Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age.

PURPOSE: This study aimed to investigate the clinical outcomes of posterior fixation, combined with one- or two-stage anterior debridement and bone grafting in treating children younger than 3 years of age with thoracic and lumbar tuberculosis. METHODS: This was a retrospective study involving 16 young children with thoracic or lumbar tuberculosis. Surgical data were recorded. Frankel Grade was used to assess neurological function. The regional kyphosis angle was measured to evaluate the deformity correction. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were detected to assess the activity of tuberculosis. Bony fusion and complications were also recorded. RESULTS: The mean operation time was 204.4 ± 41.8 min. The mean estimated blood loss was 126.3 ± 94.4 ml. Preoperative Frankel Grade results indicated five patients with Grade C, six with Grade D, and five with Grade E. At the final follow-up, all patients were in Grade E. Twelve patients were brought back to normal spinal alignment and the rest four patients remained kyphotic. There was an improvement of 29.3° ± 18.3° in regional kyphotic angle postoperatively. And the deformity correction was 27.4° ± 19.1° at the final follow-up. ESR and CRP decreased to a normal range at three months follow-up. Bony fusion was achieved in all patients. None of the cases developed fixation failure, pseudoarthrosis, or tuberculosis recurrence. CONCLUSION: Posterior fixation, combined with one- or two-stage anterior debridement and bone grafting, is a safe and effective surgical strategy for treating young children with thoracic and lumbar tuberculosis.

Associations of Tumor Necrosis Factor Alpha Gene Polymorphisms and Ankylosing Spondylitis Susceptibility: A Meta-analysis Based on 35 Case-control Studies.

BACKGROUND: Scores of studies on tumor necrosis factor alpha (TNF-α) gene polymorphisms and AS have been performed with inconsistent results. The purpose of this study was to provide some more convincing evidence on the associations of TNF-a polymorphisms and AS by using a meta-analysis approach. METHODS: Potentially relevant studies were identified from Web of Science, PubMed, EMBASE, Wanfang, and CNKI from inception to March 5, 2020. Newcastle-Ottawa Scale (NOS) was utilized to appraise the quality of included studies. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated to assess the strength of the associations under five genetic models. RESULTS: Thirty-five studies with 37 independent cohorts in total were included in the meta-analysis. Based upon NOS, eligible studies were in moderate- to high quality. The merged data suggested rs1799724 polymorphisms were significantly correlated with a reduced risk of AS (C vs. T, OR = 0.55, 95%CI 0.38-0.79, P < .001, PBon = 0.005, PFDR = 0.003). Subgroup analysis by ethnicity indicated that rs1800629 polymorphism significantly increased the risk of AS in Caucasians and decreased the risk of AS in mixed populations. Besides, rs361525 and rs1800630 polymorphisms conferred to an elevated risk of AS, and rs1799724 conferred to a reduced risk of AS in Asians. CONCLUSIONS: This study suggests that rs1800629 polymorphism is associated with an increased AS risk in Caucasians, rs361525 and rs1800630 polymorphisms are linked to an elevated AS susceptibility in Asians.

Lack of Associations between Endoplasmic Reticulum Aminopeptidase 2 Gene Polymorphisms and Ankylosing Spondylitis: A Meta-analysis with Trial Sequential Analysis.

BACKGROUND: Endoplasmic reticulum aminopeptidase 2 (ERAP2) gene is reported to be associated with inflammation-related diseases. Several studies have investigated the associations of ERAP2 gene polymorphisms and susceptibility to ankylosing spondylitis (AS). However, the findings of those studies were inconsistent. The aim of this study was to elucidate the associations by a meta-analysis with trial sequential analysis (TSA). METHODS: Online databases of PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, and CNKI were searched to identify eligible studies on the associations of ERAP2 gene polymorphisms and AS. Study quality was judged based on the Newcastle-Ottawa scale (NOS). Strengths of associations were presented by P-value, odds ratios (ORs), and 95% confidence intervals (95%CIs). TSA was employed to evaluate the information size and statistical power. RESULTS: A total of six studies encompassing 2774 AS patients and 4119 disease-free controls were eligible for this meta-analysis. Five studies reported rs2248374 polymorphism and three studies reported rs2549782 polymorphism. The pooled data suggested that the two polymorphisms were not significantly associated with AS susceptibility: rs2248374, A vs. G, OR = 0.94, 95%CI 0.86-1.02, P = .14; rs2549782, T vs. G, OR = 1.03, 95%CI 0.95-1.12, P = .45. TSA indicated that the sample sizes appeared to be inadequate to obtain a positive outcome. CONCLUSION: The present findings of this study do not support any evidence on the associations of rs2248374 and rs2549782 polymorphisms in the ERAP2 gene and susceptibility to AS. Additional well-designed and large-sample studies in diverse ethnicities are encouraged to validate the current findings.

