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1.
Int Orthop ; 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32367234

RESUMO

PURPOSE: The aim of this study was to investigate the effect of lumbar spine selective nerve root block (SNRB) experience on the learning efficiency of percutaneous endoscopic lumbar discectomy (PELD) for junior trainees. METHODS: A total of 480 patients undergoing single-level PELD performed by eight junior trainees were included. The trainees were divided into two groups based on whether they had previous SNRB experience (group A, yes; group B, no). Surgical proficiency was defined as total operation time less than 65 minutes and cumulative radiation exposure time no more than 40 seconds. The learning curve was analyzed by cumulative summation (CUSUM) test. Clinical evaluations included Macnab classification, visual analog scale (VAS)-low back score, VAS-leg score, and Oswestry Disability Index (ODI). Follow-up information at 12 months was also obtained. RESULTS: Integral number of cases before achieving an acceptable surgical level in group A (47.75 ± 2.50 cases) was significantly smaller than that in group B (56.50 ± 1.29 cases, p < 0.05), along with less accumulated failure (18.75 ± 0.96 cases vs. 25.50 ± 1.75 cases, p < 0.05). The two groups were comparable in clinical outcomes. Forty-seven cases of complications were observed, with 17 in group A and 30 in group B (p < 0.05). CONCLUSION: Previous experience of SNRB improved the performance of PELD with shorter operation time and less radiation exposure. SNRB practice may reduce the complication rate without a significant effect on the recurrence of symptoms and reoperation.

2.
Br J Neurosurg ; : 1-6, 2020 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-32279570

RESUMO

Background: Indications and clinical outcomes of percutaneous endoscopic thoracic discectomy(PETD) in treating thoracic disc herniation is rarely reported and still controversial. We reported an unsatisfied recovery of thoracic disc herniation with PETD, treated by a second posterior thoracic laminectomy and Ponte osteotomy.Case description: A male presented with lower extremity weakness and stagger caused by T3/4 intervertebral disc herniation. The upper thoracic curve was in excessive kyphosis with T2-5 Cobb angle of 34.3 degrees. The preoperative ODI score was 34 and Roelzs's JOA score was 14. Percutaneous transforaminal endoscopic thoracic discectomy (PETD) from a posterior lateral approach was performed. At five-month follow-up, his thoracic back pain and staggering gait did not improve. The postoperative T2-5 Cobb angle was 32.1 degrees, the ODI score was 24 and Roelzs's JOA score was 14. A second posterior thoracic decompression this time with fixation was performed, but no disc herniation was detected. A Ponte osteotomy was performed to correct the kyphosis. One month after the second surgery, muscle strength of the lower limbs was improving with the T2-5 Cobb angle decreased to 19.4 degrees, the ODI score decreased to 10 and Roelzs's JOA score increase to 16. Six month later, the ODI score decreased to 0 and Roelzs's JOA score improved to 18. In review of the literature, PETD doesn't guarantee the patient a satisfactory neurological recovery for kyphotic thoracic disc herniation. Posterior decompression with Ponte osteotomy may be beneficial to release the tension and decompression of the spinal cord tension.Conclusions: Thoracic disc herniation with kyphosis angle >20 degrees (T2-5), percutaneous endoscopic thoracic discectomy is not likely to get good neurologic results. Posterior laminectomy with ponte osteotomy might be beneficial for these patients to induce dorsal drifting of the spinal cord from anterior herniation.

