Uric acid-lowering effect of harpagoside and its protective effect against hyperuricemia-induced renal injury in mice.

Hyperuricemia (HUA) is caused by increased synthesis and/or insufficient excretion of uric acid (UA). Long-lasting HUA may lead to a number of diseases including gout and kidney injury. Harpagoside (Harp) is a bioactive compound with potent anti-inflammatory activity from the roots of Scrophularia ningpoensis. Nevertheless, its potential effect on HUA was not reported. The anti-HUA and nephroprotective effects of Harp on HUA mice were assessed by biochemical and histological analysis. The proteins responsible for UA production and transportation were investigated to figure out its anti-HUA mechanism, while proteins related to NF-κB/NLRP3 pathway were evaluated to reveal its nephroprotective mechanism. The safety was evaluated by testing its effect on body weight and organ coefficients. The results showed that Harp significantly reduced the SUA level and protected the kidney against HUA-induced injury but had no negative effect on safety. Mechanistically, Harp significantly reduced UA production by acting as inhibitors of xanthine oxidase (XOD) and adenosine deaminase (ADA) and decreased UA excretion by acting as activators of ABCG2, OAT1 and inhibitors of GLUT9 and URAT1. Moreover, Harp markedly reduced infiltration of inflammatory cells and down-regulated expressions of TNF-α, NF-κB, NLRP3 and IL-1ß in the kidney. Harp was a promising anti-HUA agent.

Management for degenerative lumbar spondylolisthesis: a network meta-analysis and systematic review basing on randomized controlled trials.

BACKGROUND: Consensus on the various interventions for degenerative lumbar spondylolisthesis (DLS) remains unclear. MATERIALS AND METHODS: The authors searched PubMed, Embase, Cochrane Library, Web of Science, and major scientific websites until 01 November 2023, to screen eligible randomized controlled trials (RCTs) involving the treatment of DLS. The seven most common DLS interventions [nonsurgical (NS), decompression only (DO), decompression plus fusion without internal fixation (DF), decompression plus fusion with internal fixation (DFI), endoscopic decompression plus fusion (EDF), endoscopic decompression (ED), and circumferential fusion (360F)] were compared. The primary (pain and disability) and secondary (complications, reoperation rate, operation time, blood loss, length of hospital stay, and satisfaction) outcomes were analyzed. RESULTS: Data involving 3273 patients in 16 RCTs comparing the efficacy of different interventions for DLS were reported. In terms of improving patient pain and dysfunction, there was a significant difference between surgical and NS. EDF showed the greatest improvement in short-term and long-term dysfunction (probability, 7.1 and 21.0%). Moreover, EDF had a higher complication rate (probability 70.8%), lower reoperation rate (probability, 20.2%), and caused greater blood loss (probability, 82.5%) than other surgical interventions. Endoscopic surgery had the shortest hospitalization time (EDF: probability, 42.6%; ED: probability, 3.9%). DF and DFI had the highest satisfaction scores. CONCLUSIONS: Despite the high complication rate of EDF, its advantages include improvement in pain, lower reoperation rate, and shorter hospitalization duration. Therefore, EDF may be a good option for patients with DLS as a less invasive surgical approach.

Percutaneous Fully-endoscopic Anterior Transcorporeal Procedure for the Treatment of Isolated Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Case Report.

BACKGROUND: With the development of spinal endoscopic techniques, on the basis of our previous experience in treating various types of cervical disc herniation with this endoscopic technique, we took the lead in applying the percutaneous fully endoscopic anterior transcorporeal procedure to be utilized in the treatment of the isolated cervical ossification of the posterior longitudinal ligament (OPLL). CASE PRESENTATION: A 66-year-old male patient who weighed 57 kg, with a height of 169 cm was admitted to the hospital on September 16, 2021 because of recurrent pain and numbness in the neck, shoulder, and right arm for 2 years, which as aggravated for the last 2 weeks. Two years ago, the patient developed neck and shoulder pain accompanied by right arm pain without obvious predisposing factors, and numbness in the first web space of the right hand. In the last 2 weeks, he had difficulty moving the right arm, but no pain or numbness in the contralateral arm. MRI and CT scans demonstrated that the ossified posterior longitudinal ligament of the cervical 5/6 vertebrae with spinal canal stenosis and seriously compressed the spinal cord patient was treated with a percutaneous fully endoscopic anterior transcorporeal procedure. CONCLUSION: Our percutaneous fully endoscopic anterior transcorporeal procedure is a feasible, minimally invasive surgery for treating isolated ossification of the posterior longitudinal ligament in the cervical spine.

