[Percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of spinal metastases].

OBJECTIVE: To investigate the effectiveness of percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of patients with spinal metastases. METHODS: In the study, 12 patients of spinal metastases treated with percutaneous pedicle screw fixation combined expandable tubular retractor in our hospital were retrospectively reviewed between June 2017 and October 2019. Among the 12 patients, 9 were males and 3 were females; the median age was 62.5 years [(65.1±2.9) years]. The decompression segment of 7 patients was located at the lower thoracic spine (including 1 patient with incomplete paraplegia) and the decompression segment of 5 patients was located at the lumbar spine; Tomita score was 6.0±0.6. Perioperative data of the patients were reviewed. Visual analog scale (VAS score), Karnofsky score, and Eastern Cooperative Oncology Group (ECOG) score were compared before and after surgery. The patient's survival, adjuvant treatment, and internal fixation failure were observed in the follow-up period. RESULTS: All the 12 patients had a successful operation with percuta-neous pedicle screw fixation combined expandable tubular retractor. The average operative time, blood loss, and blood transfused of the patients were (247.0±14.6) min, (804.2±222.3) mL and (500.0±100.0) mL, respectively. The average amount of drainage was (240.8±79.3) mL. Drainage tubes were pulled out early postoperative [(3.2±0.3) d], allowing early mobilization. The patients discharged (7.8±0.8) d postoperative. All the patients were followed up for 6-30 months, and the average overall survival time was (13.6±2.4) months. During the follow-up period, 2 patients experienced screw displacement, the internal fixation was stable after conservative treatment and no revision surgery was performed. The VAS of the patients was 7.1±0.2 before surgery, which decreased to 2.3±0.1 and 2.8±0.4 at 3 and 6 months after surgery (P < 0.05). The Karnofsky score of the patients was 59.2±1.9 before surgery, which increased to 75.0±1.9 and 74.2±3.1 at 3 and 6 months after surgery (P < 0.05). The ECOG of the patients was 2.3±0.2 before surgery, which decreased to 1.7±0.1 and 1.7±0.2 at 3 and 6 months after surgery (P < 0.05). CONCLUSION: For selected patients with spinal metastases, minimally invasive surgical treatment of spinal metastases (percutaneous pedicle screw internal fixation combined with expandable tubular retractor) can effectively relieve the clinical symptoms and improve the quality of life, with satisfactory clinical outcome.

HOXA10 promotes the development of bladder cancer through regulating FOSL1.

OBJECTIVE: This study was aimed to investigate the expression characteristics of HOXA10 in bladder cancer (BCa), and to further study whether it can promote the development of BCa via regulating FOSL1. PATIENTS AND METHODS: The expression of HOXA10 was examined by quantitative Real Time-PCR (qRT-PCR) in 37 pairs of tumor tissue and paracancerous specimens of BCa patients; meanwhile, in BCa cell lines, the expression of HOXA10 was also verified using qRT-PCR. Subsequently, after HOXA10 knockdown model was constructed in BCa cell lines (EJ and J82) using lentivirus transfection, transwell, as well as wound healing assays, were performed to analyze the influence of the downregulation of HOXA10 on the biological function of BCa cells. Finally, Luciferase reporting assay and cell reverse experiment were applied to explore the specific interaction between HOXA10 and FOSL1. RESULTS: The results of qRT-PCR indicated that the expression level of HOXA10 in BCa tissue samples was remarkably higher than that in adjacent normal ones, with a statistically significant difference. At the same time, the overall survival rate of patients with high expression of HOXA10 was found to be lower than those with low expression. Meanwhile, compared with cells in sh-NC group, the metastasis ability of BCa cells in sh-HOXA10 group was remarkably weakened. In addition, it was found that the levels of FOSL1 and HOXA10 were negatively correlated in BCa tissues. The result of the Luciferase reporter gene assay revealed that HOXA10 could be targeted by FOSL1 through certain binding sites between them. In addition, HOXA10 was found to be capable of further regulating the malignant progression of BCa by modulating FOSL1. CONCLUSIONS: HOXA10 expression is remarkably elevated in BCa tissues and cell lines, which is closely relevant to the poor prognosis of BCa patients. In addition, HOXA10 may be able to accelerate BCa metastasis via modulating FOSL1 expression.

