MicroRNA-497-5p stimulates osteoblast differentiation through HMGA2-mediated JNK signaling pathway.

BACKGROUND: Osteoporosis (OP) has the characteristics of the decline in bone mineral density and worsening of bone quality, contributing to a higher risk of fractures. Some microRNAs (miRNAs) have been validated as possible mediators of osteoblast differentiation. We herein aimed to clarify whether miR-497-5p regulates the differentiation of osteoblasts in MC3T3-E1 cells. METHODS: The expression of miR-497-5p in OP patients and controls was measured by RT-qPCR, and its expression changes during osteoblast differentiation were determined as well. The effects of miR-497-5p on the differentiation of MC3T3-E1 cells were studied using MTT, ALR staining, and ARS staining. The target gene of miR-497-5p was predicted by TargetScan, and the effects of its target gene on differentiation and the pathway involved were investigated. RESULTS: miR-497-5p expressed poorly in OP patients, and its expression was upregulated during MC3T3-E1 cell differentiation. Overexpression of miR-497-5p promoted mineralized nodule formation and the expression of RUNX2 and OCN. miR-497-5p targeted high mobility group AT-Hook 2 (HMGA2), while the upregulation of HMGA2 inhibited osteogenesis induced by miR-497-5p mimic. miR-497-5p significantly impaired the c-Jun NH2-terminal kinase (JNK) pathway, whereas HMGA2 activated this pathway. Activation of the JNK pathway inhibited the stimulative role of miR-497-5p mimic in osteogenesis. CONCLUSIONS: miR-497-5p inhibits the development of OP by promoting osteogenesis via targeting HMGA2.

Enhanced recovery after surgery (ERAS) pathway for microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion.

OBJECTIVES: Enhanced recovery after surgery (ERAS) principle and minimally invasive surgery allow patients to recover faster and better postoperatively. Due to a paucity of their integration, this retrospective study aims to assess clinical outcomes of ERAS pathway in microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). PATIENTS AND METHODS: A total of 72 consecutive cases were enrolled. According to their inclusion order, the former 21 cases received microendoscopy-assisted MIS-TLIF without any ERAS approach (control group), while the latter 51 participants underwent the same surgery with ERAS protocol (observation group). Perioperative parameters, including operative duration, intraoperative estimated blood loss (EBL), length of stay, postoperative analgesic usage and ambulatory time, were recorded. Visual analogue scale (VAS, back and leg), Barthel index were obtained before and at three days, one month, six months postoperatively. Modified MacNab criteria and Bridwell grading were used to assess surgical outcome and interbody fusion at one week and two years after surgery, respectively. RESULTS: Observation group had statistically improved perioperative parameters (operative duration, intraoperative EBL, length of stay, postoperative analgesic usage and ambulatory time) in comparison with control group. Remarkable decreases in VAS (back and leg) were observed continuously at three days, one month and six months post-surgery in both groups when compared with scores prior to the surgery. More significant improvement of VAS (back and leg) was found in observation group at both three days and one month postoperatively. Regarding Barthel index, despite its transient decrease at three days after surgery in control group, it showed statistical increase at postoperative one month when compared with preoperative values in both groups; moreover, its inter-groups comparison revealed much more improvement in patients receiving ERAS recommendations; while at final follow-up, it continued further increase in either group. Marginally higher proportion of patients in observation group showed perfect or good clinical outcome, as well as solid interbody fusion. CONCLUSIONS: ERAS pathway in microendoscopy-assisted MIS-TLIF has advantages of decreased operative time, reduced intraoperative haemorrhage, increased initial back pain relief, decreased length of stay, lowered analgesic usage and earlier daily activity recovery and thus, benefit postoperative rehabilitation further.