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Objective: This work explored the relationship between nosocomial infection-related factors and inflammatory factors after total hip replacement (THA). Methods: A total of 296 THA patients treated in the Zhejiang hospital from 2018 to 2022 were analyzed retrospectively. Clinical data of the patients were collected, and the nosocomial infection rate, infection site, infectious pathogen, related risk factors, and postoperative follow-up were statistically analyzed. Disease types included avascular necrosis of the femoral head, osteoarthritis, and femoral neck fracture. The troponin (Tn), blood routine, blood types, heparin-binding protein (HBP), thyroid function, thromboelastogram (TEG), brain natriuretic peptide (BNP), bone metabolism-related markers, glycosylated hemoglobin (GHb), and other indicators in three types of patients before and after surgery were analyzed. Results: 37 cases (12.5%) had necrosis of the femoral head, 105 cases had osteoarthritis (35.47%), and femoral neck fracture was observed in 154 cases (52.03%). The main infection sites were the respiratory tract, urinary tract, deep incision, and tissue infection. There were 8 pathogenic bacteria strains, including gram-positive and gram-negative bacteria. The BNP content in plasma was highly decreased after treatment [RR: 0.353 (95% CI: 0.234-0.533), P < .001]. HBP in patients with postoperative infection was notably higher than that in patients without infection [RR: 0.241 (95% CI: 0.161-0.361), P < .001]. The blood glucose of both the diabetic group and the non-diabetic group was remarkably decreased after surgery [RR: 0.367 (95% CI: 0.233-0.461), P < .001]. The level of triiodothyronine (T3) showed a downward trend, while both tetraiodothyronine (T4) and thyroid stimulating hormone (TSH) were at normal levels. There were 15 cases of postoperative loosening, 6 cases of femoral shaft loosening, and 9 cases of acetabulum loosening. Conclusion: THA can regulate and maintain the balance of inflammatory cytokines, and taking preventive measures against risk factors can effectively reduce nosocomial infection, which is of great significance in improving the quality of medical treatment.
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The inflammatory environment and excessive chondrocyte apoptosis have been demonstrated to play crucial roles in the onset of osteoarthritis (OA). Hydrogen sulfide (H2 S), a gaseous signalling molecule, exerts an inhibitory effect on inflammation and apoptosis in several degenerative diseases. However, the protective effect of H2 S against OA has not been fully clarified, and its underlying mechanism should be examined further. In the current study, the role of endogenous H2 S in the pathogenesis of OA and its protective effects on interleukin (IL)-1ß-induced chondrocytes were identified. Our data revealed decreased H2 S expression in both human degenerative OA cartilage tissue and IL-1ß-induced chondrocytes. Pretreatment with the H2 S donor sodium hydrosulfide (NaHS) dramatically attenuated IL-1ß-induced overproduction of inflammatory cytokines and improved the balance between anabolic and catabolic chondrocyte capacities, and these effects were dependent on PI3K/AKT pathway-mediated inhibition of nuclear factor kappa B (NF-κB). Moreover, mitochondrial dysfunction-related apoptosis was significantly reversed by NaHS in IL-1ß-stimulated chondrocytes. Mechanistically, NaHS partially suppressed IL-1ß-induced phosphorylation of the mitogen-activated protein kinase (MAPK) cascades. Furthermore, in the destabilization of the medial meniscus mouse model, OA progression was ameliorated by NaHS administration. Taken together, these results suggest that H2 S may antagonize IL-1ß-induced inflammation and mitochondrial dysfunction-related apoptosis via selective suppression of the PI3K/Akt/NF-κB and MAPK signalling pathways, respectively, in chondrocytes and may be a potential therapeutic agent for the treatment of OA.
