Publications by authors named "Zhengxue Quan"

68 Publications

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures.

J Pain Res 2021 31;14:3951-3959. Epub 2021 Dec 31.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.

Background: A retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs).

Methods: From January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41).

Results: Visual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C.

Conclusion: Compared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.
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http://dx.doi.org/10.2147/JPR.S345760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725857PMC
December 2021

Causal Effect of Serum Magnesium on Osteoporosis and Cardiometabolic Diseases.

Front Nutr 2021 3;8:738000. Epub 2021 Dec 3.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Serum magnesium is associated with osteoporosis and cardiometabolic diseases, but their causal associations remain elusive. We used the two-sample Mendelian randomization (MR) study to explore the causal roles of serum magnesium on osteoporosis and cardiometabolic diseases by using the aggregated genome-wide association studies (GWASs). Six single-nucleotide polymorphisms (SNPs, < 5 × 10) associated with serum magnesium concentrations were all used as instrumental variables. A genetic predisposition to higher serum magnesium concentrations was inversely associated with lower lumbar spine bone mineral density (BMD, beta-estimate: -1.982, 95% CI: -3.328 to -0.635, SE: 0.687, = 0.004), which was further confirmed by multiple sensitivity analyses. There was limited evidence of associations between serum magnesium and type 2 diabetes, coronary artery disease, heart failure, and atrial fibrillation. This work provided strong evidence that genetically increased serum magnesium concentrations were causally associated with low lumbar spine BMD and suggested that serum magnesium concentrations may be crucial to prevent osteoporosis.
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http://dx.doi.org/10.3389/fnut.2021.738000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8681341PMC
December 2021

The CT assessment of uncovertebral joints degeneration in a healthy population.

Eur J Med Res 2021 Dec 13;26(1):145. Epub 2021 Dec 13.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: A retrospective study investigated the degeneration trend of uncovertebral joints in a healthy population based on CT assessment.

Methods: A total of 200 males and 160 females, aged 21-79 years old (50.82 ± 17.06), who underwent CT examination in our hospital from September 2020 to March 2021 were enrolled. Sixty patients were included in each age group. According to the Kellgren and Lawrence classification and CT was used to evaluate the uncovertebral joints degeneration in different groups.

Results: With the increase of age, the degeneration of each segment was gradually aggravated. The uncovertebral joints started degenerating in the 20 s, and the C5-6 is the most degenerative segment, followed by the C4-5 and C6-7. Significant degeneration occurred in each segment between the 40 s and 60 s and became more severe after the 70 s.

Conclusions: The modified Kellgren and Lawrence classification based on CT scan could provide a quantitative assessment of uncovertebral joints degeneration in a healthy population and could provide more details for artificial cervical arthroplasty.
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http://dx.doi.org/10.1186/s40001-021-00619-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8667401PMC
December 2021

Effect of Surgical Timing on the Refracture Rate after Percutaneous Vertebroplasty: A Retrospective Analysis of at Least 4-Year Follow-Up.

Biomed Res Int 2021 27;2021:5503022. Epub 2021 Nov 27.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China 400016.

Introduction: The effect of surgical timing on vertebral refracture rate and mortality remains elusive after percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP), and we aim to assess the impact of surgical timing on vertebral refracture rate and mortality in patients undergoing percutaneous vertebroplasty.

Methods: We did a retrospective cohort study of patients who underwent PKP or PVP because of osteoporotic vertebral compression fracture (OVCF) between April 1, 2014 and March 31, 2016. The primary outcome measure was the incidence of vertebral refracture. Secondary outcomes included the mortality and chronic back pain.

Results: The rate of vertebral refracture was significantly lower in early surgical timing group than that in late surgical timing group (HR 2.415, 95% CI 1.318-4.427; = 0.004). We found that the bone mineral density (BMD) was only the risk factor to increase the vertebral refracture rate after vertebroplasty ( = 0.001). In addition, there was similar mortality between the two groups (15.7% in early surgical timing group versus 10% in late surgical timing group). Male patients (27.3%, 12/44) had higher mortality compared to female patients (10.6%, 20/189), while the mortality was higher in patients with cerebral infarction (25%, 3/12) than those without cerebral infarction (12.1%, 17/140).

Conclusions: Surgical timing significantly affects the vertebral refracture rate after PKP or PVP, which is also influenced by BMD. The mortality after the surgery is not affected by the surgical timing, but gender and cerebral infarction may be the risk factors of mortality.
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http://dx.doi.org/10.1155/2021/5503022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643249PMC
November 2021

Causal roles of circulating adiponectin in osteoporosis and cancers.

Bone 2022 Feb 26;155:116266. Epub 2021 Nov 26.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. Electronic address:

Circulating adiponectin has some association with the risk of osteoporosis and cancers, but their causal relationships remains elusive. Mendelian randomization (MR) study was used to explore the causal roles of circulating adiponectin in osteoporosis and cancers by using genome-wide association studies (GWASs) associated with circulating adiponectin, osteoporosis and cancers. Fifteen single nucleotide polymorphisms (SNPs) were used as instrumental variables for circulating adiponectin. Genetic predisposition to high circulating adiponectin was strongly associated with low femoral neck bone mineral density (FN-BMD, beta-estimate: -0.015, 95% CI: -0.023 to -0.006, SE: 0.004, P-value = 0.001), low forearm BMD (FA-BMD, beta-estimate: -0.027, 95% CI: -0.050 to -0.004, SE: 0.012, P-value = 0.023) and increased risk of breast cancer (beta-estimate: 0.011, 95% CI: 0.001 to 0.022, SE: 0.005, P-value = 0.031). There was limited evidence of the associations between circulating adiponectin and other outcomes (i.e. lumbar spine BMD [LS-BMD], colorectal cancer, liver cancer, lung cancer, bone cancer and prostate cancer). This study provides robust evidence that high circulating adiponectin is causally associated with low FN-BMD, low FA-BMD and increased risk of breast cancer, which may provide new insight to prevent and treat osteoporosis and breast cancer.
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http://dx.doi.org/10.1016/j.bone.2021.116266DOI Listing
February 2022

Enhancement of the bone-implant interface by applying a plasma-sprayed titanium coating on nanohydroxyapatite/polyamide66 implants in a rabbit model.

