RHOA inhibits chondrogenic differentiation of mesenchymal stem cells in adolescent idiopathic scoliosis.

PURPOSE: The etiology of adolescent idiopathic scoliosis (AIS) remains unclear. The chondrogenic differentiation of mesenchymal stem cells (MSCs) is important in AIS, and the Ras homolog gene family member A (RHOA) is associated with chondrogenesis. The purpose of this study was to explore the effect of RHOA on the chondrogenic differentiation of MSCs in AIS. METHODS: We isolated MSCs from patients with AIS (AIS MSCs) and individuals without AIS (control MSCs). The inhibitor Y27632 was used to inhibit the function of RHOA/ROCK signaling, and plasmid-based overexpression and siRNA-mediated knockdown were used to manipulate RHOA expression. CCK-8 was used to detect cell viability. The phosphorylation levels of LIMK1, MLC2 and cofilin were detected by Western blotting. The mRNA expression of aggrecan, SOX9, and COL2A1 were confirmed using RT-PCR. Immunofluorescence was used to analyze F-actin and collagen II. Alcian blue staining was performed to assess the secretion of glycosaminoglycans (GAGs). RESULTS: We found that RHOA was significantly upregulated in AIS MSCs, and the phosphorylation levels of LIMK1, MLC2, and cofilin were increased. The mRNA expressions of aggrecan, SOX9, and COL2A1 were notably reduced in AIS MSCs. However, these effects were abolished by Y27632 treatment and RHOA knockdown in AIS MSCs. In addition, RHOA knockdown in AIS MSCs increased the content of collagen II and GAGs. RHOA overexpression in the control MSCs markedly activated the RHOA/ROCK signaling and decreased the expression of aggrecan, SOX9, and COL2A1, F-actin, and GAGs. CONCLUSION: RHOA regulates the chondrogenic differentiation ability of MSCs in AIS via the RHOA/ROCK signaling pathway and this regulation may involve SOX9.

Global research trends of adult degenerative scoliosis in this decade (2010-2019): a bibliometric study.

OBJECTIVE: With the population aging, there is an associated rise in the prevalence of adult degenerative scoliosis (ADS). However, limited data were found to elaborate the trend of ADS research. Our study aims to investigate the global trend of ADS research in this decade. METHODS: ADS-related publications from 2010 to 2019 were extracted from the Web of Science and Medline database. Excel 2016, GraphPad Prism 6, and VOSviewer software were adopted to analyze the search results for number of publications, citation, and H-index. RESULTS: A total of 1282 papers were included and were cited 16,770 times. The USA accounted for 40.41% of the articles, 60.35% of the citations, and the highest H-index of 51. China ranked second in total number of articles, third in citation frequency (1373), and fourth with an H-index of 18. The journal Spine (IF = 2.903, 2019) had the highest number of publications. Shaffery CI published the most articles in this field (40). Key words of ADS research were classified into three clusters: "Surgical technique," "Mechanism," and "Radiological parameter." The "Radiological parameter" cluster became the most popular, and it came with the latest hot spots of "slope," "cervical lordosis," "mismatch," and "PI-LL." CONCLUSION: Literature growth in ADS was rapidly expanding in this decade. The USA was the most productive country and also had a largest quantity of top authors and institutes, so that scholars can keep following and cooperated with. Radiological parameter was an emerging topic and might also be a hot spot in the near future.

Cross-cultural validation of simplified Chinese version of spine functional index.

