PTEN-silencing combined with ChABC-overexpression in adipose-derived stem cells promotes functional recovery of spinal cord injury in rats.

The efficiency of cell therapy after spinal cord injury (SCI) depend on the survival of transplanted cells. However, sterile microenvironment and glial scar hyperplasia extremely reduce their numbers. Our previous study found overexpression of ChABC gene is positively correlated to migration ability. Expression of PTEN gene is closely associated with proliferation. However, whether manipulation of PTEN and ChABC on adipose-derived mesenchymal stem cells (ADSCs) promote motor recovery is unknown. This study aimed to promote hindlimb function recovery in SCI rats by enhancing proliferation and migration ability of ADSCs, transiently silencing expression of PTEN following overexpression of ChABC (double-gene modified ADSCs, DG-ADSCs). After PTEN silencing, we observed strong proliferation and accelerated G1-S transition in DG-ADSCs using CCK8 assay and flow cytometry. In addition, we demonstrated that migration numbers of DG-ADSCs were higher than control group using Transwell assay. The protein and mRNA levels of MAP2 and ßⅢ-tubulin in DG-ADSCs were increased compared with ADSCs. These results were further confirmed in SCI rats. Increased survival cells and reduction of glial scars were quantitatively analyzed in DG-ADSCs groups, which is definitely correlated to function recovery. Recovery of motor function was observed in DG-ADSCs treatment rats using BBB score, which emphasized that improved viability of transplanted cells and reduction of glial scars were an effective strategy for enhancing recovery of neurological function after SCI.

One-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion in the surgical treatment of thoracolumbar spinal tuberculosis with kyphosis in children: a preliminary report.

PURPOSE: The purpose of this study was to determine the efficacy and feasibility of surgical management of children with thoracolumbar spine tuberculosis with kyphosis by using one-stage posterior focus debridement, interbody grafts, and posterior instrumentation and fusion. METHODS: From October 2010 to September 2013, 21 children with thoracolumbar spinal tuberculosis accompanied by kyphosis were treated with one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion. There were 13 males and 8 females, aged from 7 to 13 years old (average age 9.9 years). The mean follow-up was 34 months (range26-48 months). Patients were evaluated before and after surgery in terms of ESR, neurologic status, pain, and kyphotic angle. RESULTS: Spinal tuberculosis was completely cured, and the grafted bones were fused in all 21 patients. There was no recurrent tuberculous infection. ESR got normal within 3 months in all patients. The ASIA neurologic classification improved in all cases. Pain relief was obtained in all patients. The average preoperative kyphosis was 29.7° (range 12-42°) and decreased to 5.5° (range 2-10°), postoperatively. There was no significant loss of the correction at the latest follow-up. CONCLUSIONS: Our results show that one-stage posterior decompression, interbody grafts, and posterior instrumentation and fusion were an effective treatment for children with thoracolumbar spinal tuberculosis. It is characterized as minimum surgical trauma, good neurologic recovery, good correction of kyphosis, and prevention of progressive kyphosis.

One-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged.

PURPOSE: Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. METHODS: From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60-71 years). The mean follow-up was 46.5 months (range 38-70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle. RESULTS: Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°-22.5°) and became 29.4° (range 27.1°-32.5°) at final follow-up. CONCLUSIONS: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability.

One-stage surgical management for tuberculosis of the upper cervical spine by posterior debridement, short-segment fusion, and posterior instrumentation in children.

