The application and influence of "Small Private Online Course" based on flipped classroom teaching model in the course of fundamental operations in surgery in China.

To investigate the effect of "Small Private Online Course" (SPOC) based on flipped classroom teaching model on the students in the course of fundamental operations in surgery. A prospective study. 8-year program students (juniors) majored in clinical medicine in Navy medical university. The mastery of theoretical knowledge and operational skill of the students, the comparison of final test examination score between traditional teaching method and "SPOC + flipped classroom" model and the feedback completed by students. Our study found that SPOC + flipped classroom could significantly increase the efficacy of the class and enhance the ability of the students compared with the traditional method. The new teaching model could have a positive influence for medical students on their basic knowledge and operational skill.

Reliability and validity of simplified Chinese version of Spinal Cord Injury Pain Instrument in patients with spinal cord injury in mainland China.

PURPOSE: To cross-culturally adapt the Spinal Cord Injury Pain Instrument (SCIPI) into a simplified Chinese version (SC-SCIPI) and verify reliability and validity in screening for neuropathic pain in SCI patients. METHODS: A preliminary validation study was conducted to screen for neuropathic pain after SCI using SCIPI. A total of 130 patients with SCI treated at Shanghai Changhai Hospital were enrolled. Results for internal consistency, reliability and construct validity were compared with those of the Douleur Neuropathique (DN4), Leeds Assessment of Neuropathic Pain Questionnaire (LANSS), Neuropathic Pain Questionnaire (NPQ), ID Pain scale and VAS pain scale. RESULTS: The SCIPI was successfully translated into Chinese and expert consensus was reached on final adapted version of SC-SCIPI. For test-retest, SC-SCIPI total score was 2.35 ± 1.75 in first round and 2.35 ± 1.76 in second round. Cronbach α coefficient of SC-SCIPI was 0.909, indicating good internal consistency. Pearson correlation coefficient (r) showed that SC-SCIPI correlated well with LANSS, DN4, NPQ and ID pain; and correlated fairly well with VAS, indicating good construct validity. CONCLUSION: SC-SCIPI demonstrates excellent internal consistency, reliability and good construct validity in Chinese patients with neuropathic pain, suggesting that SC-SCIPI is applicable in clinical practice to screen patients for neuropathic pain. IMPLICATION FOR REHABILITATIONThe Spinal Cord Injury pain Instrument has been cross-culturally adapted into a simplified Chinese version (SC-SCIPI).The SC-SCIPI showed excellent test-retest reliability and good construct validity.The 4-item SC-SCIPI is quite convenient to complete and it might be a useful instrument for routine application in patients with SCI for rehabilitation.

Microneedle/CD-MOF-mediated transdural controlled release of methylprednisolone sodium succinate after spinal cord injury.

A new method of transdural delivering drugs to the spinal cord has been developed, involving the use of microneedles (MNs) and a ß-cyclodextrin metal-organic framework (CD-MOF). This epidural microneedle array, dubbed MNs@CD-MOF@MPSS, can be utilized to deliver methylprednisolone sodium succinate (MPSS) to the site of spinal cord injury (SCI) in a controlled manner. MNs allows to generate micropores in the dura for direct drug delivery to the spinal cord, overcoming tissue barriers and targeting damaged regions. Additionally, the CD-MOF provides a secondary extended release after separating from the MNs. In in vitro study, inward MNs increased cellular absorption of MPSS and then reduced LPS-induced M1 polarization of microglia. And animal studies have shown that this method of drug delivery results in improved BMS scores and a reduction in M1 phenotype microphage and glial scar formation. Furthermore, the downregulation of the NLRP3-positive inflammasome and related pro-inflammatory cytokines was observed. In conclusion, this new drug platform has potential for clinical application in spinal cord diseases and is a valuable composite for minimally transdural controlled drug delivery. STATEMENT OF SIGNIFICANCE: This research presents a new epidural microneedle patch made up of microneedles (MNs) and a ß-cyclodextrin metal-organic framework (CD-MOF). The epidural microneedle patch boasts high drug loading capacity, the ability to penetrate the dura, and controlled release. When loaded with methylprednisolone sodium succinate (MPSS), it effectively reduces inflammation and improves neurological function after spinal cord injury. Therefore, it is a novel and promising drug platform for the treatment of spinal cord diseases in a clinical setting.

