Thoracic giant cell tumor after two total en bloc spondylectomies including one emergency surgery:A case report

BACKGROUND For patients with acute paraplegia caused by spinal giant cell tumor(GCT)who require emergency decompressive surgery,there is still a lack of relevant reports on surgical options.This study is the first to present the case of an acute paraplegic patient with a thoracic spinal GCT who underwent an emergency total en bloc spondylectomy(TES).Despite tumor recurrence,three-level TES was repeated after denosumab therapy.CASE SUMMARY A 27-year-old female patient who underwent single-level TES in an emergency presented with sudden severe back pain and acute paraplegia due to a thoracic spinal tumor.After emergency TES,the patient's spinal cord function recovered,and permanent paralysis was avoided.The postoperative histopathological examination revealed that the excised neoplasm was a rare GCT.Unfortunately,the tumor recurred 9 months after the first surgery.After 12 months of denosumab therapy,the tumor size was reduced,and tumor calcification.To prevent recurrent tumor progression and provide a possible cure,a three-level TES was performed again.The patient returned to an active lifestyle 1 month after the second surgery,and no recurrence of GCT was found at the last follow-up.CONCLUSION This patient with acute paraplegia underwent TES twice,including once in an emergency,and achieved good therapeutic results.TES in emergency surgery is feasible and safe when conditions permit;however,it may increase the risk of tumor recurrence.

"Five steps four quadrants" modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in laparoscopic pancreaticoduodenectomy

BACKGROUND Although en bloc dissection of hepatic hilum lymph nodes has many advantages in radical tumor treatment,the feasibility and safety of this approach for laparo-scopic pancreaticoduodenectomy(LPD)require further clinical evaluation and investigation.AIM To explore the application value of the"five steps four quadrants"modularized en bloc dissection technique for accessing hepatic hilum lymph nodes in LPD patients.METHODS A total of 52 patients who underwent LPD via the"five steps four quadrants"modularized en bloc dissection technique for hepatic hilum lymph nodes from April 2021 to July 2023 in our department were analyzed retrospectively.The patients'body mass index(BMI),preoperative laboratory indices,intraoperative variables and postoperative complications were recorded.The relationships between preoperative data and intraoperative lymph node dissection time and blood loss were also analyzed.RESULTS Among the 52 patients,36 were males and 16 were females,and the average age was 62.2±11.0 years.There were 26 patients with pancreatic head cancer,16 patients with periampullary cancer,and 10 patients with distal bile duct cancer.The BMI was 22.3±3.3 kg/m²,and the median total bilirubin(TBIL)concentration was 57.7(16.0-155.7)µmol/L.All patients successfully underwent the"five steps four quadrants"modularized en bloc dissection technique without lymph node clearance-related complications such as postoperative bleeding or lymphatic leakage.Correlation analysis revealed significant associations between preoperative BMI(r=0.3581,P=0.0091),TBIL level(r=0.2988,P=0.0341),prothrombin time(r=0.3018,P=0.0297)and lymph node dissection time.Moreover,dissection time was significantly correlated with intraoperative blood loss(r=0.7744,P<0.0001).Further stratified analysis demonstrated that patients with a preoperative BMI≥21.9 kg/m²and a TIBL concentration≥57.7μmol/L had significantly longer lymph node dissection times(both P<0.05).CONCLUSION The"five steps four quadrants"modularized en bloc dissection technique for accessing the hepatic hilum lymph node is safe and feasible for LPD.This technique is expected to improve the efficiency of hepatic hilum lymph node dissection and shorten the learning curve;thus,it is worthy of further clinical promotion and application.