The role and mechanisms of mesenchymal stem cells regulating macrophage plasticity in spinal cord injury.

Spinal Cord Injury (SCI) is a devastating neurological disorder comprising primary mechanical injury and secondary inflammatory response-mediated injury for which an effective treatment is still unavailable. It is well known that secondary inflammatory responses are a significant cause of difficulties in neurological recovery. An immune imbalance between M1/M2 macrophages at the sites of injury is involved in developing and progressing the secondary inflammatory response. Recently, Mesenchymal Stem Cells (MSCs) have shown significant therapeutic potential in tissue engineering and regenerative medicine due to their potential multidirectional differentiation and immunomodulatory properties. Accumulating evidence shows that MSCs can regulate the balance of M1/M2 macrophage polarization, suppress downstream inflammatory responses, facilitate tissue repair and regeneration, and improve the prognosis of SCI. This article briefly overviews the impact of macrophages and MSCs on SCI and repair. It discusses the mechanisms by which MSCs regulate macrophage plasticity, including paracrine action, release of exosomes and apoptotic bodies, and metabolic reprogramming. Additionally, the article summarizes the relevant signaling pathways of MSCs that regulate macrophage polarization.

[Research updates of osteoimmunomodulation in osteogenesis].

The gold-standard for bone substitution of large bone defects continues to be autogenous bone graft. Artificial bone substitutes are difficult to replace the autogenous bone grafting due to excessive immune response, fast biodegradation characteristics and inappropriate biocompatibility. Given these drawbacks, osteoimmunology and its advanced functional biomaterials have gained growing attention in recent years. Immune system plays an essential role during bone healing via regulating the shift from inflammatory to anti-inflammation phenotype, and inflammatory cytokines response. The inflammatory reaction mainly include infiltration of immune cells (such as macrophages, neutrophils, T cells, B cells, etc) and release of inflammatory factors (such as IL-1ß, IL-6, TNF-α, etc.) at the bone defects, which subsequently affect the step-wised process of bone healing rejuvenation. Hence, advanced bone biomaterials with immunomodulatory properties is of great significance for the treatment of patients with recalcitrant bone defects, especially for delayed healing or non-union. The reciprocal mechanism of immuno-modulated bone healing, however, is not fully understood and more research is required in the future.

Posterior unilateral small fenestration of lamina combined with a custom-made Y-shaped fracture reduction device for the treatment of severe thoracolumbar burst fracture: a prospective comparative study.

BACKGROUND: The purpose was to evaluate the clinical effect of a custom-made Y-shaped fracture fragment reduction device and to assist in posterior unilateral small fenestration of lamina to reduce the fracture fragments. METHODS: In this study, 40 patients were assigned to one of two groups: the traditional reduction device group (TRG) or the Y-shaped reduction device group (YRG). All patients underwent posterior unilateral small fenestration of the lamina and direct decompression through the spinal canal. And the operation time (OT), intraoperative bleeding (IB), preoperative, postoperative, and final follow-up data on the spinal stenosis rate (SSR), Cobb angle, the anterior compression ratio of injured vertebrae (ACRIV), and ASIA neurological function grade were compared between the two groups. RESULT: There were no complications, including vascular and nerve injury, serious postoperative infection, internal fixation fracture, or loosening, for any of the patients. And the average follow-up time of the two groups was 14.2 months, the average operation time of the TRG was 236.6 min, and the average intraoperative blood loss was 357.20 ml. Moreover, the average operation time of the YRG was 190.6 min, and the average intraoperative blood loss was 241.5 ml. There were significant differences between the two groups in terms of operation duration and intraoperative blood loss. The YRG's was lower than that of the TRG. Besides, there was no difference in SSR, Cobb angle, ACRIV, or neurological recovery between the two groups before or immediately after the operation or at the last follow-up. CONCLUSION: The Y-shaped fracture reduction device can reduce the fracture fragments and the OT and IB stably; it also has satisfactory postoperative curative effects and clinical utility.

