Background: Periprosthetic joint infection (PJI) is a significant complication following hip arthroplasty, especially in osteoporotic patients. Early detection is crucial for improving outcomes but remains challenging. This study assesses the effectiveness of continuous monitoring of serum markers - C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, white blood cell count (WBC), ferritin, soluble CD14 (sCD14), matrix metalloproteinase-9 (MMP-9), and serum amyloid A (SAA) - for early detection of PJI in osteoporotic patients undergoing hip arthroplasty.Methods: A prospective cohort study included 150 osteoporotic patients undergoing hip arthroplasty. Inflammatory markers were measured preoperatively and at 24-, 48-, and 72 hours post-surgery, with weekly follow-ups for 6 weeks. PJI was diagnosed based on clinical, microbiological, and imaging criteria. The diagnostic performance of individual markers was assessed using Receiver Operating Characteristic (ROC) curves.Results: Among the 150 patients, 12 (8%) developed PJI within 6 weeks. At 48 hours post-surgery, CRP PCT, ESR, D-dimer, WBC, sCD14, and SAA were significantly higher in the PJI group compared to the non-infected group (p< 0.05 for all). Ferritin and MMP-9 levels showed higher values in the infected group but did not reach statistical significance (p= 0.076 and p= 0.094, respectively). The combination of CRP D-dimer, WBC, sCD14, and SAA demonstrated 90% sensitivity and 92% specificity for PJI detection.Conclusions: Continuous monitoring of CRP, D-dimer, WBC, sCD14, and SAA offers a reliable approach for early detection of PJI in osteoporotic patients undergoing hip arthroplasty. These markers showed strong associations with infection, while ferritin and MMP-9 were less informative. This strategy may help improve early diagnosis and patient outcomes.

To refine a method of assessing lumbar stability by applying artificial intelligence and incorporating the use of a walking aid during imaging procedures. A software application was developed to evaluate lumbar stability parameters using machine learning and neural network models (Swin-Resnet). The intra-class correlation coefficient (ICC) was used to assess the agreement between Swin-Resnet and the evaluations conducted by three spine surgeons, each with over ten years of experience. Subsequently, traditional flexion-extension radiographs (FET) and flexion-extension radiographs with a walking aid (FEW) were performed on the enrolled patients with lumbar spondylolisthesis. The developed software was used to measure parameters such as sagittal translation, segmental angulation, and detection rate of lumbar instability. There was no significant statistical difference in the average error between the Swin-Resnet model and physicians in terms of sagittal translation, segmental angulation, and agreement of lumbar instability assessment. The average values of sagittal translation and segmental angulation were significantly higher in FEW than in FET (2.40 (1.09, 3.59) vs. 0.56 (0.16, 1.40); 8.00 (5.00, 10.25) vs. 2.00 (1.00, 5.25), P < 0.05). Among 50 patients, FEW detected 19 cases (38

Background: This study aimed to develop a new intervertebral disc (IVD) scaffold using magnetic resonance imaging (MRI) grayscale image analysis and gray exposure digital light processing (GE-DLP) technology to replicate the natural structure of the IVD, providing improved biomechanical performance and cell compatibility. Tissue engineering presents a promising alternative, with bio-scaffolds being a key element for IVD regeneration. Methods: In this study, a three-dimensional (3D) model of the IVD was constructed from MRI scans of a healthy volunteer, and the grayscale images were processed to distinguish between tissue types. Exposure times were adjusted based on grayscale values, and GE-DLP was employed to fabricate the biomimetic IVD scaffold in a single integrated process using bicomponent polymer network (BCN) hydrogel laden with nucleus pulposus mesenchymal stem cells (NPMSCs). The microstructure and porosity of the scaffold were analyzed using scanning electron microscopy (SEM), and the elastic modulus across the radial distribution was evaluated by nanoindentation. In addition, the biomechanical performance was determined using finite element analysis (FEA). For biocompatibility assessment, cytoskeleton staining was conducted to observe cell morphology, and cell viability was evaluated using Calcein/propidium iodide (PI) staining. Results: The biomimetic IVD scaffold mimicked the natural structure and mechanics of the intervertebral disc, with gradient changes in elastic modulus and pore size. Finite element analysis showed that the scaffold responded similarly to a real IVD during certain movements. Scanning electron microscopy showed a network of pores in the scaffold that are important for cell attachment and growth. The scaffold showed high biocompatibility, with cells surviving well for seven days. Conclusions: In this research, a novel biomimetic IVD scaffold with excellent static structural integrity and biomechanical performance was successfully engineered by combining MRI image analysis and GE-DLP technology.

