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Objective Both anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. However, long‐term follow‐up studies of each approach have not been conducted. We aimed to compare the long‐term clinical and radiographical outcomes between the two approaches. Methods In this retrospective cohort study, we included 49 patients with a minimum 6‐year follow‐up between January 2008 and March 2012. Twenty‐four patients underwent the anterior approach (anterior group), and 25 underwent the combined anterior and posterior approach (anterior–posterior group). Student's t test, Mann–Whitney U test, and Pearson's chi‐square test were used to compare the two groups regarding clinical data, such as visual analogue scale scores, Oswestry disability index scores and neurological status, and radiographical data, such as lumbosacral angle, lumbar lordosis, and L5‐S1 height. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded. Results Both groups had satisfactory clinical and radiographical outcomes until the final follow‐up. All patients achieved bony fusion, and no group differences were found in any of the clinical indices. Both groups corrected and maintained the lumbosacral angle, lumbar lordosis, and L5‐S1 height. However, the operative time, length of stay, maximum Hb drop, IBL, and PBL of the anterior group (140.63 ± 24.73 min, 12.58 ± 2.45 days, 28.33 ± 9.70 g/L, 257.08 ± 110.47 ml, and 430.60 ± 158.27 ml, respectively) were significantly lower than those of the anterior–posterior group (423.60 ± 82.81 min, P

Objective Postoperative ileus (POI) is a relatively common complication after spinal fusion surgery, which can lead to delayed recovery, prolonged length of stay and increased medical costs. However, little is known about the incidence and risk factors of POI after corrective surgery for patients with adolescent idiopathic scoliosis (AIS). This study was performed to report the incidence of POI and identify the independent risk factors for POI after postoperative corrective surgery. Methods In this retrospective cohort study, A total of 318 patients with AIS who underwent corrective surgery from April 2015 to February 2021 were enrolled and divided into two groups: those with POI and those without POI. The Student's t test, Mann–Whitney U test, and Pearson's chi‐square test were used to compare the two groups regarding patient demographics and preoperative characteristics (age, sex and the major curve type), intraoperative and postoperative parameters (lowest instrumented vertebra [LIV], number of screws, and length of stay), radiographic parameters (T5–12 thoracic kyphosis [TK], T10–L2 thoracolumbar kyphosis and height [TLK and T10–L2 height], L1–S1 lumbar lordosis [LL], and L1–5 height). Then, a multivariate logistic regression analysis was used to identify independent risk factors for POI, and a receiver operating characteristic (ROC) curve was performed to assess the predictive values of these risk factors. Results Forty‐two (13.2%) of 318 patients who developed POI following corrective surgery were identified. The group with POI had a significantly longer length of stay, more lumbar screws, higher proportions of a major lumbar curve and lumbar anterior screw breech, and a lower LIV. Among radiographic parameters, the mean lumbar Cobb angle at baseline, the changes in the lumbar Cobb angle, and T10–L2 and L1–5 height from before to after surgery were significantly larger in the group with POI than in the group without POI. Multivariate logistic regression analysis showed that large changes in T10–L2 (odds ratio [OR] =2.846, P = 0.007) and L1–5 height (OR = 31.294, p = 0.000) and lumbar anterior screw breech (OR = 5.561, P = 0.006) were independent risk factors for POI. The cutoff values for the changes in T10–L2 and L1–5 height were 1.885 cm and 1.195 cm, respectively. Conclusion In this study, we identified that large changes in T10–L2 and L1–5 height and lumbar anterior screw breech were independent risk factors for POI after corrective surgery. Improving the accuracy of pedicle screw placement might reduce the incidence of POI, and greater attention should be given to patients who are likely to have large changes in T10–L2 and L1–5 height after corrective surgery.

Abstract Autophagy is a conserved lysosomal degradation pathway where cellular components are dynamically degraded and re-processed to maintain physical homeostasis. However, the physiological effect of autophagy appears to be multifaced. On the one hand, autophagy functions as a cytoprotective mechanism, protecting against multiple diseases, especially tumor, cardiovascular disorders, and neurodegenerative and infectious disease. Conversely, autophagy may also play a detrimental role via pro-survival effects on cancer cells or cell-killing effects on normal body cells. During disorder onset and progression, the expression levels of autophagy-related regulators and proteins encoded by autophagy-related genes (ATGs) are abnormally regulated, giving rise to imbalanced autophagy flux. However, the detailed mechanisms and molecular events of this process are quite complex. Epigenetic, including DNA methylation, histone modifications and miRNAs, and post-translational modifications, including ubiquitination, phosphorylation and acetylation, precisely manipulate gene expression and protein function, and are strongly correlated with the occurrence and development of multiple diseases. There is substantial evidence that autophagy-relevant regulators and machineries are subjected to epigenetic and post-translational modulation, resulting in alterations in autophagy levels, which subsequently induces disease or affects the therapeutic effectiveness to agents. In this review, we focus on the regulatory mechanisms mediated by epigenetic and post-translational modifications in disease-related autophagy to unveil potential therapeutic targets. In addition, the effect of autophagy on the therapeutic effectiveness of epigenetic drugs or drugs targeting post-translational modification have also been discussed, providing insights into the combination with autophagy activators or inhibitors in the treatment of clinical diseases.