Sci Rep 2021 10 7;11(1):19971. Epub 2021 Oct 7.

Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Solid fusion at the bone-implant interface (BII) is considered one of the indicators of a satisfactory clinical outcome for spine surgery. Although the mechanical and physical properties of nanohydroxyapatite/polyamide66 (n-HA/PA66) offers many advantages, the results of long-term follow-up for BIIs remain limited. This study aimed to improve the BII of n-HA/PA66 by applying plasma-sprayed titanium (PST) and assessing the mechanical and histological properties. After the PST coating was applied to n-HA/PA66 implants, the coating had uneven, porous surfaces. The compression results were not significantly different between the two groups. The micro-CT results demonstrated that at 6 weeks and 12 weeks, the bone volume (BV), BV/tissue volume (TV) and trabecular number (Tb.N) values of the n-HA/PA66-PST group were significantly higher than those of the n-HA/PA66 group. The results of undecalcified bone slicing showed that more new bone appeared to form around n-HA/PA66-PST implant than around n-HA/PA66 implant. The bone-implant contact (BIC) and push-out test results of the n-HA/PA66-PST group were better than those of the n-HA/PA66 group. In conclusion, after PST coating, direct and additional new bone-to-implant bonding could be achieved, improving the BII of n-HA/PA66 implants. The n-HA/PA66-PST implants could be promising for repair purposes.
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http://dx.doi.org/10.1038/s41598-021-99494-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497622PMC
October 2021

Systematic Influence of Circulating Bilirubin Levels on Osteoporosis.

Front Endocrinol (Lausanne) 2021 26;12:719920. Epub 2021 Aug 26.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Observational studies report some association between circulating bilirubin levels and osteoporosis, but it is unknown if this association is causal or confounded. In this two-sample Mendelian randomization (MR) study, we included a large genome-wide association study (GWAS) associated with total bilirubin levels among 317,639 people, a large meta-analysis to identify genetic variants associated with bone mineral density (BMD) estimated by heel quantitative ultrasound (eBMD) among 426,824 individuals and fracture among 1.2 million individuals. The results revealed that circulating bilirubin levels had no causal influence on eBMD (beta-estimate: 0.004, 95% confidence interval [CI]: -0.019 to 0.028, SE:0.012, P-value=0.705) or the risk of fracture (beta-estimate: -0.009, 95% CI: -0.035 to 0.017, SE:0.013, P-value=0.488), which were both confirmed by multiple sensitivity analyses. Our results confirm that circulating bilirubin levels have no causal role in eBMD or the incidence of fracture, indicating that circulating bilirubin levels is unlikely to be a causal risk factor for osteoporosis or fracture.
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http://dx.doi.org/10.3389/fendo.2021.719920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447935PMC
August 2021

Causal Effect of Blood Pressure on Bone Mineral Density and Fracture: A Mendelian Randomization Study.

Front Endocrinol (Lausanne) 2021 4;12:716681. Epub 2021 Aug 4.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: Hypertension may have some association with osteoporosis. This Mendelian randomization (MR) study aimed to explore the causal effect of blood pressure (BP) on bone mineral density (BMD), fall, and fracture.

Methods: We used the genome-wide association study (GWAS) summary data among 330,956 European-descent individuals to identify 107 single-nucleotide polymorphisms (SNPs) as the instrumental variables of BP. MR analyses of these instruments were performed on 53,236 European individuals for the association with forearm BMD (FA-BMD), femoral neck BMD (FN-BMD), and lumbar spine BMD (LS-BMD); 451,179 European individuals for fall susceptibility; and up to 1.2 million individuals from European descent for fracture. Conventional inverse variance weighted (IVW) method was adopted to obtain the causal estimates of BP on different outcomes, while weighted median, MR-egger, and MR pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analyses.

Results: Genetically high pulse pressure (PP) could significantly improve FA-BMD (beta-estimate: 0.038, 95% confidence interval [CI]: 0.013 to 0.063, SE:0.013, P-value=0.003
Conclusions: Our findings reveal a potentially causal relationship between high PP and improved FA-BMD, which may provide new sights for the treatment of osteoporosis.
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http://dx.doi.org/10.3389/fendo.2021.716681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371435PMC
August 2021

A prospective study revealing the role of an immune-related eRNA, WAKMAR2, in breast cancer.

Sci Rep 2021 07 28;11(1):15328. Epub 2021 Jul 28.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Enhancer RNAs (eRNAs) are a subclass of non-coding RNAs that are generated during the transcription of enhancer regions and play an important role in tumourigenesis. In this study, we focused on the crucial eRNAs that participate in immune responses in invasive breast cancer (IBC). We first used The Cancer Genome Atlas and Human enhancer RNA Atlas to screen for tissue-specific eRNAs and their target genes. Through Pearson correlation analysis with immune genes, the eRNA WAKMAR2 was identified as a key candidate involved in IBC. Our further research suggested that WAKMAR2 is crucial in regulating the tumour microenvironment and may function by regulating immune-related genes, including IL27RA, RAC2, FABP7, IGLV1-51, IGHA1, and IGHD. Quantitative reverse transcription-polymerase chain reaction was used to detect the expression of WAKMAR2 in IBC and normal tissues, and the effect of WAKMAR2 on the regulation of downstream genes in MB-231 and MCF7 cells was studied in vitro. WAKMAR2 was found to be highly involved in tumour immunity and was downregulated in IBC tissues. Furthermore, the expression of WAKMAR2 and its target genes was observed at the pan-cancer level. This study provides evidence to suggest new potential targets for the treatment of breast cancer.
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http://dx.doi.org/10.1038/s41598-021-94784-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319425PMC
July 2021

Depression and Osteoporosis: A Mendelian Randomization Study.

Calcif Tissue Int 2021 12 14;109(6):675-684. Epub 2021 Jul 14.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Yi Xue Yuan Road, Yuzhong District, Chongqing, 400016, China.