Associations of toll-like receptor 4 and 2 gene polymorphisms with susceptibility to ankylosing spondylitis: A meta-analysis.

BACKGROUND: The published evidences on the correlations of toll-like receptor 4 (TLR4) and TLR9 gene polymorphisms and ankylosing spondylitis (AS) were conflicting. The purpose of this study was to investigate whether TLR4 and TLR9 gene polymorphisms conferred susceptibility to AS through a meta-analysis approach. METHODS: Databases of PubMed, Web of Science, EMBASE, Cochrane Library, CNKI and Wanfang were retrieved for relevant publications up to 20 June 2020. Study quality was assessed based on Newcastle-Ottawa scale (NOS). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to judge the associations. RESULTS: Totally, 13 articles with 3,055 AS cases and 4,238 controls were incorporated into this meta-analysis, and four most widely reported polymorphisms (TLR4-rs4986790, TLR4-rs4986791, TLR9-rs55704465 and TLR9-rs187084) were analysed. All included studies were in high quality. The pooled data did not support any significant association between the four studied polymorphisms and AS susceptibility. CONCLUSIONS: The present meta-analysis suggests there is no significant association between TLR4-rs4986790, TLR4-rs4986791, TLR9-rs55704465 and TLR9-rs187084 polymorphisms and AS.

Long noncoding RNA plasmacytoma variant translocation gene 1 promotes epithelial-mesenchymal transition in osteosarcoma.

OBJECTIVE: Long noncoding RNAs (lncRNAs) are involved in the proliferation, migration, and invasion of tumors. In the current study, our aim was to explore the role of lncRNA plasmacytoma variant translocation gene 1 (PVT1) in osteosarcoma. METHODS: Quantitative real-time reverse transcription-polymerase chain reaction was used to detect the expression of lncRNA PVT1 in osteosarcoma tissues and cells. The relationship between lncRNA PVT1 expression status and the prognosis of patients with osteosarcoma was analyzed. The effect of lncRNA PVT1 on the malignant biological behavior of osteosarcoma cells in vitro was also analyzed. RESULTS: LncRNA PVT1 was upregulated in osteosarcoma. High lncRNA PVT1 expression indicated poor prognosis in patients with osteosarcoma. In vitro knockdown of lncRNA PVT1 inhibited the proliferation, migration, and invasion ability of osteosarcoma cells. In addition, we confirmed that lncRNA PVT1 affected the epithelial-mesenchymal transition of osteosarcoma cells. CONCLUSION: LncRNA PVT1 is a potential therapeutic target for osteosarcoma.

[Selection of indications and surgical treatment of basilar invagination with atlantoaxial dislocation].

OBJECTIVE: To evaluate the indications and effect of surgical treatment of basilar invagination (BI) with atlantoaxial dislocation (AAD) on the basis of retrospective analysis of the clinical and imaging data of patients. METHODS: Consecutive 21 patients with BI and AAD were surgically treated in Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University from July 2000 to December 2013. There were 10 males and 11 females, aged from 7 to 59 years, with a mean of 36.4 years. The clinical symptoms and signs was recorded, and preoperative imaging examination including anteroposterior, lateral, dynamic films, MRI, CT and 3-dimensional reconstruction views of cervical spine were performed to identify the series. All cases were treated with operation. Neurological function was assessed by JOA scale and NDI score before, after surgery and at final follow-up. The postoperative X-rays, MRI or CT was taken to observed the results of decompression, fixation and fusion. RESULTS: There were 5 cases operated by posterior approach, combined anterior and posterior approach in 16 cases, atlantoaxial fixation in 2 cases, occipitocervical fixation in 19 cases. The average operation time was 200 mins, blood loss was 230 ml. Except for 2 death cases, 19 cases were followed up, the followed-up was arranged from 13 to 42 months, with an average of 21.6 months. Compared with preoperative parameters (7.8±1.3), the postoperative scores of JOA decreased significantly (14.1±0.5) and at the final follow-up (16.2±0.7) (P<0.05); compared with preoperative parameters (65.7±11.2), the postoperative scores of NDI decreased significantly (28.2±9.6) and at the final follow-up (22.7±7.4) (P<0.05) and no significant difference in JOA or NDI score existed between post-operation and last follow-up (P>0.05). The perioperative complications was discovered in 6 cases, including infection in 2 cases, cerebrospinal fluid (CSF) leakage in 2 cases, respiratory dysfunction, cleft palate in 1 case, respectively. CONCLUSION: BI with AAD can be treated by anterior, posterior or combined approaches. Careful evaluation, proper selection of indications and prevention of perioperative complications are important consideration to ensure the success of surgery.

