LncRNA AGAP2 antisense RNA 1 stabilized by insulin-like growth factor 2 mRNA binding protein 3 promotes macrophage M2 polarization in clear cell renal cell carcinoma through regulation of the microRNA-9-5p/THBS2/PI3K-Akt pathway.

BACKGROUND: Increasing evidence highlights the potential role of long non-coding RNAs (lncRNAs) in the biological behaviors of renal cell carcinoma (RCC). Here, we explored the mechanism of AGAP2-AS1 in the occurrence and development of clear cell RCC (ccRCC) involving IGF2BP3/miR-9-5p/THBS2. METHODS: The expressions of AGAP2-AS1, IGF2BP3, miR-9-5p, and THBS2 and their relationship were analyzed by bioinformatics. The targeting relationship between AGAP2-AS1 and miR-9-5p and between miR-9-5p and THBS2 was evaluated with their effect on cell biological behaviors and macrophage polarization assayed. Finally, we tested the effect of AGAP2-AS1 on ccRCC tumor formation in xenograft tumors. RESULTS: IGF2BP3 could stabilize AGAP2-AS1 through m6A modification. AGAP2-AS1 was highly expressed in ccRCC tissues and cells. The lentivirus-mediated intervention of AGAP2-AS1 induced malignant behaviors of ccRCC cells and led to M2 polarization of macrophages. In addition, THBS2 promoted M2 polarization of macrophages by activating the PI3K/AKT signaling pathway. AGAP2-AS1 could directly bind with miR-9-5p and promote the expression of THBS2 downstream of miR-9-5p. These results were further verified by in vivo experiments. CONCLUSION: AGAP2-AS1 stabilized by IGF2BP3 competitively binds to miR-9-5p to up-regulate THBS2, activating the PI3K/AKT signaling pathway and inducing macrophage M2 polarization, thus facilitating the development of RCC.

Comparison of Flexion Relaxation Phenomenon After Single-Level and Multi-Level Anterior Cervical Discectomy and Fusion.

BACKGROUND: This prospective cohort study aimed to assess the influence of the number of fused segments in cervical paravertebral muscles by comparing the changes of the cervical flexion relaxation phenomenon (FRP) after single-level versus multilevel anterior cervical discectomy and fusion (ACDF). METHODS: A total of 115 patients who had undergone ACDF were retrospectively recruited and divided into a 1-level group (n = 44), a 2-level group (n = 40) and a 3- to 4-level group (n = 31). The flexion relaxation experiment was carried out 3 days preoperatively and 12 months postoperatively by surface electromyography (SEMG). Patients were examined using the neck visual analog scale, cervical Japanese Orthopedic Association score, Neck Disability Index, and C2-C7 range of motion (ROM). RESULTS: There was a significant difference in the time-related changes in flexion relaxation ratio (FRR) among the 3 study groups before and after surgery (F = 85.701; P < .001). Thirty-five patients (79.55%) with 1-level ACDF and 11 patients (27.5%) with 2-level ACDF had FRP were restored to normal at 12 months postoperatively; however, only 1 patient (3.33%) had normalized FRP after 3- to 4-level ACDF. There were significant differences in the time-related changes of the normalized SEMG root mean square values in each phase before and after surgery (P = .018, <.001, <.001, and <.001). A significant correlation was found between the changes in C2-C7 ROM and FRR in the 3 study groups (P = .007 for 1 level, P = .003 for 2 levels, and P = .036 for 3-4 levels). CONCLUSIONS: Single-level ACDF contributes to normalizing the FRP of cervical paravertebral muscles, which is not ideally recovered by 2-level ACDF. In contrast, 3- or 4-level ACDF could not normalize the cervical FRP. Our research supports the passive structure hypothesis.

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases.

PURPOSE: To explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration. METHODS: A retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA. RESULTS: A total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = - 0.611 and - 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%). CONCLUSIONS: Emerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.

Multiple disc herniation in spondyloepiphyseal dysplasia tarda: A rare case report and review of the literature.