[Analysis of influencing factors for pathogen culture result in patients with pyogenic spondylitis].

OBJECTIVE: To investigate the effect of clinical factors on the pathogen culture results in the patients with pyogenic spondylitis, and to find out clinical controllable factors which could increase the positive rate of the pathogen culture. METHODS: A retrospective study reviewed 40 patients who were diagnosed with pyogenic spondylitis in Peking University First Hospital from January 2011 to July 2017. The patients were divided into two groups depending on the culture results, culture negative or culture positive. The influence of clinical uncontrollable factors [the patient's age, gender, predisposing factors, infection site except spine, visual analogue score (VAS), course of disease, spinal segment, white blood cell (WBC), (neutrophilic granulocyte)% (NE%), the incidence of systemic inflammatory response syndrome (SIRS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the incidence of paravertebral abscess] and controllable factors (prior antibiotics exposure within 2 weeks, tissue homogenate, surgical approach) on pathogen culture results were analyzed. RESULTS: Of the 40 patients, 18 patients were female and 22 patients were male. Causative germ was identified in 24/40 patients (60.00%) and dominant by gram positive cocci (68.00%). For clinical uncontrollable factors, there was no significant difference between the two groups in the patient's age, gender, predisposing factors, infection site except spine, VAS, course of disease, spinal segment, WBC, NE% and the incidence of SIRS. ESR [(94.38±6.91) mm/h, P=0.023)], CRP [(64.74±13.51) mg/L, P=0.040], and the incidence of paravertebral abscess (75%, P=0.018) in culture negative group were lower in contrast to culture positive group. For clinical controllable factors, prior antibiotics exposure within 2 weeks (P=0.058, OR=4.030, 95%CI: 0.956-16.993) and tissue homogenate (P=0.014, OR=0.171, 95%CI: 0.042-0.695) were significantly associated with the pathogen culture result. Surgical approach was not significantly associated with pathogen culture result. CONCLUSION: Patients with high level of ESR, CRP, and paravertebral abscess, would have high positive rate of pathogenic culture. Prior antibiotics exposure was associated with lower positive pathogen culture rate. Culture with tissue homogenate was more likely to find the causative germ, especially for patients without paravertebral abscess who had low level of ESR, CRP and prior antibiotics exposure.

[Perioperative clinical characteristics of patients with pathological fracture of proximal femur].

OBJECTIVE: To investigate the perioperative clinical characteristics of patients with pathological fracture of proximal femur. METHODS: A retrospective study reviewed 28 patients who received proximal resection and tumor hemiarthroplasty for malignant proximal femoral tumor in Peking University First Hospital from January 2011 to February 2017. According to the fracture, the patients were divided into two groups: pathological fracture group and non-pathological fracture group. We investigated the clinical characteristics during perioperative period between the two groups. RESULTS: Of the 28 patients, 14 (50.0%) patients suffered pathological fracture, and there was no significant difference between the two groups in the patient's age, gender, limb involvement, and tumor source (P>0.05). There was no significant difference between the two groups in hemoglobin (HGB), hematocrit (Hct), and lower extremity thrombosis. The albumin (ALB) of pathological fracture group were lower in contrast to non-pathological fracture group (P=0.031). There was no significant difference between the two groups in decline of HGB and Hct on postoperation day 1, operative time, bleeding during operation, time for walking with help of ambulation aid postoperative, and postoperative hospital stay (P>0.05). On post-operation day 7, HGB (P=0.025) and Hct (P=0.039) of pathological fracture group were significant lower in contrast to non-pathological fracture group. Whereas, the total blood loss calculated by Gross equation of pathological fracture group was significant higher in contrast to non-pathological fracture group [(2 066.3±419.8) mL vs. (786.0±152.6) mL, P=0.039]. The patient needed blood transfusion during operation (7/14 vs. 1/14, P=0.033) and postoperative (8/14 vs. 1/14, P=0.013) in pathological fracture group were more than in non-pathological fracture group. At last, Barthel daily life ability score (P=0.009) of pathological fracture group was lower in contrast to non-pathological fracture group, and visual analogue scale (VAS) score was higher (P<0.001). They were almost equal when the patients were discharged (P>0.05). CONCLUSION: Patients with pathological fracture had lower ALB during perioperative period. Pathological fracture had no effect on operative time, bleeding during operation and function outcomes. However, the patients with pathological fracture had more total blood loss and lower HGB, Hct in contrast to the patients without pathological fracture. Blood transfusion was more needed in pathological fracture patients.

