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BACKGROUND: Lumbar degenerative conditions are a major cause of back pain and disability in individuals aged 45 and above. Gait analysis utilizes sensor technology to collect movement data, aiding in the evaluation of various gait aspects like spatiotemporal parameters, joint angles, neuromuscular activity, and joint forces. It is widely used in conditions such as cerebral palsy and knee osteoarthritis. This research aims to assess the effectiveness of 3D gait analysis in evaluating surgical outcomes and postoperative rehabilitation for lumbar degenerative disorders. METHODS: A prospective self-controlled before-after study (n = 85) carried out at our Hospital (Sep 2018 - Dec 2021) utilized a 3D motion analysis system to analyze gait in patients with lumbar degenerative diseases. The study focused on the multifidus muscle, a crucial spinal muscle, during a minimally invasive lumbar interbody fusion surgery conducted by Shandong Weigao Pharmaceutical Co., Ltd. Pre- and postoperative assessments included time-distance parameters (gait speed, stride frequency, stride length, stance phase), hip flexion angle, and stride angle. Changes in 3D gait parameters post-surgery and during rehabilitation were examined. Pearson correlation coefficient was employed to assess relationships with the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Patient sagittal alignment was evaluated using "Surgimap" software from two types of lateral radiographs to obtain parameters like pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), intervertebral space height (DH), posterior height of the intervertebral space (PDH) at the operative segment, and anterior height of the intervertebral space (ADH). RESULTS: By the 6th week post-operation, significant improvements were observed in the VAS score, JOA score, and ODI score of the patients compared to preoperative values (P < 0.05), along with notable enhancements in 3D gait quantification parameters (P < 0.05). Pearson correlation analysis revealed a significant positive correlation between improvements in 3D gait quantification parameters and VAS score, JOA score, and ODI value (all P < 0.001). CONCLUSION: 3D gait analysis is a valuable tool for evaluating the efficacy of surgery and rehabilitation training in patients.
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Análisis de la Marcha , Vértebras Lumbares , Fusión Vertebral , Humanos , Masculino , Análisis de la Marcha/métodos , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Fusión Vertebral/rehabilitación , Anciano , Resultado del Tratamiento , Imagenología Tridimensional , Degeneración del Disco Intervertebral/cirugía , Dimensión del Dolor , Evaluación de la DiscapacidadRESUMEN
Putrescine and cadaverine are significant volatile indicators used to assess the degree of food spoilage. Herein, we propose a micro-nano multi cavity structure for surface-enhanced Raman spectroscopy (SERS) to analyze the volatile gas putrescine and cadaverine in decomposing food. The MoS2 nano-flowers are inserted into a PVDF micro-cavity through in-situ growth, followed by vacuum evaporation technology of Ag nanoparticles to form an Ag/MoS2 nano-flower cavity/PVDF micron-bowl cavity (FIB) substrate. The micro-nano multi cavity structure can improve the capture capacity of both light and gas, thereby exhibiting high sensitivity (EF = 7.71 × 107) and excellent capability for gas detection of 2-naphthalenethiol. The SERS detections of the putrescine and cadaverine are achieved in the spoiled pork samples with the FIB substrate. Therefore, this substrate can provide an efficient, accurate, and feasible method for the specific and quantitative detection in the food safety field.