BLOC-3介导Rab32线粒体定位改变对肝癌细胞生长的作用研究

目的观察溶酶体相关细胞器生物发生复合体-3(biogenesis of lysosome-related organelles complex-3,BLOC-3)亚基Hps1和Hps4对肝癌细胞中Rab32线粒体定位的影响及在肝癌细胞生长中的作用。方法通过公共数据库GenDoma,String和InBio Discover分析Hps1和Hps4与Rab32的相互作用情况。体外培养人肝癌细胞系SNU-739和Hep-3B,利用脂质体转染方法分别转染Hps1和Hps4相关的siRNAs和质粒,采用免疫荧光和Western blot观察Hps1和Hps4对Rab32线粒体定位的影响,细胞划痕、克隆形成、EdU、MTS及Transwell侵袭实验检测Hps1和Hps4调控Rab32线粒体定位后肝癌细胞迁移、增殖和侵袭的变化情况。通过公共数据库UALCAN中的数据集CPTAC分析Rab32蛋白在肝癌和正常肝脏组织中的表达差异。结果数据库分析结果显示,Hps1和Hps4均可以与Rab32相互作用;与正常肝脏组织相比,Rab32蛋白在肝癌组织中的表达显著降低(P<0.001)。在肝癌细胞系SNU-739中干涉Hps1或Hps4或同时干涉Hps1和Hps4后,Rab32线粒体定位均减少(均P<0.01),细胞线粒体Rab32蛋白表达均降低(均P<0.001),细胞增殖、迁移和侵袭能力增强(均P<0.05);在肝癌细胞系Hep-3B中过表达Hps1和Hps4后,Rab32线粒体定位增多(P<0.01),细胞线粒体Rab32蛋白表达增加(P<0.001),细胞增殖、迁移和侵袭能力均受抑制(均P<0.01),而单独过表达Hps1或Hps4时无显著抑制作用(均P>0.05)。结论BLOC-3亚基Hps1和Hps4均可与Rab32相互作用并增加Rab32线粒体定位,进而抑制肝癌细胞生长。

中低位骶骨肿瘤En-bloc切除术的护理体会

目的探讨中低位骶骨肿瘤En-bloc切除术围术期的护理方法。方法我科2004年1月～2011年10月收治21例中低位骶骨肿瘤患者,均采用En-bloc切除术,术前重视心理护理、肠道准备、括约肌收缩训练;术后加强对手术切口、引流管的护理以及指导功能锻炼,尤其加强对切口感染、切口延迟愈合、尿潴留、大便失禁及脑脊液漏等并发症的观察及护理。结果21例患者均安全度过围手术期,术后4～6周下床活动;随访时间为6个月～7年,其中2例S3-5脊索瘤患者分别于术后18和24个月复发,再次手术治疗,其余患者未见复发。结论采用En-bloc切除治疗中低位骶骨肿瘤能降低肿瘤局部复发率,有效的护理干预能减少手术并发症,促进患者机体功能的恢复,缩短住院时间。

不同抛光工具对CEREC Blocs陶瓷抛光效果的比较研究

目的比较临床常用的几种玻璃陶瓷抛光工具对CEREC Blocs陶瓷的抛光效果,为临床抛光工具的选择提供依据。方法制作60个陶瓷试件,随机分为6组(n=10),进行不同的表面处理。G组:釉膏上釉;SF组:使用松风Porcelain Adjustment Kit+Cera Master组合抛光;3M组:使用3M Sof-LexTM Discs套装抛光;Tob组:使用道邦玻璃陶瓷套装抛光;EVE组:使用EVE DIAPRO套装抛光;Ivo组:使用义获嘉伟瓦登特Optra Fine?套装抛光。测量各组试件表面粗糙度值Ra、Rz并作统计分析,通过扫描电子显微镜(SEM)观测试件并对其表面形态作定性分析。结果 G、3M、SF、Ivo、EVE、Tob组的抛光后Ra值分别为(0.069±0.008)、(0.073±0.009)、(0.223±0.025)、(0.229±0.022)、(0.491±0.093)、(0.763±0.067)μm,经统计学分析,Ra值从小到大依次为G和3M组<SF和Ivo组<EVE组<Tob组,其中G组与3M组、SF组与Ivo组的差异无统计学意义(P>0.05),其余各组间差异均有统计学意义(P<0.05)。Rz值统计结果与Ra值一致。SEM观察结果与粗糙度值的统计结果一致。结论不同抛光工具对CEREC Blocs陶瓷的抛光效果不同,本实验条件下,Sof-LexTM Discs套装抛光表面最光滑,效果近似釉膏上釉。

