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Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. Increasing evidence suggests that aberrant expression of circRNAs is associated with the occurrence and progression of many cancers. Here, we investigated the role of circNRIP1 in osteosarcoma and explored its possible underlying mechanisms. Three pairs of osteosarcoma tissues and adjacent normal tissues were applied to the detection of altered expression of circRNAs through circRNAs microarray. And the level of circNRIP1 expression was elevated in osteosarcoma tissues. Compared with that in adjacent normal tissue, circNRIP1 expression level was obviously elevated in 100 osteosarcoma tissues. Besides, circNRIP1 knockdown inhibited proliferation and migration, promoted apoptosis of osteosarcoma cells. Bioinformatic analysis demonstrated circNRIP1 contributed to FOXC2 expression by sponging miR-199a. Furthermore, METTL3 elevated circNRIP1 expression level via m6A modification. In short, METTL3-induced circNRIP1 exerted an oncogenic role in osteosarcoma by sponging miR-199a, which may provide new ideas for the treatment of osteosarcoma. [ABSTRACT FROM AUTHOR]

Objective: We focus on providing the first comprehensive national dataset on the incidence, injury aetiology and mortality of TSCI in China. Methods: A multi-stage stratified cluster sampling method was used. We included TSCI cases from all hospitals in three regions, nine provinces and 27 cities in China via search of electronic medical records and retrospectively analysed the characteristics of TSCI in China from 2009 to 2018. We estimated the incidence of TSCI in the total population and subgroups. Results: There were 5954 actual cases in 2009, corresponding to a total estimated TSCI incidence of 45.1 cases per million population (95% CI, 44.0–46.3). There were 10,074 actual cases in 2018, corresponding to a total estimated TSCI incidence of 66.5 cases per million population (95% CI, 65.2–67.8) (P < 0.001; annual average percentage change (AAPC), 4.4%). From 2009 to 2018, the incidence of almost all sex/age groups showed an increasing trend over time (P < 0.001; AAPC, 0.7–8.8%). The elderly population (aged 65–74) displayed the highest incidence of TSCI (with an average annual incidence of 127.1 cases per million [95% CI, 119.8–134.3]). Conclusions: The TSCI incidence increased significantly from 2009 to 2018. The incidence in the elderly populations was consistently high and continues to increase over time. The mortality of TSCI patients in hospitals is relatively low and continues to decrease each year, but elderly individuals remain at a high risk of hospital death. [ABSTRACT FROM AUTHOR]

Lumbar disc herniation (LDH) is a common degenerative disease of the lumbar spine, which is related to host genetic factors. Our study aimed to explore the association between MIR3142HG polymorphisms and LDH susceptibility. Six SNPs in MIR3142HG from 504 LDH patients and 500 healthy individuals were genotyped by the Agena MassARRAY platform. The relationship between SNPs and LDH susceptibility was evaluated with logistic regression analysis by calculating odds ratios (ORs) and 95% confidence intervals (CIs). The interactions between SNP and SNP were analyzed using the multifactor dimensionality reduction (MDR) method. Our study showed that rs7727115 was related to a decreased susceptibility to LDH. Rs2961920 and rs58747524 were significantly associated with an increased risk of LDH. Stratified analysis showed that rs7727115 reduced the risk of LDH in patients aged > 49 years. Rs17057846, rs2961920, and rs58747524 had a risk-increasing influence on patients aged > 49 years and women. Besides, rs7727115 decreased susceptibility in cases of disc prolapse, while rs2961920 and rs58747524 increased the risk. Rs2431689 increased susceptibility in patients with a single hernia, and rs58747524 correlated with an increased risk in cases of multiple hernias. Moreover, MDR analysis indicated that the combination of rs1582417, rs2431689, rs7727115, rs17057846, rs2961920, and rs58747524 was the best predictive model for LDH. Our study showed that MIR3142HG polymorphisms were significantly associated with LDH risk, which suggests that MIR3142HG polymorphisms play some potential roles in diagnosing LDH. [ABSTRACT FROM AUTHOR]

Metal doped bioceramic nanopowders were prepared by solid-state mechanochemical reactions. Also, genetic programming (GP) and gene expression programming (GEP) models were developed to predict the structural features of the mechanosynthesized nanopowders aimed at developing an innovative solution to enhance bone mineral density. The substitution of Ca2+ with different ions in the apatite structure was confirmed from chemical analysis and structural assessment, where irregular changes in the lattice parameters and unit cell volume were observed due to the replacement of the Ca2+ bivalent cation with monovalent, bivalent or trivalent ions as well as the carbonate ions effects on the apatite lattice. It was found that the crystallite size and micro-strain of the substituted bioceramics were between ~11 and 98 nm and ~0.31–2.49%, respectively. From the functional group analysis, the intensity of the hydroxyl groups decreased as the dopant content increased. The electron microscopy images showed that both undoped and low-doped samples consist of spheroidal particles in the nano regime, whereas the high-doped specimens exhibited a high propensity to agglomerate. The results of cytotoxicity assays corroborated that appropriate ionic substitution can prevent the toxic effects of Li on Mus musculus fibroblast cells, and thus by increasing dopant concentration up to z = 0.25, cell viability of around 90% was observed. The results obtained from the modeling demonstrated that both GP and GEP methods are reliable in predicting the structural properties of the synthetic metal-doped bioceramic nanopowders. Image 1 • LiHA nanopowders were synthesized by a solid-state mechanochemical route. • The microstructural changes were investigated in terms of dopant loading. • Defect density dramatically varied as the dopant content increased. • Low-doped samples consisted of spheroidal particles with a mean size of 15 ± 5 nm. • GP and GEP models were developed to predict the structural features. [ABSTRACT FROM AUTHOR]

Long noncoding RNAs (lncRNAs) have been identified to be critical regulator in the osteosarcoma (OS) tumorigenesis. However, the role of lncRNA MIR17HG in the OS proliferation and chemotherapy resistance is still unclear. Here, this research aims to investigate the function of lncRNA MIR17HG in the OS proliferation and cisplatin resistance. Clinically, results revealed that higher MIR17HG expression was associated with shorter overall survival. Functional investigations indicated that MIR17HG promoted the proliferation, invasion and cisplatin resistance of OS cells in vitro, and the MIR17HG knockdown inhibited the growth in vivo. Mechanistically, MIR17HG targeted the miR-130a-3p/SP1 axis, moreover, transcription factor SP1 bind with the MIR17HG promoter region to promote its expression. Taken together, MIR17HG displays the tumor-promotive role in the progression of OS through SP1/MIR17HG/miR-130a-3p/SP1 feedback loop. Our findings might help us to offer novel therapeutic strategies for OS. • Clinically, results revealed that higher MIR17HG expression was associated with shorter overall survival. • Functional investigations indicated that MIR17HG promoted the proliferation, invasion and cisplatin resistance of OS cells. • Mechanistically, MIR17HG targeted the miR-130a-3p/SP1 axis, moreover, SP1 bind withMIR17HG promoter. • MIR17HG displays the tumor-promotive role in the progression of OS through SP1/MIR17HG/miR-130a-3p/SP1 feedback loop. [ABSTRACT FROM AUTHOR]

