Background: Peripheral nerve injury (PNI) has devastating consequences. Dorsal root ganglion as a pivotal locus participates in the process of neuropathic pain and nerve regeneration. In recent years, gene sequencing technology has seen rapid rise in the biomedicine field. So, we attempt to gain insight into in the mechanism of neuropathic pain and nerve regeneration in the transcriptional level and to explore novel genes through bioinformatics analysis. Methods: The gene expression profiles of GSE96051 were downloaded from GEO database. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were performed, and protein-protein interaction (PPI) network of the differentially expressed genes (DEGs) was constructed by Cytoscape software. Results: Our results showed that both IL-6 and Jun genes and the signaling pathway of MAPK, apoptosis, P53 present their vital modulatory role in nerve regeneration and neuropathic pain. Noteworthy, 13 hub genes associated with neuropathic pain and nerve regeneration, including Ccl12, Ppp1r15a, Cdkn1a, Atf3, Nts, Dusp1, Ccl7, Csf, Gadd45a, Serpine1, Timp1 were rarely reported in PubMed database, these genes may provide us the new orientation in experimental research and clinical study. Conclusions: Our results may provide more deep insight into the mechanism and a promising therapeutic target. The next step is to put our emphasis on an experiment level and to verify the novel genes from 13 hub genes.

腰椎术后硬膜外血肿(spinal epidural hematomas,SHE)是后路腰椎术后一种常见的并发症,但大部分无临床症状,少数情况下血肿压迫硬膜囊和神经导致马尾神经功能受损,需急诊手术清除血肿.腰椎术后出现SEH的原因众多,多发生在术后72 h内,J.Kou等将术后3d以后发生的SHE定义为迟发性硬膜外血肿[1].本文报道1例79岁男性患者,后路腰椎术后2周突发腰骶部剧烈疼痛、进行性神经功能丧失,根据症状体征及MRI结果诊断为硬膜外血肿,急诊行探查血肿清除手术,术中发现腰肌穿支动脉活动性出血,术后患者神经功能恢复较为满意.结合此病例,复习相关文献,分析腰椎术后迟发性SHE的原因、治疗策略及手术时机的选择.现将病例的诊治过程及文献结果报告如下.

Background/Aims: Osteoporosis is a bone metabolic disease characterized by a systemic impairment of bone mass, which results in increased propensity of fragility fractures. A reduction in the differentiation of MSCs into osteoblasts contributes to the impaired bone formation observed in osteoporosis. Mesenchymal stem cells (MSCs) are induced to differentiate into preosteoblasts, which are regulated by the signaling cascades initiated by the various signals, including miRNAs. miR-16-2* is a newly discovered miRNA that participates in diagnosis and prognosis of hepatocellular carcinoma, cervical cancer and chronic lymphocytic leukemia. However, the effect of miR-16-2* on the regulation of osteoblast differentiation and the mechanism responsible are still unclear. Here we discuss the contribution of miR-16-2* to osteoporosis, osteoblast differentiation and mineralization. Methods: The expression pattern of miR-16-2* during osteogenesis or in osteoporosis bone samples was validated by quantitative real-time PCR (qRT-PCR). The human bone marrow mesenchymal stem cells (hBMSCs) were induced to differentiate into osteoblasts by osteogenic induced medium containing dexamethasone, ascorbate-2-phosphat, beta-glycerophosphate and vitamin-D3. The target genes of miR-16-2* were predicted by TargetScan and PicTar. The mRNA and protein levels of osteogenic key markers were detected using qRT-PCR or western blot respectively. The WNT signal activity was analyzed by TOP/FOP reporter assay. Results: The expression of miR-16-2* in patient bone tissue with osteoporosis was negatively correlated with bone formation related genes. During osteoblast differentiation process, the expression of miR-16-2* was significantly decreased. Upregulation of miR-16-2* in hBMSCs impaired the osteogenic differentiation while the downregulation of miR-16-2* increased this process. Upregulation the expression of miR-16-2* could also block the WNT signal pathway by directly target WNT5A. Furthermore, knockdown of miR-16-2* could promote the activation of RUNX2, possibly by lifting the inhibitory effect of miR-16-2* on WNT pathway. Conclusion: Taken together, we report a novel biological role of miR-16-2* in osteogenesis through regulating WNT5A response for the first time. Our data support the potential utilization of miRNA-based therapies in regenerative medicine.

