Early result of percutaneous full-endoscopic transforaminal lumbar interbody fusion in the treatment of single-level lumbar degenerative diseases: a retrospective study.

OBJECTIVE: The study aimed to evaluate the short-term clinical efficacy of percutaneous full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) for lumbar degenerative diseases (LDD). METHODS: From July 2020 to July 2021, 93 patients who underwent single-level lumbar fusion procedure were retrospective analysis. The patients were divided into Endo-TLIF group and transforaminal lumbar interbody fusion (TLIF) group. General demographic and perioperative data were recorded, the clinical outcomes were evaluated using visual analogue scale (VAS) and oswestry disability index (ODI). The disk height (DH) was compared between the two groups. RESULTS: All of the surgical procedures were successfully completed, and the patients were followed for a minimum of 2 years. Intraoperative blood loss, drainage volume, time to independent ambulation and hospital length of stay in the Endo-TLIF group were significantly decreased in comparison with the open TLIF group (p < 0.05). The VAS for back pain on postoperative 7 day and ODI on postoperative 1 month were lower in the Endo-TLIF group than in the open TLIF group (P < 0.05), but no significant difference at 1 year and 2 years postoperatively (P > 0.05). The VAS score of leg pain had no demographic statistically significant differences between the groups (P > 0.05). The DH were significantly heightened after surgery compared to the preoperative height (p < 0.05). CONCLUSION: Endo-TLIF is a minimally invasive, safety surgery which can achieve comparable short-term effects as open TLIF. It may be a promising option for the treatment of LDD.

Is unilateral-approach full-endoscopic lumbar fusion effective for single-level lumbar spondylolisthesis with bilateral symptoms? A preliminary report of 43 CT analysis.

PURPOSE: To investigate the clinical results and radiological parameters changes after unilateral-approach endoscopic lumbar interbody fusion (Endo-LIF) for lumbar spondylolisthesis with bilateral symptoms. METHODS: 43 single-level lumbar spondylolisthesis patients with bilateral lower limb symptoms were included from June 2020 to May 2022. All patients underwent unilateral-approach Endo-LIF and postoperative computed tomography. Radiological parameters including disk height (DH), degree of upper vertebral slip (DUVS), and foramen intervertebral parameters including bilateral foraminal height (FH), contralateral foraminal areas (FA) were evaluated. The clinical outcomes including low back pain and bilateral leg pain were evaluated using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. RESULTS: All cases were successfully completed surgery and followed for average 15.16 ± 5.2 months. DH (44% ± 11%) and DUVS were significantly improvement postoperatively compared with preoperatively (p < 0.05). Statistically significant increases in bilateral FH (25% ± 11% on the surgical side, 17% ± 8% on the contralateral side) and contralateral FA (26% ± 6%) were observed (p < 0.05). The VAS and the ODI scores were significantly decreased in comparison with the preoperative scores (p < 0.05). CONCLUSION: Unilateral-approach with contralateral indirect decompression in Endo-LIF can acquire satisfactory clinical outcomes. Therefore, unilateral-approach Endo-LIF may be a promising option for lumbar spondylolisthesis with bilateral symptoms.

Circ_0027885 sponges miR-203-3p to regulate RUNX2 expression and alleviates osteoporosis progression.

BACKGROUND: Osteoporosis (OP) is a progressive metabolic disorder that is difficult to cure clinically. The molecular mechanisms of OP urgently need to be further examined. This study was designed to explore the potential function of circ_0027885 during osteogenic differentiation, as well as the systematic interactions among circ_0027885, miR-203-3p and runt-related transcription factor 2 (RUNX2). METHODS: Relative levels of circ_0027885, miR-203-3p and RUNX2 were analyzed with RT-qPCR and western blotting. Alizarin red staining was performed to detect the mineralization ability under the control of circ_0027885 and miR-203-3p. Dual-luciferase reporter gene assay was conducted to examine the combination among circ_0027885, miR-203-3p and RUNX2. RESULTS: Our research demonstrated that circ_0027885 was significantly increased during hBMSCs differentiation. Overexpression of circ_0027885 notably facilitated osteogenic differentiation and upregulated RUNX2 expression, while knockdown of circ_0027885 reversed the above results. Through prediction on bioinformatics analysis, miR-203-3p was the target binding circ_0027885, and RUNX2 was the potential target of miR-203-3p. Subsequently, these changes induced by the overexpression of circ_0027885 were reversed upon addition of miR-203-3p mimic. CONCLUSIONS: Circ_0027885 could sponge miR-203-3p to regulate RUNX2 expression and alleviate osteoporosis progression.

