Publications by authors named "Dingjun Hao"

201 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

A novel anatomic titanium mesh cage for reducing the subsidence rate after anterior cervical corpectomy: a finite element study.

Sci Rep 2021 Jul 28;11(1):15399. Epub 2021 Jul 28.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.

Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. According to the test process specified in the American Society of Testing Materials (ASTM) F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Through analysis, the relative propensity values of a device to subside (Kp) of the TTMC and NTMC were 665.5 N/mm and 1007.2 N/mm, respectively. A higher Kp measurement is generally expected to indicate that the device is more resistant to subsidence into a vertebral body. The results showed that the novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after anterior cervical corpectomy and fusion (ACCF), which was approximately 51.3% higher than that of the traditional titanium mesh cage.
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http://dx.doi.org/10.1038/s41598-021-94787-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319430PMC
July 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

Circular RNA circNRIP1 plays oncogenic roles in the progression of osteosarcoma.

Mamm Genome 2021 Jul 10. Epub 2021 Jul 10.

Department of Orthopaedic, Hong Hui Hospital, Xi'an Jiaotong University, No 555.Youyi East Road, Xi'an, 710054, China.

Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. Increasing evidence suggests that aberrant expression of circRNAs is associated with the occurrence and progression of many cancers. Here, we investigated the role of circNRIP1 in osteosarcoma and explored its possible underlying mechanisms. Three pairs of osteosarcoma tissues and adjacent normal tissues were applied to the detection of altered expression of circRNAs through circRNAs microarray. And the level of circNRIP1 expression was elevated in osteosarcoma tissues. Compared with that in adjacent normal tissue, circNRIP1 expression level was obviously elevated in 100 osteosarcoma tissues. Besides, circNRIP1 knockdown inhibited proliferation and migration, promoted apoptosis of osteosarcoma cells. Bioinformatic analysis demonstrated circNRIP1 contributed to FOXC2 expression by sponging miR-199a. Furthermore, METTL3 elevated circNRIP1 expression level via m6A modification. In short, METTL3-induced circNRIP1 exerted an oncogenic role in osteosarcoma by sponging miR-199a, which may provide new ideas for the treatment of osteosarcoma.
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http://dx.doi.org/10.1007/s00335-021-09891-3DOI Listing
July 2021

Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures.

Sci Rep 2021 May 27;11(1):11102. Epub 2021 May 27.

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

Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.
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http://dx.doi.org/10.1038/s41598-021-90621-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159956PMC
May 2021

Psychometric Properties of the Chinese Version of the Sarcopenia and Quality of Life, a Quality of Life Questionnaire Specific for Sarcopenia.

Calcif Tissue Int 2021 Oct 15;109(4):415-422. Epub 2021 May 15.

Chemistry, National University of Singapore, No. 21, Lower Kent Ridge Road, Singapore, 119077, Singapore.

A quality of life questionnaire specific to sarcopenia (SarQoL®) was successfully developed. There is a huge demand for translation and validation in Chinese. The aim of this study was to translate the SarQoL® into Chinese and investigate its psychometric properties. The translation and cross-cultural adaptation process recommended by the developers of the initial questionnaire was followed. A total of 159 participants were investigated. The translation process consists of five steps: (1) two bilinguals independently translate initial English to Chinese; (2) synthesize the two translations into one; (3) backward translations; (4) expert committee review and (5) test of the pre-final version. The validation consists of three parts: (1) validity (discriminative power, construct validity); (2) reliability (internal consistency, test-retest reliability) and (3) floor and ceiling effects. There was no difficulty in translation process. Regarding the validity, good discriminant validity {quality of life for sarcopenic subjects [35.56 (29.73-42.70)] vs. non-sarcopenic ones [73.22 (60.09-82.90)], p < 0.001} and consistent construct validity [high correlations (spearman's r) of SarQoL® with generic Short Form-36 version 2 questionnaire (0.250 to 0.824) and EuroQoL-5-Dimension questionnaire (- 0.114 to - 0.823)] were found in SarQoL®. Regarding reliability, high internal consistency (Cronbach's alpha coefficient was 0.867) and excellent test-retest reliability (intraclass coefficient correlation was 0.997, 95% CI 0.994-0.998) were found. No ceiling/floor effect was reflected. A valid SarQoL® questionnaire is now available for Chinese population. It can provide a better understanding of the sarcopenia disease burden and serve as a therapeutic outcome indicator in research.
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http://dx.doi.org/10.1007/s00223-021-00859-8DOI Listing
October 2021

A modified method to treat severe asymptomatic pre-existing degeneration of adjacent segment: a retrospective case-control study.

