Publications by authors named "Baorong He"

73 Publications

Trends of epidemiological characteristics of traumatic spinal cord injury in China, 2009-2018.

Eur Spine J 2021 Aug 15. Epub 2021 Aug 15.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Youyidong Road, Xi'an, 710000, Shaanxi Province, China.

Objective: We focus on providing the first comprehensive national dataset on the incidence, injury aetiology and mortality of TSCI in China.

Methods: A multi-stage stratified cluster sampling method was used. We included TSCI cases from all hospitals in three regions, nine provinces and 27 cities in China via search of electronic medical records and retrospectively analysed the characteristics of TSCI in China from 2009 to 2018. We estimated the incidence of TSCI in the total population and subgroups.

Results: There were 5954 actual cases in 2009, corresponding to a total estimated TSCI incidence of 45.1 cases per million population (95% CI, 44.0-46.3). There were 10,074 actual cases in 2018, corresponding to a total estimated TSCI incidence of 66.5 cases per million population (95% CI, 65.2-67.8) (P < 0.001; annual average percentage change (AAPC), 4.4%). From 2009 to 2018, the incidence of almost all sex/age groups showed an increasing trend over time (P < 0.001; AAPC, 0.7-8.8%). The elderly population (aged 65-74) displayed the highest incidence of TSCI (with an average annual incidence of 127.1 cases per million [95% CI, 119.8-134.3]).

Conclusions: The TSCI incidence increased significantly from 2009 to 2018. The incidence in the elderly populations was consistently high and continues to increase over time. The mortality of TSCI patients in hospitals is relatively low and continues to decrease each year, but elderly individuals remain at a high risk of hospital death.
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http://dx.doi.org/10.1007/s00586-021-06957-3DOI Listing
August 2021

Pain location is associated with fracture type in acute osteoporotic thoracolumbar vertebral fracture: a prospective observation study.

Pain Med 2021 Jul 28. Epub 2021 Jul 28.

Department of Spine Surgery, Honghui Hospital of Xi'an Jiaotong University Health Science Center.

Objective: This study investigated the relationship between pain location and fracture type in the patients with acute osteoporotic vertebral fracture (OVF).

Design: A prospective observation study.

Subject: A total of 306 patients with acute OVF were included.

Methods: The site of pain of each patient was recorded, and the patients were divided into pain at fracture site group (group 1) and pain at non-fracture site group (group 2). The fracture type was classified into four types: type I, upper endplate type; type II, central type; type III, lower endplate type; type IV, burst type.

Results: There were 146 patients in the group 1, of which 20.55% (30/146) were type I, 33.56% (49/146) were type II, 15.75% (23/146) were type III, and 30.14% (44/146) were type IV. There were 227 patients in the group 2, of which 57.27% (130/227) were type I, 5.29% (12/227) were type II, 35.24% (80/227) were type III, and 2.20% (5/227) were type IV. There was a statistical difference in the fracture type distribution between the two groups (P < 0.05). The VAS in the group 1 was higher than that in the group 2 at the initial diagnosis (P < 0.05).

Conclusions: For patients with acute OVF, the site of pain is related to the type of fracture. The pain at the fracture site is more often observed in the central type and burst type of fractures, while pain at the non-fracture site is more often observed in the upper and lower endplate type of fractures. Additionally, when OVF are suspected, radiological assessment of thoracic and lumbar spine is recommended to better detect fractures that could cause pain distal to the site of the fracture.
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http://dx.doi.org/10.1093/pm/pnab229DOI Listing
July 2021

The anti-osteoporosis effects of Vitamin K in postmenopausal women.

Curr Stem Cell Res Ther 2021 May 11. Epub 2021 May 11.

Honghui Hospital Affiliated to Xi Spine surgery, China.

As a common systemically muscular-skeleton disorder in aging, osteoporosis is characterized by the uninterrupted deconstruction in osseous microarchitecture. Osteoporosis can consequently lead to a significantly high risk of osteoporotic fractures, such as osteoporotic vertebral compressive fractures [OVCF] in the spine and osteoporotic femoral neck fractures, which can significantly increase the numbers of mortality and morbidity in aging people, especially in postmenopausal women. In addition, vitamin K has been demonstrated to play a key role in inhibiting osteoporotic fractures among postmenopausal women, but its long-term benefits, potential harms, and effects of the combination between vitamin K and other anti-osteoporosis medicines such as bisphosphonates or teriparatide were just extensively studied. Therefore, the present review aimed to systematically reviewed published literature on the role of vitamin K in the treatment of osteoporosis. We currently, via multiple queries strategy, searched the relevant literature in Cochrane and PubMed from January 2010 to December 2019. Subsequently, we conducteda systematic review according to the standard guideline of Preferred Reporting Item for Systematic Reviews and Meta-Analyses [PRISMA]. Finally, ten relevant works of literature met our current criteria for inclusion, and then we followed the PRISMA guideline and systematically reviewed each study by the categorized data sources and analytical approaches in each study, meanwhile set up variables and defined each study outcomes.
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http://dx.doi.org/10.2174/1574888X16666210512020103DOI Listing
May 2021

TPP ionically cross-linked chitosan/PLGA microspheres for the delivery of NGF for peripheral nerve system repair.