Clinical Study of Percutaneous Endoscopic Large-channel Fusion and Transforaminal Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Spinal Stenosis.

Context: Degenerative changes in the lumbar spine more commonly cause spinal stenosis and with the aging of society, its incidence is on the rise. Endoscopic spinal surgery is a minimally invasive technique for decompression. The efficacy of percutaneous, endoscopic, large-channel fusion and transforaminal lumbar interbody fusion (TLIF) need confirmation by more studies. Objective: The study intended to investigate the clinical efficacy of percutaneous endoscopic large-channel fusion and TLIF in the treatment of degenerative lumbar spinal stenosis, to find the best treatment plan. Design: The research team performed a retrospective study. Setting: The study took place at Nanjing Lishui People's Hospital in Nanjing, Jiangsu Province, PR China. Participants: Participants were 100 patients with degenerative, lumbar, spinal stenosis who had been admitted to the hospital between October 2018 and October 2022. Intervention: The research team randomly divided participants into an intervention group and a control group, with 50 participants in each group. The intervention group received percutaneous, endoscopic, large-channel fusion and internal fixation, and the control group received foraminal, lumbar, interbody fusion. Outcome Measures: The research team measured: (1) perioperative indexes, (2) clinical efficacy at a postoperative follow-up at 6 months postintervention, (3) indexes for inflammatory responses at baseline and postintervention, (4) postoperative pain at baseline and at months 3 and 6 postintervention using a visual analog scale (VAS), (6) lumbar function at baseline and months 3 and 6 postintervention using the Oswestry Disability Index (ODI) and the Japanese Orthopedic Association (JOA) scale, and (7) complications. Results: Compared with the control group, the intervention group's perioperatively related and inflammatory-response indexes were significantly better: (1) amount of bleeding- 112.67 ± 17.38 for the control group and 78.62 ± 10.52 for the intervention group (P = .002); (2) volume of drainage-79.63 ± 14.21 for the control group and 52.18 ± 8.21 for the intervention group (P = .001); (3) ESR at baseline and postintervention-22.41 ± 5.62 and 15.18 ± 5.26, respectively, for the control group and 22.58 ± 5.82 and 10.54 ± 3.18, respectively, for the intervention group, with P = .013 postintervention; and (4) CRP at baseline and postintervention-17.42 ± 3.52 and 13.98 ± 3.65 for the control group, respectively, and 18.65 ± 3.78 and 10.14 ± 2.78 for the intervention group, with P = .008 postintervention; Also, compared to the control group, the intervention group's: (1) total effective rate was significantly higher (P = .018); (2) incidence of postoperative complications was significantly lower (P = .006); (3) VAS pain score was significantly lower at months 3 and 6, with P = .028 and P = .021, respectively; (4) Oswestry Disability Index (ODI) function score was significantly lower at months 3 and 6, with P = .016 and P = .014, respectively; and (5) postoperative JOA function score was significantly higher at months 3 and 6, with P = .011 and P = .007, respectively. Conclusions: Both percutaneous, endoscopic, large-channel fusion and TLIF had good therapeutic effects in the treatment of degenerative lumbar spinal stenosis. However, compared with the latter, the former was more effective, with better comprehensive efficacy and more obvious benefits for patients, so it's worthy of clinical promotion and use.

Expression profiling of long noncoding RNAs associated with vasculogenic mimicry in osteosarcoma.

