Extensive intracranial arterial dolichoectasia involving distal branches of intracranial arteries: two cases report and review of the literature.

With the rapid development of noninvasive angiography techniques such as Magnetic Resonance Angiography (MRA) and Computer Tomography Angiography (CTA), more and more patients with intracranial arterial dolichoectasia (IADE) have been found, and clinical studies on this kind of vascular abnormity have become hot subjects in neurology. We presented two young patients with IADE extensively involving the branches of intracranial arteries, which were different from patients described in other articles. A young male patient was diagnosed with IADE after examination on admission, and further detailed examination revealed that the patient had osteropathia striata. Another young woman had an arterial malformation that mainly affected the distal branch of the intracranial artery. These two cases give us another perspective to look into IADE.

Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell's disease.

BACKGROUND: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell's disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. METHODS: The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb's angle were assessed by imaging. RESULTS: All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. CONCLUSION: PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

Percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in geriatric patients.

PURPOSE: We aimed to investigate the surgical strategy, safety, and efficacy of percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in geriatric patients. METHODS: From January 2012 to June 2014, 25 elderly patients (18 males and 7 females) with symptomatic lumbar lateral recess stenosis were performed percutaneous endoscopic transforaminal decompression. The ages of patients ranged from 70 to 93 years (mean 79.6 years). Clinical outcomes were assessed mainly by leg pain visual analogue scale (VAS), Oswestry disability index (ODI) score, MacNab criteria, and post-operative computerized tomographic (CT) scanning. RESULTS: The surgery was successfully completed in all patients with an average operation time of 75 minutes (range, 50-110 min). The lumbar CT images at two days after the operation demonstrated distinct enlargement of the foramen intervertebrale as well as satisfactory decompression of the lumbar lateral recess. And 24 patients of the group were followed up for a mean duration of 29 ± six months (range, 12-44 months). The leg pain VAS score decreased from 8.52 ± 1.11 pre-operatively to 1.80 ± 0.63, 1.33 ± 0.89, 1.05 ± 0.69, and 0.71 ± 0.50 at one, three, six and 12 months after the operation, respectively. Besides, the ODI score also dropped from 59.43 ± 10.04 pre-operatively to 29.42 ± 10.33, 20.13 ± 8.18, 13.98 ± 6.16, and 9.86 ± 5.03 at one, three, six and 12 months during the post-operative follow-up period. Statistically significant differences existed in both VAS score and ODI score at each follow-up time point when compared with the pre-operative scores (P < 0.05). The mean reciprocal angulation change of the operated segment in dynamic lumbar lateral view was 3.2° ± 1.6° at the last follow-up. And there were 18 excellent cases, three good cases, and three fair cases according to the MacNab criteria, and the excellent and good rate was 87.5% at 12 months after the operation. There was no aggravation of the coexisting medical conditions after operation in this group. Only 1 case was found complicated with lower extremity numbness, which was recovered by conservative treatment for two weeks. No persistent neurological deficit or soft tissue infection occurred in all patients post-operatively. CONCLUSIONS: We considered that percutaneous endoscopic transforaminal decompression achieved satisfactory results and provided a safe, effective, and less invasive alternative for treating lumbar lateral recess stenosis in geriatric patients.

AKR1B1 Upregulation Contributes to Neuroinflammation and Astrocytes Proliferation by Regulating the Energy Metabolism in Rat Spinal Cord Injury.

