Publications by authors named "Jiangang Shi"

91 Publications

A Study on Supply-Demand Satisfaction of Community-Based Senior Care Combined with the Psychological Perception of the Elderly.

Healthcare (Basel) 2021 May 29;9(6). Epub 2021 May 29.

School of Economics and Management, Tongji University, Shanghai 200092, China.

Based on Maslow's hierarchy of needs theory and customer satisfaction theory, we constructed a satisfaction model for supply-demand satisfaction for community-based senior care (SSCSC) combined with the psychological perspective of the elderly, and four dimensions of basic living needs (BLNs), living environment (LE), personal traits (PTs), and livability for the aged (LA) were selected to construct the model. The data were obtained from 296 questionnaires from seniors over 50 years old (or completed by relatives on their behalf, according to their actual situation). Twenty-two observed variables were selected for the five latent variables, and their interactions were explored using structural equation modeling. The results showed that LA was the most significant factor influencing SSCSC, and it was followed by BLNs and LE. PTs did not show a direct effect on LA, but they could have an indirect effect on SSCSC through influencing BLNs and LE. Based on the current state of community aging satisfaction, we propose to establish a community elderly care service system based on the basic needs of the elderly population, providing differentiated and refined elderly care services and improving the level of aging-friendly communities. This study provides references for the government to formulate relevant policies and other supply entities to make strategic decisions and has important implications for further enhancing community elderly services to become an important part of the social security system for the elderly.
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http://dx.doi.org/10.3390/healthcare9060643DOI Listing
May 2021

Long noncoding RNA AC092155 facilitates osteogenic differentiation of adipose-derived stem cells through the miR-143-3p/STMN1 axis.

J Gene Med 2021 May 15:e3363. Epub 2021 May 15.

Department of Orthopedic Surgery, Jinling Hospital, Nanjing University, Nanjing, China.

Background: Numerous studies have demonstrated that long noncoding RNAs (lncRNAs) induce osteogenesis in adipose-derived stem cells (ADSCs). This study aimed to explore the role of lncRNAs AC092155 in promoting osteogenic differentiation of ADSCs.

Methods: MicroRNA (miRNA) and lncRNA sequencing were performed in ADSCs that underwent normal or osteogenic induction. Differentially expressed miRNAs and lncRNAs were identified using R software. The relative expression levels of lncRNA AC092155, miR-143-3p, and STMN1 during the process of osteogenic induction were determined by real-time polymerase chain reaction (RT-PCR). ADSCs were then transfected with agomiR-143-3p and pcDNA3.1-sh-lncRNA AC092155. Alkaline phosphatase (ALP) and alizarin red staining (ARS) were used to confirm the regulatory function of the lncRNA AC092155/miR-143-3p/STMN1 axis in osteogenic differentiation of ADSCs.

Results: lncRNA AC092155 was significantly upregulated in ADSCs following induction in the osteogenic medium. lncRNA AC092155 and STMN1 mimics increase the markers of osteogenic differentiation in the early and late phases, which was reflected in increased ALP activity as well as the higher deposition of calcium nodules. An miR-143-3p mimic showed the opposite effect. Luciferase reporter gene analysis demonstrated that lncRNA AC092155 directly targets miR-143-3p. Moreover, the lncRNA AC092155/miR-143-3p/STMN1 regulatory axis was found to activate the Wnt/β-catenin signaling pathway.

Conclusions: lncRNA AC092155 contributes to the osteogenic differentiation of ADSCs. The lncRNA AC092155/miR-143-3p/STMN1 axis may be a new therapeutic target for bone-related diseases.
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http://dx.doi.org/10.1002/jgm.3363DOI Listing
May 2021

Ulinastatin Ameliorates IL-1-Induced Cell Dysfunction in Human Nucleus Pulposus Cells via Nrf2/NF-B Pathway.

Oxid Med Cell Longev 2021 21;2021:5558687. Epub 2021 Apr 21.

Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), No. 415 Fengyang Road, Shanghai 200003, China.

Low back pain (LBP) has been a wide public health concern worldwide. Among the pathogenic factors, intervertebral disc degeneration (IDD) has been one of the primary contributors to LBP. IDD correlates closely with inflammatory response and oxidative stress, involving a variety of inflammation-related cytokines, such as interleukin 1 beta (IL-1), which could result in local inflammatory environment. Ulinastatin (UTI) is a kind of acidic protein extracted from human urine, which inhibits the release of tumor necrosis factor alpha (TNF-) and other inflammatory factors to protect organs from inflammatory damage. However, whether this protective effect of UTI on human nucleus pulposus (NP) exists, and how UTI affects the biological behaviors of human NP cells during IDD remain elusive. In this current study, we revealed that UTI could improve the viability of NP cells and promote the proliferation of NP cells. Additionally, UTI could protect human NP cells via ameliorating IL-1-induced apoptosis, inflammatory response, oxidative stress, and extracellular matrix (ECM) degradation. Molecular mechanism analysis suggested that the protective effect from UTI on IL-1-treated NP cells were through activating nuclear factor- (erythroid-derived 2-) like 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway and the suppression of NF-B signaling pathway. Therefore, UTI may be a promising therapeutic medicine to ameliorate IDD.
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http://dx.doi.org/10.1155/2021/5558687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084647PMC
May 2021

Gamabufotalin Inhibits Osteoclastgenesis and Counteracts Estrogen-Deficient Bone Loss in Mice by Suppressing RANKL-Induced NF-κB and ERK/MAPK Pathways.

Front Pharmacol 2021 23;12:629968. Epub 2021 Apr 23.

Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.

