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Precise manipulation of liquid metal (LM) droplets possesses the potential to enable a wide range of applications in reconfigurable electronics, robotics, and microelectromechanical systems. Although a variety of methods have been explored to actuate LM droplets on a 2D plane, versatile 3D manipulation remains a challenge due to the difficulty in overcoming their heavy weight. Here, foam-core liquid metal (FCLM) droplets that can maintain the surface properties of LM while significantly reducing the density are developed, enabling 3D manipulation in an electrolyte. The FCLM droplet is fabricated by coating LM on the surface of a copper-grafted foam sphere. The actuation of the FCLM droplet is realized by electrically inducing Marangoni flow on the LM surface. Two motion modes of the FCLM droplet are observed and studied and the actuation performance is characterized. Multiple FCLM droplets can be readily controlled to form 3D structures, demonstrating their potential to be further developed to form collaborative robots for enabling wider applications.

(1) Background: The study aims to compare the efficacy of percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs) with or without trauma. (2) Methods: Patients with OVCFs who have been treated with PKP from January 2020 to September 2020 were retrospectively analyzed and divided into trauma and non-trauma groups according to whether they had a clear history of trauma before onset. Before and after surgery, the two groups' oswestry dysfunction index (ODI), visual pain simulation score (VAS), vertebral kyphosis angle (Cobb angle), anterior height of damaged vertebrae, middle height of damaged vertebra, the rate of restoration of the damaged vertebra's anterior height, the rate of restoration of the damaged vertebra's middle height, and bone cement leakage rate were compared. (3) Results: There were several significant differences in VAS or ODI scores between the two groups before , immediately after, and one year after surgery (p> 0.05). The Cobb angle and the rate of bone cement leakage were significantly lower in the non-trauma group compared to the trauma group (p< 0.05). (4) Conclusion: Compared to patients with OVCF without trauma, patients with OVCF with trauma undergoing PKP surgery have a relatively high bone cement leakage rate, and the degree of Cobb angle recovery and the correction degree of vertebral kyphosis deformity are relatively good.

Rheumatoid arthritis (RA) is characterized by joint synovitis and bone destruction, the etiology of which remains to be explored. Overactivation of M1 macrophages and osteoclasts has been thought a direct cause of joint inflammation and bone destruction. Glioma-associated oncogene homolog 1 (GLI1) has been revealed to be closely linked to bone metabolism. In this study, GLI1-expression in synovial tissue of RA patients showed to be positively correlated with RA-related scores and was highly expressed in collagen-induced arthritis (CIA) mouse articular macrophage-like cells. The decreased expression and inhibition of nuclear transfer of GLI1 downregulated macrophage M1 polarization and osteoclast activation, the effect of which was achieved by modulation of DNA methyltransferases (DNMTs) via transcriptional regulation and protein interaction ways. By pharmacological inhibition of GLI1, the proportion of proinflammatory macrophages and the number of osteoclasts were significantly reduced, and the joint inflammatory response and bone destruction in CIA mice were alleviated. This study clarified the mechanism of GLI1 in macrophage phenotypic changes and activation of osteoclasts, suggesting potential applications of GLI1 inhibitor in the clinical treatment of RA.

Abstarct Background Cytosine-phosphate-guanine (CpG) dinucleotides has been used as adjuvants for cancer immunotherapy. However, unmodified CpG are not very efficient in clinical trials. Glucose, ligand of C-type lectin receptors (CLRs), can promote DC maturation and antigen presentation, which is the first step of induction of adaptive immune responses. Therefore, conjugation of type B CpG DNA to glucose-containing glycopolymers may enhance the therapeutic effects against tumor by CpG-based vaccine. Methods gCpG was developed by chemical conjugation of type B CpG DNA to glucose-containing glycopolymers. The therapeutic effects of gCpG-based vaccine were tested in both murine primary melanoma model and its metastasis model. Results gCpG based tumor vaccine inhibited both primary and metastasis of melanoma in mice which was dependent on CD8 + T cells and IFNγ. In tumor microenvironment, gCpG treatment increased Th1 and CTL infiltration, increased M1 macrophages, decreased Tregs and MDSCs populations, and promoted inflammatory milieu with enhanced secretion of IFNγ and TNFα. The anti-tumor efficacy of gCpG was dramatically enhanced when combined with anti-PD1 immunotherapy. Conclusions We confirmed that gCpG was a promising adjuvant for vaccine formulation by activating both tumor-specific Th1 and Tc1 responses, and regulating tumor microenvironments. Graphical Abstract

