Publications by authors named "Wenyuan Ding"

96 Publications

Intervertebral Disc Degeneration Induced by Needle Puncture and Ovariectomy: A Rat Coccygeal Model.

Biomed Res Int 2021 17;2021:5510124. Epub 2021 May 17.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.

Objectives: To establish a novel animal model of intervertebral disc degeneration (IVDD) in rats and to investigate the effect of 17-estradiol (E2) intervention in this model.

Methods: This study was divided into two parts: animal model (four groups: Sham, ovariectomy (OVX), Puncture, and OVX+Puncture; three-time points: 4, 8, and 12 weeks; three female rats/group/time point) and drug intervention (Sham, OVX+Puncture+corn oil, and OVX+Puncture+E2; three female rats/group). The rats were analyzed by micromagnetic resonance imaging (MRI), hematoxylin and eosin (HE) staining, and safranin-O staining.

Results: MRI and histological scores significantly differed among the four groups at the three-time points (all < 0.05). IVDD progressed with time in the OVX, Puncture, and OVX+Puncture groups (all < 0.05). The changes were the most obvious in the OVX+Puncture group. In the E2 intervention part, the Veh group had the worst MRI signals and histological scores ( < 0.05). The MRI scores in the E2 group were less obvious compared to the Sham group ( > 0.05). Also, the histological scores were significantly different between the Sham and E2 groups ( < 0.05).

Conclusions: The combination of ovariectomy and needle puncture can synergically induce IVDD in rat coccygeal discs. Estrogen treatment can effectively ameliorate IVDD progression in the newly established IVDD models.
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http://dx.doi.org/10.1155/2021/5510124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147532PMC
May 2021

Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis.

Adv Ther 2021 Jul 26;38(7):3803-3815. Epub 2021 May 26.

Department of Anatomy, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050017, China.

Introduction: Low back pain (LBP) still exists at the follow-up visit in some cases after long fusion arthrodesis for adult scoliosis. However, few available studies have elaborated the reasons and factors associated with this symptom. Therefore, the aim of the current study was to identify the correlative factors and predictors of postoperative LBP after long fusion arthrodesis and provide evidence to improve the surgical strategy.

Methods: Seventy-nine patients with adult scoliosis who underwent long fusion arthrodesis were divided into a group with no or mild LBP (NLBP group) and one with moderate or severe LBP (MLBP group) according to the average Oswestry Dability Index (ODI) at the last follow-up visit. The Japanese Orthopaedic Association (JOA) score, ODI and complications were used to evaluate clinical outcomes. %Fat infltration area (%FIA), sagittal and coronal parameters were recorded to evaluate radiological outcomes. Multivariate logistic regression analysis was conducted to identify the predictors and correlative factors for postoperative LBP.

Results: Thirty-three patients (41.77%) with ODI (30.06% ± 6.92%) higher than the average at the last follow-up were divided into the MLBP group, while the rest (58.23%) with last follow-up ODI (13.26% ± 5.31%) lower than the average were divided into the NLBP group. In multivariate logistic regression, the preoperative sagittal vertical axis (SVA) (P < 0.001), %FIA (P = 0.003) and osteoporosis (P = 0.016) were identified to be predictors and last follow-up SVA (P < 0.001), last follow-up lumbar lordosis (LL) (P = 0.031) and adjacent segment degeneration (ASD) (P = 0.043) were identified as correlative factors. The receiver-operating characteristic (ROC) curve showed satisfactory accuracy in preoperative SVA (P < 0.001) and %FIA (P < 0.001) to predict postoperative LBP.

Conclusion: Postoperative LBP after long fusion arthrodesis for adult scoliosis was common. Postoperative LBP was associated with increased SVA and decreased LL and ASD. Preoperative SVA > 3.54 cm, %FIA > 24.82% and osteoporosis showed good accuracy to predict the postoperative symptoms. Optimal surgical methods should be used for patients with these factors to decrease the incidence and degree of postoperative LBP.
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http://dx.doi.org/10.1007/s12325-021-01763-1DOI Listing
July 2021

Surgical site infection after posterior lumbar interbody fusion and instrumentation in patients with lumbar degenerative disease.

Int Wound J 2021 Feb 12. Epub 2021 Feb 12.

Department of Spinal Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China.

We designed this retrospective study with aims to investigate the incidence and risk factors associated with surgical site infection (SSI) following posterior lumbar interbody fusion (PLIF) and instrumentation in patients with lumbar degenerative disease. Eligible patients treated between January 2016 and June 2019 were included. Electronic medical records were inquired for data extraction and collection. Patients with SSI and without SSI were compared using the univariate analyses, and the association between variables and risk of SSI was investigated using multivariate logistics regression analyses. Among 1269 patients, 43 were found to have SSI, indicating a rate of 3.4%. Microbiological culture tests showed 88.4% patients had a positive result. Four SSIs were caused by mixed bacterial, and the remaining 34 by single bacteria. Multiple drug-resistant strains were detected in 25 (65.8%) SSIs, with meticillin-resistant coagulase-negative staphylococcus (MRCNS) predominating (12, 48.0%). ASA III and above (odd ratio (OR), 1.67; 95% confidence interval (CI), 1.11 to 3.07), preoperative stay (OR, 1.13; 95% CI, 1.04 to 1.23), heart disease (OR, 2.88; 95% CI, 1.24 to 6.71), diabetes mellitus (OR, 3.28; 95% CI, 1.66 to 6.47) and renal insufficiency (OR, 4.23; 95% CI, 1.26 to 10.21), prolonged prophylactic antibiotics use (OR, 4.43; 95% CI, 2.30 to 8.54), and the reduced lymphocyte count (OR, 2.11; 95% CI, 1.03 to 4.33) were identified as independent risk factors associated with SSI. These factors, although most not modifiable, should be kept in mind, optimised for surgical conditions, or readily adjusted in the future postoperative management of antibiotics, to reduce postoperative SSIs.
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http://dx.doi.org/10.1111/iwj.13562DOI Listing
February 2021

Novel PGC-1/ATF5 Axis Partly Activates UPR and Mediates Cardioprotective Role of Tetrahydrocurcumin in Pathological Cardiac Hypertrophy.

