Activation of MAP2K signaling by genetic engineering or HF-rTMS promotes corticospinal axon sprouting and functional regeneration.

Facilitating axon regeneration in the injured central nervous system remains a challenging task. RAF-MAP2K signaling plays a key role in axon elongation during nervous system development. Here, we show that conditional expression of a constitutively kinase-activated BRAF in mature corticospinal neurons elicited the expression of a set of transcription factors previously implicated in the regeneration of zebrafish retinal ganglion cell axons and promoted regeneration and sprouting of corticospinal tract (CST) axons after spinal cord injury in mice. Newly sprouting axon collaterals formed synaptic connections with spinal interneurons, resulting in improved recovery of motor function. Noninvasive suprathreshold high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) activated the BRAF canonical downstream effectors MAP2K1/2 and modulated the expression of a set of regeneration-related transcription factors in a pattern consistent with that induced by BRAF activation. HF-rTMS enabled CST axon regeneration and sprouting, which was abolished in MAP2K1/2 conditional null mice. These data collectively demonstrate a central role of MAP2K signaling in augmenting the growth capacity of mature corticospinal neurons and suggest that HF-rTMS might have potential for treating spinal cord injury by modulating MAP2K signaling.

miR-206 Targets MALAT1 to Suppress Cell Progression of Ectopic Endometrial Stromal Cells in Endometriosis.

BACKGROUND: miR-206 was reported to be a tumor suppressor in bladder cancer. In this study, we explore the expression and function of miR-206 in endometriosis (EM). METHODS: 40 EM patients undergoing total hysterectomy were selected as the experimental group. RT-qPCR assay was adopted to detect the expression of MALAT1 and miR-206 in EM. Cell proliferation was detected by EdU incorporation and colony formation assay. Cell migration and invasion viability of ESCs were examined by transwell assay and wound healing assay. Flow cytometry was carried out to assess cell apoptosis of ESCs. The protein expressions of Bcl-2 and Bax were examined by western blot assay. The relationship between miR-206 and MALAT1 was verified by the dual-luciferase reporter assay and RNA pull-down assay. RESULTS: In this work, miR-206 was found to be downregulated in EM. Functional experiments displayed that miR-206 mimic repressed cell proliferation, migration, and invasion of ESCs and promoted cell apoptosis of ESCs. Furthermore, miR-206 mimic reduced the expression of Bcl-2 but enhanced the expression of Bax. MALAT1 was found to be upregulated in EM. Furthermore, MALAT1 was indicated to be a target of miR-206. Additionally, MALAT1 was found to alleviate the influence of miR-206 on cell progression of ESCs. Furthermore, miR-206 inhibited tumor growth in vivo. CONCLUSION: This study indicated that miR-206 inhibited cell progression by regulating MALAT1 in EM. Hence, miR-206 was suggested to be a possible target for EM treatment.

Integrin α5ß1, as a Receptor of Fibronectin, Binds the FbaA Protein of Group A Streptococcus To Initiate Autophagy during Infection.

Group A Streptococcus (GAS), one of the most common extracellular pathogens, has been reported to invade epithelial and endothelial cells. Our results reveal that M1 GAS strain SF370 can be effectively eliminated by respiratory epithelial cells. Emerging evidence indicates that autophagy is an important strategy for nonphagocytes to eliminate intracellular bacteria. Upon pathogen recognition, cell surface receptors can directly trigger autophagy, which is a critical step in controlling infection. However, the mechanisms of how cells sense invading bacteria and use this information specifically to trigger autophagy remain unclear. In this study, we stimulated cells and infected mice with M and FbaA mutants of M1 GAS strain SF370 or with purified M and FbaA proteins (two critical surface structural proteins of GAS), and found that only FbaA protein was involved in autophagy induction. Furthermore, the FbaA protein induced autophagy independent of common pattern recognition receptors (such as Toll-like receptors); rather, it relies on binding to integrin α5ß1 expressed on the cell surface, which is mediated by extracellular matrix protein fibronectin (Fn). The FbaA-Fn-integrin α5ß1 complex activates Beclin-1 through the mTOR-ULK1-Beclin-1 pathway, which enables the Beclin-1/Vps34 complex to recruit Rab7 and, ultimately, to promote the formation of autophagosomes. By knocking down integrin α5ß1, Fn, Atg5, Beclin-1, and ULK1 in Hep2 cells and deleting Atg5 or integrin α5ß1 in mice, we reveal a novel role for integrin α5ß1 in inducing autophagy. Our study demonstrates that integrin α5ß1, through interacting with pathogen components, initiates effective host innate immunity against invading intracellular pathogens.IMPORTANCE Autophagy is generally considered a strategy used by the innate immune system to eliminate invasive pathogens through capturing and transferring them to lysosomes. Currently, researchers pay more attention to how virulence factors secreted by GAS regulate the autophagic process. Here, we provide the first evidence that the structural protein FbaA of M1 GAS strain SF370 is a potent inducer of autophagy in epithelial cells. Furthermore, we demonstrate that integrin α5ß1 in epithelial cells in vitro and in vivo acts as a receptor to initiate the signaling for inducing autophagy by binding to FbaA of M1 GAS strain SF370 via Fn. Our study reveals the underlying mechanisms by which pathogens induce Fn-integrin α5ß1 to trigger autophagy in a conserved pattern in epithelial cells.

Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons.

OBJECTIVE: In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD. METHODS: Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast. RESULTS: A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05). CONCLUSIONS: The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.

Epidural versus intravenous steroids application following percutaneous endoscopic lumbar discectomy.

Retrospectively study.The purpose of this study was to compare the effects of intraoperative epidural steroids and single dose intravenous steroids following a percutaneous endoscopic lumbar discectomy (PELD).Inflammatory irritation of dorsal root ganglia or sensory nerve roots may cause postoperative pain. Epidural steroids have been applied after a lumbar discectomy for more than 20 years. Epidural steroid application after a PELD is easier to perform and safer because the operations are under observation of the scope.We retrospectively reviewed the medical records of patients with lumbar intervertebral disc herniation who had undergone transforaminal PELD at our department. There are 60 patients in epidural steroid group, intravenous steroid group, and control group, respectively. Visual analog scores (VAS) and the Oswestry Disability Index (ODI) were collected. Successful pain control is defined as 50% or more reduction in back and leg pain (VAS scores).VAS scores (back and leg) and ODI showed a significant decrease in all groups when comparing pre- and postoperatively. Epidural steroid group had a significant improvement in successful pain control compared with the control group at 2 weeks of follow-up. VAS scores (leg) in the epidural steroid group showed a significant decrease compared with the intravenous steroids group at 1, 3, and 7 days after the surgery, but this difference had no statistical significance at 1, 6, and 12 months of follow-up. All groups did not show a significant difference in ODI at 1, 6, and 12 months follow-up.Epidural application of steroid has a better effect on controlling the postoperative pain of PELD in the short term. The epidural application of steroid did not show a tendency to cause infection.

Antidepressant-like effects of a novel curcumin derivative J147: Involvement of 5-HT1A receptor.

Depression is a dysthymia disorder characterized by a pervasive or persistent mental disorder that causes mood, cognitive and memory deficits. J147, a curcumin analogue, increases brain derived neurotrophic factor (BDNF) levels and facilitates memory in animals. Because curcumin has the antidepressant-like activity, the present study investigated the potential antidepressant-like effects of J147 in the forced swimming test (FST) and tail suspension tests (TST) and the involvement of 5-HT receptors related to cAMP signaling. The results suggested that acute treatment of J147 at doses of 5 and 10 mg/kg via gavage markedly reduced the duration of immobility in both TST and FST, either 1 h or 3 h after treatment, respectively. It did not alter locomotor activity but influence the immobile response. The molecular biological assays showed that 5-HT1A receptor expression was significantly increased at 1 h after treatment with J147 at a dose of 10 mg/kg. In addition, pre-treatment of mice with WAY-100635 blocked the J147's effect in the FST. 5-HT1B receptor expression was not significantly increased with increasing doses of J147. The 5-HT1B receptors antagonist isamoltan partially prevented J147's effect in the FST. The levels of downstream molecular targets, cAMP, PKA, pCREB and BDNF were significantly increased 1 h after treatment with J147 at doses of 5 and 10 mg/kg. The up-regulated pCREB and BDNF levels lasted for 3 h after 10 mg/kg of J147. These findings demonstrated that J147 has antidepressant-like effects that are mediated, at least in part, by activating the 5-HT1A/cAMP/PKA/CREB/BDNF-signaling pathway.