BACKGROUND: No effective constructs were available in mainland China to assess the whole spine function. The SFI was developed to evaluate spinal function based on the concept of a single kinetic chain concept for whole spine. The SFI has been translated to Spanish and Turkish with accepted psychometric properties. It is imperative to introduce the SFI in mainland China and further to explore the measurement properties. METHODS: The English versions of the SFI was cross-culturally translated according to international guidelines. Measurement properties (content validity, construct validity and reliability) were tested in accordance with the COSMIN checklists. A total of 271 patients were included in this study, and 61 participants with neck pain and 64 participants with back pain paid a second visit three to seven days later. Confirmatory factor analysis (CFA) and principal factor analysis (PCA) were applied to test the factor structure. The Functional Rating Index (FRI), Neck Disability Index (NDI), Oswestry Disability Index (ODI), SF-12 and a Visual Analogue Scale (VAS) were employed to evaluate the construct validity. Cronbach's alpha and an intra-class correlation coefficient (ICC) were calculated for internal consistency and reproducibility. RESULTS: The means score of SC-SFI was 63.60 in patients with spinal musculoskeletal disorders. A high response rate was acquired (265/271). No item was removed due to abnormal distribution or low item-total correlation. Results of CFA did not support that one-factor structure was in goodness of fit (CMIN/DF = 3.306, NNFI = 0.687, CFI = 0.756, GFI = 0.771 and RMSEA = 0.092). Yet, PCA suggested a one-factor structure was the best, accounting for 32% of the total variance. For structural validity, the SC-SFI correlated highly with the FRI, NDI, ODI, and PF, BP in SF-12 (r = 0.661, 0.610, 0.750, 0.709, 0.605, respectively). All the a priori hypotheses were verified. The Cronbach's alpha for the SC-SFI was 0.91, and ICC was 0.96 (95% CI, 0.94-0.98). Bland-Altman plot also confirmed excellent test-retest reliability. CONCLUSIONS: The SFI has been culturally adapted into SC-SFI with remarkable clinical acceptance, excellent internal consistency, reproducibility, and construct validity when applied to patients with spinal musculoskeletal disorders. The results of current study suggest that SC-SFI can be applied by physicians and researchers to measure whole-spine functional status in mainland China.

Chinese cross-cultural adaptation and validation of the Oxford shoulder score.

BACKGROUND: The Oxford Shoulder Score (OSS) is a reliable and valid construct measuring non-specific shoulder pain, which are widely used to evaluate shoulder related quality of life. This study was to cross-culturally adapt and psychometrically validate a simplified Chinese version of the OSS (SC-OSS). METHODS: Cross-cultural adaptation was performed according to the international recognized guidelines. Consecutive patients with nonspecific shoulder pain were recruited to test the psychometric properties of SC-OSS. Item response trend and item-total correlation were evaluated to measure homogeneity. Principal component analysis (PCA) was used to evaluate the factorial structure. Cronbach's α and intra-class correlations were used to determine the reliability. Construct validity was analyzed by evaluating the correlations between SC-OSS and the Constant-Murley shoulder outcome score (CMSOS), the short form (36) health survey (SF-36) containing eight domains, and pain visual analogue scale (VAS). RESULTS: Overall, 121 patients were recruited. Each of the 12 items was properly responded and correlated with the total items. PCA extracted one factor for SC-OSS. SC-OSS had excellent reliability, with a Cronbach's α of 0.92 and intra-class correlation coefficient of 0.97 (95 % CI: 0.94-0.98). SC-OSS had a high correlation with CMSOS, physical functioning (PF) and bodily pain (BP) domains of SF-36 and VAS (r = -0.70, -0.65, -0.53, and -0.66, respectively). SC-OSS moderately correlated with role-physical (RP), social functioning (SF), general health perception (GH) and vitality (VT) (r = -0.45, -0.42, -0.39 and -0.36, respectively), but had a low correlation with role-emotional (RE) and mental health (MH) domains of SF-36 (r = -0.28 and -0.23, respectively). CONCLUSIONS: SC-OSS demonstrated excellent acceptability, internal consistency, reliability and construct validity, which can be recommended for application in mainland China.

The polymorphisms of melatonin receptor 1B gene (MTNR1B) (rs4753426 and rs10830963) and susceptibility to adolescent idiopathic scoliosis: a meta-analysis.

