Differentiation of human mesenchymal stem cells: the potential mechanism for estrogen-induced preferential osteoblast versus adipocyte differentiation

INTRODUCTION

Bone marrow-derived mesenchymal stem cells (MSCs) are capable of differentiating into osteoblasts and adipocytes. This critical balance between osteoblast and adipocyte differentiation plays a significant role in maintaining normal bone homeostasis. In osteoporosis, a metabolic bone disease seen mainly in postmenopausal women because of estrogen deficiency, the concomitant occurrence of increased bone marrow adipocyte production with diminished production of osteoblasts, points to the potential role of estrogen in shifting the balance of MSC differentiation.

METHODS

We established an in vitro differentiation model of isolated human MSCs (hMSCs) and examined the role of distinct estrogen signaling pathways in regulating the differentiation of hMSCs.

RESULTS

Estrogen promoted the differentiation of hMSCs to osteoblasts in contrast to adipocytes, the former of which was mediated through the PI3K/SSH1L but not the mitogen-activated protein kinase pathway.

CONCLUSION

This study provides a novel mechanistic understanding of estrogen-related osteoporosis and identifies potential targets for antiosteoporosis therapies.

Does heterotopic ossification affect the outcomes of cervical total disc replacement? A meta-analysis

STUDY DESIGN

Meta-analysis.

OBJECTIVE

The purpose of this study was to answer the following questions: (1) Does heterotopic ossification (HO) negatively influence clinical outcomes after cervical total disc replacement (CTDR)? (2) Should patients be classified into HO and non-HO groups? (3) Is there a more rational classification?

SUMMARY OF BACKGROUND DATA

Heterotopic ossification has emerged as a common complication after CTDR and has been an important reason for reoperation, thus limiting the use of the surgery. However, the influence of HO on clinical outcomes after CTDR has not been well established.

METHODS

A meta-analysis was conducted with studies identified by searches of MEDLINE, EMBASE, and the Cochrane Library. We calculated the weighted mean differences of the visual analogue scale pain score, Neck Disability Index, and range of motion (ROM). Patients were classified into 2 groups under 3 classifications on the basis of the grade of HO. Results were pooled using a fixed effect model or a random effects model, according to the heterogeneity.

RESULTS

There were significant differences in ROM under all 3 classifications. The visual analogue scale pain score and the Neck Disability Index between the patients with and without HO showed no significant difference after CTDR. Significant differences in visual analogue scale pain score were observed when patients were classified into a "high-grade HO" group (McAfee grades 3 or 4 HO) and a "low-grade HO" group (McAfee grade 0, 1, or 2 HO).

CONCLUSIONS

The presence of HO is not associated with clinical outcomes after CTDR. However, the severity of HO actually impacts clinical outcomes in an inverse manner, which needs further investigation. It is inappropriate to classify patients on the basis of the presence of HO; further studies of the classifications (ROM-affecting HO vs. ROM-preserving HO; high-grade HO vs. low-grade HO) and cervical stability after CTDR are needed.

LEVEL OF EVIDENCE

2.

MicroRNA-150 functions as a tumor suppressor in osteosarcoma by targeting IGF2BP1

Osteosarcoma (OS) is the most common primary malignant bone tumor with high morbidity in young adults and adolescents. Increasing evidence has demonstrated that aberrant microRNA (miRNA) expression is involved in OS occurrence and development. miR-150 has been recently widely studied in many cancers, but not including OS. This study is aimed to investigate the expression and biological role of miR-150 in OS. Here, we found that miR-150 expression was consistently downregulated in OS tissues and cell lines compared with the matched adjacent normal tissues and human normal osteoblast cells (NHOst), and its expression was significantly correlated with lymph node metastasis and tumor-node-metastasis (TNM) stage. Functional study showed that restoration of miR-150 expression in OS cells could inhibit cell proliferation, migration, and invasion and induced apoptosis in vitro as well as suppressed tumor growth of OS in vivo. Mechanistically, IGF2 mRNA-binding protein 1(IGF2BP1) was confirmed to act as a direct target of miR-150, and the IGF2BP1 mRNA expression was inversely correlated with the level of miR-150 in OS tissues. In addition, downregulation of endogenous IGF2BP1 exhibited similar effects of overexpression of miR-150. Taken together, these findings suggest that miR-150 functions as a tumor suppressor in OS partially by targeting IGF2BP1.

Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study

Background

Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases.

Methods

This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL.

Results

A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028).

Conclusions

A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

Synergistic growth inhibition by sorafenib and cisplatin in human osteosarcoma cells

Molecular-targeted therapy has shown promise as a treatment for advanced osteosarcoma (OS). Sorafenib (SOR), a multikinase inhibitor, is the approved systemic drug of choice for OS, but has demonstrated limited benefits due to its toxicity and other adverse effects. Therapy strategies for reducing toxicity include using lower doses of SOR in combination with other complementary agents. Cisplatin (CDDP) has been shown to be a promising anticancer drug against various types of cancer including OS. In the present study, SOR was combined with CDDP to determine whether this combinatorial treatment suppressed tumor growth thereby simultaneously reducing doses of the two drugs for the treatment of OS. Human Saos-2 OS cells were treated with SOR and CDDP, alone and in combination, and the effect of these treatments on cell proliferation, colony formation, cell cycle, apoptosis, migration, and invasion, and involvement in receptor signaling, as well as tumor growth ability in nude mice was determined. It was found that the combination of low concentrations of SOR and CDDP significantly suppressed the cell proliferation, colony formation, migration and invasion, and induced cell apoptosis and cell cycle arrest in the G0/G1 stage, and suppressed tumor growth in a nude mouse model compared to the actions of either agent alone. The results also showed that SOR in combination with CDDP significantly suppressed the phosphorylation of extracellular signal-regulated kinase (ERK), which may contribute to the inhibition of tumor growth. These results suggested that SOR in combination with CDDP acts synergistically in the treatment of OS.

Oligosaccharide nanomedicine of alginate sodium improves therapeutic results of posterior lumbar interbody fusion with cages for degenerative lumbar disease in osteoporosis patients by downregulating serum miR-155

Degenerative lumbar disease (DLD) is a significant issue for public health. Posterior lumbar intervertebral fusion with cages (PLIFC) has high-level fusion rate and realignment on DLD. However, there are some complications following the surgery. Alginate oligosaccharides (AOS) have antioxidant and anti-inflammatory activities and may be suitable for infection therapy. MiR-155 is a biomarker associated with inflammatory and oxidative stress. AOS may promote PLIFC therapy by regulating miR-155. Pluronic nanoparticles and oligosaccharide nanomedicine of alginate sodium (ONAS) were prepared with ampicillin at size <200 nm. Ninety-six DLD osteoporosis patients received PLIFC and were evenly assigned into ONAS group (OG, oral administration of 100 mg ONAS daily) and control group (PG, 100 mg pluronic nanoparticles). Serum miR-155 level was measured by real-time quantitative PCR. The levels of superoxide dismutase (SOD), glutathione (GSH), aspartate aminotransaminase (AST), alanine aminotransferase (ALT), interleukin-1β (IL-1β), and interleukin-1 receptor antagonist (IL-1ra) were measured. Weighted mean difference (WMD), relative risk (RR), complications, surgery infection rate, fusion rate, and Japanese Orthopaedic Association (JOA) scores were used to evaluate therapeutic efficacy. After 1-month therapy, infection rates and side effects were lower in OG than those in PG (RR =0.64, 95% confidence interval [CI] [0.48, 0.84], P=0.001). The fusion rates were higher in OG than in PG (WMD =21.96, 95% CI [−0.24, 37.62], P=0.021). The JOA scores were higher in OG than in PG (RR =0.52, 95% CI [0.33, 0.84], P=0.007), and no significant difference was found for the visual analog scale and Oswestry Disability Index. Serum levels of miR-155, ALT, AST, and IL-1β were lower while SOD, GSH, and IL-1ra were higher in OG than in PG. MiR-155 mimic increased the levels of ALT, AST, and IL-1β and reduced the levels of SOD, GSH, and IL-1ra. In contrast, miR-155 inhibitor had reverse results. Therefore, ONAS has better improvement in complications and therapeutic effects on DLD by regulating serum miR-155.

