Intradiscal Injection of Autologous Discogenic Cells in Patients with Discectomy: A Prospective Clinical Study of Its Safety and Feasibility.

The treatment of intervertebral disc degeneration (IVDD) is still a huge challenge for clinical updated surgical techniques and basic strategies of intervertebral disc regeneration. Few studies have ever tried to combine surgery and cell therapy to bridge the gap between clinical and basic research. A prospective clinical study with a 72-month follow-up was conducted to assess the safety and feasibility of autologous discogenic cells transplantation combined with discectomy in the treatment of lumbar disc herniation (LDH) and to evaluate the regenerative ability of discogenic cells in IVDD. Forty patients with LDH who were scheduled to have discectomy enrolled in our study and were divided into the observed group (transplantation of autologous discogenic cells after discectomy) and control group (only-discectomy). Serial MRI and X-ray were used to evaluate the degenerative extent of index discs, and clinical scores were used to determine the symptomatic improvement. No adverse events were observed in the observed group, and seven patients in the control group underwent revisions. Both groups had significant improvement of all functional scores post-operatively, with the observed group improving more considerably at 36-month and 72-month follow-up. The height and water content of discs in both groups decreased significantly since 36 months post-op with the control group decreased more obviously. Discectomy combined with autologous discogenic cells transplantation is safe and feasible in the treatment of LDH. Radiological analysis demonstrated that discogenic cells transplantation could slow down the further degeneration of index discs and decrease the complications of discectomy.

Internal fixation and unicompartmental knee arthroplasty for an elderly patient with patellar fracture and anteromedial osteoarthritis: A case report.

BACKGROUND: Open reduction and internal fixation (ORIF) is the traditional surgical treatment for patellar fractures, and unicompartmental knee arthroplasty (UKA), especially Oxford UKA, has been increasingly used in patients with medial knee osteoarthritis (OA). However, the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear. We present the case of a patient with a patellar fracture and anteromedial OA. CASE SUMMARY: We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA. She also experienced a recent left patellar fracture. ORIF and Oxford UKA were performed in a single stage. The patient showed excellent postoperative clinical results. CONCLUSION: ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

Osteoporotic vertebral fracture misdiagnosed as "normal postoperative phenomenon" in post decompression surgery: a case report.

BACKGROUND: Previous research and published literature indicate that some patients with spinal diseases who underwent percutaneous transforaminal endoscopic decompression (PTED) still suffer some discomfort in the early recovery stage in the form of pain, stiffness, and swelling. These are usually considered minor residual symptoms or normal postoperative phenomenon (NPF) in the clinic, occur frequently, and are acknowledged by surgeons worldwide. To the best of our knowledge, we report the first case of a patient who had an osteoporotic vertebral fracture (OVF) misdiagnosed as NPF after she underwent PTED as a result of lumbar disc herniation (LDH). CASE PRESENTATION: A 71-year-old female with Parkinson's disease who presented with lower back pain radiating to the legs was diagnosed as LDH in L4-5, after which a PTED of L4-5 was performed, with temporary alleviation of symptoms. However, severe lower back pain recurred. Unfortunately, the recurred pain initially misdiagnosed as NPF, in fact, was finally confirmed to be OVF by CT-scan. OVF in the early stage of post-PTED seldom occurs and is rarely reported in the literature. With a percutaneous vertebroplasty, the pain was significantly relieved, and she resumed walking. After 36-weeks of follow-up, the pain improved satisfactorily. CONCLUSION: Doctors should not immediately diagnose a relapse of back pain following PTED as NPF, and hands-on careful physical and imaging examinations are necessary to manage recurring pain rightly and timely.

Lumbar plain radiograph is not reliable to identify lumbosacral transitional vertebra types according to Castellvi classification principle.