3.
Spine (Phila Pa 1976) ; 45(8): 504-511, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32224806

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: To assess the long-term results of zero-profile spacer for 3-level anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Although widely used, there are still controversies about the long-term results of zero-profile spacer, especially in multilevel cases. METHODS: Cases received 3-level ACDF for cervical spondylotic myelopathy (CSM) using either zero-profile spacer (n = 27) (ZP Group), or plate and cages (n = 34) (PC Group), and with 5-year follow-up were reviewed. Neurological function and life quality were assessed by modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and Short-Form 36 (SF-36) score. Disc height, cervical lordosis, fusion rate, and surgical complications were observed. RESULTS: Neurological recovery and life quality improvement were similar in both groups. Disc height and cervical lordosis (C2-7 Cobb angle) were well restored after operations, but lost in both groups during follow-up. Loss of correction (LOC) in disc height was larger in ZP Group (11.38% vs 5.71%, P < 0.05) at 5-year follow-up. LOC of cervical lordosis in ZP group constantly grew from 11.28% to 48.13% during 5-year follow-up, significantly higher than that in the PC group (from 7.43% to 14.01%) (P < 0.05). The rate of postoperative dysphagia was no statistical difference between the two groups, and symptoms were all disappeared within 1 year. There were 10 levels of adjacent segment degeneration (1 in ZP Group, and 10 in PC Group, P = 0.02). Cage subsidence (11 of 81 levels, 13.58%) and screw migration (2 of 81 levels, 2.47%) were only observed in the ZP Group. The migrated screws in one case were surgically removed. Fusion was achieved in all cases. CONCLUSIONS: In long-term follow-up of 3-level ACDF for CSM, zero-profile spacer has the similar clinical results, but loss of correction of disc height and cervical alignment were significantly higher, compared with anterior plate and cages. LEVEL OF EVIDENCE: 3.

4.
Br J Neurosurg ; : 1-4, 2019 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-31544531

RESUMO

Background: We know of five cases of cervical nerve root variants that have been reported, all of which were found during posterior cervical surgery. We reported two cases of cervical nerve root variants. One had two anomalous branches of the C7 root, is the other had a C5, C6 nerve root communication branch. Case description: A 62-year-old female presented with neck and right upper extremity pain, accompanied by hypaesthesia in her right forearm for 4 months. Preoperative X-ray film, magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated C6-7 uncovertebral joint hyperplasia and foraminal stenosis. She underwent posterior cervical endoscopic foraminoplasty. The right C7 nerve root was observed to have two anomalous branches originated from a proximal trunk. After the surgery, the symptoms resolved. A 54-year-old female presented with radiating pain and numbness in her right arm and hand for 4 months. Preoperative MRI showed a C5/6 intervertebral disc herniation. She had hypaesthesia in radial side of her right arm and 1st-3rd fingers. Posterior cervical endoscopic foraminalplasty was performed for the patient. After decompression of the bony wall of the posterior nerve root canal, a 2-mm thick communicating nerve was observed emerging from the dura with the C6 nerve root and exiting to the caudal level. After the surgery, the symptoms resolved immediately. Conclusions: Cervical nerve root variant may be more apparent on edoscopic approaches to the cervical foraminae than at open surgery.

5.
World Neurosurg ; 130: e915-e925, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301447

RESUMO

OBJECTIVE: To evaluate the clinical and radiographic outcomes of an anterior-only approach for the correction of severe cervical kyphotic deformities. METHODS: We performed a retrospective study of 33 consecutive patients with severe cervical kyphosis treated with an anterior cervical operation and preoperative and intraoperative skull traction. Cobb angle, kyphosis index (KI), kyphosis level, C2-7 sagittal vertical axis (SVA), and T1 slope were measured. The preoperative and postoperative Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) score for neck pain, Neck Disability Index (NDI) scores, and cervical alignment were compared. RESULTS: The mean angle of the kyphosis was 83.2 ± 20.4°. The mean Cobb angle of the operative region was 71.7 ± 18.5° preoperation, which was reduced to 10.6 ± 5.7° postoperation (mean correction, 85.2%). The mean KI was 75.1 ± 18.2 preoperation, which was reduced to 14.4 ± 9.1 postoperation (mean correction, 80.8%). The preoperative and postoperative mean C2-7 Cobb angle was 53.8 ± 16.5° and 14.7 ± 7.6°, respectively. The preoperative and postoperative mean C2-7 SVA was 3.9 ± 14.5 mm and 12.8 ± 7.3 mm, respectively. The preoperative and postoperative mean T1 slope was -9.4 ± 15.7° and 7.3 ± 13.1°, respectively. The average postoperative C2-7 Cobb angle, Cobb angle of the operative region, KI, C2-7 SVA, and T1 slope changed significantly compared with preoperative values (P < 0.05). The average postoperative JOA, VAS, and NDI scores improved significantly compared with preoperative scores (P < 0.05). CONCLUSIONS: Preoperative and intraoperative skull traction combined with anterior-only cervical operation may be a safe and effective technique for treating severe cervical kyphosis. If the postoperative correction is >80%, sufficient decompression could be achieved.


