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C2 pedicle screw placement in patients with basilar invagination (BI) is fraught with risks because of a high incidence of anatomical variations and high-riding vertebral artery (HRVA). However, no study can be found in the literature that attempted to identify the ideal entry point and trajectory through the C2 pedicle in BI patients with HRVA.To investigate the parameters of ideal entry point and trajectory for C2 pedicle screw placement in BI patients with HRVA and compare them with those in BI patients without HRVA and patients without BI as control. These parameters would serve as a guide to pedicle screw placement.A retrospective comparative study.A total of 396 patients (198 consecutive BI patients and 198 matched patients without BI as control) and 792 unilateral pedicles from April 2017 to October 2021 at two medical centers were included.The insertion parameters of mediolateral angle, surface distance, cephalad angle, and vertical distance from the superior border of the lamina were the primary outcome measures for the reference of C2 pedicle screw placement. Furthermore, factors that affect the primary insertion parameters were assessed via multiple linear regression analyses.According to the diagnosis of BI and HRVA, the unilateral pedicles were assigned into HRVA of BI, non-HRVA of BI, HRVA of control, and non-HRVA of control groups. Subgroup analyses based on Goel types A and B were also performed. Moreover, vertebral artery (VA) anomalies that might result in potentially serious complications were identified and systematically compared.The measurements of insertion parameters in BI patients with HRVA indicated a mean mediolateral angle of 27.42°, a mean cephalad angle of 43.02°, a mean surface distance of 9.74 mm, and a mean vertical distance from the superior border of the lamina of 3.85 mm. Compared with that in BI patients without HRVA, the measurements suggested that the entry point in BI patients with HRVA should be shifted upward by 0.38 mm and the trajectory should be angled cephalad by 6.05° and medially by 4.78°. In the control group, changes in the insertion parameters between HRVA and non-HRVA showed a similar trend to the BI group. Multiple linear regression showed that mediolateral angle was significantly associated with the male gender (B=-0.930, p=.017) and the diagnoses of HRVA (B=6.964, p.001), Goel type A (B=-1.656, p=.003), and Goel type B (B=0.981, p=.030). Moreover, cephalad angle was significantly associated with the length of lateral mass (B=-0.319, p=.001) and the diagnoses of HRVA (B=3.254, p.001) and Goel type A (B=6.924, p.001). The VA anomalies were significantly higher in the BI group than in the control group.The insertion parameters of the ideal entry point and trajectory for C2 screw placement in BI patients with HRVA were remarkably different from those of non-HRVA of BI, HRVA of control, and non-HRVA of control cohorts. Preoperative 3D computed tomography (CT) and CT angiography are highly recommended in such patients to improve intraoperative safety and reduce postoperative complications.

Lactate dehydrogenase (LDH) is a biomarker for cancer. However, the relationship between serum LDH levels and the survival of patients with brain metastasis has been fully revealed. We aimed to evaluate the serum LDH levels and assess its prognostic value in patients with BM.The serum LDH levels were collected from 2507 patients with BM. Patients were categorized into four groups according to the quartile of serum LDH levels. The association between serum LDH levels and overall survival (OS) was evaluated using Cox regression models and Kaplan-Meier curves. Three predictive models were used to evaluate patients.The Kaplan-Meier curve for survival by the serum LDH group demonstrates clear separation between four groups (P 0.001). The participants in the lower group had longer OS than those in the higher group. After adjusting in multivariate Cox regression models remained significant for patients in the Q4 compared with patients in the Q1 (Q4:Q1 OR 1.58, 95% CI 1.38-1.80). Furthermore, the GPA-LDH model generates a pooled area under the curve of 0.630 (95% CI 0.600, 0.660).Serum LDH levels and OS in patients with brain metastasis is an inverse association. Moreover, Serum LDH levels can improve the prognosis of the GPA model.

