Decompression alone or fusion in single-level lumbar spinal stenosis with spondylolisthesis? A systematic review and meta analysis.

PURPOSE: The objective of this systematic review and metaanalysis is to compare the efficacy and safety of decompression alone versus decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. METHODS: A comprehensive search of the PubMed, Embase, Cochrane Library, and Ovid Medline databases was conducted to find randomized control trials (RCTs) or cohort studies that compared decompression alone and decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. Operation time; reoperation; postoperative complications; postoperative Oswestry disability index(ODI) scores and scores related to back and leg pain were collected from eligible studies for meta-analysis. RESULTS: We included 3 randomized controlled trials and 9 cohort studies with 6182 patients. The decompression alone group showed less operative time(P < 0.001) and intraoperative blood loss(p = 0.000), and no significant difference in postoperative complications was observed in randomized controlled trials(p = 0.428) or cohort studies(p = 0.731). There was no significant difference between the other two groups in reoperation(P = 0.071), postoperative ODI scores and scores related to back and leg pain. CONCLUSIONS: In this study, we found that the decompression alone group performed better in terms of operation time and intraoperative blood loss, and there was no significant difference between the two surgical methods in rate of reoperation and postoperative complications, ODI, low back pain and leg pain. Therefore, we come to the conclusion that decompression alone is not inferior to decompression and fusion in patients with single-level lumbar spinal stenosis with spondylolisthesis.

Enhancing osteoporosis treatment using a targeted, sustained-release drug delivery system based on macrocyclic amphiphile.

Osteoporosis, a prevalent systemic bone metabolic disorder, primarily affects postmenopausal women and is characterized by increased bone fragility and a heightened risk of fractures. The efficacy of current osteoporosis treatments is often limited by non-specific drug targeting and undesirable off-target skeletal side effects. To address this challenge, we have developed a novel hydroxyapatite-responsive drug delivery system. This system utilizes a self-assembled p-phosphonatocalix[4]arene tetradodecyl ether (PC4A12C), engineered to specifically target and sustain the release of osteoporosis medication at sites of bone remodeling. Our focus centers on icariin (ICA), a drug known for its potent osteogenic properties and minimal adverse effects. In vitro, ICA-loaded PC4A12C (ICA@PC4A12C) demonstrated enhanced proliferation, differentiation, and mineralization in bone marrow mesenchymal stem cells (BMSCs). In vivo, ICA@PC4A12C exhibited superior efficacy in specifically targeting bone tissue, ensuring a controlled and slow release of icariin directly within the bone environment. In an osteoporosis mouse model, treatment with ICA@PC4A12C showed notable enhancement in osteogenic activity and a significant increase in bone density compared to ICA alone. These results demonstrate the potential of PC4A12C as an effective drug carrier in the development of advanced antiosteoporotic drug delivery systems.

Up-regulation of NCAPG mediated by E2F1 facilitates the progression of osteosarcoma through the Wnt/ß-catenin signaling pathway.

Background: In recent years, there are few reports on non-SMC condensin I complex subunit G (NCAPG) in osteosarcoma. Our study aims to explore the biological role of NCAPG in osteosarcoma and its underlying molecular mechanism and to further clarify the reasons for the abnormal expression of NCAPG in osteosarcoma. Methods: Here, we mined The Cancer Genome Atlas (TCGA) Program public database through bioinformatics methods, analyzed the differential expression of NCAPG in sarcoma tissue and normal tissue, and explored the relationship between NCAPG expression level and sarcoma tissue differentiation, including tumor recurrence, metastasis, and patient survival. Next, the transcription factors responsible for the abnormal expression of NCAPG in osteosarcoma tumors were predicted by multiple online website tools and verified via cellular experiments. Subsequently, loss of function and cell phenotype experiments were performed to confirm the effect of NCAPG on the malignant biological behavior of osteosarcoma cells. Mechanistically, by reviewing the literature, we found that NCAPG can affect the malignant progression of many solid tumors by regulating the Wnt/ß-catenin signaling pathway. Therefore, we preliminarily investigated the potential effect of NCAPG on this pathway via western blot experiments in osteosarcoma. Results: Increased expression of NCAPG was found in sarcoma compared to normal tissues, which was positively correlated with poor differentiation, metastasis, and poor prognosis. Combining the transcription factor prediction results, correlation analysis, and expression level in the TCGA public database with validation outcomes of in vitro cell assays, we found that E2F transcription factor 1 (E2F1) regulated the increased expression of NCAPG in osteosarcoma. The results of cell phenotype experiments showed that silencing NCAPG could inhibit the proliferation, migration, and invasion of osteosarcoma cells. The preliminary mechanistic investigation suggested that NCAPG may affect osteosarcoma progression through the Wnt/ß-catenin pathway. Conclusions: Our data reveal that E2F1 facilitates NCAPG expression in osteosarcoma by regulating the transcription of the NCAPG gene. Up-regulation of NCAPG promotes osteosarcoma progression via the Wnt/ß-catenin signaling axis.

