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The conventional surgical method of percutaneous pedicle screw fixation (PPSF) mainly uses X-ray fluoroscopy guidance to target the vertebral pedicle for screw placement. This study aimed to explore the feasibility of establishing a personalized drill guide template for PPSF based on a three-dimensional (3D) printing technique and to evaluate the accuracy and safety of the method for assisting screw insertion in cadaveric specimens. The T3-L3 trunk cadaveric specimens from six adults were subject to a computed tomography (CT) scan in the prone position. A three-dimensional model containing the back skin contour was reconstructed. A bilateral ideal pedicle screw in the T6-L1 segment was designed. Then, the reverse templates were designed. The two templates were fused and printed into an individualized guide template. PPSF was performed under the assistance of the guide template, and the CT scan was taken postoperatively to access the screw position. Ninety-six pedicle screws were successfully placed on the bilateral vertebral body of the T6-L1 segment with the assistance of a guide template. The guide plate was not loosened or displaced when operated by a single hand, and the operation time was 24.6 ± 7.9 s. The axial CT images after puncture indicated that in 96 puncture needles, 90 needles were grade I and 6 were grade II, with a puncture accuracy rate of 98.6%. In conclusion, an individualized PPSF navigation template was developed using Mimics software and 3D printing prototyping, which improved the accuracy of PPSF in cadaveric specimens.

Surgical site infection (SSI) in spine surgery remains a significant cause of morbidity and prolonged hospitalization. We intended to document our experience in our center and to highlight possible factors influencing SSI in posterior lumbar fusion surgery.Between June 2015 and March 2017, 448 consecutive patients with lumbar degenerative disease who underwent classic open transforaminal lumbar interbody fusion were enrolled in the study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analyses were performed to determine risk factors.There was a significant difference between groups in age (P = 0.001), body mass index (P0.001), subcutaneous fat thickness (P0.001), preoperative American Society of Anesthesiologists (ASA) score (P0.001), postoperative hemoglobin (P = 0.003), preoperative serum albumin (P0.001), operative time (P0.001), operated levels (P0.001), postoperative drainage (P = 0.004), time of draining (P0.001) and late-presenting dural tear (P = 0.008). Logistic regression analysis of these differences showed that thicker subcutaneous fat thickness, higher preoperative ASA score, lower preoperative serum albumin, and longer time of draining were significantly related to SSI (P0.05).The risk factors for SSI after lumbar fusion surgery are multifactorial. These data should provide a step toward the development of quality improvement measures aimed at reducing complications in high-risk patients. These factors may prove useful for patient counseling and for surgical planning.

Retrospective clinical series.To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China.rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent.Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis.There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH.Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery.3.

Glucocorticoid-induced osteoporosis (GIO) is a secondary osteoporosis with extensive use of glucocorticoids (GCs). GCs can increase bone fragility and fracture via inhibiting osteoblastic proliferation and differentiation. Luteolin (LUT), a kind of plant flavonoid, has been reported to exhibit the antioxidant activity, but the effects of LUT on GIO still remain unclear. This study aimed to investigate the effects of LUT on GIO both in vivo and in vitro and elaborate the potential molecular mechanisms. LUT increased the superoxide dismutase activity, glutathione level and decreased reactive oxygen species (ROS) level and lactate dehydrogenase release in GIO. Meanwhile, LUT decreased caspase-3, caspase-9, and Bax protein expressions and increased Bcl-2 protein expression in GIO. LUT increased the ratio of osteoprotegerin (OPG)/receptor activator of nuclear factor-κB Ligand (RANKL) messenger RNA (mRNA) expression and mRNA expression levels of osteogenic markers, including runt-related transcription factor 2, osterix, collagen type I, and osteocalcin. LUT also enhanced the extracellular signal-regulated kinases (ERK) phosphorylation, glycogen synthase kinase 3β (GSK-3β) phosphorylation, mRNA expression levels of lipoprotein-receptor-related protein 5 (Lrp-5) and β-catenin. Further study revealed that Lrp-5 small interfering RNA (siRNA )and ERK-siRNA reduced the effects of LUT on GSK-3β phosphorylation, alkaline phosphatase (ALP) activity and the ratio of OPG/RANKL mRNA expression. Moreover, ERK-siRNA decreased Lrp-5 mRNA expression in vitro. These results indicated that LUT promoted proliferation by attenuating oxidative stress and promoted osteoblastic differentiation by regulating the ERK/Lrp-5/GSK-3β pathway in GIO. This study may bring to light the possible mechanisms involved in the action of LUT in GIO treatment, and benefit for further research on GIO.