Spinal cord injury (SCI) is one of the most common and serious condition, which leads to permanent neurological dysfunction and poor prognosis in patients. Hyperglycemia impairs neural functional recovery after SCI resulting in the overproduction of reactive oxygen species (ROS) and inflammatory cytokines. However, the effect of glucose metabolism in the spinal cord after injury remains unclear. AKR1B1, one member of the aldo/keto reductase superfamily, is involved in the energy metabolism of plasm glucose and ROS production. The role of AKR1B1 in cancer cell proliferation and invasion has been confirmed. Meanwhile, Akt, one pivotal transcription factor particularly, is involved in the regulation of cell cycle and ROS-mediated secondary injury in the lesion site. In our study, we established an acute SCI rat model to identify the expression of AKR1B1 and its role in neural recovery processes. Western blotting revealed the expression of AKR1B1 protein was elevated after injury, peaked at 3 days and declined gradually to normal at 14 days. Similar results was illustrated in immunohistochemistry staining of white matter. Double immunofluorescence staining showed AKR1B1 was expressed in glial cells and its expression was significantly increased in proliferative astrocytes during the pathological processes. Further experiments showed AKR1B1 was co-located with Akt protein in GFAP positive cells and immunoprecipitated with Akt in injured spinal cord as well. In summary, the present study demonstrated AKR1B1 played a vital role in astrocytes proliferation through Akt pathway, associated with the metabolism of hyperglycemia induced by SCI.

Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis.

PURPOSE: The purpose of this research is to compare the clinical efficacy, postoperative complication and surgical trauma between anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of the posterior longitudinal ligament (OPLL). STUDY DESIGN: Systematic review and meta-analysis. METHODS: An comprehensive search of literature was implemented in three electronic databases (Embase, Pubmed, and the Cochrane library). Randomized or non-randomized controlled studies published since January 1990 to July 2017 that compared anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for the treatment of cervical oppressive myelopathy owing to OPLL were acquired. Exclusion criteria were non-human studies, non-controlled studies, combined anterior and posterior operative approach, the other anterior or posterior approaches involving cervical discectomy and fusion and laminectomy with (or without) instrumented fusion, revision surgeries, and cervical myelopathy caused by cervical spondylotic myelopathy. The quality of the included articles was evaluated according to GRADE. The main outcome measures included: preoperative and postoperative Japanese Orthopedic Association (JOA) score; neuro-functional recovery rate; complication rate; reoperation rate; preoperative and postoperative C2-C7 Cobb angle; operation time and intraoperative blood loss; and subgroup analysis was performed according to the mean preoperative canal occupying ratio (Subgroup A:the mean preoperative canal occupying ratio < 60%, and Subgroup B:the mean preoperative canal occupying ratio ≥ 60%). RESULTS: A total of 10 studies containing 735 patients were included in this meta-analysis. And all of the selected studies were non-randomized controlled trials with relatively low quality as assessed by GRADE. The results revealed that there was no obvious statistical difference in preoperative JOA score between the ACCF and LAMP groups in both subgroups. Also, in subgroup A (the mean preoperative canal occupying ratio < 60%), no obvious statistical difference was observed in the postoperative JOA score and neurofunctional recovery rate between the ACCF and LAMP groups. But, in subgroup B (the mean preoperative canal occupying ratio ≥ 60%), the ACCF group illustrated obviously higher postoperative JOA score and neurofunctional recovery rate than the LAMP group (P < 0.01, WMD 1.89 [1.50, 2.28] and P < 0.01, WMD 24.40 [20.10, 28.70], respectively). Moreover, the incidence of both complication and reoperation was markedly higher in the ACCF group compared with LAMP group (P < 0.05, OR 1.76 [1.05, 2.97] and P < 0.05, OR 4.63 [1.86, 11.52], respectively). In addition, the preoperative cervical C2-C7 Cobb angle was obviously larger in the LAMP group compared with ACCF group (P < 0.05, WMD - 5.77 [- 9.70, - 1.84]). But no statistically obvious difference was detected in the postoperative cervical C2-C7 Cobb angle between the two groups. Furthermore, the ACCF group showed significantly more operation time as well as blood loss compared with LAMP group (P < 0.01, WMD 111.43 [40.32,182.54], and P < 0.01, WMD 111.32 [61.22, 161.42], respectively). CONCLUSION: In summary, when the preoperative canal occupying ratio < 60%, no palpable difference was tested in postoperative JOA score and neurofunctional recovery rate. But, when the preoperative canal occupying ratio ≥ 60% ACCF was associated with better postoperative JOA score and the recovery rate of neurological function compared with LAMP. Synchronously, ACCF in the cure for cervical myelopathy owing to OPLL led to more surgical trauma and more incidence of complication and reoperation. On the other hand, LAMP had gone a diminished postoperative C2-C7 Cobb angle, that might be a cause of relatively higher incidence of postoperative late neurofunctional deterioration. In brief, when the preoperative canal occupying ratio < 60%, LAMP seems to be effective and safe. However, when the preoperative canal occupying ratio ≥ 60%, we prefer to choose ACCF while complications could be controlled by careful manipulation and advanced surgical techniques. No matter which option you choose, benefits and risks ought to be balanced.