Objective This study aims to identify potential independent risk factors for residual low back pain (LBP) in patients with thoracolumbar osteoporotic vertebral compression fractures (OVCFs) following percutaneous kyphoplasty (PKP) treatment. Additionally, we aim to develop a nomogram that can accurately predict the occurrence of residual LBP. Methods We conducted a retrospective review of the medical records of thoracolumbar OVCFs patients who underwent PKP treatment at our hospital between July 2021 and December 2022. Residual LBP was defined as the presence of moderate or greater pain (VAS score ≥ 4) in the low back one day after surgery, and patients were divided into two groups: the LBP group and the non-LBP group. These patients were then randomly allocated to either a training or a validation set in the ratio of 7:3. To identify potential risk factors for residual LBP, we employed lasso regression for multivariate analysis, and from this, we constructed a nomogram. Subsequently, the predictive accuracy and practical clinical application of the nomogram were evaluated through a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve analysis (DCA). Results Our predictive model revealed that five variables—posterior fascial oedema, intravertebral vacuum cleft, time from fracture to surgery, sarcopenia, and interspinous ligament degeneration—were correlated with the presence of residual LBP. In the training set, the area under the ROC was 0.844 (95% CI 0.772–0.917), and in the validation set, it was 0.842 (95% CI 0.744–0.940), indicating that the model demonstrated strong discriminative performance. Furthermore, the predictions closely matched actual observations in both the training and validation sets. The decision curve analysis (DCA) curve suggested that the model provides a substantial net clinical benefit. Conclusions We have created a novel numerical model capable of accurately predicting the potential risk factors associated with the occurrence of residual LBP following PKP in thoracolumbar OVCFs patients. This model serves as a valuable tool for guiding specific clinical decisions for patients with OVCFs.

Calcium carbonate (CaCO3), which exhibits excellent biocompatibility and bioactivity, is a well-established bone filling material for bone defects. Here, we synthesized CaCO3microspheres (CMs) to use as an intelligent carrier to load bone morphogenetic protein-2 (BMP-2). Subsequently, drug-loaded CMs and catalase (CAT) were added to methacrylated gelatin (GelMA) hydrogels to prepare a composite hydrogel for differential release of the drugs. CAT inside hydrogels was released with a fast rate to eliminate H2O2and generate oxygen. Constant BMP-2 release from CMs induced rapid osteogenesis. Resultsin vitroindicated that the composite hydrogels efficiently reduced the level of intracellular reactive oxygen species, preventing cells from being injured by oxidative stress, promoting cell survival and proliferation, and enhancing osteogenesis. Furthermore, animal experiments demonstrated that the composite hydrogels were able to inhibit the inflammatory response, regulate macrophage polarization, and facilitate the healing of bone defects. These findings indicate that a multi-pronged strategy is greatly expected to promote the bone healing by modulating pathological microenvironments.

ABSTRACT Objectives Osteoarthritis (OA) is the most common age-related chronic and disabling joint disease, frequently causing pain and disability in the adult population. Given that there are no proven disease-modifying drugs for OA, it is urgent to gain a deeper understanding of OA pathogenesis. This study intended to uncover the circFOXK2 regulation in OA. Methods First, an in vitro OA cell model was constructed by treating murine chondrocytes with interleukin (IL)-1β. Then, a series of functional assays were conducted to evaluate the effect of circFOXK2 on OA progression in murine chondrocytes. Bioinformatics analysis and mechanism investigations were performed to investigate the competitive endogenous ribonucleic acid (RNA) network of circFOXK2 in OA. Results circFOXK2 is overexpressed in IL-1β-treated chondrocyte. We confirmed the cyclic structure and cytoplasmic distribution of circFOXK2. Functionally, circFOXK2 promotes chondrocyte apoptosis and extracellular matrix degradation but inhibits chondrocyte proliferation. Mechanically, circFOXK2 competitively binds to microRNA-4640-5p (miR-4640-5p) to enhance NOTCH2 expression in OA, affecting OA progression. Besides, circFOXK2 could motivate the NOTCH pathway to accelerate OA progression. Conclusions The circFOXK2/miR-4640-5p/NOTCH2 axis stimulates the NOTCH pathway to promote the transcription of inflammatory cytokines (IL33, IL17F, and IL6), consequently facilitating OA progression in murine chondrocytes.