Measurement Properties of the Simplified Chinese Version of the Lumbar Spine Instability Questionnaire for Patients With Low Back Pain in Mainland China.

STUDY DESIGN: A prospective study. OBJECTIVE: To develop a simplified Chinese version of Lumbar Spine Instability Questionnaire (SC-LSIQ) and test its measurement properties. SUMMARY OF BACKGROUND DATA: The LSIQ has been translated into several languages. Different versions of LSIQ have proved good reliability and validity in evaluating patients with low back pain. However, there is no simplified Chinese version of LSIQ (SC-LSIQ). MATERIALS AND METHODS: The SC-LSIQ has been translated into a simplified Chinese version according to a standard procedure. A total of 155 patients with low back pain completed the SC-LSIQ along with Oswestry Disability Index, Roland-Morris disability questionnaire, Tampa Scale for Kinesiophobia, and visual analogue scale (VAS). The internal consistency, test-retest reliability, and validity of SC-LSIQ were then calculated to evaluate the measurement properties of SC-LSIQ. RESULTS: The results of SC-LSIQ demonstrated that there was no ceiling or floor effect detected. The Cronbach α coefficient of 0.911 determined a well internal consistency. The intraclass correlation coefficient (0.98) presented an excellent reliability of SC-LSIQ. The Pearson correlation coefficient (r) showed that the SC-LSIQ was excellent correlated to Oswestry Disability Index (r=0.809), Roland-Morris disability questionnaire (r=0.870), and Tampa Scale for Kinesiophobia (r=0.945,). Furthermore, it moderately correlated to visual analogue scale (r=0.586). CONCLUSION: The SC-LSIQ features good internal consistency, reliability, and validity for evaluating Chinese patients with LBP. Results suggest that the SC-LSIQ can be appropriately applied to patients with LBP in routine clinical practice.

Do hypokyphotic adolescent idiopathic scoliosis patients treated with Ponte osteotomy obtain a better clinical efficacy? A preliminary retrospective study.

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS: Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. RESULTS: The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. CONCLUSIONS: Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.

RHOA inhibits chondrogenic differentiation of mesenchymal stem cells in adolescent idiopathic scoliosis.

PURPOSE: The etiology of adolescent idiopathic scoliosis (AIS) remains unclear. The chondrogenic differentiation of mesenchymal stem cells (MSCs) is important in AIS, and the Ras homolog gene family member A (RHOA) is associated with chondrogenesis. The purpose of this study was to explore the effect of RHOA on the chondrogenic differentiation of MSCs in AIS. METHODS: We isolated MSCs from patients with AIS (AIS MSCs) and individuals without AIS (control MSCs). The inhibitor Y27632 was used to inhibit the function of RHOA/ROCK signaling, and plasmid-based overexpression and siRNA-mediated knockdown were used to manipulate RHOA expression. CCK-8 was used to detect cell viability. The phosphorylation levels of LIMK1, MLC2 and cofilin were detected by Western blotting. The mRNA expression of aggrecan, SOX9, and COL2A1 were confirmed using RT-PCR. Immunofluorescence was used to analyze F-actin and collagen II. Alcian blue staining was performed to assess the secretion of glycosaminoglycans (GAGs). RESULTS: We found that RHOA was significantly upregulated in AIS MSCs, and the phosphorylation levels of LIMK1, MLC2, and cofilin were increased. The mRNA expressions of aggrecan, SOX9, and COL2A1 were notably reduced in AIS MSCs. However, these effects were abolished by Y27632 treatment and RHOA knockdown in AIS MSCs. In addition, RHOA knockdown in AIS MSCs increased the content of collagen II and GAGs. RHOA overexpression in the control MSCs markedly activated the RHOA/ROCK signaling and decreased the expression of aggrecan, SOX9, and COL2A1, F-actin, and GAGs. CONCLUSION: RHOA regulates the chondrogenic differentiation ability of MSCs in AIS via the RHOA/ROCK signaling pathway and this regulation may involve SOX9.

Global research trends of adult degenerative scoliosis in this decade (2010-2019): a bibliometric study.