Critical bone defects are a common yet challenging orthopedic problem. Tissue engineering is an emerging and promising strategy for bone regeneration in large-scale bone defects. The precise on-demand release of osteogenic factors is critical for controlling the osteogenic differentiation of seed cells with the support of appropriate three dimensional scaffolds. However, most of the effective osteogenic factors are biomacromolecules with release behaviors that are difficult to control. Here, the cholesterol-modified non-coding microRNA Chol-miR-26a was used to promote the osteogenic differentiation of human mesenchymal stem cells (hMSCs). Chol-miR-26a was conjugated to an injectable poly(ethylene glycol) (PEG) hydrogel through an ultraviolet (UV)-cleavable ester bond. The injectable PEG hydrogel was formed by a copper-free click reaction between the terminal azide groups of 8-armed PEG and dibenzocyclooctyne-biofunctionalized PEG, into which UV-cleavable Chol-miR-26a was simultaneously conjugated via a Michael addition reaction. Upon UV irradiation, Gel-c-miR-26a (MLCaged) released Chol-c-miR-26a selectively and exhibited significantly improved efficacy in bone regeneration compared to the hydrogel without UV irradiation and UV-uncleavable MLControl. MLCaged significantly enhanced alkaline phosphatase activity and promoted calcium nodule deposition in vitro and repaired critical skull defects in a rat animal model, demonstrating that injectable implantation with the precise release of osteogenic factors has the potential to repair large-scale bone defects in clinical practice. Statement of significance Provide a novel and practical strategy via hydrogel for efficient delivery and precisely controlled release of miRNAs into bone defect sites. The hydrogel is formed by polyethylene glycol (PEG), which is crosslinked by ‘click’ reaction. Cholesterol-modified miR-26a loading on the hydrogel is covalently patterned onto the fibers of hydrogel through a UV light-cleavable linker, which prevents undesired release of miRNA. This hydrogel could realize the controlled release of miRNA under light regulation both in vitro and in vivo, thus realize bone regeneration.

Objectives The aim of this study was to evaluate the clinical outcomes of the Wiltse approach and percutaneous pedicle screw placement under O‐arm navigation for the treatment of thoracolumbar fracture. Methods We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture who received minimally invasive treatments between October 2014 and October 2018 in this retrospective study. Among these, 28 patients (22 males and six females, with a mean age of 48.6 ± 9.6 years) were treated with pedicle screw fixation through the Wiltse approach (WPSF), and another 26 (15 males and 11 females, with a mean age of 45.7 ± 10.6 years) received percutaneous pedicle screw fixation under O‐arm navigation (OPSF). Statistical methods were used to perform a detailed comparison of clinical outcomes, radiologic findings, and complications between the two groups obtained preoperatively, postoperatively, and at last follow‐up. Results All patients underwent surgery successfully and finished a follow‐up of more than 12 months. No serious complications, such as infection, blood vessel injury, or spinal cord or nerve root injury occurred. Visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA), and R value were notably improved after surgery, though there was no clear discrepancy between the groups at each time point (P > 0.05). During the follow‐up period, no patients developed neurological impairment or implant‐related complications, and no patients underwent revision surgery. The WPSF group had a significantly shorter operation time than the OPSF group (68.1 ± 9.8 vs 76.1 ± 9.0 minutes, P = 0.005). Moreover, the WPSF group showed less cost of surgery than the WPSF group (48142.1 ± 1430.1 vs 59035.4 ± 1152.7 CNY, P 0.05). The accuracy of pedicle screw placement was 95.2% (160/168) in the WPSF group and 96.8% (151/156) in the OPSF group, with no significant difference between the groups (P = 0.432). Conclusion Both WPSF and OPSF were safe and effective for the treatment of thoracolumbar fracture. Although the two groups showed favorable clinical and radiologic outcomes through to final follow‐up, we recommended the minimally invasive WPSF given its shorter operation time and lower cost of surgery., Both WPSF and OPSF were safe and effective for the treatment of thoracolumbar fracture. Although the two groups showed favorable clinical and radiologic outcomes through to final follow‐up, we recommended the minimally invasive WPSF given its shorter operation time and lower cost of surgery.