Background: Cervicothoracic spinal tuberculosis is a rare disease. Due to its difficult and challenging surgical exposure, its surgical treatment approach remains inconclusive. Long-term follow-up studies to address this puzzling issue are rarely seen in the literature. The purpose of this study was to explore the selection of surgical treatment approaches for cervicothoracic spinal tuberculosis through a 10-year case review. Methods: From January 2003 to January 2013, 45 patients suffering from cervicothoracic spinal tuberculosis were treated surgically. According to the relation between the tuberculosis lesion segments and the suprasternal notch on sagittal MRI, 19 patients were treated with a single-stage anterior debridement, fusion and instrumentation approach, and the other 26 patients were treated with a single-stage anterior debridement and fusion, posterior fusion and instrumentation approach. The clinical efficacy was evaluated using statistical analysis based on the Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system. The neurofunctional recovery was assessed by the American Spinal Injury Association (ASIA) system. Results: All patients were followed up for 6.6 years on average (range 3–13 years). No instrumentation loosening, migration or breakage was observed during the follow-up. The kyphosis angle and NDI and JOA scores were significantly changed from preoperative values of 34.7±6.8°, 39.6±4.6 and 10.7±2.8 to postoperative values of 10.2±2.4°, 11.4±3.6 and 17.6±2.4, respectively (p<0.05). Aside from one recurrent patient, bone fusion was achieved in the other 44 patients within 6 to 9 months (mean 7.2 months). No severe postoperative complications occurred, and patients’ neurologic function was improved in various degrees. Conclusions: In the surgical treatment of cervicothoracic spinal tuberculosis, single-stage cervical anterior approach with or without partial manubriotomy is capable of complete debridement for tuberculosis lesions. The manner of fixation should be selected based on the anatomical relation of the suprasternal notch and the diseased segments as revealed on sagittal MRI images. [ABSTRACT FROM AUTHOR]

Excessive bone resorption plays a central role on the development of bone erosive diseases, including osteoporosis, rheumatoid arthritis, and periodontitis. Osteoclasts, bone-resorbing multinucleated cells, are differentiated from hemopoietic progenitors of the monocyte/macrophage lineage. Regulation of osteoclast differentiation is considered an effective therapeutic target to the treatment of pathological bone loss. Natural plant-derived products, with potential therapeutic and preventive activities against bone-lytic diseases, have received increasing attention in recent years because of their whole regulative effects and specific pharmacological activities, which are more suitable for long-term use than chemically synthesized medicines. In this review, we summarized the detailed research progress on the active compounds derived from medical plants with potential anti-resorptive effects and their molecular mechanisms on inhibiting osteoclast formation and function. The active ingredients derived from natural plants that are efficacious in suppressing osteoclastogenesis and bone resorption include flavonoids, terpenoids (sesquiterpenoids, diterpenoids, triterpenoids), glycosides, lignans, coumarins, alkaloids, polyphenols, limonoids, quinones and others (steroid, oxoxishhone, fatty acid). Studies have shown that above natural products exert the inhibitory effects via regulating many factors involved in the process of osteoclast differentiation and bone resorption, including the essential cytokines (RANKL, M -CSF), transcription factors (NFATc1, c -Fos), signaling pathways (NF-κB, MAPKs, Src/PI3K/Akt, the calcium ion signaling), osteoclast-specific genes (TRAP, CTSK, MMP-9, integrin β3, OSCAR, DC-STAMP, Atp6v0d2) and local factors (ROS, LPS, NO). The development of osteoclast-targeting natural products is of great value for the prevention or treatment of bone diseases and for bone regenerative medicine. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide morphological data of endplates for the redesign of cervical artificial disc for use in the middle and lower cervical spine (C3-C7).Methods: Reformatted CT scans of 73 individuals were analysed. The shapes of superior endplates (SEPs) and inferior endplates (IEPs) were classified as either flat or arced. The curvature radius of the IEP and sagittal disc angle were measured in the mid-sagittal plane. The maximum transverse diameter (MTD) of the SEPs and IEP was measured in the coronal plane.Results: The majority of SEPs were flat (79.5 % at C7 and 91.8-95.9 % at C3-C6). Almost all (98.6-100 %) IEPs were arced. The curvature radius has a gradually increasing trend from C3 to C6 (P < 0.05, mean 29.26 mm). There were significant differences at C3-C7 in the average sagittal disc angles (5.80°, 6.92°, 7.51°, and 8.82°, respectively; P < 0.05; mean 7.26°), the average MTDs of the SEPs (13.64, 14.42, 15.03, and 16.74 mm, respectively, P < 0.05; mean 14.96 mm) and the average MTD of the IEPs (16.77, 17.67, 19.15, and 21.66 mm, respectively; P < 0.05; mean 18.81 mm).Conclusion: The majority of SEPs were flat, while almost all IEPs were curved. The curvature radius of IEPs has a gradually increasing trend from C3 to C6. The average sagittal disc angles, MTDs of the SEPs and IEPs significantly increased from C3 to C7. Based on the above, the current cervical artificial disc design does not sufficiently match the morphology of cervical endplates (CEPs). This mismatch may lead to some postoperative complications of cervical disc arthroplasty. [ABSTRACT FROM AUTHOR]

Purpose: Residual back pain (RBP) after percutaneous vertebral augmentation (PVA) still exists considerable, and it even affects daily life due to moderate or severe back pain. A variety of risk factors have been previously identified for developing residual back pain. However, there are conflicting reports regarding the association between sarcopenia and residual back pain. As such, the aim of this study was to investigate whether paraspinal muscle fatty degeneration is a predictor of residual back pain. Methods: We retrospectively reviewed the medical records of patients with single-segment OVCF who underwent PVA from January 2016 to January 2022. Patients were divided into RBP group (86 patients) and control group (790 patients) according to whether the visual analog scale (VAS) score ≥ 4. The clinical and radiological data were analyzed. Paraspinal musculature fatty degeneration was measured using the Goutallier classification system (GCS) at the L4 − 5 intervertebral disc level. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results: The results of multivariate logistical regression analysis revealed that posterior fascia injury (odds ratio (OR) = 5.23; 95% confidence interval (CI) 3.12–5.50; P < 0.001), as regards paraspinal muscle fatty degeneration, including Goutallier grading (OR = 12.23; 95% CI 7.81–23.41; P < 0.001), fCSA (OR = 3.06; 95% CI 1.63–6.84; P = 0.002), fCSA/CSA (%) (OR = 14.38; 95% CI 8.80–26.29; P < 0.001), and facet joint violation (OR = 8.54; 95% CI 6.35–15.71; P < 0.001) were identified as independent risk factors for RBP. Conclusions: Posterior fascia injury, paraspinal muscle fatty degeneration, and facet joint violation were identified as independent risk factors for RBP, with paraspinal muscle fatty degeneration playing an important role. [ABSTRACT FROM AUTHOR]

