Anterior percutaneous full-endoscopic transcorporeal decompression for cervical disc herniation: a finite element analysis and long-term follow-up study.

OBJECTIVE: The purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint. METHODS: A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery. RESULTS: The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments. CONCLUSIONS: Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.

Gene therapy targeting miR­212­3p exerts therapeutic effects on MAFLD similar to those of exercise.

Exercise is the main treatment for patients with metabolic­associated fatty liver disease (MAFLD); however, it may be difficult for some patients to adhere to or tolerate an exercise regime. Thus, finding a treatment alternative to exercise is of particular importance. The authors have previously demonstrated that the high expression of microRNA (miRNA/miR)­212 promotes lipogenesis in vitro. The present study aimed to explore the therapeutic potential, as well as the mechanisms of action of miR­212 in MAFLD. The expression of miR­212­3p, but not that of miR­212­5p, was found to be significantly elevated in MAFLD and to be decreased by exercise. Compared with exercise treatment, the inhibition of miR­212­3p expression in a mouse model fed a high­fat diet exerted beneficial effects on MAFLD similar to those of exercise. Conversely, the overexpression of miR­212­3p abolished the ameliorative effects of exercise on MAFLD. Fibroblast growth factor 21 (FGF21) and chromodomain helicase DNA binding protein 1 (CHD1) were identified as target genes of miR­212­3p in lipid metabolism using bioinformatics analysis. Mechanistically, the inhibition of miR­212­3p mimicked the effects of exercise on lipid metabolism by regulating FGF21, but not CHD1. The exercise­related transcription factor, early growth response 1 (EGR1), was identified upstream of miR­212­3p through promoter motif analysis. EGR1 overexpression inhibited miR­212­3p expression. The overexpression of miR­212­3p abolished the effects of exercise on lipid metabolism by exogenously attenuating the transcriptional repression of EGR1. Moreover, the overexpression of miR­212­3p abolished the regulatory effects of EGR1 on FGF21. On the whole, the present study demonstrates that miR­212­3p plays a key role in the effects of exercise on MAFLD. The findings presented herein suggest a potential therapeutic effect of targeting miR­212­3p in MAFLD.

Identification and validation of immune related core transcription factors GTF2I in NAFLD.

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide that endangers human health. Transcription factors (TFs) have gradually become hot spots for drug development in NAFLD for their impacts on metabolism. However, the specific TFs that regulate immune response in the development of NAFLD is not clear. This study aimed to investigate the TFs involved in the immune response of NAFLD and provide novel targets for drug development. Methods: Microarray data were obtained from liver samples from 26 normal volunteers and 109 NAFLD patients using the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were analyzed by limma package. Differentially expressed transcription factors (DETFs) were obtained on DEGs combined with Cistrome Cancer database. Immune signatures and pathways hallmark were identified by ssGSSEA and GSVA. The co-regulation network was constructed by the above results. Further, quantitative Real-time Polymerase Chain Reaction (qRT-PCR), Western blot (WB) and Immunohistochemistry (IHC) were used to validate the relationship between GTF2I and NAFLD. CIBERSORT analysis was performed to identify cell types to explore the relationship between differential expression of GTF2I and immune cell surface markers. Results: A total of 617 DEGs and six DETFs (ESR1, CHD2, GTF2I, EGR1, HCFC1, SP2) were obtained by differential analysis. Immune signatures and pathway hallmarks were identified by ssGSSEA and GSVA. GTF2I and CHD2 were screened through the co-regulatory networks of DEGs, DETFs, immune signatures and pathway hallmarks. Furthermore, qRT-PCR, WB and IHC indicated that GTF2I but not CHD2 was significantly upregulated in NAFLD. Finally, in silico, our data confirmed that GTF2I has a wide impact on the immune profile by negatively regulating the expression of the chemokine receptor family (227/261, count of significance). Conclusion: GTF2I plays a role in NAFLD by negatively regulating the chemokine receptor family, which affects the immune profile. This study may provide a potential target for the diagnosis or therapy of NAFLD.

A clinical and laboratory-based nomogram for predicting nonalcoholic fatty liver disease in non-diabetic adults: a cross-sectional study.