Surgical Treatment for Displaced Odontoid Synchondrosis Fracture: A Retrospective Case Series Study.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Odontoid synchondrosis fracture is rare, and there is a paucity of literature on its surgical treatments. This case series study analyzed patients treated with C1 to C2 internal fixation with or without anterior atlantoaxial release and discussed the clinical effectiveness of the procedure. METHODS: Data were retrospectively collected from a single-center cohort of patients who had undergone surgical treatments for displaced odontoid synchondrosis fracture. The operation time and blood loss volume were recorded. Neurological function was assessed and classified using the Frankel grades. The odontoid process tilting angle (OPTA) was used to evaluate fracture reduction. Fusion duration and complications were also analyzed. RESULTS: Seven patients (1 boy and 6 girls) were included in the analysis. Three patients underwent anterior release and posterior fixation surgery, and the other 4 underwent posterior-only surgery. The fixation segment was C1 to C2. The average follow-up period was 34.7 ± 8.5 months. The average operation time was 145.7 ± 45.3 min, with an average blood loss volume of 95.7 ± 33.3 mL. The OPTA was corrected from 41.9° ± 11.1° preoperative to 2.4° ± 3.2° at the final follow-up (P < .05). The preoperative Frankel grade of 1 patient was grade C, of 2 patients was grade D, and of 4 patients was grade E. The neurological function of the patients in grade C and grade D recovered to grade E at the final follow-up. None of the patients developed a complication. All the patients achieved odontoid fracture healing. CONCLUSIONS: Posterior C1 to C2 internal fixation with or without anterior atlantoaxial release is a safe and effective method for treating young children with displaced odontoid synchondrosis fracture.

Application of cement-augmented pedicle screws in elderly patients with spinal tuberculosis and severe osteoporosis: a preliminary study.

OBJECTIVE: Surgical management of elderly patients with spinal tuberculosis and severe osteoporosis is challenging. Cement-augmented pedicle screws (CAPS) have been specifically designed for elderly patients with osteoporotic spines. Herein, we investigated the feasibility of CAPS applied in elderly patients with spinal tuberculosis and severe osteoporosis. METHODS: We retrospectively analyzed data of patients with spinal tuberculosis and severe osteoporosis between January 2017 and January 2021. Surgical data, including surgical duration and intraoperative blood loss, were recorded. Radiological parameters, such as correction of regional kyphotic angle and screw loosening, were also evaluated. Additionally, visual analog scores (VAS) and Oswestry disability index (ODI) were used to evaluate back pain and functional recovery, respectively. Erythrocyte sedimentation (ESR) and C-reactive protein (CRP) concentrations were detected to assess tuberculosis activity. The presence of complications and fusion rate was also assessed. RESULTS: A total of 15 patients were included in this study. The surgical duration was 263.0 ± 56.2 min, with an average blood loss of 378.7 ± 237.0 ml. The correction of regional kyphotic angle was 12.4° ± 15.0°, and it was well maintained until the final follow-up. The mean VAS decreased from 6.0 ± 1.2 points to 0.5 ± 0.6 points, and ODI reduced from 37.8% ± 7.6% to 8.3% ± 2.8% (P < 0.01). At the final follow-up, ESR and CRP levels were within normal range. Bony fusion occurred in all patients, with an average fusion duration of 8.8 ± 1.5 months. No cases of pedicle screw pullout, screw loosening, or pseudoarthrosis occurred. Tuberculosis recurrence and dissemination were not observed during the follow-ups. CONCLUSIONS: CAPS fixation is an effective and safe technique to achieve solid fixation and favorable clinical outcomes in elderly patients with spinal tuberculosis and severe osteoporosis.