The Editor-in-Chief has retracted this article [1] because of an error in the meta analysis. Re-examination of the data has showed that there is only one published randomized controlled trial comparing Superion with XStop. Due to a misunderstanding of the published clinical data, the conclusions drawn in the article are incorrect. Author Xing Yu approved this retraction, none of the other authors replied to correspondence from the publisher about this retraction.

BACKGROUND:Nowadays, anterior cervical artificial disc replacement (ACDR) has achieved favorable outcomes in treatment for patients with single-level cervical spondylosis. However, It is still controversial that whether or not it will become a potent therapeutic alternation in treating 2 contiguous levels cervical spondylosis compared with anterior cervical decompression and fusion (ACDF). Therefore, we conducted a systematic review and meta-analysis to compare the efficacy and safety of ACDR and ACDF in patients with 2 contiguous levels cervical spondylosis. METHODS:According to the computer-based online search, PubMed, Embase, Web of Science, and Cochrane Library for articles published before July 1, 2017 were searched. The following outcome measures were extracted: neck disability index (NDI), visual analog scale (VAS) neck, VAS arm, Short Form (SF)-12 mental component summary (MCS), SF-12 physical component summary (PCS), overall clinical success (OCS), patient satisfaction (PS), device-related adverse event (DRAE), subsequent surgical intervention (SSI), neurological deterioration (ND), and adjacent segment degeneration (ASD). Methodological quality was evaluated independently by 2 reviewers using the Furlan for randomized controlled trial (RCT) and MINORS scale for clinical controlled trials (CCT). The chi-squared test and Higgin I test were used to evaluate the heterogeneity. A P < .10 for the chi-squared test or I values exceeding 50% indicated substantial heterogeneity and a random-effect model was applied; otherwise, a fixed-effect model was used. All quantitative data were analyzed by the Review Manager 5.2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS:Nine RCTs and 2 CCT studies containing 2715 patients were included for this meta-analysis. The pooled analysis indicated that the ACDR group is superior to ACDF in NDI, VAS neck, PCS score, OCS, PS, DRAE, ASD, and SSI. However, the pooled results indicate that there was no significant difference in the ND, VAS arm and in MCS score. CONCLUSIONS:The present meta-analysis suggests that for bi-level cervical spondylosis, ACDR appears to provide superior clinical effectiveness and safety effects than ACDF. In the future, more high-quality RCTs are warranted to enhance this conclusion.

BACKGROUND:In the current surgical therapeutic regimen for symptomatic cervical degenerative disc disease, both anterior cervical discectomy and fusion (ACDF) and anterior cervical disc replacement (ACDR) are still widely accepted. However, many complications exist in both surgeries. Therefore, this study aims to compare the adverse events between ACDR and ACDF, and provide vital evidence-based guidance for spine surgeons and designers to evaluation of prognosis and improvement of dynamic devices. METHODS:A systematic review and meta-analysis that will be performed according to the PRISMA. The electric database of PubMed, Medline, Embase, Google Scholar, and Cochrane library will be systematic search. A standard data form will be used to extract the data of included studies. We will assess the studies according to the Cochrane Handbook for Systematic Reviews of Interventions, and perform analysis in RevMan 5.3 software. Fixed effects models will be used for homogeneity data, while random-effects will be used for heterogeneity data. The overall effect sizes will be determined as weighted mean difference (WMD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. RESULT:The results of this study will be disseminated via international or national conferences, or submit to peer-reviewed journal in spinal field. CONCLUSION:The conclusion of this study will provide key evidence-based guidance for spine surgeons and designers to the evaluation of prognosis and improvement of dynamic devices.