PURPOSE: To evaluate the clinical study efficacy and feasibility of 11 children with tuberculosis of the upper cervical spine treated by one-stage posterior debridement, short-segment fusion, and posterior instrumentation. METHODS: Eleven children who suffered from tuberculosis of the upper cervical spine were admitted to our hospital between June 2005 and December 2010. All of them were treated by one-stage posterior debridement, short-segment fusion, and posterior instrumentation. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the visual analogue scale (VAS) scores of pain, JOA scores of nerve function and erythrocyte sedimentation rate (ESR), which were collected at certain time. RESULTS: The average follow-up period was 28.1 ± 10.5 months (13-42 months). In the 11 cases, no postoperative complications related to instrumentation occurred and neurologic function was improved in various degrees. The average pretreatment ESR was 58.4 ± 4.9 mm/h (53-69 mm/h), which got normal (8.9 ± 6.5 mm/h) within 3 months in all patients. The average preoperative VAS was 7.4 ± 2.2, which decreased to 1.6 ± 1.8 postoperatively. Mean preoperative JOA was 11.2 ± 3.8, and the JOA at the last visit was 16.3 ± 1.0. All patients got bony fusion within 3-8 months after surgery. CONCLUSIONS: One-stage posterior debridement, short-segment fusion, and posterior instrumentation can be an effective treatment method for the treatment of tuberculosis of the upper cervical spine in children.

One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series.

PURPOSE: The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time. METHODS: Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B. RESULTS: The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients. CONCLUSIONS: Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.

Feasibility, safety, and efficacy of task-oriented mirrored robotic training on upper-limb functions and activities of daily living in subacute poststroke patients: a pilot study.

BACKGROUND: Robotic training with high repetitions facilitates upper-limb movements but provides fewer benefits for activities of daily living. Integrating activities of daily living training tasks and mirror therapy into a robot may enhance the functional gains of robotic training. AIM: The aim of this study was to investigate the feasibility, safety, and efficacy of the task-oriented mirrored upper-limb robotic training on the upper-limb functions and activities of daily living of subacute poststroke patients. DESIGN: This study is a single-blinded, active-controlled pilot study. SETTING: The study was carried out at rehabilitation outpatient clinic and ward. POPULATION: A total of 32 subacute poststroke patients were enrolled in the study. METHODS: The enrolled patients were allocated into two groups in a ratio of 1:1. The experimental group received 4 weeks of task-oriented mirrored upper-limb robotic training, consisting of five sessions of 30-minute duration, along with 30 minutes of conventional training. The control group only received 60 minutes of conventional training. The outcome measures were the Fugl-Meyer Assessment Scale for Upper Extremity, Modified Barthel Index, Stroke Self-Efficacy Scale, System Usability Scale, and Quebec User Evaluation with Assistive Technology. RESULTS: All patients completed the full training sessions without significant adverse events related to robotic training. The task-oriented mirrored upper-limb robotic training led to increased Fugl-Meyer Assessment Scale for Upper Extremity (difference: 10.38 points, P<0.001) and Modified Barthel Index (difference: 18.38 points, P<0.001) scores, both of which exceeded the minimal clinically important difference. Intergroup analysis showed significantly higher improvements in the Fugl-Meyer Assessment Scale for Upper Extremity total scores, shoulder, wrist, and hand scores; and Modified Barthel Index scores in the experimental group than in conventional training (all P<0.05). Both groups showed significant improvements in Stroke Self-Efficacy Scale scores after the intervention (both P<0.001), but without a statistically significant intergroup difference (P>0.05). Participants in the experimental group scored an average usability perception score of 74.74 (good) and an average satisfaction score of four or more out of five. CONCLUSIONS: In general, task-oriented mirrored upper-limb robotic training appears feasible and safe for subacute poststroke rehabilitation, facilitating the recovery of upper-limb functions and activities of daily living. CLINICAL REHABILITATION IMPACT: Task-oriented mirrored upper-limb robotic training shows promise for future clinical rehabilitation and clinical trials involving subacute poststroke patients.

Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged.

