Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis:A case report

BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.

Solitary bone plasmacytoma of the upper cervical spine: A case report

BACKGROUND Solitary bone plasmacytoma(SBP)of the upper cervical spine is a rare diagnosis.The exact role of surgery for SBP remains unclear.CASE SUMMARY We present the first case of SBP of the C2.A 69-year-old Chinese woman presented with severe neck pain and limitation of rotative activity for 2 mo.She underwent anterior one-stage debridement combined with cement augmentation in the C2 to reconstruct stability of the spine.The patient did not receive postoperative radiotherapy.She now remains disease free with no neck pain or neurological deficit after follow-up of 3 years.CONCLUSION Anterior one-stage debridement combined with cement augmentation of the upper cervical spine may be an alternative treatment for SBP.

Effect of axial vertical vibration on degeneration of lumbar intervertebral discs in modified bipedal rats: An in-vivo study

Objective: To assess the effects of axial vibrations on gene expression and lumbar intervertebral disc degeneration in vivo. Methods: A modified bipedal rat model was established using a brachial plexus rhizotomy approach to imitate human upright posture. The experimental animals were randomly divided into three groups: control, vertical vibration, and whole-body vibration. Gene expression in degeneration of the intervertebral discs was assessed by reverse transcription-quantitative polymerase chain reaction. Results: The expression of aggrecan, Col1α1, Col2α1, and decorin were shown to be up-regulated in 14-week-old rats in the vertical vibration and whole-body vibration groups, whereas biglycan and versican expression was down-regulated in 14-week-old rats of the two experimental groups. Furthermore, biglycan and versican expression levels were shown to be lower in the whole-body vibration group than in the vertical vibration group(P<0.05). Conclusions: This in-vivo study demonstrated that vibrations can influence the expression of anabolic genes. Furthermore, whole-body vibrations seem to have a greater effect in this regard than vertical vibrations. A new method is expected to relieve the low back pain of the patients through our research.

Missed diagnosis of femoral deep artery rupture after femoral shaft fracture: A case report

BACKGROUND Vascular injury is a rare complication of femoral shaft fractures,and rupture of the deep femoral artery is more difficult to diagnose because of its anatomical location and symptoms.Despite its low incidence,deep femoral artery rupture can lead to life-threatening outcomes,such as compartment syndrome,making early identification and diagnosis critical.CASE SUMMARY A 45-year-old male patient was admitted to our hospital due to right lower limb trauma in a car accident,with complaints of severe pain and swelling on his right thigh.X-ray demonstrated a right femoral shaft fracture.During preparation for emergency surgery,his blood pressure and blood oxygen saturation dropped,and sensorimotor function was lost.Computed tomography angiography was performed immediately to confirm the diagnosis of rupture of the deep femoral artery and compartment syndrome,so fasciotomy and vacuum-assisted closure were performed.Rhabdomyolysis took place after the operation and the patient was treated with appropriate electrolyte correction and diuretic therapy.Twenty days after the fasciotomy,treatment with the Hoffman Type II External Fixation System was planned,but it was unable to be immobilized internally based on a new esophageal cancer diagnosis.We kept the external fixation for 1 year,and 3 years of follow-up showed improvement of the patient’s overall conditions and muscle strength.CONCLUSION For patients with thigh swelling,pain,anemia,and unstable vital signs,anterior femoral artery injury should be highly suspected.Once diagnosed,surgical treatment should be performed immediately and complications of artery rupture must be suspected and addressed in time.

Single door laminoplasty plus posterior fusion for posterior atlantoaxial dislocation with congenital malformation:A case report and review of literature

BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.

Combining Posterolateral Lumbar Fusion and Posterior Lumber Interbody Fusion Surgery for Treating Three-Level Lumber Spondylolysis and Single-Level Spondylolisthesis: Case Report

Lumbar spondylolysis is a relatively common condition that can cause a variety of clinical manifestations related to the lumbar spine. However, multi-level lumbar spondylolysis is rare and accounts for less than 6% of lumbar spondylolysis. We report a case of three-level lumbar spondylolysis with single-level spondylolisthesis. A 47-year-old woman presented to us with low back pain for 9 years that progressively worsened and the pain was exacerbated with standing and walking. She was diagnosed with three-level lumbar spondylolysis at L3-5 and spondylolisthesis at L4. We performed posterolateral lumber fusion (PLF) and posterior lumbar interbody fusion (PLIF) surgery for her. During the same period, pain recovery and fusion rate of the patient were evaluated after surgery. The results were favorable and proved the efficacy of combining PLF and PLIF technique for treatment for three-level lumbar spondylolysis and single-level spondylolisthesis.