不同表面处理对椅旁瓷块CERECBlocs贴面色彩的影响

背景:椅旁计算机辅助设计/计算机辅助制作(computer aided design/computer aided manufacture,CAD/CAM)系统制作瓷贴面方便快捷,然而贴面切削后直接黏固色彩还原不理想,常需要经过各种表面处理获得理想的色彩效果。目的:研究不同表面处理对椅旁CEREC Blocs贴面色彩的影响及其与牙齿的颜色匹配性。方法:选取离体新鲜人上颌中切牙5颗,进行牙体预备。椅旁CAD/CAM制作0.6 mm的CEREC Blocs瓷贴面试件,共25个,随机分组,对照组不做任何处理;其余4组试件分别进行抛光、上釉、抛光上釉、上釉染色处理,选择离体牙和贴面试件唇面中1/3为测量目标区域,用Shade Eye NCC电子比色仪测量试件色彩参数L*a*b*值,计算与离体牙的色差(?E),SPSS 19.0软件对数据进行统计学分析。结果与结论:1与对照组相比,上釉组、抛光上釉组、上釉染色组L*值下降(P<0.05),上釉染色组L*值最低;各组间a*、b*值比较差异无显著性意义(P>0.05);2与对照组相比,上釉组、抛光上釉组、上釉染色组色差ΔE值明显减小(P<0.05),其中上釉染色组色差最小。与对照组相比,上釉组、抛光上釉组、上釉染色组?L*值明显减小(P<0.05),上釉染色组?L*值最低。与对照组相比,仅上釉染色组?b*值明显减小(P<0.05)。各组间?a*值比较差异无显著性意义(P>0.05);3结果表明,通过上釉染色处理,椅旁CEREC Blocs贴面可取得满意的色彩效果。

地震定位程序BLOC及其变体——华北地区遥测地震台网联网论文续二

简要描述了研制并几经修改扩充的地震定位程序BLOC,并以它的最新扩展版本NC 91为例说明其使用方法,最后讨论了BLOC定位程序进一步发展的构想.

原发性骶尾部肿瘤En bloc切除疗效观察

目的探讨原发性骶尾部肿瘤En bloc切除术的疗效。方法回顾性分析我科采用后方入路En bloc切除术治疗27例原发性骶尾部肿瘤患者的疗效。结果术后病理报告示:脊索瘤17例、骨巨细胞瘤5例、软骨肉瘤3例、神经纤维肉瘤1例、神经纤维瘤1例。27例患者手术后症状均有不同程度改善,平均无瘤生存时间为33.5月。5例手术保留S1或以上神经根的患者大小便失禁伴会阴部感觉丧失,经理疗功能训练后,3例部分恢复,2例无进展;保全S2以上神经根的12例患者术后均出现膀胱及直肠功能障碍,经康复理疗和功能训练后,10例基本恢复正常,2例患者仍存在不同程度的两便障碍。10例保留S3或以上神经根的患者能保全括约肌功能。随访期间5例局部复发,1例肺部转移,其余均无瘤生存。结论En bloc切除是治疗原发性骶尾部肿瘤的有效疗法,可最大限度减少肿瘤的复发并延长患者无瘤生存时间。

基于BLOC86程序的新疆地区震源深度定位软件

介绍基于BLOC86程序的新疆地区震源深度定位软件的原理、主要功能模块和使用效果。利用该软件定位新疆测震台网地震,计算结果稳定性较好,与震中烈度结果有较好的对应关系,有效弥补了大震应急工作对震源深度参数的需求。

不同的表面处理对Sirona CEREC Blocs陶瓷表面粗糙度的影响

目的比较不同表面处理对Sirona CEREC Blocs陶瓷表面粗糙度的影响。方法按照不同的表面处理方式将试件分为7组:对照组(A)、自身上釉组(B)、釉膏上釉组(C)、2组不同松风抛光方案组(D、E),2组不同EVE抛光方案组(F、G),测量试件表面处理后的粗糙度值,体视显微镜定性分析试件表面形貌。结果各组粗糙度值依次为:A组(0.139±0.010)μm、B组(0.129±0.006)μm、C组(0.090±0.029)μm、D组(0.145±0.009)μm、E组(0.101±0.007)μm、F组(0.172±0.016)μm、G组(0.278±0.027)μm;A组与C组、D组与E组、D组与G组、E组与F组、E组与G组及F组与G组之间均有显著性差异(P<0.05),A组与B组、C组与E组及D组与F组之间均无统计学差异(P>0.05);体视显微镜分析结果与粗糙度值分析结果一致。结论釉膏上釉较其它表明处理方式效果好,不同的抛光工具对Sirona CEREC Blocs陶瓷的抛光效果不同,其中松风抛光工具抛光效果堪比釉膏上釉的效果。

