[Comparison of three different posterior cervical approaches for treating cervical spine trauma with ossification of posterior longitudinal ligament]

Objective: To investigate the clinical application value of using laminoplasty combine with short-segment pedicle screw fixation in the treatment of cervical spine trauma patients with ossification of posterior longitudinal ligament (OPLL). Methods: Fifty-four cervical spine trauma patients with OPLL from June 2014 to June 2016 were retrospectively analyzed of Department of Spine Surgery, Changzheng Hospital, Naval Military Medical University. There were 31 males and 23 females, aging (68.4±4.3) years (rang: 46 to 82 years). All patients had a history of cervical spine trauma, confirmed by imaging examination of OPLL, and there are signs and symptoms related to cervical spinal cord compression. Eighteen patients underwent one-stage laminoplasty combine with short-segment pedicle screw fixation(group A), and 15 patients underwent posterior cervical laminectomy and pedicle screw fixation (group B). Twenty-one patients underwent posterior laminoplasty (C group). According to the range of OPLL and the compression of the spinal cord, the range of laminoplasty was selected. MRI scan was used to evaluated the compression condition of cervical spine and the injury condition of anterior longitudinal ligament injury and other factors that can cause local instability of the cervical spine. Posterior unilateral pedicle screw fixation (two pedicles) were performed in the instability segment. The neurological function of the patients was assessed by the Japanese Orthopedic Association (JOA) Score before surgery, the second day after surgery, 3 months, 1 year and the last follow-up. The cervical spine X-ray films were used to evaluate cervical curvature, cervical spine activity and internal fixation-related complications. Results: The average follow-up time was 18 months (6-30 months). Satisfactory neurological improvement was achieved in all three groups, and no internal fixation-related complications occurred during follow-up. The range of laminoplasty was 22 cases in 4 segments (C(3)-C(6), C(4)-C(7)) and 17 cases in 5 segments (C(3)-C(7)). Unilateral pedicle screw fixation was performed in 11 patients with C(3-4) fixation and 7 patients with C(4-5) fixation. Cervical curvature was basically the same in the three groups after operation and at the last follow-up. No significant changes in cervical curvature and kyphosis were observed during the follow-up period. The overall cervical mobility (C(2)-C(7)) in group A and group C had no significant difference compared with preoperative (P=0.077). The overall mobility of cervical vertebrae in group B was significantly lower than that before surgery (P=0.013). Conclusions: For cervical spine trauma patients with OPLL, laminoplasty combined short-segment pedicle screw fixation can increase cervical segmental stability while extensive decompression of cervical spinal cord compression. At the same time, to some extent, the complications of postoperative axial symptoms caused by posterior cervical laminectomy and pedicle screw fixation were avoided.

Complementary Roles of Dynamic Contrast-Enhanced MR Imaging and Postcontrast Vessel Wall Imaging in Detecting High-Risk Intracranial Aneurysms

BACKGROUND AND PURPOSE

Individual assessment of the absolute risk of intracranial aneurysm rupture remains challenging. Emerging imaging techniques such as dynamic contrast-enhanced MR imaging and postcontrast vessel wall MR imaging may improve risk estimation by providing new information on aneurysm wall properties. The purpose of this study was to investigate the relationship between aneurysm wall permeability on dynamic contrast-enhanced MR imaging and aneurysm wall enhancement on postcontrast vessel wall MR imaging in unruptured intracranial aneurysms.

MATERIALS AND METHODS

Patients with unruptured saccular intracranial aneurysms were imaged with vessel wall MR imaging before and after gadolinium contrast administration. Dynamic contrast-enhanced MR imaging was performed coincident with contrast injection using 3D T1-weighted spoiled gradient-echo imaging. The transfer constant (K ^trans) was measured adjacent to intracranial aneurysm and adjacent to the normal intracranial artery.

RESULTS

Twenty-nine subjects were analyzed (mean age, 53.9 ± 13.5 years; 24% men; PHASES score: median, 8; interquartile range, 4.75-10). K ^trans was higher in intracranial aneurysms compared with the normal intracranial artery (median, 0.0110; interquartile range, 0.0060-0.0390 versus median, 0.0032; interquartile range, 0.0018-0.0048 min^-1; P < .001), which correlated with intracranial aneurysm size (Spearman ρ = 0.54, P = .002) and PHASES score (ρ = 0.40, P = .30). Aneurysm wall enhancement, detected in 19 (66%) aneurysms, was associated with intracranial aneurysm size and the PHASES score but not significantly with K ^trans (P = .30). Aneurysms of 2 of the 9 patients undergoing conservative treatment ruptured during 1-year follow-up. Both ruptured aneurysms had increased K ^trans, whereas only 1 had aneurysm wall enhancement at baseline.

CONCLUSIONS

Dynamic contrast-enhanced MR imaging showed increased K ^trans adjacent to intracranial aneurysms, which was independent of aneurysm wall enhancement on postcontrast vessel wall MR imaging. Increased aneurysm wall permeability on dynamic contrast-enhanced MR imaging provides new information that may be useful in intracranial aneurysm risk assessment.