Assuntos
Vértebras Cervicais/cirurgia , Cuidados Intraoperatórios/métodos , Cifose/cirurgia , Cuidados Pré-Operatórios/métodos , Crânio/cirurgia , Tração/métodos , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Terapia Combinada/métodos , Terapia Combinada/tendências , Feminino , Humanos , Cuidados Intraoperatórios/tendências , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Índice de Gravidade de Doença , Crânio/diagnóstico por imagem , Tração/tendências , Resultado do Tratamento , Adulto Jovem
6.
World Neurosurg ; 129: e586-e593, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158541

RESUMO

BACKGROUND: The purpose of this study was to determine the number of cases needed to achieve the level of competence for percutaneous endoscopic lumbar diskectomy (PELD) via the bi-needle technique using the cumulative summation test for learning curve (LC-CUSUM). METHODS: A retrospective design was used. We included 60 patients who underwent a single-level PELD via the bi-needle technique performed by a single surgeon. The surgeon had 5 years of experience in open surgery including the transforaminal endoscopic spine system and Yeung endoscopic spine system but no experience in the bi-needle technique. Surgery success was defined as an operative time <60 minutes, and the acceptable procedure was completed within 3 times of C-arm fluoroscopies. The LC-CUSUM was used to analyze the data. RESULTS: The average operative time for PELD via the bi-needle technique was 58.3 ± 12.4 minutes. The mean operative time was 65.7 ± 12.1 minutes in the early learning period (30 cases) and 51.0 ± 7.5 minutes in the late learning period (30 cases) (P < 0.05). On the basis of the evaluation indexes of the operative time and radioactive exposure, the LC-CUSUM signaled proficiency for the bi-needle technique at the 50th-54th operation. Seven cases of complications were observed during the whole learning process, with 6 in the early period and 1 in the late period (P < 0.05). CONCLUSIONS: The novel bi-needle technique is safe and effective for PELD with appropriate patients, and the learning curve is acceptable. A substantial learning period (50-54 cases) is needed before a spine surgeon can master the bi-needle technique.


Assuntos
Competência Clínica , Discotomia Percutânea/educação , Deslocamento do Disco Intervertebral/cirurgia , Adulto , Discotomia Percutânea/métodos , Feminino , Humanos , Curva de Aprendizado , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
7.
Gene ; 704: 15-24, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30965128

RESUMO

OBJECTIVE: The objective of our study was to verify the hypothesis that the expression of connective tissue growth factor (CTGF/CCN2), a key molecule essential for the maintenance of nucleus pulposus (NP) matrix homeostasis, is regulated by osmolarity and intracellular calcium in NP cells. METHODS: Gene and protein expression levels of CCN2 were assessed using quantitative real-time PCR and western blot. Transfections and dual luciferase assays were performed to measure the effect of hyperosmolarity, tonicity enhancer binding protein (TonEBP) and Ca2+-calcineurin (Cn)-NFAT signaling on CCN2 promoter activity. RESULTS: Cultured in hyperosmotic media, there was a significant decrease in the levels of CCN2 promoter activity, gene and protein expression in NP cells. The JASPAR database was used to analyze the construction of human CCN2 promoter, we found conserved TonE and NFAT binding sites. We then investigated whether TonEBP controlled CCN2 expression. Forced expression of TonEBP in NP cells showed that TonEBP negatively regulated CCN2 promoter activity, while suppression of TonEBP induced CCN2 promoter activity and expression. We then examined if Ca2+-Cn-NFAT signaling participated in the regulation of CCN2 expression. Co-expression of CCN2 reporter with individual NFAT1-4 expression plasmids and/or calcineurin A/B constructs suggested this signaling pathway played a role in the regulation of CCN2expression in NP cells. CONCLUSIONS: Results of these studies illustrated that the expression of CCN2 in NP cells was regulated by the NFAT family through a signaling pathway network involving both activator (Ca2+-Cn-NFAT signaling) and suppressor (Hyperosmolarity-TonEBP) molecules.