Carnosic acid protects against ferroptosis in PC12 cells exposed to erastin through activation of Nrf2 pathway.

AIMS: Ferroptosis is involved in the pathogenesis of spinal cord injury (SCI). Carnosic acid (CA) is a natural phenolic diterpene, which possesses diversiform activities. However, whether the protective effect of CA on SCI is partly due to inhibition of ferroptosis was seldom investigated. Therefore, the objective of this study aimed to investigate the role of CA on ferroptosis in PC12 cells and the underlying mechanisms. MAIN METHODS: Cell viability, malondialdehyde (MDA) contents, glutathione (GSH) levels, and iron levels were detected to identify the construction of ferroptosis model in PC12 cell induced by erastin. The safe concentrations of CA on PC12 cells were measured via cell counting kit-8 (CCK-8) assays. Then, cellular MDA contents, GSH levels, iron levels, reactive species (RS) generation, and mitochondrial morphology were tested to determine the influence of CA on ferroptosis in erastin-treated PC12 cells. In addition, Western blot and RT-qPCR were utilized to detecteddetect the ferroptosis-related genes and proteins expression levels. KEY FINDINGS: Our study indicated that treatment with CA could reversed the increased MDA, iron, and RS levels, as well as the decreased GSH levels in erastin-treated PC12 cells. The protective effect of CA could be blocked by ML385. The inhibitory effect of CA on ferroptosis probably was partially governed by activation of Nrf2 to regulate the GSH synthesis and metabolism and cellular iron homeostasis. SIGNIFICANCE: CA can inhibit ferroptosis in PC12 cells induced by erastin via activating Nrf2 pathway, indicating that CA could lead to neuroprotective effect by restraining the occurrence of ferroptosis.

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis.

Brucellar spondylodiscitis (BS) is the most prevalent and significant osteoarticular presentation of human Brucellosis, which is commonly manifested in pastoral communities. It is difficult to differentially diagnose and usually leads to irreversible neurologic deficits and spinal deformities. The initial diagnosis of BS is based on clinical findings and radiographic assessments, and the confirmed diagnosis should be established by the isolation of Brucella species from the blood and/or the standard tube agglutination test. Differential diagnosis of multifocal BS from either degenerative disc diseases or tuberculosis is especially highlighted. The surgical approach, either endoscopic or open, is demonstrated in detail, accompanied by radiographic evidence of structural compression or severe instability. Further, the crucial surgical steps, including single-stage transforaminal decompression, debridement, interbody fusion, and internal fixation, are explained. Moreover, perioperative care and postoperative rehabilitation are also addressed. Taken together, this clinical algorithm presents a practical guide that has yielded substantially satisfactory outcomes in the past decades, which can also be introduced for large-scale application to manage human BS, especially in endemic regions.

Associations between vitamin D receptor gene polymorphisms and spinal degenerative disease: evidence from a meta-analysis based on 35 case-control studies.

OBJECTIVE: Dozens of reports on the associations of vitamin D receptor (VDR) gene polymorphisms and susceptibility to spinal degenerative disease (SDD) were conducted with inconsistent findings. This study aimed to elucidate the associations through a meta-analysis approach. METHODS: Databases of PubMed, EMBASE, Web of Science, CNKI, and Wanfang were searched until July 10, 2020. Study quality was evaluated by using Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated to evaluate the associations under allelic model (1 vs. 2), homozygous model (11 vs. 22), heterozygous model (12 vs. 22), dominant model (11 + 12 vs. 22), and recessive model (11 vs. 12 + 22). RESULTS: A total of 5021 cases and 5746 controls from 35 studies were eligible to this meta-analysis. According to NOS, the included studies were in excellent quality. In the overall population, the pooled data indicated that ApaI was associated with a reduced SDD susceptibility (AA vs. Aa + aa, OR = 0.83, 95%CI 0.71 - 0.96, P = 0.010). But the association was not observed in FokI, TaqI, and BsmI polymorphisms. Subgroup analysis suggested that TaqI polymorphism was correlated to an elevated SDD risk in Asians (TT + Tt vs. tt, OR = 2.55, 95%CI 1.90 - 3.44, P < 0.001). CONCLUSION: The present study indicates that ApaI polymorphism may contribute to a reduced risk to SDD in the overall population, and TaqI polymorphism confers an elevated susceptibility to SDD in Asians. While, BsmI and FokI polymorphisms appear to have no significant association with SDD.