Does intraoperative reduction result in better outcomes in low-grade lumbar spondylolisthesis after transforaminal lumbar interbody fusion? A systematic review and meta-analysis.

Objective: This study aimed to compare the clinical efficacy and safety of reduction vs. arthrodesis in situ with transforaminal lumbar interbody fusion (TLIF) for low-grade lumbar spondylolisthesis. Study design: Systematic review and meta-analysis. Methods: A comprehensive literature search was implemented in PubMed, Embase, and Cochrane Library databases. Randomized or non-randomized controlled trials that were published until July 2023 that compared reduction vs. arthrodesis in situ techniques with minimally invasive or open-TLIF for low-grade spondylolisthesis were selected. The quality of the included studies was evaluated by the Newcastle-Ottawa Scale (NOS). Data were extracted according to the predefined outcome measures, including operation time and intraoperative blood loss; short- and long-time follow-up of visual analog scale (VAS) back pain (VAS-BP) and Oswestry Disability Index (ODI); slippage and segmental lordosis; and the complication and fusion rate. Results: Five studies (n = 495 patients) were finally included. All of them were retrospective cohort studies with Evidence Level II. The pooled data revealed that both techniques had similar patient-reported outcomes (VAS, ODI, and good and excellent rate) during short- and long-term follow-up. In addition, no significant differences were observed in the fusion and complication rates. However, although the reduction group did achieve better slippage correction, it was associated with increased operation time and intraoperative blood loss compared with the in situ arthrodesis group. Conclusions: Based on the available evidence, intraoperative reduction does not result in better clinical outcomes in low-grade spondylolisthesis after minimally invasive or open-TLIF, and the in situ arthrodesis technique could be an alternative.

Sodium Tanshinone IIA Sulfonate Ameliorates Injury-Induced Oxidative Stress and Intervertebral Disc Degeneration in Rats by Inhibiting p38 MAPK Signaling Pathway.

OBJECTIVE: Sodium tanshinone IIA sulfonate (STS) is a water-soluble derivative of tanshinone IIA, a representative traditional Chinese medicine. The aim of the study was to investigate the capability of STS to reverse injury-induced intervertebral disc degeneration (IDD) and explore the potential mechanisms. METHODS: Forty adult rats were randomly allocated into groups (control, IDD, STS10, and STS20). An IDD model was established by puncturing the Co8-9 disc using a needle. Rats in the STS groups were administered STS by daily intraperitoneal injection (10 or 20 mg/kg body weight) while rats in the control and IDD groups received the same quantity of normal saline. After four weeks, the entire spine from each rat was scanned for X-ray and MRI analysis. Each Co8-9 IVD underwent histological analysis (H&E, Safranin-O Fast green, and alcian blue staining). A tissue was analyzed by immunohistochemical (IHC) staining to determine the expression levels of collagen II (COL2), aggrecan, matrix metalloproteinase-3/13 (MMP-3/13), interleukin-1ß (IL-1ß), IL-6, and tumor necrosis factor-α (TNF-α). Levels of oxidative stress were measured using an ELISA while activity of the p38 MAPK pathway was assessed using Western blot analysis. RESULTS: Compared with the control group, needle puncture significantly decreased IVD volume and T-2 weighted MR signal intensity, confirming disc degeneration. These alterations were significantly attenuated by treatment with 10 or 20 mg/kg STS. Lower COL2 and aggrecan and higher MMP-3/13, IL-1ß, IL-6, and TNF-α levels in the IDD group were substantially reversed by STS. In addition, treatment with STS increased antioxidative enzyme activity and decreased levels of oxidative stress induced by needle puncture. Furthermore, STS inhibited the p38 MAPK pathway in the rat model of IDD. CONCLUSIONS: STS ameliorated injury-induced intervertebral disc degeneration and displayed anti-inflammatory and antioxidative properties in a rat model of IDD, possibly via inhibition of the p38 MAPK signaling pathway.