PURPOSE: To evaluate the clinical study efficacy and feasibility of 17 aged patients with lumbo-sacral tuberculosis treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation. METHODS: 17 aged patients who suffered from lumbo-sacral tuberculosis were admitted into our hospital between March 2003 and October 2010. All of them were treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation. Then the clinical efficacy with statistical analysis was evaluated based on the materials on the lumbo-sacral angle, neurological status that was recorded by Frankel grade system, and erythrocyte sedimentation rate (ESR), which were collected at certain time. RESULTS: The average follow-up period was 47.5 ± 17.1 months (17-71 months), In the 17 cases, no postoperative complications related to instrumentation occurred and neurologic function was improved in various degrees. The mean preoperative lumbo-sacral angle was 20.5° ± 1.7° (range 18.0°-23.0°). The lumbo-sacral angle became 29.1° ± 1.5° (range 26.4°-31.0°) postoperatively. The average pretreatment ESR was 57.4 ± 16.8 mm/h (33-95 mm/h), which got normal (9.2 ± 3.1 mm/h) within 3 months in all patients. All patients got bony fusion within 6-8 months after surgery. CONCLUSIONS: One-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation can be an effective treatment method for the treatment of lumbo-sacral tuberculosis in the aged patients.

Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF).

PURPOSE: Multilevel noncontiguous thoracic spinal tuberculosis has rarely been reported in the literature. We present a retrospective clinical study of 14 patients with multilevel noncontiguous thoracic spinal tuberculosis treated by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF) and determine the clinical effectiveness of such surgical treatment for MNTST. METHODS: Fourteen patients with multilevel noncontiguous thoracic spinal tuberculosis were treated with modified TTIF. The mean follow-up was 27.36 ± 10.46 months (range 13-42 months). The kyphotic angle ranged from -2° to 47° before operation, with an average of 19.21° ± 12.63°. The erythrocyte sedimentation rate (ESR) of patients upon admission ranged from 30 to 62 mm/h before operation, with an average of 46.43 ± 10.77 mm/h. The Frankel Grade was used to evaluate the neurological deficits. RESULTS: The average ESR got normal (8.14 ± 5.89 mm/h) within 3 months in all patients. The average kyphotic angle decreased to 8.07° ± 6.91° postoperatively. Mean deformity angle was measured as 8.79° ± 7.29° at the last visit. Solid fusion was achieved in all cases. Neurologic status of the 12 patients with preoperative neurologic deficit was 6 with grade D recovered to normal; 2 with grade B, both of them to grade D; 4 with grade C, 2 to grade D, 1 to grade E, and 1 still in grade C. CONCLUSIONS: Modified TTIF can be an effective treatment method of multilevel noncontiguous thoracic spinal tuberculosis.

Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches.

PURPOSE: To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly. MATERIALS AND METHODS: This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B. RESULTS: All patients were followed up for an average of 35.1 ± 5.8 months (range 26-45 months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups. CONCLUSION: Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.

Exosomes Secreted by Hypoxia-Pre-conditioned Adipose-Derived Mesenchymal Stem Cells Reduce Neuronal Apoptosis in Rats with Spinal Cord Injury.

Neuronal death is the main cause of nerve function impairment after spinal cord injury (SCI). Exosome-based therapy has become a novel strategy for tissue injury repair. We designed a method to treat SCI using exosomes secreted by adipose tissue-derived stromal cells (ADSCs) under hypoxic conditions. We established a neuronal oxygen-glucose deprivation and reperfusion (OGD/R) model in vitro to simulate the hypoxic environment after SCI. We observed that exosomes derived from hypoxia-conditioned ADSCs (Hypo-exo) significantly reduced neuronal apoptosis after OGD. By establishing a rat SCI model, we found that Hypo-exo can significantly reduce the formation of cavities in the injured area and improve the functional recovery of the hindlimbs of rats after injury. To explore the molecular mechanism, we conducted microRNA sequencing analysis of exosomes. Through real-time polymerase chain reaction, dual luciferase reporter assays and signaling pathway chip analysis, we determined that miR-499a-5p regulates the JNK3/c-jun-apoptotic signaling pathway by targeting JNK3. Further, we verified the expression of the key proteins in the JNK3/c-jun-apoptotic signaling pathway by immunofluorescence and Western blotting. These results support the hypothesis that Hypo-exo can reduce neuronal apoptosis after SCI and may provide new methods to treat SCI.