Prognostic impact of colorectal cancer patients with bone metastases: a single-center experience.

The incidence of bone metastasis (BM) in colorectal cancer (CRC) patients is low and the prognosis is poor. There is no clear conclusion on the risk factors affecting the survival of CRC patients with BM. The aim of this study was to investigate the factors that may affect the prognosis of CRC patients with BM. The clinical and pathological data of CRC patients with BM were retrospectively analyzed. The overall survival after BM diagnosis was estimated using the Kaplan-Meier method and Log-rank test, and a multivariable cox regression model was used to identify the prognostic factors of overall survival. This study included 178 CRC patients with BM, of whom 151 had left-sided CRC and 27 had right-sided colon cancer. 1124 CRC patients with BM from the SEER database were included to perform a sensitivity analysis of the primary outcome. Multivariate analysis showed that the N staging, site of BM, and primary tumor sidedness (PTS) were independent prognostic factors for CRC with BM. Among them, right-sided colon cancer patients with BM had a poorer prognosis. Sensitivity analyses showed that PTS was an independent prognostic factor in CRC patients with BM. Primary tumor sidedness and N stage may be potential prognostic markers for BM of CRC. The prognosis of N0 stage CRC with BM is better, while the prognosis of right-sided colon cancer is poor.

Comparison of discover cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical degenerative disc diseases: A meta-analysis of prospective, randomized controlled trials.

Objective: This study aims to evaluate the clinical efficacy and safety between Discover cervical disc arthroplasty (DCDA) and anterior cervical discectomy and fusion (ACDF) in Cervical degenerative disc diseases. Methods: Two researchers independently conducted a search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails (CENTRAL) for randomized controlled trials (RCTs) following the Cochrane methodology guidelines. A fixed-effects or random-effects model was applied based on different heterogeneity. Review Manager (Version 5.4.1) software was used to perform data analysis. Results: A total of 8 RCT studies were included in this meta-analysis. The results indicate that the DCDA group had a higher incidence of reoperation (P = 0.03) and a lower incidence of ASD (P = 0.04) than the CDA group. There was no significant difference between two groups regarding NDI score (P = 0.36), VAS ARM score (P = 0.73), VAS NECK score (P = 0.63), EQ-5D score (P = 0.61) and dysphagia incidence (0.18). Conclusion: DCDA and ACDF have similar results in terms of NDI scores, VAS scores, EQ-5D scores, and dysphagia. In addition, DCDA can reduce the risk of ASD but increases the risk of reoperation.

A Unified Therapeutic-Prophylactic Tissue-Engineering Scaffold Demonstrated to Prevent Tumor Recurrence and Overcoming Infection toward Bone Remodeling.

Osteosarcoma occurs in children and adolescents frequently and leads to a high fatality rate. Although surgical resection is the most common methods in clinic, patients always suffer from tumor metastasis and recurrence and it is difficult for them to self-repair large bone defects. Furthermore, the postoperative infection from bacteria triggers an inflammatory response and hinders the bone-repair process. This work demonstrates a gadolinium (Gd)-complex and molybdenum sulfide (MoS2 ) co-doped N-acryloyl glycinamide (NAGA)/gelatin methacrylate (Gel-MA) multifunctional hydrogel (GMNG). The combination between NAGA and Gel-MA endows the GMNG with attractive mechanical properties and controllable degradation ability. The MoS2 improves the hydrogel system, which has excellent photothermal ability to kill tumor cells and inhibit bacterial infection both in vitro and in vivo. Based on the Gd-complex, the magnetic resonance imaging (MRI) effect can be used to monitor the position and degradation situation of the hydrogel. Notably, accompanied by the degradation of GMNG hydrogel, the gradually released Gd3+ from the hydrogel exhibits osteogenic property and could promote new bone formation efficiently in vivo. Therefore, this strategy supplies a method to prepare multifunctional bone-defect-repair materials and is expected to represent a significant guidance and reference to the development of biomaterials for bone tissue engineering.

Predictors of residual low back pain in patients with osteoporotic vertebral fractures following percutaneous kyphoplasty.