Danshen Attenuates Intervertebral Disc Degeneration via Antioxidation in SD Rats.

OBJECTIVE: To investigate the effects of Danshen on the imaging and histological parameters, expression levels of ECM-associated proteins and inflammatory factors, and antioxidative activity in the degenerated intervertebral disc (IVD) of SD rats. METHODS: Sixty male rats were randomly divided into three groups (control, IDD, and Danshen IDD). Percutaneous needle puncture in Co8-9 intervertebral disc was conducted in all rats of the IDD and Danshen IDD groups to induce intervertebral disc degeneration (IDD). After operation, animals of the Danshen IDD group were administrated with Danshen granules (3 g/kg body weight ) by gavage once a day. Four weeks later, the coccygeal vertebrae were harvested and used for imaging (disc height and MR signal), histological, immunohistochemical, and biochemical [water content, glycosaminoglycans (GAG), superoxide dismutase (SOD2), glutathione (GSH), and malondialdehyde (MDA)] analyses. RESULTS: The puncture induced significant decreased IVD space and MR T2 signal at both 2 and 4 weeks, which were attenuated by Danshen treatment. The disc degeneration in the IDD group (HE and Safranin O-Fast Green histological staining was markedly more serious compared with that in the control group. Four weeks of Danshen treatment significantly alleviated this degeneration compared with the IDD group. Needle puncture resulted in the upregulation of IL-1ß and TNF-α, MMP-3, and downregulation of COL2 and aggrecan in the IDD group. However, this change was significantly weakened by Danshen treatment. Significantly lower water and GAG content, as well as the SOD2 and GSH levels, in the IDD group were found compared with those in the control group. However, the above parameters of the Danshen IDD group were significantly higher than those of the IDD group. Danshen treatment significantly decreased the content of MDA which was increased by needle puncture in the IDD group. CONCLUSION: Danshen can attenuate intervertebral disc degeneration in SD rats by suppressing the oxidation reaction.

Minimally invasive versus traditional open transforaminal lumbar interbody fusion for the treatment of low-grade degenerative spondylolisthesis: a retrospective study.

This was a retrospective study. We aimed to compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of low-grade lumbar degenerative spondylolisthesis (LDS). 81 patients with LDS grades 1 and 2 treated in our spinal department from January 2014 to July 2016 were retrospectively analyzed. The MIS-TLIF group included 23 males and 11 females, while the TO-TLIF group included 29 males and 18 females. Follow-up points were set at 7 days, 3 months, 6 months, 12 months postoperatively and the last follow-up. Various clinical and radiological indicators were used to evaluate and compare the efficacy and safety between the two procedures. 8 cases (3 in the MIS-TLIF group and 5 in the TO-TLIF group) were loss of follow-up after discharge. And the remaining 73 patients were followed up for at least 2 years. No statistically significant difference was observed in the terms of age, sex, BMI, slippage grade, and surgical segments. The MIS-TLIF group had a longer operation and fluoroscopy time compared with the TO-TLIF group. But the MIS-TLIF group was associated with less blood loss, ambulation time, hospital stay, and time of return to work. In each group, significant improvement were observed in BP-VAS, ODI and vertebral slip ratio at any time-point of follow-up when compared with the preoperative condition. When the time-point of follow-up was less than 1 year, the MIS-TLIF group had significant advantages in the BP-VAS and ODI compared with TO-TLIF group. But no significant difference was observed in the BP-VAS and ODI at either 12 month follow-up or the last follow-up. Besides, no statistical difference was detected in vertebral slip ratio at any time-point of follow-up between the two groups. Successful intervertebral bone fusion was found in all patients and no significant difference was found in the incidence of total complications. Thus, we considered that MIS-TLIF and TO-TLIF both achieve satisfactory clinical efficacy in the treatment of low-grade single-segment LDS. But MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue damage, less blood loss and quicker recovery.