OBJECTIVE: With the population aging, there is an associated rise in the prevalence of adult degenerative scoliosis (ADS). However, limited data were found to elaborate the trend of ADS research. Our study aims to investigate the global trend of ADS research in this decade. METHODS: ADS-related publications from 2010 to 2019 were extracted from the Web of Science and Medline database. Excel 2016, GraphPad Prism 6, and VOSviewer software were adopted to analyze the search results for number of publications, citation, and H-index. RESULTS: A total of 1282 papers were included and were cited 16,770 times. The USA accounted for 40.41% of the articles, 60.35% of the citations, and the highest H-index of 51. China ranked second in total number of articles, third in citation frequency (1373), and fourth with an H-index of 18. The journal Spine (IF = 2.903, 2019) had the highest number of publications. Shaffery CI published the most articles in this field (40). Key words of ADS research were classified into three clusters: "Surgical technique," "Mechanism," and "Radiological parameter." The "Radiological parameter" cluster became the most popular, and it came with the latest hot spots of "slope," "cervical lordosis," "mismatch," and "PI-LL." CONCLUSION: Literature growth in ADS was rapidly expanding in this decade. The USA was the most productive country and also had a largest quantity of top authors and institutes, so that scholars can keep following and cooperated with. Radiological parameter was an emerging topic and might also be a hot spot in the near future.

Shikonin mitigates ovariectomy-induced bone loss and RANKL-induced osteoclastogenesis via TRAF6-mediated signaling pathways.

BACKGROUND: Postmenopausal osteoporosis results from estrogen withdrawal and is characterized mainly by bone resorption. Shikonin is a bioactive constitute of Chinese traditional herb which plays a role in antimicrobial and antitumor activities. The study was designed to investigate the role of shikonin on postmenopausal osteoporosis and explore its underlying mechanisms. METHODS: Immunofluorescence staining was performed to evaluate the effects of shikonin on actin ring formation. The expression levels of the nuclear factor kappa-B (NF-κB) and mitogen-activated protein kinase (MAPK) pathway were determined by Western blot analysis. To determine whether shikonin influences the receptor activator of nuclear factor-κB ligand (RANKL)-induced association between receptor activator of NF-κB (RANK) and tumor necrosis factor receptor associated factor 6 (TRAF6), immunofluorescence staining and immunoprecipitation experiments were performed. During our validation model, histomorphometric examination and micro-computed tomography (CT) were conducted to assess the morphology of osteoporosis. RESULTS: Shikonin prevented bone loss by inhibiting osteoclastogenesis in vitro and improving bone loss in ovariectomized mice in vivo. At the molecular level, Western blot analysis indicated that shikonin inhibited the phosphorylation of inhibitor of NF-κB (IκB), P50, P65, extracellular regulated protein kinases (ERK), c-Jun N-terminal kinase (JNK), and P38. Interaction of TRAF6 and RANK was prevented, and downstream MAPK and NF-κB signaling pathways were downregulated. CONCLUSION: Osteoclastic bone resorption was reduced in the presence of shikonin in vitro and in vivo. Shikonin is a promising candidate for treatment of postmenopausal osteoporosis.

Assessment of Sagittal Spinopelvic Balance in a Population of Normal Chinese Children.

STUDY DESIGN: A retrospective study of 257 normal children at a single center from July 2016 to November 2018 was performed. OBJECTIVE: To evaluate the spinopelvic parameters in a population of normal children and adolescents in mainland China. SUMMARY OF BACKGROUND DATA: Values for sagittal parameters of the spine vary significantly by ages and different population. No study has yet quantified the normal measures for children and adolescents in China, or how these measures compare with other populations. METHODS: Pelvic incidence (PI), sacral slope, pelvic tilt, thoracic kyphosis (TK, T5-T12), lumbar lordosis (LL, L1-S1), and sagittal vertical axis were measured and evaluated by whole spine AP&lateral X-ray images. RESULTS: A total of 257 subjects, including 116 boys (45%) and 141 girls (55%) aged 3 to 12 years, were enrolled. Correlation matrix analysis demonstrated that sagittal balance is strongly correlated with age and Risser sign, including PI, a reported fixed parameter. Further investigation showed that PI could be expressed by the equation PI = 26.243+1.153×age. CONCLUSION: PI was not a fixed but a dynamic parameter in the population under 12-year old. Indeed, PI increases with age and bone maturity in childhood. We also found lower PI, pelvic tilt, and sacral slope compared with published studies of adolescents in other countries. These results may aid in the treatment of patients with spinal deformity, to help them achieve a certain degree of sagittal spinopelvic balance. LEVEL OF EVIDENCE: 2.