OBJECTIVE: To determine whether MTNR1B rs4753426 and rs10830963 polymorphisms are correlated with AIS. Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity, while its etiology remains uncertain. Melatonin receptor 1B (MTNR1B) gene polymorphisms have been found to be significantly associated with AIS risk; however, some of these results are controversial. METHODS: An systematic online search was performed using PubMed, EMBASE, Web of Science and the Cochrane Library to identify case-control studies investigating the relationship between MTNR1B rs4753426 and rs10830963 polymorphisms and the susceptibility of AIS. The pooled odds ratio (OR) with 95 % confidence interval (95 % CI) was calculated to assess the associations, and subgroup meta-analyses were performed according to the ethnicity of the study populations. RESULTS: A total of five studies involving 2395 cases and 3645 controls met the inclusion criteria after assessment by two reviewers. Overall, no significant associations were found between MTNR1B rs4753426 polymorphism and AIS risk (C vs. T: OR = 1.11, 95 % CI 0.94-1.30, P = 0.21; CC vs. TT: OR = 1.15, 95 % CI 0.97-1.36, P = 0.12; CT vs. TT: OR = 1.14, 95 % CI 0.97-1.35, P = 0.10; CC/CT vs. TT: OR = 1.14, 95 % CI 0.98-1.33, P = 0.09; CC vs. CT/TT: OR = 1.10, 95 % CI 0.84-1.45, P = 0.48), as well as the MTNR1B rs10830963 polymorphism (G vs. C: OR = 0.99, 95 % CI 0.88-1.12, P = 0.91; GG vs. CC: OR = 0.99, 95 % CI 0.74-1.33, P = 0.96; CG vs. CC: OR = 1.00, 95 % CI 0.84-1.18, P = 0.88; GG/CG vs. CC: OR = 0.99, 95 % CI 0.84-1.17, P = 0.93; GG vs. CG/CC: OR = 0.99, 95 % CI 0.75-1.30, P = 0.92). When stratified by ethnicity, there were no significant associations between MTNR1B rs4753426 and MTNR1B rs10830963 polymorphisms and AIS risk in either Asian or Caucasian populations. CONCLUSION: MTNR1B rs4753426 and MTNR1B rs10830963 polymorphisms are not obviously associated with risk of AIS in either Asian populations or Caucasian populations.

Effect of lordosis angle change after lumbar/lumbosacral fusion on sacrum angular displacement: a finite element study.

PURPOSE: To assess and characterize the sacrum angular displacements in response to lumbar lordosis after lumbar/lumbosacral fusion. METHODS: A finite element model of the lower lumbar spine-pelvis was established and used to simulate the posterior fusion at L3-L5 and L4-S1. The lordosis angle in the fusion segments was set to five different conditions with respect to the intact model: 10° less than intact, 5° less than intact, same as intact, 5° more than intact, and 10° more than intact. Variations of the sacrum angular displacements with lordosis changes were analyzed under loading setting of axial compression, flexion, extension, lateral bending, and axial rotation. RESULTS: Compared with the intact lordosis, both increased and decreased lumbar lordosis angles caused the sacrum angular displacements to be increased. The lordosis angle increased by 10° induced the most substantial increase in sacrum angular displacements. In addition, the sacrum angular displacements of the L4-S1 fusion model at different lordosis angles were higher than those of the L3-L5 fusion model. CONCLUSION: The sacrum angular displacements occur as a result of the fusion surgery (L4-S1) and the changes in lumbar lordosis.

[Changhai fulcrum bending radiographic technique to assess curve flexibility in patients with adolescent idiopathic scoliosis].

OBJECTIVE: To evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients. METHODS: Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes. RESULTS: A total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001). CONCLUSIONS: CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.

The application and influence of "Small Private Online Course" based on flipped classroom teaching model in the course of fundamental operations in surgery in China.

To investigate the effect of "Small Private Online Course" (SPOC) based on flipped classroom teaching model on the students in the course of fundamental operations in surgery. A prospective study. 8-year program students (juniors) majored in clinical medicine in Navy medical university. The mastery of theoretical knowledge and operational skill of the students, the comparison of final test examination score between traditional teaching method and "SPOC + flipped classroom" model and the feedback completed by students. Our study found that SPOC + flipped classroom could significantly increase the efficacy of the class and enhance the ability of the students compared with the traditional method. The new teaching model could have a positive influence for medical students on their basic knowledge and operational skill.

Whole-blood gene expression profiling in ankylosing spondylitis identifies novel candidate genes that may contribute to the inflammatory and tissue-destructive disease aspects.

