Severe traumatic dislocation of the lower cervical spine with mild neurological symptoms: Case reports and literature review.

CONTEXT: Severe traumatic fractures and dislocations of the lower cervical spine are usually accompanied by irreversible spinal cord injuries. Such patients rarely have mild or no neurological symptoms. FINDINGS: We report three cases of severe lower cervical dislocation without spinal cord injury and discuss the mechanisms underlying this type of injury. All three patients had severe lower cervical dislocation, but their neurological symptoms were mild. In all cases, the fractures occurred at the bilateral junctions of the lamina and pedicle, resulting in severe cervical spondylolisthesis, whereas the posterior structure remained in place, thereby increasing the cross-sectional area of the spinal canal. After preoperative skull traction for a few days, the patients underwent anterior or combined anterior and posterior cervical surgeries. All surgeries were successfully completed and the patient's symptoms disappeared at the last follow-up. CONCLUSION: Severe traumatic dislocation of the lower cervical spine with an intact neurological status is rare in clinical practice. Pathological canal enlargement preserves neurological function, and the most commonly injured segment is C7. Preoperative traction for closed reduction remains controversial. We suggest that if no obvious anterior compression is observed, closed reduction should be pursued. Anterior or combined anterior and posterior cervical surgeries can provide rigid fixation with satisfactory results.

Anxiety Symptoms and Associated Factors Among Chronic Low Back Pain Patients in China: A Cross-Sectional Study.

Background: This study aimed to investigate the prevalence of anxiety symptoms among patients with chronic low back pain and explore its related factors. Methods: A cross-sectional study was conducted on patients with chronic low back pain from two general hospitals in China. Anxiety symptoms were assessed by the Generalized Anxiety Disorder-7. Binary logistic regression was used to examine the association between demographic characteristics, pain severity, pain self-efficacy, family functioning and anxiety symptoms. Results: This study involved 1,172 chronic low back pain patients, with an effective rate of 94.67%. The prevalence of anxiety symptoms among patients with chronic low back pain in China was 23.89%. In the binary logistic regression, patients with more severe pain (OR = 1.15, 95%CI: 1.11-1.18) and pain duration between 1~5 years (1~3 years: OR = 2.45, 95%CI: 1.38-4.36; 3~5 years: OR = 2.99, 95%CI: 1.49-6.00) had a higher risk to anxiety symptoms. In contrast, patients with higher monthly income (OR = 0.62, 95%CI: 0.39-0.98), better family functioning (highly functional family: OR = 0.22, 95% CI: 0.13-0.37; moderately dysfunctional family: OR = 0.44, 95% CI: 0.27-0.72) and higher pain self-efficacy (OR = 0.95, 95%CI: 0.94-0.96) had a lower risk to anxiety symptoms. Conclusion: The prevalence of anxiety symptoms among chronic low back pain patients was high in China. Targeted intervention measures should be taken to reduce anxiety symptoms levels of chronic low back pain patients.

ALKBH5 regulates STAT3 activity to affect the proliferation and tumorigenicity of osteosarcoma via an m6A-YTHDF2-dependent manner.

BACKGROUND: N6-methyladenosine (m6A) is the most common and abundant mRNA modification and it plays crucial roles in many biological processes. However, as a key RNA demethylase, alkylation repair homolog protein 5 (ALKBH5) has not been well studied in human osteosarcoma. The present study sought to explore ALKBH5-mediated m6A modification and the underlying mechanisms in human osteosarcoma. METHODS: The expression of ALKBH5 and its correlation with clinicopathological features were examined by bioinformatics analysis and tissue microarrays. Cellular proliferation was detected by CCK8 assays. Cell cycle and apoptosis were analyzed by TUNEL and Flow cytometry assay. Finally, investigation of the regulatory mechanism of ALKBH5 in human osteosarcoma was performed by MeRIP assay, RNA-sequencing, dual luciferase reporter assay, RNA pull-down and RNA stability assay. Tumor xenograft models were established for in vivo experiments. FINDINGS: Our data showed that low expression of ALKBH5 was associated with worse overall survival for osteosarcoma patients. Reducing m6A mRNA levels in human osteosarcoma cells through ALKBH5 up-regulation lead to cell proliferation inhibition, cell apoptosis and cycle arrest. We identified SOCS3, a negative regulator of STAT3, as a downstream target of ALKBH5-mediated m6A modification. And the m6A modified SOCS3 mRNA was recognized by YTHDF2, which promotes the decay of SOCS3. Mechanistically, our data revealed that ALKBH5 inactivated STAT3 pathway by increasing SOCS3 expression via an m6A-YTHDF2-dependent manner. INTERPRETATION: M6A methylation is rising as a pathway affecting tumorigenicity and tumor progression. Our findings illuminate the clinical significance of ALKBH5-mediated m6A modification in human osteosarcoma and the regulatory mechanisms underlying tumor proliferation and growth, suggesting that ALKBH5 is a potential biomarker for treatment in human osteosarcoma. FUNDING: This work was supported by and Science and Technology foundation of Hubei, China (Grant No.2017CFB762); the Tongji hospital foundation (Grant No.2201103013); and the National Natural Science Foudation of China (No.82002849).