FBXO17 promotes malignant progression of hepatocellular carcinoma by activating wnt/ß-catenin pathway.

OBJECTIVE: This study was to investigate the expression of FBXO17 in hepatocellular carcinoma (HCC) and its relationship with clinical HCC features and patient prognosis. PATIENTS AND METHODS: The expression of FBXO17 at mRNA level and protein level in tumor tissues and paracancerous tissues of 45 patients with HCC was respectively detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) and Western blot. Besides, FBXO17 expression and its pathological characteristics of HCC, as well as the prognosis of patients, were also analyzed. Then, the expression level of FBXO17 in HCC cell lines was further verified using qRT-PCR assay. In addition, FBXO17 overexpression and knockdown models were constructed using lentivirus in HCC cell lines including Bel-7402 and HepG2. Cell counting kit-8 (CCK-8), 5-Ethynyl-2'-deoxyuridine (EDU), cell clone experiment, flow cytometry, and transwell assay were used to explore the effect of FBXO17 on the biological function of HCC cells. Finally, whether FBXO17 could exert its biological characteristics through wnt/ß-catenin pathway was determined. RESULTS: Results showed that FBXO17 expression in tumor tissues of HCC patients was markedly higher than that in adjacent tissues. Meanwhile, compared with patients with low FBXO17 expression, the pathological grade was higher and the overall survival rate was lower in patients with high expressed FBXO17. In vitro experiments showed that the cell proliferation and metastasis ability in the Anti-FBXO17 group was markedly decreased, and the apoptosis was significantly enhanced compared with the NC group. In contrast, overexpression of FBXO17 markedly increased cell proliferation and metastasis ability while decreased cell apoptosis. Finally, Western blot results indicated that silencing FBXO17 might function through downregulating the expression of proteins in wnt/ß-catenin pathway such as c-Myc, MMP-9, and MMP-2 while upregulating GSK-3ß level, thereby promoting the malignant progression of HCC. CONCLUSIONS: FBXO17 was significantly increased in tumor tissues of HCC patients, which was significantly associated with pathological stage and poor prognosis of these patients. In addition, FBXO17 might promote the malignant progression of HCC by inhibiting wnt/ß-catenin pathway.

[Measurement of the tibial alignment after total knee replacement without the extramedullary cutting guide].

OBJECTIVE: To evaluate the accuracy and analysis of the influencing factors of the tibia prosthetic coronal alignment after total knee arthroplasty without tibia extramedullary cutting guide. METHODS: In the study, 76 patients (96 knees) who had primary total knee arthroplasty in Peking University First Hospital from February 2012 to April 2016 were selected retrospectively. All of the cases were performed by the same experienced orthopedic surgeon team. The patients were divided into 2 groups randomly: tibia cutting without guide group and tibia cutting with extramedullary guide group. Lower extremity standard anterior and posterior X-ray films of the knees were taken before and after surgery, and the anatomical tibial angle (AT), the posterior slope angle (PSA) before and after surgery, the tibia component angle (TCA) were measured in the X-ray films. We also recorded the beginning and finishing time of the operation, the operation sequence of the day respectively at the same time. The data were analyzed by correlation analysis, t test and chi square test between the two groups. RESULTS: The age, gender, body mass index, AT/PSA before the surgery and TCA/PSA after the surgery of the two groups were no significant differences (P>0.05). The rate of 90-TCA≥ 3° was 31.5% (17 knees) and 31% (12 knees) respectively, there were no significant differences (P=0.956) between the two groups. The postoperative TCA of two groups was not correlated with age, gender, body mass index (BMI), operation side (P>0.05), there was also no correlation between the postoperative TCA and the start time of the operation, the whole operation time, and the operation sequence of the day (P>0.05). The two groups were divided into subgroups according to 90-AT before the operation (0°≤90-AT<3°, 3°≤90-AT<5°, 5°≤90-AT<8°, 90-AT≥8°), and there was no difference among them. But we found there was a much higher rate of 90-TCA<3° in the group without cutting guide than the group with extramedullary guide when 90-AT≥8° before the surgery (the rates were 71.4 % and 42.9%, P<0.05). CONCLUSION: There is no significant difference of the tibia prosthetic coronal alignment accuracy between the tibia cutting without guide and the traditional extramedullary guided bone cutting by experienced surgeons. Only if when patients already have suffered severe malformation of knee joint (90-AT≥8°) before the operation, tibia cutting without cutting guide is more effective to rectify the tibia prosthetic coronal alignment.

