Antibiotic resistance and host immune evasion in Staphylococcus aureus mediated by a metabolic adaptation.

Staphylococcus aureus is a notorious human bacterial pathogen with considerable capacity to develop antibiotic resistance. We have observed that human infections caused by highly drug-resistant S. aureus are more prolonged, complicated, and difficult to eradicate. Here we describe a metabolic adaptation strategy used by clinical S. aureus strains that leads to resistance to the last-line antibiotic, daptomycin, and simultaneously affects host innate immunity. This response was characterized by a change in anionic membrane phospholipid composition induced by point mutations in the phospholipid biosynthesis gene, cls2, encoding cardiolipin synthase. Single cls2 point mutations were sufficient for daptomycin resistance, antibiotic treatment failure, and persistent infection. These phenotypes were mediated by enhanced cardiolipin biosynthesis, leading to increased bacterial membrane cardiolipin and reduced phosphatidylglycerol. The changes in membrane phospholipid profile led to modifications in membrane structure that impaired daptomycin penetration and membrane disruption. The cls2 point mutations also allowed S. aureus to evade neutrophil chemotaxis, mediated by the reduction in bacterial membrane phosphatidylglycerol, a previously undescribed bacterial-driven chemoattractant. Together, these data illustrate a metabolic strategy used by S. aureus to circumvent antibiotic and immune attack and provide crucial insights into membrane-based therapeutic targeting of this troublesome pathogen.

Distributions of Deuterated Polystyrene Chains in Perforated Layers of Blend Films of a Symmetric Polystyrene-block-poly(methyl methacrylate).

We have examined the spatial distributions of polymer chains in blend films of weakly segregated polystyrene-block-poly(methyl methacrylate) [P(S-b-MMA)] and deuterated polystyrene (dPS). By fine-tuning the composition (ϕPS+dPS = 63.8 vol %) of the total PS/dPS component and annealing temperature (230 and 270 °C), P(S-b-MMA)/dPS blend films mainly form perforated layers with a parallel orientation (hereafter PLs//). The distributions of dPS in PLs// were probed by grazing-incidence small-angle neutron scattering (GISANS) and time-of-flight neutron reflectivity (ToF-NR). GISANS and ToF-NR results offer evidence that dPS chains preferentially locate at the free surface and within the PS layers for blend films that were annealed at 230 °C. Upon annealing at 270 °C, dPS chains distribute within PS layers and perforated PMMA layers. Nevertheless, dPS chains still retain a surface preference for thin films. In contrast, such surface segregation of dPS chains is prohibited for thick films when annealed at 270 °C.

Effects of the Density of Chemical Cross-links and Physical Entanglements of Ultraviolet-Irradiated Polystyrene Chains on Domain Orientation and Spatial Order of Polystyrene-block-Poly(methyl methacrylate) Nano-Domains.

Ultraviolet irradiation (UVI) of varied duration caused cross-linking and neutralization of polystyrene (PS) homopolymers of molar mass (Mn) from 6 to 290 kg mol-1 on a silicon-oxide surface. An optimal neutral skin layer on the surface of the PS was obtained via brief UVI in air (UVIA), by which the PS had no preferential interaction with either block in the copolymer. UVI in an inert environment (gaseous dinitrogen) (UVIN) stabilized the PS layers via cross-linking and enabled the PS networks to have an effective adhesive contact with the underlying substrate. Thorough examination of domain orientations and spatial orders of a series of block copolymer, polystyrene-block-poly(methyl methacrylate) (PS-b-PMMA), thin films deposited on these UVI-treated PS support layers yielded clear evidence that a dense layer of neutralized PS chains was required for the perpendicular orientation of PS-b-PMMA nanodomains. In particular, in addition to neutralization, two factors-the densities of physical entanglements and of chemical crosslinks-both in UVI-treated PS should be considered for the perpendicular orientation of nanolamellae and nanocylinders in symmetric and asymmetric PS-b-PMMA thin films. The density of physical entanglement in PS depends intrinsically on Mn of the PS, whereas the density of chemical cross-links was controlled with a varied duration of UVIN. Sufficiently large densities of physical entanglements and chemical cross-links can prevent PS-b-PMMA chains from penetrating through the neutral skin layer. The total density of physical entanglements and chemical cross-links required for the perpendicular orientation is correlated with the dimensions of the PS-b-PMMA chains.