Risk factors for local recurrence after en bloc endoscopic submucosal dissection for early gastric cancer

AIM: To investigate factors related to recurrence following en bloc resection using endoscopic submucosal dissection(ESD) in patients with early gastric cancer(EGC). METHODS: A total of 1121 patients(1215 lesions) who had undergone ESD for gastric neoplasia between April 2003 and May 2010 were retrospectively reviewed. Data from 401 patients(415 lesions) were analyzed, following the exclusion of those who underwent piecemeal resection, with deep resection margin invasion or lateral margin infiltration, and diagnosed with benign lesions. RESULTS: Local recurrence after en bloc ESD was found in 36 cases(8.7%). Unclear resection margins, long procedure times, and narrow safety margins were identified as risk factors for recurrence. Lesions located in the upper third of the stomach showed a higher rate of recurrence than those located in the lower third of the stomach(OR = 2.9, P = 0.03). The probability of no recurrence for up to 24 mo was 79.9% in those with a safety resection margin ≤ 1 mm and 89.5% in those with a margin > 1 mm(log-rank test, P = 0.03). CONCLUSION: Even in cases in which en bloc ESD is performed for EGC, local recurrence still occurs. To reduce local recurrences, more careful assessment will be needed prior to the implementation of ESD in casesin which the tumor is located in the upper third of the stomach. In addition, clear identification of tumor boundaries as well as the securing of sufficient safety resection margins will be important.

不同基底对Sirona CEREC Blocs可切削陶瓷断裂强度的影响

目的:研究不同材料及形状的基底代型对Sirona CEREC Blocs可切削陶瓷断裂强度的影响。方法:选择人第三磨牙12颗,随机分为2组。第1组垂直于牙长轴去除牙合面釉质,第2组制成牙本质片。用Filtek Z250光固化复合树脂分别复制第一组和第二组试件各6颗。用MultilinkRSpeed树脂粘接剂将瓷片粘接于所有基底代型试件上,粘接1h后储存于37℃蒸馏水中24h,然后测试瓷片断裂强度值,并在光学显微镜下观察粘接破坏情况。结果:树脂牙代型做基底时,瓷片的断裂载荷最高,与离体牙组差异有统计学意义(P<0.05),但与树脂片组间差异无统计学意义(P>0.05)。离体牙组的瓷片断裂载荷高于牙本质片组,差异有统计学意义(P<0.05)。结论:不同材料及形状的基底代型对全瓷材料的强度均有影响,光固化复合树脂做基底时无论是牙状还是片状,瓷片的断裂载荷都高于对应的离体牙组。

Endoscopic en bloc resection of an exophytic gastrointestinal stromal tumor with suction excavation technique

Here, we report the first successful endoscopic resection of an exophytic gastrointestinal stromal tumor(GIST) using a novel perforation-free suction excavation technique. A 49-year-old woman presented for further management of a gastric subepithelial tumor on the lesser curvature of the lower body, originally detected via routine upper gastrointestinal endoscopy. Abdominal computed tomography and endoscopic ultrasound showed a 4-cm extraluminally protruding mass originating from the muscularis propria layer. The patient firmly refused surgical resection owing to potential cardiac problems, and informed consent was obtained for endoscopic removal. Careful dissection and suction of the tumor was repeated until successful extraction was achieved without serosal injury. We named this procedure the suction excavation technique. The tumor's dimensions were 3.5 cm × 2.8 cm × 2.5 cm. The tumor was positive for C-KIT and CD34 by immunohistochemical staining. The mitotic count was 6/50 high-power fields. The patient was followed for 5 years without tumor recurrence. This case demonstrated the use of endoscopic resection of an exophytic GIST using the suction excavation technique as a potential therapy without surgical resection.