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BACKGROUND CONTEXT: With the aging population, osteoporosis, which leads to poor fusion, has become a common challenge for lumbar surgery. In addition, most people with osteoporosis are elderly individuals with poor surgical tolerance, and poor bone quality can also weaken the stability of internal fixation. PURPOSE: This study compared the fixation strength of the bilateral traditional trajectory screw structure (TT-TT), the bilateral cortical bone trajectory screw structure (CBT-CBT), and the hybrid CBT-TT (CBT screws at the cranial level and TT screws at the caudal level) structure under different bone mineral density conditions. STUDY DESIGN: A finite element (FE) analysis study. METHODS: Above all, we established a healthy adult lumbar spine model. Second, under normal and osteoporotic conditions, three transforaminal lumbar interbody fusion (TLIF) models were established: bilateral traditional trajectory (TT-TT) screw fixation, bilateral cortical bone trajectory (CBT-CBT) screw fixation, and hybrid cortical bone trajectory screw and traditional trajectory screw (CBT-TT) fixation. Finally, a 500-N compression load with a torque of 10 N/m was applied to simulate flexion, extension, lateral bending, and axial rotation. We compared the range of motion (ROM), adjacent disc stress, cage stress, and posterior fixation stress of the different fusion models. RESULTS: Under different bone mineral density conditions, the range of motion of the fusion segment was significantly reduced. Compared to normal bone conditions, the ROM of the L4-L5 segment, the stress of the adjacent intervertebral disc, the surface stress of the cage, and the maximum stress of the posterior fixation system were all increased in osteoporosis. Under most loads, the ROM and surface stress of the cage and the maximum stress of the posterior fixation system of the TT-TT structure are the lowest under normal bone mineral density conditions. However, under osteoporotic conditions, the fixation strength of the CBT-CBT and CBT-TT structures are higher than that of the TT-TT structures under certain load conditions. At the same time, the surface stress of the intervertebral fusion cage and the maximum stress of the posterior fixation system for the two structures are lower than those of the TT-TT structure. CONCLUSION: Under normal bone mineral density conditions, transforaminal lumbar interbody fusion combined with TT-TT fixation provides the best biomechanictability. However, under osteoporotic conditions, CBT-CBT and CBT-TT structures have higher fixed strength compared to TT-TT structures. The hybrid CBT-TT structure exhibits advantages in minimal trauma and fixation strength. Therefore, this seems to be an alternative fixation method for patients with osteoporosis and degenerative spinal diseases. CLINICAL SIGNIFICANCE: This study provides biomechanical support for the clinical application of hybrid CBT-TT structure for osteoporotic patients undergoing TLIF surgery.
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Análisis de Elementos Finitos , Vértebras Lumbares , Osteoporosis , Fusión Vertebral , Humanos , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Vértebras Lumbares/cirugía , Osteoporosis/cirugía , Fenómenos Biomecánicos , Densidad Ósea , Adulto , Tornillos ÓseosRESUMEN
Nerve damage of spine areas is a common cause of disability and paralysis. The lumbosacral plexus segmentation from magnetic resonance imaging (MRI) scans plays an important role in many computer-aided diagnoses and surgery of spinal nerve lesions. Due to the complex structure and low contrast of the lumbosacral plexus, it is difficult to delineate the regions of edges accurately. To address this issue, we propose a Multi-Scale Edge Fusion Network (MSEF-Net) to fully enhance the edge feature in the encoder and adaptively fuse multi-scale features in the decoder. Specifically, to highlight the edge structure feature, we propose an edge feature fusion module (EFFM) by combining the Sobel operator edge detection and the edge-guided attention module (EAM), respectively. To adaptively fuse the multi-scale feature map in the decoder, we introduce an adaptive multi-scale fusion module (AMSF). Our proposed MSEF-Net method was evaluated on the collected spinal MRI dataset with 89 patients (a total of 2848 MR images). Experimental results demonstrate that our MSEF-Net is effective for lumbosacral plexus segmentation with MR images, when compared with several state-of-the-art segmentation methods.
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Plexo Lumbosacro , Imagen por Resonancia Magnética , Humanos , Plexo Lumbosacro/diagnóstico por imagen , Diagnóstico por Computador , Procesamiento de Imagen Asistido por ComputadorRESUMEN
BACKGROUND: We aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH. METHODS: This study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events. RESULTS: After surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups. CONCLUSION: Compared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.
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Discectomía Percutánea , Desplazamiento del Disco Intervertebral , Herida Quirúrgica , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Vértebras Lumbares/cirugía , Discectomía/efectos adversos , Discectomía/métodos , Endoscopía/métodos , Dolor/etiología , Herida Quirúrgica/etiología , Discectomía Percutánea/métodosRESUMEN
Poor visual field and limited submucosal space could obstruct endoscopic submucosal dissection (ESD) and increase the risk of complications. In this manuscript, we presented ESD assisted by water pressure method and magnifying endoscopy for a difficult case of early esophageal cancer.