BMC Surg 2021 Mar 23;21(1):161. Epub 2021 Mar 23.

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

Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management.

Methods: We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated.

Results: Mean follow-up time was 58.5 months (range, 48-75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last-follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last-follow-up value of 15.9 ± 9.3 % (P < 0.05).

Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.
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http://dx.doi.org/10.1186/s12893-021-01163-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989102PMC
March 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

One-stage posterior en-bloc spondylectomy following reconstruction with individualized 3D printed artificial vertebrae for multi-segment thoracolumbar metastases: case report and literature review.

Am J Transl Res 2021 15;13(1):115-123. Epub 2021 Jan 15.

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

In thoracolumbar vertebral tumors, reconstruction of complex multi-segment thoracolumbar vertebrae after total en-bloc spondylectomy (TES) is still challenging. In recent years, with the development of 3D printing technology, individualized 3D printed artificial vertebrae have been attempted to reconstruct complex multi-segment thoracolumbar spine. Compared with traditional titanium mesh or bone transplantation, it helps reduce long-term complications, bringing a new dawn for reconstructing multi-segment thoracolumbar spine. A 69-year-old female complained of low back pain with limited motion for 1 month. More than 2 months ago, she underwent radical mastectomy due to breast cancer (Luminal A subtype). Imageology examination revealed an osteolytic lesion involving the T11-L1 vertebra. She was performed one-stage 3-segment (T11-L1) en-bloc spondylectomy via posterior approach, and then an artificial vertebrae produced by a novel individualized 3D printing technology was used for reconstruction. The patient was follow-up for 2 years, and she recovered well, with no tumor recurrence, and no complications after spinal reconstruction. The application of individualized 3D printed artificial vertebrae in multi-segment thoracolumbar spine reconstruction can not only reconstruct the bone defect more accurately through the individualized design, but the porous design is able to achieve biomechanical performance comparable to that of cancellous bone, and it is conducive to inducing bone growth, all of which help reduce long-term mechanical complications. Furthermore, the application of artificial vertebrae in surgery can significantly shorten the operation time, reduce intraoperative blood loss and reduce the risk of perioperative complications. Therefore, individualized 3D printed artificial vertebrae is a good choice for complex multi-segment thoracolumbar spine reconstruction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847514PMC
January 2021

[Effects of calcium phosphate cement combined with hyaluronic acid/curcumin on the proliferation and osteogenesis of osteoblasts].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Jan;35(1):104-110

Shaanxi University of Traditional Chinese Medicine, Xianyang Shaanxi, 712046, P.R.China;Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China.

Objective: After using hyaluronic acid (HA) to modify curcumin (CUR), the effects of calcium phosphate cement (CPC) combined with HA/CUR on the proliferation and osteogenesis of osteoblasts were investigated.

Methods: First, HA and CUR were esterified and covalently combined to prepare HA/CUR, and the characteristics were observed and the infrared spectrum was tested. Then, HA, CUR, and HA/CUR were mixed with CPC according to 5% ( / ) to prepare HA-CPC, CUR-CPC, and HA/CUR-CPC, respectively. Setting time detection, scanning electron microscope observation, injectable performance test, and compression strength test were conducted; and the CPC was used as a control. Osteoblasts were isolated and cultured from the skull of newborn Sprague Dawley rats, and the 2nd generation cells were cultured with the 4 types of bone cement, respectively. The effects of HA/CUR-CPC on the proliferation and osteogenesis of osteoblasts were estimated by the scanning electron microscopy observation, live/dead cell fluorescence staining, cell counting, osteopontin (OPN) immunofluorescence staining, alkaline phosphatase (ALP) staining,and alizarin red staining.

Results: Infrared spectroscopy test showed that HA and CUR successfully covalently combined. The HA/CUR-CPC group had no significant difference in initial setting time, final setting time, injectable rate, and compressive strength when compared with the other 3 groups ( >0.05); scanning electron microscope observation showed that HA/CUR was scattered on CPC surface. After co-culture of bone cement and osteoblasts, scanning electron microscopy observation showed that the osteoblasts, which had normal morphology and the growth characteristics of osteoblasts, clustered and adhered to HA/CUR-CPC. There was no significant difference in cell survival rate between HA/CUR-CPC group and other groups ( >0.05), and the number of cells significantly increased ( <0.05); the degrees of OPN immunofluorescence staining, ALP staining, and alizarin red staining were stronger than other groups.