Assuntos
Cálcio/farmacologia , Fator de Crescimento do Tecido Conjuntivo/genética , Núcleo Pulposo/efeitos dos fármacos , Núcleo Pulposo/metabolismo , Equilíbrio Hidroeletrolítico , Animais , Células Cultivadas , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Homeostase/efeitos dos fármacos , Homeostase/genética , Masculino , Fatores de Transcrição NFATC/fisiologia , Concentração Osmolar , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/fisiologia , Desequilíbrio Hidroeletrolítico/genética , Desequilíbrio Hidroeletrolítico/metabolismo
8.
World Neurosurg ; 126: e842-e852, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30862596

RESUMO

OBJECTIVE: To compare the clinical and radiologic outcomes of 3 anterior surgical techniques for the treatment of 3-level cervical spondylotic myelopathy (CSM) and the evolution of intramedullary T2-weighted increased signal intensity (ISI). METHODS: A total of 98 consecutive patients (61 males, 37 females) with 3-level CSM who underwent anterior cervical surgery between January 2006 and January 2016 were retrospectively enrolled. Based on different anterior reconstructive techniques, the patients were divided into 3 groups: anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrid decompression and fusion (HDF) groups. The Japanese Orthopaedic Association score and its recovery rate were used to evaluate the clinical outcomes. The cervical alignment and range of motion were used to assess radiologic outcomes. In addition, the signal change ratio and length of ISI were used to measure the ISI. RESULTS: No statistical differences in preoperative factors were found among the 3 groups (P > 0.05). Although the HDF group had intermediate surgery time and blood loss compared with other groups (P < 0.05), it achieved greater postoperative Japanese Orthopaedic Association score and recovery rate than other groups (P < 0.05). The postoperative C2-C7 lordotic angle and postoperative range of motion in the HDF group were similar to that in the ACDF group (P > 0.05), both greater than that in the ACCF group (P < 0.05). The incidence of complications in the HDF group was close to the ACDF group (P > 0.05), and both groups were lower than that in the ACCF group (P < 0.05). In addition, the postoperative signal change ratio in the HDF group was lower than in other groups (P < 0.05). The postoperative length of ISI in the HDF group was similar to the ACCF group (P > 0.05), which was both shorter than that in the ACDF group (P < 0.05). CONCLUSIONS: For patients with 3-level CSM with ISI on T2-weighted MRI, HDF can be considered as the optimal technique that achieves better clinical and radiologic outcomes than the ACDF or ACCF procedure. HDF also has a better postoperative regression of ISI compared with the ACDF or ACCF procedure, which may potentially be an important indicator for improving surgical outcomes.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Discotomia/métodos , Fusão Vertebral/métodos , Espondilose/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Resultado do Tratamento
9.
Spine J ; 19(4): 735-743, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30352301

RESUMO

BACKGROUND CONTEXT: The presence of ossification of posterior longitudinal ligament (OPLL) can lead to symptomatic spinal cord compression and myelopathy. The surgical approach in patients with myelopathy is influenced by the presence of OPLL. Diagnose of OPLL currently requires computed tomography which incurs a large dose of radiation. Circulating disease-specific microRNAs (miRNAs) may serve as promising diagnostic markers with no radiation and easy accessibility for OPLL patients. PURPOSE: The purpose of this study is to evaluate the accuracy and significance of OPLL-specific microRNAs in discriminating OPLL from normal and intervertebral disc degenerated (IDD) patients by detecting the microRNAs' plasma level. STUDY DESIGN/PATIENT SAMPLES: The level of microRNAs in OPLL patients' plasma or serum were detected and compared to that of normal and IDD patients to evaluate the accuracy and significance of diagnosing OPLL. METHODS: Taking advantage of the high through-put microRNA sequencing data, we selectively tested the ten most differentially regulated microRNAs in patients with: (1) radiologically diagnosed OPLL (n = 68), (2) radiologically diagnosed disc herniated patients with no evidence of OPLL (n = 45), (3) non-OPLL and nonmyelopathy patients (n = 53).The feasibility of the biomarkers in identifying OPLL was assessed through analysis of sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and area under the curve (AUC) values. RESULTS: Of the ten miRNAs validated, miR-10a-3p, miR-10a-5p, miR-563, miR-210-3p, and miR-218-3p showed significance between OPLL and non-OPLL blood samples. While miR-10a-5p, miR-563, and miR-210-3p showed high accuracy and significance in identifying OPLL from other groups individually, and an index that combines these miRNAs achieved the highest accuracy and AUC among these individual miRNAs. CONCLUSIONS: Analysis of miR-10a-5p, miR-563, and miR-210-3p may be of important value in diagnosing OPLL. These markers maybe useful in a clinical setting in the early detection of OPLL patients by blood testing.


