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P50-associated cyclooxygenase-2 (COX-2) extragenic RNA (PACER) is a novel long noncoding RNA that has been found to activate the COX-2 gene, which may function as an oncogene in osteosarcoma. However, the role of PACER and the relationship between PACER and COX-2 in osteosarcoma progression have been unknown until now. Here, we examined the expression levels of PACER in clinical tumor samples and human osteosarcoma cell lines, assessed the functions of PACER in osteosarcoma cell proliferation and invasion, and then explored the mechanism of PACER dysregulation in osteosarcoma. The results showed that PACER was overexpressed in osteosarcoma tissues and cell lines compared with normal tissues and osteoblasts, respectively. PACER knockdown inhibited the proliferation and invasion of human osteosarcoma cells. Downregulation of PACER significantly suppressed the expression of COX-2, and the effects of PACER on cell proliferation and invasion were rescued by COX-2 overexpression. Furthermore, COX-2 activation by PACER was NF-κB-dependent. The regulation of PACER by CCCTC-binding factor (CTCF) was associated with DNA methylation status. Taken together, these findings suggest that PACER promotes proliferation and metastasis of osteosarcoma cells by activating the COX-2 gene and its own expression was influenced by DNA methylation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical efficacy of the one-stage posterior approach in treating consecutive multiple-segment thoracic tuberculosis with kyphosis., Material and Methods: A retrospective study was performed. The data of 22 patients with consecutive multi-level thoracic tuberculosis and kyphosis who underwent the one-stage posterior approach of debridement, bone grafting, drainage and pedicle screws fixation were collected. The kyphotic angle was 61.6°±3.1° pre-operatively. The neurologic status based on American Spinal Injury Association (ASIA) scoring was A in 5 cases, B in 4 cases, C in 9 cases, D in 3 cases and E in 1 case., Results: The average follow-up period was 43.4±5.0 months. The kyphotic angle was 19.8°±0.7° after operation (p < 0.01), and 21.9°±1.2° at the last visit (p < 0.01). No neurological deterioration was observed in any patients after surgery. A significant difference in ASIA score was detected when the state before the operation and at the last visit was compared (p < 0.01). There was no recurrent paravertebral abscess of thoracic tuberculosis in any of these cases., Conclusion: The one-stage posterior approach of debridement and drainage is a feasible surgical option for consecutive multisegment thoracic tuberculosis with kyphosis. It can achieve debridement, decompression, and stabilization simultaneously.

P50-associated cyclooxygenase-2 (COX-2) extragenic RNA (PACER) is a novel long noncoding RNA that has been found to activate the COX-2 gene, which may function as an oncogene in osteosarcoma. However, the role of PACER and the relationship between PACER and COX-2 in osteosarcoma progression have been unknown until now. Here, we examined the expression levels of PACER in clinical tumor samples and human osteosarcoma cell lines, assessed the functions of PACER in osteosarcoma cell proliferation and invasion, and then explored the mechanism of PACER dysregulation in osteosarcoma. The results showed that PACER was overexpressed in osteosarcoma tissues and cell lines compared with normal tissues and osteoblasts, respectively. PACER knockdown inhibited the proliferation and invasion of human osteosarcoma cells. Downregulation of PACER significantly suppressed the expression of COX-2, and the effects of PACER on cell proliferation and invasion were rescued by COX-2 overexpression. Furthermore, COX-2 activation by PACER was NF-κB-dependent. The regulation of PACER by CCCTC-binding factor (CTCF) was associated with DNA methylation status. Taken together, these findings suggest that PACER promotes proliferation and metastasis of osteosarcoma cells by activating the COX-2 gene and its own expression was influenced by DNA methylation.

Aim: To compare both the clinical characteristics and incidence of postoperative cervical nerve root palsy in cervical spondylosis patients treated by posterior total laminectomy, decompression and instrumentation with two different common body positions, traction bed and plaster bed., Material and Methods: One hundred and thirty-three patients, with a mean age of 49.5 years suffering from multilevel cervical spondylosis and treated by laminectomy from 2007 to 2009, were reviewed., Results: Overall 30 of 133 (22.56%) patients had C5 palsy, of which 14 (19.44%) out of 72 patients were in the plaster bed group, while 16 of 61 (26.23%) patients were in the traction bed group. The difference was statistically significant (P < 0.05)., Conclusion: The cervical curvature index (CCI) reflected both the change of cervical height and the change of the overall cervical curvature. CCI was related with the incidence of C5 nerve root palsy postoperatively. The patients in the traction bed group had a higher nerve root palsy rate and change in cervical alignment because of over traction.

Glomus tumors are very infrequent in the spine. The lesions can grow intraosseously along the entire spinal axis. A single female presenting with back pain from the upper thoracic spine is reported on. Removal of this lesion may require reconstruction of the anterior column with posterior fixation resulting in significant blood loss. The current report describes an embolization procedure prior to removal in order to reduce the significant blood loss that occurs with removal of this lesion, and summarizes the clinical and pathological characteristics of this rare tumor. A single, recent case and removal of an intraosseous tumor arising from the upper thoracic vertebra of T2-T4 is described. A 45-year-old female presenting with symptoms secondary to a glomus tumor of the upper thoracic vertebra of T2-T4 underwent resection of the lesion followed by reconstruction of the anterior column following preoperative emobolization. She had neurological symptoms for 3 years, and an irregular crescent-shaped lesion was seen going through the foramen at T3 to the chest cavity in the MRI scans. The operation was performed with a posterior approach in a single stage. The use of preoperative embolization of the T2-T4 segmental arteries resulted in significantly less blood loss as compared to without an embolization procedure. It was confirmed by histopathological examination that the glomus tumor rose from the smooth muscle cells in the right paravertebral muscles of T2. The glomus tumor has not recurred in the MRI during the five-year follow-up. Intraosseous glomus tumors are rare lesions that may extend into the epidural space and through the neural foramina and chest compartments resulting in neurological compromise. Over time, they may grow very large. Radiotherapy can be useful for eradication of this rare lesion. However, it can reoccur requiring extensive surgery resulting in significant blood loss. Preoperative embolization results in a reduction of blood loss and can be a very useful technique when performing the resection of large lesions suspected to be glomus tumors.