What are the differences in paraspinal muscle morphometry among degenerative spondylolisthesis patients, isthmic spondylolisthesis patients, and healthy individuals? A propensity score matching analysis.

PURPOSE: To compare the morphometry of paraspinal muscles in patients with degenerative spondylolisthesis (DS), isthmic spondylolisthesis (IS), and healthy individuals. METHODS: Thirty-seven pairs of DS patients were selected using propensity score matching with IS patients, while 37 healthy individuals matched for age, sex, and BMI were selected as controls. The relative cross-sectional area (rCSA), and relative functional cross-sectional area (rfCSA) of paraspinal muscles were measured, and the degree of fatty infiltration (FI) was calculated. Based on occupational differences, the patients were also divided into worker and farmer groups, and the same measurements were taken on them. RESULTS: At the L3/L4 level, the multifidus (MF) FI was greater in the DS and IS groups than in the control group, the erector spinae (ES) rfCSA was higher in the IS group than in the DS and control groups. At the L4/L5 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS and control groups. At the L5/S1 level, MF rfCSA was smaller in the DS and IS groups than in the control group; ES rfCSA was higher in the IS group than in the DS group. At the L3/L4, L4/L5 level, MF rfCSA were higher in the worker group than in the farmer group (p < 0.05). CONCLUSION: The morphological changes in paraspinal muscles in patients with DS were dominated by selective atrophy of the MF, while in patients with IS, the morphological changes in paraspinal muscle showed selective atrophy of the MF accompanied by compensatory hypertrophy of the ES. The surgeon should consider the morphological differences in paraspinal muscle between different types of lumbar spondylolisthesis when establishing the appropriate surgical program.

17ß-Estradiol Protects Rat Annulus Fibrosus Cells Against Apoptosis via α1 Integrin-Mediated Adhesion to Type I Collagen: An In-vitro Study.

BACKGROUND 17ß-Estradiol (E2) has been reported to protect annulus fibrosus (AF) cells in vitro against interleukin-1ß (IL-1ß)-induced apoptosis in a concentration-dependent manner. However, its time-response effect remains unexplored. In addition, integrin α2/collagen II interaction has been reported to influence the apoptosis of nucleus pulposus cells in vitro. Thus, we hypothesized that integrin α1/collagen II might play a role in exerting the anti-apoptosis effect by E2. The aim of the current study was to further investigate the anti-apoptotic effect of E2 and determine the role of integrin a1/collagen II interaction. MATERIAL AND METHODS Rat AF cells were primary cultured and used for the following experiments. AF cells were identified by immunocytochemistry of type I collagen. Cell apoptosis was detected by fluorescence-activated cell sorter (FACS) analysis. The activity of active caspase-3 was determined by use of a caspase-3 detection kit. AF cell adhesion to type I collagen was determined by cell adhesion assay. Protein level of integrin subunit α1 was quantified by Western blot and mRNA expression was determined by real-time qPCR. RESULTS The immunocytochemistry of type I collagen revealed that cell purity was eligible for the following experiments with 98% of purity. FACS analysis indicated time-dependent anti-apoptosis effect of E2 at time points of 6 h, 12 h, and 24 h, which was confirmed by Caspase-3 activity. Furthermore, cell adhesion assay showed that E2 significantly increased cell binding to 95% of control, and qPCR and Western blot analysis showed that E2 effectively upregulated integrin α1. However, estrogen receptor antagonist ICI182780 prohibited the effect of E2. CONCLUSIONS This study shows that E2 protects against apoptosis in a time-dependent manner, and α1 integrin-mediated adhesion to collagen II is essential for estrogen-dependent anti-apoptosis in rat annulus fibrosus cells in vitro.

LINC00092 Suppresses the Malignant Progression of Breast Invasive Ductal Carcinoma Through Modulating SFRP1 Expression by Sponging miR-1827.

Breast invasive ductal carcinoma (IDC) is a most common kind of breast cancer (BC), yet to date the corresponding effective therapies are limited. Extensive evidence has indicated that lncRNAs are involved in multiple cancers, and the potential mechanism of lncRNAs, such as LINC00092, mentioned in IDC remains elusive. IDC clinical samples from TCGA database were used to analyze the expression levels of LINC00092, miR-1827 and SFRP1. Kaplan-Meier method was applied to plot the overall survival curves. KEGG and GO were employed to screen the pathway that LINC00092 participated in. Pearson's correlation analysis determined the relationship between LINC00092 and SFRP1. Bioinformatics analysis and dual-luciferase reporter assay examined the association among LINC00092, miR-1827, and SFRP1. Cell counting kit-8, colony formation and transwell assays were performed to detect cell viability, colony formation, and migration and invasion, respectively. Quantitative reverse-transcription polymerase chain reaction and western blot were utilized to investigate the expression at RNA and protein levels. LINC00092 expression was down-regulated in IDC tissues and cells, which was correlated with poor prognosis. Down-regulated LINC00092 facilitated cell proliferation, colony formation, and cell migration and invasion, while up-regulated LINC00092 inhibited cell malignant behaviors. LINC00092/SFRP1 physically bound to miR-1827 in IDC. SFRP1 expression was proportional to LINC00092 expression and inversely proportional to miR-1827 expression. The inhibitory effects of LINC00092 on cell aggressive behaviors were partially regulated by miR-1827/SFRP1. In summary, our results indicated that overexpression of LINC00092 inhibited the development of IDC through modulating miR-1827/SFRP1 axis, suggesting new therapeutic targets to treat IDC.