Assuntos
MicroRNAs/sangue , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/sangue
10.
World Neurosurg ; 118: e505-e512, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30257303

RESUMO

OBJECTIVE: To investigate whether different quantitative measurements of increased signal intensity (ISI) on T2-weighted magnetic resonance imaging are useful for predicting surgical outcome in patients with cervical spondylotic myelopathy (CSM). METHODS: We retrospectively reviewed 108 patients with ISI who underwent surgery for CSM. Clinical outcome was evaluated via the Japanese Orthopaedic Association (JOA) score and the recovery rate. Patients were divided into 2 groups based on the JOA recovery rate: good (≥50%) and fair (<50%). The quantitative measurements of ISI included the maximum vertical length and the signal change ratio (SCR). C2-C7 sagittal alignment, C2-C7 sagittal vertical axis, C2-C7 range of motion, maximum spinal cord compression, and maximum canal compromise also were assessed. RESULTS: There were no significant differences in cervical sagittal alignment parameters between the groups. Multivariate analysis showed that a longer duration of symptoms, a lower preoperative JOA score, a longer preoperative ISI length, and a greater preoperative SCR were negatively associated with clinical outcomes. Receiver operating characteristic curve analysis showed that the best cutoff values of ISI length and SCR as negative predictors of surgical outcome were 15.50 mm and 1.56, respectively, and the areas under the receiver operating characteristic curve of preoperative ISI length, SCR that discriminate recovery rate of JOA score (≥50%, <50%) were 0.8507, 0.8422, respectively, and was 0.8903 for a combination of the 2. CONCLUSIONS: Duration of symptoms, preoperative JOA score, preoperative ISI length, and SCR can reflect surgical outcome in patients with CSM; however, cervical sagittal alignment may not affect surgical outcome. Combining ISI length and SCR to depict ISI on T2-weighted magnetic resonance imaging is optimal and accurate. Patients with ISI length >15.50 mm and SCR >1.56 have fair surgical recovery.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia
11.
Cell Physiol Biochem ; 49(6): 2463-2482, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30261504

RESUMO

BACKGROUND/AIMS: Intervertebral discs consist of an extracellular matrix (ECM) with a central gelatinous nucleus pulposus (NP) enclosed in an outer layer known as the annulus fibrosus. ECM metabolic disorders result in loss of boundary between the annulus fibrosus and NP, which can lead to intervertebral disc degeneration (IDD). Proinflammatory cytokines, such as interleukin (IL)-1ß, mediate the progression of IDD. Nicotinamide phosphoribosyltransferase (Nampt) catalyzes the first step in the biosynthesis of nicotinamide adenine dinucleotide (NAD) and is known to be induced by IL-1ß. APO866 is an inhibitor of NAD biosynthesis and is involved in autophagy. LC3 (microtubule-associated protein 1 light chain 3) is a key regulator of autophagy and is used as an indicator of increased autophagy. Herein, we investigate the role of APO866 in regulating autophagy in NP cells and IL-1ß mediated NP cell degeneration and apoptosis. METHODS: NP cells were extracted from IDD tissues and cultured in DMEM/F12 medium. Nampt was induced by different concentrations of IL-1ß (0, 0.5, 1, 5, 10 ng/mL) for 24 h or NP cells were treated with 10 ng/mL IL-1ß for 0, 6, 12, 48 h. QRT-PCR and western blots were used to detect Nampt and ECM-related protein expression in NP tissue of patients with IDD and in NP cells. Confocal analysis was used to detect membrane-bound LC3, Aggrecan, and Collagen II. RESULTS: Nampt is expressed in NP tissue at higher levels in severe grades of IDD (Grade IV and V) compared with low grades (Grade II and III). In NP cells, 10 ng/mL IL-1ß induced Nampt expression for 48 h, increased expression of the degradative-associated proteins, ADAMTS4/5 and MMP-3/13, and decreased expression of ECM-related proteins, Aggrecan and Collagen II. However, the Nampt inhibitor APO866 blocked IL-1ß induction, and the knockdown of Nampt expression increased the expression of ECM proteins that were inhibited by IL-1ß. Moreover, evidence provided by the autophagic markers LC3 and Beclin-1 indicated that APO866 induced NP cell autophagy. Furthermore, although APO866 inhibited the downregulated expression of ECM-related proteins by IL-1ß, this function was blocked by autophagy inhibitor, 3-methyladenine. CONCLUSION: APO866 protects NP cells and induces autophagy by inhibiting IL-1ß-induced NP cell degeneration and apoptosis, which may have therapeutic potential in IDD.


