Xingang Cui

MicroRNA‐23a modulates tumor necrosis factor‐alpha‐induced osteoblasts apoptosis by directly targeting fas

Tumor necrosis factor (TNF)‐alpha is a key cytokine regulator of bone and mediates inflammatory bone loss. The molecular signaling that regulates bone loss downstream of TNF‐alpha is poorly defined. Recent studies implicated an important role of microRNAs (miRNAs) in TNF‐alpha‐mediated bone metabolism, including osteoblasts differentiation, osteoclasts differentiation and apoptosis. However, there are very few studies on the complex regulation of miRNAs during TNF‐alpha‐induced osteoblasts apoptosis. In the present study, the clonal murine osteoblastic cell line, MC3T3‐E1, was used. We screened for differentially expressed miRNAs during TNF‐alpha induced MC3T3‐E1 cell apoptosis and identified microRNA‐23a as a potential inhibitor of apoptosis. To delineate the role of microRNA‐23a in apoptosis, we respectively silenced and overexpressed microRNA‐23a in MC3T3‐E1 cells. We found that microRNA‐23a depletion significantly enhances TNF‐alpha‐induced MC3T3‐E1 cell apoptosis and over‐expressing microRNA‐23a remarkably attenuates this phenomenon. Mechanistic studies showed that microRNA‐23a inhibits Fas expression through a microRNA‐23a‐binding site within the 3′‐untranslational region of Fas. The post‐transcriptional repression of Fas was further confirmed by luciferase reporter assay. These results showed that microRNA‐23a, an important protecting factor, plays a significant role in the process of TNF‐alpha induced MC3T3‐E1 cell apoptosis, by regulating Fas expression. J. Cell. Biochem. 114: 2738–2745, 2013.

One-Stage Correction Surgery of Scoliosis Associated With Syringomyelia: Is it Safe to Leave Untreated a Syrinx Without Neurological Symptom?

Study Design: Retrospective study. Objective: To investigate the safety to leave a syrinx untreated in 1-stage correction surgery of scoliosis associated with syringomyelia without progressive neurological symptom. Background Material: The present protocol for patients with scoliosis secondary to syringomyelia advocated to treat the syrinx first because of the increased risk in correction surgery. However, in daily life, these patients could still do lateral bending, in which spinal cord distracted albeit without any neurological symptom occurred. Materials and Methods: Twenty-one consecutive patients with scoliosis associated with syringomyelia with or without Chiari malformation underwent surgery in our department from 2003 to 2010 were included in this study. Patients with progressive neural deficits were excluded. Every patient received detailed neurological and radiologic examination before the surgery, including whole spine films, lateral-bending and fulcrum-bending films, 3-dimensional computed tomography scan, and magnetic resonance imaging. All the patients underwent 1-stage correction surgery without treatment of syrinx. During the surgery, Spinal Cord Monitor (SCM) and wake-up test were used to prevent serious neurological complications. At follow-up, patients received neurological examination and whole spine x-ray films. Results: There were 13 male and 8 female patients. Before the surgery, 3 patients complained wasting of the intrinsic muscles of hand, 1 complained numbness of left upper extremity, and 4 complained back pain. Negative abdomen reflex occurred on 12 of 21 patients. All the patients were single major curve, including 14 thoracic curves and 7 thoracolumbar curves. The mean preoperative Cobb angle of scoliosis was 68.05±20.1 degrees, on bending films was 39.48±21.56 degrees, postoperative was 23.19±14.14 degrees, at final follow-up was 25.76±14.46 degrees. The mean flexibility was 0.452±0.158, correction ratio was 0.685±0.140. During the operation, SCM showed motor evoked potential (MEP) loss transiently in 2 patients, and somatosensory evoked potential (SEP) was normal in all the patients. Wake-up test was normal for all the patients. No neurological complication was observed after the surgery and at follow-up; 2 patients complained back pain and 1 patient got early postoperative infection. The mean follow-up time was 4.5 years (1.6∼8.5 y). Conclusions: For scoliosis patients associated with syringomyelia without neurological deficits, it might be safe and could be an option to leave a syrinx untreated before 1-stage correction surgery. Besides, a residual scoliosis was important to make sure the neural safety. The correction procedure during the surgery should be controlled by about 15 degrees or 50% more than on the bending film. Not placing the pedicle screw in the apical region was beneficial for controlling the correction rate.

Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: A retrospective study

The present study examined the histopathological and magnetic resonance imaging (MRI) features of pyogenic, brucella and tuberculous spondylitis (PS, BS and TS, respectively). A total of 22 PS, 20 BS and 20 TS patients were included in the study. Histopathological examination was used to assess the lesion structure and composition, and the MRI observation identified the lesion location and signal features. The following histopathological and MRI features were identified significantly more in patients with PS than in patients with BS and TS: Predominant neutrophil infiltration, abnormal intervertebral disk signal, lesions on the ventral and lateral sides of the vertebral bodies, and thick and irregular abscess walls. The following histopathological and MRI features were identified significantly more in patients with BS than in patients with PS and TS: Predominant lymphocyte infiltration, new bone formation, epithelioid granuloma, lesions on the ventral sides of the vertebral bodies, no, or very mild, vertebral body deformation, no abnormal paraspinal soft tissue signal, no intraosseous or paraspinal abscesses, and thin and irregular abscess walls. The following histopathological and MRI features were identified significantly more in patients with TS than in patients with BS and PS: Sequestrum, Langerhans giant cells, caseous necrosis, lesions primarily in the thoracic region and on the lateral sides of the vertebral bodies, no obvious intervertebral disk damage, obvious vertebral body deformation, abnormal paraspinal soft tissue signal, intraosseous or paraspinal abscesses, and thin and smooth abscess walls. In conclusion, it can be suggested that these significant differences in histopathological and MRI features between the three different types of spondylitis may contribute towards the differential diagnosis of the diseases.

The Surgical Treatment of Andersson Lesions Associated With Ankylosing Spondylitis

Eight men with Andersson lesions associated with ankylosing spondylitis who underwent surgical treatment were reviewed for this study. Eight Andersson lesions were found in the 8 patients, and all presented as pseudoarthrosis. Including a patient with obvious vertebral body destruction, no obvious local kyphosis was observed. Spinal cord compression and neural deficit were observed in 1 patient. Without established instructions for the surgical treatment of Andersson lesions, we alternated the surgical technique for each patient. Therefore, 5 patients, including the patient with obvious anterior destruction requiring reconstruction, underwent surgical treatment with lesion curettage and anterior bone graft and fusion; 3 other patients underwent surgical treatment without lesion curettage and anterior bone graft. All surgeries were performed from a posterior approach. Posterolateral autograft was supplemented to posterior instrumentation with or without anterior bone graft.All 8 patients experienced pain relief immediately postoperatively. No evidence of non-union was observed on radiographs at the level of pseudoarthrosis at final follow-up, and no neural and infectious complications were observed. Based on these results, surgical treatment with only posterior instrumentation supplemented by posterolateral autograft was effective for patients with Andersson lesions without obvious vertebral body destruction requiring reconstruction. Anterior lesion curettage and bone graft were not necessary. Solid immobilization, achieved by posterior instrumentation, should be the focus of the treatment of Andersson lesions with ankylosing spondylitis.

Evaluation and Surgical Management of Adult Degenerative Scoliosis Associated With Lumbar Stenosis

AbstractAdult degenerative scoliosis associated with lumbar stenosis has become a common issue in the elderly population. But its surgical management is on debating. The main issue condenses on the management priority of scoliosis or stenosis.This study is to investigate surgical management strategy and outcome of adult degenerative scoliosis associated with lumbar stenosis.Between January 2003 and December 2010, 108 patients were admitted to the authors’ institution for adult degenerative scoliosis associated with lumbar stenosis. They were divided into 3 groups based on the symptom. Then the surgical management was carried out. The clinical outcome was evaluated according to the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 score (SRS-22 score) at follow up. Group 1 was with primary lumbar stenosis symptom, local decompression and short fusion were performed. Group 2 was with compensated spinal imbalance symptom, local decompression of the symptomatic spinal stenosis and short fusion were performed. Group 3 was with primary spinal imbalance, correction surgery and long fusion were performed.For Group 1, the ODI scores declined from 62.5 ± 4.2 preoperatively to 21.8 ± 2.5 at final follow up, the SRS-22 scores decreased from 44.8 ± 3.2 preoperatively to 70.9 ± 6.0 at final follow up. For Group 2, the ODI and SRS-22 scores were 73.4 ± 8.4 and 40.8 ± 8.5 before the surgery, declined to 22.4 ± 4.2 and 73.2 ± 7.9 at final follow up. For Group 3, the ODI and SRS-22 scores were 73.4 ± 4.9 and 45.3 ± 6.4 before surgery, declined to 30.4 ± 8.9 and 68.8 ± 8.1 at final follow up.It was effective to perform decompression and short fusion for Group 1 and correction surgery and long fusion for Group 3. For Group 2, the compensated imbalance symptom was always provoked by the symptomatic lumbar stenosis. The cases in the Group 2 got well clinical improvements after local surgical intervene on the symptomatic spinal stenosis and short fusion, leaving the deformity untreated.

