miRNA-296-5p functions as a potential tumor suppressor in human osteosarcoma by targeting SND1.

BACKGROUND: The pathogenesis of osteosarcoma (OS) is still unclear, and it is still necessary to find new targets and drugs for anti-OS. This study aimed to investigate the role and mechanism of the anti-OS effects of miR-296-5p. METHODS: We measured the expression of miR-296-5p in human OS cell lines and tissues. The effect of miR-296-5p and its target gene staphylococcal nuclease and tudor domain containing 1 on proliferation, migration, and invasion of human OS lines was examined. The Student's t test was used for statistical analysis. RESULTS: We found that microRNA (miR)-296-5p was significantly downregulated in OS cell lines and tissues (control vs. OS, 1.802 ±â€Š0.313 vs. 0.618 ±â€Š0.235, t = 6.402, P < 0.01). Overexpression of miR-296-5p suppressed proliferation, migration, and invasion of OA cells. SND1 was identified as a target of miR-296-5p by bioinformatic analysis and dual-luciferase reporter assay. Overexpression of SND1 abrogated the effects induced by miR-296-5p upregulation (miRNA-296-5p vs. miRNA-296-5p + SND1, 0.294 ±â€Š0.159 vs. 2.300 ±â€Š0.277, t = 12.68, P = 0.003). CONCLUSION: Our study indicates that miR-296-5p may function as a tumor suppressor by targeting SND1 in OS.

[Clinical application of percutaneous transforaminal endoscope-assisted lumbar interbody fusion].

OBJECTIVE: To conclude of the technical notes of percutaneous transforaminal endoscope-assisted lumbar interbody fusion (PT-Endo-LIF), and to investigate its safety and efficacy for treatment of degenerative lumbar disease. METHODS: Twenty-four patients were treated by PT-Endo-LIF combined with posterior percutaneous pedicle screws fixation from October 2017 to April 2018. There were 16 males and 8 females, ranging in age from 39 to 72 years old, with a mean of (59.6±9.5) years old. There were 15 cases diagnosed with lumbar intervertebral disc herniation combined with degenerative disc, the other 9 cases were diagnosed as low level lumbar spondylolistheses w/o segmental instability. Single segmental fusion was performed for 22 cases(one for L2,3, 3 for L3,4 and 18 for L4,5) and 2 segmental fusion was performed for the other 2 cases (both for L3,4 and L4,5). PT-Endo-LIF was performed under local anesthesia with conscious sedation, followed by decompression through endoscopic technics. After that, end-plate preparation and autogenous bone and expandable cage implantation were performed. Finally, percutaneous screws and rod instrumentation were used. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. The operation time, intraoperative bleeding volume, intraoperative and postoperative complications were recorded. All patients underwent X-ray, CT plain scan, three-dimensional reconstruction and MRI examination to evaluate the stability of the implants and fusion rate before 3 days and 1, 3, 6, 12 and 18 months after operation. RESULTS: All patients were followed up, and the duration ranged from 12 to 18 months. The operation time of single-segment fusion was (192.3±22.7) min, and that of double-segment fusion was (272.5±24.7) min. The estimated intraoperative bleeding volume was less than 50 ml per segment, and no blood transfusion was performed in all patients. The VAS improved from preoperative 7.4±1.1 to postoperative 2.3±0.8 (t=-19.65, P<0.000 5). The ODI improved from preoperative (41.2±3.3)% to the final follow-up (12.3±2.5)%(t=-35.76, P<0.000 5). Postoperative complications occurred in 4 cases, and contralateral radicular symptoms occurred in 2 cases. After contralateral foraminoscopic decompression, the symptoms were completely alleviated. One case had neurological symptoms related to percutaneous screw placement, and the symptoms were alleviated after removal of the lateral screw rod internal fixation. The other cases had surgical incision infection and improved after debridement and suture. At the latest follow-up, no displacement or loosening of the fusion cage and screw rod system occurred in all patients, and 14 cases showed signs of fusion. CONCLUSIONS: PT-Endo-LIF is a minimal invasive, safe and efficient surgical procedure for treatment of degenerative lumbar disease. Nevertheless, the long-term results still need to be confirmed by a multi-center and lagre sample follow-up study.

Perforation of Gastric Wall by Polymethylmethacrylate after Percutaneous Kyphoplasty: Case Report and Literature Review.