Objective: Patients with osteoporotic vertebral fractures (OVFs) often suffer from residual low back pain (LBP) after percutaneous kyphoplasty (PKP). The purpose of this study was to identify risk factors for postoperative residual LBP and to develop a nomogram to predict the occurrence of residual LBP. Methods: We retrospectively reviewed 236 patients who underwent PKP for OVFs and had a minimum follow-up of 12 months. The mean age was 72.1 ± 6.3, 74.3% were female and 25.7% were male. Patients with LBP VAS scores ≥ 3.5 at the 12th month postoperatively were considered to have residual LBP. Risk factors for residual LBP were identified by univariate and multifactorial logistic regression analysis. Then, a predictive nomogram was constructed and validated using the bootstrap method. The discrimination, calibration, and clinical utility of the nomogram were assessed using a receiver operating characteristic curve (ROC), a calibration curve, and a decision curve analysis (DCA). Results: univariate and multifactorial logistic regression analysis identified depression (P = 0.02), intravertebral vacuum cleft (P = 0.01), no anti-osteoporosis treatment (P < 0.001), cement volume <3 ml (P = 0.02), and cement distrubution (P = 0.01) as independent risk factors for residual LBP. The area under the ROC was 0.83 (0.74-0.93) and further validated by bootstrap method was 0.83 (0.73-0.92). The calibration curve illustrated the consistency between the predicted probability and the observed results. DCA showed that nomogram exhibits clinical utility and net benefit when the threshold probability is between 6% and 73%. Conclusions: Our study found that depression, intravertebral vacuum cleft, no anti-osteoporosis treatment, cement volume <3 ml and cement distribution represent independent risk factors for residual LBP. The nomogram containing the above five predictors can accurately predict the risk of residual LBP after surgery.

Predictive models based on machine learning for bone metastasis in patients with diagnosed colorectal cancer.

Background: This study aimed to develop an artificial intelligence predictive model for predicting the probability of developing BM in CRC patients. Methods: From SEER database, 50,566 CRC patients were identified between January 2015 and December 2019 without missing data. SVM and LR models were trained and tested on the dataset. Accuracy, area under the curve (AUC), and IDI were used to evaluate and compare the models. Results: For bone metastases in the entire cohort, SVM model with poly as kernel function presents the best performance, whose accuracy is 0.908, recall is 0.838, and AUC is 0.926, outperforming LR model. The top three most important factors affecting the model's prediction of BM include extraosseous metastases (EM), CEA, and size. Conclusion: Our study developed an SVM model with poly as kernel function for predicting BM in CRC patients. SVM model could improve personalized clinical decision-making, help rationalize the bone metastasis screening process, and reduce the burden on healthcare systems and patients.

The efficacy of platelet-rich plasma applicated in spinal fusion surgery: A meta-analysis.

Objective: The purpose of this meta-analysis is to evaluate the effect of the application of platelet-rich plasma (PRP) in spinal fusion surgery on the fusion rate of the spine. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, and Science Direct databases was conducted to identify randomized control trials (RCTs) or observational cohort studies that evaluated the efficacy and safety of PRP in spinal fusion. Data on final fusion rate, changes in the visual analog scale (VAS), estimated blood loss (EBL), and operative time was collected from the eligible studies for meta-analysis. Patients were divided into PRP and non-PRP groups according to whether PRP was used during the spinal fusion procedure. Results: According to the selection criteria, 4 randomized controlled trials and 8 cohort studies with 833 patients and 918 levels were included. The outcomes indicated that PRP application is associated with a lower fusion rat (OR = 0.62, 95% CI: (0.43, 0.89), P = 0.009) at final follow-up (>24 months). Subgroup analysis showed a lower rate of spinal fusion in the PRP group compared to the non-PRP group (OR = 0.35, 95% CI: (0.21, 0.58), P < 0.001) when spinal fusion was assessed using only anterior-posterior radiographs. When the bone graft material was a combination of autologous bone + artificial bone, the spinal fusion rate was lower in the PRP group than in the non-PRP group (OR = 0.34, 95% CI: (0.16, 0.71), P = 0.004). The PRP and non-PRP groups showed no significant differences in VAS changes at the 24th postoperative month (WMD = 0.36, 95% CI: (-0.37, 1.09), P = 0.33); Application of PRP does not reduce the estimated blood loss (WMD = -86.03, 95% CI: (-188.23, 16.17), P = 0.10). In terms of operation time, using PRP does not prolong operation time (WMD = -3.74, 95% CI: (-20.53, 13.04), P = 0.66). Conclusion: Compared with bone graft fusion alone, PRP cannot increase the rate of spinal fusion. Inappropriate methods of spinal fusion assessment or mixing PRP with artificial/allograft bone may have been responsible for the lower rate of spinal fusion in the PRP group. Systematic Review Registration: doi: 10.37766/inplasy2022.5.0055.

[Effects and mechanism of morroniside on osteogenic differentiation and proliferation of mouse MC3T3-E1 cells].