Oxid Med Cell Longev 2020 26;2020:9187065. Epub 2020 Dec 26.

Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, 127 Changle West Road, Xi'an, 710032, China.

Mitochondrial unfolding protein response (UPR) effectively resists the pathological cardiac hypertrophy and improves the mitochondrial function. However, the specific activation mechanism and drugs that can effectively activate UPR in the cardiac muscle are yet to be elucidated. The aim of this study was to determine the regulation role of UPR on preventing pathological cardiac hypertrophy by tetrahydrocurcumin (THC) and explore its underlying molecular mechanism. Male C57BL/6J wild-type (WT) mice were divided into a control group and subjected to sham treatment for 4 weeks, and a test group which was subjected to transverse aortic constriction (TAC) surgery. Animals in the control and test group were orally administered THC (50 mg/kg) for 4 weeks after TAC procedure; an equivalent amount of saline was orally administered in the control sham-treated group and the TAC group. Subsequently, oxidative stress and UPR markers were assessed in these mice, and cardiac hypertrophy, fibrosis, and cardiac function were tested. Small interfering RNA (siRNA) targeting proliferator-activated receptor-gamma coactivator (PGC)-1 and activating transcription factor 5 (ATF5) were used to determine the UPR activation mechanism. THC supplement partly upregulated UPR effectors and inhibited TAC-induced oxidative stress compared with TAC-operated WT mice, thereby substantially attenuating contractile dysfunction, cardiac hypertrophy, and fibrosis. Furthermore, PGC-1 knockdown blunted the UPR activation and the cardioprotective role of THC. The interaction between PGC-1 and ATF5 was tested in neonatal rat cardiac myocytes under normal conditions. The results showed that PGC-1 was an upstream effector of ATF5 and partly activated UPR. In vitro, phenylephrine- (PE-) induced cardiomyocyte hypertrophy caused ATF5 upregulating rather than downregulating corresponding to the downregulation of PGC-1. The PGC-1/ATF5 axis mediated the UPR activation and stress-resistance role of THC in vitro. Collectively, the present study provides the first evidence that PGC-1 and ATF5 can form a signaling axis to partly activate UPR that mediates the cardioprotective role of THC in pathological cardiac hypertrophy.
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http://dx.doi.org/10.1155/2020/9187065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781724PMC
December 2020

Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis.

J Orthop Surg Res 2020 Dec 3;15(1):582. Epub 2020 Dec 3.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.

Study Design: A meta-analysis.

Objective: We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery.

Methods: An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

Results: Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD.

Conclusions: In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.
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http://dx.doi.org/10.1186/s13018-020-02032-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713357PMC
December 2020

A modified protocol for the isolation, culture, and cryopreservation of rat embryonic neural stem cells.

Exp Ther Med 2020 Dec 6;20(6):156. Epub 2020 Oct 6.

Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China.

Neural stem cells (NSCs) are characterized by their potential for self-renewal and ability to differentiate into neurons, astrocytes, and oligodendrocytes. They are of great value to scientific studies and clinical applications. Culturing NSCs is important for characterizing their properties under controlled environmental conditions that may be modified and monitored accurately. The present study explored a modified, detailed and efficient protocol for the isolation, culture and cryopreservation of rat embryonic NSCs. In particular, the viability, nestin expression, and self-renewal and multi-differentiation capabilities of NSCs cryopreserved for various periods of time (7 days, or 1, 6 or 12 months) were characterized and compared. Rat embryonic NSCs were successfully obtained and maintained their self-renewal and multipotent differentiation capabilities even following long-term cryopreservation (for up to 12 months).
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http://dx.doi.org/10.3892/etm.2020.9285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571407PMC
December 2020

Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials.

Eur Spine J 2020 11 8;29(11):2734-2744. Epub 2020 Aug 8.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.

Purpose: To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF).

Methods: A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration's tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software.

Results: A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC.

Conclusion: In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures.
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http://dx.doi.org/10.1007/s00586-020-06561-xDOI Listing
November 2020

Hounsfield Unit for Assessing Vertebral Bone Quality and Asymmetrical Vertebral Degeneration in Degenerative Lumbar Scoliosis.

Spine (Phila Pa 1976) 2020 Nov;45(22):1559-1566

Orthopaedic Department of Peking University Third Hospital, Beijing, China.

Study Design: Retrospective analysis.

Objectives: The aim of this study was to demonstrate the correlation between degenerative lumbar scoliosis (DLS) and osteoporosis based on Hounsfield unit (HU) measurement from computed tomography (CT) scans, and to investigate the asymmetrical vertebral degeneration in DLS.

Summary Of Background Data: The correlation between DLS and osteoporosis measured by dual-energy x-ray absorptiometry (DEXA) is debated, since T-scores measured by DEXA scan can be overestimated due to abdominal vessel wall calcification, degenerative bony spurs, and facet hypertrophy. The reliability and accuracy of HU to determine osteoporosis are shown in many reports, but it has never been used to assess the vertebral bone quality for DLS patients.

Methods: Nighty-five DLS patients were retrospectively reviewed. Regions of interest for HU were measured on three coronal images of the lumbar vertebrae. HU measurement of the whole vertebrae from L1 to L5 was obtained, then HU measurement within concave and convex sides were obtained separately in L5, upper and lower end vertebrae, apex vertebrae, neutral vertebrae, stable vertebrae.

Results: HU value presented a gradually increasing trend from L1 to L5. No correlation was detected between Cobb angle and mean HU value of the 5 lumbar vertebrae, or between Cobb angle and HU value of every lumbar vertebrae separately. HU value was higher within concavity than that within convexity of the same vertebrae both in major and compensatory curve. Asymmetric HU ratio in apex vertebrae positively correlated with Cobb angle. Stable vertebrae were the first proximal vertebrae that present opposite orientation of asymmetric HU ratio from the other lumbar vertebrae.

Conclusion: Progression of degenerative scoliosis presents no correlation with osteoporosis based on HU measurement but could increase the asymmetrical vertebral degeneration, especially in apex vertebrae. Distraction of the pedicle screws at concave side, instead of compression of pedicle screws at convex side, should be a priority to correct lumbosacral curve.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003639DOI Listing
November 2020

Resveratrol protects against apoptosis induced by interleukin-1β in nucleus pulposus cells via activating mTOR/caspase-3 and GSK-3β/caspase-3 pathways.