Observational studies suggest a link between depression and osteoporosis, but these may be subject to confounding and reverse causality. In this two-sample Mendelian randomization analysis, we included the large meta-analysis of genome-wide association studies for depression among 807,553 individuals (246,363 cases and 561,190 controls) of European descent, the large meta-analysis to identify genetic variants associated with femoral neck bone mineral density (FN-BMD), forearm BMD (FA-BMD) and lumbar spine BMD (LS-BMD) among 53,236 individuals of European ancestry, and the GWAS summary data of heel BMD (HE-BMD) and fracture among 426,824 individuals of European ancestry. The results revealed that genetic predisposition towards depression showed no causal effect on FA-BMD (beta-estimate: 0.091, 95% confidence interval [CI] - 0.088 to 0.269, SE:0.091, P value = 0.320), FN-BMD (beta-estimate: 0.066, 95% CI - 0.016 to 0.148, SE:0.042, P value = 0.113), LS-BMD (beta-estimate: 0.074, 95% CI - 0.029 to 0.177, SE:0.052, P value = 0.159), HE-BMD (beta-estimate: 0.009, 95% CI - 0.043 to 0.061, SE:0.027, P value = 0.727), or fracture (beta-estimate: 0.008, 95% CI - 0.071 to 0.087, SE:0.041, P value = 0.844). These results were also confirmed by multiple sensitivity analyses. Contrary to the findings of observational studies, our results do not reveal a causal role of depression in osteoporosis or fracture.
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http://dx.doi.org/10.1007/s00223-021-00886-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531056PMC
December 2021

Revealing the Immune Infiltration Landscape and Identifying Diagnostic Biomarkers for Lumbar Disc Herniation.

Front Immunol 2021 27;12:666355. Epub 2021 May 27.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Intervertebral disc (IVD) degeneration and its inflammatory microenvironment ultimately led to discogenic pain, which is thought to originate in the nucleus pulposus (NP). In this study, key genes involved in NP tissue immune infiltration in lumbar disc herniation (LDH) were identified by bioinformatic analysis. Gene expression profiles were downloaded from the Gene Expression Omnibus (GEO) database. The CIBERSORT algorithm was used to analyze the immune infiltration into NP tissue between the LDH and control groups. Hub genes were identified by the WGCNA R package in Bioconductor and single-cell sequencing data was analyzed using R packages. Gene expression levels were evaluated by quantitative real-time polymerase chain reaction. The immune infiltration profiles varied significantly between the LDH and control groups. Compared with control tissue, LDH tissue contained a higher proportion of regulatory T cells and macrophages, which are associated with the macrophage polarization process. The most significant module contained three hub genes and four subclusters of NP cells. Functional analysis of these genes was performed, the hub gene expression pattern was confirmed by PCR, and clinical features of the patients were investigated. Finally, we identified TGF-β and MAPK signaling pathways as crucial in this process and these pathways may provide diagnostic markers for LDH. We hypothesize that the hub genes expressed in the specific NP subclusters, along with the infiltrating macrophages play important roles in the pathogenesis of IVD degeneration and ultimately, disc herniation.
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http://dx.doi.org/10.3389/fimmu.2021.666355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190407PMC
October 2021

Pan-cancer analysis reveals tumor-associated macrophage communication in the tumor microenvironment.

Exp Hematol Oncol 2021 May 10;10(1):31. Epub 2021 May 10.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

Background: Tumor-associated macrophages (TAMs) are abundant in the tumor microenvironment (TME). However, their contribution to the immunosuppressive status of the TME remains unclear.

Methods: We integrated single-cell sequencing and transcriptome data from different tumor types to uncover the molecular features of TAMs. In vitro experiments and prospective clinical tests confirmed the results of these analysis.

Results: We first detected intra- and inter-tumoral heterogeneities between TAM subpopulations and their functions, with CD86 TAMs playing a crucial role in tumor progression. Next, we focused on the ligand-receptor interactions between TAMs and tumor cells in different TME phenotypes and discovered that aberrant expressions of six hub genes, including FLI1, are involved in this process. A TAM-tumor cell co-culture experiment proved that FLI1 was involved in tumor cell invasion, and FLI1 also showed a unique pattern in patients. Finally, TAMs were discovered to communicate with immune and stromal cells.

Conclusion: We determined the role of TAMs in the TME by focusing on their communication pattern with other TME components. Additionally, the screening of hub genes revealed potential therapeutic targets.
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http://dx.doi.org/10.1186/s40164-021-00226-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108336PMC
May 2021

One-stage posterior laminectomy with instrumented fusion and foraminotomy for cervical ossification of posterior longitudinal ligament with radiculopathy pain.

J Orthop Surg Res 2021 Apr 26;16(1):277. Epub 2021 Apr 26.

Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China.

Objective: To explore the clinical efficacy of posterior LFF for cervical OPLL with radicular pain of upper limbs METHODS: Between January 2014 and January 2018, 48 OPLL patients with radicular pain symptoms of upper limbs who underwent a one-stage posterior laminectomy and instrumented fusion with/without foraminotomy were reviewed retrospectively and divided into two groups: LF group (laminectomy with instrumented fusion without foraminotomy) and LFF group (laminectomy with instrumented fusion and foraminotomy). Clinical data were assessed and compared between the two groups. The radicular pain of upper limbs and neck was measured using the visual analog scale (VAS). The neurological function was evaluated with the American Spinal Injury Association (ASIA) scale. Changes of sagittal alignment were investigated by postoperative plain x-ray or computed tomography (CT). Moreover, the decompression of the spinal cord was evaluated based on postoperative MRI.

Results: All the 48 patients were followed up for 24-42 months with an average follow-up time of 31.1±5.3 months. A total of 56 cervical intervertebral foramens were enlarged in 48 patients, including 40 cases (83.3%) with 1 intervertebral foramen enlargement and 8 cases (16.7%) with 2 intervertebral foramen enlargements. There were no significant differences in intraoperative blood loss, postoperative drainage amount, Japanese Orthopaedic Association (JOA) scores, JOA recovery rates, VAS scores for neck pain, and ASIA grade between two groups. The mean operative time was shorter in the LF group compared with the LFF group. The VAS score for arm pain was significantly lower while the surgical duration was longer in group B. No statistical difference was observed between the two groups in terms of C2-C7 SVA, cervical lordosis, focal angulation at the foraminotomy segment, and local spinal cord angle. Compared with the LF group, there was no segmental kyphosis or instability where the additional posterior foraminotomy was performed in the LFF group.