Comparative Effects and Safety of Full-Endoscopic Versus Microscopic Spinal Decompression for Lumbar Spinal Stenosis: A Meta-Analysis and Statistical Power Analysis of 6 Randomized Controlled Trials.

OBJECTIVE: This meta-analysis with statistical power analysis aimed to evaluate the difference between full-endoscopic and microscopic spinal decompression in treating spinal stenosis. METHODS: We searched PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CNKI (China National Knowledge Infrastructure) for relevant randomized controlled trials (RCTs) regarding the comparison of full-endoscopic versus microscopic spinal decompression in treating lumbar spinal stenosis through February 28, 2022. Two independent investigators selected studies, extracted information, and appraised methodological quality. Meta-analysis was conducted using RevMan 5.4 and STATA 14.0, and statistical power analysis was performed using G*Power 3.1. RESULTS: Six RCTs involving 646 patients met selection criteria. Meta-analysis suggested that, compared with microscopic decompression, full-endoscopic spinal decompression achieved more leg pain improvement (mean difference [MD], -0.20; 95% confidence interval [CI], -0.30 to -0.10; p = 0.001), shortened operative time (MD, -12.71; 95% CI, -18.27 to -7.15; p < 0.001), and decreased the incidence of complications (risk ratio, 0.43; 95% CI, 0.22-0.82; p = 0.01), which was supported by a statistical power of 98.57%, 99.97%, and 81.88%, respectively. CONCLUSION: Full-endoscopic spinal decompression is a better treatment for lumbar spinal stenosis, showing more effective leg pain improvement, shorter operative time, and fewer complications than microscopic decompression.

Prevalence and Associated Factors of Depressive Symptoms Among Patients With Chronic Low Back Pain: A Cross-Sectional Study.

Background: Few studies have focused on depressive symptoms among patients with chronic low back pain in China. The aim of this cross-sectional study was to assess the prevalence and associated factors of depressive symptoms in patients with chronic low back pain. Methods: From May to August 2021, 1,172 patients with chronic low back pain were recruited in China. Depressive symptoms were assessed through the Patient Health Questionnaire. Associations of demographic characteristics, clinical characters and social-psychological factors with depressive symptoms were investigated among patients with chronic low back pain. Results: The prevalence of depressive symptoms was 25.00%. Logistic regression analysis found that duration of pain in 1-5 years (1-3 years: OR = 2.91, 95%CI: 1.65-5.14, 3-5 years: OR = 3.09, 95%CI: 1.55-6.15) and more severe pain (OR = 1.13, 95%CI: 1.10-1.17) were associated with higher risks of depressive symptoms. Better family function (good family function: OR = 0.25, 95%CI: 0.15-0.41, moderate family dysfunction: OR = 0.47, 95%CI: 0.29-0.77) and higher pain self-efficacy (OR = 0.94, 95%CI: 0.93-0.95) were associated with lower risks of depressive symptoms. Conclusion: Patients with chronic low back pain have a high prevalence of depressive symptoms in China. Duration of pain, pain severity, family function and pain self-efficacy were predictors of depressive symptoms among chronic low back pain patients in China. Early identification of the associated factors may be helpful for the timely management of depressive symptoms.

Comparative effectiveness of all levels miniplate fixation versus a modified hybrid fixation in cervical expansive open-door laminoplasty.

In this study, we first reported of a modified hybrid fixation method in expansive open-door laminoplasty (EOLP) in order to reduce medical costs. The purpose of the present study is to compare the surgical outcomes and cost-effectiveness of the modified fixation with all levels miniplate fixation in EOLP for multilevel cervical spondylotic myelopathy.Data of 67 patients who underwent EOLP from July 2015 to June 2016 were retrospectively analyzed, with 33 in the modified group and 34 in the all miniplate group based on their surgical approaches. Laminae were kept open with alternate levels miniplate and anchor fixation in the modified group, while with all levels miniplate fixation in the all miniplate group. Medical costs and clinical results including Japanese Orthopedic Association (JOA) scores, Visual Analogue Scale (VAS) scores and occurrences of complications were investigated and compared between the 2 groups. After evaluation on X-ray, CT, and MRI, radiographic data reflecting cervical alignments, spinal canal enlargement and spinal cord decompression were collected and compared within each group and between the 2 groups.After a follow-up period of about 18 months, no significant differences in operation time, intraoperative blood loss, complication rates, VAS scores, neurological recovery rates and postoperative hospital stays were observed between the 2 groups. However, EOLP with the modified fixation costed less. When comparing the 2 groups, cervical curvature index (CCIs) which reflected cervical alignments and anteroposterior diameters (APDs) reflecting spinal canal enlargement at all the follow-ups had no significant differences. Postoperative open angles which reflected spinal cord decompression of C4 and C6 were significantly smaller in the modified group. However, that difference was no longer detected at the final follow-up. Within each group, APDs increased significantly after surgery. However, no significant differences in CCIs and open angles at different follow-ups were observed in each group.Compared with all miniplate fixation, the modified hybrid fixation in EOLP showed almost the same clinical and radiographic results. However, the modified hybrid fixation method could reduce costs.