Low-intensity pulsed ultrasound promotes spinal fusion by regulating macrophage polarization.

BACKGROUND: Spinal fusion is considered the gold standard procedure for treating spinal degeneration, tumors, and trauma. An inflammatory response is an important part of bone repair. We investigated the polarization change of inflammatory macrophages (M1) and resident macrophages (M2) during low-intensity pulsed ultrasound (LIPUS) treatment. METHODS: Thirty male Sprague Dawley rats (age: 12 weeks; weight: 300 g) were used in the study. A rat spinal fusion model was established by surgical procedures. LIPUS treatment (20 min. d, 5 d/wk) was begun 3 days after surgery. The rats were randomly divided into a control group (5 subgroups, 3 rats in each subgroup) and LIPUS group (5 subgroups, 3 rats in each subgroup), and sacrificed on day 3, 5, 7, 10, and 14 after spinal fusion surgery for further evaluation. Bone volume was measured by micro-CT, fusion region was examined by histological analyses, types of macrophages in the fusion area were examined by immunohistochemical staining. Raw264.7 cells and bone marrow-derived macrophages (BMDM) were used in cell experiments. Cells were divided into a control group and LIPUS group. Flow cytometry was used to examine the rate of resident macrophages, and real-time PCR was used to examine the mRNA expression of anti-inflammation genes. RESULTS: LIPUS promoted spinal fusion and stimulated the transition of F4-80+/Mac-2+ (M1) to F4-80+/Mac-2- (M2), leading to the early appearance of resident macrophages. Cell experiments showed CD206+ macrophages (M2) were significantly increased after LIPUS treatment. M2-related genes and anti-inflammation factors (Arg-1, PPAR-γ, and IL-4) were increased after LIPUS treatment. CONCLUSION: The earlier transition from inflammatory to resident macrophage might be one reason for the positive effect of LIPUS on spinal fusion.

Validation of Simplified Chinese Version of the Pain Self-Efficacy Questionnaire (SC-PSEQ) and SC-PSEQ-2 for Patients With Nonspecific Low Back Pain in Mainland China.

STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to develop the simplified Chinese version of Pain Self-efficacy Questionnaire (PSEQ) (SC-PESQ) and PSEQ-2 (SC-PSEQ-2), and evaluate the psychometric properties of the two questionnaires in patients with nonspecific low back pain. SUMMARY OF BACKGROUND DATA: PSEQ has been cross-culturally adapted into many languages with excellent reliability and validity. Recently, the short form of PSEQ-2 was developed and exhibited satisfactory psychometric properties. However, PSEQ and PSEQ-2 has not been translated or validated in mainland China. METHODS: The original version of PSEQ and PSEQ-2 was linguistically translated and adapted to formulate the simplified Chinese version, which was then administrated by 219 patients with low back pain, along with a set of self-report health-related instruments. Statistical analysis was performed to evaluate the psychometric properties of the SC-PESQ and SC-PSEQ-2. RESULTS: Two hundred nineteen patients with nonspecific low back pain were enlisted into the analysis. The SC-PSEQ and SC-PSEQ-2 had been determined excellent internal consistency (Cronbach alpha, 0.95 and 0.83), test-retest reliability (overall ICC, 0.91 and 0.88), and sound construct validity, which were supported by moderately strong association with the criterion measures, respectively. In addition, exploratory and confirmatory factor analysis have found and confirmed one-factor solution in SC-PSEQ as hypothesized. CONCLUSION: The SC-PESQ and SC-PSEQ-2 showed satisfactory psychometric properties in Chinese population with low back pain, and could be safely utilized to evaluating the self-efficacy in clinical and research setting. LEVEL OF EVIDENCE: 4.

Cross-cultural Adaptation and Validation of the Simplified-Chinese Version of Neck Bournemouth Questionnaire for Patients in Mainland China.