Morphology-Mediated Photoresponsive and Fluorescence Behaviors of Azobenzene-Containing Block Copolymers.

We investigated the relationship between the self-assembled morphology of poly( tert-butyl acrylate)- block-poly(6-[4-(4'-methoxyphenylazo)phenoxy]hexyl methacrylate) (P tBA- b-PAzoMA) block copolymers and their photoresponsive and fluorescence behaviors. The morphology of P tBA- b-PAzoMA copolymers was manipulated by dissolving them in mixed dimethylformamide (DMF)/hexanol solvents. When P tBA- b-PAzoMA was dissolved in DMF-rich (neutral) solvents, a favorable interaction between the DMF molecules and both blocks resulted in a random-coiled conformation. The unconfined morphology facilitated the formation of both nonassociated and head-to-head organized azobenzene mesogens, which promoted fluorescence emission. When hexanol, a P tBA-selective solvent, was added to DMF, the solvency of P tBA- b-PAzoMA worsened, leading to its assembly into micelles, with PAzoMA in the micelle core. The confinement of azobenzene moieties in the micelle core hindered their trans-to- cis photoisomerization, thereby considerably decreasing the kinetics of photoisomerization and the population of cis isomers. Additionally, a nanoconfined geometry resulted in compactly packed chromophores, causing fluorescence loss. When P tBA- b-PAzoMA was exposed to UV light, the increased number of cis isomers hampered the closely packed mesogens, resulting in a substantial enhancement of fluorescence emission. When the mole fraction of the PAzoMA block was increased, P tBA- b-PAzoMA formed clusters, causing the slow kinetics of photoisomerization and fluorescence quenching.

Effects of Alkali Cations and Halide Anions on the Self-Assembly of Phosphatidylcholine in Oils.

The interactions between ions and phospholipids are closely associated with the structures and functions of cell membrane. Instead of conventional aqueous systems, we systematically investigated the effects of inorganic ions on the self-assembly of lecithin, a zwitterionic phosphatidylcholine, in cyclohexane. Previous studies have shown that addition of inorganic salts with specific divalent and trivalent cations can transform lecithin organosols into organogels. In this study, we focused on the effect of monovalent alkali halides. Fourier transform infrared spectroscopy was used to demonstrate that the binding strength of the alkali cations with the phosphate of lecithin is in the order Li+ > Na+ > K+. More importantly, the cation-phosphate interaction is affected by the paired halide anions, and the effect follows the series I- > Br- > Cl-. The salts of stronger interactions with lecithin, including LiCl, LiBr, LiI, and NaI, were found to induce cylindrical micelles sufficiently long to form organogels, while others remain organosols. A mechanism based on the charge density of ions and the enthalpy change of the ion exchange between alkali halides and lecithin headgroup is provided to explain the contrasting interactions and the effectiveness of the salts to induce organogelation.

DNA damage-induced NF-κB activation in human glioblastoma cells promotes miR-181b expression and cell proliferation.

BACKGROUND: Glioblastoma (GBM) is the most common and most aggressive form of brain cancer. After surgery, radiotherapy is the mainstay of treatment for GBM patients. Unfortunately, the vast majority of GBM patients fail responding to radiotherapy because GBM cells remain highly resistant to radiation. Radiotherapy-induced DNA damage response may correlate with therapeutic resistance. METHODS: Ionizing radiation (IR) was used to induce DNA damage. Cell proliferation and migration were detected by wound-healing, MTT and apoptosis assays. Dual-luciferase assays and Western blot analysis were performed to evaluate NF-κB activation and validate microRNA targets. Real-time PCR was used to study mRNA and microRNA levels. RESULTS: IR-induced DNA damage activated NF-κB in GBM cells which promoted expression of IL-6, IL-8 and Bcl-xL, thereby contributing to cell survival and invasion. Knockdown SENP2 expression enhanced NF-κB essential modulator (NEMO) SUMOylation and NF-κB activity following IR exposure. miR-181b targets SENP2 and positively regulated NF-κB activity. CONCLUSION: NF-κB activation by DNA damage in GBM cells confers resistance to radiation-induced death.

