Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases.

OBJECTIVE: This research aims to compare the clinical outcomes of VBE-TLIF and MIS-TLIF for the treatment of patients with single-level degenerative lumbar diseases. METHODS: Ninety patients were enrolled in this study. The estimated blood loss, operation time, postoperative hospitalization days, time to functional exercise, amount of surgical drain and inflammatory index were recorded. The visual analog scale, Oswestry dysfunction index and modified MacNab criteria were used to assessed the patient's back and leg pain, functional status and clinical satisfaction rates. RESULTS: The average operation time of the VBE-TLIF group was longer than that of the MIS-TLIF group. The time for functional exercise, length of hospital stay, estimated blood loss and amount of surgical drain in the VBE-TLIF group were relative shorter than those in the MIS-TLIF group. Additionally, the levels of CRP, neutrophil, IL-6 and CPK in the VBE-TLIF group were significantly lower than those in the MIS-TLIF group at postoperative days 1 and 3, respectively (P < 0.001). Patients undergoing VBE-TLIF had significantly lower back VAS scores than those in the MIS-TLIF group on postoperative days 1 and 3 (P < 0.001). No significant differences were found in the clinical satisfaction rates (95.83 vs. 95.24%, P = 0.458) or interbody fusion rate (97.92 vs. 95.24%, P = 0.730) between these two surgical procedures. CONCLUSIONS: Both VBE-TLIF and MIS-TLIF are safe and effective surgical procedures for patients with lumbar diseases, but VBE-TLIF technique is a preferred surgical procedure with merits of reduced surgical trauma and quicker recovery.

Rehabilitation exercise-driven symbiotic electrical stimulation system accelerating bone regeneration.

Electrical stimulation can effectively accelerate bone healing. However, the substantial size and weight of electrical stimulation devices result in reduced patient benefits and compliance. It remains a challenge to establish a flexible and lightweight implantable microelectronic stimulator for bone regeneration. Here, we use self-powered technology to develop an electric pulse stimulator without circuits and batteries, which removes the problems of weight, volume, and necessary rigid packaging. The fully implantable bone defect electrical stimulation (BD-ES) system combines a hybrid tribo/piezoelectric nanogenerator to provide biphasic electric pulses in response to rehabilitation exercise with a conductive bioactive hydrogel. BD-ES can enhance multiple osteogenesis-related biological processes, including calcium ion import and osteogenic differentiation. In a rat model of critical-sized femoral defects, the bone defect was reversed by electrical stimulation therapy with BD-ES and subsequent bone mineralization, and the femur completely healed within 6 weeks. This work is expected to advance the development of symbiotic electrical stimulation therapy devices without batteries and circuits.

Scutellarin alleviates liver injury in type 2 diabetic mellitus by suppressing hepatocyte apoptosis in vitro and in vivo.

Objective: Scutellarin is a primary active composition come from Erigeron breviscapus. It is well known that scutellarin has anti-inflammatory and antioxidant physiological functions. In this study, we detected the effects of scutellarin on hepatocyte cell apoptosis in type 2 diabetes mellitus (T2DM) rats. Methods: Sprague Dawley (SD) (6-8 weeks, 160-180 g) rats were randomly divided into six groups: control, model, scutellarin low-dose, medium-dose, high-dose treatment, and rosiglitazone positive groups; with 10 SD rats in each group (n = 10). The changes of biochemical factors in serum were detected by automatic biochemical instrument, the pathological changes of liver tissue were detected by hematoxylin and eosin (HE) staining, the apoptosis of liver tissue and cells was detected by tissue staining and flow analyzer, and the expression of apoptosis-related factors were determined by qPCR, Western blot and immunohistochemistry in liver tissues or cells. Results: The results showed that scutellarin decreased the levels of fasting blood glucose, total cholesterol, triglyceride, and low-density lipoprotein and increased the levels of high-density lipoprotein. Meanwhile, scutellarin decreased the levels of alanine transaminase (ALT) and aspartate transaminase (AST) and improved liver function. In addition, scutellarin suppressed the secretion of interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and reduced hepatocyte apoptosis. Furthermore, scutellarin inhibited the expression of cleaved Caspase-3, Bax, and cytochrome C (Cyt-C) and promoted the expression of Bcl-2. Conclusion: Scutellarin can inhibit the apoptotic pathway, thereby relieving T2DM.