STUDY DESIGN: A prospective study. OBJECTIVE: The aim of this study was to develop and assess the internal reliability and structure validity of a simplified Chinese version of the Neck Bournemouth Questionnaire (SC-NBQ) for evaluation of patients with nonspecific neck pain (NP) in mainland China. SUMMARY OF BACKGROUND DATA: The NBQ has been cross-culturally translated into several languages with good internal consistency and construct validity to evaluate low back pain and NP. However, the NBQ has been not translated or validated for Chinese-speaking patients. METHODS: The SC-NBQ was developed by standard cross-translation procedures, and completed by 106 patients with nonspecific NP, along with other self-reported questionnaires, including the Neck Disability Index (NDI), Hospital Anxiety and Depression Scale (HADS), Functional Rating Index (FRI), and 36-Item Short Form Health Survey (SF-36). The internal consistency, test-retest reliability, and construct validity of the SC-NBQ were determined. RESULTS: The NBQ was successfully translated into Chinese. All patients completed the SC-NBQ twice, and the other instruments. Score distribution demonstrated that there was no floor or ceiling effects of the SC-NBQ. Cronbach α coefficient (α = 0.89) and intraclass correlation coefficient (ICC = 0.97) showed good internal consistency and test-retest reliability. A good construct validity was shown by strong correlation with HADS (r = 0.75), NDI (r = 0.82), FRI (r = 0.90) and SF-36 physical functioning (r = 0.75), and bodily pain (r = 0.75) subscales. CONCLUSION: The SC-NBQ demonstrated good internal consistency, test-retest reliability, and construct validity, and may be used for the evaluation of NP in Chinese-speaking patients. LEVEL OF EVIDENCE: 2.

Effects of Low-Intensity Pulsed Ultrasound on Knee Osteoarthritis: A Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Osteoarthritis (OA) is a common degeneration disease characterized with joint pain. The aim of the present study was to systemically review the effects of LIPUS on pain relief and functional recovery in patients with knee osteoarthritis (OA). METHODS: PubMed, Embase, and Cochrane Library were searched manually for researches on LIPUS treatment in patients with knee OA from 1945 to July 2017. Two investigators independently selected the studies according to the inclusion and exclusion criteria, extracted the concerned data, and assessed the included studies. Meta-analysis was performed to evaluate VAS, WOMAC, and ambulation speed between control and LIPUS groups. RESULTS: Five studies were selected in this study. Compared with control group, LIPUS group received a decrease of pain intensity with moderate heterogeneity (-0.79, 95% CI, -1.57 to 0.00; I2 = 65%, P = 0.04) by VAS and improvement in knee function by WOMAC (-5.30, 95% CI, -2.88 to -7.71; I2 = 44%, P = 0.17). No significant improvement was found in ambulation speed (0.08 m/s, 95% CI, -0.02 to 0.18 m/s; I2 = 68%, P = 0.03). CONCLUSION: The present study includes 5 high quality randomized controlled trials. The result indicated that LIPUS, used to treat knee OA without any adverse effect, had a beneficial effect on pain relief and knee functional recovery. More evidence is needed to prove whether LIPUS is effective in improving walking ability.

Bibliometric Analysis of Global Scientific Research on lncRNA: A Swiftly Expanding Trend.

To investigate trends in long-noncoding (lnc) RNA research systematically, we compared the contribution of publications among different regions, institutions, and authors. Publications on lncRNA were retrieved from Web of Science (WoS) from 1975 to 2017. A total of 3879 papers were identified, and together they were cited 62967 times. The literature on lncRNA had been continuously growing since 2006, and the expansion might continue at a rapid pace until around 2021. China contributed the greatest proportion (63.47%) of lncRNA publications, and the USA ranked second in the number of publications (944 articles), while it had the highest citation frequency (43168 times) and H-index (97). The journal Oncotarget has the greatest number of publications on lncRNA research, with 305 papers. The keywords could be stratified into two clusters: cluster 1 (application) and cluster 2 (characteristics). Correspondingly, the "TNM stage," "epithelial mesenchymal transition (EMT)," "cell apoptosis," and "overall survival" are research hotspots since 2015. Thus, research on lncRNA showed a swiftly expanding trend, with China making the largest contribution. The focus on lncRNA is gradually shifting from "characteristics" to "application."

Low-intensity pulsed ultrasound promotes spinal fusion and enhances migration and proliferation of MG63s through sonic hedgehog signaling pathway.