Osteolytic bone disease is a condition of imbalanced bone homeostasis, characterized mainly by excessive bone-resorptive activity, which could predispose these populations, such as the old and postmenopausal women, to developing high risk of skeletal fragility and fracture. The nature of bone homeostasis is the coordination between the osteoblasts (OBs) and osteoclasts (OCs). Abnormal activation of osteoclasts (OCs) could compromise the bone homeostasis, constantly followed by a clutch of osteolytic diseases, including postmenopausal osteoporosis, osteoarthritis, and rheumatoid arthritis. Thus, it is imperatively urgent to explore effective medical interventions for patients. The traditional Chinese medicine (TCM) gamabufotalin (CS-6) is a newly identified natural product from Chansu and has been utilized for oncologic therapies owing to its good clinical efficacy with less adverse events. Previous study suggested that CS-6 could be a novel anti-osteoporotic agent. Nevertheless, whether CS-6 suppresses RANK-(receptor activator of nuclear factor-κ B ligand)/TRAF6 (TNF receptor-associated factor 6)-mediated downstream signaling activation in OCs, as well as the effects of CS-6 on OC differentiation , remains elusive. Therefore, in this present study, we aimed to explore the biological effects of CS-6 on osteoclastogenesis and RANKL-induced activation of related signaling pathways, and further to examine the potential therapeutic application in estrogen-deficient bone loss in the mice model. The results of experiment showed that CS-6 can inhibit RANKL-induced OC formation and the ability of bone resorption in a dose-dependent manner at both the early and late stages of osteoclastogenesis. The gene expression of OC-related key genes such as tartrate-resistant acid phosphatase (TRAP), CTSK, DC-STAMP, MMP9, and β3 integrin was evidently reduced. In addition, CS-6 could mitigate the systemic estrogen-dependent bone loss and pro-inframammary cytokines in mice . The molecular mechanism analysis suggested that CS-6 can suppress RANKL/TRAF6-induced early activation of NF-κB and ERK/MAPK signaling pathways, which consequently suppressed the transcription activity of c-Fos and NFATc1. Taken together, this present study provided ample evidence that CS-6 has the promise to become a therapeutic candidate in treating osteolytic conditions mediated by elevated OC formation and bone resorption.
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http://dx.doi.org/10.3389/fphar.2021.629968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104077PMC
April 2021

Neuropeptide Y prevents nucleus pulposus cells from cell apoptosis and IL‑1β‑induced extracellular matrix degradation.

Cell Cycle 2021 May 8;20(10):960-977. Epub 2021 May 8.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China.

Intervertebral disc degeneration (IDD) is characterized by excessive inflammatory reaction, and neuropeptide Y (NPY) was reported to have anti-inflammatory effect. However, the effect of NPY on NP cells has not been investigated up to date. This study aimed to clarify the role of NPY on the process of IDD. Fourteen fresh human lumbar intervertebral discs were harvested, and degeneration-related proteins were examined. Pfirrmann grading system was used to evaluate IDD. Rat nucleus pulposus (NP) cells were used to investigate the effect of NPY on the proliferation, apoptosis, and extracellular matrix (ECM) in NP cell induced by IL-1βin vitro. The expression levels of NPY and its receptors (type 1 receptor, Y1R, and type 2 receptor, Y2R) were detected via immunohistochemical analysis, western blot, and quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability and proliferation were explored using cell counting kit-8 assay, western blot, and immunofluorescence analysis. Cell apoptosis was investigated by Hoechst staining, JC-1 Staining, annexin V-FITC/PI double staining, and western blot. The secretion of NPY from NP cells was determined via enzyme-linked immunosorbent assay (ELISA). The expression of anabolic and catabolic gene was analyzed by qRT-PCR, western blot, immunofluorescence analysis, and ELISA. The expression of Y2R was significantly increased in both human degenerative intervertebral discs and IL-1β-induced NP cells. Although no positive results for NPY indicated by western blot both in vivo and in vitro, ELISA results demonstrated that the secretion of NPY from NP cells was increased by low-concentration IL-1β, but was decreased when the concentration of IL-1β was 30 ng/ml and above. In addition, NPY could promote NP cells proliferation and protect NP cells against IL‑1β‑induced apoptosis via suppressing mitochondrial-mediated apoptosis pathway. What's more, NPY can suppress the expression of catabolic gene and ameliorate IL-1β- induced matrix degeneration in NP cells. In conclusion, NPY could promote NP cell proliferation and alleviate IL‑1β‑induced cell apoptosis via mitochondrial pathway. In addition, NPY can suppress the expression of ECM‑catabolic proteinases and ameliorate IL-1β- induced ECM degeneration in vitro.
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http://dx.doi.org/10.1080/15384101.2021.1911914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172154PMC
May 2021

PD-L1 Improves Motor Function and Alleviates Neuropathic Pain in Male Mice After Spinal Cord Injury by Inhibiting MAPK Pathway.

Front Immunol 2021 15;12:670646. Epub 2021 Apr 15.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China.

Background: Traumatic spinal cord injury (SCI) causes severe motor dysfunction and persistent central neuropathic pain (Nep), which has not yet been effectively cured. Programmed cell death ligand-1 (PD-L1) is typically produced by cancer cells and contributes to the immune-suppressive in tumor microenvironment. However, the role of PD-L1 in regulating inflammatory response and Nep after SCI remains unclear. A growing amount of researches have begun to investigate the effect of PD-L1 on macrophages and microglia in recent years. Considering the pivotal role of macrophages/microglia in the inflammatory response after SCI, we proposed the hypothesis that PD-L1 improved the recovery of locomotor and sensory functions after SCI through regulating macrophages and microglia.

Methods: The mice SCI model was established to determine the changes in expression patterns of PD-L1. Meanwhile, we constructed PD-L1 knockout mice to observe differences in functional recovery and phenotypes of macrophages/microglia post-SCI.

Results: In present study, PD-L1 was significantly upregulated after SCI and highly expressed on macrophages/microglia at the injury epicenter. PD-L1 knockout (KO) mice showed worse locomotor recovery and more serious pathological pain compared with wild-type (WT) mice. Furthermore, deletion of PD-L1 significantly increased the polarization of M1-like macrophages/microglia. Mechanistic analysis revealed that PD-L1 may improve functional outcomes following SCI by inhibiting phosphorylation of p38 and ERK1/2.

Conclusions: Our observations implicate the involvement of PD-L1 in recovery of SCI and provide a new treatment strategy for the prevention and treatment of this traumatic condition.
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http://dx.doi.org/10.3389/fimmu.2021.670646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081847PMC
April 2021

A Special type of non-traumatic posterior interosseous nerve compression syndrome.

Acta Orthop Traumatol Turc 2021 Mar;55(2):181-183

Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.

The posterior interosseous nerve (PIN) is the terminal branch of the radial nerve. The symptoms of PIN palsy vary markedly according to its types. In this report, we present the case of a 61-years-old male patient with an unusual manifestation of non-traumatic novel type of PIN palsy. A complicated course was involved in the diagnosis of this disease. The operation was performed after verification of PIN palsy. Recovery of symptoms was observed in a follow-up conducted three years later. Additionally, the electromyography examination returned to normal.
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http://dx.doi.org/10.5152/j.aott.2021.19254DOI Listing
March 2021

METTL3 Regulates Ossification of the Posterior Longitudinal Ligament via the lncRNA XIST/miR-302a-3p/USP8 Axis.