[Clinical characteristics and prognosis of cultured negative pyogenic spondylitis].

OBJECTIVE: There are limited data describing the clinical characteristics and prognosis of culture negative pyogenic spondylitis. The aim of this study was to investigate the treatment, prognosis and clinical characteristics of culture negative pyogenic spondylitis. METHODS: A retrospective study reviewed 74 patients who were diagnosed with spondylitis in Peking University First Hospital from January 2010 to December 2015. A total of 27 patients suffered from pyogenic spondylitis. According to the pathogenic culture results, the patients were divided into two groups: culture negative group and culture positive group. The clinical characteristics and treatment outcomes between the two groups were compared. RESULTS: The elder were more vulnerable to pyogenic spondylitis, and of the 27 patients, 12 patients were female and 15 male. All patients had no history of administration of antibiotics prior to obtaining culture samples. A causative germ was identified in 14/27 patients (51.9%) with Staphylococcus aureus being the most common pathogen. There was no significant difference between the two groups in the patient's age, gender, visual analogue score (VAS), predisposing factor, clinical symptom, sign and spinal segment (P>0.05). Erythrocyte sedimentation rate (ESR) (P=0.056) and C-reactive protein (CRP) (P=0.040) of culture negative group were lower in contrast to culture positive group. The incidence of vertebral abscess in culture negative group was higher than in culture positive group (P=0.046). After treatment, ESR dropped almost equally in both groups, and CRP dropped faster in the culture positive group (P=0.192). At last, there was no significant difference between the two groups in hospital stay, pain relief, open debridement operation rate, and recurrence rate of infection. CONCLUSION: ESR and CRP of the culture negative patient were lower than those of the culture positive patient, and the incidence rate of paravertebral abscess was higher than that of the culture positive patient. After administration of antibiotics, there was no significant difference between the two groups in duration of antibiotics, open debridement operation rate and recurrence rate of infection. So, culture negative may not necessarily be a negative prognostic factor for pyogenic spondylitis. However, we should watch out for the drug resistant bacteria or double infection, due to the long term use of wide-spectrum antibiotic in culture negative patients.

Intra-articular injection of Torin 1 reduces degeneration of articular cartilage in a rabbit osteoarthritis model.

OBJECTIVES: Recent studies have shown that systemic injection of rapamycin can prevent the development of osteoarthritis (OA)-like changes in human chondrocytes and reduce the severity of experimental OA. However, the systemic injection of rapamycin leads to many side effects. The purpose of this study was to determine the effects of intra-articular injection of Torin 1, which as a specific inhibitor of mTOR which can cause induction of autophagy, is similar to rapamycin, on articular cartilage degeneration in a rabbit osteoarthritis model and to investigate the mechanism of Torin 1's effects on experimental OA. METHODS: Collagenase (type II) was injected twice into both knees of three-month-old rabbits to induce OA, combined with two intra-articular injections of Torin 1 (400 nM). Degeneration of articular cartilage was evaluated by histology using the Mankin scoring system at eight weeks after injection. Chondrocyte degeneration and autophagosomes were observed by transmission electron microscopy. Matrix metallopeptidase-13 (MMP-13) and vascular endothelial growth factor (VEGF) expression were analysed by quantitative RT-PCR (qPCR).Beclin-1 and light chain 3 (LC3) expression were examined by Western blotting. RESULTS: Intra-articular injection of Torin 1 significantly reduced degeneration of the articular cartilage after induction of OA. Autophagosomes andBeclin-1 and LC3 expression were increased in the chondrocytes from Torin 1-treated rabbits. Torin 1 treatment also reduced MMP-13 and VEGF expression at eight weeks after collagenase injection. CONCLUSION: Our results demonstrate that intra-articular injection of Torin 1 reduces degeneration of articular cartilage in collagenase-induced OA, at least partially by autophagy activation, suggesting a novel therapeutic approach for preventing cartilage degeneration and treating OA.Cite this article: N-T. Cheng, A. Guo, Y-P. Cui. Intra-articular injection of Torin 1 reduces degeneration of articular cartilage in a rabbit osteoarthritis model. Bone Joint Res 2016;5:218-224. DOI: 10.1302/2046-3758.56.BJR-2015-0001.