Neural differentiation of allogenic mixed-cultured rat bone mesenchymal stem cells

Many studies showed that bone mesenchymal stem cells (BMSCs) can transdifferentiate to neural cell in vitro. The purpose of this study was to investigate the mixed-culture of allogenic rat BMSCs in vitro, and to perform neural differentiation potential characterization. Rat BMSCs were isolated and cultured by plastic adherence and density gradient centrifugation respectively, and the 3rd passage cells were harvested and mixed-cultured with same concentration. The second passage cells of the mixed-cultured cells were obtained to perform Wright-Gemsa staining for morphological observation, to identify the surface marker of CD29, CD45, CD90 by flow cytometry and induced to differentiate into neural cell, then performed immunocytochemistry of Nestin, NSE and GFAP. Results showed that after Wright-Giemsa staining, the mixed-cultured cells displayed typical spindle-shape, presented layered and whirlpool-like growth;and the mixed-cultured cells were positive for CD29 and CD90, but negative for CD45 by flow cytometry. After induction, the mixed-cultured cells appeared morphological changes of neuron and glial cell, and were positive expression of Nestin, neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP). The results demonstrated that the mixed-cultured allogenic rat BMSCs can be induced into neural cell such as neuron and glial cell in vitro.

Preoperative traction is a risk factor for osteonecrosis of femoral head in patients with stable femoral neck fractures

To explore the relationship between preoperative traction and osteonecrosis of femoral head(ONFH)in patients with stable femoral neck fractures.Data from medical charts for 115 patients admitted to our institution with Garden II femoral neck fracture operated from January 2012 to December 2013 were extracted.Seven-year retrospective comparative study in the first affiliated hospital of Soochow University.Patients were divided into two groups by preoperative treatment:a preoperative traction group(group I)and a T-shaped shoe fixation group(group II).There were 14 patients lost to follow-up.101 patients with Garden II femoral neck fracture followed until July 2016 were available for complete analysis.Intervention:patients received skeletal traction or T-shaped shoe fixation preoperatively.All patients accepted internal fixation with multiple annulated screws.Main outcome measurements:the incidence of osteonecrosis of femoral head was analyzed based on preoperative traction,gender and implant removal.The average follow-up of these patients was 35 months(range,24-48 months).There was no implant failure or nonunion in our study.Nine patients(8.91%)had avascular necrosis.8(15.38%)patients in group I had osteonecrosis of femoral head,whereas only onepatient(2.04%)in group II had osteonecrosis of femoral head.Patients with preoperative traction had significantly higher incidence of osteonecrosis of femoral head compared with T shaped shoe fixation(P=0.032).No significant difference was found between the incidence of osteonecrosis of femoral head based on gender,age,injury-to-surgery interval time,implant removal or weight-bearing time.In patients with femoral neck fracture,preoperative traction may increase the incidence of osteonecrosis.Preoperative traction may not benefit patients with Garden II femoral neck fracture.The weight of traction may be a risk factor to osteonecrosis of femoral head.

Kyphoplasty versus vertebroplasty for the treatment of malignant vertebral compression fractures caused by metastases： a retrospective study