[Expression of anaplastic lymphoma kinase fusion gene in patients with lung sarcomatoid carcinoma and treatment analysis]

Objective: To investigate the expression status of anaplastic lymphoma kinase (ALK) fusion gene in lung sarcomatoid carcinoma (LSC) and the role of ALK inhibitors for treatment. Methods: Total of 84 cases of LSC confirmed by histopathology were detected for ALK fusion gene from January 2011 to December 2014 in the Cancer Hospital of Chinese Academy of Medical Science&Peking Union Medical College and Shandong Zibo Wanjie Cancer Hospital. All patients were primarily treated by the multi-disciplinary mode in combination with chemotherapy or targeted therapy based on surgery. Postoperative adjuvant chemotherapy was given on platinum based two-drug combination regimen. In ALK fusion gene (+ ) patients with recurrence or metastasis, crizotinib target therapy was prefered. Chi-square test was applied for the comparison of 1, 3, 5-year survival rates between the two groups. Results: Eighty-two cases completed the follow-up. ALK fusion gene was found in 9(10.7%) patients. After application of crizotinib, 1 case was evaluated as complete remission, 6 cases as partial response, 2 cases as stable disease; the 1, 3, 5-year survival rate was 100% (9/9), 100% (9/9) and 88.9% (8/9) for the patients with ALK fusion gene, and it was 65.8% (48/73), 15.1% (11/73) and 6.8% (5/73) respectively for patients without ALK fusion gene. There was significant difference in the survival rate between the two groups (χ(2)=1.56, 1.56, 0.83, all P<0.05). Conclusion: ALK fusion gene maybe expressed in LSC patients. Compared with conventional chemotherapy, crizotinib can significantly prolong the survival time of patients with ALK fusion gene.

Kaempferol inhibited bovine herpesvirus 1 replication and LPS-induced inflammatory response

Plant-derived flavonoids contain large amount of compounds with pharmacological effects. In this study, we showed the compound Kaempferol to have robust antiviral activity against bovine herpesvirus 1 (BoHV-1) replication in vitro. Kaempferol at a concentration of 100 μmol/l completely inhibited viral replication in MDBK cells. It mainly affects the viral replication at the post-entry stages. The inhibition of Akt signaling is a potential mechanism underlying the antiviral effect of Kaempferol. In addition, at a concentration of 25 and 50 μmol/l Kaempferol could significantly reduce the expression of inflammatory mediators such as tumor necrosis factor alpha (TNF-α), interleukin-8 (IL-8) and macrophage inflammatory protein 1 alpha (MIP-1α) in human promonocytic U937 cells-derived macrophages (dU937) in response to lipopolysaccharides (LPS) stimulation. Overall, our results indicated that Kaempferol provides a potent protection against BoHV-1 infection and LPS-induced inflammatory response.

Antiviral effect of baicalin phospholipid complex against duck hepatitis A virus type 1

Duck hepatitis A virus type 1 (DHAV-1) is one of the main pathogens of ducklings and causes a high mortality rate. Baicalin (BA) has potent antiviral effect, but the solubility is very poor. In order to increase the absorption, solubility, and pharmacological activity, the phospholipid complex was used to modify BA in present study. Therefore, BA phospholipid complex (BAPC) was prepared. The anti-DHAV-1 abilities of BA and BAPC in vitro was evaluated by cell counting kit-8 and reverse transcription quantitative PCR. The curative effects of BA and BAPC on ducklings which were infected by DHAV-1 in addition to the ALT and AST levels were also detected. The results indicated the anti-DHAV-1 ability of BAPC was stronger than that of BA both in vitro and in vivo. To explore the anti-DHAV-1 mechanism, the influence of BAPC on DHAV-1 adsorption, replication, and release was studied. Furthermore, the anti-oxidative and immuno-enhancing abilities of BAPC in the treatment of infected ducklings were also determined. The results showed BAPC inhibited DHAV-1 adsorption, replication and release. Furthermore, it played anti-oxidative and immno-enhancing roles in the treatment, and the immno-enhancing role was crucial to the treatment.

[MicroRNA and sensorineural hearing loss]

Hearing loss caused by disorders throughout the cochlea or auditory pathway called sensorineural hearing loss. The etiology of sensorineural deafness is complex and diverse, and the sensory epithelial cell damage of the inner ear spiral is the main pathological change. MicroRNAs play a role in the regulation of gene expression by inhibiting or degrading the mRNA of target genes. More and more studies have shown that microRNA plays an important role in the development of sensorineural deafness. This article will review the process of microRNA involvement in the development of sensorineural hearing loss.