Multiple strategies enhance the efficacy of MSCs transplantation for spinal cord injury.

Spinal cord injury (SCI) is a serious complication of the central nervous system (CNS) after spine injury, often resulting in severe sensory, motor, and autonomic dysfunction below the level of injury. To date, there is no effective treatment strategy for SCI. Recently, stem cell therapy has brought hope to patients with neurological diseases. Mesenchymal stem cells (MSCs) are considered to be the most promising source of cellular therapy after SCI due to their immunomodulatory, neuroprotective and angiogenic potential. Considering the limited therapeutic effect of MSCs due to the complex pathophysiological environment following SCI, this paper not only reviews the specific mechanism of MSCs to facilitate SCI repair, but also further discusses the research status of these pluripotent stem cells combined with other therapeutic approaches to promote anatomical and functional recovery post-SCI.

A comparative study on efficacies of posterior microscopic mini-open and open technique for thoracolumbar burst fractures with severe traumatic spinal stenosis.

PURPOSE: This study compares the efficacies of minimally invasive decompression by posterior microscopic mini-open technique combined with percutaneous pedicle fixation (hereafter MOT) to traditional open surgery in patients with severe traumatic spinal canal stenosis resulting from Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 or A4 thoracolumbar burst fractures and provides references for clinical treatment. METHODS: In total, 133 patients with severe traumatic spinal canal stenosis caused by AO type A3 or A4 thoracolumbar burst fractures who underwent MOT (group A) or traditional open surgery (group B) were retrospectively enrolled. The demographic and radiological data of the two groups were analyzed and compared. RESULTS: A total of 64 patients were finally recruited in this study. There were no significant differences in gender, age, follow-up time, injury mechanism, injury level, AO classification, American Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, and duration of hospital stay between the two groups (P > 0.05). After the procedures, the prevertebral height ratio (PHR), the Cobb angle, and the mid-sagittal canal diameter compression ratio (MSDCR) were significantly improved (P < 0.05) in both groups. However, group A demonstrated less intraoperative bleeding and a greater VAS score improvement postoperatively and at the last follow-up but involved a longer operation time (P < 0.05). The PHR and the Cobb angle in the two groups showed no significant difference postoperatively and at the last follow-up (P > 0.05). In contrast, a significant improvement in MSDCR was observed at the last follow-up when compared with the postoperative value (P < 0.05). However, the Cobb angle in group A was better maintained than in group B at the last follow-up (P < 0.05), while the MSDCR in group B demonstrated a greater improvement at the last follow-up than in group A (P < 0.05). CONCLUSIONS: Both the MOT and traditional open surgery are effective treatment options for AO type A3 and A4 thoracolumbar burst fractures with severe traumatic spinal stenosis. The advantages of MOT include the minimally invasive procedure, extremely fine spinal canal decompression, less intraoperative bleeding, and significant pain relief. We suggest that MOT should be preferentially performed for AO type A3 or A4 thoracolumbar burst fractures with severe traumatic spinal stenosis.

Advances in the research of the role of macrophage/microglia polarization-mediated inflammatory response in spinal cord injury.

It is often difficult to regain neurological function following spinal cord injury (SCI). Neuroinflammation is thought to be responsible for this failure. Regulating the inflammatory response post-SCI may contribute to the recovery of neurological function. Over the past few decades, studies have found that macrophages/microglia are one of the primary effector cells in the inflammatory response following SCI. Growing evidence has documented that macrophages/microglia are plastic cells that can polarize in response to microenvironmental signals into M1 and M2 macrophages/microglia. M1 produces pro-inflammatory cytokines to induce inflammation and worsen tissue damage, while M2 has anti-inflammatory activities in wound healing and tissue regeneration. Recent studies have indicated that the transition from the M1 to the M2 phenotype of macrophage/microglia supports the regression of inflammation and tissue repair. Here, we will review the role of the inflammatory response and macrophages/microglia in SCI and repair. In addition, we will discuss potential molecular mechanisms that induce macrophage/microglia polarization, with emphasis on neuroprotective therapies that modulate macrophage/microglia polarization, which will provide new insights into therapeutic strategies for SCI.

