Unilateral biportal endoscopic (UBE) surgery is an innovative minimally invasive technique for treating lumbar disc herniation. However, conventional surgical positioning, which combines preoperative surface localization with intraoperative fluoroscopy, has several limitations, including suboptimal accuracy, procedural complexity, and reduced operative efficiency. Additionally, incomplete decompression and over-decompression are common issues in UBE surgery, might leading to disastrous outcomes. However, determining the extent of laminectomy remain a significant challenge. This study explores the use of Kirschner Wire as a localization tool in UBE surgery to enhance localization precision and the the appropriate decompression range. This study included 78 patients diagnosed with lumbar disc herniation (LDH) and radicular pain who underwent UBE discectomy using Kirschner Wires as a localization tool. Another 73 patients with LDH underwent standard UBE discectomy without Kirschner Wires. We compared demographic data, surgical variables, postoperative complications, and health-related quality of life (HRQOL) between the two groups. Incorrect segmental localization occurred in 2 patients in the Kirschner Wire group and 11 patients in the standard UBE discectomy group, indicating a significant difference. The Kirschner Wire group demonstrated shorter total operation time, less time spent identifying the correct segment, fewer instances of radiology exposure, and reduced intraoperative blood loss. Additionally, less paraspinal muscle injury was observed in the Kirschner Wire group. Incomplete decompression was identified in 4 patients in the standard UBE discectomy group, all of whom required revision surgery, whereas no cases of incomplete decompression were observed in the Kirschner Wire group. The incidence of facet injury was higher in the standard UBE discectomy group due to the over-decompression. However, no significant differences were found between the groups in terms of dural tear, root injury, incision infection, and revision surgery. Both groups showed improvements in visual analog scale (VAS) scores for back pain, VAS scores for leg pain, and Oswestry Disability Index (ODI), with a more significant decrease in leg pain VAS scores observed in the Kirschner Wire group. Kirschner Wire is an effective localization tool in UBE discectomy, providing accurate segmental localization and aiding surgeons in determining the extent of laminectomy for decompression, thus reducing the likelihood of incomplete decompression or over-decompression. Additionally, the use of Kirschner Wire can decrease total operation time, radiation exposure, intraoperative blood loss, and paraspinal muscle injury. We recommend Kirschner Wire as localization tools in UBE discectomy to enhance surgical precision and outcomes.

With the emergence of numerous classifications, surgical treatment for adolescent idiopathic scoliosis (AIS) can be guided more effectively. However, surgical decision-making and optimal strategies still lack standardization and personalized customization. Our study aims to devise proper deep learning (DL) models that incorporate key factors influencing surgical outcomes on the coronal plane in AIS patients to facilitate surgical decision-making and predict surgical results for AIS patients. A total of 425 AIS patients who underwent posterior spinal fixation were collected. Variables such as age, gender, preoperative and final follow-up horizontal and vertical coordinate vectors, and screw positioning data were preprocessed by parameterizing image data and transforming various data types into a unified, continuous high-dimensional feature space. Four deep learning models were designed, including Multi-Layer Perceptron model, Encoder-Decoder model, CNN-LSTM Attention model and Deep FM model. For the implementation of deep learning, 70% of the data was adopted for training and 30% for evaluation. The mean square error (MSE), mean absolute error (MAE) and curve fitting between the predicted and corresponding real postoperative spinal coordinates of the test set were adopted to validate and compare the efficacy of the DL models. A total of 425 patients with an average age of 14.60 ± 2.08 years, including 77 males and 348 females, were enrolled in this study. The Lenke type 1 and 5 AIS patients accounted for the majority of the included patients. The results showed that the Multi-Layer Perceptron model achieved the best performance among the four DL models, with a mean square error of 2.77 × 10–5 and an average absolute error of 0.00350 on the validation set. Moreover, the results predicted by the Multi-Layer Perceptron model closely matched the actual coordinate positions on the original postoperative images of patients with Lenke type 1 and AIS patients. Deep learning models can provide alternative and effective decision-making support for AIS patients undergoing surgery. Regarding the learning curve and data volume, the optimal DL models should be adjusted and refined to meet future demands.