Silencing XIAP suppresses osteosarcoma cell growth, and enhances the sensitivity of osteosarcoma cells to doxorubicin and cisplatin

X-chromosome-linked inhibitor of apoptosis protein (XIAP) is an important member of the inhibitors of apoptosis (IAP) family. It has been shown that XIAP promotes the invasion, metastasis, growth and survival of malignant cells, and confers resistance to some chemotherapeutic drugs in various types of cancer. However, little is known regarding its detailed role in osteosarcoma (OS). In the present study, we first investigated the expression of XIAP in OS tissues, and an increased expression of XIAP in OS tissues compared to adjacent non-tumor tissue was identified. Additionally, its expression level correlated with key pathological characteristics including clinical stage, tumor size and metastasis. Subsequently, small interfering RNA (siRNA) was used to block XIAP expression to evaluate the effect of XIAP siRNA on cell proliferation, colony formation, cell cycle, apoptosis, tumorigenicity, and the combined effects of doxorubicin or cisplatin in OS cell lines (MG63 cells). Downregulation of XIAP expression using the RNA silencing approach efficiently decreased cell proliferation and colony formation, and induced cell apoptosis and cell cycle in the G0/G1 stage. In addition, this downregulation inhibited tumor growth in a nude murine model. The resuls also showed that treatment with XIAP-shRNA in combination with doxorubicin or cisplatin enhanced chemosensitivity. These results suggested that XIAP may aid the diagnosis of OS and may be an effective strategy for gene therapy of this disease.

Knockdown of long non-coding RNA HOXD-AS1 inhibits the progression of osteosarcoma

Long non-coding RNA HOXD-AS1 (HOXD-AS1) has recently been shown to be involved in the development and progression of multiple cancers. However, the expression, significance, and biological function of HOXD-AS1 in osteosarcoma (OS) remain unknown. Here, we found that the expression level of HOXD-AS1 was significantly upregulated in OS tissues and cells. Furthermore, high expression of HOXD-AS1 was positively associated with the clinical and pathological characteristics of OS, including tumor stage and lymph node metastasis, and negatively correlated with overall survival rate. in vitro assays confirmed that knockdown of HOXD-AS1 suppressed cell proliferation, colony formation, migration, and invasion, and promoted cell cycle arrest at G1 stage and apoptosis in OS cells. in vivo assays confirmed that knockdown of HOXD-AS1 significantly decreased tumor growth in xenograft mice, and decreased tumor size and weight. Importantly, we also showed that knockdown of HOXD-AS1 significantly reduced signal transducer and activator of transcription 3 and its target protein (CyclinD1, Bcl-2, and MMP-2) expression in vitro and in vivo. Moreover, overexpression of STAT3 could reverse the suppression of proliferation ability induced by sh-HOXD-AS1 in U2OS cells. Collectively, our data indicated that HOXD-AS1 might be an oncogenic long non-coding RNA (lncRNA) and might be a potential attractive therapeutic target for OS.

The role of slingshot-1L (SSH1L) in the differentiation of human bone marrow mesenchymal stem cells into cardiomyocyte-like cells

Adult cardiomyocytes (CMs) have very limited capacity to regenerate. Therefore, there is a great interest in developing strategies to treat infarcted CMs that are able to regenerate cardiac tissue and promote revascularization of infarcted zones in the heart. Recently, stem cell transplantation has been proposed to replace infarcted CMs and to restore the function of the affected tissue. This area of research has become very active in recent years due to the huge clinical need to improve the efficacy of currently available therapies. Slingshot (SSH) is a family of protein phosphatases, which can specifically dephosphorylate and reactivate cofilin and inhibit the polymerization of actin filaments and actively involved in cytoskeleton rearrangement. In this study, we found that SSH1L promoted morphology changes of microfilaments during differentiation but was inhibited by the inhibitors of actin polymerization such as cytochalasin D. Overexpression of SSH1L could promote cardiac-specific protein and genes expression. 5-Aza can induce the differentiation of hMSCs into cardiomyocyte-like cells in vitro. We also observed that SSH1L efficiently promotes hMSCs differentiation into cardiomyocyte-like cells through regulation and rearrangement of cytoskeleton. Our work provides evidence that supports the positive role of SSH1L in the mechanism of stem cell differentiation into cardiomyocyte-like cells.