Front Cell Dev Biol 2021 5;9:629895. Epub 2021 Mar 5.

Spine Center, Department of Orthopaedics, Changzheng Hospital, Naval Medical University, Shanghai, China.

The prevalence of ossification of the posterior longitudinal ligament (OPLL) is increasing, and currently there is no effective medical treatment for OPLL. Methyltransferase like 3 (METTL3), one of the components of the -methyladenosine (mA) methyltransferase complex, regulates gene expression via modification of mRNA. Although METTL3 has been implicated in a variety of diseases, its role in OPLL remains to be elucidated. Primary ligament fibroblasts were used in this study. To investigate the role of METTL3 in OPLL, METTL3 was silenced or overexpressed. mA RNA methylation was measured by commercially available kits. Luciferase reporter assay was performed to investigate the binding of miR-302a-3p and METTL3, and the binding of miR-302a-3p and USP8. Quantitative RT-PCR and western blots were used to evaluate mRNA and protein expression, respectively. OPLL increases METTL3 and its mA modification. Overexpressing METTL3 significantly promoted osteogenic differentiation of primary ligament fibroblasts. Mechanism study showed that METTL3 increased mA methylation of long non-coding RNA (lncRNA) X-inactive specific transcript (XIST). Further study showed that lncRNA XIST regulates osteogenic differentiation of primary ligament fibroblasts via miR-302a-3p, which targets ubiquitin-specific protease 8 (USP8). METTL3 enhanced osteogenic differentiation of primary ligament fibroblasts via the lncRNA XIST/miR-302a-3p/USP8 axis. The findings highlight the importance of METTL3-mediated mA methylation of XIST in OPLL and provide new insights into therapeutic strategies for OPLL.
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http://dx.doi.org/10.3389/fcell.2021.629895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973222PMC
March 2021

A Novel Scoring System for Ossification of Posterior Longitudinal Ligament of the Cervical Spine Based on Magnetic Resonance Imaging-CSFM Scoring System.

World Neurosurg 2021 Jun 17;150:e466-e473. Epub 2021 Mar 17.

Department of Orthopedic Surgery, the 903rd Hospital of PLA, Hangzhou, China. Electronic address:

Objective: To establish a new scoring system to assess spinal cord compression of ossification of posterior longitudinal ligament (OPLL) of the cervical spine.

Methods: Literature review and expert advice were used to determine variables of the novel CSFM scoring system. The CSFM score included 4 variables: curvature of spinal cord (C), increased signal intensity of spinal cord (S), cerebrospinal fluid imaging (F), and cross-section morphology of spinal cord (M). From June 2015 to June 2018, clinical and imaging data of 387 patients with cervical OPLL were retrospectively analyzed. The 4 variables were measured and recorded. Different scores were assigned based on analysis of the relationship between the variables and the Japanese Orthopaedic Association score. Two spine surgeons scored the patients according to the CSFM score and analyzed the internal consistency and reliability of the CSFM score.

Results: The CSFM scoring system consisted of 4 variables, each of which was divided into 4 grades. Each variable was assigned a score of 0-3 according to different grades. The total possible score was 12, and the minimum score was 0. A higher score indicated more severe spinal cord compression.

Conclusions: The CSFM scoring system can effectively reflect the degree of spinal cord compression for cervical OPLL.
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http://dx.doi.org/10.1016/j.wneu.2021.03.032DOI Listing
June 2021

Effect analysis of the driving factors of super-gentrification using structural equation modeling.

PLoS One 2021 12;16(3):e0248265. Epub 2021 Mar 12.

Hospitality Management School, Shanghai Business School, Shanghai, China.

The study of super-gentrification has important practical significance for maintaining social fairness, spatial justice and achieving sustainable urban development. In this article, 23 driving factors influencing super-gentrification are identified by literature research and Delphi method. Then, the 23 driving factors affecting super-gentrification are divided into four dimensions: political, economic, social and spatial dimension. On this basis, hypotheses are proposed and a structural equation model is established. Then, SPSS 25.0 and AMOS 24.0 software are used to test the reliability and validity of the questionnaire data, and the model results are fitted and modified. Finally, the optimization model and path coefficient of super-gentrification driving factors are calculated. The results of the study show that political factors, economic factors, social factors, and spatial factors, all play a positive role in the development of super-gentrification. Social factors are the fundamental factors to promote super-gentrification, political factors, economic factors, and spatial factors also play a key role in the super-gentrification process.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248265PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954290PMC
March 2021

Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum.

Global Spine J 2021 Mar 9:2192568221996689. Epub 2021 Mar 9.

Department of Spine Surgery, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.

Study Design: A retrospective study.

Objectives: This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF).

Methods: Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed.

Results: The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate ( < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage.

Conclusion: The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.
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http://dx.doi.org/10.1177/2192568221996689DOI Listing
March 2021

The Gantry Crane Technique: A Novel Technique for Treating Severe Thoracic Spinal Stenosis and Myelopathy Caused by Ossification of the Ligamentum Flavum and Preliminary Clinical Results.

Global Spine J 2021 Mar 5:2192568221996693. Epub 2021 Mar 5.

Department of Spine Surgery, 56652Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.

Study Design: Retrospective single-arm study.

Objective: To propose a novel technique named the gantry crane technique for treating severe thoracic spinal stenosis and myelopathy caused by thoracic ossification of the ligamentum flavum (TOLF) and investigate its clinical results.

Methods: From June 2017 to January 2019, 18 patients presenting with severe spinal stenosis and myelopathy caused by TOLF were included in our study. All patients were treated with gantry crane technique, pre-operative JOA score, as well as 3 days-, 3 months-, 6 months-, 12 months-, 24 months after operation, and Hirabayashi recovery rate were reported. Pre- and post-operative image were utilized for the assessment of post-operative effect. Peri-operative complications were recorded to assess the safety of the gantry crane technique.