Single vs dual(en bloc) kidney transplants from donors ≤ 5 years of age: A single center experience

AIM: To compare outcomes between single and dual en bloc(EB) kidney transplants(KT) from small pediatric donors. METHODS: Monocentric nonprospective review of KTs from pediatric donors ≤ 5 years of age. Dual EB KT was defined as keeping both donor kidneys attached tothe inferior vena cava and aorta, which were then used as venous and arterial conduits for the subsequent transplant into a single recipient. Donor age was less useful than either donor weight or kidney size in decision-making for kidney utilization as kidneys from donors < 8 kg or kidneys < 6 cm in length were not transplanted. Post-transplant management strategies were standardized in all patients.RESULTS: From 2002-2015, 59 KTs were performed including 34 dual EB and 25 single KTs. Mean age of donors(17 mo vs 38 mo, P < 0.001), mean weight(11.0 kg vs 17.4 kg, P = 0.046) and male donors(50% vs 84%, P = 0.01) were lower in the dual EB compared to the single KT group, respectively. Mean cold ischemia time(21 h), kidney donor profile index(KDPI; 73% vs 62%) and levels of serum creatinine(SCr, 0.37 mg/d L vs 0.49 mg/d L, all P = NS) were comparable in the dual EB and single KT groups, respectively. Actuarial graft and patient survival rates at 5-years follow-up were comparable. There was one case of thrombosis resulting in graft loss in each group. Delayed graft function incidence(12% dual EB vs 20% single KT, P = NS) was slightly lower in dual EB KT recipients. Initial duration of hospital stay(mean 5.4 d vs 5.6 d) and the one-year incidences of acute rejection(6% vs 16%), operative complications(3% vs 4%), and major infection were comparable in the dual EB and single KT groups, respectively(all P = NS). Mean 12 mo SCr and abbreviated MDRD levels were 1.17 mg/d L vs 1.35 mg/d L and 72.5 m L/min per 1.73 m^2 vs 60.5 m L/min per 1.73 m^2(both P = NS) in the dual EB and single KT groups, respectively. CONCLUSION: By transplanting kidneys from young pediatric donors into adult recipients, one can effectively expand the limited donor pool and achieve excellent medium-term outcomes.

Novel technique for endoscopic en bloc resection(EMR+)-Evaluation in a porcine model

BACKGROUND Endoscopic en bloc resection of larger polyps is relevant because risk of advanced neoplasia or malignancy correlates with tumor size. Recurrence rates after piecemeal endoscopic mucosal resection (EMR) are high and endoscopic submucosal dissection (ESD) is associated with higher complication rates in the western world. AIM To develop a modified endoscopic en bloc resection technique using an external additional working channel and novel agent for submucosal injection. METHODS EMR+ was considered as modified grasp and snare technique. For simultaneous use of a grasping and cutting device a novel additional working channel was used (AWC■, Ovesco Endoscopy, Tübingen, Germany). AWC■ is installed on the outer surface of the endoscope, covered with a plastic sleeve and designed for single use. For submucosal injection a new agent consisting of poloxamers was used (LiftUp■, Ovesco Endoscopy, Tübingen, Germany). The agent is liquid at room temperature and forms a stable and permanent gel cushion after injection. Safety of LiftUp? has been shown in a pre-clinical study in domestic pigs. LiftUp■ is commercially not yet available but approval is expected in early 2019. EMR+ was first developed ex vivo (explanted pig stomach) and subsequently evaluated in vivo (stomach, porcine model, 3 domestic pigs). Main outcome measurements were: Procedure time, macroscopic en bloc resection and adverse events. RESULTS Concept of EMR+ was first developed ex vivo (explanted pig stomach). Ex vivo, 22 resections were performed after technique was established. Median procedure time (measured from begin of injection to extraction of resection specimen) was 7 min (range 5-11, SD 1.68) and median size of resection specimens was 30 mm × 26 mm × 11 mm ex vivo. Subsequently 13 resections were performed in vivo (stomach, porcine model, 3 domestic pigs). In vivo, median procedure time (measured from begin of injection to extraction of resection specimen) was 5 min (range 3-12, SD 2.72) and median size of resection specimens was 35 mm × 35 mm × 11 mm. In vivo, resection was macroscopic complete in 92.3%, major adverse events were not observed. In one case (7.7%) minor periprocedural bleeding was observed and managed by coagulation. CONCLUSION EMR+ appeared to be effective and safe and was easy and fast to perform in the porcine model. EMR+ needs to be further evaluated clinically in comparative trials.