Background: In the current surgical therapeutic regimen for symptomatic cervical degenerative disc disease, both anterior cervical discectomy and fusion (ACDF) and anterior cervical disc replacement (ACDR) are still widely accepted. However, many complications exist in both surgeries. Therefore, this study aims to compare the adverse events between ACDR and ACDF, and provide vital evidence-based guidance for spine surgeons and designers to evaluation of prognosis and improvement of dynamic devices. Methods: A systematic review and meta-analysis that will be performed according to the PRISMA. The electric database of PubMed, Medline, Embase, Google Scholar, and Cochrane library will be systematic search. A standard data form will be used to extract the data of included studies. We will assess the studies according to the Cochrane Handbook for Systematic Reviews of Interventions, and perform analysis in RevMan 5.3 software. Fixed effects models will be used for homogeneity data, while random-effects will be used for heterogeneity data. The overall effect sizes will be determined as weighted mean difference (WMD) for continuous outcomes and relative risk (RR) for dichotomous outcomes. Result: The results of this study will be disseminated via international or national conferences, or submit to peer-reviewed journal in spinal field. Conclusion: The conclusion of this study will provide key evidence-based guidance for spine surgeons and designers to the evaluation of prognosis and improvement of dynamic devices.

Objective To investigate the feasibility of ultrasonography in the detection of postoperative hematoma and edema in the clearance of anterior cervical surgery and to explore the potential related causes of postoperative complications.Methods This study enrolled 24 patients with 2-segment hybrid surgery.All patients underwent ultrasonography at 24 hours before the surgery, 1-day and 5-day post operation, respectively.Postoperative hematoma was screened, and Image J was used to evaluate a specified rectangular area of local soft tissue at the surgical incision plane.The area of local edema was calculated and the results were statistically analyzed in combination with the postoperative complications score.Results 24 patients underwent ultrasonography at the appointed time, and no postoperative hematoma occurred.The area of edema at 1-day and 5-day post operation were (1.73±0.64) cm2, (0.67±0.58) cm2, respectively.Compared with 1-day post operation, the score of low tone, hoarseness, dysphagia, and feeling of neck swelling were significantly decreased (P＜0.05) in the 5-day post operation.Conclusions Postoperative complications were influenced by various factors during the perioperative period, and ultrasonography could be an effective way to identify hematoma and edema in the early stage after the surgery.