Retrospective kinematic analysis of treated level, adjacent levels, and overall cervical spine after single-level dynamic cervical implant (DCI) stabilization versus anterior cervical discectomy and fusion (ACDF). Between June 2009 and March 2013, 70 consecutive patients with a symptomatic single-level cervical degenerative disk disease (DDD) were enrolled in this study and divided into DCI (n = 35) group and ACDF (n = 35) group. All cases were followed up for more than 5 years. The study compared perioperative parameters; clinical outcomes; and radiological parameters. Kinematic analysis included range of motion (ROM) of treated level and adjacent level, overall ROM (C2–C7), and changes in adjacent disk spaces. There were no significant differences between the DCI group and ACDF group in terms of improvement in the SF-36, VAS, NDI, and JOA scores. DCI stabilization resulted in better ROM of C2–C7 and the treated level than ACDF did. The ROM of treated level decreased significantly at 24 months after surgery and last follow-up in the DCI group, and the C2–C7 ROM showed different degrees of reduction after the 24 months after surgery. Radiological evidence of adjacent segment degeneration (ASD) at last follow-up was observed in 4/22 patients (18.2%) in the DCI group and 5/23 patients (21.7%) in the ACDF group which was not a significant difference between groups (p > 0.05). DCI stabilization for the treatment of cervical DDD cannot preserve the normal kinematics of the cervical spine for a long time, especially the treated level. DCI stabilization cannot decrease the risk of ASD compared with ACDF. These slides can be retrieved under Electronic Supplementary Material.

Recently, accumulating evidence has indicated that glucocorticoid-induced osteoporosis (GIOP) is closely related to oxidative stress and apoptosis. Alpha-lipoic acid (LA), a naturally endogenous anti-oxidant, possesses anti-oxidative and anti-apoptosis activities, implicating LA as a therapeutic agent for the treatment of GIOP. In this study, the osteogenesis-promoting effects of LA against GIOP were investigated and the mechanisms were further probed. Here, the results showed that LA inhibited oxidative stress, suppressed apoptosis and improved osteopenia by promoting the expression of osteogenesis markers, including ALP, COL-I, OCN, BMP-2, RUNX2 and OSX. Further study revealed that the osteogenesis-promoting effects of LA likely occur via the regulation of the NOX4, NF-kappaB, JNK and PI3K/AKT pathways. The present study indicated that LA may prevent GIOP and promote osteogenesis and might be a candidate for the treatment of GIOP.

RATIONALE Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient. PATIENT CONCERNS Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury. DIAGNOSES X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location. INTERVENTIONS The foreign body was removed completely following a microsuture of the cephalic vein. OUTCOMES The procedure was uneventful, and the patient remained asymptomatic after 6 months of clinical follow-up. LESSONS This case indicated that the foreign body in the superficial tissue needed to be accurately diagnosed and located. X-ray and C-arm fluoroscope imaging should be combined with the patient's medical history to ensure sufficient preoperative preparation.

Icariin, a traditional Chinese medicine, has previously been demonstrated to promote chondrogenesis of bone marrow mesenchymal stem cells (BMSCs) in traditional 2D cell culture. The present study investigated whether icariin has the potential to promote stable chondrogenic differentiation of BMSCs without hypertrophy in a 3D microenvironment. BMSCs were cultivated in a self‑assembling peptide nanofiber hydrogel scaffold in chondrogenic medium for 3 weeks. Icariin was added to the medium throughout the culture period at concentrations of 1x10‑6 M. Chondrogenic differentiation markers, including collagen II and SRY‑type high mobility group box 9 (SOX9) were detected by immunofluorescence, reverse transcription‑quantitative polymerase chain reaction and toluidine blue staining. Hypertrophic differentiation was further assessed by detecting collagen X and collagen I gene expression levels and alkaline phosphatase activity. The results demonstrated that icariin significantly enhanced cartilage extracellular matrix synthesis and gene expression levels of collagen II and SOX9, and additionally promoted more chondrocyte‑like rounded morphology in BMSCs. Furthermore, chondrogenic medium led to hypertrophic differentiation via upregulation of collagen X and collagen I gene expression levels and alkaline phosphatase activity, which was not potentiated by icariin. In conclusion, these results suggested that icariin treatment may promote chondrogenic differentiation of BMSCs, and inhibit the side effect of growth factor activity, thus preventing further hypertrophic differentiation. Therefore, icariin may be a potential compound for cartilage tissue engineering.

In a recent meta-analysis by Laudy et al ,1 the authors used a fixed-effects model when there was significant heterogeneity for Western Ontario and McMaster Universities Osteoarthritis (WOMAC) knee pain (refer to figure 11 of the article, χ2=17.12, I2=94%, p