Biportal endoscopic transforaminal lumbar interbody fusion with large cage: a technique without additional spacer portal.

BACKGROUND: Large spacers offer numerous advantages such as higher fusion rates and lower subsidence rates. However, due to the anatomical constraints of the approach, the use of large spacers in biportal endoscopic transforaminal lumbar interbody fusion(BE-TLIF) necessitates an additional incision and special instruments for spacer implantation leading to less frequent use. METHODS: This study has refined several techniques within BE-TLIF. We insert the cage and impact the cage transverse with a special design instrument in the same working portal. This allows for the use of large spacers during BE-TLIF procedures without the need for an auxiliary cage-inserting incision. CONCLUSION: The technique is a straightforward, safe, and minimally invasive method for inserting large cages in the treatment of lumbar instability.

The biportal endoscopic posterior open-door laminoplasty with the use of mini-plate for cervical spondylotic myelopathy: Case report and literature review.

INTRODUCTION: Biportal endoscopy, a newly developed technique rapidly applied in lumbar spine surgery, has recently been utilized for treating cervical spine diseases. We present a case of cervical spondylotic myelopathy managed with open-door laminoplasty fixed by mini-plate and performed with biportal endoscopy assistance. PRESENTATION OF CASE: The patient, a 62-year-old woman, presented with gradually developing weakness in the lower extremities. CT and MR images showed cervical stenosis at C4-5 and C5-6. We performed a posterior open-door laminoplasty using biportal endoscopy assisted by a mini-plate. After completing the gutters on both sides of the hinge and open-door, we detached the spinous process from the lamina through endoscopic-guided burr grinding. The skin incisions of the portals on the open-door side were connected for direct fixation of the elevated lamina with a mini-plate. There was improvement in ambulatory capacity for the patient along with radiological evidence of decompressed cervical canal. DISCUSSION: Endoscopic technology is increasingly employed in spinal surgery, with several studies documenting the utilization of biportal endoscopic techniques to facilitate open-door laminoplasty procedures for managing myelopathic cervical spondylosis. The procedures we report allow for safer and more efficient placement of the mini-plate that prevents door re-closing. CONCLUSIONS: The potential applications of biportal endoscopic technology in open-door cervical spine surgery are worth considering, given the soft tissue damage caused by traditional posterior cervical spine surgery. However, the safety and effectiveness of this method still require more studies with a larger number of cases and longer follow-up to be substantiated.

Neutrophil extracellular traps promote immune escape in hepatocellular carcinoma by up-regulating CD73 through Notch2.

Immune escape is the main reason that immunotherapy is ineffective in hepatocellular carcinoma (HCC). Here, this study illustrates a pathway mediated by neutrophil extracellular traps (NETs) that can promote immune escape of HCC. Mechanistically, we demonstrated that NETs up-regulated CD73 expression through activating Notch2 mediated nuclear factor kappa B (NF-κB) pathway, promoting regulatory T cells (Tregs) infiltration to mediate immune escape of HCC. In addition, we found the similar results in mouse HCC models by hydrodynamic plasmid transfection. The treatment of deoxyribonuclease I (DNase I) could inhibit the action of NETs and improve the therapeutic effect of anti-programmed cell death protein 1 (PD-1). In summary, our results revealed that targeting of NETs was a promising treatment to improve the therapeutic effect of anti-PD-1.

A novel repair strategy using knotless squeeze anchors for lumbar disc herniation with endplate junction lesions under biportal endoscopic spinal surgery.

BACKGROUND: Annulus fibrosus-endplate (AF-EP) junction lesions are important determinants for lumbar disc herniation (LDH). Utilizing biportal endoscopic spinal surgery (BESS), we introduce a novel repair method using bioabsorbable PushLock anchors with suture fibers to stretch disconnected AF tissues to the vertebral cortex. METHODS: The viewing and working portals are established to excise herniated disc materials causing radiculopathy. Through the working portal, a suture strand is passed through the intact AF tissue near the lesion and retrieved using the Suture Crossing Device. Then, the knotless suture limbs are secured into the cortical bone socket of the vertebral body with a PushLock anchor. CONCLUSION: The procedure is a simple, safe, and feasible knotless suturing technique for the treatment of LDH with AF-EP junction lesions.