Protein phosphorylation plays an important role in the signal transduction and is capable of regulation of cell activity. The death-associated protein kinase 1 (DAPK1), as a Ser/Thr kinase, interacts with calmodulin (CaM) to regulate apoptotic and autophagic signaling. Autophosphorylation of DAPK1 at Ser308 located at the autoregulatory domain (ARD) blocks CaM binding and inhibits kinase catalytic activity. However, the mechanism underlying the influence of Ser308 phosphorylation (pS308) on the DAPK1 activity remains unclear. Here, we performed multiple, microsecond length molecular dynamics (MD) simulations, the molecular mechanics generalized Born/surface area (MM-GBSA) binding free energy calculations, principal component analysis, and dynamic cross-correlation analysis to unravel the conformational dynamics and allostery of the DAPK1 - CaM interaction triggered by the pS308 at the ARD. MD simulations showed that pS308 affected the conformational stability of the DAPK1 - CaM complex. Further energetic and structural exploration revealed that pS308 weakened the association of the phosphorylated DAPK1 to CaM, which lowered the susceptibility of DAPK1 to be activated by CaM. This result can provide mechanistic insights into the molecular underpinning through which the DAPK1 kinase activity is modulated by the auto-phosphorylation.

Adolescent idiopathic scoliosis (AIS), a complex early-onset three-dimensional spinal deformity, remains etiologically ambiguous despite extensive ongoing investigations. Currently, braces and surgeries are primary treatments of AIS, which come with inherent risks and costs. Therefore, there is an urgent need for biotherapeutic targets for AIS. Using human specimens obtained from the clinic, we discovered that ORM1 was expressed in AIS bone tissues. Also, immune cells were found to interact with osteoclasts through the LTB-LTBR pathway, resulting in elevated ORM1 expression, proliferation promotion and differentiation of monocytes/osteoclasts. Protein analysis showed that in ORM1-positive AIS patient-derived osteoblasts, there was an increased expression of RANKL, decreased expression of OPG, and an increased RANKL/OPG ratio. Furthermore, osteoclasts overexpressing ORM1 promoted their own differentiation while inhibiting osteoblast proliferation and function. ORM1 knockdown osteoclasts co-cultured with osteoblasts, along with the addition of leptin, significantly inhibited osteoclast differentiation while promoting osteoblast proliferation and function-related protein expression. In conclusion, ORM1 acts as a detrimental factor in the pathogenesis of Adolescent Idiopathic Scoliosis (AIS) by promoting osteoclast differentiation and inhibiting both the proliferation and function of osteoblasts. This suggests that ORM1 may represent a valuable therapeutic target for AIS.

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Abstract Objective We present for the first time a novel entry point of pedicle screws (Short Rod Technique, SRT), which can avoid superior facet violation and has been verified as a safe screw placement method. The objective of this study is to report the clinical outcomes of SRT in transforaminal lumbar interbody fusion (TLIF) surgery through Wiltse approach. Methods We retrospectively analyzed the clinical outcomes of 64 patients who received SRT through Wiltse approach with a minimum of 2 years of follow-ups. Demographics, clinical outcomes and radiological parapmeters were recorded and analyzed. Results Less total postoperative drainage volume before removall (27.88 ± 10.27), shorter days of removal of drainage (1.08 ± 0.27) was observed in SRT through Wiltse approach. In addition, patients felt less wound pain after the surgery, improving their HRQOL. Upper adjacent segment degeneration (ASD) was found in 2 petients at final follow-up, and they also received revision surgery. Both back pain, leg pain and ODI improved after the surgery; however, due to the ASD patients, the mean value of leg pain and ODI were greater at final follow-up than they’re at post-operation. Less change of LL was observed at final follow-up than it at post-operation with significant difference. Compared with increase of SS at post-operation, SS decreased at final follow-up with significant difference of change of SS. PT decreased at post-operation, while it was found to be increased at final follow-up. PI remained constant before and after the surgery with no significant difference of change of PI. Sagittal alignment also tended to be imbalanced with the change of SVA signficantly greater at final follow-up than it at post-operation. In addition, due to the two cases of ASD, the loss of disc hight and change of slippage distance of upper adjacent segment were signficantly greater at final follow-up than they’re at post-operation. More degeneration of intervertebral disc was also observed at final follow-up. Conclusion Application of SRT through Wiltse approach in TLIF surgery has been validated as an effective technique with good clinical outcomes, especially for reducing the blood loss and postoperative wound pain and improving patients’ HRQOL. The present study provides spinal surgeons with a novel method for performing TLIF surgery.

Purpose We present for the first time a novel entry point of pedicle screws (Short Rod Technique, SRT), which can avoid superior facet violation and has been verified as a safe screw placement method. The purpose of this study is to determine the clinical outcomes of SRT in posterior lumbar interbody fusion (PLIF) surgery. Methods We retrospectively analyzed the clinical outcomes of 89 patients who received SRT and 109 patients who received PLIF surgery with regular entry points of pedicle screws with a minimum of 2 years of follow-ups. Patients were divided into three groups according to the number of fusion segments, and the clinical outcomes of the three groups were compared. Results The length of the wound and the length of rods were significantly shorter in the each SRT group. Less intraoperative blood loss was observed in the SRT group in patients with a single segment and two segments fusions, but not in three segments fusions. Fewer degenerations of the upper adjacent segment were observed in the SRT group in patients with a single segment and three segments fusions. In addition, less postoperative wound pain related to PLIF surgery was observed in the SRT group in patients with two and three segments fusions. Conclusion SRT has been validated as an effective technique with good clinical outcomes, especially for reducing the occurrence of upper ASD in PLIF surgery with a single segment and three segments. The present study provides spinal surgeons with a novel method for performing PLIF surgery.

