Intervertebral disc degeneration (IDD) is the main cause of low back pain (LBP), and it is caused by the deterioration of the physiological function and structure of the nucleus pulposus. Previous research has separately studied the effects of adipose-derived mesenchymal stem cells (ADSCs) and periodic mechanical stress (PMS) in IDD. However, the synergistic effect of these two on the repair of IDD remains unclear. Therefore, we simulated the effects of periodic mechanical stress co-culture (PMSC) on nucleus pulposus cells (NPCs) by using Transwell chambers and periodic compression device. We found that PMSC can promote the proliferation of NPCs and activate autophagy by activating Integrin alpha1(ITGA1), and rescue the apoptosis of NPCs under inflammatory conditions. To elucidate the mechanism underlying the effects of PMSC, the expression of ITGA1 was inhibited. It was found that PMSC regulates the Src/GIT1/ERK11/2 axis through ITGA1, thus promoting proliferation and inducing autophagy in NPCs.

OBJECTIVE:To assess if pre-emptive bilateral approach decompression (BAD) lowers early neural events and enhances very-early recovery versus unilateral approach decompression (UAD) in single-level transforaminal lumbar interbody fusion for Meyerding grade I degenerative spondylolisthesis. METHODS:Single-center retrospective study (2015-2022) with ≥24-month follow-up. Allocation by practice evolution: UAD (2015-2018) and BAD (2019-2022), limited to uniform mild-to-moderate contralateral risks. PRIMARY ENDPOINTS:very-early recovery (visual analog scale/Oswestry Disability Index/Japanese Orthopaedic Association at postoperative day [POD] 1/POD7) and neural complications. RESULTS:Analyzed 208 patients (UAD n = 102; BAD n = 106). BAD had longer operative time (114 ± 10 vs. 75 ± 9 minutes; P < 0.001). BAD improved very-early recovery: visual analog scale POD7 4.2 ± 0.6 versus 5.0 ± 0.7 (P < 0.001). Neural events were lower in BAD: early postoperative radicular pain 1.9% versus 9.8% (P = 0.017) and contralateral aggravation 0% versus 4.9% (P = 0.027). Two-year Japanese Orthopaedic Association recovery was similar (73% vs. 73%). CONCLUSIONS:In grade I spondylolisthesis transforaminal lumbar interbody fusion, BAD reduces early neural events and boosts very-early recovery without added blood loss or fusion compromise.

PurposeThe clinical results of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBED) for the treatment of L4/L5 disc herniation were compared.MethodsPatients with L4/L5 disc herniation who had either Percutaneous Transforaminal Endoscopic Discectomy (PTED; n = 53) or Unilateral Biportal Endoscopic Discectomy (UBED; n = 69) at our facility during the same time period were the subject of a retrospective evaluation. Clinical outcomes, radiological information, and complications were collected and evaluated for each group.ResultsA retrospective analysis of 122 patients with L4/L5 disc herniation revealed that 69 of them received unilateral biportal endoscopic discectomy (UBED) and 53 got percutaneous transforaminal endoscopic discectomy (PTED). Leg pain (P = 0.242) and low back pain (P = 0.645) preoperative, postoperative day 1, and final follow-up VAS scores did not show any significant between-group differences. By the final follow-up, Oswestry Disability Index (ODI) scores were significantly improved for both groups (P < 0.001). The UBED group's patient satisfaction rate was 95.7%, while the PTED group's was 94.0%, according to the modified MacNab criteria. The two groups did not differ statistically significantly (P = 1). Similarly, radiological outcomes did not differ significantly between groups. Compared to the PTED group, patients in the UBED group experienced higher hemoglobin loss and longer hospital stays. On the other hand, intraoperative fluoroscopy exposures were dramatically decreased (P < 0.01) by the UBED method.ConclusionBoth UBED and PTED are effective and safe treatment options for L4/L5 disc herniation. UBED entailed less fluoroscopic exposure, and PTED contributed to less blood loss as well as a shorter hospital stay.