Cell membranes composition is defined in ER and their restitution proceed by en bloc fusion of ER generated transport vesicles

The synthesis of endoplasmic reticulum (ER)-derived transport vesicles is dictated by the contents and derivation of the cellular cytosol. The ER transport vesicles synthesized in the presence of gastric epithelial cells cytosol are destined for en bloc fusion with apical epithelial membrane, whereas those generated in hepa-tocytes-derived cytosol are destined for en bloc fusion with basolateral membrane. Moreover, during assembly of the dominant fraction of the apical or basolateral transport vesicles, a sub-stantial fraction of the vesicles is produced that fuses with endosomes, and the vesicles with still unknown destination that remain in cytosol. The process of ER vesicles synthesis is blocked by RNase treatment, whereas Golgi vesicles as-sembly is not affected. The experiments indicate that transport vesicles’ membrane composition and fidelity of its construction is defined in ER. The process involves synchronous membrane lipid synthesis, cotranslational intercalation of integral membrane proteins and containment of the vesicular cargo.

Elaboration and costs multi-nutritional blocs with goatee leaves (<i>Pithecellobium acatlense</i>) consumed by goats in the Mixteca Poblana, Mexico

The elaboration of multinutritional blocs (MB) is an alternative that allows supplement energy, protein, vitamins and minerals, and additionally, it can be administered and take natural resources as protein banks, mainly in the dry season, raising their cost and the concentrates decreasing profitability to producers. An aid is green or dried foliage of the tree-shrub of the Mixteca Poblana that drop their leaves to the ground (dry hay) in the dry season, thus becomes valuable forage consumed by goats, being great for your protein content and low cost in diets of small ruminants in silvopastoral production systems, at the dwindle the foliage of woody perennials in a time of the year. The aim of this study was to develop and meet production costs multinutrient blocks with goatee sheets (Pithecellobium acatlense) consumed by goats in the Mixteca Puebla. The study was done in the community of Tehuaxtla, belonging to the municipality Piaxtla in the Mixteca Poblana, which shows a secondary vegetation (arboreal, shrubby) that is consumed by goats in that region. 8 multinutritional blocks were used with Pithecellobium acatlense into two groups of 30 goats. Chemical analysis threw goatee 11.7% CP during the dry season and 14.8% CP for rains regarding consumption of BM group A showed 20% less compared to Group B, with respect to consumption of the block multinutrient the group A was 56 g/day/goat, whilst the group B has consumed 73 g/day/goat, where he converted ±0.14 g/goat/day for this preparation (MB), with a cost /goat when consuming block/8 days 0.14 USD.

Total En Bloc Spondylectomy for Lumbar Renal Cell Carcinoma and Review of the Literature

Introduction: Total en bloc spondylectomy (TES) is gaining increasing favour as a treatment of choice for cancers of the spine that are resistant to radiological and chemotherapeautic intervention such as renal cell carcinoma (RCC). Until recently, RCC of the lumbar spine has presented a surgical challenge due to anatomical and vascular constraints. The development of the combined posterior-anterior en bloc spondylectomy offers improved access to the lumbar region. This case report and review of the literature presents a combined posterior-anterior lumbar en bloc spondylectomy for RCC involving L3 vertebra, which we believe is the first reported in Australia. Methods: A 46-year-old male with a seven-year history of renal cell carcinoma resulting in a left nephrectomy presented with a lytic lesion involving the L3 vertebral body, extending to the epidural space and compressing the cauda equina and left L3 and L4 nerve roots on MRI. A literature review revealed ten previous cases of the posterior-anterior TES in the lumbar spine for cancerous lesions but none from Australia. Results: A posterior-anterior TES and L2-L4 fusion was performed to remove a cancerous renal cell carcinoma of L3 with wide margins. Blood loss was the major complication. The patient remains recurrence free at nineteen months post procedure. Conclusion: Despite being an aggressive and invasive procedure, TES is rapidly becoming the treatment of choice for curative and palliative care in select patients with isolated metastatic tumours of the lumbar spine.

Pathological unit and the octagonal en bloc resection of thoracic ossification ligamentum flavum

Objective To describe the pathological unit and octagonal en bloc resection for the treatment of ossification ligamentum flavum(OLF)in thoracic spine with spondylotic myelopathy.Methods Ninety-five patients from January 2002 to January

En bloc resection of semi-facet and lamina for thoracic ossification of ligamentum flavum with epidural adhesion

Objective To explore the strategy and outcomes of surgical treatment of thoracic ossification of ligamentum flavum(OLF),especially combined with ossification of posterior longitudinal ligament,thoracic kyphosis and epidural