Conclusions: One-stage posterior LFF can achieve satisfied clinical efficacy in improving neurological function and relieving the radicular pain of the upper limbs for OPLL patients with radiculopathy symptoms.
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http://dx.doi.org/10.1186/s13018-021-02431-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074402PMC
April 2021

Addition of Celebrex and Pregabalin to Ropivacaine for Posterior Spinal Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Drug Des Devel Ther 2021 22;15:735-742. Epub 2021 Feb 22.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

Background: Serious pain commonly occurs after posterior spinal surgery. This study aims to evaluate the effect of preemptive and multimodal analgesia using celebrex, pregabalin and ropivacaine on pain control after this surgery.

Methods: Ninety-three patients undergoing posterior spinal surgery were enrolled in this prospective, randomized, double-blind, placebo-controlled clinical trial. All patients were treated with patient- controlled analgesia (PCA, intravenous tramadol hydrochloride and flurbiprofen) as required. They were randomized to combination analgesia intervention (oral celebrex, pregabalin and subcutaneous infiltration of ropivacaine), ropivacaine intervention (only subcutaneous infiltration of ropivacaine), and control intervention (placebo). We compared postoperative visual analog scale (VAS) scores and PCA dose among the three groups.

Results: The VAS scores were significantly lower in the combination analgesia group than in the control group at 0 h, 2 h, 12 h, 24 h, 3 d, 5 d, 7 d and 14 d after posterior spinal surgery, while combination analgesia was also superior to ropivacaine in terms of VAS scores at 24 h and 14 d postoperatively. The combination analgesia group was also associated with significantly reduced PCA consumption compared with the control group, but there was no statistical difference in PCA consumption between the ropivacaine group and control group.

Conclusion: Combination analgesia using celebrex, pregabalin and ropivacaine is effective and safe to alleviate pain after posterior spinal surgery.

Clinical Trial Registration: Chinese Clinical Trial Registry No. ChiCTR2000031236.
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http://dx.doi.org/10.2147/DDDT.S292847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910150PMC
October 2021

One-stage posterior debridement, autogenous spinous process bone graft and instrumentation for single segment lumbar pyogenic spondylitis.

Sci Rep 2021 02 4;11(1):3065. Epub 2021 Feb 4.

Department of Rehabilitation, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, People's Republic of China.

To compare the surgical outcomes of autogenous spinous process with iliac bone graft in managing single segment lumbar pyogenic spondylitis (PS) after posterior debridement and instrumentation. We performed a retrospective study for adult patients with single level lumbar PS. 60 patients with single segment lumbar PS underwent one-stage posterior debridement, autogenous bone graft and instrumentations. The patients were divided into Group A (autogenous iliac bone) and Group B (autogenous spinous process). Preoperative Charlson comorbidity index (CCI) was analyzed to assess the comorbidity. Low back pain was evaluated using the visual analog scale (VAS). Neurological status was assessed with the American Spinal Injury Association (ASIA) scale. Clinical infection index including the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also reviewed. Moreover, fusion and changes of sagittal alignment were investigated radiologically. There was a significantly longer operative time, hospital stay and greater blood loss in group A. The VAS scores improved significantly at each follow-up interval and post-operative VAS score was significantly lower in group B. At the last follow-up, ESR and CRP returned to normal for all patients. There was at least one grade level improvement in ASIA score. No statistical difference in corrected rate, loss of sagittal angle and lumbar lordosis was found between the two groups. There was no significant difference in fusion rate, mean fusion time and complications between the two groups. Compared with iliac bone graft, the autogenous spinous process bone graft can be less invasive and painful for the single segment lumbar PS. One-stage posterior debridement, autogenous spinous process bone graft and instrumentation can provide satisfactory results for appropriate cases.
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http://dx.doi.org/10.1038/s41598-021-82695-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862586PMC
February 2021

Identification of Immune-Related Genes and in Relation to Macrophage and Type-2 T-Helper Cells in Osteosarcoma Tumor Micro-Environments as Anti-metastasis Signatures.

Front Mol Biosci 2020 14;7:576298. Epub 2020 Dec 14.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Metastasis of osteosarcoma (OS) is an essential factor affecting the prognosis and survival of patients. The tumor microenvironment, including tumor immune-infiltrating cells (TIIC), is closely related to tumor progression. The purpose of this study was to investigate the differences between metastatic and non-metastatic immune-infiltrating cells in OS and to identify key immune-related genes. The differences in immune infiltration in OS metastasis were calculated based on the ssGSEA algorithm of 28 immuno-infiltrating cells. Weighted gene co-expression network analysis (WGCNA) and intersection analysis were used to screen immune-related modules and hubgenes. Univariate/multivariate/Lasso Cox regressions were used for models construction and signatures screening. The receiver operating characteristic (ROC) and Kaplan-Meier (K-M) curves were constructed to observe the metastases of different groups. Both internal and external data were verified. We found that macrophages and Type-2 T-helper cells were significantly decreased in patients with OS metastases. The high-risk groups obtained from multivariate/Lasso Cox models constructed with 11 immune-related hubgenes almost all underwent distant metastases within 5 years. Interestingly and importantly, two genes, and , appeared in various models and various hubgenes, which play an anti-metastasis role and may prolong overall survival in OS. Our study may help elucidate the impact of TIIC on OS metastasis outcomes and to identify biomarkers and therapeutic targets.
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http://dx.doi.org/10.3389/fmolb.2020.576298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768026PMC
December 2020

Midterm surgical results of the lamina with spinous process in treating one-level thoracic or lumbar tuberculosis: a retrospective study.

Sci Rep 2020 12 16;10(1):22036. Epub 2020 Dec 16.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

A retrospective study investigated the results of the lamina with spinous process (LSP) as a bone graft in one-level thoracic or lumbar spinal tuberculosis with the one-stage posterior approach of debridement, fusion and internal instrumentation. Data from 35 patients from January 2013 to December 2015 were analysed. Surgery time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All of the patients were followed up for a mean 43.90 ± 10.39 months. The mean age, surgery time, blood loss, hospitalization time, hospital cost and drainage volume were 33.65 ± 11.06 years, 182.40 ± 23.82 min, 280.80 ± 76.82 mL, 14.05 ± 3.58 days, 74,382.00 ± 11,938.00 yuan, and 340.00 ± 167.20 mL, respectively. VAS and ODI were significantly improved at the final FU. The ESR and CRP recovered to normal. The mean angle of 24.35 ± 5.74°preoperatively showed a significant difference between 1 week, postoperatively and final FU. Although there were the loss of angle at final FU comparing with the 1 week postoperatively, it still maintain the good alignment and the segmental stability. All patients achieved bony fusion with a mean time of 12.90 ± 3.91 months. In conclusion, the LSP as a structural bone graft is reliable, safe and effective for segmental stability reconstruction, which could be one choice for surgical management of thoracic or lumbar spinal TB.
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http://dx.doi.org/10.1038/s41598-020-79209-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745010PMC
December 2020

Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion.