Objective: To study the effects of morroniside (MOR) on the proliferation and osteogenic differentiation of mouse MC3T3-E1 cells. Methods: The 4th generation MC3T3-E1 cells were randomly divided into 6 groups: control group (group A), MOR low dose group (10 µmol/L, group B), MOR medium-low dose group (20 µmol/L, group C), MOR medium dose group (40 µmol/L, group D), MOR medium-high dose group (80 µmol/L, group E), and MOR high dose group (100 µmol/L, group F). The proliferation activity of each group was detected by cell counting kit 8 (CCK-8) assay; the bone differentiation and mineralized nodule formation of each group were detected by alizarin red staining; real-time fluorescence quantitative PCR (RT-qPCR) was performed to detect cyclin-dependent kinase inhibitor 1A (P21), recombinant Cyclin D1 (CCND1), proliferating cell nuclear antigen (PCNA), alkaline phosphatase (ALP), collagen type Ⅰ (COL-1), bone morphogenetic protein 2 (BMP-2), and adenosine A2A receptor (A2AR) mRNA expressions; Western blot was used to detecte the expressions of osteopontin (OPN), Runt-related transcription factor 2 (RUNX2), and adenosine A2AR protein. Results: The CCK-8 assay showed that the absorbance ( A) values of groups B to F were significantly higher than that of group A at 24 hours of culture, with group C significantly higher than the rest of the groups ( P<0.05). The MOR concentration (20 µmol/L) of group C was selected for the subsequent CCK-8 assay; the results showed that the A values of group C were significantly higher than those of group A at 24, 48, and 72 hours of culture ( P<0.05). Alizarin red staining showed that orange-red mineralized nodules were visible in all groups and the number of mineralized nodules was significantly higher in groups B and C than in group A ( P<0.05). RT-qPCR showed that the relative expressions of P21, CCND1, and PCNA mRNAs were significantly higher in group C than in group A ( P<0.05). The expressions of ALP, BMP-2, COL-1, and adenosine A2AR mRNAs in groups B to E were significantly higher than those in group A, with the expressions of ALP, BMP-2, COL-1 mRNAs in group C significantly higher than the rest of the groups ( P<0.05). Compared with group A, the expressions of OPN and RUNX2 proteins in groups B and C were significantly increased, while those in group D and E were significantly inhibited ( P<0.05). There was no significant difference between groups B and C and between groups D and E ( P>0.05). The relative expression of adenosine A2AR protein in groups B to E was significantly higher than that in group A, with group C significantly higher than the rest of the groups ( P<0.05). Conclusion: MOR can promote the proliferation and osteogenic differentiation of MC3T3-E1 cells; the mechanism of MOR may be achieved by interacting with adenosine A2AR.

Robot-Assisted Kyphoplasty Improves Clinical and Radiological Features Better Than Fluoroscopy-Assisted Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Meta-Analysis.

Purpose: This meta-analysis aimed to determine whether patients treated with robot-assisted kyphoplasty for vertebral compression fractures have superior clinical and radiographic improvement than those treated with fluoroscopy. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, Science Direct, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or observational cohort studies that compared robotic-assisted kyphoplasty (RA-kyphoplasty) with fluoroscopy-assisted kyphoplasty (FA-kyphoplasty) in treating vertebral compression fractures. Preoperative, postoperative, and final follow-up data on vertebral height (VH), vertebral kyphosis angle (VKA), visual analog scale (VAS) for back pain, and cement leakage rate were collected from eligible studies for meta-analysis. Patients were divided into RA and FA groups depending on whether the operation was robotically or fluoroscopically guided. Results: We included 6 cohort studies with 491 patients and 633 vertebrae. The results of the meta-analysis showed that the RA group had a higher VH than the FA group at both postoperation (p < 0.001) and final follow-up (p < 0.001); the VKA in the RA group was lower than that in the FA group at postoperation (p < 0.001) and final follow-up (p < 0.001); the back pain VAS score was lower in the RA group than in the FA group at postoperation (p = 0.01) and final follow-up (p = 0.03); and the cement leakage rate in the RA group was lower than those in the FA group (p < 0.001). Conclusion: This meta-analysis demonstrated that RA-kyphoplasty outperformed FA-kyphoplasty in vertebral height restoration, kyphosis angle correction, VAS score reduction for back pain, and lower cement leakage rate in the treatment of vertebral compression fractures.

Comparison of radiological and clinical outcomes of 3D-printed artificial vertebral body with Titanium mesh cage in single-level anterior cervical corpectomy and fusion: A meta-analysis.