Conclusion: HA/CUR-CPC has good biocompatibility and mechanical properties, which can promote the proliferation and osteogenesis of osteoblasts.
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http://dx.doi.org/10.7507/1002-1892.202007088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171596PMC
January 2021

[Risk factors analysis of adjacent fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 Jan;35(1):20-25

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

Objective: To investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).

Methods: A total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors.

Results: All patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation ( <0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients ( <0.05).

Conclusion: The risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.
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http://dx.doi.org/10.7507/1002-1892.202008044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171608PMC
January 2021

Pediculoplasty combined with vertebroplasty for the treatment of Kummell's disease without neurological impairment: robot-assisted and fluoroscopy-guided.

Am J Transl Res 2020 15;12(12):8019-8029. Epub 2020 Dec 15.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine No. 76 Nanguo Road, Xi'an 710054, Shaanxi, China.

With the development of radiology and minimally invasive technology, vertebroplasty has become the mainstream treatment for Kummell's disease. However, the catastrophic complication of bone cement displacement appears occasionally. We use robot-assisted pediculoplasty combined with vertebroplasty to avoid such complications. From January 2015 to January 2018, 87 patients suffering from thoracolumbar Kummell's disease without neurological symptoms were treated by robot-assisted pediculoplasty combined with vertebroplasty. Pediculoplasty as a "bridge" allows the bone cement at the anterior edge of the vertebral body to be fixed in the vertebral body through the intrapedicular cement, which can effectively prevent bone cement displacement. The clinical efficacy was evaluated based on the statistical analysis results of vertebral body index (VBI), Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) at 3, 6, 12, 18, and 24 months after treatment. The average operation time was 85.23±10.48 min, and the average volume of cement injected was 4.97±0.66 ml. The patients' preoperative VBI, Cobb angle, VAS and ODI scores were 62.01±11.32, 33.78±11.99°, 7.47±0.82, and 78.37±7.14, respectively. The postoperative measurements were 87.06±4.45, 16.57±6.46°, 2.89±0.95, and 46.91±8.44. At the last follow-up, the outcomes were 86.82±4.27, 16.72±6.22°, 1.75±0.69, and 20.48±4.48, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). The four evaluation indexes improved by 65.3%, 50.5%, 76.6%, and 73.9%, respectively. This 2-year follow-up study shows robot-assisted and fluoroscopy-guided pediculoplasty combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell's disease without neurological impairment. This technique effectively prevents cement displacement and achieves rapid pain relief, with satisfactory vertebral body height restoration, and kyphotic deformity improvement.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791521PMC
December 2020

Intraoperative anti-inflammatory drugs combined with no drainage after MIS-TLIF in the treatment of recurrent lumbar disc herniation: an RCT.

J Orthop Surg Res 2021 Jan 7;16(1):20. Epub 2021 Jan 7.

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

Background: Minimally invasive-transforaminal lumbar interbody fusions (MIS-TLIF), in which the nerve root pain is caused by early postoperative edema reaction, is a common clinical complication. However, there is no effective method to solve this problem. We aimed to use gelatin sponge impregnated with mixed anti-inflammatory drugs combined with no drainage after MIS-TLIF to optimize postoperative effect in the treatment of recurrent lumbar disc herniation (LDH).

Methods: From June 2018, the middle-aged patients (45-60 years old) with recurrent LDH were recruited. Included patients were treated with MIS-TLIF surgery, and no drainage tube was placed after surgery. All patients were randomly divided into intervention group (gelatin sponge impregnated with mixed anti-inflammatory drugs) and control group (saline was immersed in gelatin sponge as a control).

Results: The intervention group included 63 cases, and the control group included 65 cases. The length of hospital stays and bedridden period in the intervention group were significantly lower than those in the control group (P < 0.05). The VAS score of low back pain in the intervention group was significantly lower than that of the control group at postoperative days 1-6 (P < 0.05, for all). The VAS scores of leg pain in the intervention group at postoperative days 1-9 were statistically lower than the control group (P < 0.05, for all).

Conclusions: Application of gelatin sponge impregnated with mixed anti-inflammatory drugs combined with no drainage after MIS-TLIF can significantly further optimize the surgical effect of recurrent LDH and shorten the bedridden period and hospital stays, to achieve the purpose of early rehabilitation.

Trial Registration: China Clinical Trial Registration Center, ChiCTR1800016236. Registered on May 21, 2018, http://www.chictr.org.cn/listbycreater.aspx.
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http://dx.doi.org/10.1186/s13018-020-02155-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791676PMC
January 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

Kinematic MRI Analysis of Reducible Atlantoaxial Dislocation for Decompression.