[Hydrogen sulfide in cartilage and its inhibitory effect on matrix metalloproteinase 13 expression in chondrocytes induced by interlukin-1ß].

OBJECTIVE: To investigate whether endogenous hydrogen sulfide (H2S) was involved in the pathogenesis of osteoarthritis (OA) and its underlying mechanism, to detect H2S and its synthases expression in knee cartilage in patients diagnosed with different severity of OA, and to explore the transcription and expression of gene MMP-13 in chondrocytes treated with IL-1ß or H2S. METHODS: Synovial fluids of the in-patients with different severity of OA hospitalized in Peking University First Hospital were collected for measurement of H2S content using methylene blue assay. Articular cartilages of the patients who underwent knee arthroplasty were collected for the cell culture of relatively normal chondrocytes. The chondrocytes were cultured to the P3 generation and H2S molecular probes were used for detection of endogenous H2S generation in the chondrocytes. Immunocytochemistry was used to detect the localization of H2S synthases including cystathionine ß-synthase (CBS), cystathionine-γ-lyase (CSE), and mercaptopyruvate sulfurtransferase (MPST) in OA chondrocytes. Western blot was used to quantify the protein expressions of CSE, MPST, and CBS in cartilage tissues of the patients who were diagnosed with OA and underwent knee arthroplasty. The relatively normal human chondrocytes were cultured to passage 3 and then divided into 4 groups for different treatments: (1)the normal control group, no reagent was added; (2)the IL-1ß group, 5 µg/L of IL-1ß was added; (3)the IL-1ß+H2S group, 200 µmol/L of NaHS was added 30 min before adding 5 µg/L of IL-1ß;(4)the H2S group, 200 µmol/L of NaHS was added. The transcription and expression of gene MMP-13 in chondrocytes of each group were determined with Real-time PCR and Western blot, respectively. And the total NF-κB p65 and phosphorylated NF-κB p65 in chondrocytes were detected with Western blot. RESULTS: The content of H2S in the synovial fluid of degenerative knee was (14.3±3.3) µmol/L. Expressions of endogenous H2S and its synthases including CBS, CSE and MPST were present in the cytoplasm of chondrocytes.CSE protein expression in Grade 3 (defined by outerbridge grading) cartilage tissues was significantly increased as compared with that of Grade 1 cartilage tissues (1.67±0.09 vs. 1.26±0.11, P< 0.05). However, no significant difference of CBS or MPST expression among the different groups was observed. The expression of MMP-13 protein in the IL-1ßgroup was significantly higher than that in the normal chondrocytes (1.87±0.67 vs. 0.22±0.10, P<0.05), and that in the IL-1ß+H2S group was significantly decreased than that in the IL-1ß group (0.55±0.11 vs. 1.87±0.67, P< 0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The transcription of MMP-13 protein in the IL-1ß group was significantly higher than that in the normal chondrocytes (31.40±0.31 vs. 1.00±0.00, P<0.05), and that in the IL-1ß+H2S group was significantly decreased than that in the IL-1ß group (24.41±1.28 vs. 31.40±0.31, P<0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The total NF-κB p65 in the IL-1ß group was significantly higher than that in the normal chondrocytes (2.13±0.08 vs. 0.73±0.08, P< 0.05), and that in the IL-1ß+H2S group was significantly decreased than that in the IL-1ß group (1.24±0.13 vs. 2.13±0.08, P<0.05), and that in the H2S group had no significant difference compared with that in the normal control group. The phosphorylated NF-κB p65 in IL-1ß group was significantly higher than that in the normal chondrocytes (1.30±0.13 vs. 0.19±0.04, P<0.05), and that in IL-1ß+H2S group was significantly decreased than that in the IL-1ß group (0.92±0.26 vs. 1.30±0.13, P<0.05), and that in the H2S group had no significant difference compared with that in the normal control group. CONCLUSION: H2S affected the cartilage degeneration by partly inhibiting the degradation of extracellular matrix.