Propose: This meta-analysis aimed to determine whether 3D-printed artificial vertebral body have superior clinical and radiographic outcome than Titanium Mesh Cage(TMC) in single-level anterior cervical corpectomy and fusion. Methods: A comprehensive search of the PubMed, Embase, Cochrane Library, Web of Science, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or cohort studies that compared 3D-printed artificial vertebral body with conventional Titanium Mesh Cage (TMC) in single-level anterior cervical corpectomy and fusion (SL-ACCF). Operation time; intraoperative blood loss; subsidence of vertebral body; preoperative, and final follow-up C2-C7 Cobb angle, Japanese Orthopedic Association (JOA) scores, and Visual Analog Scale(VAS) scores were collected from eligible studies for meta-analysis. Results: We included 6 cohort studies with 341 patients. The results of the meta-analysis showed that the 3D group has a shorter operation time than the traditional TMC group(p = 0.04) and the TMC group had more severe subsidence(≥3 mm) of vertebral body than the 3D group(p < 0.0001). And the cervical C2-C7 Cobb angle in the 3D group was larger than that in the TMC group at the final follow-up. Conclusion: This meta-analysis demonstrates that 3D-printed artificial vertebral body is superior to traditional TMC in reducing the operation time and maintaining the postoperative vertebral height and restoring sagittal balance to the cervical spine in single-level anterior cervical corpectomy and fusion.

Metabolic syndrome increases risk for perioperative outcomes following posterior lumbar interbody fusion.

The present study is a retrospective cohort study. Metabolic syndrome (MetS) is a clustering of clinical findings that has been shown to increase the risk of the surgical outcomes. Our study aimed to evaluate whether MetS was a risk factor for increased perioperative outcomes in patients undergoing posterior lumbar interbody fusion (PLIF).We retrospectively analyzed patients over 18 years following elective posterior lumbar spine fusion from January 2014 to December 2018. Emergency procedures, infections, tumor, fracture, and revision surgeries were excluded. Patients were divided into 2 groups with and without MetS. The MetS was defined by having 3 of the following 4 criteria: obesity (body mass index ≥30 kg/m), dyslipidemia, hypertension, and diabetes. The follow-up period lasted up to 30 days after surgery. The outcomes of demographics, comorbidities, perioperative complications, and length of stay were compared between the 2 groups. Multivariate logistic regression analysis was used to identify perioperative outcomes that were independently associated with MetS.The overall prevalence of MetS was 12.5% (360/2880). Patients with MetS was a significantly higher risk factor for perioperative complications, and longer length of stay cmpared with patients without MetS (P < .05). The MetS group had a higher rate of cardiac complications (P = .019), pulmonary complication (P = .035), pneumonia (P = .026), cerebrovascular event (P = .023), urinary tract infection (P = .018), postoperative ICU admission (P = .02), and deep vein thrombosis (P = .029) than non-MetS group. The patients with MetS had longer hospital stays than the patients without MetS (22.16 vs 19.99 days, P < .001). Logistic regression analysis revealed that patients with MetS were more likely to experience perioperative complications (odds ratio [OR] 1.31; 95% confidence interval [CI]: 1.06-2.07; P < .001), and extend the length of stay (OR: 1.69; 95% CI: 1.25-2028; P = .001).The MetS is a significant risk factor for increased perioperative complications, and extend length of stay after PLIF. Strategies to minimize the adverse effect of MetS should be considered for these patients.

miR-532-3p inhibits osteogenic differentiation in MC3T3-E1 cells by downregulating ETS1.

BACKGROUND: Many studies had identified that MicroRNAs (miRNAs) could affect bone metabolism by regulating the expression of various proteins. This study explored the effect and mechanism of miR-532-3p on osteogenic differentiation. METHODS: We analyzed the content of miR-532-3p in osteoporosis patients, osteoporosis rats, and osteogenic induced MC3T3-E1 cells. MiR-532-3p mimic or inhibitor utilized to alter intracellular miR-532-3p content. MTT method executed to detect the effect of miR-532-3p on osteoblast proliferation. Real-time qPCR, Western blot, alkaline phosphatase staining, and alizarin red staining utilized to ascertain the influence of miR-532-3p on osteogenic differentiation. Then, databases and a dual-luciferase reporter gene assay used to verify the target of miR-532-3p. Furthermore, the lentiviral vector was utilized to overexpress interesting target gene expression and checked whether the target gene was involved in the regulation of osteogenic differentiation by miR-532-3p. RESULTS: MiR-532-3p expression boosted in low bone mineral density (BMD) patients and rats. In MC3T3-E1 cells, miR-532-3p expression gradually decreased as osteogenic induction matures. MiR-532-3p mimic negatively regulated succinate dehydrogenase (SDH) activity, alkaline phosphatase (ALP) activity, mineralization ability, the osteogenic-associated gene (Col1A1, Runx2, ALP, OPN, and OCN) and E-26 transformation specific-1 (ETS1) expression of MC3T3-E1 cells. Things are the opposite of the miR-532-3p inhibitor. ETS1 identified as the miR-532-3p target gene, and miR-532-3p could inhibit its expression. Besides, improved ETS1 expression could rescue the suppressive effect of miR-532-3p mimic on osteogenic differentiation. CONCLUSION: miR-532-3p can suppress osteogenic differentiation by downregulating ETS1 expression.