Nano- and Microstructures of Collagen-Nanocellulose Hydrogels as Engineered Extracellular Matrices.

The extracellular matrix (ECM) is the fundamental acellular element of human tissues, providing their mechanical structure while delivering biomechanical and biochemical signals to cells. Three-dimensional (3D) tissue models commonly use hydrogels to recreate the ECM in vitro and support the growth of cells as organoids and spheroids. Collagen-nanocellulose (COL-NC) hydrogels rely on the blending of both polymers to design matrices with tailorable physical properties. Despite the promising application of these biomaterials in 3D tissue models, the architecture and network organization of COL-NC remain unclear. Here, we investigate the structural effects of incorporating NC fibers into COL hydrogels by small-angle neutron scattering (SANS) and ultra-SANS (USANS). The critical hierarchical structure parameters of fiber dimensions, interfiber distance, and coassembled open structures of NC and COL in the absence and presence of cells were determined. We found that NC expanded and increased the homogeneity in the COL network without affecting the inherent fiber properties of both polymers. Cells cultured as spheroids in COL-NC remodeled the hydrogel network without a significant impact on its architecture. Our study reveals the polymer organization of COL-NC hydrogels and demonstrates SANS and USANS as exceptional techniques to reveal nano- and micron-scale details on polymer organization, which leads to a better understanding of the structural properties of hydrogels to engineer novel ECMs.

Emergence of the isotropic Kitaev honeycomb latticeα-RuCl3and its magnetic properties.

We present a comprehensive investigation of the crystal and magnetic structures of the van der Waals antiferromagnetα-RuCl3using single crystal x-ray and neutron diffraction. The crystal structure at room temperature is a monoclinic (C2/m). However, with decreasing temperature, a remarkable first-order structural phase transition is observed, leading to the emergence of a rhombohedral (R3-) structure characterized by three-fold rotational symmetry forming an isotropic honeycomb lattice. On further cooling, a zigzag-type antiferromagnetic order develops belowTN=6∼6.6K. The critical exponent of the magnetic order parameter was determined to beß=0.11(1), which is close to the two-dimensional Ising model. Additionally, the angular dependence of the magnetic critical field of the zigzag antiferromagnetic order for the polarized ferromagnetic phase reveals a six-fold rotational symmetry within theab-plane. These findingsreflect the symmetry associated with the Ising-like bond-dependent Kitaev spin interactions and underscore the universality of the Kitaev interaction-dominated antiferromagnetic system.

Recent Progress of 2D Layered Materials in Water-in-Salt/Deep Eutectic Solvent-Based Liquid Electrolytes for Supercapacitors.

Supercapacitors are candidates with the greatest potential for use in sustainable energy resources. Extensive research is being carried out to improve the performances of state-of-art supercapacitors to meet our increased energy demands because of huge technological innovations in various fields. The development of high-performing materials for supercapacitor components such as electrodes, electrolytes, current collectors, and separators is inevitable. To boost research in materials design and production toward supercapacitors, the up-to-date collection of recent advancements is necessary for the benefit of active researchers. This review summarizes the most recent developments of water-in-salt (WIS) and deep eutectic solvents (DES), which are considered significant electrolyte systems to advance the energy density of supercapacitors, with a focus on two-dimensional layered nanomaterials. It provides a comprehensive survey of 2D materials (graphene, MXenes, and transition-metal oxides/dichalcogenides/sulfides) employed in supercapacitors using WIS/DES electrolytes. The synthesis and characterization of various 2D materials along with their electrochemical performances in WIS and DES electrolyte systems are described. In addition, the challenges and opportunities for the next-generation supercapacitor devices are summarily discussed.