Assuntos
Acrilamidas/farmacologia , Autofagia/efeitos dos fármacos , Interleucina-1beta/farmacologia , Degeneração do Disco Intervertebral/patologia , Nicotinamida Fosforribosiltransferase/metabolismo , Piperidinas/farmacologia , Proteína ADAMTS4/metabolismo , Agrecanas/metabolismo , Células Cultivadas , Colágeno Tipo II/metabolismo , Citocinas/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Feminino , Humanos , Degeneração do Disco Intervertebral/metabolismo , Masculino , Metaloproteinase 3 da Matriz/metabolismo , Proteínas Associadas aos Microtúbulos/metabolismo , Pessoa de Meia-Idade , Nicotinamida Fosforribosiltransferase/antagonistas & inibidores , Nicotinamida Fosforribosiltransferase/genética , Núcleo Pulposo/citologia , Núcleo Pulposo/efeitos dos fármacos , Núcleo Pulposo/metabolismo , Interferência de RNA , RNA Interferente Pequeno/metabolismo
12.
Sci Rep ; 8(1): 9225, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29907859

RESUMO

Ossification of the posterior longitudinal ligament (OPLL) presents as pathological heterotopic ossification of the spinal ligaments. However, its underlying molecular mechanism is still unclear. Our previous findings suggested that altered microRNA regulatory network are critical for the development of OPLL. Here, we set out to unveiling the detailed mechanism of those altered OPLL-specific microRNAs. We screened a set of differentially expressed OPLL-specific microRNAs from the previous sequencing data and showed that microRNA-10a actively modulates the ossification of posterior ligament cells in vitro. Using a tissue-engineered scaffold grown from 4-week-old BALB/c homozygous nude mice, we found that altered microRNA-10a expression in posterior ligament cells indeed affected the heterotopic bone formation in vivo. Furthermore, computational analysis showed that the negative ossification regulator ID3 is a functional target gene of microRNA-10a, and its expression was also significantly altered during microRNA-10a modulation both in vitro and in vivo. Also, we have demonstrated that the ossification promoting function of microRNA-10a requires ID3, as ID3 actively inhibits RUNX2. Thus, we identified a critical role for highly altered OPLL-specific microRNA-10a in regulating the development of OPLL by modulating the ID3/RUNX2 axis.


Assuntos
Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Proteínas Inibidoras de Diferenciação/metabolismo , Ligamentos Longitudinais/metabolismo , MicroRNAs/metabolismo , Proteínas de Neoplasias/metabolismo , Ossificação do Ligamento Longitudinal Posterior/metabolismo , Ossificação Heterotópica/metabolismo , Animais , Células Cultivadas , Feminino , Humanos , Ligamentos Longitudinais/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Ossificação do Ligamento Longitudinal Posterior/patologia , Ossificação Heterotópica/patologia
14.
J Bone Miner Res ; 31(5): 1003-14, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26679066

RESUMO

Osteogenesis imperfecta (OI) is a genetic bone dysplasia characterized by brittle bones with increased fracture risk. Although current treatment options to improve bone strength in OI focus on antiresorptive bisphosphonates, controlled clinical trials suggest they have an equivocal effect on reducing fracture risk. Strontium ranelate (SrR) is a promising therapy with a dual mode of action that is capable of simultaneously maintaining bone formation and reducing bone resorption, and may be beneficial for the treatment of OI. In this study, SrR therapy was investigated to assess its effects on fracture frequency and bone mass and strength in an animal model of OI, the oim/oim mouse. Three-week-old oim/oim and wt/wt mice were treated with either SrR or vehicle (Veh) for 11 weeks. After treatment, the average number of fractures sustained by SrR-treated oim/oim mice was significantly reduced compared to Veh-treated oim/oim mice. Micro-computed tomographic (µCT) analyses of femurs showed that both trabecular and cortical bone mass were significantly improved with SrR treatment in both genotypes. SrR significantly inhibited bone resorption, whereas bone formation indices were maintained. Biomechanical testing revealed improved bone structural properties in both oim/oim and wild-type (wt/wt) mice under the treatment, whereas no significant effects on bone brittleness and material quality were observed. In conclusion, SrR was able to effectively reduce fractures in oim/oim mice by improving bone mass and strength and thus represents a potential therapy for the treatment of pediatric OI. © 2015 American Society for Bone and Mineral Research.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/prevenção & controle , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/tratamento farmacológico , Tiofenos/farmacologia , Microtomografia por Raio-X , Animais , Modelos Animais de Doenças , Fraturas Ósseas/genética , Incidência , Camundongos , Camundongos Mutantes , Osteogênese Imperfeita/genética
15.
PLoS One ; 10(9): e0136042, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26327216

