Publications by authors named "Zhongjun Liu"

161 Publications

Comparison of Surgical Outcomes Between Staged and Simultaneous Decompression of Discontinuous Thoracic Ossification of the Ligamentum Flavum: A Retrospective Study.

World Neurosurg 2021 Jul 24. Epub 2021 Jul 24.

Department of Orthopaedics, Peking University Third Hospital, No. 49 Huayuanbei Rd, Haidian District, Beijing 100191, China.

Background: Discontinuous thoracic ossification of the ligamentum flavum (TOLF) is diagnosed according to the number and distribution of involved segments seen on magnetic resonance images. When TOLF causes thoracic myelopathy, surgical intervention for these lesions becomes unavoidable. However, there are few reports on the outcomes of surgery for discontinuous TOLF.

Methods: The study included 26 patients of mean age 55.0 years who underwent simultaneous (n=16) or staged (n=10) decompression of discontinuous TOLF between July 2006 and June 2016. Final neurological status was evaluated using the modified Japanese Orthopaedic Association (JOA) score. The surgical data and incidence of complications were compared. The mean follow-up duration was 73.3 months.

Results: There was no between-group difference in number of levels decompressed or the amount of intraoperative blood loss. There was a significant improvement in the JOA score from 4.0 before surgery to 8.0 postoperatively, with an average recovery rate of 58.3%. The JOA recovery rate was significantly better in the staged group than in the simultaneous group (68.4% vs. 52.0%, P<0.05). However, the incidence of complications was similar between the staged and simultaneous groups, including for dural tear (1 vs. 6, P=0.19), cerebrospinal fluid leak (4 vs. 6, P=1.00), and transient neurological deterioration (0 vs. 2, P=0.51).

Conclusions: The surgical outcome of staged decompression for discontinuous TOLF seems to be better than that of simultaneous decompression. The complication rates of these two strategies are similar.
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http://dx.doi.org/10.1016/j.wneu.2021.07.075DOI Listing
July 2021

Identification of ZNF704 as a Novel Oncogene and an Independent Prognostic Marker in Chondrosarcoma.

Cancer Manag Res 2021 21;13:4911-4919. Epub 2021 Jun 21.

Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211, People's Republic of China.

Purpose: The transcription factor zinc finger protein 704 (ZNF704) is implicated in tumorigenesis. However, the underlying role of ZNF704 in the pathogenesis of chondrosarcoma remains not well delineated. This study investigates the expression level, prognostic significance and potential biological function of ZNF704 in human chondrosarcoma.

Materials And Methods: The mRNA and protein levels of ZNF704 in fresh chondrosarcomas and the paired adjacent non-tumor tissues were evaluated using real-time PCR and immunoblotting, respectively. The protein expression of ZNF704 in chondrosarcoma specimens was detected by immunohistochemistry, and the associations among its expression level, clinicopathological characteristics and prognosis were further investigated. Cell viability, colony formation and apoptosis assay were determined in chondrosarcoma cells and a xenograft model with ZNF704 knockdown.

Results: The expression levels of ZNF704 mRNA and protein in chondrosarcoma tissues were significantly higher than those in the paired adjacent non-tumor tissues and benign cartilage tumors. Clinicopathological analysis revealed that ZNF704 was expressed at higher levels in chondrosarcoma patients with higher histological grade and advanced MSTS stage. We also found that high expression of ZNF704 significantly correlated with a worse overall survival of chondrosarcoma patients. Multivariate Cox regression analysis indicated that ZNF704 was an independent prognostic marker in chondrosarcoma patients. Our in vitro studies demonstrated that knockdown of ZNF704 markedly inhibited chondrosarcoma cell viability, colony formation and induced apoptosis. In a nude mouse xenograft model, ZNF704 knockdown slowed down chondrosarcoma growth by inducing apoptosis in vivo.

Conclusion: These findings suggest that ZNF704 may act as a potent oncogene implicated in chondrosarcoma development, and serve as a independent prognostic marker, highlight the potential of ZNF704 as a novel biomarker and therapeutic target for chondrosarcoma.
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http://dx.doi.org/10.2147/CMAR.S313229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232878PMC
June 2021

Reliability and validity of simplified Chinese version of the Italian spine youth quality of life questionnaire in adolescents with idiopathic scoliosis.

BMC Musculoskelet Disord 2021 Jun 21;22(1):568. Epub 2021 Jun 21.

Department of Orthopaedic Surgery, Peking University Third Hospital, 100191, Beijing, China.

Background: The Italian Spine Youth Quality of Life (ISYQOL) questionnaire is used to evaluate health-related quality of life in adolescents with Idiopathic Scoliosis. The study aimed to undertake the process of cultural adaptation of the ISYQOL questionnaire into Simplified Chinese.

Methods: Translate from Italian into Simplified Chinese. It involved 138 adolescents whose Cobb angle ranged between 20 and 40 degrees, 50 wearing the brace and 88 not wearing the brace. Statistical analysis calculated the reliability, floor effects, and ceiling effects of the ISYQOL. After that, construct validity was measured by analyzing the ISYQOL relationship Scoliosis Research Society-22 patient Questionnaire (SRS-22).

Results: There were no floor or ceiling effects in the ISYQOL questionnaire. Cronbach's alpha coefficient evaluated for Internal consistency was 0.75 in the no-treated group and 0.88 in the brace-treated group. Intraclass correlation coefficients assessed with the use of the test-retest method were 0.72 in the no-treated group and 0.80 in the brace-treated group. A strong relationship exists between the ISYQOL measure and SRS-22 scores (rho = 0.62; p < 0.01), reflecting the high validity of the questionnaires. Both ISYQOL and SRS-22 scores showed no statistical difference between groups wearing and not wearing the brace (p > 0.05).

Conclusions: Trans-cultural validation in Chinses language showed the reliability and validity of the ISYQOL.
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http://dx.doi.org/10.1186/s12891-021-04462-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218420PMC
June 2021

Dysregulation of Zinc Finger Protein 395 Contributes to the Pathogenesis of Chondrosarcoma.

Onco Targets Ther 2021 1;14:3545-3553. Epub 2021 Jun 1.

Department of Spinal Surgery, Tianjin Hospital, Tianjin, 300211, People's Republic of China.

Introduction: The transcription factor zinc finger protein 395 (ZNF395) is involved in several cellular responses and tumorigenesis. However, the potential role and clinical significance of ZNF395 in chondrosarcoma are not well investigated. This study determines the expression profile, prognostic value and biological function of ZNF395 in human chondrosarcoma.