Adsorption and fouling behaviors of customized nanocomposite membrane to trace pharmaceutically active compounds under multiple influent matrices.

Rare information is available on fouling behavior of customized nanofiltration (NF) membrane evoked by pharmaceutically active compounds (PhACs) under real multiple influent matrices pretreated by ultrafiltration module beforehand. To this end, a novel tight NF membrane with excellent perm-selectivity and antiadhesion was fabricated and used to assess its separation performance/mechanism and fouling behavior to a broad range of small molecular PhACs in the context. The adsorption ratio results revealed that the affinities between five selected PhACs and the customized nanocomposite membrane surface were all much weaker (below 5.5%) than the solute-solute interacting forces (between 23.6 and 83.2%), whether for natural or synthetic complex micropollutants. The predominant membrane fouling could be interpreted by the incomplete blocking model in the permeation of both influent conditions. For neat nanocomposite membrane, the order of critical factors important on separation mechanism was electrostatic effect, adsorption and steric hindrance. The fouling layer seemed to act as a secondary separating layer for those negatively charged or hydrophilic PhACs, but showed the cake enhanced concentration polarization effect for the neutral and hydrophobic ones. This study provides valuable insights for defining PhACs fate and NF membrane fouling behavior to fit increasingly stringent criteria for wastewater treatment.

The Role of Hippo Signaling Pathway in the Development of the Nervous System.

Hippo signaling pathway is a highly conserved and crucial signaling pathway that controls the size of tissues and organs by regulating the proliferation, differentiation, and apoptosis of cells. The nervous system is a complicated system that participates in information collection, integration, and procession. The balance of various aspects of the nervous system is vital for the normal regulation of physiological conditions of the body, like the population and distribution of nerve cells, nerve connections, and so on. Defects in these aspects may lead to cognitive, behavioral, and neurological dysfunction, resulting in various nervous system diseases. Recently, accumulating evidence proposes that Hippo pathway maintains numerous biological functions in the nervous system development, including modulating the proliferation and differentiation of nerve cells and promoting the development of synapse, corpus callosum, and cortex. In this review, we will summarize recent findings of Hippo pathway in the nervous system to improve our understanding on its function and to provide potential therapeutic strategies of nervous system diseases in the future.

Upper Lumbar Intradural Disc Herniation: A Rare Case Report and Etiologic Analysis.

BACKGROUND: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms. CASE DESCRIPTION: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient's pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up. CONCLUSION: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.

The feasibility of UF-RO integrated membrane system combined with coagulation/flocculation for hairwork dyeing effluent reclamation.

This paper aims to validate the feasibility of hairwork dyeing effluent (HDE) reclamation using an ultrafiltration (UF)-reverse osmosis (RO) integrated membrane system combined with coagulation-flocculation and sedimentation acquiring the highest possible product water recovery rate along with both satisfactory separation performance and well controlled membrane fouling. Under the circumstance of only physical cleaning involved, the laboratory-scale test yielded a higher and satisfactory reuse ratio of 76% for HDE, and the corresponding RO product as reclaimed water contained only 223 mg·L-1 of TDS, 3.87 mg·mL-1 of DOC and 10.3 mg·mL-1 of total hardness, which was obviously better than the quality of existing feedwater in hairwork dyeing process. After each processing unit, the distributions of fulvic (region III) and humic (region V) organics decreased continuously, while an overall rising trend in distribution of protein-like organics (regions I and II) was observed. Contact angle for the fouled UF and RO membranes significantly increased by 19.5° and decreased by 19.7°, respectively, which suggested that different polarity of organic or inorganic adsorption rather than membrane roughness was the main factors affecting wetting properties of the fouled employed membranes. Both ATR-FTIR and XPS spectra indicated that organic fouling on UF membrane surface under harsh condition (RUF = 90%) was mild and tolerable, whereas a surprising amount of hydrophilic micromolecular organics riched in carboxyl and hydroxyl functional groups were absorbed on RO membrane surface after permeation.

[Effects of Luteolin on Proliferation and Programmed Cell Death of Human Multiple Myeloma Cell RPMI-8226].