Biosci Rep 2020 07;40(7)

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China.

Objective: The purpose of the present study was to investigate the specific downstream signaling pathway mediated by PI3K/Akt in resveratrol (RES) anti-apoptosis of nucleus pulposus cells (NPCs).

Materials And Methods: Human NPCs were cultured and divided into six groups. Interleukin (IL)-1β was used to induce apoptosis and RES to inhibit apoptosis. Fluorescence-activated cell sorting (FACS) analysis was used to test apoptotic incidence of NPCs, cell counting kit-8 (CCK-8) assay was performed to detect cell viability, The expression level of caspase-3 mRNA was detected by RT-qPCR, and protein levels were determined by Western blot.

Results: Flow cytometry analysis showed that IL-1β increased the apoptosis rate of NPCs in each group, and RES significantly decreased the apoptosis rate, while rapamycin (RAPA) and SB216763 inhibited the effect of RES and increased the apoptosis rate again. Similarly, CCK-8 showed that IL-1β decreased activity of NPCs in each group, while RES increased cell activity, RAPA and SB216763 inhibited the effect of RES and decreased cell activity. RT-qPCR results showed IL-1β significantly increased the level of caspase-3 expression, but it was significantly decreased by using RES, RAPA and SB216763 respectively attenuated effects of RES. Western blot results showed that activated caspase-3 was inhibited by RES effect, and was up-regulated again after the addition of RAPA and SB216763. In addition, p-mTOR and p-GSK-3β were up-regulated by RES and down-regulated by RAPA and SB216763.

Conclusion: RES can inhibit apoptosis induced by IL-1β in human NPCs. PI3K/Akt/mTOR/caspase-3 and PI3K/Akt/GSK-3β/caspase-3 pathways are potential mechanisms underlying this process.
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http://dx.doi.org/10.1042/BSR20202019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391128PMC
July 2020

ClC-2 inhibition prevents macrophage foam cell formation by suppressing Nlrp3 inflammasome activation.

Biosci Biotechnol Biochem 2020 Oct 13;84(10):2096-2103. Epub 2020 Jul 13.

Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University , Jinan, China.

Macrophage foam cell formation and inflammation are a pathological hallmark of atherosclerosis. ClC-2 has been implicated in various pathological processes, including inflammation and lipid metabolic disorder. However, the functional role of ClC-2 in macrophage foam cell formation and inflammation is unclear. Here, we found that ClC-2 was dominantly expressed in macrophages of atherosclerotic plaque and increased in atherogenesis. Knockdown of ClC-2 inhibited ox-LDL -induced lipid uptake and deposition in macrophages. The increase in CD36 expression and the decrease in ABCA1 expression induced by ox-LDL were alleviated by ClC-2 downregulation. Further, ClC-2 lacking limited the ox-LDL-induced secretion of inflammatory cytokines and chemokine, and suppressed Nlrp3 inflammasome activation. Restoration of Nlrp3 expression reversed the effect of ClC-2 downregulation on macrophage lipid accumulation and inflammation. Collectively, our study demonstrates that ClC-2 knockdown ameliorates ox-LDL-induced macrophage foam cell formation and inflammation by inhibiting Nlrp3 inflammasome activation.
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http://dx.doi.org/10.1080/09168451.2020.1793294DOI Listing
October 2020

Pelnac® Artificial Dermis Assisted by VSD for Treatment of Complex Wound with Bone/Tendon Exposed at the Foot and Ankle, A Prospective Study.

J Invest Surg 2020 Aug 26;33(7):636-641. Epub 2018 Dec 26.

Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China.

This study aims to assess the efficacy and safety of Pelnac dermal regeneration template assisted by vacuum sealing drainage (VSD) and a split-thickness skin graft to cover the large skin and soft-tissue defects at foot and ankle. This study began from March 2013, up to February 2017. A total of 16 patients met the inclusion and exclusion criteria and were included. For every patient, 2 separate operations were performed, the first being thorough debridement of necrotic tissues immediate coverage of VSD at continuous negative pressure suction, and the second being the autologous split-thickness skin graft. At each follow-up, relevant data were documented. The average follow-up was 16.5 months (range, 12 to 42 months). No infections, hematoma, or seroma were observed. 13 out of 16 patients had a complete skin graft "take" (100%). Patients' satisfaction of esthetic appearance was 76.5 ± 5.2/100. The VSS value was 2.2 ± 2.1, representing a good result. Regarding the sensory recovery, the response "normal or near normal" could be obtained in 14/16 patients. Mean AROM for extension/flexion of the ankle was 48.5 ± 4.8° (range 35-62°), and 93.7% (15/16) of patient could obtain a satisfying functional result. Our report indicated Pelnac provided an effective method for management of complex wounds with underlying bone or tendons exposed.
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http://dx.doi.org/10.1080/08941939.2018.1536177DOI Listing
August 2020

Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries.

J Thromb Thrombolysis 2021 Feb;51(2):397-404

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Street, Shijiazhuang, 050051, Hebei, China.

To determine the incidence of DVT and to evaluate the risk factors of DVT under LMWH prophylaxis in patients with thoracolumbar fractures caused by high‑energy injuries postoperatively. A total of 534 patients from January 2016 to November 2019 were included in this retrospective study. Medical record data, including demographic data, perioperative variables, and laboratory results, were collected. LMWH prophylaxis was used for DVT in all the patients. The incidence and risk factors of DVT after surgery were identified by logistic regression analysis and receiver operating characteristic (ROC) curve analysis. The overall incidence of postoperative DVT was 18.91% (101/534). Three patients (0.56%) had proximal DVT and ninety-eight (18.35%) patients had distal DVT. The incidence of postoperative DVT in patients with thoracic fractures was 26.80% and 15.50% with lumbar fractures. The multivariate analysis showed that six risk factors increased the incidence of postoperative DVT, including advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, fibrinogen (FIB), and D-dimer. The ROC analysis indicated that the diagnostic value of D-dimer was highest whose area under the ROC curves (AUC) value was 0.754. Despite LMWH prophylaxis, the risk of postoperative DVT is still very high, especially in thoracic fracture. Advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, FIB, and D-dimer are risk factors for DVT. Moreover, the diagnostic value of D-dimer is the highest among these factors.
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http://dx.doi.org/10.1007/s11239-020-02192-7DOI Listing
February 2021

Clinical Efficacy of Laminectomy with Instrumented Fixation in Treating Thoracolumbar Intradural Extramedullary Schwannomas: A Comparative Study.