Purpose To investigate the cell viability, proliferation of nucleus pulposus mesenchymal stem cells(NPMSCs) in different types of collagen scaffolds, and to construct a double-layer collagen scaffold to provide a method for the treatment of intervertebral disc degeneration. Methods Type I collagen extracted from porcine tendon.Type II collagen extracted from porcine articular cartilage.Giving appropriate pressure to collagen with a cover slip and then freeze-drying it in a vacuum.It is a collogen membrane with double layers: porous upper layer and compact lower layer. We take EDC/NHS as a compound crosslinking agent to make collagen structure more stable. The pores of the scaffolds before and after cross-linking were observed by scanning electron microscope (SEM), and the anti-degradation performance of the scaffolds before and after cross-linking was evaluated. The influence of the scaffold on nucleus pulposus mesenchymal stem cells(NPMSCs) proliferation was assessed by the CCK-8.The three-dimensional structure of the scaffolds co-cultured with NPMSCs was observed by a JSM-5600LV SEM. Results Scanning electron microscopy showed that collagenⅠhad a dense network structure and collagen Ⅱhad a loose and porous structure. The results of CCK-8 showed that both collagen scaffolds could promote the proliferation of NPMSCs(p < 0.05). The proliferative effect of collagenⅡwas more significant than that of collagenⅠ. (p < 0.05). The degradation rate of the cross-linked scaffolds was significantly slowed down, and the cross-linked scaffolds had more pores and more uniform sizes. Scanning electron microscopy showed NPMSCs can adhere and grow on scaffolds. Conclusion Type Ⅱ collagen is more suitable as a scaffold for tissue engineering nucleus pulposus.

ObjectiveTo study the clinical efficacy of unilateral biportal endoscopic lumbar interbody fusion (ULIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases, and to compare perioperative indicators, radiological outcomes, and paraspinal muscle –atrophy resulting from these two different surgical methods.BackgroundTransforaminal lumbar interbody fusion (TLIF) is widely acknowledged as an efficacious surgical modality for alleviating low back pain. In recent years, unilateral biportal endoscopic lumbar interbody fusion (ULIF) has gained increasing application.MethodsWe recorded the basic information of patients who underwent single-segment ULIF or TLIF for the first time in our hospital from May 2021 to November 2022, including age, gender, BMI, diagnosis, and surgical segment. Perioperative indicators such as estimated blood loss, operation time, postoperative hospital stay, and complications were observed in both groups. Clinical efficacy was assessed preoperatively and at 1 month, 3 months, and 12 months postoperatively using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the modified Macnab criteria. The displacement of the fusion device was also assessed. x-rays were taken preoperatively, at 3 months postoperatively, and at 12 months postoperatively to observe fusion device displacement and measure the intervertebral disc height of the upper and lower segments. The Cobb angle was used to measure lumbar lordosis and segmental lumbar lordosis. CT scans at 3 months postoperatively were used to observe intervertebral fusion, including bridging trabeculae, endplate cysts, and screw loosening. MRI at 1 year postoperatively was used to manually trace the cross-sectional area of the paraspinal muscles to compare muscle atrophy.ResultsA total of 150 patients were included in the study, with 71 patients in the ULIF group and 79 patients in the TLIF group. No statistically significant disparities were observed between the two groups with respect to age, gender, BMI, diagnosis, and surgical segment. The estimated blood loss in the ULIF group was 108.78 ± 58.3 ml, which was significantly less than that in the TLIF group at 199.44 ± 84.91 ml (p < 0.001). The postoperative hospital stay was shorter in the ULIF group (p = 0.020), although the operation time was longer for ULIF. There were no significant differences in complications between the two groups. Patients in the ULIF group experienced quicker relief from back pain postoperatively, but there were no significant differences between the ULIF and TLIF groups in the VAS, ODI, and satisfaction rates at the final follow-up. At 3 months postoperatively, the ULIF group demonstrated a higher incidence of bridging trabeculae, a lower incidence of endplate cysts, and less fusion device displacement. There were no significant differences between the two groups in the correction of segmental lumbar lordosis (SL) and overall lumbar lordosis (LL). Additionally, the ULIF group showed less muscle damage.ConclusionULIF has the advantages of reducing pain in the short term, less blood loss, and shorter hospital stays. Its more precise handling of the intervertebral space reduces the occurrence of endplate cysts and fusion device displacement, which has certain significance in preventing delayed fusion and nonunion. However, ULIF requires a longer operation time, which increases potential risks for elderly patients or those with poor nutritional status. Although ULIF causes less damage to the bony structure, it has not shown a significant advantage in improving adjacent segment degeneration.