Strategy and Efficacy of Surgery for Congenital Cervicothoracic Scoliosis with or without Hemivertebra Osteotomy.

OBJECTIVE: Cervicothoracic scoliosis will cause severe deformities in the early stage, and its structure is complex and the surgical methods are varied. The purpose of this research is to explore the indication and analyze the corrective effect of the two different posterior approach surgical strategies, including correction with fusion and hemivertebra osteotomy, for congenital cervicothoracic scoliosis deformities in children and adolescents. METHODS: This was a retrospective study of 21 patients with cervicothoracic scoliosis who received surgical treatment from January 2010 to June 2020, including nine cases of posterior hemivertebra osteotomy and fusion surgery and 12 cases of posterior correction and fusion alone. The Cobb angle, T1 tilt angle, clavicular angle, neck tilt angle, radiographic shoulder height, sagittal vertical axis, coronal balance distance, and local kyphosis angle were measured preoperatively, postoperatively, and at the last follow-up. Posterior approach hemivertebra resection or correction with fusion surgery was adopted based on the different individual characteristics of deformity such as main curve Cobb angle, growth potential, and flexibility. Patients were divided into two groups (osteotomy group and nonosteotomy group) according to whether a hemivertebra osteotomy was performed, and the corrective results in the two groups were compared. Paired-sample t tests or independent-sample t tests were used. RESULTS: The median follow-up after surgery of the 21 patients was 36 months (range, 18-72 months). The Cobb angle was corrected from 45.81° ± 14.23° preoperatively to 10.48° ± 5.56° postoperatively (correction rate, 77.78% ± 8.93%). The T1 tilt angle decreased from 15.26° ± 7.08° preoperatively to 3.33° ± 2.14° postoperatively (correction rate,73.42% ± 21.86%). The radiographic shoulder height was corrected from 1.13 ± 0.74 cm preoperatively to 0.52 ± 0.42 cm postoperatively (correction rate, 39.51% ± 35.65%). The clavicular angle improved from 2.52° ± 1.55° preoperatively to 1.16° ± 0.96° postoperatively (correction rate, 47.18% ± 35.84%). No significant differences were found at the last follow-up (p > 0.05). The Cobb angle of the main curve, T1 tilt angle, clavicular angle, cervical tilt angle, and shoulder height difference were similar in the two groups (p > 0.05). CONCLUSIONS: Posterior approach hemivertebra resection or correction with fusion surgery can be used in the treatment of congenital cervicothoracic scoliosis with satisfactory results, and the surgeon can make an individualized surgical plan according to individual characteristics of deformity.

One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report.

PURPOSE: To determine the efficacy and feasibility of surgical management of cervicothoracic tuberculosis accompanied by kyphosis in children by using one-stage posterior focus debridement, bone graft fusion, and instrumentation at a single institution. METHODS: Ten consecutive cases with cervicothoracic tuberculosis with kyphosis were treated with one-stage posterior focus debridement, bone graft fusion, and instrumentation. The mean follow-up was 36 months (range 26-47 months). The kyphotic angle ranged from 35° to 62° before operation, 50.5° in average. The American Spinal Injury Association score system was used to evaluate the neurological deficits. RESULTS: Spinal tuberculosis was completely cured in all ten patients. There was no recurrent tuberculous infection. The postoperative kyphotic angle was 10° to 22°, 17.5° in average, and there was no significant loss of the correction at the latest follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. CONCLUSIONS: One-stage posterior debridement, bone grafting, and instrumentation can be an effective treatment method of cervicothoracic spinal tuberculosis with kyphosis in children.

Adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia: a retrospective study of correction and fusion strategies.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To study the correction and fusion strategies for adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia by using posterior pedicle screw instrumentation (PPSI). Surgical intervention for Chiari malformation and syringomyelia before surgical correction of scoliosis has been reported; however, there are no clinical trials for the PPSI-based correction and fusion procedures used in these patients. METHODS: From 2002 to 2009, 13 adult patients (mean age, 34.9 years) suffering from thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia underwent correction and fusion by using PPSI. Preoperative, postoperative, and final follow-up coronary Cobb angle, correction rate, pelvic obliquity (PO), apical vertebral rotation (AVR), apical vertebral translation (AVT), trunk shift (TS), sagittal thoracic kyphosis angle, and lumbar lordosis angle were analyzed on radiographs. RESULTS: The preoperative and postoperative mean coronary Cobb angle was from 46.8° to 9.2°, correction rate was 80.7%, PO from 9.9° to 3.2°, AVR from 1.9° to 0.3°, AVT from 3.6 to 0.8 cm, TS from 16.8 to 1.6 cm, sagittal thoracic kyphosis angle from 18.2° to 23.5°, and lumbar lordosis angle was from 37.4° to 41.8°. The mean follow-up period was 35.2 months (range, 24-50 months). There were no obvious pseudoarticulations or loss of correction and trunk equilibrium at the final follow-up; no aggravation of the original neural symptoms or new irreversible neural injury was observed. CONCLUSIONS: In patients with mild or moderate adult thoracolumbar or lumbar scoliosis with Chiari malformation and syringomyelia, the correction and fusion by using PPSI can yield a satisfactory clinical effect.

Tenosynovial giant cell tumor involving the cervical spine: A case report.

BACKGROUND: Tenosynovial giant cell tumors (TGCTs) are a frequent benign proliferative disease originating from the synovial membrane. However, TGCTs rarely occur in the spine. The purpose of this paper is to report a case of TGCT occurring in the cervical spine. Although the disease is rare, it is essential to consider the possibility of TGCT in axial skeletal lesions. Awareness of spinal TGCTs is important because their characteristics are similar to common spinal tumor lesions. CASE SUMMARY: A 49-year-old man with a 2-year history of neck pain and weakness in both lower extremities was referred to our ward. Imaging revealed a mass extending from the left epidural space to the C4-5 paravertebral muscles with uneven enhancement. The tumor originated in the synovium of the C4-5 lesser joint and eroded mainly the C4-5 vertebral arch and spine. Puncture biopsy was suggestive of a giant cell-rich lesion. The patient had pulmonary tuberculosis, and we first administered anti-tuberculosis treatment. After the preoperative requirements of the anti-tuberculosis treatment were met, we used a posterior cervical approach to completely remove the mass after fixation with eight pedicle screws. The mass was identified as a TGCT by postoperative immunohistochemical analysis. Recurrence was not detected after 1 year of follow-up. CONCLUSION: Spinal TGCTs are often misdiagnosed. The radiological changes are not specific. The ideal treatment comprises complete excision with proper internal fixation, which can significantly reduce postoperative recurrence.

Deformed Complex Vertebral Osteotomy Technique for Management of Severe Congenital Spinal Angular Kyphotic Deformity.