Med Sci Monit 2020 Jun 9;26:e921719. Epub 2020 Jun 9.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).

BACKGROUND This study investigated the clinical effect of laminectomy plus pedicle screw fixation in treating thoracolumbar intradural extramedullary schwannomas. MATERIAL AND METHODS Between October 2011 and May 2017, 57 patients undergoing resection of thoracolumbar schwannomas were retrospectively identified and included in the study. Based on the surgical procedures used, all participants were assigned to either the laminectomy-only group (n=33) or the combination group (laminectomy plus pedicle screw fixation, n=24). All participants were followed up for over 2 years. In the laminectomy, the spinal process, vertebral laminae, and bilateral upper articular processes of the surgical segments were completely resected and the lower articular processes were reserved. For further analysis, we evaluated the pain levels using visual analogue scale (VAS) score. The assessment of neurological function was performed with Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI). The comparisons of Cobb angle changes were carried out pre-surgery and post-surgery. RESULTS The demographic data were well matched between the laminectomy-only group and combination group, without significant differences (P>0.05). After surgery, both surgical procedures achieved significant improvement in VAS score, ODI, and JOA score (P<0.001), but no significant differences were found between these 2 surgical procedures (P>0.05). The postoperative change in Cobb angle indicated a significant difference in the laminectomy-only group, but not in the combination group (P<0.05). In addition, postoperative spinal instability/deformity was found in the laminectomy-only group (P<0.05). CONCLUSIONS In conclusion, the combination of laminectomy and pedicle screw fixation is a safe and effective surgical procedure when used to treat thoracolumbar schwannoma, and appears to be superior to the laminectomy-only procedure.
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http://dx.doi.org/10.12659/MSM.921719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299065PMC
June 2020

Correlation between the changes of serum COX 2, APE1, VEGF, TGF-β and TSGF levels and prognosis in patients with osteosarcoma before and after treatment.

J Cancer Res Ther 2020 ;16(2):335-342

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Context: Osteosarcoma (OS) is a progressive primary bone tumor that originates from immature stromal spindle cells. After chemotherapy, the serum-related indexes which are related to the prognosis.

Aims: The aim of this study is to investigate the correlation between changes in serum cyclooxygenase-2 (COX-2), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), and tumor-specific growth factor (TSGF) levels and prognosis of patients with osteosarcoma (OS) before and after treatment.

Settings And Design: Data of 75 patients with OS (observation group) and 55 healthy controls (control group) were retrospectively analyzed.

Materials And Methods: Chemotherapy was administered to the observation group. Serum lactate dehydrogenase, alkaline phosphatase, and TSGF levels were measured before and after treatment. The observation group patients were classified as normal or abnormal according to the changes in serum COX-2, bFGF, VEGF, TGF-β, and TSGF levels after chemotherapy. Patients were followed up for 7.5 years, and the survival rate was determined.

Statistical Analysis Used: Single-factor influencing prognosis was included in the Cox model, and independent factors influencing prognosis were analyzed.

Results: After chemotherapy, the mean serum COX-2, bFGF, VEGF, and TSGF levels decreased significantly in the observation group but were still higher than those in the control group. Furthermore, serum TGF-β levels increased in the observation group but were still lower than those in the control group. The 5-year survival rate of patients with normal serum COX-2, bFGF, VEGF, and TSGF levels was significantly higher in the normal subgroup than in the abnormal subgroup. Cox analysis showed that the Enneking stage and COX-2 level after chemotherapy were independent prognostic factors.

Conclusions: The serum COX-2, bFGF, VEGF, and TSGF levels of patients with OS significantly changed after chemotherapy, and the short-term survival rate of patients with normal levels of these biomarkers after chemotherapy was high.
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http://dx.doi.org/10.4103/jcrt.JCRT_11_20DOI Listing
September 2020

Prevalence and Predictors for Preoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fractures Caused by High-Energy Injuries.

World Neurosurg 2020 09 24;141:e431-e436. Epub 2020 May 24.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China.

Objective: To determine the prevalence of preoperative deep vein thrombosis (DVT) and to identify the predictors for preoperative DVT in patients with thoracolumbar fractures caused by high-energy injuries.

Methods: A total of 429 patients with thoracolumbar fractures caused by high-energy injuries from October 2016 to November 2019 were included in this retrospective study. The patients underwent ultrasonography before operation and were divided into the DVT group and non-DVT group. Demographic data and laboratory results were collected, and mechanical and chemical prophylaxis were performed to prevent DVT. The incidence of DVT was evaluated and the predictors of preoperative DVT were identified.

Results: The overall incidence of preoperative DVT was 14.45% (62/429). Of all patients, 1 (0.23%) had proximal DVT and 61 (14.22%) had distal DVT. The incidence of preoperative DVT was 24.59% in patients with thoracic fractures and 11.04% in those with lumbar fractures. Multivariate logistic regression identified 3 predictors, including lower extremity motor (P < 0.001), time from injury to operation (P < 0.001), and D-dimer (P = 0.001). Lower extremity motor score <3, time from injury to operation >3 days, and D-dimer >1.81 mg/L showed satisfied accuracy for predicting preoperative DVT. The receiver operating characteristic curve analysis indicated the diagnostic value of D-dimer was the highest when the area under the receiver operating characteristic curve curve was 0.769.

Conclusions: Despite mechanical and chemical prophylaxis, the incidence of preoperative DVT is still very high, especially in thoracic fractures. Lower extremity motor score <3, time from injury to operation >3 days, and D-dimer >1.81 mg/L are predictors for preoperative DVT. More attention is warranted to prevent preoperative DVT when ≥2 predictors are present.
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http://dx.doi.org/10.1016/j.wneu.2020.05.162DOI Listing
September 2020

Lumbar Vertebral Endplate Defects on Magnetic Resonance Imaging in Degenerative Spondylolisthesis: Novel Classification, Characteristics, and Correlative Factor Analysis.