We performed a comprehensive gene expression analysis to identify differentially expressed genes (DEGs) between AS (ankylosing spondylitis) and health controls. A total of 1454 DEGs were obtained, including 919 up-regulated genes and 535 down-regulated genes. There were 218 interactions and 224 pairs in the conPPI network. Topological analysis showed that 11 genes had a close relationship with AS. GO (gene ontology) functional enrichment analysis of the two modules showed that the DEGs in conPPI mainly participated in the biologic process of immune response. The KEGG pathway analysis showed that most DEGs in the two modules were enriched into cell receptor signaling pathway, natural killer cell mediated cytotoxicity and primary immunodeficiency. We hypothesized that these DEGs associated with immune response DEGs might provide basic for depth understanding of the AS development.

Gene expression profile analysis of human intervertebral disc degeneration.

In this study, we used microarray analysis to investigate the biogenesis and progression of intervertebral disc degeneration. The gene expression profiles of 37 disc tissue samples obtained from patients with herniated discs and degenerative disc disease collected by the National Cancer Institute Cooperative Tissue Network were analyzed. Differentially expressed genes between more and less degenerated discs were identified by significant analysis of microarray. A total of 555 genes were significantly overexpressed in more degenerated discs with a false discovery rate of < 3%. Functional annotation showed that these genes were significantly associated with membrane-bound vesicles, calcium ion binding and extracellular matrix. Protein-protein interaction analysis showed that these genes, including previously reported genes such as fibronectin, COL2A1 and ß-catenin, may play key roles in disc degeneration. Unsupervised clustering indicated that the widely used morphology-based Thompson grading system was only marginally associated with the molecular classification of intervertebral disc degeneration. These findings indicate that detailed, systematic gene analysis may be a useful way of studying the biology of intervertebral disc degeneration.

Reliability and validity of simplified Chinese version of Spinal Cord Injury Pain Instrument in patients with spinal cord injury in mainland China.

PURPOSE: To cross-culturally adapt the Spinal Cord Injury Pain Instrument (SCIPI) into a simplified Chinese version (SC-SCIPI) and verify reliability and validity in screening for neuropathic pain in SCI patients. METHODS: A preliminary validation study was conducted to screen for neuropathic pain after SCI using SCIPI. A total of 130 patients with SCI treated at Shanghai Changhai Hospital were enrolled. Results for internal consistency, reliability and construct validity were compared with those of the Douleur Neuropathique (DN4), Leeds Assessment of Neuropathic Pain Questionnaire (LANSS), Neuropathic Pain Questionnaire (NPQ), ID Pain scale and VAS pain scale. RESULTS: The SCIPI was successfully translated into Chinese and expert consensus was reached on final adapted version of SC-SCIPI. For test-retest, SC-SCIPI total score was 2.35 ± 1.75 in first round and 2.35 ± 1.76 in second round. Cronbach α coefficient of SC-SCIPI was 0.909, indicating good internal consistency. Pearson correlation coefficient (r) showed that SC-SCIPI correlated well with LANSS, DN4, NPQ and ID pain; and correlated fairly well with VAS, indicating good construct validity. CONCLUSION: SC-SCIPI demonstrates excellent internal consistency, reliability and good construct validity in Chinese patients with neuropathic pain, suggesting that SC-SCIPI is applicable in clinical practice to screen patients for neuropathic pain. IMPLICATION FOR REHABILITATIONThe Spinal Cord Injury pain Instrument has been cross-culturally adapted into a simplified Chinese version (SC-SCIPI).The SC-SCIPI showed excellent test-retest reliability and good construct validity.The 4-item SC-SCIPI is quite convenient to complete and it might be a useful instrument for routine application in patients with SCI for rehabilitation.

Measurement Properties of the Simplified Chinese Version of the Lumbar Spine Instability Questionnaire for Patients With Low Back Pain in Mainland China.