Roles and current applications of S-nitrosoglutathione in anti-infective biomaterials.

Bacterial infections can compromise the physical and biological functionalities of humans and pose a huge economical and psychological burden on infected patients. Nitric oxide (NO) is a broad-spectrum antimicrobial agent, whose mechanism of action is not affected by bacterial resistance. S-nitrosoglutathione (GSNO), an endogenous donor and carrier of NO, has gained increasing attention because of its potent antibacterial activity and efficient biocompatibility. Significant breakthroughs have been made in the application of GSNO in biomaterials. This review is based on the existing evidence that comprehensively summarizes the progress of antimicrobial GSNO applications focusing on their anti-infective performance, underlying antibacterial mechanisms, and application in anti-infective biomaterials. We provide an accurate overview of the roles and applications of GSNO in antibacterial biomaterials and shed new light on the avenues for future studies.

The Difference of Disease Injury and Postoperative Recovery in the Occupational Characteristics of Thoracolumbar Fracture Patients: A Retrospective Study.

OBJECTIVES: Understanding the occupational characteristics of patients is not only related to patients' life and health, but also conducive to improving their happiness. However, there were no studies that had been conducted on the relationship between occupation characteristic and postoperative recovery in patients with spinal fractures. The purpose of this study was to explore the relationship between the occupation characteristics of patients with thoracolumbar fracture and the characteristics of disease injury, treatment, and recovery so as to reduce the incidence and improve postoperative rehabilitation. METHODS: Patients (n = 719) with thoracolumbar fractures were recruited. Patients were grouped according to the characteristic of occupations: unemployed group (n = 299), white-collar worker group (n = 20), and blue-collar worker group (n = 400). Data were collected, including the characteristics, injury and treatment information, and the recovery records for 1 year after operation. One-way ANOVA analysis, χ2 test, and binary logistic regression analysis was used to explore the relationship among these factors. RESULTS: Male, high-falling injuries and single segment injury (mainly T 11, T 12 and L2) were common in patients with thoracolumbar fractures, especially in the blue-collar worker group (70.8%, 78.3%, and 85.4%). Compared with the unemployed group, the patients in the white-collar worker group and blue-collar worker group had a higher proportion of young patients, a higher height and weight, a lesser rate of hypertension or diabetes. One week after injury, 73.4% of patients underwent surgery, with the blue-collar worker group accounted for the largest proportion. One month after surgery, 77.1% of patients were able to get out of bed, with the white-collar worker group accounted for the largest proportion. In the postoperative recovery information, patients in the blue-collar worker group were more likely to have severe low back pain (OR = 2.023, 95% CI: 1.440-2.284) and pain-disturbed sleep (OR = 2.287, 95% CI: 1.585-3.299) than those who in the unemployed group. CONCLUSIONS: Blue-collar workers, with a high risk of thoracolumbar fracture, have a higher incidence of low back leg pain and pain-disturbed sleep in the recovery after thoracolumbar fracture surgery, and this requires more attention.

PBMSCs transplantation facilitates functional recovery after spinal cord injury by regulating microglia/macrophages plasticity.