Background: Anterior cervical discectomy and fusion (ACDF) has been widely performed to treat cervical generative diseases. Cage subsidence is a complication after ACDF. Although it is known that segmental kyphosis, acceleration of adjacent segmental disease, and restenosis may occur due to cages subsidence; however detailed research comparing zero-profile cages (ROI-C) and conventional plate and cage construct (CPC) on cage subsidence has been lacking.Objective: The objectives of this study was to compare the rate of postoperative cage subsidence between zero profile anchored spacer (ROI-C) and conventional cage and plate construct (CPC) and investigate the risk factors associated with cage subsidence following ACDF.Methods: Seventy-four patients with ACDF who received either ROI-C or CPC treatment from October 2013 to August 2018 were included in this retrospective cohort study. Clinical and radiological outcomes and the incidence of cage subsidence at final follow up-were compared between groups. All patients were further categorized into the cage subsidence (CS) and non-cage subsidence (NCS) groups for subgroup analysis.Results: The overall subsidence rate was higher in the ROI-C group than in the CPC group (66.67 vs. 38.46%, P = 0.006). The incidence of cage subsidence was significantly different between groups for multiple-segment surgeries (75 vs. 34.6%, P = 0.003), but not for single-segment surgeries (54.55 vs. 42.30%, P = 0.563). Male sex, operation in multiple segments, using an ROI-C, and over-distraction increased the risk of subsidence. Clinical outcomes and fusion rates were not affected by cage subsidence.Conclusion: ROI-C use resulted in a higher subsidence rate than CPC use in multi-segment ACDF procedures. The male sex, the use of ROI-C, operation in multiple segments, and over-distraction were the most significant factors associated with an increase in the risk of cage subsidence.

Postmenopausal osteoporosis is a disease of bone mass reduction and structural changes due to estrogen deficiency, which can eventually lead to increased pain and fracture risk. Chronic inflammatory microenvironment leading to the decreased activation of osteoblasts and inhibition of bone formation is an important pathological factor that leads to osteoporosis. Theaflavin-3,3′-digallate (TFDG) is an extract of black tea, which has potential anti-inflammatory and antiviral effects. In our study, we found that TFDG significantly increased the bone mass of ovariectomized (OVX) mice by micro-CT analysis. Compared with OVX mice, TFDG reduced the release of proinflammatory cytokines and increased the expression of osteogenic markers in vivo. In vitro experiments demonstrated that TFDG could promote the formation of osteoblasts in inflammatory environment and enhance their mineralization ability. In this process, TFDG activated MAPK, Wnt/β-Catenin and BMP/Smad signaling pathways inhibited by TNF-α, and then promoted the transcription of osteogenic related factors including Runx2 and Osterix, promoting the differentiation and maturation of osteoblasts eventually. In general, our study confirmed that TFDG was able to promote osteoblast differentiation under inflammatory environment, enhance its mineralization ability, and ultimately increase bone mass in ovariectomized mice. These results suggested that TFDG might have the potential to be a more effective treatment of postmenopausal osteoporosis.

Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF ( P P P Orthopedics . 2021;44(1):e7–e12.]

Background: To evaluate the clinical efficacy of the Wiltse paraspinal approach and percutaneous pedicle screw placement under O-arm navigation for the treatment of thoracolumbar fracture.Methods: We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture who received minimally invasive treatment. Among these, 28 patients were treated with pedicle screw fixation through the Wiltse paraspinal approach (WPSF), and another 26 were received percutaneous pedicle screw fixation under O-arm navigation (OPSF). Statistical methods were used to perform a detailed comparison of clinical outcomes, radiologic findings and complications between the two groups obtained preoperatively, postoperatively and at last follow-up.Results: There were no significant differences between the two groups in terms of the intraoperative bleeding, length of incision, postoperative hospitalization durations or accuracy rate of pedicle screw placement (p>0.05). Visual analog scale (VAS) scores, Oswestry disability in­dex (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA) and R value were notably improved after surgery, though no clear discrepancy between the groups at each time point (p>0.05). However, the OPSF group had a longer operation time and greater surgical expenditure than the WPSF group (p

Background Compared with traditional surgical methods, which only rely on doctors' experience, three-dimensional robot-assisted navigation technology could locate the lesion more accurately. Methods The transformation principle of three-dimensional navigation system was analyzed. The surgical path was planned on the reconstructed three-dimensional model. The experimental data of positioning position and posture were used as two important parameters to evaluate the accuracy of the robot-assisted spine surgery navigation system. Results The final experimental results show that the accuracy of the positioning and navigation position of the robot-assisted surgical navigation system was 2.54 ± 0.15mm (range 2.25-2.76 mm). The accuracy of positioning and navigation posture was 2.55 ° ± 0.49°(range 1.92°-3.21°). Conclusion It could be seen the three-dimensional positioning and navigation system proposed in this study had a high accuracy and could basically meet the basic accuracy requirements of spine surgery.