[Expression of granulocyte colony-stimulating factor receptor in colitis-associated colonic carcinogenesis]

Objective: To investigate the expression of granulocyte-colony stimulating factor receptor (G-CSFR) in a mouse model of colitis-associated cancer (CAC), and the roles of G-CSFR positive immune cells in the development of CAC. Methods: The C57BL/6 mouse model of CAC was established by azoxymethane and dextran sulphate sodium. Three different stages in the development of CAC, including inflammation (AD1), mild dysplasia (AD2) and adenocarcinoma (AD3) were simulated. Colon tissue was digested into single cell suspension and the expressions of G-CSF and G-CSFR were analyzed by real-time PCR and fluorescence activated cell sorter (FACS). The expressions of G-CSFR on T cell, macrophage and neutrophil were analyzed by FACS. Results: The establishment of mouse model can effectively simulate the disease progression of CAC. The results of real-time PCR detection showed that the expression level of G-CSF mRNA in AD1, AD2 and AD3 groups were 1.2, 7.3 and 18.0-fold changes of the control group, respectively. The differences between AD2, AD3 and control groups were statistically significant (P<0.05). G-CSFR mRNA levels in AD1, AD2 and AD3 groups were 1.5, 2.2 and 4.5-fold changes of the control group, respectively. The difference between AD3 and control groups was statistically significant (P<0.05). FACS showed that the percentages of CD45(+) G-CSFR(+) cells in colorectal tissues of the control group, AD1, AD2 and AD3 groups were (21.84±1.77)%, (41.48±4.15)%, (44.84±8.54)% and (57.76±1.95)%, respectively.The percentages of CD45(+) G-CSFR(+) cells in AD2 and AD3 groups were significantly higher than that of control group (P<0.05). The percentages of CD45(+) G-CSFR(+) macrophage in the colorectal tissues of the control group, AD1, AD2 and AD3 groups were (21.54±5.88)%, (47.14±5.25)%, (42.49±7.80)% and (29.25±8.24)%, respectively. The percentages of CD45(+) G-CSFR(+) T cells in these groups were (30.04±6.87)%, (29.65±8.08)%, (33.75±7.37)% and (33.32±9.85)%, respectively. The percentages of CD45(+) G-CSFR(+) granulocyte were (2.39±2.10)%, (4.05±1.56)%, (3.62±2.67)% and (2.26±0.85)%, respectively (P<0.05). The percentages of G-CSFR(+) macrophage and G-CSFR(+) T cells were significantly higher than that of G-CSFR(+) granulocyte (P<0.05). The differences between AD1 and control group, AD2 and control group, AD1 and AD2 group, AD2 and AD3 group were statistically significant (P<0.05). Conclusions: The expression of G-CSFR is significantly up-regulated in the development of CAC. The enrichment of G-CSFR(+) macrophages in the colon tissue suggests G-CSFR(+) macrophages participate in the development of CAC.

[A prospective cohort study on the relationship between maternal prenatal depressive symptoms and children's behavioral problems at 2 years old]

Objective: To explore the associations between maternal and prenatal depressive symptoms and children's behavioral problems at 2 years old. Methods: In the present study, a total of 491 mother-child pairs were selected from the Shanghai-Minhang Birth Cohort Study (S-MBCS) which was conducted in Maternal and Child Health Hospital of Minhang District in Shanghai between April and December, 2012. Data from the Center for Epidemiologic Studies on Depression was gathered to assess the maternal depressive symptoms in the second and third trimester of pregnancy, as well as at 6 months and 12 months postpartum. Neurodevelopment at 2 years was assessed, using the Child Behavior Checklist. We used generalized linear models with a log-link function and a Binomial distribution to estimate the risk ratios (RRs) and 95%CIs, on children's behavioral problems at 2 years of age. Sensitivity analyses were performed among participants without postpartum depressive symptoms. Results: After adjustment on factors as maternal age, gestation week, average monthly income per person, parental education and children's gender etc., maternal depression in second trimester of pregnancy was found associated with higher risk of both developing emotional (RR=2.61, 95%CI: 1.36-4.99) and internalizing problems (RR=1.94, 95%CI: 1.22-3.08). However, maternal depression in third trimester was found to be associated with higher risks of developing emotional (RR=6.46, 95%CI: 3.09-13.53), withdrawn (RR=2.42, 95%CI: 1.16-5.02), aggressive (RR=2.93, 95%CI: 1.45-5.94), internalizing (RR=1.79, 95%CI: 1.01-3.16) or externalizing problems (RR=2.56, 95%CI:1.49-4.42). In sensitivity analysis, antenatal maternal depression was found positively associated with children's emotional, internalizing and externalizing problems and the differences all statistically significant. Conclusions: Maternal depression during pregnancy might increase the risks of children's behavioral problems. In order to decrease the incidence of children's behavioral problems and promoting both maternal and child health status, monitoring program regarding maternal mental health care should be strengthened.