World Neurosurg 2020 09 24;141:e423-e430. Epub 2020 May 24.

Department of Spine Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China. Electronic address:

Background: Endplate defects are commonly seen in patients with lumbar degenerative disease. However, little is known about the presence of endplate defects in patients with degenerative spondylolisthesis (DS). In the present study, we have introduced a classification system for endplate defects in patients with DS using routine magnetic resonance imaging findings and explored the correlative factors.

Methods: Endplate defects were classified into 3 major categories (rim defects, focal defects, and erosive defects) and 5 subtypes (anterior type, posterior type, arc type at the anterior rim, notch type, and Schmorl's nodes). The incidence rates of the endplate defects were compared between the slippage and nonslippage levels. The correlations between the endplate defects and age, sex, disc degeneration, Modic changes (MCs), body mass index, slippage segment, and slippage degree were analyzed.

Results: Endplate defects were present in 47.43% of the endplates in DS. The most common endplate defects were rim defects. The occurrence of endplate defects, especially anterior defects, was more common at the slippage levels. Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration. The slippage degree, slippage segment, body mass index, and sex differences were not associated with endplate defects in our study. The results obtained using this novel classification system were stable and consistent.

Conclusions: The results from the present study have shown that the novel radiological classification system of endplate defects is reliable. Endplate defects were associated with slippage but not with the slippage degree or slippage segment differences in DS. The correlation between endplate defects and age and between MCs and disc degeneration were important features on the magnetic resonance imaging scans of patients with DS.
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http://dx.doi.org/10.1016/j.wneu.2020.05.163DOI Listing
September 2020

Exosomes Derived from Bone Marrow Mesenchymal Stem Cells Prevent Acidic pH-Induced Damage in Human Nucleus Pulposus Cells.

Med Sci Monit 2020 May 21;26:e922928. Epub 2020 May 21.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).

BACKGROUND The exosomes (Exo) derived from mesenchymal stem cells (MSCs) are capable of attenuating the apoptosis of nucleus pulposus cells (NPCs) elicited by proinflammatory cytokines. However, it remains unknown whether MSC-derived Exo also exert a protective effect on NPCs in the pathological acid environment. MATERIAL AND METHODS NPCs were divided into 3 groups: Group A, pH 7.1-7.3; Group B, pH 6.5-6.7 and Group C, pH 5.9-6.1. The NPCs were cultured in the above-defined acidic medium, and 3 different amounts of Exo were added into the media. Finally, the expression of the caspase-3, aggrecan, collagen II, and MMP-13 was analyzed and compared among the different groups. RESULTS Compared with cells cultured at pH 7.1-7.3 (Group A), proliferation activity of NPCs cultured at pH 5.9-6.7 (Group B and C) decreased significantly. Collagen II and aggrecan expression was also obviously reduced with the decrease of cell proliferation. Conversely, the expression of caspase-3 and MMP-13 significantly increased. Further experiments showed that proliferation activity was significantly attenuated in NPCs cultured at pH 5.9-6.1 without Exo treatment (Group E) compared with those cultured at pH 7.1-7.3 without Exo treatment (Group D). CONCLUSIONS In the pathological acid environment, MSC-derived Exo promotes the expression of chondrocyte extracellular matrix, collagen II, and aggrecan, and reduces matrix degradation by downregulating matrix-degrading enzymes, protecting NPCs from acidic pH-induced apoptosis. This study reveals a promising strategy for treatment of IVD degeneration.
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http://dx.doi.org/10.12659/MSM.922928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257871PMC
May 2020

Oblique Lumbar Interbody Fusion with Stand-Alone Cages for the Treatment of Degenerative Lumbar Spondylolisthesis: A Retrospective Study with 1-Year Follow-Up.

Pain Res Manag 2020 11;2020:9016219. Epub 2020 Jan 11.

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China.

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative ( < 0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle ( < 0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.
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http://dx.doi.org/10.1155/2020/9016219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201502PMC
October 2020

Modic Changes (MCs) Associated with Endplate Sclerosis Can Prevent Cage Subsidence in Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone.

World Neurosurg 2020 06 17;138:e160-e168. Epub 2020 Feb 17.

Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou, Zhejiang, China. Electronic address:

Objective: To investigate the association between Modic changes (MCs) and endplate sclerosis; and to investigate the effect of MCs and endplate sclerosis on cage subsidence in oblique lumbar interbody fusion (OLIF) stand-alone.

Methods: We included 78 inpatients who underwent OLIF stand-alone from August 2015 to August 2017. All patients underwent computed tomography (CT) and magnetic resonance imaging. The presence and the types of MCs were assessed. Endplate sclerosis was evaluated from sagittally reconstructed CT images. Cage subsidence was evaluated at the 1-, 3-, 6-, and 12-month follow-up.

Results: Of 78 patients, 92 discs underwent OLIF without posterior instrumentation; 32 of 92 (34.8%) had MCs. Type I, II, and III MCs were seen in 10 (10.9%), 19 (20.7%), and 3 (3.2%) endplates, respectively. Among 32 endplates with MCs, 10 (31.3%) showed evidence of sclerosis on CT images, including 2 of 10 endplates (20%) with type I MCs, 5 of 19 (26.3%) with type II, and 3 of 3 (100%) with type III. Among 60 endplates without MCs, 5 (8.3%) showed evidence of sclerosis. Cage subsidence rate in the no-MCs group was higher than that in the MCs group (P <0.01). We found only 1 case of cage subsidence in the MCs group (n = 32), which was classified as MCs type I, whereas 6 cases of cage subsidence were observed in the no-MCs group (n = 60). Hounsfield unit ratios for sclerotic and no-sclerotic endplates were 2.2 ± 0.3 and 1.1 ± 0.1, respectively. No subsidence of cage was found in the sclerotic endplates group (n = 15), whereas 7 cases of cage subsidence were found in the no-sclerotic group (n = 77).

Conclusion: MCs associated with endplate sclerosis can prevent cage subsidence in OLIF stand-alone.
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http://dx.doi.org/10.1016/j.wneu.2020.02.047DOI Listing
June 2020

Foraminoplasty affects the clinical outcomes of discectomy during percutaneous transforaminal endoscopy: a two-year follow-up retrospective study on 64 patients.