Results: The JOA score increased from 10.56 ± 3.76 preoperatively to 12.94 ± 3.33, 13.56 ± 3.48, 13.94 ± 3.32, 14.17 ± 3.70 and 14.06 ± 3.54 in 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. The post-operative JOA scores were improved with statistical significance at the level of < 0.05. The recovery rate was (39.09 ± 33.85) %, (51.35 ± 42.60) %, (55.79 ± 36.10) %, (64.98 ± 29.24) % and (60.98 ± 35.96) % for 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. There were 2 cases of SSI (surgical site infection), 1 case of NI (neurovascular injury) and 1 case of cerebrospinal fluid (CSF) leakage.

Conclusions: This study highlights a safe and effective technique, the gantry crane technique, for treating severe thoracic spinal stenosis and myelopathy caused by TOLF.
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http://dx.doi.org/10.1177/2192568221996693DOI Listing
March 2021

Exclusion of Ossified Ligaments Behind C2 Vertebra Combined with Anterior Controllable Antedisplacement and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament Extending to C2 Segment.

World Neurosurg 2021 Feb 9;146:e1351-e1359. Epub 2020 Dec 9.

Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.

Objective: We sought to introduce an anterior surgical technique for cervical ossification of posterior longitudinal ligament (OPLL) extending to C2.

Methods: A total of 29 patients with multilevel OPLL extending to C2 underwent surgery from January 2016 to January 2019. The rationale of our surgical technique is to transect the ossified ligament at the level of C2/3, dividing OPLL into 2 parts. OPLL behind the C2 vertebra is reserved as "focus exclusion," and OPLL below C2 is performed anterior controllable antedisplacement and fusion. Neurologic condition was evaluated using the Japanese Orthopaedic Association scoring system and its improvement ratio. Radiologic assessment included type and extent of OPLL, occupying rate, thickness and length of ossified mass, and curvature of spinal cord. Surgery- and implant-related complications were recorded.

Results: The mean Japanese Orthopaedic Association score increased from 9.4 to 15.8 points at last follow-up, with a significant improvement (P < 0.01). The mean preoperative length of the ossified mass behind C2 was 15.4 mm, and its thickness was 2.2 mm, with no significant progression at last follow-up (15.3 mm and 2.2 mm, P > 0.05). There was also no statistical difference in OPLL thickness at the largest occupying rate level between preoperation and last follow-up (7.4 mm vs. 7.3 mm, P > 0.05). Four patients presented with cerebrospinal fluid leakage, 1 with screw displacement, and 1 with dysphagia.

Conclusions: For patients with cervical OPLL extending to C2, exclusion of ossified ligaments behind C2 combined with anterior controllable antedisplacement and fusion below C2 is an effective and alternative technique.
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http://dx.doi.org/10.1016/j.wneu.2020.12.015DOI Listing
February 2021

Sensitivity analysis of biomechanical effect in vertebral body of two different augmenters.

Clin Biomech (Bristol, Avon) 2020 12 10;80:105166. Epub 2020 Sep 10.

Department of Orthopedics, Shanghai Changzheng Hospital Affiliated to The Second Military Medical University, Shanghai,China.

Background: Transvertebral Bone Graft and Augmentation (TBGA) has achieved good clinical effects in the treatment of osteoporotic vertebral compression fractures (OVCFs). This study aimed to investigate the postoperatively biomechanical effects of TBGA and compare the biomechanical sensitivity of two different augmenters: a cylindrical enhancement device (CED) and bone cement.

Methods: Finite element models of the spine segment T11-L3 were created, including one model based on normal segment and the other three with L1 augmentation for pathological conditions. Three treatments were simulated including CED implant treatment A, CED implant treatment B, and bone cement treatment. The stress distribution and maximum displacement of the four models under different treatments were analyzed. A method of linear fitting of dummy variables was used to analyze the sensitivity of biomechanical parameters to the degree of osteoporosis (DO) and load.

Findings: The reduction of stress with increasing DO in augmented and adjacent vertebral bodies under bone cement augmentation was less than that under CED augmentation. The stress of augmented vertebral body and the adjacent vertebral body was most sensitive to extension and rotation loading conditions. As DO increasing, the bone cement augmentation significantly increased the stress level on the upper and lower endplates.

Interpretation: When the degree of osteoporosis increased, CED outperforms bone cement in terms of the stress reduction in augmented vertebral and adjacent vertebral, which could be beneficial for avoiding re-fracture. Using TBGA to treat OVCFs, especially with Plan B method, the condition of the pathological spine is closer to the original status in terms of the sensitivity to stress and the spinal range of motion. The TBGA treatment is sensitive to lateral bending and torsion, therefore patients should be advised to avoid high-risk motions like lateral bending and rotation.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105166DOI Listing
December 2020

Analysis of the Incompletely Hoisted Vertebrae in the Anterior Controllable Antedisplacement and Fusion Surgery: Causes and Prevention.

Clin Spine Surg 2021 May;34(4):125-131

Department of Statistics, Second Military Medical University, Shanghai, China.

Purpose: Anterior controllable antedisplacement and fusion (ACAF) has been reported to be a safe and effective technique. However, incompletely hoisted vertebrae (IV) were found in the postoperative images. This study aims to analyze the causes and prevention of IV.

Methods: The ACAF-treated case series subjects were retrospectively reviewed. The vertebrae were separated into the IV group and completely hoisted vertebrae (CV) group according to the gap between the vertebrae and plate. The radiographic data, degree of cervical lordosis, bone mineral density, number of hoisted vertebrae, operative time, blood loss, and Japanese Orthopaedic Association score were compared between the patients with IV and the patients without IV.

Results: A total of 248 vertebrae were hoisted in the enrolled patients. Intervertebral disc height in the IV group was 3.7±0.4 mm, which is significantly lower than that in the CV group. The anterior or posterior overhanging lip, osteoporosis, and oblique osteotomy troughs and hinges existing after osteotomy were found to be impingements preventing the hoisting of the vertebrae. There were no differences in the age, sex, degree of cervical lordosis, number of hoisted vertebrae, and neurological improvement rate between the groups of patients with and without IV.

Conclusions: Lower intervertebral space height and impingements preventing hoisting were found to be possible causes of IV in ACAF. Measures to prevent the problem should be carried out.
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http://dx.doi.org/10.1097/BSD.0000000000001037DOI Listing
May 2021

Expression of Nogo-A in dorsal root ganglion in rats with cauda equina injury.