OBJECTIVE:The purpose of this study was to explore the optimal needle-tip depth through conventional percutaneous vertebroplasty (PVP) and further analyze the correlation between needle-tip depth and anterior cement leakage in osteoporotic vertebral compression fractures. METHODS:A total of 560 patients with PVP were retrospectively analyzed, and they were stratified into a shallow (needle-tip at 2/3-3/4 depth, n = 291) and deep placement group (3/4-7/8 depth, n = 269). The clinical outcomes and anterior leakage rates were compared. Biomechanical parameters, including symmetric cement diffusion, flow velocity, anterior wall arrival time, and contact pressure, were derived from finite element analysis. RESULTS:Anterior leakage risk was significantly higher with deep placement (P = 0.005). Finite element analysis demonstrated increased distal diffusion asymmetry fraction, decreased anterior wall arrival time, increased cement flow velocity, and increased contact pressure for the deep insertion (all P < 0.0001). Risk of leakage was particularly elevated in the type 4 German Society for Orthopaedics and Trauma Surgery Osteoporotic Fracture Classification fracture group when placed deep (72.92% vs. 29.17%, P < 0.001). CONCLUSIONS:Greater amount of cement septum extension during PVP increases anterior cement leakage risk, especially in osteoporotic fracture type 4 fractures, suggestive that practitioners should be cautious about controlling needle-depth in order to effectively minimize complications.

Purpose To compare the clinical outcomes of unilateral biportal endoscopic discectomy (UBED) and percutaneous interlaminar endoscopic discectomy (PIED) for treating L5/S1 disc herniation. Methods Patients with L5/S1 disc herniation treated with UBED (n = 46) and PIED (n = 50) in our hospital during the same period were retrospectively reviewed. Clinical outcome, radiographic parameters, and complications of each group were collected and evaluated. Results The mean follow-up period was 14.11 ± 3.47 months in the UBED group and 14.52 ± 5.37 months in the PIED group. There was no significant difference in visual analog scale score for the leg (P = 0.836) or lumbar scores (P = 0.335) between PIED and UBED group at preoperative, 1-day postoperative, and last follow-up point. Within the same group, there were significant differences in visual analog scale score for the leg (P < 0.001) and lumbar scores (P < 0.001) compared pairwise at 3 time points. Oswestry Disability Index scores of both groups showed significant improvement at the last follow-up (P < 0.001, P < 0.001), and there was no significant difference in patient satisfaction rates (97.8% vs. 96%) between the 2 groups on the basis of the MacNab criteria. The percentage of facet joint preservation was 96.74 ± 9.10% in the UBED group and 99.22 ± 1.52% in the PIED group. The total blood loss and hospitalization cost was greater in the UBED group. One patient in both groups showed postoperative hematoma. A dural tear occurred in UBED group and a never root injury occurred in the PIED group. Conclusions UBED indicates similar short-term efficacy compared with PIED for treating L5/S1 disc herniation. No difference was found in facet joint preservation between the 2 groups. We believe the increased cost of UBED as the result of surgical consumables will decrease in the future.

Perlecan (HSPG2), a key component of basement membrane proteins, plays a crucial role in tissue development and regeneration. However, its direct impact on mesenchymal tissue differentiation, mediated through both genetic modification (gain- and loss-of-function mutations) and epigenetic changes (matrix microenvironment alterations), remains underexplored. In this study, we utilized CRISPR/Cas9 to achieve knockout (KO) and overexpression (OE) of HSPG2 in human fetal nucleus pulposus stem/progenitor cells (NPSCs) and adult infrapatellar fat pad-derived stem cells (IPFSCs) to investigate perlecan's influence on mesenchymal differentiation. We also assessed the effects of decellularized extracellular matrix (dECM) derived from fetal NPSCs with modified HSPG2 expression on the proliferation and differentiation of adult NPSCs. Our findings demonstrate that HSPG2-KO enhanced chondrogenic differentiation, while HSPG2-OE suppressed adipogenic differentiation in both fetal NPSCs and adult IPFSCs. Notably, dECM from HSPG2-OE fetal NPSCs significantly promoted chondrogenic differentiation in adult NPSCs, suggesting potential applications for perlecan in developing advanced biomaterials for cartilage regeneration.