Objective The nanohydroxyapatite/polyamide‐66 (n‐HA/PA66) cage is a novel bioactive nonmetal cage that is now used in some medical centers, while the polyetheretherketone (PEEK) cage is a typical device that has been widely used for decades with excellent clinical outcomes. This study was performed to compare the long‐term radiographic and clinical outcomes of these two different cages used in transforaminal lumbar interbody fusion (TLIF). Methods In this retrospective and matched‐pair case control study, we included 200 patients who underwent TLIF from January 2010 to December 2014 with a minimum 7‐year follow‐up. One hundred patients who used n‐HA/PA66 cages were matched with 100 patients who used PEEK cages for age, sex, diagnosis, and fusion level. The independent student's t‐test and Pearson's chi‐square test were used to compare the two groups regarding radiographic (fusion status, cage subsidence rate, segmental angle [SA], and interbody space height [IH]) and clinical (Oswestry Disability Index [ODI], and Visual Analog Scale [VAS] for back and leg) parameters preoperatively, postoperatively, and at the final follow‐up. Results The n‐HA/PA66 and PEEK groups had similar fusion rates of bone inside and outside the cage at the final follow‐up (95.3% vs 91.8%, p = 0.181, 92.4% vs 90.1%, p = 0.435). The cage union ratios exposed to the upper and lower endplates of the n‐HA/PA66 group were significantly larger than those of the PEEK group (p

Abstract Background The compound Danshen Dripping Pill (CDDP), which is a mixture of extracts from Radix Salviae and Panax notoginseng, is a patented traditional Chinese medicine that is widely used in multiple countries for relieving coronary heart disease (CHD), but its pharmacological mechanism has not been fully elucidated. In this study, we screened the key pharmacological pathways and targets of CDDP that act on CHD using a network pharmacology-based strategy, and the angiogenic activity of CDDP was directly visually investigated in zebrafish embryos in vivo. Methods The potential therapeutic targets and pathways were predicted through a bioinformatics analysis. The proangiogenic effects of CDDP were examined using vascular sprouting assays on subintestinal vessels (SIVs) and optic arteries (OAs) as well as injury assays on intersegmental vessels (ISVs). Pharmacological experiments were applied to confirm the pathway involved. Results Sixty-five potential therapeutic targets of CDDP on CHD were identified and enriched in the PI3K/AKT and VEGF/VEGFR pathways. An in vivo study revealed that CDDP promoted angiogenesis in SIVs and OAs in a dose-dependent manner and relieved the impairments in ISVs induced by lenvatinib, a VEGF receptor kinase inhibitor (VRI). In addition, Vegfaa and Kdrl expression were significantly upregulated after CDDP treatment. Furthermore, the proangiogenic effect of CDDP could be abolished by PI3K/AKT pathway inhibitors. Conclusions CDDP has a proangiogenic effect, the mechanism of which involves the VEGF/VEGFR and PI3K/AKT signaling pathways. These results suggest a new insight into the cardiovascular protective effect of CDDP.

Abstract Background PIA has been proven to be a predictor for postoperative dysphagia in patients who undergo occipitospinal fusion. However, its predictive effect for postoperative dysphagia in patients who undergo OCF is unknown. The aim of this study was to evaluate the predictive ability of the pharyngeal inlet angle (PIA) for the occurrence of postoperative dysphagia in patients who undergo occipitocervical fusion (OCF). Methods Between 2010 and 2018, 98 patients who had undergone OCF were enrolled and reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic parameters, including the atlas-dens interval (ADI), O-C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2 tilting angle (C2Ta), C2-7 angle (C2-7a), PIA and narrowest oropharyngeal airway space (nPAS), were measured and compared. Simple linear regression and multiple regression analysis were used to evaluate the radiographic predictors for dysphagia. In addition, we used PIA = 90° as a threshold to analyze its effect on predicting dysphagia. Results Of the 98 patients, 26 exhibited postoperative dysphagia. Preoperatively, PIA in the dysphagia group was significantly higher than that in the nondysphagia group. We detected that O-C2a, O-EAa, PIA and nPAS all decreased sharply in the dysphagia group but increased slightly in the nondysphagia group. The changes were all significant. Through regression analyses, we found that PIA had a similar predictive effect as O-EAa for postoperative dysphagia and changes in nPAS. Additionally, patients with an increasing PIA exhibited no dysphagia, and the sensitivity of PIA