Objective:To observe the effect of Bushen Zhuangjin Tang (补肾壮筋汤,BSZJT)on intervertebral disc and behavioral characteristics of rats with lumbar intervertebral disc degeneration and its safety.Methods:Forty 8-week-old clean-grade female SD rats were selected and randomly divided into sham-operated group,model group,BSZJT group and indometacin group,10 cases in each group.The models of L5/L6 intervertebral disc degeneration(IVDD) were built in rats in model group,BSZJT group and indometacin group by using intervertebral disc puncture method,while the rats in sham-operated group were treated with sham-operation to adequately expose the anterior border of L5/L6 intervertebral disc without any puncture intervention.At 24 hours after the modeling,the rats in BSZJT group and indometacin group were intragastric administrated with BSZJT(1.5 g/kg)and indometacin solution(7.5 mg/kg)respectively,while the rats in sham-operated group and model group were intragastric administrated with normal saline (10 mL · kg-1),once a day for consecutive 7 weeks.The mechanical paw withdrawal threshold(MPWT) test and the tiltboard test were carried out before modeling and at 1,3,5 and 7 weeks after the beginning of drug intervention respectively.The blood were fetched out from fundus oculi venous plexus after the last behavioral characteristics measurement,and the serum levels of alanine aminotransferase (AAT),aspartate aminotransferase (AST),creatinine (CRE) and urea nitrogen(UN) were measured.The L5/L6 intervertebral discs,livers and kidneys were fetched out.The intervertebral disc tissues were received HE staining and improved safranin O-fast green staining respectively and the hepatic tissues and nephridial tissues were received HE staining and Masson staining for observing the histopathological changes.Results:There was statistical difference in the pain threshold values between different timepoints before modeling and after the beginning of drug intervention,in other words,there was time effect(F =36.245,P =0.000).The pain threshold value changed unconspicuously with time in sham-operated group and the pain threshold value decreased gradually with time in model group.The lowest pain threshold value was found at 1 week after the beginning of drug intervention and the pain threshold value changed unconspicuously with time in later period in BSZJT group and indometacin group.There was statistical difference in the pain threshold values between the 4 groups in general,in other words,there was group effect (F =54.170,P =0.000).There was not statistical difference in the pain threshold values between the 4 groups before the modeling(F =1.375,P =0.266),and there was statistical difference in the pain threshold values between the 4 groups at each timepoint after the beginning of drug intervention(F =30.059,P =0.000;F =34.117,P =0.000;F =33.454,P =0.000;F =35.617,P =0.000).The pain threshold values were higher in sham-operated group compared to model group at each timepoint after the beginning of drug intervention (P =0.000;P =0.000;P =0.000;P =0.000).The pain threshold values were lower in model group compared to BSZJT group and indometacin group (P =0.010,P =0.013;P =0.000,P =0.000;P =0.000,P =0.000) except at 1 week after the beginning of drug intervention (P =0.197,P =0.191).There was no statistical difference in the pain threshold values between BSZJT group and indometacin group at each timepoint after the beginning of drug intervention (P =0.100;P =0.067;P =0.108;P =0.097).There was interaction between time factor and grouping factor (F =16.490,P =0.000).There was statistical difference in the tiltboard test angle between different timepoints before modeling and after the beginning of drug intervention,in other words,there was time effect (F =3.746,P =0.019).The tiltboard test angle increased with time in general in sham-operated group,BSZJT group and indometacin group,while the tiltboard test angle decreased with time in general in model group.There was statistical difference in the tiltboard test angle between the 4 groups in general,in other words,there was group effect(F =7.640,P =0.000).There was no statistical difference in the tiltboard test angle between the 4 groups before modeling and at 1 and 3 weeks after the beginning of drug intervention (F =0.575,P =0.635;F =2.664,P =0.063;F =0.994,P =0.407).There was statistical difference in the tiltboard test angle between the 4 groups at 5 and 7 weeks after the beginning of drug intervention (F =9.666,P =0.000;F =2.685,P =0.006).The tiltboard test angle was larger in sham-operated group compared to model group(P =0.000;P =0.026)and was smaller in model group compared to BSZJT group and indometacin group (P =0.000,P =0.007;P =0.000,P =0.042)and was larger in BSZJT group compared to indometacin group (P =0.000;P =0.047).There was interaction between time factor and grouping factor(F =2.934,P =0.012).There was no statistical difference in the serum contents of AAT,AST,CRE and UN between the 4 groups after the end of drug intervention(F =1.023,P =0.398;F =0.237,P =0.869;F =0.629,P =0.602;F =1.141,P =0.35).HE staining results and improved safranin 0-fast green staining results showed the degeneration degree of lumbar intervertebral disc tissue was slighter in BSZJT group and indometacin group compared to model group and the degeneration degree was slightest in BSZJT group.HE staining results and Masson staining results showed that no fibrosis were found in hepatic tissues and nephridial tissues in model group,BSZJT group and indometacin group.Conclusion:BSZJT can delay intervertebral disc degeneration and improve the behavioral characteristics to some extent in rats with lumbar intervetebral disc degeneration,and it slightly surpasses indometacin in the effect.Moreover,short-term application of BSZJT can not cause damage to hepatorenal tissues and hepatorenal function.

BACKGROUND: Primary injuries of the spinal cord are irreversible in the pathoplhysiological process. Most of studies have focused on prevention against secondary injuries, by reducing neuronal apoptosis and necrosis as well as decreasing damage area, which provides favorable environment for axonal regeneration, blocks secondary injury and promotes neural regeneration after spinal cord injury.OBJECTIVE: To review the recent advances in the signaling pathway related to secondary injuries after spinal cord injury,and to clarify the related signaling pathways, thereby providing theoretical basis for the treatment of spinal cord injury.METHODS: PubMed, EMBASE, Medline, CNKI, CJFD and Wanfang databases were retrieved for the articles addressing the signaling pathways in spinal cord injury published between 2006 to 2016. The keywords were "spinal cord injury, signaling pathway" in English and Chinese, respectively. The signaling pathways in secondary injuries after spinal cord injury were summarized.RESULTS AND CONCLUSION: Mitogen activated protein kinase, nuclear factor of kappa B, PI3K/PKB (Akt), Janus kinase/signal transducer and activator of transcription, and Wnt signaling pathways are mainly involved in secondary injuries after spinal cord injury. All these pathways play a significant role in the development and repair of spinal cord injury, and future investigation on them is warranted.