OBJECTIVE: To investigate the effect of Luteolin on proliferation and cell death of human multiple myeloma cell line RPMI-8226 and its mechanisms. METHODS: The effect of Luteolin on the growth of human multiple myeloma cell line RPMI-8226 was detected by CCK-8, and then the minimal effective concentration was determined and was used to treat RPMI-8226 cells. The effects of luteolin and chloroquine on expression of cleaved-caspase 3 and LC3 in RPMI8826 cells was detected by Western blot. RESULTS: The luteolin significant inhibited RPMI-8226 cell proliferation in a dose-dependent manner. Treatment with lutedin 40-80µmol/L for 24 hours and luteolin 20-80µmol/L for 48 hours inhibited RPMI-8226 cell proliferation in a dose-dependent manner (24 h, r= -0.983; 48 h, r= -0.985). After treatment with lutelin 20µmol/L for 48 h, the expression of cleaved caspase3 and LC3 Ⅱ/Ⅰ in RPMI 8826 cells significantly increased; after treatment with chloroquine at the same time, the expression of cleaved-caspase 3 and LC3 Ⅱ/Ⅰ significantly decreased. CONCLUSION: Luteolin inhibits the proliferation of RPMI-8226 cells by inducing the pathways of both apoptosis and autophagy, moreover the actions of apoptosis and autophagy are interactive or/and promotive each other.

Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study.

BACKGROUND: Restoring the normal joint line (JL) is an important goal to achieve in total knee arthroplasty (TKA). We intended to study the veracity of several landmarks used to level the normal JL in Chinese people. METHODS: Two hundred fifteen standard CT scans of knee joint were included to measure the distances from landmarks to distal JL (DJL) and posterior JL (PJL), along with femoral width (FW) in order to calculate the ratios. Landmarks included adductor tubercle (AT), medial epicondyle (ME), lateral epicondyle (LE), tibial tubercle (TT), fibular head (FH) and the inferior pole of the patella (IPP). Ratios were calculated between distances and FW (e.g. FHDJL/FW). Linear regression analysis and t test were used to determine the accuracy and the differences amongst sides of the leg, genders and races. RESULTS: The average of IPPDJL/FW, TTDJL/FW, FHDJL/FW, LEDJL/FW, LEPJL/FW, MEDJL/FW, MEPJL/FW, ATDJL/FW and ATPJL/FW were 0.165, 0.295, 0.232, 0.297, 0.281, 0.327, 0.3PJL, 0.558 and 0.313, respectively. No significant difference had been found between the left and right leg. A gender difference was only found statistically on the ratio of IPP, and also, no linear correlation was observed only between IPP and FW. Most of the difference values lain in a 4-mm threshold for MEDJL (95.81%), LEDJL (94.88%), MEPJL (97.21%), LEPJL (94.88%), ATPJL (93.49%) and ATDJL (100%). Significant differences were observed amongst different races. CONCLUSIONS: AT, ME and LE can be used as reliable landmarks to locate the normal JL in Chinese population intraoperatively. It is meaningful to come up with a set of ratios to different races.

Morphologic features of the distal femur and tibia plateau in Southeastern Chinese population: A cross-sectional study.

Morphologic measurements of the femoral and tibial features of western population have been done in several studies, which provides the fundamental data for the design of total knee arthroplasty prosthesis used globally, including China. However, researches on anatomic and morphologic features of the knee in Chinese populations of both sexes have never been conducted. Our study was aimed at investigating the anatomic and morphologic features of the knees of the Southeastern Chinese population by magnetic resonance imaging (MRI) scans, so as to provide parameters for sex- and ethnic-specific implant designs in the future.A total of 245 knees from 244 Chinese adults (130 females and 114 males, aging from 18 to 89 years) who received knee MRI scan from November 2014 to October 2015 were recruited and analyzed. A set of linear and angular parameters, and 6 normalized ratios were measured and calculated on the distal femur and proximal tibia.The knee size was significantly different between sexes. Compared with women, men have larger (P < .01) medial-lateral (ML) and anterior-posterior (AP) dimensions in both distal femur and proximal tibia. Differences in femoral shape, represented by the femur surface ratio, between both sexes were also identified (1.23 ±â€Š0.07 vs 1.27 ±â€Š0.07, P < .01), whereas the ML/AP ratios of the tibia are similar between both sexes (1.44 ±â€Š0.07 vs 1.44 ±â€Š0.09, P = .97). We also found substantial difference in the morphology of femur and tibia plateau in Southeastern Chinese population compared with data obtained from western populations.Our study measured the anatomic and morphologic features of the knees in Southeastern Chinese population, and identified knee morphologic differences between both sexes, as well as western and Chinese population. Further clinical studies are needed to determine other essential parameters for the design of prosthesis to the Chinese populations.