This study sought to explore the value of major ozonated autohemotherapy (MOA) as a treatment for spinal cord injury (SCI) in a rat model system. In total, 54 female Sprague-Dawley rats were randomized into sham-operated, SCI model, and MOA treatment groups. We found that relative to the SCI model group, rats that underwent MOA treatment exhibited improved locomotor scores on days 14, 21, and 28 after injury (p < 0.05) together with reduced residual urine on days 5, 7, 14, and 21 after injury (p < 0.05). MOA treatment also lowered proinflammatory TNF-α, IL-1α, and C1q levels on day 3 post-injury (p < 0.05), decreased malondialdehyde levels, and enhanced superoxide dismutase activity (p < 0.001). Activated astrocytes in MOA-treated rats exhibited larger soma and higher levels of extracellular matrix secretion, whereas reactive microglia in the MOA group presented with a ramified morphology in contrast to the amoeboid morphology exhibited by these cells in SCI model rats. MOA offers potential value as a means of protecting spinal cord integrity, potentially through anti-inflammatory, antioxidant, and regulatory effects that shape the polarization of astrocytes and microglia.

As one of the most widespread musculoskeletal diseases worldwide, intervertebral disc degeneration (IVDD) remains an intractable clinical problem. Currently, oxidative stress has been widely considered as a significant risk factor in the IVDD pathological changes, and targeting oxidative stress injury to improve the harsh microenvironment may provide a novel and promising strategy for disc repair. It is evident that spermidine (SPD) has the ability to attenuate oxidative stress across several disease models. However, limited research exists regarding its impact on oxidative stress within the intervertebral disc. Moreover, enhancing the local utilization rate of SPD holds great significance in IVDD management. This study aimed to develop an intelligent biodegradable mesoporous polydopamine (PDA) nanoplatform for sustained release of SPD. The obtained PDA nanoparticles with spherical morphology and mesoporous structure released loaded-therapeutic molecules under low pH and H2O2. Combined treatment with SPD loaded into PDA nanoparticles (SPD/PDA) resulted in better therapeutic potential than those with SPD alone on oxidative stress injury. Furthermore, both SPD and SPD/PDA could induce anti-inflammatory M2 macrophage polarization. Upon injection into degenerative IVDs, the SPD/PDA group achieved a good repair efficacy with a long-term therapeutic effect. These findings indicated that the synergized use of SPD with responsive drug delivery nanocarriers may steadily scavenge reactive oxygen species and provide an effective approach toward the treatment of IVDD.

Background: K & uuml;mmell disease (KD)-a rare and relatively complex spinal condition-is a type of posttraumatic osteoporotic vertebral compression fracture manifesting as a delayed collapse of a vertebral body. Although most patients with KD present with pain in the fracture area, some present with pain in the rib region or distal lumbosacral region, without pain in the fracture area, which poses challenges for diagnosing and treating KD. Objective: We aimed to explore whether percutaneous kyphoplasty can alleviate pain distal to the fracture area caused by either Stage I or Stage II KD. Study Design: A retrospective study. Setting: This study was conducted at a university-affiliated hospital. Methods: We conducted a retrospective analysis on patients with Stage I or Stage II KD who underwent surgical treatment in our hospital from December 2021 through October 2023. All patients were accompanied by pain distal to the fracture area (i.e., pain in the rib region or the distal lumbosacral region). All patients underwent percutaneous kyphoplasty. Postoperative follow-up thoracic or lumbar x-rays confirmed polymethylmethacrylate diffusion and vertebral reduction. Pain distal to the fracture area and functional impairment were evaluated at presurgery and at postsurgery one day, one week, and one month. In addition, the anterior, middle, and posterior vertebral heights and the Cobb angle were measured at pre- and postsurgery. Results: A total of 42 patients were enrolled; 39 (92.9%) were women. Their average age was 73.48 +/- 8.81 years. The fracture segments with KD and pain distal to the fracture area were as follows: T7 (9 cases, 21.4%); T10 (9 cases, 21.4%); and T8 (8 cases, 19.0%). The common location of pain distal to the fracture area was the rib region (30 cases, 71.4%). The preoperative Visual Analog Scale score of pain distal to the fracture area and the Oswestry Disability Index scores were significantly higher than those at postsurgery one day, one week, and one month. The heights of the anterior, middle, and posterior edges of the vertebrae on x-ray were significantly higher postoperatively than preoperatively. The Cobb angle of the fractured vertebrae was also higher postoperatively than preoperatively. Limitations: Our study was conducted at a single center; single-center studies may introduce bias. Our study also had a relatively short follow-up time. Conclusion: Patients with Stage I or Stage II KD may experience pain distal to the fracture area, which may effectively be alleviated by percutaneous kyphoplasty