Stem cell approaches have become an attractive therapeutic option for intervertebral disc degeneration (IVDD). Nucleus pulposus mesenchymal stem cells (NP-MSCs) participate in the regeneration and homeostasis of the intervertebral disc (IVD), but the molecular mechanisms governing these processes remain to be elucidated. Acid-sensing ion channels (ASICs) which act as key receptors for extracellular protons in central and peripheral neurons, have been implicated in IVDD where degeneration is associated with reduced microenvironmental pH. Here we show that ASIC1 and ASIC3, but not ASIC2 and ASIC4 are upregulated in human IVDs according to the degree of clinical degeneration. Subjecting IVD-derived NP-MSCs to pH 6.6 culture conditions to mimic pathological IVD changes resulted in decreased cell proliferation that was associated with cell cycle arrest and induction of senescence. Key molecular changes observed were increased expression of p53, p21, p27, p16 and Rb1. Instructively, premature senescence in NP-MSCs could be largely alleviated using ASIC inhibitors, suggesting both ASIC1 and ASIC3 act decisively upstream to activate senescence programming pathways including p53-p21/p27 and p16-Rb1 signaling. These results highlight the potential of ASIC inhibitors as a therapeutic approach for IVDD and broadly define an in vitro system that can be used to evaluate other IVDD therapies.

Robotic guidance (RG) pedicle screw placement has been increasingly used to improve the rate of insertion accuracy. However, the superiority of the RG technique over computer-assisted navigation (CAN) remains debatable.To determine whether the Mazor RG technique is superior to CAN in terms of the rate of insertion accuracy and 4 other clinical indices, namely, intraoperative time, blood loss, complications and revision surgery caused by malposition.A search of PubMed, Embase, Cochrane, Web of Science, CNKI, and WanFang was conducted. We mainly aimed to evaluate the accuracy of pedicle screw placement between the Mazor RG and CAN techniques. The secondary objectives were intraoperative time, blood loss, complications, and revision surgery caused by malposition. The meta-analysis was conducted using the RevMan 5.3 and Stata 15.1 software.A randomized controlled trial and 5 comparative cohort studies consisting of 529 patients and 4081 pedicle screws were included in this meta-analysis. The RG technique has a significantly higher accuracy than CAN in terms of optimal (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.85-2.76; P0.01) and clinically acceptable (OR, 1.69; 95% CI, 1.22-2.34; P = 0.002) pedicle screw insertions. Furthermore, the RG technique showed significantly less blood loss (mean difference, -42.49; 95% CI, -78.38 to -6.61; P = 0.02) than did the CAN technique but has equivalent intraoperative time (mean difference, 0.75; 95% CI, -5.89 to 7.40; P = 0.82), complications (OR, 0.65; 95% CI, 0.32-1.33, P = 0.24), and revision surgery caused by malposition (OR, 0.46; 95% CI, 0.15-1.43, P = 0.18).The Mazor RG technique is superior to CAN concerning the accuracy of pedicle screw placement. Thus, the Mazor RG technique is accurate and safe in clinical application.

Maternal alcohol use and gestational diabetes mellitus (GDM) have been serious public health issues worldwide. This study aimed to investigate the association between maternal alcohol use during pregnancy and risk of GDM via a meta-analysis. PubMed, ScienceDirect, and Cochrane Library databases were systematically searched up to March 25, 2020. Observational studies on associations between maternal alcohol use during pregnancy and risk of GDM were retrieved. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) for with versus without alcohol use during pregnancy were calculated using a random-effect model. The publication bias was assessed by Begg’s rank correlation test. A total of 7 observational studies (185,235 participants, including 8368 GDM cases) were included in this meta-analysis. Compared with women without any use of alcohol during pregnancy, the pooled OR for women with alcohol use was 0.74 (95% CI 0.50–1.10). In subgroup analysis, the pooled OR was 0.79 (95% CI 0.60–1.05) and 0.71 (95% CI 0.28–1.80), respectively, for individual study with and without adjusting for body mass index. Our findings suggest that there is no discernible association between maternal alcohol use during pregnancy and risk of GDM. However, given other possible pregnancy complications and adverse birth outcomes induced by alcohol use, women who have been pregnant and are planning to become pregnant should quit drinking.