OBJECTIVES: To (i) introduce the deformed complex vertebral osteotomy (DCVO) technique for the treatment of severe congenital angular spinal kyphosis; (ii) evaluate the sagittal correction efficacy of the DCVO technique; and (iii) discuss the advantages and limitations of the DCVO technique. METHODS: Multiple malformed vertebrae were considered a malformed complex, and large-range and angle wedge osteotomy was performed within the complex using the DCVO technique. Patients with local kyphosis greater than 80° who were treated with DCVO and did not have tumors, infections, or a history of surgery were included. A retrospective case study was performed in these patients with severe angular kyphosis who underwent the DCVO technique from 2008 to 2016. Demographic data, the operating time, and the volume of intraoperative blood loss were collected. Spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], and sacral slope [SS]), local and global sagittal parameters (deformity angle, thoracic kyphosis [TK], and lumbar lordosis [LL]), visual analog scale (VAS) score, and Oswestry disability index (ODI) score were recorded pre- and postoperatively. Paired t-tests (α = 0.05) were used for all data (to compare the mean preoperative value with the mean postoperative and most recent follow-up values). P < 0.05 was considered statistically significant. RESULTS: Twenty-nine patients with a mean age of 34 years (range, 15-55) were included in the final analysis. Seventeen patients were male, and 12 were female. The mean follow-up was 44 months (range, 26-62). The mean operating time was 299 min (range, 260-320 min). The mean blood loss was 2110 mL (range, 1500-2900 mL). Three patients had T7 -T8 deformities (3/29, 10.3%), six had T8 -T9 deformities (6/29, 20.7%), six had T9 -T10 deformities (6/29, 20.7%), 10 had T10 -T11 deformities (10/29, 34.5%), three had T11 -T12 deformities (3/29, 10.3%), and one had T9 -T11 deformities (1/29, 3.4%). The mean local deformity angle significantly improved from 94.9° ± 10.8° to 24.0° ± 2.3° through the DCVO technique, with no significant loss at the follow-up. Moreover, the global sagittal parameters and spinopelvic parameters exhibited ideal magnitudes of improvement; TK decreased from 86.1° ± 12.1° to 28.7° ± 2.5°, LL improved from 94.5° ± 4.1° to 46.1° ± 3.0°, and PI minus LL improved from -60.9° ± 6.5° to -13.7° ± 2.6°. Both the VAS and ODI scores significantly improved at the last follow-up. CSF fistula and neural injury did not occur during the perioperative period. At the last follow-up, fixation failure was not observed. CONCLUSION: The DCVO technique provides an alternative and effective method for the treatment of congenital severe angular spinal kyphotic deformities and may decrease the occurrence of perioperative complications.

Identification of a Transcription Factor-microRNA-Gene Coregulation Network in Meningioma through a Bioinformatic Analysis.

BACKGROUND: Meningioma is a prevalent type of brain tumor. However, the initiation and progression mechanisms involved in the meningioma are mostly unknown. This study aimed at exploring the potential transcription factors/micro(mi)RNAs/genes and biological pathways associated with meningioma. METHODS: mRNA expressions from GSE88720, GSE43290, and GSE54934 datasets, containing data from 83 meningioma samples and eight control samples, along with miRNA expression dataset GSE88721, which had 14 meningioma samples and one control sample, were integrated analyzed. The bioinformatics approaches were used for identifying differentially expressed genes and miRNAs, as well as predicting transcription factor targets related to the differentially expressed genes. The approaches were also used for gene ontology term analysis and biological pathway enrichment analysis, construction, and analysis of protein-protein interaction network, and transcription factor-miRNA-gene coregulation network construction. RESULTS: Fifty-six upregulated and 179 downregulated genes were identified. Thirty transcription factors able to target the differentially expressed genes were predicted and selected based on public databases. One hundred seventeen overlapping genes were identified from the differentially expressed genes and the miRNAs predicted by miRWalk. Furthermore, NF-κB/IL6, PTGS2, MYC/hsa-miR-574-5p, hsa-miR-26b-5p, hsa-miR-335-5p, and hsa-miR-98-5p, which are involved in the transcription factor-miRNA-mRNA coregulation network, were found to be associated with meningioma. CONCLUSION: The bioinformatics analysis identified several potential molecules and relevant pathways that may represent critical mechanisms involved in the progression and development of meningioma. This work provides new insights into meningioma pathogenesis and treatments.

Debridement and Interbody Graft Using Titanium Mesh Cage, Posterior Monosegmental Instrumentation, and Fusion in the Surgical Treatment of Monosegmental Lumbar or Lumbosacral Pyogenic Vertebral Osteomyelitis via a Posterior-Only Approach.

OBJECTIVE: The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. METHODS: From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32-56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26-53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery. RESULTS: PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients. CONCLUSIONS: Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.

[Practical experience of virtual acupuncture and moxibustion teaching system in the operation teaching course of Acupuncture Sciences].