Synergistic interplay between the two major bone minerals, hydroxyapatite and whitlockite nanoparticles, for osteogenic differentiation of mesenchymal stem cells.

The inorganic part of human bone is mainly composed of hydroxyapatite (HAP: Ca10(PO4)6(OH)2) and whitlockite (WH: Ca18Mg2(HPO4)2(PO4)12) minerals, where the WH phase occupies up to 20-35% of total weight. These two bone minerals have different crystal structures and physicochemical properties, implying their distinguished role in bone physiology. However, until now, the biological significance of the presence of a certain ratio between HAP and WH in bone is unclear. To address this fundamental question, bone mimetic scaffolds are designed to encapsulate human mesenchymal stem cells (MSCs) for assessing their osteogenic activity depending on different ratios of HAP and WH. Interestingly, cellular growth and osteogenic differentiation are significantly promoted when MSCs are grown with a 3-1 ratio of HAP and WH nanoparticles, which is similar to bone. One of the reasons for this synergism between HAP and WH in hydrogel scaffolds is that, while WH nanoparticles can enhance osteogenic differentiation of MSCs compared to HAP, WH counterintuitively decreases the mechanical stiffness of nanocomposite hydrogels and hinders the osteogenic activity of cells. Taken together, these findings identify the optimal ratio between two major minerals in bone mimetic scaffolds to maximize the osteogenic differentiation of MSCs. STATEMENT OF SIGNIFICANCE: Human bone minerals are composed of HAP and WH inorganic nanoparticles which have different material properties. However, the reason for the coexistence of HAP and WH in human bone is not fully identified, and HAP and WH composite biomaterial has not been utilized in the clinic. In this study, we have developed bone mimetic HAP and WH nanocomposite hydrogel scaffolds with various ratios. Importantly, we found out that HAP can promote the mechanical stiffness of the composite hydrogel scaffolds while WH can enhance the osteogenic activity of stem cells, which together induced synergism to maximize osteogenic differentiation of stem cells when mixed into 3-1 ratio that is similar to human bone.

3D Printed Anchoring Sutures for Permanent Shaping of Tissues.

Sutures are one of the most widely used devices for adhering separated tissues after injury or surgery. However, most sutures require knotting, which can create a risk of inflammation, and can act as mechanically weak points that often result in breakage and slipping. Here, an anchoring suture is presented with a design that facilitates its propagation parallel to the suturing direction, while maximizing its resistive force against the opposite direction of external force to lock its position in tissues. Different microstructures of suture anchors are systematically designed using orthogonal arrays, and selected based on shape factors associated with mechanical strength. 3D printing is used to fabricate different types of hollow microstructured suture anchors, and optimize their structure for the effective shaping of tissues. To define the structural design for fixing tissues, the maximum force required to pull 3D printed anchors in different directions is examined with tissues. The tissue reshaping function of suture anchors is further simulated ex vivo by using swine ear, nose, and skin, and bovine muscle tendon. This study provides advantages for building functional sutures that can be used for permanently reshaping tissues with enhanced mechanical strength, eliminating the need for knotting to improve surgical efficiency.

Isocentric Navigation of Percutaneous Endoscopic Transforaminal Discectomy at the L5/S1 Level in Difficult Puncture Cases: A Technical Note.