[Safety evaluation of pedicle screw placement in proximal thoracic vertebrae via funnel technique].

OBJECTIVE: To evaluate the safety of funnel technique for the placement of proximal thoracic pedicle screws (T1-T5). METHODS: Between March 2006 and October 2010, 105 patients undergoing pedicle screw placement of proximal thoracic vertebrae were retrospectively reviewed. There were 57 males and 48 females with an average age of 40.3 years old. According to the techniques of placing pedicle screws, they were classified into the funnel technique group (group A, n = 54) and bare hand technique group (group B, n = 51). Their perioperative and postoperative complications were examined simultaneously. Postoperative CT (computed tomography) scans were performed in all cases to determine the instrument malposition. The percentage of malposition was analyzed between two groups and among different levels. RESULTS: A total of 402 proximal thoracic pedicle screws were placed in 105 cases. No injuries of spinal cord, large blood vessels or lung were reported. There were 13 intraoperative pedicle fractures and 4 dural tears. A total of 45 screws were misplaced in 105 patients (11.19%). In group A, the percentage of malposition was 10.14%. And there were no statistic significance among different levels (P > 0.05). In group B, the percentage of malposition was 12.31% and no statistic significance existed among different levels (P > 0.05). No intra-group statistical significance was found for group A or B. Medial malposition was found in 17 cases. And lateral malposition occurred in 25 screws while only 3 screws penetrated anterior cortex. Among 59 patients with neurological deficits, 37 cases showed postoperative improvements according to the AISA (American Spinal Injury Association) scale. CONCLUSION: The funnel technique is both safe and reliable for the placements of proximal thoracic pedicle screws.

[Effects of rotating cell culture system on constructing of tissue engineering intervertebral nucleus pulposus].

OBJECTIVE: To study the effect of rotating cell culture system (RCCS) on the in vitro constructing of tissue engineering nucleus pulposus. METHODS: Nucleus pulposus cells from rabbit thoracic and lumbar intervertebral discs were proliferated in vitro to the third generation and seeded into PLGA (poly-lactide-co-glycolide) scaffolds (3 × 10(7)/ml). Experimental group was subjected to the RCCS while the control group was cultured under a normal condition. Both groups were cultured in vitro. The complex of nucleus pulposus and scaffolds was observed after 4 weeks. Tissue texture, scanning electron microscope, type II collagen, content of GAG (glycosaminoglycan) and DNA were assessed. RESULTS: After 4 weeks, the tissue engineered nucleus pulposus under RCCS were morphologically thicker and bigger. And the content of GAG, DNA and percentage of typeII collagen were more than those in the control group. The structural arrange of tissue engineering nucleus pulposus was visualized directly. CONCLUSION: The RCCS promotes intervertebral disc cells to secrete collagen and GAG. It may benefit the construction of tissue engineering intervertebral disc.

Reduction of PGRN increased fibrosis during skin wound healing in mice.

Progranulin (PGRN) is a multi-functional growth factor known to be involved in regulating of development, cell cycle progression, cell motility, tumorigenesis and angiogenesis. Research has revealed that PGRN is a crucial mediator of skin wound healing. Nonetheless, the role of PGRN in the fibrosis process of cutaneous wound healing has not been identified. In the present study, mice with excisional wounds were treated with si-m-PGRN or physiological saline. We observed the expression of PGRN in intact and post-injury skin by immunohistochemistry. Tissue sections of skin around the wound were performed by hematoxylin & eosin and masson's trichrome staining. After PGRN knockdown by siRNA, the expression of PGRN, collagen I (Col I), small mothers against decapentaplegic homolog 3 (Smad3), phosphorylated Smad3 (P-Smad3), transforming growth factor (TGF)-ß1 and TGF-ß receptor I (TßRI) were detected by real-time reverse transcription polymerase chain reaction (RT-qPCR) or Western blot. PGRN mRNA and protein expressions were increased after insult and remained above that of intact skin through day 20. Down-regulation of PGRN augmented fibrosis area, skin thickness and the expression of Col I. In addition, reduction of PGRN considerably increased the expression of TGF-ß1, TßRI, Smad3 and P-Smad3. These results indicate that PGRN knockdown enhances the fibrosis degree, probably via the TGF-ß/Smad signaling pathway.