Background The zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate. Methods We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the PubMed and Embase databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by the RevMan 5.3 software. Results Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) versus 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61–3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55–4.40, P = 0.0003) after multilevel (≥ 2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate, or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time. Conclusion Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multicenter randomized controlled trial is required to validate our results in the future.

Background To evaluate the clinical efficacy of Wiltse paraspinal approach and percutaneous pedicle screw placement under O-arm navigation for the treatment of thoracolumbar fracture.Methods We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture that received minimally invasive technology. Among these, 28 cases were treated with pedicle screw fixation through Wiltse paraspinal approach (WPSF), and another 26 cases were received percutaneous pedicle screws fixation under O-arm navigation (OPSF). The statistical methods were used to performing a detailed comparison of clinical outcomes, radiologic findings and complications between the two groups at pre-op, post-op and last follow-up.Results There were no significant differences between the two groups among intraoperative bleeding, length of incision, postoperative hospitalization times and accuracy rate of pedicle screw placement (p>0.05). Visual analog scale (VAS) scores, Oswestry disability in­dex (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA) and R value were obviously improved after surgery, though no clear discrepancy between the groups at each time point (p>0.05). However, the OPSF group had longer operation time and higher surgical expenditure than the WPSF group (p

BackgroundKyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear.PurposeTo evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients.Material and MethodsThirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation.ResultsAll patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P ConclusionThe possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.

Peri-implant osteolysis (PIO) and the following aseptic loosening is the leading cause of implant failure. Emerging evidence suggests that receptor activator of nuclear factor kappa-B ligand (RANKL)-induced osteoclast formation and osteoclastic bone resorption are responsible for particle-stimulated PIO. Here, we explored the effect of theaflavin-3,3′-digallate (TF3) on titanium particle-induced osteolysis in vivo and in vitro. Twenty-eight male C57BL/6 mice were randomly separated into four groups: sham control (sham), titanium particles only (titanium), titanium particles with low TF3 concentration (low-TF3, 1 mg/kg TF3), and titanium particles with high TF3 concentration (high-TF3, 10 mg/kg TF3). Two weeks later, micro-computed tomography and histological analysis were performed. Bone-marrow-derived macrophages and RAW264.7 murine macrophages were applied to examine osteoclast formation and differentiation. TF3 significantly inhibited titanium particle-induced osteolysis and prevented bone destruction compared with titanium group. Interestingly, the number of mature osteoclasts reduced after treatment with TF3 in vivo, suggesting osteoclast formation might be inhibited by TF3. In vitro, TF3 suppressed osteoclast formation, polarization and osteoclastic bone resorption by specifically targeting the RANKL-induced ERK signal pathway. Collectively, these results suggest that TF3, a natural active compound derived from black tea, is a promising candidate for the treatment of osteoclast-related osteolytic diseases, such as wear debris-induced PIO. Statement of Significance Total joint arthroplasty is widely accepted for the treatment of end-stage joint diseases. However, it is reported that aseptic loosening, initiated by peri-implant osteolysis, is the major reason for prosthesis failure. Although the pathophysiology of PIO remains unclear, increasing evidence indicates that osteoclasts are excessively activated at the implant site by wear debris from materials. Here, we demonstrated that theaflavin-3,3′-digallate, a natural active compound derived from black tea, inhibited osteoclast formation and osteoclastic bone resorption mainly via suppressing the ERK pathway. Moreover, the findings of this study have confirmed for the first time that theaflavin-3,3′-digallate has a protective effect on particle-induced osteolysis in a mouse calvarial model, thus preventing bone loss. These results indicate that theaflavin-3,3′-digallate may be a suitable therapeutic agent to treat wear debris-induced peri-implant osteolysis.

When patients combined thoracolumbar osteoporotic vertebral compression fracture (OVCF) with lumbar degenerative disease, whose main clinical manifestations are distal lumbosacral pain (DLP), the therapeutic schedule should be made cautiously. We reported an 80-year-old female presented with long-term lumbosacral pain accused of lumbar disc herniation. Percutaneous kyphoplasty (PKP) had been received because of OVCF at L1 vertebral body. Twenty days ago, the elderly felt the DLP was aggravated with no obvious reason. Magnetic resonance imaging (MRI) showed the fresh compression fracture of L2 vertebral body, but the palpation found absence of focal tenderness. Then, we chose to perform PKP at L2 vertebral body, and the patient felt substantial pain relief of lumbosacral area after operation. This case showed that patient manifested as DLP that combined thoracolumbar OVCF with lumbar degenerative disease, PKP has a significant relieving effect on lumbosacral pain.