Application of Anchoring Technique in Unilateral Percutaneous Vertebroplasty for Neurologically Intact Kümmell's Disease.

Purpose: We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell's disease. Methods: From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell's disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results: All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P < 0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P < 0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions: We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell's disease.

Treatment of the acute thromboembolic event during endovascular embolization of intracranial aneurysm.

OBJECTIVE: The study aimed to discuss the treatment of acute thromboembolic event (TE) during endovascular embolization of intracranial aneurysms. METHODS: Between April 2013 and April 2019, 158 patients with 167 intracranial aneurysms were treated with endovascular embolization in our hospital, in which 9 cases of acute TEs occurred during the embolization procedures. The clinical data, radiological findings and treatments of the 9 patients were reviewed and analyzed. RESULTS: The TEs occurred at the aneurysmal neck in 3 patients, at distal part of the parent artery in 3, in the stent in 2, and at the proximal part of the parent artery in 1. Intra-arterial (IA) infusion of tirofiban were performed in 6 patients, mechanical thromboectomy (MT) with a stent in 2 patients, and combined use of the two methods in 1 patients. According to the modified Thrombolysis In Cerebral Infarction (mTICI) score, 7 patients had recanalization of 2b/3a, 1 patients had recanalization of 1, and 1 patients had recanalization of 0. At discharge, the mRS score was 0 in 3 patients, 1 in 3 patients, and 2, 3, 4 in 1 patient each. 6 months after the endovascular treatment, the mRS score was 0 in 5 patients, 1 in 2 patients, and 3 in 1 patient. CONCLUSIONS: IA tirofiban and MT are effective remedies for the acute TE during endovascular embolization of intracranial aneurysm, reasonable selection of which may improve the prognosis of patients.

Percutaneous Endoscopic Transforaminal Decompression in the Treatment of Patients with Migrated Lumbar Disc Herniation: A Retrospective Study.

OBJECTIVE: We aimed to discuss the surgical strategies, safety and clinical efficacy of percutaneous endoscopic transforaminal decompression for the treatment of patients with migrated lumbar disc herniation. METHODS: This is a retrospective study. From May 2014 to April 2017, a total of 56 patients (32 men and 24 women) with migrated lumbar disc herniation were operated on by percutaneous endoscopic decompression via transforaminal approach. All enrolled patients had clinical symptoms with radiculopathy, and were identified as single-level, soft herniated disc by computed tomography and magnetic resonance imaging. Clinical efficacy were evaluated chiefly by leg pain visual analogue scale score, Oswestry disability index score, and modified MacNab criteria. RESULTS: Patients were all successfully treated by percutaneous endoscopic transforaminal decompression, with an mean operation time of 63 ± 12 minutes. The patients were followed up for a mean duration of 15 ± 2.7 months (range 12-18 months). The leg pain visual analogue scale score was dropped from 8.2 ± 1.9 preoperatively to 2.4 ± 1.5, 2.2 ± 1.3, and 1.8 ± 1.1 at 1, 6, and 12 months after the operation, respectively. Similarly, the Oswestry disability index score was also decreased from 62.4 ± 8.2 preoperatively to 18.4 ± 6.2, 12.6 ± 5.1, and 9.2 ± 3.4 at 1, 6, and 12 months postoperatively. There were 38 excellent cases, 13 good cases, and 5 fair cases by the assessment method of modified MacNab criteria at 12 months after the operation, with an excellent and good rate of 91.07%. Two cases were complicated with low extremity numbness, which were recovered by conservative treatment in 3 weeks. No persistent neurological deficit or infection occurred in this group postoperatively. CONCLUSIONS: We consider that percutaneous endoscopic decompression via transforaminal approach provided a safe, effective and minimally invasive alternative for the treatment of patients with migrated lumbar disc herniation.

Anterior Cervical Corpectomy and Fusion Versus Posterior Laminoplasty for Cervical Oppressive Myelopathy Secondary to Ossification of the Posterior Longitudinal Ligament: A Meta-analysis.