BACKGROUND Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra. STUDY DESIGN Retrospective study. SETTING The study was carried out at a university hospital. METHODS We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. RESULTS A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery. LIMITATIONS This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias. CONCLUSION The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture.

OBJECTIVE:To propose a new standardized technique for evaluating lumbar stability in degenerative lumbar spondylolisthesis using lumbar lateral flexion-extension radiographs with brackets and magnetic resonance facet fluid. METHODS:A retrospective analysis of 57 patients diagnosed with lumbar (L4-5) spondylolisthesis was performed. We analyzed lateral flexion-extension radiographs obtained with a bracket (LFEB) and without a bracket (LFE). Sagittal translation, segmental angulation, posterior opening, lumbar instability, and changes in lumbar lordosis were compared using functional radiographs. The mean width and maximum width of the facet fluid, mean facet joint length, and facet fluid index (FFI) of the 2 groups were compared using sagittal translation. RESULTS:The average value of sagittal translation was 1.68 ± 0.96 mm in LFE and 3.07 ± 1.29 mm in LFEB, and the difference was significant (P < 0.05). Segmental angulation, posterior opening, and changes in lumbar lordosis were significantly greater in LFEB than in LFE. The instability detection rate was 14.0% in LFE and 35.1% in LFEB. The FFI, maximum width, and mean width were significantly increased in the unstable lumbar spondylolisthesis group compared with the stable group in LFEB. The FFI and maximum width of the facet fluid were significantly increased in the unstable lumbar spondylolisthesis group compared with the stable group in LFE. CONCLUSIONS:Lumbar lateral flexion-extension radiographs with brackets can standardize the operation process and provide sufficient hyperflexion and hyperextension images. The width of the facet fluid and FFI are significant factors in the evaluation of lumbar stability in patients with lumbar spondylolisthesis.

Spinal cord injury (SCI) is a common clinical disease that can cause permanent disruption of nerve function. Inflammation and glial scar formation influence the recovery of injured spinal cord. X-ray irradiation can reduce inflammation, inhibit cell proliferation and increase cell apoptosis. However, the regulatory effects of X-ray irradiation on inflammation and glial scars and the underlying molecular mechanisms are still unclear. This study was aimed to investigate the therapeutic effect and molecular mechanism of X-ray irradiation on spinal cord injury. Behavioural experiments showed that X-ray irradiation can promote the recovery of nerve function after SCI. X-ray irradiation inhibited the inflammatory response by reducing the expression of inflammatory factors (TNF-α and IL-1β) at the lesion site, thereby reducing neuronal apoptosis. X-ray irradiation inhibited the formation of the glial scar (GFAP and vimentin) in the lesion. P38MAPK and Akt signalling pathways were involved in these processes. Furthermore, the 10 Gy dose had the most significant effects among the 2 Gy, 10 Gy and 20 Gy doses. In summary, X-ray irradiation may exert an active therapeutic effect on SCI by inhibiting inflammation and glial scar formation, which may be related to the inhibition of p38MAPK and Akt signalling pathways.

OBJECTIVE:The authors investigated a new standardized technique for evaluating lumbar stability in lumbar lateral flexion-extension (LFE) radiographs. For patients with lumbar spondylolisthesis, a three-part fulcrum with a support platform that included a semiarc leaning tool with armrests, a lifting platform for height adjustment, and a base for stability were used. Standard functional radiographs were used for comparison to determine whether adequate flexion-extension was acquired through use of the fulcrum method.METHODS:A total of 67 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis were enrolled in the study. The authors analyzed LFE radiographs taken with the patient supported by a fulcrum (LFEF) and without a fulcrum. Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), change in lumbar lordosis (CLL), and lumbar instability (LI) were measured for comparison using functional radiographs.RESULTS:The average value of SA was 5.76° ± 3.72° in LFE and 9.96° ± 4.00° in LFEF radiographs, with a significant difference between them (p < 0.05). ST and PO were also significantly greater in LFEF than in LFE. The detection rate of instability was 10.4% in LFE and 31.3% in LFEF, and the difference was significant. The CLL was 27.31° ± 11.96° in LFE and 37.07° ± 12.963.16° in LFEF, with a significant difference between these values (p < 0.05).CONCLUSIONS:Compared with traditional LFE radiographs, the LFEF radiographs significantly improved the detection rate of LI. In addition, this method may reduce patient discomfort during the process of obtaining radiographs.

