Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes.

BACKGROUND: The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. OBJECTIVE: To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. METHODS: Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. RESULTS: The mean follow-up period was 20.95 ± 2.09 (18-24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an "excellent" outcome and the remaining four (19%) patients obtained a "good" outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. CONCLUSIONS: Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

CircRNA_0078767 promotes osteosarcoma progression by increasing CDK14 expression through sponging microRNA-330-3p.

Circular RNA (circRNA)-associated competing endogenous RNA (ceRNA) mechanism have emerged as critical mechanism in cancer initiation and progression. However, the roles of the circRNA-microRNA (miRNA)-messenger RNA ceRNA network in osteosarcoma are still not fully characterized. In this study, therefore, circ_0078767-related ceRNA mechanism in osteosarcoma was studied. Bioinformatics tools primarily identified differentially expressed circRNAs and their downstream miRNAs in osteosarcoma, implying the potential interaction between circ_0078767, miR-330-3p, and cyclin-dependent kinase 14 (CDK14) in this malignancy, which were further verified by means of RNA immunoprecipitation, RNA pull-down, and dual-luciferase reporter gene assays. Aberrant abundance of circ_0078767 was found in both osteosarcoma tissues and cells, relating to dismal prognosis in patients with osteosarcoma. Functionally, circ0078767 strengthened the proliferation, invasiveness, and migration of osteosarcoma cells, which could be neutralized by miR-330-3p. Additionally, miR-330-3p targeted and decreased CDK14 expression whereby motivating the malignant phenotypes of osteosarcoma cells. Through in vivo experiments, we further confirmed that circ_0078767 targeted miR-330-3p to upregulate CDK14, whereby strengthening the in vivo tumorigenic and metastatic ability of osteosarcoma cells. Circ_0078767 promotes the occurrence and development of osteosarcoma by upregulating CDK14 in a miR-330-3p-dependent manner.

Sulforaphene inhibits the progression of osteosarcoma via regulating FSTL1/NF-κB pathway.

AIMS: Sulforaphene (SFE), a naturally occurring isothiocyanate found in cruciferous vegetables, has attracted increasing attention for its anti-cancer effect in many cancers. MAIN METHODS: We explored the therapeutic effects of SFE in modulating the progression of osteosarcoma. CCK8 assay, colony formation assay, western blot, wounding healing assay and transwell assay were conducted to detect the proliferation, apoptosis, migration and invasion of osteosarcoma cells (U2OS and Saos2) treated with different concentrations of SFE. In addition, tumor xenograft in nude mice is performed to test the effects of SFE in tumorigenesis in vivo. Moreover, the levels of FSTL1 and NF-κB were determined by western blot, and loss of functions of FATL1 and NF-κB were further conducted to evaluate the underlying mechanisms of SFE on osteosarcoma development. KEY FINDINGS: The results revealed that SFE inhibited the growth while promoted apoptosis of U2OS and Saos2 cells in a dose-dependent manner. Mechanistically, SFE significantly inhibited the expression of NF-κB and FSTL1. However, the genetic intervention of FSTL1 or pharmacologically inhibiting NF-κB weakened the anti-tumor role of SFE. SIGNIFICANCE: This study suggested that SFE alleviates the progression of osteosarcoma through modulating the FSTL1/NF-κB pathway.

Association of ADAM33 gene polymorphisms with COPD in a northeastern Chinese population.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is influenced by both environmental and genetic factors. ADAM33 (a disintegrin and metalloproteinase 33) has been one of the most exciting candidate genes for asthma since its first association with the disease in Caucasian populations. Recently, ADAM33 was shown to be associated with excessive decline of lung function and COPD. The aim of this study was to evaluate the potential relationship between polymorphisms of ADAM33 and COPD in a Han population in northeastern China. METHODS: A total of 312 COPD patients and a control group of 319 healthy volunteers were recruited for this study. Eight polymorphic loci (V4, T+1, T2, T1, S2, S1, Q-1, and F+1) of ADAM33 were selected for genotyping. Genotypes were determined by using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: Statistically significant differences in the distributions of the T2G, T1G, S2C, and Q-1G alleles between patients and controls were observed (P < 0.001, odds ratio (OR) = 2.81, 95% confidence interval (CI) = 2.19-3.61; P < 0.001, OR = 2.60, 95% CI = 2.06-3.30; P = 0.03, OR = 1.31, 95% CI = 1.02-1.69; and P < 0.001, OR = 1.93, 95% CI = 1.50-2.50, respectively). Haplotype analysis showed that the frequencies of the CGGGGAGC, CGGGGAGT, CGGGCAGC, and CGGGGGGC haplotypes were significantly higher in the case group than in the control group (P = 0.0002, 0.0001, 0.0005, and 0.0074, respectively). In contrast, the haplotype CGAAGAGC was more common in the control group than in the case group (P < 0.0001). CONCLUSION: These preliminary results suggest an association between ADAM33 polymorphisms and COPD in a Chinese Han population.

Correction to: Outcomes of oblique lateral interbody fusion for degenerative lumbar disease in patients under or over 65 years of age.

In the original publication of this article [1] is an error in the Results section in the first paragraph in regards to a patient value introduced.

Outcomes of oblique lateral interbody fusion for degenerative lumbar disease in patients under or over 65 years of age.