The purpose of this study was to compare the clinical effect of anterior cervical corpectomy with fusion vs laminoplasty for cervical ossification of the posterior longitudinal ligament. The outcome measures included the Japanese Orthopaedic Association score, neurological recovery rate, and complication rate. Subgroup A represented studies with the mean preoperative canal occupying ratio being less than 50%, whereas subgroup B represented studies with the mean canal occupying ratio being 50% or greater. In subgroup A, no difference was found between the 2 groups in the postoperative Japanese Orthopaedic Association score and neurological recovery rate. In subgroup B, the anterior cervical corpectomy with fusion group had a higher postoperative Japanese Orthopaedic Association score and neurological recovery rate. The authors recommend anterior cervical corpectomy with fusion for cervical ossification of the posterior longitudinal ligament when the canal occupying ratio is 50% or greater, and they prefer laminoplasty when the canal occupying ratio is less than 50%. [Orthopedics. 2019; 42(3):e309-e316.].

Minimally Invasive Versus Traditional Open Transforaminal Lumbar Interbody Fusion for the Treatment of Single-Level Spondylolisthesis Grades 1 and 2: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare the clinical efficacy and safety between minimally invasive and traditional open transforaminal lumbar interbody fusion in the treatment of single-level spondylolisthesis grades 1 and 2. METHODS: This was a systematic review and meta-analysis. A comprehensive literature retrieval was performed in 3 electronic databases (PubMed, Embase, and Cochrane library). Randomized or nonrandomized controlled studies published from January 2000 to April 2018 that compared minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with traditional open transforaminal lumbar interbody fusion (TO-TLIF) for treating single-level spondylolisthesis grades 1 and 2 were retrieved. Quality of included studies were evaluated by the modified Jadad scale. Data were extracted according to the predefined clinical outcome measures, including preoperative and postoperative back pain visual analogue scale and Oswestry Disability Index score; operation time and estimated intraoperative blood loss; length of hospitalization; and the complications, reoperation, and fusion rate. RESULTS: Six studies (n = 394 patients) were finally included. Two were randomized controlled trials and the remaining 4 were prospective or retrospective cohort studies. The pooled data revealed that both techniques had similar preoperative and last follow-up back pain visual analogue scale scores, complication rate, reoperation rate, and fusion rate. However, with the exception of more operation time, MIS-TLIF was associated with less intraoperative blood loss, shorter hospital stay, and better long-term functional outcome when compared with TO-TLIF. CONCLUSIONS: Based on the available evidence, MIS-TLIF appears to be a more efficacious and safe technique with reduced tissue trauma, quicker postoperative recovery, and better long-term functional outcome for the treatment of single-level spondylolisthesis grades 1 and 2.

Correction to: Sam68 Promotes Invasion, Migration, and Proliferation of Fibroblast-like Synoviocytes by Enhancing the NF-κB/P65 Pathway in Rheumatoid Arthritis.

Unfortunately the author name, Rongqing Qin, was wrongly spelt as Rongqin Qin in the original version. It has been updated and the complete corrected author group is given below.

Prognosis and distribution of lymph nodes metastases in resectable primary pulmonary lymphoepithelioma-like carcinoma: A large cohort from a single center.