BACKGROUND: It is still controversial that interspinous dynamic stabilization system Wallis and Coflex which one can provide better clinical effects for lumbar degenerative disease.OBJECTIVE: To systematically assess the clinical effectiveness and safety of Wallis and Coflex for lumbar degenerative disease.METHODS: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM,CNKI, Wanfang Database, and VIP, articles published before August 1st, 2016 were searched. Articles about Wallis comparing with Coflex for lumbar degenerative disease were included; the quality score of methodology was assessed by MINORS. Research data abstracted and synthesized by Review Manager 5.3 were used for meta-analysis.RESULTS AND CONCLUSION: (1) Six studies were included, and all studies were designed for non-randomized controlled trial. (2) There were no significant statistical differences in Japanese Orthopedic Association, Oswestry disability index, visual analogue scale score, Prolo functional score, segmental lordosis angle, and segment movement degree. Incidence of adverse events was significantlue scale less in the Wallis group than in the Conflex group (P < 0.05).(3) There was no significant difference in clinical efficacy between Wallis and Coflex in the early and mid-term follow-up.We can conclude that Wallis may provide better clinical safety than Coflex.

Objectives:To systematically assess the antifibrinolytic agents for spinal surgery.Methods:According to the computer-based online search of PubMed,Embase,Medline,Cochrane Library,CBM,CNKI,Wanfang Database,VIP for articles published before June 1st,2016 were searched for articles on antifibrinolytic agents(AA) for spinal surgery.Group AA included tranexanic acid(TXA) and epsilon aminocaproic acid (EACA);control group(CG) included placebo.18 randomized controlled trials(RCTs) were included for the present study.Two authors independently assessed trial quality and extracted data.The data of total blood loss,intraoperative blood loss,postoperative blood loss,total blood transfusion,intraoperative transfusion,postoperative transfusion,operation time,adverse events were abstracted and synthesized by Review Manager 5.3 for Meta-analysis.Reasults:18 studies were included with a total of 1571 patients.The methodological quality score of 9 RCT studies included in the Meta-analysis was 5,which of 6 studies was 4 and 3 studies was 3.Ten studies with total blood loss were reported:TXA VS.Placebo[SMD=-0.95;95％CI:(-1.28,-0.62),P＜0.00001];EACA VS.Placebo[SMD=-0.91;95％CI:(-1.24,-0.58),P＜0.00001];TXA VS.EACA[SMD=0.13;95％CI:(-0.47,-0.73),P=0.67].13 studies with intraoperative blood loss were reported:TXA VS.Placebo [SMD=-0.47;95％CI:(-0.66,-0.29),P＜0.00001];EACA VS.Placebo[SMD=-1.01;95％CI:(-1.56,-0.47),P＜0.0003];TXA VS.EACA[SMD=0.47;95％CI:(0.13,0.81),P=0.007].8 studies with postoperative blood loss were reported:TXA VS.Placebo[SMD=-0.74;95％CI:(-1.13,-0.34),P=0.0002];EACA VS.Placebo Placebo [SMD=-0.80;95％CI:(-1.44,-0.16),P=0.01];TXA VS.EACA [SMD=0.06;95％CI:(-1.02,1.14),P=0.92].7 studies with total blood transfusion were reported [SMD=-0.51;95％CI:(-0.67,-0.34),P＜0.00001].4 studies with intraoperative transfusion were reported [RR=0.91;95％CI:(0.68,1.21),P--0.52].6 studies with postoperative transfusion were reported[RR=0.44;95％CI:(0.31,0.62),P＜0.00001].8 studies with operation time were reported [SMD=-0.04;95％CI:(-0.21,0.14),P=0.69].3 studies with adverse events were reported [RR=1.07;95％CI:(0.24,4.81),P=0.93].Conclusions:Administration of antifibrinolytic agents in perioperative period of spinal surgery may help not in reducing total blood loss,intraoperative blood loss,postoperative blood loss,total blood transfusion,postoperative transfusion,but in intraoperative transfusion,operation time,adverse events.

