Injectable Nanorobot-Hydrogel Superstructure for Hemostasis and Anticancer Therapy of Spinal Metastasis

Surgery remains the standard treatment for spinal metastasis.However,uncontrolled intraoperative bleeding poses a significant challenge for adequate surgical resection and compromises surgical outcomes.In this study,we develop a thrombin(Thr)-loaded nanorobothydrogel hybrid superstructure by incorporating nanorobots into regenerated silk fibroin nanofibril hydrogels.This superstructure with superior thixotropic properties is injected percutaneously and dispersed into the spinal metastasis of hepatocellular carcinoma(HCC)with easy bleeding characteristics,before spinal surgery in a mouse model.Under near-infrared irradiation,the self-motile nanorobots penetrate into the deep spinal tumor,releasing Thr in a controlled manner.Thr-induced thrombosis effectively blocks the tumor vasculature and reduces bleeding,inhibiting tumor growth and postoperative recurrence with Au nanorod-mediated photothermal therapy.Our minimally invasive treatment platform provides a novel preoperative therapeutic strategy for HCC spinal metastasis effectively controlling intraoperative bleeding and tumor growth,with potentially reduced surgical complications and enhanced operative outcomes.

A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings

Although spinal tumors are uncommon, they may reduce survival or cause serious functional disorders in the extremities. Metastatic spinal tumors from malignant tumors can induce symptoms of spinal cord compression, such as paraplegia, quadriplegia, and vesicorectal disturbance, which are aggravated with progression of the diseases and time. We report a patient with hepatocellular carcinoma (HCC) who was suspected of having spinal lesions based on neurological findings, and a metastatic spinal tumor was found by imaging examination. Assuming that metastasis had occurred at the time lumbar pain developed, the patient reached the level of gait disturbance within only 4 mo, showing a rapid advancement of symptoms. If early diagnosis had been possible, treatment could be performed before acute myelopathy progressed to complete paralysis. We speculate that the terminal stage of HCC is not only liver failure associated with intrahepatic lesions but also metastasis to other regions, treatment for individual pathologies therefore, will be needed, which constitutes an important issue.

Preliminary study of transforaminal endoscope in the treatment of spinal metastasis

Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May 2019 were retrospectively collected.According to different surgical methods,they were divided into control group(20 cases)and experimental group(8 cases),among which control group was treated with traditional open palliative decompression,while the experimental group was treated with transforaminal endoscopic decompression.The surgery and recovery indicators were compared between the two groups,including surgery time,incision length,postoperative drainage volume,out of bed activity time,length of hospital stay,the Japanese Orthopaedic Association(JOA)scores of 7 days after surgery,pain degree,complications(wound infection,transient reduction of muscle strength,hypoproteinemia with wound drainage and delayed healing),and activity of daily living.Results:The surgery time,incision length,postoperative drainage volume,out of bed activity time,and postoperative length of hospital stay of the experimental group were all less than those of the control group,and the JOA score of 7 days after surgery was higher than that of the control group,showing statistically significant differences(P<0.05).VAS scores of the experimental group on the day 1 and day 7 after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group,but the difference was not significant(P>0.05).Conclusions:Transforaminal endoscope used in suitable patients with spinal metastases can greatly reduce the incision length,soft tissue and bone tissue damages,and postoperative drainage,promote early mobilization and early discharge,and reduce a series of complications due to hemorrhage and hypoproteinemia,which has a better early clinical effect in comparison with the traditional open palliative decompression.

Game-changing insights on vertebral skeletal stem cells in bone metastasis and therapeutic horizons

Greenblatt and his team have unveiled vertebral skeletal stem cells(vSSCs)as a critical player in the landscape of bone metastasis.This commentary delves into the transformative discoveries surrounding vSSCs,emphasizing their distinct role in bone metastasis compared to other stem cell lineages.We illuminate the unique properties and functions of vSSCs,which may account for the elevated susceptibility of vertebral bones to metastatic invasion.Furthermore,we explore the exciting therapeutic horizons opened by this newfound understanding.These include potential interventions targeting vSSCs,modulation of associated signaling pathways,and broader implications for the treatment and management of bone metastasis.By shedding light on these game-changing insights,we hope to pave the way for novel strategies that could revolutionize the prognosis and treatment landscape for cancer patients with metastatic bone disease.

Evaluate the characteristics and clinical significance of “toxic twin-leaf” sign in spinal epidural metastases before percutaneous vertebroplasty

Objective: Our study aimed to analyze morphological features of spinal epidural metastases using magnetic resonance imaging(MRI) and investigate the formation mechanism and clinical significance of the "toxic twinleaf" sign in spinal epidural metastasis.Materials and methods: We retrospectively studied 108 patients with spinal epidural metastases who underwent MRI. Patients were divided into "toxic twin-leaf" sign group(group A) and irregular group(group B). Chi-square test was used to analyze data on sex, vertebra location, presence of fracture in the corresponding vertebral body,involvement of the corresponding pedicle, and the primary tumor. Further, group data were analyzed using the rank sum test;p < 0.05 was considered significant.Results: The "twin-leaf" sign was noted in 88 cases with 136 epidural masses and 20 cases of irregular shape in 108 patients;the "toxic twin-leaf" sign accounted for 87.18% of spinal epidural metastases. A difference between groups in the vertebra location(p < 0.01) was observed, but no differences were found in sex, presence of fractures in the corresponding vertebral body, involvement of the corresponding pedicle, and primary tumor(p >0.05). Intergroup differences in the rate of spinal stenosis on axial and sagittal images were significant.Conclusions: MRI axial sequences clearly revealed the morphology of spinal epidural metastases. Detection of the"toxic twin-leaf" sign in spinal epidural metastases was of great clinical significance. Furthermore, determining the degree of spinal stenosis in the axial sequence provided a more accurate evaluation of patients’ condition compared to the sagittal sequence.

Intramedullary Spinal Cord Metastases in Breast Cancer: Report a Case

Background: Intramedullary spinal cord metastasis (ISCM) from breast cancer is a relatively rare disease. We present this disease. Case presentation: The patient was a 67-year-old woman with lung metastasis appearing 3 years after breast cancer surgery. Complete remission was achieved for the metastatic lesion with chemotherapy, but multiple cerebellar metastases were found 3 months after the completion of chemotherapy. Whole-brain irradiation was administered, resulting in symptomatic improvement. Approximately 6 months later, the patient experienced weakness in the lower extremities and difficulty walking. Magnetic resonance imaging detected a well-defined intraspinal tumor measuring 13 × 13 × 30 mm at the level of Th12-L1. After 20-Gy irradiation to the tumor, oral steroid administration, and rehabilitation, the patient regained the ability to walk. Eight months have passed, to date, since these interventions and the patient is currently receiving treatment for metastases to bones, including the spine, but is still capable of walking without difficulty. We herein report this case with a review of the relevant literature. Conclusion: ISCM in the breast cancer is relatively rare. But, it is the clinical condition which it should always place in the mind.