Ameliorating Effects of Leaf Water Extract of Three Aromatic Plant Species on Ozone-Polluted Snap Bean (Phaseolus vulgaris L. 'Jiangjunyoudou')

Ozone (O₃) is one of the major pollutants in near-surface air. In order to protect sensitive plants from O₃ pollution, many kinds of protectants including synthetic ones, were assessed in previous studies. Although they have certain protective effects, some of them are not environment-friendly. In the present study, leaf water extracts of aromatic plants [Plectranthus hadiensis var. tomentosus (PHT), Pelargonium hortorum (PHB), Tagetes patula (TP)] were compared for mitigating the damages caused by O₃ (150 ppb for 3 days, 8 h day^-1) on snap bean (Phaseolus vulgaris 'Jiangjunyoudou'). Our results showed that O₃ fumigation impaired plasma membrane, decreased chlorophyll content, increased contents of malondialdehyde and superoxide anion, inhibited photosynthesis, and caused visible injury. Leaf water extracts of PHT, PHB or TP ameliorated the negative effects of O₃. Among them, extract of PHT showed the greatest potential to alleviate the O₃-caused injury, followed by PHB and TP.

[A novel chemo-resistant gene MSX2 discovered by establishment of two pancreatic cancer drug resistant cell lines JF305/CDDP and PANC-1/GEM]

Objective: To explore new multidrug resistant genes of pancreatic cancer by establishment and characterization of chemo-resistant cell lines. Methods: The cisplatin-resistant cell line JF305/CDDP and the gemcitabine-resistant cell line PANC-1/GEM were induced by high-dose intermittent treatment. CCK-8 assay was used to detect the 50% inhibiting concentration (IC(50)), drug resistance index (R), cross-resistance, and growth difference of different cells. The changes of cell cycle and migration ability of drug-resistant cells were determined by flow cytometry and transwell assay, respectively. And then real-time fluorescence quantitative PCR was used to detect the expression of multidrug resistance-related genes. Results: The drug resistance indexes of JF305/CDDP and PANC-1/GEM were 15.3 and 27.31, respectively, and there was cross-resistance. Compared with the parental cells, the proliferation rate of JF305/CDDP was decreased by 40% on the fourth day (P<0.05); the proportion of S phase was decreased from (45±2)% to (30±2)% (P<0.05), and the migration ability was enhanced from (32 ±1) cells per field to (158±5) cells per field (P<0.01). The expression of multidrug resistance-related genes MRP2, MDR1, LRP and MSX2 was increased in JF305/CDDP cells (P<0.05). Knockdown of MSX2 in JF305 cells reduced the expression of MRP2, whereas overexpression of MSX2 in PANC-1 cells upregulated MRP2 level (P<0.05). Conclusions: Two stable multidrug resistant cell lines of pancreatic cancer, JF305/CDDP and PANC-1/GEM, were successfully established. MSX2 might be a new drug resistance related gene in pancreatic cancer cells by up-regulation of MRP2 expression.

First report of bovine herpesvirus 1 isolation from bull semen samples in China

Bovine herpesvirus 1 (BoHV-1) infection causes substantial economic losses to the cattle industry worldwide. So far, the isolation of BoHV-1 field virus has not been reported in China. Here, for the first time we report that two isolates of BoHV-1 designated as NJ16-1 and NJ16-2 were obtained from semen samples from breeding bulls in China. Typical cytopathic effect in MDBK cells, detection of viral protein VP16 in western blot analysis, PCR detection of BoHV-1 gB gene proved BoHV-1 infection and subsequent nucleotide sequence analysis showed a 99% identity with BoHV-1 Cooper strain. These results suggest that these isolated viruses are BoHV-1.

Motor subtypes and other risk factors associated with drooling in Parkinson's disease patients

OBJECTIVE

To explore the relationship between motor subtypes and drooling, and other risk factors associated with drooling in a large cohort of Chinese patients with Parkinson's disease (PD).

METHODS

A total of 586 PD patients were enrolled in this study. Unified Parkinson's disease rating scale (UPDRS) and Hoehn & Yahr stage (H & Y stage) scale, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Rating Scale for Depression-24 item (HRSD), and Mini-Mental State Examination (MMSE) were applied to all subjects. Salivary subscores of UPDRS part II were used to evaluate drooling. Constipation was diagnosed using the Rome III criteria.

RESULTS

The prevalence of drooling in this cohort is 54.6% (320/586). Non-TD subtype PD patients tend to have higher daily levodopa-equivalent dose (LED), H & Y stage, UPDRS I, UPDRS II, and UPDRS III scores, HRSD score and ESS score, a higher percentage of levodopa treatment, drooling, dyskinesia, and constipation. After adjusting for confounders, non-TD subtype, male sex, UPDRS III score, ESS and PSQI scores, and constipation were still associated with drooling, with corresponding Odds ratios and 95% confidence intervals (95% CIs) were 1.865 (95% CI, 1.137-3.060), 1. 951 (95% CI, 1.326-2.869), 1.024 (95% CI, 1.002-1.046), 1.064 (95% CI, 1.024-1.105), 1.058 (95% CI, 1.000-1.119), and 1.603 (95% CI, 1.092-2.353), respectively.

CONCLUSION

Drooling is common, even in mild-to-moderate PD patients. PD patients with non-TD subtype are at a higher risk of drooling. Male sex, motor severity, excessive daytime sleepiness, poor nighttime sleep, and constipation are also associated with drooling in patients with PD.