RESUMO

OBJECTIVE: To investigate the clinical and imaging predictors of surgical outcomes in patients with ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS: From May 2010 to April 2012, a total of 200 consecutive patients with cervical OPLL were recruited for this study. Of them, 184 patients (130 men and 54 women) who could be tracked for more than 24 months after surgery were finally included for analysis. Their demographic, clinical and radiological data were collected preoperatively. The recovery ratio in terms of JOA score was used to assess the outcome of the patients preoperatively and at 2 years postoperatively. A JOA recovery rate less than 50% was considered a poor outcome. RESULTS: Compared with good outcome group, an older mean age at operation, a longer mean duration of symptoms, a lower mean pre-operativer JOA score, and a higher proportion of diabetics were observed in poor outcome group. Patients in poor outcome group were more likely to present kyphotic cervical alignment, smaller mean transverse area of the spinal cord, and intramedullary signal abnormalities. The result of multivariate stepwise logistic regression showed that a longer duration of symptoms and the presence of T1 hypo-intensity intramedullary changes on MRI were significant risk factors of lower JOA recovery ratios. CONCLUSION: A longer duration of symptom, T1 hypointensity on MRI and a history of minor trauma were highly predictive of a poor outcome for patients undergoing surgical treatment of OPLL. Age at operation, the history of diabetes, the preoperative JOA score, the transverse area of the spinal cord and T2 hyper-intensity on MRI were also associated with the prognosis of OPLL.


Assuntos
Vértebras Cervicais/patologia , Ossificação do Ligamento Longitudinal Posterior/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Zhonghua Wai Ke Za Zhi ; 52(5): 355-60, 2014 May.
Artigo em Chinês | MEDLINE | ID: mdl-25034743

RESUMO

OBJECTIVE: To evaluate the role and value of Changhai fulcrum bending radiograph(CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis(AIS) patients. METHODS: Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled, including 31 female and 6 male patients whose age ranged from 10 to 19 years, averaged of 15.0 years. The assessment of radiographs included preoperative standing posterior-anterior radiograph, supine side-bending radiograph, traditional fulcrum bending radiograph, Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph. Postoperatively, radiographs were assessed at one week. The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum. All measurements of angle were made with use of the Cobb method. The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients. The maximum height of CH-FBR, basic weight and maximum weight were measured for all AIS. Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples. The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate, the maximum height of CH-FBR and maximum weight, the height changes of CH-FBR and weight changes. RESULTS: A total of 46 curves were involved in this study, including 28 thoracic and 18 thoracolumbar/lumbar curves. Preoperatively, the mean Cobb angle of the 46 structural curves was 47° ± 11°. Postoperatively, the mean Cobb angle was 11° ± 5°. Cobb's angle in supine side-bending(t = 7.2, P = 0.001), traditional fulcrum bending (t = 7.1, P = 0.001) and lowest height of Changhai fulcrum bending (t = 6.5, P = 0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t = 11.0, P = 0.001) and lowest height of Changhai fulcrum bending (t = 13.6, P = 0.001) were significantly different from the optimized height CH-FBR Cobb angle. There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t = 2.0, P = 0.051), optimized height CH-FBR Cobb angle and postoperative Cobb angle (t = 0.9, P = 0.36), lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t = 2.0, P = 0.051). The maximum height of CH-FBR, basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ± 6)kg, and (40 ± 6) kg. Preoperatively, the mean Cobb angle of the 28 structural curves(main thoracic curves) was 46° ± 11°. Postoperatively, the mean Cobb angle was 12° ± 6°. Preoperatively, the mean Cobb angle of the 18 structural curves(thoracolumbar/lumbar curves) was 49° ± 12°. Postoperatively, the mean Cobb angle was 10° ± 5°. The results were same in 28 structural curves, 18 structural curves as well as 46 curves. Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r = 0.69, r(2) = 0.47, P = 0.001), the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r = 0.62, r(2) = 0.38, P = 0.001). CONCLUSIONS: CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients. Moreover, compared to the traditional FBR and side-bending radiograph, the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.