BACKGROUND: Stem cell therapy has been proven as one of the promising strategies for treating spinal cord injury (SCI). However, the role of peripheral blood-derived mesenchymal stem cells (PBMSCs) in animal models of SCI has not been fully uncovered. This study aimed to investigate whether transplanted PBMSCs could inhibit neuroinflammation and then promote the functional recovery by shifting the microglia/macrophages phenotype from M1 to M2 at the site of injury after SCI. METHODS: PBMSCs harvested from peripheral blood were analyzed by morphology and phenotype. Rat models of SCI were administrated with PBMSCs 1 week after injury. Inclined plane test and Basso-Beattie-Bresnahan (BBB) scores were used for assessing the functional recovery. Enzyme-linked immunosorbent assay (ELISA), reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and flow cytometry (FCM) were performed on days 3, 7, 14, 28 and 56 after PBMSCs transplantation. RESULTS: PBMSCs were plastic-adherent and fibroblast-like with positive expression of cluster of differentiation (CD)29, CD90 and CD44. ELISA and RT-qPCR both showed a lower expression of pro-inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α while a higher expression of anti-inflammatory cytokines IL-10 and transforming growth factor (TGF)-ß1 after PBMSCs transplantation. This was associated with increased numbers of M2 microglia/macrophages and decreased numbers of M1 microglia/macrophages. These changes taken together were associated with the functional recovery in PBMSCs groups. CONCLUSIONS: Administration of PBMSCs following SCI may provide an anti-inflammatory and reparative micro-environment for locomotive recovery by shifting microglia/macrophages phenotype from M1 towards M2.

Regulatory Role of Mesenchymal Stem Cells on Secondary Inflammation in Spinal Cord Injury.

Spinal cord injury (SCI) is a catastrophic condition with high morbidity and mortality that still lacks effective therapeutic strategies. It is well known that the most important stage in SCI pathogenesis is secondary injury, and among the involved mechanisms, the inflammatory cascade is the main contributor and directly influences neurological function recovery. In recent years, increasing evidence has shown that mesenchymal stem cells (MSCs) transplantation is a promising immunomodulatory strategy. Transplanted MSCs can regulate macrophage-, astrocyte-, and T lymphocyte-mediated neuroinflammation and help create a microenvironment that facilitates tissue repair and regeneration. This review focuses on the effects of different types of immune cells and MSCs, specifically the immunoregulatory capacity of MSCs in SCI and repair. We will also discuss how to exploit MSCs transplantation to regulate immune cells and develop novel therapeutic strategies for SCI.

Traumatic spinal cord injury caused by a dagger in the spine: A case report.

Acute traumatic spinal cord injury (SCI) combined with foreign matter retention is rare in the clinic, which causes less literature reported, browsed, and analyzed. A 36-year-old male was rushed to our institution due to an attack on the back. His superficial sensation below the nipple had disappeared (mainly in the left breast), the proprioception of both lower limbs was obviously decreased, and the muscle strength of the left lower limb was level 0 and that of the right lower limb was level 3. Computed tomography of the thoracic vertebrae showed that the dagger had completely pierced into the T9 vertebral body and the spinal canal. Prehospital transport: the spinal cord may be injured again due to the movement of the remaining foreign matter and the posture of the patients while they are being transported. Pathophysiology: the incidence of incomplete SCI is higher than that of other types of SCI. Imaging examination: magnetic resonance imaging might cause unexpected secondary injuries. Treatments: surgical intervention including removal of foreign matter and decompression is an essential and important measure for recovery of neurological function. Patients could benefit from administration of methylprednisolone.

Involvement of PAR2 in platelet-derived growth factor receptor-α-positive cell proliferation in the colon of diabetic mice.