Biomed Res Int 2020 15;2020:5395071. Epub 2020 Dec 15.

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

Background: Many doctors ignored the possibility that there is still a spinal cord compression (SCC) need for decompression after atlantoaxial reduction. Reduction can be achieved on kinematic magnetic resonance imaging (MRI); thus, we want to analyze the role of kinematic MRI in reducible atlantoaxial dislocation and make a preoperative decision whether to perform decompression.

Methods: 36 patients with atlantoaxial reduction on preoperative kinematic MRI in extension postures were enrolled retrospectively. Grouping was based on the condition of SCC after atlantoaxial reduction preoperatively. Group A: patients with SCC after atlantoaxial reduction on dynamic cervical MRI were treated with C1 laminectomy for decompression and atlantoaxial fixation. Group B: patients with no significant SCC, according to dynamic MRI, underwent only atlantoaxial fixation. Clinical outcomes were evaluated using JOA score for spinal cord function. Radiological outcomes were assessed by measuring spinal cord diameter on MRI.

Results: The mean follow-up time was 17.1 months. Postoperative JOA score and percentage of SCC in both groups were significantly better than its preoperative score. There were no significant statistical differences in the JOA score at 12 months after surgery and the JOA improvement rate between two groups. All patients in the two groups had a lower percentage of SCC on preoperative extension MRI, compared with neutral MRI. No significant statistical differences in the spinal decompression improvement rate were observed between the two groups.

Conclusions: Decompression should be performed in patients who still have significant SCC on preoperative kinematic MRI. Kinematic MRI could be used to assess SCC and decide whether to perform decompression preoperatively.
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http://dx.doi.org/10.1155/2020/5395071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755474PMC
June 2021

A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at the vertebral anterior border: A minimum 3-year follow-up study.

Clin Neurol Neurosurg 2021 02 17;201:106434. Epub 2020 Dec 17.

Department of Orthopedics, The Frist Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China. Electronic address:

Objectives: When vertebroplasty is used to treat Kummell disease with bone deficiency at the vertebral anterior border, bone cement displacement often occurs intraoperatively or postoperatively. We designed and used a new bone cement screw system to avoid this serious complication. The purpose of this study was to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up.

Patients And Methods: From January 2014 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at the vertebral anterior border were treated by vertebroplasty combined with a novel bone cement screw. Bone cement was released into the diseased vertebrae through the screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperatively or postoperatively displacement. All patients received surgery involving a unilateral technique, and only one screw was implanted in each patient. The clinical efficacy was evaluated using Odom's criteria and statistical analysis of the vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), Oswestry disability index (ODI), and the results of the MOS 36-item short form health survey (SF-36).

Results: The operation was completed successfully in 27 cases. The average operation time was 49.63 ± 10.82 min, and the average volume of cement injected was 4.70 ± 0.87 mL. The patients' preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11 ± 5.94, 21.04 ± 2.55, 45.00 ± 6.26, 7.59 ± 0.84, and 79.85 ± 7.58, respectively. The postoperative measurements were 78.70 ± 2.55, 12.70 ± 2.11, 26.11 ± 4.73, 3.22 ± 0.93 and 50.04 ± 9.28, respectively. At the last follow-up, the measurements were 78.04 ± 2.30, 13.15 ± 2.38, 27.07 ± 4.87, 2.04 ± 0.65, and 22.85 ± 5.06, respectively. There was a significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P < 0.05). Comparing the results of SF-36 before operation and at the last follow-up revealed significant differences in physical function, role-physical, body pain, vitality, and social function (P < 0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3 %) had good to excellent clinical outcomes according to Odom's criteria.

Conclusions: This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect in patients with Kummell disease and bone deficiency at the vertebral anterior border, while its long-term efficacy is subject to further studies.
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http://dx.doi.org/10.1016/j.clineuro.2020.106434DOI Listing
February 2021

Current Study of Medicinal Chemistry for Treating Spinal Tuberculosis.