Synthesis and Characterization of Supermagnetic Nanocomposites Coated with Pluronic F127 as a Contrast Agent for Biomedical Applications.

Nanomedicine has garnered significant interest owing to advances in drug delivery, effectively demonstrated in the treatment of certain diseases. Here, smart supermagnetic nanocomposites based on iron oxide nanoparticles (MNPs) coated with Pluronic F127 (F127) were developed for the delivery of doxorubicin (DOX) to tumor tissues. The XRD patterns for all samples revealed peaks consistent with Fe3O4, as shown by their indices (220), (311), (400), (422), (511), and (440), demonstrating that the structure of Fe3O4 did not change after the coating process. After loading with DOX, the as-prepared smart nanocomposites demonstrated drug-loading efficiency and drug-loading capacity percentages of 45 ± 0.10 and 17 ± 0.58% for MNP-F127-2-DOX and 65 ± 0.12 and 13 ± 0.79% for MNP-F127-3-DOX, respectively. Moreover, a better DOX release rate was observed under acidic conditions, which may be credited to the pH sensitivity of the polymer. In vitro analysis demonstrated the survival rate of approximately 90% in HepG2 cells treated with PBS and MNP-F127-3 nanocomposites. Furthermore, after treatment with MNP-F127-3-DOX, the survival rate decreased, confirming cellular inhibition. Hence, the synthesized smart nanocomposites showed great promise for drug delivery in liver cancer treatment, overcoming the limitations of traditional therapies.

Effect of temperature on the conformation and functionality of poly(N-isopropylacrylamide) (PNIPAM)-grafted nanocellulose hydrogels.

HYPOTHESIS: Poly(N-isopropylacrylamide) [PNIPAM]-grafted cellulose nanofibers (CNFs) are new thermo-responsive hydrogels which can be used for a wide range of applications. Currently, there is no clear understanding of the precise mechanism by which CNFs and PNIPAM interact together. Here, we hypothesize that the physical crosslinking of grafted PNIPAM on CNF inhibits the free movement of individual CNF, which increases the gel strength while sustaining its thermo-responsive properties. EXPERIMENTS: The thermo-responsive behaviour of PNIPAM-grafted CNFs (PNIPAM-g-CNFs), synthesized via silver-catalyzed decarboxylative radical polymerization, and PNIPAM-blended CNFs (PNIPAM-b-CNFs) was studied. Small angle neutron scattering (SANS) combined with Ultra-SANS (USANS) revealed the nano to microscale conformation changes of these polymer hybrids as a function of temperature. The effect of temperature on the optical and viscoelastic properties of hydrogels was also investigated. FINDINGS: Grafting PNIPAM from CNFs shifted the lower critical solution temperature (LCST) from 32 °C to 36 °C. Below LCST, the PNIPAM chains in PNIPAM-g-CNF sustain an open conformation and poor interaction with CNF, and exhibit water-like behaviour. At and above LCST, the PNIPAM chains change conformation to entangle and aggregate nearby CNFs. Large voids are formed in solution between the aggregated PNIPAM-CNF walls. In comparison, PNIPAM-b-CNF sustains liquid-like behaviour below LCST. At and above LCST, the blended PNIPAM phase separates from CNF to form large aggregates which do not affect CNF network and thus PNIPAM-b-CNF demonstrates low viscosity. Understanding of temperature-dependent conformation of PNIPAM-g-CNFs engineer thermo-responsive hydrogels for biomedical and functional applications.

Structural basis underlying the synergism of NADase and SLO during group A Streptococcus infection.

