Functional Outcomes of Therapeutic Selective Nerve Root Block for Single-Segment Lumbar Spinal Stenosis: A Retrospective Study.

BACKGROUND Functional evaluation after therapeutic selective nerve root block (SNRB) has been rarely reported. We explored functional outcomes of SNRB for single-segment lumbar spinal stenosis (LSS). MATERIAL AND METHODS Data for 117 patients with single-segment LSS who underwent single therapeutic SNRB were retrospectively collected between January 2019 and December 2021. Functional outcomes were assessed using Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scores preoperatively, and 3 days, and 3, 6, and 12 months after SNRB, which were compared in subgroups stratified by age, sex, BMI, sedentary time, hypertension, diabetes, affected side, pathology level, intervertebral disk. Correlation between ODI and JOA was analyzed using univariate linear regression analysis. RESULTS Clinical symptoms of LSS significantly improved within 12 months after SNRB, especially at 6 months (P<0.05). ODI scores in each subgroup gradually decreased within 6 months after SNRB, and JOA scores gradually increased. Most subgroup analyses revealed significantly increased ODI scores and decreased JOA scores at 12 months after SNRB, compared with 6-month scores (P<0.05). Notably, ODI and JOA scores at 12 months after SNRB were not significantly different than those before SNRB in patients with BMI >25 or sedentary time >8 h (P>0.05). A significant correlation existed between ODI and JOA scores (P<0.05). CONCLUSIONS Therapeutic SNRB was an effective treatment for alleviating LSS within at least 6 months. Changing sedentary habits with appropriate exercise and controlling weight with a healthy diet can improve the effectiveness of SNRB, especially in patients for whom conservative treatment is ineffective and who are unsuitable for surgical treatment.

Imaging-Navigated Surgery.

It is vitally important to guide or navigate therapeutic proceedings with a direct and visual approach in order to carefully undertake precision medical manipulations and efficiently evaluate the treatments. Imaging-navigated surgery is one of the common and prevailing technologies to realize this target, and more importantly it merges visualized medicine into next-generation theranostic paradigms in modern medicine. Endoscopes, surgical robots, and nanorobots are three major domains in terms of imaging-navigated surgery. The history of endoscopy has seen upgraded developments since the early 1800s. In contrast, surgical robots have been widely used and investigated in recent years, and they came into clinical uses only in the past decades. Nanorobots which closely depend on innovated and multifunctional biomaterials are still in their infancy. All these imaging-navigated technologies show similar and apparent advantages such as minimal invasiveness, minimized pain, positive prognosis, and relatively expected recovery, which have greatly improved surgery efficiency and patients' life quality. Therefore, the imaging-navigated surgery will be discussed in this chapter, and advanced clinical and preclinical medical applications will also be demonstrated for a diverse readers and comprehensive understanding.

Effects of the cage height and positioning on clinical and radiographic outcome of lateral lumbar interbody fusion: a retrospective study.

BACKGROUND: The proper cage positioning and height in lateral lumbar interbody fusion (LLIF). This study evaluated their effects on clinical and radiographic outcome measures in patients undergoing LLIF. METHODS: This single-center retrospective study analyzed the characteristics and perioperative data of patients who underwent LLIF between January 2019 and December 2020. Radiographic (lumbar lordosis [LL], foraminal height, disc height [DH], segmental angle [SA], cross-sectional area [CSA] of thecal sac) and clinical (Oswestry Disability Index and Visual Analog Scale) outcomes were assessed preoperatively, postoperatively, and at the last follow-up. The effects of cage height and positioning on these parameters were also investigated. RESULTS: With a mean follow-up of 12.8 months, 47 patients with 70 operated level were analyzed. Data demonstrated that postsurgical clinical and radiographic outcome measures were significantly better than before surgery(P < 0.05). Cage height and positioning showed no significant difference with regarding to clinical outcome(P > 0.05). Subgroup analysis of the cage positioning showed that DH and SA were better restored by the final follow-up in patients with anteriorly placed cages than those with posteriorly placed cages (P < 0.05). Cages of posterior position showed significantly upgrading cage subsidence (P = 0.047). Cage height subgroup analysis showed that the preoperative forminal height, DH, and SA in the 11-mm cage group were significantly lower than in the 13-mm cage group; however, these parameters were comparable in the two groups postoperatively and at the final follow-up (P > 0.05). Furthermore, the postoperative and final follow-up degrees of DH, SA, and LL have improved in the 11-mm cage group more than the 13-mm cage group. The preoperative, postoperative, and final follow-up LL values in the 11-mm cage group were lower than in the 13-mm cage group(P < 0.01). CONCLUSIONS: Cage height and positioning did not affect the clinical outcomes in the present study. Cages in anterior position showed better restoration in DH, SA and decreased the incidence of cage subsidence. A comparable radiographic outcome can be achieved by inserting an appropriate cage height based on preoperative radiography.