Kyphoplasty is a minimal invasive technique with a low rate of complications. To the best of our knowledge, perforation of gastric wall following kyphoplasty has not been described yet. We present a case that was operated for radical resection of esophageal carcinoma eleven years ago and who underwent kyphoplasty after a recent sixth and seventh thoracic vertebral fracture was diagnosed. Afterwards, the patient complained of dysphagia and fever. His laboratory results showed signs of inflammation. Gastroscopy showed a foreign body in the stomach. Plain radiography, computed tomography scan and positron emission computed tomography confirmed the diagnosis of perforation of the gastric wall by polymethylmethacrylate. Despite adequate antibiotic treatment, the patient died from septic multiple organ failure. Indication for kyphoplasty in patients with any history of thoracic surgery should be scrutinized rigorously. Although this kind of complication may be relatively rare, awareness of this condition will improve our response to avoid any delay in making the correct diagnosis and providing specific treatment.

[Case-control study on Zero-profile implant for anterior cervical discectomy and fusion and conventional cage plate internal fixation for the treatment of single segmental cervical intervertebral disc herniation].

OBJECTIVE: To compare clinical efficacy of Zero-profile implant for anterior cervical discectomy and fusion and conventional titanium plate with cage internal fixation for the treatment of single segmental cervical intervertebral disc herniation. METHODS: From August 2011 to March 2014, clinical data of 139 patients with single cervical disc herniation treated with anterior cervical discectomy and interbody fusion with internal fixation were retrospectively analyzed. The patients were divided into two groups according to its operation method. There were 63 patients in group A which performed anterior discectomy and interbody fusion with Zero-profile;76 patients in group B which performed anterior cervical discectomy and cage plate internal fixation. JOA score and Odom functional rating between two groups were compared before and after operation. Videofluorographic swallowing study (VFSS) were used to evaluate thickness of prevertebral soft tissue. Bazaz dysphagia score were used to assess incidence of dysphagia. Postoperative AP X-ray and CT of cervical vertebra at 12 months were applied for evaluating bone graft fusion. Postoperative MRI was applied for evaluating the incidence of adjacent segment degeneration. Blood loss,operative time, preoperative and postoperative JOA score, Odom functional rating and VFSS score, Bazaz score, fusion rate between vertebral bodies and incidence of adjacent segment degeneration were compared between two groups. RESULTS: There were no statistical meaning between two groups in JOA score, Odom functional rating before and after operation (P > 0.05); and no significant meaning in VFSS score between two groups before operation (P > 0.05); There were no significant difference in operative time and blood loss. There was statistical meaning in VFSS, Bazaz dysphagia score at 2 days, and 6 months after operation (P < 0.05). All patients obtained bone union at 1 year after operation, and no obvious meaning in fusion rate (P > 0.05). Eight patients (12.7%) in group A occurred adjacent segment degeneration and 19 patients (25%) in group B occurred adjacent segment degeneration, and there was significant meaning between two groups (P < 0.05). CONCLUSION: Both of Zero-profile implant for anterior cervical discectomy and fusion and conventional cage internal fixation for the treatment of single segmental cervical intervertebral disc herniation could obtain satisfied clinical results. While Zero-profile implant for anterior cervical discectomy and fusion has advantages of lower incidence of adjacent segment degeneration, and its mid and long term following-up results still further observation.

MicroRNA-191 promotes osteosarcoma cells proliferation by targeting checkpoint kinase 2.

MicroRNAs (miRNAs) are small noncoding RNAs of 19-25 nt that can regulate gene expression at a posttranscriptional level. Increasing evidence indicates that miRNAs participate in almost every step of cellular processes and are often aberrantly expressed in human cancer. The aim of this study was to investigate the functional significance of miR-191 and to identify its possible target genes in osteosarcoma cells. Here, we found that the expression level of miR-191 was increased in osteosarcoma tissues in comparison with the adjacent normal tissues. The enforced expression of miR-191 was able to promote cell proliferation in Saos-2 and MG62 cells, while miR-191 antisense oligonucleotides blocked cell proliferation. At the molecular level, our results further revealed that expression of tumor suppressor gene, checkpoint kinase 2, was negatively regulated by miR-191. Therefore, we consider that miR-191 act as an onco-MicroRNA for osteosarcoma and it would offer a new way in molecular targeting cancer treatment.

[Zero-profile implant for anterior cervical discectomy and fusion in treating single cervical disc herniation].