Low-intensity pulsed ultrasound (LIPUS) has been found to accelerate the healing process of spinal fusion via a process closely related to osteoblast differentiation and migration. Sonic hedgehog (Shh) signaling plays an important role in development and homeostasis, including a critical function in bone formation. However, its role in spinal fusion during LIPUS treatment is still unknown. This study showed that LIPUS treatment after spinal fusion surgery increased bone formation. The increased bone mass under LIPUS treatment appeared to result from the increased migration and proliferation of osteoblasts, resulting from upregulation of the Shh signaling pathway. In contrast, inhibition of Shh reduced the migratory and proliferative ability of osteoblast-like MG63 cells and blocked the efficacy of LIPUS treatment.

Cross-cultural validation of simplified Chinese version of spine functional index.

BACKGROUND: No effective constructs were available in mainland China to assess the whole spine function. The SFI was developed to evaluate spinal function based on the concept of a single kinetic chain concept for whole spine. The SFI has been translated to Spanish and Turkish with accepted psychometric properties. It is imperative to introduce the SFI in mainland China and further to explore the measurement properties. METHODS: The English versions of the SFI was cross-culturally translated according to international guidelines. Measurement properties (content validity, construct validity and reliability) were tested in accordance with the COSMIN checklists. A total of 271 patients were included in this study, and 61 participants with neck pain and 64 participants with back pain paid a second visit three to seven days later. Confirmatory factor analysis (CFA) and principal factor analysis (PCA) were applied to test the factor structure. The Functional Rating Index (FRI), Neck Disability Index (NDI), Oswestry Disability Index (ODI), SF-12 and a Visual Analogue Scale (VAS) were employed to evaluate the construct validity. Cronbach's alpha and an intra-class correlation coefficient (ICC) were calculated for internal consistency and reproducibility. RESULTS: The means score of SC-SFI was 63.60 in patients with spinal musculoskeletal disorders. A high response rate was acquired (265/271). No item was removed due to abnormal distribution or low item-total correlation. Results of CFA did not support that one-factor structure was in goodness of fit (CMIN/DF = 3.306, NNFI = 0.687, CFI = 0.756, GFI = 0.771 and RMSEA = 0.092). Yet, PCA suggested a one-factor structure was the best, accounting for 32% of the total variance. For structural validity, the SC-SFI correlated highly with the FRI, NDI, ODI, and PF, BP in SF-12 (r = 0.661, 0.610, 0.750, 0.709, 0.605, respectively). All the a priori hypotheses were verified. The Cronbach's alpha for the SC-SFI was 0.91, and ICC was 0.96 (95% CI, 0.94-0.98). Bland-Altman plot also confirmed excellent test-retest reliability. CONCLUSIONS: The SFI has been culturally adapted into SC-SFI with remarkable clinical acceptance, excellent internal consistency, reproducibility, and construct validity when applied to patients with spinal musculoskeletal disorders. The results of current study suggest that SC-SFI can be applied by physicians and researchers to measure whole-spine functional status in mainland China.

Low-intensity pulsed ultrasound promotes endothelial cell-mediated osteogenesis in a conditioned medium coculture system with osteoblasts.

Angiogenesis plays an important role during bone regeneration. Low-intensity pulsed ultrasound (LIPUS) has been proven to accelerate the process of bone fracture healing. However, the mechanism of the effect of LIPUS on bone regeneration is still unclear. In the present study, we used human umbilical vein endothelial cell (HUVEC) and human osteosarcoma cell (MG-63) to investigate the effect of LIPUS stimulation in an endothelial cell-osteoblast coculture system. At the same time, we used transwell and in vitro angiogenesis assay to observe how LIPUS affects endothelial cells. The results demonstrated that LIPUS could significantly increase the migratory ability and promote tube formation in angiogenesis of HUVECs. Furthermore, LIPUS could significantly elevate the expression of osteogenesis-related genes on osteoblasts such as Runt-related transcription factor 2, alkaline phosphatase, Osteorix, and Cyclin-D1, indicating the pro-osteogenesis effect of LIPUS in our coculture system. In conclusion, endothelial cell is involved in LIPUS-accelerated bone regeneration, the positive effect of LIPUS may be transferred via endothelial cells surrounding fracture healing site.

Global research trends in spinal ultrasound: a systematic bibliometric analysis.