Background: Percutaneous kyphoplasty (PKP) is widely used in osteoporotic vertebral compression fractures (OVCF). But in some patients, distal lumbosacral pain (DLP) persists even after treatment and affects their quality of life. Objective: To investigate the effectiveness of local anesthetic and steroid injection in improving DLP after PKP. Study Design: A prospective, randomized, and controlled clinical trial. Setting: The study was carried out in a university hospital. Methods: A total of 150 patients were included in this study and randomly divided into 2 groups of 75 patients each. Patients in the control group (PKP) underwent PKP, and those in the observation group (PKP + LAI) received an injection of lidocaine + triamcinolone acetonide suspensions during the surgery. The visual analog scale (VAS) of the fracture site, Oswestry disability index (ODI), and the rate of patients with lower back pain were compared between the 2 groups at 1 day, 3 days, 1 week, 1 month, and 3 months after the surgery. Results: One hundred thirty-nine patients completed the entire postoperative follow-up schedule, with 70 patients in the PKP group and 69 cases in the PKP + LAI group. The VAS and ODI in the PKP + LAI group were significantly lower than those in the PKP group 1 day, 3 days, 1 week, and 1 month after the surgery; there was no significant difference 3 months after the operation. The rate of patients with lower back pain in the PKP + LAI group 1 day, 3 days, and 1 week after the operation was significantly lower than that in the control group; there was no significant difference 1 month and 3 months after the operation. Limitations: The number of cases was small, and the follow-up time was short. Conclusion: Local anesthetic and steroid injection improved the short-term clinical outcome of PKP for OVCF, which will enhance the confidence of patients in performing out-of-bed activities and functional exercises early after the operation.

<bold>Objective</bold>: To analyse the neuroprotective effect of Netrin-1 on spinal cord injury in rats by activating the adenosine monophosphate-activated protein kinase/mammalian target protein of rapamycin (AMPK/mTOR) signalling pathway to promote neuronal autophagy and inhibit neuronal apoptosis. <bold>Methods:</bold> A total of 72 healthy male Sprague Dawley (SD) rats of clean grade were randomly divided into a sham operation group (treated with excision of the conical plate without spinal cord attack and intraperitoneal injection of 1 mL phosphate solution), model group (treated with intraperitoneal injection of 1 mL phosphate solution), and Netrin-1 group (treated with intraperitoneal injection of Netrin-1 recombinant protein), with 24 rats in each group. The BBB method was used to determine the motor function score of each group of rats. Survival of anterior horn neurons in the spinal cord of rats in each group was detected by Nissls staining. The residual tissue area of the spinal cord cross section was determined by HE staining. The expression levels of p-mTOR, p-AMPT, autophagy-associated protein Beclin-1, microtubule-associated protein light chain 3 (LC3) and C-caspase-3 in spinal cord tissues after spinal cord injury in each group of rats were measured by western blot assay. The number of TUNEL-positive neurons in each group was determined by immunofluorescence. <bold> </bold>Results: The BBB scores in the sham operation group were significantly higher than those in the model and Netrin-1 groups from day 1 to day 21 (P<0.05). The BBB scores of the model group were the same as those of the Netrin-1 group at Day 1, and those of the Netrin-1 group were higher than the model group at Day 3 and day 7, but there was no significant difference between the two groups (P>0.05). At day 14 and day 21, the BBB score of the Netrin-1 group was significantly higher than that of the model group (P<0.05). The survival number of anterior horn neurons in the spinal cord, residual tissue area of the spinal cord cross section and the expression of p-mTOR were lower in the model group and the Netrin-1 group than in the sham operation group. Moreover, the expression of P-AMPK, C-caspase-3, Beclin-1 and LC3 in the model group and the Netrin-1 group were significantly higher than those in the sham operation group. Compared with the model group, the survival number of anterior horn neurons in the spinal cord, residual tissue area of the spinal cord cross section, p-AMPK, LC3 and Beclin-1 of the Netrin-1 group were markedly increased, and the expression levels of p-mTOR and C-caspase-3 were significantly decreased (P<0.05). Compared with the sham operation group, the number of TUNEL-positive neurons in the model group increased markedly. Compared with the model group, the number of TUNEL-positive neurons in the Netrin-1 group decreased significantly (P<0.05). <bold> </bold>Conclusion: Netrin-1 can significantly promote neuronal autophagy, inhibit neuronal apoptosis, improve motor function and increase the survival number of anterior horn neurons in the spinal cord and the residual tissue area of the spinal cord cross section. Netrin-1 has an obvious neuroprotective effect, which may be achieved through the AMPK/mTOR signalling pathway.

