The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort.

Background: Patients on maintenance hemodialysis have an increased risk of fracture. However, the relationship between fracture and poor prognosis is not clear. Methods: A total of 182 maintenance hemodialysis patients were enrolled in the study. The relationship between fracture and poor prognosis (cardiovascular events, stroke, malignancy and 5-year all-cause mortality) were analyzed. Results: 21 of 182 patients had a history of fracture at the time of enrollment. 26 patients had a new fracture after enrollment. A total of 57 fractures occurred in 47 patients, the most common fracture site was the rib. Patients with fracture group had a higher proportion of elderly and female, higher serum phosphorus and B-type natriuretic peptide and lower hemoglobin, albumin, and potassium compared with those without fracture. Age (OR=3.809, 95% CI: 1.064-8.966, p=0.038), hemoglobin (OR=0.961, 95% CI: 0.925-0.997, p=0.035), and serum phosphorus (OR=3.325, 95% CI:1.104-10.019, p=0.033) were the independent risk factors of new fractures in MHD patients. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture (p<0.05). But there was no significant difference in the incidence of acute myocardial infarction or stroke. Conclusion: 25.8% of maintenance hemodialysis patients had at least one fracture, with rib fractures accounting for the highest proportion. Age, hemoglobin and serum phosphorus were the independent risk factors of new fractures. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture, but there was no significant difference in the incidence of acute myocardial infarction and stroke.

To determine the incidence of fractures in hemodialysis patients, we conducted this single center, prospective observational study. 182 patients were enrolled. We also recorded the 5-year incidence of acute myocardial infarction(AMI), stroke, malignancy, and mortality. Our results showed that the incidence of fracture in hemodialysis patients was 25.8%. The most common fracture site was the rib. There were significant statistical differences in age, gender, hemoglobin, serum albumin, B-type natriuretic peptide, potassium and phosphorus between patients with and without fractures. Logistic regression analysis suggested that advanced age, anaemia and hyperphosphatemia were independent risk factors for new fractures in hemodialysis patients. We followed 182 patients for 5 years and recorded the incidence of stroke, AMI and malignancy. The rates of AMI and stroke did not differ significantly between the two groups. However, the incidence of malignancy in patients with fractures is significantly higher than that in patients without fractures. In our study, a total of 74 patients died, including 24 deaths in the fracture group and 50 deaths in the non-fracture group. The main causes of death in 74 cases were cardiovascular events. Our study provides some insight into the association between fractures and poor outcomes in hemodialysis patients.

tsRNA-04002 alleviates intervertebral disk degeneration by targeting PRKCA to inhibit apoptosis of nucleus pulposus cells.

BACKGROUND: Intervertebral disk degeneration (IDD) is a degenerative disease that underlies various musculoskeletal and spinal disorders and is positively correlated with age. tRNA-derived small RNAs (tsRNA), as a new small noncoding RNAs, its function in IDD is unclear. Herein, our goal was to find the key tsRNA that affects IDD independently of age and explore the underlying mechanisms. METHODS: Small RNA sequencing was performed in nucleus pulposus (NP) tissues of traumatic lumbar fracture individuals, young IDD (IDDY) patients, and old IDD (IDDO) patients. The biological functions of tsRNA-04002 in NP cells (NPCs) were investigated by qRT-PCR, western blot, and flow cytometry analysis. The molecular mechanism of tsRNA-04002 was demonstrated by luciferase assays and rescue experiments. Furthermore, the therapeutic effects of tsRNA-04002 on IDD rat model were used and evaluated in vivo. RESULTS: Compared with fresh traumatic lumbar fracture patients, a total of 695 disordered tsRNAs is obtained (398 down-regulated tsRNAs and 297 up-regulated tsRNAs). These disordered tsRNAs were mainly involved in Wnt signaling pathway and MAPK signaling pathway. tsRNA-04002 was an age-independent key target in IDD, which was both lower expressed in IDDY and IDDO groups than control group. Overexpression of tsRNA-04002 restrained inflammatory cytokines IL-1ß and TNF-α expression, increased the COL2A1, and inhibited the NPCs apoptosis. Furthermore, we determined that PRKCA was the target gene of tsRNA-04002 and was negatively regulated by tsRNA-04002. The rescue experiment results suggested that the high expression of PRKCA reversed the inhibitory effect of tsRNA-04002 mimics on NPCs inflammation and apoptosis, and promotive effect of COL2A1. Moreover, tsRNA-04002 treatment dramatically ameliorated the IDD process in the puncture-induced rat model, together with the blockade of PRKCA in vivo. CONCLUSION: Collectively, our results substantiated that tsRNA-04002 could alleviate IDD by targeting PRKCA to inhibit apoptosis of NPCs. tsRNA-04002 may be a novel therapeutic target of IDD progression.

A Study on COMP and CTX-II as Molecular Markers for the Diagnosis of Intervertebral Disc Degeneration.