Objective: To introduce a specialized device designed for the fixation of the cervical-thoracic spine and describe its surgical installation, finite element analysis, and clinical outcomes. Methods: A finite element model of the C6-T1 segment was developed and validated, and simulations of subtotal resection of anterior cervical vertebrae, artificial vertebrae placement, and titanium plate fixation were performed. The model was subjected to a 75 N load to simulate the weight of the head and a 1 N·m force to simulate flexion, lateral bending, and axial rotation. The analysis focused on range of motion, total stress, stress in the artificial vertebrae, and stress in the device. The clinical outcomes were evaluated in a retrospective case series of 140 patients with cervical spine fractures. Results: Under the same loading conditions, the maximum stresses on specialized anatomical and biomechanical devices for the fixation of the cervicothoracic segment of the spine during neutral, forwards flexion, backwards extension, left lateral bending, right lateral bending, left rotation, right rotation and other working conditions were 25.097 MPa, 149.480 MPa, 64.150 MPa, 67.804 MPa, 72.754 MPa, and 117.98 MPa, respectively. And, the maximum ROMs were 2.230 mm, 5.585 mm, 4.682 mm, 3.184 mm, 3.061 mm, 4.451 mm, and 4.645 mm. Compared with those in the preoperative period, the patients' CL, OPCL, UCL, LCL, UROM, LROM, VAS score, NDI score, JOA score, intervertebral space height at the injured segment, cervical anterior kyphosis angle, Cobb angle, vertebral displacement, ASIA grade, fracture classification, and vertebral displacement improved (P < 0.05). Sixty-two patients had dysphagia, and 3 patients experienced leakage of cerebrospinal fluid. Conclusion: The design of the new cervicothoracic internal fixation device conforms to the anatomical structure of the cervicothoracic spine, which can provide immediate stability, better screw placement and adequate bone grafting, and reduce the risk of complications. Despite some disadvantages, it is a good device for segmental fixation of the cervical and thoracic spine. [ABSTRACT FROM AUTHOR]

In the wastewater treatment device, the core moving parts (such as the check valve in the pump body) are prone to failure due to wear and corrosion. There is an urgent need to develop high-performance self-lubricating materials suitable for moving components in electroplating wastewater. Therein, the tribological properties of Si 3 N 4 (silicon nitride) based composites with the addition of hBN (hexagonal boron nitride) against 2507 duplex stainless steel in electroplating wastewater were investigated using a Pin-On-Disc (POD) tribometer. The results show that the addition of hBN to the ceramic matrix could effectively improve the tribological properties of Si 3 N 4 materials. The friction coefficient and wear rate of Si 3 N 4 are lowered to 0.14 when the hBN content reaches 30 wt%, which is attributed to the formation of a lubricating films (containing hBN, Si(OH) 4 and Cu and its oxides) on the worn surfaces. A segmental test results indicate that the lubricating film undergoes processes such as formation, spalling, and regeneration during the friction process. Meanwhile, hBN and Si(OH) 4 , due to their inherent structural characteristics, can lubricate and protect the worn surfaces. The molecular dynamics simulation results indicate that Cu and its oxides are prone to slip under normal and transverse forces, and have a positive effect on reducing friction. [ABSTRACT FROM AUTHOR]

Open-door laminoplasty is a useful operation in the surgical management of cervical myelopathy with favorable outcomes and relatively low complications. One potential undesirable outcome is a decrease in cervical lordosis postoperatively. It is unknown whether the most the distal level or proximal level undergoing laminoplasty affects the magnitude of loss of lordosis. This study aimed to compare the loss of cervical lordosis postoperatively in patients for whom the most proximal level undergoing laminoplasty is proximal level. A retrospective radiographic review as a center was carried out. A total of 513 patients at a single institution who underwent plated open door laminoplasty for cervical myelopathy by multiple surgeons over a 5-year period were included. The primary outcome was change in cervical lordosis, which was the difference in C2-T1 Cobb angle between the postoperative and preoperative film. Patients were divided into two groups based on the most proximal vertebral level undergoing laminoplasty. There were 157 patients who underwent laminoplasty beginning at C2, whereas 171 patients underwent laminoplasty beginning at C3, whereas 137 patients underwent laminoplasty beginning at C4, whereas 48 patients underwent laminoplasty beginning at C5. The C2-T1 Cobb angle was measured on the preoperative film and on the final postoperative follow-up film. The difference between these values was calculated for each patient, and the mean of the differences for the C3 group was compared with that of the C4 group. When C2 was the proximal plated laminoplasty level, loss of lordosis averaged 12°. When C3 was the proximal plated laminoplasty level, loss of lordosis averaged 10°. When C4 was the proximal plated laminoplasty level, loss of lordosis averaged 4°. In contrast, when C5 was the proximal plated level, loss of lordosis was significantly less and averaged only 2° (p=0.041). In the group as a whole, mean preoperative lordosis was 21° compared with 12° postoperatively, for an overall 8° loss of lordosis. Starting the laminoplasty at C4 led to significantly less loss of lordosis than starting at C2-C3. When the pattern of spinal cord compression does not require laminoplasty at C3, consideration should be given to making C4 the most cephalad laminoplasty level rather than C3 to better preserve lordosis. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Background: The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis.Case Presentation: A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2-4 had complete osseous fusion without sequestrum.Conclusion: Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation. [ABSTRACT FROM AUTHOR]

Objectives: We conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3–10 years. Methods: Herein, 52 TLJ TB patients (age range = 3–10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant. Results: The average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients' VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up. Conclusion: For pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach. [ABSTRACT FROM AUTHOR]

Objective This study investigated the relationship between pain location and fracture type in patients with acute osteoporotic vertebral fracture (OVF). Design A prospective observational study. Subject A total of 306 patients with acute OVF were included. Methods The site of pain of each patient was recorded, and the patients were divided into a group with pain at the fracture site (group 1) and a group with pain at a non-fracture site (group 2). Fractures were classified into four types: type I, upper endplate type; type II, central type; type III, lower endplate type; and type IV, burst type. Results There were 146 patients in group 1, of whom 20.55% (30/146) had type I fractures, 33.56% (49/146) had type II fractures, 15.75% (23/146) had type III fractures, and 30.14% (44/146) had type IV fractures. There were 227 patients in group 2, of whom 57.27% (130/227) had type I fractures, 5.29% (12/227) had type II fractures, 35.24% (80/227) had type III fractures, and 2.20% (5/227) had type IV fractures. There was a statistical difference in the fracture type distribution between the two groups (P  < 0.05). The visual analog scale score in group 1 was higher than that in group 2 at the initial diagnosis (P  < 0.05). Conclusions For patients with acute OVF, the site of pain is related to the type of fracture. The pain at the fracture site is more often observed in the central type and burst type of fractures, whereas pain at a non-fracture site is more often observed in the upper and lower endplate types of fractures. Additionally, when OVF is suspected, radiological assessment of the thoracic and lumbar spine is recommended to better detect fractures that could cause pain distal to the site of the fracture. [ABSTRACT FROM AUTHOR]