Study design A meta-analysis. Objective Through meta-analysis, whether RA techniques are superior to conventional freehand (FH) techniques was determined in terms of cranial facet joint protection and four other clinical indexes, namely, the accuracy of pedicle screw placement, the number of surgical revision due to malposition, intraoperative radiation dose, and operative time. Summary of background data Cranial facet joint violation (FJV) is an important risk factor for adjacent segment degeneration. Some studies recommended the use of robot-assisted (RA) pedicle screw placement in reducing the rate of cranial FJV instead of conventional FH pedicle screw placement. However, the superiority of RA techniques to FH techniques remains controversial. Methods A comprehensive search on PubMed, EMBASE, Cochrane, Web of Science, CNKI, and WanFang was conducted for the selection of potential eligible literature. The outcomes were evaluated in terms of odds ratio (OR) or standardized mean difference and corresponding 95% confidence interval (CI). The meta-analysis was conducted using RevMan 5.3. The subgroup analyses of the violation of the cranial facet joint and the accuracy of pedicle screw placement were performed on the basis of robot type. Result Three randomized controlled trials, two prospective cohort study, and one retrospective cohort study consisting of 783 patients and 2694 cranial pedicle screws were included in the meta-analysis. RA pedicle screw placement was associated with significantly fewer cranial FJVs than FH screw placement. Subgroup analyses showed that the Renaissance (OR = 0.19, 95% CI = 0.07-0.56) and TINAVI (OR = 0.19, 95% CI = 0.09-0.38) robots under RA techniques were associated with significantly fewer cranial FJVs than FH techniques. Furthermore, the RA techniques showed more accurate pedicle screw placement and lower intraoperative radiation dose, equivalent number of surgical revision due to malposition, but longer operative time than the FH techniques. Conclusion The RA (Renaissance and TINAVI) techniques are superior to conventional FH techniques in terms of protecting the cranial facet joint. RA techniques are accurate and safe in clinical application. Level of evidence 2.

Clear cell renal cell carcinoma (ccRCC) is the most common subtype among kidney cancer, which has poor prognosis. The aim of this study was to screen out novel prognostic biomarkers and therapeutic targets for immunotherapy, and some novel molecule drugs for ccRCC treatment. Immune scores ranged from -1109.36 to 2920.81 and stromal scores ranged from -1530.11 to 1955.39 were firstly calculated by applying ESTIMATE algorithm. Then 17 DEGs associated with immune score and stromal score were further identified. 6 candidate hub genes were screened out by performing overall survival (OS) and disease-free survival analyses based on TCGA-KIRC data, one of which including TGFBI was further regarded as hub gene associated with prognosis by calculating the R2 (R2 = 0.011, P = 0.018) and AUC (AUC = 0.874). The prognostic value of TGFBI was validated by performing OS, CSS, and PFS analyses based on GSE29609 and E-MTAB-3267. CMap analysis suggested that 3 molecule drugs might be novel choice for ccRCC treatment. Further analysis demonstrated that CNVs of TGFBI was associated with OS of patients with ccRCC. TGFBI expression was also correlated with histologic grade, pathologic stage, and immune infiltration level, significantly. TGFBI was the most relevant gene with OS among the candidate hub genes, which might be novel DNA methylation biomarkers for ccRCC. In conclusion, our findings indicated that TGFBI was correlated with prognosis of patients with ccRCC, which might be novel prognostic biomarkers, and targets for immunotherapy in ccRCC. Three small molecule drugs were also identified, which showed strong potential for ccRCC treatment.

Study Design Retrospective cohort study. Objective To investigate the effect of HRVA on the intrapedicular accuracy of C2PS placement through the freehand method in patients with BI and analyse the possible risk factors for C2PS malpositioning. Method A total of 91 consecutive patients with BI who received 174 unilateral C2PS placements through the freehand method were retrospectively included. The unilateral pedicles were assigned to the HRVA and non-HRVA groups. The primary outcome was the intrapedicular accuracy of C2PS placement in accordance with the Gertzbein–Robbins scale. Moreover, the risk factors that possibly affected intrapedicular accuracy were assessed. Results The rate of intrapedicular accuracy in C2PS placement in patients with BI was 23.6%. Results showed that the non-HRVA group had remarkably higher rates of optimal and clinically acceptable C2PS placement than the HRVA group. Nevertheless, the HRVA group exhibited similar results for grade B classification as the non-HRVA group. Moreover, in the HRVA and non-HRVA groups, the most common direction of screw deviations was the lateral direction. Furthermore, the multivariate analyses showed that the obliquity of the lateral atlantoaxial joint in the sagittal plane ≥15°, and that in the coronal plane ≥ 20°, isthmus height < 4.3 mm, and distance from the skin to the spinous process ≥ 2.8 cm independently contributed to a high rate of screw malpositioning in BI patients. Conclusion The presence of HRVA in BI patients contributed to the high rate of malpositioning in C2PS placement via the freehand method. However, the rates of intrapedicular accuracy in patients with BI with and without HRVA were considerably low.

