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Osteosarcoma (OS) is the most common malignant bone tumor in children and adolescents. Increasing evidence suggests that aberrant expression of circRNAs is associated with the occurrence and progression of many cancers. Here, we investigated the role of circNRIP1 in osteosarcoma and explored its possible underlying mechanisms. Three pairs of osteosarcoma tissues and adjacent normal tissues were applied to the detection of altered expression of circRNAs through circRNAs microarray. And the level of circNRIP1 expression was elevated in osteosarcoma tissues. Compared with that in adjacent normal tissue, circNRIP1 expression level was obviously elevated in 100 osteosarcoma tissues. Besides, circNRIP1 knockdown inhibited proliferation and migration, promoted apoptosis of osteosarcoma cells. Bioinformatic analysis demonstrated circNRIP1 contributed to FOXC2 expression by sponging miR-199a. Furthermore, METTL3 elevated circNRIP1 expression level via m6A modification. In short, METTL3-induced circNRIP1 exerted an oncogenic role in osteosarcoma by sponging miR-199a, which may provide new ideas for the treatment of osteosarcoma.

Background The technique of posterior pedicle screw fixation has already been widely applied in the treatment of upper thoracic spinal tuberculosis. However, lesions of tuberculosis directly invade the vertebrae and surrounding soft tissues, which increases the risk of esophageal perforation induced by the posterior pedicle screw placement. Herein, we report the first case of esophageal perforation following pedicle screw placement in the upper thoracic spinal tuberculosis, and describe the underlying causes, as well as the treatment and prognosis. Case presentation A 48-year-old female patient with upper thoracic spinal tuberculosis presented sputum-like secretions from the wound after she was treated with one-stage operation through the posterolateral approach. Endoscopy was immediately conducted, which confirmed that the patient complicated with postoperative esophageal perforation caused by screws. CT scan showed that the right screw perforated the anterior cortex of the vertebrae and the esophagus at the T4 level. Fortunately, mediastinal infection was not observed. The T4 screw was removed, Vacuum Sealing Drainage (VSD) was performed, and jejunum catheterization was used for enteral nutrition. After continuous treatment with sensitive antibiotics for 2.5 months and 5 times of VSD aspiration, the infected wound recovered gradually. With 18-month follow-up, the esophagus healed well, without symptoms of dysphagia and stomach discomfort, and CT scan showed that T2–4 had complete osseous fusion without sequestrum. Conclusion Tuberculosis increases the risk of postoperative esophageal perforation in a certain degree for patients with upper thoracic tuberculosis. The damages to esophagus during the operation should be prevented. The screws with the length no more than 30 mm should be selected. Moreover, close monitoring after operation should be conducted to help the early identification, diagnosis and treatment, which could help preventing the adverse effects induced by the delayed diagnosis and treatment of esophageal perforation.

Background Rotator cuff tear is one of the most common complaint with shoulder pain, disability, or dysfunction. So far, different arthroscopic techniques including single row (SR), double row (DR), modified Mason–Allen (MMA), suture bridge (SB) and transosseous (TO) have been identified to repair rotator cuff. However, no study has reported the comparative efficacy of these 5 suture configurations. The overall aim of this network meta-analysis was to analyze the clinical outcomes and healing rate with arthroscopy among SR, DR, MMA, SB and TO. Methods A systematic literature was searched from PubMed, EBSCO-MEDLINE, Web of Science, google scholar and www.dayi100.com , and checked for the inclusion and exclusion standards. The network meta-analysis was conducted using Review Manager 5.3 and SATA 15.0 software. Results Thirty-four studies were eligible for inclusion, including 15 randomized controlled trials, 17 retrospective and 2 prospective cohort studies, with total 3250 shoulders. Two individual reviewers evaluated the quality of the 34 studies, the score form 5 and 9 of 10 were attained according to the Newcastle–Ottawa Scale for the 17 retrospective and 2 prospective studies. There was no significant distinction for the Constant score among 5 groups in the 16 studies with 1381 shoulders. The treatment strategies were ranked as MMA, DR, SB, SR and TO. In ASES score, 14 studies included 1464 shoulders showed that no significant differences was showed among all 5 groups after surgery. Whereas the efficacy probability was TO, MMA, DR, SB and SR according to the cumulative ranking curve. The healing rate in 25 studies include 2023 shoulders was significant in both SR versus DR [risk ratio 0.45 with 95% credible interval (0.31, 0.65)], and SR versus SB [risk ratio 0.45 (95% credible interval 0.29, 0.69)], and no significant in the other comparison, the ranking probability was MMA, SB, DR, TO and SR. Conclusion Based on the clinical results, this network meta-analysis revealed that these 5 suture configurations shows no significant difference. Meanwhile, suture bridge may be the optimum treatment strategy which may improve the healing rate postoperatively, whereas the DR is a suboptimal option for arthroscopic rotator cuff repairs.