Currently, intervertebral disc (IVD) degeneration is believed to lead to local accumulation of lactic acid in the IVD, a decrease in pH, activation of the inflammatory pathway, and continued destruction of homeostasis of the IVD. To address these issues, the intelligent and accurate release of drugs is particularly important. In this study, acid-sensitive release methacrylated hyaluronic acid (HAMA) microspheres were constructed by using microfluidic technology, which can be used as a targeted drug delivery system for intervertebral disc degeneration (IVDD) through Schiff base chemical bonding on the surface of the microspheres to achieve intelligent drug release. Interleukin-1 receptor antagonist (IL-1 Ra) is a naturally occurring anti-inflammatory antagonist of the interleukin-1 family of pro-inflammatory cytokines. Despite its outstanding broad-spectrum anti-inflammatory effects, IL-1 Ra has a short biological half-life (4-6 h). The slow-release performance of IL-1 Ra can be greatly improved using bovine serum albumin nanoparticles (BNP). In addition, the modified HAMA microspheres exhibited good injectability and porosity, and efficient and uniform loading of nanoparticles was achieved via the Schiff base bond. The inflammatory microenvironment can be significantly reversed by transporting the modified HAMA microspheres-BNPs (Modified MS) to the degenerative nucleus pulposus.

Background The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis. Methods Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation. Results The VAS for back and leg pain improved from 7.24 +/- 0.80 and 7.59 +/- 0.59 preoperatively to 2.41 +/- 0.55 and 2.37 +/- 0.62 ( p < 0.05) postoperatively and 1.37 +/- 0.54 and 1.51 +/- 0.55 at the last follow-up ( p < 0.05). For ODI, improvement from 60.37 +/- 4.44 preoperatively to 18.90 +/- 4.66 ( p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 +/- 87.81 to 232.97 +/- 88.42 mm ( p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 +/- 3.13 and 19.57 +/- 3.80 to 22.19 +/- 4.56 and 21.04 +/- 3.72 mm, respectively ( p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 +/- 1.12 and 3.20 +/- 1.14 mm preoperatively and 4.03 +/- 1.37 and 3.83 +/- 1.32 mm ( p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively. Conclusion The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.

Background Chordoma is a bone tumor that tends to occur in middle-aged and elderly people. It grows relatively slowly but is aggressive. The prognosis of middle-aged and elderly patients with chordoma is quite different from that of young patients with chordoma. Objectives The purpose of the research was to construct a nomogram to predict the Individualized prognosis of middle-aged and elderly (age greater than or equal to 40 years) patients with chordoma. Methods In this study, we screened 658 patients diagnosed with chordoma from 1983 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We determined the independently prognostic factors that affect the survival of patients by univariate and multivariate Cox proportional hazards model. Based on the independent prognostic factors, we constructed a nomogram to predict the overall survival (OS) rates of middle-aged and elderly patients with chordoma at 3 and 5 years. The validation of this nomogram was completed by evaluating the calibration curve and the C-index. Results We screened a total of 658 patients and divided them into two cohort. Training cohort had 462 samples and validation cohort had 196 samples. The multivariate Cox proportional hazards model of the training group showed an association of age, tumor size, histology, primary site, surgery, and extent of disease with OS rates. Based on these results, we constructed the corresponding nomogram. The calibration curve and C-index showed the satisfactory ability of the nomogram in terms of predictive ability. Conclusion Nomogram can be an effective prognostic tool to assess the prognosis of middle-aged and elderly patients with chordoma and can help clinicians in medical decision-making and enable patients to receive more accurate and reasonable treatment.