Despite percutaneous kyphoplasty (PKP) being widely used to treat osteoporotic vertebral compression fractures (OVCFs), the details of puncture are still controversial. With the development of surgical robots in spine surgery, robotic-assisted PKP surgery will become a promising treatment strategy.To evaluate the efficacy and safety of establishing an optimal working path through a unilateral pedicle approach to improve bone cement distribution under the assistance of a surgical robot in percutaneous kyphoplasty.Experimental and prospective study.PKP surgery under the assistance of the TINAVI robot was performed on 78 patients with osteoporotic vertebral compression fractures (OVCFs) from May 2018 to January 2020 in a single spine center. During the operation, the optimal path of the working channel made through unilateral pedicle puncture was designed according to the details of the fractured vertebral body under the guidance of the TINAVI surgical robot. Visual analog scale (VAS) scores of back pain, intraoperative blood loss, surgical time, and complications were recorded and evaluated. Postoperative fluoroscopy and 3D-CT were used to evaluate the distribution of bone cement.We have successfully performed 78 PKP surgeries under the assistance of the TINAVI robot. The mean procedure time was 13.9 ± 2.6 minutes from the beginning of C-arm scan to finish the injection of bone cement, and the intraoperative blood loss was 5.4 ± 2.8 mL. Pain of all cases was relieved immediately and significantly after PKP surgery; the VAS score was 7.5 ± 2.3 before surgery and 1.4 ± 0.8 post-surgery. The mean volume of bone cement was 4.7 ± 1.9 mL, and bone cement leakage occurred at the anterior edge of the fractured vertebral body in 2 patients, with no neurological and vascular injury in any of the cases. Postoperative fluoroscopy and 3D-CT showed that a good bone cement distribution evenly through unilateral pedicle puncture in the fractured vertebral body in all cases except the bone cement leakage in 2 patients.More cases are needed to evaluate the efficacy and stability of robot-assisted PKP surgery. A control group of PKP performed freehand should be included in this study.Robotic-assisted PKP surgery through the unilateral approach to establishing an optimal working channel is a safe and available procedure for treating OVCFs in terms of better distribution of bone cement, high accuracy, good repeatability, and less surgical trauma.

Background Robot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures. Methods A total of 90 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups at 1:1:1 ratio from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.Results The optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 79.3%, and 88.7%, respectively. This finding indicates no significant differences between RA and FH techniques (P =0.062), but significantly higher accuracies of RA over FP (P＜0.001), and FH over FP (P= 0.013). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 29.3%, and 22.7%, respectively. The RA had a significantly greater proportion of intact facet joints than the FP (P= 0.001) and FH (P= 0.035). However, FP and FH showed significantly similar outcomes with respect to the proximal FJV (P= 0.149). The logistic regression analysis showed that FP technique (OR= 2.791), pedicle angle (OR= 0.916), and L3 insertion (OR= 0.081) were independently associated with insertion accuracy. Meanwhile, the age (OR= 0.966), pedicle angle (OR= 0.940), mild facet joint osteoarthritis (OR= 5.906), moderate facet joint osteoarthritis (OR= 5.906), severe facet joint osteoarthritis (OR= 9.991), and distance from skin to insertion point (OR= 0.575) were independently associated with cranial FJV.Conclusion RA technique showed higher rate of intrapedicular accuracy and lower rate of cranial FJV than FH and FP techniques, and it might be a safe method for pedicle screw placement in thoracolumbar surgery.