Comparative clinical efficacy and safety of cortical bone trajectory screw fixation and traditional pedicle screw fixation in posterior lumbar fusion: a systematic review and meta-analysis.

PURPOSE: To compare the clinical efficacy and safety between cortical bone trajectory (CBT) and pedicle screw (PS) in posterior lumbar fusion surgery. METHODS: Five electronic databases were used to identify relevant studies comparing the clinical efficacy and safety between CBT and PS. The main outcomes were postoperative fusion rates and complication (especially in superior facet joint violations, symptomatic ASD, wound infection, dural tear, screw malposition and hematoma). The secondary results included operation time, intraoperative blood loss, length of hospital stay, incision length, ODI, VAS, JOA score, JOA recovery rate, patients' satisfaction and health-related quality of life. RESULTS: The outcomes showed that there was no significant difference in terms of fusion rate (p = 0.55), back and leg VAS score (p > 0.05), JOA score (p = 0.08) and incidence of reoperation (p = 0.07). However, CBT was superior to PS with Oswestry Disability Index (ODI) (p = 0.02), JOA recovery rate (p < 0.00001) and patients' satisfaction (p = 0.001). In addition, CBT was superior to PS with significantly lower incidence of superior facet joint violation and symptomatic ASD. However, there was no significant difference regarding wound infection (p > 0.05) and screw malposition (p > 0.05). CBT group required significant shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay in comparison with PS group (p < 0.05). CONCLUSIONS: Both CBT and PS achieve similar, fusion rate and revision surgery rate. Furthermore, CBT is superior to PS with lower incidence of complications, shorter operation time, less blood loss, shorter incision length and shorter length of hospital stay. These slides can be retrieved under Electronic Supplementary Material.

Application of Vancomycin Powder to Reduce Surgical Infection and Deep Surgical Infection in Spinal Surgery: A Meta-analysis.

STUDY DESIGN: This was a meta-analysis study. OBJECTIVE: Our meta-analysis study aimed to evaluate the efficacy of vancomycin powder to reduce the surgical site infection (SSI) in spinal surgery. SUMMARY OF BACKGROUND DATA: The SSI is a potential and devastating complication after spinal surgery. Local application of vancomycin powder is an attractive adjunctive therapy to reduce SSI in spinal surgery. METHODS: Studies were identified from PubMed, The Cochrane Library, AMED, Web of Science, Scopus, Ovid, EMBASE, and Ebsco Medline. The fixed-effects model was used to compute the merge of relative risk and 95% confidence interval (CI). Heterogeneity tests were checked by I statistics. Subgroup analysis was performed to determine whether vancomycin powder was beneficial, that could reduce the SSI in spinal surgery, or not. Publication bias was explored by funnel plot. RESULTS: We included 21 studies for final analysis. In our analysis, application of vancomycin powder was associated with a significantly reduced risk of SSI and deep SSI. Pooled relative risks showed significant changes: SSI, 0.36 (95% CI: 0.27-0.47, P=0.000), SSI in the instrumented group, 0.35 (95% CI: 0.25-0.49, P=0.000), SSI in the noninstrumented group, 0.39 (95% CI: 0.24-0.65, P=0.000), deep SSI, 0.28 (95% CI: 0.18-0.44, P=0.000), and the incidence pseudoarthrosis, 0.88 (95% CI: 0.35-2.21, P=0.784). In the subgroup analysis, vancomycin powder showed beneficial effects to SSI in the instrumented group. Pooled the heterogeneity: SSI (P=0.124, I=30.0%), SSI in the instrumented group (P=0.366, I=8.2%), SSI in the noninstrumented group (P=0.039, I=60.5%), deep SSI (P=0.107, I=33.5%). CONCLUSIONS: The application of vancomycin powder could decrease the SSI and deep SSI in spinal surgery. In the subgroup, vancomycin powder is beneficial to the SSI in the instrumented group. The available evidence is too limited to make the conclusion that the use of vancomycin powder causes pseudoarthrosis in spinal surgery, its extrapolation should be carefully executed.

Impact of different laminae open angles on axial symptoms after expansive open-door laminoplasty.

