RESUMO
OBJECTIVES: The diagnosis and treatment of tandem stenosis have been widely discussed. However, studies on concurrent cervical and thoracic spinal stenosis are rare in the literature. This study was aimed to investigate the risk factors for thoracic spinal stenosis (TSS) in patients with cervical spinal stenosis (CSS). METHODS: This retrospective cohort study assessed the risk factors for TSS in 162 patients who were diagnosed with CSS. Patients were divided into TSS (n = 45) and non-TSS (n = 117) groups. We retrospectively analyzed clinical characteristics and radiographic parameters including age, gender, body mass index, ossification of the cervical posterior longitudinal ligament (OPLLc), hypertrophy of cervical ligamentum flavum (HLFc), cervical stenosis segments, and cervical sagittal parameters. Cervical sagittal parameters were measured on T2-weighted magnetic resonance imaging including C2-7 Cobb angle, cervical tilt, T1 slope, thoracic inlet angle (TIA), C2-C7 sagittal vertical axis (C2-C7), and cervical curvature. RESULTS: Two groups showed significant differences in ossification of the cervical posterior longitudinal ligament, HLFc, cervical stenosis segments, and TIA. The receiver operating characteristic curves demonstrated that the optimal threshold for TIA was 68.25. In multivariate logistic regression analysis, OPLLc (odds ratio [OR] = 4.403, 95% confidence interval [CI] = 1.782-10.880, P = 0.001), HLFc (OR = 4.849, 95% CI = 1.995-11.782, P < 0.001), and TIA >68.25 degrees (OR = 2.555, 95% CI = 1.044-6.251, P = 0.040) were independent risk factors for TSS. Moreover, the multiindex receiver operating characteristic curve demonstrated that the area under the curve for predicted probability was 0.799 (P < 0.001). CONCLUSIONS: Routine thoracic magnetic resonance imaging assessment is strongly recommended in CSS patients with OPLLc, HLFc, and enlarged TIA to screen for neglected but vital thoracic disease.
RESUMO
Spinal cord injury (SCI) can result in irreversible sensory and motor disability with no effective treatment currently. After SCI, infiltrated macrophages accumulate in epicenter through destructed blood-spinal cord barrier (BSCB). Further, great majority of macrophages are preferentially polarized to M1 phenotype, with only a few transient M2 phenotype. The purpose of this study was to explore roles of vascular endothelial cells in microglia/macrophages polarization and the underlying mechanism. Lipopolysaccharide (LPS) was used to pretreat BV2 microglia and RAW264.7 macrophages followed by administration of conditioned medium from microvascular endothelial cell line bEnd.3 cells (ECM). Analyses were then performed to determine the effects of exosomes on microglia/macrophages polarization and mitochondrial function. The findings demonstrated that administration of ECM shifted microglia/macrophages towards M2 polarization, ameliorated mitochondrial impairment, and reduced reactive oxygen species (ROS) production in vitro. Notably, administration of GW4869, an exosomal secretion inhibitor, significantly reversed these observed benefits. Further results revealed that exosomes derived from bEnd.3 cells (Exos) promote motor rehabilitation and M2 polarization of microglia/macrophages in vivo. Ubiquitin-specific protease 13 (USP13) was shown to be significantly enriched in BV2 microglia treated with Exos. USP13 binds to, deubiquitinates and stabilizes the NF-κB inhibitor alpha (IκBα), thus regulating microglia/macrophages polarization. Administration of the selective IκBα inhibitor betulinic acid (BA) inhibited the beneficial effect of Exos in vivo. These findings uncovered the potential mechanism underlying the communications between vascular endothelial cells and microglia/macrophages after SCI. In addition, this study indicates exosomes might be a promising therapeutic strategy for SCI treatment.