BACKGROUND: Spondyloepiphyseal dysplasia tarda (SEDT) is a rare, hereditary, X-linked skeletal disorder. To our knowledge, there are few reports about orthopedic surgery in these patients. This is the first report on patients with SEDT undergoing spinal and fracture reduction surgery. CASE PRESENTATION: A 31-year-old male patient who had been misdiagnosed with juvenile idiopathic arthritis (JIA) for 20 years and who had been treated with femoral shaft internal fixation for lower extremity fracture caused by minor trauma presented at hospital with stiffness and weakness in the lower extremities for the past two years. Radiographs showed bony dysplastic features of flattened vertebral bodies, Scheuermann-like changes in the spine, and osteoarthritis-like changes in the joints. Laboratory examination, including routine blood tests and rheumatism-related indicators showed negative results. Considering the history, radiology, and genetic findings, a diagnosis of spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) was considered. Further neurological examination indicated that severe spinal cord compression was an important reason for the patient's inability to walk. Laminectomy, spinal canal decompression, internal fixation and fusion were performed. Clinical outcome was satisfactory at one-year follow-up. The lower-limb fatigue was relieved, the patient could walk independently, and his examination showed osseous fusion. The English database was searched and the literature was reviewed for the relevant keywords of "SEDT-PA". CONCLUSIONS: Progress has been made in genetic research on SEDT; early diagnosis is particularly important, but the clinical diagnosis and treatment plans are still evaluated on a case-by-case basis. The best treatment for SEDT is to identify patients with progressive neurological and joint-mobility impairments and perform appropriate surgical intervention. Surgical intervention can improve neurological function and quality of life. However, surgery, as palliative care, does not alter the progression of the disease.

Cervical arthroplasty versus anterior cervical discectomy in the treatment of symptomatic cervical spondylosis: A protocol.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both the effective techniques in treatment of cervical spondylosis. The purpose of this present retrospective cohort research was to assess the efficacy and safety of ACDF and CDA in treating the symptomatic cervical spondylosis over the 6-year follow-up. METHODS: From our registry database, we identified retrospectively patients who received CDA or ACDF in our academic institutions from 2012 to 2015. The study was approved by the Institutional Review Board in Zigong No.4 People's Hospital (Z10058072). All the subjects who participated in this trial were informed consent in writing. The inclusion criteria were the degenerative disc diseases between C3-7 resulting in myelopathy or radiculopathy, which was unresponsive to the conservative treatment. The clinical results were determined via Short Form-36, and neck disability index, numerical scoring scales for complications, arm pain and neck pain. The radiographic assessment contained the cervical lordosis, and the motion range of the functional spinal unit and total cervical spine. The routine follow-up was performed to collect the data of radiographic and clinical assessment at 6, 12, 24, 48, and 72 months before and after the surgery. RESULTS: This study had limited inclusion and exclusion criteria and a well-controlled intervention. It was assumed that both techniques could obtain the similar postoperative effects. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5878).

Hidden blood loss and the risk factors after posterior lumbar fusion surgery: A retrospective study.