Carbohydr Polym 2021 Apr 22;258:117684. Epub 2021 Jan 22.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China. Electronic address:

To control the release of nerve growth factor (NGF) in the injured peripheral nerve, NGF-loaded chitosan/PLGA composite microspheres ionically cross-linked by tripolyphosphate (TPP/Chitosan/PLGA-NGF) were prepared. The encapsulation efficiency of NGF ranged from 83.4 ± 1.5 % to 72.1 ± 1.6 % with TPP concentrations from 1 % to 10 %. Zeta potential and FT-IR analyses together with confocal microscopy demonstrated that multiple NGF-loaded PLGA microspheres were embedded in chitosan matrix, the mean size of TPP/Chitosan/PLGA-NGF microspheres ranged from 40.2 ± 3.4 to 49.3 ± 3.1 μm. The increase of TPP concentration improved the network stability and decreased the swelling ratio, resulting in the decreased NGF release from 67.7 ± 1.2 % to 45.7 ± 0.8 % in 49 days. The sustained release of NGF could promote PC12 cells differentiation and neurite growth in vitro. Moreover, in comparison with NGF solution without microencapsulation, TPP/Chitosan/PLGA-NGF microspheres enhanced sciatic nerve regeneration and prevented gastrocnemius muscle atrophy in rats. These results demonstrate the feasibility of using TPP/Chitosan/PLGA-NGF microspheres for neural tissue repair.
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http://dx.doi.org/10.1016/j.carbpol.2021.117684DOI Listing
April 2021

Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases.

BMC Surg 2021 Jan 6;21(1):22. Epub 2021 Jan 6.

Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China.

Background: Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches.

Methods: We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed.

Results: All 238 patients were followed up for 12-38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E.

Conclusion: In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.
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http://dx.doi.org/10.1186/s12893-020-01013-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789173PMC
January 2021

[Polymethylmethacrylate-augmented screw fixation in treatment of senile thoracolumbar tuberculosis combined with severe osteoporosis].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Dec;34(12):1526-1532

Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.

Objective: To explore the safety and effectiveness of polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly thoracolumbar tuberculosis combined with severe osteoporosis.

Methods: The clinical data of 20 elderly patients with thoracolumbar tuberculosis and severe osteoporosis who underwent PASF after anterior or posterior debridement and bone grafting and met the selection criteria between December 2012 and December 2014 were retrospectively analyzed. There were 8 males and 12 females with an average age of 68.5 years (range, 65-72 years). T value of bone mineral density was -4.2 to -3.6, with an average of -3.9. There were 12 cases of thoracic tuberculosis, 3 cases of thoracolumbar tuberculosis, and 5 cases of lumbar tuberculosis. The diseased segments involved T -L , including 11 cases of single-segment disease, 6 cases of double-segment disease, and 3 cases of multi-segment disease. The disease duration was 3-9 months, with an average of 6 months. The preoperative spinal nerve function of the patients was evaluated by the American Spinal Injury Association (ASIA) grading. There were 2 cases of grade A, 5 cases of grade B, 6 cases of grade C, 4 cases of grade D, and 3 cases of grade E. Postoperative imaging examination was used to evaluate the bone graft fusion and paravertebral abscess absorption, and to measure the Cobb angle of the segment to evaluate the improvement of kyphosis. The levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and ASIA grading were used to evaluate the effectivreness before operation, at 1 month after operation, and at last follow-up. The clinical cure of tuberculosis was also evaluated.

Results: All operation successfully completed. The operation time was 154-250 minutes, with an average of 202 minutes; the intraoperative blood loss was 368-656 mL, with an average of 512 mL. All 20 patients were followed up 18-42 months, with an average of 26.8 months. The postoperative pain and symptoms of tuberculosis in all patients relieved, and the paravertebral abscess was absorbed, reaching the cure standard for spinal tuberculosis. All bone grafts fusion achieved within 1 year after operation. Only 1 case had asymptomatic bone cement leakage into the paravertebral veins, and the remaining patients had no serious complications such as bone cement leakage in the spinal canal, pulmonary embolism, and neurovascular injury. At last follow-up, spinal cord nerve function significantly improved when compared with preoperative one. Among them, ASIA grading were 7 cases of grade C, 8 cases of grade D, and 5 cases of grade E, showing significant difference when compared with preoperative one ( =2.139, =0.000). VAS score, ODI score, segmental Cobb angle, ESR, and CRP at 1 month after operation and at last follow-up were significantly improved when compared with preoperative ones ( <0.05); there was no significant difference between 1 month after operation and last follow-up ( >0.05). During the follow-up, no complications such as failure of internal fixation, proximal junctional kyphosis, or tuberculosis recurrence occurred.

Conclusion: For elderly patients with thoracolumbar tuberculosis and severe osteoporosis, PASF treatment is safe and effective.
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http://dx.doi.org/10.7507/1002-1892.202006014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171576PMC
December 2020

Epidemiological characteristics of traumatic spinal cord injury in Xi'an, China.

Spinal Cord 2021 Jul 2;59(7):804-813. Epub 2020 Dec 2.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiao Tong University, Xi'an, China.

Study Design: A hospital-based retrospective epidemiological study.

Objective: To describe the demographic and epidemiological characteristics of patients with traumatic spinal cord injury (TSCI) in Xi'an to help health-related institutions formulate corresponding measures.

Setting: People with TSCI, all spine centres and orthopaedic centres in Xi'an, China.

Methods: We retrospectively reviewed the medical records of the all spine centers or orthopedic centers in Xi'an according to the International Classification of Disease Version 10 (ICD-10) and diagnostic code of TSCI. Variables included gender, age, medical insurance, etiology, occupation, level of injury, and severity of injury, multiple injury, complication, treatment, and so on.

Results: The study included the medical records of 1730 patients with TSCI from 2014 to 2018. The estimated annual incidence rate increased from 39.0 cases (95% CI, 34.7-43.3 cases) per 1 million persons in 2014 to 43.2 cases (95% CI, 39.0-47.5 cases) per 1 million persons in 2018. The leading cause of TSCI was high falls (35.5%, 614 cases). The most common injury site was the cervical spinal cord, accounting for 55.7% (963 cases). The degree of injury severity with the highest proportion was incomplete tetraplegia (47.2%, 816 cases). In addition, 71.4% (1236 cases) of TSCI cases had spinal fracture or dislocation.

