Predictive Factors for Residual Low Back Pain Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Lumbar Disc Herniation.

BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is a mature and popular surgery for treatment of lumbar disc herniation (LDH). The main objective of our study was to identify risk factors for residual low back pain after PELD and to improve postoperative management. MATERIAL AND METHODS We retrospectively analyzed the clinical and imaging data of 251 patients who underwent PELD for LDH. We defined residual LBP as visual analog scale (VAS) score for LBP ≥3 at 2 years postoperatively, and severe LBP was defined as VAS for LBP ≥7.5. The clinical and imaging data were analyzed by comparing patients with VAS scores ≥3 and <3, and univariate analysis and multivariable logistic regression analysis were applied to predict the risk factors for residual LBP. RESULTS There were 56 (22.3%) patients with LBP VAS ≥3 at 2 years postoperatively. Multivariable logistic regression analysis demonstrated that severe baseline VAS for LBP (P<0.001), MCs type I (P=0.006), and severe fatty infiltration of the paravertebral muscles (P<0.001) were independent risk factors for residual LBP after PELD. CONCLUSIONS In patients with LDH, MCs type I, severe baseline LBP, and fatty infiltration of the paravertebral muscles were predictive factors for residual LBP after PELD. Our study suggests that spine surgeons should pay more attention to these imaging parameters, which may be a helpful indicator for the choice of surgical modality.

Risk Factors and Causes of Reoperation in Lumbar Disc Herniation Patients after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Case Series with a Minimum 2-Year Follow-Up.

BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has gained popularity as a minimally invasive surgery for treating lumbar disc herniation. However, there is limited research focusing on the reoperation rate and its associated factors. This study aims to investigate the rate of reoperation and identify the causes and risk factors for reoperation after PELD. MATERIAL AND METHODS We conducted a retrospective analysis of patients who underwent PELD (interlaminar and transforaminal approaches) at our hospital from November 2016 to May 2020. A matched case-control design was employed to identify relevant risk factors for reoperation, with a matching ratio of 1:3. Clinical characteristics and radiological parameters were compared, and univariate analysis was performed using independent samples t-test and chi-squared test. RESULTS Among the 435 patients included in the study, the reoperation rate for those with a minimum 2-year follow-up was 6.2% (27/435). The causes of reoperation and their respective rates were as follows: recurrence of lumbar disc herniation (3.2%, 14/435), incomplete decompression (1.8%, 8/435), persistent low back pain (0.7%, 3/435), and postoperative infection (0.5%, 2/435). Univariate analysis revealed that age (P=0.015), Pfirrmann grade IV-V (P=0.017), and lack of active straight leg raise exercises (P=0.026) were significantly associated with reoperation. Multiple logistic regression analysis indicated that age (P=0.001), Pfirrmann grade IV-V (P=0.033), and lack of active straight leg raise exercises postoperatively (P=0.003) were independent risk factors for reoperation after PELD. CONCLUSIONS The primary cause of reoperation in lumbar disc herniation patients after PELD was recurrence of the herniation. Additionally, severe disc degeneration, older age, and lack of active straight leg raise exercises were identified as significant risk factors associated with an increased reoperation rate.

The potential performance of serum albumin to globulin ratio, albumin and globulin in the diagnosis of periprosthetic joint infection and prediction of reinfection following reimplantation.

