Efficacy of non-pharmacological interventions in females with overactive bladder: A systematic review and network meta-analysis.

AIMS AND OBJECTIVES: To compare and rank the effectiveness of non-pharmacological interventions for symptoms of Overactive Bladder (OAB) in network meta-analysis. BACKGROUND: Overactive Bladder affects many patients, which often generates bothersome symptoms and debilitates the quality of life. Non-pharmacological therapies have been widely used in OAB. However, due to insufficient evidence, it remains unclear which strategies are most suitable for OAB. METHODS: We integrated randomised controlled trials (RCTs), which were searched up to 1 January 2021, from 8 databases (PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc). Studies that met the eligible criteria were assessed the risk of bias. Then, network meta-analyses were conducted by STATA, R, and OpenBUGS. The review followed PRISMA statement. RESULTS: A total of 24 studies comprising 2347 patients with OAB were included in this review, most of which were low to moderate risk of bias. The results of network meta-analysis implied that electric stimulation (ES) was the most effective intervention to reduce voided frequency and nocturia frequency of OAB. CONCLUSIONS: Electric stimulation ranked the best in the management of OAB, and future studies should pay more attention to ES.

Duraplasty of PHBV/PLA/Col membranes promotes axonal regeneration by inhibiting NLRP3 complex and M1 macrophage polarization in rats with spinal cord injury.

Duraplasty after decompression decreases the lesion size and scar formation, promoting better functional recovery, but the underlying mechanism has not been clarified. Here, we fabricated a series of poly(hydroxybutyrate-co-hydroxyvalerate)/polylactic acid/collagen (PHBV/PLA/Col) membranes and cultured them with VSC4.1 motor neurons. The material characteristics and in vitro biological characteristics were evaluated. In the subcutaneous implantation test, PHBV/PLA/COl scaffolds supported the cellular infiltration, microvasculature formation, and decreased CD86-positive macrophage aggregation. Following contusion spinal cord injury at T10 in Sprague-Dawley rats, durotomy was performed with allograft dura mater or PHBV/PLA or PHBV/PLA/Col membranes. At 3 days post-injury, Western blot assay showed decreased the expression of the NLRP3, ASC, cleaved-caspase-1, IL-1ß, TNF-α, and CD86 expression but increased the expression of CD206. Immunofluorescence demonstrated that duraplasty with PHBV/PLA/Col membranes reduced the infiltration of CD86-positive macrophages in the lesion site, decreased the glial fibrillary acidic protein expression, and increased the expression of NF-200. Moreover, duraplasty with PHBV/PLA/Col membranes improved locomotor functional recovery at 8 weeks post-injury. Thus, duraplasty with PHBV/PLA/Col membranes decreased the glial scar formation and promoted axon growth by inhibiting inflammasome activation and modulating macrophage polarization in acute spinal cord injury.

In Vitro Immune Activation of Raw264.7 Cells by Nanodiamonds with Different Surface Chemistry.

In this study, three commercially available nanodiamonds (NDs) of similar size (about 5 nm in diameter) but with different surface chemistry (-COOH, -NH2 and -poly(ethylene glycol)) were used to study the toxicity and immune activation of Raw264.7 cells. Only ND-PEG is well dispersed in water and cell culture medium (about 10 nm in diameter), while ND-COOH and ND-NH2 only showed some aggregation, about 50 nm in water and about 100 nm in cell culture medium. The three NDs showed different zeta potentials in water but the difference disappeared in cell culture medium due to the surface adsorption of the proteins. The ND-PEG did not show any obvious signs of cytotoxicity or activation on Raw264.7 cells under tested conditions. The ND-COOH and ND-NH2 caused dose-dependent toxicity, with the amino group capped NDs being much more toxic compare to those of the carboxylic acid group at the same exposure conditions. ND-COOH induced a certain immune response in Raw264.7 cells, leading to a higher expression of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), especially with a significantly longer incubation time. ND-NH2 also induced significant expression of TNF-α and IL-6 in Raw264.7 cells at first, but this expression was reduced with a longer incubation time due to cell death.

Morphometric measurement of the lumbosacral spine for minimally invasive cortical bone trajectory implant using computed tomography.