Conclusions: There are specific epidemiological characteristics of TSCI patients in Xi'an, and preventive measures are suggested to be based on the characteristics of the different types of patients with TSCI and focused on high-risk groups.
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http://dx.doi.org/10.1038/s41393-020-00592-3DOI Listing
July 2021

Blockade of IL-6 alleviates bone loss induced by modeled microgravity in mice.

Can J Physiol Pharmacol 2020 Oct 13;98(10):678-683. Epub 2020 Aug 13.

Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.

This study investigated the effects of blockade of IL-6 on bone loss induced by modeled microgravity (MG). Adult male mice were exposed to hind-limb suspension (HLS) and treated with IL-6-neutralizing antibody (IL-6 nAb) for 4 weeks. HLS in mice led to upregulation of IL-6 expression in both sera and femurs. IL-6 nAb treatment in HLS mice significantly alleviated bone loss, evidenced by increased bone mineral density of whole tibia, trabecular thickness and number, bone volume fraction of proximal tibiae, and ultimate load and stiffness of femoral diaphysis. IL-6 nAb treatment in HLS mice significantly enhanced levels of osteocalcin in sera and reduced levels of deoxypyridinoline. In MC3T3-E1 cells exposed to MG in vitro, IL-6 nAb treatment increased mRNA expression and activity of alkaline phosphatase, mRNA expression of osteopontin and runt-related transcription factor 2, and protein levels of osteoprotegerin and decreased protein levels of receptor activator of the NF-κB ligand. In RAW254.7 cells exposed to MG, IL-6 nAb treatment downregulated mRNA expression of cathepsin K and tartrate-resistant acid phosphatase (TRAP) and reduced numbers of TRAP-positive multinucleated osteoclasts. In conclusion, blockade of IL-6 alleviated the bone loss induced by MG.
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http://dx.doi.org/10.1139/cjpp-2019-0632DOI Listing
October 2020

Effect of Vicenin-2 on ovariectomy-induced osteoporosis in rats.

Biomed Pharmacother 2020 Sep 10;129:110474. Epub 2020 Jul 10.

Department of Spinal Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No.555 Youyi East Road, Beilin District, Xi'an, Shaanxi, 710054, China. Electronic address:

In worldwide, osteoporosis has become one of the severe public health distress and over 200 million people get affected by tenderness and fissure during their life period. Vicenin-2 is a naturally occurring flavonoid glycoside present in Moringa oleifera, Peperomia blanda and Ocimum sanctum Linn with numerous biological activities. The present study aims to assess the effect of Vicenin-2 on ovariectomy-induced postmenopausal osteoporosis in female rats. Surgical removal of ovaries was achieved to institute the ovariectomy animal model. The ovariectomized (OVX) animals were alienated into four groups: Control, OVX alone (model), OVX with Vicenin-2 (5 mg/kg b.w), and OVX with Vicenin-2 (10 mg/kg b.w). Also, their consistent conduct remained managed intragastrically for about 12 weeks. OVX rats treated with Vicenin-2 effectually improved body mass, uterus index, lipid profiles, inflammatory markers, bone turnover markers and amplified the presence of calcium in the OVX rat serum. Vicenin-2 was found to suppress the actions of ACP, E2, and BGP in OVX rats. Besides, Vicenin-2 showed some adverse effects over histomorphometric percentage and histological studies, in which tabular thickness and area were restored in the control and Vicenin-2 managed OVX rats. PCR results of Alp, Runx 2, Osx showed diminished expressions in OVX rats whereas treatment with Vicenin-2 displays up-regulated expression of these genes. Through our study, we established that Vicenin-2 did not wield a detrimental upshot on the skeletal organization of OVX rats. Besides, we put forward that Vicenin-2 could be an excellent candidate to treat and manage bone related disease or disorders.
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http://dx.doi.org/10.1016/j.biopha.2020.110474DOI Listing
September 2020

Quantification evaluation of structural autograft versus morcellized fragments autograft in patients who underwent single-level lumbar laminectomy.

Exp Ther Med 2020 Aug 3;20(2):1803-1807. Epub 2020 Jun 3.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, School of Medicine, Xi'an, Shaanxi 710054, P.R. China.

Posterolateral fusion (PLIF) with autogenous bone graft is considered the gold standard for lumbar spinal fusion. However, the fusion rate and effectiveness of locally derived corticocancellous structural autograft vs. morcellized fragments autograft for lumbar PLIF, following single level lumbar laminectomy in patients with symptomatic lumbar spinal stenosis, remain unknown. Thus, the present study aimed to compare the fusion rates of corticocancellous structural autograft and morcellized fragments autograft for the treatment of lumbar PLIF. A randomized self-controlled trial was conducted comprising of 135 patients with symptomatic lumbar spinal stenosis, single level lumbar laminectomy and PLIF, with corticocancellous structural autograft (group 1) and morcellized fragments autograft (group 2). The primary outcome measurements included the PLIF rate, radio density and dimensions of PLIF mass on both sides, which were assessed via X-rays at 3, 6 and 12 months, postoperatively. Furthermore, changes in bilateral bone fusion bridges were assessed via CT scanning, according to the Lenke CT fusion measurement criteria. The follow-up period lasted for 1 year (period between January 2013 and January 2018). Of the 135 patients were initially included in the present study, 7 patients were lost during the following up process. Therefore, data from 128 patents were eventually assessed, 94.8% of surgical levels were observed at Honghui Hospital. According to the Lenke CT fusion measurement criteria, the overall unilateral fusion rates were 71.9% (92/128) in group 1 and 31.3% (40/128) in group 2. Furthermore, both the radio density and dimensions of PLIF mass significantly decreased at a faster rate in group 1 compared with group 2 (radio density; 0.65-0.49 vs. 0.63-0.61; P<0.05 and PLIF mass; 398-124 vs. 376-223 mm; P<0.05). The CT scan results demonstrated that the mean volume of bone graft was significantly greater in group 1 compared with group 2, at 12 months postoperatively (1.47 vs. 1 cm; P<0.05). Taken together, the results of the present study suggested that corticocancellous structural autograft is more effective for earlier resorption and stabilization of patients undergoing PLIF, compared with morcellized fragments autograft.
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http://dx.doi.org/10.3892/etm.2020.8831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388275PMC
August 2020