Background Cortical bone trajectory (CBT) has been well-known in spine surgery for obtaining improved fixation while minimizing soft tissue dissection. This study was designed to compare the bone mineral density (BMD) between the CBT and traditional trajectory (TT) by using Hounsfield unit (HU) values and identify the ideal decades of patients and the suitable lumbar segments using this CBT technology from a radiological standpoint. Methods Patients were selected randomly from an institutional database based on age (evenly distributed by a decade of life) and gender. A total of 240 healthy patients had a computed tomography (CT) scan of the chest, abdomen, and pelvis. For each patient, axial slices of every vertebra were cut in two planes: one horizontal to the pedicle representing the plane wherein pedicle screws were inserted using the TT and the other in a caudocranial plane representing the plane wherein pedicle screws were inserted using the CBT. For each trajectory, a region of interest (ROI) was selected within the area wherein the screws were inserted. A CT number (HU values) was then calculated within each ROI to represent bone density. Results HU values measured at the ROI of CBT were significantly greater than those of the traditional pedicle screw in all age groups, and the specific value (ratio of the HU values of CBT/the HU values of TT) between CBT and TT was 1.92. A significant difference was observed between male and female. The HU values of CBT and TT of males were generally higher than those of females (males: CBT/TT 1.89 ± 0.45; Females: CBT/TT 1.95 ± 0.47). The specific value in HU values significantly increased with increasing age (p = 0.000) and cauda lumbar level (p = 0.000) in males and females. Conclusion BMD, as measured by HU values for the ROI of the CBT screw, was significantly greater than that of the traditional pedicle screw, especially in old patients and cauda lumbar segments.

STUDY DESIGN A retrospective study. OBJECTIVE To compare the accuracy of pedicle screw placement and proximal facet joint violation (FJV) in single-level degenerative lumbar diseases using cortical bone trajectory (CBT) and traditional trajectory (TT) techniques, and analyze their possible risk factors. SUMMARY OF BACKGROUND DATA CBT screws have been utilized increasingly to improve cortical bone contact to prevent screw pullout and reduce approach-related morbidity. However, the studies on intra-pedicular accuracy and proximal FJV between the two methods are rare. METHODS A total of 40 patients who required single-level instruments were included in the retrospective study treated with the CBT-TLIF and the TT-TLIF at a 1:1 ratio from March 2019 to August 2020. The radiographic outcomes were the intra-pedicular accuracy and proximal FJV. Moreover, the possible risk factors were assessed using bivariate and multivariate analyses. RESULTS As for the intra-pedicular accuracy, 73 screws (91.3%) were classified as grade A, 7 screws (8.7%) classified as grade B in the CBT group. A total of 71 screws (88.8%) were graded A with remaining 8 screws (10.0%) graded B and 1 screw (1.2%) graded C in the TT group. The proportion of optimal and clinically acceptable screw positions in the two groups were not significantly different (P > 0.05). In addition, the rate of proximal FJV in CBT approach (8.3%) was significantly lower than that in the TT approach (35.0%) (P

Objective To determine the rates and risk factors of pedicle screw placement accuracy and the proximal facet joint violation (FJV) using TINAVI robot-assisted technique. Methods Patients with thoracolumbar fractures or degenerative diseases were retrospectively recruited from June 2018 and June 2020. The pedicle penetration and proximal FJV were compared in different instrumental levels to identify the safe and risk segments during insertion. Moreover, the factors were also assessed using univariate and multivariate analyses. Results A total of 72 patients with 332 pedicle screws were included in the current study. The optimal and clinically acceptable screw positions were 85.8% and 93.4%. Of the 332 screws concerning the intra-pedicular accuracy, 285 screws (85.8%) were evaluated as Grade A according to the Gertzbein and Robbins scale, with the remaining 25 (7.6%), 10 (3.0%), 6 (1.8%), and 6 screws (1.8%) as Grades B, C, D, and E. Moreover, in terms of the proximal FJV, 255 screws (76.8%) screws were assessed as Grade 0 according to the Babu scale, with the remaining 34 (10.3%), 22 (6.6%), and 21 screws (6.3%) as Grades 1, 2, and 3. Furthermore, the univariate analysis showed significantly higher rate of penetration for patients with age p = 0.007), facet angle ≥ 45° (adjusted OR 0.266, 95% CI 0.090–0.786; p = 0.017), distance from skin to insertion point ≥ 4.5 cm (adjusted OR 0.342, 95% CI 0.134–0.868; p = 0.024), and lumbosacral instrumentation (adjusted OR 0.227, 95% CI 0.091–0.566; p = 0.001) were independently associated with intra-pedicular accuracy; the L5 insertion (adjusted OR 2.020, 95% CI 1.084–3.766; p = 0.027) and facet angle ≥ 45° (adjusted OR 1.839, 95% CI 1.026–3.298; p = 0.041) were independently associated with the proximal FJV. Conclusion TINAVI robot-assisted technique was associated with a high rate of pedicle screw placement and a low rate of proximal FJV. This new technique showed a safe and precise performance for pedicle screw placement in spinal surgery. Facet angle ≥ 45° is independently associated with both the intra-pedicular accuracy and proximal FJV.