Osteosarcoma (OS) is the most common highly malignant bone tumor in teens. Vasculogenic mimicry (VM) is defined as de novo extracellular matrix-rich vascular-like networks formed by highly aggressive tumor cells. We previously reported the presence of VM and it is an unfavorable prognostic factor in OS patients. Long noncoding RNAs (lncRNAs) are aberrantly expressed in OS and involved in cancer cell VM. However, lncRNAs in VM formation of OS have not been investigated. We, therefore, profiled the expression of lncRNAs in highly aggressive OS cell line 143B compared with its parental poorly aggressive cell line HOS. The differentially expressed (DE) lncRNAs and messenger RNA (mRNAs) were subjected to constructed lncRNA-mRNA coexpressed network. The top-ranked hub gene lncRNA n340532 knockdown 143B cells were used for in vitro and in vivo VM assays. The annotation of DE lncRNAs was performed according to the coexpressed mRNAs by Gene Ontology and pathway analysis. A total of 1360 DE lncRNAs and 1353 DE mRNAs were screened out. lncRNA MALAT1 and FTX, which have known functions related to VM formation and tumorigenesis were identified in our data. The coexpression network composed of 226 lncRNAs and 118 mRNAs in which lncRNA n340532 had the highest degree number. lncRNA n340532 knockdown reduced VM formation in vitro. The suppression of n340532 also exhibited potent anti-VM and antimetastasis effect in vivo, suggesting its potential role in OS VM and metastasis. Furthermore, n340532 coexpressed with 10 upregulation mRNAs and 3 downregulation mRNAs. The enriched transforming growth factor-ß signaling pathway, angiogenesis and so forth were targeted by those coexpressed mRNAs, implying n340532 may facilitate VM formation in OS through these pathways and gene functions. Our findings provide evidence for the potential role of lncRNAs in VM formation of OS that could be used in the clinic for anti-VM therapy in OS.

Migration-inducing gene-7 independently predicts poor prognosis of human osteosarcoma and is associated with vasculogenic mimicry.

Vasculogenic mimicry (VM) is a special type of vascular channel formed by tumor cells without endothelial cell participation. Migration-inducing gene 7 (MIG-7) plays an important role in regulating VM. In this study, immunohistochemical staining was used to detect MIG-7 in tissue specimens from 141 primary osteosarcoma patients, and the relationship between MIG-7 and VM was examined. Survival analysis were performed to evaluate the prognoses. MIG-7 knockdown osteosarcoma cells were used for cell proliferation, apoptosis, migration, invasiveness and VM formation assays. A spontaneously metastasizing cell line-derived orthotopic xenograft mouse model was established to evaluate the effect of MIG-7 knockdown on tumorigenesis, VM formation and lung metastasis. MIG-7 expression was associated with VM formation. There were significant differences in overall and metastasis-free survival between the MIG-7-positive and MIG-7-negative groups. The MIG-7 expression was shown to be an independent indicator of both overall and metastasis-free survival. In vitro knockdown of MIG-7 dramatically reduced migration, invasion and VM formation in osteosarcoma cells without any significant effect on cell proliferation and apoptosis. MIG-7 knockdown also exhibited potent antitumor, antimetastasis and anti-VM effects in the orthotopic mouse model of 143B osteosarcoma. Therefore, MIG-7 serves as an independent unfavorable prognostic indicator in osteosarcoma patients and MIG-7 is an important mediator of osteosarcoma VM formation.

Rehabilitation training enhanced the therapeutic effect of calycosin on neurological function recovery of rats following spinal cord injury.