Int J Neurosci 2021 Jan 5;131(1):1-6. Epub 2020 Mar 5.

Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China.

The aim of this study was to assess the significance of how the degree of injury of the facet joint affects clinical outcomes in foraminoplasty. We retrospectively enrolled 64 patients treated with percutaneous endoscopic transforaminal discectomy with foraminoplasty (PETDF) from January of 2015 to December of 2016. The patients were divided into two groups depending on whether the articular surface of the facet joint was damaged. Preoperative, perioperative, demographic data, and radiographic parameters for these two groups were extracted and compared. There were no significant differences between the two groups in terms of the duration of operation ( = 0.331), intraoperative blood loss volume ( = 0.631), the weight of disc ( = 0.274) or cut bone ( = 0.526). There were no significant differences between the two groups for VAS or ODI at the same time point ( > 0.05). There were significant differences in the VAS scores of low-back pain at 24 h and 24 months after surgery in the injured group. There were significant differences in ISH, ISA, rate of lumbar instability, recurrent herniation, and Macnab scores between the two groups at 24 months after surgery ( < 0.05). The regression equation between ISA and ISH was  = 4.237 + 0.565x (where Y denotes an increase of ISA; X, reduction of ISH;  = 6.219,  = 0.015). The Poisson ratio was 0.363 ( = 0.003). PETDF is effective and safe for the treatment of lumbar disc herniation. However, when foraminoplasty destroys the articular surface of the facet joint, there may be increases in lumbar instability and recurrence rate post-operation.
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http://dx.doi.org/10.1080/00207454.2020.1732968DOI Listing
January 2021

Resveratrol Combined with 17-Estradiol Prevents IL-1 Induced Apoptosis in Human Nucleus Pulposus Via The PI3K/AKT/Mtor and PI3K/AKT/GSK-3 Pathway.

J Invest Surg 2020 Feb 10:1-8. Epub 2020 Feb 10.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Nucleus pulposus (NP) apoptosis is mainly charged for the pathological process of Intervertebral disc degeneration (IVDD). Our previous study revealed that Resveratrol (RSV) combined with 17β-estradiol (E2) was more effective in cutting down IL-1β induced NP cell apoptosis via PI3K/AKT pathway. The present study further evaluated the effect of RSV and E2 in the anti-apoptosis process of IVDD. Human nucleus pulposus (NP) cells culture system and IL-1β inducing apoptosis model were constructed in this research. RSV and E2 were used to inhibit apoptosis. FACS (Fluorescence-activated cell sorting) and CCK-8 (Cell Counting Kit-8) assays were respectively used to determine apoptotic incidence and cell viability of NP cells. Quantitative RT-PCR was used to determine expression of target genes in mRNA level, and western blot analysis was performed to detect the changes of related protein expression. RSV combined with E2 attenuated IL-1β-induced cell apoptosis and recovered cell viability. Blockers for mTOR and GSK-3β abated the effect of RSV and E2. RSV combined with E2 obviously increased activated P-mTOR and P-GSK-3β, which contributes to the downregulation of caspase-3. Activated P-NF-kappa B was not involved in the anti-apoptosis process of RSV and E2. Combination of Resveratrol and 17β-estradiol efficiently resisted IL-1β induced apoptosis of NP cell, mainly through PI3K/AKT/mTOR/caspase-3 and PI3K/AKT/GSK-3β pathway.
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http://dx.doi.org/10.1080/08941939.2019.1705941DOI Listing
February 2020

Clinical Rehabilitation Effect of Postoperative Lower-Limb Training on the Patients Undergoing OLIF Surgery: A Retrospective Study.

Pain Res Manag 2020 16;2020:1065202. Epub 2020 Jan 16.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei Province, China.

Background: In this study, it was aimed to investigate the clinical rehabilitation effect of lower-limb training on the patients that undergo oblique lumbar interbody fusion (OLIF) procedures.

Methods: The eligible participants undergoing OLIF procedures between 01/2017 and 07/2019 were identified. All the patients underwent one-segment fusion operation (L3-4 or L4-5). Based on whether the participants received postoperative rehabilitation training, they were divided into two groups: intervention group and control group. Postoperatively, the participants in the intervention group were trained with lower-extremity rehabilitation exercise and maintained for three months. All participants got reexamined at the first postoperative week, the second postoperative week, the first postoperative month, and the third postoperative month (last follow-up). Comparisons were made in terms of the lower-extremity muscle force, visual analogue scale (VAS) score, lumbar JOA score, Oswestry disability index (ODI), the incidence of deep venous thrombosis (DVT), and patient satisfaction.

Results: Seventy-seven participants in the intervention group (32 males and 45 females) and 82 in the control group (39 males and 43 females) were incorporated in this study. The median age of the participants was 57 years (39∼73) in the intervention group and 54 years (35∼71) in the control group. No statistical significance between the two groups was found ( > 0.05). ODI score was less in the intervention group as compared to the control group in the first week after surgery (=0.029). VAS and JOA scores were better in the intervention group in the first two weeks after surgery ( < 0.05). DVT incidence in the intervention group was lower than the control group at final follow-up (=0.037). Both group participants have achieved good grading in muscle force rehabilitation but no significant differences between the two groups. Additionally, satisfaction was higher in the intervention group than the control group.

Conclusions: In summary, postoperative lower-extremity rehabilitation exercise can effectively accelerate patients' health recovery from the OLIF surgery and increase their satisfaction.
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http://dx.doi.org/10.1155/2020/1065202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985932PMC
August 2020

Posterior Vertebral Column Resection Combined With Bone Cement Augmentation of Pedicle Screw Fixation for Treatment of Severe Vertebral Compression Fractures With Kyphotic Deformity: A Retrospective Case Series.

Clin Spine Surg 2020 07;33(6):E269-E275

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang.

Study Design: This was a retrospective study.

Objective: Severe osteoporotic vertebral compression fractures with kyphotic deformity are difficult to treat. The objective of this study was to investigate the clinical efficacy of posterior vertebral column resection (PVCR) combined with bone cement augmentation of pedicle screw fixation in the treatment of severe vertebral compression fractures with kyphotic deformity.