Background: Parathyroid hormone, with its anabolic effect on bone formation, has shown excellent outcomes of curing postmenopausal osteoporosis as well as enhancing osseointegration around orthopaedic and stomatologic implants.The purpose of the present study is to test if low-dose intermittent PTH (1-34) treatment could achieve a satisfactory osseointegration in 2-mm peri-implant gaps, as to provide a new idea for improving the stability of such prosthesis, which will be of great clinical value.Methods: A custom-made titanium implant was implanted on the calvarium of New Zealand White rabbits. 48 male rabbits were randomly divided into control and PTH group. PTH group received subcutaneous injection of PTH (20 μg/day, 5 days/week). Animals were sacrificed at 4 and 8 weeks after surgery. Quantitative micro-computed tomography, histology and biomechanical pull-out testing were performed to evaluate the gap healing at implantation site.Results: Analysis of micro-computed tomography demonstrated that PTH group achieved more new bone formation in 2-mm gaps and on bone-implant interface. Quantitatively, significant differences were observed between two groups in regard to BIC and BV/TV at each time-point. Histological staining revealed that PTH group had a superiority in trabecular number, thickness, separation and better osseointegration compared to control group. As for biomechanical pull-out testing, PTH group also showed significant improvement of ultimate force than control group.Conclusions: Low-dose intermittent administration of PTH for 4 and 8 weeks enhances early osseointegration and fixation of orthopedic implants surrounded by a 2-mm gap in terms of increased bone regeneration and mechanical stability. These findings suggest PTH a potential for reducing the postoperative complications of implants by improving bone healing at peri-implant gaps. [ABSTRACT FROM AUTHOR]

A quality of life questionnaire specific to sarcopenia (SarQoL®) was successfully developed. There is a huge demand for translation and validation in Chinese. The aim of this study was to translate the SarQoL® into Chinese and investigate its psychometric properties. The translation and cross-cultural adaptation process recommended by the developers of the initial questionnaire was followed. A total of 159 participants were investigated. The translation process consists of five steps: (1) two bilinguals independently translate initial English to Chinese; (2) synthesize the two translations into one; (3) backward translations; (4) expert committee review and (5) test of the pre-final version. The validation consists of three parts: (1) validity (discriminative power, construct validity); (2) reliability (internal consistency, test–retest reliability) and (3) floor and ceiling effects. There was no difficulty in translation process. Regarding the validity, good discriminant validity {quality of life for sarcopenic subjects [35.56 (29.73–42.70)] vs. non-sarcopenic ones [73.22 (60.09–82.90)], p < 0.001} and consistent construct validity [high correlations (spearman's r) of SarQoL® with generic Short Form-36 version 2 questionnaire (0.250 to 0.824) and EuroQoL-5-Dimension questionnaire (− 0.114 to − 0.823)] were found in SarQoL®. Regarding reliability, high internal consistency (Cronbach's alpha coefficient was 0.867) and excellent test–retest reliability (intraclass coefficient correlation was 0.997, 95% CI 0.994–0.998) were found. No ceiling/floor effect was reflected. A valid SarQoL® questionnaire is now available for Chinese population. It can provide a better understanding of the sarcopenia disease burden and serve as a therapeutic outcome indicator in research. [ABSTRACT FROM AUTHOR]

Local kyphoscoliosis deformity caused by coronal asymmetric vertebral compression fracture due to osteoporosis is very rare. As far as we know, there are no related reports. To evaluate the efficacy and safety of manipulative reduction combined with concave side percutaneous kyhphoplasty (PKP) in the treatment of kyphoscoliosis deformity caused by thoracolumbar osteoporotic vertebral compression fractures (OVCF). A retrospective study. Twenty-eight thoracolumbar OVCF patients with coronal asymmetric compression fractures from January 2016 to January 2017. The visual analog score (VAS), Oswestry Disability Index (ODI), Cobb angle of local kyphosis and scoliosis of local spine. A retrospective analysis of 28 thoracolumbar OVCF patients with coronal asymmetric compression fractures admitted to our hospital from January 2017 to January 2018 was conducted, including 10 male and 18 female patients, with an average age of 68.3±5.5 years. Preoperative CT or X-ray confirmed lateral and anterior compression fracture of vertebral body, and MRI suggested fresh vertebral fracture. All patients underwent extension and reverse lateral flexion position to reduce preoperatively, and concave side PKP under local anesthesia. The VAS, ODI, Cobb angle of local kyphosis and scoliosis were recorded before the surgery, at 1 day after operation and at the last follow-up. Surgery of all patients went successfully, with an average follow-up of 16.1 ± 3.4 months. Before and 1 day after surgery, and at the last follow-up, the patient's VAS scores were 8.3±0.6, 2.5±0.6, and 2.2±0.4, respectively, and the ODI scores were 48.5±8.7, 20.2±5.6, and 18.6±5.5, respectively. The VAS and ODI score were significantly improved at 1 day after surgery and at the last follow-up (P <0.05), and there was no significant difference between the scores at 1 day after surgery and at the last follow-up (P >0.05). Before and 1 day after surgery, and at the last follow-up, the Cobb angles of local kyphosis of the injured vertebrae were 23.4±2.3°, 10.7±.1.8°, and 11±2.5°, and the Cobb angles of the scoliosis were 10.5±1.7° and 3.2±2.2°, and 4.1±2.4°, respectively. The kyphosis and scoliosis Cobb angle were significantly improved at 1 day after the surgery and at the last follow-up (P <0.05), but there was no difference between the values at 1 day after surgery and at the last follow-up (P >0.05). During the operation, one case occurred cement leakage in front of vertebral body, and 2 cases had concave side cement leakage, all of which did not lead to any clinical symptom. No new vertebral fractures occurred during the follow-up period. Manipulative reduction combined with concave side PKP is a safe and effective method for the treatment of kyphoscoliosis deformity caused by thoracolumbar OVCF. It can effectively relieve pain, improve the quality of life and improve local kyphoscoliosis deformity of local spine. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Background: Recent progress in the induced generation of dopaminergic (DA) neurons from different types of stem cells or reprogrammed somatic cells holds tremendous potential for the treatment of Parkinson's disease (PD). However, the lack of a reliable source for cell replacement therapy remains a major limitation in the treatment of human neurological disorders. Additionally, the current protocols for in vitro differentiation or cell reprogramming to generate human DA neurons are laborious, time-consuming, and expensive, and efficient conversion of human spermatogonial stem cells (hSSCs) to functional DA neurons has not yet been achieved. Methods: Primary hSSCs from testicular tissues of patients were exposed to an improved induction system, which consisted mainly of olfactory ensheathing cell conditioned culture medium (OECCM) and a set of defined cell-extrinsic factors and small molecules. Morphological changes were assessed, along with the expression of various DA neuron phenotypic markers (e.g., Tuj-1, TH, Nurr1, DAT) and several critical pro-DA neurogenesis effectors (e.g., EN-1, Pitx3, Foxa2, Lmx1a, Lmx1b, and OTX2). In addition, transcriptome analysis was used to further evaluate the genetic similarity between the artificially differentiated DA neurons and genuine ones. Concomitantly, the functional properties of converted DA neurons including synapse formation, dopamine release, electrophysiological activity, and neuron-specific Ca2+ signaling images were determined. Finally, hSSCs in the early stage of induction were evaluated for survival, differentiation, migration, tumorigenicity in the mouse striatum, and improvement of functional deficits in MPTP-induced PD animals. Results: The hSSC-derived neurons not only acquired neuronal morphological features but also expressed various phenotypic genes and protein characteristic of DA neurons and several effectors critical for pro-DA neurogenesis. Strikingly, as the period of induction was prolonged, expression of the critical molecules for DA neuron epigenetic status gradually increased while hSSC-specific markers sharply decreased. After 3 weeks of induction, the transdifferentiation efficiency reached 21%. In addition, hierarchical clustering analysis showed that the differentiated DA neurons closely resembled genuine ones. Furthermore, the hSSC-derived neurons gained sophisticated functional properties of wild-type DA neurons, and pro-induced hSSCs efficiently survived, migrated, and differentiated into DA neurons without tumorigenesis after transplantation into mouse striatum, leading to improvement of functional deficits in PD animals. Conclusions: The results showed that, using the present improved straightforward approach, hSSCs could acquire DA neuron morphological features and functional properties and rescue parkinsonian phenotypes. Our strategy for the conversion of hSSCs into DA neurons is very efficient and thus may provide an alternative approach suitable for clinical cell therapy to treat neurodegenerative diseases including PD. [ABSTRACT FROM AUTHOR]

