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Background Intervertebral disc degeneration (IVDD) is the initiating factor of adult degenerative scoliosis (ADS), and ADS further accelerates IVDD, creating a vicious cycle. Nevertheless, the role of the Wnt/β-Catenin pathway in ADS combined with IVDD (ADS-IVDD) remains a mystery. Accordingly, this study was proposed to investigate the effect of axial stress on the Wnt/β-Catenin pathway in nucleus pulposus cells (NPCs) isolated from DS-IVDD patients. Methods Normal NPCs (N-NPC) were purchased and the NPCs of young (25–30 years; Y-NPC) and old (65–70 years; O-NPC) from ADS-IVDD patients were primary cultured. After treatment of NPC with overloaded axial pressure, CCK-8 and Annexin V-FITC kits were applied for detecting proliferation and apoptosis of N-NPC, Y-NPC and O-NPC, and western blotting was performed to assess the expression of Wnt 3a, β-Catenin, NPC markers and apoptosis markers (Bax, Bcl2 and Caspase 3). Results N-NPC, Y-NPC and O-NPC were mainly oval, polygonal and spindle-shaped with pseudopods, and the cell morphology tended to be flattened with age. N-NPC, Y-NPC and O-NPC were capable of synthesizing proteoglycans and expressing the NPC markers (Collagen II and Aggrecan). Notably, the expression of Wnt 3a, β-Catenin, Collagen II and Aggrecan was reduced in N-NPC, Y-NPC and O-NPC in that order. After overload axial stress treatment, cell viability of N-NPC and Y-NPC was significantly reduced, and the percentage of apoptosis and expression of Wnt 3a and β-Catenin were significantly increased. Conclusions Overloaded axial pressure activates the Wnt/β-Catenin pathway to suppress proliferation and facilitate apoptosis of NPC in ADS-IVDD patients.

Background: Osteochondral injury is one of the common sports injuries. Hyaline cartilage does not regenerate spontaneously when injured, and Osteochondral injuries can cause pain, swelling, catching, and limited mobility and lead to early osteoarthritis. Numerous treatment methods for osteochondral repair have been implemented, including auto- and allogeneic osteochondral transplantations, combined bone and chondrocyte transplantations, and synthetic implants, but no gold-standard treatment has been established. Osteochondral autograft transplantation (OAT) is widely used in clinical practice and is a treatment best reserved for small osteochondral lesions in the knee that are 2 in size. Autologous dual-tissue transplantation (ADTT) is a promising method with more comprehensive indications for osteochondral injuries, but fewer studies have been reported. This study aimed to compare the histological and radiographic results of ADTT and OAT using a pig model. Methods: Osteochondral defects were made in 12 Dian-nan Small-Ear pigs with bilateral medial condyles of the knee and divided into three groups: ADTT group (n = 8), OAT group (n = 8), and empty control group (n = 8). Gross evaluation by ICRS score, radiographic assessment by CT and MOCART score based on MRI, and histological evaluation by O'Driscoll histological score of the repair tissue was performed at 2 and 4 months postoperatively. Results: At 2 months postoperatively, the ICRS score of gross evaluation, CT evaluation, MOCART score based on MRI, and O'Driscoll score of the OAT group was better than the ADTT group (P < 0.05); at 4 months postoperatively, these results of OAT group better than ADTT group but without significant differences (P > 0.05). Conclusion: Using the Dian-nan Small-Ear pig model, ADTT and OAT are effective treatments for osteochondral defects in weight-bearing areas. ADTT can be used as an alternative procedure to OAT for treating osteochondral defects.

Wei Lu,1– 3 Zhaowei Teng,1,2 Jiayu Chen,1– 3 Rongmao Shi,4 Tiannan Zou,1– 3 Ming Gao,1– 3 Weichao Li,1– 3 Zhi Peng,1– 3 Long Wang,1– 3 Yonghui Zhao,1– 3 Sheng Lu1– 3 1Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China; 2Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China; 3Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China; 4Department of Orthopedics, Clinical College of the 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming, People’s Republic of ChinaCorrespondence: Sheng Lu, Department of Orthopedics, the First People’s Hospital of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, People’s Republic of China, Tel +86-0871-63633071, Fax +86-0871-63633071, Email drlusheng@163.comPurpose: The objective of this study was to analyze the clinical characteristics and the therapeutic effects of treatment at our spinal center in OVCF patients associated with referred pain. The underlying goals were to deepen the understanding of referred pain caused by OVCFs, improve the currently low early diagnosis rate of OVCFs, and improve the effectiveness of treatment.Methods: The patients who had referred pain from OVCFs and met the inclusion criteria were retrospectively analyzed. All patients were treated with percutaneous kyphoplasty (PKP). Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were used to evaluate the therapeutic effect at different time points.Results: There were 11 males (19.6%) and 45 females (80.4%). Their corresponding mean bone mineral density (BMD) value was − 3.3 ± 0.4. The regression coefficient of BMD in the linear regression equation was − 4.51 (P< 0.001). According to the classification system for referred pain in OVCFs, there were 27 cases of type A (48.2%), 12 cases of type B (21.2%), 8 cases of type C (14.3%), 3 cases of type D (5.4%), and 6 cases of type E (10.7%). All patients were followed up for at least 6 months, and both VAS scores and ODI were found to be significantly better postoperatively than preoperatively (P< 0.001). There was no significant difference in VAS scores and ODI between different types preoperatively or 6 months postoperatively (P > 0.05). Within each type, there were significant differences in VAS scores and ODI between the pre- and postoperative timepoints (P < 0.05).Conclusion: Attention should be paid to referred pain in OVCF patients, which is not uncommon in clinical practice. Our summary of the characteristics of referred pain caused by OVCFs can improve the early diagnosis rate of OVCFs patients and provide a reference for their prognosis after PKP.Keywords: referred pain, radicular pain, vertebral fracture, percutaneous kyphoplasty, osteoporosis, spinal fracture

To observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.All 15 cases of 15 hips were followed up 6-24 months, with an average of 14 months. During the follow-up, the patient's ONFH did not worsen, the femoral head did not collapse, the joint space was normal, and the hip joint fextion and extension function was acceptable. At last follow-up, the VAS score was 1.9±0.2, and the hip Harris score was 92.1±0.8, both of which were significantly improved when compared with preoperative ones (For patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.观察数字减影血管造影（digital subtraction angiography，DSA）技术辅助肌骨瓣移植治疗股骨头坏死（osteonecrosis of the femoral head，ONFH）的临床疗效。.回顾分析 2016 年 1 月—2019 年 12 月收治的 15 例 15 髋 ONFH 患者临床资料。患者均为男性，年龄 20～45 岁，平均 31.6 岁。病因：激素型 9 例，酒精型 6 例。病程 15 d～3 年，平均 8 个月。国际骨循环协会（ARCO）分期：Ⅱ期 4 髋，Ⅲ期 11 髋。术前疼痛视觉模拟评分（VAS）为（6.2±0.2）分，髋关节 Harris 评分为（57.3±1.3）分。术前行股骨头 DSA 检查确定股骨头血管病变部位，根据造影结果指导肌骨瓣移植术式的选择。对于股骨头上、下支持带血管均显影者行单纯髓芯减压术，对上支持带血管显影而下支持带血管未显影者采用前外侧入路的阔筋膜张肌骨瓣移植，对上支持带血管不显影而下支持带血管显影者采用经后外侧入路的股方肌骨瓣移植，对上、下支持带血管均未显影者行吻合血管的腓骨瓣移植。.15 例 15 髋均获随访，随访时间 6～24 个月，平均 14 个月。随访期间患者 ONFH 未进一步加重，股骨头无塌陷，关节间隙正常，髋关节屈伸功能可。末次随访时，VAS 评分为（1.9±0.2）分，髋关节 Harris 评分为（92.1±0.8）分，均较术前显著改善，差异有统计学意义（对于需行肌骨瓣移植的 ONFH 患者，术前行股骨头 DSA 可明确股骨头血管病变部位，以此指导肌骨瓣移植术式的选择，对保髋手术具有重要意义。.

Background The maintenance of nucleus pulposus (NP) viability in vitro is difficult. The annulus fibrosus (AF) pathway reflects one nutrient transport channel and may have an important effect on NP viability in disc organ cultures. The present study describes a feasible disc pre-treatment involving the AF and investigates its efficacy in improving NP bioactivity in an in vitro disc bioreactor culture. Methods Rabbit discs that were randomly assigned to the experimental group (EG) were pretreated via the surgical removal and controlled trypsinization of the outer AF. The discs in the control group (CG) did not receive any special treatment. All discs were organ-cultured in a self-developed bioreactor. Solute transport into the central NP was measured using a methylene blue solution. On days 7 and 14, histological properties, cell viability, cell membrane damage, gene expression and matrix composition within the NP in these two groups were compared with each other and with the corresponding parameters of fresh NP samples. Additionally, the structures of the outer AF and the cartilage endplate (CEP) following pre-treatment were also assessed. Results The outer AF in the EG became disorganized, but no specific changes occurred in the CEP or the inner AF following pre-treatment. The discs in the EG exhibited increased penetration of methylene blue into the central NP. On days 7 and 14, the NP bioactivity in the EG was improved compared with that of the CG in terms of cell viability, cell membrane damage, gene expression profile and matrix synthesis. Moreover, cell viability and matrix synthesis parameters in the EG were more similar to those of fresh samples than they were to the same parameters in the CG on day 14. Conclusions Using this disc pre-treatment, i.e., the surgical removal and controlled trypsinization of the outer AF, NP bioactivity was better maintained for up to 14 days in an in vitro disc bioreactor culture.

In this paper, we proposes an efficient algorithm for finding reverse k nearest neighbor (RkNN) search. Given a set V of objects and a query object q, a RkNN query returns a subset of V such that each element of the subset has q as its kNN member according to a certain similarity metric. Early methods pre-compute NN of each data objects and find RNN. Recent methods introduce index based on the mutual distance between two objects. Our method can find RkNN for any k straightforwardly with constant running cost. It can be applied to any RkNN searches whenever the mutual distance between objects can be figured out. It does not require the triangle inequality even. It is also based on pre-compute information, under the assumptions that secondary storage (hard disk drive) is cheap and the current computers are powerful enough so their spare power can be used to update data offline. We evaluate the efficiency and effectiveness of the proposed method.