Curr Med Chem 2021 ;28(25):5201-5212

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

Tuberculosis, caused by Mycobacterium tuberculosis, is one of the oldest diseases in the world and is one of the top ten causes of death in the world, ranking first mortality in infectious diseases, far beyond the frightening disease AIDS. Besides that, spinal tuberculosis is the most common form of extrapulmonary tuberculosis, accounting for approximately 1 to 3% of all tuberculosis cases, and accounting for 50% of musculoskeletal infections. However, the drug-resistant situation of spinal tuberculosis is still challenging world wide. This situation directly leads that spinal tuberculosis has a high disability rate and is difficult to treat, which causes a heavy burden to patients, families and society. Therefore, it has been one of the focuses of tuberculosis researchers and spine doctors. Considering that, in this review, we aim to overview the current studies that focused on the novel understanding of current spinal tuberculosis medicine usage and extensive explorations for treating this severe disease.
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http://dx.doi.org/10.2174/0929867328666201222125225DOI Listing
August 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

Spermatogonial stem cells are a promising and pluripotent cell source for regenerative medicine.

Am J Transl Res 2020 15;12(11):7048-7059. Epub 2020 Nov 15.

Translational Medicine Center, Hong Hui Hospital, Xi'an Jiaotong University Xi'an 710054, China.

Regenerative medicine has been shown to hold enormous potential to treat traumatic and degenerative diseases, and substantial advancements have been made in the recent decades. In particular, different cell types were evaluated in basic research and preclinical studies on cell-based therapy applications. Despite the extraordinary achievements made in experimental studies and clinical practice, a considerable number of obstacles, such as the cellular source, ethical and safety issues, hinder further clinical applications. Spermatogonial stem cells (SSCs) are gradually becoming the research focus of cell-based regenerative medicine owing to their unique merits over other types of stem cells, particularly the lack of ethical concerns and lower immunogenicity. In addition, SSCs have been successfully induced to differentiate into other cell types under different appropriate conditions in compelling studies. Based on these properties, we systemically reviewed the development of SSCs as an attractive cell source for cell-based regenerative medicine.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724348PMC
November 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

Involvement of α7nAChR in the Protective Effects of Genistein Against β-Amyloid-Induced Oxidative Stress in Neurons via a PI3K/Akt/Nrf2 Pathway-Related Mechanism.

Cell Mol Neurobiol 2021 Mar 19;41(2):377-393. Epub 2020 Nov 19.

Translational Medicine Center, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.

Abnormal excessive production and deposition of β-amyloid (Aβ) peptides in selectively susceptible brain regions are thought to be a key pathogenic mechanism underlying Alzheimer's disease (AD), resulting in memory deficits and cognitive impairment. Genistein is a phytoestrogen with great promise for counteracting diverse Aβ-induced insults, including oxidative stress and mitochondrial dysfunction. However, the exact molecular mechanism or mechanisms underlying the neuroprotective effects of genistein against Aβ-induced insults are largely uncharacterized. To further elucidate the possible mechanism(s) underlying these protective effects, we investigated the neuroprotective effects of genistein against Aβ-induced oxidative stress mediated by orchestrating α7 nicotinic acetylcholine receptor (α7nAChR) signaling in rat primary hippocampal neurons. Genistein significantly increased cell viability, reduced the number of apoptotic cells, decreased accumulation of reactive oxygen species (ROS), decreased contents of malondialdehyde (MDA) and lactate dehydrogenase (LDH), upregulated BCL-2 expression, and suppressed Caspase-3 activity occurring after treatment with 25 μM Aβ25-35. Simultaneously, genistein markedly inhibited the decreases in α7nAChR mRNA and protein expression in cells treated with Aβ25-35. In addition, α7nAChR signaling was intimately involved in the genistein-mediated activation of phosphatidylinositol 3-kinase (PI3K)/Akt and Nrf2/keap1 signaling. Thus, α7nAChR activity together with the PI3K/Akt/Nrf2 signaling cascade likely orchestrates the molecular mechanism underlying the neuroprotective effects of genistein against Aβ-induced oxidative injury.
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http://dx.doi.org/10.1007/s10571-020-01009-8DOI Listing
March 2021

Esophageal perforation following pedicle screw placement for the treatment of upper thoracic spinal tuberculosis: a case report and review of the literature.

BMC Musculoskelet Disord 2020 Nov 18;21(1):756. Epub 2020 Nov 18.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, China.

Background: The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis.

Case Presentation: A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2-4 had complete osseous fusion without sequestrum.

Conclusion: Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation.
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http://dx.doi.org/10.1186/s12891-020-03783-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672849PMC
November 2020

Letter to the editor concerning "Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine" by Bourassa-Moreau E, et al. (Spine J. 2020; 20(1):22-31).

Spine J 2020 11;20(11):1887

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East Road, Xi'an 710054, Shaanxi, China. Electronic address:

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http://dx.doi.org/10.1016/j.spinee.2020.05.560DOI Listing
November 2020

Radiological and clinical differences between robotic-assisted pedicle screw fixation with and without real-time optical tracking.