随着人口老龄化的加剧,越来越多与年龄相关的疾病得到临床医生的重视.退变性脊柱侧凸(degenerative scoliosis,DS)的发病率随年龄增长而上升,已逐渐成为全球性的公共卫生问题,主要表现为脊柱冠状位及矢状位失衡,极大地影响患者的生存质量[1、2].脊柱是一个多组织的结构复合体,其稳定性主要依靠骨性结构、椎旁肌肉及相关韧带结构来维持,其中椎旁肌肉的作用至关重要[3.已有研究表明,椎旁肌肉退变与DS的发生和发展具有相关性,但具体作用机制尚不明确.笔者通过回顾相关文献,对椎旁肌退变及其与DS关系的研究现状进行综述,并对疾病的诊断治疗提出展望,以期提高DS患者的诊疗水平,改善老年人的远期生活质量.

慢性腰痛在人群与个体一生中均有较高的患病率,对患者与社会医疗保健系统造成了重大经济负担,已经成为近年的研究热点.随着研究的深入,慢性腰痛的发病机制与影响因素被陆续发现,诊断与治疗指南被持续更新.然而,因为缺乏明确的病因,慢性腰痛的概念尚不统一,其诊断与治疗也存在争议.本文对慢性腰痛的概念、发病机制与影响因素、诊断与治疗的研究进展进行综述,为其临床诊疗与研究提供参考.

The aim of this study was to explore whether a robot-assisted (RA) technique has advantages over the conventional fluoroscopy-assisted (FA) technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in adolescent idiopathic scoliosis (AIS) correction surgery. A total of 101 patients with AIS were recruited (RA group: 45 patients underwent RA screw insertion; FA group: 56 patients underwent FA screw insertion). When comparing the radiological data between the two groups, the major and secondary curves were both corrected proficiently with no difference in Cobb angle comparison at the last follow-up, suggesting that both the RA technique and the FA technique could lead to efficient radiographic correction and similar clinical outcomes (all, p > 0.05). In the RA group, operation time, blood loss, and transfusion volume were significantly greater than those in the FA group, while the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve in the RA group was higher than that in the FA group. In conclusion, both the RA and FA techniques could approach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with the conventional fluoroscopy technique, the RA technique might improve the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve, while the increased operation time, blood loss, and transfusion volume might be the disadvantages due to the preliminary stage of the learning curve.

The aim of the present study was to report a clinical survey of hereditary multiple exostoses (HME) in a large Chinese pedigree, and the identification of a novel deletion mutation of exostosin glycosyltransferase 2 (EXT-2) gene. A patient with multiple exostoses with huge cartilage-capped tumors in scapula, knees and ankles received surgery in Department of Orthopedics (Shanghai Changhai Hospital). A total of 20 family members were recruited to the study, with seven members (five male; two female) diagnosed as HME. The family members of the patients with HME were examined, clinical data and peripheral blood samples were collected, and their DNA was sequenced. The incidence of HME in this family pedigree was 35%. Exostoses were most frequently in the tibiae with occurrence in six patients, followed by ribs, femurs, radii, fibulae, scapulae and humeri. DNA sequencing of peripheral blood revealed a novel deletion mutation, c.824-826delGCA, in exon 5 of the EXT-2 gene, which was observed in all the patients with HME, but not in the healthy family members. Several characteristics of HME in the pedigree were observed, such as susceptibility of male gender, decreased average age of onset and height and increased severity of clinical symptoms with generations.

Calcium (Ca2+) signaling plays an important role in the regulation of many cellular functions. Ca2+-binding protein calmodulin (CaM) serves as a primary effector of calcium function. Ca2+/CaM binds to the death-associated protein kinase 1 (DAPK1) to regulate intracellular signaling pathways. However, the mechanism underlying the influence of Ca2+ on the conformational dynamics of the DAPK1−CaM interactions is still unclear. Here, we performed large-scale molecular dynamics (MD) simulations of the DAPK1−CaM complex in the Ca2+-bound and-unbound states to reveal the importance of Ca2+. MD simulations revealed that removal of Ca2+ increased the anti-correlated inter-domain motions between DAPK1 and CaM, which weakened the DAPK1−CaM interactions. Binding free energy calculations validated the decreased DAPK1−CaM interactions in the Ca2+-unbound state. Structural analysis further revealed that Ca2+ removal caused the significant conformational changes at the DAPK1−CaM interface, especially the helices α1, α2, α4, α6, and α7 from the CaM and the basic loop and the phosphate-binding loop from the DAPK1. These results may be useful to understand the biological role of Ca2+ in physiological processes.