[Occurrence of radiation-induced injury in vagina after radical radiotherapy of cervical cancer and its affecting factors]

Objective: To investigate the occurrence and degree of radiation-induced injury in vagina after radical radiotherapy of cervical cancer. Methods: A total of 282 cases of patients with cervical cancer were collected from November 2016 to September 2017. All of the above patients underwent radical radiotherapy from 2008 to 2017 in the First Affiliated Hospital of Xi'an Jiaotong University. The patients' International Federation of Gynecology and Obstetrics (FIGO) staging (2009) , brachytherapy dose, whether receive synchronous chemotherapy or not, age and body mass index (BMI) for the occurrence and severity of vaginal radiation injury at different time periods were analyzed by cross-sectional survey method. The single factor would be analyzed by the method of Chi-square test and the multiple factors would be analyzed by logistic regression method to checkout. Results: Of the 282 patients, the incidence of radiation-injury in vaginal was 84.4% (238/282) , with the incidence rate of degree Ⅰ,Ⅱ and Ⅲ radiation injury were respectively 50.7% (143/282), 29.8% (84/282) and 3.9% (11/282; χ(2)=153.375, P<0.05) , and there was no degree Ⅳ. Until the end of the follow-up time, the incidence of radiation-induced injury in vaginal after completing the treatment within 1 year, 1-2 years,>2-<5 years and ≥5 years were respectively 80.0% (24/30) , 87.2% (102/117) , 88.2% (60/68) and 77.6% (52/67; χ(2)=4.231, P=0.238) . There were 30 cases be followed within 1 year after treatment, the incidence rate of degreeⅠ,Ⅱ and Ⅲ of radiation injury in vagina was 60.0% (18/30) , 20.0% (6/30) and 0, respectively (χ(2)=28.636, P<0.05). There were 117 cases be followed between 1-2 years after treatment, the incidence rate of degreeⅠ,Ⅱ and Ⅲ vaginal radiation-induced injury were 54.7% (64/117) , 29.9% (35/117) and 2.6% (3/117) , respectively (χ(2)=77.198, P<0.05) . There were 68 cases be followed between >2-<5 years after treatment, the incidence rate of degree Ⅰ,Ⅱ and Ⅲ vaginal radiation-induced injury were 51.5% (35/68) ,33.8% (23/68) and 2.9% (2/68) , respectively (χ(2)=39.525, P<0.05) . There were 67 cases be followed ≥5 years after treatment, the incidence rate of degree Ⅰ,Ⅱ and Ⅲ vaginal radiation injury were 38.8% (26/67) , 29.9% (20/67) and 9.0% (6/67) , respectively (χ(2)=16.395, P<0.05) . The single-factor analysis result indicated that the brachytherapy dose had an obvious effect on vaginal radiation-induced injury (χ(2)=5.344, P=0.021) ; however, other factors, such as age, BMI, FIGO stages and synchronous chemotherapy, had no obvious effect on vaginal radiation-induced injury (all P>0.05) . The multifactor analysis indicated that the brachytherapy dose was an independent factor affecting the occurrence of vaginal radiation-induced injury (P=0.043) . Conclusion: After the radical radiotherapy of cervical cancer, the vaginal radiation-induced injury is associated with the dose of brachytherapy.

CHD1 loss sensitizes prostate cancer to DNA damaging therapy by promoting error-prone double-strand break repair

Background

Deletion of the chromatin remodeler chromodomain helicase DNA-binding protein 1 (CHD1) is a common genomic alteration found in human prostate cancers (PCas). CHD1 loss represents a distinct PCa subtype characterized by SPOP mutation and higher genomic instability. However, the role of CHD1 in PCa development in vivo and its clinical utility remain unclear.

Patients and methods

To study the role of CHD1 in PCa development and its loss in clinical management, we generated a genetically engineered mouse model with prostate-specific deletion of murine Chd1 as well as isogenic CHD1 wild-type and homozygous deleted human benign and PCa lines. We also developed patient-derived organoid cultures and screened patients with metastatic PCa for CHD1 loss.

Results

We demonstrate that CHD1 loss sensitizes cells to DNA damage and causes a synthetic lethal response to DNA damaging therapy in vitro, in vivo, ex vivo, in patient-derived organoid cultures and in a patient with metastatic PCa. Mechanistically, CHD1 regulates 53BP1 stability and CHD1 loss leads to decreased error-free homologous recombination (HR) repair, which is compensated by increased error-prone non-homologous end joining (NHEJ) repair for DNA double-strand break (DSB) repair.

Conclusions

Our study provides the first in vivo and in patient evidence supporting the role of CHD1 in DSB repair and in response to DNA damaging therapy. We uncover mechanistic insights that CHD1 modulates the choice between HR and NHEJ DSB repair and suggest that CHD1 loss may contribute to the genomic instability seen in this subset of PCas.