BackgroundThe incidence of chondrosarcoma is increasing every year, and the treatment and prognosis of patients with high-grade chondrosarcoma are becoming more and more important. Nomogram is a tool that can quickly and easily predict the overall survival of tumor patients. Therefore, the development and validation of a nomogram to predict overall survival in patients with high-grade chondrosarcoma was desired.MethodsWe retrospectively collected 396 patients with high-grade chondrosarcoma from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015. Randomly divided into model and validation groups, the best cut-off values for age and tumor size grouping were derived by using X-tile software. Then, independent prognostic factors for high-grade chondrosarcoma were derived by SPSS.26 univariate and multivariate Cox analyses analysis in the model group, and the model was evaluated by using R software, using C-indix and ROC curves, and finally these independent prognostic factors were included in Nomogram.Results396 patients were randomly assigned to the modelling group (n = 280) or the validation group (n = 116). Age, tissue-type, tumor size, AJCC stage, regional expansion and surgery were identified as independent prognostic factors (p < 0.05) which further combined to construct a nomogram. The C-index of internal validation for overall survival(OS) was 0.757, while the C-index of external validation for overall survival(OS) was 0.832. Both internal and external calibration curves show a good agreement between nomogram prediction and actual survival.ConclusionIn this study, we established age, tumour size, AJCC stage, tissue type, surgery and tumor extension as independent prognostic factors for high-grade chondrosarcoma and constructed a nomogram to predict 3- and 5-year survival rates for high-grade chondrosarcoma.

Objective:To determine the main risk factors for early postoperative contralateral radicular pain in patients after transforaminal interbody fusion (TLIF) who often suffer from contralateral radicular pain.Methods:Patients who underwent TLIF surgery in the Department of Spinal surgery of Changzhou second people's Hospital affiliated to Nanjing Medical University were collected and divided into asymptomatic group and symptomatic group according to whether they had early contralateral nerve root pain after operation. A total of 170 patients underwent TLIF surgery in our department from January 2020 to January 2022, of which 66 patients met the inclusion and exclusion criteria and 33 patients developed early postoperative contralateral nerve root pain. The patients of the two groups were followed up after operation, the general data and operation-related indexes were collected, and the concentration of inflammatory factors in wound drainage fluid 3 days after operation were compared and analyzed by regression analysis.Results:Finally, 66 patients were included in the study, and the follow-up time was (26.6±1.1) days. There were 36 males and 30 females with an average age of (66±8) years. Univariate analysis showed that the concentration of PGE2 in drainage fluid in symptom group was lower than that in asymptomatic group, and the concentrations of HIS and BK in drainage fluid in symptom group were higher than those in asymptomatic group. The differences between groups in univariate analysis were included in multivariate regression analysis. The results showed that HIS (OR=4.384) and BK (OR=10.921) in drainage fluid were the influencing factors of contralateral early nerve root pain after TLIF.Conclusion:The levels of HIS and BK in the drainage fluid of patients after TLIF are independent risk factors for the occurrence of contralateral early nerve root pain, which can be used as a reference basis for managing patients with early contralateral nerve root pain after operation, and provide new ideas for clinical treatment of this kind of patients.

目的 近年来单侧双通道内镜(unilateral biportal endoscopy,UBE)技术在脊柱微创治疗的应用中逐步开展,优势是操作器械可直接采用开放手术器械,减压效率高,较开放手术创伤更小,然而该技术目前报告主要限于脊柱退行性疾病及脊柱感染.本研究拟开展UBE技术在腰椎转移性肿瘤伴神经损伤患者中应用.方法 1 例腰椎转移性肿瘤伴神经损伤的患者,进行个性化定制UBE分离术加经皮椎体成形术,症状显著改善.结果 术后患者视觉模拟量表(visual analogue scale,VAS)评分较术前改善,日本骨科协会(Japanese Orthopaedic Association,JOA)评分改善率为显著改善.影像数据显示术后椎管狭窄、神经受压情况得到改善.无手术相关并发症发生.结论 本研究认为单侧双通道内镜(UBE)技术可应用于腰椎转移性肿瘤伴神经损伤患者的治疗,具有微创、安全、个性化特点.