OBJECTIVE: To explore the efficacy and safety of zero-profile implant for anterior cervical discectomy and fusion (ACDF) in treating single cervical disc herniation. METHODS: From August 2011 to June 2012,30 patients with single cervical disc herniation were treated with ACDF using zero-profile implant in one motion segment. There were 18 males and 12 females with a mean age of 55.3 years old (ranged, 36 to 68). Incidence of dysphagia, height of intervertebral space and condition of bone fusion were observed after operation. Spinal nerves function and clinical results were assessed according to Japanese Orthopaedic Association (JOA) score, Odom criteria. RESULTS: All patients were followed up from 12 to 24 months with an average of 15.9 months. The mean intraoperative blood loss was (85.3 +/- 14.2) ml (70 to 120 ml) and operative time was (90.0 +/- 12.8) min (70 to 120 ml). Preoperative, postoperative at 3 months and 1 year, JOA score was 8.72 +/- 2.36 (5.0 to 13.0), 14.72 +/- 1.66 (11.5 to 17.0) and 15.65 +/- 1.03 (13.5 to 17.0), respectively. One year after operation, according Odom criteria to assess, 22 cases got excellent results, 7 good, 1 fair. All dysphagiaes vanished completely at 3 months after operation. The lost height of intervertebral space was (0.34 +/- 0.13) mm (0.1 to 0.6 mm) and (0.39 +/- 0.15) mm (0.2 to 0.7 mm) at 3, 12 months after operation, respectively. All patients obtained bone fusion at 1 year after operation. CONCLUSION: The zero-profile implant is a valid alternative to anterior cervical plate in treating single cervical disc herniation with ACDF, it has advantages of convenient procedure, satisfactory effect, lower incidence of postoperative dysphagia, reliable stability and less implant-related complications.

[Single midline posterior approach for 360 degree decompression and internal fixation with interbody bone graft fusion for severe thoracolumbar spinal fractures].

OBJECTIVE: To discuss the safety and effectiveness of the single midline posterior approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for treatment severe thoracolumbar spinal fractures accompanied with spinal compression. METHODS: From January 2009 to March 2010,5 consecutive cases with severe thoracolumbar spinal fracture of totally 108 spinal fracture cases underwent a single midline posterior approach surgery. There were 2 males and 3 females,aged from 23 to 72 years old. Two cases had both T12 and L1 fractures, and 1 case had L1 fracture. The length of the surgical procedure, estimated intra-operative blood loss, VAS score and dosages of morphine at the first 24 hours after operation, the peri-operative complications were recorded. RESULTS: Five patients were follow-up from 12 to 18 months with an average of 14.6 months. The operative time was 3.1 to 6.2 hours. The blood loss was 1 000 to 2 300 ml. VAS score at the first post-operative 24 hours was 1 to 4. The dosage of morphine of the first post-operative 24 hours was 28.8 to 30.8 mg. The preoperative Frankel/ASIA grade was grade B in 1 case, C in 2 cases, D in 1 case and E in 1 case, the post-operative Frankel/ASIA grade was E in 4 cases and D in case. No serious peri-operative complications were found. CONCLUSION: The single midline posterior approach is a safe and effective surgical approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for severe thoracolumbar spinal fractures with less post-operative pains and complications.

[Surgical treatment of ossification of ligamentum flavum in thoracic spine and its therapeutic effect analysis].

OBJECTIVE: To explore the correlation between CT classification and operative method and to discuss its therapeutic effect. METHODS: From January of 2001 to June of 2010, 30 patients with thoracic ossification of ligamentum flavum were reviewed retrospectively, including 22 males and 8 females with an average age of 52.8 years old (ranged from 37 to 68 years old). The course of duration ranged from 2 months to 6 years. Single segment lesion was in 11 cases and multiple segments were in 19 cases. Two patients were accompanied by cervical ossification of ligamentum flavum and 1 was accompanied by ossification of posterior longitudinal ligament. The ossified lesions were located at T1,2 to T4,5 in 5 cases,T5,6 to T8,9 in 7 cases, T9,10 to T11,12 in 12 cases, at the upper and middle thoracic levels in 2 cases, at the middle and lower thoracic levels in 4 cases. They were divided into 2 types according to the morphologic features of the CT scan:simple type, 18 segments with lateral, slice or unfused type; complex type, 42 segments with thickened, fused or nodular type. The clinical manifestation was paralysis of upper motor neuron in 21 cases, and of upper and lower motor neuron in other 9 cases. Sphincter dysfunction was found in 26 cases. Preoperative JOA sphincter function score was 1.97 +/- 0.56. Preoperative modified JOA motor function score of lower limb was 1.20 +/- 0.76. Different surgical procedure was applied to one of the 2 types. For the simple type, an en bloc laminectomy was performed. However,for the complex type, a laminar shelling decompression was done. Laminectomy combined with internal fixation and lateral fusion was performed in patients whose decompressive areas were wider. RESULTS: The mean decompression length was 3.1 lamina (2 to 6 lamina). Cerebrospinal fluid leakage was found in 3 cases and hematoma in incision was found in 1 case. The mean follow-up duration was 26 months (12 to 96 months). Twenty-two patients with the feel of constriction of trunk or lower limbs were completely recovered; 18 cases with sensation disturbance, numbness and pain of the lower limb were totally recovered, and relived in 10 cases. Postoperative JOA sphincter function score was 2.73 +/- 0.45, comparing with the preoperative score, and the difference was significant (P < 0.01). Postoperative JOA motor function score was 3.57 +/- 0.77, comparing with the preoperative score, and the difference was significant (P < 0.01 ). The lower limb function relief rate was 86.1%, 24 patients got an excellent results, 3 good, 2 poor and 1 bad. CONCLUSION: Different surgical procedures will be safely and effectively applied to treat thoracic ossification of ligamentum flavum according to CT classification.