Circulating LncRNAs Serve as Diagnostic Markers for Hepatocellular Carcinoma

BACKGROUND/AIMS

Circulating (serous or plasmic) long non-coding RNA (lncRNA) as biomarkers for predicting the diagnosis or prognosis of human disease have been well documented. Due to the sensibility or specificity limitation of Alpha Fetoprotein (AFP), a cluster lncRNAs were revealed as fingerprints for hepatocellular carcinoma (HCC). In this study, we enrolled all the reported circulating lncRNAs in HCC as candidate targets and examined in an independent cohort.

METHODS

The candidate lncRNAs were determined by qRT-PCR divided into training and validation sets. The risk score analysis was employed to evaluate the potential diagnosis ability of the lncRNAs independently or combining with AFP value. The receiver operating characteristic curve (ROC) was applied for presentation of sensibility or specificity.

RESULTS

Among the ten candidate circulating lncRNA, LINC00152, RP11-160H22.5, XLOC014172 and LOC149086 were screened with significant difference in training set. Further investigation in validation set indicated LINC00152, RP11-160H22.5 and XLOC014172 might be the fingerprints for HCC comparing with chronic hepatitis (CH) patients or healthy controls. The risk score analysis revealed the combination of three lncRNAs with AFP could distinguish the HCC from either CH or healthy control with the area under curve value (AUC) of 0.986 and 0.985, respectively.

CONCLUSION

The three lncRNAs may act as novel biomarkers for acting as fingerprint in HCC combining with AFP.

Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials

We designed a study to compare the efficacy of five main therapeutic options, including external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN) in treating humeral shaft fractures. Our results indicated that MIPO and IMN were recommended as the optimal treatments for clinical use.

PURPOSE

Nowadays, five main therapeutic options are used in treating humeral shaft fractures: external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN). Aiming to provide reliable evidence for clinical selection, we designed a network meta-analysis (NMA) to evaluate the efficacy of these treatments.

METHODS

NMA was conducted on Bayesian framework with software R 3.3.2 and STATA 13.0. Nonunion rate, radial nerve palsy rate, union time, complication rate, and infection rate were considered as primary outcomes. Mean operation time was the secondary outcome. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or mean difference (MD) with 95% CrIs. Surface under cumulative ranking curve (SUCRA) was calculated to show the ranking probability of each treatment.

RESULTS

Our results indicated that ORPO had a higher risk of radial nerve palsy than MIPO (OR = 2.83, 95% CrIs = 1.28-6.23), and DCP had a better performance in preventing complications than IMN (OR = 0.31, 95% CrIs = 0.11-0.84); no other significant difference were observed. According to the SUCRA results, MIPO had a high-ranking probability in almost all outcomes, while external fixation had lowest values in the majority of outcomes.

CONCLUSIONS

We recommended MIPO as the optimal treatment for humeral shaft fractures after taking all outcomes into consideration; IMN was also recommended for its relatively good performance, but its complication still needed to be noticed.

Comparing effects of cervical anterior approach and laminoplasty in surgical management of cervical ossification of posterior longitudinal ligament by a prospective nonrandomized controlled study

INTRODUCTION

The laminoplasty has been the most widely used surgical method for OPLL. In recent years, increasing attention has been drawn to the anterior operative approaches for surgical treatment of cervical OPLL. However, which method is the optimum selection for therapy of cervical OPLL is still obscure. Therefore, we performed this prospective nonrandomized clinical study in patients with multilevel cervical myelopathy due to OPLL and compare the therapeutic efficiency of laminoplasty and anterior approach (cervical discectomy and/or cervical corpectomy) in the management of multilevel cervical OPLL.

HYPOTHESIS

There is no difference in clinical effects between anterior cervical spine surgery and laminoplasty in the treatment of multilevel cervical OPLL.

MATERIAL AND METHODS

A total of 150 consecutive patients with multilevels of cervical OPLL underwent anterior approaches (ACDF, ACCF and HDF) from July 2010 to June 2014, which were enrolled in this study. During the same period, one hundred and two patients receiving the laminoplasty were enrolled in the study. The clinical effects, alignment and range of motion (ROM) of cervical spine in patients of the anterior group and posterior group were assessed, respectively. The effects of high signals in T2 weighed MRI scans and percentage of spinal canal stenosis in these patients were also evaluated. Finally, postoperative complications regarding each group were analyzed.

RESULTS

Although significant differences in types of OPLL and preoperative sagittal alignment of cervical spine occurred in the two groups (P<0.05), clinical effects of the two groups were similar (P>0.05). The cervical curvature in laminoplasty group showed significant decrease at final follow-up (P<0.05). For ROM of cervical spine, no significant alteration was observed in both groups. The high T2 weighed signals and rate of spinal canal stenosis can influence clinical effects of both anterior group and laminoplasty group. In addition, significantly higher complication rate was observed in laminoplasty group compared with anterior group (P<0.05).

DISCUSSION

Both anterior and laminoplasty approaches can be considered effective and safe procedures in the treatment of the multilevel OPLL. However, the anterior approach with relatively lower incidence of postoperative complications is a better choice for cases with poor cervical curvature and serious spinal canal stenosis.

TYPE OF STUDY AND LEVEL OF PROOF

Level 3 nonrandomized, controlled clinical trials.