Active artificial bone substitutes are crucial in bone repair and reconstruction. Calcium phosphate bone cement (CPC) is known for its biocompatibility, degradability, and ability to fill various shaped bone defects. However, its low osteoinductive capacity limits bone regeneration applications. Effectively integrating osteoinductive magnesium ions with CPC remains a challenge. Herein, we developed magnesium malate-modified CPC (MCPC). Incorporating 5% magnesium malate significantly enhances the compressive strength of CPC to (6.18 ± 0.49) MPa, reduces setting time and improves disintegration resistance. In vitro, MCPC steadily releases magnesium ions, promoting the proliferation of MC3T3-E1 cells without causing significant apoptosis, proving its biocompatibility. Molecularly, magnesium malate prompts macrophages to release prostaglandin E2 (PGE2) and synergistically stimulates dorsal root ganglion (DRG) neurons to synthesize and release calcitonin gene-related peptide (CGRP). The CGRP released by DRG neurons enhances the expression of the key osteogenic transcription factor Runt-related transcription factor-2 (RUNX2) in MC3T3-E1 cells, promoting osteogenesis. In vivo experiments using minipig vertebral bone defect model showed MCPC significantly increases the bone volume fraction, bone density, new bone formation, and proportion of mature bone in the defect area compared to CPC. Additionally, MCPC group exhibited significantly higher levels of osteogenesis and angiogenesis markers compared to CPC group, with no inflammation or necrosis observed in the hearts, livers, or kidneys, indicating its good biocompatibility. In conclusion, MCPC participates in the repair of bone defects in the complex post-fracture microenvironment through interactions among macrophages, DRG neurons, and osteoblasts. This demonstrates its significant potential for clinical application in bone defect repair. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT Cervicothoracic spinal tuberculosis is a rare disease. Due to its difficult and challenging surgical exposure, its surgical treatment approach remains inconclusive. Long-term follow-up studies to address this puzzling issue are rarely seen in the literature. PURPOSE The purpose of this study was to explore the selection of surgical treatment approaches for cervicothoracic spinal tuberculosis through a 10-year case review. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 45 patients. OUTCOME MEASURES X ray, CT scan, Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system and neurological function evaluation. METHODS From January 2003 to January 2013, 45 patients suffering from cervicothoracic spinal tuberculosis were treated surgically. According to the relation between the tuberculosis lesion segments and the suprasternal notch on sagittal MRI, 19 patients were treated with a single-stage anterior debridement, fusion and instrumentation approach, and the other 26 patients were treated with a single-stage anterior debridement and fusion, posterior fusion and instrumentation approach. The clinical efficacy was evaluated using statistical analysis based on the Cobb angle of kyphosis, the NDI and the JOA scoring system. The neurofunctional recovery was assessed by the American Spinal Injury Association (ASIA) system. RESULTS All patients were followed up for 6.6years on average (range 3–13 years). No instrumentation loosening, migration or breakage was observed during the follow-up. The kyphosis angle and NDI and JOA scores were significantly changed from preoperative values of 34.7±6.8°, 39.6±4.6 and 10.7±2.8 to postoperative values of 10.2±2.4°, 11.4±3.6 and 17.6±2.4, respectively (p<.05). Aside from one recurrent patient, bone fusion was achieved in the other 44 patients within 6-9 months (mean 7.2 months). No severe postoperative complications occurred, and patients' neurologic function was improved in various degrees. CONCLUSIONS In the surgical treatment of cervicothoracic spinal tuberculosis, single-stage cervical anterior approach with or without partial manubriotomy is capable of complete debridement for tuberculosis lesions. The manner of fixation should be selected based on the anatomical relation of the suprasternal notch and the diseased segments as revealed on sagittal MRI images. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT C1 pedicle screw technique is increasingly popular for atlantoaxial screw-rod fixation. Many authors have reported anatomic studies for C1 pedicle screw insertion. Most of them focused on whether the pedicle screw would injury transverse foramen, vertebral groove and spinal dura. No study evaluates the risk of atlantooccipital joint injury during C1 pedicle screw insertion yet. PURPOSE To evaluate the risk of atlantooccipital joint injury when inserting C1 pedicle screw and analyse the related anatomic factors. STUDY DESIGN/SETTING A CT-based morphology study. PATIENT SAMPLE Two hundred study units. OUTCOME MEASURES Atlantooccipital joint penetration by the pedicle screw was defined as atlantooccipital joint injury. METHODS One hundred thin-cut upper cervical spine computed tomography (CT) scans which met our inclusion criteria were acquired. The sagittal plane of the planned C1 pedicle screw trajectory was reconstructed. Each sagittal plane was considered as a single unit. And then a 3.5-mm-diameter cylinder was draw to simulate a 3.5-mm-diameter pedicle screw inserting into atlas on each sagittal plane. Atlantooccipital joint penetration by the pedicle screw was defined as atlantooccipital joint injury. Those sagittal planes with atlantooccipital joint injury were carefully studied and the morphology of the atlas was observed and analyzed. RESULTS Two hundred study units were obtained from one hundred upper cervical spine CT scans. Virtual C1 pedicle screw insertion showed that atlantooccipital joint injury occurred in thirty-two units (16%) with bilaterally in eleven patients and unilaterally in ten patients. Over-concave superior articular facet of atlas, high junction of C1 pedicle and C1 lateral mass, and over-cephalad incline of C1 pedicle were observed in units with atlantooccipital joint injury. CONCLUSIONS Two hundred study units were obtained from one hundred upper cervical spine CT scans. Virtual C1 pedicle screw insertion showed that atlantooccipital joint injury occurred in thirty-two units (16%) with bilaterally in eleven patients and unilaterally in ten patients. Over-concave superior articular facet of atlas, high junction of C1 pedicle and C1 lateral mass, and over-cephalad incline of C1 pedicle were observed in units with atlantooccipital joint injury. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT With the development of spine minimally invasive techniques, more and more surgeons make the choice of minimal invasive posterior transforminal lumbar interbody fusion (MIS-TLIF) for treating single level lumbar spine degenerative diseases. PURPOSE The aim of this study was to compare the fusion rate between MIS-TLIF and open posterior transforminal lumbar interbody fusion (OPEN-TLIF), and to evaluate the safety and reliability of MIS-TLIF for treating single level lumbar spine degenerative diseases. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 148 patients. OUTCOME MEASURES The operation time, intraoperative blood loss and postoperative drainage were compared between MIS-TLIF group and OPEN-TLIF group, and the fusion status of two groups were evaluated by X-ray and CT scanning. In addition, clinical outcomes in terms of back pain VAS score, leg pain VAS score, and ODI score. METHODS A retrospective cohort study was performed on consecutive 148 patients who underwent MIS-TLIFor OPEN-TLIFsurgical treatment with single level lumbar spine degenerative diseases from January 2009 to January 2011. Among them, 65 cases received MIS-TLIF and 83 cases received OPEN-TLIF. The operation time, intraoperative blood loss and postoperative drainage were compared between MIS-TLIF group and OPEN-TLIF group, and the fusion status of two groups were evaluated by x-ray and CT scanning. In addition, clinical outcomes in terms of back pain VAS score, leg pain VAS score, and ODI score. RESULTS The operation time, intraoperative blood loss and postoperative drainage in MIS-TLIF group were 218.4±38.2minutes, 156.4±58.6ml and 132.8±64.5ml respectively, and in OPEN-TLIF group the outcomes were 123.6±45.4minutes, 326.6±85.4ml and 358.2±94.4ml respectively. Although the operation time of MIS-TLIF group was longer than OPEN-TLIF group (p<.05), the operative blood loss and the postoperative drainage of MIS-TLIF group was statistically significantless than OPEN-TLIF group (p<.05). The mean follow-up time was 6.9±0.7 year. At the last follow-up, the VAS score decreased from 4.9±2.3 to 1.2±0.6 for low back pain and from 6.8±2.4 to 1.5±0.7 for leg pain, and the ODI score also decreased from 23.3±10.2 to 10.2±5.6 in the MIS-TLIF group. In the terms of OPEN-TLIF group, the VAS score decreased from 5.2±2.4 to 1.4±0.8 for low back pain and from 6.0±2.8 to 1.2±0.8 for leg pain, and the ODI score also decreased from 23.8±9.4 to 12.4±6.8, respectively. There were significant differences with respect to the improvement of ODI and VAS scores for two groups' patients (P<.05), but no significant difference (p>.05) was noted between the two groups. Lumbar interbody fusion rate assessed by CT scanning showed 89.2% (58/65) in MIS-TLIF group and 95.2% (79/83) in OPEN-TLIF group, and the mean fusion time was 6.7±2.3 and 4.4±1.8 month, respectively. Although lumbar interbody fusion ratewas no significant (p>.05), the fusion time of MIS-TLIF group was significant longer than OPEN-TLIF group (p<.05). CONCLUSIONS For single level lumbar spine degenerative diseases, MIS-TLIF can achieve similar clinical results and lumbar interbody fusion rate compared to OPEN-TLIF. However, the fusion time of MIS-TLIF was significant longer than OPEN-TLIF due to less bone graft. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, the techniques for minimally invasive spinal stabilization have improved significantly. The multiaxial screw utilized in minimally invasive operations is limited in restoring fracture height, reconstructing the anterior vertebral column, and improving kyphosis. Therefore, the percutaneous, minimally invasive approach is not recommended for a thoracolumbar fracture with severe vertebral height loss. We report our novel, percutaneous, self-expanding, forceful reduction screw system to address this problem. Methods: Thirty-eight patients experiencing thoracolumbar fracture, with a vertebral height loss more than 50%, were treated with the novel, percutaneous, self-expanding, forceful reduction screw between March 2014 and June 2015. The patients' charts and radiographs were reviewed. The vertebral body index (VBI), height of the anterior margin of fractured vertebra (HAMFV), vertebral body angle (VBA), bisegmental Cobb angle (BCA), and Oswestry disability index (ODI) scores were obtained before and after the operation, as well as during the 2-year follow-up. The scoring results were compared using t tests. Results: The operation was completed successfully in 38 patients. A total of 152 screws were placed. The average operation time was 90.7 ± 21.9 min, and the average intraoperative bleeding amount was 89.2 ± 31.9 ml. The patients were discharged at a mean of 3.2 ± 0.9 postoperative days, with a mean hospital stay of 4.8 ± 1.0 days. The VBI, HAMFV, VBA, and BCA scores were significantly improved after treatment with the novel screw system; there was a significant difference between pre- and postoperative parameters (p < 0.05). Although the decreases in all of the parameters were variable during the 2-year follow-up, there were no statistical differences between the postoperative imaging parameters and the last follow-up imaging parameters (p > 0.05). The ODI score at the last follow-up examination was 5.9 ± 2.7, which was significantly improved compared with the preoperative score of 44.6 ± 2.3 (p < 0.05). Conclusions: We believe that the novel, percutaneous, self-expanding, forceful reduction screw system developed by us not only successfully expands the minimally invasive percutaneous surgery to the thoracolumbar fracture with severe vertebral height loss but also achieves significant vertebral height restoration and kyphosis correction. [ABSTRACT FROM AUTHOR]