Started from the needs of clinical teaching and practice of acupuncture and moxibustion, based on the acupuncture Tongren education and assessment model, the virtual acupuncture teaching system was developed with the help of virtual reality (VR) technology, and applied to the course teaching of meridian and acupoint and needling and moxibustion method of Acupuncture Sciences. Compared with conventional teaching, this system can effectively improve practical operation test scores of students, meanwhile, it has higher interest, interactivity and helpfulness for knowledge learning, and improve independent learning ability, learning effect and memory depth, so student's satisfaction is higher.

Multivariate analysis of incision infection after posterior lumbar surgery in diabetic patients: A single-center retrospective analysis.

BACKGROUND: Patients requiring posterior lumbar surgery have increased annually. Incision infection after lumbar surgery has serious consequences for patients. However, data on the related factors of incision infection after lumbar surgery in diabetic patients are limited. Therefore, this study aimed to analyze diabetic patients who underwent lumbar surgery and to explore the risk factors of perioperative incision infection to provide a scientific basis for perioperative intervention of lumbar spine surgery and reduce risk of incision infection in such patients. METHODS: We retrospectively reviewed data of diabetic patients who underwent posterior lumbar surgery from 2011 to 2016. A total of 523 diabetic patients undergoing posterior lumbar surgery were analyzed for the influence of various risk factors on postoperative incision infection. Univariate and multivariate logistic regression was performed. The test level was α=.05, and P < .05 was considered statistically significant. RESULTS: In the past 6 years, among the 523 diabetic patients, the incidence of incision infection after posterior lumbar surgery was approximately 7.1%, of which the shallow incision infection rate was 4.2% and the deep incision infection rate was 2.9%. Incision infection of posterior lumbar surgery in diabetic patients is related to smoking, preoperative glycosylated hemoglobin A1c, postoperative albumin (Alb), surgical segment, operation time, and intraoperative blood loss, especially on postoperative fasting blood glucose, postoperative postprandial blood glucose, local subcutaneous fat thickness, and operation sequence (odds ratio >5.00). Meanwhile, sex, age, body mass index (BMI), preoperative Alb, and newly diagnosed diabetes were not highly correlated with incision infection after posterior lumbar surgery. CONCLUSION: Local subcutaneous fat thickness is a better indicator for predicting incision infection compared with BMI. In diabetic patients undergoing lumbar surgery, actively controlling blood glucose fluctuations, restoring normal diet early after surgery, and optimizing surgical procedures to reduce trauma and operative time can effectively reduce the risk of infection after posterior lumbar surgery.

Andrographolide Promotes Neural Differentiation of Rat Adipose Tissue-Derived Stromal Cells through Wnt/ß-Catenin Signaling Pathway.

Adipose tissue-derived stromal cells (ADSCs) are a high-yield source of pluripotent stem cells for use in cell-based therapies. We explored the effect of andrographolide (ANDRO, one of the ingredients of the medicinal herb extract) on the neural differentiation of rat ADSCs and associated molecular mechanisms. We observed that rat ADSCs were small and spindle-shaped and expressed multiple stem cell markers including nestin. They were multipotent as evidenced by adipogenic, osteogenic, chondrogenic, and neural differentiation under appropriate conditions. The proportion of cells exhibiting neural-like morphology was higher, and neurites developed faster in the ANDRO group than in the control group in the same neural differentiation medium. Expression levels of the neural lineage markers MAP2, tau, GFAP, and ß-tubulin III were higher in the ANDRO group. ANDRO induced a concentration-dependent increase in Wnt/ß-catenin signaling as evidenced by the enhanced expression of nuclear ß-catenin and the inhibited form of GSK-3ß (pSer9). Thus, this study shows for the first time how by enhancing the neural differentiation of ADSCs we expect that ANDRO pretreatment may increase the efficacy of adult stem cell transplantation in nervous system diseases, but more exploration is needed.