Hidden blood loss (HBL) plays an important role in perioperative rehabilitation of patients underwent posterior lumbar fusion surgery. This study was to calculate the volume of HBL and evaluate the risk factors among patients after posterior lumbar fusion surgery.A retrospective analysis was made on the clinical data of 143 patients underwent posterior lumbar fusion surgery from March 2017 to December 2017. Recording preoperative and postoperative hematocrit to calculate HBL according to Gross formula and analyzing its related factors including age, sex, height, weight, body mass index (BMI), surgery levels, surgical time, surgery types, duration of symptoms, disorder type, specific gravity of urine (SGU), plasma albumin (ALB), glomerular filtration rate (GFR), glucose (GLU), drainage volume, hypertension. Risk factors were further analyzed by multivariate linear regression analysis and t test.Eighty-six males and 57 females, mean age 52.7 ±â€Š11.4 years, mean height 162 ±â€Š7.0, mean weight 61.5 ±â€Š9.4, were included in this study. The HBL was 449 ±â€Š191 mL, with a percentage of 44.2% ±â€Š16.6% in the total perioperative blood loss. Multivariate linear regression analysis revealed that patients with higher BMI (P = .026), PLIF procedures (P = .040), and more surgical time (P = .018) had a greater amount of HBL. Whereas age (P = 0.713), sex (P = .276), surgery levels (P = .921), duration of symptoms (P = .801), disorder type (P = .511), SGU (P = .183), ALB (P = .478), GFR (P = .139), GLU (P = .423), hypertension (P = .337) were not statistically significant differences with HBL.HBL is a large proportion of total blood loss in patients after posterior lumbar fusion surgery. BMI >24 kg/m, PLIF procedures, and more surgical time are risk factors of HBL. Whereas age, sex, surgery levels, duration of symptoms, disorder type, SGU, ALB, GFR, GLU, hypertension were not associated with HBL.

Total and hidden blood loss between open posterior lumbar interbody fusion and transforaminal lumbar interbody fusion by Wiltse approach.

The purpose of this study was to calculate and compare the volume of hidden blood loss (HBL) and perioperative blood loss between open posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) by Wiltse approach.We retrospectively analyzed 143 patients between March 2017 and December 2017, they were randomly divided into PLIF group and TLIF group. The following information were collected on admission: patient's age, gender, height, weight, body mass index (BMI), surgery levels, surgical time, duration time, disorder type, intraoperative bleeding, wound drainage, visual analog scale (VAS) scores, neurological complications, transfusion rate. Preoperative and postoperative hematocrit (Hct) were recorded in order to calculate total blood loss (TBL) according to Gross's formula. To calculate each patient's HBL, chi-square test and Student's t test were used to analyze data.Patients in PLIF had a mean TBL of 1144 ±â€Š356 mL, and the mean HBL was 486 ±â€Š203 mL, 43.9 ±â€Š16.2% of the TBL. While patients in TLIF, the mean TBL was 952 ±â€Š303 mL, and the mean HBL was 421 ±â€Š178 mL, 44.7 ±â€Š17.0% of the TBL. Hence, there was significant difference in TBL and HBL between 2 groups, respectively (P = .000, P = .044). However, there was no difference in the ratio of the HBL between 2 groups (P = .797).The volume of HBL is lower in open TLIF by Wiltse approach than that in PLIF, which may be a large proportion of TBL in posterior lumbar fusion surgery. Comprehensive understanding of HBL can contribute to keep patient safety and better to rehabilitation in perioperative.

[Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures].

OBJECTIVE: To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF). METHODS: The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients' symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded. RESULTS: The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups ( t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups ( χ 2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation ( P<0.05), and there were significant differences among the postoperative time points ( P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group ( P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up ( P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups ( P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant ( χ 2=4.105, P=0.043; χ 2=4.661, P=0.031). CONCLUSION: Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.

LncRNA FER1L4 induces apoptosis and suppresses EMT and the activation of PI3K/AKT pathway in osteosarcoma cells via inhibiting miR-18a-5p to promote SOCS5.