BACKGROUND: Accurate puncture during percutaneous transforaminal endoscopic discectomy at the L5/S1 level in cases with high iliac crest and narrow foramen were difficult, even though the difficulties of foraminoplasty could be overcome by advanced instruments like reamers. OBJECTIVES: The report aimed to describe an isocentric navigation technique with a definite pathway in difficult puncture cases at the L5/S1 level. STUDY DESIGN: Technical note. SETTING: Difficult punctures were defined as over 10 punctures of the needle before obtaining an ideal puncture location by senior surgeons with experience of over 500 percutaneous endoscopic transforaminal discectomy (PETD) cases. METHODS: A total of 124 punctures were recorded in 11 difficult puncture cases at the L5/S1 level. A definite pathway was created by an isocentric navigation theory, which was based on a surface locator and an arch-guided device. The surface locator was used to rapidly and accurately identify the puncture target with the recognition of the surrounding rods under fluoroscopy. The arch-guided device can ensure that the puncture target always remains at the center of a virtual sphere. We recorded the puncture times, fluoroscopy exposure times, radiation exposure time, operative time, visual analog scale (VAS) score, Japanese Orthopeadic Association (JOA) score, and patient satisfaction. RESULTS: The average puncture times were significantly reduced to 1.27 with the arch-guided device compared with conventional puncture methods (P < 0.05). The average operative time was 90.09 ± 11.00 minutes and the fluoroscopy times were 53.36 ± 5.85. The radiation exposure time was 50.91 ± 5.20 seconds. VAS score of leg and back pain, as well as JOA score, were all significantly improved after surgery (P < 0.05). The excellent and good rate of satisfaction was 90.91%. No major complications, including cerebral fluid leakage, surgical infection, and postoperative nerve root injury, were recorded in this small sample. LIMITATIONS: This was a small-sample study with a short follow-up. CONCLUSIONS: The novel isocentric navigation technique with a definite pathway is practical and effective in reducing puncture times among difficult puncture cases at the L5/S1 level, which may contribute to the capacity of PETD at the L5/S1 level.

Significant reduction of fluoroscopy repetition with lumbar localization system in minimally invasive spine surgery: A prospective study.

The conventional location methods for minimally invasive spinal surgery (MISS) were mainly based on repeated fluoroscopy in a trial-and-error manner preoperatively and intraoperatively. Localization system mainly consisted of preoperative applied radiopaque frame and intraoperative guiding device, which has the potential to minimize fluoroscopy repetition in MISS. The study aimed to evaluate the efficacy of a novel lumbar localization system in reducing radiation exposure to patients.Included patients underwent minimally invasive transforaminal lumbar interbody fusion (MISTLIF) or percutaneous transforaminal endoscopic discectomy (PTED). Patients treated with novel localization system were regarded as Group A, and patients treated without novel localization system were regarded as Group B.For PTED, The estimated effective dose was 0.41 ±â€Š0.13 mSv in Group A and 0.57 ±â€Š0.14 mSv in Group B (P < .001); the fluoroscopy exposure time of PTED was 22.18 ±â€Š7.30 seconds in Group A and 30.53 ±â€Š7.56 seconds in Group B (P < .001); The estimated cancer risk of radiation exposure was 22.68 ±â€Š7.38 (10) in Group A and 31.20 ±â€Š7.96 (10) in Group B (P < .001). For MISTLIF, the estimated effective dose was 0.45 ±â€Š0.09 mSv in Group A and 0.58 ±â€Š0.09 mSv in Group B (P < .001); The fluoroscopy exposure time was 25.41 ±â€Š5.52 seconds in Group A and 32.82 ±â€Š5.03 seconds in Group B (P < .001); The estimated cancer risk was 24.90 ±â€Š5.15 (10) in Group A and 31.96 ±â€Š5.04 (10) in Group B (P < .001). There were also significant differences in localization time and operation time between the 2 groups either for MISTLIF or PTED.The lumbar localization system could be a potential protection strategy for minimizing radiation hazards.

Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy.

PURPOSE: Beginners usually need increased punctures and dozens of fluoroscopy in learning transforamimal percutaneous endoscopic lumbar discectomy (tPELD). Navigator-assisted spinal surgery (NASS) is a novel technique that could induce a definite trajectory. The retrospective study aimed to investigate the impact of a definite trajectory on the learning curve of tPELD. METHODS: A total of 120 patients with symptomatic lumbar disc herniation who received tPELD between 2012 and 2014. Patients receiving tPELD with NASS technique by one surgeon were regarded as group A, and those receiving conventional methods by another surgeon were regarded as group B. Each group was divided into three subgroups (case 1-20, case 21-40, case 41-60). RESULTS: The fluoroscopy times were 22.62 ± 3.80 in group A and 34.32 ± 4.78 in group B (P < 0.001). The pre-operative location time was 3.56 ± 0.60 minutes in group A and 5.49 ± 1.48 minutes in group B (P < 0.001). The puncture-channel time was 21.85 ± 4.31 minutes in group A and 34.20 ± 8.88 minutes in group B (P < 0.001). The operation time was 84.62 ± 9.20 minutes in group A and 101.97 ± 14.92 minutes in group B (P < 0.001), and the learning curve of tPELD in group A was steeper than that in group B. No significant differences were detected in patient-reported outcomes, hospital stay, patient satisfaction, and complication rate between the two groups (p > 0.05). CONCLUSIONS: Definite trajectory significantly reduced the operation time, preoperative location time, puncture-channel time, and fluoroscopy times of tPELD by beginners, and thus reshaped the learning curve of tPELD and minimized the radiation exposure.