BACKGROUND: Oblique lateral interbody fusion (OLIF) offers the solution to problems of anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF). However, OLIF technique for degenerative spinal diseases of elderly patients has been rarely reported. The objective of this study was to determine the clinical and radiological results of OLIF technique for degenerative spinal diseases in patients under or over 65 years of age. METHODS: Sixty-three patients who underwent OLIF procedure were enrolled, including 29 patients who were less than 65 years of age and 34 patients who were over 65 years of age. Fusion rate, change of disc height and lumbar lordotic angle, Numeric Rating Scale (NRS), return to daily activity, patient's satisfaction rate (PSR), and Oswestry disability index (ODI) were used to assess clinical and functional outcomes. RESULTS: The mean NRS scores for back and leg pain decreased, respectively, from 4.6 and 5.9 to 2.3 and 1.8 in the group A (less than 65 years) and from 4.5 and 6.8 to 2.6 and 2.2 in the group B (over 65 years) at the final follow-up period. The mean ODI scores improved from 48.4 to 24.0% in the group A and from 46.5 to 25.2% in the group B at the final follow-up period. In both groups, the NRS and ODI scores significantly changed preoperatively to postoperatively (p <  0.001). However, statistical analysis yielded no significant difference in postoperative NRS/ODI scores between two groups. In both groups, the changes in the disc height, segmental lordosis, and fusion rate between the preoperative and postoperative periods were significant. The amount of change between preoperative and postoperative disc height, segmental lordosis, and whole lumbar lordosis demonstrated significant intergroup differences (p <  0.05). Overall perioperative complications occurred in 8 of 29 (27.6%) patients in the group A and in 10 of 34 (29.4%) patients in the group B. In both groups, the major complication incidence was 0 and 3%, respectively. CONCLUSION: Although there was the slightly high incidence of complication associated with high rate of co-morbidities in elderly patients, OLIF for degenerative lumbar diseases in elderly patients showed favorable clinical and radiological outcomes.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparison Study Based on End Plate Subsidence and Cystic Change in Individuals Older and Younger than 65 Years.

OBJECTIVE: To compare the outcomes between patients older and younger than 65 years who underwent single-level minimally invasive transforaminal interbody fusion (MI-TLIF) surgery. METHODS: This study is a retrospective analysis of 76 patients who underwent MI-TLIF between April 2012 and June 2016. Group A consisted of 35 patients (<65 years) and group B consisted of 41 patients (≥65 years). Intraoperative data were recorded. The evaluation of clinical outcomes was based on the visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes including cage subsidence, end plate cyst formation, and fusion rate were assessed. RESULTS: The mean age of the study subjects was 65.3 years, and the mean duration of follow-up was 18.98 months. Group B had a higher rate of comorbidities compared with group A (90.24% vs. 57.14%, respectively; P < 0.05). There was no statistically significant difference in the rate of complications between the groups (group A, 14.29%; group B, 17.07%). Clinical outcomes significantly improved in both groups postoperatively (P < 0.05). Although bony fusion in group A was slightly higher than that in group B, the fusion rate was not statistically different according to age. There were no statistically significant differences in the rates of cage subsidence or positive cyst sign between the groups. CONCLUSIONS: MI-TLIF presented similar safeness and acceptable outcomes and complication rate in both groups. Cyst formation may be aggravated by cage subsidence, because cage subsidence was a useful potential predictor of cyst formation.

A novel diagnostic algorithm for chronic and subacute cough.

BACKGROUND: Cough remains the most common reason for patients to seek medical attention. We practised a novel diagnostic algorithm for chronic and subacute cough. METHODS: Chronic and subacute cough patients with normal chest X-ray results and without respiratory tract infections in the preceding eight weeks were recruited. The patients were divided into two groups: Group A, patients with typical symptoms and signs of postnasal drip syndrome (PNDS), asthma syndromes (AS) and gastroesophageal reflux disease (GERD); Group B, patients without the typical symptoms and signs. The two groups received targeted or sequential empirical trials of therapy according to the algorithm. RESULTS: Among the 524 patients available for analysis in Groups A and B, 436 (83.6%) were diagnosed to have PNDS (34.2%), AS (44.5%) and/or GERD (10.1%), among which 26 had two causes (6.0%) and 6 had three causes (1.4%). After empirical trials of therapy, 81.5% of the patients were diagnosed. The mean time for diagnosis was considerably shorter in Group A (13.1 ± 5.6 d) than in Group B (23.4 ± 7.2 d) (p < 0.01). The diagnosis rate of the first trial in Group A (54.1%) was significantly higher than that in Group B (28.6%, p < 0.01). CONCLUSIONS: The proposed algorithm is a promising and practical approach to diagnose chronic and subacute cough.

Beneficial effects of early (but not late) intervention of heme oxygenase-1 on bleomycin-induced pulmonary fibrosis in mice.

The aim of this study is to explore the effects of early and late intervention in heme oxygenase-1 (HO-1) expression or activity on pulmonary fibrosis in mice. Mice were divided into four groups: one control and three bleomycin hydrochloride-induced groups in which mice were administered phosphate-buffered saline (PBS), hemin or Cr (III) mesoporphyrin IX chloride (CrMP). Early intervention with hemin, an HO-1 inducer, abrogated bleomycin-induced pulmonary fibrosis (fibrotic/reparative score decrease from 21.0±2.4 to 13.8±1.7, P<0.01), and early intervention with CrMP, an HO-1 inhibitor, worsened bleomycin-induced pulmonary fibrosis (fibrotic/reparative score increase from 21.0±2.4 to 32.5±2.9, P<0.01). Elevated glutathione expression and reduced expression of TGF-ß1, hydroxyproline, LDH and MDA were seen in the lungs of the early hemin intervention group compared to that seen in the PBS group (P<0.05). These results taken together show that HO-1 can prevent or ameliorate pulmonary fibrosis and oxidative stress and inflammation at an early stage of pulmonary fibrosis.