Pedicle morphology of the thoracic and lumbar spine in scoliosis associated with Chiari malformation/syringomyelia: comparison with adolescent idiopathic scoliosis.

Objective To investigate the morphology of pedicle in thoracic and lumbar spine in scoliosis associated with Chiari malformation/Syringomyelia—comparison with adolescent idiopathic scoliosis (AIS). Material and Methods Twenty-three patients of Lenke type 1 AIS and 21 patients of scoliosis associated with Chiari malformation/Syringomyelia with the similar curve type to Lenke 1 AIS underwent preoperational computed tomographic scans. Anatomic parameters were measured from T1 to L4, which included pedicle width, transverse pedicle angle, and chord length. Statistical comparison was performed within and between 2 groups. Result Pedicle width of patients with scoliosis associated with Chairi malformation/Syringomyelia ranged from 3 to 10.9 mm; pedicle width of convex side was wider than concave side in apex region and upper end vertebrae region (P<0.05), whereas in some thoracolumbar vertebrae(T11,L1,L3), pedicle width of concave side was wider than convex side (P<0.05). No statistical distinction was found between convex and concave side both in pedicle angle and chord length in scoliosis associated with Chiari malformation/Syringomyelia (P≥0.05), except several vertebrae. Statistic comparison between 2 groups showed no significance for the difference values of convex and concave pedicle width, transverse angle, and chord length (P≥0.05), except several vertebrae (T8, T12). Although the mean value of pedicle width of scoliosis associated with Chiari malformation/Syringomyelia was smaller than of AIS in every vertebra, statistical comparison showed no significance. Conclusions The morphology of pedicle in scoliosis associated with Chiari Malformation/Syringomyelia was substantially different form normal, especially in apex region, where the change is similar to AIS; however, in thoracolumbar region, pedicle width of concave side was wider than convex side in several vertebrae. Alternative pattern was similar between 2 groups for both transverse pedicle angle and chord length.

Comparison of Tuberculous and Brucellar Spondylitis on Magnetic Resonance Images

Study Design. Retrospective cross-sectional study. Objective. To investigate the differences between tuberculous spondylitis (TS) and brucellar spondylitis (BS) on magnetic resonance images (MRI). Summary of Background Data. Both TS and BS are common spinal affections and can cause deformities and permanent neurologic deficiencies without prompt diagnosis and treatment. However, differentiating the types of spondylitis clinically and radiographically is challenging. Despite the diagnosis studies on spine infection throughout the literature, the outcome has not been established. Our study about the different characteristics between TS and BS on MRI may be helpful. Methods. Eighteen patients with TS and 26 with BS were included in this study. MRI images were obtained and analyzed. For statistical analysis, the &khgr;2 test was performed. Statistical significance was defined as P < 0.05. Results. There were statistically significant differences between TS and BS on the MRI images: (i) subligamentous spread to three or more vertebral levels [TS 54% (7/13) vs. BS 8% (1/12)]; (ii) subligamentous spread to fewer than three vertebral levels [23% (3/13) vs. 58% (7/12)]; (iii) thoracic spine involvement [50% (9/18) vs. 4% (1/26)]; and lumbar spine involvement [22% (4/18) vs. 77% (20/26)]; (iv) abnormal signal from the vertebral disc on T2-weighted images [33% (7/21) vs. 85% (30/35)]; (v) focal or fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images [14% (7/50) vs. 50% (31/62)] and especially fan-shaped hyperintense signal [0% (0/50) vs. 23% (14/62)]; (vi) spinal kyphosis [22% (11/50) vs. 3% (2/62)]; (vii) vertebral collapse [42% (21/50) vs. 2% (1/62)]; (viii) peridiscal bone destruction [22% (11/50) vs. 44% (27/62)]; and (ix) psoas abscesses [6% (3/50) vs. 0% (0/62)]. Conclusion. MRI is a sensitive imaging technique and can clearly define the different features between TS and BS, so it should be the first choice for imaging in the diagnosis of spondylodiscitis. Level of Evidence: 4

Whole mitochondrial genome sequence for an osteoarthritis model of spontaneous mice DBA/1 strain.