BACKGROUND: The anteroposterior view of the lumbar plain radiograph (AP-LPR) was chosen as the original and first radiographic tool to determine and classify lumbosacral transitional vertebra with morphological abnormality (MA-LSTV) according to the Castellvi classification. However, recent studies found that AP-LPR might not be sufficient to detect or classify MA-LSTV correctly. The present study aims to verify the reliability of AP-LPR on detecting and classifying MA-LSTV types, taking coronal reconstructed CT images (CT-CRIs) as the gold criteria. METHODS: Patients with suspected MA-LSTVs determined by AP-LPR were initially enrolled. Among them, those who received CT-CRIs were formally enrolled to verify the sensitivity of AP-LPR on detecting and classifying MA-LSTV types according to the Castellvi classification principle. RESULTS: A total of 298 cases were initially enrolled as suspected MA-LSTV, among which 91 cases who received CT-CRIs were enrolled into the final study group. All suspected MA-LSTVs were verified to be real MA-LSTVs by CT-CRIs. However, 35.2% of the suspected MA-LSTV types judged by AP-LPR were not consistent with the final types judged by CT-CRIs. Two suspected type IIIa and 20 suspected type IIIb MA-LSTVs were verified to be true, while 9 of 39 suspected type IIa, 9 and 3 of 17 suspected type IIb, and 11 of 13 suspected type IV MA-LSTVs were verified to truly be type IIIa, IIIb, IV and IIIb MA-LSTVs by CT-CRIs, respectively. Incomplete joint-like structure (JLS) or bony union structure (BUS) and remnants of sclerotic band (RSB) between the transverse process (TP) and sacrum were considered to be the main reasons for misclassification. CONCLUSION: Although AP-LPR could correctly detect MA-LSTV, it could not give accurate type classification. CT-CRIs could provide detailed information between the TP and sacrum area and could be taken as the gold standard to detect and classify MA-LSTV.

Successful Bony Healing For An Adult Patient With Isthmic Spondylolysis At Terminal Stage After Conservative Treatment: A Case Report.

PURPOSE: Spondylolysis, a defect or fracture of the pars interarticularis due to mechanical stress, is a common cause of lower back pain (LBP) in children and adolescents. Although conservative treatment has been shown to be most effective for young patients at early or progressive stage, few studies have reported the outcomes of conservative treatment for adult spondylolysis at terminal stage. We present the possibility of bony healing in the isthmic defect at terminal stage after conservative treatment. PATIENTS AND METHODS: A 50-year-old male patient complaining of moderate LBP was diagnosed as having L5 bilateral pars defect accompanied with related grade I spondylolisthesis though radiological evaluation. Magnetic resonance imaging revealed the sclerotic change in the defect of the isthmus, indicating spondylolysis at the terminal stage. This patient was treated with conservative management including lower back muscle functional exercises and medication when necessary. RESULTS: After five years of follow-up, the patient had a good recovery without reoccurrence. The repeated radiography and computed tomography demonstrated the pars defect had disappeared and been replaced by trabeculation, with no evidence of progressive segmental instability or vertebrae slip. CONCLUSION: Symptomatic adult patients with isthmus spondylolysis at terminal stage might still have an opportunity to be effectively managed with rigorous conservative treatment for obtaining bony healing. However, the progression of listhesis or persistent debilitating pain should warrant consideration for surgical treatment.

CXCR4-Overexpressing Umbilical Cord Mesenchymal Stem Cells Enhance Protection against Radiation-Induced Lung Injury.

Less quantity of transplanted mesenchymal stem cells (MSCs) influences the therapeutic effects on radiation-induced lung injury (RILI). Previous studies have demonstrated that MSCs overexpressing Chemokine (C-X-C motif) receptor 4 (CXCR4) could increase the quantity of transplanted cells to local tissues. In the present study, we conducted overexpressing CXCR4 human umbilical cord mesenchymal stem cell (HUMSC) therapy for RILI. C57BL mice received single dose of thoracic irradiation with 13 Gy of X-rays and then were administered saline, control HUMSCs, or CXCR4-overexpressing HUMSCs via tail vein. Transfection with CXCR4 enhanced the quantity of transplanted HUMSCs in the radiation-induced injured lung tissues. CXCR4-overexpressing HUMSCs not only improved histopathological changes but also decreased the radiation-induced expression of SDF-1, TGF-ß1, α-SMA, and collagen I and inhibited the radiation-induced decreased expression of E-cadherin. Transplanted CXCR4-overexpressing HUMSCs also could express pro-SP-C, indicated adopting the feature of ATII. These finding suggests that CXCR4-overexpressing HUMSCs enhance the protection against RILI and may be a promising strategy for RILI treatment.