BACKGROUND: This study was conducted to evaluate the performance of serum albumin (ALB), globulin (GLO), and albumin to globulin ratio (AGR) in the diagnosis of PJI and prediction of reinfection following reimplantation in PJI patients who underwent two-stage revision. METHODS: We perform a retrospective data collection on identified patients who underwent revision arthroplasties in our institution from January 2010 to January 2020. A total of 241 patients were stratified into: group A (PJI), group B (aseptic loosening). Fifty-five patients who underwent two-stage revision in group A were assigned to group C. Group C was stratified into subgroup 1 (reinfection) and subgroup 2 (non-reinfection). Receiver operating characteristic curves were used to evaluate the utility of serum markers for diagnosing PJI and predicting reinfection following reimplantation. RESULTS: In the diagnosis of PJI, there were significant differences in the levels of ALB, GLO, and AGR between groups A and group B (P < 0.05). The AUC value of serum AGR (0.851) was similar to ESR (0.841) and CRP (0.866) (all p > 0.05). The AUC values of serum ALB and GLO were 0.757 and 0.753, respectively. As for predicting reinfection following reimplantation, the serum ALB in the non-reinfection group was higher than that in the reinfection group (p = 0.041). The AUC value of serum ALB was 0.7. CONCLUSION: AGR was promising adjunct marker for the diagnosis of PJI, similar to CRP and ESR. ALB and GLO have an acceptable value for the diagnosis of PJI. ALB may be expected to be a kind of effective marker for predicting reinfection following reimplantation.

Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis.

OBJECTIVE: The objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. METHODS: Finite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. RESULTS: Group A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. CONCLUSION: Combining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).

Case report: Traumatic lumbosacral spondyloptosis with locked L5 inferior articular process.

Background: Traumatic lumbosacral spondyloptosis is a very rare spinal disease caused by high-energy trauma. We report a case of traumatic lumbosacral spondyloptosis with locked L5 inferior articular process. Case presentation: A 33-year-old man presented with multisite pain for 6 h following waist trauma and was admitted to the hospital. He suffered multiple injuries from severe impact on the waist after driving an out of control forklift truck. Preoperative imaging examinations revealed that the patient was diagnosed with traumatic lumbosacral spondyloptosis and the L5 inferior articular process was locked into the anterior margin of the S1 vertebra. A posterior instrumentation, decompression of the cauda equina, and interbody fusion procedure was performed. The patient received hyperbaric oxygen and rehabilitation treatment 10 days after the surgery. At the 6-month postoperative follow-up, the muscle strength of the lower limbs was improved, the patient had no numbness of both lower limbs, and the urinary retention symptom was significantly improved. The American Spinal Injury Association grade improved from grade C preoperatively to grade D postoperatively. As far as we know, there have been no relevant reports on traumatic lumbosacral spondyloptosis with locked L5 inferior articular process yet. Conclusion: We believe that the hyperflexion and shear forces were the potential causes of this injury. In addition, the preoperative imaging examinations should be evaluated carefully. If the inferior articular process of L5 were locked, we suggest removing the bilateral inferior articular processes first and then perform reduction.

Research Status and Hotspots of Chronic Osteomyelitis: A Bibliometric and Visualized Analysis.

OBJECTIVE: The treatment of chronic osteomyelitis (COM) is extremely challenging for physicians and patients. It is of great significance to explore the research status, development trend and future research hotspots in the field of COM to promote the development of this field. This study is aimed to explore the global research status of COM and predict its future research hotspots based on bibliometric and visualized analysis. METHODS: Web of Science core collection database was used to search the related literature of COM from 1994 to 2020. All data were imported into Microsoft Excel 2019 for collation. Additionally, the literature quality of countries, authors, journals, and institutions is evaluated. The VOS viewer software was used for conducting co-analysis, co-citation analysis, and keyword co-occurrence analysis of literature to analyze the global status and predict the future hotspots of the COM field. RESULTS: A total of 726 articles were retrieved in this study. The number of global publications shows a trend of wave growth, but the increase is not significant. It is expected that the number of COM articles will remain at more than 50 per year in the next decade. The COM literature published in the United States (Publications = 160, H index = 37, average citations per item = 28.63) is of the highest quality. Girschick HJ (Publications = 16, H index = 14, average citations per item = 52.25) is the most contributed scholar in the field of COM. UNIV IOWA (Publications = 15, H index = 11, average citations per item = 57.27) and UNIV WURZBURG (Publications = 18, H index = 15, average citations per item = 47.5) are influential institutions in the field of COM. The results of co-occurrence analysis show that the field of COM can be roughly divided into the following five modules: COM surgical research, COM basic research, COM diagnosis-related research, chronic recurrent multifocal osteomyelitis (CRMO)-related research, risk factors of COM. Risk factors of COM are the module with the highest concentration of hot words. CONCLUSION: COM-related research will continue to develop further in the next decade. The diagnosis research and risk factors of COM are the most popular research modules in recent years. Some controversial or troubled issues including the efficacy of perforator flap and fascia flap covering soft tissue, searching exclusive detection methods for the diagnosis of COM and bisphosphonates and biological agents in the treatment of CRMO may lead to the development of the COM field.