Previous studies have determined that long non-coding RNA (lncRNA) Fer-1-like protein 4 (FER1L4) is suppressed in osteosarcoma (OS) and inhibits the tumorigenesis in a variety of cancer. However, the precise biological of FER1L4 in OS has not been cleared. The aim of this study is to investigate the roles and potential mechanisms of FER1L4 in apoptosis and epithelial-mesenchymal transition (EMT) in OS. In the present study, the levels of FER1L4 were decreased significantly in OS tissues and cell lines compared with non-tumorous tissues or hFOB1.19. Knockdown of FER1L4 in OS cells decreased the apoptosis rate, but increased the OS cell proliferation, upregulated the expression levels of CD133 and Nanog, as well as promoted Twist1 expression, increased the N-cadherin and Vimentin expression. In turn, the opposite trends were observed upon overexpression of FER1L4. In addition, the expression of PI3K, p-AKT (Ser470) and p-AKT (Thr308) was upregulated by siFER1L4, while decreased upon overexpression of FER1L4. MicroRNA (miRNA) -18a-5p, an osteosarcoma-promoting miRNA which was suggested a target of FER1L4 in osteosarcoma, was identified to be a functional target of FER1L4 on the regulating of cell apoptosis and EMT, presently. The effects of FER1L4 overexpression on the markers of cell apoptosis, proliferation, EMT, and stemness and PI3K/AKT signaling were all reversed by miR-18a-5p upregulation. Furthermore, the suppressor of cytokine signaling 5 (SOCS5) was confirmed a target gene of miR-18a-5p by luciferase gene reporter assay and SOCS5 suppression by miR-18a-5p attenuated the effects of FER1L4 overexpression on the OS cells apoptosis and the expressed levels of PI3K, AKT, Twist1, N-cadherin and Vimentin. In conclusion, our data indicated thatthe overexpression of FER1L4 promoted apoptosis and inhibited the EMT markers expression and PI3K/AKT signaling pathway activation in OS cells via downregulating miR-18a-5p to promote SOCS5.

Comparison of the Anteroposterior and Posterior Approaches for Percutaneous Catheter Drainage of Tuberculous Psoas Abscess.

BACKGROUND Tuberculous infection of the lumbar spine may be associated with psoas abscess. The aim of this clinical study was to compare the outcome of posterior lumbar debridement and spinal fusion, combined with either a one-stage anteroposterior (AP) or posterior (P) approach to percutaneous catheter drainage (PCD) for the treatment of lumbar tuberculosis with psoas abscess. MATERIAL AND METHODS From January 2008 to June 2012, 74 patients were diagnosed at our hospital with lumbar tuberculosis with unilateral or bilateral psoas abscess. Forty-three patients underwent P-PCD (group A), and 31 patients underwent AP-PCD (group B). Operative duration, blood loss, the length of hospital stay, spinal correction, clinical cure rate, and other clinical outcomes in the two groups were compared. RESULTS Comparison of the outcome for the P-PCD and AP-PCD patients showed that there was no significant difference in outcome for spinal bone fusion, correction of spinal deformity, or cure rate from tuberculosis infection (P>0.05). Blood loss, operative time, and the length of hospital stay for patients in group A, the P-PCD group, were significantly less than for group B, the AP-PCD group (P<0.05). Also, group B, the AP-PCD group, had an increased incidence of complications than group A, the P-PCD group, leading to increased hospital stay (OR 3.04, CI 0.52-17.75). CONCLUSIONS For the treatment of tuberculous psoas abscess using PCD, the posterior approach may achieve the same clinical efficacy as the anteroposterior approach, but is associated with reduced length of hospital stay, and lower risk of complications.

The protective effect of berberine hydrochloride on LPS­induced osteoclastogenesis through inhibiting TRAF6­Ca2+­calcineurin­NFATcl signaling pathway.