Group A Streptococcus (GAS) is a strict human pathogen possessing a unique pathogenic trait that utilizes the cooperative activity of NAD+-glycohydrolase (NADase) and Streptolysin O (SLO) to enhance its virulence. How NADase interacts with SLO to synergistically promote GAS cytotoxicity and intracellular survival is a long-standing question. Here, the structure and dynamic nature of the NADase/SLO complex are elucidated by X-ray crystallography and small-angle scattering, illustrating atomic details of the complex interface and functionally relevant conformations. Structure-guided studies reveal a salt-bridge interaction between NADase and SLO is important to cytotoxicity and resistance to phagocytic killing during GAS infection. Furthermore, the biological significance of the NADase/SLO complex in GAS virulence is demonstrated in a murine infection model. Overall, this work delivers the structure-functional relationship of the NADase/SLO complex and pinpoints the key interacting residues that are central to the coordinated actions of NADase and SLO in the pathogenesis of GAS infection.

Β-elemene inhibits Hsp90/Raf-1 molecular complex inducing apoptosis of glioblastoma cells.

ß-Elemene, an active component of herb medicine Curcuma wenyujin, has been shown to antagonize glioblastoma cells by inducing apoptosis. However, how ß-elemene induces apoptosis of these cells remains unclear. In this study, we report that ß-elemene disrupted the formation of the Hsp90/Raf-1 complex, a key step in maintaining the conformation stability of Raf-1, and caused deactivation of Raf-1 and inhibition of the ERK pathway, thereby leading to apoptosis of glioblastoma cells. Specifically, treatment of glioblastoma cell lines with ß-elemene attenuated phosphorylation of multiple members of the kinase families in the Ras/Raf/MEK/ERK cascade, including Raf-1 and ERK as well as downstream signaling targets such as Bcl-2. These results suggest that the Hsp90/Raf-1 complex could be a promising molecular target for new drug development for the treatment of glioblastoma.

Design and synthesis of triazolyl coumarins as Hg2+ selective fluorescent chemosensors.

A series of triazolyl coumarin derivatives L1-L4, with and without spacer groups between the coumarin and the triazole groups, were synthesized as fluorescent sensors to study their binding ability and selectivity toward metal ions. Ligand L3, which contains an acetyl linker between the triazole and the coumarin, exhibited a high selectivity toward Hg(2+) in polar protic solvents MeOH-CHCl(3) (9 : 1, v/v) with fluorescent enhancement, furthermore, it was found to bind two Hg(2+) at a high concentration (>12.5 mM) of Hg(ClO(4))(2). In contrast, L4, in which position 4 of the triazole unit was replaced by a benzyl group instead of the 4-tert-butylphenoxymethyl group used in L1-L3, showed a binding stoichiometry toward only one Hg(2+). On the basis of the fluorescent sensing, IR, and (1)H NMR titration results of ligands L1-L4, we proposed that not only the acetyl C=O but also the ether group of the 4-tert-butylphenoxymethyl of assisted the triazole nitrogen atoms in the complexation of Hg(2+) to form a 1 : 2 complex (L3·(Hg(2+))(2)).

Non-conventional superconductivity in magnetic In and Sn nanoparticles.

We report on experimental evidence of non-conversional pairing in In and Sn nanoparticle assemblies. Spontaneous magnetizations are observed, through extremely weak-field magnetization and neutron-diffraction measurements, to develop when the nanoparticles enter the superconducting state. The superconducting transition temperature TC shifts to a noticeably higher temperature when an external magnetic field or magnetic Ni nanoparticles are introduced into the vicinity of the superconducting In or Sn nanoparticles. There is a critical magnetic field and a critical Ni composition that must be reached before the magnetic environment will suppress the superconductivity. The observations may be understood when assuming development of spin-parallel superconducting pairs on the surfaces and spin-antiparallel superconducting pairs in the core of the nanoparticles.

A polytherapy based approach to combat antimicrobial resistance using cubosomes.