BACKGROUND: Calycosin (CA), a flavonoids component, has demonstrated potential neuroprotection effects by inhibiting oxidative stress in spinal cord injury (SCI) models. This study aims to investigate the impact of combined rehabilitation training (RT) and calycosin therapy on neurological function following SCI, primarily by assessing changes in motor function recovery, neuronal survival, neuronal oxidative stress levels, and neural proliferation, in order to provide novel insights for the treatment of SCI. MATERIALS AND METHODS: The SCI model was constructed by compressing the spinal cord using vascular clamps. Calycosin was injected intraperitoneally into the SCI model rats, and a group of 5 rats underwent RT. The motor function of rats after SCI was evaluated using the Basso Beattle Bresnaha (BBB) score and the inclined plate test. Histopathological changes were evaluated by NeuN immunohistochemistry, HE and Nissl staining. Apoptosis was detected by TUNEL staining. The antioxidant effect of combined treatment was assessed by measuring changes in oxidative stress markers after SCI. Western blot analysis was conducted to examine changes in Hsp90-Akt/ASK1-p38 pathway-related proteins. Finally, cell proliferation was detected by BrdU and Ki67 assays. RESULTS: RT significantly improved the BBB score and angle of incline promoted by calycosin, resulting in enhanced motor function recovery in rats with SCI. Combining rehabilitation training with calycosin has a positive effect on morphological recovery. Similarly, combined RT enhanced the Nissl and NeuN staining signals of spinal cord neurons increased by calycosin, thereby increasing the number of neurons. TUNEL staining results indicated that calycosin treatment reduced the apoptosis signal in SCI, and the addition of RT further reduced the apoptosis. Moreover, RT combined with calycosin reduced oxidative stress by increasing SOD and GSH levels, while decreasing MDA, NO, ROS, and LDH expressions compared to the calycosin alone. RT slightly enhanced the effect of calycosin in activating Hsp90 and Akt and inhibiting the activation of ASK1 and p38, leading to enhanced inhibition of oxidative stress by calycosin. Additionally, the proliferation indexes (Ki67 and BrdU) assays showed that calycosin treatment alone increased both, whereas the combination treatment further promoted cell proliferation. CONCLUSION: Our research findings demonstrate that rehabilitation training enhances the ability of calycosin to reduce oxidative stress, resulting in a decrease in neuronal apoptosis and an increase in proliferation, ultimately promoting neuronal survival.

Comparison of Outcomes Between Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Degenerative Disease: A Retrospective Study.

OBJECTIVE: The objective of this study was to compare the clinical and radiological outcomes of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS: This retrospective study included 110 patients with single-level lumbar degenerative disease who underwent Endo-TLIF or MIS-TLIF between January 2019 and December 2021. Patients were divided into Endo-TLIF (n = 55) and MIS-TLIF groups (n = 55). Perioperative, clinical, and radiological outcomes were assessed. RESULTS: The Endo-TLIF group had significantly lower blood loss and shorter hospital stay. However, the operation time was significantly longer and there was more x-ray exposure than in the MIS-TLIF group. There were no significant differences in complications between the groups. The Endo-TLIF group showed significantly lower creatine kinase levels than the MIS-TLIF group at 3 days postoperatively (P < 0.05), but not at 7 days postoperatively (P > 0.05). Oswestry Disability Index and visual analog scale scores were significantly reduced in both groups at different time points postoperation compared to preoperation. The visual analog scale score in the Endo-TLIF group was lower than that in the MIS-TLIF group at 3 days postoperatively. Moreover, no significant differences were found in fusion rates, lumbar lordosis, and lumbar segmental lordosis between the 2 groups (P > 0.05). CONCLUSIONS: Endo-TLIF might be considered as an effective and reliable treatment option for single-level lumbar degeneration. It results in less trauma and faster postoperative recovery, but a longer operative time and more x-ray exposure than MIS-TLIF. Endo-TLIF has effects on clinical and radiological outcomes that are comparable to those of MIS-TLIF.

Intervertebral disk regeneration in a rat model by allopurinol-loaded chitosan/alginate hydrogel.

Intervertebral disk degeneration remains one of the most challenging health problems. In the current study, allopurinol was loaded into the chitosan nanoparticles and then incorporated into chitosan/alginate hydrogels and then further studied for its disk regeneration potential in a rat model. In vitro studies were performed to characterize the hydrogel system, including scanning electron microscopy, cell viability assay, cytoprotection assay, cell migration assay, swelling assay, and drug release assay. In vivo study was performed in a rat model of the intervertebral disk injury. Animal studies showed that allopurinol-loaded hydrogels had significantly higher disk regeneration potential compared with other experimental groups. The gene expression studies showed that the animals treated with allopurinol-loaded hydrogel had significantly higher tissue expression levels of type I and type II collagen genes than other groups. Furthermore, the tissue expression levels of nuclear factor κB (NF-κB) and glutathione peroxidase (GPx) genes were significantly lower in this group. The relative expression levels of type I collagen, type II collagen, NF-κB, and GPx genes in the allopurinol-loaded hydrogel group were 2.77 ± 0.2%, 2.86 ± 0.25%, 0.58 ± 0.03%, and 0.45 ± 0.02%, respectively. We showed for the first time that allopurinol-loaded hydrogel promoted intervertebral disk repair, which could be due to its potential to modulate oxidative stress, reduce inflammation, and improve matrix synthesis.