The Regulation of E3 Ubiquitin Ligases Cbl and its Cross-talking in Bone Homeostasis.

Curr Stem Cell Res Ther 2021 ;16(6):683-687

Department of Spine Surgery, Honghui Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China.

The E3 ubiquitin ligases Cbl has been found play an important role in regulating cellular proliferation and migration. Whereas, the excessive differentiation of osteoclast and/or its overexpressing of resorptive functions could lead the pathological bone homeostasis by overly bone matrix degradation. Since the first time of the important role of Cbl in the regulating osteoclast differentiation (also named osteoclastogenesis) has been reported in decades ago. The extensively studies have been conducted for in-depth exploring Cbl's definite role during osteoclastogenesis, as well as its cross talking with other signaling pathways (such as: Src and PI3K signaling) in bone homeostasis. Herein, our current study aims to briefly conclude the current studies of osteoclastogenesis and the regulatory role of Cbl, as well as its cross-talking in bone homeostasis.
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http://dx.doi.org/10.2174/1574888X15666200712191623DOI Listing
January 2021

The role of Rho GTPases' substrates Rac and Cdc42 in osteoclastogenesis and relevant natural medicinal products study.

Biosci Rep 2020 07;40(7)

Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, U.S.A.

Recently, Rho GTPases substrates include Rac (Rac1 and Rac2) and Cdc42 that have been reported to exert multiple cellular functions in osteoclasts, the most prominent of which includes regulating the dynamic actin cytoskeleton rearrangements. In addition, natural products and their molecular frameworks have a long tradition as valuable starting points for medicinal chemistry and drug discovery. Although currently, there are reports about the natural product, which could play a therapeutic role in bone loss diseases (osteoporosis and osteolysis) through the regulation of Rac1/2 and Cdc42 during osteoclasts cytoskeletal structuring. There have been several excellent studies for exploring the therapeutic potentials of various natural products for their role in inhibiting cancer cells migration and function via regulating the Rac1/2 and Cdc42. Herein in this review, we try to focus on recent advancement studies for extensively understanding the role of Rho GTPases substrates Rac1, Rac2 and Cdc42 in osteoclastogenesis, as well as therapeutic potentials of natural medicinal products for their properties on the regulation of Rac1, and/or Rac2 and Cdc42, which is in order to inspire drug discovery in regulating osteoclastogenesis.
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http://dx.doi.org/10.1042/BSR20200407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364480PMC
July 2020

Retraction notice to "Melatonin alleviates acute spinal cord injury in rats through promoting on progenitor cells proliferation" [Saudi Pharm. J. 25 (2017) 570-574].

Saudi Pharm J 2020 05 12;28(5):638. Epub 2020 May 12.

Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an 710054, China.

[This retracts the article DOI: 10.1016/j.jsps.2017.04.025.].
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http://dx.doi.org/10.1016/j.jsps.2020.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229324PMC
May 2020

Calcium alginate template-mineral substituted hydroxyapatite hydrogel coated titanium implant for tibia bone regeneration.

Int J Pharm 2020 May 5;582:119303. Epub 2020 Apr 5.

Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Beilin District, Xi'an, Shaanxi Province 710054, China. Electronic address:

Osteogenic differentiation is great significance for improving the bone regeneration. Present study evaluates the osteogenic ability of lanthanum (La) and silicate (SiO) substituted hydroxyapatite (MHAP) - polymeric composite coated surface treated titanium (Ti) implant. The bio-ceramic MHAP was synthesized by hydrothermal process with assistance of calcium alginate template. For enhance the hydrophilicity, the polymer poly (vinyl pyrrolidone) (PVP) was included in the composite by ultra-sonication method. The negative zeta potential value -9.97 mV of Ca-alg/ La, Si-HAP was observed after the incorporation of PVP in the matrix. Incorporation of minerals and PVP polymer was confirmed and analyzed by Energy Dispersive X-ray analysis (EDX), Fourier Transform Infra-Red spectroscopy (FT-IR) and Electron Microscopy techniques. A compact coating of the composite with the thickness of 448 nm on Ti surface was achieved by Electrophoretic deposition (EPD) method. The in-vitro MTT assay method and alkaline phosphate ALP activity (94% and 0.94 a.u respectively for the optimized composite) were utilized to determine the cell viability and differentiation on human Bone Marrow-Derived Stem Cells (hBMSCs). The osteogenic ability of bio-composite coated Ti in hBMSCs and in-vivo rat model has strongly suggests the fabricated Ti plate with bio-composite coatings can act as promising biomaterial for orthopedics.
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http://dx.doi.org/10.1016/j.ijpharm.2020.119303DOI Listing
May 2020

The Anti-osteoporosis Effects of Natto on Bone Mineral Density in Perimenopausal Women.

