Vertebral augmentation in osteoporotic spine fractures: WFNS Spine Committee recommendations.

INTRODUCTION: The aim of this study was to formulate the WFNS Spine Committee guidelines on indications, outcomes, and complications of vertebral augmentation in osteoporotic spine fractures. EVIDENCE ACQUISITION: Computerized literature was searched from 2010 to 2021 using keywords "vertebral augmentation," "osteoporotic fracture," "technique," "surgery," "complication," and "outcome." PubMed yielded 92 articles whereas Google scholar resulted in 120 articles. 29 articles were studied in detail. The studies comprised of seventeen RCT's, two prospective non-randomized studies, three retrospective studies, and seven systematic reviews. The statements were produced to reach a consensus in two separate meetings of WFNS Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. EVIDENCE SYNTHESIS: Drafted statements on "Vertebral Augmentation in osteoporotic Spine Fractures" were voted upon by expert panelists in Virtual WFNS Spine Committee Consensus Meetings conducted on January 11, 2021, and February 13, 2021. Statements reaching positive consensus provided the basis for the WFNS guidelines regarding vertebral augmentation in osteoporotic spine fractures. CONCLUSIONS: WFNS Spine Committee recommendations on vertebral augmentation in osteoporotic spine fractures are summarized in this article. Vertebral augmentation is superior to conservative treatment for vertebral osteoporotic fractures but has conflicting results on comparison with placebo. Both vertebroplasty and kyphoplasty are equally effective. Most of the studies regarding the efficacy of vertebral augmentation procedures to reduce pain have been largely inconclusive. It is suggested that further high quality, better designed randomized controlled studies are required to establish the role of vertebral augmentation in spine osteoporotic compression fractures.

Comparative molecular analyses of select pH- and osmoregulatory genes in three freshwater crayfish Cherax quadricarinatus, C. destructor and C. cainii.

Systemic acid-base balance and osmotic/ionic regulation in decapod crustaceans are in part maintained by a set of transport-related enzymes such as carbonic anhydrase (CA), Na+/K+-ATPase (NKA), H+-ATPase (HAT), Na+/K+/2Cl- cotransporter (NKCC), Na+/Cl-/HCO[Formula: see text] cotransporter (NBC), Na+/H+ exchanger (NHE), Arginine kinase (AK), Sarcoplasmic Ca+2-ATPase (SERCA) and Calreticulin (CRT). We carried out a comparative molecular analysis of these genes in three commercially important yet eco-physiologically distinct freshwater crayfish, Cherax quadricarinatus, C. destructor and C. cainii, with the aim to identify mutations in these genes and determine if observed patterns of mutations were consistent with the action of natural selection. We also conducted a tissue-specific expression analysis of these genes across seven different organs, including gills, hepatopancreas, heart, kidney, liver, nerve and testes using NGS transcriptome data. The molecular analysis of the candidate genes revealed a high level of sequence conservation across the three Cherax sp. Hyphy analysis revealed that all candidate genes showed patterns of molecular variation consistent with neutral evolution. The tissue-specific expression analysis showed that 46% of candidate genes were expressed in all tissue types examined, while approximately 10% of candidate genes were only expressed in a single tissue type. The largest number of genes was observed in nerve (84%) and gills (78%) and the lowest in testes (66%). The tissue-specific expression analysis also revealed that most of the master genes regulating pH and osmoregulation (CA, NKA, HAT, NKCC, NBC, NHE) were expressed in all tissue types indicating an important physiological role for these genes outside of osmoregulation in other tissue types. The high level of sequence conservation observed in the candidate genes may be explained by the important role of these genes as well as potentially having a number of other basic physiological functions in different tissue types.