Which surgery is better for obese patients with lumbar degenerative diseases: open TLIF or Endo-LIF? A retrospective matched case-control study.

OBJECTIVE: This study aimed to evaluate short-term clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (Endo-LIF) in the treatment of obese patients with lumbar degenerative diseases (LDD). METHODS: Patients who underwent single-level lumbar fusion surgery from July 2020 to July 2022 were retrospectively analyzed in this study. The main inclusion criterion was a body mass index (BMI) ≥30kg/m2. A matched case-control design was conducted to compare the short-term outcomes between the Endo-LIF and transforaminal lumbar interbody fusion (TLIF) in obese patients. Cases were defined as those who underwent Endo-LIF, and controls were matched from those patients with open TLIF according to corresponding matched criteria. Surgeon satisfaction was evaluated by questionnaires at the end of each surgery, patient satisfaction and their willingness to undergo the same surgery again were collected. RESULTS: Two groups of patients were successfully completed surgery. In comparison with the open TLIF group, the Endo-LIF group had significantly less blood loss, less time to postoperative ambulation, less postoperative complications and shorter hospitalization days, but longer operation time and x-ray exposure times. The satisfaction of surgeons and patients in Endo-LIF group significantly were superior to open TLIF group. CONCLUSION: Endo-LIF is a safe and effective surgery in the treatment of obese patients. Although this procedure needs longer operation time and x-ray exposure times, it still maybe a promising option for obese patients with LDD.

Meta-Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery.

Objective: The safety and effectiveness of topical tranexamic acid in spinal surgery has not yet been reached, and further research is needed to confirm it. This study is aimed at detecting the effectiveness and safety on the tranexamic acid in spinal surgery. Methods: The Cochrane Library, PubMed, Embase, CNKI, and other databases were searched. The search time was from 2016 to 2019. All randomized controlled trials comparing the topical tranexamic acid group and the control group were collected. The experimental group used topical application. Tranexamic acid was used to treat bleeding after spinal surgery. The control group was no tranexamic acid or isotonic saline. The total bleeding, blood transfusion rate, and the occurrence of deep vein thrombosis were compared between the two groups. Rev Man 5.2.0 software was used for meta-analysis. Results: A total of 8 randomized controlled trials were included, including 884 patients. Meta-analysis results showed that the total bleeding volume of the tranexamic acid group was lower than that of the control group, and the difference was statistically significant weighted mean difference ((WMD) = -360.27 mL, 95% confidence interval (CI) (-412.68, -307.87) mL, P < 0.00001). The blood transfusion rate in the tranexamic acid group was lower than that in the control group (odds ratio (OR) = 0.22, 95% CI (0.14, 0.33), P < 0.00001). There was no significant difference in the incidence of deep vein thrombosis between the two groups: OR = 1.48, 95% CI (0.41, 5.34), P = 0.55. Conclusion: Tranexamic acid can significantly reduce perioperative total blood loss, intraoperative blood loss, and blood transfusion rate during spinal surgery but has no significant effect on blood transfusion and thrombosis.

Subcutaneous Lumbar Spine Index (SLSI) as a Risk Factor for Surgical Site Infection After Lumbar Fusion Surgery: A Retrospective Matched Case-Control Study.