Sequence identification, chromosomal mapping and tissue specific expression of the porcine paraoxonase 1 (PON1) gene.

Serum paraoxonase (PON1) plays an important role in protecting low-density lipoprotein against oxidative modification. In this study, the full-length cDNA sequence (1,416 bp) of porcine PON1 was cloned by reverse transcription polymerase chain reaction and rapid amplification of cDNA ends. It was found to contain a 1,068 bp open reading frame encoding a deduced protein of 355 amino acids with a calculated molecular weight of 40.02 kDa. The genomic structure and sequence of porcine PON1 were also analyzed using a bacterial artificial chromosome clone of a Chinese Erhualian pig. The porcine PON1 gene contained nine exons and eight introns spanning approximately 29 kb, and was located on chromosome nine between microsatellite markers SWR915 and SW944 by IMpRH mapping. Porcine PON1 was highly expressed in kidney, followed by liver, lung and small intestine, expressed at an extremely low level in heart, and was hardly expressed in spleen, lymph, muscle of the anterior limb, cerebrum, fat, cerebellum or hypothalamus.

Sequence identification, tissue distribution and polymorphism of the porcine cathepsin D (CTSD) gene.

Cathepsin D (CTSD), a major ubiquitously expressed aspartic protease, is not only involved in muscle protein degradation, but also related to some pathological processes. In this study, we characterized the full-length cDNA, genomic DNA sequence, expression profile and polymorphism of the porcine CTSD gene. The full-length cDNA of porcine CTSD gene and the predicted protein sequence shared high identities wih other mammalian orthologous. Northern-blot analysis and Reverse transcription (RT)-PCR results indicated that the CTSD gene has one transcript of approximately 2.0 kb in normal tissues and was expressed ubiquitously in pigs, without significant differences in porcine heart, liver, spleen, lung, kidney, stomach, fat, triceps brachi, biceps femoris, and longissimus muscles. The porcine CTSD gene spans approximately 9.0 kb including nine exons. All exon/intron boundaries adhere to the GT/AG rule. Altogether 35 nucleotide polymorphisms of CTSD gene were discovered between Duroc, Landrace, Erhualian, and Dahuabai pigs. These polymorphisms included three missense mutations, eight synonymous mutations, and 24 intronic substitutions, and most polymorphisms are located in the intron 4 and 5. Three polymorphisms were genotyped in Duroc, Landrace, Dahuabai, and Erhualian pigs by PCR-RFLP method, and significant differences of their genotype frequencies were observed between Chinese native breeds (Dahuabai and Erhualian) and western breeds (Duroc and Landrace).

An integrated analysis revealed different microRNA-mRNA profiles during skeletal muscle development between Landrace and Lantang pigs.

Pigs supply vital dietary proteins for human consumption, and their economic value depends largely on muscle production. MicroRNAs are known to play important roles in skeletal muscle development. However, their relationship to distinct muscle production between pig breeds remains unknown. Here, we performed an integrated analysis of microRNA-mRNA expression profiles for Landrace (LR, lean) pigs and the Chinese indigenous Lantang pig (LT, lard-type) during 8 stages of skeletal muscle developmental, including at 35, 49, 63, 77 dpc (days post coitum) and 2, 28, 90, 180 dpn (days postnatal). As differentially expressed-miRNA expression profiles can be well classified into two clusters by PCA analysis, we grouped the embryonic stages as G1 and the postnatal stages as G2. A total of 203 genes were predicted miRNA targets, and a STEM analysis showed distinct expression patterns between G1 and G2 in both breeds based on their transcriptomic data. Furthermore, a STRING analysis predicted interactions between 22 genes and 35 miRNAs, including some crucial myogenic factors and myofibrillar genes. Thus, it can be reasonably speculated that myogenic miRNAs may regulate myofibrillar genes in myofiber formation during embryonic stages and muscle hypertrophy during postnatal stages, leading to distinct differences in muscle production between breeds.