The present study investigated the protective effect of berberine hydrochloride on lipopolysaccharide (LPS) ­induced acute bone destruction through inhibition of the TNF receptor associated factor 6 (TRAF6)­Ca2+­calcineurin­nuclear factor of activated T­cell 1 (NFATc1) signaling pathway. An osteoclast culture system of RAW264.7 cells induced by LPS in vitro was established. A polymerase chain reaction (PCR) assay was applied to determine the effect of berberine hydrochloride on the mRNA expression levels of fos­related antigen 2 (Fra­2), tartrate­resistant acid phosphatase (TRAP), ß3­integrin, cathepsin K, dendritic cell­specific transmembrane protein (DC­STAMP), V­type proton ATPase subunit d 2 (Atp6v0d2) and NFATcl. An ELISA assay was performed to measure the release of tumor necrosis factor­α (TNF­α). Western blot analysis was used to measure the effect of berberine hydrochloride on the expression of calcineurin in the LPS­induced NFATc1 signaling pathway, as well as the expression levels of phosphoinositide phospholipase C­Î³l (PLC­Î³1), toll like receptor 4 (TLR4) and TRAF6. The effect of berberine hydrochloride on Ca2+ concentration was detected using a confocal technique with a Flou­3/acetoxymethyl ester Ca2+ probe. The PCR results demonstrated that berberine hydrochloride inhibited the mRNA expression levels of Fra­2, TRAP, ß3­integrin, cathepsin K, DC­STAMP, Atp6v0d2 and NFATc1. Furthermore, the ELISA results demonstrated that TNF­α expression was decreased. The western blot analysis revelead that berberine hydrochloride treatment results in decreased expression levels of PLC­Î³1, TLR4 and TRAF6, and inhibition of Ca2+ influx. In conclusion, the results of the present study suggest that berberine hydrochloride targets TRAF6 and NFATc1, thus inhibiting osteoclastogenesis and bone destruction via inhibition of the TRAF6­Ca2+­calcineurin­NFATcl signaling pathway.

[Increased IL-1 and IL-6 expressions are negatively correlated with modified Japanese Orthopedic Association (mJOA) scores of discogenic low back pain].

OBJECTIVE: To detect the expressions of IL-1 and IL-6 in the degenerative intervertebral discs of patients with discogenic low back pain (DLBP), record the modified Japanese Orthopedic Association (mJOA) scores and analyze the correlation between the expressions and the scores. METHODS: The study chose 30 cases of DLBP aged between 45-65 years old from the same race and district and 10 control cases of vertebral fractures scheduled for surgical treatment but with no history of low back pain within one year and no disc degeneration based on imaging data. The degree of DLBP was evaluated by mJOA scores. Immunohistochemistry and Western blotting were used to observe the expressions of IL-1 and IL-6 in the discs. The relationship between the IL-1, IL-6 expressions and the mJOA scores was revealed by Pearson linear correlation analysis. RESULTS: Compared with the control group, the expressions of IL-1 and IL-6 in the discs of DLBP patients increased significantly as immunohistochemistry and Western blotting indicated. The highest mJOA score of DLBP group was 16 points and the lowest was 7 points before operation. The expressions of IL-1 and IL-6 were negatively correlated with the mJOA scores of low back pain. CONCLUSION: The expressions of IL-1 and IL-6 in the discs of DLBP patients were significantly elevated and negatively correlated with the mJOA scores of low back pain.

[COMPARISON OF SHORT SEGMENTAL FIXATION WITH AND WITHOUT FUSION IN TREATMENT OF THORACOLUMBAR BURST FRACTURE BY POSTERIOR APPROACH].

OBJECTIVE: To compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. METHODS: A retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P>0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. RESULTS: The operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P<0.05), but no significant difference was found in hospitalization days between 2 groups (P>0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P>0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P>0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P<0.05), but no significant difference was found in Greenough low-back outcome score, VAS score, and ASIA grade between 2 groups (P>0.05). CONCLUSIONS: Fusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.

Enhancing tissue repair in annulus fibrosus defects of the intervertebral disc: analysis of a bio-integrative annulus implant in an in-vivo ovine model.

Annulus fibrosus repair techniques for the intervertebral disc (IVD) address the unsolved problem of reherniation after IVD herniation and might facilitate the development of nucleus pulposus replacement techniques for IVD diseases. This study investigates the suitability of a bio-integrative annulus implant.Standardized box defects were applied to the annulus L3/4 and L4/5 of 16 sheep, followed by randomized insertion of the textile polyglycolic acid/polyvinylidene fluoride annulus implant in one of the defects. Explantation was conducted after 2, 6 and 12 weeks, followed by provocative pressure testing and histological analysis. At 2 weeks' follow-up, all specimens of the control defect group demonstrated uncontained herniated nucleus pulposus tissue in the annulus defects. For the treated specimens, the annulus implant consistently provided an effective barrier for herniating nucleus pulposus tissue, with no implant dislocation at all time-points. After 2 weeks, a homogeneous cell infiltration of the annulus implant was observed, leading to a progressive directional matrix build-up. Repair tissue thickness was significantly stronger with the annulus implant at all follow-ups (p < 0.01). No pronounced foreign body reaction and no difference in the amount of supra-annular scar tissue over the defect sites were observed. The implantation procedure inflicted annulus damage adjacent to the defect. At later time-points, however, no difference in comparison with the control defect group was evident. The investigated biointegrative annulus implant showed promising results with regard to biointegration, enhancement of repair tissue and function as a mechanical barrier in an ovine model.

