P50-associated COX-2 extragenic RNA (PACER) overexpression promotes proliferation and metastasis of osteosarcoma cells by activating COX-2 gene.

P50-associated cyclooxygenase-2 (COX-2) extragenic RNA (PACER) is a novel long noncoding RNA that has been found to activate the COX-2 gene, which may function as an oncogene in osteosarcoma. However, the role of PACER and the relationship between PACER and COX-2 in osteosarcoma progression have been unknown until now. Here, we examined the expression levels of PACER in clinical tumor samples and human osteosarcoma cell lines, assessed the functions of PACER in osteosarcoma cell proliferation and invasion, and then explored the mechanism of PACER dysregulation in osteosarcoma. The results showed that PACER was overexpressed in osteosarcoma tissues and cell lines compared with normal tissues and osteoblasts, respectively. PACER knockdown inhibited the proliferation and invasion of human osteosarcoma cells. Downregulation of PACER significantly suppressed the expression of COX-2, and the effects of PACER on cell proliferation and invasion were rescued by COX-2 overexpression. Furthermore, COX-2 activation by PACER was NF-κB-dependent. The regulation of PACER by CCCTC-binding factor (CTCF) was associated with DNA methylation status. Taken together, these findings suggest that PACER promotes proliferation and metastasis of osteosarcoma cells by activating the COX-2 gene and its own expression was influenced by DNA methylation.

Scientific publication in orthopedics journals from Chinese authors: a survey of 10-year survey of the literature.

PURPOSE: In the scientific community, a scientist's productivity is usually measured by his scientific output. The productivity of a group, an institution or, on a larger scale, a country can be assessed in similar manner. This study aims to show the contribution of Chinese authors to orthopedics research, from three major regions, namely Mainland China, Taiwan, and Hong Kong. METHODS: Articles published in 63 orthopedics journals originating from Mainland China, Taiwan, and Hong Kong from 2003 to 2012 were retrieved from the PubMed database and Journal Citation Report. Quantitative and qualitative analyses were conducted for the total number of articles, clinical trials, randomized controlled trails, case reports, impact factors (IF), citations, and articles published in high-impact journals. RESULTS: There were totally 3473 articles from Mainland China (1859), Taiwan (1111), and Hong Kong (503) from 2003 to 2012, showing gradual increase from 2003 to 2012. From 2006 onward, the number of published articles from Mainland China exceeded that from Hong Kong and exceeded that from Taiwan in 2008. The accumulated IF of articles from Mainland China (3746.21) was higher than that from Taiwan (2466.74) and that from Hong Kong (1089.35). However, Taiwan witnessed the highest mean IF (2.22), followed by Hong Kong (2.17), and Mainland China (2.02). Hong Kong displayed the highest mean citations of each article (9.35), followed by Taiwan (9.12), and Mainland China (5.71). By contract, Spine was the most popular journal to choose in these three regions. CONCLUSIONS: The total number of orthopedics articles in China increased markedly from 2003 to 2012. Of the three regions, Mainland China published the most articles, clinical trials, randomized controlled trails, and case reports. In general, Spine was the most popular journal to choose in the three regions.

En bloc resection for treatment of tumor-induced osteomalacia: a case presentation and a systematic review.

BACKGROUND: Tumor-induced osteomalacia (TIO) is a rare disorder, which is commonly found in craniofacial locations and in the extremities. To the best of our knowledge, only 16 cases have been described in the spine, and this is the first report to describe a case of patient with TIO in the thoracic spine combined with a mesenchymal hamartoma which had confused the therapeutic strategies to date. CASE DESCRIPTION: We report the case of a 60-year-old patient with hypophosphatemia and presented with limb weakness. Treating with phosphate did not correct the hypophosphatemia and an (111)In pentetreotide scintigraphy (octreotide scan) revealed an increased uptake at the right forearm. The tumor was resected totally, and the histopathology revealed a mesenchymal hamartoma, but we noticed that hypophosphatemia was not corrected after the tumor resection. Then a whole-body magnetic resonance imaging (WB-MRI) was performed and the results revealed tumorous tissues at the right T1 vertebral pedicle. The tumor was removed with an en bloc method, and the pathology showed phosphaturic mesenchymal tumor. Follow-up at 1 year after surgery revealed no recurrence, and the serum phosphorus level of the patient was normal. CONCLUSIONS: Tumor-induced osteomalacia is exceedingly rare with only 16 cases in spine published in the literature. It is difficult to find and leads to years of suffering debilitating complications. In this regard, the WB-MRI is a better method to locate the real tumor. Treating with phosphate can only relieve symptoms, and a complete surgical removal remains the gold standard treatment.

The valuation of using FDG PET-CT in detecting osteoid osteoma of the cervical spine.