Development and Internal Validation of a Nomogram to Predict Mortality During the ICU Stay of Thoracic Fracture Patients Without Neurological Compromise: An Analysis of the MIMIC-III Clinical Database

Background: This study aimed to develop and validate a nomogram for predicting mortality in patients with thoracic fractures without neurological compromise and hospitalized in the intensive care unit. Methods: A total of 298 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included in the study, and 35 clinical indicators were collected within 24 h of patient admission. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was established, and a nomogram was constructed. Internal validation was performed by the 1,000 bootstrap samples; a receiver operating curve (ROC) was plotted, and the area under the curve (AUC), sensitivity, and specificity were calculated. In addition, the calibration of our model was evaluated by the calibration curve and Hosmer-Lemeshow goodness-of-fit test (HL test). A decision curve analysis (DCA) was performed, and the nomogram was compared with scoring systems commonly used during clinical practice to assess the net clinical benefit. Results: Indicators included in the nomogram were age, OASIS score, SAPS II score, respiratory rate, partial thromboplastin time (PTT), cardiac arrhythmias, and fluid-electrolyte disorders. The results showed that our model yielded satisfied diagnostic performance with an AUC value of 0.902 and 0.883 using the training set and on internal validation. The calibration curve and the Hosmer-Lemeshow goodness-of-fit (HL). The HL tests exhibited satisfactory concordance between predicted and actual outcomes (P = 0.648). The DCA showed a superior net clinical benefit of our model over previously reported scoring systems. Conclusion: In summary, we explored the incidence of mortality during the ICU stay of thoracic fracture patients without neurological compromise and developed a prediction model that facilitates clinical decision making. However, external validation will be needed in the future.

Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis

Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis.

Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated.

Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions.

Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.

Peptide/glycyrrhizic acid supramolecular polymer: An emerging medical adhesive for dural sealing and repairing

Medical adhesives have emerged as potential materials for sealing, hemostasis and wound repairing in modern clinical surgery. However, most of existing medical adhesives are still far away from the clinical requirements for simultaneously meeting desirable tissue adhesion, safety, biodegradability, anti-swelling property, and convenient operability. Here, we present an entirely new kind of peptide-based underwater adhesives, which are constructed via cross-linked supramolecular copolymerization between cationic short peptides and glycyrrhizic acid (GA) in an aqueous solution. We revealed the unique molecular mechanism of the peptide/GA supramolecular polymers and underlined the importance of arginine residues in the enhancement of the bulk cohesion of the peptide/GA adhesive. We thus concluded a design guideline that the peptide sequence has to be encoded with multiple arginine termini and hydrophobic residues. The resulting adhesives exhibited effective tissue adhesion, robust cohesion, low cell cytotoxicity, acceptable hemocompatibility, inappreciable inflammation response, appropriate biodegradability, and excellent anti-swelling property. More attractively, the dried peptide/GA powder was able to rapidly self-gel into adhesives by absorbing water, suggesting conveniently clinical operability. Animal experiments showed that the peptide/GA supramolecular polymers could be utilized as reliable medical adhesives for dural sealing and repairing.

Multimodal intraoperative monitoring during reduction of spine burst fracture and dislocation prevents neurologic injury

This study aims to evaluate the application of multimodal intraoperative monitoring (MIOM) in surgical treatment for spine burst fracture and dislocation (SBFD) patients.Eleven patients who underwent posterior reduction and instrumentation (PRI) for SBFD from June 2014 to July 2016 were included into the study. The function of the spinal cord was monitored by MIOM. The muscle strength of the lower extremities and American Spinal Injury Association (ASIA) scores were, respectively, evaluated (before surgery, and at 1, 3, 6, and 12 months after surgery). Furthermore, the extent of reduction was also assessed.Muscle strength recovery, ASIA score changes, and the extent of reduction were correlated with MIOM results. Among the 11 patients who received surgery under MIOM, 8 patients with negative MIOM results during the operation did not demonstrate neurological deterioration postoperatively and exhibited improvements in ASIA scores during follow-ups. However, among the 3 patients who encountered MIOM events (case 4, 7, and 8), 2 patients avoided nerve lesion and 1 patient suffered from neurologic deterioration postoperatively.The application of MIOM technology during PRI surgery may detect spinal cord impairment at the early stage, and operative schemes can be modified before permanent nerve compromise is triggered by surgical manipulation.

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

Background

The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL).

Methods

We conducted a retrospective, single-center study based on 885 patients receiving PSL, and data was obtained from May 2015 to September 2019. Univariable and multivariable logistics regression analysis were conducted to identify risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model.