Objective The finite element method was used to investigate the biomechanical adjustments of adjacent and fixed segments after lumbar fusion and fixation with traditional trajectory (TT) and cortical bone trajectory (CBT) screws. Methods The model used was a validated nonlinearly L3–S1 finite element model. Interbody fusion cages and 2 types of screws were used to work on the L4–L5. To simulate flexion, extension, lateral bending, and axial rotation, all models were loaded in 3 planes with a compressive pre-load of 400 N and a bending moment of 7.5 N/m. Under various loading conditions, the range of motion (ROM), peak Von Mises stress of the vertebral body, stress of the intervertebral disc, stress of the facet joints, stress of the endplate, and stress of internal fixation were compared. Results In all instrumentation models, the ROM at fixed segments decreased. At adjacent segments, the ROM of the CBT model was greater than that of the TT model. The CBT model had a greater peak Von Mises stress of the L4 and L5 vertebral bodies, as well as greater stress of internal fixation, than the TT model. Furthermore, as compared with the TT model, the CBT model's facet joint and endplate stress were lower at fixed segments but higher at adjacent segments. The stress on the L3–L4 and L5–S1 intervertebral discs in the CBT and TT models, on the other hand, was nearly equivalent. Conclusions At the fixed section, CBT may provide slightly better stability, endplate tension, and facet joint stress than TT. The greater ROM, endplate stress, and facet joint stress of CBT in adjacent segments, on the other hand, should be taken into account in the future.

Basic environment construction is a livelihood project, especially water environment management is a hot topic in current engineering construction. There are more or fewer risks in the water environment treatment construction process, especially the black and smelly water treatment during the flood season. Hidden dangers, especially this year is the resumption of work and production after the epidemic, which coincides with the flood season. This article takes the EPC project of comprehensive water environment management in the east of a city as an example, and combines the WBS-RBS method and AHP analysis to analyze the risks of the water environment management project during the flood period. Analysis enables the project risk to be predicted in advance, and the risk is quantified, so that the risk coefficient is minimized and the project construction can proceed smoothly.

ObjectiveDynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology (ASP) in clinical practice. However, the advantages of DS method remain controversial. This meta-analysis was to compare the radiographic and clinical outcomes between DS and instrumented fusion in patients with or without grade I spondylolisthesis at a minimum follow-up period of 2 years. MethodsWe conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases for potentially eligible articles. Clinical outcomes were assessed in terms of surgical time, intraoperative blood loss, length of hospital stay, in-hospital complications, VAS and ODI scores, screw loosening and breakage, and reoperation. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. Data are expressed as risk ratio or standardized mean difference with the associated 95% confidence intervals. The meta-analysis was performed using RevMan 5.3 and STATA 15.1 software.ResultsFourteen studies with 1078 patients were included in the meta-analysis. The mean durations of follow-up ranged from 26.64 ± 5.16 months to 93.6 ± 16.5 months. The DS group was associated with significantly shorter surgical time, fewer intraoperative blood loss, shorter length of hospital stay, less in-hospital complications, lower postoperative VAS scores for low-back and leg pain than the fusion group (P < 0.05). Moreover, the ROM at the stabilized segments of the fusion group decreased significantly (P < 0.01) and that at the adjacent segments increased significantly compared with those of the Dynesys group (P < 0.01). Additionally, the Dynesys group showed significantly less ASDeg than the fusion group (P < 0.01) but showed no significant advantage over the fusion group in terms of preventing ASDis (P = 0.33). Furthermore, the Dynesys group was insignificantly different from the fusion group in terms of ODI, screw loosening, screw breakage, surgical reoperation, and disc heigh at stabilized and adjacent segments (P > 0.05).ConclusionDynesys stabilization showed satisfactory clinical outcomes and provided additional benefits in preserving the motion at the stabilized segments and limiting the hypermobility at the adjacent segments compared with fusion method. Dynesys stabilization represented a complementary choice in the treatment of degenerative spinal lumbar disease with or without grade I spondylolisthesis.