Glycopolymers/PEI complexes as serum-tolerant vectors for enhanced gene delivery to hepatocytes.

Serum stability is a crucial factor for ideal polymeric gene vectors. In this work, a series of serum-tolerant and low-toxicity glycopolymers/poly(ethyleneimine) (PEI) complexes were designed for gene delivery. Atomic transfer radical polymerization (ATRP) was used to synthesize the comb-shaped random copolymers dextran-g-poly(2-dimethylaminoethyl methacrylate-co-2-lactobionamidoethyl methacrylate) (DDrL). Then DDrLs/PEI were investigated for their use as plasmid DNA (pDNA) vectors, which can completely condense the pDNA into nanoparticles. The DDrLs/PEI/pDNA complexes in serum-containing media showed better stability than PEI/pDNA complexes. in vitro gene transfection studies showed that DDrLs/PEI exhibited a remarkable transfection efficiency enhancement in the presence of serum compared to that in serum-free conditions. Moreover, the transfection level of DDrLs/PEI were two orders of magnitude higher than that of PEI alone in the presence of 30% serum. DDrLs/PEI complexes with galactose enhanced pDNA delivery to hepatocytes, with higher protein expression in ASGPr-presenting HepG2 than in HeLa cells, which lack the receptor. All of the DDrLs/PEI/pDNA complexes had lower cytotoxicity than PEI/pDNA.

[Research advances of three-dimension printing technology in vertebrae and intervertebral disc tissue engineering].

Three-dimensional (3D) printing technology is characterized by "inside-out" stack manufacturing. Compared with conventional technologies, 3D printing has the advantage of personalization and precision. Therefore, the shape and internal structure of the scaffolds made by 3D printing technology are highly biomimetic. Besides, 3D bioprinting can precisely deposit the biomaterials, seeding cells and cytokines at the same time, which is a breakthrough in printing technique and material science. With the development of 3D printing, it will make great contributions to the reconstruction of vertebrae and intervertebral disc in the future.

Effects of decompressive cervical surgery on blood pressure in cervical spondylosis patients with hypertension: a time series cohort study.

BACKGROUND: Patients with cervical spondylosis myelopathy (CSM) and complicated with hypertension are often experiencing a blood pressure decrease after taking cervical decompressive surgery in clinical observations, but how this blood pressure reduction is associated with the surgery, which cut cervical sympathetic nervous, has never been rigorously assessed. Thus, the purpose of this study is to investigate the effect of cervical decompressive surgery on blood pressure among CSM patients with hypertension. METHODS/DESIGN: The study will be a time series cohort study. Fifty eligible patients will be selected consecutively from the Peking University First Hospital. Two 24-h ambulatory blood pressure measurement (ABPM) will be taken before the surgery, apart by at least 3 days. The patients will be followed up for another two ABPMs at 1 and 3 months after the surgery. We will recruit subjects with cervical spondylosis myelopathy meeting operation indications and scheduled for receiving cervical decompressive surgery, aged 18-84 years, have a history of hypertension or office systolic blood pressure ≥140 mmHg on initial screening, and willing to participate in the study and provide informed consent. Exclusion criteria includes a history of known secondary hypertension, visual analogue scale (VAS) score ≥4, and unable to comply with study due to severe psychosis. The change in systolic ABPs over the four times will be analyzed to observe the overall pattern of the blood pressure change in relation to the surgery, but the primary analysis will be the comparison of systolic ABP between the 2(nd) and 3(rd), 4(th) measurements (before and after the surgery). We will also calculate the regression-to-the-mean adjusted changes in systolic ABP as sensitivity analysis. Secondary endpoints are the changes in 24 h ABPM diastolic blood pressure, blood pressure control status, the use and dose adjustment of antihypertensive medication, and the incidence of operative complications. Primary outcome analyses will be carried out using analysis of covariance, as well as the first secondary endpoint. DISCUSSION: This study will inform us the important knowledge about cervical sympathetic nervous system (SNS) and blood pressure. Once confirmed, it may help to produce new method for control of hypertension, which is the leading cause of death in the world. TRIAL REGISTRATION: The study is registered to Clinical Trials.gov (NCT02016768).