Comparison of Intraoperative Endplate Injury between Mini-Open Lateral Lumbar Interbody Fusion (LLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) and Analysis of Risk Factors: A Retrospective Study.

OBJECTIVE: The study aimed to compare the incidence of intraoperative endplate injury in patients who underwent Transforaminal interbody fusion (TLIF) and mini-open lumbar interbody fusion (LLIF) surgery. The independent risk factors related to endplate injury in LLIF procedure were analyzed. METHODS: A total of 199 patients who underwent LLIF (n = 106) or TLIF (n = 93) surgery from June 2019 to September 2021 were reviewed. The endplate injury was assessed by postoperative sagittal CT scan. A binary logistic analysis model were used to identify independent risk factors related to LLIF endplate injury based on univariate analysis. RESULTS: There was an obvious difference in the occurrence of intraoperative endplate injury between LLIF (42/106, 39.6%) and TLIF group (26/93, 28%), although it did not reach the significant level. L1 CT value (OR = 0.985, 95% CI = 0.972-0.998), cage position (OR = 3.881, 95% CI = 1.398-10.771) and height variance (OR = 1.263, 95% CI = 1.013-1.575) were independent risk factors for endplate injury in LLIF procedure. According to the cage settlement patterns, there 5 types of A to E. The severity of the facet joint degeneration was positively related to the occurrence of endplate injury. CONCLUSIONS: The incidence of intraoperative endplate injury is higher in LLIF than in TLIF procedures. Low bone quantity, cage posterior position and larger height variance are risk factors to induce endplate injury in LLIF surgery. The facet joint degeneration may be related to severe endplate injuries and even fractures.

Effect of miRNA-146a-mediated TLR4 Signal Pathway on the Pain of Lumbar Disc Herniation.

The current experiment was carried out to explore the effect of the miR-146a-mediated TLR4 signaling pathway on the lumbar disc herniation pains. For this aim, a total of 32 rats were divided randomly into 4 groups - the blank group (Group C), Model group (M), miR-146a overexpression group (agomiR-146a group) and negative control group (NC group), with 8 rats in each group. Rats in Group M were prepared for the construction of lumbar disc herniation models, while those in the agomiR-146a group or NC group, in addition to the model construction, would receive the intrathecal injection of agomiR-146a or agomiRNA-146a NC. Thereafter, a series of tests were performed for rats, including the mechanical pain test and heat pain test to measure the pain threshold, RT-PCR to detect the expression of miR-146a, and the transcription of TLR4, IRAK1, TRAF6, IL-6 and TNF-α, Western blot to determine the expression of IRAK1 and TRAF6 and ELISA to determine the expression of IL-6 and TNF-α. Results showed that as compared to the blank group, rats in Group M were more sensitive to the pains, presenting with declines in the thresholds in the pain, and upregulation in the TRL4 signaling pathway (TLR4, IRAK1 and TRAF6) and pro-inflammatory factors, including IL-6 and TNF-α. In comparison with Group M, intrathecal injection of agomiR-146a relieved the pains, with significant upregulation of miR-146a and downregulation of TLR4, IRAK1, TRAF6, IL-6 and TNF-α. Then upregulation of miR-146a could reduce the activity of the TLR4 signaling pathway and the release of pro-inflammatory factors, which may be a potential strategy for the treatment of lumbar disc herniation.

A Double-Layered Belief Rule Base Model for Driving Anger Detection Using Human, Vehicle, and Environment Characteristics: A Naturalistic Experimental Study.

"Road rage," namely, driving anger, has been becoming increasingly common in auto era. As "road rage" has serious negative impact on road safety, it has attracted great concern to relevant scholar, practitioner, and governor. This study aims to propose a model to effectively and efficiently detect driving anger states with different intensities for taking targeted intervening measures in intelligent connected vehicles. Forty-two private car drivers were enrolled to conduct naturalistic experiments on a predetermined and busy route in Wuhan, China, where drivers' anger can be induced by various incentive events like weaving/cutting in line, jaywalking, and traffic congestion. Then, a data-driven model based on double-layered belief rule base is proposed according to the accumulation of the naturalistic experiments data. The proposed model can be used to effectively detect different driving anger states as a function of driver characteristics, vehicle motion, and driving environments. The study results indicate that average accuracy of the proposed model is 82.52% for all four-intensity driving anger states (none, low, medium, and high), which is 1.15%, 1.52%, 3.53%, 5.75%, and 7.42%, higher than C4.5, BPNN, NBC, SVM, and kNN, respectively. Moreover, the runtime ratio of the proposed model is superior to that of those models except for C4.5. Hence, the proposed model can be implemented in connected intelligent vehicle for detecting driving anger states in real time.

"Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report.

Background: Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL. Methods: A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated. Results: Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%. Conclusion: UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.

PEGDA/HA mineralized hydrogel loaded with Exendin4 promotes bone regeneration in rat models with bone defects by inducing osteogenesis.

Scaffolds with osteogenic differentiation function play an important role in the healing process of bone defects. Here, we designed a high strength Poly(ethyleneglycol) diacrylate/Hydroxyapatite (PEGDA/HA) mineralized hydrogel loaded with Exendin4 for inducing osteogenic differentiation. In this study, PEGDA hydrogel was prepared by photo initiating method. PEGDA/HA mineralized hydrogel was prepared by in-situ precipitation method, and Exendin4 was loaded by gel adsorption. The effects of different calcium and phosphorus concentrations on the strength and Exendin4 release of PEGDA/HA hydrogels were investigated. Rat models of bone defect were made and randomly divided into 5 groups. The experimental group was implanted with PEGDA hydrogel, Exendin4-PEGDA hydrogel, PEGDA/HA mineralized hydrogel, Exendin4-PEGDA/HA mineralized hydrogel, and no materials were implanted in the blank control group. Computed tomography (CT) and histology were observed 4 and 8 weeks after operation. Our results revealed that the PEGDA/HA mineralized hydrogel had porous structure, high mechanical strength and good biocompatibility. In vitro release test showed that the mineralized hydrogel exhibited good sustained release profile within 20 d. The animal experiments showed that the mineralized hydrogel accelerated the formation of new bone after 4 and 8 weeks, and formed a seamless union on the defected bone area after 8 weeks. In conclusions, The Exendin4-PEGDA/HA mineralized hydrogel can effectively repair bone defects in rats, and it is expected to be used as a biomaterial for human bone tissue repair.

Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review.

Traumatic incarceration of the small bowel accompanied by vertebral fractures and dislocation is rare and usually misdiagnosed until laparotomy. This report presents a rare case of jejunum entrapment between lumbar spine fractures. A 43-year-old man was clamped between two railway tracks on the upper abdomen and lower back. Following ineffective conservative treatment, he underwent a laparotomy due to the development of guarding and rebound tenderness. Loss of vitality of the jejunal loop, which was incarcerated between the L3 and L4 vertebrae, was observed. The necrotic bowel was removed and end-to-end anastomosis was performed. When his condition was stable, anterior and posterior lumbar fixation surgery was performed. The patient had no abdominal complications and lower limb nerve function deficiency during the follow-up period. A review of the literature since 1979 on incarceration of the bowel associated with lumbar fracture and dislocation identified 12 cases: five patients showed persistent neurological symptoms, but none of the patients died as a result of their injuries. It should be borne in mind that patients with hyperextension or flexion-distraction injury of the lumbar spine could show symptoms of intestinal obstruction and bowel incarceration. Enhanced computed tomography or magnetic resonance imaging will be helpful for diagnosis.

[Differentially expressed genes in asthenospermia: a bioinformatics-based study].

OBJECTIVE: To study the differentially expressed genes in asthenospermia to gain a deeper insight into the molecular mechanisms of the disease. METHODS: We analyzed the differentially expressed genes in asthenospermia using GATHER, PANTHER and ToppGene online bioinformatics tools. RESULTS: Our bioinformatics mining and analyses revealed that the differentially expressed genes in asthenospermia played important roles in the cellular protein and macromolecular metabolism, protein modification, cell death, cell apoptosis and apoptosis induction. CONCLUSION: Asthenospermia patients experience a decline in sperm activity and the basic life activities of sperm simultaneously, and are also prone to cell apoptosis or death. Such differentially expressed genes as KIF3B, MYO15A, KIF6, KIF26B, KIF3A, DNHD2, DMN, DYNC2H1, STARD9, MYOHD1, and TPM1, which are involved in cytoskeletal structure, microtubule movement and cell movement, may be associated with asthenospermia, and therefore deserve further studies.