Background and Objective: Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine. Mesenchymal stem cells (MSCs) regulate bone mass homeostasis in AIS, which might be related to the pathogenesis of AIS. However, the mRNA–miRNA–lncRNA network linked to the regulation of the genetic pathogenesis of MSCs remains unknown. Methods: We conducted an exhaustive literature search of PubMed, EMBASE, and the Gene Expression Omnibus database to find differentially expressed genes (DEGs), differentially expressed miRNAs (DE miRNAs), and differentially expressed lncRNAs (DE lncRNAs). Functional enrichment analysis was performed through Enrichr database. Protein–protein interaction (PPI) network was constructed using STRING database, and hub genes were identified by CytoHubba. Potential regulatory miRNAs and lncRNAs of mRNAs were predicted by miRTarBase and RNA22, respectively. Results: We identified 551 upregulated and 476 downregulated genes, 42 upregulated and 12 downregulated miRNAs, and 345 upregulated and 313 downregulated lncRNAs as DEGs, DE miRNAs, and DE lncRNAs, respectively. Functional enrichment analysis revealed that they were significantly enriched in protein deglutamylation and regulation of endoplasmic reticulum unfolded protein response. According to node degree, one upregulated hub gene and eight downregulated hub genes were identified. After drawing the Venn diagrams and matching to Cytoscape, an mRNA–miRNA–lncRNA network linked to the pathogenesis of MSCs in AIS was constructed. Conclusion: We established a novel triple regulatory network of mRNA–miRNA–lncRNA ceRNA, among which all RNAs may be utilized as the pathogenesis biomarker of MSCs in AIS.

Objectives: Prostate cancer (PC) is the second most frequent tumor in men, which has a high recurrence rate and poor prognosis. Therefore, this study aimed to identify novel prognostic biomarkers and therapeutic targets for immunotherapy and small molecule drugs for PC treatment. Materials and Methods: The Estimation of Stromal and Immune cells in Malignant Tumor tissues using Expression data (ESTIMATE) algorithm was applied to calculate immune scores and stromal scores of TCGA-PRAD data. Differentially expressed genes (DEGs) were identified using R package "limma." GO, KEGG, and DO analyses were performed to analyze DEGs. Overall survival and disease-free survival analyses were conducted for hub gene identification. To validate the hub gene at the mRNA and protein expression levels, genetic alterations were measured, and CCLE and Cox regression analyses were performed. Connectivity map (CMap) analysis and GSEA were performed for drug exploration and function analysis, respectively. Results: Immune scores ranged from -1795.98 to 2339.39, and stomal scores ranged from -1877.60 to 1659.96. In total, 45 tumor microenvironment (TME)-related DEGs were identified, of which Complement C7 (C7) was selected and validated as a hub gene. CMap analysis identified six small molecule drugs as potential agents for PC treatment. Further analysis demonstrated that C7 expression was significantly correlated with clinical T, pathological N, and immune infiltration level. Conclusions: In conclusion, of the 45 TME-related DEGs, C7 was shown to correlate with PC prognosis in patients, indicating it as a novel prognostic biomarker and immunotherapy target in PC. Additionally, six small molecule drugs showed strong therapeutic potential for PC treatment.

Objective To investigate the association of vitamin D receptor (VDR) gene polymorphisms with OA susceptibility. Methods Meta-analyses were performed using allelic contrast, contrast of homozygotes, and recessive and dominant models to clarify the association between OA and VDR ApaI, BsmI, TaqI and FokI polymorphisms. Odds ratio (OR) and the corresponding 95% CI were obtained, and subgroup analyses were performed based on the ethnicity and OA sites. Results A total of 18 studies with 2983 OA patients and 4177 controls were included in this meta-analysis. There were statistically significant associations in the spine between OA susceptibility and the VDR BsmI (B vs b: OR = 1.25, 95% CI: 1.03, 1.53, P = 0.026; BB vs bb: OR = 1.56, 95% CI: 1.02, 2.37, P = 0.038) and TaqI (T vs t: OR = 0.73, 95% CI: 0.54, 0.99, P = 0.044; TT vs Tt + tt: OR = 0.63, 95% CI: 0.42, 0.95, P = 0.028) polymorphisms, but not for the other polymorphisms. A statistically significant association was found between the VDR FokI polymorphism and OA susceptibility in the knee in the recessive model contrast (FF vs Ff + ff: OR = 0.63, 95% CI: 0.42, 0.95, P = 0.028), but this result was only pooled from one study. However, no significant associations were found between the VDR ApaI polymorphism and OA. Besides, ethnic stratification also indicated that there was no significant association between VDR gene polymorphism and OA in Caucasians or Asians. Conclusion Our meta-analysis suggests that the VDR BsmI and TaqI polymorphisms are associated with OA susceptibility in the spine. However, the VDR ApaI polymorphism is not a significant genetic risk factor for OA.