Summary Of Background Data: The data of patients with a severe vertebral compression fracture and kyphotic deformity treated at our university between October 2013 and October 2017 were retrospectively reviewed.

Materials And Methods: All patients underwent PVCR combined with bone cement augmentation of pedicle screw fixation and anterior column reconstruction. The operative time, intraoperative blood loss, postoperative complications, and screw stability at the last follow-up in all patients were documented. The clinical benefits were evaluated by the Visual Analog Scale (VAS) score, Oswestry Dysfunction Index (ODI), Japanese Orthopedic Association (JOA) scores, and Frankel classification.

Results: The mean Cobb angle, sagittal vertical axis, VAS score, JOA score, and ODI were 48.5±6.9 degrees, 44.0±5.7, 6.5±1.5, 11.2±2.7, and 59.0±5.7 before surgery, respectively. The average follow-up period was 28.7±3.2 months. The Frankel grade in 5 patients with neurological impairment improved from D to E after surgery. The average Cobb angles for kyphotic deformity, sagittal vertical axis, VAS score, JOA score, and ODI were 9.5±3.8 degrees, 18.3±3.5, 2.6±1.2, 20.5±3.6, and 20.7±4.0, respectively, at the last follow-up (all P<0.05 compared with before surgery).

Conclusions: For patients with severe vertebral compression fractures and kyphotic deformity, PVCR combined with bone cement augmentation of pedicle screw fixation can restore the spine sequence to achieve good clinical efficacy. Clinical trials are necessary for confirmation.
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http://dx.doi.org/10.1097/BSD.0000000000000941DOI Listing
July 2020

Laves Phase Evolution in China Low-Activation Martensitic (CLAM) Steel during Long-Term Aging at 550 °C.

Materials (Basel) 2019 Dec 31;13(1). Epub 2019 Dec 31.

College of Materials and Metallurgy, Guizhou University, Guiyang 550025, China.

To clarify the precipitation and evolution law of the Laves phase in China low-activation martensitic (CLAM) steel during long-term aging at high temperature, this paper carried out an aging treatment of CLAM steel at 550 °C for up to 30,000 h. The segregation behavior of alloy elements and the precipitation amount and average size of the Laves phase were quantitatively characterized by transmission electron microscopy (TEM) and scanning electron microscopy (SEM), and the precipitation and coarsening behavior of the Laves phase were obtained. The results show that the Laves phase begins to precipitate within 5000 h after aging and mainly depends on MC carbides to nucleate and grow at the grain boundary and subgrain boundary. During the aging process, the average size of the Laves phase grows continuously. After more than 25,000 h, the growth rate of the Laves phase decreases. After 30,000 h of aging, the average size reaches 439.9 nm, and the maximum size exceeds 800 nm. The area fraction of the Laves phase increases continuously during the 20,000 h aging process and tends to be stable after aging for 20,000 h. The area fraction is approximately 1.85%.
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http://dx.doi.org/10.3390/ma13010154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982184PMC
December 2019

Unilateral versus bilateral pedicle screw fixation in lumbar fusion: A systematic review of overlapping meta-analyses.

PLoS One 2019 20;14(12):e0226848. Epub 2019 Dec 20.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Objectives: To carry out a systematic review on the basis of overlapping meta-analyses that compare unilateral with bilateral pedicle screw fixation (PSF) in lumbar fusion to identify which study represents the current best evidence, and to provide recommendations of treatment on this topic.

Methods: A comprehensive literature search in PubMed, Embase, and the Cochrane Library databases was conducted to identify meta-analyses that compare unilateral with bilateral PSF in lumbar fusion. Only meta-analyses exclusively covering randomized controlled trials were included. Study quality was evaluated using the Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Then, the Jadad decision algorithm was applied to select the highest-quality study to represent the current best evidence.

Results: A total of 9 studies with Level II of evidence fulfilled the eligibility criteria and were included. The scores of AMSTAR criteria for them varied from 5 to 9 (mean 7.78). The current best evidence detected no significant differences between unilateral and bilateral PSF for short-segment lumbar fusion in the functional scores, length of hospital stay, fusion rate, and complication rate. However, unilateral PSF involved a remarkable decrease in operative time and blood loss but increase of cage migration when compared with bilateral PSF.

Conclusions: According to this systematic review, unilateral PSF is an effective method of fixation for short-segment lumbar fusion, has the advantages of reduced operative time and blood loss over bilateral PSF, but increases the risk of cage migration.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226848PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924673PMC
April 2020

The use of dermal regeneration template for treatment of complex wound with bone/tendon exposed at the forearm and hand, a prospective cohort study.

Medicine (Baltimore) 2019 Nov;98(44):e17726

Department of Spine Surgery, the Third Hospital of Hebei Medical University.

The purpose of this study was to assess the efficacy and safety of Pelnac and split-thickness skin graft for management of complex wound with underlying bone/tendon exposure at forearm and hand.This is a prospective study, beginning from March 2013 up to May 2017. There were 13 patients, with age of 31.2 years. All of them underwent the staged Pelnac and split-thickness skin graft to manage the complex wound with bone/tendon. Postoperatively, scheduled follow-up was conducted.The average follow-up was 15 months. There were no infections, wound necrosis, hematoma, or seroma during the phase when Pelnac was applied. There was 100% "take" of the Pelnac in 12/13 patients. In 11 patients, there was complete skin graft "take". Patients' satisfaction for the esthetic appearance of the grafted area was 75.0 ± 8.5/100. The VSS value was 2.9 ± 2.5. Regarding the sensory recovery, the response of "normal or near normal" could be obtained in 7/13 patients, "slight loss" in 5 patients and "significant loss" in 1 case. The average DASH score was 27.2 ± 18.5, and most patients (12/13) could obtain an acceptable ability to perform the daily activities.Pelnac dermal template is a favorable alternative to flap reconstruction in the treatment of complex wound with underlying tissues exposure.
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http://dx.doi.org/10.1097/MD.0000000000017726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946402PMC
November 2019

Comparison of intervertebral fusion rates of different bone graft materials in extreme lateral interbody fusion.

Medicine (Baltimore) 2019 Nov;98(44):e17685

Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China.