To introduce a new technique using real-size 3D-printed acromioclavicular joint models as preoperative tools for treating acromioclavicular (AC) joint dislocation.Both the injured AC joint and the mirrored normal side AC joint are 3D printed into real-size models. A proper hook plate is selected and pre-bended to fit the normal side AC joint. The bended plate is then used to perform a reduction operation on a real-size injured AC joint model and the result is compared with the mirrored normal AC joint model to see if the reduction is accurate.It is easy to select and bend a clavicle hook plate to achieve an accurate reduction with the help of a 3D printing technique.With this technique, surgeons can achieve an accurate reduction of the injured AC joint with a clavicle hook plate which might be helpful to reduce the risk of complications.ZIEL: Einführung einer neuen Technik unter Verwendung von 3D-gedruckten akromioklavierförmigen Gelenkmodellen in realer Größe als präoperative Werkzeuge zur Behandlung akromioklavikulärer (AC) Gelenkverrenkungen.Sowohl das verletzte AC-Gelenk als auch das gespiegelte normale Seiten-AC-Gelenk werden in 3D-Formate gedruckt. Eine richtige Hakenplatte wird ausgewählt und vorgebogen, um die normale Seitenacac-Verbindung zu passen. Die gebogene Platte wird dann verwendet, um eine Reduktionsoperation auf einem realen verletzten AC-Gelenkmodell durchzuführen und das Ergebnis wird mit dem gespiegelten normalen AC-Gelenkmodell verglichen, um zu sehen, ob die Reduzierung korrekt ist.Es ist einfach, eine Schlüsselklappenplatte auszuwählen und zu biegen, um eine genaue Reduktion mit Hilfe einer 3D-Drucktechnik zu erreichen.Mit dieser Technik können Chirurgen eine genaue Reduktion des verletzten AC-Gelenks mit einer Schlüsselbeinhakenplatte erreichen, die hilfreich sein könnte, um das Risiko von Komplikationen zu reduzieren.

Background To explore a new quantitative index to assess the matching performance of anatomical bone plates using digital technology. Methods CT data of normal tibias of 40 adults were collected. Two brands of medial distal tibia plates were digitized. Two trained orthopedists simulated the surgical operation in Rhino 5.1 software by placing the plate curve on the medial distal tibia surface. The volume of the interstice between the plate curve and the bone surface was measured. The inverse value of this average interstice distance was used as the matching performance index (MPI). A wall thickness analysis tool was used to mark various interstice distances with varied colors. Results The Kangli medial distal tibia plate had a MPI of 0.55 ± 0.08 by operator A and 0.55 ± 0.06 by operator B. The general care medial distal tibia plate had a MPI of 0.32 ± 0.06 by operator A and 0.31 ± 0.05 by operator B. There were significant variations in the MPI between the two types of plates by both operators (p

Purpose.To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function.Methods.We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients’ shoulder function to judge if it has been affected by subacromial osteolysis.Results.We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are93.38±3.56versus94.24±3.60,P>0.05).Conclusion.The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

Background Percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) are minimally invasive and effective vertebral augmentation techniques for managing osteoporotic vertebral compression fractures (OVCFs). Recent meta-analyses have compared the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques or conservative treatment; however, the inclusions were not thorough and rigorous enough, and the effects of each technique on the incidence of secondary vertebral fractures remain unclear. Purpose To perform an updated systematic review and meta-analysis of the studies with more rigorous inclusion criteria on the effects of vertebral augmentation techniques and conservative treatment for OVCF on the incidence of secondary vertebral fractures. Material and Methods PubMed, MEDLINE, EMBASE, SpringerLink, Web of Science, and the Cochrane Library database were searched for relevant original articles comparing the incidence of secondary vertebral fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (NRCTs) were identified. The methodological qualities of the studies were evaluated, relevant data were extracted and recorded, and an appropriate meta-analysis was conducted. Results A total of 13 articles were included. The pooled results from included studies showed no statistically significant differences in the incidence of secondary vertebral fractures between patients treated with vertebral augmentation techniques and conservative treatment. Subgroup analysis comparing different study designs, durations of symptoms, follow-up times, races of patients, and techniques were conducted, and no significant differences in the incidence of secondary fractures were identified ( P > 0.05). No obvious publication bias was detected by either Begg’s test ( P = 0.360 > 0.05) or Egger’s test ( P = 0.373 > 0.05). Conclusion Despite current thinking in the field that vertebral augmentation procedures may increase the incidence of secondary fractures, we found no differences in the incidence of secondary fractures between vertebral augmentation techniques and conservative treatment for patients with OVCFs.