STUDY DESIGN: Osteoid osteomas (OOs) are bone tumors that rarely occur in the cervical spine. The current study is a retrospective analysis on 10 patients who were diagnosed with this rare spinal bone tumor. We have excised OOs of the cervical spine with the use of FDG Positron emission tomography-computed tomography (PET-CT) for preoperative diagnosis. OBJECTIVE: With the help of the FDG PET-CT, we can confidently remove the nidus of the OOs, while minimize iatrogenic injury of the surrounding normal bone elements, and preserve the stability of the cervical spine. SUMMARY OF BACKGROUND DATA: OO of the cervical spine is frequently located at the nerve root adjacent to the vertebral artery, spinal cord. PET-CT is a sensitive tool with applications in the detection of bone lesions, especially in patients with difficult diagnosis or continuing misdiagnosis of tumors. MATERIALS AND METHODS: Ten patients (8 male and 2 female patients) underwent surgery for tumor removal using PET-CT in our department. Various diagnostic imaging modalities including x-ray, magnetic resonance imaging, CT, bone scintigraphy, and PET-CT were used. PET-CT scan results were measured using standard uptake value. (The size of the cases series was from 4×5 mm to 12×15 mm.) Pain was evaluated using the visual analogue score. Clinical outcome was evaluated immediately postoperatively and at a mean follow-up of 49.8±0.2 months (range, 7-92 mo). RESULTS: All tumors were successfully diagnosed with the use of PET-CT. The average standard uptake value was 2.7±0.1 (range, 2.0-3.4). The nidus of the OO was detected and removed, and the peripheral elements were preserved. The visual analogue score was 8.1±0.1 preoperation, and it significantly decreased to 2.5±0.3 (P<0.01) postoperation and 0.2±0.1 (P<0.01) at the final visit. Immediately after surgery, the patients were relieved of their pain symptoms. There was no injury of the vertebral artery, leakage of cerebrospinal fluid, infectious complications, and neurological injury during the procedure. CONCLUSIONS: It is valuable of using of PET-CT to diagnose OOs of the cervical vertebra. Subsequently, it is a good way that helps us in efficient removal of the OOs completely.

One-stage Posterior Approach in the Treatment of Consecutive Multi-segment Thoracic Tuberculosis with Kyphosis.

AIM: To evaluate the clinical efficacy of the one-stage posterior approach in treating consecutive multiple-segment thoracic tuberculosis with kyphosis. MATERIAL AND METHODS: A retrospective study was performed. The data of 22 patients with consecutive multi-level thoracic tuberculosis and kyphosis who underwent the one-stage posterior approach of debridement, bone grafting, drainage and pedicle screws fixation were collected. The kyphotic angle was 61.6°±3.1° pre-operatively. The neurologic status based on American Spinal Injury Association (ASIA) scoring was A in 5 cases, B in 4 cases, C in 9 cases, D in 3 cases and E in 1 case. RESULTS: The average follow-up period was 43.4±5.0 months. The kyphotic angle was 19.8°±0.7° after operation (p < 0.01), and 21.9°±1.2° at the last visit (p < 0.01). No neurological deterioration was observed in any patients after surgery. A significant difference in ASIA score was detected when the state before the operation and at the last visit was compared (p < 0.01). There was no recurrent paravertebral abscess of thoracic tuberculosis in any of these cases. CONCLUSION: The one-stage posterior approach of debridement and drainage is a feasible surgical option for consecutive multisegment thoracic tuberculosis with kyphosis. It can achieve debridement, decompression, and stabilization simultaneously.

[Operative strategy of the thoracolumbar fracture dislocation].

OBJECTIVE: To explore the operative strategy and clinical outcome of the thoracolumbar fracture dislocation. METHODS: Forty-two patients with the thoracolumbar fracture dislocation were treated with anterior approach (10 patients), posterior approach (28 patients), and anterior combined with posterior approach (4 patients) in order to construct the stabilities of the spine. The ASIA grades were used to evaluate the recovery of the neurological function, and the improvement of the kyphosis deformities was evaluated by the cobb's angle post-operation. RESULTS: All the patients had no complications of injury in the vascular and neurological system. The ASIA grades after the operation were superior to those of pre-operation, and the cobb's angle was rectified distinctly. CONCLUSION: When appropriate operative strategies are adopted, thoracolumbar fracture dislocation can be treated with satisfactory outcome.

[Pedicle screws in the posterior reconstructive operation of the lower cervical vertebra].