STUDY DESIGN: A prospective study. OBJECTIVE: To develop a simplified Chinese version of Lumbar Spine Instability Questionnaire (SC-LSIQ) and test its measurement properties. SUMMARY OF BACKGROUND DATA: The LSIQ has been translated into several languages. Different versions of LSIQ have proved good reliability and validity in evaluating patients with low back pain. However, there is no simplified Chinese version of LSIQ (SC-LSIQ). MATERIALS AND METHODS: The SC-LSIQ has been translated into a simplified Chinese version according to a standard procedure. A total of 155 patients with low back pain completed the SC-LSIQ along with Oswestry Disability Index, Roland-Morris disability questionnaire, Tampa Scale for Kinesiophobia, and visual analogue scale (VAS). The internal consistency, test-retest reliability, and validity of SC-LSIQ were then calculated to evaluate the measurement properties of SC-LSIQ. RESULTS: The results of SC-LSIQ demonstrated that there was no ceiling or floor effect detected. The Cronbach α coefficient of 0.911 determined a well internal consistency. The intraclass correlation coefficient (0.98) presented an excellent reliability of SC-LSIQ. The Pearson correlation coefficient (r) showed that the SC-LSIQ was excellent correlated to Oswestry Disability Index (r=0.809), Roland-Morris disability questionnaire (r=0.870), and Tampa Scale for Kinesiophobia (r=0.945,). Furthermore, it moderately correlated to visual analogue scale (r=0.586). CONCLUSION: The SC-LSIQ features good internal consistency, reliability, and validity for evaluating Chinese patients with LBP. Results suggest that the SC-LSIQ can be appropriately applied to patients with LBP in routine clinical practice.

Microneedle/CD-MOF-mediated transdural controlled release of methylprednisolone sodium succinate after spinal cord injury.

A new method of transdural delivering drugs to the spinal cord has been developed, involving the use of microneedles (MNs) and a ß-cyclodextrin metal-organic framework (CD-MOF). This epidural microneedle array, dubbed MNs@CD-MOF@MPSS, can be utilized to deliver methylprednisolone sodium succinate (MPSS) to the site of spinal cord injury (SCI) in a controlled manner. MNs allows to generate micropores in the dura for direct drug delivery to the spinal cord, overcoming tissue barriers and targeting damaged regions. Additionally, the CD-MOF provides a secondary extended release after separating from the MNs. In in vitro study, inward MNs increased cellular absorption of MPSS and then reduced LPS-induced M1 polarization of microglia. And animal studies have shown that this method of drug delivery results in improved BMS scores and a reduction in M1 phenotype microphage and glial scar formation. Furthermore, the downregulation of the NLRP3-positive inflammasome and related pro-inflammatory cytokines was observed. In conclusion, this new drug platform has potential for clinical application in spinal cord diseases and is a valuable composite for minimally transdural controlled drug delivery. STATEMENT OF SIGNIFICANCE: This research presents a new epidural microneedle patch made up of microneedles (MNs) and a ß-cyclodextrin metal-organic framework (CD-MOF). The epidural microneedle patch boasts high drug loading capacity, the ability to penetrate the dura, and controlled release. When loaded with methylprednisolone sodium succinate (MPSS), it effectively reduces inflammation and improves neurological function after spinal cord injury. Therefore, it is a novel and promising drug platform for the treatment of spinal cord diseases in a clinical setting.

Expression and significance of Kruppel-like factor 6 gene in osteosarcoma.

PURPOSE: Osteosarcoma is primary malignant tumour of bone. Kruppel-like factor 6 (KLF6) is a tumor suppressor gene frequently inactivated in a number of human cancers and a ubiquitously expressed zinc-finger transcription factor. The present study aimed to first explore the relationship between the expression level of the KLF6 gene in osteosarcoma and the occurrence of bone tumours. METHODS: KLF6 mRNA and protein expression levels in osteosarcoma and normal bone tissue were assayed by real-time quantitative PCR and immunohistochemistry. KLF6 mRNA and protein expression levels in osteosarcoma cells and normal osteoblasts were detected by semi-quantitative reverse transcription PCR and Western blotting, respectively. RESULTS: Both the expression of KLF6 mRNA and protein in osteosarcoma cells and tissues were significantly lower than that in normal cells and tumour-adjacent tissues. CONCLUSIONS: KLF6 is a putative tumor suppressor gene involved in osteosarcoma which can be used as a new therapeutic target and an important marker for early diagnosis and postoperative monitoring.

All-pedicle-screw versus hybrid hook-screw instrumentation for posterior spinal correction surgery in adolescent idiopathic scoliosis: a curve flexibility matched-pair study.