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Aims: The differential diagnosis between ALK-negative anaplastic large cell lymphoma (ALK- ALCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) with high expression of CD30 (CD30high) are essential. However, no reliable biomarker is available in daily practice except CD30. STAT3 is characteristically activated in ALCL. We aimed to investigate whether the status of STAT3 phosphorylation could help the differential diagnosis. Methods: The status of phosphorylation of STAT3 was examined using two antibodies against pSTAT3-Y705 and pSTAT3-S727 by immunohistochemistry in ALK+ ALCL (n=33), ALK- ALCL (n=22) and PTCL, NOS (n=34). Ten PTCL, NOS with diffuse CD30 expression were defined as CD30high PTCL, NOS. Flowcytometric analysis were performed to evaluate the expression of pSTAT3-Y705/S727 in PTCL, NOS (n=3). Results: The median H-scores of pSTAT3-Y705 and S727 were 280 and 260 in ALK+ ALCL, 250 and 240 in ALK- ALCL, and 45 and 75 in CD30high subgroup, respectively. Using H score of 145 as the cutoff value, pSTAT3-S727 alone distinguished between ALK- ALCL and CD30high PTCL, NOS with a sensitivity of 100% and specificity of 83%. Additionally, pSTAT3-S727, but not pSTAT3-Y705, was also expressed by background tumor-infiltrating lymphocytes (S727TILs) in PTCL, NOS. PTCL, NOS patients with high S727TILs H score had a favorable prognosis than those with no TILs (3-year OS rate: 43% vs. 0, p=0.013) or low S727TILs (3-year OS rate: 43% vs. 0, p=0.099). Flowcytometric analysis revealed that of the three patients investigated, two had enhanced pSTAT-S727 signals in neoplastic cell populations, and all three patients were negative for pSTAT3-Y705 expression in both tumor cells and background lymphocytes. Conclusions: pSTAT3-Y705/S727 can be used to help distinguish ALK- ALCL from CD30high PTCL, NOS and pSTAT3-S727 expression by TILs predicts the prognosis of a subset of PTCL, NOS.
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Linfoma de Células T Periférico , Humanos , Biomarcadores , Linfocitos Infiltrantes de Tumor , Anticuerpos , Proteínas Tirosina Quinasas Receptoras , Factor de Transcripción STAT3RESUMEN
BACKGROUND: Necroptosis and pyroptosis, two types of proinflammatory programmed cell death, were recently found to play important roles in spinal cord injury (SCI). Moreover, cyclic helix B peptide (CHBP) was designed to maintain erythropoietin (EPO) activity and protect tissue against the adverse effects of EPO. However, the protective mechanism of CHBP following SCI is still unknown. This research explored the necroptosis- and pyroptosis-related mechanism underlying the neuroprotective effect of CHBP after SCI. METHODS: Gene Expression Omnibus (GEO) datasets and RNA sequencing were used to identify the molecular mechanisms of CHBP for SCI. A mouse model of contusion SCI was constructed, and HE staining, Nissl staining, Masson staining, footprint analysis and the Basso Mouse Scale (BMS) were applied for histological and behavioural analyses. qPCR, Western blot analysis, immunoprecipitation and immunofluorescence were utilized to analyse the levels of necroptosis, pyroptosis, autophagy and molecules associated with the AMPK signalling pathway. RESULTS: The results revealed that CHBP significantly improved functional restoration, elevated autophagy, suppressed pyroptosis, and mitigated necroptosis after SCI. 3-Methyladenine (3-MA), an autophagy inhibitor, attenuated these beneficial effects of CHBP. Furthermore, CHBP-triggered elevation of autophagy was mediated by the dephosphorylation and nuclear translocation of TFEB, and this effect was due to stimulation of the AMPK-FOXO3a-SPK2-CARM1 and AMPK-mTOR signalling pathways. CONCLUSION: CHBP acts as a powerful regulator of autophagy that improves functional recovery by alleviating proinflammatory cell death after SCI and thus might be a prospective therapeutic agent for clinical application.