Methods: The mRNA and protein expressions of ZNF395 in fresh chondrosarcomas and the matched adjacent non-tumor tissues were assessed using real-time PCR and immunoblotting, respectively. The protein expression of ZNF395 in chondrosarcoma specimens was evaluated by immunohistochemistry, and the relationships among its protein level, clinicopathological parameters and prognosis were further detected. Cell viability, colony formation, migration, invasion and apoptosis assay were evaluated in chondrosarcoma cells with depletion of ZNF395.

Results: The mRNA and protein expressions of ZNF395 in chondrosarcoma tissues were significantly higher than those in the matched adjacent non-tumor tissues and benign cartilage tumors. Clinical analysis displayed that ZNF395 was expressed at higher levels in chondrosarcoma patients with higher histological grade and advanced MSTS stage. Furthermore, we demonstrated that high expression of ZNF395 correlated with a worse overall survival of chondrosarcoma patients. Multivariate Cox regression analysis indicated that ZNF395 was an independent prognostic marker in chondrosarcoma patients. Functional studies revealed that depletion of ZNF395 markedly inhibited cell viability, colony formation, migration and invasion, and promoted apoptosis in chondrosarcoma.

Conclusion: These findings suggest that dysregulation of ZNF395 contributes to chondrosarcoma development, and ZNF395 may act as a potent oncogene and serve as a independently prognostic factor, highlight the potential of ZNF395 as a novel biomarker and therapeutic target for chondrosarcoma.
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http://dx.doi.org/10.2147/OTT.S310164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183675PMC
June 2021

Application and Evaluation of an Independent Robotic Arm System in K-wire Placement for Lumbar Fusion.

Clin Spine Surg 2021 May 28. Epub 2021 May 28.

Orthopedic Department Clinical Epidemiological Research Center, Peking University Third Hospital Department of Clinical Medicine, Peking University Health Science Center, Beijing, China Department of Science and Technology Studies, Cornell University, Ithaca, NY.

Study Design: A single-center randomized controlled study.

Objective: The objective of this study was to introduce a novel robotic system with an independent arm ("Orthbot Intelligent Orthopedic Minimally Invasive System"; Xin Junte Surgical Technologies) that has been developed and tested as a surgical assistant for autoplacement of the Kirschner wire (K-wire) in lumbar fusion, and to evaluate its accuracy by comparing it with the conventional free-hand instrumentation.

Summary Of Background Data: Robotic technology has performed excellently in spine surgeries and has demonstrated high clinical value and potential. Robot-assisted spinal surgery is now being promoted as a paradigm for technology-led advancement.

Materials And Methods: A total of 24 patients were recruited and assigned randomly to the robotic arm group (RG) or the free-hand group (FG). Deviation distance and deviation angle (DA) of K-wire placement were measured and compared between the RG and the FG.

Results: The average deviation distance was 0.88±0.08 mm in the RG and 5.13±1.68 mm in the FG (P<0.001). In both coronal and sagittal radiographs, the average DA of K-wire placement was smaller in the RG (P<0.05), and in both axial and sagittal computed tomography scans, the average DA of pedicle screw placement was also lower in the RG (P<0.05), which indicated higher accuracy of the robotic system.

Conclusions: The novel robotic system in this study has shown certain advantages over the conventional free-hand approach in K-wire placement for lumbar fusion, including being more accurate in K-wire placement, fully automatic, and more adaptive to preoperative plans. Although the robotic arm proves to be promising in our results, the small sample size in this clinical study necessitates further multicenter, large sample follow-up studies to verify its advantages.
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http://dx.doi.org/10.1097/BSD.0000000000001191DOI Listing
May 2021

Practical strategy to construct anti-osteosarcoma bone substitutes by loading cisplatin into 3D-printed titanium alloy implants using a thermosensitive hydrogel.

Bioact Mater 2021 Dec 14;6(12):4542-4557. Epub 2021 May 14.

Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China.

Surgical resection and perioperative adjuvant chemotherapy-based therapies have improved the prognosis of patients with osteosarcoma; however, intraoperative bone defects, local tumour recurrence, and chemotherapy-induced adverse effects still affect the quality of life of patients. Emerging 3D-printed titanium alloy (TiAlV) implants have advantages over traditional implants in bone repair, including lower elastic modulus, lower stiffness, better bone conduction, more bone in-growth, stronger mechanical interlocking, and lager drug-loading capacity by their inherent porous structure. Here, cisplatin, a clinical first-line anti-osteosarcoma drug, was loaded into TiAlV implants, within a PLGA-PEG-PLGA thermo-sensitive hydrogel, to construct bone substitutes with both anti-osteosarcoma and bone-repair functions. The optimal concentrations of cisplatin (0.8 and 1.6 mg/mL) were first determined . Thereafter, the anti-tumour effect and biosafety of the cisplatin/hydrogel-loaded implants, as well as their bone-repair potential were evaluated in tumour-bearing mouse, and bone defect rabbit models, respectively. The loading of cisplatin reduced tumour volume by more than two-thirds (from 641.1 to 201.4 mm) with negligible organ damage, achieving better anti-tumour effects while avoiding the adverse effects of systemic cisplatin delivery. Although bone repair was hindered by cisplatin loading at 4 weeks, no difference was observed at 8 weeks in the context of implants with versus without cisplatin, indicating acceptable long-term stability of all implants (with 8.48%-10.04% bone in-growth and 16.94%-20.53% osseointegration). Overall, cisplatin/hydrogel-loaded 3D-printed TiAlV implants are safe and effective for treating osteosarcoma-caused bone defects, and should be considered for clinical use.
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http://dx.doi.org/10.1016/j.bioactmat.2021.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138733PMC
December 2021

Three-dimensional-printed individualized porous implants: A new "implant-bone" interface fusion concept for large bone defect treatment.

Bioact Mater 2021 Nov 6;6(11):3659-3670. Epub 2021 Apr 6.

Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China.