Balloon kyphoplasty (BKP) is an effective method for osteoporotic vertebral compression fractures. However osteoporotic spinal fractures with middle column compromise are mentioned as a relative contraindication to BKP. Thus we investigated the safety and efficacy of BKP in the treatment of osteoporotic spinal fractures with middle column compromise but without neurological deficit.In this retrospective study, 45 patients who suffered osteoporotic fractures with middle column compromise but without neurological deficits were treated by BKP from May 2007 to December 2010. The final follow-ups were finished during the time of July 2011-September 2011. The mean follow-up period was 20.2 months. The height of the compromised vertebral body, the kyphotic angle and spinal canal compromise were measured before surgery, one day after surgery, and at the final follow-up. A visual analogue scale (VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain and functional activity.The mean VAS and ODI scores improved significantly from pre- to post-operation (p0.05), and this improvement was sustained at the final follow-up. The mean anterior vertebral body height ratio improved from 57.6%± 11.8% preoperatively to 86.2%± 12.2% postoperatively (p0.05), so did the mean middle vertebral body height ratio. The kyphotic angle improved from 16.3° ± 3.7° preoperatively to 9.3° ± 2.6° postoperatively (p0.05). At final follow-up, BKP stabilised vertebral height and prevented further kyphotic deformity. While there were no differences in spinal canal compromise between pre-operation and one day after surgery (p0.05), there was a significant difference from the measurement at the final follow-up (p0.05).BKP is a safe and effective method for osteoporotic spinal fractures with middle column compromise but without neurological deficit. Spontaneous remodelling of the spinal canal also occurs after BKP.

RNA extraction from the nucleus pulposus of intervertebral discs has been extensively used in orthopedic studies. We compared two methods for extracting RNA from the nucleus pulposus: liquid nitrogen grinding and enzyme digestion. The RNA was detected by agarose gel electrophoresis, and the purity was evaluated by absorbance ratio using a spectrophotometer. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) expression was assayed by reverse transcription-polymerase chain reaction (RT-PCR). Thirty human lumbar intervertebral discs were used in this study. The liquid nitrogen-grinding method was used for RNA extraction from 15 samples, and the mean RNA concentration was 491.04 ± 44.16 ng/mL. The enzyme digestion method was used on 15 samples, and the mean RNA concentration was 898.42 ± 38.64 ng/mL. The statistical analysis revealed that there was a significant difference in concentration between the different methods. Apparent 28S, 18S, and 5S bands were detectable in RNA extracted using the enzyme digestion method, whereas no 28S or 18S bands were detected in RNA extracted using the liquid nitrogen-grinding method. The GAPDH band was visible, and no non-specific band was detected in the RT-PCR assay by the enzyme digestion method. Therefore, the enzyme digestion method is an efficient and easy method for RNA extraction from the nucleus pulposus of intervertebral discs for further intervertebral disc degeneration-related studies.

Study design A case report of polyostotic fibrous dysplasia including thoracic spine, sacral vertebrae, and temporal bone, with the symptom of back pain. Objective To treat the lesions with percutaneous kyphoplasty. Summary of background data Polyostotic fibrous dysplasia involving either spine or temporal bone is rarely seen. Few reports of this disorder appear in the literature. This is the first case including thoracic spine, sacrum, and temporal bone together presented to date. Methods The patient was a 56-year-old woman with polyostotic fibrous dysplasia involving the thoracic spine of the eighth, ninth, and 10th vertebral body; adjacent rib; the right temporal bone and the sacrum. Percutaneous kyphoplasty in ninth and 10th vertebral body was carried out to achieve substantial pain relief and rapid stabilization of the spine with minimal invasion. Results The patient experienced complete pain relief and had no clinical complications associated with the cement leakage. The patient tolerated the procedure well. There were no clinical complications and substantial pain relief was noted within hours of the procedure. She has no pain or disability at 1-year follow-up. Conclusion Percutaneous kyphoplasty was a good therapeutic option for the reported patient.