The present study is a retrospective study.Axial symptoms are frequently encountered complication after laminoplasty. Some studies have reported the influencing factors and preventive measures of axial symptoms after laminoplasty. However, impact of different laminae open angles on the postoperative axial symptoms remains unclear.The objective of the present study was to explore the effect of different laminae open angles on postoperative axial symptoms and to discuss the possible mechanisms of the impact of different open angles on axial symptoms.We retrospectively analyzed 124 patients with multilevel cervical compression myelopathy who were treated with expansive open-door laminoplasty from February 2012 to January 2015. The operational level ranged from C3-C7 in all patients. The laminae open angles at the C4, C5, and C6 levels were measured 1 week postoperative. The mean value was taken for statistical analysis. The patients were divided into 2 groups, group A (open angles < 40°, 71 patients including 44 males and 27 females) and group B (open angles ≥ 40°, 53 patients including 32 males and 21 females). C2-C7 Cobb angle, range of cervical motion (ROM), Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS) score for axial pain were compared between the 2 groups.All patients completed at least 2-year follow-up. Both groups gained significant JOA improvement postoperatively (P < .05). Preoperative and postoperative C2-C7 Cobb angle and ROM comparisons were significantly different (P < .05) in both groups. There were no significant difference for other clinical and radiography parameters between the groups (P > .05). At 2 weeks and 6 months after surgery, there was significant difference in axial symptoms between the 2 groups (P < .05). At final follow-up, the difference between the 2 groups was not statistically significant (P > .05).In different angles of the lamina open-door, incidence of axial symptoms has statistically difference between the 2 groups. When the lamina open-door angles are <40°, there are not only ensure adequate spinal cord decompression but reduces the incidence of early and midterm postoperative axial pain.

MicroRNA-152 inhibits ovarian cancer cell proliferation and migration and may infer improved outcomes in ovarian cancer through targeting FOXP1.

microRNA (miR) are a class of endogenous small non-coding RNA that are aberrantly expressed and are critical in tumorigenesis. Amongst them, miR-152 was reported to be dysregulated in epithelial ovarian cancer (EOC). However, the function and mechanism of miR-152 is not well understood. In the present study, total RNA was extracted from 58 ovarian epithelial carcinoma tissue samples and adjacent non-tumor tissues and measured by reverse transcription-quantitative polymerase chain reaction. The observations of the present study revealed that the expression of miR-152 was significantly downregulated in EOC specimens, as well as three ovarian cancer (OC) cell lines. The higher expression of miR-152 indicated a better overall survival rate in patients with EOC. Following miR-152 mimic transfection into SKOV3 or OVCAR3 cells, MTT assay revealed that cell proliferation was significantly inhibited (P<0.05). Although miR-152 had no effect on SKOV3 cell migration, miR-152 inhibited OVCAR3 cell migration. Bioinformatics analyses and luciferase reporter assays demonstrated that miR-152 targeted the 3'-untranslated region (3'-UTR) of the forkhead box protein 1 (FOXP1). Furthermore, introducing FOXP1 without the 3'-UTR abrogated the effect of miR-152-induced proliferation and migration alteration, respectively. In addition, the expression level of FOXP1 was higher in the EOC tumor tissues and cell lines. Additionally, the level of miR-152 and FOXP1 was inversely correlated in grade 3 and 4 ovarian tumor tissues. Altogether, these observations indicated that miR-152 may be involved in the inhibition of OC through repression of FOXP1. In the future, miR-152 and FOXP1 may act as novel biomarkers for early detection of EOC or therapeutic targets.

Efficacy of antifibrinolytic agents on surgical bleeding and transfusion requirements in spine surgery: a meta-analysis.