Background There are few comparative studies regarding kyphoplasty （KP） and vertebroplasty （VP） for the treatment of painful vertebral compression fractures （VCF） in patients with cancer. The purpose of this study is to retrospectively compare KP with VP in pain improvement, cement leakage incidence, and the cost of treatment of malignant VCE Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases, treated with KP in 42 cases and VP in 38. Visual analog scale （VAS） scores were collected pre-operatively, post-operatively, at 1 month, 6 months, and 1 year after treatment. Cement leakage was identified using fluoroscopy and CT scan. Total cost per patient was also collected. Results There was a significant difference between the pre- and post-operative VAS scores （7.4＋2.0 to 3.8＋1.6, P 〈0.001 in the KP group; 6.7＋2.4 to 3.7＋1.4, P 〈0.001 in the VP group）, and was maintained at 1-year follow-up （3.2＋1.4 in the KP group, 3.1＋1.3 in the VP group）. However, the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively （P 〉0.05）. The incidence of cement leakage in the KP group was lower than that of the VP group （16.9% （14/83） vs 30.3% （23/76）, P 〈0.05）. However, none of the patients developed any symptoms. The length of postoperative hospital stay in the VP group was shorter than that of the KP group （（2.4＋1.3） vs （5.3＋1.9） days, P 〈0.05）. Total hospital cost in the KP group was much higher than that of the VP group （RMB Yuan 8 492_＋3 332 vs RMB Yuan 3 173~1 341, P〈0.01）. Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF. KP provides no greater degree of pain improvement. KP is associated with a lower rate of cement leakage compared with VP. VP is associated with lower cost and shorter postoperative hospital stay in China.

Albumin mediated reactive oxygen species scavenging and targeted delivery of methotrexate for rheumatoid arthritis therapy

Rheumatoid arthritis(RA)is a common chronic systemic autoimmune disease.Although there are a variety of treatments for RA,the substantial clinical therapies are still limited to disease-modifying anti-rheumatic drugs(DMARD),which would induce obvious side-effect in patients after long-term administration.Herein,an uncomplicated drug-induced self-assembly strategy was proposed to fabricate enzyme-loaded albumin nanomedicine.The hydrophobic drug methotrexate(MTX)could induce self-assembly of superoxide dismutase(SOD)and human serum albumin(HSA)to form HSA-SOD-MTX nanoparticle.After intravenous injection,dual-modal imaging including fluorescence imaging or single-photon emission computed tomography(SPECT)/CT imaging exhibits high accumulation of cyanine 5.5(Cy5.5)or 125l labeled HSA-SOD-MTX nanoparticles in the joints of collagen-induced arthritis(CIA)mice.Importantly,using the synergy therapy of SOD enzyme to scavenge the reactive oxygen species(ROS)and MTX to suppress inflammation,HSA-SOD-MTX nanoparticles exhibit excellent therapeutic efficiency of RA in CIA mice compared with the other groups.Micro-CT and clinical arthritis score of RA mice further demonstrate that RA symptoms of mice treated with HSA-SOD-MTX nanoparticles is significantly relived,which was further demonstrated by the histological analysis and the inflammatory factors measurement.The synergy therapy of inflammation by MTX and SOD enzyme based on HSA-SOD-MTX nanoparticles show excellent therapeutic effects of RA without inducing obvious side effects.Therefore,our strategy may further promote the highly efficient therapy of RA using SOD enzyme to scavenge the ROS and decreasing the side-effect of MTX,which may provide the reference for clinical RA treatment.

A novel rat tail disc degeneration model induced by static bending and compression

Background:A new rat tail intervertebral disc degeneration model was established to observe the morphologic and biologic changes of static bending and compression applied to the discs.Methods:In total,20 Sprague-Dawley rats with similar weight were randomly di-vided into 4 groups.Group 1 served as a control group for a baseline assessment of normal discs.Group 2 underwent a sham surgery,using an external device to bend the vertebrae of coccygeal 8-10.Groups 3 and 4 were the loaded groups,and exter-nal devices were instrumented to bend the spine with a compression level of 1.8 N and 4.5 N,respectively.Magnetic resonance imaging(MRI),histological,and quanti-tative real-time PCR(qRT-PCR)analysis were performed on all animals on day 14 of the experiment.Results:Magnetic resonance imaging and histological results showed that the changes of intervertebral disc degeneration increased with the size of compression load.Some architecture disorganizations in nucleus pulposus and annulus fibro-sus were found on both of the convex and concave side in the groups of 1.8 N and 4.5 N.An upregulation of MM-3,MM-13,and collagen 1-α1 mRNA expression and a downregulation of collagen 2-α1 and aggrecan mRNA expression were observed in the sham and loading groups.Significant changes were found between the loading groups,whereas the sham group showed similar results to the control group.Conclusions:Static bending and compression could induce progressive disc degen-eration,which could be used for biologic study on disc degeneration promoted by static complex loading.