BACKGROUND: Although the close relationship between nonalcoholic fatty liver disease (NAFLD) and insulin resistance has been clarified and there is a five-fold higher prevalence of NAFLD in patients with diabetes compared to that in patients without diabetes, this is not a reason to focus only on the incidence of NAFLD in people with diabetes because people who are insulin resistant are not necessarily diagnosed with diabetes, which leads to the overlook of NAFLD in non-diabetic population. Actually, we are obligated to pay more attention to the non-diabetic population for early detection and intervention of NAFLD. There is a lack of a convenient tool for predicting NAFLD in non-diabetic adults, and thus we aim to develop and validate a novel clinical nomogram to predict NAFLD among non-diabetic population to save more medical resources and make less missed diagnosis. METHODS: Researchers initially enrolled 20,944 patients and excluded those with history of drinking, known medication usage, viral hepatitis, known liver disease, missing covariant data, age <18 years, and impaired fasting blood glucose, leaving 14,251 adults participating in the baseline analysis, who were randomly divided in a ratio of 3:1 into a training dataset with 10,689 participants and a validation dataset with 3,562 participants, using the classification and regression training (caret) package in R software v. 4.0.3. Variables for prediction were selected by multivariable logistic regression analysis, the LASSO method, and clinical experience. Based on these, we constructed a prediction model. Performance of this model was validated by the area under the receiver operator characteristic curve, calibration curve, and decision curve analysis. RESULTS: We used 6 variables to construct the prediction model: body mass index (BMI), aspartate aminotransferase (AST), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), hemoglobin A1c (HbA1c), and diastolic blood pressure (DBP). In the training and validation datasets, the AUROC value of this prediction was 0.891 [95% confidence interval (CI): 0.884 to 0.899] and 0.902 (95% CI: 0.890 to 0.914), respectively. The calibration plots and the decision curve analysis (DCA) demonstrated that the accuracy of this model was good, with high clinical practicability. CONCLUSIONS: The nomogram could screen non-diabetic adults for NAFLD and may aid clinical decision-making.

The adiposity indicators in relation to diabetes among adults in China: a cross-sectional study from China Health and Nutrition Survey.

BACKGROUND: Diabetes is a metabolic disease which has been confirmed to be involved with abnormal or excessive body fat accumulation. There is still a lack of nationwide research in China to discuss the relationship between adiposity indicators included body mass index (BMI), waist circumference (WC), visceral adiposity index, waist-height ratio, waist-to-hip ratio (WHR) and diabetes. The question of which one is the best indicator of obesity to predict diabetes in China remains to be unclear. METHODS: Data were collected from the China Health and Nutrition Survey (CHNS) in 2009, including 7,930 participants aged over 18 years old for cross-sectional analysis. Information about height, weight, WC, hip circumference, smoking status, alcohol consumption, physical activity, energy intake and blood samples were analyzed. Binary logistic regression models were used to explore the association of WC, BMI, WHR, waist-to-height ration (WHtR) and visceral adipose index (VAI) with the prevalence of diabetes in the 2009 CHNS respectively. Predictive potential of five adiposity indicators was validated by the area under the receiver operator characteristic curve (AUROC). The optimal cut-off points were determined by Youden's index, which was used to estimate the performance of adiposity indicators. RESULTS: The study shows patients in the highest quartile were more likely to have diabetes than those in the lowest quartile of WC (OR: 4.237, 95% CI: 3.265-5.499), BMI (OR: 3.312, 95% CI: 2.601-4.218), WHR (OR: 3.199, 95% CI: 2.493-4.104), WHtR (OR: 3.760, 95% CI: 2.891-4.890), VAI (OR: 4.347, 95% CI: 3.411-5.541). The area under the receiver operator characteristic curve of WC, BMI, WHR, WHtR and VAI for diabetes was 0.700, 0.663, 0.668, and 0.697 and 0.694, respectively. The optimal cut-offs regarding diabetes in Chinese are WHtR ≥0.520 for men and VAI ≥1.878 for women. CONCLUSIONS: Our findings indicate that WC, WHtR, BMI, WHR and VAI are all independent risk factors for diabetes among Chinese adults. WHtR is the most accurate indicator for diabetes in men, while VAI for women.

ELOVLs Predict Distinct Prognosis Value and Immunotherapy Efficacy In Patients With Hepatocellular Carcinoma.