J Orthop Surg Res 2020 Nov 17;15(1):538. Epub 2020 Nov 17.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.

Background: Although serum albumin levels are increasingly used as an indicator of nutritional status in the clinic, the relationship between perioperative hypoalbuminemia and wound complications after posterior lumbar interbody fusion in the treatment of lumbar degenerative disease remains ambiguous. The aim of this study was to evaluate perioperative serum albumin in relation to postoperative wound complications after posterior lumbar interbody fusion in the treatment of single-segment lumbar degenerative disease.

Material And Methods: We reviewed patients who underwent single-segment posterior lumbar interbody fusion surgery from December 2014 to April 2017 in the Department of Orthopedics at the First Affiliated Hospital of Chongqing Medical University. Perioperative (preoperative and early postoperative) serum albumin levels were assessed in all patients and were used to quantify nutritional status. We divided the patients into a surgical wound dehiscence (SWD) group and a normal wound healing group and into a surgical site infection (SSI) group and a non-SSI group. To evaluate the relationship between perioperative serum albumin level and postoperative wound complications, we conducted univariate and multiple logistic regression analyses.

Results: A total of 554 patients were enrolled in the study. The univariate and multiple logistic regression analysis of these differences showed that preoperative serum albumin < 3.5 g/dl (P = 0.001) and postoperative serum albumin < 3.0 g/dl (P = 0.001) were significantly correlated to SWD. There were also significant differences between the SSI groups in terms of preoperative serum albumin < 3.5 g/dl (P = 0.001) and chronic steroid use (P = 0.003). Additionally, the increased hospitalization costs (P < 0.001) and length of hospitalization (P < 0.001) were statistically significant for patients with perioperative hypoalbuminemia.

Conclusions: For patients who underwent single-segment posterior lumbar interbody fusion surgery, we need to pay more attention to perioperative hypoalbuminemia and chronic steroid use, which are more likely to be associated with increased wound complications, hospitalization costs, and length of hospitalization after surgery. Adequate assessment and management of these risk factors will help reduce wound complications and hospital stays for surgical patients and will save medical costs.
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http://dx.doi.org/10.1186/s13018-020-02051-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672919PMC
November 2020

Clinical efficacy of three types of autogenous bone grafts in treatment of single-segment thoracic tuberculosis: A retrospective cohort study.

Int J Med Sci 2020 16;17(17):2844-2849. Epub 2020 Oct 16.

Department of Orthopedic surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

A retrospective study investigated and compared the results of lamina with spinous process (LSP), transverse process strut (TPS) and iliac graft (IG) as bone graft in thoracic single-segment spinal tuberculosis(TB) with the one-stage posterior approach of debridement, fusion and internal instrumentation. 99 patients treated from January 2012 to December 2015 were reviewed. LSP was performed in 35 patients (group A), TPS was undertaken in 33 patients (group B), and IG was carried out in 31 patients (group C). Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, intervertebral height and bone fusion time were compared between preoperative and final FU. All the patients were followed up for a mean 43.90±10.39 months in group A, 45.30±6.20 months in group B, 44.32±7.17 months in group C without difference(>0.05). The mean age was younger, the blood loss was less, the hospitalization time and the surgical time were shorter in group A than those in group B and C (<0.05). The drainage volume was less in group A than that in group B and group C. The CRP, ESR, VAS, and ODI were significantly decreased and there were no significant difference among the groups at the final FU. The neurological function after surgery was improved compared with preoperation among the groups. The bony fusion at a mean time 12.90±3.91 months in group A was longer than that in group B (6.75±1.55 months) and group C (5.52±1.64 months) (<0.05). No significant difference was found at the mean segmental angle, mean intervetebral height of preoperation and final FU among the groups (>0.05). In conclusion, the LSP and TPS as bone graft are reliable, safe, and effective for single-segment stability reconstruction for surgical management of thoracic TB and TPS could be new bone graft methods.
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http://dx.doi.org/10.7150/ijms.47309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645334PMC
August 2021

Imaging evaluation of nano-hydroxyapatite/polyamide 66 strut in cervical construction after 1-level corpectomy: a retrospective study of 520 patients.

Eur J Med Res 2020 Sep 1;25(1):38. Epub 2020 Sep 1.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: The application of nano-hydroxyapatite/polyamide 66(n-HA/PA66) struts has become reliable in anterior cervical corpectomy and fusion (ACCF) as a source of sufficient segmental stability. This was a retrospective and long-term imaging evaluation of the n-HA/PA66 strut in 1-level ACCF.

Methods: The patients between June 2006 and December 2014, who underwent 1-level ACCF using an n-HA/PA66 strut, were reviewed. The neurological status was assessed using the Japanese Orthopedic Association (JOA) score and axial pain was evaluated using a Visual Analogue Scale (VAS) score and the radiographic parameters were determined by X-ray and 3-D CT examinations when necessary for the evaluation of bone fusion using the Brantigan scale and imaging characteristics.

Results: A total of 520 patients underwent one-level ACCF, with a mean follow-up (FU) duration of 72.38 ± 24.56 months. The level of surgery was C4 in 58 cases, C5 in 173 cases, C6 in 208 cases, and C7 in 81 cases. According to the Brantigan scale, on X-ray examination, the bony fusion rate was observed to be 40%, 70%, 93%, and 98% at 3 months, 6 months, 1 year and the final FU. An interesting radiographic appearance of the bone graft growth pattern was classified into three types. 95% of the patients accounted for types a and b. No significant differences were observed in age, hospitalization duration, surgical haemorrhage volume, or fusion rate among the types except in the percentage and sex of the patients among the types. Type a had better cervical lordosis, and less subsidence than types b and c (P < 0.05). No significant difference was found in segment angle between type a and type b. Type c was more often observed with subsidence rate, segmental angle loss and cervical alignment loss than types a and b (P < 0.05). Type a also had a slightly higher fusion rate, than types b and c, but there were no significant differences. The overall mean JOA score at the final follow-up among the groups were significantly improved comparing that preoperatively and no significant differences were found among the groups, no matter pre-operation or final follow-up. The overall mean VAS score at the final follow-up among the groups were significantly improved comparing that preoperatively and no significant differences in preoperative VAS score were found among the groups. However, the VAS score at the final follow-up of type a or type b was better than type c. No patients received revision surgery.