BACKGROUND: Primary pulmonary lymphoepithelioma-like carcinoma is a rare subtype of lung cancer. Until now, the characteristics of lymph nodes metastases in resectable cases have not yet been reported. METHODS: In this study, a total of 87 consecutive patients with primary pulmonary lymphoepithelioma-like carcinoma that received surgical treatment were investigated from October 1999 to August 2016. The clinical and radiological data and follow-up information were extracted from hospital records in detail. RESULTS: In a univariate analysis, those patients with an early pathological stage (I-II), low rate of lymph node metastases (<30%) and a low number of positive lymph nodes (<5) showed longer recurrence-free survival and overall survival (all P < 0.05). However, the early pathological stage was identified as the only factor independently associated with recurrence-free survival by multivariate analysis (P = 0.038). In a preoperative lymph nodes evaluation, the accuracy and specificity of computed tomography alone were 52.9% (46/87) and 88% (302/343), respectively, and 73.2% of these cases with incorrect nodal staging (30/41) were upstaged. Skipping metastases were more frequent in operated stage N2 cases (71.4%), whereas whether or not those patients showed skipping metastasis did not affect their recurrence-free survival or overall survival (P > 0.05). The highest metastasis frequencies for specific lobes with primary lymphoepithelioma-like carcinoma are as follows: #5 left upper lobe (21.4%); #7 left lower lobe (40.7%); #2R (28.6%) and/or #4R (14.3%) right upper lobe; #7 (42.9%) right lower lobe; #7 (28%) and/or superior mediastinal nodes (36%) right middle lobe. CONCLUSION: Based on accurate staging and uncertain survival benefit, complete mediastinal lymph nodes dissection is still required for curative resection.

Percutaneous Endoscopic Lumbar Discectomy Versus Posterior Open Lumbar Microdiscectomy for the Treatment of Symptomatic Lumbar Disc Herniation: A Systemic Review and Meta-Analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis was to compare the clinical efficacy between percutaneous endoscopic lumbar discectomy (PELD) versus posterior open lumbar microdiscectomy (OLMD) for the treatment of symptomatic lumbar disc herniation. METHODS: We performed a comprehensive retrieval of related studies in 4 electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library). Randomized or nonrandomized controlled trials reported from January 1990 to December 2017 that compared PELD versus OLMD for the treatment of symptomatic lumbar disc herniation were acquired. The quality of randomized controlled trials was evaluated by the criteria of the Cochrane Back Review Group, and the quality of cohort studies was assessed according to the Newcastle-Ottawa Scale. The primary outcome measurements included preoperative and postoperative visual analog scale (VAS) score of sciatica; the Oswestry Disability Index (ODI) before and after surgery; the Excellent and Good outcome rate based on Macnab criteria. The secondary outcome measurements included the incidence of complication, residual disk, recurrence, and reoperation; operation time; hospital stay; and time to return to work. Two authors independently extracted data and assessed each study for quality. RESULTS: Nine studies with 1585 patients were included in our meta-analysis. Two were randomized controlled trials and the remaining 7 were retrospective cohort studies. The forest plots showed that no statistically significant difference was observed between the 2 groups in terms of preoperative and postoperative VAS score of sciatica, ODI before and after surgery, the Excellent and Good outcome rate, the complication rate, and the incidence of recurrence and reoperation. However, the PELD group had a higher incidence of residual disk or incomplete decompression than did the OLMD group. In addition, no significant difference was detected in the operation time between the 2 groups, but the PELD group was associated with shorter hospital stay and time of return to work. CONCLUSIONS: Based on the present meta-analysis, no significant difference existed in VAS and ODI scores between the 2 surgical procedures, and they were also similar in terms of operation time, complication rate, and incidence of recurrence and reoperation, but PELD showed shorter hospital stay and time of return to work. Thus, under the premise of careful manipulation and complete decompression, we consider that PELD is a relatively more minimally invasive technique, which could be an alternative to OLMD.

Sam68 Promotes Invasion, Migration, and Proliferation of Fibroblast-like Synoviocytes by Enhancing the NF-κB/P65 Pathway in Rheumatoid Arthritis.