Assuntos
Amplitude de Movimento Articular , Escoliose/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Radiografia , Escoliose/cirurgia , Adulto Jovem
17.
Spine (Phila Pa 1976) ; 38(24): E1527-32, 2013 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-24220308

RESUMO

STUDY DESIGN: A prospective clinical and radiographical study. OBJECTIVE: To introduce a redesigned fulcrum-bending radiographical (FBR) method, and to validate the effectiveness of this method in assessing patients with (AIS). SUMMARY OF BACKGROUND DATA: Several radiographical methods exist to evaluate curve flexibility in patients with AIS. The technique of FBR has been demonstrated to better predict coronal plane correction of main thoracic curves. However, the amount of weight applied may affect the results of flexibility evaluation and have not been well studied to date. METHODS: Seventeen patients with AIS with 19 curves were involved in this study. The assessment of radiographs included preoperative standing posterior-anterior, supine side-bending, traditional FBR, new FBR (CH-FBR), and postoperative standing posterior-anterior radiographs. CH-FBR was performed at variable device heights while measuring the applied weight at the apex. RESULTS: Preoperatively, the mean Cobb angle was 47.5° ± 8.8° on the posterior-anterior radiographs, 14.3° ± 7.0° on supine side-bending radiographs, 13.3° ± 5.7° on traditional FBR, 11.3° ± 4.5° at the lowest height using CH-FBR (lowest weight), and 7.8° ± 4.1° at the optimized height using CH-FBR (maximal weight). Postoperatively, the mean Cobb angle was 9.1° ± 5.2°. There was a significant difference found between supine side-bending radiograph and postoperative Cobb angle (P = 0.001), traditional FBR, and postoperative Cobb angle (P = 0.002). There was no significant difference found between optimized height CH-FBR and postoperative Cobb angle (P = 0.16). Correlation analysis indicated that the maximum height of CH-FBR positively correlated with maximum weight applied (r = 0.68, r= 0.46, P = 0.001). CONCLUSION: CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending radiographs to measure curve flexibility in patients with AIS. Moreover, the flexibility suggested by the CH-FBRs more closely approximated the postoperative results from posterior pedicle screw instrumentation. LEVEL OF EVIDENCE: 3.


Assuntos
Radiografia/métodos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Adolescente , Parafusos Ósseos , Criança , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Período Pós-Operatório , Postura , Período Pré-Operatório , Estudos Prospectivos , Radiografia/instrumentação , Reprodutibilidade dos Testes , Decúbito Dorsal , Vértebras Torácicas/anormalidades , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adulto Jovem
18.
Cancer Nurs ; 36(1): 41-51, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22495499

RESUMO

BACKGROUND: The City of Hope Quality of Life-Ostomy Questionnaire is a widely accepted scale to assess quality of life in ostomy patients. However, the validity and reliability of the Chinese version (C-COH) have not been studied. OBJECTIVE: The objective of the study was to assess the validity and reliability of the C-COH among ostomy patients sampled from Shanghai from August 2010 to June 2011. METHODS: Content validity was examined based on the reviews of a panel of 10 experts; test-retest was conducted to assess the item reliabilities of the scale; a pilot sample (n = 274) was selected to explore the factorial structure of the C-COH using exploratory factor analysis; a validation sample (n = 370) was selected to confirm the findings from the exploratory study using confirmatory factor analysis (CFA). Statistical package SPSS version 16.0 was used for the exploratory factor analysis, and Amos 17.0 was used for the CFA. RESULTS: The C-COH was developed by modifying 1 item and excluding 11 items from the original scale. Four factors/subscales (physical well-being, psychological well-being, social well-being, and spiritual well-being) were identified and confirmed in the C-COH The scale reliabilities estimated from the CFA results for the 4 subscales were 0.860, 0.885, 0.864, and 0.686, respectively. CONCLUSIONS: Findings support the reliability and validity of the C-COH. IMPLICATIONS FOR PRACTICE: The C-COH could be a useful measure of the level of quality of life among Chinese patients with a stoma and may provide important intervention implications for healthcare providers to help improve the life quality of patients with a stoma.


Assuntos
Estomia , Qualidade de Vida , Inquéritos e Questionários , Adulto , China , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estomia/psicologia , Reprodutibilidade dos Testes
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