PURPOSE: Spine surgery is usually associated with large amount of blood loss and blood transfusion. Excessive blood loss may cause hypotension, inadequate oxygenation of organs, necessitate allogeneic blood transfusion, and spinal epidural hematoma formation. Aprotinin, TXA, and EACA are antifibrinolytics currently offered as prophylactic agents to reduce surgery-associated blood loss. The purpose of this study was to assess the efficacy of using antifibrinolytic agents in reducing blood loss and blood transfusions in spine surgery. METHODS: PubMed, Embase, and Cochrane-controlled trials register were used to identify RCTs published before April 2015 that examined the effectiveness of intravenous aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) on reduction of blood loss and blood transfusions, compared with placebo in spine surgery. Randomized controlled trials reported the primary outcome that included total blood loss, intra-operative blood loss, post-operative blood loss, blood transfusion requirements, blood transfusion rate, and incidence of deep vein thrombosis. Meta-analysis was performed using the Stata12.0. Weighted mean difference with 95 % confidence intervals was used to summarize the findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratios with 95 % confidence intervals. A P < 0.05 was considered statistically significant. RESULTS: 17 studies involving 1191 patients were identified. Among them, 13 RCTs with 943 patients were included for the evaluation of total blood loss. Compared with the control group, the antifibrinolytic agents reduced total blood loss (SMD = -0.62; 95 % CI -0.75, -0.48; P = 0.000), The aprotinin group (SMD = -0.80; 95 % CI -1.22, -0.37; P = 0.938), The TXA group (SMD = -0.75; 95 % CI -0.93, -0.57; P = 0.000), and the EACA group (SMD = -0.28; 95 % CI -0.54, -0.01; P = 0.185). Thirteen RCTs with eight hundred and ninety four patients were included for the evaluation of intra-operative blood loss. Compared with the control group, the antifibrinolytic agents reduced intra-operative blood loss (SMD = -0.41; 95 % CI -0.55, -0.28; P = 0.010), The aprotinin group (SMD = -0.62; 95 % CI -0.93, -0.30; P = 0.862), The TXA group (SMD = -0.47; 95 % CI -0.64, -0.29; P = 0.005), and the EACA group (SMD = -0.16; 95 % CI -0.42, -0.11; P = 0.897). Eight RCTs with six hundred and seven patients were included for the evaluation of post-operative blood loss. Compared with the control group, the antifibrinolytic agents reduced post-operative blood loss (SMD = -0.68; 95 % CI -0.85, -0.51; P = 0.000), the aprotinin group (SMD = -0.48; 95 % CI -0.85, -0.12; P = 0.036), the TXA group (SMD = -0.80; 95 % CI -1.01, -0.59; P = 0.000), and the EACA group (SMD = -0.32; 95 % CI -0.68, -0.04; P = 0.009). Ten RCTs with seven hundred and twenty twopatients were included for the evaluation of blood transfusion. Compared with the control group, the antifibrinolytic agents reduced blood transfusion (SMD = -0.68; 95 % CI -0.85, -0.51; P = 0.000), the aprotinin group (SMD = -0.80; 95 % CI -1.22, -0.37; P = 0.938), the TXA group (SMD = -0.38; 95 % CI -0.58, -0.18; P = 0.000), and the EACA group (SMD = -0.28; 95 % CI -0.54, -0.01; P = 0.185). Twelve RCTs with eight hundred and fifteenpatients were included for the evaluation of blood transfusion rate. The transfusion rate was 35.6 % in the patients with antifibrinolytic agents and 55.2 % in the patients with placebo (RR = 0.75; 95 % CI 0.63, 0.89; P = 0.939). All studies were included for the evaluation of safety, with a total of eight thromboembolic events reported overall (two in the experimental group and six in the control group). CONCLUSIONS: The antifibrinolytic agents were able to reduce perioperative blood loss and transfusion requirements in spine surgery. TXA appeared more effective than aprotinin and EACA in reducing total blood loss, intra-operative blood loss, and blood transfusion according to the results of this analysis. The three groups in reducing the post-operative blood loss are significantly better than control groups. There was no evidence that the use of antifibrinolytic agents was a risk factor for thromboembolism in spine surgery. Further multicenter, large-sample, double-blind RCTs are required to confirm the efficacy and safety of the three antifibrinolytic agents in spine surgery.

Silencing of Transient Receptor Potential Channel 4 Alleviates oxLDL-induced Angiogenesis in Human Coronary Artery Endothelial Cells by Inhibition of VEGF and NF-κB.

BACKGROUND: Transient receptor potential channel 4 (TRPC4) plays central roles in endothelial cell function. The aim of this study was to investigate the silencing effects of TRPC4 on oxidized low-density lipoprotein (oxLDL)-induced angiogenesis in human coronary artery endothelial cells (HCAECs), as well as the underlying molecular mechanism involved in this process. MATERIAL/METHODS: HCAECs were transfected with small interfering RNA (siRNA) targeting TRPC4 (TRPC4-siRNA) or with a negative control (NC)-siRNA. The expression of TRPC4 was confirmed by real-time polymerase chain reaction (RT-PCR) and Western blotting. After the siRNA transfection, oxLDL was added to the medium. Cell proliferation, migration, and in vitro angiogenesis were determined by bromodeoxyuridine (BrdU) enzyme-linked immunosorbent assay (ELISA), Transwell assay and scratch-wound assay, respectively, and tube formation on Matrigel. Expression of vascular endothelial growth factor (VEGF) and nuclear factor (NF)-κB p65 were assessed by Western blotting. RESULTS: Both the mRNA and protein levels of TRPC4 were significantly reduced by transfection with TRPC4-siRNA compared to the control group or NC-siRNA group (P<0.05). Silencing of TRPC4 significantly decreased the cell proliferation, migration, and tube formation (all P<0.05). Furthermore, the expression levels of VEGF and NF-κB p65 were markedly lowered by silencing of TRPC4 in HCAECs. CONCLUSIONS: These results suggest that silencing of TRPC4 alleviates angiogenesis induced by oxLDL in HCAECs through inactivation of VEGF and NF-κB. Suppression of TRPC4 might be an alternative therapeutic strategy for atherosclerotic neovascularization.