Src-associated substrate during mitosis of 68 KDa (Sam68), also known as KH domain containing, RNA binding, signal transduction associated 1 (KHDRBS1), is the prototypic member of the signal transduction activator of RNA (STAR) family of RNA-binding proteins. Previous studies have indicated that Sam68 regulates nuclear transcription factor kappa B (NF-κB) to mediate inflammation. In this study, we analyzed the effect and possible mechanisms of Sam68 in rheumatoid arthritis (RA). By western blot analysis and immunohistochemistry, we found that the expression of Sam68 in synovial tissue of RA patients was increased compared with the control group. Immunoflourescent staining demonstrated that Sam68 co-localized with fibroblast-like synoviocytes (FLS) of RA patients. Additionally, the expression of Sam68 in FLS was increased by tumor necrosis factor (TNF)-α stimulation, in a time-dependent manner. Upon TNF-α treatment, Sam68 translocated from the cytoplasm to the nucleus where it interacted with the p65 subunit of NF-κB, as examined by immunoprecipitation and immunofluorescent staining assay. Furthermore, inhibiting the expression of Sam68 by siRNA significantly suppressed the TNF-α-induced expression of interleukin (IL)-6, and matrix metalloproteinase (MMP)-1, reduced the proliferation, migration, and invasion, and markedly decreased the phosphorylation of P65 and IκBα in FLS. Collectively, our findings suggested that Sam68 contributed to the production of inflammatory cytokines, proliferation, migration, and invasion of RA FLS through the NF-κB P65 signal transduction pathway and underscored the importance of Sam68 in the inflammation process of RA.

Tumor-stroma ratio (TSR) in non-small cell lung cancer (NSCLC) patients after lung resection is a prognostic factor for survival.

BACKGROUND: In recent years, the tumor-stroma ratio (TSR) has been considered to a new and independent predictive variable for the prognosis of some kinds of neoplasms. The objective of this study was to assess the prognostic significance of the TSR in non-small cell lung cancer (NSCLC). METHODS: A cohort of 261 NSCLC patients who underwent radical surgery of lung cancer were included in the present study. Two independent observers visually estimated the TSR on hematoxylin-eosin (H&E) stained tissue pathological slices. According to the proportion of stroma ≥50% or <50%, We separate the patients into two groups: those with stroma-poor and those with stroma-rich tumors. RESULTS: Both univariate and multivariate analyses disclosed that the TSR was associated with overall survival (OS) [hazard ratio (HR), 1.741; 95% confidence intervals (CI), 1.040-2.913 and HR, 1.904; 95% CI, 1.132-3.202, respectively]. The HR values for disease-free survival (DFS) were 1.795 (95% CI, 1.073-3.005) and 2.034 (95% CI, 1.210-3.420). The OS and DFS of patients with stroma-poor tumors were better than those with stroma-rich tumors. CONCLUSIONS: These results demonstrated that the TSR is a new prognostic factor for NSCLC. Stroma-poor tumors were associated with longer disease-free period and better prognosis than were stroma-rich tumors in NSCLC patients. The TSR may contribute to the development of individualized treatment for NSCLC in the future.

The role of postoperative adjuvant chemotherapy for lymph node-positive esophageal squamous cell carcinoma: a propensity score matching analysis.

The prognosis of patients with lymph node-positive esophageal squamous cell carcinoma (ESCC) who primarily receive radical esophagectomy remains poor. In this study, we aimed to retrospectively investigate the role of postoperative adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens in these patients. A total of 434 consecutive patients were included in this study who underwent radical esophagectomy and were pathologically confirmed to have lymph node-positive ESCC from January 2005 to December 2010 in our institution. Among these patients, 113 patients received postoperative adjuvant chemotherapy (Group SC), and 321 patients underwent surgery alone (Group S). Propensity score matching and multivariate analyses were used to compensate for differences in some baseline characteristics. After matching, Group SC had significantly longer median disease-free survival (DFS) than that in Group S (23.63 months vs. 16.70 months; p = 0.006); further subset analysis revealed that a benefit regarding DFS was only associated with patients with N1 stage and with tumor length <4.5 cm. The median overall survival (OS) was similar between the two groups (38.57 months for Group SC vs. 25.27 months for Group S; p = 0.05). Multivariate analysis showed that postoperative chemotherapy, length of the tumor, T status, and N category were significantly independent predictive factors of tumor recurrence (p < 0.05). Our data suggested that adjuvant chemotherapy with docetaxel- or paclitaxel-based regimens could significantly improve DFS for patients with N1 stage and tumor length <4.5 cm ESCC and that it could potentially prolong OS for patients with lymph node-positive ESCC after surgery, compared with surgery alone. These results warrant further confirmation in prospective, randomized trials.