To compare diffusion tensor imaging (DTI) parameters of the spinal cord between patients with cervical spondylotic myelopathy (CSM) and normal subjects, and investigate their significance in the clinical diagnosis, surgical planning and post-operative evaluation of CSM. Routine sequence magnetic resonance imaging (MRI) and DTI scans were performed in 50 normal subjects and 60 cases of CSM with 3.0-T MR. DTI images, apparent diffusion coefficient (ADC) and fractional anisotropy (FA) colormaps corresponding to spinal cord cross-sections were obtained. The spinal cord function of CSM patients was measured using modified Japanese Orthopaedic Association (mJOA) scoring and Nurick grade at different times. The changes in DTI parameters and their correlation with spinal cord function scores were analysed by SPSS 19. There were significant differences in DTI parameters of the spinal cord between normal subjects and patients with CSM (ADC: 1.119 ± 0.087 vs. 1.395 ± 0.091, P

A retrospective study. The objectives of the study were to investigate the predictors for hyponatraemia in patients with cervical spinal cord injuries (CSCIs) and to define the relationship between magnetic resonance imaging (MRI) scans and hyponatraemia. The study was carried out at The First Affiliated Hospital of Anhui Medical University. A total of 292 patients with CSCIs were retrospectively reviewed to determine the predictors of hyponatraemia. Fourteen variables were extracted from the medical records: age, sex, blood pressure (BP), tracheostomy, serum potassium, serum chloride, serum bicarbonate, serum albumin, intravenous fluid intake and urine volume for 24 h, haematocrit, haemoglobin, neurological assessment and four MRI signal patterns. Univariate and multivariate analyses were used to determine the effect of each variable on hyponatraemia. Eighty-two of the 270 patients (30%) developed hyponatraemia. Univariate analyses indicated that the following variables were significant predictors of hyponatraemia: tracheostomy; the initial American Spinal Injury Association (ASIA) Impairment Scale (AIS) A assessment; and haemorrhage changes on T2-weighted MRI scans, and low BP. Multivariate regression analyses revealed two variables were significant predictors of hyponatraemia: haemorrhage changes on T2-weighted MRI scans and low BP. Haemorrhage changes on MRI scans were closely associated with the onset of hyponatremia and could provide objective data for forecasting hyponatraemia in CSCI patients. Low BP was also a reasonable predictor of hyponatremia.

An acidic environment is vital for the maintenance of cellular activities but can be affected tremendously during intervertebral disc degeneration (IVDD). The effect of changes in the acidity of the environment on human nucleus pulposus mesenchymal stem cells (NP-MSCs) is, however, unknown. Thus, this study aimed to observe the biological effects of acidic conditions mimicking a degenerated intervertebral disc on NP-MSCs in vitro. NP-MSCs were isolated from patients with lumbar disc herniation and were further identified by their immunophenotypes and multilineage differentiation. Then, cells were cultured at acidic pH levels (pH 6.2, pH 6.5, pH 6.8, pH 7.1, and pH 7.4) with/without amiloride, an acid-sensing ion channel (ASIC) blocker. The proliferation and apoptosis of NP-MSCs and the expression of stem cell-related genes (Oct4, Nanog, Jagged, Notch1), ASICs, and functional genes (Aggrecan, SOX-9, Collagen-I, and Collagen-II) in NP-MSCs were evaluated. Our work showed that cells obtained from human degenerated NP met the criteria of International Society for Cellular Therapy. Therefore, cells obtained from a degenerated nucleus pulposus were definitively identified as NP-MSCs. Our results also indicated that acidic conditions could significantly inhibit cell proliferation and increase cell apoptosis. Gene expression results demonstrated that acidic conditions could decrease the expression of stem cell-related genes and inhibit extracellular matrix synthesis, whereas it could increase the expression of ASICs. Our study further verified that the above-mentioned biological activities of NP-MSCs could be significantly improved by amiloride. Therefore, the results of the study indicated that the biological behavior of NP-MSCs could be inhibited by acidic conditions during IVDD, and amiloride may meliorate IVDD by improving the activities of NP-MSCs.