Guide wire breakage during posterolateral endoscopic lumbar discectomy procedure: A case report.

OBJECTIVE: To present a unique case of guide wire breakage as a rare complication during posterolateral endoscopic lumbar discectomy. BACKGROUND: Posterolateral endoscopic lumbar discectomy (PELD) has become a routinely performed minimally invasive spinal procedure. However, several complications of PELD have attracted our concerns, including the intraoperative injury to neural and vascular structures and failure of the surgery. We have countered a rare intraoperative complication of guidewire breakage during a PELD procedure, as far as we know, this has not been reported previously, and we wish to draw attention to this hazard. METHODS: The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. RESULTS: A 28-year-old man presented with right posterior sciatica for 3 months was admitted to the hospital. Unsatisfactory improvement was observed under supervised conservative treatment. Preoperative magnetic resonance imaging (MRI) showed a disc herniation at the L4-L5 level. After preoperative evaluation, a PELD procedure was performed with local anesthesia. After advancement of guide wire and discography, the guiding rod was found not in the vicinity of the extruding disc fragment. Therefore, the operator tried to redirect the guiding rod. However, after several attempts, the guide wire was broken in the disc fragment under imaging. With the patient's permit, the operator inserted the working cannula to the broken end of guide wire and retrieved it using straightened grasping forceps. Then foraminotomy and fragmentectomy were accomplished under endoscope. The patient made uneventful recovery and was free of symptoms for the following 6 months. CONCLUSIONS: In conclusion, the guide wire breakage during PELD procedures is a rare but a serious complication. An appropriate manner and operation is very important to prevent this complication. Once it does occur, the remnant of the guide wire can possibly be retrieved under endoscope with great experience. However, as for the beginners, a transfer to open operation is suggested to prevent new complications.

Lower Learning Difficulty and Fluoroscopy Reduction of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with an Accurate Preoperative Location Method.

BACKGROUND: Transforaminal percutaneous endoscopic lumbar discectomy (tPELD) poses great challenges for junior surgeons. Beginners often require repeated attempts using fluoroscopy causing more punctures, which may significantly undermine their confidence and increase the radiation exposure to medical staff and patients. Moreover, the impact of an accurate location on the learning curve of tPELD has not been defined. OBJECTIVE: The study aimed to investigate the impact of an accurate preoperative location method on learning difficulty and fluoroscopy time of tPELD. STUDY DESIGN: Retrospective evaluation. SETTING: Patients receiving tPELD by one surgeon with a novel accurate preoperative location method were regarded as Group A, and those receiving tPELD by another surgeon with a conventional fluoroscopy method were regarded as Group B. METHODS: From January 2012 to August 2014, we retrospectively reviewed the first 80 tPELD cases conducted by 2 junior surgeons. The operation time, fluoroscopy times, preoperative location time, and puncture-channel time were thoroughly analyzed. RESULTS: The operation time of the first 20 patients were 99.75 ± 10.38 minutes in Group A and 115.7 ± 16.46 minutes in Group B, while the operation time of all 80 patients was 88.36 ± 11.56 minutes in Group A and 98.26 ± 14.90 minutes in Group B. Significant differences were detected in operation time between the 2 groups, both for the first 20 patients and total 80 patients (P < 0.05). The fluoroscopy times were 26.78 ± 4.17 in Group A and 33.98 ± 2.69 in Group B (P < 0.001). The preoperative location time was 3.43 ± 0.61 minutes in Group A and 5.59 ± 1.46 minutes in Group B (P < 0.001). The puncture-channel time was 27.20 ± 4.49 minutes in Group A and 34.64 ± 8.35 minutes in Group B (P < 0.001). There was a moderate correlation between preoperative location time and puncture-channel time (r = 0.408, P < 0.001), and a moderate correlation between preoperative location time and fluoroscopy times (r = 0.441, P < 0.001). Mild correlations were also observed between preoperative location time and operation time (r = 0.270, P = 0.001). There were no significant differences in preoperative back visual analogue scale (VAS) score, postoperative back VAS, preoperative leg VAS, postoperative leg VAS, preoperative Japanese Orthopaedic Association (JOA) score, postoperative JOA, preoperative Oswestry disability score (ODI), or postoperative ODI (P > 0.05). However, significant differences were all detected between preoperative abovementioned scores and postoperative scores (P < 0.05). Moreover, there was no significant differences in Macnab satisfaction between the 2 groups (P = 0.179). There were 2 patients with recurrence in Group A and 3 patients in Group B. Twelve patients with postoperative disc remnants were identified in Group A and 9 patients in Group B. No significant difference was identified between the 2 groups (P = 0.718). LIMITATIONS: The preoperative lumbar location method is just a tiny step in tPELD, junior surgeons still need to focus on their subjective feelings during punctures and accumulating their experience in endoscopic discectomy. CONCLUSIONS: The accurate preoperative location method lowered the learning difficulty and reduced the fluoroscopy time of tPELD, which was also associated with lower preoperative location time and puncture-channel time. Key words: Learning difficulty, fluoroscopy reduction, transforamimal percutaneous endoscopic lumbar discectomy, preoperative locationLearning difficulty, fluoroscopy reduction, transforamimal percutaneous endoscopic lumbar discectomy, preoperative location.

Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis.

The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P > 0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P < 0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P < 0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis.

Patient-reported and radiographic outcomes of minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis with or without reduction: A comparative study.

This retrospective study aimed to compare the patient-reported outcomes and radiographic assessment of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis with reduction versus in situ fusion. Patients receiving MI-TLIF with reduction were assigned as Group A, and those without reduction were assigned as Group B. Radiographic fusion was assessed using Bridwell's grading criteria. Preoperative and postoperative patient-reported outcomes including visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) scale and improvement rate were analyzed. There were 41 patients in Group A and 37 patients in Group B. The mean follow-up was 30.78±14.15months in Group A and 28.95±10.75months in Group B (p=0.525). There were no significant differences in hospital stay (p=0.261), estimated blood loss (p=0.639), blood transfusion (p=0.336), operation time (p=0.762) and complications (p=1.00) between the two groups. Radiographic fusion rate was 92.68% (38/41) in Group A, and 81.08% (30/37) in Group B (p=0.110). Significant differences were observed in either 3-month or last follow-up JOA, VAS, and ODI compared with preoperative JOA, VAS, and ODI, respectively (p<0.05). However, there were no significant differences in JOA, VAS, and ODI between the two groups whenever preoperatively, or 3-month postoperatively, or at the last follow-up (p>0.05). According to MacNab criteria, the excellent and good rate was 85.37% in Group A and 86.49% in Group B (p=0.983). MI-TLIF is an effective and satisfactory surgical technique to manage degenerative spondylolisthesis regardless of reduction or not, so routine reduction may not be a requirement in MI-TLIF for degenerative spondylolisthesis.

Global scientific production of robotic surgery in medicine: A 20-year survey of research activities.

INTRODUCTION: Robot-assisted surgery operations are being performed more frequently in the world these years. In order to have a macroscopic view of publication activities about robotic surgery, the first bibliometric analysis was conducted to investigate the publication distributions of robotic surgery. METHODS: The original articles about robotic surgery were extracted from the Science Citation Index Expanded (SCI-E) on Web of Science and analyzed concerning their distributions. We also explored the potential correlations between publications of different countries and their Gross Domestic Product (GDP). RESULTS: The total number of original articles retrieved from SCI-E was 3362 from 1994 to 2015. The number of original articles published in the last decade has a burgeoning increase of 572.87% compared with that published in the former decade. The leading country was USA who have published 1402 pieces of articles (41.701%), followed by Germany with 342 (10.173%). The journal published the highest number of original articles was Journal of Endourology with 237 (7.049%), followed by Surgical Endoscopy and Other Interventional Techniques (188, 5.592%). There was strong correlations between publication numbers and GDP of different countries (r(2) = 0.889, p < 0.001). In the different medical fields, urology has the highest number of articles (n = 878, 26.007%). DISCUSSIONS: The macroscopic view of research activities has the potential to guide future trend in the field of robotic surgery. CONCLUSIONS: There is a skyrocket trend of robotic surgery in medical research over the last two decades, and countries with high GDP tend to make more contributions to the medical field of robotic surgery.

Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation through Two Working Channels.

UNLABELLED: The technique of percutaneous endoscopic lumbar discetomy (PELD) in the transforaminal approach has evolved over the years due to the advances in endoscopic photology and instrumentation and become the most popular technique for lumbar disc herniation. Although PELD offers many advantages, the indications of PELD are limited mostly to non-migrated or low-migrated disc herniation. It is very difficult for PELD in the transforaminal approach to remove the highly migrated disc fragment successfully due to the anatomic barrier. Nowadays, with the advances of instruments and technique, it might be possible for PELD in the transforaminal approach to remove these high-grade migrated disc fragments. The purpose of this study was to describe a technique to effectively treat highly migrated disc herniation via 2 working channels. KEY WORDS: Percutaneous endoscopic lumbar discectomy, far-migrated disc herniation, working channels.

Minimally Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis: In Situ Versus Reduction.

OBJECTIVE: The study aimed to compare the clinical outcomes of reduction versus in situ fusion with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for isthmic spondylolisthesis. METHODS: Demographic, preoperative, and postoperative data were collected from the medical records. Radiographic fusion was assessed by use of the grading criteria of Bridwell. Preoperative and postoperative patient-reported outcomes including visual analog scale, Oswestry Disability Index, Japanese Orthopedic Association scale and improvement rate were calculated. Patient satisfaction was assessed with the criteria of Macnab (excellent, good, fair, poor). RESULTS: There were 24 patients (11 male) in the reduction group and 21 patients (10 male) in the in situ fusion group. The average follow-up was 34.75 ± 8.06 months in reduction group and 31.05 ± 6.52 months in the in situ fusion group (P = 0.101). There were no significant differences in hospital stay, estimated blood loss, blood transfusion, operation time, fusion grading, and complications between the 2 groups (P > 0.05). Spinal fusion rate was 91.67% (22/24) in the reduction group and 85.71% (18/21) in the in situ group (P = 0.835). There were no significant differences in Japanese Orthopedic Association scale, visual analog scale, and Oswestry Disability Index score between the 2 groups whenever preoperatively, 3-month postoperatively, or at the last follow-up (P > 0.05). According to the criteria of Macnab, the rate of excellent and good was 83.33% in reduction group and 80.95% in the in situ group (P = 0.899). CONCLUSIONS: MIS-TLIF with reduction did not induce significantly better patient-reported outcomes, spinal fusion rate, perioperative outcomes, or fewer complications in isthmic spondylolisthesis. Intentional reduction may not be a requirement in MIS-TLIF for isthmic spondylolisthesis.

Endoscopic Retrieval of a Broken Guidewire During Spinal Surgery.

Since the percutaneous posterolateral approach in treating lumbar disc herniation was introduced in 1973, percutaneous endoscopic lumbar discectomy (PELD) has become a routine minimally invasive spinal procedure. However, as clinical evidence accumulated, several complications of PELD have raised our concerns, including the intraoperative injury to neural, vascular structures and failure of surgery. Herein, we present 2 patients who experienced guidewire breakage during PELD procedure to demonstrate the details.The 2 patients, who are 28 and 33 years old, were diagnosed with lumbar disc herniation with or without intervertebral foreman stenosis by magnetic resonance imaging. Following a preoperative evaluation, a PELD procedure was performed with the help of local anesthesia. During the advancement of the obturator and foraminotomy under fluoroscopy, the guidewire was found broken. With the patients permission, the operator inserted the working cannula to the broken end of the guidewire and retrieved it by straight grasping forceps under endoscopy. The patients were reported to recover from their back pain immediately after the operation and hence the postoperative course was stable.In conclusion, the guidewire breakage in PELD procedures is a rare but severe complication, which requires immediate removal. An appropriate manner and fluoroscopic control are recommended to forestall such problems. It is.