Extracellular matrix (ECM) production and nucleus pulposus (NP) cell migration increase under periodic mechanical stress (PMS), but the underpinning regulatory mechanism remains unclear. This work aimed to examine the regulatory effects of cytoskeleton-lipid raft-integrin α1 signaling in NP cells exposed to PMS. Briefly, In NP cells, cytoskeleton rearrangement, lipid raft aggregation and integrin α1 expression in the stress and control groups were assessed by immunofluorescent staining and immunoblot. In addition, cell migration and ECM gene expression were detected by a scratch test and quantitative reverse transcription polymerase chain reaction (qRT‑PCR), respectively. As a result, PMS up-regulated ECM gene expression and enhanced NP cell migration (both P < 0.05), accompanied by increased integrin α1, lipid raft, caveolin-3, F-actin and β-tubulin amounts. Pretreatment with the lipid raft inhibitor methyl-β-cyclodextrin (MβCD) or small interfering RNA (siRNA) targeting caveolin-3 resulted in decreased ECM mRNA synthesis and cell migration induced by PMS (both P < 0.05); meanwhile, integrin α1 expression was also reduced. F-actin and β-tubulin inhibition by cytochalasin D and colchicine, respectively, not only reduced ECM mRNA synthesis and cell migration (both P < 0.05), but also disrupted lipid raft and caveolin-3 amount increases induced by PMS in NP cells. In conclusion, PMS promotes ECM mRNA up-regulation and cell migration through the cytoskeleton-lipid raft-integrin α1 signaling pathway, inhibiting cytoskeleton and lipid rafts could block the cellular effects.

A common cause of hearing impairment is exposure to loud noise. Recent research has demonstrated that the auditory mechanosensory cells are essential for normal hearing sensitivity and frequency selectivity. However, little is known about the effect of noise exposure on the mechanical properties of the auditory sensory cells. Here we report a significant reduction in the stiffness and cell length of the outer hair cells after impulse noise exposure, suggesting that mechanical changes at the cellular level are involved in noise-induced hearing loss. There is a recovery of the cellular stiffness and cell length over a two-week period, indicating an activation of cellular repair mechanisms for restoring the auditory function following noise trauma. The reduced stiffness observed at the cellular level is likely to be the cause for the downward shift of the characteristic frequency seen following acoustic trauma. The deterioration and the recovery of the mechanical properties of outer hair cells may form important underlying factors in all kinds of noise-induced hearing loss.

ObjectiveTo compare the clinical efficacy of performing simple plate fixation with that using a plate combined with fracture end fixation to investigate the necessity of fracture end fixation outside the plate in cases of oblique fracture of the middle clavicle.MethodsThis was a retrospective follow‐up study of patients with middle clavicle oblique fractures (Robinson types 2A1 and 2A2) between 2015 and 2020. Patients were divided into two groups according to their treatment options: the simple plate fixation (SPF) group (n = 79; 43 men and 36 women; average age, 46.37 ± 14.54 years) and the plate combined with fracture local fixation (PLFP) group (n = 81; 36 men and 45 women; average age, 48.42 ± 12.55 years). Intraoperative blood loss, operation time, postoperative fracture healing time, postoperative shoulder function score (Constant–Murley and disabilities of the arm, shoulder, and hand [DASH] scores), clinical complications, and postoperative subjective satisfaction were compared between the two groups.ResultsOne hundred sixty patients with a sufficient follow‐up period were included in the final analysis: 79 in the SPF group (follow‐up time: 16.24 ± 3.94 months) and 81 in the PLFP group (follow‐up time: 16.15 ± 3.43 months). Age, sex, body mass index, follow‐up duration, fracture classification, and cause of injury were not significantly different between the two groups. There was no significant difference in blood loss, Constant–Murley and DASH scores, follow‐up period, and postoperative subjective satisfaction between the two groups (P > 0.05). The fracture healing time was shorter in the PLFP group than in the SPF group (4.41 ± 0.99 vs. 4.87 ± 1.60 months, P < 0.05), but the operation duration was longer in the PLFP group than in the SPF group (65.48 ± 16.48 min, P < 0.05). There were seven (complication rate, 8.86%) and five (complication rate, 6.17%) cases that had complications in the SPF and PLFP groups, respectively. There was no significant difference in the complication rates between the two groups (P > 0.05).ConclusionAlthough the healing time was shorter in the PLFP group than in the SPF group, the clinical efficiency of the two methods in the treatment of oblique fracture of the middle clavicle was similar.