[Experimental study on tissue engineered cartilage complex three-dimensional nano-scaffold with collagen type II and hyaluronic acid in vitro].

OBJECTIVE: To explore the possibility of constructing tissue engineered cartilage complex three-dimensional nano-scaffold with collagen type II and hyaluronic acid (HA) by electrospinning. METHODS: The three-dimensional porous nano-scaffolds were prepared by electrospinning techniques with collagen type II and HA (8 : 1, W : W), which was dissolved in mixed solvent of 3-trifluoroethanol and water (1 : 1, V : V). The morphology were observed by light microscope and scanning electron microscope (SEM). And the porosity, water absorption rate, contact angle, and degradation rate were detected. Chondrocytes were harvested from 1-week-old Japanese white rabbit, which was disgested by 0.25% trypsin 30 minutes and 1% collagenase overlight. The passage 2 chondrocytes were seeded on the nano-scaffold. The cell adhesion and proliferation were evaluated by cell counting kit 8 (CCK-8). The cell-scaffold composites were cultured for 2 weeks in vitro, and the biological morphology and extracelluar matrix (ECM) secretion were observed by histological analysis. RESULTS: The optimal electrospinning condition of nano-scaffold was 10% electrospinning solution concentration, 10 cm receiver distance, 5 mL/h spinning injection speed. The scaffold had uniform diameter and good porosity through the light microscope and SEM. The diameter was 300-600 nm, and the porosity was 89.5% +/- 25.0%. The contact angle was (35.6 +/- 3.4) degrees, and the water absorption was 1 120% +/- 34% at 24 hours, which indicated excellent hydrophilicity. The degradation rate was 42.24% +/- 1.51% at 48 days. CCK-8 results showed that the adhesive rate of cells with scaffold was 169.14% +/- 11.26% at 12 hours, and the cell survival rate was 126.03% +/- 4.54% at 7 days. The histological and immunohistochemical staining results showed that the chondrocytes could grow well on the scaffold and secreted ECM. And the similar cartilage lacuma structure could be found at 2 weeks after co-culture, which suggested that hyaline cartilage formed. CONCLUSION: The collage type II and HA complex three-dimensional nano-scaffold has good physicochemical properties and excellent biocompatibility, so it can be used as a tissue engineered cartilage

[Advancement of cytoskeleton and axon outgrowth of neuron].

OBJECTIVE: To summarize the advancement of cytoskeleton and axon outgrowth of neuron. METHODS: The recent literature concerning cytoskeleton and axon outgrowth of neuron was reviewed and summarized. RESULTS: The actin filaments and microtubules in neuron were highly polarized and dynamic structures confined to the tips of axons and the reciprocal interactions between these two major cytoskeletal polymers was also dynamic. Attractive or a repulsive cue whose final common path of action was the growth cone cytoskeleton mediated the growth of axons of neuron by intracellular signaling cascades. Regulating the actin filament and microtubule dynamics as well as their interactions in growth cones played a key role in neurite outgrowth and axon guidance. Rho-GTPases and glycogen synthase kinase 3beta (GSK-3beta), the two major intracellular signaling pathways had emerged in recent years as candidates for regulating the dynamics of actin filaments and microtubules. CONCLUSION: The axon outgrowth and guidance depend on well-coordinated cytoskeletal and reciprocal interaction dynamics which also mediate axon regeneration after spinal cord injury. Regulating activity of Rho-GTPases and GSK-3beta simultaneously may acts as key role to regulate the dynamics of cytoskeletal and to determine axon outgrowth.