"Acquired" Type Castellvi-IIIa Lumbarization Transformed From Castellvi-IIa Following Discectomy and Fusion at Lumbosacral Level: A Case Report.

STUDY DESIGN: A retrospective case report. OBJECTIVE: To report a case that transformed from type Castellvi-IIa sacralization to type Castellvi-IIIa after decompression and fusion surgery at transitional disc (TD). SUMMARY OF BACKGROUND DATA: Traditionally, lumbosacral transitional vertebra has been regarded as a congenital anomaly. No literature has ever reported that transformation from one type lumbosacral transitional vertebra to another would happen after birth. METHODS: A 60-year-old man presented to our department with the complaint of low back pain and left sciatic pain, and was diagnosed of lumbar disc herniation at L4-5 and L5-S1 levels. Lumbar digital radiography revealed an anomalous articulation formed between sacrum and enlarged right L5 transverse process, exhibiting a typical Castellvi-IIa sacralization. Dynamic lateral radiographs showed mobilization existed at L5-S1 disc which was TD. The patient received posterior lumbar interbody fusion (PLIF) surgery at L4-5 and L5-S1 levels. Postoperative computed tomography examinations were taken to identify the progress of solid fusion at the operated segments. RESULTS: After surgery, the patient's symptoms alleviated obviously. As solid fusion developed at intended interbody regions with time, we found that bony bridge passed through the patient's anomalous articulation region gradually, and finally, complete osseous fusion of the right L5 transverse process to the sacrum developed 1 year after surgery. CONCLUSION: Following PLIF surgery at TD segment on a Castellvi-IIa Sacralization case, "acquired" transformation to Castellvi-IIIa might develop. LEVEL OF EVIDENCE: 5.

A Comparison of Concentrations and Congener Patterns of Polybrominated Diphenyl Ethers in Seasonally Sampled Outdoor Air from a Farmland Area in Guangzhou, South China.

To investigate the concentration and congener patterns of polybrominated diphenyl ethers (PBDE) in outdoor air from farmland area, air samples were collected using passive and active sample methods from April to November 2012, in an e-waste dismantling town in the Guangzhou region of South China. The sum of gaseous and particulate PBDE concentrations averaged 74.26 pg/m3 and ranged between 3.24 and 247.30 pg/m3, while the mean gaseous and particulate PBDEs were 19.20 and 55.07 pg/m3, respectively. The PBDE level was comparable to those in urban air of non-electric waste areas, but much lower than those in both indoor and outdoor air of e-waste dismantling workshop area. Dominant congeners were BDE-47 and BDE-28 for the gaseous phase and BDE-209 and BDE-99 for the particulate phase. Relationship analysis showed that soil PBDEs were more significantly correlated with passive samples than with active samples, indicating that passive sample pattern could capture the accumulative effect of the sampling period and better represent the extent of soil contamination.

* Coculture with Partial Digestion Notochordal Cell-Rich Nucleus Pulposus Tissue Activates Degenerative Human Nucleus Pulposus Cells.