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Péptidos Cíclicos , Traumatismos de la Médula Espinal , Ratones , Animales , Péptidos Cíclicos/farmacología , Péptidos Cíclicos/uso terapéutico , Proteínas Quinasas Activadas por AMP/metabolismo , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/genética , Traumatismos de la Médula Espinal/metabolismo , Apoptosis , Transducción de Señal , AutofagiaRESUMEN
Although the fabrication of controllable three-dimensional (3D) microstructures on substrates has been proposed as an effective solution for SERS, there remains a gap in the detection and manufacturability of 3D substrates with high performance. In this study, photolithography is adopted to obtain a pyramid-like array on a patterned sapphire substrate (PSS), with Al2O3 as the dielectric layer. In addition, silver nanoparticles (AgNPs) are used to decorate Au films to obtain mass-producible 3D SRES substrates. In the case of low fluorescence, the substrate realizes the coupling of localized surface plasmon polaritons (LSPs) and surface plasmon polaritons (SPPs), which is consistent with the simulation results obtained using the finite element method. The performance of the SERS substrate is evaluated using rhodamine 6G (R6G) and toluidine blue (TB) as probe molecules with detection limits of 10-11 M and 10-9 M, respectively. The substrate exhibits high hydrophobicity and excellent light-capturing capability. Moreover, it shows self-cleaning ability and long-term stability in practical applications. Allowing for the consistency of the composite substrate in the preparation process and the high reproducibility of the test results, it is considered to be promising for mass production.
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Low-Dose Computed Tomography (LDCT) technique, which reduces the radiation harm to human bodies, is now attracting increasing interest in the medical imaging field. As the image quality is degraded by low dose radiation, LDCT exams require specialized reconstruction methods or denoising algorithms. However, most of the recent effective methods overlook the inner-structure of the original projection data (sinogram) which limits their denoising ability. The inner-structure of the sinogram represents special characteristics of the data in the sinogram domain. By maintaining this structure while denoising, the noise can be obviously restrained. Therefore, we propose an LDCT denoising network namely Sinogram Inner-Structure Transformer (SIST) to reduce the noise by utilizing the inner-structure in the sinogram domain. Specifically, we study the CT imaging mechanism and statistical characteristics of sinogram to design the sinogram inner-structure loss including the global and local inner-structure for restoring high-quality CT images. Besides, we propose a sinogram transformer module to better extract sinogram features. The transformer architecture using a self-attention mechanism can exploit interrelations between projections of different view angles, which achieves an outstanding performance in sinogram denoising. Furthermore, in order to improve the performance in the image domain, we propose the image reconstruction module to complementarily denoise both in the sinogram and image domain.
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Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada por Rayos X , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Algoritmos , EndoscopíaAsunto(s)
Humanos , Masculino , Adulto , Resección Endoscópica de la Mucosa , Presión Hidrostática , Endoscopía , Neoplasias EsofágicasRESUMEN
BACKGROUND: Morton's neuroma is a painful enlargement of the plantar digital nerve between the metatarsal heads that causes pain of the forefoot. Several approaches have been used to treat Morton's neuroma, each of them having distinct advantages and disadvantages. OBJECTIVES: The purpose of this study was to investigate and compare the clinical outcomes of neurectomy in the treatment of Morton's neuroma through plantar and dorsal approaches. MATERIALS AND METHODS: A total of 20 patients with a mean age of 48.5 ± 13.0 years (range: 19-66 years) who underwent excision of a Morton's neuroma that did not respond to conservative treatment were retrospectively analysed from June 2014 to June 2021. All the neurectomies were performed using a plantar or dorsal approach. Outcomes were evaluated using visual analogue scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, the Foot and Ankle Ability Measure (FAAM), and complications. The appearance index (AI) was also used to assess the influence of foot appearance on the quality of life after surgery. RESULTS: Eight patients underwent neurectomy by the dorsal approach, and 12 patients underwent neurectomy by the plantar approach. The average follow-up time was 28.9 ± 12.9 months (range: 15-72 months). No statistically significant difference was found between the dorsal and plantar approach groups with respect to postoperative pain measured by the VAS score. The postoperative AOFAS scores and FAAM outcomes were not significantly different between the groups. The complications reported in the dorsal approach group were significantly less than those of the plantar group, mainly discomfort in wearing shoes. The AI of the plantar group and the dorsal group were significantly different. CONCLUSION: The excision of the Morton's neuroma by both the dorsal and plantar approach resulted in satisfactory outcomes. However, the foot appearance after surgery by the plantar approach had less influence on the quality of life than that using the dorsal approach. Our recommendation is that surgeons should choose the approach they are most familiar with and with which they are most confident in performing. In addition, the plantar approach is recommended if the patient needs a better appearance.