PURPOSE: The cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory. The aim of this study was to conduct a detailed morphometric measurement of the lumbosacral spine for CBT pedicle screw, using the inferior facet of the cephalad level as a bony landmark. METHODS: The three-dimensional computed tomography (3D-CT) scans of 86 adults who underwent examination of the lumbosacral spine were studied. The distances from the starting point to the inferior, lateral and medial border of the inferior facet of the cephalad level were measured. The angles formed between the screw trajectory and the sagittal plane, the superior endplate of the vertebral body and the posterior margin of the pars interarticularis were defined as the transverse angle (TA), cephalad angle 1 (CA1) and cephalad angle 2 (CA2), respectively. RESULTS: The distances from the inferior border of inferior facet to the starting point from L1 to S1 were 8.9, 6.3, 4.1, 2.9, 1.4 and 0 mm, respectively. The distances from the medial border of the inferior facet to the starting point from L1 to S1 were between 3 and 4 mm. TA from L1 to S1 was 9.0°, 9.6°, 11.3°, 13.5°, 15.5°, and 8.2°, respectively. CA1/CA2 from L1 to S1 was 26.7°/38.7°, 26.0°/38.7°, 26.9°/38.0°, 24.4°/37.2°, 22.9°/35.1° and 18.4°/47.8°, respectively. The maximum screw diameters from L1 to S1 were 4.8, 5.1, 6.1, 6.8, 7.8, and 6.1 mm, respectively. Twenty-five millimeter can serve as a safe maximum length of CBT pedicle screws. CONCLUSIONS: The inferior facet of the cephalad level is an attractive bony landmark for establishing a starting point of CBT for minimally invasive spine surgery.

Silicate Nanoplatelets Promotes Neuronal Differentiation of Neural Stem Cells and Restoration of Spinal Cord Injury.

Neural stem cell (NSC) transplantation has been suggested as a promising therapeutic strategy to replace lost neurons after spinal cord injury (SCI). However, the low survival rate and neuronal differentiation efficiency of implanted NSCs within the lesion cavity limit the application. Furthermore, it is difficult for transplanted cells to form connections with host cells. Thus, effective and feasible methods to enhance the efficacy of cell transplantation are needed. In this study, the effect of Laponite nanoplatelets, a type of silicate nanoplatelets, on stem cell therapy is explored. Laponite nanoplatelets can induce the neuronal differentiation of NSCs in vitro within five days, and RNA sequencing and protein expression analysis demonstrated that the NF-κB pathway is involved in this process. Moreover, histological results revealed that Laponite nanoplatelets can increase the survival rate of transplanted NSCs and promote NSCs to differentiate into mature neurons. Finally, the formation of connections between transplanted cells and host cells is confirmed by axon tracing. Hence, Laponite nanoplatelets, which drove neuronal differentiation and the maturation of NSCs both in vitro and in vivo, can be considered a convenient and practical biomaterial to promote repair of the injured spinal cord by enhancing the efficacy of NSC transplantation.

Posterior-only approach with selective segmental TLIF for degenerative lumbar scoliosis.

STUDY DESIGN: Forty-six patients with degenerative lumbar scoliosis, and treated with selective segmental transforaminal lumbar interbody fusion (TLIF), were studied retrospectively. OBJECTIVES: To investigate the surgery outcomes of the posterior-only approach with selective segmental TLIF for the treatment of degenerative lumbar scoliosis. SUMMARY OF BACKGROUND DATA: Degenerative lumbar scoliosis usually occurs late in the life of patients with no history of scoliosis. TLIF has been successfully used in the surgical treatment of other degenerative diseases of the lumbar spine. METHODS: Forty-six patients with degenerative lumbar scoliosis and treated with selective segmental TLIF were studied retrospectively. There were 14 male and 32 female patients, with a mean age of 66.4 years. The indications for TLIF of the motion segment included segmental kyphosis in the lumbar spine, significant vertebral translation in any orientation, segmental instability, and significant upper endplate obliquities of L3 or L4. All the patients were followed for a mean duration of 42 months postoperatively. Radiographic evaluation included Cobb angle of scoliosis, lumbar lordosis angle, and segmental lordosis angle. The clinical outcomes were assessed by means of Japanese Orthopedic Association score and patient satisfaction index. RESULTS: The mean preoperative Cobb angle of 31.7 ± 14.4 degrees was corrected to 10.2 ± 6.5 degrees at the final follow-up (t = 15.262, P < 0.001), and the correction rate was 67.8%. The mean preoperative lumbar lordosis angle of -27.5 ± 12.6 degrees was corrected to -39.3 ± 9.7 degrees (t = 12.165, P < 0.001), and the correction rate was 44.4%. The mean preoperative segmental lordosis angle of -6.5 ± 5.1 degrees in the TLIF segment was increased to -11.6 ± 5.9 degrees, and the correction rate was 80%. Besides, the segmental deformity and vertebral translation were also corrected. The mean preoperative Japanese Orthopedic Association score of 14.1 ± 4.2 was increased to 22.2 ± 4.8 (t = 11.453, P < 0.001), and 81% of patients would undergo this surgery again with the same results. CONCLUSIONS: Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity, and translation, and thus obtaining satisfactory outcome in the treatment of degenerative lumbar scoliosis.