Biochem Biophys Res Commun 2020 06 28;527(1):131-137. Epub 2020 Apr 28.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China. Electronic address:

Objective: To investigate the expression of Nogo-A in dorsal root ganglion (DRG) in rats with cauda equina injury and the therapeutic effects of blocking Nogo-A and its receptor.

Methods And Materials: Fifty-eight male Sprague-Dawley rats were divided randomly into either the sham operation group (n = 24) or the cauda equina compression (CEC) control group (n = 34). Behavioral, histological, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) analyses were conducted to assess the establishment of the model. The dynamic expression change of Nogo-A was evaluated using real time-qPCR. Immunofluorescence was used to evaluate the expression of Nogo-A in the DRG and cauda equina. Furthermore, 20 male Sprague-Dawley rats were equally divided into 4 groups, including the sham group, the CEC group, the NEP1-40 (the NgR antagonist peptide) treatment group, and the JTE-013 (the S1PR2 antagonist) treatment group. Behavioral assessments and western blotting were used to evaluate the therapeutic effect of cauda equina injury via blocking Nogo-A and its receptor.

Results: Tactile allodynia and heat hyperalgesia in the CEC model developed as soon as 1 day after surgery and recovered to normal at 7 days, which was followed by the downregulation of Nogo-A in DRG neurons. However, the locomotor function impairment in the CEC model showed a different prognosis from the sensory function, which was consistent with the expression change of Nogo-A in the spinal cord. Immunofluorescence results also demonstrated that Nogo A-positive/NF200-negative neurons and axons increased in the DRG and cauda equina 7 days after surgery. Surprisingly, Schwann cells, which myelinate axons in the PNS, also expressed considerable amounts of Nogo-A. Then, after blocking the Nogo-A/NgR signaling pathway by NEP1-40, significant improvement of mechanical allodynia was identified in the first 2 days after the surgery. Western blotting suggested the NEP1-40 treatment group had lower expression of cleaved caspase-3 than the CEC and JTE-013 treatment group.

Conclusion: Neuronal Nogo-A in the DRG may be involved in regeneration and play a protective role in the CEC model. Whereas Nogo-A, released from the injured axons or expressed by Schwann cells, may act as an inhibiting factor in the process of CEC repairment. Thus, blocking the Nogo-A/NgR signaling pathway can alleviate mechanical allodynia by apoptosis inhibition.
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http://dx.doi.org/10.1016/j.bbrc.2020.04.094DOI Listing
June 2020

Epigenetic modulation of macrophage polarization prevents lumbar disc degeneration.

Aging (Albany NY) 2020 04 20;12(8):6558-6569. Epub 2020 Apr 20.

Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.

Inflammation plays an essential role in the development of lumbar disc degeneration (LDD), although the exact effects of macrophage subtypes on LDD remain unclear. Based on previous studies, we hypothesized that M2-polarization of local macrophages and simultaneous suppression of their production of fibrotic transforming growth factor beta 1 (TGFβ1) could inhibit progression of LDD. Thus, we applied an orthotopic injection of adeno-associated virus (AAV) carrying shRNA for DNA Methyltransferase 1 (DNMT1) and/or shRNA for TGFβ1 under a macrophage-specific CD68 promoter to specifically target local macrophages in a mouse model for LDD. We found that shDNMT1 significantly reduced levels of the pro-inflammatory cytokines TNFα, IL-1β and IL-6, significantly increased levels of the anti-inflammatory cytokines IL-4 and IL-10, significantly increased M2 macrophage polarization, significantly reduced cell apoptosis in the disc degeneration zone and significantly reduced LDD-associated pain. The anti-apoptotic and anti-pain effects were further strengthened by co-application of shTGFβ1. Together, these data suggest that M2 polarization of macrophages induced by both epigenetic modulation and suppressed production and release of TGFβ1 from polarized M2 macrophages, may have a demonstrable therapeutic effect on LDD.
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http://dx.doi.org/10.18632/aging.102909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202517PMC
April 2020

Reliability and validity of multi-shot DWI in diagnosis of cervical spondylotic myelopathy: a study based on 3-T MRI.

Eur Spine J 2020 06 4;29(6):1219-1226. Epub 2020 Apr 4.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.

Objective: To investigate whether multi-shot diffusion-weighted imaging (ms-DWI) could be applied in diagnosis and quantitative evaluation of cervical spondylotic myelopathy (CSM).

Methods: Thirty-three normal volunteers and 78 patients with CSM were included in this study. The apparent diffusion coefficient (ADC) values were measured at C2-C7 levels on sagittal section ADC map. The intraclass correlation coefficient (ICC) and Bland and Altman plot and Spearman coefficient were used to quantify the reproducibility of test and retest and inter-rater reliability. Pearson correlations were calculated to compare lADC and rADC versus mJOA and NDI scores. Receiver operating characteristic curve and the area under the curve (AUC) were applied to evaluate the diagnostic reliability.

Results: There was no statistically significant difference between ADC values obtained from normal volunteers at C2-C7 levels (P < 0.05). The ICC and spearman coefficient of lADC and rADC indicated excellent test-retest and inter-rater reliability. The mean lADC and rADC were significantly higher from patients than that from volunteers (all P < 0.01). The lADC had moderate to good correlations with mJOA and NDI (all P < 0.0001). Moreover, rADC had good to excellent correlations with mJOA and NDI (all P < 0.0001). Comparing AUCs, rADC was significantly superior in diagnosis which participants were CSM than lADC (P = 0.0118).

Conclusion: The ms-DWI could be applied in diagnosis and quantitive assessment of CSM according to lADC and rADC. A new parameter, rADC, could be served as a diagnostic indice for CSM, which may quantitively reflect the severity of CSM. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-020-06381-zDOI Listing
June 2020

Comparison of Anterior Controllable Antedisplacement and Fusion With Posterior Laminoplasty in the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective, Randomized, and Control Study With at Least 1-Year Follow Up.

Spine (Phila Pa 1976) 2020 Aug;45(16):1091-1101

Spine Center, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.

Study Design: A prospective, randomized, controlled study.

Objective: To compare anterior controllable antidisplacement and fusion (ACAF) with laminoplasty in the treatment of multilevel ossification of the posterior longitudinal ligament (OPLL), and evaluate the efficacy and safety of this procedure.

Summary Of Background Data: The optimal approach for the treatment of OPLL still remains controversial. Both anterior and posterior approaches have their advantages and disadvantages.