OBJECTIVE:Diabetic foot ulcers (DFUs) are one of the most serious diabetic consequences, leading to amputations. Various therapies have been used to treat DFUs; however, a combination of negative pressure suction, artificial skin and autogenous skin implantation have never been investigated. This study aimed to evaluate the effectiveness of a novel three-step therapy protocol using negative pressure wound therapy (NPWT), artificial skin and autogenous skin implantation in patients with DFUs.METHOD:At a single tertiary university hospital between 2015 and 2018, the three-step therapy protocol was applied to patients with DFUs and its safety and efficacy was investigated.RESULTS:A total of 21 patients took part in the study. The majority of the patients were female (62%), with a mean age of 65 years and a mean body mass index of 21kg/m2. A third (n=7) of operative sites experienced minor complications, with two requiring re-operation. At a median follow up of 24 months, the average time of complete wound healing was 46 days, and the wound healing rate was 71%. The first-stage wound healing rate was 90%. All patients had achieved remission without any further recurrence of disease.CONCLUSION:This comprehensive surgical technique for managing DFUs achieved a high local cure rate, minimal functional morbidity, and acceptable wound complication rates. The three-step therapy protocol has the potential to promote the healing process of DFUs, which is expected to serve as a new method for the treatment and cure of DFUs.

Intervertebral disc (IVD) degeneration, which is common among elderly individuals, mainly manifests as low back pain and is caused by structural deterioration of the nucleus pulposus (NP) due to physiological mechanical stress. NP mesenchymal stem cells (NPMSCs) around the IVD endplate have multidirectional differentiation potential and can be used for tissue repair. To define favorable conditions for NPMSC proliferation and differentiation into chondroid cells for NP repair, the present study simulated periodic mechanical stress (PMS) of the NP under physiological conditions using MSC chondrogenic differentiation medium and recombinant human BMP-2 (rhBMP-2). rhBMP-2 effectively promoted NPMSC proliferation and differentiation. To clarify the mechanism of action of rhBMP-2, integrin alpha 1 (ITG A1) and BMP-2 were inhibited. PMS regulated the BMP-2/Smad1/RUNX2 pathway through ITG A1 and promoted NPMSC proliferation and differentiation. During tissue-engineered NP construction, PMS can effectively reduce osteogenic differentiation and promote extracellular matrix protein synthesis to enhance structural NP recovery.

The annular defect because of the primary lumbar disc herniation (LDH) or surgical procedure is considered a primary reason for recurrent herniation and eventually reoperation. Efforts to close the defect with annular repair devices have been attempted several times, but the results were controversial. The present aims to detect whether the annular repair techniques were useful for reducing the re-herniation and re- operation rate. The Pubmed, Cochrane library, and Embase databases were searched to retrieve relevant studies published before January 1, 2021. Continuous variables were compared by calculating the standard difference of the means (SDM), whereas categorical dichotomous variables were assessed using relative risks (RRs). A random-effects model was used if the heterogeneity statistic was significant; otherwise, a fixed-effects model was used. A total of 10 researches were suitable for the meta-analysis, including four different repair techniques and 1907 participates. Compared with the control group, there was no statistical difference with the ODI, VAS-leg, and VAS-back scales for patients treated with the annular repair. However, using an annular repair device was associated with a significant reduction in the re- herniation (p=0.004) and re-operation (0.004) rates. There was no difference between the groups with perioperative complications. However, much more device-related long-term complications happened in the annual repair group (p=0.031) though it still decreased the overall re-operation rate significantly (p=0.006).Our results demonstrated that using an annular repair device was safe and beneficial for reducing re-herniation and re-operation rates.