[Neuron differential attachment purification and its influence factor].

OBJECTIVE: Neuron purification is essential to procedure of various nerve cell experimental research, however, at present there is few reports on the effect of various factors on neural axons during purification. To find out a simple method of neuron purification, and to investigate the influence factors of corresponding purification culture in dorsal root ganglion (DRG) tissue culture on beta3-tubulin positive axon. METHODS: The DRGs were obtained from the 3 days neonatal SD rat microscopically and were made into cell suspension. Then, the amount of attached DRG neurons and nonneuronal cells in poly-D-lysine (PDL) group, PDL/Laminin (PDL/LN) group and collagen-I (Col I) group was observed from 10 to 100 minutes. Then, the extension and arborization of beta3-tubulin positive axons were observed after 72 hours completely randomised DRG tissue culture for the research of the influences among culture substrates (PDL, PDL/LN, and Col I), FBS (0, 5%, and 10%), 5 fluorouracil (5-Fu, 0, 20, and 40 micromol/L), and cytarabine (Ara-C, 0, 10, and 20 micromol/L). RESULTS: Adherent cells were observed instantly after inoculation by inverted phase contrast microscope and inverted fluorescence microscope; after cell suspension was removed, adherent growth of DRGn cells and non-DRGn cells were still seen. In PDL group, the amount of NSE negative cells was significantly higher than that of NSE positive cells at 10 and 30 minutes (P < 0.05); the amount of NSE positive cells was significantly higher than that of NSE negative cells at 80, 90 and 100 minutes (P < 0.05). In PDL/LN group, there was no significant difference (P > 0.05) in the amount of NSE negative cells and NSE positive cells at 10, 20, 30, 40, and 50 minutes; the amount of NSE positive cells was significantly higher (P < 0.05) than that of NSE negative cells at 60, 70, 80, 90, 100 minutes. In Col I group, the amount of NSE negative cells was higher than that of NSE positive cells at 10-40 minutes, but showing no significant difference (P > 0.05); the amount of NSE positive cells was significantly higher (P < 0.05) than that of NSE negative cells at 70-100 minutes. At 72 hours after DRG tissue culture, the best result of beta3-tubulin positive axon extension and arborization was obtained when the substrate level was PDL/LN, and the average length of PDL/LN level was significantly larger than that of other two substrates (P < 0.05). The highest number of beta3-tubulin positive axon distal end was obtained at 5% concentration level of FBS (P < 0.05), but showing no significant differences in beta3-tubulin positive axon length among three levels (P > 0.05). Both the most of beta3-tubulin positive axon distal ends and the longest beta3-tubulin positive axon average length were obtained at 0 micromol/L concentration level of 5-Fu, showing significant differences between 0 micromol/L level and 20, 40 micromol/L levels (P < 0.05). A similar result of 33-tubulin positive axon distal end was got at the 0 micromol/L level and 10 micromol/L level of Ara-C, which was significantly higher than that of 20 micromol/L level (P < 0.05). CONCLUSION: A purified DRG neuron suspension for neuron culture could be obtained via PDL differential attachment for 30 minutes. When DRG neuron culture, neuron special medium, PDL/LN substrate and 10 micromol/L Ara-C are recommended in beta3-tubulin positive axon research.

[Modified Galveston technology for lumbosacral tuberculosis].

OBJECTIVE: To study the clinical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. METHODS: From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including 13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were complicated with neural symptom of the lower limbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were complicated with iliac abscess, 3 cases with psoas abscess, 3 cases with sacroiliac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogenous iliac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogenous iliac bone fragment grafting, and anterior focus debridement was performed. RESULTS: The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroiliac joint tuberculosis achieved sacroiliac joint fusion. For those 7 patients with combinations of the neural symptom of the lower limbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P < 0.05). CONCLUSION: The modified Galveston technology is helpful to reconstruct the stability of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.