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Antirreumáticos/farmacologia , Apoptose/efeitos dos fármacos , Condrócitos/efeitos dos fármacos , Sulfeto de Hidrogênio/farmacologia , Mediadores da Inflamação/metabolismo , Interleucina-1beta/toxicidade , Articulações/efeitos dos fármacos , Mitocôndrias/efeitos dos fármacos , Osteoartrite/tratamento farmacológico , Sulfetos/farmacologia , Idoso , Animais , Antirreumáticos/metabolismo , Estudos de Casos e Controles , Células Cultivadas , Condrócitos/imunologia , Condrócitos/metabolismo , Condrócitos/patologia , Modelos Animais de Doenças , Feminino , Humanos , Sulfeto de Hidrogênio/metabolismo , Articulações/imunologia , Articulações/metabolismo , Articulações/patologia , Masculino , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Mitocôndrias/imunologia , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Proteínas Quinases Ativadas por Mitógeno/metabolismo , NF-kappa B/metabolismo , Osteoartrite/imunologia , Osteoartrite/metabolismo , Osteoartrite/patologia , Fosfatidilinositol 3-Quinase/metabolismo , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais , Sulfetos/metabolismoRESUMO
Steroid-induced avascular necrosis of the femoral head (SANFH) is mainly induced by glucocorticoids. Fludarabine (Flu) is a specific signal transducer and activator of transcription 1 (STAT1) inhibitor. In this study, we investigated the effect of Flu on SANFH and the role played by the STAT1/caspase-3 signaling pathway. Sprague-Dawley rats were divided into control, SANFH, and Flu-treated SANFH groups. Femoral head tissues were collected for hematoxylin-eosin (H&E) staining and Western blot analysis. The latter was used to measure the levels of stat1, phospho-stat1, caspase-3, cleaved caspase-3, caspase-9, cleaved caspase-9, Bax, cytochrome C, Bak, B-cell lymphoma-extra large, and B-cell lymphoma-2 protein expression. The results showed that Flu regulates protein expression in dexamethasone (Dex)-induced SANFH. H&E staining showed a decrease in the ratio of empty lacunae induced by Dex. Taken together, our study demonstrated the involvement of the STAT1/caspase-3 signaling pathway in SANFH and the potential of Flu as a therapeutic agent for patients with SANFH.
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Caspase 3/metabolismo , Dexametasona/efeitos adversos , Regulação para Baixo/efeitos dos fármacos , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/patologia , Fator de Transcrição STAT1/metabolismo , Transdução de Sinais/efeitos dos fármacos , Vidarabina/análogos & derivados , Animais , Modelos Animais de Doenças , Progressão da Doença , Cabeça do Fêmur/enzimologia , Cabeça do Fêmur/metabolismo , Necrose da Cabeça do Fêmur/tratamento farmacológico , Masculino , Ratos Sprague-Dawley , Vidarabina/farmacologia , Vidarabina/uso terapêuticoRESUMO
Intervertebral disc degeneration (IVDD) is one of the major causes of low back pain. Polydatin (PD) has been shown to exert multiple pharmacological effects on different diseases; here, we test the therapeutic potential of PD for IVDD. In in-vitro experiments, we confirmed PD is nontoxic to nucleus pulposus cells (NPCs) under the concentration of 400 µmol/L. Furthermore, PD was able to decrease the level of senescence in TNF-α-treated NPCs, as indicated by ß-gal staining as well as senescence markers p53 and p16 expression. In the aspect of extracellular matrix (ECM), PD not only reduced metalloproteinase 3 (MMP-3), metalloproteinase 13 (MMP-13) and a disintegrin-like and metalloproteinase thrombospondin type 1 motif 4 (ADAMTS-4) expression, but also increased aggrecan and collagen II levels. Mitochondrion is closely related to cellular senescence and ECM homeostasis; mechanistically, we found PD may rescue TNF-α-induced mitochondrial dysfunction, and it may also promote Nrf2 expression and activity. Silencing Nrf2 partly abolished the protective effects of PD on mitochondrial homeostasis, senescence and ECM homeostasis in TNF-α-treated NPCs. Correspondingly, PD ameliorated IVDD in rat model by promoting Nrf2 activity, preserving ECM and inhibiting senescence in nucleus pulposus cells. To sum up, our study suggests that PD exerts protective effects in NPCs against IVDD and reveals the underlying mechanism of PD on Nrf2 activation in NPCs.