PURPOSE:The etiology of adolescent idiopathic scoliosis (AIS) remains unclear. The chondrogenic differentiation of mesenchymal stem cells (MSCs) is important in AIS, and the Ras homolog gene family member A (RHOA) is associated with chondrogenesis. The purpose of this study was to explore the effect of RHOA on the chondrogenic differentiation of MSCs in AIS.METHODS:We isolated MSCs from patients with AIS (AIS MSCs) and individuals without AIS (control MSCs). The inhibitor Y27632 was used to inhibit the function of RHOA/ROCK signaling, and plasmid-based overexpression and siRNA-mediated knockdown were used to manipulate RHOA expression. CCK-8 was used to detect cell viability. The phosphorylation levels of LIMK1, MLC2 and cofilin were detected by Western blotting. The mRNA expression of aggrecan, SOX9, and COL2A1 were confirmed using RT-PCR. Immunofluorescence was used to analyze F-actin and collagen II. Alcian blue staining was performed to assess the secretion of glycosaminoglycans (GAGs).RESULTS:We found that RHOA was significantly upregulated in AIS MSCs, and the phosphorylation levels of LIMK1, MLC2, and cofilin were increased. The mRNA expressions of aggrecan, SOX9, and COL2A1 were notably reduced in AIS MSCs. However, these effects were abolished by Y27632 treatment and RHOA knockdown in AIS MSCs. In addition, RHOA knockdown in AIS MSCs increased the content of collagen II and GAGs. RHOA overexpression in the control MSCs markedly activated the RHOA/ROCK signaling and decreased the expression of aggrecan, SOX9, and COL2A1, F-actin, and GAGs.CONCLUSION:RHOA regulates the chondrogenic differentiation ability of MSCs in AIS via the RHOA/ROCK signaling pathway and this regulation may involve SOX9.

Backgrounds Abnormal vertebral growth and development have been found in adolescent idiopathic scoliosis (AIS) patients, and the proliferation and differentiation of bone development-related cells play important roles in its pathogenesis. However, a comprehensive single-cell-level differentiation roadmap in AIS has not been achieved. Methods The present study compared the single-cell level cellular landscapes of spinal cancellous bone tissues between AIS patients and healthy subjects using high throughput single-cell RNA sequencing (scRNA-seq), which covers multiple cellular lineages including osteoblast, chondrocyte, osteoclast and related immunocytes. We constructed the differentiation trajectories of bone development-related cell lineages through pseudotime analysis, and the intercellular-communication networks between bone development-related cells and immunocytes were further developed. Results A total of 11 distinct cell clusters were identified according to the genome-wide transcriptome profiles. t-Distributed stochastic neighbor embedding (t-SNE) analysis showed that mesenchymal stem cells (MSC) were classified into three subtypes: MSC-LOXL2, MSC-IGFBP5, and MSC-GJA1. Gene ontology (GO) analysis showed that MSC-GJA1 might possess greater osteoblast differentiation potential than the others. MSC-IGFBP5 was the specific MSC subtype observed only in AIS. There were two distinct gene expression clusters: OB-DPT and OB-OLFML2B, and the counts of osteoblasts derived from AIS was significantly less than that of non-AIS subjects. In AIS patients, MSC-IGFBP5 failed to differentiate into osteoblasts and exhibited negative regulation of cell proliferation and enhanced cell death. CPC-PCNA was found to be the specific chondrocyte progenitor cell (CPC) subtype observed only in AIS patients. The cell counts of OC-BIRC3 in AIS were less than those in controls. Pseudotime analysis suggested two possible distinct osteoclast differentiation patterns in AIS and control subjects. Monocytes in AIS mainly differentiated into OC-CRISP3. Conclusions Our single-cell analysis first revealed differences existed in the cellular states between AIS patients and healthy subjects and found the differentiation disruption of specific MSC and CPC clusters in AIS. Cell communication analysis provided the possible pathogenesis of osteoblast and chondrocyte differentiation dysfunction in AIS.