A depleted antimicrobial drug pipeline combined with an increasing prevalence of Gram-negative 'superbugs' has increased interest in nano therapies to treat antibiotic resistance. As cubosomes and polymyxins disrupt the outer membrane of Gram-negative bacteria via different mechanisms, we herein examine the antimicrobial activity of polymyxin-loaded cubosomes and explore an alternative strategy via the polytherapy treatment of pathogens with cubosomes in combination with polymyxin. The polytherapy treatment substantially increases antimicrobial activity compared to polymyxin B-loaded cubosomes or polymyxin and cubosomes alone. Confocal microscopy and neutron reflectometry suggest the superior polytherapy activity is achieved via a two-step process. Firstly, electrostatic interactions between polymyxin and lipid A initially destabilize the outer membrane. Subsequently, an influx of cubosomes results in further membrane disruption via a lipid exchange process. These findings demonstrate that nanoparticle-based polytherapy treatments may potentially serve as improved alternatives to the conventional use of drug-loaded lipid nanoparticles for the treatment of "superbugs".

Substrate-dependent arrangements of the subunits of the BAM complex determined by neutron reflectometry.

In Gram-negative bacteria, the ß-barrel assembly machinery (BAM) complex catalyses the assembly of ß-barrel proteins into the outer membrane, and is composed of five subunits: BamA, BamB, BamC, BamD and BamE. Once assembled, - ß-barrel proteins can be involved in various functions including uptake of nutrients, export of toxins and mediating host-pathogen interactions, but the precise mechanism by which these ubiquitous and often essential ß-barrel proteins are assembled is yet to be established. In order to determine the relative positions of BAM subunits in the membrane environment we reconstituted each subunit into a biomimetic membrane, characterizing their interaction and structural changes by Quartz Crystal Microbalance with Dissipation monitoring (QCM-D) and neutron reflectometry. Our results suggested that the binding of BamE, or a BamDE dimer, to BamA induced conformational changes in the polypeptide transported-associated (POTRA) domains of BamA, but that BamB or BamD alone did not promote any such changes. As monitored by neutron reflectometry, addition of an unfolded substrate protein extended the length of POTRA domains further away from the membrane interface as part of the mechanism whereby the substrate protein was folded into the membrane.

Targeted delivery of LM22A-4 by cubosomes protects retinal ganglion cells in an experimental glaucoma model.

Glaucoma, a major cause of irreversible blindness worldwide, is associated with elevated intraocular pressure (IOP) and progressive loss of retinal ganglion cells (RGCs) that undergo apoptosis. A mechanism for RGCs injury involves impairment of neurotrophic support and exogenous supply of neurotrophic factors has been shown to be beneficial. However, neurotrophic factors can have widespread effects on neuronal tissues, thus targeting neurotrophic support to injured neurons may be a better neuroprotective strategy. In this study, we have encapsulated LM22A-4, a small neurotrophic factor mimetic, into Annexin V-conjugated cubosomes (L4-ACs) for targeted delivery to injured RGCs in a model of acute IOP elevation, which is induced by acute IOP elevation. We have tested cubosomes formulations that encapsulate from 9% to 33% LM22A-4. Our data indicated that cubosomes encapsulating 9% and 17% LM22A-4 exhibited a mixture of Pn3m/Im3m cubic phase, whereas 23% and 33% showed a pure Im3m cubic phase. We found that 17% L4-ACs with Pn3m/Im3m symmetries showed better in-situ and in-vitro lipid membrane interactions than the 23% and 33% L4-ACs with Im3m symmetry. In vivo experiments showed that 17% L4-ACs targeted the posterior retina and the optic nerve head, which prevented RGCs loss and improved functional outcomes in a mouse model of acute IOP elevation. These results provide evidence that Annexin V-conjugated cubosomes-based LM22A-4 delivery may be a useful targeted approach to prevent the progression of RGCs loss in glaucoma. STATEMENT OF SIGNIFICANCE: Recent studies suggest that the therapy of effectively delivering neurotrophic factors to the injured retinal ganglion cells (RGCs) could promote the survival of RGCs in glaucoma. Our present work has for the first time used cubosomes as an active targeted delivery system and have successfully delivered a neuroprotective drug to the damaged RGCs in vivo. Our new cubosomal formulation can protect apoptotic cell death in vitro and in vivo, showing that cubosomes are a promising drug carrier system for ocular drug delivery and glaucoma treatment. We have further found that by controlling cubosomes in Pn3m phase we can facilitate delivery of neuroprotective drug through apoptotic membranes. This data, we believe, has important implications for future design and formulation of cubosomes for therapeutic applications.