Quercetin Alleviates Intervertebral Disc Degeneration by Modulating p38 MAPK-Mediated Autophagy.

Intervertebral disc degeneration (IVDD) is a degenerative and chronic spinal disorder often associated with the older population. Oxidative stress is a major pathogenic factor of aging that results in the apoptosis of nucleus pulposus cells (NPCs) and extracellular matrix (ECM) degradation. Quercetin (QUE), a naturally occurring flavonoid with antioxidant and anti-inflammatory properties, has been studied in research on degenerative diseases. However, the potential effects and mechanisms of action of QUE on IVDD remain unclear. In this study, the effects of QUE on antiapoptosis and ECM metabolism were firstly investigated in TBHP-treated NPCs. Meanwhile, the autophagy inhibitor, 3-MA, and p38 MAPK inhibitor, SB203580, were used in subsequent TBHP-induced NPC experiments to determine whether QUE exerted its protective effects through autophagy and the p38 MAPK/mTOR signaling pathway. Finally, the therapeutic effects of QUE were confirmed in vivo using a rat tail needle puncture-induced model of IVDD. We found that QUE treatment significantly alleviated oxidative stress-decreased cell viability and intracellular ROS levels in NPCs treated with TBHP. Furthermore, treatment with QUE led to a decrease in apoptosis as measured by decreased Bax and increased Bcl-2 expression and PE/7-AAD flow cytometry analysis. QUE also promoted ECM stability as measured by increased collagen II and aggrecan and decreased MMP13 levels. Our results also showed that QUE promoted the expression of autophagy markers beclin-1, LC3-II/I, and decreased p62. Inhibition of autophagy by inhibitor 3-MA may partially reverse the protective effect of QUE on apoptosis and ECM degeneration, indicating that autophagy was involved in the protective effect of QUE in NPCs. Further study confirmed that QUE partially inhibited the p38 MAPK signaling pathway and inhibition of p38 MAPK by SB203580 activated autophagy, indicating that QUE protected NPCs against apoptosis and prevented ECM degeneration via the p38 MAPK-autophagy pathway. Finally, using a rat tail puncture-induced model of IVDD, we confirmed that QUE had a protective effect against IVDD. Our results suggest that QUE could prevent IVDD by modulating p38 MAPK-mediated autophagy and, therefore, is a potential therapeutic strategy in the treatment of IVDD.

[Clinical characteristics and treatment for patients with low back and leg pain caused by lumbar annular tears].

OBJECTIVE: To investigate whether annular tears is a cause of low back and radiating leg pain and explore the clinical characteristics and treatment for patients with this condition. METHODS: A total of 34 patients with low back and radiating leg pain, but without lumbar disc herniation on CT (computed tomography) or MRI (magnetic resonance imaging), were examined by electrophysiological studies and discography to identify whether there were or not annular tears and nerve root injury and decipher the relations between them. The series included 15 males and 19 females with an average age of 45.6 years old and the average duration of symptoms was 25.8 months. All patients with annular tears and positive pain provocation test were treated by local windowing decompression and debridement of nucleus pulposus after failed conservative treatment. The pre- and post-operative functions and pain were evaluated by JOA (Japanese Orthopedic Association) and VAS (visual analog scale) scores respectively. The average follow-up was 17.4 months. RESULTS: The clinical manifestations included low back and radiating leg pain, intermittent claudication and nerve root injury. No significant abnormalities were discovered on X-ray and CT scan. T2W images of magnetic resonance demonstrated a low intensity or black disc in all patients and high-intensity zone (HIZ) (n = 21). Electromyography showed nerve root injury (n = 27). Abnormality of conduction velocities of common peroneal nerve (n = 7) and tibial nerve (n = 3) were found. Thirty-four patients with 38 discs displayed pain reproduction on contrast injection during discography and the sites of annular tears were confirmed on CT scan after discography. Pre- and post-operative average JOA scale score was 8.7 points and 13.5 points, the recovery ratio 76.2% and the excellent and good outcomes 88.2%. Pre- and post-operative average VAS score was 8.6 points and 2.8 points. And the recovery rate was 80.5%. CONCLUSION: The annular tears result in low back and radiating leg pain. And the typical characteristics are low back and radiating leg pain, intermittent claudication and nerve root injury. MRI and electrophysiological studies play an important role in diagnosing this condition. Lumbar discography is the decisive method and prerequisite of selecting surgery. Local windowing decompression and debridement of nucleus pulposus is a simple and effective method.