Bone defect repairs are based on bone graft fusion or replacement. Current large bone defect treatments are inadequate and lack of reliable technology. Therefore, we aimed to investigate a simple technique using three-dimensional (3D)-printed individualized porous implants without any bone grafts, osteoinductive agents, or surface biofunctionalization to treat large bone defects, and systematically study its long-term therapeutic effects and osseointegration characteristics. Twenty-six patients with large bone defects caused by tumor, infection, or trauma received treatment with individualized porous implants; among them, three typical cases underwent a detailed study. Additionally, a large segmental femur defect sheep model was used to study the osseointegration characteristics. Immediate and long-term biomechanical stability was achieved, and the animal study revealed that the bone grew into the pores with gradual remodeling, resulting in a long-term mechanically stable implant-bone complex. Advantages of 3D-printed microporous implants for the repair of bone defects included 1) that the stabilization devices were immediately designed and constructed to achieve early postoperative mobility, and 2) that osseointegration between the host bone and implants was achieved without bone grafting. Our osseointegration method, in which the "implant-bone" interface fusion concept was used instead of "bone-bone" fusion, subverts the traditional idea of osseointegration.
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http://dx.doi.org/10.1016/j.bioactmat.2021.03.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056181PMC
November 2021

Translation and validation of the Chinese version of Brace Questionnaire (BrQ).

Transl Pediatr 2021 Mar;10(3):598-603

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

Background: The Brace Questionnaire (BrQ) is a tool developed to assess the health-related quality of life (HRQoL) among patients with adolescent idiopathic scoliosis (AIS) who receiving bracing as the primary treatment. It was initially developed and validated in Greek. The current study aimed to culturally adapt and psychometrically validate the BrQ in contemporary Chinese used in mainland China.

Methods: Translation of the BrQ from the original Greek into Chinese was performed. This study involved 70 Chinese adolescents between 10 and 18 years of age with a diagnosis of AIS and a Cobb angle measuring between 20 and 40 degrees. All patients received the same kind of brace for more than 4 months. Statistical analyses included internal consistency and the floor and ceiling effects of the BrQ. Subsequently, convergent validity was evaluated by correlating the measures in the BrQ with those in the Scoliosis Research Society-22 Questionnaire (SRS-22).

Results: There were no floor and ceiling effects observed with the Chinese version of BrQ. The intra-class correlation coefficient (ICC) was 0.967. Internal consistency as measured by Cronbach's alpha was 0.923. The global BrQ score correlated strongly with the SRS-22 total score (r=0.743, P<0.001). Most domain-level sub-scores from the BrQ correlated with the respective domain scores of SRS-22.

Conclusions: Cross-cultural translation and validation demonstrated excellent reliability, high internal consistency and satisfactory concurrent validity of the Chinese version of BrQ.
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http://dx.doi.org/10.21037/tp-20-377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039779PMC
March 2021

Risk factors associated with post-operative neurological deterioration in patients with thoracic disc disorders with myelopathy.

Int Orthop 2021 06 7;45(6):1539-1547. Epub 2021 Apr 7.

Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Hai Dian District, Beijing, 100191, China.

Purpose: Post-operative neurological deterioration (ND) is a severe complication. However, limited literature exists on the ND in thoracic disc disorders with myelopathy (TDM). This study describes the risk factors of neurological deterioration in TDM with instrumentation and fusion.

Methods: A single-centre review of TDM with instrumentation and fusion during 2006-2019 was performed. Post-operative neurological deterioration was defined as the deterioration of pre-existing neurological function or the appearance of new neurological symptoms. Patients were then grouped into two groups depending on neurological deterioration (ND group) or not (non-ND group). Demographics, radiographic parameters, and surgical characteristics were compared between the two groups.

Results: A total of 257 cases were included, and neurological deterioration occurred in 16 (6.23%) cases. Multivariate analysis revealed spinal canal occupancy ratio > 75%, U-shaped compressed spinal cord in axial MRI, calcified herniated disc, anterior approach, and intra-operative blood loss > 1500 mL were associated with ND. Ten patients (62.5%) had complete neurological recovery within six months, and four patients (25%) had progressive neurological function improvement and equal or better than pre-operation within nine months.

Conclusions: The rate of neurological deterioration is 6.23%, and a higher spinal canal occupancy ratio, U-shaped compressed spinal cord, calcified herniated disc, anterior approach, and massive intra-operative blood loss were associated with neurological deterioration. Long-term outcomes of neurological deterioration are favourable, and 62.5% of patients experienced complete neurological recovery within six months. Patients with TMD who undergo surgery should be properly informed of the potential risks of neurological deterioration, despite its usually transient nature in most patients.
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http://dx.doi.org/10.1007/s00264-021-04999-2DOI Listing
June 2021

Relationship between patellofemoral finite helical axis and femoral trans-epicondylar axis using a static magnetic resonance-based methodology.

J Orthop Surg Res 2021 Mar 24;16(1):212. Epub 2021 Mar 24.

Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.

Background: To manage patellofemoral joint disorders, a complete understanding of the in vivo patellofemoral kinematics is critical. However, as one of the parameters of joint kinematics, the location and orientation of the patellofemoral finite helical axis (FHA) remains unclear. The purpose of this study is to quantify the location and orientation of the patellar FHA, both in vivo and non-invasively at various flexion angles, and evaluate the relationship of the FHA and the trans-epicondylar axis (TEA).

Methods: The magnetic resonance (MR) images of 18 unilateral knees were collected at full extension, 30°, 60°, 90°, and maximum angle of knee flexion. Three-dimensional models of the knee joint at different flexion angles were created using the MR images, and then used to calculate the patellar tracking and FHA with a spline interpolation algorithm. By using a coordinate system based on the TEA, the FHA tracking was quantified. Six parameters concerning the location and orientation of the patellar FHA were analysed.

Results: The average patellar FHA drew an L-shaped tracking on the midsagittal plane moving from the posteroinferior to the anterosuperior side of the TEA with knee flexion. Before 90° flexion, the patellar rotational radius decreased slightly, with an average value of 5.65 ± 1.09 cm. During 20° to 90° knee flexion, the average angle between the patellar FHA and the TEA was approximately 10° and that between the FHA and the coronal plane was maintained at about 0°, while that between the FHA and the level plane fluctuated between - 10° and 10°.

Conclusions: This study quantitatively reported the continuous location and direction of the patellar FHA during knee flexion. The patellar FHA was close to but not coincident with the femoral TEA both in location and orientation, and the patellar rotational radius decreased slightly with knee flexion. These findings could provide a clear direction for further studies on the difference in patellofemoral FHA among various types of patellofemoral disorders, and provide a foundation for the application of FHA in surgical evaluation, preoperative planning and prosthesis design, thereby assisting in the diagnosis and treatment of patellofemoral disorders.
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http://dx.doi.org/10.1186/s13018-021-02328-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988974PMC
March 2021

Imaging features and atypical signs of symptomatic vertebral haemangioma: a retrospective single-centre analysis of 118 patients.

Br J Radiol 2021 May 26;94(1121):20201250. Epub 2021 Feb 26.

Departments of Orthopaedics, Peking University Third Hospital, Beijing, China.