This study investigated the effects of blockade of IL-6 on bone loss induced by modeled microgravity (MG). Adult male mice were exposed to hind-limb suspension (HLS) and treated with IL-6-neutralizing antibody (IL-6 nAb) for 4 weeks. HLS in mice led to upregulation of IL-6 expression in both sera and femurs. IL-6 nAb treatment in HLS mice significantly alleviated bone loss, evidenced by increased bone mineral density of whole tibia, trabecular thickness and number, bone volume fraction of proximal tibiae, and ultimate load and stiffness of femoral diaphysis. IL-6 nAb treatment in HLS mice significantly enhanced levels of osteocalcin in sera and reduced levels of deoxypyridinoline. In MC3T3-E1 cells exposed to MG in vitro, IL-6 nAb treatment increased mRNA expression and activity of alkaline phosphatase, mRNA expression of osteopontin and runt-related transcription factor 2, and protein levels of osteoprotegerin and decreased protein levels of receptor activator of the NF-κB ligand. In RAW254.7 cells exposed to MG, IL-6 nAb treatment downregulated mRNA expression of cathepsin K and tartrate-resistant acid phosphatase (TRAP) and reduced numbers of TRAP-positive multinucleated osteoclasts. In conclusion, blockade of IL-6 alleviated the bone loss induced by MG. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is a prevalent global disease characterized by bone mass loss and microstructural destruction, resulting in increased bone fragility and fracture susceptibility. Our study aims to investigate the potential of kaempferol in preventing and treating OP through a combination of network pharmacology and molecular experiments. Kaempferol and OP-related targets were retrieved from the public database. A protein–protein interaction (PPI) network of common targets was constructed using the STRING database and visualized with Cytoscape 3.9.1 software. Enrichment analyses for GO and KEGG of potential therapeutic targets were conducted using the Hiplot platform. Molecular docking was performed using Molecular operating environment (MOE) software, and cell experiments were conducted to validate the mechanism of kaempferol in treating OP. Network pharmacology analysis identified 54 overlapping targets between kaempferol and OP, with 10 core targets identified. The primarily enriched pathways included atherosclerosis-related signaling pathways, the AGE/RAGE signaling pathway, and the TNF signaling pathway. Molecular docking results indicated stable binding of kaempferol and two target proteins, AKT1 and MMP9. In vitro cell experiments demonstrated significant upregulation of AKT1 expression in MC3T3-E1 cells (p < 0.001) with kaempferol treatment, along with downregulation of MMP9 expression (p < 0.05) compared to the control group. This study predicted the core targets and pathways of kaempferol in OP treatment using network pharmacology, and validated these findings through in vitro experiments, suggesting a promising avenue for future clinical treatment of OP. [ABSTRACT FROM AUTHOR]