STUDY DESIGN: A retrospective matched case-control study. OBJECTIVE: This study aims to investigate the value of Subcutaneous Lumbar Spine Index (SLSI) as a predictor of early surgical site infection (SSI) after lumbar intervertebral fusion surgery. METHODS: A retrospective case-control study was performed on patients who underwent transforaminal lumbar interbody fusion (TLIF) from January 1, 2014 to December 31, 2019 in a single institution. Cases were defined as those who developed early SSI according to the US Center for Disease Control and Prevention criteria, and controls were matched from those patients without early SSI using the following matched criteria: gender, age, time of surgery and diabetes. Subcutaneous fat thickness (SFT) and SLSI were measured on preoperative MRI mid-sagittal T2 weighted images. RESULTS: A total of 3615 patients who underwent TLIF were enrolled in this study. Thirty-three patients were included in early SSI, and sixty-six patients were selected as matched controls. Univariate analysis indicated that fusion levels (P = .007), operation time (P = .022), obesity (P = .013), SFT (P = .002) and SLSI (P = .001) were significantly associated with early SSI. Multiple logistic regression analysis revealed that multilevel fusion levels (P = .021), obesity (P = .035), a large SFT (P = .026) and a high SLSI (P = .012) were independent risk factors. Body mass index (BMI) and SLSI were moderately correlated (r2 = .55). ROC curve demonstrated that SLSI was more sensitive than SFT to predict the early SSI. CONCLUSION: SLSI is a novel radiological risk factor for early SSI development and is a better indicator than SFT to predict early SSI risk after lumbar intervertebral fusion.

Long-term effects of cemented and cementless fixations of total knee arthroplasty: a meta-analysis and systematic review of randomized controlled trials.

BACKGROUND: To determine the long-term effects (a minimum follow-up time 8.8 years) of cemented and cementless fixations used for total knee arthroplasty (TKA). METHODS: PubMed, EMBASE, Ovid, Cochrane Library, CINAHL, China National Knowledge Infrastructure and China Wangfang database were interrogated for appropriate randomized controlled trials (RCTs) through July 2020. Data were extracted and assessed for accuracy by 2 of the authors acting independently. Any controversial discrepancies were resolved after discussion with a third author. RESULT: Eight RCTs were included with low to moderate bias risks. The cemented fixation of TKA was comparable to cementless fixation in terms of implant survival (relative risk, 1.016; 95% CI 0.978 to 1.056; P = 0.417), Knee Society (KS) knee score (standardized mean difference (SMD), - 0.107; 95% CI - 0.259 to 0.045; P = 0.168), KS function score (SMD - 0.065; 95% CI - 0.238 to 0.109; P = 0.463), KS pain score (SMD - 0.300; 95% CI - 0.641 to 0.042; P = 0.085), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (SMD - 0.117; 95% CI - 0.307 to 0.073; P = 0.227), HSS score (SMD - 0.027; 95% CI - 0.270 to 0.217; P = 0.829), range of motion (SMD 0.061; 95% CI - 0.205 to 0.327; P = 0.652) at ≥ 8.8 years of follow-up. In terms of radiographic outcomes at ≥ 8.8 years of follow-up, the incidence of a radiolucent line in the cementless group was lower than for the cemented group (SMD 3.828; 95% CI 2.228 to 6.576; P < 0.001). However, the maximum total point motion (MTPM) of the cementless group was greater than for the cemented group (SMD - 0.739; 95% CI - 1.474 to - 0.005; P = 0.048). CONCLUSIONS: Long-term follow-up verified that cementless and cemented fixation have similar prosthesis survival rates, clinical scores and mobility. However, radiography suggested that each technique had an advantage with regard to the radiolucent line and MTPM.

Regulation of Hippo Signaling by Mechanical Signals and the Cytoskeleton.

Hippo signaling regulates the balance between cell proliferation and apoptosis to control the size of organs during development. Appropriate Hippo signaling is associated with stem cell differentiation, and inappropriate signaling can result in tumorigenesis and cancer. Hippo signaling activity is influenced not only by biochemical signals but also by mechanical force and the cytoskeleton transmitted through cell-cell junctions and cell-matrix adhesions. In this review, we describe the evidence for the regulation of Hippo signaling by the spatial reorganization of signaling components, mechanical force, and the cytoskeleton. Although our understanding of the relationship between Hippo signal transduction and mechanical force and the cytoskeleton is developing rapidly, many unresolved questions remain.

Percutaneous transforaminal endoscopic decompression in the treatment of spinal metastases: A case report.