BACKGROUND: Diagnosis of intervertebral disc degeneration (IVDD) is challenging at the early stage. The cartilage oligomeric matrix protein (COMP) and extracellular matrix degradation products of C-telopeptide of type II collagen (CTX-II) serve as markers for the serological diagnosis of IVDD. Oxidative stress might cause IVDD and matrix degeneration. METHODS: A total of 128 male adult Sprague-Dawley (SD) rats were randomly and equally assigned to the experimental and control groups. The experimental group was used to construct IVDD models by acupuncture, while the control group underwent sham operation. The animals were executed every week for 8 weeks after intervertebral disc acupuncture, and serum samples were collected for the estimation of CTX-II and COMP concentrations by enzyme-linked immunosorbent assay (ELISA). Also, the histological changes and caudal magnetic resonance imaging (MRI) changes were examined in the intervertebral disc. RESULTS: IVDD in rats worsened with prolonged follow-up after acupuncture. At all the time points, the experimental group showed altered histological and caudal vertebra MRI signals, and serum CTX-II and COMP concentrations were significantly greater than those of the control group. These levels increase with the process of IVDD. CONCLUSION: Serum CTX-II and COMP estimation is a reliable method to diagnose IVDD, and their concentrations show a positive correlation with the process of IVDD.

USP15 promotes the apoptosis of degenerative nucleus pulposus cells by suppressing the PI3K/AKT signalling pathway.

OBJECTIVES: Degenerative disc disease is characterized by an enhanced breakdown of its existing nucleus pulposus (NP) matrix due to the dysregulation of matrix enzymes and factors. Ubiquitin-specific protease 15 (USP15) is reported to be abnormal in certain human diseases. However, its role in NP degeneration remains unclear. Therefore, we aimed to explore the function of USP15 in degenerative NP cell specimens. METHODS: We induced gene silencing and overexpression of USP15 in degenerative NP cells using RNA interference (RNAi) and a lentiviral vector, respectively. qRT-PCR and Western blotting were used to determine gene and protein expression levels. Cell apoptosis was analysed via flow cytometry. Protein interaction was examined by performing a co-immunoprecipitation assay. Furthermore, the PI3K inhibitor LY294002 and agonist IGF-1 were used to investigate the link between USP15 and AKT in NP degeneration. RESULTS: We found that USP15 was up-regulated in degenerative NP cells and that its overexpression accelerated the process of apoptosis. Moreover, USP15 expression levels negatively correlated with AKT phosphorylation in degenerative NP cells. Furthermore, targeting and silencing USP15 with miR-338-3p and studying its interaction with FK506-binding protein 5 (FKBP5) revealed enhancement of FKBP5 ubiquitination, indicating that USP15 is a component of the FKBP5/AKT signalling pathway in degenerative NP cells. CONCLUSIONS: Our results show that USP15 exacerbates NP degradation by deubiquitinating and stabilizing FKBP5. This in turn results in the suppression of AKT phosphorylation in degenerative NP cells. Therefore, our study provides insights into the understanding of USP15 function as a potential molecule in the network of NP degeneration.

Eccentric technique for foraminoplasty in percutaneous endoscopic transforaminal procedure: A technical note.

OBJECTIVE: To describe a modified technique usied for foraminoplasty in percutaneous endoscopic transforaminal procedure. METHODS: 58 patients (20 males and 38 females, average age 52.5 years) underwent percutaneous endoscopic transforaminal procedure by using our modified technique. Under the guidance of C-arm fluoroscopy, a kirschner wire was inserted into targeted superior articular process. After expanding the soft tissues, a trepan with the largest diameter was located through the kirschner wire and the angle of trepan was flexible enough to adjust to different operative conditions. This technique could help to avoided using step-by-step larger diameters of trepans without slippage during foraminoplasty. RESULTS: With our modified technique, the mean operation time was 65 min (range 50-80 min) and mean estimated blood loss was 12 ml (range 10-30 ml). Fluoroscopy was less (the mean duration of fluoroscopy was 20.4 ± 9.2 s and the mean radiation dose was 0.9 ± 0.2 mSv) and no complications occurred. All foraminoplasties were excellent via CT scans after surgery and all patients were discharged on 2nd day after operation. The results of 58 patients with an average follow-up of 18 (6-36) months demonstrated our eccentric technique to be effective. CONCLUSION: Our eccentric technique could help to avoid step-by-step larger diameters of trepans during foraminoplasty to shorten operation time and reduced the number of fluoroscopy intraoperative.

Percutaneous endoscopical transforaminal approach versus PLF to treat the single-level adjacent segment disease after PLF/PLIF: 1-2 years follow-up.