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Huesos Metatarsianos , Neuroma de Morton , Adulto , Humanos , Huesos Metatarsianos/cirugía , Persona de Mediana Edad , Neuroma de Morton/diagnóstico por imagen , Neuroma de Morton/cirugía , Dolor Postoperatorio , Calidad de Vida , Estudios RetrospectivosRESUMEN
Accurate segmentation of the lumbosacral plexus is a crucial step for diagnosis and analysis of nerve damage in clinical. Due to the extremely low contrast and complicated structure around the lumbosacral plexus, it has been remaining a challenging task to effectively segment the lumbosacral plexus from spinal MR images. Even though several deep learning methods for spine segmentation have been developed, most of them only pay attention to the segmentation of vertebral bodies and intervertebral discs rather than nerves. To solve these problems, in this paper, we propose a residual-atrous attention network (RA2-Net) for lumbosacral plexus segmentation with MR images. Specifically, the RA2-Net consists of three main parts, (1) the atrous encoder module is employed to learn multi-scale contextual features from MR images in the encoder, (2) the residual skip connection operation is used to integrate the features with high-resolution spatial details in the encoder and the high-level contextual features in the decoder, and (3) the scale attention block is proposed for fusing the multi-scale high-level features in the decoder. We perform our proposed RA2-Net for the lumbosacral plexus segmentation on the collected spinal MRI dataset with 10 patients (a total of 236 MRI scans). Extensive experiments demonstrate that our RA2-Net achieves better performance in lumbosacral plexus segmentation with MR images when compared with several state-of-the-art methods.
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Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Plexo Lumbosacro/diagnóstico por imagen , Imagen por Resonancia Magnética/métodosRESUMEN
Osteoporosis is a common bone disease in the elderly with high morbidity and mortality. Previous studies have shown ROS-revulsive osteoblast apoptosis to be involved in the pathogenesis of osteoporosis. At present, a research hotspot exists on the topic of the ROS-targeted clinical treatment of osteoporosis. TC-G 1008, a potent and selective GPR39 agonist, exerts a conspicuous influence on a myriad of cellular processes, ranging from cellular redox status, to gene expression, to cell apoptosis. However, the underlying mechanism by which TC-G 1008 regulates osteoblast function under oxidative stress has not yet been elucidated. The purpose of this study was to investigate the effect and underlying mechanism of TC-G 1008 in the rescue of ROS-induced apoptosis by upregulating peroxiredoxin (Prx1). In this study, experimental results demonstrated that TC-G 1008 could activate GPR39, which then accelerated ROS obliteration and apoptosis inhibition in osteoblasts via Prx1 upregulation through the nuclear factor (erythroid-derived 2)-related factor 2 (Nrf2). Interestingly, being regarded as an 'information' molecule rather than an anti-oxidase molecule, Prx1 was shown to restrict the dissociation of the apoptosis signal-regulating kinase 1 (ASK1)/thioredoxin (Trx) under oxidative stress, which signified the activation of the ASK1 pathway, thereby resulting in the suppression of apoptosis. In summary, this study explores the double mechanism of TC-G 1008 in osteoblast apoptosis amelioration under oxidative stress through (i) ROS elimination and (ii) ASK1/Trx signal suppression, both of which contribute to increased Prx1 expression, and the results suggest that TC-G 1008 has great potential in the clinical treatment of osteoporosis.