目的:建立一个新的预测成人最大腰椎前凸的公式,评价其可靠性和有效性.方法:收集311例健康成人的一般资料与站立位脊柱全长侧位X线片,在X线片上测量最大腰椎前凸(maximal lumbar lordosis,maxLL)、最大胸椎后凸(maximal thoracic kyphosis,maxTK)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT),骨盆入射角(pelvic incidence,PI).应用Pearson相关分析在其中220例研究对象中分析maxLL与maxTK、SS、PT和PI之间的相关关系,利用与maxL相关的变量进行多元回归分析,建立腰椎前凸预测公式;利用建立的公式对其余91例研究对象的maxLL进行预测,并与实际测量的maxLL进行比较,验证预测公式的可靠性与有效性.结果:maxLL与maxTK(r=0.564,P＜0.001)、SS(r=0.783,P＜0.001)、PT(r=-0.155,P=0.021)和PI(r=0.483,P＜0.001)有关.多元回归分析表明maxLL与maxTK、PI显著相关性(P＜0.001),建立预测公式为:maxLL=0.6×maxTK+0.5×PI+3 (R2=0.55).用公式预测的maxLL为49.32°±7.06°,实际测量的maxLL为48.70°±9.46°,差异无显著性(P=0.408).结论:maxTK与PI是maxLL的主要影响因素,建立的预测公式预测成人最大腰椎前凸具有良好的可靠性与有效性.

Study design Retrospective study and comparative meta-analysis. Objective To document the sagittal spinopelvic alignment in a large cohort study in asymptomatic Chinese juveniles and adolescents, and to explore whether these parameters were different from various regions using meta-analysis. Methods Medical records of 656 asymptomatic Chinese juveniles and adolescents were reviewed, whose mean age was 13.14 ± 3.41 years old, including 254 male and 402 female volunteers. Demographic and lateral radiological parameters were evaluated. Furthermore, a systematic online search was performed to identify eligible studies. Weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate whether these sagittal parameters were different from various regions. Results The mean value of sagittal spinopelvic alignment in this study was calculated and analyzed respectively. Significant differences of PI (34.20 ± 4.00 vs. 43.18 ± 7.12, P < 0.001) and PT (3.99 ± 6.04 vs. 8.42 ± 7.08, P < 0.001) were found between juveniles and adolescents. A total of 17 studies were recruited for meta-analysis. For juvenile populations, TK, PI and SS of Caucasians were significantly larger than those of our study (all P < 0.001). As for adolescent populations, PI ( P = 0.017), TK ( P = 0.017) and SS ( P < 0.001) of Caucasians was found to be greater when compared with that of our study. All in all, TK, PI and SS in Chinese pre-adult populations were significantly smaller than those populations in Caucasian regions (all P < 0.001). Conclusion Our study was the first large-scale study that reported the mean values of sagittal parameters in asymptomatic Chinese juveniles and adolescents. There were significant differences in TK, PI and SS between our study and other previous reported populations, which reminded us for using specific mean values in different populations when restoring a relatively normal sagittal spinopelvic balance in spinal deformity.