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Glucosídeos/farmacologia , Degeneração do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Fator 2 Relacionado a NF-E2/genética , Estilbenos/farmacologia , Proteína ADAMTS4/genética , Agrecanas/genética , Animais , Células Cultivadas , Senescência Celular/efeitos dos fármacos , Colágeno/genética , Modelos Animais de Doenças , Matriz Extracelular/efeitos dos fármacos , Matriz Extracelular/genética , Humanos , Disco Intervertebral/efeitos dos fármacos , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/genética , Degeneração do Disco Intervertebral/patologia , Dor Lombar/genética , Dor Lombar/patologia , Metaloproteinase 13 da Matriz/genética , Metaloproteinase 3 da Matriz/genética , Núcleo Pulposo/efeitos dos fármacos , Núcleo Pulposo/patologia , Ratos , Fator de Necrose Tumoral alfa/genéticaRESUMO
Objective: To retrospectively explore the effect of a half-dose buprenorphine transdermal patch for analgesia after arthroscopic rotator cuff repair (ARCR). Methods: This analysis was performed with clinical data from patients who received unilateral ARCR in our hospital between October 2017 and December 2020. The patients were divided into three groups (30 cases each). In group A (control group), 100 mg flurbiprofen axetil (FA) was administered twice a day for 5 days after surgery. In group B (experimental group), 100 mg FA was administered twice a day for 5 days and half (2.5 mg) of a buprenorphine transdermal patch was applied after surgery; an additional half (2.5 mg) patch was applied 3 days later. In group C (condition control group), 100 mg FA was administered twice a day for 5 days and a 5-mg patch was applied directly after surgery. The visual analog scale (VAS) was administered repeatedly 1 day before surgery and 1, 2, 3, 5, and 14 days after surgery in each group. The simple shoulder test (SST) score, range of shoulder forward elevation (FE), and external rotation (ER) were recorded preoperatively and 12 weeks postoperatively. Results: VAS scores on postoperative days 3 and 5 were significantly lower in groups B and C than in group A (p < 0.05). The VAS score on postoperative day 14 was significantly lower in group C than in group A (p < 0.05). The difference in VAS score between groups B and C was not significant (p > 0.05). All patients had significantly improved VAS scores, SST scores, FE, and ER at 12 weeks postoperatively. Conclusion: The half-dose buprenorphine transdermal patch had a good analgesic effect with minimal side effects after ARCR and did not delay the recovery of shoulder joint function.
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OBJECTIVE: To explore the clinical outcomes of anteromedial combined with lateral locking plate for complex proximal humeral fractures in the eldery. METHODS: From June 2018 to October 2020, 30 patients who underwent surgical treatment for Neer grade 3 to 4 proximal humeral fractures, including 8 males and 22 females, aged from 51 to 78 years old with an average of (61.5±7.5) years old. Of them, 15 patients had fractures fixed with anteromedial combined with lateral locking plate(ALLP group), whereas 15 received internal fixation with proximal humerus locking plate only(PHLP group). The clinical data, simple shoulder test (SST), humeral head height loss, varus angle and shoulder range of motion were compared between the two groups. RESULTS: All fractures were healed. The follow-up time ranged from 12 to 24 months, with an average of(14.3±2.9) months. The operation time of ALLP group was longer than that of PHLP group (P<0.05). There was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no significant difference in SST score between the two groups at 1, 3 and 12 months after operation (P>0.05). In terms of radiographic measurement, there was no significant difference in humeral head height loss and varus angle between the two groups at 1 and 3 months after operation (P>0.05). At 12 months after operation, the height loss and varus angle of humeral head in ALLP group were lower than those in PHLP group (P<0.05). In shoulder range of motion, the range of forward elevation in ALLP group was larger than that in PHLP group 1 year after operation(P<0.05). There was no significant difference in external rotation between the two groups. CONCLUSION: Anteromedial combined with lateral locking plate in the treatment of complex proximal humeral fractures in the elderly can increase the stability of the medial column and obtain a good fracture prognosis. But there are also disadvantages such as longer operation time, so it should be individualized according to the fracture type of the patient.
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Fraturas do Úmero , Fraturas do Ombro , Masculino , Feminino , Humanos , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fixação Interna de Fraturas , Ombro , Cabeça do Úmero , Placas Ósseas , Fraturas do Úmero/cirurgiaRESUMO
OBJECTIVE: To investigate the prevalence of 11 thoracic vertebrae (TVs), four lumbar vertebrae (LVs) and six LVs among asymptomatic Chinese volunteers, and the influence of spine variations on the global spinal sagittal parameters. METHODS: A total of 389 asymptomatic Chinese volunteers were recruited. Each subject underwent a full-spine X-ray examination with measurement of global spinal sagittal parameters. The radiographs were examined by a spine surgeon and a radiologist to determine the variation in the number of vertebrae. These parameters were used to compare individuals with five LVs to those with 11 TVs, four LVs, and six LVs. RESULTS: The study population included 12 individuals (3.1%) with seven cervical vertebrae (C) + 11 thoracic vertebrae (T) + five lumbar vertebrae (L), 8 (2.1%) with 7C + 11T + 6L, 8 (2.1%) with 7C + 12T + 4L, and 15 (3.9%) with 7C + 12T + 6L. Compared to the 7C + 12T + 5L individuals, those with 7C + 11T + 5L had significantly lower C6 -T5 Cobb values (P < 0.05); 7C + 12T + 4L individuals had significantly greater thoracic inlet angles (P < 0.05) and significantly lower pelvic tilt (P < 0.05); individuals with 7C + 12T + 6L had significantly greater sacral slope, pelvic tilt, pelvic incidence, and L1-5 Cobb values (all P < 0.05), but significantly lower thoracic inlet angle (P < 0.05). There were no significant differences in any of the parameters examined between the 7C + 11T + 6L group and the 7C + 12T + 5L group. CONCLUSIONS: Asymptomatic adults with 7C + 12T + 6L, 7C + 12T + 4L, and 7C + 11T + 5L presented with different spinal sagittal alignment compared to those with 7C + 12T + 5L. Compared to variation in the number of LVs, the variation in the number of TVs had less effect on global spinal sagittal parameters. Spinal surgeons and researchers should be aware of the effects of variation in numbers of TVs and LVs on global spinal parameters and sagittal balance.