Methods: Between September 2016 and April 2018, a total of 80 patients with multilevel OPLL were randomized in a 1:1 ratio to ACAF group and laminoplasty group. All patients were followed up at least 1 year. Clinical and radiological results were compared between ACAF group and laminoplasty group.

Results: ACAF took a longer operation time. C5 palsy and axial pain occurred more commonly in laminoplasty group, whereas dysphagia and hoarseness appeared easily in ACAF group. At 1-year follow-up, the final Japanese Orthopedic Association (JOA) score and recovery rate were significant higher in ACAF group than those in laminoplasty group, when occupying rate (OR) was not less than 60%, or K-line was negative. ACAF was also good at preservation of cervical lordosis and sagittal balance, but range of movement of cervical spine in both groups decreased significantly.

Conclusion: Generally speaking, ACAF is a safe and effective alternative for multilevel OPLL. Compared with laminoplasty, ACAF is more effective in the cases when OR is not less than 60%, or K-line is negative.

Level Of Evidence: 2.
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http://dx.doi.org/10.1097/BRS.0000000000003462DOI Listing
August 2020

Inflammatory macrophages facilitate mechanical stress-induced osteogenesis.

Aging (Albany NY) 2020 02 25;12(4):3617-3625. Epub 2020 Feb 25.

Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200001, China.

Mechanical stress has been recognized as a key inducer of bone regeneration in bone damage, which is experimentally mimicked by distraction osteogenesis (DO), a bone-regenerative process induced by post-osteotomy distraction of the surrounding vascularized bone segments, and realized by new bone formation within the distraction gap. The mechanisms that underlie the DO-induced bone regeneration remain poorly understood and a role of macrophages in the process has been inadequately studied. Here, in a mouse model of DO, we showed significant increase in macrophages in the regeneration area. Moreover, in a loss-of-function approach by depleting inflammatory macrophages, the bone regeneration was compromised by assessment of histology and molecular biology. Thus, our study demonstrates the necessary participation of inflammatory macrophages in the process of DO-induced bone regeneration, and suggests that targeting inflammatory macrophages may help to improve clinical bone repair.
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http://dx.doi.org/10.18632/aging.102833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066933PMC
February 2020

A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases.

Int Orthop 2020 05 21;44(5):935-945. Epub 2020 Feb 21.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.

Study Design: This is a prospective case-controlled study.

Purpose: The purpose of this study is to investigate the effect of a modified transforaminal lumbar interbody fusion (TLIF) on the immediate post-operative symptoms in patients with lumbar disc herniation (LDH) accompanied with stenosis.

Methods: A total of 204 LDH patients with single-level TLIF were enrolled. According to the sequence of the placement of rods and cage, patients were divided into group R (rod-prior-to-cage) and group C (cage-prior-to-rod). Neurological function was evaluated by the Japanese Orthopedic Association (JOA) score. Radiological assessment includes height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL). Change of original symptoms (pain/numb) and new-onset symptoms (pain/numb) after surgery were also recorded.

Results: Patients in group R had less change of HIS at L3/4, L4/5, and L5/S1 levels compared with pre-operation (all p > 0.05), whereas group C had larger change (all p < 0.05). No statistical difference was found in FH between the two groups before and after surgery at L3/4, L4/5, and L5/S1, respectively (all p > 0.05). In terms of FA, patients in group R had better improvement after surgery than those in group C at L3/4 and L4/5 (both p < 0.05). Patients in both groups acquired good improvement of neurological function. However, there were fewer patients in group R who experienced post-operative leg pain or numb compared with those in group C (p < 0.05).

Conclusion: The modified open TLIF can significantly reduce the incidence of immediate post-operative symptoms for patients with single-level lumbar disc herniation via installation of rods prior to insertion of cage and the "neural standard" should serve as the goal of decompression for spine surgeons to restore disc/foraminal height and to minimize nerve distraction.
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http://dx.doi.org/10.1007/s00264-020-04508-xDOI Listing
May 2020

Increased gene dosages induce congenital cervical vertebral malformations in humans and mice.

J Med Genet 2020 06 30;57(6):371-379. Epub 2019 Dec 30.

Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.

Background: Congenital vertebral malformations (CVMs) manifest with abnormal vertebral morphology. Genetic factors have been implicated in CVM pathogenesis, but the underlying pathogenic mechanisms remain unclear in most subjects. We previously reported that the human 16p11.2 BP4-BP5 deletion and its associated dosage reduction caused CVMs. We aim to investigate the reciprocal 16p11.2 BP4-BP5 duplication and its potential genetic contributions to CVMs.

Methods And Results: Patients who were found to carry the 16p11.2 BP4-BP5 duplication by chromosomal microarray analysis were retrospectively analysed for their vertebral phenotypes. The spinal assessments in seven duplication carriers showed that four (57%) presented characteristics of CVMs, supporting the contention that increased dosage could induce CVMs. For further in vivo functional investigation in a model organism, we conducted genome editing of the upstream regulatory region of mouse using CRISPR-Cas9 and obtained three mouse mutant alleles ( to ) with elevated expression levels of . Luciferase reporter assays showed that the allele presented with the 160% expression level of that observed in the reference (+) allele. Therefore, the homozygous mice could functionally mimic the dosage of heterozygous carriers of 16p11.2 BP4-BP5 duplication (approximately 150%, ie, 3/2 gene dosage of the normal level). Remarkably, 60% of the mice manifested with CVMs. Consistent with our observations in humans, the CVMs induced by increased dosage in mice mainly affected the cervical vertebrae.

Conclusion: Our findings in humans and mice consistently support that an increased dosage contributes to the risk of developing cervical CVMs.
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http://dx.doi.org/10.1136/jmedgenet-2019-106333DOI Listing
June 2020

Analysis of the spinal cord angle for severe cervical ossification of the posterior longitudinal ligament: comparison between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy.

Eur Spine J 2020 05 3;29(5):1001-1012. Epub 2019 Dec 3.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.

Objective: To investigate the changes of spinal cord angle between anterior controllable antedisplacement and fusion (ACAF) and posterior laminectomy in treating severe ossification of the posterior longitudinal ligament (OPLL).