The aim of the present study was to integrate all the eligible studies and investigate whether the transforming growth factor-b1 (TGF-b1) gene polymorphisms (TGF-b1 T869C and TGF-b1 T29C) are correlated with postmenopausal osteoporosis (PMOP) risk. PMOP is a common skeletal disease and several genetic factors play an important role in the development and progression of PMOP. Significant associations between TGF-b1 gene polymorphisms (TGFb1 T869C and TGF-b1 T29C) and PMOP risk have been reported; however, some of these results are controversial. A systematic online search was performed using PubMed, EMBASE, Web of Science, and the Cochrane Library to identify case–control studies investigating the relationship between TGF-b1 T869C and TGF-b1 T29C polymorphisms and the susceptibility of PMOP. The pooled odds ratio (OR) with 95% confidence interval (95% CI) was calculated to assess the associations, and subgroup meta-analyses were performed according to the ethnicity of the study populations. Eight studies involving 1851 cases and 2247 controls met the inclusion criteria after assessment by 2 reviewers. Overall, there were significant associations between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP (TGF-b1 T869C—C vs T: OR1⁄4 1.18, 95% CI1⁄4 1.02–1.36, P1⁄4 0.030; CC vs TT: OR1⁄4 1.38, 95% CI1⁄4 1.01–1.88, P1⁄4 0.042; CC vs CT/TT: OR1⁄4 1.39, 95% CI1⁄4 1.09–1.76, P1⁄4 0.008; TGF-b1 T29C—CT vs TT: OR1⁄4 1.25, 95% CI1⁄4 1.02–1.53, P1⁄4 0.032; CT/CC vs TT: OR1⁄4 1.37, 95% CI1⁄4 1.02–1.84, P1⁄4 0.035). In the subgroup analysis of ethnicity, significant association was observed between TGF-b1 T869C polymorphism and PMOP risk in Asian population (C vs T: OR1⁄4 1.18, 95% CI1⁄4 1.01–1.38, P1⁄4 0.043; CC vs TT: OR1⁄4 1.41, 95% CI1⁄4 1.01–1.97, P1⁄4 0.047; CT/CC vs TT: OR1⁄4 1.31, 95% CI1⁄4 1.03– 1.66, P1⁄4 0.026; CC vs CT/TT: OR1⁄4 1.35, 95% CI1⁄4 1.03–1.75, P1⁄4 0.028); however, there was no significant association between TGF-b1 T869C polymorphism and PMOP risk in Caucasian population. With regard to TGF-b1 T29C polymorphism, significant association was also observed in Asian population (CT vs TT: OR1⁄4 1.37, 95% CI1⁄4 1.07– 1.75, P1⁄4 0.013; CT/CC vs TT: OR1⁄4 1.54, 95% CI1⁄4 1.16–2.05, P1⁄4 0.003), while there was no significant association in Caucasian population. The TGF-b1 T869C and TGF-b1 T29C polymorphisms may be involved in susceptibility to PMOP, particular in Asian patients. (Medicine 94(4):e461) Abbreviations: BMD = bone mineral density, HWE = Hardy– Weinberg equilibrium, PMOP = postmenopausal osteoporosis. INTRODUCTION P ostmenopausal osteoporosis (PMOP) is the most common bone disease, and features bone loss and susceptibility to fragility fractures that are associated with a low bone mineral density (BMD). PMOP is among the most prevalent metabolic bone diseases in postmenopausal women. Although PMOP has been described decades ago, its exact mechanisms remain poorly understood. Genetic or acquired disorders can compromise gains in bone quantity and quality leading to osteoporosis early in life. Previous studies indicated that low BMD was a major risk factor for PMOP and was highly heritable. Besides, many association studies have shown that genes and genetic factors might be involved in the pathogenesis of PMOP. Recently, many studies deduced that transforming growth factor superfamily catalyzed enzymes for osteoporosis. Transforming growth factor-b1 (TGF-b1), a member of the transforming growth factor superfamily, is abundant in bone and has been implicated as an important regulator of both bone formation and resorption, which can stimulate proliferation or differentiation of preosteoblasts as well as inhibit mature osteoclasts and proliferation of mononuclear osteoclast precursors in vitro. Molecular biological evidence showed that polymorphisms in the TGF-b result in a Leu!Pro substitution at amino acid 10, which includes a T!C transition at nucleotide 29 and a T!C transition at nucleotide 869 in the region encoding the signal sequence. This change influenced the bone remodeling, indicating that genetic polymorphisms of the T29C and T869C genes might be associated with increased risk for osteoporosis. Recently, significant association has been found between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP in several studies. But the results of these studies are complex and even opposite. Furthermore, no consolidated reports have been conducted to investigate the associations between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP. Therefore, we performed this Editor: James Franklin Kellam. Received: December 6, 2014; revised: December 19, 2014; accepted: December 22, 2014. From the Department of Orthopaedic Surgery (JS, CZ, LX, HY), The First Affiliated Hospital of Soochow University; and Department of Orthopaedics (MY), Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China. Correspondence: Huilin Yang, No. 188 Shizi Street, Suzhou 215006, China (e-mail: orthopaedicvit@163.com). JS and CZ contributed equally to this work. This research was funded by Natural Science Foundation of China (81171689) and Jiangsu Provincial Special Program of Medical Science, China (BL2012004). The authors have no conflicts of interest to disclose. Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. ISSN: 0025-7974 DOI: 10.1097/MD.0000000000000461 Medicine Volume 94, Number 4, January 2015 www.md-journal.com | 1 meta-analysis to make contribution to obtain a more exact evaluation of the associations between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP risk. MATERIALS AND METHODS Literature Search Databases including PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for the eligible case– control studies that examined the relationship between TGF-b1 polymorphisms (TGF-b1 T869C and TGF-b1 T29C) and the susceptibility to PMOP. The following search terms were used: (Postmenopausal osteoporosis OR PMOP) AND (Transforming growth factor-b1 OR TGF-b1 OR TGF-b1 T869C OR TGF-b1 T29C) AND (polymorphism OR single nucleotide polymorphism OR SNP OR variation). There were no language restrictions in our study selection. Secondary searches of unpublished literature were conducted by searching the reference lists of the selected studies and reviews. Inclusion and Exclusion Criteria The inclusion criteria of our meta-analysis were as follows: case–control study; evaluation of PMOP risk and at least one of these identified TGF-b1 gene polymorphisms (TGF-b1 T869C and TGF-b1 T29C); and sufficient data, including number or frequency of alleles and genotypes. The exclusion criteria were reviews or case reports that were not case–control studies, no available data reported, and duplicated reports. Data Extraction Data from the eligible studies were extracted according to the inclusion and exclusion criteria by 2 authors, and a consensus was reached. For each study, the following data were collected: author list, year of publication, ethnicity, sample size, alleles, and genotypes of TGF-b1 T869C and TGF-b1 T29C polymorphisms. Furthermore, we also evaluated whether the genotype distributions of the control group followed the Hardy– Weinberg equilibrium (HWE). Data Synthesis and Statistical Analysis Odds ratio (OR) and 95% confidence interval (CI) were calculated to evaluate the association between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP risk. Allele contrast (C vs T), heterozygote (CT vs TT), homozygote (CC vs TT), dominant (CT/CC vs TT), and recessive (CC vs CT/TT) models were used to evaluate the relationship between TGF-b1 T869C and TGF-b1 T29C polymorphisms and PMOP risk. The assumption that there was heterogeneity was verified by a x-based Q statistical test and quantified by I metric value. If I value is >50% or P< 0.10, suggesting that an obvious heterogeneity existed, ORs were pooled by random effect model; otherwise, the fixed effect model was used. Sensitivity analysis was performed to assess the impact of each study on the combined effect of the present meta-analysis and subgroup analysis was performed according to the ethnicity of the study populations. All metaanalyses were performed using Stata 12.0 software (StataCorp, College Station, TX) and a P value below 0.05 was considered statistically significant. This is a systematic review about literatures, so ethical approval was not necessary for our research. RESULTS Study Characteristics A total of 8 studies involving 1851 cases and 2247 controls eventually satisfied the eligibility criteria (Figure 1). Three studies reported both alleles and genotypes of Records identified through database searching (n = 56) pubMed: 25, EMBASE:31 Additional records identified trhough other sources (n = 2) Records after duplicates removed (n = 23) Records screened (n = 23) Records excluded (n = 10) 10 studies did not meet the aim of our study Full-text articles excluded (n = 5) 5, no sufficient data 4 studies reported TGF-β1 T869C 4 studies reported TGF-β1 T29C Full-text articles assessed for eligibility (n = 13) Studies included in metaanalysis (n = 8) FIGURE 1. The study selection and inclusion process. Sun et al Medicine Volume 94, Number 4, January 2015 2 | www.md-journal.com Copyright # 2015 Wolters Kluwer Health, Inc. All rights reserved. TABLE 1. General Characteristics of Studies Included in the Meta-Analysis Author Year Ethnicity Sample Size TGF-b1 T869C Case TGF-b1 T869C Control TGF-b1 T29C Case TGF-b1 T29C Control Case Control C/T CC/TC/TT C/T CC/TC/TT C/T CC/TC/TT C/T CC/TC/TT Tural et al 2013 Caucasian 146 97 167/125 50/67/29 104/90 24/56/17 Yamada et al 2001 Asian 288 625 276/300 58/160/70 536/71