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Cifose , Lordose , Doenças da Coluna Vertebral , Adulto , Vértebras Cervicais , Humanos , Vértebras Lombares/diagnóstico por imagem , Sacro , Coluna Vertebral , Vértebras Torácicas/diagnóstico por imagemRESUMO
Inflammation and extracellular matrix (ECM) degradation have been implicated in the pathological process of osteoarthritis (OA). α-Cyperone is the main active component of the traditional Chinese medicine Cyperus rotundus L. In this study, we found that α-Cyperone abolished the IL-1ß-induced production of inflammatory cytokines in isolated rat chondrocytes, such as cyclooxygenase-2 (COX-2), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) and inducible nitric oxide synthase (iNOS), in a dose-dependent manner (0.75, 1.5 or 3 µM). Also, the results showed that α-Cyperone downregulated the expression of metalloproteinases (MMPs) and thrombospondin motifs 5 (ADAMTS5), and upregulated the expression of type-2 collagen. Mechanistically, molecular docking tests revealed that α-Cyperone stably and effectively binds to p65, p38, extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). α-Cyperone inhibited NF-κB activation by blocking its nuclear transfer, and decreasing the phosphorylation of mitogen-activated protein kinase (MAPKs). In addition, in vivo studies based on a mouse model of arthritis showed that α-Cyperone prevented the development of osteoarthritis. Therefore, α-Cyperone may be a potential anti-OA drug.
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Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Matriz Extracelular/efeitos dos fármacos , Inflamação/tratamento farmacológico , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , NF-kappa B/efeitos dos fármacos , Naftalenos/farmacologia , Naftalenos/uso terapêutico , Osteoartrite/tratamento farmacológico , Transdução de Sinais/efeitos dos fármacos , Animais , Condrócitos/efeitos dos fármacos , Cyperus , Regulação para Baixo , Matriz Extracelular/patologia , MAP Quinases Reguladas por Sinal Extracelular , Regulação da Expressão Gênica/efeitos dos fármacos , Interleucina-1beta/biossíntese , Interleucina-1beta/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Simulação de Acoplamento Molecular , Osteoartrite/patologia , Osteoartrite/prevenção & controle , RatosRESUMO
Background: Early dysphagia is a frequent complication of anterior cervical (AC) spine surgery. However, there are no reports that have discussed the correlation between early dysphagia and the positional relationship between thyroid cartilage and the surgical level.Methods: We retrospectively enrolled 82 patients in our hospital who underwent single-level AC discectomy performed by the same surgeon using the same internal fixation apparatus from 2015 to 2017. Swallowing difficulty was rated during the first five postoperative days using a 10-point scoring system. The positional relationship between the thyroid cartilage and the surgical level was defined as discectomy within the thyroid cartilage (IN group) or outside the thyroid cartilage (OUT group) using preoperative computed tomography (CT) images. The confounding factors such as gender, age, body mass index (BMI), hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, and blood loss were analyzed by a binomial logistic regression.Results: The thyroid cartilage was most commonly located above the C5 level (65.1%). Early dysphagia developed in 47.6% of the patients during the first five postoperative days. The IN and OUT groups each contained 41 cases. The difference in the cumulative postoperative early dysphagia score between the IN and OUT groups was statistically significant (p < .05). The factors of gender, age, BMI, hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, blood loss did not significantly influence the incidence of postoperative early dysphagia.Conclusions: We found that early dysphagia, which is a self-limiting complication, was correlated with surgery performed at levels outside the thyroid cartilage region. Preoperative review of the positional relationship between the thyroid cartilage and the surgical level can predict the incidence of postoperative transient dysphagia.