OBJECTIVE: To explore the efficiency of the cervical pedicle screws in the posterior reconstructive operation of the lower cervical diseases. METHODS: From November 2001 to July 2003, 31 patients suffering from the lower cervical diseases were treated with the posterior pedicle screws fixation. We put the screws in the inferior articular process of the upper centrum, the lateral of the intervertebral facet center (3 - 5 mm the medial edge of lateral mass). The angles of toe-in sagittal plane varied from 30 degrees to 45 degrees, and the screws were from 18 to 26 mm (22.3 mm) in average. RESULTS: There were 193 pedicle screws in this group, and no one had spinal cord injury or vertebral artery injury. The improvement rate was 84.5%. Follow-up was from 9 to 28 months (17 months in average). The screws were fixed properly without being loose and broken, and the bone graft fusions within 9 to 12 months in the X-ray and CT scan examination were satisfactory. The Japanese orthopaedics association score (JOA) was 9.7 preoperatively, but it was raised to 16.3 postoperatively. CONCLUSION: The posterior reconstructive operation with cervical pedicle screws is a good choice for patients with lower cervical diseases.

The Correlation Study of C5 Nerve Root Palsy and Common Body Position in Posterior Total Laminectomy Decompression and Instrumentation.

AIM: To compare both the clinical characteristics and incidence of postoperative cervical nerve root palsy in cervical spondylosis patients treated by posterior total laminectomy, decompression and instrumentation with two different common body positions, traction bed and plaster bed. MATERIAL AND METHODS: One hundred and thirty-three patients, with a mean age of 49.5 years suffering from multilevel cervical spondylosis and treated by laminectomy from 2007 to 2009, were reviewed. RESULTS: Overall 30 of 133 (22.56%) patients had C5 palsy, of which 14 (19.44%) out of 72 patients were in the plaster bed group, while 16 of 61 (26.23%) patients were in the traction bed group. The difference was statistically significant (P < 0.05). CONCLUSION: The cervical curvature index (CCI) reflected both the change of cervical height and the change of the overall cervical curvature. CCI was related with the incidence of C5 nerve root palsy postoperatively. The patients in the traction bed group had a higher nerve root palsy rate and change in cervical alignment because of over traction.

[Cervical pedicle screw in the treatment of cervical fracture complicating ankylosing spondylitis].

OBJECTIVE: To determine the effect of cervical pedicle screw in the treatment of cervical fracture complicating ankylosing spondylitis. METHODS: A retrospective study was done in 5 patients of cervical fracture complicating ankylosing spondylitis who were treated with cervical pedicle screw. According to Frankel's standard, 1 patient was in Grade A, 2 patients in Grade B and 1 patient in Grade C and 1 patient in Grade D. All patients were treated with decompression, fusion and posterior fixation with cervical pedicle screw. RESULTS: The average bony healing time was 3.6 months (3.1 to approximately 4.5 months). The instrumentation was not loose, pulled-out or ruptured. Only one C6 pedide was perforated and the vertebral artery was broken, but there was no new postoperative symptom. Three of the patients with neurological deficits improved postoperatively but the other two who were in Grade A were remained unchanged. CONCLUSION: The good biomechanical characteristics of cervical pedicle screw help the successful treatment in the application of cervical fracture complicating ankylosing spondylitis.

Embolization in the treatment of an intraosseous glomus tumor in the upper thoracic spine complicating compression myelopathy: a case report and a literature review.

Glomus tumors are very infrequent in the spine. The lesions can grow intraosseously along the entire spinal axis. A single female presenting with back pain from the upper thoracic spine is reported on. Removal of this lesion may require reconstruction of the anterior column with posterior fixation resulting in significant blood loss. The current report describes an embolization procedure prior to removal in order to reduce the significant blood loss that occurs with removal of this lesion, and summarizes the clinical and pathological characteristics of this rare tumor. A single, recent case and removal of an intraosseous tumor arising from the upper thoracic vertebra of T2-T4 is described. A 45-year-old female presenting with symptoms secondary to a glomus tumor of the upper thoracic vertebra of T2-T4 underwent resection of the lesion followed by reconstruction of the anterior column following preoperative emobolization. She had neurological symptoms for 3 years, and an irregular crescent-shaped lesion was seen going through the foramen at T3 to the chest cavity in the MRI scans. The operation was performed with a posterior approach in a single stage. The use of preoperative embolization of the T2-T4 segmental arteries resulted in significantly less blood loss as compared to without an embolization procedure. It was confirmed by histopathological examination that the glomus tumor rose from the smooth muscle cells in the right paravertebral muscles of T2. The glomus tumor has not recurred in the MRI during the five-year follow-up. Intraosseous glomus tumors are rare lesions that may extend into the epidural space and through the neural foramina and chest compartments resulting in neurological compromise. Over time, they may grow very large. Radiotherapy can be useful for eradication of this rare lesion. However, it can reoccur requiring extensive surgery resulting in significant blood loss. Preoperative embolization results in a reduction of blood loss and can be a very useful technique when performing the resection of large lesions suspected to be glomus tumors.