Fabrication of an injectable hydrogel with inherent photothermal effects from tannic acid for synergistic photothermal-chemotherapy.

Developing injectable hydrogels with near-infrared (NIR)-responsive photothermal effects has increasingly become a promising strategy for local cancer treatment via combinational photothermal-chemotherapy. Herein, a biocompatible hydrogel with a remarkable shear-thinning and recovery capability for injection application was fabricated from 4-arm-PEG-SH and tannic acid through chemical crosslinking and multiple physical interactions. Benefiting from the formation of dynamic TA/Fe3+ complexes within gel networks, the obtained hydrogel exhibited an intrinsic NIR absorption property for photothermal ablation of tumor cells, and enhanced cellular uptake of chemotherapeutic drugs. Both in vitro and in vivo experiments revealed that the injectable hydrogel exhibited an excellent biocompatibility and a synergistic therapeutic effect on tumor growth via combinational photothermal-chemotherapy. Therefore, this work provides a promising attempt to develop an injectable and NIR-responsive hydrogel from TA/Fe3+ complexes, which could work as a localized drug delivery platform for synergistic photothermal-chemotherapy.

Design and development of 1,3,5-triazine derivatives as protective agent against spinal cord injury in rat via inhibition of NF-ĸB.

Spinal cord injury (SCI) is a chronic disease causing motor and sensory loss in the affected individuals. The SCI has a huge impact on the lives of patients that makes them susceptible to life-long disability. However, the current clinical modalities are ineffective to cope the aftermath of SCI. Thus, in the present study, we aimed to develop a series of 1,3,5-triazine derivatives as a protective agent against SCI. The molecules were developed by facile synthetic route and obtained in excellent yield. The compounds were tested for their efficacy to inhibit the transcription of NF-κB in RAW 264.7 cells, where they displayed mild to potent activity. Compound 8a was identified as most potent NF-κB inhibitor among the tested analogues. The effect of compound 8a was further scrutinized against the SCI injury in rats induced by contusion injury. It has been found that compound 8a improves motor function of rats together with reduction in inflammation and edema in spinal cord of rats. It also showed to inhibit oxidative stress and inflammation in the SCI rats. In a western blot analysis, after SCI induction, compound 8a inhibited NF-κB and its upstream regulator TLR4 in a dose-dependent manner. Collectively, our study provides a novel class of agent that provide protective action against SCI.

Protective effect of Oxymatrine against acute spinal cord injury in rats via modulating oxidative stress, inflammation and apoptosis.

The present study was performed to examine the effect of oxymatrine (OMT) on motor functions and histopathologic changes after spinal cord injury and the mechanism underlying its neuroprotective effects. Results suggested that, OMT causes regain of lost motor function near to normal via attenuating oxidative stress, inflammatory response and cellular apoptosis. These observations were further supported by histological examination of spinal cord of rats. It also showed to regulate pro-inflammatory cytokines, Bcl2 family proteins and reduces the level of toll like receptor (TLR-4) and nuclear factor-kappa B (NF-ĸB) in concentration dependent manner. The mitogen-activated protein kinase (MAPK) pathway was also regulated by OMT after SCI. It has been suggested that, OMT promotes the recovery of motor function after SCI in rats via multiple mechanism, and this effect may be related to its anti-oxidant, anti-inflammatory and anti-apoptotic effects.