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Vértebras Cervicais/cirurgia , Transtornos de Deglutição/epidemiologia , Discotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Cartilagem Tireóidea/anatomia & histologia , Adulto , Idoso , Transtornos de Deglutição/etiologia , Discotomia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/cirurgia , Adulto JovemRESUMO
OBJECTIVE: To evaluate the clinical characteristics, genetic abnormalities, treatment efficacy and prognostic factors in patients with plasma cell leukemia(PCL). METHODS: 30 patients diagnosed as PCL in our hospital from January 1993 to December 2019 were enrolled, and the clinical characteristics, laboratory findings, therapeutic regimes, and survival data of the patients were retrospectively analyzed. RESULTS: The median age of the 30 patients was 56.5 (28-80) years old, among them, 25 patients were primary plasma cell leukemia, and 5 patients were secondary plasma cell leukemia. Complex karyotypes and subdiploids were most common in cytogenetic abnormalities. Among the 20 cases of chromosome G banding, 11 (55%) cases were complex karyotypes and 8 (40%) cases were hypodiploid. Fluorescent in situ hybridization (FISH) test showed that among 11 cases, 6 cases showed 17p13 deletion, 8 cases showed at least two kinds of abnormalities, which including t (14; 16), t (8; 14), t (11;14), 17p13 deletion, and 13q14 deletion. The median overall survival (OS) time was 10.5 months for all patients. The median OS time of the patients in ECOG score ≤ 2 group was 21.5 months, which was significantly longer than those in the ECOG score>2 group(1.2 months) (P=0.017). The median OS time of the patients treated with novel agents (including proteasome inhibitor and/or immunomodulator) was 24.9 months, which was significantly longer than the patients treated with traditional chemotherapy group(10.5 months) (Pï¼0.001). For the patients treated with novel agents, the median OS time of patients accepted two novel agents combination was 30.9 months, which was longer than those of single novel agent(11.5 months) (P=0.021). The effect of genetic abnormolity to the OS of the patients showed no statistical difference. Multivariate statistical analysis showed that ECOG score>2 was the independent prognostic factor of plasma cell leukemia patients. There were two patients underwent allogeneic hematopoietic stem cell transplantation in the study,but died due to the pulmonary infection within 6 months after transplantation. CONCLUSION: In the era of novel agents, ECOG score is an independent prognostic factor of plasma cell leukemia. Multiple novel agents treatment should be underwent as soon as possible to improve the prognosis of the patients. Pulmonary infection is a common factor that cause the death of the patients after allogeneic hematopoietic stem cell transplantation.
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Transplante de Células-Tronco Hematopoéticas , Leucemia Plasmocitária , Idoso , Idoso de 80 Anos ou mais , Humanos , Hibridização in Situ Fluorescente , Leucemia Plasmocitária/genética , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
The aim of the present study was to identify whether lumbar spinal subtypes (LSS) were associated with lumbar disc degeneration (LDD) among asymptomatic middle-aged and aged subjects. A cohort of 158 asymptomatic Chinese adults aged >40 years was recruited and 97 volunteers that met the inclusion criteria with complete information available were selected for inclusion. According to spinal morphology, volunteers were divided into four subtypes based on the classification of Roussouly. After baseline information was collected and spinopelvic parameters were measured, the data were compared among the four groups. According to the Pfirrmann classification, the degree of LDD was evaluated at each level on the MRI. For grades I-V, LDD at each level was effectively compared. Each of the four LSS from I to IV according to Roussouly classification from types I to IV were comprised of 25 (25.8%), 19 (19.6%), 38 (39.2%) and 15 (15.5%) of volunteers, respectively. Lumbar lordosis, sacral slope and pelvic incidence were significantly different among the four sub-types (P<0.001 for each), but no difference in pelvic tilt was observed (P=0.21). From types I to IV LSS, the proportion of disc degeneration was found to be 44, 52, 50 and 48%, respectively, which exhibited no statistically significant difference among LSS. No correlation between LSS and intervertebral disc degeneration was obtained among the asymptomatic middle-aged and aged subjects. The present study provides a reference for spinal surgery and indicated that additional risk factors should be assessed in the asymptomatic population of this age group, particularly in terms of differentially expressed genes.
