patients died during the course of follow-up. The 0.5-1-, 3-, and 5-year survival rates were 64.3, 48.2, 32.1, and 21.4%, respectively. Overall survival was significantly associated with tumour malignant degree (P = 0.012).Conclusion Diagnosis of spinal MPNSTs should be made with reference to clinical, radiological, and pathological findings. Surgical resection is the best available option for treating spinal MPNST; however, postoperative prognosis is poor.