To compare imaging indicators and clinical effects of extreme lateral interbody fusion (XLIF) using allogenic bone, autologous bone marrow + allogenic bone, and rhBMP-2 + allogenic bone as bone graft materials in the treatment of degenerative lumbar diseases.This was a retrospective study of 93 patients with lumbar interbody fusion who underwent the extreme lateral approach from May 2016 to December 2017. According to the different bone graft materials, patients were divided into allogenic bone groups (group A, 31 cases), rhBMP-2 + allogenic bone (group B, 32 cases), and autologous bone marrow + allogenic bone (group C, 30 cases). There were no significant differences in gender, age, lesion segment, preoperative intervertebral space height, and preoperative Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) scores among the 3 groups (P > .05). Intervertebral space height, bone graft fusion rate, and ODI and VAS scores were compared immediately after surgery, and at 3, 6, and 12 months after surgery.All groups were followed up for 12 months. The intervertebral space height was significantly higher in the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery, in comparison to before surgery (P < .05). There was no significant difference in the intervertebral space height among the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery (P > .05). The fusion rate of group B and C was higher than that of groups A at 3, 6, and 12 months after surgery (P < .05). In the 3 groups, the VAS and ODI scores at 3, 6, and 12 months after surgery were significantly improved compared with the preoperative scores (P < .05). The VAS and ODI scores in groups B and C were significantly higher than those in group A (P < .05), but there was no significant difference between groups B and C (P > .05).The rhBMP-2 + allograft bone combination had good clinical effects and high fusion rate in XLIF.
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http://dx.doi.org/10.1097/MD.0000000000017685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946436PMC
November 2019

Intervertebral disc ageing and degeneration: The antiapoptotic effect of oestrogen.

Ageing Res Rev 2020 01 24;57:100978. Epub 2019 Oct 24.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, 139Ziqiang Rd, Shijiazhuang 050051, PR China. Electronic address:

As an important part of the spinal column, the intervertebral disc (IVD) plays an important role in the intervertebral juncture and spinal movement in general. IVD degeneration (IVDD), which mimics disc ageing but at an accelerated rate, is a common and chronic process that results in severe spinal symptoms, such as lower back pain. It is generally assumed that lower back pain caused by IVDD can also develop secondary conditions, including spinal canal stenosis, spinal segmental instability, osteophyte formation, disc herniation and spinal cord and nerve root compression. Over the past few years, many researchers around the world have widely studied the relevance between oestrogen and IVDD, indicating that oestrogen can effectively alleviate IVDD development by inhibiting the apoptosis of IVD cells. Oestrogen can decrease IVD cell apoptosis in multiple ways, including the inhibition of the inflammatory cytokines IL-1β and TNF-α, reducing catabolism because of inhibition of matrix metalloproteinases, upregulating integrin αβ and IVD anabolism, activating the PI3K/Akt pathway, decreasing oxidative damage and promoting autophagy. In this article, we perform an overview of the literature regarding the antiapoptotic effect of oestrogen in IVDD.
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http://dx.doi.org/10.1016/j.arr.2019.100978DOI Listing
January 2020

Analysis of the disc pressure of the upper thoracic spine using pressure-sensitive film: an experimental study in porcine model-implications for scoliosis progression.

Australas Phys Eng Sci Med 2019 Dec 15;42(4):1069-1079. Epub 2019 Oct 15.

Department of Spinal Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.

There has been few studies focusing on the disc pressure of the upper thoracic spine and it still lacks the quantitative pressure measurement of each spinal disc segment. The aim of this study was to study the pressure changes of intervertebral disc in porcine upper thoracic spine using pressure-sensitive film. Twelve porcine thoracic motion segments were harvested and successively loaded with vertical loads of 100 N, 150 N, and 200 N during 5° of anterior flexion, 5° of posterior extension and 5° of lateral bending. The resulting pressure values were measured. During anterior flexion, the anterior annulus of all segments at all loads showed higher mean pressure values than those during vertical compression, whereas the posterior annulus did not show higher mean values. During posterior extension, the anterior annulus of all segments showed lower mean pressure values than those during vertical compression, whereas the posterior annulus did not show lower mean pressure values. During lateral bending, the annulus of all segments showed higher mean pressure values than those during vertical compression. The posterior thoracic vertebra plays an important role in the motion of the upper thoracic vertebral segment and pressure distribution. During lateral bending, the concave side pressure of the annulus increases obviously, suggesting that asymmetrical force is a contributory factor for scoliosis progression.
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http://dx.doi.org/10.1007/s13246-019-00804-yDOI Listing
December 2019

Time-to-event analyses of lower-limb venous thromboembolism in aged patients undergoing lumbar spine surgery: a retrospective study of 1620 patients.

Aging (Albany NY) 2019 10 15;11(19):8701-8709. Epub 2019 Oct 15.

Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China.

After spine surgery, venous thromboembolism (VTE) is not uncommon in aged patients. This study investigates time-to-event risk factors of postoperative VTE based on medical records of aged patients (age≥60 yr) between January 2013 and December 2018. All participants had undergone lower extremity ultrasonography pre- and postoperatively at the first, second, fourth, eighth, and twelfth weeks. Mann-Whitney U tests and chi-square tests were used for univariate analyses, and Cox regression was utilized for multivariate analyses. A total of 1620 cases were recruited, VTE group (N=382, 23.6%) and non-VTE group (N=1238, 76.4%), aged 67 (IQR 11) years and 65 (IQR 6) years, respectively. The univariate analyses indicated significant differences between the VTE and non-VTE groups regarding advanced age, VTE history, hypertension, fusion, hospital stay, FIB, HDL, D-dimer, and TC (all P<0.05). The Cox regression showed that advanced age (OR=1.108; 95% CI, 1.091-1.126), VTE history (OR=4.962; 95% CI, 3.849-6.397), and hypertension (OR=1.344; 95% CI, 1.084-1.667) were the risk factors for postoperative VTE (P<0.05). The time-to-event analyses indicated that the hazard of VTE formation was highest in the first postoperative week. In conclusion, advanced age, VTE history, and hypertension are main risks for VTE formation, particularly in the first postoperative week.
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http://dx.doi.org/10.18632/aging.102364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814587PMC
October 2019
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