Results

Of 885 patients, 885 were enrolled in the final study population, and 289 received blood transfusion. Statistical analyses showed that low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion > 1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI 0.847–0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility.

Conclusions

In summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion can contribute to clinicians in making clinical decision. However, external validation is still needed in the further.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-020-02053-2.

Combined 3D rapid prototyping and computer navigation facilitate surgical treatment of congenital scoliosis: A case report and description of technique

RATIONALE

This study describes the technique of combined Orbic 3D navigation (O3DN) and 3D rapid prototyping (3DRP) to assist surgical correction of congenital scoliosis.

PATIENT CONCERNS

A 12-year-old boy with congenital scoliosis. His father brought him to our hospital upon noticing the boy's asymmetry of the trunk.

DIAGNOSES

Congenital scoliosis.

INTERVENTIONS

O3DN and 3DRP were used to assist correction surgery in this patient.

OUTCOMES

The Cobb angle of segmental scoliosis (T8-L2) was 46.9° preoperatively and 2.3° at the last postoperative follow-up; correction was 95.1%. The average segmental kyphosis (T5-T12) was 45.2° preoperatively and 18.6° at the postoperative follow-up; correction was 58.9%. The preoperative sagittal imbalance of 56.2 mm was improved to 9.7 mm. The mean distance between the center sacral vertical line and the C7 plumb line was reduced from 5.7 to 4.1 mm. Operative time and bleeding volume was impressively little, with no misplacement of pedicle screws or other surgical complications.

LESSONS

Combined 3DRP and O3DN helped achieve satisfactory correction for this case of congenital scoliosis. The application of 3DRP aided by O3DN in surgical treatment of congenital scoliosis can reduce operative time, lessen blood loss, reduce screw misplacement, and avoid neurovascular damage. However, patients' hospital costs were greater. Our lessons learnt are that the relative position between the tracker and the pedicle must be static to ensure the accuracy of the whole system during the entire operation.

Multimodal intraoperative monitoring during surgical correction of scoliosis to avoid neurologic damage

The purpose of this study was to evaluate the application of multimodal intraoperative monitoring (MIOM) system in patients with congenital scoliosis (CS) and adolescent idiopathic scoliosis (AIS).Twelve patients who underwent posterior surgical correction of scoliosis for CS and AIS from June 2014 to July 2018 were enrolled in this study. During the operation, we monitored the functional status of the spinal cord by MIOM. An abnormal somatosensory evoked potential was defined as a prolonged latency of more than 10% or a peak-to-peak amplitude decline of more than 50% when compared to baseline. An abnormal transcranial motor evoked potential (TcMEP) was defined as a TcMEP amplitude decrease of more than 50%. A normal triggered electromyography response, which presented with the absence of an electrical response on stimulation at 8.2 mA, indicated that the pedicle screw was not in contact with the spinal cord or nerve root.A total of 12 patients underwent MIOM surgery, of which 9 patients with negative MIOM had no significant deterioration of neurological function postoperatively, and exhibited satisfactory surgical correction of scoliosis during follow-ups. However, the remaining 3 patients suffered from MIOM events, 2 patients had normal neurological function, and 1 patient had deteriorated neurological function postoperatively.Using MIOM in CS and AIS surgery could promptly detect iatrogenic neurological injury at the early stage. Therefore, rapid response by appropriate intraoperative interventions can be taken to minimize the injury. Besides, stable MIOM recordings encourage surgeons to correct scoliosis even when the Cobb angle of scoliosis was extremely large.

Prediction of the risk of C5 palsy after posterior laminectomy and fusion with cervical myelopathy using a support vector machine: an analysis of 184 consecutive patients

Background

This study aimed to predict C5 palsy (C5P) after posterior laminectomy and fusion (PLF) with cervical myelopathy (CM) from routinely available variables using a support vector machine (SVM) method.

Methods

We conducted a retrospective investigation based on 184 consecutive patients with CM after PLF, and data were collected from March 2013 to December 2019. Clinical and imaging variables were obtained and imported into univariable and multivariable logistic regression analyses to identify risk factors for C5P. According to published reports and clinical experience, a series of variables was selected to develop an SVM machine learning model to predict C5P. The accuracy (ACC), area under the receiver operating characteristic curve (AUC), and confusion matrices were used to evaluate the performance of the prediction model.