Relationship Between Femur and Femoral Arteries for Identifying Risk Factors for Vascular Injury.

BACKGROUND This study aimed to identify risk factors for vascular injury in proximal femoral fracture through identifying frequency and distances between femur and femoral arteries with computed tomography angiography and 3-dimensional reconstruction. MATERIAL AND METHODS In a series of 400 participants, based on measurement results regarding the distribution of femoral arteries in the medial femur, the femoral portion covering that part was divided into levels A-E. The center region, margin region, and risky area in the medial femur were defined. The frequency of femoral arteries and interested shortest distance between the outer femur and superficial, deep, and perforating femoral arteries (SFAs, DFAs, and PFAs) in the center region, margin region, and risky area at each level were recorded. RESULTS There were 173 males and 227 females (average age: 63.61±19.18 years) in this study. The starting point and end point for femoral arteries in the medial femur were from 22.55±4.23% to 54.56±8.39% of the whole femur. The femoral arteries in the medial femur mainly were distributed at levels B (88.2%), C (65.9%), and D (40.6%). The femoral arteries in center regions in the risky area, most of which were DFAs and PFAs, were mainly concentrated at levels B (26.93%) and C (11.81%). CONCLUSIONS The mid-shaft level was the most risky level, and the DFAs and PFAs were easier to injure than the SFAs when performing internal fixation of proximal femoral fracture. We recommended that great attention be paid to drill and screw insertion around the mid-shaft level for prevention of iatrogenic vascular injury.

A new method to diagnose discoid lateral menisci on radiographs.

PURPOSE: The aim of this study was to prove that it is feasible to diagnose discoid lateral meniscus in radiographs. Plain radiographic findings of discoid lateral menisci with matched controls were analysed and compared in a quantitative method. METHODS: Sixty consecutive patients (60 knees) who were diagnosed with discoid lateral meniscus (discoid group) by magnetic resonance imaging (MRI) were included. Another 60 age- and sex-matched controls with normal medial and lateral menisci on the basis of MRI findings were included as the control group. Each plain radiograph was evaluated from the anteroposterior view for the following variables: height of the fibular head (HFH), lateral joint space distance (LJSD), height of the lateral tibial spine (HLTS), obliquity of the lateral tibial plateau, obliquity of the lateral femoral condyle, distance from the lateral tibial spine to the lateral femoral condyle, height of the medial tibial spine, chordal distance of the femoral condyle (CDLF, CDMF), the HFH/LJSD, LJSD/HLTS and the CDLF/CDMF. RESULTS: A significant difference was found in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS between the two groups. The cut-off values of the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS were 12.9 mm, 6.6 mm, 7.8 mm, 3.0 mm, 2.7 mm, 2.0 and 0.9, respectively. Among the cut-off values in diagnosing discoid lateral meniscus, the sensitivity, specificity and ROC curve area of LJSD/HLTS were as high as 73.6 %, 83.0 % and 0.8, respectively. The corresponding values of the HFH/LJSD were as high as 66.0 %, 86.8 % and 0.8. For the first two indicators, the results of the HFH/LJSD and LJSD/HLTS were higher than that of most other parameters. At the same time, the ROC curve area of the HFH/LJSD and LJSD/HLTS ranked highest among all the results. CONCLUSION: There were significant differences in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS, especially the HFH/LJSD and the LJSD/HLTS, between plain radiographic findings of discoid lateral meniscus patients and normal controls. The results of the HFH/LJSD and the LJSD/HLTS showed a positive impact on the diagnosis of discoid lateral meniscus in this research. These findings enable radiographs to screen for discoid lateral meniscus. LEVEL OF EVIDENCE: II.