[Expressions of cysteine-rich secretory protein 2 in asthenospermia].

OBJECTIVE: To investigate the mRNA and protein expression levels of cysteine-rich secretory protein 2 (CRISP2) in the sperm of asthenospermia patients, and explore their relationship with sperm motility and related molecular mechanism. METHODS: We collected 78 semen samples from adult male patients with asthenospermia and another 70 from healthy volunteers as controls. We extracted total RNA and total protein from the sperm following purification of the sperm by Percoll gradient centrifugation, and detected the relative expressions of CRISP2 mRNA and protein in the two groups by RT-PCR, SYBR Green real-time PCR and Western blot. RESULTS: The expression of CRISP2 mRNA was down-regulated by 4.3 times and that of the CRISP2 protein by 1.71 times in the asthenospermia patients, significantly lower than in the normal control group (P < 0.05). CONCLUSION: The down-regulation of CRISP2 mRNA and protein expressions in the sperm of asthenospermia patients may be closely related with decreased sperm motility, which suggests that CRISP2 may serve as a potential molecular target for the research of asthenospermia.

[Effects of cyclosporine-impregnated versus freeze-dried bone allografts in repairing radial defects in rabbits: a comparative study].

OBJECTIVE: To compare the effects of cyclosporine-impregnated bone allograft (CAB) and freeze-dried bone allograft (FDAB) in repairing radial defects in rabbits. METHODS: Thirty New Zealand white rabbits were randomized into bone graft donor group, experimental group, and control group (n=10). The bilateral ilia of the donor rabbits were dissected to prepare CAB and FDAB. In the other 20 rabbits, a 10-mm long segmental osteoperiosteal defect was induced in the right radius and repaired with CAB (experimental group) or with FDAB (control group). At postoperative weeks 4 and 12, 5 rabbits from each group were sacrificed to evaluate the bone healing by radiographic, general and histological observations. RESULTS: Four weeks after the operation, the rabbits in the experimental group showed significantly higher X-ray scores (P=0.001) with greater amount of new bone and better incorporation of the allograft and autogenous bone than those in the control group. At 12 weeks, the X-ray scores were still significantly higher in the experimental group (P=0.002), which also showed better bone remodeling than the control group. CONCLUSION: CAB is superior to FDAB for repairing radial defects in rabbits, but the potential involvement of local immunoreaction in this difference awaits further investigation.

[Correlation of aging with psychological and organic ED: nocturnal electrobioimpedance volumetric assessment of 83 cases].

OBJECTIVE: The ratio of psychological to organic ED changes with aging. This study aimed to analyze the results of nocturnal electrobioimpedance volumetric assessment (NEVA) for ED patients of different age groups and their significance in the diagnosis of ED. METHODS: A total of 83 ED patients were divided into 4 age groups (< or = 29 yr, 30 -39 yr, 40 -49 yr and > or = 50 yr) and detected for nocturnal penile tumescence (NPT) by NEVA. RESULTS: Thirty-four of the cases were diagnosed as organic ED, and the other 49 as psychological ED. With the increase of age, the former was increased from 30.3% in the < or = 29 yr group to 60.0% in the > or = 50 yr group, while the latter decreased from 69.7% to 40.0%. CONCLUSION: The percentage of organic ED tends to grow with the increase of age, while that of psychological ED is just the opposite.

[Identification of human testicular embryonal carcinoma proteins by two-dimensional gel electrophoresis and mass spectrometry].

OBJECTIVE: To separate and identify human testicular embryonal carcinoma proteomics using two-dimensional electrophoresis (2-DE) and mass spectrometry. METHODS: Immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis was used to separate the total proteins of the samples. After silver staining, PDQuest 7.30 image analysis software was applied to analyze the 2-DE images. Three of the proteins highly expressed in human testicular embryonal carcinoma were identified by matrix-assisted laser adsorption/ionization-time of flight-tandem mass spectrometry (MALDI-TOF-MS/MS). RESULTS: 2-DE effectively screened the differentially expressed proteins in the carcinoma tissues. Three proteins highly expressed in the carcinoma were successfully identified. CONCLUSION: The proteins of human testicular embryonal carcinoma can be effectively separated and analyzed using 2-DE and mass spectrometry. Proteomic analysis offers a new means for further study of this carcinoma.