Abstract Animal models play an important role in osteoarthritis studies. Here, the complete mitochondrial genome sequence of the spontaneous mice DBA/1 strain was reported for the first time. The total length of the mitogenome was 16,769 bp. It contained the typical structure, including two ribosomal RNA genes, 13 protein-coding genes, 22 transfer RNA genes, and one non-coding control region (D-loop region). The overall GC content of the mitogenome was estimated to be 39.2%. This mitochondrial genome sequence will provide new genetic resource into osteoarthritis disease.

Morphology study of thoracic transverse processes and its significance in pedicle-rib unit screw fixation.

Background: Thoracic transverse process is an important anatomic structure of the spine. Several anatomic studies have investigated the adjacent structures of the thoracic transverse process. But there is still a blank on the morphology of the thoracic transverse processes. The purpose of the cadaveric study is to investigate the morphology of thoracic transverse processes and to provide morphology basis for the pedicle-rib unit (extrapedicular) screw fixation method. Methods: Forty-five adult dehydrated skeletons (T1–T10) were included in this study. The length, width, thickness, and the tilt angle (upward and backward) of the thoracic transverse process were measured. The data were then analyzed statistically. On the basis of the morphometric study, 5 fresh cadavers were used to place screws from transverse processes to the vertebral body in the thoracic spine, and then observed by the naked eye and on computed tomography scans. Results: The lengths of thoracic transverse processes were between 16.63±1.59 and 18.10±1.95 mm; the longest was at T7, and the shortest was at T10. The widths of thoracic transverse processes were between 11.68±0.80 and 12.87±1.48 mm; the widest was at T3, and the narrowest was at T7. The thicknesses of thoracic transverse processes were between 7.86±1.24 and 10.78±1.35 mm; the thickest was at T1, and the thinnest was at T7. The upward tilt angles of thoracic transverse processes were between 24.9±3.1 and 3.0±1.56 degrees; the maximal upward tilt angle was at T1, and the minimal upward tilt angle was at T7. The upward tilt angles of T1 and T2 were obviously different from the other thoracic transverse processes (P<0.01). The backward tilt angles of thoracic transverse processes gradually increased from 24.5±2.91 degrees at T1 to 64.5±5.12 degrees at T10. The backward tilt angles were significantly different between each other, except between T5 and T6. In the validation study, screws were all placed successfully from transverse processes to the vertebrae of thoracic spine. Conclusions: The length, width, and thickness of the thoracic transverse processes are suitable for screw placement. And the obvious upward and backward tilt angles provide an excellent screw passage from transverse process to the vertebral body. Screw placement from the transverse processes to the vertebral body is feasible in the thoracic spine. However, there is still some place for improvement of the pedicle-rib unit screw fixation method.

One-stage posterior excision of lumbosacral hemivertebrae: Retrospective study of case series and literature review

Abstract Lumbosacral hemivertebrae causes unique problems as early trunk decompensation and long compensatory curve above. There are only a few reports on it. This case series is a fair supplement in the literatures. To evaluate the clinical and radiological outcomes of lumbosacral hemivertebrae resection through 1-stage posterior approach. Between 2005 and 2014, a consecutive series of congenital scoliosis due to lumbosacral hemivertebrae underwent hemivertebrae excision through 1-stage posterior only approach. Demographic, operative, radiological, and quality of life data were reviewed. The mean lumbosacral curve was 29 ± 7° preoperatively, 10 ± 3° postoperatively, and 13 ± 5° at the final follow up. The final correction rate was 55 ± 9%. The gravity trunk shift was 11 ± 3 mm preoperatively, 37 ± 12 mm (range, 6–49 mm) postoperatively, 14 ± 9 mm at final follow up. The rib cage shift was 36 ± 12 mm preoperatively, 19 ± 5 mm postoperatively, and 15 ± 4 mm at the final follow up. The mean blood loss was 527 ± 125 mL and the mean surgery time was 336 ± 98 minutes. The mean follow up period was 41 ± 6 months. Two patients underwent transient neurological complications, 2 had wound bad healing, and 1 got wound infection. No pseudoarthrosis and instrumentation failure was observed. One-stage posterior hemivertebrae excision could gain reasonable outcome. It is crucial to completely resect the hemivertebrae and the Y-shaped disc. Bending the rod to appropriate lordosis is helpful to close the convex side. Early surgical intervene is a preferred choice to restore the trunk balance and avoid extensive fusion. The neurological complication rate is high. Convex radiculopathy is often caused by retraction, it could recover at follow up.