Eur Spine J 2021 01 20;30(1):142-150. Epub 2020 Oct 20.

Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Friendship East Road, Xi'an City, 710054, Shaanxi Province, China.

Objective: To study radiological and clinical differences between robotic-assisted pedicle screw fixation with and without real-time optical tracking.

Methods: Patients who underwent lumbar internal fixation in our hospital from June 2017 to February 2020 were divided into Tinavi group (with optical tracking) and Renaissance group (without optical tracking) according to assisted technology. The imaging data of the patients were collected, and the accuracy of screw implantation was measured according to Rampersaud A-D grade. Clinical outcomes such as operative time, fluoroscopic time and radiations dose were also collected.

Results: A total of 376 patients were included, including 201 patients in the Tinavi group with 968 screws implanted and 175 patients in the Renaissance group with 822 screws implanted. The accuracy of "perfect" and "clinically acceptable" pedicle screw implantation in the Tinavi group was 94.9%-98.7%, respectively, while in the Renaissance group was 91.2%-94.5%, respectively. There was significant difference between the two groups (P < 0.05). The operative time and operative time per screw in the Tinavi group were lower than those in the Renaissance group. However, fluoroscopic time per screw and radiations dose of the Tinavi group were significantly higher than those of the Renaissance group.

Conclusion: Optical tracking in robotic system appears to increase accuracy because of the ability to detect the real-time position of the patient. Although there are still many problems to be solved, robot with optical tracking system shows its great potential in clinical application.
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http://dx.doi.org/10.1007/s00586-020-06641-yDOI Listing
January 2021

Novel Approach for Efficient Recovery for Spinal Cord Injury Repair via Biofabricated Nano-Cerium Oxide Loaded PCL With Resveratrol to Improve in Vitro Biocompatibility and Autorecovery Abilities.

Dose Response 2020 Jul-Sep;18(3):1559325820933518. Epub 2020 Sep 2.

Department of Orthopedic, Hong-Hui Hospital, Xi' an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, People's Republic of China.

It is more difficult to develop the low-cost spinal cord injury repair materials with high stability and biocompatibility for the biomedical applications. Herein, for the first time, we demonstrated the functional restoration of an injured spinal cord by the nano CeO particles assembled onto poly (∊-caprolactone) (PCL)/resveratrol (RVL) were synthesized using the biocompatible ionic liquid. The as-prepared biocompatible nanomaterials were characterized and confirmed by using different instruments such as Fourier transform infra-red spectroscopy for functional groups identification, X-ray diffraction for crystalline nature, Scanning electron microscopy, transmission electron microscopy for morphological structure, Dynamic light scattering for size distribution of the nanoparticles and thermogravimetric analysis for thermal properties. The synergetic effect between the uniform distributions of nano-sized CeO particles onto the PCL polymer with RVL can remarkably enhance the catalytic performance. Biofabricated nano-cerium oxide loaded PCL with RVL revealed that treatment significantly preserved hydrogen peroxide and also good catalytic performance. This study presents a nano-sized cerium oxide particles loaded PCL with RVL biocompatible materials have been providing highly efficient regenerative activity and biocompatibility in spinal card regeneration.
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http://dx.doi.org/10.1177/1559325820933518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476352PMC
September 2020

Mesenchymal stem cells regulate inflammatory milieu within degenerative nucleus pulposus cells via p38 MAPK pathway.

Exp Ther Med 2020 Nov 27;20(5):22. Epub 2020 Aug 27.

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

It has been established that excessive apoptosis of nucleus pulposus cells (NPCs) are responsible for pathogenesis of human intervertebral disc degeneration (IDD). The present study aimed to shed light on the molecular mechanisms underlying the protective effects of mesenchymal stem cells (MSCs) on NPCs in an inflammatory environment. NPCs were treated with TNF-α to induce inflammation and then co-cultured with Wharton's Jelly-derived MSCs (WJ-MSCs)without direct interaction. The levels of inflammation markers (IL-1β, IL-6 and IL-8) in NPCs were detected by performing enzyme-linked immunosorbent assay (ELISA), and expression of metalloproteases and aggrecan, as well as the activity of p38 MAPK pathway were determined through immunoblotting. SB-203580 was used to inhibit p38 signaling, prior to evaluation of the effects of Wharton's Jelly-derived MSCs (WJ-MSCs) on inflammatory response within the co-cultured NPCs. After TNF-α treatment, the levels of inflammatory cytokines, MMP-3, and MMP-13 in NPCs were increased whereas aggrecan was decreased, which was then dramatically reversed by WJ-MSCs co-culture. Likewise, WJ-MSCs suppressed TNF-α-induced phosphorylation of p38 MAPK signaling components including p38, ASK-1, MKK-3 and MKK-6. Blocking p38 MAPK pathway enhanced the anti-inflammatory impact of WJ-MSCs, and there was no significant difference between NPCs co-cultured with WJ-MSCs or the cells cultured alone. WJ-MSCs co-culture mitigate TNF-α-induced inflammatory response and ECM degeneration in NPCs, the major pathological events are implicated in IDD development, probably by suppressing the p38 MAPK signaling cascade.
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http://dx.doi.org/10.3892/etm.2020.9150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471866PMC
November 2020