Background Cell-based therapy is currently focusing on bone marrow as an ideal source. However, harvesting of bone marrow is always associated with some potential morbidity. It was recently revealed that adipose derived stromal cells contain a cell population with multipotency. In addition to an adequate supply, these cells do not appear to decline with age. The purpose of our study was to assess osteogenic capability of these cells in vitro and in vivo. Materials and Methods Adipose derived stromal cells were isolated from New Zealand white rabbit fat pads. After primary culture in basic medium and expanded to two passages, the cells were cultured in an osteogenic medium for 2–4 wk to induce osteogenesis. In vivo, segmental bone defects were created at left radius in 30 rabbits. The cultured cells were implanted into the defects through open operation. Results Adipose derived stromal cells were able to be induced to osteogenesis confirmed by ALP and von Kossa staining. Some specific markers, such as ALP, osteopontin, osteocalcin, were also detected by PCR. The segmental defects had complete union, judged by radiographic analysis and histologic analysis, in the group transplanted with these cells. Conclusion Adipose derived stromal cells have the potential to differentiate into osteogenic lineage both in vitro and in vivo. It would be a promising novel cell-based therapy for healing bone defects in the clinical setting.

Background Vertebral compression fractures are a common clinical manifestation of osteoporosis. The introduction of kyphoplasty has allowed minimally invasive treatment of these fractures. However, in patients with loss of vertebral wall integrity, balloon kyphoplasty is contraindicated due to the possibility of extruding wall fragments into the canal and cement extravasation. We evaluated the efficacy and safety of kyphoplasty in the treatment of vertebral compression fractures in patients with compromised vertebral walls using individualised surgical techniques to avoid cement extravasation. Methods Symptomatic vertebral fractures (59 fractures in 55 patients) were treated by kyphoplasty. In levels with compromised anterior vertebral walls, two distinct sequential applications of cement were performed to avoid anterior leakage. In levels that demonstrated posterior or lateral wall deficiencies, the cement was injected under live fluoroscopy to monitor lateral or posterior extravasation. Radiographic outcomes were evaluated by comparing pre- and postoperative anterior/middle vertebral body height and local kyphotic angle. Clinical outcomes were evaluated by comparing Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values preoperatively, postoperatively, and at 3-, 6- and 12-month follow-ups. Results Symptomatic cement extravasation and complications after kyphoplasty were not observed. Vertebral height was restored and the mean kyphotic angle was improved. The mean VAS decreased significantly from pre-surgery to post-surgery, as did the ODI (p Conclusion Kyphoplasty is a safe, clinically effective treatment for osteoporotic vertebral fracture with peripheral wall damage when using individualised surgical techniques to prevent bone cement leakage.

Introduction Vertebral destruction secondary to multiple myeloma is a significant clinical issue, and controversy still exists over how many levels should undergo kyphoplasty in multiple myeloma. In addition, in vertebrae that have lost wall integrity, cement extravasation remains an important consideration and is relatively contraindicated. Methods Forty-three symptomatic vertebral fractures from multiple myeloma were diagnosed by magnetic resonance imaging (MRI). In levels with anterior vertebral wall compromise, two distinct sequential applications of cement were performed. In levels with demonstrated posterior or lateral wall deficiency, cement was injected under fluoroscopy. Results All patients tolerated the procedure well and had immediate relief of back pain after kyphoplasty. Symptomatic cement extravasation and other complications were not observed. Vertebral height was restored (anterior 56.9 ± 14.2% to 82.9 ± 11.2%, middle 71.0 ± 13.4% to 81.1 ± 6.4%) (P

Background and Aims Osteosarcoma is the most frequent malignant bone tumor with a peak incidence in the second and third decades of life. Survivin, a member of the IAP family of proteins, is overexpressed in osteosarcomas and plays an important role in protecting cells from apoptosis. Here we investigated the anti-cancer effects of downregulating survivin by shRNA vector pSUPER-sh in combination with chemotherapeutic drugs on human osteosarcoma cells. Methods Expression of survivin was detected by Western blot. The effects of pSUPER-sh and chemotherapeutic drugs on osteosarcoma cell lines Saos-2 and U2OS by cell viability assay and its underlying mechanisms were analyzed by flow cytometry and caspase-3 activity assay. Results Downregulated survivin could significantly induce apoptosis of osteosarcoma cell lines Saos-2 and U2OS. The effect probably resulted from downregulation of survivin induced by pSUPER-sh. Importantly, we found that the downregulation of survivin by pSUPER-sh could enhance the anticancer effects of chemotherapies such as etoposide, cisplatin and doxorubicin through decreasing mitochondrial membrane potentials and increasing caspase-3 activity. Conclusions Downregulated survivin by pSUPER-sh could markedly induce apoptosis of osteosarcoma cells lines and pSUPER-sh may be a promising adjuvant in osteosarcoma chemotherapy.