Patients And Methods: Seventy-one patients with cervical OPLL were enrolled. Patients in this study were divided into group A and group P. Japanese Orthopaedic Association (JOA) score was utilized to evaluate the neurological function. Radiological assessments included the spinal cord angle, Cobb angle, and area of the spinal cord. Surgery-related complications were also recorded.

Results: At the final follow-up, patients in group A had better recovery of local and whole cord angle, and the area of the cord than those in group P (all p < 0.05). A strong correlation between the change of local cord angle and the recovery of the spinal cord area was observed (r = - 0.867, p < 0.05). In addition, patients in group P had worse Cobb angle (9.15° ± 1.10°) than in group A (18.58° ± 0.73°) (p < 0.05). The final mean JOA score and its improvement rate were better in the group A than in group P (p < 0.05). During the follow-up, 15.15% patients in group P experienced surgery-related complications and 7.89% in group A.

Conclusion: This present study revealed that ACAF can achieve better recovery of the expansion of the spinal cord, spinal cord alignment, and Cobb angle, with better postoperative JOA score and less complications, compared with posterior laminectomy in treating severe cervical OPLL. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-019-06216-6DOI Listing
May 2020

Endoplasmic reticulum stress regulates mechanical stress-induced ossification of posterior longitudinal ligament.

Eur Spine J 2019 10 19;28(10):2249-2256. Epub 2019 Jul 19.

Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, No 415, Fengyang Road, Huangpu District, Shanghai, China.

Purpose: The pathogenesis of ossification of posterior longitudinal ligament (OPLL) is not completely clear. Previous study has confirmed a single-pass type I endoplasmic reticulum (ER) membrane protein kinase (PERK), which is a major transducer of the ER stress, participates in the process of OPLL in vitro. This study aimed to demonstrate the role of ER stress in mechanical stress (MS)-induced OPLL.

Methods: The posterior longitudinal ligaments were collected intraoperatively. The expression of ER stress markers in ligament tissue samples was compared between OPLL and non-OPLL patients in vivo. Ligament fibroblasts were isolated and cultured. Loaded by MS, the expression of ER stress markers in fibroblasts deriving from non-ossified areas of the ligament tissues from OPLL patients was detected. The influence of inhibition of ER stress on MS-induced OPLL and activation of mitogen-activated protein kinase (MAPK) pathways by MS was also investigated.

Results: We confirmed the ER stress markers were highly expressed in non-ossified areas of the ligament tissues from OPLL patients but could barely be detected in the ligaments from non-OPLL patients in vivo. We also found ER stress could be activated by MS during the process of OPLL in vitro. Moreover, inhibition of ER stress could hinder MS-induced OPLL and activation of MAPK signaling pathways by MS in vitro.

Conclusion: Activated ER stress was observed in OPLL patients both in vitro and in vivo. Mechanical stress could activate ER stress response in posterior longitudinal ligament fibroblasts and further promote OPLL in vitro. In this process, ER stress might work through the MAPK signaling pathways. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-019-06074-2DOI Listing
October 2019

Metabolic Changes in Serum in the Rat Model of Cauda Equina Injury.

World Neurosurg 2019 Oct 16;130:e1051-e1060. Epub 2019 Jul 16.

Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.

Objective: To identify the potent metabolic biomarkers of cauda equina injury (CEI).

Methods: A total of 50 Sprague-Dawley rats were used to establish the CEI model in this study. The serum was collected at 12 hours, 1 day, 2 days, and 7 days after surgery. Ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry was performed to analyze metabolic changes in the serum of the CEI rats from different groups. The differences between the metabolic profiles of the rats in 5 groups were analyzed using partial least squares discriminant analysis (PLS-DA).

Results: Metabolic profiling revealed significant differences between the sham operated and other groups. A total of 57 potential CEI metabolite biomarkers were identified between the sham operated group and the model groups at the different time points. Principal component analysis and PLS-DA analyses revealed clear segregation between CEI versus sham operation group. These potential biomarkers appear in 15 metabolic pathways.

Conclusions: Using metabolomic analysis, we were able to identify the novel serum biomarkers of CEI that may be relevant to the diagnosis and prognosis of CEI. In addition, our pathway analysis provides important insights into the etiology of CEI and a basis for clinical diagnosis, locating biomarkers in the early stages of the pathological process.
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http://dx.doi.org/10.1016/j.wneu.2019.07.077DOI Listing
October 2019

How to Avoid Postoperative Remaining Ossification Mass in Anterior Controllable Antedisplacement and Fusion Surgery.

World Neurosurg X 2019 Jul 1;3:100034. Epub 2019 Apr 1.

Second Department of Spine Surgery, Changzheng Hospital, Shanghai, China.

Objectives: To retrospectively review the cases with ossification of the posterior longitudinal ligament (OPLL) treated with anterior controllable antedisplacement and fusion (ACAF). Patients with postoperative remaining ossification mass (PROM) are analyzed to figure out the causes and preventions of this problem.

Methods: A total of 115 patients were included. PROM was identified as remaining OPLL existed in the spinal canal other than included in the vertebral-OPLL complex on postoperative computed tomography. The Japanese Orthopaedic Association scoring system was used to evaluate the neurologic status. Surgery-related complications such as cerebrospinal fluid (CSF) leakage and spinal cord or nerve injury were all recorded. The patients with the PROM group and those without the PROM group were compared.

Results: There were 14 patients with wide-base OPLL (12.2%) and 10 patients (8.7%) with PROM among the 115 patients with OPLL. The 10 patients with PROM were all with wide-base OPLL. The average improvement rate of Japanese Orthopaedic Association score in patients without PROM was significantly larger than that in patients with PROM (69.5 ± 22.6% vs. 36.7 ± 22.0, < 0.01). Incidence rate of postoperative CSF leakage and neural deterioration were significantly higher in patients with PROM than that in patients without PROM (CSF leakage, 40.0% vs. 5.9%; neural deterioration, 50.0% vs. 3.0%). No other complications were observed.

Conclusions: The occurrence of PROM might cause complications and poor neural function recovery in patients treated with ACAF. Surgical techniques should be noted to avoid PROM in ACAF surgery.
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http://dx.doi.org/10.1016/j.wnsx.2019.100034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584598PMC
July 2019

A Preliminary Attempt of Nonintervention in the Treatment of Patients with Intervertebral Disc Calcification Combined with Ossification of the Posterior Longitudinal Ligament.