Risk Factors for Lower Limb Deep Vein Thrombosis in Patients With Single-Level Lumbar Fusion: A Prospective Study of 710 Cases.

Lower limb deep vein thrombosis (DVT) is not an uncommon postoperative complication of spinal fusion surgery. However, the related risk factors identified in previous studies remain controversial. This study aimed to investigate risk factors for lower limb DVT in patients with single-level lumbar fusion surgery. Between January 2010 and December 2016, a total of 710 patients undergoing lumbar fusion were recruited for this study, including 172 males and 538 females (aged 18-75 years). Deep vein thrombosis was detected by ultrasonography. Accordingly, patients were divided into the DVT group and the non-DVT group and compared in terms of operative data, underlying diseases, and biochemical data. Additionally, logistic regression analysis was performed to identify risk factors for lower limb DVT. The incidence of lower limb DVT was 11.8% (84 of 710 cases). Five patients were symptomatic, with lower limb pain and swelling. Two patients developed pulmonary embolism and 1 died. Binary logistic regression indicated that advanced age (P = .001, odds ratio [OR] = 2.86, 95% CI: 1.85-5.12), hypertension (P = .006, OR = 4.10, 95% CI: 1.09-2.30), and increased d-dimer (P < .001, OR = 3.49, 95% CI: 2.05-6.36) were risk factors for postoperative DVT. In conclusion, for patients with single-level lumbar fusion, advanced age, increased d-dimer, and hypertension may contribute to DVT development after spinal fusion surgery. Therefore, patients with these risk factors should be protected during the perioperative period.

Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy: A meta-analysis.

OBJECTIVE: A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy combined with discectomy) in the treatment for multilevel cervical spondylotic myelopathy (mCSM). SUMMARY OF BACKGROUND DATA: Both ACDF and HS are used to treat mCSM, however, which one is better treatment for mCSM remains considerable controversy. METHODS: An extensive search of literature was searched in PubMed/Medline, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus HS treating mCSM from January 2011 to December 2017. The following variables were extracted: blood loss, operation time, fusion rate, Cobb angles of C2-C7, total complications, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS: A total of 4 studies including 669 patients were included in our study. The pooled analysis showed that there were no significant difference in the operation time, fusion rate, Cobb angles of C2-C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. However, there were significant difference between 2 groups in blood loss [P < .00001, SMD = -30.29 (-45.06, -15.52); heterogeneity: P = .38, I = 0%= and total complications [P = .04, OR = 0.66 95%CI (0.44, 0.98); heterogeneity: P = .37, I = 4%]. CONCLUSIONS: Based on our meta-analysis, except for blood loss and total complications, both ACDF and hybrid surgery are effective options for the treatment of multilevel cervical spondylotic myelopathy.

[Inhibitory effect of RGDS peptide on experimental choroidal neovascularization in a rat model].

OBJECTIVE: To investigate the efficacy and feasibility of RGDS (Arg-Gly-Asp-Ser) peptide (an alpha(nu)-integrin antagonist) in a rat model of laser-induced choroidal neovascularization (CNV). METHODS: Experimental CNV was induced by laser photocoagulation in Brown Norway rats (50 microm diameter, 0.05 second duration and 525 mw intensity). Phosphate buffered saline (PBS) or 100, 300 microg of RGDS peptide in PBS were being injected intravitreally after laser surgery for 7 days. On the 14th day after photocoagulation, CNV was observed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). The area of CNV by high molecular weight FITC-dextran (MW 2 x 10(6)) for high resolution angiography in RPE-choroid-sclera flat mounts and the thickness microscopically on histologic sections were evaluated. New vessels were detected and quantified by an-antibody against factor VIII. Two eyes from each group were examined by transmission electron microscopy. RESULTS: In eyes with injections of 300 or 100 microg of RGDS peptide on the 14th day after laser photocoagulation, the development of CNV was significantly (P < 0.01) inhibited showing by RPE-choroid-sclera flat mounts. Histologically, the thickness of the CNV lesions was significantly (P < 0.01) reduced in eyes that received 300 or 100 microg of RGDS peptide injection. Immunoreactivity of factor VIII in CNV showed significant difference (P < 0.01) in eyes injected with RGDS peptide compared with control eyes. The reduction of the area and the thickness of CNV by RGDS peptide were in a dose-dependent manner. No evidence of toxicity was found in retina by transmission electron microscopy in every group. CONCLUSIONS: RGDS peptide effectively inhibits CNV progression in a rat model of laser-induced CNV, suggesting that this alpha(nu)-integrin antagonist may be beneficial in the treatment of CNV.

