Tantalum Fusion Device in Anterior Cervical Discectomy and Fusion For Treatment of Cervical Degeneration Disease: A Systematic Review and Meta-Analysis.

STUDY DESIGN: This is a systematic review and meta-analysis study. OBJECTIVE: The purpose of this systematic review and meta-analysis study is to evaluate the outcomes of a tantalum fusion device in anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degeneration disease. SUMMARY OF BACKGROUND DATA: A great interest has raised for porous tantalum in cervical fusion, but several studies reported the divergent clinical outcome and fusion rate. No systematic review and meta-analysis has been conducted up to present to evaluate the outcomes of the tantalum fusion device. METHODS: We comprehensively searched multiple databases for studies that investigated the tantalum fusion device in ACDF. The retrieved results were last updated on February 15, 2018. Outcomes of interest comprised of operative parameters, fusion rate, the incidence of adverse events as well as patient-reported outcomes, including the Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score, Short Form-36 Physical Component Scores and complications. RESULTS: Ten studies included were included in this review and 6 randomized controlled trial studies included. All studies were pooled to evaluate the outcome of fusion rate, NDI, and VAS after tantalum fusion treatment. The results of the meta-analysis showed that implantation of the tantalum fusion device is associated with significantly shorter operative and fewer adverse events when compared with autologous iliac crest bone graft. However, no difference was found with regards to the fusion rate, NDI, VAS, and global assessment. CONCLUSIONS: Through this systemic review and meta-analysis, no significant difference was found with regards to fusion rate, postoperative NDI, and VAS between tantalum fusion and iliac crest bone graft in ACDF. More longer-term and randomized studies with large samples are warranted to validate any association found in this study. LEVEL OF EVIDENCE: Level II.

Prognostic Factors Associated With Bone Lymphoma Primarily Presenting in the Spine.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To determine the prognostic indicators in patients with bone lymphoma of the spine. SUMMARY OF BACKGROUND DATA: To date, prognosis for patients with spinal bone lymphoma is based on results from small series. Large population-based observational studies are lacking. METHODS: The Surveillance, Epidemiology, and End Results Registry was used to identify all patients with bone lymphoma of the spine from 1995 through 2014. Overall survival (OS) and disease-specific survival (DSS) estimates were obtained using the Kaplan-Meier method and compared across groups using log-rank test. Association of survival with variables was assessed using Cox proportional-hazards regression analysis. Nomograms were established and validated by R software. RESULTS: A total of 1338 patients were identified with bone lymphoma of the spine. The trend of incidence was relative steady from 1995 to 2014. The mean and median age of diagnosis was 62.9 and 66.0 years, respectively. Men constituted a slightly greater proportion (55.5%) of the cohort. The most common subtype of lymphoma was diffuse large B-cell lymphoma (59.8%). The 5- and 10-year OS rates for those patients were 60.6% and 44.7%, respectively. Multivariate analysis revealed that age, sex, marital status, and race were sociodemographic predictors of OS and DSS. Extracompartmental invasion of tumor and stage IV of lymphoma were significantly correlated with poor OS and DSS. Patients without surgery or radiotherapy was linked to a poor OS. Both OS and DSS of patients with spinal bone lymphoma improved in 2005 to 2014 when compared to 1995 to 2004. In addition, pretreatment nomograms to predict 5- and 10-year survival were established. CONCLUSION: The findings of this study provide population-based estimates of the prognosis for patients with spinal bone lymphoma. Both sociodemographic and clinical factors may have an impact on the outcomes. LEVEL OF EVIDENCE: 4.

Synovial fibroblast-targeting liposomes encapsulating an NF-κB-blocking peptide ameliorates zymosan-induced synovial inflammation.

Synovial fibroblasts (SFs) play a crucial role in the inflammatory process of rheumatoid arthritis (RA). The highly activated NF-κB signal in SFs is responsible for most of the synovial inflammation associated with this disease. In this study, we have developed an SF-targeting liposomal system that encapsulates the NF-κB-blocking peptide (NBD peptide) HAP-lipo/NBD. HAP-lipo/NBDs demonstrated efficient SF-specific targeting in vitro and in vivo. Our study also showed a significant inhibitory effect of HAP-lipo/NBD on NF-κB activation, inflammatory cytokine release and SF migration capability after zymosan stimulation. Furthermore, the systemic administration of HAP-lipo/NBDs significantly inhibited synovial inflammation and improved the pathological scores of arthritis induced by zymosan. Thus, these results suggest that an SF-targeting NF-κB-blocking strategy is a potential approach for the development of alternative, targeted anti-RA therapies.

Modification of Human Umbilical Cord Blood Stem Cells Using Polyethylenimine Combined with Modified TAT Peptide to Enhance BMP-2 Production.

With the emerging role of umbilical cord blood-derived mesenchymal stem cells (hUCB-MSC) for bone regeneration and delivery of therapeutic proteins, there is an increasing need for effective gene delivery systems to modify such cells. mTAT, a TAT peptide sequence bearing histidine and cysteine residues, has been successfully used for intracellular gene delivery. Using a gWiz-GFP plasmid, we demonstrated that polyethylenimine combined with mTAT (mTAT/PEI) displayed good transfection efficacy in hUCB-MSC. hUCB-MSC transfected with mTAT/PEI were shown to express more BMP-2 protein and mRNA, indicating the feasibility of using the cells as a BMP-2 delivery system. Importantly, compared to PEI25, a "gold standard" nonviral transfection polymer, mTAT/PEI had limited toxicity to the cells. Furthermore, we demonstrated enhanced osteogenic activity in vitro for BMP-2 expressing hUCB-MSC. These results provide encouraging evidence for the potential use of mTAT/PEI to genetically modify hUCB-MSC as an approach to enhance tissue regeneration.