The aim of this study was to explore whether a robot-assisted (RA) technique has advantages over the conventional fluoroscopy-assisted (FA) technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in adolescent idiopathic scoliosis (AIS) correction surgery. A total of 101 patients with AIS were recruited (RA group: 45 patients underwent RA screw insertion; FA group: 56 patients underwent FA screw insertion). When comparing the radiological data between the two groups, the major and secondary curves were both corrected proficiently with no difference in Cobb angle comparison at the last follow-up, suggesting that both the RA technique and the FA technique could lead to efficient radiographic correction and similar clinical outcomes (all, p > 0.05). In the RA group, operation time, blood loss, and transfusion volume were significantly greater than those in the FA group, while the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve in the RA group was higher than that in the FA group. In conclusion, both the RA and FA techniques could approach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with the conventional fluoroscopy technique, the RA technique might improve the accuracy of screw implantations in patients with AIS with a thoracic scoliotic curve, while the increased operation time, blood loss, and transfusion volume might be the disadvantages due to the preliminary stage of the learning curve.
Abstract Backgrounds Abnormal vertebral growth and development have been found in adolescent idiopathic scoliosis (AIS) patients, and the proliferation and differentiation of bone development‐related cells play important roles in its pathogenesis. However, a comprehensive single‐cell‐level differentiation roadmap in AIS has not been achieved. Methods The present study compared the single‐cell level cellular landscapes of spinal cancellous bone tissues between AIS patients and healthy subjects using high throughput single‐cell RNA sequencing (scRNA‐seq), which covers multiple cellular lineages including osteoblast, chondrocyte, osteoclast and related immunocytes. We constructed the differentiation trajectories of bone development‐related cell lineages through pseudotime analysis, and the intercellular‐communication networks between bone development‐related cells and immunocytes were further developed. Results A total of 11 distinct cell clusters were identified according to the genome‐wide transcriptome profiles. t ‐Distributed stochastic neighbor embedding (t‐SNE) analysis showed that mesenchymal stem cells (MSC) were classified into three subtypes: MSC‐LOXL2, MSC‐IGFBP5, and MSC‐GJA1. Gene ontology (GO) analysis showed that MSC‐GJA1 might possess greater osteoblast differentiation potential than the others. MSC‐IGFBP5 was the specific MSC subtype observed only in AIS. There were two distinct gene expression clusters: OB‐DPT and OB‐OLFML2B, and the counts of osteoblasts derived from AIS was significantly less than that of non‐AIS subjects. In AIS patients, MSC‐IGFBP5 failed to differentiate into osteoblasts and exhibited negative regulation of cell proliferation and enhanced cell death. CPC‐PCNA was found to be the specific chondrocyte progenitor cell (CPC) subtype observed only in AIS patients. The cell counts of OC‐BIRC3 in AIS were less than those in controls. Pseudotime analysis suggested two possible distinct osteoclast differentiation patterns in AIS and control subjects. Monocytes in AIS mainly differentiated into OC‐CRISP3. Conclusions Our single‐cell analysis first revealed differences existed in the cellular states between AIS patients and healthy subjects and found the differentiation disruption of specific MSC and CPC clusters in AIS. Cell communication analysis provided the possible pathogenesis of osteoblast and chondrocyte differentiation dysfunction in AIS.
Abstract The aim of this study is to explore whether robot-assisted technique has advantages over conventional fluoroscopy-assisted technique in clinical and radiological outcomes and whether it could decrease the incidence of mis-implantations of pedicle screws in AIS correction surgery.A total of 101 AIS patients were recruited (RA group: 45 patients underwent robot-assisted screw insertion; FA group: 56 patients underwent fluoroscopy-assisted screw insertion). When compared the radiological data between two groups, major and secondary curve were both corrected proficiently with no difference in the Cobb angle comparison at last follow-up, suggesting that both robot-assisted technique and fluoroscopy-assisted technique could lead to efficient radiographic correction and similar clinical outcomes (all, P< 0.05). In RA group, operation time, blood loss and transfusion volume were significantly greater than those in FA group, while the accuracy of screw implantations in AIS patients with thoracic scoliotic curve in RA group was higher than that in FA group.In conclusion, both robot-assisted and fluoroscopy-assisted technique could reach proficient radiographic correction and similar clinical outcomes in AIS surgery. Compared with conventional fluoroscopy technique, robot-assisted technique might improve the accuracy of screw implantations in AIS patients with thoracic scoliotic curve, while the increased operation time, blood loss and transfusion volume might be the disadvantages due to preliminary stage of learning curve.