World Neurosurg 2019 Sep 27;129:181-185. Epub 2019 May 27.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China. Electronic address:

Background: Calcification of intervertebral disc is a common impairment, which has been considered as the degenerative condition of the spine. In clinical practice, we note that the onset of intervertebral disc calcification (IDC) and ossification of the posterior longitudinal ligament (OPLL) can exist simultaneously in some cases, especially in younger children. However, only 8 cases have been reported in detail previously. In addition, controversy remains in terms of the best way to treat this condition.

Case Description: An 8-year-old female child was referred to our department in March 2018 complaining of severe back pain and neck pain with a sign of neurologic dysfunction. Computed tomography and magnetic resonance imaging revealed the calcified intervertebral disc and OPLL at the C5-C6 level and spinal cord compression. We performed a noninterventional strategy for the patient. The patient's symptom recovered significantly in approximately 1 month. At 6 months of follow-up, the patient felt no discomfort, and computed tomography revealed the complete resorption of ossified lesion. Magnetic resonance imaging also showed no sign of compression on the spinal cord and nerve root at the involved segment.

Conclusions: Pediatric IDC accompanied with OPLL is much less frequent, but we must be aware of this disease. Since the distribution of this disease is age-specific and sex-specific, further research is necessary. Treatment for IDC combined with OPLL needs to follow the treatment principles as described in the text.
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http://dx.doi.org/10.1016/j.wneu.2019.05.169DOI Listing
September 2019

Profiling and bioinformatics analysis of differentially expressed circular RNAs in human intervertebral disc degeneration.

Acta Biochim Biophys Sin (Shanghai) 2019 Jun;51(6):571-579

Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.

The functional changes of nucleus pulposus (NP) cells are considered to be the initiating factors of intervertebral disc degeneration (IDD), and the differentially expressed circRNAs in NP cells may play an important role in the process of IDD. To identify circular RNAs (circRNAs) associated with human IDD, we isolated the NP cells from human degenerated and non-degenerated intervertebral disc and identified NP cells by microscopy and cell proliferation. CircRNA microarray expression profiles were obtained from NP cells of degenerated and non-degenerated intervertebral disc and further validated by quantitative reverse transcription PCR (qRT-PCR). The expression data were analyzed by bioinformatics. Microarray analysis identified 7294 circRNAs differentially expressed in degenerated human IDD NP cells. Among them, 3724 circRNAs were up-regulated and 3570 circRNAs were down-regulated by more than 2 folds. After validating by qRT-PCR, we predicted the possible miRNAs of the top dysregulated circRNAs using TargetScan, and miRanda. Furthermore, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that the most modulated circRNAs regulate the viability, degradation, apoptosis and oxidative stress in NP cells, and the possible mechanism underlying IDD was discussed. These results revealed that circRNAs may play a role in IDD and might be a promising candidate molecular target for gene therapy.
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http://dx.doi.org/10.1093/abbs/gmz036DOI Listing
June 2019

Skip corpectomy and fusion (SCF) versus anterior controllable antedisplacement and fusion (ACAF): which is better for patients with multilevel cervical OPLL?

Arch Orthop Trauma Surg 2019 Nov 5;139(11):1533-1541. Epub 2019 Apr 5.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415, Fengyang Road, Shanghai, 200003, People's Republic of China.

Background: The aim of this study was to compare the clinical efficacy and radiological outcomes of skip corpectomy and fusion (SCF) with anterior controllable antedisplacement and fusion (ACAF) for treating multilevel ossification of the posterior longitudinal ligament (OPLL).

Methods: 62 patients with multilevel OPLL who had undergone SCF or ACAF were analyzed retrospectively. Types of OPLL, occupying ratio (OR), Japanese Orthopaedic Association (JOA) score, Recovery Rate (RR), Neck Disability Index (NDI) score, Cobb's angles of C2-C7, operation time, blood loss, hospital stay, ratings for fusion assessment and complications were recorded and assessed.

Results: Postoperative C2-C7 Cobb's angle (11.1 ± 3.2° vs. 13.7 ± 2.5°; P < 0.05), NDI scores at final follow-up (14.3 ± 1.6 vs. 13.3 ± 1.3; P < 0.05), and rate of cerebral fluid (CSF) leakage (5, 16.7% vs. 0,0%; P < 0.05) were significantly better in the ACAF group. At 6 months, bone graft fusion rate was significantly greater in the ACAF group (24.75% vs. 15.50%; P < 0.05).

Conclusions: Surgical treatment of multilevel OPLL by SCF or ACAF showed no significant differences in clinical outcomes, with the exception of better NDI scores at final follow-up in ACAF. In addition, ACAF is better than SCF in terms of early bone graft fusion rate, lordotic curvature improvement, risk of CSF leakage.
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http://dx.doi.org/10.1007/s00402-019-03182-yDOI Listing
November 2019

Assessing Spinal Cord Injury Area in Patients with Tethered Cord Syndrome by Diffusion Tensor Imaging.

World Neurosurg 2019 Jul 27;127:e542-e547. Epub 2019 Mar 27.

Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China. Electronic address:

Objective: We evaluated the spinal cord injury range in patients with tethered cord syndrome (TCS) who had urinary incontinence.

Methods: We included 30 subjects in the present study, 15 with tethered cord syndrome and urinary incontinence and 15 normal volunteers. All 30 subjects underwent magnetic resonance diffusion tensor imaging (DTI). Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated from a region of interest). All the patients and volunteers were measured 4 segments above the conus medullaris.

Results: All the FA values and ADC values could be measured from the DTI scans in the normal volunteers and patients. The average ADC value was 1.244 ± 0.061 in the control group and 1.052 ± 0.045 in the TCS group. The difference was statistically significant (P < 0.05). The average FA value was 0.866 ± 0.030 in the control group and 1.079 ± 0.049 in the TCS group, with a statistically significant difference (P < 0.05). The differences in the ADC values in each segment were statistically significant in the 2 groups, although only the difference in the FA value of the fourth segment above the conus medullaris was statistically significant in the 2 groups.

Conclusion: DTI can detect the spinal cord damage range in patients with TCS. In the patients with urinary incontinence, the spinal cord damage was widespread, and the most severe lesion was at the fourth segment above the conus medullaris. This might indicate that decompression of the spinal cord should at least include the fourth segment above the conus medullaris.
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http://dx.doi.org/10.1016/j.wneu.2019.03.195DOI Listing
July 2019