Sustained release of Semaphorin 3A from a-tricalcium phosphate based cement composite contributes to osteoblastic differentiation of MC3T3-E1 cells

The reinforcement of calcium phosphate materials with silk fibroin （SF） has been one of the strategies to overcome the brittleness. However, the lack of osteoinductivity may still restrict their further use. This study aimed to investigate the biocompatibility and osteogenesis capacity of a novel Semaphorin 3A-loaded chitosan microspheres/SF/a-tricalcium phosphate composite （Sema3A CMs/SF/a-TCP） in vitro. Sema3A was first incorporated into CMs, and the Sema3A CMs/SF/a-TCP composite was then prepared. The morphology of the CMs was observed using SEM. The in vitro release kinetics, cytotoxicity, and cell compatibility were evaluated, and the real-time quantitative polymerase chain reaction （RT-qPCR） and activity of alkaline phosphatase （ALP） were used to evaluate the osteogenesis capacity of the composite. The in vitro release of Sema3A from the Sema3A CMs/SF/a-TCP composite showed a temporally controlled manner. The extract of the Sema3A CMs/SF/a-TCP composite presented no obvious side effect on the MC3T3-E1 cell proliferation, nor promote cell proliferation. The MC3T3-E1 cells were well-spread and presented an elongated shape on the Sema3A CMs/SF/a-TCP composite surface; the ALP activity and the osteogenic-related gene expression were higher than those seeded on the surface of the CMs/SF/a-TCP and SF/a-TCP composites. In conclusion, Sema3A CMslSF/a-TCP has excellent biocompatibility and contributes to the osteoblastic differentiation of MC3T3-E1 cells.

具有涡流热效应的液态金属微球用于磁热增强的癌症栓塞-免疫联合治疗

肝细胞癌患者由于肝癌的高转移性和高复发率表现出预后差的特征.本文提出了一种通过磁热疗法(MHT)增强癌症免疫治疗联合经导管动脉栓塞(TAE)治疗肝癌肿瘤的有效策略.通过微流控技术制备的尺寸均匀液态金属微球(LM MSs),由于在交变磁场下的涡流热效应表现出显著的磁感应加热能力,可同时作为MHT和TAE两种癌症治疗策略的有效药物.一方面,LM MSs优异的涡流磁热效应表现出高效的MHT治疗疗效.另一方面,LM MSs引发的MHT可以显著增强免疫系统激活,促进免疫细胞的浸润;与免疫检查点阻断(ICB)治疗联合后可以进一步刺激强大的免疫应答,从而抑制远端肿瘤的生长.此外,LM MSs-碘油栓塞剂在兔子原位肝癌模型中表现出优异的栓塞-磁热联合治疗效果.总之,该工作不仅证明了LM MSs可以作为有效的MHT试剂实现MHT-免疫联合治疗,而且还展示了TAE与MHT联合治疗在原位大型肝肿瘤治疗中的重要应用前景.

Nimbolide targeting SIRT1 mitigates intervertebral disc degeneration by reprogramming cholesterol metabolism and inhibiting inflammatory signaling

Inflammation,abnormal cholesterol metabolism,and macrophage infiltration are involved in the destruction of the extracellular matrix of the nucleus pulposus(NP),culminating in intervertebral disc degeneration(IDD).Whether nimbolide(Nim),a natural extract,can alleviate IDD is unclear.In this study,we demonstrated that Nim promotes cholesterol efflux and inhibits the activation of the nuclear factor kappa B(NF-κB)and mitogen-activated protein kinase(MAPK)signaling pathways by activating sirtuin 1(SIRT1)in nucleus pulposus cells(NPCs)during inflammation.Thus,Nim balanced matrix anabolism and catabolism of NPCs.However,the inhibition of SIRT1 significantly attenuated the effects of Nim.We also found that Nim promoted the expression of SIRT1 in RAW 264.7,which enhanced the proportion of M2 macrophages by facilitating cholesterol homeostasis reprogramming and impeded M1-like macrophages polarization by blocking the activation of inflammatory signaling.Based on these results,Nim can improve the microenvironment and facilitate matrix metabolism equilibrium in NPCs.Furthermore,in vivo treatment with Nim delayed IDD progression by boosting SIRT1 expression,modulating macrophage polarization and preserving the extracellular matrix.In conclusion,Nim may represent a novel therapeutic strategy for treating IDD.