Association of rs27044 and rs30187 polymorphisms in endoplasmic reticulum aminopeptidase 1 gene and ankylosing spondylitis susceptibility: A meta-analysis.

BACKGROUND: The findings regarding association of endoplasmic reticulum aminopeptidase 1 (ERAP1) gene polymorphisms and ankylosing spondylitis (AS) susceptibility are inconsistent. Our aim is to appraise and merge the existing evidence on the relationship of rs27044 and rs30187 polymorphisms in ERAP1 gene and susceptibility to AS. METHODS: Electronic databases of PubMed, Web of Science, EMBASE, Cochrane Library, Wanfang, and CNKI were retrieved for relevant publications. The search was conducted from inception to 10 June, 2019. Studies on the association of rs27044 and rs30187 polymorphisms and risk of AS were included. Quality evaluation was carried out using Newcastle-Ottawa Scale (NOS). Summary odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to appraise the associations under allelic and genotypic models. RESULTS: In total, 26 case-control studies with 31 cohorts containing 17 223 AS patients and 36 915 controls were eligible for this meta-analysis. According to NOS, each study received ≥ 5 scores. The pooled data indicated that rs27044 and rs30187 polymorphisms were significantly associated with AS susceptibility in the overall population: rs27044, G versus C, OR = 1.24, 95% CI 1.16-1.33, P<.001; rs30187, T versus C, OR = 1.24, 95% CI 1.17-1.33, P<.001. When stratified by ethnicity, rs27044 appeared to be significantly correlated with AS in both Asians and Caucasians. For rs30187, despite positive association being observed under the allelic model in both Asians and Caucasians, the findings of genotypic comparisons supported the association only existed in Caucasians but not Asians. CONCLUSION: This study suggests that rs27044 and rs30187 polymorphisms are significantly associated with increased risk of AS, especially in Caucasians.

An Eight-Year Follow-Up Study on the Treatment of Single-Level Cervical Spondylosis Through Intervertebral Disc Replacement and Anterior Cervical Decompression and Fusion.

OBJECTIVE: To compare the efficacy and safety of the postoperative long-term effect of the treatment of single-level cervical spondylosis through anterior cervical discectomy and fusion (ACDF) and artificial cervical disc replacement (ACDR). METHODS: This is a retrospective contrastive study, which was conducted for the period of January 2007 and January 2009 at the Department of Spine Surgery of the First Affiliated Hospital of Xinjiang Medical University. A total of 113 patients were divided into two groups depending on the operation method: ACDF group (fusion group, n = 66) and ACDR group (replacement group, n = 47). The ACDR group comprised of 23 males and 24 females. The age of these patients ranged from 31-60 years, with an average age of 42.89 ± 6.30 years. The ACDF group comprised of 38 males and 28 females. The age of these patients ranged from 28-73 years old, with an average age of 49.38 ± 9.89 years old. The evaluation index included the visual analogue scale (VAS), neck disability index (NDI), range of motion, dysphagia, adjacent vertebral disease, and related complications (prosthesis displacement, heterotopic ossification, etc.). RESULTS: A total of 113 patients met the inclusion criteria, and these patients receive more than 96 months of follow-up. The VAS and NDI of these two groups of patients significantly improved, when compared with those before the operation. In the last follow-up visit, the range of motion in the ACDR group and ACDF group was 43.22 ± 3.58 and 32.54 ± 2.82, respectively, and both are significantly different comparing to the values measured before the operation (P < 0.05). The dysphagia incidence of the ACDR group was higher than that of the ACDF group at the 36th month, but was lower than that of the ACDF group in other points time. In the last follow-up visit, six patients (12.77%) in the ACDR group and 18 patients (27.27%) in the ACDF suffered from adjacent segment degeneration (ASD). The general complication rate in the replacement group and fusion group was 38.31% and 37.88%, respectively, but the difference between the two groups was not statistically significant (P > 0.05). CONCLUSION: Overall, the clinical efficacy and related complication rate of single-level cervical spondylosis after an anterior cervical approach operation was superior in the ACDR group when compared to the ACDF group.