Curr Med Chem 2021 ;28(25):5191-5200

Department of Spine, Honghui-Hospital, Xi'an Jiaotong University, School of Medicine, Xi'an, China.

Objective and Aims: This study aims to conduct a systematic review and meta-analysis for prospective studies to investigate the improvement effects of natto on bone mineral density (BMD) in perimenopausal women.

Methods: PubMed, EMBASE and Cochrane database searched upto February 2019. This study was carried out according to the PRISMA guidelines10 for systematic reviews. The protocol of the review was registered in the PROSPERO registry (CRD42019133183).

Results: The review identified 3 unique prospective studies comprising 1658 non-overlapping participants. Meta-analysis showed that natto could significantly improve lumbar bone mineral density (BMD) (P=0.002, WMD=0.26; 95% CI:0.09-0.43) in cohort studies. However, the randomized controlled study showed no statistical difference between the two (P=0.31, WMD=0.05; 95% CI:- 0.05-0.15). In addition, natto significantly improved the BMD of the femoral neck in a cohort study and randomized control study (P=0.03, WMD=0.42). 95% CI:0.05-0.79, I2= 72%); (P < 0.0001, WMD=0.16; 95% CI:0.08-0.24), respectively. However, all studies demonstrated that natto has no improvement effects on a hip joint (BMD). In that, the cohort study showed no statistical significance between the natto intake group and the control group (P=0.21, WMD=0.10). 95% CI:-0.06-0.25, I2= 18%) and the randomized controlled study also showed no statistical significance between the natto intake group and the control group (P=0.09, WMD=-0.06). 95% CI:-0.13- 0.01).

Conclusion: Through our current systematic review and meta-analyize of these prosepctive studies of natto's anti-osteoporostic effecs on BMD, we found that the dietary intake of natto demonstrated a improving effects on the BMD of the femoral neck, but has no effects on the hip joint. Such interesting results may be related to the differences between anatomical structure between various tissues. Besides that, the results of the RCT study and cohort study on the lumbar spine were not the same, which may be related to the fact that participants in the RCT study were Caucasian and participants in the cohort study were Asian. Therefore, more large-sample and high-quality RCT studies are needed to further clarify the improvement effect of natto on osteoporosis.
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http://dx.doi.org/10.2174/0929867327666200306123140DOI Listing
August 2021

Integrin-associated molecules and signalling cross talking in osteoclast cytoskeleton regulation.

J Cell Mol Med 2020 03 11;24(6):3271-3281. Epub 2020 Feb 11.

Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.

In the ageing skeleton, the balance of bone reconstruction could commonly be broken by the increasing of bone resorption and decreasing of bone formation. Consequently, the bone resorption gradually occupies a dominant status. During this imbalance process, osteoclast is unique cell linage act the bone resorptive biological activity, which is a highly differentiated ultimate cell derived from monocyte/macrophage. The erosive function of osteoclasts is that they have to adhere the bone matrix and migrate along it, in which adhesive cytoskeleton recombination of osteoclast is essential. In that, the podosome is a membrane binding microdomain organelle, based on dynamic actin, which forms a cytoskeleton superstructure connected with the plasma membrane. Otherwise, as the main adhesive protein, integrin regulates the formation of podosome and cytoskeleton, which collaborates with the various molecules including: c-Cbl, p130 , c-Src and Pyk2, through several signalling cascades cross talking, including: M-CSF and RANKL. In our current study, we discuss the role of integrin and associated molecules in osteoclastogenesis cytoskeletal, especially podosomes, regulation and relevant signalling cascades cross talking.
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http://dx.doi.org/10.1111/jcmm.15052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7131929PMC
March 2020

Phospholipase Cγ Signaling in Bone Marrow Stem Cell and Relevant Natural Compounds Therapy.

Curr Stem Cell Res Ther 2020 ;15(7):579-587

Department of Spine Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.

Excessive bone resorption has been recognized play a major role in the development of bone-related diseases such as osteoporosis, rheumatoid arthritis, Paget's disease of bone, and cancer. Phospholipase Cγ (PLCγ) family members PLCγ1 and PLCγ2 are critical regulators of signaling pathways downstream of growth factor receptors, integrins, and immune complexes and play a crucial role in osteoclast. Ca2+ signaling has been recognized as an essential pathway to the differentiation of osteoclasts. With growing attention and research about natural occurring compounds, the therapeutic use of natural active plant-derived products has been widely recognized in recent years. In this review, we summarized the recent research on PLCγ signaling in bone marrow stem cells and the use of several natural compounds that were proven to inhibit RANKL-mediated osteoclastogenesis via modulating PLCγ signaling pathways.
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http://dx.doi.org/10.2174/1574888X14666191107103755DOI Listing
July 2021

Study of Monocytes/Macrophages Stimuli as the Targets of Treating Inflammatory Bone Diseases.

Curr Drug Targets 2020 ;21(4):338-343

Department of Orthopedics, Honghui-hospital, Xi'an Jiaotong University, School of medicine, Xi'an, China.

Inflammation is the most common pathology in many orthopedic diseases, such as: rheumatoid arthritis (RA), osteoarthritis (OA) and other reasons caused osteolysis. The leading factor of inflammation was considered as the differentiation of monocyte and the polarization of macrophage. However, cytokines and different cell models could regulate this progress in some aspects. Therefore, in the current review, we summarize several cytokines and cell models, which could lead to inflammatory orthopedic diseases via regulating monocytes and macrophages. In order to extensively explore the potential therapeutic and medicine targets for inflammation-induced bone diseases.
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http://dx.doi.org/10.2174/1389450120666191015211737DOI Listing
February 2021

The Study of Natural Compounds Targeting RANKL Signaling Pathway for the Treatment of Bone Diseases.