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Factor 2 Relacionado con NF-E2 , Osteoporosis , Anciano , Apoptosis , Humanos , MAP Quinasa Quinasa Quinasa 5/genética , MAP Quinasa Quinasa Quinasa 5/metabolismo , MAP Quinasa Quinasa Quinasa 5/farmacología , Factor 2 Relacionado con NF-E2/metabolismo , Osteoblastos , Osteoporosis/metabolismo , Estrés Oxidativo , Peroxirredoxinas/metabolismo , Pirimidinas , Especies Reactivas de Oxígeno/metabolismo , Receptores Acoplados a Proteínas G/metabolismo , Sulfonamidas , Tiorredoxinas/metabolismo , Regulación hacia ArribaRESUMEN
BACKGROUND AND PURPOSE: Internal fixation surgeries are currently the most effective treatments for lumbar spondylolysis, but the optimal fixation method is still on debate. This study was designed to compare the biomechanical characteristics of two fixation methods for lumbar spondylolysis, the pedicle screw-U shape rod (PSUSR) internal fixation system, and the pedicle screw-vertebral plate hook (PSVPH) internal fixation system, through three-dimensional finite element analysis, expecting to provide clinical guidance. METHODS: Four finite element models (A, B, C, D) of L4-S1 vertebral body of a female patient were reconstructed by CT image segmentation. (A: intact model. B: spondylolysis model. C: spondylolysis model with PSUSR internal fixation. D: spondylolysis model with PSVPH internal fixation). Six physiological motion states were simulated by applying 500N concentrated force and 10Nm moment load to four models. The biomechanical advantages of the two internal fixation systems were evaluated by comparing the range of motion (ROM), maximum stress, maximum strain, and maximum displacement of the models. RESULTS: Compared to model B, the ROM decreased by 35.7%-57.1% in model C and 39.7%-64.8% in model D. The maximum displacements of model C and D both decreased. The maximum stresses in both vertebral and the internal fixation system are greater in model C than those in model D. The maximum stress and strain reduction of L5-S1 intervertebral disc in model D was greater than that in model C. Model D restores the articular cartilage stresses to the normal levels of model A. The maximum stress and maximum displacement of the bone graft in model C are greater than those in model D. CONCLUSIONS: The PSVPH internal fixation system has better biomechanical properties than PSUSR internal fixation system in several mechanical comparisons. Experimental results suggest that PSVPH internal fixation system can effectively treat lumbar spondylolysis while preserving segmental mobility, and can be the treatment of choice.
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Tornillos Pediculares , Fusión Vertebral , Espondilólisis , Fenómenos Biomecánicos , Placas Óseas , Femenino , Análisis de Elementos Finitos , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiología , Vértebras Lumbares/cirugía , Rango del Movimiento Articular/fisiología , Espondilólisis/diagnóstico por imagen , Espondilólisis/cirugíaRESUMEN
STUDY DESIGN: A prospective and nonrandomized concurrent controlled trial. OBJECTIVE: To address the early effects of concurrent treatment with vitamin K2 and vitamin D3 on fusion rates in patients who have undergone spinal surgery. SUMMARY OF BACKGROUND DATA: Intervertebral pseudarthrosis has been reported after transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF), especially in patients with osteopenia or osteoporosis. No study has assessed the early effects of concurrent treatment with vitamin K2 and vitamin D3 on fusion rates. METHODS: Patients with osteopenia or osteoporosis who underwent TLIF or PLIF in our department were included. Patients in the VK2+VD3 group received vitamin K2, vitamin D3, and calcium treatment, whereas subjects in the control group only received calcium and vitamin D3. Spine fusion was evaluated by computed tomography. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and visual analog scale (VAS) were used to assess the clinical and neurological symptoms. Bone mineral density (BMD) and bone metabolism markers were measured for osteoporotic evaluation. RESULTS: Seventy-eight patients were included, and nine patients subsequently discontinued because of 2019-nCoV. At six months postoperatively, complete fusion rates were significantly higher in the VK2+VD3 group than that in the control group (91.18% vs 71.43%, Pâ=â0.036). At six months postoperatively, BMD was increased in the VK2+VD3 group and was higher than that in the control group, although there was no significant difference. At three months postoperatively, a significant increase in procollagen type I amino terminal propeptide (91.81%) and a slight decrease in C-terminal end peptide (8.06%) were observed in the VK2+VD3 group. In both groups, the JOA-BPEQ and VAS scores were significantly improved after spine surgery. CONCLUSION: Administration of vitamin K2 and vitamin D3 can increase lumbar interbody fusion rates, improve clinical symptoms, promote bone information, and avoid further decline in BMD within six months after TLIF or PLIF.Level of Evidence: 3.