Conclusions: The type a bone graft growth pattern could allow a lower incidence of subsidence and better maintenance of local and global alignment to be achieved and is thus proposed for surgeons.
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http://dx.doi.org/10.1186/s40001-020-00440-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466497PMC
September 2020

Transcriptome Analysis Reveals the Effects of Troxerutin and Cerebroprotein Hydrolysate Injection on Injured Spinal Cords in Rats.

Evid Based Complement Alternat Med 2020 4;2020:3561235. Epub 2020 Aug 4.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

Spinal cord injury (SCI) is a serious condition that results in disability and has a high morbidity rate; its treatment is very difficult. Although troxerutin and cerebroprotein hydrolysate (TCH) injections have been extensively used in clinics in China for the treatment of traumatic brain injury (TBI) and cerebral stroke, the potential efficacy of TCH injection in the treatment of SCI has never been revealed. In this study, the effects of administering TCH injections on neurological recovery in post-SCI rats were first tested with regard to the behavior and histology; subsequently, the specific expression profile of mRNAs and long noncoding RNAs (LncRNAs) in their spinal cords were conducted using RNA sequencing (RNA-seq). The LncRNA-mRNA networks were also elucidated. After SCI, we found that TCH injection with the right dose is effective for the recovery of locomotion function and repairing of the damaged tissue in the spinal cord; TCH injection is also discovered to have a role in the regulation of 443 differentially expressed genes (DEGs) and 27 differentially expressed LncRNAs (DELs) that are identified to have multiple functions, including locomotion, blood vessel morphogenesis, thiamine metabolism, Hippo signaling pathway, and axon guidance, by applying the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) analysis. In addition, it is revealed that, after SCI, the highly expressed LncRNA AABR07071383.1 in the post-SCI cis/trans-regulates the expression of mRNA Acpp mRNA that encodes a key enzyme involved in the metabolic process of thiamine in the abirritation of the dorsal root ganglion (DRG), which implies that TCH injection may be more effective when administered with benfotiamine (a common treatment drug).
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http://dx.doi.org/10.1155/2020/3561235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424371PMC
August 2020

Complications rate of and risk factors for the unplanned reoperation of degenerative lumbar spondylolisthesis in elderly patients: a retrospective single-Centre cohort study of 33 patients.

BMC Geriatr 2020 08 24;20(1):301. Epub 2020 Aug 24.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing, Medical University, Chongqing, China.

Background: The study was to investigate the complications rate of and risk factors for unplanned reoperation among elderly patients who underwent posterior lumbar fusion (PLF) for degenerative lumbar spondylolisthesis (DLS).

Methods: A total of 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016. 33 patients underwent unplanned reoperations and were analysed and divided into two groups (group A: posterolateral fusion, 650 patients; group B: intervertebral fusion, 450 patients). Sex, body mass index (BMI), radiographic data and clinical outcome data were analysed to evaluate the complications rate of and the risk factors for unplanned reoperations.

Results: A total of 33 patients underwent unplanned reoperations (3%). The patients were followed up for an average of 4.20 ± 2.25 years (group A) and 4.32 ± 2.54 years (group B) without a significant difference. Significant differences were found in mean age, levels of involvement, hospital stay, surgery time, and blood loss between the groups. The causes of unplanned operation were wound infection, screw misplacement, neurological deficit, nonunion, and screw fracture, which were significant except for wound infection between the groups. Higher BMI (obesity), diabetes mellitus (DM), more bleeding and sex (female) were risk factors for complications. Cases of screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significant than those in group B.

Conclusion: Patients with higher BMI, DM, older age, posterolateral fusion, and female sex predicted a higher incidence of unplanned reoperations. Spine surgeons may need to pay more attention to their preoperative training and to improving surgical techniques that could reduce the reoperation rate.
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http://dx.doi.org/10.1186/s12877-020-01717-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446205PMC
August 2020

Transverse process strut and titanium mesh cages in the stability reconstruction of thoracic single segment tuberculosis: a retrospective single-center cohort study.

BMC Musculoskelet Disord 2020 Mar 16;21(1):172. Epub 2020 Mar 16.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: A retrospective and comparative study of transverse process strut (TPS, Group A) compared with titanium mesh cages (TMCs, Group B) in the reconstruction of thoracic stability through the one-stage posterior approach to treat single-segment tuberculosis.

Methods: Sixty patients from January 2013 to December 2016 were analyzed and divided into two groups. The following data of clinical and radiographical assessments were observed preoperatively, postoperatively and during follow-up (FU).

Results: The patients were followed up for an average of 50.20 ± 25.10 months (Group A) and 48.70 ± 27.30 months(Group B) without significant difference. No significant differences were found in the mean of operation time in minutes, blood loss, hospitalization time, drainage and follow-up duration between the groups. The VAS, ODI, ESR and CRP were reduced significantly at the final FU compared with the preoperation values and there was no significance between the groups. Neurological deficits were improved in all patients at the final FU without significant difference between the groups(P > 0.05). The bony fusion times were 5.85 ± 1.82 months and 8.4 ± 5.1 months with significant difference(P < 0.05). Comparing with the preoperative values, the kyphosis angle significantly improved, but at the final FU the significant difference was found between the groups (P < 0.05). The loss of the angular correction and the fused segmental height in group A was lower than that in group B (P < 0.05).

Conclusions: TPS had a better osseous fusion rate, effective maintenance of fused segment stability which is a good bone graft for surgical management of single-segment thoracic spinal tuberculosis.
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http://dx.doi.org/10.1186/s12891-020-03196-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077101PMC
March 2020

3D-printed titanium implant-coated polydopamine for repairing femoral condyle defects in rabbits.