目的 空心钉与镍钛形状记忆合金弓齿钉治疗Ekrol2型第五跖骨基底部骨折的疗效对比研究较少.文中旨在比较空心钉与镍钛形状记忆合金弓齿钉治疗Ekrol2型第五跖骨基底部骨折的疗效.方法 回顾性分析2016年12月至2018年12月苏州大学附属第二医院骨科50例第五跖骨基底部Ekrol 2型骨折患者的临床资料.依据不同的治疗方法分组:空心钉组(微型加压螺钉治疗,n=23)及记忆合金组(镍钛形状记忆合金弓齿钉治疗,n=27).比较2组治疗前后的跖骨长度及移位距离、骨折愈合时间、美国足踝协会(AOFAS)前足评分标准、视觉模拟评分(VAS)以及生活质量调查表(SF-36)评分,评估治疗效果.结果 所有患者骨折均获得骨性愈合.空心钉组患者骨折愈合时间、手术时间、AOFAS评分、VAS评分、SF-36评分与记忆合金组比较差异无统计学意义(P>0.05).记忆合金组治疗前后跖骨长度短缩[1.4(5.8～1.5)mm]较空心钉组[3.1(6.2～1.8)mm]明显缩小(P<0.05).记忆合金组并发症发病率较空心钉组明显降低(3.70％vs 13.04％,P=0.013),结论镍钛形状记忆合金弓齿钉治疗Ekrol 2型第五跖骨基底部骨折,疗效满意,可减少跖骨长度短缩及软组织引发的并发症,值得在临床推广.

Objective:To investigate the roles of toll-like receptor 4 (TLR4) and nuclear factor-κB (NF-κB) in regulating the endogenous hydrogen sulfide-producing enzyme cystathionine β synthetase (CBS) protein expression and the mechanism that was involved in increasing sciatic nerve hypersensitivity in lumbar disc herniation (LDH).Methods:We generated a LDH rat model. We measured excitability with patch-clamp techniques. We recorded the synaptic neuron excitability and transmission in the substantia gelatinosa (SG) of spinal cord using patch clamping in vitro. Western blotting was used to detect the protein expression of TLR4, NF-κB, and CBS in dorsal horn of spinal cord (SC) from sham and LDH rats. The behavior study was used to measure the pain sensitive of animals. Results:LDH enhanced the excitation ( t=2.564, P<0.01) and spontaneous excitatory neurotransmission in SG neurons ( t=2.225, P<0.05). We detected significant upregulation of TLR4, NF-κB, and CBS proteins in SC neurons in the LDH rat model ( t=7.071, t=2.40, t=2.767, P<0.05). Intrathecal administration of the TLR4-selective inhibitor, CLI095, significantly suppressed the expression of NF-κB, and CBS proteins ( t=10.070, P<0.01; t=2.531, P<0.05) and the frequency of glutamatergic synaptic activities of SG neurons ( t=4.334, t=2.437, P<0.05) and attenuated sciatic hypersensitivity in LDH rats. Conclusion:LDH increased the expression of TLR4 and NF-κB proteins, which in turn sensitized sciatic nerve hypersensitivity by upregulating CBS-H2S protein levels, finally leading to the pathological pain.