Effects of paricalcitol on cardiovascular outcomes and renal function in patients with chronic kidney disease : A meta-analysis

BACKGROUND

Paricalcitol, a selective activator of the vitamin D receptor (VDR), influences calcium and phosphorus homeostasis and bone metabolism. Whether paricalcitol reduces cardiovascular risk and protects renal function remains unclear. To systematically evaluate this in patients with chronic kidney disease (CKD), we conducted a meta-analysis of published randomized controlled trials (RCTs).

METHODS

We searched MEDLINE, Embase, the Cochrane Library, and reference lists for RCTs comparing paricalcitol with placebo in stage 2-5 CKD (including pre-dialysis and renal replacement patients). The Cochrane quality assessment method was used to evaluate study quality. Results were summarized as risk ratios (RRs) for dichotomous outcomes or mean differences (MD) for continuous outcomes.

RESULTS

We included 21 studies comprising 1894 patients. Compared to placebo, paricalcitol reduced the risk of cardiovascular events (RR 0.55; 95% CI 0.35-0.87; p = 0.01), but the RR of hypercalcemia associated with paricalcitol was 6.50 (95% CI 3.21-13.15; p < 0.00001). Paricalcitol cannot significantly change systolic blood pressure and cardiac structure. Although proteinuria reduction was achieved more frequently with paricalcitol (RR 1.51; 95% CI 1.25-1.82; p < 0.0001), it did not significantly reduce proteinuria level compared to placebo. Paricalcitol could not protect renal function to delay CKD progression, since it reduced the glomerular filtration rate (MD -3.15; 95% CI -4.35--1.96; p < 0.0001) and elevated serum creatinine (MD 0.93; 95% CI 0.10-0.68; p = 0.008).

CONCLUSION

Paricalcitol reduces the risk of cardiovascular events in CKD patients but increases the risk of hypercalcemia and cannot improve cardiac structure. Meanwhile, it cannot significantly reduce proteinuria level or protect renal function.

[MicroRNA-563 promotes the osteogenic differentiation of posterior longitudinal ligament cells by inhibiting SMURF1]

Objective: To investigate the function and mechanism of miR-563 in regulating the ossification of posterior longitudinal ligament (OPLL) cells. Methods: Posterior longitudinal ligament cells were isolated and cultured from both OPLL patients (n=6) and non-ossified ligament patients (PLL, n=4) who underwent spine surgery from March to June 2015 in First Department of Spinal Surgery, Changzheng Hospital Affiliated to Second Military Medical University. The expression levels of miR-563 in OPLL and PLL groups were analyzed using real-time PCR. MicroRNA mimics were utilized to over express miR-563, and microRNA inhibitors were designed to knockdown its expression. Using the over expression and inhibition method, the level of Alizarin Red staining, alkaline phosphatase and ossification related genes in miR-563 were analyzed over expressed or inhibited and ossification induced ligament cells. After that the potential target of miR-563 was predicted using Targetscan and verified using dual-luciferase reporter assay. The results between the groups were compared by t test. Results: The expression level of miR-563 was significantly higher in OPLL than PLL groups (8.53±0.84 vs. 1.00±0.12, t'=21.629, P=0.000). The over expression of miR-563 resulted in higher level of alizarin red staining (2.52±0.25 vs.1.00±0.14), alkaline phosphatase activities (3.11±0.55 vs.1.00±0.11) and ossification related genes (RUNX2: 3.25±0.55 vs.1.00±0.10; IBSP: 2.35±0.32 vs. 1.00±0.14; t: 7.43 to 10.99, all P=0.000), while the inhibition resulted in lower level (alizarin red staining: 0.52±0.21 vs. 1.00±0.12; alkaline phosphatase activities: 0.41±0.12 vs. 1.00±0.09; RUNX2: 0.35±0.13 vs. 1.00±0.12; IBSP: 0.55±0.12 vs.1.00±0.11; t: 4.36 to 8.45, all P<0.05). Combining the prediction results of Targetscan and expression profiles between OPLL and PLL, SMURF1 was found as a potential target of miR-563, and dual-luciferase reporter assay also identified their relationship. By over expression, the expression level of SMURF1 was significantly decreased (0.25±0.06 vs.1.00±0.10, t=-12.862, P=0.000), which again verified the hypothesis. Conclusion: miRNA-563 significantly promotes the osteogenic differentiation of posterior longitudinal ligament cells in vitro, and the mechanism of which is possibly through down regulating SMURF1.