Gal-3 is a potential biomarker for spinal cord injury and Gal-3 deficiency attenuates neuroinflammation through ROS/TXNIP/NLRP3 signaling pathway.

Spinal cord injury (SCI) often occurs in young and middle-aged population. The present study aimed to clarify the function of Galectin-3 (Gal-3) in neuroinflammation of SCI. Sprague-Dawley (SD) rat models with SCI were established in vivo. PC12 cell model in vitro was induced by lipopolysaccharide (LPS). Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Gene chip were used to analyze the expression levels of genes in the signaling pathway. Histological assessment, ELISA and Western blotting were conducted to evaluate the effects of Gal-3 upon the SCI model. In the in vivo SD rat model, Gal-3 expression level was up-regulated. The inhibition of Gal-3 attenuated the neuroinflammation in SCI model. The inhibition of Gal-3 could also mitigate the neuroinflammation and reactive oxygen species (ROS) in in vitro model. ROS reduced the effect of Gal-3 on oxidative stress in in vitro model. Down-regulating the content of TXNIP decreased the effect of Gal-3 on neuroinflammation in in vitro model. Suppressing the level of NLRP3 could weaken the effect of Gal-3 on neuroinflammation in in vitro model. Our data highlight that the Gal-3 plays a vital role in regulating the severity of neuroinflammation of SCI by enhancing the activation of ROS/TXNIP/NLRP3 signaling pathway. In addition, inflammasome/IL-1ß production probably acts as the therapeutic target in SCI.

Ameliorative effects of echinacoside against spinal cord injury via inhibiting NLRP3 inflammasome signaling pathway.

AIMS: The activation of NLRP3 inflammasome, which initiates an inflammatory cascade and triggers inflammatory death, plays a crucial role in the pathogenesis of spinal cord injury (SCI). Echinacoside (ECH) is a phenylethanoid glycoside possessing prominent anti-inflammatory effects and various neuroprotective properties in the central nervous system, but the effect of ECH on SCI was rarely studied. Therefore, the purpose of this experiment was to look into the therapeutic effects of ECH on SCI and the underlying mechanisms. MAIN METHODS: Basso-Beattie-Bresnahan (BBB) locomotion scale, Nissl staining, and hematoxylin-eosin (HE) staining was employed to examine the therapeutic effects of ECH on SCI. In addition, reactive oxygen species (ROS) generation, mitochondrial membrane potential (MMP) in BV-2 cells stimulated with lipopolysaccharides and adenosine 5'-triphosphate were examined. The expression levels of proteins involving NLRP3 inflammasome-related pathway were measured. KEY FINDINGS: The in vivo experiment indicated that administration of ECH significantly enhanced the BBB scores, reduced the neuron loss, and ameliorated the tissue architecture after SCI. Additionally, ECH dramatically inhibited NLRP3 inflammasome activation in the rat SCI model. In vitro study indicated that ECH significantly reduced ROS level, improved the MMP, blocked activation of NF-κB, and inhibited the NLRP3 inflammasome signaling pathway. The effect of ECH on inhibition of NLRP3 inflammasome signaling pathway was partially governed by suppression of the generation of ROS and activation of NF-κB. SIGNIFICANCE: ECH can accelerate motor function recovery in rats following SCI by inhibiting NLRP3 inflammasome-related signaling pathway, suggesting that ECH may serve as a potential therapeutic agent for treating SCI.

Establishment and Initial Testing of a Medium-Sized, Surgically Feasible Animal Model for Brucellar Spondylodiscitis: A Preliminary Study.