INTRODUCTION: Comparisons of all-pedicle-screw (PS) and hybrid hook-screw (HS) instrumentation for the treatment of adolescent idiopathic scoliosis (AIS) have produced conflicting results. The aim of this study was to compare all-pedicle-screw and hybrid hook-screw instrumentation for the treatment of AIS using a matched-pair study design in which preoperative flexibility was matched. METHODS: In this retrospective study conducted at one medical center, 21 all-pedicle-screw/hybrid hook-screw pairs of Lenke type I AIS patients matched for age, height, weight, body mass index, sex, and preoperative curve flexibility who had been treated at our institution from January 2000 to October 2006 were selected. Postoperative and 2-year postoperative coronal curve correction, postoperative kyphosis, blood transfusion needs, operation time, and hospital cost were measured and analyzed statistically. RESULTS: The PS group compared with the HS group had better postoperative correction (P = 0.0231) and 2-year coronal curve correction (P = 0.016). While statistically significant (P = 0.0073), the postoperative Cobb angle was only 3° less in the PS group, Maintenance of correction after 2 years was better in the PS group (P = 0.0016). The PS group had less blood loss (P < 0.0001) and shorter operation time (P < 0.0001), but the hospital cost for the PS group was higher (P < 0.0001). CONCLUSIONS: All-pedicle-screw and hybrid hook-screw instrumentations are comparable with regard to curve correction, but all-pedicle screw instrumentation reduces blood loss during surgery and shortens the operation time, which may help shorten healing time.

Do hypokyphotic adolescent idiopathic scoliosis patients treated with Ponte osteotomy obtain a better clinical efficacy? A preliminary retrospective study.

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS: Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. RESULTS: The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. CONCLUSIONS: Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.

Shikonin mitigates ovariectomy-induced bone loss and RANKL-induced osteoclastogenesis via TRAF6-mediated signaling pathways.

BACKGROUND: Postmenopausal osteoporosis results from estrogen withdrawal and is characterized mainly by bone resorption. Shikonin is a bioactive constitute of Chinese traditional herb which plays a role in antimicrobial and antitumor activities. The study was designed to investigate the role of shikonin on postmenopausal osteoporosis and explore its underlying mechanisms. METHODS: Immunofluorescence staining was performed to evaluate the effects of shikonin on actin ring formation. The expression levels of the nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) pathway were determined by Western blot analysis. To determine whether shikonin influences the receptor activator of nuclear factor-κB ligand (RANKL)-induced association between receptor activator of NF-κB (RANK) and tumor necrosis factor receptor associated factor 6 (TRAF6), immunofluorescence staining and immunoprecipitation experiments were performed. During our validation model, histomorphometric examination and micro-computed tomography (CT) were conducted to assess the morphology of osteoporosis. RESULTS: Shikonin prevented bone loss by inhibiting osteoclastogenesis in vitro and improving bone loss in ovariectomized mice in vivo. At the molecular level, Western blot analysis indicated that shikonin inhibited the phosphorylation of inhibitor of NF-κB (IκB), P50, P65, extracellular regulated protein kinases (ERK), c-Jun N-terminal kinase (JNK), and P38. Interaction of TRAF6 and RANK was prevented, and downstream MAPK and NF-κB signaling pathways were downregulated. CONCLUSION: Osteoclastic bone resorption was reduced in the presence of shikonin in vitro and in vivo. Shikonin is a promising candidate for treatment of postmenopausal osteoporosis.

Assessment of Sagittal Spinopelvic Balance in a Population of Normal Chinese Children.

STUDY DESIGN: A retrospective study of 257 normal children at a single center from July 2016 to November 2018 was performed. OBJECTIVE: To evaluate the spinopelvic parameters in a population of normal children and adolescents in mainland China. SUMMARY OF BACKGROUND DATA: Values for sagittal parameters of the spine vary significantly by ages and different population. No study has yet quantified the normal measures for children and adolescents in China, or how these measures compare with other populations. METHODS: Pelvic incidence (PI), sacral slope, pelvic tilt, thoracic kyphosis (TK, T5-T12), lumbar lordosis (LL, L1-S1), and sagittal vertical axis were measured and evaluated by whole spine AP&lateral X-ray images. RESULTS: A total of 257 subjects, including 116 boys (45%) and 141 girls (55%) aged 3 to 12 years, were enrolled. Correlation matrix analysis demonstrated that sagittal balance is strongly correlated with age and Risser sign, including PI, a reported fixed parameter. Further investigation showed that PI could be expressed by the equation PI = 26.243+1.153×age. CONCLUSION: PI was not a fixed but a dynamic parameter in the population under 12-year old. Indeed, PI increases with age and bone maturity in childhood. We also found lower PI, pelvic tilt, and sacral slope compared with published studies of adolescents in other countries. These results may aid in the treatment of patients with spinal deformity, to help them achieve a certain degree of sagittal spinopelvic balance. LEVEL OF EVIDENCE: 2.