Objectives: Symptomatic vertebral haemangioma (SVH) can present with atypical imaging features. Thus, this study analysed the imaging features of SVH using CT and MRI to improve SVH awareness.

Methods: We retrospectively analysed CT and MRI characteristics of 118 patients with clinically and pathologically confirmed SVH.

Results: Overall, 118 patients were diagnosed with SVH, including 79 females and 39 males (mean age, 45.76 ± 16.36 years). The thoracic spine ( = 86) was the most common location of SVH, followed by the lumbar spine ( = 17). Involvement of multiple spinal segments was observed in 15 patients (12.71%). A total of 101 lesions (85.59%) were centred in the vertebral body, 15 lesions (12.71%) were centred in the posterior attachment, and two lesions (2%) were centred in the paraspinal region. CT showed 39 lesions (33.05%) without a typical honeycomb or polka-dot pattern. Compression fracture was observed in 23 patients (19.49%). Extraosseous extension was present in 111 patients (94.1%), and 17 lesions (14.41%) presented with foraminal extension. Epidural bony compression was observed in 46 patients (38.98%). 20 lesions (16.95%) had atypical weighted MRI signals, and 8 lesions (10.26%) showed atypical enhancement.

Conclusion: SVH was predominantly located in the thoracic spine. Involvement of multiple segments, posterior attachment localisation, absence of honeycomb or polka-dot signs, compression fracture, and atypical weighted imaging signals and enhancement were uncommon. Epidural bony compression was not uncommon and has important clinical significance.

Advances In Knowledge: The imaging features of SVHs are not fully understood. We examined the largest series of SVH cases reported to date.
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http://dx.doi.org/10.1259/bjr.20201250DOI Listing
May 2021

A novel 3D-printed locking cage for anterior atlantoaxial fixation and fusion: case report and in vitro biomechanical evaluation.

BMC Musculoskelet Disord 2021 Jan 29;22(1):121. Epub 2021 Jan 29.

Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.

Background: Treatment of atlantoaxial dislocation is aimed at reduction and stabilization of the atlantoaxial joint. 3D printing refers to a process where additive manufacturing is achieved under precise computer control. Literature on its utilization in anterior atlantoaxial fixation and fusion is rare. This study is the first report on a 3D-printed locking cage used in the anterior procedure for atlantoaxial dislocation.

Methods: A middle-aged male in his 40s presented with weakness and numbness of his extremities for 3 years and could only walk slowly with assistance. Imaging studies revealed severe anterior migration of C1, irreducible atlantoaxial dislocation, and severe cervical-medullary compression. A preoperative plan consisting of trans-oral soft tissue release and fixation using tailor-designed 3D-printed cages was devised. Following fluoroscopic confirmation of reduction of the atlantoaxial joints, two customized 3D-printed cages made of titanium alloy were inserted into the bilateral facet joints, which were then locked by six screws into the lateral masses of C1 and C2. The microstructure of the inserted cages was optimized for improved biomechanical stability and enhanced osseo-integration, without the need for bone grafting. In addition, a biomechanical test was performed on seven human cadaveric specimens comparing the novel implant with the conventional C1 lateral mass-C2 pedicle screw construct in three modes of motion (flexion-extension, lateral bending, axial rotation).

Results: Improvement of neurologic function in the patient was evident immediately after surgery. He was able to walk independently 1 month post-operatively. At the 12-month follow-up, coronal reconstruction of CT demonstrated properly-positioned 3D-printed cages, evidence of osseo-integration at the bone-implant interface, and no subsidence or displacement of the implant. Eighteen months out of surgery, the mJOA score improved to 15, and lateral X-ray confirmed reduction of atlanto-axial dislocation. Additionally, the new construct provided strong fixation comparable to that conferred by conventional constructs as there was no significant difference observed between the two groups in all three directions of motion.

Conclusions: The novel implant represents a new option in the treatment of irreducible atlantoaxial dislocation. It can provide strong anterior support for solid fixation and fusion with a low profile and a microstructure that obviates the need for bone grafting.
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http://dx.doi.org/10.1186/s12891-021-03987-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844893PMC
January 2021

Comparison of Anterior Approach and Posterior Circumspinal Decompression in the Treatment of Giant Thoracic Discs.

Global Spine J 2021 Jan 29:2192568221989964. Epub 2021 Jan 29.

Department of Orthopedics, 66482Peking University Third Hospital, Beijing, China.

Study Design: Retrospective cohort study.

Objectives: The treatment of giant thoracic disc herniation (gTDH)remains challenging for surgeons worldwide because of its large volume and calcified or ossified nature and the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. We aim to compare the anterior decompression and spinal fusion (ASF) and posterior circumspinal decompression and spinal fusion (PCDF) for patients with myelopathy due to gTDH in the largest study to date by sample size.

Methods: Preoperative and postoperative functional status, surgical details, and complication rates were compared between the 2 groups.

Results: A total of 186 patients were included: 63 (33.9%) ASF and 123(66.1%) PCDF. The PCDF group had significantly shorter operation duration (163.06 ± 53.49 min vs. 180.78 ± 52.06 min, = 0.032) and a significant decrease in intraoperative blood loss(716.83 mL vs. 947.94 mL, = 0.045), and also a shorter hospital length of stay (LOS) and postoperative LOS (6 vs. 7, = 0.011). The perioperative complication rate (13.8% vs. 28.6%, = 0.015) and surgery-associated complication rate(13.0% vs. 27.0%, = 0.018) were significantly higher in the ASF group. A higher rate of complete decompression was achieved in the PCDF group. There were no observed significant differences in changes in functional status between the 2 groups.

Conclusion: PCDF for central or paracentral gTDHs is a highly effective and reliable technique. It can be performed safely with a low complication rate. If either procedure can adequately excise a central or paracentral gTDH, a PCDF approach may be a better option.
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http://dx.doi.org/10.1177/2192568221989964DOI Listing
January 2021

Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center.

Global Spine J 2021 Jan 27:2192568220982280. Epub 2021 Jan 27.

Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, China.

Study Design: Retrospective study.

Objectives: Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy.

Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed.

Results: Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid-fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%.

Conclusions: Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.
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http://dx.doi.org/10.1177/2192568220982280DOI Listing
January 2021

Delayed postoperative radiotherapy increases the incidence of radiographic local tumor progression before radiotherapy and leads to poor prognosis in spinal metastases.

Radiat Oncol 2021 Jan 22;16(1):21. Epub 2021 Jan 22.

Department of Orthopedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.