Spinal cord decompression reduces rat neural cell apoptosis secondary to spinal cord injury.

OBJECTIVE: To determine whether spinal cord decompression plays a role in neural cell apoptosis after spinal cord injury. STUDY DESIGN: We used an animal model of compressive spinal cord injury with incomplete paraparesis to evaluate neural cell apoptosis after decompression. Apoptosis and cellular damage were assessed by staining with terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate nick-end labelling (TUNEL) and immunostaining for caspase-3, Bcl-2 and Bax. METHODS: Experiments were conducted in male Sprague-Dawley rats (n=78) weighing 300-400 g. The spinal cord was compressed posteriorly at T10 level using a custom-made screw for 6 h, 24 h or continuously, followed by decompression by removal of the screw. The rats were sacrificed on Day 1 or 3 or in Week 1 or 4 post-decompression. The spinal cord was removed en bloc and examined at lesion site, rostral site and caudal site (7.5 mm away from the lesion). RESULTS: The numbers of TUNEL-positive cells were significantly lower at the site of decompression on Day 1, and also at the rostral and caudal sites between Day 3 and Week 4 post-decompression, compared with the persistently compressed group. The numbers of cells between Day 1 and Week 4 were immunoreactive to caspase-3 and B-cell lymphoma-2 (Bcl-2)-associated X-protein (Bax), but not to Bcl-2, correlated with those of TUNEL-positive cells. CONCLUSION: Our results suggest that decompression reduces neural cell apoptosis following spinal cord injury.

Kyphotic Angle of the Motion Segment Most Accurately Predicts Injury to the Ligamentous Complex on Computed Tomography Scan of Thoracolumbar Fractures.

OBJECTIVE: To define radiologic parameters and the diagnostic accuracy of computed tomography (CT) scan on posterior ligamentous complex (PLC) injury, identified by magnetic resonance imaging (MRI) in patients with thoracolumbar (TL) fracture. METHODS: We retrospectively analyzed 88 patients with TL fractures divided into 2 groups by PLC status evident on MRI: intact and ruptured. The parameters assessed included the anterior fractured vertebral body height (AVH) and posterior fractured vertebral body height, upper and lower AVH, anterior/posterior vertebral height ratio, AVH ratio, local kyphotic angle (LKA), region angle (RA), sagittal index (SI), Gardner angle (GA), Gardner index (GI), Cobb angle, interspinous distance (ISD), upper and lower ISD, ISD ratio, interspinous distance minus (ISDM), interspinous angle (ISA), and upper and lower ISA. The t test, Pearson χ2 test, and multivariate logistic regression were used. RESULTS: PLC rupture (vs. intact) was associated with RA, GA, GI, ISD, ISD ratio, and ISDM. The positive risk factors for PLC rupture were GA, LKA, SI, and RA. The negative risk factors for PLC rupture were SI greater than 20° and GI. PLC rupture was associated with the SI, upper interspinous distance, ISD ratio, ISDM, and ISA in those with type A1/A2 fractures and the GA, GI, ISD, ISD ratio, and ISDM in those with type A3/A4 fractures. CONCLUSIONS: An RA greater than 16°, SI greater than 20°, and GI greater than 24° were associated with PLC injury in patients with type A TL fractures, and an RA greater than 16° and SI greater than 20° predicted PLC injury in type A1 and A2 fractures. An SI greater than 20°, GI greater than 24°, LKA greater than 26°, and ISD ratio greater than 56% predicted PLC injury in type A3 and A4 fractures.