Curr Drug Targets 2020 ;21(4):344-357

Department of Spine Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.

Millions of people, especially for the aging people, are suffered by bone-loss diseases, such as rheumatoid arthritis (RA) and osteoporosis. Therefore, better understanding the involved mechanisms of bone metabolism is required for further treat on such diseases. Particularly, during the pathological process of bone losing, RANKL as a member of the tumor necrosis factor (TNF) superfamily, could induce osteoclast precursor cells differentiate into mature osteoclast, which grant its essential role in osteolysis. In recent years, with the increased attention paid to the natural compounds discovering studies, the therapeutic application of natural plant-derivatives have been widely recognized. Therefore, our present study aim to summarize the current novel research progressions on RANKL and its downstream signaling pathways in bone cellular differentiation, and provide a further insight for RANKL as the important drug targets in bone loss diseases. Besides that, in our current study, we also aim to briefly introduce the current application of several natural compounds for treating RANKL-mediated osteoclastic activation by modulating the RANKL signaling pathway and their therapeutic effects on the prevention of osteoporosis, osteoarthritis (OA) and RA.
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http://dx.doi.org/10.2174/1389450120666190930145144DOI Listing
February 2021

Treg-promoted New Bone Formation Through Suppressing TH17 by Secreting Interleukin-10 in Ankylosing Spondylitis.

Spine (Phila Pa 1976) 2019 Dec;44(23):E1349-E1355

Department of Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China.

Study Design: Retrospective single-center study.

Objective: We want to know whether interleukin (IL)-10-secreting regulatory T cells (Treg) promote the new bone formation (NBF) through suppressing TH17 in ankylosing spondylitis (AS).

Summary Of Background Data: NBF in AS is unknown. Since there are balances of bone remodeling in human body and proinflammatory helper T cells TH17 promoted bone resorption.

Methods: Eighteen AS patients with or without NBF (both nine cases) and nine healthy individuals were selected and the demographic data, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), MRI sacroiliitis score (MRISIS), and computer tomography sacroiliitis score (CTSIS) were recorded. Removed hip ligament tissue in the lesions after arthroplasty was collected and the lymphocytes and the peripheral blood mononuclear cells were prepared. Second, pathological section in hematoxylin-eosin stain were analyzed and flow cytometry and quantitative polymerase chain reaction analyses were carried out to detect the levels of TH17, Treg, IL-10, and nuclear factor (NF)-κB, and the relevance between them. The effect of Treg on TH17 was further analyzed by using Transwell coculturing.

Results: Compared to AS patients without NBF, AS patients with NBF had significantly higher CTSIS and complications (P < 0.05 and 0.01, respectively), but significantly lower BASDAI (3.0 ± 0.4) and MRISIS (3.3 ± 0.8) (P < 0.01 and 0.05, respectively) and no acute inflammation in HE stain for hip joint. Compared to healthy donors, the ratio of TH17/Treg was significantly higher in AS patients without NBF and lower in AS patient with NBF (both P < 0.01) in flow cytometry analysis (FCA). Furthermore, TH17 significantly decreased after indirectly coculturing with Treg in FCA (P < 0.01). Finally, IL-10 had significantly higher mRNA expression in AS patients with NBF (P < 0.01), and NF-κB had significantly higher mRNA expression in AS patients without NBF (P < 0.05) than healthy donors. Only the mRNA expression of IL-10 was significantly correlated to the ratio of TH17/Treg (r = -0.93, P < 0.01).

Conclusion: Treg-induced NBF of AS through suppressing TH17 by secreting IL10 and declining of the ratio of TH17/Treg indicated the development of NBF. This is important not only for screening development of NBF, but also for control of NBF of AS by immune therapy.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1097/BRS.0000000000003169DOI Listing
December 2019

Puerarin for OVX-Induced Postmenopausal Osteoporosis in Murine Model: Systematic Review and Meta-Analysis.

Curr Stem Cell Res Ther 2020 ;15(1):37-42

Department of Spine, Honghui-Hospital, Xi'an Jiaotong University, School of Medicine, Xi'an 710032, China.

Aims/background: Ovariectomy (OVX)-induced murine model is widely used for postmenopausal osteoporosis study. Our current study was conducted to systematically review and essentially quantified the bone mass enhancing effect of puerarin on treating OVX-induced postmenopausal osteoporosis in murine model.

Methods: Literatures from PUBMED, EMBASE, and CNKI were involved in our searching strategy by limited the inception date to January 9th, 2019. Moreover, the enhancing effect of puerarin on bone mass compared to OVX-induced rats is evaluated by four independent reviewers. Finally, all the data were extracted, quantified and analyzed via RevMan, besides that in our current review study, we assessed the methodological quality for each involved study.

Results: Based on the searching strategy, eight randomization studies were finally included in current meta-analysis and systematic review. According to the data analysis by RevMan, puerarin could improve bone mineral density (BMD); (eight studies, n=203; weighted mean difference, 0.05; 95% CI, 0.03-0.07; P<0.0001) using a random-effects model. There is no significant difference between puerarin and estrogen (seven studies, n=184; weighted mean difference, 0.00; 95% CI, -0.01 to 0.00; P=0.30).

Conclusion: Puerarin showed upregulating effects on bone mass in OVX-induced postmenopausal osteoporosis in murine model. More studies of the effect of puerarin on bone density in OVX animals are needed.
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http://dx.doi.org/10.2174/1574888X14666190703143946DOI Listing
November 2020

Letter: Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury.

Neurosurgery 2019 08;85(2):E399-E400

Department of Spine Surgery Hong-Hui Hospital Xi'an Jiaotong University College of Medicine Xi'an, China.