This study explored the feasibility and clinical outcome of kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures without neurological deficit. A total of 25 consecutive patients with painful type-A3 amyelic thoracolumbar fractures without neurological deficit were treated by kyphoplasty. Pain was measured using the self-reporting visual analog pain scale (VAS) preoperatively, postoperatively, and at 6-month follow-up. Disability was measured using the Oswestry Disability Index (ODI) preoperatively, postoperatively, and at 6-month follow-up. The height of the fractured vertebral body, kyphotic angle, and spinal canal compromise were measured preoperatively, postoperatively, and at 6-month follow-up. Relief of pain was achieved 24 hours postoperatively. Mean VAS score decreased from 8.2±1.3 preoperatively to 2.8±0.8 postoperatively ( P P

Despite recent developments reported in studies of (-)-epigallocatechin-3-gallate (EGCG), its early preventive effect of mitigating bone loss is not well understood. We investigated the effect of EGCG in preventing bone loss in ovariectomized (OVX) female rats, and explored the possible underlying mechanisms. Twelve-week-old female Sprague-Dawley rats, were divided into 3 groups: group A received intraperitoneal EGCG for 12 consecutive weeks, begun 3 days after ovariectomy; group B received ovariectomy alone; group C, received a sham operation. At the end of the experiment, tibias and femurs were harvested for: (1) micro-CT scanning and measurement of bone mineral density (BMD) and bone morphological parameters; (2) a 3-point bending test; (3) HE staining and an immunohistological study investigating Sema4D expression. Results: The BMD and BV/TV of group A were significantly higher than for the OVX group. The trabecular separation (Tb.Sp) of group A was significantly lower than for group B. Results from the 3-point bending test showed no statistical significance among all the groups. Bone histological studies indicated that trabecular bone was denser in group C, while group B had less dense trabecular bone, and the bone morphological status of group A was intermediate between groups A and C. The immunohistological study demonstrated that Sema4D was more highly expressed as a percentage of the brown-stained area in group B than in the other 2 groups. Conclusion: EGCG had a positive effect on mitigating bone loss in ovariectomized rats, and it inhibited Sema4D expression in bone tissue. Early stage supplementation of EGCG at a dose of 10 mg/kg/day after the onset of ovariectomy did not entirely eliminate bone loss.

Background Osteoporotic vertebral biconcave-shaped fractures are not commonly seen in clinical practice. Some articles have been published showing the outcome of vertebroplasty (PV) and balloon kyphoplasty (BKP), but few comparative studies have been performed. Purpose To compare the effect and safety of PV and BKP in treating osteoporotic vertebral biconcave-shaped fractures. Material and Methods In this retrospective comparative study, 38 patients with osteoporotic vertebral biconcave-shaped fractures were treated by PV, and 41 patients were treated by BKP from May 2005 to July 2011. The heights of the compromised vertebral body and the kyphotic angles were measured. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate pain and functional activity, respectively. The occurrence of refracture and cement leakage were determined, and the costs were recorded. Results The mean VAS and ODI scores significantly improved for both procedures at postsurgical measurements ( P Conclusion Both PV and BKP achieved similar improvements in pain and functional outcomes for the treatment of osteoporotic vertebral biconcave-shaped fractures. BKP had a significant advantage over PV in terms of the restoration of the middle vertebral height and fewer cement leakages than PV.

This article describes the independent factors that affect kyphotic angle reduction in the treatment of osteoporotic vertebral compression fractures with kyphoplasty. Between January 2008 and September 2011, one hundred twenty-six patients with a single-level osteoporotic compression fracture who underwent kyphoplasty were evaluated for a minimum of 1 year postoperatively. Nine independent variables related to patient characteristics (age, sex, bone mineral density [BMD], and body mass index), fracture characteristics (fracture level, fracture age, and preoperative kyphotic angle), and surgical variables (total injected cement volume and cement leakage) were assessed. Kyphotic angle reduction was the dependent variable. Univariate and multivariate linear regression analyses were used to determine the factors associated with kyphotic angle reduction. Significant improvements occurred in mean anterior vertebral height variation, middle vertebral height variation, kyphotic angle, and visual analog scale and Oswestry Disability Index scores immediate postoperatively and at final follow-up compared with the preoperative values. Univariate analyses indicated correlations between kyphotic angle reduction with BMD, fracture age, preoperative kyphotic angle, and cement volume. The final multiple linear regression model resulted in a formula that accounted for 23.3% of the variability in kyphotic angle reduction: preoperative kyphotic angle (b=0.260; P =.002), BMD (b=−0.249; P =.004), and fracture age (b=−0.226; P =.009). Kyphoplasty is a safe and effective treatment for osteoporotic compression fractures.