[Impact of CD137-CD137L signaling mediated exocytosis of autophagosome within vascular smooth muscle cells on the formation of atherosclerotic calcification]

Objective: To explore whether CD137-CD137L signaling mediated exocytosis of autophagosome within vascular smooth muscle cells (VSMCs) could influence the formation of atherosclerotic calcification. Methods: Fifteen 8-week-old male ApoE(-/-)(C57BL/6J-KO) mice fed with high fat diet for 5 weeks were randomly divided into three groups by using stochastic indicator method as follows: control group, n=5; agonist-CD137 group: agonist-CD137 antibody 200 μg/2 weeks for 4 weeks, ip, n=5; anti-CD137 group: 200 μg anti-CD137 antibody+ 200 μg agonist-CD137 antibody/2 weeks for 4 weeks, ip, n=5. Von Kossa staining was applied to observe the calcification of the thoracic aortic atherosclerotic plaque in each group. Immunohistochemistry was used to detect the expression of LC3 and Beclin1 which were the autophage markers of early-to-mid stage; Western blot was adopted to quantify protein level of microtubule-associated proteins 1 light chain 3B(LC3B) and mammalian ortholog of the yeast autophagy-related gene 6 (Beclin1). Transmission electron microscope (TME) was used to observe the formation of autophagosome in plaque. C57BL/6J mouse VSMCs were cultured by using tissue piece inoculation method. Groups of in vitro studies were the same as in vivo study: control group, agonist-CD137 group, anti-CD137 group, the agonist-CD137 groups was treated with agonist-CD137 antibody (10 μg/ml) and anti-CD137 group was treated with anti-CD137 antibody (10 μg/ml) for 30 minutes, followed by agonist-CD137 antibody (10 μg/ml). Von Kossa staining and osteogenesis phenotypic alkaline phosphatase (ALP) activity detection were adopted to observe calcification in VSMCs. Autophagosomes were separated from the supernatant of the agonist-CD137 group with density gradient centrifugation method. VSMCs were divided into two groups: positive group (containing complete medium with above autophagosomes to a final concentration 15 μg/ml) and negative group (only complete medium) after being pretreated with mixed inflammatory cytokines (IL-1β、IFN-γ and TNF-α, final concentration was 25 ng/ml respectively) for 24 hours and calcium deposition and osteogenesis phenotypic marker bone morphogenetic protein 2(BMP2) were then detected. Results: (1) Compared with the control group, activation of the CD137-CD137L signal significantly increased the formation of calcification area in thoracic aortic atherosclerotic plaque of ApoE(-/-) mice((1.82±0.15)×10(4) μm(2) vs. (0.34±0.08)×10(4) μm(2,) P<0.01), this effect was significantly attenuated by inhibiting this signal ((0.83±0.30)×10(4) μm(2) vs. (1.82±0.15)×10(4) μm(2,) P<0.05); positive autophagy makers LC3B and Beclin1 were detected in both agonist-CD137 group and anti-CD137 groups and the expression of LC3B and Beclin1 was substantially higher in anti-CD137 group. Western blot analysis indicated that the expression of LC3B and Beclin1 in agonist-CD137 group was significantly upregulated compared with the control group (0.17±0.01 vs. 0.03±0.08, P<0.05, and 0.12±0.02 vs. 0.06±0.02, P<0.05), which could be significantly downregulated in anti-CD137 group (0.28±0.09 vs. 0.17±0.01, P<0.05 and 0.17±0.02 vs. 0.12±0.02, P<0.05). TME showed that the number (QTY /HP) of autophagosome of agonist-CD137 group and anti-CD137 group in plaque were both increased (14.67±2.52 vs. 3.67±1.53, P<0.01, and 15.33±2.08 vs. 3.67±1.53, P<0.01), while in the agonist-CD137 group, the number of extracellular autophagosome within thoracic aortic atherosclerotic plaque of ApoE(-/-) mice increased more substantially (5.33±1.53 vs. 1.33±0.58, P<0.01). (2) In vitro study showed that activating CD137-CD137L signal could promote calcium deposition in extracellular matrix and the activity of osteogenesis phenotypic ALP((6.73±0.02) μmol/mg protein vs. (1.07±0.03) μmol/mg protein, P<0.05), and ((563.20±0.72) U/mg protein vs. (117.50±0.64) U/mg protein, P<0.05), while these effects were significantly blunted in anti-CD137 group ((1.94±0.05) μmol/mg protein vs. (6.73±0.02) μmol/mg protein, P<0.05, and (236.10±0.14) U/mg protein vs. (563.20±0.72) U/mg protein, P<0.05). TME showed that the number of intracellular autophagosome in agonist-CD137 group and anti-CD137 group was both significantly higher than in control group ((21.65±1.34) μg/ml vs. (8.32±1.58) μg/ml, P<0.01, and (15.42±1.65) μg/ml vs. (8.32±1.58) μg/ml, P<0.05). After the density gradient centrifugation, exocytotic autophagosome in the medium of agonist-CD137 group was markedly higher than in control group ((14.67±1.53) μg/ml vs. (2.33±1.15) μg/ml, P<0.01). (3) Compared with the control group, autophagosomes isolated from culture supernatant (final concentration: 15 μg/ml) could significantly stimulate calcium deposition((2.30±0.10) μmol/mg protein vs. (0.15±0.40) μmol/mg protein, P<0.05) and enhance the expression of bone morphogenetic protein 2 (2.10±0.04 vs. 0.30±0.01, P<0.05). Conclusion: CD137-CD137L signaling could mediate exocytosis of autophagosome within VSMCs, thus influence the formation of atherosclerotic calcification.