[Bone marrow mesenchymal stem cells in Sprague-Dawley rat model of osteoarthritis].

OBJECTIVE: To investigate the efficacy of single time intra-articular different concentration of allogeneic bone marrow mesenchymal stem cells (BM-MSCs) injection in the treatment of Sprague-Dawley (SD) rat model of osteoarthritis (OA). METHODS: In the study, 32 SD rats were equally randomized into 4 groups: control group, high concentration group (1×10(7)/mL BM-MSCs), low concentration group (5×10(6)/mL BM-MSCs) and high vs. low concentration group. The two knees of each rat were set up to a pair. The induction of OA was performed surgically randomly at one side in model group, and bilaterally in the other groups, which were through anterior cruciate ligament transaction (ACLT) and medial meniscus excising. After the operation, the SD rats were allowed free movement. Four weeks later, different concentrations of allogeneic BM-MSCs isolated from the SD rats, expanded in vitro and suspended in phosphate buffered solution (PBS) were delivered in the articular cavity of both knees; PBS was used as the control. After injection, we excised the femoral nerve and sciatic nerve to disuse the low limb. The cartilage histological sections of knees were scored by Mankin scoring system to assess the severity of the pathology. mRNA of collagen II was detected by real time polymerase chain reaction (RT-PCR). eGFP was detected by fluorescence microscope. Assessments were carried out 4 weeks after the operation in model group, and 3 weeks after injection in the other groups. RESULTS: Mankin scores of the BM-MSCs side and control side were 6.60±0.40 vs. 10.00±0.32 in low concentration group (P<0.05), and 5.40±0.51 vs. 9.60 ±0.51 in high concentration group (P<0.05). Mankin scores of high vs. low concentration group were 6.40±0.51 vs. 7.60±0.75 (P>0.05). mRNA expression of collagen II of the BM-MSCs side in low concentration group was 106%±1% in contrast to the control side. As in high concentration group it was 108%±1%, and 102%±1% in high vs. low concentration group. Labeled BM-MSCs were detected unexpectedly in the synovial membrane but not in cartilage tissue three weeks from injection. CONCLUSION: BM-MSCs could promote cartilage repair and inhibit OA progression through a trophic mechanism. There was no difference between the two concentrations.

The PPI network and cluster ONE analysis to explain the mechanism of bladder cancer.

BACKGROUND: Bladder cancer is a common cancer worldwide whose incidence continues to increase. It is estimated that there are 261,000 cases of bladder cancer resulting in 115,000 deaths worldwide. AIM: Although some studies can be initiated using small local tissue collections, high quality collection of fresh tissues from new clinical trials will be crucial for proper evaluation of associations with clinical outcome. For superficial bladder cancer, identification of tumors that will progress has long been perceived as a potential application of genetic studies. MATERIALS AND METHODS: In our study, we constructed the Protein-Protein Interactions (PPI) network using the Cytoscape and detected some network modeling clusters. In addition, we enriched GO categories among these genes in the first cluster and detected a pathway i.e. Spliceosome (hsa03040). Most Gene Ontology (GO) categories and Spliceosome were closely to RNA splicing and cellular macromolecular complex (CMC) assembly, which indicates that the mutation of RNA splicing and CMC assembly maybe important factors causing bladder cancer. RESULTS: In our study, these clusters of GO:0034622, GO:0006397 and GO:0034621 in bladder cancer belong to cellular macromolecular complex assembly, which may play an important role in the occurrence of cancer cells. CONCLUSIONS: It is a great significance for the detection and treatment of bladder cancer to understand the mechanism of RNA splicing and CMC assembly.