Background: Most previous studies focused on the minimum interval between surgery and radiotherapy in spinal metastases, leaving the maximum interval under-investigated. However, in real world, limited radiotherapist and equipment cannot meet the needs of a large patient population to obtain timely radiotherapy after the index spine surgery in developing countries. This study aimed to estimate the clinical risks of delayed radiotherapy after surgery in patients with spinal metastases in developing country.

Methods: Data from 89 patients who underwent surgery and postoperative radiotherapy at a single site in a developing country were retrospectively reviewed. Patients were divided into the progression before radiotherapy (PBR) and no progression before radiotherapy (NPBR) groups. Kaplan-Meier analysis and log-rank tests were used to compare the local control (LC) and overall survival (OS) between groups.

Results: Within 1 month after surgery, only 20.2% of patients underwent radiotherapy. Risk of local progression before radiotherapy at 1, 3, and 6 months was 1.2%, 24.1%, and 45.1%, respectively. The LC rate at 1 year was lower in the PBR group than in the NPBR group (53.3% vs. 76.3%, P = 0.040). The OS rate at 1 year was 61.9% and 79.6% in the PBR and NPBR groups, respectively (P = 0.001). The Karnofsky performance status significantly improved only in the NPBR group (52.5 ± 17.6 vs. 66.8 ± 26.3, P < 0.001). The sphincter dysfunction significantly improved in the NPBR group (0.3 ± 0.5 vs. 0.1 ± 0.3, P = 0.007) but it tended to be deteriorated in the PBR group (0.1 ± 0.4 vs. 0.3 ± 0.5, P = 0.500).

Conclusions: In real world, about 80% of patients had delayed radiotherapy 1 month after spine surgery for metastases in our developing country. Patients had a higher risk for radiographic local progression before radiotherapy and poorer LC, OS, and quality of life as time to radiotherapy increased.
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http://dx.doi.org/10.1186/s13014-020-01740-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825226PMC
January 2021

Radiographic and clinical features of thoracic disk disease associated with myelopathy: a retrospective analysis of 257 cases.

Eur Spine J 2021 Jan 3. Epub 2021 Jan 3.

Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.

Purpose: To analyze the clinical and radiographic characteristics of thoracic disk disease associated with myelopathy (TDM).

Methods: This is a retrospective clinical review of prospectively collected imaging data based at a single institute. Based on preoperative CT and MRI, we classified TDM as thoracic disk herniation (TDH), THD with ossification (THDO), TDH with posterior bony avulsions of the vertebrae (TDH with PBA), TDH with posterior vertebral osteophytes (TDH with PVO), giant thoracic osteophyte and calcific discitis with herniation (CDH). Patient characteristics and radiographic data were compared between different types of TDM.

Results: Among the 257 patients included, 12.06% of patients presented with symptoms after traumatic events. The most frequent complaint at onset and preoperative was back pain (29.2%) and subjective lower limb weakness (75.5%), respectively. All TDH with PBA is distributed at the lower thoracic segments, while CDH predominantly in the middle and lower thoracic segments. TDH with PBA was more frequent in men than TDH and CDH. Compared with TDH, TDHO, and TDH with PVO, TDH with PBA was younger in surgery age, and TDH and CDH had lower preoperative JOA scores than TDH with PBA. CDH had a larger ventral occupying ratio than TDH, TDHO, and TDH with PBA.

Conclusions: The onset of TDM was generally insidious but may be triggered acutely by apparently trivial events. With a low prevalence, TDM varied clinical symptoms. Different types of TDM had various clinical features, which might indicate different pathological mechanisms.
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http://dx.doi.org/10.1007/s00586-020-06688-xDOI Listing
January 2021

A Randomized Controlled Trial of Psychological Intervention to Improve Satisfaction for Patients with Depression Undergoing TKA: A 2-Year Follow-up.

J Bone Joint Surg Am 2021 04;103(7):567-574

Orthopaedic Department (X.G., X.W., G.Z., F.L., Y.L., M.Z., Z.L., and H.T.) and the Research Center of Clinical Epidemiology (H.C.), Peking University Third Hospital, Beijing, People's Republic of China.

Background: The overall satisfaction of patients after total knee arthroplasty (TKA) is approximately 80%, and current studies have demonstrated that patients with depression may have lower patient satisfaction. The purpose of this study was to determine whether perioperative psychological intervention in patients with depression improves the clinical outcomes and patient satisfaction in patients undergoing TKA.

Methods: Six hundred patients who underwent primary TKA from May 2016 to January 2018 were prospectively screened for eligibility. A preoperative psychological evaluation was conducted by a psychiatrist to evaluate each patient's psychological status. Patients who were diagnosed with depression were randomly divided into 2 groups: the intervention group (patients received psychological interventions that were administered by a psychiatrist at the first visit before surgery and from then on) and the control group (patients received routine TKA care without psychological interventions). The primary outcome was patient satisfaction at 6 months postoperatively. The secondary outcomes were patient satisfaction at 2 years postoperatively as well as the Hospital for Special Surgery (HSS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and range of motion at 6 months and 2 years postoperatively.

Results: Fifty-three patients with depression were identified. Fifty-one patients were enrolled in the randomized controlled trial. Two patients were lost to follow-up at 6 months after surgery. Therefore, 49 patients (25 in the intervention group and 24 in the control group) remained in the final analysis. At 6 months postoperatively, statistical differences in patient satisfaction were identified between the 2 groups (88.0% in the intervention group compared with 62.5% in the control group; odds ratio = 4.40; 95% confidence interval, 1.02 to 18.99). There was a significant improvement in the Self-Rating Depression Scale (SDS) score (the reduction rate was 51.97% in the intervention group compared with 17.35% in the control group) and the Symptom Checklist 90 Revised (SCL-90-R) subscore for depression (the reduction rate was 44.66% in the intervention group compared with 15.73% in the control group). The clinical outcomes, including the WOMAC scores, the HSS scores, and maximal range of motion, in the intervention group had improved significantly more compared with those in the control group.

Conclusions: Psychological interventions during the perioperative period can improve patient satisfaction in patients with depression who undergo TKA. Therefore, psychological intervention and management may be beneficial for patients with depression who are planning to undergo TKA.

Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.20.00169DOI Listing
April 2021

Correlation between femorotibial pressure and joint gap in osteoarthritis patients with varus deformity: an intraoperative measurement using sensor device in primary posterior-stabilized total knee arthroplasty.