Clinically used intervertebral cages have several bottleneck problems, such as lack of osteogenic properties and high subsidence rate. This research aims to design a novel biomimetic titanium alloy cage through three improvements: cross-sectional shape mimics, Young's modulus matches and osteogenic property enhances. Two inner porous structures (1450–200 μm and 800–200 μm) were selected, and the Young's modulus were 540.7 MPa (similar to cancellous bone) and 1139.2 MPa, respectively. Shape of the cages was designed by radiographic images and assistant softwares to make the dense border contact the peripheral cortical bone of the vertebrae. Hydroxyapatite (HA) biocoating was performed through the slurry foaming and impregnation method, and the average thickness was approximately 40 μm. The biocoated and nonbiocoated cages were then implanted in goats’ intervertebral space. During the 6-month follow-up, the lordosis angle and disc space height maintained well in all groups. Histological results showed a significant increase in bone ingrowth area between the nonbiocoating and biocoating groups, meaning a great enhancement of osteogenic properties by HA biocoating. The osseointegration also improved greatly. Additionally, the fusion condition of Young's modulus matching cages, before or after biocoating, was superior to that of unmatched cages. The results demonstrated that biomimetic designs could help avoid subsidence and promote fusion.

Summary: The protocol outlines the steps for growing silica nanowires on various substrates such as glass and stainless-steel foil. Silica nanowires are grown by thermal chemical vapor deposition via a vapor-liquid-solid mechanism, in which silicon wafers are used as silicon sources and platinum films as catalysts. This protocol can be used to grow silica nanowires on other substrates such as quartz filter, quartz sphere, alumina plate, and silicon wafer, provided the substrate materials can tolerate the temperature during process heating.For complete details on the use and execution of this profile, please refer to Lee et al. (2019), Tsai and Shieh (2019), and Tsai et al. (2021).

Abstract Background To evaluate the mid- to long-term clinical and radiographic outcomes of anterior cervical discectomy and dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease. Methods From April 2010 to October 2010, 38 patients with single- or double-level cervical disc herniation underwent anterior cervical discectomy and DCI arthroplasty. The clinical results and radiographic outcomes of these 38 patients (42 levels) were retrospectively evaluated. The clinical results included the visual analogue scale, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey questionnaire, and incidences of complications and neurological deterioration. Radiographic results including cervical alignment, intervertebral height, cervical range of motion (ROM), ROM of the functional spinal unit, adjacent intervertebral ROM, migration, subsidence, and heterotopic ossification (HO) were assessed on plain radiography, three-dimensional computed tomography, and magnetic resonance imaging. Results The mean follow-up period was 72.3 months (range 68–78 months). During follow-up, all patients showed significant improvements in the visual analogue scale score, Japanese Orthopaedic Association score, Neck Disability Index score, 36-item short form health survey physical component summary score and mental component summary score. The ROM of the functional spinal unit was partly reduced. The DCI migrated forward in 10 of 42 (23.8%) cases, and HO was detected in 24 of the 42 (57.1%) DCI segments. Subsidence was observed in 14 of 42 (33.3%) DCI segments. Two patients experienced symptom recurrence, and were treated conservatively. Conclusions The clinical efficacy of DCI arthroplasty was maintained during mid- to long-term follow-up. HO formation is a common phenomenon, leading to a substantial decrease in ROM at the index level and recurrence of neurological symptoms. The incidence of implant subsidence and migration is relatively high, leaving a potential risk of symptoms at the index level and adjacent segment degeneration. We consider that the first choice for patients with degenerative cervical disc disease should still be total disc replacement or anterior cervical discectomy and fusion, rather than DCI arthroplasty.

Abstract Background Osteoblastoma is a rare and benign tumor which requires early diagnosis and surgical excision. Scoliosis is a common presentation following osteoblastoma. It is considered due to pain-provoked muscle spasm on the side of the lesion. Few researches about osteoblastoma combined with severe scoliosis have been reported. Case presentation A 14-year-old girl presents with progressive scoliosis deformity for 3 years, with gradually appeared low back pain and numbness of left leg. Radiographic results showed osteoblastic mass at the left side of L3-L4 with severe scoliosis deformity, pelvic obliquity and spinal imbalance. The patient underwent posterior tumor excision, spinal decompression, scoliosis correction, spinal fusion with auto-graft and instrumentation from T8-S1. The mass was found to be osteoblastoma. The patient had a full neurological recovery with no aggravate of scoliosis or spinal imbalance during the follow-up. Conclusions This case emphasizes the importance of early diagnosis and surgical treatment of osteoblastoma. Early surgical excision will not only prevent neurological deficit but also the progression of scoliosis. Atypical scoliosis presence without pain requires carefully examination of whether a tumor exists.