Validation of Simplified Chinese Version of the Pain Self-Efficacy Questionnaire (SC-PSEQ) and SC-PSEQ-2 for Patients With Nonspecific Low Back Pain in Mainland China.

STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to develop the simplified Chinese version of Pain Self-efficacy Questionnaire (PSEQ) (SC-PESQ) and PSEQ-2 (SC-PSEQ-2), and evaluate the psychometric properties of the two questionnaires in patients with nonspecific low back pain. SUMMARY OF BACKGROUND DATA: PSEQ has been cross-culturally adapted into many languages with excellent reliability and validity. Recently, the short form of PSEQ-2 was developed and exhibited satisfactory psychometric properties. However, PSEQ and PSEQ-2 has not been translated or validated in mainland China. METHODS: The original version of PSEQ and PSEQ-2 was linguistically translated and adapted to formulate the simplified Chinese version, which was then administrated by 219 patients with low back pain, along with a set of self-report health-related instruments. Statistical analysis was performed to evaluate the psychometric properties of the SC-PESQ and SC-PSEQ-2. RESULTS: Two hundred nineteen patients with nonspecific low back pain were enlisted into the analysis. The SC-PSEQ and SC-PSEQ-2 had been determined excellent internal consistency (Cronbach alpha, 0.95 and 0.83), test-retest reliability (overall ICC, 0.91 and 0.88), and sound construct validity, which were supported by moderately strong association with the criterion measures, respectively. In addition, exploratory and confirmatory factor analysis have found and confirmed one-factor solution in SC-PSEQ as hypothesized. CONCLUSION: The SC-PESQ and SC-PSEQ-2 showed satisfactory psychometric properties in Chinese population with low back pain, and could be safely utilized to evaluating the self-efficacy in clinical and research setting. LEVEL OF EVIDENCE: 4.

Low-intensity pulsed ultrasound promotes spinal fusion by regulating macrophage polarization.

BACKGROUND: Spinal fusion is considered the gold standard procedure for treating spinal degeneration, tumors, and trauma. An inflammatory response is an important part of bone repair. We investigated the polarization change of inflammatory macrophages (M1) and resident macrophages (M2) during low-intensity pulsed ultrasound (LIPUS) treatment. METHODS: Thirty male Sprague Dawley rats (age: 12 weeks; weight: 300 g) were used in the study. A rat spinal fusion model was established by surgical procedures. LIPUS treatment (20 min. d, 5 d/wk) was begun 3 days after surgery. The rats were randomly divided into a control group (5 subgroups, 3 rats in each subgroup) and LIPUS group (5 subgroups, 3 rats in each subgroup), and sacrificed on day 3, 5, 7, 10, and 14 after spinal fusion surgery for further evaluation. Bone volume was measured by micro-CT, fusion region was examined by histological analyses, types of macrophages in the fusion area were examined by immunohistochemical staining. Raw264.7 cells and bone marrow-derived macrophages (BMDM) were used in cell experiments. Cells were divided into a control group and LIPUS group. Flow cytometry was used to examine the rate of resident macrophages, and real-time PCR was used to examine the mRNA expression of anti-inflammation genes. RESULTS: LIPUS promoted spinal fusion and stimulated the transition of F4-80+/Mac-2+ (M1) to F4-80+/Mac-2- (M2), leading to the early appearance of resident macrophages. Cell experiments showed CD206+ macrophages (M2) were significantly increased after LIPUS treatment. M2-related genes and anti-inflammation factors (Arg-1, PPAR-γ, and IL-4) were increased after LIPUS treatment. CONCLUSION: The earlier transition from inflammatory to resident macrophage might be one reason for the positive effect of LIPUS on spinal fusion.