Objective:To assess Bushenzhuangjin Decoction for orthopaedics clinical application from evidence-based medicine.Methods:According to the computer-based online search,articles of PubMed,Embase,Medline,Cochrane Library,CBM,CNKI,Wanfang Database and VIP published before May lst,2016 were searched for Bushen Zhuangjin Decoction in orthopaedics clinical application.Seven studies were abstracted and synthesized by ReviewManager 5.3 for Meta-analysis.Results:Compared with positive control group,Bushenzhuangjin decoction had equal outcome for osteoarthritis at early stage follow-up [RR =1.07;95％ CI:(0.99,1.15),P =0.09].However,Bushenzhuangjin decoction had better outcome than positive control group at early stage follow-up [RR =1.33;95％ CI:(1.19,1.50),P ＜ 0.00001].Conclusion:Bushenzhuangjin Decoction had advantage in treatment of orthopedic diseases.However,because of limition of the RCTs,the result of this study can be deviation.Therefore,more qualitified researches with large sample were expected to evaluate these resaults.

The inflammatory cytokines of IL-1β and TNF-α participate in the process of intervertebral disc degeneration is focused by the spine surgeons. Inflammatory cytokines represented by IL-1β and TNF-α act as the key factors in the process of intervertebral disc degeneration resulting in low back pain and radicular symptoms. Annulus fibrosus and nucleus pulposus can secrete TNF-α and IL-1β under the stimulation of mechanical injury, overstressed, genetic susceptibility and infection. The mechanism of inflammatory cytokines in intervertebral disc degeneration needs further investigation. The emphasis of researches will be on the inflammatory cytokines in the regulation of mechanism in the intervertebral disc degeneration, molecular targeted therapy, cell signaling pathways and the best time of anti-inflammatory therapy providing more evidence in the clinical application.

目的:系统评价前路颈椎人工椎间盘置换术(anterior cervical artificial disc replacement,ACDR)与前路颈椎减压融合术(anterior cervical decompression and fusion,ACDF)治疗双节段颈椎病的有效性与安全性.方法:计算机检索2016年5月1口以前PubMed、Embase、Medline、Cochrane图书馆、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Database)、维普中文科技期刊数据库(VIP)关于应用ACDR与ACDF治疗双节段颈椎病的随机对照试验(randomized controlled trials,RCT)及队列研究(cohortstudy)的文献,纳入文献的方法学质量采用改良Jadad量表及MINORS量表评价,提取各研究中术后24个月、48个月、60个月时的颈部功能障碍指数(NDI)评分、颈痛VAS评分、上肢痛VAS评分、SF-36评分、神经功能改善率、邻近节段椎间盘退变、再手术率、不良事件、患者满意度数据,并将这些研究的数据通过ReviewManager 5.3软件进行Meta分析.结果:共纳入9篇文献、2570例患者,随访时间24～60个月,ACDR组1601例,ACDF组969例.纳入文献改良Jadad评4分3篇,3分4篇;MINORS评分18分2篇.Meta分析结果显示:术后24个月、48个月、60个月随访时,ACDR组的NDI[SMD=0.52;95％CI:(0.43,0.62),P＜0.00001]、颈痛VAS[SMD=0.19;95％CI:(0.10,0.29),P＜0.0001]、上肢痛VAS[SMD=0.15;95％CI:(0.06,0.25),P=0.002]、SF-36生理健康评分(PCS) [SMD=0.35;95％CI:(0.25,0.44),P＜0.00001]改善均优于ACDF组;神经功能改善率[RR=1.01;95％CI:(0.97,1.05),P=0.54]两组比较无统计学差异;两组上位椎间盘退变[RR=0.43;95％CI:(0.37,0.51),P＜0.00001]、下位椎间盘退变[RR=0.35;95％CI:(0.19,0.66),P=0.001]、再手术率[RR--0.30;95％CI:(0.23,0.40),P＜0.00001]、不良事件发生率[RR=0.72;95％CI:(0.58,0.89),P=0.003]、满意度[RR=1.08;95％ CI:(1.04,1.11),P＜0.0001]比较差异均有统计学意义,ACDR组均优于ACDF组.结论:ACDR和ACDF治疗双节段颈椎病在改善神经功能方面一致,但在提高患者术后生活质量、减少手术相关并发症方面,前者优于后者.