[Triple no loop Endobutton plate combined with Orthcord line for the treatment of acromioclavicular dislocation of Tossy type III].

OBJECTIVE: To explore the clinical effects of the triple no loop Endobutton plate combined with Orthcord line in treating acromioclavicular dislocation of Tossy type III. METHODS: Between February 2011 and September 2013, 36 patients with acromioclavicular dislocation of Tossy type III were treated with triple no loop Endobutton plate and Orthcord line. There were 21 males and 15 females, aged from 9 to 48 years old with an average of (26.41±14.05) years. Couse of disease was from 2 to 7 days in the patients. The patients had the clinical manifestations such as shoulder pain, extension limited, acromioclavicular tenderness, positive organ point sign. Clinical effects were assessed by acromioclavicular scoring system. RESULTS: Thirty six patients were followed up from 8 to 15 months with an average of (12.2±4.3) months. All incisions got primary healing. At the final follow up, all shoulder pain vanished, acromioclavicular joints without tenderness, negative organ point sign. No redislocation and steel plate loosening were found. According to the acromioclavicular scoring system, 31 cases obtained excellent results, 5 good. CONCLUSIONS: The method of triple no loop Endobutton plate combined with Orthcord line for acromioclavicular dislocation of Tossy type III has advantage of less risk and complication, good functional rehabilitation and is an ideal method.

CEP2 attenuates myoblast differentiation but does not affect proliferation.

CEP2 (CDC42EP2) is a member of the CDC42 subfamily that belongs to the Rho family. The Rho family plays an important role in a variety of cellular processes including skeletal myogenesis. Here, we find the expression of CEP2 increased significantly during C2C12 myogenesis. Overexpression of CEP2 could attenuate myoblast differentiation, while knockdown of CEP2 by siRNA results in enhancing myogenesis. Furthermore, we demonstrate for the first time that CEP2 attenuates myoblast differentiation via suppression of muscle regulatory factors (MRFs) rather than influencing myoblast proliferation. These results indicate that CEP2 acts as a repressor during myogenesis, which provides new insights into the role of CEP2 in muscle development.

Overexpression of SIRT6 in porcine fetal fibroblasts attenuates cytotoxicity and premature senescence caused by D-galactose and tert-butylhydroperoxide.

SIRT6, a member of the yeast silent information regulator 2 (SIR2) family, possesses both robust ADP-ribosyltransferase activity and protein deacetylase activity depending on NAD(+). It has been shown to maintain genomic stability and telomere integrity, and to prevent age-related disorders and premature ageing. However, the mechanism by which SIRT6 overexpression affects cellular ageing is not well understood. In this study, we investigated the effect of SIRT6 overexpression on cytotoxicity and ageing syndromes. A full-length cDNA of porcine SIRT6 was inserted into pcDNA3.1(-) and subsequently transfected into porcine fetal fibroblasts (PFFs). Overexpression of SIRT6 was identified by quantitative real-time polymerase chain reaction and western blot assay. The cells were incubated with D-galactose and tert-butylhydroperoxide at their cytotoxic concentrations. The damage caused by the stresses was detected with fluorescence microscopy using 4',6-diamidino-2-phenylindole (DAPI) staining, DNA ladder analysis, and observation under transmission electron microscopy. The results showed that SIRT6 overexpression in cells decreased damage to the nuclei. It also protected against the generation of DNA fragmentation and damage in the ultramicrostructure of the cells, especially damage to mitochondria. Our observations suggested that one function of SIRT6 in PFFs was to dampen cytotoxicity, and, therefore, to decrease the damage that causes premature senescence.