Results

Among the 184 consecutive patients, C5P occurred in 26 patients (14.13%). Multivariate analyses demonstrated the following 4 independent factors associated with C5P: abnormal electromyogram (odds ratio [OR] = 7.861), JOA recovery rate (OR = 1.412), modified Pavlov ratio (OR = 0.009), and presence of C4C5 foraminal stenosis (OR = 15.492). The SVM model achieved an area under the receiver operating characteristic curve (AUC) of 0.923 and an ACC of 0.918. Additionally, the confusion matrix showed the classification results of the discriminant analysis.

Conclusions

The designed SVM model presented satisfactory performance in predicting C5P from routinely available variables. However, future external validation is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02476-5.

LIM kinase 1 is required for insulin‑dependent cell growth of osteosarcoma cell lines

Osteosarcoma is a type of malignant bone tumor with high metastasis and poor prognosis. Previous studies have demonstrated the involvement of LIM kinase 1 (LIMK1) in the proliferation of osteosarcoma cells. LIMK1 is overexpressed in human osteosarcoma tissues and cell lines. To further study LIMK1-associated mechanisms, we used shRNA targeted to the LIMK1 gene to block its expression in the osteosarcoma cell lines MG63 and U2OS. Insulin promoted the proliferation of MG63 cells in a time- and dose-dependent manner, however, this insulin induced proliferation was significantly inhibited by transfection of shRNA targeted to the LIMK1 gene, as well as by the PI3K inhibitor LY294002, but not by the mitogen‑activated protein kinase (MAPK) inhibitor PD98059. The level of cofilin phosphorylation was increased significantly following stimulation of insulin for 24 h, indicating the activation of LIMK1. MG63 cell proliferation was also significantly inhibited by 1,25-dihydroxy vitamin D3 (1,25(OH)2D3) in a time-dependent manner. Furthermore, 1,25(OH)2D3 negated the inhibitory effect of LIMK1 shRNA, indicating that LIMK1 is important in the inhibitory pathway of 1,25(OH)2D3. The present study confirms that LIMK1 is important in regulating osteosarcoma cell proliferation via the insulin/PI3K/LIMK1 signaling pathway, thus the development of gene therapy for osteosarcoma targeting LIMK1 is warranted.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability. Traditional open surgery has a large amount of bleeding, which is not suitable for patients with acute pelvic fracture. Navigation-guided, percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages, which include less trauma, faster recovery times, and less bleeding. However, due to the complexity of pelvic anatomy, doctors often encounter some problems when using navigation to treat pelvic fractures. This article reviews the indications, contraindications, surgical procedures, and related complications of this procedure for the treatment of sacral fractures, sacroiliac joint injuries, pelvic ring injuries, and acetabular fractures. We also analyze the causes of inaccurate screw placement. Percutaneous screw placement under navigational guidance has the advantages of high accuracy, low incidence of complications and small soft-tissue damage, minimal blood loss, short hospital stays, and quick recovery. There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones. However, computer navigation technology requires extensive training, and attention should be given to avoid complications such as screw misplacement, intestinal injury, and serious blood vessel and nerve injuries caused by navigational drift.

Chitosan-Coated Titanium Dioxide-Embedded Paclitaxel Nanoparticles Enhance Anti-Tumor Efficacy Against Osteosarcoma

Objective

Titanium dioxide nanoparticles (TiO₂) nanoparticles have been widely explored in the prevention of cancer risk. Due to the difficult solubility of TiO₂ nanoparticles, it is essential to synthesize new surfactants to increase its bioavailability and anti-tumor activity and reduce its cytotoxicity. Furthermore, oxidative and inflammation are closely associated with the osteosarcoma risk. Chitosan has biocompatibility, antioxidant and anti-inflammatory properties. The effects of chitosan-coated TiO₂-embedded paclitaxel nanoparticles on an osteosarcoma model were explored.

Methods

An osteosarcoma model was established and chitosan-coated TiO₂-embedded paclitaxel nanoparticles were prepared using a freeze-drying strategy. The morphological characteristics of nanoparticles were observed using scanning electron microscopy (SEM). The physicochemical properties of nanoparticle were evaluated by X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. The cytotoxicity was tested by using human osteoblast cells hFob1.19 and osteosarcoma cells 143B. Osteosarcoma mice were treated with PBS buffer, paclitaxel, TiO₂-embedded paclitaxel and chitosan-coated TiO₂-embedded paclitaxel nanoparticles. The biomarkers of oxidative-inflammatory status, anti-tumor activities and survival rates of the model were measured.