Interplay between the crystalline and magnetic structures in lightly Cr-doped Bi(0.37)Ca(0.63)Mn(0.96)Cr(0.04)O(2.99).

The interplay between the crystalline and magnetic structures of a 4% Cr-doped Bi(0.37)Ca(0.63)Mn(0.96)Cr(0.04)O(2.99) has been investigated by alternating current (ac) magnetic susceptibility, electrical resistivity, and neutron diffraction measurements. The compound crystallizes into a monoclinic P2(1)/m symmetry. A Jahn-Teller distortion occurs at 280 K. The thermal behavior of charge transport may be described by a three-dimensional variable range hopping conduction. Strong interplay between the localized magnetic electrons and the itinerant electrons are clearly revealed as the localization length increases by 20% when the Mn spins become ordered below 85 K. Short range magnetic correlations persist up to 160 K. The collinear magnetic structure can be viewed as consisting of ferromagnetic spin-trimers antiferromagnetically embedded in a ferromagnetic environment. Cr-doping reduces the charge ordering temperature and the magnetic ordering temperature. It nevertheless introduces long-range ferromagnetism.

[Comparison of treatment with micro endoscopic discectomy and posterior lumbar interbody fusion using single and double B-Twin expandable spinal spacer].

OBJECTIVE: To compare the therapeutic effect of posterior lumbar interbody fusion by single and double B-Twin expandable spinal spacer with micro endoscopic discectomy (MED) for lumbar intervertebral disc protrusion accompanying degenerative instability. METHODS: From March 2006 to May 2008, 45 patients with lumbar intervertebral disc protrusion accompanying degenerative instability were admitted and managed with posterior lumbar interbody fusion by B-Twin expandable spinal spacer with MED. The patients were randomly assigned to treatment with single B-Twin (Single group, n = 24) or double B-Twin (Double group, n = 21). There were 16 males and 8 females, with an average age of 45.5 years (43 - 60 years) in Single group; 13 males and 8 females, with an average age of 43.7 years (44-61 years) in Double group. All the cases suffered from only one level disc protrusion, L(3-4) 2 cases, L(4-5) 29 cases and L5-S1 14 cases. Clinical outcomes were evaluated with surgical time, blood loss, visual analogue scale (VAS) scores preoperatively, 1, 3, 6 month postoperatively. Oswestry disability questionnaire (ODI) of the preoperative, 1 month postoperative, and latest follow-up and the disk space heights. RESULTS: Forty three patients were followed-up for 1 to 3 years after surgery. The mean surgical time of Double group was longer than Single group [(152 ± 32) min vs. (91 ± 15) min, P < 0.01]. The average blood loss in Double group was more than that in Single group [(146 ± 73) ml vs. (95 ± 58) ml, P < 0.01]. The mean time of hospital stay in Single group was similar to that in Double group [(11.0 ± 3.2) d vs. (10.9 ± 3.3) d, P > 0.05]. Both groups could keep the disk space heights till the last follow-up [(7.7 ± 1.8) mm vs. (8.5 ± 1.7) mm]. In the 6 months follow-up post operation, the VAS score decreased from (8.1 ± 1.8) to (2.0 ± 1.0) in Single group, and (8.1 ± 1.9) to (2.1 ± 1.0) in Double group. At the last follow-up, the ODI decreased from (36 ± 7)% to (10 ± 4)% in Single group and (37 ± 6)% to (9 ± 4)% in Double group, but there was no significant difference between the two groups (P > 0.05). All the cases achieved fusion at the last follow-up, 3 patients in Single group and 2 patients in Double group suffered from intractable low back pain. One of the fins broke in one patient without any uncomfortable feeling. CONCLUSIONS: Compared with the management of lumbar intervertebral disc protrusion accompanying degenerative instability by double B-Twin expandable spinal spacer with micro endoscopic discectomy, the single B-twin can get similar clinical outcomes, but shorter surgical time, less blood loss and less medical costs.