[Anterior-posterior operation with posteriorly limited fixation for the irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking].

OBJECTIVE: To investigate the clinical outcome and application value of single stage circumferential surgery for irreducible old dislocation of the inferior cervical vertebra combined with tiny joint interlocking. METHODS: From Mar. 2004 to Aug. 2010,18 patients with old dislocation of the inferior cervical vertebra, in which 16 showed double joint interlocking and the others 2 showed single by the three dimensional CT scan. MRI showed that all patients had intervertebral disc injury including intervertebral disc rupture (9 cases), intervertebral disc herniation (2 cases) and the fracture of inferior cervical vertebra accompanying with intervertebral disc rupture (7 cases). All patients were treated with anterior-posterior operation with posteriorly limited fixation. Stability and fusion rate of injury segment were observe by X-ray and CT scan;function of spinal cord was assessed by Frankel grade criteria. RESULTS: All patients were followed up from 6 to 12 months with an average of 8.6 months. Dislocation of cervical vertebra got complete reduction and all grafts got fusion. There was no complication of internal fixation breakage, loosening ,displacement and there was no injury of blood vessel, nerve, esophagus during the operation. No function of spinal cord got worse after operation and the function improved by 1.2 grades in average in Frankel grade. CONCLUSION: Single stage circumferential surgery in treating irreducibly old dislocation of inferior cervical vertebra combined with tiny joint interlocking can complete recover the sequence of the cervical vertebra and relieve the compression of spinal cord and can obtain postoperative immediate stability for injury segment and will not aggravate the injury of the spinal cord and may create beneficial condition for functional recovery of the spinal cord.

[Retrospective study of comparing the different internal fixation methods in treating intertrochanteric fracture of femur].

OBJECTIVE: To investigate the selective strategy of the internal fixation methods in treating intertrochanteric femoral fracture by comparing the different methods. METHODS: Data of 326 cases of intertrochanteric femoral fractures treated with different internal fixation methods were concluded. One hundred and sixty-five cases were treated with the dynamic hip screws (DHS group), 78 male, 87 female, age 38 to 98 years. One hundred and three cases were treated with the anatomical plates of proximal femur (AP group), 48 male, 55 female, age 39 to 89 years. Fifty-eight cases were treated with the fixation expandable proximal femoral nails (PFN group), 31 male, 27 female, age 41 to 92 years. According to Evans classification of intertrochanteric femoral fractures, fractures were divided into type I, II, III, IV and retro-intertrochanteric type. The cases of each type of three groups were DHS(12, 35, 61, 42, 15); AP(9, 23, 38, 25, 8); PFN (6, 13, 21, 13,5). Data of each group was collected for statistical analysis on the following aspects: operation time,blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function and the total complications. RESULTS: The difference of operation time, blood loss, fluoroscopy exposures, drainage, clinical healing time of fracture, post-operative restored function were of statistical significance (P < 0.01). In comparing with group DHS and AP, group PFN was of less operation time, blood loss, drainage, clinical healing time of fracture, but more fluoroscopy exposures, and the post-operative restored function of group PFN was more satisfied. The difference of operative complications were of no statistical significance (P = 0.05). CONCLUSION: The fixation expandable proximal femoral nail is a good choice for intertrochanteric femoral fracture.