BACKGROUND: In recent years, there has been increased interest in the use of ultrasound technology in the evaluation of spinal and paraspinal regions. OBJECTIVE: This study aimed to investigate trends in spinal ultrasound research from 1994 to 2015 and compare the contributions of such research from different countries and authors. STUDY DESIGN: Bibliometric analysis. SETTING: Publications related to spinal ultrasound from 1994 to 2015 were retrieved from the Web of Science database. METHODS: Excel 2013, GraphPad Prism 5, and VOSviewer were used to summarise bibliometric features, including the number of publications, citation frequency, H-index, and country contributions and hotspots (keywords of popular scientific fields). RESULTS: A total of 3859 papers were included. The global inflection point (the point in time when the publication growth rate moved from positive to negative) came in 2010. The United States contributed the largest percentage of articles (1041; 26.9%), with the most citations (19 848) and the highest H-index (61). The journals Osteoporosis International and Spine had the highest publication number. The University of Toronto and the University of California, San Francisco were the most contributive institutions. Studies could be divided into three clusters: surgery, osteoporosis, and others. The keywords 'adolescent idiopathic scoliosis' and 'anaesthesia' were the latest hotspots, appearing around 2012. CONCLUSION: Spinal ultrasound literature has grown continuously over the last 22 years, with the rate slowing down after 2010. The United States was the largest contributor in this field. Recent studies on topics related to 'adolescent idiopathic scoliosis' and 'anaesthesia' were relatively new and should be closely followed in spinal ultrasound research.

I-BET151 inhibits expression of RANKL, OPG, MMP3 and MMP9 in ankylosing spondylitis in vivo and in vitro.

Ankylosing spondylitis (AS) is characterized by osteoclastogenesis and inflammatory bone resorption. The present study aimed to investigate the effect of bromodomain and extra-terminal domain (BET) protein inhibitor I-BET151 on AS process. A total of 38 AS Chinese patients were recruited and a further 38 sex- and age-matched healthy participants were selected as control. The Bath AS Function Index and Bath AS Disease Activity Index were assessed in AS patients and levels of erythrocyte sedimentation rate and C-reactive protein were measured in AS and healthy groups. Serum from AS patients was used to induce MG63 osteoblasts and BET inhibitor I-BET151 at concentrations of 50, 100 and 200 ng/ml used for treatment of the cells. A HLA-B27/ß2m transgenic AS Lewis rat model was established and treated with 30 mg/kg I-BET151 for 5 weeks. Levels of receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), matrix metalloproteinase (MMP)3, and MMP9 were measured using ELISA in vivo and additionally detected with western blotting and polymerase chain reaction in vitro. The levels of RANKL, OPG, MMP3 and MMP9 were upregulated in AS serum, AS serum treated MG63 cells and HLA-B27/ß2m transgenic AS rats. Conversely, levels of RANKL, OPG, MMP3 and MMP9 were significantly inhibited in cells or animals treated with I-BET151. Overall, the results of the present study demonstrated that BET inhibitor I-BET151 suppresses levels of RANKL, OPG, MMP3 and MMP9 in AS in vivo and in vitro. I-BET151 may exhibit the potential to be used as a therapeutic in the treatment of AS patients.

Global scientific trends on exosome research during 2007-2016: a bibliometric analysis.

BACKGROUND: Exosomes are small vesicles of endosomal origin, and they can be used for the diagnosis and the treatment. However, limited data were for the evaluation of the trend of exosome researches. This study aims to investigate the trend of exosome researches and compare the contribution of research from different regions, organizations and authors. METHODS: Exosome related publications from 2007 to 2016 were retrieved from the Web of Science database. Excel, GraphPad Prism 5 and VOSviewer software were used to analyze the research trend. RESULTS: A total of 1852 papers were identified and were cited 62967 times. The United States accounted for 38.8% of the articles, 42.0% of the citations, and the highest H-index (76). China ranked the second in the number of articles, but the sixth in citation frequency (4337) and the fourth in H-index (36). The journals, PLoS ONE and J Biol Chem had the highest number of publications. The author, Gabrielsson S., has published the most papers in this field (22). The keyword "ribonucleic acid" was mentioned the most at 746 times, and the words, "stem cell", "drug resistance" and "monocyte cell factor" were the latest hotspots appeared around 2015. CONCLUSION: Literature growth related to exosome is expanding rapidly. The quality of the articles from China still requires improvement. Recent studies focus on the relationship with tumor, and "stem cell", "drug resistance" and "michigan cancer foundation-7" may be the newest topics that should be closely followed in exosome research.