Ann Transl Med 2020 Nov;8(21):1387

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

Background: The normal femorotibial pressure and its variation under different gap values remain unknown. Thus, for the purpose of improving soft-tissue balancing in total knee arthroplasty (TKA), a load-sensor device was used to measure femorotibial pressures. More specifically, the aim of this study was to analyze the trend in pressure changes.

Methods: Twenty TKAs were first balanced by conventional techniques, and then femorotibial pressure was measured using the sensor. After this, the difference in pressure among different joint gaps was calculated to analyze the trend. A repeated measure of analysis of variance and a Tukey's honestly significant difference (HSD) test were used to analyze the data.

Results: The medial gap pressure was significantly increased at extension and flexion as the thickness of the sensor increased in most patients, while the lateral gap pressure changed without a specific trend. The average medial gap pressure was significantly larger than the average lateral gap pressure at both the full extension and 90° flexion positions. The average extension gap pressure was larger than the average flexion gap pressure at both the medial and lateral gaps.

Conclusions: The tension of the soft tissue around the knee joint changes with the joint gap. The tension at the medial side is higher than that on the lateral side, and that of the extension position is higher than that of the flexion position. The use of the pressure sensor insert has a better auxiliary effect on the operation using the gap-balancing technique.
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http://dx.doi.org/10.21037/atm-20-2044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723655PMC
November 2020

3D-printed brace in the treatment of adolescent idiopathic scoliosis: a study protocol of a prospective randomised controlled trial.

BMJ Open 2020 11 27;10(11):e038373. Epub 2020 Nov 27.

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

Introduction: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Brace treatment is effective for eligible patients with AIS and the effectiveness is significantly correlated with the average brace-wear time per day. Three-dimensional (3D) printing technology is a recent advancement that offers unique opportunities for biomedical applications, and customisation of scoliosis braces might lead to greater patient satisfaction and improved compliance. We present here the design of a randomised controlled trial on the clinical effectiveness of 3D-printed braces versus thoracolumbosacral orthoses (TLSO) for patients with AIS.

Methods And Analysis: Patients with AIS (age 10-16 years) with Risser sign 0-II, Cobb angle of main curve of 20°-40°, premenarchal or no more than 1-year postmenarchal (for women), and no history of treatment are eligible, unless they are unable to tolerate the treatment or refuse participation. A total of 88 patients will be randomised into either the 3D group or TLSO group on a 1:1 basis. Participants in the 3D group will choose between a 3D-printed brace and TLSO, according to the Zelen's design of the trial. Primary outcome measures will include the average brace-wear time per day, health-related quality of life and Cobb angle progression of the primary curve. Secondary outcome measures will include immediate in-brace correction of Cobb angle of the primary curve, rate of conversion to surgery and incidence of any adverse events. This study is designed as a single-centre, two-arm, superiority and open-label randomised controlled trial. The sample size is calculated with reference to the preliminary study and based on the sample size calculation formula.

Ethics And Dissemination: This study was approved by the Peking University Third Hospital Medicine Science Research Ethics Committee (No: 2019-017-02). Results of the trial will be submitted for publication in a peer-reviewed journal and as conference presentations.

Trial Registration Number: ChiCTR1900027379, pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-038373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703428PMC
November 2020

Correction to: A new 3D printing porous trabecular titanium metal acetabular cup for primary total hip arthroplasty: a minimum 2-year follow-up of 92 consecutive patients.

J Orthop Surg Res 2020 Nov 26;15(1):560. Epub 2020 Nov 26.

Department of Orthopaedics, Peking University Third Hospital, No. 49 North, Garden Road, Beijing, 100191, China.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s13018-020-02095-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690123PMC
November 2020

Evaluation of a new spinal surgical robotic system of Kirschner wire placement for lumbar fusion: A multi-centre, randomised controlled clinical study.

Int J Med Robot 2021 Apr 10;17(2):e2207. Epub 2020 Dec 10.

Department of Orthopedics, Southern Medical University Nanfang Hospital, Guangzhou, China.

Background: To introduce a novel robotic system 'Orthbot' that has been developed and tested as a surgical assistant for auto-placement of the K-wire in lumbar fusion.

Methods: This is a multi-centre, randomized controlled clinical study that includes 56 patients (robot group, RG: 27, free-hand group, FG: 29). Following the pre-operative planning and intra-operative fluoroscopic images, the 'Orthbot' automatically completed registration and K-wire placement under the supervision of the surgeon. Deviation distance (DD) and deviation angle (DA) were used as the primary parameters to evaluate the accuracy of the robotic system.

Results: The average DD was 0.95 ± 0.377 mm and 4.35 ± 2.01 mm, respectively in the RG and FG (p < 0.001). The average DA of the K-wire in the coronal plane and the sagittal plane in X-Ray was respectively 6.80 ± 7.79° and 1.27 ± 2.32° in the RG (p < 0.001), and 22.22 ± 16.85° and 4.57 ± 3.86° in the FG (p < 0.001), which showed a higher accuracy rate in the robotic-assisted cases compared to the free-hand cases.

Conclusions: The novel robotic system could achieve accurate K-wire insertions as indicated by the radiological results.
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http://dx.doi.org/10.1002/rcs.2207DOI Listing
April 2021

What Predicts the Prognosis of Spinal Metastases in Separation Surgery Procedures?

World Neurosurg 2021 02 7;146:e714-e723. Epub 2020 Nov 7.

Department of Orthopaedics, Peking University Third Hospital, Beijing, China. Electronic address:

Background: Separation surgery is performed to provide a safe gap between the epidural tumor and spinal cord for postoperative stereotactic body radiotherapy (SBRT) in cases of spinal metastases. However, there is a gap in evidence regarding sufficient tumor resection in separation surgery. We describe the prognoses according to the extent of resection in separation surgery.

Methods: This retrospective study included 36 consecutive patients who underwent separation surgery and postoperative SBRT between December 2016 and December 2019 at a single center. Local control (LC), overall survival (OS), distance of separation (DS), and quality-of-life parameters were analyzed. P values <0.05 were considered statistically significant.

Results: Patients were assigned to the aggressive resection group (ARG, n = 18) or moderate resection group (MRG, n = 18), with estimated LC and OS at 1 year of 79.0% and 75.9%, respectively. There were no significant differences between ARG and MRG in estimated LC (85.9% vs. 72.2%; P = 0.317) or OS (69.3% vs. 80.9%, P = 0.953) at 1 year. All 5 patients in MRG who developed local progression had less satisfactory tumor resection with DS <3 mm. A borderline significant difference in estimated LC at 1 year was noted between individuals with DS <3 mm and those with DS ≥3 mm (51.9% vs. 100.0%; P = 0.053) in MRG. There was no statistical difference between ARG and MRG in quality-of-life parameters.