Microglia/macrophages are major contributors to neuroinflammation in the central nervous system (CNS) injury and exhibit either pro- or anti-inflammatory phenotypes in response to specific microenvironmental signals. Our latest in vivo and in vitro studies demonstrated that curcumin-treated olfactory ensheathing cells (aOECs) can effectively enhance neural survival and axonal outgrowth, and transplantation of aOECs improves the neurological outcome after spinal cord injury (SCI). The therapeutic effect is largely attributed to aOEC anti-inflammatory activity through the modulation of microglial polarization from the M1 to M2 phenotype. However, very little is known about what viable molecules from aOECs are actively responsible for the switch of M1 to M2 microglial phenotypes and the underlying mechanisms of microglial polarization. Herein, we show that Interleukin-4 (IL-4) plays a leading role in triggering the M1 to M2 microglial phenotype, appreciably decreasing the levels of M1 markers IL‑1β, IL‑6, tumour necrosis factor-alpha (TNF-α) and inducible nitric oxide synthase (iNOS) and elevating the levels of M2 markers Arg-1, TGF-β, IL-10, and CD206. Strikingly, blockade of IL-4 signaling by siRNA and a neutralizing antibody in aOEC medium reverses the transition of M1 to M2, and the activated microglia stimulated with the aOEC medium lacking IL-4 significantly decreases neuronal survival and neurite outgrowth. In addition, transplantation of aOECs improved the neurological function deficits after SCI in rats. More importantly, the crosstalk between JAK1/STAT1/3/6-targeted downstream signals and NF-κB/SOCS1/3 signaling predominantly orchestrates IL-4-modulated microglial polarization event. These results provide new insights into the molecular mechanisms of aOECs driving the M1-to-M2 shift of microglia and shed light on new therapies for SCI through the modulation of microglial polarization. [ABSTRACT FROM AUTHOR]

Hypertension and osteoporosis are common geriatric diseases, sharing similar risk factors. This study aims to investigate this association and explore relatively mixed variables. Our study included 12,787 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Included participants had valid data on hypertension and osteoporosis, without tumors, liver diseases, gout or thyroid diseases. We explored the association between hypertension and osteoporosis by logistic regression and examined blood pressure and BMD/BMC by linear and non-linear regression. Moreover, we used machine learning models to predict the importance of various factors in the occurrence of osteoporosis and evaluated causality by mendelian randomization. Our study found that osteoporosis is significantly associated with hypertension [OR 2.072 (95% CI 2.067–2.077), p < 0.001]. After adjusting for co-variances, the association remained significant [OR 1.223 (95% CI 1.220–1.227), p < 0.001]. Our study showed that osteoporosis is positively associated with hypertension in the US population. A variety of factors influence this relationship. Specific regulatory mechanisms and confounding factors need to be further investigated. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and safety of novel percutaneous minimally invasive pedicle screw fixation and traditional open surgery for thoracolumbar fractures without neurological deficit.Methods: Sixty adult patients with single thoracolumbar fracture between June 2014 and June 2016 were recruited in this study, randomly divided into open fixation group (group A) or minimally invasive percutaneous fixation group (group B). Clinical and surgical evaluation including surgery time, blood losses, radiation times, hospital stay, and complication were performed. The two groups of patients with pre-operative and last follow-up anterior height ratio of fracture vertebral, Cobb angle of fracture vertebral, and VAS score of back pain were compared.Results: All patients completed valid follow-ups, with an average time period of 15.4 months (12-26 months). Group B achieved much better results in time of operation, intra-operative blood loss, and length of stay than group A (P < 0.05). Group A was significantly better than group B in the times of radiation (P < 0.05). The VAS score was significantly lower in group B than in group A at three days after the operation (P < 0.05). There were no significant differences between the two groups in the anterior height ratio of fracture vertebral, Cobb angle, and VAS score in the last follow-up (P > 0.05). No injured nerve or other severe complications occurred in both groups; one of the patients from group A had back and loin pain lasting for about one month, which resolved after analgesia and functional training. There was no significant difference between the two groups in incidence of complications.Conclusions: Novel percutaneous pedicle screws with angle reset function can achieve the same effect as traditional open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve injuries. Percutaneous minimally invasive pedicle screw fixation has the characteristics of shorter operative time, less bleeding, and less pain, but it needs more radiation times. [ABSTRACT FROM AUTHOR]

The aim of the present study was to analyze the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis (TB) treated by application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter (TCLC). Posterior debridement and indwelling catheterization in the lesion area were performed for direct injection of anti-TB drugs, so as to reduce the recurrence rate. The present prospective study comprised 26 patients with active thoracolumbar spinal TB who underwent TCLC at Hong Hui Hospital affiliated to Xi'an Jiaotong University (Xi'an, China). The kyphotic Cobb angle at presentation, after surgery and at the final follow-up were 22.7±9.8, 9.8±7.3 and 10.3±8.8°, respectively, with an average correction of 13.1±5.4° after surgery, and a loss of correction of 1.8±1.0° at the final follow-up. The rate of correction and loss of correction were 56.6 and 8.3%, respectively. At six months after the surgery, all abnormal erythrocyte sedimentation rates and C-reactive protein levels had returned to normal. The average time to union was ~5 months. All patients had bony union and improved neurological function, with their daily activity returning to normal. In conclusion, in the present study, application of TCLC for the treatment of spinal TB achieved satisfactory healing of lesions. The surgical treatment for spinal TB comprised the removal of the disease as far as possible, and the local administration of anti-TB chemotherapy to the lesion is key to successful treatment. [ABSTRACT FROM AUTHOR]

Abstract Macrophages, as crucial cellular components of innate immunity, are characterized by possessing high plasticity and an abnormal ability to differentiate in response to numerous stimuli. Given this, macrophages show extreme heterogeneity under both physiological and pathological conditions. Typically, macrophages can be polarized into classically activated macrophages (M1) and alternatively activated macrophages (M2) depending on their environment. The relative functions of these two subtypes are almost exactly opposed to one another. Recent studies have suggested that some naturally occurring compounds can exert regulatory effects on the progression of macrophage polarization, which implies that they could be promising therapeutic tools to treat relevant diseases. Therefore, in our current review, we summarize recent studies on several naturally occurring compounds that may possess the ability to regulate macrophage polarization and explore the associated molecular mechanisms. Highlights • We briefly concluded the polarization of macrophages and relevant mechanisms. • We summarized several herbal compounds, which possess the regulating effects on macrophages. • We explored the molecular mechanisms of relevant compounds for the treatment of macrophage polarization. [ABSTRACT FROM AUTHOR]