Results

XRD analysis showed that the peaks of chitosan/TiO₂ (anatase) were consistent with those of crystalline TiO₂ and broad phase of chitosan. The FTIR spectrum indicated the relevant functional groups in TiO₂. Chitosan-coated TiO₂-embedded paclitaxel nanoparticles had good biocompatibility and improve antioxidant and anti-inflammatory properties in the osteosarcoma model. Chitosan-coated TiO₂-embedded paclitaxel nanoparticles was less toxic to the cells hFob1.19 and more toxic to the cells 143B than TiO₂-embedded paclitaxel nanoparticles. Chitosan-coated TiO₂-embedded paclitaxel nanoparticles showed significant antitumor activity and increased the survival rate of the osteosarcoma model (P < 0.05).

Conclusions

Chitosan improved anti-tumor potential of TiO₂-embedded paclitaxel nanoparticles in the prevention of osteosarcoma.

Chitin Oligosaccharide (COS) Reduces Antibiotics Dose and Prevents Antibiotics-Caused Side Effects in Adolescent Idiopathic Scoliosis (AIS) Patients with Spinal Fusion Surgery

Antibiotics are always considered for surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) surgery. However, the use of antibiotics often causes the antibiotic resistance of pathogens and side effects. Thus, it is necessary to explore natural products as drug candidates. Chitin Oligosaccharide (COS) has anti-inflammation and anti-bacteria functions. The effects of COS on surgical infection in AIS surgery were investigated. A total of 312 AIS patients were evenly and randomly assigned into control group (CG, each patient took one-gram alternative Azithromycin/Erythromycin/Cloxacillin/Aztreonam/Ceftazidime or combined daily), experiment group (EG, each patient took 20 mg COS and half-dose antibiotics daily), and placebo group (PG, each patient took 20 mg placebo and half-dose antibiotics daily). The average follow-up was one month, and infection severity and side effects were analyzed. The effects of COS on isolated pathogens were analyzed. SSI rates were 2%, 3% and 8% for spine wounds and 1%, 2% and 7% for iliac wound in CG, EG and PG (p < 0.05), respectively. COS reduces the side effects caused by antibiotics (p < 0.05). COS improved biochemical indexes and reduced the levels of interleukin (IL)-6 and tumor necrosis factor (TNF) alpha. COS reduced the antibiotics dose and antibiotics-caused side effects in AIS patients with spinal fusion surgery by improving antioxidant and anti-inflammatory activities. COS should be developed as potential adjuvant for antibiotics therapies.

Evaluation of a new Mg-Zn-Ca-Y alloy for biomedical application

In this study, a new Mg-Zn-Ca-Y alloy was evaluated for blood compatibility and in vivo biocompatibility in rabbits after implantation in the sacral crest muscle. Blood test and HE staining was performed to examine the host response, and scanning electron microscope was used to observe the fibrous membrane and corrosion of the magnesium alloy. The results showed that hemolysis rate decreased with the Mg(2+) concentration, in particularly, the hemolysis rate was 47.24 % for the magnesium alloy 100 % mixture solution, while was 0.1372 % for the 1 % extract solution. After implantation, the rabbits showed generally good condition, without swelling and wound secretions. One week after implantation, in the experimental group, a few lymphocytes and macrophages could be observed around the local muscle tissue, and fiber membrane structure had not yet formed; after 2 weeks, loose fiber membranes formed, while the number of inflammatory cells decreased; the fiber membrane became thinner at 4 and 12 weeks,. The fiber membrane thickness at 24 weeks were measured by scanning electron microscopy, at about 15-25 μm, which accord with the U.S. ASTM-F4 implant requirements (<30 μm). Acceptable degradation and corrosion were observed after implantation into rabbits. Through the in vivo study, the new magnesium alloy exhibited good biocompatibility and non-toxic in the experimental animals. Addition of Zn, Ca and Y can slow the degradation rate, and have acceptable side effects in vivo, resulting in improved corrosion properties and desirable biocompatibility at the same time.