Conclusions: Moderate resection of ventral dural mass did not significantly reduce patients' prognosis in separation surgery. However, the minimal distance between the postoperative residual epidural tumor and spinal cord should be ≥3 mm.
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http://dx.doi.org/10.1016/j.wneu.2020.10.172DOI Listing
February 2021

Can formetric 4D measurements predict the development of adjacent segment degeneration after single-segment PLIF?: Relative rotation angle as a sensitive predictor.

J Orthop Sci 2020 Nov 1. Epub 2020 Nov 1.

Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China. Electronic address:

Background: Adjacent segment degeneration (ASD) is a major issue after posterior lumbar interbody fusion (PLIF). The postoperative dynamic change of adjacent segments remains unknown. Hence, this study using the formetric 4D system (DIERS, International GmbH of Schlangenbad, Germany) to determine the impact of PLIF on ASD, and to compare the effectiveness with traditional radiography for the predication of ASD.

Methods: Eighty-five consecutive patients who underwent PLIF of a single-segment were included. The formetric 4D system was used to calculate the relative rotation angle between the fusion segment and the upper and lower adjacent vertebrae before and at 6, 12 and 24 months after surgery. The range of motion (ROM) and disc height (DH) of adjacent segments were measured using radiography before surgery and 24 months postoperatively. At the final follow-up, the visual analogue scale (VAS) and Oswestry disability index were used to evaluate the surgical outcome. The patients were divided into two groups according to the occurrence of radiographic ASD: the ASD group with progression of degeneration and the N-ASD group without progression of degeneration.

Results: The index fusion segments included L2-3 to L5-S1. Preoperatively, the relative rotation angles formed by the fusion segment with the upper and lower adjacent vertebrae were 5.1° ± 2.2° and 3.3° ± 2.0°, respectively, and both angles increased significantly at all time points after surgery (p < 0.05). The angles changed most significantly during L2-3 fusion. Radiographic ASD developed in 13 of 85 patients (15.3%) at 24 months. And the relative rotation angle with the upper adjacent vertebra was larger in the ASD group than in the N-ASD group (p < 0.05).

Conclusion: The relative rotation angle with adjacent vertebra increased significantly after lumbar fusion surgery. It may be a more sensitive predictor than the flexion-extension ROM and DH for the development of radiographic ASD.
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http://dx.doi.org/10.1016/j.jos.2020.09.011DOI Listing
November 2020

A prospective randomized cohort study on 3D-printed artificial vertebral body in single-level anterior cervical corpectomy for cervical spondylotic myelopathy.

Ann Transl Med 2020 Sep;8(17):1070

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

Background: This was a prospective randomized cohort study aiming at examining the safety and efficacy of artificial vertebral body (AVB) fabricated by electron beam melting (EBM) in comparison to conventional titanium mesh cage (TMC) used in single-level anterior cervical corpectomy and fusion (SL-ACCF).

Methods: Forty patients with cervical spondylotic myelopathy (CSM) underwent SL-ACCF using either the EBM-AVB or the TMC. Patients were evaluated for their demographics, radiological characteristics, neurologic function [using the Japanese Orthopaedic Association (JOA) scale], and health-related quality-of-life (HRQoL) aspects [using the Short Form 36 (SF-36)] before and after the surgery and comparison was made between the two groups both at baseline and the last follow-up. The Student t-text, paired-sample t-text, and Fisher's exact test were used when appropriate to detect any statistical significance at the level of α=0.05.

Results: Post-operative recovery was uneventful for all patients and no revision surgery was required. There were no significant differences between the EBM-AVB group and the TMC group at baseline. Patients in both groups demonstrated significant improvement in cervical alignment, JOA score, and SF-36 score after the surgery. Six months post-operatively, patients in the EBM-AVB group were found to have significantly less loss of fusion height and lower incidence for severe implant subsidence compared with the TMC group. Patients in the two groups were comparable at the last follow-up regarding their rate of fusion, cervical alignment, JOA recovery rate, SF-36 score, and by Odom's criteria.

Conclusions: For CSM patients undergoing SL-ACCF, the EBM-AVB group demonstrated comparable outcomes regarding patient cervical alignment, neurologic function, and HRQoL in comparison with the TMC group. Furthermore, the use of EBM-AVB was associated with decreased loss of the height of the fusion mass and a lower rate for severe implant subsidence.
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http://dx.doi.org/10.21037/atm-19-4719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575998PMC
September 2020

Recent Advances of Magnetic Nanomaterials in Bone Tissue Repair.

Front Chem 2020 25;8:745. Epub 2020 Sep 25.

Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.

The magnetic field has been proven to enhance bone tissue repair by affecting cell metabolic behavior. Magnetic nanoparticles are used as biomaterials due to their unique magnetic properties and good biocompatibility. Through endocytosis, entering the cell makes it easier to affect the physiological function of the cell. Once the magnetic particles are exposed to an external magnetic field, they will be rapidly magnetized. The magnetic particles and the magnetic field work together to enhance the effectiveness of their bone tissue repair treatment. This article reviews the common synthesis methods, the mechanism, and application of magnetic nanomaterials in the field of bone tissue repair.
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http://dx.doi.org/10.3389/fchem.2020.00745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545026PMC
September 2020

Expression profiles and prognostic significance of AFTPH in different tumors.

FEBS Open Bio 2020 12 28;10(12):2666-2677. Epub 2020 Oct 28.

Third Hospital of Peking University, Beijing, China.

Aftiphilin (AFTPH) plays an important role in regulating intracellular trafficking, exocytosis, and the pro-inflammatory response. However, the potential prognostic role of AFTPH in cancers remains unclear. Here, we examined the expression profiles and prognostic significance of AFTPH in breast invasive carcinoma (BRCA), diffuse large B-cell lymphoma (DLBC), lung squamous cell carcinoma (LUSC), and pancreatic adenocarcinoma (PADD) using the GEPIA and UALCAN databases. AFTPH expression was observed to be higher in cancer tissues than in normal tissues, but expression did not differ significantly between tumor stages for the four cancer types. AFTPH expression in cancer cell lines was investigated using the CCLE database; AFTPH was found to be highly expressed in four cancer cell lines. The relationship between AFTPH expression and patient prognosis was analyzed using GEPIA, LinkedOmics, and Kaplan-Meier plotter databases. Low expression of AFTPH was associated with improved prognosis for BRCA, DLBC, LUSC, and PAAD. Genetic alterations of AFTPH in cancers were explored using the cBioPortal website, revealing that gene copy number gains and amplification are common in BRCA, DLBC, LUSC, and PAAD. Related genes and markers associated with AFTPH were discovered using the LinkedOmics database. Furthermore, transfection of cells with AFTPH siRNA demonstrated that AFTPH exerts positive effects on cell proliferation in BRCA, LUSC, and PAAD cells. In conclusion, AFTPH may be a potential therapeutic target and prognostic biomarker for BRCA, DLBC, LUSC, and/or PAAD.
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http://dx.doi.org/10.1002/2211-5463.13003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714068PMC
December 2020

Typical and Atypical Radiographic Features of Symptomatic Osteoblastoma in the Spine.