RATIONALE: Spinal metastases are always associated with specific pain of back and limbs caused by nerve root compression. Although percutaneous endoscopic lumbar discectomy (PELD) has been widely performed on patients with back and radicular pain originating from lumbar disc herniation, this minimally invasive surgery is rarely used for the treatment of spinal metastases. PATIENT CONCERNS: A 71-year-old woman with colon cancer and a known L3 vertebral body metastasis presented with significant progressive pain of low back and limbs. DIAGNOSES: Magnetic resonance imaging (MRI) showed the L3 vertebral body had been involved by osteolytic vertebral metastasis, which extended into spinal canal and compressed the dural sac and nerve root. INTERVENTIONS: The patient was treated with percutaneous transforaminal endoscopic decompression and palliative resection of metastases was performed twice on both sides, respectively. After the minimally invasive procedure, the decompression of the dural sac and nerve root was ideal. OUTCOMES: No complications during the procedure were reported. The minimally invasive surgery resulted in prompt and permanent pain relief until the patient died 6 months later. LESSONS: Percutaneous transforaminal endoscopic decompression could be an appropriate treatment option for the patients who suffer neurologic deficits that result from the spinal metastases.

Sinomenine ameliorates intervertebral disc degeneration via inhibition of apoptosis and autophagy in vitro and in vivo.

BACKGROUND: Aberrant apoptosis in nucleus pulposus (NP) cells is the primary cause of intervertebral disc degeneration (IDD). In contrast, a large number of studies have confirmed that autophagy may protect NP cells from apoptosis. Sinomenine is an alkaloid monomer, which has been reported to stimulate cell autophagy. Therefore, the aim of the present study was to investigate the effects of sinomenine on IDD. METHODS: The effects of sinomenine on the proliferation and apoptosis of NP cells were evaluated with the CCK-8 assay and Annexin V/PI staining, respectively. RESULTS: The data obtained from the present study demonstrated that sinomenine could notably reverse TBHP-induced growth inhibition and apoptosis in rat NP cells. In addition, sinomenine significantly induced autophagy in rat NP cells, which was completely inhibited by 3-methyladenine (3MA). In addition, the protective effect of sinomenine against TBHP in rat NP cells was abolished following treatment with 3MA. Finally, an in vivo study further confirmed that sinomenine could ameliorate rat IDD. CONCLUSION: Taken together, the results of the present study indicated sinomenine could ameliorate rat IDD via induction of autophagy in vitro and in vivo. These findings suggest the therapeutic potential of sinomenine in the prevention of IDD.

[Clinical diagnosis and surgical treatment of congenital contractural arachnodactyly: analysis of 6 cases].

OBJECTIVE: To discuss the clinical diagnosis and surgical treatment of congenital contractural arachnodactyly (CCA). METHODS: The clinical data of 6 CCA patients, 1 male and 5 female, aged 7.5 (5-14) were analyzed. All cases had kyphoscoliosis, 2 in the thoracic segments and 4 in the thoracolumbar segments. The average scoliosis Cobb angle was 88.6 degrees (85 degrees-117 degrees). The average kyphosis Cobb angle was 93.6 degrees (75 degrees-123 degrees). All of the cases underwent internal fixation with pedicle screw and lamina hooks instrumentation, in which 4 cases underwent posterior Smith-Petersen osteotomy. The diagnosis was based on a constellation of clinical findings. The clinical manifestations included marfanoid habitus, flexion contractures of multiple joints (elbow, knee, hip, and finger), kyphoscoliosis, muscular hypoplasia, and abnormal pinnae ("crumpled" outer helices). Molecular genetic testing showed mutation in the fibrillin-2 (FBN2) gene encoding the extracellular matrix microfibril. Four cases were followed up for 6-9 months. RESULTS: After operation the average Cobb angle of the scoliosis and kyphosis were 37.6 degrees (35 degrees-52 degrees) and 38.6 degrees (28 degrees-54 degrees) immediately, with 62.3% and 68.7% curve correction respectively. Three cases got excellent synostosis of posterior lamina, 1 case underwent revision with lamina hook because the distal screw was loose and hurt the nerve root, and the other 2 cases lost follow-up. The patients' body appearance and pulmonary function were obviously improved. CONCLUSION: The characteristic clinical manifestation include severe and stiff kyphoscoliosis, difficult to correct , and enhanced Cobb angle, and pedicle dysplasia of vertebral pedicle leading to difficulty in installing screws. Smith-Petersen osteotomy is often necessary. CCA should be differentiated with Marfan syndrome (MFS), Stickler syndrome, Homocystinuria, and distal arthrogryposis, especially MFS.