Our previous study indicated that streptozotocin (STZ)-induced diabetes leads to colonic platelet-derived growth factor receptor-α-positive (PDGFRα+ ) cell proliferation accompanied by slow colonic transit in mice; however, the mechanism of this effect is unclear. The present study used western blotting, immunohistochemistry, and quantitative PCR to investigate whether proteinase-activated receptor 2 (PAR2) mediates PDGFRα+ cell proliferation. Our results showed that PDGFRα, PAR2, and Ki-67 coexpression was increased in the diabetic colonic muscle layer. PDGFRα and PAR2 mRNA and protein expression levels were also markedly enhanced in the diabetic colonic muscle layer. Mice treated with 2-furoyl-LIGRLO-amide (2-F-L-a), a PAR2 agonist, exhibited significant colon elongation and increased smooth muscle weight. In the 2-F-L-a-treated mice, PDGFRα, PAR2, and Ki-67 coexpression was increased and PDGFRα and PAR2 mRNA and protein expression was significantly enhanced in the colonic smooth muscle layer. 2-F-L-a also increased proliferation and PDGFRα expression in NIH/3T3 cells cultured in high glucose, while LY294002, a PI3K antagonist, decreased cell proliferation and PDGFRα expression. PI3K and Akt protein and mRNA expression and p-Akt protein expression in diabetic and 2-F-L-a-treated mice were markedly reduced in colonic smooth muscle. 2-F-L-a also reduced PI3K, Akt, and p-Akt protein expression in NIH/3T3 cells, while the PI3K antagonist LY294002 increased this expression. The results indicate that PAR2 is involved in the proliferation of PDGFRα+ cells through the PI3K/Akt signaling pathway in the colon of STZ-induced diabetic mice, which may contribute to the slow transit and constipation that are associated with diabetes.

miR-23a-3p regulated by LncRNA SNHG5 suppresses the chondrogenic differentiation of human adipose-derived stem cells via targeting SOX6/SOX5.

Cartilage generation and degradation are controlled by miRNAs. Our previous study showed miR-23a-3p was downregulated during chondrogenic differentiation in chondrogenic human adipose-derived mesenchymal stem cells (hADSCs). In the present study, we explored the function of miR-23a-3p in chondrogenesis differentiation. The role of miR-23a-3p in chondrogenic differentiation potential of hADSCs was assessed by Alcian blue staining, quantitative real-time polymerase chain reaction (qRT-PCR), and Western blot. We show that miR-23a-3p suppressed the chondrogenic differentiation of hADSCs. LncRNA SNHG5 interacted with miR-23a-3p, and suppression or overexpression of SNHG5 correlates with inhibition and promotion of hADSC chondrogenic differentiation, respectively. We have determined that SNHG5 can sponge miR-23a-3p to regulate the expression of SOX6/SOX5, transcription factors that play essential roles in chondrocyte differentiation. Furthermore, the overexpression of SNHG5 activates the JNK/MAPK/ERK pathway. In conclusion, miR-23a-3p regulated by lncRNA SNHG5 suppresses the chondrogenic differentiation of human adipose-derived stem cells via targeting SOX6/SOX5.

Translaminar Osseous Channel-Assisted Full-Endoscopic Flavectomy Decompression of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Surgical Technique and Results.

BACKGROUND: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk. OBJECTIVES: Report a novel minimally invasive technique, translaminar osseous channel-assisted posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for the treatment of OLF-related TM. STUDY DESIGN: A retrospective cohort study. SETTING: A center for spine surgery and pain medicine. METHODS: Thirteen patients with TM caused by isolated OLF who underwent translaminar osseous channel-assisted p-PEF were retrospectively analyzed. Preoperative and postoperative radiographic findings and clinical results were compared to confirm the efficacy of the procedure and perioperative complications were investigated to evaluate the technical safety. RESULTS: All 13 patients with 23 isolated ossified sites were successfully treated with the translaminar osseous channel-assisted p-PEF technique and no additional internal fixation was needed. With an average follow-up of 29.2 months (range, 24-36 months), no local instability was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac was 47.87 ± 8.98 mm2 and 130.47± 19.07 mm2, respectively (P < 0.0001). The mean modified Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P = 0.001). No serious complications ensued. LIMITATIONS: This was a retrospective study with several limitations, including the lack of a control group, small number of included samples and unavoidable nature of the single-center study design. CONCLUSIONS: Translaminar osseous channel-assisted p-PEF technique, with less tissue trauma and impact on the stability of the spine, can provide adequate decompression and satisfying outcomes in the treatment of OLF-related TM and should be considered as an alternative procedure for isolated OLF.

Osteoimmune Modulation and Guided Osteogenesis Promoted by Barrier Membranes Incorporated with S-Nitrosoglutathione (GSNO) and Mesenchymal Stem Cell-Derived Exosomes.