Background: Hepatocellular carcinoma (HCC) is a primary malignancy of the liver with high prevalence worldwide and poor prognosis. It has been verified that elongation of very-long-chain fatty acids gene family (ELOVLs), a group of genes that responsible for elongation of saturated and polyunsaturated fatty acids, participate in the pathogenesis and development of multiplex disease including cancers. However, the functions and prognosis of ELOVLs in HCC are still indistinguishable. Methods: First, we searched the mRNA expression and survival data of ELOVLs in patients with HCC via the data of The Cancer Genome Atlas (TCGA). The prognosis value of ELOVLs on HCC was assessed by Kaplan-Meier plotter and Cox regression analysis. reverse transcription quantitative- polymerase chain reaction (RT-qPCR), Western blot (WB), and immunohistochemistry were applied to assess the specific mRNA and protein expression of ELOVLs in HCC clinical specimens of our cohort. Then, the functional enrichment of ELOVL1 especially the pathways relating to the immune was conducted utilizing the Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) analysis. Additionally, TIMER, CIBERSOR, and tumor immune dysfunction and exclusion (TIDE) were employed to evaluate the relationship between ELOVL1 and immune responses. Last, the correlation of ELOVL1 with genome heterogeneity [microsatellite instability (MSI), tumor mutational burden (TMB), mutant-allele tumor heterogeneity (MATH), homologous recombination deficiency (HRD), purity, ploidy, loss of heterozygosity (LOH), and neoantigens] and mutational landscape were also evaluated basing on the date in TCGA. Results: Significant expression alteration was observed in ELOVLs family at the pan-cancer level. In liver cancer, ELOVL1 and ELOVL3 were strongly associated with poor prognosis of HCC by survival analysis and differential expression analysis. Immunohistochemistry microarray, WB, and RT-qPCR confirmed that ELOVL1 but not ELOVL3 played an important role in HCC. Mechanistically, functional network analysis revealed that ELOVL1 might be involved in the immune response. ELOVL1 could affect immune cell infiltration and immune checkpoint markers such as PD-1 and CTLA4 in HCC. Meanwhile, high expression of ELOVL1 would be insensitive to immunotherapy. Correlation analysis of immunotherapy markers showed that ELOVL1 has been associated with MSI, TMB, and oncogene mutations such as TP53. Conclusion: ELOVLs play distinct prognostic value in HCC. ELOVL1 could predict the poor prognosis and might be a potential indicator of immunotherapy efficacy in HCC patients.

Protective effects of gastrodin pretreatment on mouse hepatic ischemia-reperfusion occurring through antioxidant and anti-apoptotic mechanisms.

Hepatic ischemia-reperfusion injury (HIRI) often occurs following surgical procedures such as liver resection and transplantation. However, despite its clinical prominence, to the best of our knowledge, there remain no effective strategies to treat HIRI. Therefore, the aim of present study was to identify therapeutic agents that can exert beneficial effects against HIRI. The present study found that following hepatic IR modeling in mice, gastrodin (Gas) pretreatment improved the IR outcomes in terms of the serum biochemical indexes (alanine transaminase and aspartate transaminase), tissue biochemical indexes (superoxide dismutase, malondialdehyde and reduced glutathione content) and tissue pathology (H&E staining). In addition, compared with those in the IR + vehicle group, the IR + Gas group showed upregulated expression levels of nuclear erythroid 2-related factor 2, heme oxygenase 1 and Bcl-2 as detected by western blotting and reverse transcription-quantitative PCR. The mRNA and protein expression levels of Bax and caspase-3 were downregulated in the IR + Gas group compared with the IR + vehicle group. Concurrently, no significant differences were observed in the parameters between the Sham + vehicle and the Sham + Gas groups, indicating that Gas pretreatment may not cause liver damage. In conclusion, the findings of the present study revealed that Gas pretreatment exerted a protective effect in HIRI through both antioxidant and anti-apoptotic mechanisms.

A Novel Technique of Endoscopic Anterior Transcorporeal Approach with Channel Repair for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion.

OBJECTIVE: To first report the application of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) with channel repair for a patient with adjacent segment disease (ASD) after anterior cervical discectomy and fusion. METHODS: PEATCD with channel repair was performed for a patient with ASD at the cranial level adjacent to previous fusion at the C5-C6 level. The pre- and postoperative clinical symptoms were evaluated with Japanese Orthopedic Association and visual analog scale (VAS). The radiological examinations included magnetic resonance imaging, computed tomography, and plain radiographs, which were used to evaluate the cervical alignment, stability, intraoperative decompression, and bony channel. RESULTS: The procedure was successfully completed within 70 minutes. The drainage tube was unnecessary. No surgery-related complications were recorded. The postoperative neck pain immediately improved to VAS 3 from preoperative VAS 6. The Japanese Orthopedic Association scores also took a turn for the better gradually from preoperative 10 to final 16 (improvement rate 85.7%). The muscle power recovered completely, and the Hoffman sign turned to negative during follow-up periods. Magnetic resonance imaging 1 week postoperatively showed a total removal of the herniation. The bony channel was almost disappeared on computed tomography images 3 months postoperatively. During postoperative periods, no relapse, channel collapse, bone plug migration, or instability was observed. CONCLUSION: As a novel and supplemental procedure for ASD after anterior cervical discectomy and fusion, PEATCD combines the advantages of transcorporeal approach and endoscopy together, which decreases iatrogenic damage to disc, preserves the cervical motion segment, and reduces surgical trauma. As the limitations of 1 case show, the effectiveness and reliability of PEATCD for patients with ASD should be verified in further studies.