Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing.

PURPOSE: Application of AOSpine subaxial cervical spine injury classification system to explore the optimal surgical decompression timing for different types of traumatic cervical spinal cord injury (CSCI). METHODS: A single-center prospective cohort study was conducted that included patients with traumatic CSCIs (C3-C7) between February 2015 and October 2016. After enrollment, patients underwent either early (< 72 h after injury) or late (≥ 72 h after injury) decompressive surgery of the cervical spinal cord. Each group was divided into A0, A1-4, B, C/F4 and F1-3 subgroups. The primary outcomes were ordinal changes in the ASIA Impairment Scale (AIS) and the Spinal Cord Independence Measure III (SCIM version 3) at a 12-month follow-up. The secondary outcomes included length of hospital stay, postoperative neurological deterioration, other complications and mortality. RESULTS: A total of 402 patients were included. Of these, 187 patients underwent early decompression surgery, and 215 patients underwent delayed decompression surgery. Statistical results included the following comparisons of the early vs late groups: AIS improvement ≥ 1 grade (combined groups: P < 0.0001; A0: P = 0.554; A1-4: P = 0.084; B: P = 0.013; C/F4: P = 0.040; F1-3: P = 0.742); AIS improvement ≥ 2 grades, P = 0.003 for all groups; SCIM version 3 (combined groups: P < 0.0001; A0: P = 0.126; A1-4: P = 0.912; B: P = 0.006; C/F4: P = 0.111; F1-3: P = 0.875). CONCLUSION: Type A and F1-3 fractures are not required to undergo aggressive early decompression. Type B and type C/F4 fractures should receive early surgical treatment for better clinical outcomes. These slides can be retrieved under Electronic Supplementary Material.

Decompression for Traumatic Thoracic/Thoracolumbar Incomplete Spinal Cord Injury: Application of AO Spine Injury Classification System to Identify the Timing of Operation.

OBJECTIVE: Application of AO spine injury classification system (AOSICS) to identify the timing of operation for different types of traumatic thoracic/thoracolumbar incomplete spinal cord injury (SCI). METHODS: A single-center prospective cohort study was conducted to enroll patients with thoracic/thoracolumbar incomplete SCI from April 2013 to November 2016; they were divided into an early group (<24 hours after SCI) and a late group (24-72 hours after SCI). Each group was divided into A, B, C subgroups according to AOSICS. The primary outcomes were ordinal changes in ASIA Impairment Scale at 12-month follow-up. The secondary outcomes included the Medical outcomes study 36-term short form health survey physical component summary (PCS), complications, mortality, and hospital length of stay (LOS). RESULTS: Seven hundred twenty-one patients with thoracic/thoracolumbar incomplete SCI were included; 335 patients underwent early surgery, and 386 patients underwent delayed surgery. Statistical results included the following comparisons of the early versus late groups: AIS improvement of 1 grade or more (combined groups: P = 0.009, odds ratio [OR] = 1.487; A: P = 0.777, OR = 1.072; B: P = 0.029, OR = 1.701; C: P = 0.007, OR = 1.762), AIS improvement 2 grades or more (combined groups: P = 0.002, OR = 2.471; A: P = 0.189, OR = 3.939; B: P = 0.011, OR = 2.550; C: P = 0.035, OR = 3.964) and PCS (combined groups: P = 0.327; A: P = 0.776; B: P = 0.019; C: P = 0.562). LOS (combined groups: P < 0.0001; A, B and C: P < 0.0001). Complications (combined groups: P = 0.267; A: P = 0.830; B: P = 0.111; C: P = 0.757). CONCLUSIONS: Patients with type-A injuries with incomplete SCI do not have to undergo aggressive early operations. Patients with type-B and type-C injuries should undergo an operation early to achieve better clinical results.

Long Noncoding RNA CRNDE Promotes Multiple Myeloma Cell Growth by Suppressing miR-451.

It has been determined that long noncoding RNAs (lncRNAs) are identified as a potential regulatory factor in multiple tumors as well as multiple myeloma (MM). However, the role of colorectal neoplasia differentially expressed (CRNDE) in the pathogenesis of MM remains unclear. In this study, we found that the CRNDE expression level, in MM samples and cell lines, is higher than that in the control detected by real-time qPCR, which is also closely related to tumor progression and poor survival in MM patients. Knockdown of CRNDE significantly inhibits the proliferative vitality of MM cells (U266 and RPMI-8226), induces cell cycle arrest in the G0/G1 phase, and promotes apoptosis. After being transfected with siRNA, miR-451 expression observably increases. Bioinformatics analysis and luciferase assay reveal the interaction by complementary bonding between CRNDE and miR-451. Pearson's correlation shows that CRNDE is negatively correlated to miR-451 expression in human MM samples. Subsequently, miR-451 inhibitor rescues the inhibited tumorigenesis induced by CRNDE knockdown. Our study illustrates that lncRNA CRNDE induces the proliferation and antiapoptosis capability of MM by acting as a ceRNA or molecular sponge via negatively targeting miR-451, which could act as a novel diagnostic marker and therapeutic target for MM.