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Arthroscopic rotator cuff (RC) repair is now considered as an effective treatment for patients with symptomatic rotator cuff tears. We reported a new method for repairing a full-thickness RC tear by using the double-row technique with transposition of the long head of biceps (LHB). The novelty of this technique is using the long head of the biceps as an augmentation. The indication of this technique consists of two aspects including LHB lesions and RC tears. Three patients were enrolled. An ideal reconstruction of the anatomic footprint of the tendon and stabilization of glenohumeral joint was achieved after the double-row technique with the transposition of the long head of biceps. At 6-month postoperation, the mean VAS score was 1.23±0.15 and the mean Constant score was 88.00±9.17. Transposition of the long head of biceps is a choice for full-thickness RC tear. LEVEL OF EVIDENCE: IV, case series.
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Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Humanos , Tendões/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Cervical sagittal imbalance compromises health-related quality of life and can lead to myriad incapacitating symptoms through compression of the spinal cord. Questions regarding which parameters play primary roles in the progression of cervical sagittal imbalance and which might be compensatory factors remain unanswered. METHODS: This study enrolled 246 asymptomatic volunteers from July 2016 to June 2018. After demographic and radiologic parameters were measured, the data were analyzed using correlation coefficient test and multiple regression analysis. A predictive equation was assessed with variance analysis, residual analysis, collinearity analysis, and a paired t test. RESULTS: Average values are as follows: orbital tilt, 64 ± 6°; orbital slope (OS), 15 ± 6°; C0-C2 lordosis (C0C2), 28 ± 8°; cervical lordosis (CL), 5 ± 11°; C2-C7 sagittal vertical axis (C2C7SVA), 15 ± 8 mm; T1 slope (TS), 17 ± 6°; thoracic inlet angle, 69 ± 8°; thoracic kyphosis, 34 ± 9°; lumbar lordosis, 50 ± 10°; sacral slope, 38 ± 7°; pelvic index, 48 ± 9°; sagittal vertical axis, 10 ± 19 mm. Correlations of C2C7SVA were observed with body mass index (BMI), OS, C0C2, CL, and TS. The validated predictive equation was: C2C7SVA = 0.38 × BMI - 0.73 × OS + 0.73 × C0C2 + 0.15 × CL + 0.18 × TS - 6.53. CONCLUSIONS: BMI, OS, C0C2, CL, and TS were primary influencers in the progression of cervical sagittal imbalance and established a predictive equation of asymptomatic population, which can provide clinical advice and remind surgeons of the primary influencers of reconstructive surgery for better prognoses.
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Vértebras Cervicais/diagnóstico por imagem , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Índice de Massa Corporal , Progressão da Doença , Feminino , Humanos , Masculino , Dados Preliminares , Análise de Regressão , Curvaturas da Coluna Vertebral/epidemiologiaRESUMO
Osteoarthritis (OA) is the most prevalent disease of knee especially in the aged people. Isofraxidin (IF) is a coumarin compound refined from traditional Chinese medicines with potential anti-inflammatory ability. This study aimed to evaluate protective anti-inflammatory effects of IF in human OA chondrocytes. The chondrocytes were isolated from OA patients and pretreated with IF before treatment with IL-1ß. The results showed that IF blocked IL-1ß-stimulated production of NO and PGE2. In addition, IF inhibited the expression of COX-2, iNOs, MMP-1, MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5, and increased the levels of aggrecan and collagen-II. Mechanistically, IF suppressed IL-1ß-induced IκB-α degradation and NF-κB activation. In conclusion, our results demonstrate that IF inhibits inflammation in OA via the regulation of NF-κB signaling, and suggest that IF may be a potential therapeutic agent for OA.
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Condrócitos/efeitos dos fármacos , Cumarínicos/farmacologia , Inflamação/prevenção & controle , Interleucina-1beta/antagonistas & inibidores , Osteoartrite/tratamento farmacológico , Proteína ADAMTS4/análise , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Colágeno Tipo II/análise , Cumarínicos/uso terapêutico , Dinoprostona/biossíntese , Humanos , Metaloproteases/genética , NF-kappa B/fisiologia , Óxido Nítrico Sintase Tipo II/genéticaRESUMO
BACKGROUND: An increasing number of studies on spinal morphology in asymptomatic Asian and Western patients have been reported. Variation in spinal anatomy among patients is considered as the cause of wrong-level surgery in up to 40% of cases. The present study examined the rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae in 293 asymptomatic Chinese adult volunteers. METHODS: From May 27, 2016, to November 11, 2017, a cohort of 325 asymptomatic Chinese adults meeting the study exclusion criteria was recruited. The radiographs were examined by a spine surgeon and a radiologist to assess the number of thoracic and lumbar vertebrae. RESULTS: In total, 293 volunteers were included in this study: 17 (5.8%) had 11 thoracic vertebrae, and 16 (5.5%) had 6 lumbar vertebrae. Among all volunteers, 12 (4.1%) had 7 cervical vertebrae (C), 11 thoracic vertebrae (T), and 5 lumbar vertebrae (L); 5 (1.7%) had 7C, 11T, and 6L; and 11 (3.8%) had 7C, 12T, and 6L. There was no difference between the findings of the spine surgeon and the radiologist. CONCLUSIONS: For the first time, this study describes the rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae in 293 asymptomatic Chinese adult volunteers. Variations in the number of thoracic and lumbar vertebrae tend to be ignored by spine surgeons. We encourage spinal surgeons and researchers to be aware of such variations when performing thoracic- and lumbar-level surgery and assessing spinal alignment and parameters.