World Neurosurg 2021 01 13;145:e209-e215. Epub 2020 Oct 13.

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

Background: Spine osteoblastomas (OBs) are relatively rare. In contrast to osteoid osteoma, radiologic and clinical manifestations of OB can be varied and atypical. Typical radiographic features in spinal OB include peritumoral bone sclerosis, bone marrow edema, and soft tissue edema. Atypical radiographic features include lesions involving ≥3 segments, lesions with extensive (≥3 segments) bone sclerosis, excessive edema (≥3 segments) of soft tissue and bone marrow, no intralesional calcification, and location in the vertebral body only. The aim of this study was to identify typical and atypical features of OB.

Methods: Pretreatment computed tomography scans and magnetic resonance imaging were reviewed retrospectively. Percutaneous biopsies were performed to confirm pathology in atypical cases.

Results: A total of 50 images from patients with diagnosed OB were reviewed. Atypical radiographic features were found in 18 cases (36%). Pathologic diagnosis was confirmed as OB in 86.2% (25/29) cases after percutaneous computed tomography-guided biopsy.

Conclusions: Our results show that >30% of spinal OB cases might have atypical radiographic features. In cases with atypical radiographic features, computed tomography-guided biopsies are recommended.
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http://dx.doi.org/10.1016/j.wneu.2020.10.014DOI Listing
January 2021

A6 peptide-tagged, ultra-small and reduction-sensitive polymersomal vincristine sulfate as a smart and specific treatment for CD44+ acute myeloid leukemia.

J Control Release 2021 01 5;329:706-716. Epub 2020 Oct 5.

Biomedical Polymers Laboratory, College of Chemistry, Chemical Engineering and Materials Science, State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou 215123, PR China. Electronic address:

Acute myeloid leukemia (AML) is a severe blood malignancy associated with a high relapse rate. The current clinical chemotherapy is typically perplexed with serious side effects. Here, A6 peptide-tagged, small and reduction-sensitive polymersomal vincristine sulfate (A6-cPS-VCR) is reported as a novel, smart and specific treatment for CD44 positive AML. A6-cPS-VCR stably loaded with 3.3 wt% VCR displays a size of ≈ 31 nm and pronounced selectivity toward CD44-overexpressed MV4-11 leukemia cells. Intriguingly, A6-cPS-VCR effectively represses the outgrowth of orthotopic MV4-11 AML in vivo, as revealed by significant reduction of leukemia burdens in the circulation, bone marrow, liver and spleen, and significantly extends the median survival time of MV4-11 AML-bearing mice. In addition to active targetability and therapeutic benefits, A6-cPS-VCR has the advantage of easy fabrication, rendering it potentially interesting for clinical translation.
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http://dx.doi.org/10.1016/j.jconrel.2020.10.005DOI Listing
January 2021

Low cost Ti-Si intermetallic compound membrane with nano-pores synthesized by in-situ reactive sintering process.

Sci Rep 2020 Oct 7;10(1):16750. Epub 2020 Oct 7.

Key Laboratory of Electromagnetic Processing of Materials, Ministry of Education, Northeastern University, Shenyang, 110819, China.

A low cost Ti-Si intermetallic compound membrane with nano-pores was successfully prepared by an in-situ reactive sintering process. The all synthesized membrane shows the presence of Ti, TiSi, TiSi and TiO phases, and the Ti:Si atomic ratio of membrane is about 1.9. Two different synthesized granule configuration zones on membrane are observed. Membrane synthesized on the surface of Ti particles contains the mean sizes of both 631 nm nano-particles and 238 nm nano-pores, which is considerably different from that of membrane growing on top of the micro-pores of Ti matrix, 238 nm nano-particles and 80 nm nano-pores, respectively.
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http://dx.doi.org/10.1038/s41598-020-73869-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541496PMC
October 2020

New Classification Algorithm Guiding Surgical Decision-making for Posterior Longitudinal Ligament Ossification of the Thoracic Spine: A Study of 108 Patients With Mid-term to Long-term Follow-up.

Clin Spine Surg 2021 Apr;34(3):E172-E176

Orthopaedic Department, Peking University Third Hospital.

Study Design: This is a single-center, retrospective, cohort study.

Objective: The objective of this study was to propose a surgical classification algorithm guiding the choice of surgical approaches for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine based on the characteristics of each patient's specific pathology.

Summary Of Background Data: Surgical decision-making in this OPLL patient population requires balancing a more definitive decompression of the thoracic spinal cord through direct decompression against a higher risk of significant complications.

Materials And Methods: Patients with a primary diagnosis of thoracic OPLL who received surgical decompression in a tertiary spine center between May 2009 and June 2015 were included. Surgical planning was guided by our classification algorithm according to the location and the extent of OPLL in each patient. Patient demographics, neurological function using the 11-point Japanese Orthopaedic Association scale, length of procedure, estimated blood loss, the occurrence of major complications, etc., were extracted from the database of electronic medical record system. The Kruskal-Wallis test and Fisher exact test were used when data were not normally distributed.

Results: A total of 115 patients (33 men and 82 women) were included in this study, among whom 108 had a follow-up of at least 12 months (average: 51.7±22.2 mo, range: 12-100 mo). On the basis of our classification algorithm, 11 patients were type I, 26 were type II, 60 were type III, 11 were type IV, and the choice of surgical decompression techniques used in each patient followed that recommended by the algorithm in all cases. On average, the Japanese Orthopaedic Association score improved from 5.0±1.8 preoperatively to 8.7±1.7 postoperatively, with a Hirabayashi improvement rate of 63.6%.

Conclusion: A new surgical classification algorithm guiding the choice of approach for decompression of OPLL in the thoracic spine was validated in a series of 108 patients through an analysis of their clinical outcomes and surgical complications.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1097/BSD.0000000000001080DOI Listing
April 2021
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