[Relationship between alterations of circulating cell-derived microparticles and glucocorticosteroid application].

OBJECTIVE: To explore the relationship between the alterations of circulating cell-derived microparticles (MPs) and large-dose glucocorticosteroid application. METHODS: Peripheral blood samples were collected from 33 patients with history of large-dose glucocorticosteroid application (glucocorticosteroid group) and 24 age-, sex-, and race-matched healthy controls (healthy control group). Platelet-poor plasma was obtained by centrifugation. Plasma microparticles were labeled with monoclonal antibodies of PE-conjugated mouse anti-human CD31, CD54, and FITC-conjugated mouse anti-human CD42b, CD45, CD51/61, CD105, and PE-Cy5-conjugated mouse anti-human CD62E. Cell-derived microparticles were measured by three-color flow cytometry. RESULTS: The mean ranks of CD31+ MPs, CD45+ MPs, CD51/61 MPs, CD31+ CD42b+ MPs, and CD31+ CD45+ MPs of the glucocorticosteroid group were: 24.1, 25.5, 25.6, 21.6, and 24.8 respectively, all significantly lower than those of the control group (35.7, 33.8, 33.7, 39.3, and 34.8 respectively, P = 0.009, 0.019, 0.045, 0.000, and 0.009). CONCLUSION: High-dose glucocorticosteroid application remarkably reduces plasma MPs that may be responsible for microcirculation disturbance.

[Clinical characteristics of hemophilic pseudotumor: analysis of 8 cases].

OBJECTIVE: To analyze the clinical manifestations and imaging features of hemophilic pseudotumor. METHODS: Eight patients with hemophilic pseudotumor, all males, aged 26.1 (18 -38), were hospitalized, underwent resection of pseudotumor and bone reconstruction, and followed up for 38.6 months (7 months to 11 years). The clinical data were analyzed. RESULTS: Femur was involved in 4 patient, and fifth metacarpus, iliopsoas, quadriceps femoris, and gastrocnemius were involved in 1 patient respectively. No recurrence was found. Excellent healing was seen in 6 cases, claudication occurred in 1 case with shortening femur, while unpleasant outcome happened to 1 case because of formation of clotting factor inhibitor, together with poor wound-healing waiting for amputation. CONCLUSION: Medical history and imaging features are essential for the diagnosis of hemophilic pseudotumor. It is the key for successful treatment to master its clinical characteristics.

[Risk factors for skin necrosis around incision after total knee arthroplasty].

OBJECTIVES: To analyze the risk factors of skin necrosis around incision after total knee arthroplasty, and explore measures for prevention and treatment. METHODS: From January 2003 to November 2005, skin necrosis around incision occurred to 15 out of the 382 cases (494 knees) treated by total knee arthroplasty. The data of the 15 cases were analyzed. Preoperative hospital for special surgery knee score (HSS) was 60 points on average. RESULTS: All wound were healed after debridement. However, the recover time was over 3 weeks longer than the healing time by first intention. Extensor weakness with anterior knee pain appeared among 9 patients, and 6 months later, the symptoms improved obviously. At two years follow-up, the average range of motion was 92 degrees, and the average HSS improved to 86. There were no secondary infection and deformity in the group. CONCLUSIONS: It is the key to prevent skin necrosis around incision during total knee arthroplasty that surgeons must accurately grasp technique of minimally invasive surgery for total knee arthroplasty. To acquire satisfactory outcome, it is imperative to perform debridement as soon as possible while the skin necrosis happens. At the same time, it is important to persist in doing adequate functional exercises throughout the period of treatment.