Brucellar spondylodiscitis, the most prevalent and significant osteoarticular presentation of human Brucellosis, is difficult to diagnose and usually yields irreversible neurologic deficits and spinal deformities. However, no animal models of Brucellar spondylodiscitis exist, allowing for preclinical investigations. The present study investigated whether intraosseous injection of attenuated Brucella melitensis vaccine into rabbits' lumbar vertebrae imitates the radiographic and histopathological characteristics of human Brucellar spondylodiscitis. Radiographic and histopathological analyses at 8 weeks postoperatively revealed radiographic changes within vertebral bodies and intervertebral discs, abscesses formation within the paravertebral soft tissue, and typical prominent inflammation response without caseous necrosis, which were largely comparable to human Brucellar spondylodiscitis. Such a medium-sized, surgically feasible rabbit model provides a promising in vivo setting for further preclinical investigation of Brucellar spondylodiscitis.

Significant association of IL-6-572G/C, IL-6-597G/A, and IL-6-174G/C polymorphisms and susceptibility to lumbar degenerative disease: A meta-analysis.

OBJECTIVES: To assess and synthesize the current evidence on the association of interleukin-6 (IL-6)-572 G/C, IL-6-597 G/A, and IL-6-174 G/C polymorphisms and risk of lumbar degenerative disease (LDD). PATIENTS AND METHODS: Five electronic databases including PubMed, EMBASE, Web of Science, CNKI and Wanfang were systematically searched for potential studies previous to August 10, 2018. Summary odds ratio (OR) and corresponding 95% confidence interval (95%CI) were calculated to evaluate the association. RESULTS: Nine case-control studies comprising 1519 cases and 1887 controls were obtained for the meta-analysis. For IL-6-572 G/C, IL-6-597 G/A, and IL-6-174 G/C polymorphisms, there were seven, six, and seven studies eventually included in the meta-analysis respectively. The findings indicated that the three polymorphisms had significant associations with risk of LDD: for IL-6-572 G/C, G vs. C, OR = 1.37, 95%CI 1.11-1.69, P = 0.004; for IL-6-597 G/A, G vs. A, OR = 1.38, 95 %CI 1.16-1.65, P = 0.000; for IL-6-174 G/C, G vs. C, OR = 1.63, 95%CI 1.15-2.29, P = 0.006. CONCLUSION: The present meta-analysis found IL-6-572 G/C, IL-6-597 G/A, and IL-6-174 G/C polymorphisms were significantly associated with increased risk of LDD susceptibility.

Tocotrienol alleviates inflammation and oxidative stress in a rat model of spinal cord injury via suppression of transforming growth factor-ß.

In recent years accumulating evidence has indicated that tocotrienol exhibits an oxidation resistance function, decreased cholesterol function, inhibits cancer function and has unique physiological functions, including anti-inflammatory, anti-apoptotic and anti-oxidative properties. The present study investigated the effect of tocotrienols on spinal cord injury (SCI) by evaluating oxidative stress, inflammation and inducible nitric oxide synthase (iNOS) in rats. A rat model of SCI was induced by operation. SCI rats were treated with 120 mg/kg/day tocotrienol once a day for eight consecutive weeks. Functional recovery following SCI was measured by using the Basso Beattie Bresnahan (BBB) locomotor rating scale. Then the volume of spinal cord contusions was measured following induction of SCI in the rats. In SCI rats, serum malondialdehyde, superoxide dismutase, catalase, glutathione peroxidase, nuclear factor-κB p65 unit, tumor necrosis factor-α, interleukin (IL)-1ß and IL-6 levels were analyzed using respective commercial immunoassay kits. Firstly, iNOS, transforming growth factor (TGF)-ß, collagen type IV and fibronectin protein expression levels, in addition to iNOS activity and plasma nitric oxide (NO) production in SCI rats was analyzed using western blot analysis, commercial kits and Griess reagent, respectively. Tocotrienol treatment elevated BBB scores and contused volume in the SCI rats. Tocotrienol protected against SCI with reduced oxidative stress and inflammation, and inhibited iNOS protein expression iNOS activity and plasma NO production in rats. In addition, treatment with tocotrienols suppressed TGF-ß, collagen type IV and fibronectin protein expression levels in SCI rats. These results suggest that tocotrienols protect SCI, and suppress oxidative stress, inflammation and iNOS in this model of SCI through TGF-ß, collagen type IV and fibronectin signaling pathways.