目的 研究中国东部地区不同年龄阶段脊柱骨盆矢状面参数的差异及随年龄如何变化.方法 回顾性分析2014年1月至2015年8月于我院健康体检中心留存的311名无症状健康志愿者的资料,由2名外科医师收集人口统计学数据及脊柱骨盆矢状面影像学参数,包括年龄、性别、最大胸椎后凸角、最大腰椎前凸角、最大腰椎前凸角-最大胸椎后凸角、骶骨倾斜角、骨盆倾斜角、骨盆入射角、骨盆倾斜角与骶骨倾斜角比值、骨盆入射角-腰椎前凸角、矢状面躯干偏移、T1矢状面角度、T1骨盆角度及T1脊柱骨盆倾斜角.采用Pearson相关分析研究年龄与矢状面参数的关系,建立多元线性回归方程分析年龄与最大胸椎后凸角的关系.根据年龄将研究对象分为7组:<20岁、≥20且<30岁、≥30且<40岁、≥40且<50岁、≥50且<60岁、≥60且<70岁和≥70岁,采用Kruskal-Wallis H检验比较各年龄段脊柱骨盆矢状面参数的差异.结果 311名健康志愿者的最大胸椎后凸角(r=0.280,P<0.01)、最大腰椎前凸角-最大胸椎后凸角(r=-0.320,P<0.01)、骶骨倾斜角(r=-0.216,P<0.01)、骨盆倾斜角(r=0.237,P<0.01)、骨盆倾斜角与骶骨倾斜角比值(r=0.282,P<0.01)、矢状面躯干偏移(r=0.279,P<0.01)、T1矢状面角度(r=0.247,P<0.01)及T1骨盆角度(r=0.259,P<0.01)均与年龄相关,而最大腰椎前凸角、骨盆入射角、骨盆入射角-腰椎前凸角及T1脊柱骨盆倾斜角均与年龄无明显相关性(P均>0.05).建立多元线性回归方程:最大胸椎后凸角=0.175×年龄+28.233,年龄每增长10岁最大胸椎后凸角增加1.75°.<20岁、≥20且<30岁、≥30且<40岁、≥40且<50岁、≥50且<60岁、≥60且<70岁和≥70岁组人数分别为8、56、51、59、56、56、25名,最大胸椎后凸角、骨盆倾斜角、骨盆倾斜角与骶骨倾斜角比值、矢状面躯干偏移、T1矢状面角度及T1骨盆角度均随年龄增长而增大(P均<0.01),最大腰椎前凸角-最大胸椎后凸角、骶骨倾斜角则随年龄增长而减小(P<0.01、P<0.05).结论 在中国东部地区无症状健康志愿者中,最大胸椎后凸角随年龄增长而增大(年龄每增长10岁最大胸椎后凸角增大1.75°).