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http://dx.doi.org/10.1093/neuros/nyz154DOI Listing
August 2019

[Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Apr;33(4):410-415

Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiao Tong University, Xi'an Shaanxi, 710054, P.R.China.

Objective: To investigate the effectiveness of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF).

Methods: A retrospective analysis was made of 161 patients with single segment L or L isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups ( >0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria.

Results: The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group ( <0.05). All the 161 patients were followed up 12-18 months (mean, 14.3 months). There was 1 case of dural sac tear in the trial group and 1 case of superficial infection in the control group; no complication such as dural tear and infection occurred in other patients. The fusion rate was 76.5% (64/85) in the trial group and 57.9% (44/76) in the control group at 6 months after operation, showing significant difference ( =6.44, =0.02); at 12 months after operation, the fusion rate was 96.5% (82/85) in the trial group and 90.8% (69/76) in the control group (including 3 cases of Cage displacement and 4 cases of screw breakage), showing no significant difference in the fusion rate between the two groups ( =1.54, =0.26). The VAS and ODI scores of the two groups decreased gradually at 3, 6, and 12 months after operation, and improved significantly when compared with those before operation ( <0.05). There was no significant difference in VAS and ODI scores between the two groups before and after operation ( >0.05).

Conclusion: Both Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.
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http://dx.doi.org/10.7507/1002-1892.201806125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8337176PMC
April 2019

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study.

Med Sci Monit 2019 Apr 4;25:2479-2487. Epub 2019 Apr 4.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland).

BACKGROUND With the in-depth development of minimally invasive spine surgery in recent years, robot- and computer-assisted technologies have been increasingly used and successfully applied to spinal surgery. MATERIAL AND METHODS We performed a retrospective analysis of 60 patients with grade I or II lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from January 2017 to December 2017. A robot-assisted surgical system was used in 30 patients for pedicle screw placement. The other 30 patients underwent fluoroscopy-guided percutaneous pedicle screw placement. RESULTS There were 130 screws placed under fluoroscopic guidance, with 26.2% penetration of the pedicle wall. There were 130 screws placed in robotic-assisted surgery, with 6.2% penetration of the pedicle wall. Severe screw deviation (Neo grade III) was identified in 4 screws in the fluoroscopy-guided group, while no severe deviation was noted in the robot-assisted group. In the fluoroscopic group, 15.6% of screws penetrated the superior articular process, and 2.1% screws had severe complications (Babu grade III). However, only 5.1% of screws in the robot-assisted group had severe complications. The mean screw insertion angle was significantly greater in the robot-assisted group than in the fluoroscopy-guided group (23.8±6.1° vs. 18.4±7.2°, P=0.017). CONCLUSIONS Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the following advantages: greater accuracy, lower incidences of screw penetration of the pedicle wall and invasion of the facet joints, and better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.
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http://dx.doi.org/10.12659/MSM.913124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462172PMC
April 2019

Treatment with hydrogen sulfide donor attenuates bone loss induced by modeled microgravity.

Can J Physiol Pharmacol 2019 Jul 14;97(7):655-660. Epub 2019 Mar 14.

Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.

The present study was undertaken to explore the therapeutic potential of hydrogen sulfide against bone loss induced by modeled microgravity. Hindlimb suspension (HLS) and rotary wall vessel bioreactor were applied to model microgravity in vivo and in vitro, respectively. Treatment of rats with GYY4137 (a water soluble donor of hydrogen sulfide, 25 mg/kg per day, i.p.) attenuated HLS-induced reduction of bone mineral density in tibiae, and preserved bone structure in tibiae and mechanical strength in femurs. In HLS group, GYY4137 treatment significantly increased levels of osteocalcin in sera. Interestingly, treatment of HLS rats with GYY4137 enhanced osteoblast surface, but had no significant effect on osteoclast surface of proximal tibiae. In MC3T3-E1 cells exposed to modeled microgravity, GYY4137 stimulated transcriptional levels of runt-related transcription factor 2 and enhanced osteoblastic differentiation, as evidenced by increased mRNA expression and activity of alkaline phosphatase. HLS in rats led to enhanced levels of interleukin 6 in sera, skeletal muscle, and tibiae, which could be attenuated by GYY4137 treatment. Our study showed that GYY4137 preserved bone structure in rats exposed to HLS and promoted osteoblastic differentiation in MC3T3-E1 cells under modeled microgravity.
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http://dx.doi.org/10.1139/cjpp-2018-0521DOI Listing
July 2019

M1 and M2 macrophage polarization and potentially therapeutic naturally occurring compounds.

Int Immunopharmacol 2019 May 9;70:459-466. Epub 2019 Mar 9.

Department of Spine Surgery, Honghui-hospital, Xi'an Jiaotong Uinversity, School of Medicine, Xi'an, China. Electronic address:

Macrophages, as crucial cellular components of innate immunity, are characterized by possessing high plasticity and an abnormal ability to differentiate in response to numerous stimuli. Given this, macrophages show extreme heterogeneity under both physiological and pathological conditions. Typically, macrophages can be polarized into classically activated macrophages (M1) and alternatively activated macrophages (M2) depending on their environment. The relative functions of these two subtypes are almost exactly opposed to one another. Recent studies have suggested that some naturally occurring compounds can exert regulatory effects on the progression of macrophage polarization, which implies that they could be promising therapeutic tools to treat relevant diseases. Therefore, in our current review, we summarize recent studies on several naturally occurring compounds that may possess the ability to regulate macrophage polarization and explore the associated molecular mechanisms.
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http://dx.doi.org/10.1016/j.intimp.2019.02.050DOI Listing
May 2019

Correlation between the progression of cancer and the expression of matrix metalloproteinase-9 in metastatic spinal tumor.