Recent studies suggested that notochordal cells (NCs) and NC-conditioned medium (NCCM) can stimulate cell viability and matrix production of nucleus pulposus cells (NPCs). However, the potential of notochordal cell-rich nucleus pulposus (NRNP) incorporating the native environment of the intervertebral disc (IVD) has not been evaluated. The objective of this study was to develop an optimal NRNP model and test whether it can allow a significant level of NPC activation in vitro. Rabbit NRNP explants were divided into three groups according to different digestion time: digestion NRNP of 8 h, partial digestion NRNP of 2 h, and natural NRNP. Cell viability and NC phenotype were compared between these groups after 14 days of incubation. The products of the selected partial digestion NRNP group were then cocultured with human degenerated NPCs for 14 days. NPC viability, cell proliferation and senescence, the production of glycosaminoglycan (GAG) found in extracellular matrix, and NP matrix production by NPCs were assessed. The results showed that coculturing with partial digestion NRNP significantly improved the cell proliferation, cell senescence, and disc matrix gene expression of NPCs compared with those in the monoculture group. In addition, GAG/DNA ratio in the coculture group increased significantly, while the level of collagen II protein remained unchanged. In this study, we demonstrated that partial digestion NRNP may show a promising potential for NPC regeneration in IVD tissue engineering.

[Research progress of application of middle and lower cervical anterior transpedicular screw fixation].

OBJECTIVE: To review the present situation of experimental study and clinical application of middle and lower cervical anterior transpedicular screw (CATPS) fixation. METHODS: The literature on the CATPS fixation was reviewed and summarized. RESULTS: There is a safe area to implement the CATPS fixation and anterior decompression, and fusion can be done at the same time. It can provide a new idea for surgical treatment of complex cervical disease. Although it has so many advantages, its complex operating methods and optimal design of plate should be attended. Long-term effectiveness and specific indications still should be researched. CONCLUSION: Middle and lower cervical anterior transpedicular screw is an effective and safe fixation for cervical diseases. But the time for clinical use is short, the long-term effectiveness, surgical technique, and internal fixation devices are still need further study.

[The construction of recombinant adenovirus containing p38MAPK gene and its expression in mouse osteoblast-like cells (MC3T3-E1)].

AIM: To construct a recombinant adenovirus vector containing p38MAPK gene and to identify its expression in mouse osteoblast-like cells, MC3T3-E1, in vitro. METHODS: The p38MAPK gene was amplified by PCR from mouse liver cDNA library, and inserted into pMD18-T vector and sequenced. Double digested with Bgl II and Hind III, p38MAPK gene was inserted into pShuttle-CMV. This recombinant plasmid was linearized by Pme I and electronically transfected into BJ5183 to get the recombinant adenovirus vector Ad-p38MAPK. Then the Ad-p38MAPK was obtained by packaging Pac I linearized in AD293 cells. The recombinant adenovirus expressing p38MAPK was infected into osteoblast- like cells(MC3T3-E1).The expression of exogenous p38MAPK was observed by Western blot. RESULTS: The recombinant plasmid Ad-p38MAPK was successfully generated, which increased p38MAPK protein expression levels in MC3T3-E1. CONCLUSION: The bioactive recombinant adenovirus Ad-p38MAPK has been successfully constructed. The study laid a foundation for further research of the function of p38MAPK in osteoblast.

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) could be an effective adjuvant therapy for orthopedic implant-related infections (OIRI).

Bone infections associated with foreign bodies are very difficult to treat satisfactorily. The tissue damage and circulation destruction caused by surgery make the organism susceptible to infection. Meanwhile, the presence of foreign body lowers the threshold of bacterial infection and often generates local immunosuppression. In such cases, antibiotic therapies are usually not efficacious and removing the implant is the only solution for completely eradicating the problem. Recombinant human granulocyte colony-stimulating factor (rhG-CSF) has been in clinical use for about two decades, most commonly adopted for treating of various types of neutropenia. Many studies have also demonstrated that rhG-CSF play important roles in nonneutropenic infections, angiogenic response and tissue repairing. In addition to increasing the number of neutrophils, rhG-CSF helps to enhance the neutrophil microbicidal functions. More importantly, orthopedic implant-related infections (OIRI) are especially good indications for the administration of rhG-CSF in therapeutic regimens. rhG-CSF may also play important roles in the process of postsurgery revascularization and tissue repairing, which would help a lot in treating infections and preventing implant failure. So far, there has been no report of such cases in this field. Therefore, a hypothesis is put forward in the paper that application of rhG-CSF may well be an effective adjuvant therapy for OIRI.