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COVID-19 , Degeneración del Disco Intervertebral , Osteoporosis , Fusión Vertebral , Colágeno Tipo I , Humanos , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/diagnóstico por imagen , Degeneración del Disco Intervertebral/tratamiento farmacológico , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Osteoporosis/complicaciones , Osteoporosis/tratamiento farmacológico , Estudios Prospectivos , Estudios Retrospectivos , SARS-CoV-2 , Fusión Vertebral/efectos adversos , Resultado del Tratamiento , Vitamina K 2RESUMEN
The apoptosis of mature osteocytes is the main factor causing damage to the microstructure of cortical bone in glucocorticoid-induced osteoporosis (GIOP). Our previous research found damaged areas and empty osteocytes lacunae in the tibial cortical bone of GIOP mice. However, the specific mechanism has not been clarified. Recently, a study showed that the quality of the cortical bone significantly increased by knocking out Notum, a gene encoding α/ß hydrolase. However, it is not clear whether Notum affects cortical bone remodeling by participating in glucocorticoids (GCs)-induced apoptosis of osteocytes. The present study aimed to explore the correlation between Notum, osteocytes apoptosis, and cortical bone quality in GIOP. Prednisolone acetate was intragastrically administered to mice for two weeks. Histochemical staining was applied to evaluate changes in GIOP and Notum expression. Osteocytes were stimulated with prednisolone, and cell viability was assessed via CCK8. Hoechst 33342/PI staining, flow cytometry, RT-PCR, and western blot were used to detect osteocytes apoptosis, siRNA transfection efficiency, and expressions of pathway related factors. The results showed that the number of empty osteocytes lacunae increased in GIOP mice. TUNEL-stained apoptotic osteocytes and Notum immuno-positive osteocytes were also observed. Furthermore, prednisolone was found to promote Notum expression and osteocytes apoptosis in vitro. Knocking down Notum via siRNA partially restored osteocytes apoptosis and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/glycogen synthase kinase-3ß (GSK3ß)/ß-catenin pathway. These findings showed GCs-induced osteocytes apoptosis by promoting Notum expression and inhibiting PI3K/AKT/GSK3ß/ß-catenin pathway. Thus, Notum might be a potential therapeutic target for the treatment of GIOP.
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Apoptosis , Esterasas/metabolismo , Glucógeno Sintasa Quinasa 3 beta/metabolismo , Osteocitos/citología , Osteocitos/metabolismo , Fosfatidilinositol 3-Quinasa/metabolismo , Prednisolona/farmacología , Proteínas Proto-Oncogénicas c-akt/metabolismo , Fosfatasa Alcalina/metabolismo , Animales , Apoptosis/efectos de los fármacos , Línea Celular , Supervivencia Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Osteoblastos/efectos de los fármacos , Osteoblastos/metabolismo , Osteoclastos/efectos de los fármacos , Osteoclastos/metabolismo , Osteocitos/efectos de los fármacos , Osteoporosis/inducido químicamente , Osteoporosis/patología , ARN Mensajero/genética , ARN Mensajero/metabolismo , Transducción de Señal , Fosfatasa Ácida Tartratorresistente/metabolismoRESUMEN
BACKGROUND AND OBJECTIVE: The technique of tri-cortical pedicle screw (TCPS) has been used to improve the anchoring strength in the sacral vertebrae. However, no studies have reported their application in the thoracic vertebrae. Our research is aimed to assess the stability and strength of the TCPS in thoracic vertebrae under osteoporotic condition by three dimensional (3D) finite element method on the basis of medical image reconstruction using computed tomography (CT), and verifying its effectiveness in clinical application. MATERIALS AND METHODS: The 3D finite element models were constructed using Mimcs to transfer two dimensional CT images into 3D models by marching cubes algorithm of six-partition. Six physiological activities were simulated in 3D finite element models. Compared with the strength and stability of the uni-cortical pedicle screw (UCPS) and bi-cortical pedicle screw (BCPS), the effectiveness of TCPS was assessed. The stress distribution and maximum stress were measured to evaluate the strength. The maximum displacement and the range of motion were analysed to assessed the stability. EXPERIMENTAL RESULTS: Four geometrically accurate and nonlinear T7-T9 finite element models were constructed successfully by 3D finite element method based on the CT images. Three kinds of internal fixation methods in the osteoporotic thoracic vertebral body can improved the maximum stress, decrease the maximum displacement and range of motion in six physiological activities. The range of motion and maximum displacement of TCPS decreased more significantly than that of UCPS and BCPS. The maximum von Mises stress of TCPS was minimum and UCPS was maximum under the condition of extension, right lateral bending, left rotation and right rotation. CONCLUSIONS: Effectively, TCPS can provide better stability and strength than that of UCPS and BCPS techniques in the osteoporotic thoracic vertebrae. In practice, the technique of TCPS can be applied in the osteoporotic thoracic vertebral body to enhance the griping strength of the screws and reduce the risk of pedicle screw loosening. However, further cadaver experiments and more biomechanical analysis are necessary to confirmed our findings.