Stromal cell­derived factor­1 induces matrix metalloproteinase expression in human endplate chondrocytes, cartilage endplate degradation in explant culture, and the amelioration of nucleus pulposus degeneration in vivo.

Intervertebral disc (IVD) degeneration is a strong etiological factor in chronic lower back pain. Stem cell migration toward the site of IVD degeneration for regeneration is restricted by avascularity and distance. Our previous study indicated that the expression of stromal cell­derived factor­1 (SDF­1) and its receptor, C-X-C chemokine receptor type 4 (CXCR4) was upregulated in degenerated cartilage endplate (CEP) and nucleus pulposus (NP). In the present study, SDF­1 increased CXCR4 mRNA and protein expression in human endplate chondrocytes in a dose­dependent manner. The results of reverse transcription-quantitative polymerase chain reaction, western blotting and zymography indicated that SDF­1 increased matrix metalloproteinase (MMP)­1, ­3 and ­13 mRNA and protein expression in human endplate chondrocytes in a dose­dependent manner. The results of zymography suggested that SDF­1 also increased MMP­2 and ­9 protein expression in a dose­dependent manner. The CXCR4­specific chemical inhibitor AMD3100 significantly decreased the levels of MMP­1, ­2, ­3, ­9 and ­13 expression. In a human cartilage explant culture model, SDF­1 accelerated the degradation of extracellular matrix (ECM), and AMD3100 decreased cartilage cleavage. However, in a rat tail disc degeneration model, the injection of SDF­1 into the NP resulted in the retention of dense areas of proteoglycan matrix and enhanced NP regeneration. These results suggest that SDF­1, as an inflammatory cytokine, induces MMP expression in human endplate chondrocytes and that ECM remodeling in the CEP may be a favorable factor of endogenous stem cell homing into the NP for regeneration in vivo.

[Diagnosis and treatment of odontoid fracture combined with lower cervical spinal injury].

OBJECTIVE: To investigate the mechanism, clinical features and treatment of odontoid fracture combined with lower cervical spinal injury. METHODS: From January 1999 to December 2004, 57 cases of type II or shallow type III odontoid fractures were studied retrospectively. Six cases were found combined with lower cervical injury, the mean age was 54 years, and 4 of the 6 cases were complicated with cervical spondylarthrosis or ankylosing spondylitis. For the lower cervical injury, fracture-dislocation was found in 2 cases, the disruption of disc and ligament was found in 4 cases among which 2 cases were suffered from incomplete spinal cord injury; Both were caused by lower cervical spinal injury. All of the 6 cases were performed with surgery in odontoid fracture and lower cervical spinal injury simultaneously; Lower cervical spinal injuries were stabilized firstly in 2 cases, which responsible for neurological involvement; For the other 4 cases without neurological involvement, stabilization was performed in odontoid fracture firstly in 2 cases, due to inability to achieve reduction of odontoid fracture preoperatively, however, for the another 2 cases with anatomic reduction of the odontoid fracture preoperatively, lower cervical injuries were stabilized firstly. RESULTS: After an average follow-up of 10 months, all cases were obtained solid fusion both in odontoid fracture and lower cervical spinal injury, and without the complications associated with operation and prolonged bed rest. Two cases with neurological defect improved 1 scale in Frankel score. CONCLUSIONS: The incidence of odontoid fracture combined with lower cervical spinal injury is about 10.5% of the odontoid fracture, and it is vulnerable in the elderly patient with cervical spondylarthrosis. MRI should be used routinely for accurate diagnosis. Surgical stabilization is the choice of treatment due to facilitating early rehabilitation and reducing the complications. The surgical schedule is planned according to the fact of neurological involvement and the extent of stability between the odontoid fracture and lower cervical spinal injury.

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail.

OBJECTIVE: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsilateral hip and femoral shaft fractures. METHODS: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsilateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. RESULTS: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varus malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. CONCLUSIONS: The reconstructive intramedullary interlocking nail, with less trauma, reliable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.

Posterolateral lumbar fusion versus transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis.