[Complications of surgical treatment for femoral intertrochanteric fractures using dynamic hip screw].

OBJECTIVE: To investigate the complications of surgical treatments for femoral intertrochateric fractures using dynamic hip screw (DHS). METHODS: From Jan. 2002 to Dec. 2007, sixty-nine patients with intertrochanteric fractures were treated by dynamic hip screw fixation included 27 males and 42 females,with an average age of 72.9 years ranging from 53 to 96 years. According to Evans classification there were 10 cases in type I ,21 in type II, 22 in type III, and 16 in type IV, of which 51 patients (73.9%) suffered from systematic diseases preoperatively. RESULTS: Fifty-seven patients were followed up for 8 to 70 months (41 months on average). Four patients died, 17 cases occurrenced systematic complications postoperatively. Internal fixation related complications occurred in 12 patients. There were 8 cases with mechanical failure of DHS including 4 of screw loosen,3 of cutting-out of device through femoral head and neck and 1 of plate breakage. Five patients had a coxa vara, and delayed union occurred in 4 patients. CONCLUSION: Unstable fracture pattern produced high percentage of mechanical failure. In such cases DHS should not be the first choice for treatment. The appropriate treatment should be in relation to pre-operative fracture stability and osteoporosis.

Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study.

BACKGROUND: Spinal fusion can be complicated by accelerated degeneration of the adjacent segments. Artificial disc replacements have been developed, but results are variable. Successful transplantations of intervertebral disc autografts, fresh allografts, and fresh-frozen allografts-ie, a non-fusion strategy-in which the mobility and stability of the spinal segment were preserved have been done in a primate model. Our aim was to determine the feasibility, safety, and long-term clinical results of disc transplantation in human beings. METHODS: Five patients, average age 47 years, with cervical disc herniation underwent transplantation of fresh-frozen composite disc allografts after disc excision. Serial MRI and static and dynamic radiographs were used to monitor the status of the grafts and the sagittal stability and mobility of the segment. FINDINGS: Good union of the graft endplates was seen by the end of 3 months after surgery in all patients. At a minimum follow-up of 5 years, the neurological symptoms of all patients had improved from before surgery levels. No immunoreaction was encountered. There was no olisthesis and only mild degenerative changes of the transplanted discs. All except one of the discs showed preservation of 7.0-11.3 degrees of sagittal motion at the final follow-up. MRI at 5 years showed preservation of hydration in at least two discs. INTERPRETATION: Despite signs of mild disc degeneration, the motion and stability of the spinal unit was preserved after transplantation of fresh-frozen allogenic intervertebral discs in our patients. With further refinements, such transplantations could be an effective treatment for degenerative disc disease.

[Compliance variation following the change of longitudinal stretch ratio. A study on femoral artery and vein in a rabbit model].

This study was aimed to establish a rabbit model of bridging artery defect with autogenous vein under equal arterial and venous compliances by selecting an appropriate anastomosing tension based on assessing the influence of vessel's longitudinal strain on compliance. The exponential form P = M1 x [eM2(v-v0)-1] was employed to fit the blood pressure-unit volume curves under different stretch ratios(lambda) obtained from real curves on 13 femoral arteries and 12 veins whose uniaxial loading tests at longitudinal directions had been performed, then the quantic M = a1 lambda 5 + a2 lambda 4 + a3 lambda 3 + a lambda 2 + a5 lambda + a6 was done to fit M-lambda data. Results showed the differential form dv/dp = 1/(M1 x M2 + 11.78 M2) derived from P = M1 x [eM2(v-v0)-1], and lambda reflected the relationship between compliance and stretch ratio (or longitudinal tension) under average artery pressure 11.78 KPa well. It was found that under longitudinal tension 1.19 g, the arterial and venous compliances were equal(0.031 microliter/KPa) while the respective stretch ratios were 1.32 and 1.67.