Postmenopausal osteoporosis is caused by the deficiency of estrogen, which breaks bone homeostasis and induces levels of pro-inflammatory cytokines. Muscone is a potent anti-inflammatory agent and is used to treat bone fracture in traditional Chinese medicine. However, its anti-osteoclastogenic effects remain unclear. For in vitro study, morphology tests of osteoclastogenesis were firstly performed. And then, factors in RANK-induced NF-κB and MAPK pathways were examined by RT-PCR and Western blot, and the binding of TNF receptor-associated factor (TRAF)6 to RANK was inspected by coimmunoprecipitation and immunofluorescence staining. For in vivo experiments, C57BL/6 ovariectomized (OVX) mice were used for detection, including H&E staining, TRAP staining, and micro CT. As a result, muscone reduced OVX-induced bone loss in mice and osteoclast differentiation in vitro, by inhibiting TRAF6 binding to RANK, and then suppressed NF-κB and MAPK signaling pathways. The expression of the downstream biomarkers was finally inhibited, including NFATc1, CTR, TRAP, cathepsin K, and MMP-9. The inflammatory factors, TNF-a and IL-6, were also reduced by muscone. Taken together, muscone inhibited the binding of TRAF6 to RANK induced by RANKL, thus blocking NF-kB and MAPK pathways, and down-regulating related gene expression. Finally, muscone inhibited osteoclastogenesis and osteoclast function by blocking RANK-TRAF6 binding, as well as downstream signaling pathways in vitro. Muscone also reduced ovariectomy-induced bone loss in vivo.
Spinal fusion is considered the gold standard procedure for treating spinal degeneration, tumors, and trauma. An inflammatory response is an important part of bone repair. We investigated the polarization change of inflammatory macrophages (M1) and resident macrophages (M2) during low-intensity pulsed ultrasound (LIPUS) treatment.Thirty male Sprague Dawley rats (age: 12 weeks; weight: 300 g) were used in the study. A rat spinal fusion model was established by surgical procedures. LIPUS treatment (20 min. d, 5 d/wk) was begun 3 days after surgery. The rats were randomly divided into a control group (5 subgroups, 3 rats in each subgroup) and LIPUS group (5 subgroups, 3 rats in each subgroup), and sacrificed on day 3, 5, 7, 10, and 14 after spinal fusion surgery for further evaluation. Bone volume was measured by micro-CT, fusion region was examined by histological analyses, types of macrophages in the fusion area were examined by immunohistochemical staining. Raw264.7 cells and bone marrow-derived macrophages (BMDM) were used in cell experiments. Cells were divided into a control group and LIPUS group. Flow cytometry was used to examine the rate of resident macrophages, and real-time PCR was used to examine the mRNA expression of anti-inflammation genes.LIPUS promoted spinal fusion and stimulated the transition of F4-80+/Mac-2+ (M1) to F4-80+/Mac-2- (M2), leading to the early appearance of resident macrophages. Cell experiments showed CD206+ macrophages (M2) were significantly increased after LIPUS treatment. M2-related genes and anti-inflammation factors (Arg-1, PPAR-γ, and IL-4) were increased after LIPUS treatment.The earlier transition from inflammatory to resident macrophage might be one reason for the positive effect of LIPUS on spinal fusion.
Abstract Background: PSEQ has been cross-culturally adapted into many languages with excellent reliability and validity. Recently, the short form of PSEQ-2 was developed and exhibited satisfactory psychometric properties. However, PSEQ and PSEQ-2 has not been translated or validated in mainland China. The present study aimed to evaluate the psychometric properties of simplified Chinese version of PSEQ and PSEQ-2 in patients with chronic pain. Methods: The original version of PSEQ and PSEQ-2 were linguistically translated and adapted to formulate the simplified Chinese version, which were then administrated by 219 patients with chronic pain, along with a set of self-report health-related instruments. Statistical analysis was performed to evaluate the psychometric properties of the simplified Chinese version PSEQ and PSEQ-2. Results: The simplified Chinese version of PSEQ and PSEQ-2 had been determined good to excellent internal consistency (Cronbach’s alpha, 0.95 and 0.83), test-retest reliability (overall ICC, ). and sound construct validity, which was supported by moderately strong association with the criterion measures. Additionally, exploratory and confirmatory factor analysis have found and confirmed one factor solution as hypothesized. Conclusion: The simplified Chinese version of PSEQ and PSEQ-2 showed satisfactory psychometric properties in Chinese population with chronic pain, and could be safely utilized to evaluating the self-efficacy in clinical and research setting. Keyword. PSEQ; PSEQ-2; simplified Chinese; validation
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