J BUON 2018 Sep-Oct;23(5):1534-1539

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, 710054, China.

Purpose: To explore whether the expression levels of matrix metalloproteinase-9 (MMP-9) are related to spinal metastasis of gastric carcinoma.

Methods: Fifty tissue specimens were collected from gastric carcinoma with spinal metastasis and set as test group A; 30 tissue specimens of primary gastric carcinoma were collected and set as control group B; 30 healthy paracancerous gastric tissue specimens were collected and set as control group C. The expression levels of MMP-9 and vascular endothelial growth factor (VEGF) in the specimens were analyzed by immunohistochemistry.

Results: The positive expression rates of MMP-9 in the three groups were 82.0, 63.33 and 16.67% respectively, and the positive expression rates of VEGF were 78.00, 56.67 and 13.33%, respectively. The positive expression rates of MMP-9 and VEGF in the test group A were statistically significantly higher than those of control group B and C (p<0.05). These findings suggest a positive correlation between MMP-9 and VEGF expression.

Conclusion: Increased expression of MMP-9 is associated with the spinal metastasis of gastric carcinoma.
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September 2019

Mini-review: Functions and Action Mechanisms of PQQ in Osteoporosis and Neuro Injury.

Curr Stem Cell Res Ther 2020 ;15(1):32-36

Department of Spine Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.

Pyrroloquinoline Quinone (PQQ) is the third coenzyme found after niacinamide and flavone nucleotides and is widely present in microorganisms, plants, animals, and humans. PQQ can stimulate the growth of organisms and is very important for the growth, development and reproduction of animals. Owing to the inherent properties of PQQ as an antioxidant and redox modulator in various systems. In recent years, the role of PQQ in the field of osteoporosis and neuro injury has become a research hotspot. This article mainly discusses the derivatives, distribution of PQQ, in vitro models of osteoporosis and neuro injury, and the research progress of its mechanism of action. It provides new ideas in the study of osteoporosis and neuro injury.
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http://dx.doi.org/10.2174/1574888X14666181210165539DOI Listing
November 2020

Stimuli and Relevant Signaling Cascades for NFATc1 in Bone Cell Homeostasis: Friend or Foe?

Curr Stem Cell Res Ther 2019 ;14(3):239-243

Department of Spine Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China.

Bone homeostasis is strictly regulated by balanced activity of bone-forming osteoblasts and bone-resorbing osteoclasts.Disruption of the balance of activity between osteoblasts and osteoclasts leads to various metabolic bone diseases. Osteoclasts are cells of hematopoietic origin that they are large, multinucleated cells formed by the fusion of precursor cells of monocyte/macrophage lineage, they are unique cells that degrade the bone matrix, activation of transcription factors nuclear factoractivated T cells c1 (NFATc1) is required for sufficient osteoclast differentiation and it plays the role of a master transcription regulator of osteoclast differentiation, meanwhile, NFATc1 could be employed to elicit anabolic effects on bone. In this review, we have summarized the various mechanisms that control NFATc1 regulation during osteoclast and osteoblast differentiation as well as a new strategy for promoting bone regeneration in osteopenic disease.
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http://dx.doi.org/10.2174/1574888X14666181205122729DOI Listing
August 2019

[Comparison of accuracy between robot-assisted and fluoroscopy-guided percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 11;32(11):1371-1376

Department of Spine Surgery, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.

Objective: To explore the clinical application value of the spinal robot-assisted surgical system in mild to moderate lumbar spondylolisthesis and evaluate the accuracy of its implantation.

Methods: The clinical data of 56 patients with Meyerding grade Ⅰ or Ⅱ lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between January 2017 and December 2017 were retrospectively analysed. Among them, 28 cases were preoperatively planned with robotic arm and percutaneous pedicle screw placement according to preoperative planning (group A); the other 28 cases underwent fluoroscopy-guided percutaneous pedicle screw placement (group B). There was no significant difference in gender, age, body mass index, slippage type, Meyerding grade, and surgical segmental distribution between the two groups ( >0.05). The screw insertion angle was measured by CT, the accuracy of screw implantation was evaluated by Neo's criteria, and the invasion of superior articular process was evaluated by Babu's method.

Results: One hundred and twelve screws were implanted in the two groups respectively, 5 screws (4.5%) in group A and 26 screws (23.2%) in group B penetrated the lateral wall of pedicle, and the difference was significant ( =9.157, =0.002); the accuracy of nail implantation was assessed according to Neo's criteria, the results were 107 screws of degree 0, 3 of degree 1, 2 of degree 2 in group A, and 86 screws of degree 0, 16 of degree 1, 6 of degree 2, 4 of degree 3 in group B, showing significant difference between the two groups ( =4.915, =0.031). In group B, 20 (17.9%) screws penetrated the superior articular process, while in group A, 80 screws were removed from the decompression side, and only 3 (3.8%) screws penetrated the superior articular process. According to Babu's method, the degree of screw penetration into the facet joint was assessed. The results were 77 screws of grade 0, 2 of grade 1, 1 of grade 2 in group A, and 92 screws of grade 0, 13 of grade 1, 4 of grade 2, 3 of grade 3 in group B, showing significant difference between the two groups ( =7.814, =0.029). The screw insertion angles of groups A and B were (23.5±6.6)° and (18.1±7.5)° respectively, showing significant difference ( =3.100, =0.003).

Conclusion: Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the advantages such as greater accuracy, lower incidence of screw penetration of the pedicle wall and invasion of the facet joints, and has a better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.
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http://dx.doi.org/10.7507/1002-1892.201804049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414108PMC
November 2018
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