BACKGROUND: The use of polycaprolactone (PCL) for bone defects in a clinical setting is limited due to a lack of bioactivity. Exosomes derived from mesenchymal stem cells (MSCs) have an important immunoregulatory potential and together with S-nitrosoglutathione (GSNO) they possess therapeutic potential for bone regeneration. MATERIALS AND METHODS: In this study, PCL was modified with GSNO and MSC-derived exosomes and the impact on macrophages and osteogenes is evaluated. RESULTS: MSC-derived exosomes exhibited a cup-shaped morphology and were internalized by macrophages and human bone marrow-derived mesenchymal stromal cells (hBMSCs). The pattern of internalization of scaffold-immobilized exosomes was similar in RAW264.7 cells and hBMSCs after 4h and 24h of co-culture. Assessment of macrophage morphology under inflammatory conditions by scanning electronic microscopy (SEM) and confocal microscopy demonstrated macrophages were significantly elongated and expression of pro-inflammatory genes markedly decreased when co-cultured with PCL/PDA + GSNO + exosome scaffolds. Furthermore, this scaffold modification significantly enhanced osteogenic differentiation of hBMSCs. DISCUSSION: This study demonstrated the possibility of using a GSNO- and exosome-based strategy to adapt barrier membrane scaffolds. PCL/PDA + GSNO + exosome scaffolds may serve as an important barrier membrane for osteogenesis and tissue regeneration.

Posterior Percutaneous Endoscopic Technique Through Bilateral Translaminar Osseous Channels for Thoracic Spinal Stenosis Caused by Ossification of the Ligamentum Flavum Combined with Disk Herniation at the T10-11 Level: A Technical Note.

BACKGROUND: The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level. METHODS: We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores. RESULTS: The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 5. CONCLUSIONS: We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.

[Percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for lumbar spinal stenosis].

OBJECTIVE: To design the surgical strategy of percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral lumbar spinal stenosis (LSS) and to evaluate the effectiveness. METHODS: The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for bilateral LSS was designed according to the pathological features of LSS. The technique was used to treat 42 patients with LSS between January 2016 and January 2018. There were 18 males and 24 females with an average age of 61.7 years (range, 46-81 years). The duration of symptoms was 1-20 years, with an average of 9.7 years. The surgical segment at L 4, 5 were 27 cases, at L 5, S 1 were 15 cases. The operation time and perioperative complications were recorded. Lumbar X-ray, CT, and MRI examinations were performed at 1 week, 3 months, and 1 year after operation. Visual analogue scale (VAS) score was used to evaluate the low back pain and leg pain, Oswestry disability index (ODI) was used to evaluate the lumbar function, and single continuous walking distance (SCWD) was used to evaluate lower extremity nerve function. The clinical efficacy was evaluated by MacNab criteria at 1 year after operation. RESULTS: All patients underwent surgery successfully. The operation time was 68-141 minutes with an average of 98.2 minutes. All 42 patients were followed up 12-24 months with an average of 18.8 months. There were 2 cases of dural tears during operation, and 1 case of transient dysfunction of the lower limbs of the decompression channel after operation. All of them were cured after corresponding treatment. No serious complications such as death, major bleeding, or irreversible nerve injury occurred during follow-up. No segmental instability was found according to postoperative lumbar hyperextension and flexion X-ray films, and postoperative CT and MRI imaging showed that the stenotic lumbar spinal canal was significantly enlarged, and the compression of the nerve root was sufficient. The VAS score of low back pain and leg pain, ODI score, and SCWD at each time point after operation were significantly improved when compared with those before operation ( P<0.05); the indexes were significantly improved over time after operation, and the differences were significantly ( P<0.05). The clinical efficacy was evaluated by MacNab standard at 1 year after operation, and the results were excellent in 18 cases, good in 20 cases, fair in 3 cases, and poor in 1 case. The excellent and good rate was 90.5%. CONCLUSION: The percutaneous full-endoscopic bilateral decompression via unilateral posterior approach for LSS is a safe and effective procedure. A well-designed surgical strategy and mastery of its technical points are important guarantees for successful operation and satisfactory results.