J Orthop Surg Res 2020 Mar 11;15(1):102. Epub 2020 Mar 11.

Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.

Background: Large segmental bone defects are still one of the challenges for orthopaedic surgeons. Although 3D-printed porous titanium is a potential bone substitute material because of its porous structure simulating natural bone, the titanium surface has low bioactivity, integrates with bone tissue through the simple mechanical interlock. The study aims to investigate the capability and osteogenesis of 3D-printed porous titanium (3D PPT)-coated polydopamine (PDA) for repairing bone defects.

Methods: Fifteen 6-month New Zealand white rabbits were implanted with PDA-3D PPT to repair 6 mm × 10 mm defects on the femoral condyle compared with the group of 3D PPT and comparing with the blank group. After 6 weeks and 12 weeks, micro-CT and histological examination were performed to observe bone growth.

Results: All the PDA-3D PPT group, the 3D PPT group and the blank group recovered in good condition. The images showed that the boundaries between the implant area and the surrounding area were obscure in the three groups. The results of micro-CT demonstrated that at 6 weeks and 12 weeks, the bone volume (BV) values of PDA-3D PPT implants group were significantly higher than those of the 3D PPT implants group and blank group (P < 0.05), the BV/tissue volume (TV) and the trabecular number (Tb.N) of PDA-3D PPT implants were significantly higher than those of the 3D PPT group and blank group (P < 0.05). The results of un-decalcified bone slicing showed that ore new bone appeared to form around the PDA-3D PPT than that of 3D PPT and blank group. The bone-implant contact (BIC) of PDA-3D PPT was better (P < 0.05) than that of 3D PPT group.

Conclusion: PDA-3D PPT could improve the bioactivity and promote the growth and healing of bone tissue and can be a promising repairing material.
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http://dx.doi.org/10.1186/s13018-020-01593-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065349PMC
March 2020

Identification of aberrantly methylated‑differentially expressed genes and gene ontology in prostate cancer.

Mol Med Rep 2020 02 11;21(2):744-758. Epub 2019 Dec 11.

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China.

Prostate cancer (PCa) is the most frequent urological malignancy in men worldwide. DNA methylation has an essential role in the etiology and pathogenesis of PCa. The purpose of the present study was to identify the aberrantly methylated‑differentially expressed genes and to determine their potential roles in PCa. The important node genes identified were screened by integrated analysis. Gene expression microarrays and gene methylation microarrays were downloaded and aberrantly methylated‑differentially expressed genes were obtained. Enrichment analysis and protein‑protein interactions (PPI) were obtained, their interactive and visual networks were created, and the node genes in the PPI network were validated. A total of 105 hypomethylation‑high expression genes and 561 hypermethylation‑low expression genes along with their biological processes were identified. The top 10 node genes obtained from the PPI network were identified for each of the two gene groups. The methylation and gene expression status of node genes in TCGA database, GEPIA tool, and the HPA database were generally consistent with those of our results. In conclusion, the present study identified 20 aberrantly methylated‑differentially expressed genes in PCa by combining bioinformatics analyses of gene expression and gene methylation microarrays, and concurrently, the survival of these genes was analyzed. Notably, methylation is a reversible biological process, which makes it of great biological significance for the diagnosis and treatment of prostate cancer using bioinformatics technology to determine abnormal methylation gene markers. The present study provided novel therapeutic targets for the treatment of PCa.
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http://dx.doi.org/10.3892/mmr.2019.10876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947816PMC
February 2020

Global Trends of Researches on Sacral Fracture Surgery: A Bibliometric Study Based on VOSviewer.

Spine (Phila Pa 1976) 2020 Jun;45(12):E721-E728

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.

Study Design: Bibliometric analysis.

Objective: This study aims to identify and summarize the articles related to sacral fracture surgery, to compare the papers from different countries and journals, to show the trends of researches on sacral fracture surgery.

Summary Of Background Data: In recent years, studies on sacral fracture are growing rapidly, but there were no bibliometric studies regarding sacral fracture surgery.

Methods: Excel 2016 and VOSviewer were used to identify and summarize the articles from Web of Science between 1900 and 2018. Publication number, publication year, publication country, publication organization, publication source, author, sum of times cited, H-index, and journal's impact factors were recorded and analyzed. Bibliometric maps of co-citations and maps of co-occurrence of keywords are drawn.

Results: A total of 611 publications were extracted. United States published most articles (227, 37.2%), both total citations (3536) and H-index (32) of United States ranked first of all the countries. The most productive organization on sacral fracture surgery is Johns Hopkins University (14). Spine (43) published the most articles on sacral fracture surgery. The latest keyword "patterns" appeared in 2017 in 5 articles. Other relatively new keywords include "proximal junctional kyphosis," "spondylopelvic dissociation," "fragility fracture," "lumbopelvic fixation" that appeared in 2017 in eight, six, six, and 25 articles, respectively.

Conclusion: This bibliometric study showed that there is a growing trend both in published articles related to sacral fracture surgery and relative research interest in the last 30 years. United States dominates the research regarding sacral fracture surgery. Johns Hopkins University, Johannes Gutenberg University of Mainz, and Harborview Medical Center are the best institutions related to sacral fracture surgery research. Spine, J Orthop Trauma, and Injury are the top three productive journals on sacral fracture surgery. Sacral fracture patterns, proximal junctional kyphosis, spondylopelvic dissociation, fragility fracture, and lumbopelvic fixation may be the new research hotspot in this field.

Level Of Evidence: 5.
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http://dx.doi.org/10.1097/BRS.0000000000003381DOI Listing
June 2020

Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures.

Sci Rep 2020 01 15;10(1):399. Epub 2020 Jan 15.

Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

The study aimed to analyze the radiographic and magnetic resonance imaging (MRI) findings that might predict the risk for adjacent segmental fractures (ASFs) when percutaneous vertebroplasty (PV) is used for the treatment of osteoporotic thoracolumbar fractures (OTFs). A total of 92 OTFs patients who underwent PV between January 2013 and January 2015 were retrospectively reviewed. The visual analog scale (VAS), Oswestry-Disability Index (ODI) and radiolographic measurements were assessed. The VAS and ODI scores improved significantly at the final follow-up (FU) compared with the preoperation scores. Compared with the preoperative values, the fractured body alignment (FBA) significantly improved at the 3-month FU and the final FU, but the adjacent segment alignment (ASA) and thoracolumbar alignment (TLA) did not improve. According to the correlation analysis, the final FU TLA and the final FU ASA were correlated with the preoperative FBA, ASA, and TLA on plain radiography and were highly correlated on MRI. However, the final FU FBA was not correlated with the preoperative FBA, ASA, or TLA on plain radiography or MRI (P > 0.05). The ASFs were correlated with the 3-month FU TLA (r = 0.6044, P = 0.0037) and the final FU TLA (r = 0.5699, P = 0.007) on plain radiography, and the final TLA was more correlated with the preoperative FBA, ASA, and TLA on MRI than on plain radiography. In conclusion, the preoperative ASA and TLA on MRI were risk factors associated with ASFs in OTFs treated with PV.
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http://dx.doi.org/10.1038/s41598-019-57355-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962453PMC
January 2020

Vertebroplasty and vertebroplasty in combination with intermediate bilateral pedicle screw fixation for OF4 in osteoporotic vertebral compression fractures: a retrospective single-Centre cohort study.

BMC Surg 2019 Nov 27;19(1):178. Epub 2019 Nov 27.

Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Background: Although various studies have described the outcomes and complications of each treatment for OF 4 in osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. This study aimed to investigate the clinical effect of OF 4 in patients with OVCFs treated with percutaneous vertebroplasty (PV) compared with PV in combination with intermediate bilateral pedicle screw fixation (IBPSF).

Methods: A total of 110 patients with OF 4 in OVCFs from January 2011 to December 2013 were reviewed retrospectively and divided into two groups (group A: PV, group B: PV + IBPSF). According to the guidelines of the German Society for Orthopaedics and Trauma (DGOU), OF 4 consists of 3 fracture types. The clinical and radiographic assessments were observed preoperatively, postoperatively, and during follow-up.

Results: The patients were followed for an average of 60.50 ± 15.20 months (group A) and 58.20 ± 17.60 months (group B) without significant differences. No significant differences were found in BMD, BMI and cement volume between the two groups, but differences were found for operation time, blood loss, and hospitalization time. The VAS and ODI scores improved better significantly at the final follow-up in group B but not in group A. Compared with the preoperative values, the postoperative kyphosis angle and loss of fractured segment height significantly improved, but the difference between the groups was significant after 3 months postoperatively. The loss of angular correction and fractured segment height in group A were greater than those in group B. A total of 15 cases of cement leakage were observed in group A and 8 cases in group B, and no complications or revision surgeries were observed in either group. Thirteen new fractures occurred (11 in group A and 2 in group B), which was significant.

Conclusion: PV with IBPSF could provide effective restoration and maintenance of fractured segment height and segment alignment as well as a lower rate of complications of OF 4 in OVCFs.
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http://dx.doi.org/10.1186/s12893-019-0646-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880590PMC
November 2019

One-stage posterior debridement with transverse process strut as bone graft in the surgical treatment of single-segment thoracic tuberculosis: A retrospective single-center study.

Medicine (Baltimore) 2019 Nov;98(47):e18022

Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

This retrospective study investigated the effect of the novel bone graft transverse process strut (TPS) in single segmental thoracic spinal tuberculosis (TB) with the one-stage posterior approach of debridement, fusion, and internal instrumentation. Thirty patients treated in our department from March 2014 to October 2016 were retrospectively analyzed. Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All the patients were followed for a mean 50.10 ± 25.10 months; the mean age, surgical time in minutes, blood loss, hospitalization time, and drainage volume were 46.23 ± 17.20 years, 195.08 ± 24.0 minutes, 280.77 ± 189.90 mL, 17.31 ± 4.23 days, 436.92 ± 193.81 mL, respectively. VAS and ODI scores were significantly improved at the final FU. The ESR and CRP returned to normal. All patients achieved bony fusion with a mean time of 5.85 ± 1.82 months and a mean segmental angle of 18.77 ± 2.49° preoperatively, which significantly decreased to 9.31 ± 1.54° at the final FU (P < .05). No complications, such as bone graft failure, pleural effusion, fistula, or wound infection were recorded except for cerebrospinal fluid leakage (one case), water electrolyte imbalance (5 cases), superficial infection (1 case), and mild intestinal obstruction (1 case). TPS as a bone graft is reliable, safe, and effective for segmental stability reconstruction for surgical management of single-segment thoracic spinal TB.
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http://dx.doi.org/10.1097/MD.0000000000018022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882565PMC
November 2019

Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis.

J Orthop Surg Res 2019 Sep 2;14(1):288. Epub 2019 Sep 2.

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.

Background: There was a controversy about bone grafting of spinal tuberculosis treatment. The aim of this study was to compare the clinical efficacy of a new bone grafting method-transverse bone grafting (TBG)-with iliac bone grafting (IBG) and titanium mesh grafting (TMG) in the treatment of single-segment thoracic spinal tuberculosis.

Material And Methods: TBG was undertaken in 30 patients (group A), IBG was carried out in 28 patients (group B), and TMG was performed in 36 patients (group C). The operative time, intraoperative blood loss, postoperative drainage amount, postoperative complications, length of hospital stay, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score for back pain, Oswestry dysfunction index (ODI), intervertebral height, and time to bone graft fusion were compared. Changes in the Cobb angle of kyphosis, intervertebral height, and loss to the final follow-up were measured. Neurological function recovery was evaluated according to the criteria of the American Spinal Injury Association (ASIA).

Results: The operative times in group A was significantly shorter than those in groups B and C (P = 0.036, P = 0.005, P = 0.901). The hospital stay in group A was significantly shorter than that in groups B and C (P = 0.022, P = 0.031, P = 0.424). The intraoperative blood loss in group A was significantly less than that in groups B and C (P = 0.045, P = 0.004, P = 0.586). The VAS score, ODI, ESR level, CRP level, Cobb angle of kyphosis, and intervertebral height of the affected segment were significantly improved compared with those before surgery (P < 0.05).

Conclusion: For the treatment of single-segment thoracic spinal tuberculosis, the new interbody fusion technique using transverse process bone grafting is a safe, reliable, effective, and ideal bone grafting method.
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http://dx.doi.org/10.1186/s13018-019-1312-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721193PMC
September 2019
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