Coexistence of multiple rare spinal abnormalities in type 1 neurofibromatosis: a case report and literature review.

Orthopaedic involvement is the most common clinical presentation of Neurofibromatosis type 1 (NF-1) patients with the spinal abnormalities more frequently affected. In the spinal deformities of NF-1 patients, despite the scoliosis is the most frequent finding, several distinctive radiographic features, such as dural ectasia, defective pedicles, and spondylolisthesis, are relatively less common. Here, we reported a 16-year-old boy diagnosed with NF-1 who presented with dural ectasia, defective pedicles, and spondylolisthesis concomitantly, described the surgical treatment and provided a literature review. The boy complained of low back and leg pain for two months. On clinical examination, the patient showed multiple café au lait spots on his back and no neurological deficit. He had a family history of neurofibromatosis as his father suffering from NF-1. Imaging results demonstrated mild scoliosis, posterior scalloping of the lumber spine, L5 spondylolisthesis on plain radiographs, and marked dural ectasia of L3-L5 on MRI. Furthermore, the CT scan showed presence of thin pedicles at L3, bilateral symmetrical pedicle clefts at L4, and pars interarticularis fractures at L5. The patient received a long level posterior fusion from L1 to S1 with pedicle screws. Iliac crest autogenous graft mixed with artificial bone were used to achieve solid arthrodesis. At nine-month follow-up, the patient was asymptomatic and able to live a normal life. Our observation demonstrated that familiarity with those distinctive features in NF-1 patients could be contributed to making an early diagnosis and optimizing treatment.

Role of integrin-linked kinase in multi-drug resistance of human gastric carcinoma SGC7901/DDP cells.

Gastric carcinoma is a leading cause of cancer death in the world and multi-drug resistance (MDR) is an essential aspect of gastric carcinoma chemotherapy failure. Recent studies have shown that integrin-linked kinase (ILK) is involved in metastasis of human tumors, expression silencing of ILK inhibiting the metastasis of several types of cultured human cancer cells. However, the role and potential mechanism of ILK to reverse the multi- drug resistance in human gastric carcinoma is not fully clear. In this report, we focused on roles of expression silencing of ILK in multi-drug resistance reversal of human gastric carcinoma SGC7901/DDP cells, including increased drug sensitivity to cisplatin, cell apoptosis rates, and intracellular accumulation of Rhodamine-123, and decreased mRNA and protein expression of multi-drug resistance gene (MDR1), multi-drug resistance- associated protein (MRP1), excision repair cross-complementing gene 1 (ERCC1), glutathione S-transferase -π (GST-π) and RhoE, and transcriptional activation of AP-1 and NF-κB in ILK silenced SGC7901/DDP cells. We also found that there was a decreased level of p-Akt and p-ERK. The results indicated that ILK might be used as a potential therapeutic strategy to combat multi-drug resistance through blocking PI3K-Akt and MAPK-ERK pathways in human gastric carcinoma.

Treatment of proximal and middle one-third humeral fractures with lateral distal tibial helical plate.

OBJECTIVE: To evaluate the outcomes of treating patients with proximal and middle one-third humeral fractures treated with lateral distal tibial helical plate. MATERIALS AND METHODS: From June 2004 to January 2009, 12 patients (8 men, 4 women: average age: 46.8 years, range: 25-63) with proximal and middle one-third humeral fractures were treated with open reduction and internal fixation using lateral distal tibial helical plate. Standard anterior-posterior and lateral radiographs were obtained and evaluated. Shoulder function was assessed according to the Constant-Murley score. RESULTS: At follow-up (average: 18 months), all fractures had healed (average: 15 weeks, range: 9-23). There were no cases of intraoperative complications, implant failures, infections, or iatrogenic intra- or post-operative nerve lesions. All patients achieved at least 100° of abduction by 3 months post-surgery and full range of movement by 12 months post-surgery, with the exception of one patient who had an impingement symptom with moderate loss of abduction and external rotation. The average Constant-Murley score was 88 points at 12-month follow-up. According to Constant-Murley score, 28% of patients had excellent functional outcome, 64% had good outcome, 8% had moderate outcome, and none had failure. According to self-reporting, all patients had returned to the pre-injury level of activity. CONCLUSIONS: The lateral distal tibial helical plate promotes bone healing and minimizes the damage to the deltoid muscle insertion region, thereby facilitating rapid and good functional recovery. In addition, the helical plate design avoids affecting sliding of the biceps tendon and maintains good reduction position. The lateral distal tibial helical plate is an effective surgical option for proximal and middle one-third humeral fractures.