BACKGROUND: Adjacent segment disease (ASD) is a common complication after lumbar decompression and fusion surgery. Traditional revision-surgery, including posterior lumbar decompression and posterolateral fusion (PLF) or interbody fusion (PLIF) is traumatic. The percutaneous endoscopic transforaminal procedure (PE-TF) has been widely used in patients with lumbar disc disease. However, there are no reports about using PE-TF procedure to treat ASD in the current literature. OBJECTIVE: To compare the clinical outcomes between PE-TF and PLF for single-level ASD after PLF or PLIF. STUDY DESIGN: A retrospective study. SETTING: Department of Spine Surgery. METHODS: There were 64 patients diagnosed with single-level ASD and accepted revision surgery. 33 patients accepted PE-TF (Group A) and 31 underwent PLF (Group B). Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scores were used to evaluate clinical outcomes. Complications, length of skin incision, hospitalization time and blood loss were investigated according to patient records. RESULTS: All symptoms had improved at the final follow-up. The improvement rate was 82.75% in group A and 86.28% in group B. The satisfactory clinical outcomes were similar in both groups with no recurrence in all cases. PE-TF procedure had significant advantages in the following items: traumatization, cosmetology, hospitalization time and blood loss. CONCLUSIONS: Clinical outcomes of using PE-TF procedure to treat single-level ASD were similar to those of PLF approach, but PE-TF was less invasive and could shorten hospitalization time.

Transforaminal endoscopic system technique for discogenic low back pain: A prospective Cohort study.

OBJECTIVE: To investigate the clinical outcomes of transforaminal endoscopic system(TESSYS) for discogenic low back pain(DLBP). METHODS: 62 consecutive patients with one-level DLBP applying to the including criteria underwent TESSYS from January 2010 to December 2013. These patients included 38 males and 24 females with a mean age of 42.7 ± 5.4 years (range, 18-73 yr) and a mean follow-up of 26.8 ± 4.2 months (range, 12-48 months). The visual analog scale (VAS) were used for back pain, the Oswestry Disability Index (ODI) for lumbar function, and the modified MacNab criteria for clinical global outcomes. RESULTS: 24 patients showed only inflammatory granuloma on annulus tear tissues(Group A), 16 patients showed no annulus tear but adhesion and inflammatory granuloma among the intracanal annulus fibrous(AF), posterior longitudinal ligament(PLL) and the abdomen side of the dura sac(Group B) and 22 patients showed both(Group C). Concordant pain could be triggered by touching the inflammation with the bipolar radiofrequency probe. The success rate (excellent and good) of group C was much higher than A and B(P < 0.05). The whole success rate was 75.8%. Of the 4 patients with poor result, 2 refused further surgical treatment and showed either no improvement or worsening. The remaining 2 patients had spinal fusion surgery and achieved better results. VAS and ODI had significantly improved after surgery (P < 0.01). No unexpected complications were seen. CONCLUSION: TEEYS is an effective method in treating DLBP and the complete management of the inflammatory granuloma was the key point in achieving better results.

Comparative analysis of autologous blood transfusion and allogeneic blood transfusion in surgical patients.

OBJECTIVE: To investigate application effects of autologous blood transfusion and allogeneic blood transfusion in surgically treated patients receiving spine surgery, abdomen surgery and ectopic pregnancy surgery. METHODS: 130 patients who would undergo selective operations were divided into autologous transfusion group and allogeneic transfusion group. Both groups received the same anesthesia, and there was no significant difference in transfusion volume or fluid infusion volume. RESULTS: The serum TNF-α level in autologous transfusion group after operation showed a clear upward trend and had significant difference compared with that before operation (P < 0.05). Meanwhile, after operation, the serum TNF-α level in autologous transfusion group was all significantly higher than that allogeneic transfusion group and the comparative difference was statistically significant (P < 0.05). IgG level in treatment group did not significantly fluctuate during perioperative period, but IgG level in allogeneic transfusion group after operation was all significantly lower than that before operation, and there was statistically significant difference between both groups (P < 0.05). At the same time, complement C3 level in treatment group after operation was significantly higher than that before operation (P < 0.05), but complement C3 level in allogeneic transfusion group did not significantly change. After operation, there was statistically significant difference in complement C3 level between both groups (P < 0.05). CONCLUSION: Autologous transfusion is already a widely accepted transfusion method at present, and it can increase TNF-α and complement C3 levels in the body of surgically treated patients to strengthen immune ability against infection.

Accumulation of Pb, Cu, and Zn in native plants growing on contaminated sites and their potential accumulation capacity in Heqing, Yunnan.

Phytoremediation is one of the cost-effective and environmental friendly technologies used to remove contaminants from contaminated soils, which has been intensively studied during the last decade. Presently, few economical and effective remediation methods are available for the remediation of Pb contaminated sites. This study was conducted to assess the potential of 19 plants growing on contaminated sites in Pb mine area. Plants and associated soil samples were collected and analyzed for total metal concentrations. While total soil Pb, Cu and Zn concentrations varied from 1,239 to 4,311, 36 to 1,020 and 240 to 2,380 mg/kg, those in the plant shoots ranged from 6.3 to 2,029, 20 to 570, and 36 to 690 mg/kg, respectively. Among the plants, we found that one cultivated crop (Ricinus communis L.) and two native species (Tephrosia candida and Debregeasia orientalis) have a great potential for phytoremediation of Pb contaminated soils, the Pb hyperaccumulation capacity of the 3 plants was found as the order: R. communis > D. orientalis > T. candida in the investigated area.