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Doenças Assintomáticas/epidemiologia , Vértebras Lombares/anormalidades , Vértebras Lombares/diagnóstico por imagem , Vértebras Torácicas/anormalidades , Vértebras Torácicas/diagnóstico por imagem , Adulto , China/epidemiologia , Estudos de Coortes , Feminino , Voluntários Saudáveis , Humanos , MasculinoRESUMO
Intervertebral disc degeneration (IDD) is a major cause of lower back pain, but few efficacious medicines have been developed for IDD. Increased nucleus pulposus cells apoptosis is a dominant pathogenesis of IDD and is considered a therapeutic target. Previously, our group proved that autophagy may protect nucleus pulposus cells against apoptosis. As one of the major bioflavonoids of citrus, naringin activates autophagy. Therefore, we hypothesize that naringin may have therapeutic potential for IDD by activating autophagy in nucleus pulposus cells. In this study, we evaluated the effects of naringin on TBHP-induced oxidative stress in nucleus pulposus cells in vitro as well as in puncture-induced rat IDD model in vivo. Our results showed that naringin could reduce the incidence of oxidative stress-induced apoptosis in nucleus pulposus cells and promoted the expression of autophagy markers LC3-II/I and beclin-1. Meanwhile, inhibition of autophagy by 3-MA may partially reverse the anti-apoptotic effect of naringin, indicating that autophagy was involved in the protective effect of naringin in nucleus pulposus cells. Further study showed that autophagy regulation of naringin may be related to AMPK signaling. Also, we found that naringin treatment can regulate the expression of collagen II, aggrecan and Mmp13 to sustain the extracellular matrix. Furthermore, our in vivo study showed that naringin can ameliorate IDD in puncture-induced rat model. In conclusion, our study suggests that naringin can protect nucleus pulposus cells against apoptosis and ameliorate IDD in vivo, the mechanism may relate to its autophagy regulation.
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OBJECTIVE: We sought to acquire the whole sagittal spine parameters and investigated the acceptable chin-brow vertical angle (CBVA) for neutral position radiography in an asymptomatic Chinese population. METHODS: The parameters measured in 257 asymptomatic volunteers included CBVA, occipital slope, orbital tilt, occipital incidence, C0-C2 Cobb angle, C2-C7 Cobb angle, C1-C7 Cobb angle, C2-C7 sagittal vertical axis and absolute rotation angle, cervical tilt, cranial tilt, T1 slope, and thoracic kyphosis, and others. We used Pearson correlation analyses to find relationships between CBVA and other variables. The subjects were divided into 5 groups according to the CBVA percentile: group A, 0%-20% CBVA; group B, 20%-40% CBVA; group C, 40%-60% CBVA; group D, 60%-80% CBVA; and group E, 80%-100% CBVA. We used analysis of variance to analyze differences among the 5 groups. RESULTS: Orbital tilt, Occipital incidence, C1-C7 Cobb angle, C2-C7 sagittal vertical axis, and cranial tilt all increased with increasing CBVA (P < 0.001). The occipital slope, C2-C7 Cobb angle, C2-C7 absolute rotation angle, cervical tilt, T1 slope, and thoracic kyphosis decreased with decreasing CBVA (P < 0.05). No correlations between other sagittal parameters and the CBVA were found. A slight deviation was found in groups B-D, with a greater deviation in groups A, C, and E. CONCLUSIONS: An acceptable range of -1.5° to 5.8° is recommended for the CBVA for cervical radiography in the neutral position. When spinal surgeons evaluate the cervical plane, the effects of the CBVA deviation on cervical curvature must be considered.