Background: Pheochromocytoma is an adrenal medullary neuroendocrine tumor that rarely metastasizes to the spine. Currently, its specific treatment methods still present challenges. Case Description: A 41‐year‐old male patient who underwent left total adrenalectomy due to pheochromocytoma 3 years ago presented with lower back pain, accompanied by numbness and decreased muscle strength in both legs, as well as decreased sensation. Abnormal transmittance of the L3 vertebral body could be seen on anterior–posterior and lateral lumbar X‐rays, irregular bone destruction of the L3 vertebral body was found on CT, and an MRI scan showed that the tumor was located within the L3 vertebral body, protruding into the spinal canal and compressing the epidural sac. No recurrence was found in the abdomen. Preoperatively, perform local embolization of the blood vessels supplying the tumor. First, the L2‐3 intervertebral disc, L3‐4 intervertebral disc and L3 vertebral body were removed using an anterior approach, the whole tumor was removed, and some of the vertebrae were taken for pathological examination and replaced with a 3D‐printed prosthesis. Then, four pedicle screws were placed in the bilateral pedicles of L2 and L4 using the posterior approach, pre‐bent connecting rods were installed to replace the bone cortex of the lamina and articular process followed by bone graft fusion of the interlaminar and facet joints. The postoperative results were satisfactory, and there were no perioperative complications. Conclusion: Lumbar pheochromocytoma metastasis is rare, difficult to treat, and should be considered in spinal metastases' differential diagnoses so early diagnosis can be made based on medical history and imaging. Preoperative local vascular imaging and embolization of the blood supply vessels were performed. After total en‐bloc spondylectomy of the tumor during surgery, a prosthesis was implanted and combined with pedicle screw fixation to reconstruct spinal biomechanical stability, achieving satisfactory results. Therefore, 3D printed artificial vertebral bodies are a good choice for treating adrenal pheochromocytoma lumbar metastasis. The key to successful treatment is close interdisciplinary collaboration in formulating rigorous comprehensive perioperative plans. [ABSTRACT FROM AUTHOR]

Osteoporosis is a prevalent bone disease with multigene involved, and the molecular mechanisms of its pathogenesis are not entirely understood. This study aims to identify novel key genes involved in osteoporosis to discover potential pharmacological targets. We analyzed three microarray datasets and identified four differentially expressed genes. The LASSO model indicated that RNA-binding motif protein 5 (RBM5) is associated with osteoporosis and is a potential drug target. We conducted the Spearman correlation analysis and found 52 genes that were significantly related to RBM5. Enrichment analysis showed that these genes were primarily involved in RNA splicing and osteoclast differentiation pathways. By using lentivirus-based shRNA, we successfully knocked down RBM5 expression in RAW264.7 cell line, which showed that RBM5 knockdown significantly impaired their differentiation potential to mature osteoclasts and significantly inhibited bone-resorbing activity. RT-qPCR analyses revealed the expression of osteoclastogenesis marker genes was downregulated along with RBM5 expression. These findings suggest that RBM5 plays a crucial role in the pathogenesis of osteoporosis and provides a new potential pharmacological target. [ABSTRACT FROM AUTHOR]

Osteoporosis is a common bone disease characterized by loss of bone mass, reduced bone strength, and deterioration of bone microstructure. ROS-induced oxidative stress plays an important role in osteoporosis. However, the biomarkers and molecular mechanisms of oxidative stress are still unclear. We obtained the datasets from the Gene Expression Omnibus (GEO) database, and performed differential analysis, Venn analysis, and weighted correlation network analysis (WGCNA) analysis out the hub genes. Then, the correlation between inflammatory factors and hub genes was analyzed, and a Mendelian randomization (MR) analysis was performed on cytokines and osteoporosis outcomes. In addition, "CIBERSORT" was used to analyze the infiltration of immune cells and single-cell RNA-seq data was used to analyze the expression distribution of hub genes and cell–cell communications. Finally, we collected human blood samples for RT-qPCR and Elisa experiments, the miRNA-mRNA network was constructed using the miRBase database, the 3D structure was predicted using the RNAfold, Vfold3D database, and the drug sensitivity analysis was performed using the RNAactDrug database. We obtained three differentially expressed genes associated with oxidative stress: DBH, TAF15, and STAT4 by differential, WGCNA clustering, and Venn screening analyses, and further analyzed the correlation of these 3 genes with inflammatory factors and immune cell infiltration and found that STAT4 was significantly and positively correlated with IL-2. Single-cell data analysis showed that the STAT4 gene was highly expressed mainly in dendritic cells and monocytes. In addition, the results of RT-qPCR and Elisa experiments verified that the expression of STAT4 was consistent with the previous analysis, and a significant causal relationship between IL-2 and STAT4 SNPs and osteoporosis was found by Mendelian randomization. Finally, through miRNA-mRNA network and drug sensitivity analysis, we analyzed to get Palbociclib/miR-141-3p/STAT4 axis, which can be used for the prevention and treatment of osteoporosis. In this study, we proposed the Palbociclib/miR-141-3p/STAT4 axis for the first time and provided new insights into the mechanism of oxidative stress in osteoporosis. [ABSTRACT FROM AUTHOR]

Background: The most severe complication after posterior single-segment lumbar interbody fusion and internal fixation (PIFIF) surgery for degenerative lumbar diseases is deep surgical site infection (DSSI). Preoperatively diagnosing such complications proves to be challenging. Platelets, as acute-phase reactants, undergo changes in response to infections and inflammation. This study aims to assess whether platelet indices can further aid in the diagnosis of DSSI. Methods: A single-center retrospective study was conducted from January 2016 to February 2021 at Xi'an Jiaotong University-Affiliated Honghui Hospital, involving 83 patients who underwent revision surgery after PIFIF due to lumbar degenerative diseases. Among them, 24 patients were diagnosed with DSSI based on combined bacterial culture and imaging data. Preoperative complete serological indicators including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet count and mean platelet volume ratio (P/M ratio) were analyzed using receiver operating characteristic (ROC) curve analysis to determine cutoff values, sensitivity, and specificity. This was done to further assess the ability of these serological indicators to identify the occurrence of DSSI after PIFIF. Results: There were no significant differences in baseline demographic characteristics between the two patient groups (P > 0.05). The P/M ratio was 13.54 ± 5.05 in the aseptic revision group, while it was 19.21 ± 6.30 in the DSSI revision patients, showing a significant difference (P < 0.001). ROC curve analysis revealed that the optimal cutoff value for the P/M ratio was 17.50, with a sensitivity of 58.3% and a specificity of 78.6%. The areas under the curve (AUC) for ESR, CRP, and P/M ratio were 0.797, 0.845, and 0.756, respectively. The negative predictive value (NPV) was 87.04%, 89.47%, and 82.45%, respectively; the positive predictive value (PPV) was 58.62%, 69.23%, and 53.84%, respectively, for ESR, CRP, and P/M ratio, respectively. When P/M ratio is used in combination with ESR and CRP, the AUC is 0.887, with a sensitivity of 95.4%, specificity of 67.8%, NPV of 97.56%, PPV of 54.76%. The diagnostic performance of the model for evaluating DSSI is significantly improved compared to using ESR and CRP alone (P < 0.05). Conclusion: Platelets and their related serum biomarkers are closely associated with DSSI. The P/M ratio can serve as a reliable test for screening DSSI and is worth considering for inclusion in the assessment of patients at risk of developing DSSI after potential PIFIF surgery. [ABSTRACT FROM AUTHOR]