Transforming growth factor β1 (TGF-β1) can promote the proliferation and differentiation of intervertebral disc cells and participates in its repair process. However, whether TGF-β1 engages in the process of disc degeneration has not yet been fully elucidated. The present study aimed to investigate the function of high-dose TGF-β1 on the metabolism of nucleus pulposus cells (NPCs). TGF-β1 levels in human degenerative intervertebral disc tissues and tumor necrosis factor (TNF)-α-induced degenerative NPCs were analyzed. Furthermore, NPCs were treated with TGF-β1 and inhibitors of TGF-β1 receptors [ALK tyrosine kinase receptor (ALK) 1 and ALK5] to determine the effect of the receptors in the mediation of NPC degeneration. The NPC state was determined by the components of secretory collagen I/II, tissue inhibitor of metalloproteinase-3 (TIMP-3) and matrix metalloproteinase (MMP)-13. The mRNA expression of Smad1/2/3/5/8, the downstream gene of TGF-β1 mediated by ALK, was also measured. Results showed that TGF-β1 and ALK1 were positively associated with the degree of degeneration of NP or NPCs in vitro, but negatively associated with ALK5. Furthermore, high-doses of TGF-β1 suppressed collagen II, but enhanced collagen I, TIMP-3, MMP-13, ALK1/5 and Smad1/2/3/5/8 expression. ALK5 inhibition induced the suppression of Smad2/3 and aggravated high-dose TGF-β1-induced NPC degeneration, as shown by the reduction in collagen II and increase in collagen I, TIMP-3 and MMP-13. By contrast, ALK1 inhibition resulted in Smad1/5/8 suppression and alleviated high-dose TGF-β1-induced NPC degeneration. Taken together, it was concluded that high-doses of TGF-β1 contributed to the degeneration of NPCs via the upregulation of ALK1 and Smad1/5/8.

Purpose Akt/mTOR/p70S6K signaling pathway promotes motor function recovery after spinal cord injury (SCI) in both neurons and astrocytes. But the role and mechanism of this pathway in oligodendrocytes during nerve repair following SCI has not been researched. This study aimed to investigate the effect and mechanism of this signaling pathway in oligodendrocytes on nerve myelin regeneration and motor function recovery in rats with SCI. Methods After inhibiting or activating this signaling pathway, Western blotting and double immunofluorescence labeling were used to determine the levels of the signaling molecules in this pathway and myelin formation-related proteins in the plane of the thoracic segment of the injured spinal cord. The level of motor function recovery was evaluated and the oligodendrocytes involved in nerve myelin regeneration were studied. Primary oligodendrocytes were isolated and cultured in vitro, then MBP, PLP, and MOG were measured with reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results Akt/mTOR/p70S6K signaling pathway was activated after SCI compared with the sham-operated rats, prominently elevated levels of the pathway components were observed in the SC79-treated group. The activation of the signaling pathway significantly increased the expression levels of myelin formation-related proteins, including MBP, PLP, and MOG, and improved the Basso, Beattie, and Bresnahan (BBB) scores in the injured spinal cord. Conversely, rapamycin suppressed the expression of these signaling molecules and reduced the levels of myelin formation-related proteins. Conclusion Akt/mTOR/p70S6K signaling pathway activation can contribute to nerve myelin regeneration and has the potential to improve the regenerative environment and motor function, as well as the potential to promote repair of SCI.

Currently, there is no cure for spinal cord injury (SCI), a heavy burden on patients physiology and psychology. We found that microRNA-139-5p (miR-139-5p) expression was significantly downregulated in damaged spinal cords in mice. So, we aimed to test the effect of treatment with miR-139-5p on functional recovery and neuropathic pain in mice with SCI and investigate the underlying mechanism. The luciferase reporter assay revealed that miR-139-5p directly targeted mammalian sterile 20-like kinase 1 (Mst1), and miR-139-5p treatment suppressed Mst1 protein expression in damaged spinal cords of mice. Wild-type mice and Mst1(−/−) mice were exposed to SCI and treated with miR-139-5p agomir via intrathecal infusion. Treatment of SCI mice with miR-139-5p accelerated locomotor functional recovery, reduced hypersensitivities to mechanical and thermal stimulations, and promoted neuronal survival in damaged spinal cords. Treatment with miR-139-5p enhanced phosphorylation of adenosine monophosphate-activated protein kinase alpha (AMPKα), improved mitochondrial function, and suppressed NF-κB-related inflammation in damaged spinal cords. Deficiency of Mst1 had similar benefits in mice with SCI. Furthermore, miR-139-5p treatment did not provide further protection in Mst1(−/−) mice against SCI. In conclusion, miR-139-5p treatment enhanced functional recovery and reduced pain hypersensitivity in mice with SCI, possibly through targeting Mst1.