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Queixo/anatomia & histologia , Sobrancelhas/anatomia & histologia , Radiografia/métodos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Povo Asiático , Vértebras Cervicais/diagnóstico por imagem , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To explore whether the iliac wing influences L5 pedicle screw (PS) fixation and to propose methods to reduce such influence. METHODS: A total of 100 computed tomography scans (from 50 male and 50 female patients) of the lower lumbar region and pelvis were obtained and 3-dimensionally reconstructed. Cylinders with 6.5-mm diameters were drawn to simulate the different trajectories of L5 PS. The maximum lengths and lateral angles of trajectories, and the vertical distances from the inner edge of the iliac wing to these trajectories, were measured. RESULTS: The maximum lengths and lateral angles differed significantly among trajectories; the maximum length, but not the lateral angle, differed significantly between male and female subjects. The influence of the iliac wing was more significant in male than in female subjects. The iliac wing had a greater effect on screws implanted along the pedicle axis than on screws for which the trajectories commenced at Du's entry point and passed through the center of the pedicle. CONCLUSIONS: This study elucidates the influence of the iliac wing on L5 PS fixation. Careful attention is required when implanting PSs, especially in male patients. The combined use of Du's technique and a percutaneous method for PS implantation effectively reduces the influence of the iliac wing. To minimize the complications of PS fixation further, preoperative simulation of fixation for each patient is very important.
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Ílio/anatomia & histologia , Imageamento Tridimensional , Vértebras Lombares/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Tomografia Computadorizada por Raios X , Antropometria , Feminino , Humanos , Ílio/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Caracteres SexuaisRESUMO
BACKGROUND: Surgical wound closure directly influences spinal surgical efficiency and several postoperative complications. The traditional suture technique is time-consuming and associated with greater rates of complications. Bidirectional absorbable barbed sutures seem to compensate for some of the limitations of traditional suture; however, they rarely are reported in spinal surgery. We designed a novel suture technique for use in thoracolumbar spinal surgery. METHODS: The data of 189 patients with traumatic thoracolumbar fractures were analyzed between bidirectional barbed suture closure and traditional interrupted suture closure. Data of operative time, wound closure time, length of incision, intraoperative blood loss, complications of wound dehiscence and postoperative hematoma, cost, and neurologic status were collected. RESULTS: No significant differences were observed in the baseline demographics of included patients. Compared with the traditional suturing group, the barbed sutures decreased the mean operative time (P = 0.037), suture time (P < 0.01), and mean suturing time (P < 0.01) significantly, although no statistically significant differences were found in blood loss (P = 0.724) and neurologic functional scores (preoperative: P = 0.901; 3 months after surgery: P = 0.208; final follow-up assessments: P = 0.163), and no statistically significant differences were found in rates of postoperative infection, hematoma, and wound dehiscence. CONCLUSIONS: Our findings suggest that the novel knotless barbed suture has comparable strength to traditional sutures, with the advantage of less suturing time. It is an efficient, safe technique, and alternative choice for patients with thoracolumbar fracture after posterior surgery.
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Vértebras Lombares/cirurgia , Duração da Cirurgia , Fraturas da Coluna Vertebral/cirurgia , Técnicas de Sutura/tendências , Vértebras Torácicas/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Técnicas de Sutura/normas , Vértebras Torácicas/lesõesRESUMO
OBJECTIVES: To investigate the effect of sequential ligament failure on the range of motion (ROM) and location of the instantaneous axes of rotation (IAR) of the thoracolumbar spine (T12-L1) finite element (FE) model, and to verify the role of the supraspinous ligament (SSL) in maintaining the stability of the injured thoracolumbar spine. METHODS: An FE model of the fractured thoracolumbar spine was developed and validated against published data. The posterior ligamentous complex (PLC) in the fractured T12-L1 segment was then reduced in a sequential manner from the facet capsular ligament (FCL), part of the interspinous ligament (ISL), SSL, and entire ISL, to the ligamentum flavum (LF). The ROM and IAR of the T12-L1 segment were measured at the fracture and at each reduced ligament step under 4 directions of flexion, extension, lateral bending, and rotation, and 4 bending motions of 1.5, 3.0, 4.5, 6.0 Nm. RESULTS: The FE model showed a consistent increase in the ROM and location of the IAR as the ligaments were removed sequentially. Furthermore, failure of the SSL had the most significant influence on the change in the ROM and IAR in flexion. In extension, removal of the FCL caused the largest shift. CONCLUSIONS: The SSL is a significant ligament that allows the PLC to maintain the stability of the thoracolumbar spine during injury.