This study compares the safety and efficacy of posterolateral lumbar fusion (PLF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS). Forty DLS patients with Cobb angles of 20-60 degrees were randomized into either the PLF or TLIF treatment group, and were followed up for 2-5 years. Operating time, intraoperative blood loss, clinical outcomes, complications and imaging were compared between the two groups. There were significant differences between the PLF and TLIF treatment groups in operative time (187.8±63.5 minutes and 253.2±57.6 minutes, respectively; p=0.002) and intraoperative blood loss (1166.7±554.1 mL and 1673.7±922.4 mL, respectively; p=0.048). The occurrence rates of early complications in the two groups were 11.1% and 26.3%. The recovery rates of the lumbar lordotic angle and spinal sagittal balance were significantly different (36.7% versus 62.5% and 44.8% versus 64.1%, respectively). In various domains of the Scoliosis Research Society-22 (SRS-22) questionnaire, the scores for pain and satisfaction with the treatment showed significant differences between PLF and TLIF group (p=0.033 and p=0.006, for pain and satisfaction respectively), and the TLIF group showed better outcomes than the PLF group. There were no significant differences in the recovery rates in the Cobb angle and the spinal coronal balance, function, self-image, or mental health scores. Although TLIF increases the surgical trauma and occurrence of complications, it helps to improve lumbar lordosis and sagittal balance and shows better clinical outcomes. For patients without significant loss of lumbar lordosis and with good spinal sagittal balance preoperatively, PLF is still an option.

Clinical application of a new plate fixation system in open-door laminoplasty.

The purpose of this retrospective clinical series was to evaluate the benefits and complications of plate fixation for open-door laminoplasty in cervical spondylotic myelopathy with multilevel spinal stenosis compared with open-door laminoplasty without fixation. Forty-nine patients underwent open-door laminoplasty for cervical myelopathy with multilevel spinal stenosis with at least 13 months of follow-up. A plate was used as the sole method of fixation between the lateral mass and lamina with 3 screws. Computed tomography scans obtained pre- and postoperatively were assessed for plate complications and spinal canal enlargement. Pre- and postoperative neurological condition was assessed by the Japanese Orthopedic Association (JOA) myelopathy score. Overall cervical spine range of motion (ROM) was measured in full flexion and extension radiographs pre- and postoperatively. No restenosis due to door reclosure was noted, and no plates failed. No screws were backed out or broken. Almost all patients showed neurological improvement. The JOA score increased by 3.9±0.7 points in the suture group and 4.3±0.8 points in the plate group (P>.05). The postoperative increase in mean anteroposterior diameter of the spinal canal from C3 to C7 was 4.5±0.6 mm in the suture group and 5.1±0.5 mm in the plate group. The greater mean anteroposterior diameter increase in the plate group was statistically significant (P<.01). The mean cervical ROM decreased in the plate and suture groups postoperatively (P<.001). No significant difference was found in mean cervical ROM reduction between the groups (P>.05). No difference in axial symptoms was found between the 2 groups.

Changes in the expression of platelet-derived growth factor in astrocytes in diabetic rats with spinal cord injury.

BACKGROUND: Prospective mortality studies in the United States revealed that the mortality was elevated in diabetics compared to normal individuals following chronic spinal cord injury (SCI). Our study was conducted to investigate the levels of platelet-derived growth factor (PDGF) of astrocytes in SCI in streptozotocin (STZ)-induced diabetic rats. METHODS: Thirty male Sprague-Dawley (SD) rats were randomly divided into 3 groups: SCI group, diabetic SCI group, and sham operation control group. We employed STZ-induced diabetic SD rats and a weight-drop contusion SCI model. The rats were sacrificed on day 7 after the induction of SCI. Immunohistochemistry and Western blotting analysis were used to detect the PDGF expression level. Basso, Beattie and Bresnahan locomotor rating scale (BBB) was also used to evaluate the neurological recovery level of the rats. RESULTS: PDGF positive astrocyte numbers were significantly higher and PDGF staining was more intensive in astrocytes in the SCI group than in the diabetic SCI group (P < 0.05). The diabetic SCI group showed a slower recovery of motor function with a lower BBB score 7 days after acute spinal injury. CONCLUSIONS: PDGF is an important factor for the recovery of neurological function after acute spinal injury and hyperglycemia in diabetic rats could depress the expression of PDGF in injured spinal cord. This may help to explain the slower recovery and higher mortality in diabetics after SCI.