BACKGROUND CONTEXT: Anterior controllable antedisplacement and fusion (ACAF) is a novel surgical technique for the treatment of ossification of the posterior longitudinal ligament (OPLL). Its prognostic factors for decompression have not been well studied. Additionally, no detailed radiological standard has been set for hoisting the vertebrae-OPLL complex (VOC) in ACAF. PURPOSE: To identify the possible prognostic factors for decompression outcomes after ACAF for cervical OPLL, to determine the critical value of radiological parameters for predicting good outcomes, and to establish a radiological standard for hoisting the VOC in ACAF. STUDY DESIGN: This was a retrospective multicenter study. PATIENT SAMPLE: A total of 121 consecutive patients with OPLL who underwent ACAF at a point between January 2017 and June 2018 at any one of seven facilities and were monitored for at least 1 year afterward were enrolled in a multicenter study. OUTCOME MEASURES: Japanese Orthopedic Association (JOA) scores, recovery rate (RR) of neurologic function, and surgical complications were used to determine the effectiveness of ACAF. METHODS: Patients were divided into two groups according to their RR for neurologic function. Patients with an RR of >= 50% and an RR of <50% were designated as having good and poor decompression outcomes, respectively. The relationship between various possible prognostic factors and decompression outcomes was assessed by univariate and multivariate analysis. The receiver operating characteristic curve was used to determine the optimal cutoff value of the radiological parameters for prediction of good decompression outcomes. Next, the patients were redivided into three groups according to the cutoff value of the selected radiological parameter (postoperative anteroposterior canal diameter [APD] ratio). Patients with postoperative APD ratios of <= 80.7%, 80.7%-100%, and >= 100% were defined as members of the incomplete, optimal, and excessive antedisplacement groups, respectively. Differences in decompression outcomes among the three groups were compared to verify the reliability of the postoperative APD ratio and assess the necessity of excessive antedisplacement. RESULTS: Multivariate logistic regression analysis showed that patients' age at surgery (odds ratio [OR]=1.18; 95% confidence interval [CI]=1.08-1.29; p<.01) and postoperative APD ratio (OR=0.83; 95% CI=0.77 -0.90; p<.01) were independently associated with decompression outcomes. The optimal cutoff point of the postoperative APD ratio was calculated at 80.7%, with 86.2% sensitivity and 73.5% specificity. There were no significant differences in the postoperative JOA scores and RRs between the excessive antedisplacement group and optimal antedisplacement group (p>.05). However, a lower incidence of cerebrospinal fluid leakage and screw slippage was observed in the optimal antedisplacement group (p<.05). CONCLUSIONS: Patients' age at surgery and their postoperative APD ratio are the two prognostic factors of decompression outcomes after ACAF. The postoperative APD ratio is also the most accurate radiological parameter for predicting good outcomes. Our findings suggest that it is essential for neurologic recovery to restore the spinal canal to more than 80.7% of its original size (postoperative APD ratio >80.7%), and restoration to less than its original size (postoperative APD ratio <100%) will help reduce the incidence of surgical complications. This may serve as a valuable reference for establishment of a radiological standard for hoisting the VOC in ACAF. (C) 2020 Elsevier Inc. All rights reserved.

退变性脊柱侧凸常见于老年患者,通常合并高血压病、冠心病、糖尿病和骨质疏松等基础疾病,手术风险高、并发症多.加速康复外科(ERAS)要求综合考量患者的年龄、症状、体征、身体状况和骨质量等因素,以制定个体化的手术方案和围手术期干预措施,这对改善患者预后和康复十分重要.经全国多位脊柱外科专家多次讨论,在循证医学证据支持下,针对退变性脊柱侧凸手术ERAS围手术期管理策略制定本共识意见,供临床工作参考和应用.