[Efficacy and safety of tranexamic acid sequential rivaroxaban on blood loss in elderly patients during lumbar interbody fusion].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Sep;34(9):1158-1162

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

Objective: To investigate the effect and safety of tranexamic acid sequential rivaroxaban on perioperative blood loss and preventing thrombosis for elderly patients during lumbar interbody fusion (LIF) with a prospective randomized controlled study.

Methods: Between April and October 2019, the elderly patients with lumbar degenerative diseases requiring LIF were included in the study, among which were 80 patients met the selection criteria. According to the antifibrinolysis and anticoagulation protocols, they were randomly divided into a tranexamic acid sequential rivaroxaban group (trial group) and a simple rivaroxaban group (control group) on average. Finally, 69 patients (35 in the trial group and 34 in the control group) were included for comparison. There was no significant difference in general data ( >0.05) such as gender, age, body mass index, disease duration, diseased segment, type of disease, and preoperative hemoglobin between the two groups. The operation time, intraoperative blood loss, drainage within 3 days after operation, perioperative total blood loss, and proportion of blood transfusion patients were compared between the two groups, as well as postoperative venous thrombosis of lower extremities, pulmonary embolism, and bleeding-related complications.

Results: The operations of the two groups completed successfully, and there was no significant difference in the operation time ( >0.05); the intraoperative blood loss, drainage within 3 days after operation, and perioperative total blood loss in the trial group were significantly lower than those in the control group ( <0.05). The proportion of blood transfusion patients in the trial group was 25.71% (9/35), which was significantly lower than that in the control group [52.94% (18/34)] ( =5.368, =0.021). Postoperative incision bleeding occurred in 4 cases of the trial group and 3 cases of the control group, and there was no significant difference in bleeding-related complications between the two groups ( =1.000). There was 1 case of venous thrombosis of the lower extremities in each group after operation, and there was no significant difference in the incidence between the two groups ( =1.000). Besides, no pulmonary embolism occurred in the two groups.

Conclusion: Perioperative use of tranexamic acid sequential rivaroxaban in elderly LIF patients can effectively reduce the amount of blood loss and the proportion of blood transfusion patients without increasing the risk of postoperative thrombosis.
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http://dx.doi.org/10.7507/1002-1892.202002041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171734PMC
September 2020

[A comparative study on treatment of lumbar degenerative disease with osteoporosis by manual and robot-assisted cortical bone trajectory screws fixation].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020 Sep;34(9):1142-1148

Department of Orthopedics, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an Shanxi, 710054, P.R.China.

Objective: To compare the safety and accuracy of manual and robot-assisted cortical bone trajectory (CBT) screws fixation in the treatment of lumbar degenerative diseases with osteoporosis.

Methods: The clinical data of 58 cases of lumbar degenerative disease with osteoporosis treated by CBT screw fixation between February 2017 and February 2019 were analyzed retrospectively. Among them, 29 cases were fixed with CBT screws assisted by robot (group A), 29 cases were fixed with CBT screws by hand (group B). There was no significant difference between the two groups in terms of gender, age, body mass index, lesion type, T-value of bone mineral density, and operative segment ( >0.05), with comparability. The accuracy of implant was evaluated by Kaito's grading method, and the invasion of CBT screw to the superior articular process was evaluated by Babu's method.