Abnormal sub-pathways competitively regulated by lncRNAs contribute to postmenopausal osteoporosis.

Abnormal sub-pathways competitively regulated by long non-coding RNAs (lncRNAs) for postmenopausal osteoporosis (PO) based on integration of lncRNA-mRNA expression data and pathway network topologies were investigated. Interesting lncRNA-mRNA pairs were selected by Pearsons correlation coefficient (PCC) algorithm on the basis of lncRNA-miRNA and miRNA-mRNA interactions and gene expression profiles. Then, lncRNAs in interesting pairs were embedded into pathway graphs as signature nodes by linking to their regulated-mRNAs, and lncRNA competitively regulated pathways (LCRPs) were gained for PO patients. Moreover, sub-pathways were detected dependent on the shortest distance similarity and the pathway topology. The abnormal sub-pathways were determined utilizing the Wallenius approximation methods through evaluating the statistical significance of sub-pathways. In total 75 interesting lncRNA-mRNA pairs (representing 17 lncRNAs and 74 mRNAs) were identified. Subsequently, 42 LCRPs were extracted from pathway graphs by signature lncRNA regulated mRNAs. Moreover, 14 abnormal sub-pathways with P<0.05 were obtained between PO patients and controls, such as sub-pathways of PI3K-Akt signaling pathway and long-term potentiation. This finding may facilitate understanding the molecular mechanism of PO, and point a new direction to identify potential biomarkers for treatment and prevention of the disease.

Porous beta-tricalcium phosphate/collagen composites prepared in an alkaline condition.

Bone substitute materials with natural bone-like structure are considered to be favorable for bone regeneration. In this work, porous beta-tricalcium phosphate (beta-TCP)/collagen composite consisting of bone-like microstructural units was prepared using nanosized beta-TCP particles and alkaline-disassembled collagen. The resulting composite showed a good interconnecting porous structure with approximately 90% porosity and 100 approximately 300 microm pore size. The pore walls were dense, and the combination status of collagen and nanosized beta-TCP particles demonstrated that nanosized beta-TCP particles tightly connected collagen microfibrils as a bone-like microstructural unit. MTT and alkaline phosphatase (ALP) assays showed that the porous composite had enhanced effects on cellular proliferation and activity of osteoblast compared with a control of pure collagen. It is suggested that the adoption of nanosized beta-TCP particles is a main contribution to the formation of the composite with a bone-like microstructural unit, and the unique microstructure could be a main role for the composite to have the positive influence on osteoblast cell proliferation.

Preparation, characterization and cytocompatibility of porous ACP/PLLA composites.

The purpose of this work was to incorporate amorphous calcium phosphate (ACP) into porous poly(L-lactic acid) (PLLA), because ACP is capable of fast phase transformation and morphological change in body fluid, such, a desired pore wall surface within bone tissue engineering scaffolds can be created. A highly porous ACP/PLLA composite was prepared by a thermally induced phase separation technique. The results showed that the composite had an interconnected pore structure with 100 mum macropores and 10 mum micropores, and 91% porosity; 40 nm primary particles of ACP were agglomerated to 3 mum aggregates, and the aggregates were homogeneously distributed in pore walls; These aggregates showed to be in situ transformed into bone-like apatite after 1 h soaking in phosphate buffered saline solution. Human osteoblast-like cell culture showed that the ACP/PLLA composite had better cell adhesion and alkaline phosphotase activity than pure PLLA. This study demonstrates that the ACP/PLLA composite can enhance cytocompatibility and could act as a promising scaffold for bone tissue engineering.