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Fijación Interna de Fracturas/métodos , Osteoporosis/cirugía , Tornillos Pediculares , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X , Simulación por Computador , Diseño de Equipo , Análisis de Elementos Finitos , Humanos , Imagenología Tridimensional , Vértebras Lumbares/lesiones , Rango del Movimiento ArticularRESUMEN
BACKGROUND AND OBJECTIVE: The traditional pedicle screw-rod internal fixation system has been widely used for thoracic diseases in clinical practice, but its high profile increases the damage to soft tissue, leading to long-term intractable back stiffness. The purpose of this study is to compare biomechanical advantages between the new spine pedicle screw-plate internal fixation system and traditional pedicle screw-rod internal fixation system using finite element analysis. METHODS: Based on computed tomography (CT), four three-dimensional finite element models of T7-T9 were constructed. The downward concentrated force of 150 N and the moment of 5 Nm was applied to the models to simulate six physiological activities, including flexion, extension, left and right lateral bending, left and right axial torsion. The maximum displacement, range of motion (ROM) and maximum stress of the two models in six physiological activities, was measured to evaluate the biomechanical advantages of the novel pedicle screw-plate internal fixation system. RESULTS: The novel pedicle screw-plate internal fixation system has a lower profile than the traditional pedicle screw-rod internal fixation system. With regards to the stability, the maximum displacement of the models of two internal fixation systems decreased by 56.2%-91.4% under the six motion status when comparing with the unstable model. Meanwhile, the ROM remained unchanged between the two models of internal fixation systems besides the left lateral bending. However, there is no significant difference in the ROM between the models of the two internal fixation systems in left lateral bending motion (Pâ¯=â¯0.203). In terms of the strength, the maximum stress in the model with the new pedicle screw-plate internal fixation system was higher than that of model with the traditional pedicle screw-rod internal fixation system in every motion status but left and right lateral bending motion. CONCLUSIONS: The novel pedicle screw-plate internal fixation system has lower profile in orthopedics and higher strength, However, it has no disadvantage when comparing with the traditional pedicle screw-rod internal fixation system in terms of the stability. In summary, we suggest that the novel spine pedicle screw-plate system can be used as a new internal fixation and provide better comfort for patients.
Asunto(s)
Tornillos Óseos , Análisis de Elementos Finitos , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X , Fenómenos Biomecánicos , Placas Óseas , Diseño de Equipo , Humanos , Vértebras Lumbares , Movimiento (Física) , Ortopedia , Tornillos Pediculares , Presión , Rango del Movimiento Articular , Fusión Vertebral , Estrés MecánicoRESUMEN
In this study, the output energy in topological insulators (TIs)-based Erbium-doped fiber laser (EDFL) was improved using two strategies: bidirectional pumped laser cavity and saturable absorber (SA) with high damage threshold and large modulation depth. Using the chemical vapor deposition (CVD) method, Bismuth Selenide (Bi2Se3) film was synthesized and improved to a SA. Employing this CVD-Bi2Se3 SA in an EDFL, bright and bright-dark soliton operations were achieved. The average output power/pulse energy was 82.6â mW/48.3 nJ and 81.2â mW/47.5 nJ, respectively. The results demonstrate that CVD-Bi2Se3 can act as an excellent performance material to improve output power performance in TISA-based EDFL.