Results: The operation time and intraoperative blood loss in group A were significantly less than those in group B ( =-8.921, =0.000; =-14.101, =0.000). One hundred and sixteen CBT screws were implanted in the two groups. At 3 days after operation, according to the Kaito's grading method, the accuracy of implant in group A was 108 screws of grade 0, 6 of grade 1, and 2 of grade 2; and in group B was 86 screws of grade 0, 12 of grade 1, and 18 of grade 2; the difference was significant ( =4.007, =0.000). There were 114 accepted screws (98.3%) in group A and 98 (84.5%) in group B, the difference was significant ( =8.309, =0.009). At 3 days after operation, according to Babu's method, there were 85 screws in grade 0, 3 in grade 1, and 2 in grade 2 in group A; and in group B, there were 91 screws in grade 0, 16 in grade 1, 5 in grade 2, and 4 in grade 3; the difference was significant ( =7.943, =0.000). No serious injury of spinal cord, nerve, and blood vessel was found in the two groups. One patient in group A had delayed cerebrospinal fluid leakage, and 2 patients in group B had mild anemia. Both groups were followed up 10-14 months (mean, 11.6 months). The neurological symptoms were improved, and no screw loosening or fracture was found during the follow-up.

Conclusion: Compared with manual implantation of CBT screw, robot-assisted spinal implant has higher accuracy, lower incidence of invasion of superior articular process, and strong holding power of CBT screw, which can be applied to the treatment of lumbar degenerative diseases with osteoporosis.
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http://dx.doi.org/10.7507/1002-1892.202001070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171727PMC
September 2020

Radiological and Clinical Differences between Tinavi Orthopedic Robot and O-Arm Navigation System in Thoracolumbar Screw Implantation for Reconstruction of Spinal Stability.

Med Sci Monit 2020 Sep 12;26:e924770. Epub 2020 Sep 12.

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

BACKGROUND Pedicle screw fixation is one of the most commonly used methods in spine surgery. We introduce a surgical robot system from China based on 3-dimensional fluoroscopy imaging and compare it with the commonly used O-arm navigation system. We study the differences in accuracy, safety, and clinical effect in auxiliary pedicle screw fixation. MATERIAL AND METHODS Patients who underwent thoracolumbar internal fixation in our hospital from 2017 to 2019 were divided into a robot and navigation group according to whether surgery was assisted by the Tinavi orthopedic robot or O-arm navigation system. Imaging data of patients were searched from the image system and accuracy of screw implantation was measured by Rampersaud A to D grade classification. Deviation sagittal, deviation transversal, and facet joint violation were also measured and calculated. RESULTS In total, 306 patients were included: 136 patients in the robot group with 760 screws implanted; 166 patients in the navigation group with 908 screws implanted. The accuracy of "perfect" and "clinically acceptable" pedicle screw implantation was 96.2% and 99.6%, respectively, in the robot group and 90.5% and 96.7%, respectively, in the navigation group, with a significant difference between the 2 groups (P<0.05). The sagittal and transversal deviations in the robot group were significantly less than those in the navigation group (P<0.05). CONCLUSIONS The Tinavi orthopedic robot can significantly improve surgical accuracy and safety of pedicle screw fixation, as compared with that of O-arm navigation technology, without increasing complications. It shows great potential in clinical application.
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http://dx.doi.org/10.12659/MSM.924770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507796PMC
September 2020

Assessment of interleukin 6 gene polymorphisms with rheumatoid arthritis.

Gene 2021 Jan 6;765:145070. Epub 2020 Sep 6.

Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China. Electronic address:

Background: Rheumatoid arthritis (RA) is complex autoimmune system disease and significant impact on the health of population in our world. Numerous studies confirmed that genetic factors play a crucial role in the pathogenesis of RA. In this current study, we aimed to investigate IL-6 polymorphisms and RA risk in Chinese Han population.

Methods: 508 RA patients and 494 age- and gender- matched healthy controls were recruited, all subjects were genotyped with an Agena MassARRAY platform. Subsequently, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression after adjusting for age and gender.

Results: Our results suggested that IL-6 rs2243289 allele and genotype frequencies were associated with reduced RA risk under all genetic models (all p < 0.05). Stratification analysis revealed that IL-6 rs2243289 polymorphism was significant associated with decreased the risk of RA in the old groups (age > 54) (all p < 0.05). However, IL-6 rs2069837 and rs1800796 polymorphisms were associated with increased risk of RA among the young groups (age ≤ 54) (all p < 0.05). In addition, subgroup analysis by gender suggested that IL-6 rs2069837 and rs1800796 polymorphism were interacted with increased the risk of RA in males (all p < 0.05). Besides, IL-6 rs2243289 was associated with reduced RA risk in females.

Conclusions: In conclusion, our results demonstrated the correlation between IL and 6 polymorphisms and RA susceptibility and confirmed for the first time that the relationship was restricted to age and gender in Chinese Han population.
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http://dx.doi.org/10.1016/j.gene.2020.145070DOI Listing
January 2021
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