This study is to assess an innovative technique - a vertebral osteotome (VO) combined with side-opening injection cannula for percutaneous vertebroplasty (PVP). A retrospective study by propensity score matching. From January 2016 to April 2016, 63 patients who were diagnosed with monosegmental osteoporotic vertebral compression fracture received the innovative technique. The epidemiologic data, surgical indexes, and recovery outcomes were collected in the follow-up period. Propensity score matching identified 63 pairs form historical controls by traditional unilateral PVP approach in 2015 using six independent variables: age, sex, preoperative visual analog score (VAS), Oswestry Disability Index (ODI), body mass index, and bone mineral density. The surgical duration and cement distribution were longer and larger in patients by VO method. Besides, postoperative VAS and ODI in the VO group were lower than those in the control group. However, there were no differences in radiation exposure times, improvement of Cobb angle, cement leakage, or adjacent vertebral fracture between two groups. Cement volume in the VO group was less than that in the control group. This new innovative technique makes PVP safe and effective. Although it lasts longer, the restoration rate of vertebral height and cement distribution can be improved, which contributes to a better pain relief.

Purpose N 6 -methyladenosine (m 6 A) modification is a pivotal transcript chemical modification of eukaryotics, which has been identified to play critical roles on tumor metabolic reprogramming. However, the functions of m 6 A-reading protein YTH N 6 -methyladenosine RNA-binding protein 3 (YTHDF3) in osteosarcoma is still unclear. This research planned to investigate the bio-functions and mechanism in osteosarcoma tumorigenesis. Methods The aerobic glycolysis of osteosarcoma cells were calculated by glucose uptake, lactate production analysis, ATP analysis and metabolic flux analysis for extracellular acidification rate (ECAR). Molecular binding was identified by RIP-qPCR, RNA decay analysis. Results Results indicated that YTHDF3 is upregulated in the osteosarcoma tissue samples and cells, and closely correlated to the poor prognosis of osteosarcoma patients. Functionally, gain and loss-of-functional assays illustrated that YTHDF3 promoted the proliferation and aerobic glycolysis of osteosarcoma cells in vitro, and accelerated the tumor growth in vivo. Mechanistically, a m 6 A-modified PGK1 mRNA functioned as the target of YTHDF3, and YTHDF3 enhanced the PGK1 mRNA stability via m 6 A-dependent manner. Conclusions In conclusion, these findings indicated that YTHDF3 functioned as an oncogene in osteosarcoma tumorigenesis through m 6 A/PGK1 manner, providing a therapeutic strategy for human osteosarcoma.

Purpose The purpose of this study was to compare and evaluate the safety and efficacy of percutaneous vertebroplasty at a hyperextension position (PVPHP) and percutaneous kyphoplasty at a hyperextension position (PKPHP) for the treatment of osteoporotic Kümmell’s disease. Methods This study was a retrospective, single-centre study. There were 35 patients with osteoporotic Kümmell’s disease who were analyzed. Twenty-two of them underwent PVPHP and the other 13 patients underwent PKPHP from January 2013 to January 2015. The volume of bone cement injection and operation costs were compared. We compared the visual analogue score (VAS) and vertebral Cobb’s angle at pre-operation, the second day after operation, and the final follow-up. We compared the Oswestry disability index (ODI) score at the pre-operation and the final follow-up. Results There were no significant differences in gender, age, course of disease, bone mineral density (BMD), and mean follow-up time between the two groups ( P  > 0.05). Regarding the costs of the operation, the PKPHP group was significantly higher than the PVPHP group ( P  < 0.05). Compared with the pre-operation ( P  < 0.05), the post-operative ODI score, VAS, and Cobb’s angle of the two groups were improved significantly. Even though the correction of Cobb’s angle in the PKPHP group was slightly better than the PVPHP position group, there were no significant differences between two groups ( P  > 0.05). At the final follow-up, the Cobb’s angle was increased in both groups, but there was no significant difference ( P  > 0.05). There was no significant difference in the bone cement leakage rate between the two groups ( P  > 0.05). Conclusion For the treatment of Kümmell’s disease, PVPHP and PKPHP are both safe and effective, but PVPHP is more economical and can be considered a preferred method of treatment.

Background: Percutaneous kyphoplasty (PKP) could achieve rapid pain relief for older patients with osteoporotic vertebral compression fractures (OVCFs). Bone cement in PKP was the key factor keeping the stabilization of the vertebral body. However, the same amount of cement can distribute differently in a vertebral body and can thereby result in different surgery outcomes. Therefore, the volume and distribution of bone cement should be considered as 2 distinct variables to evaluate the effectiveness of PKP. Objectives: On the basis of comparing surgery outcomes between patients with different recovery states measured by visual analog scores (VAS) and exploring the relationships among bone cement, surgery outcomes, and degrees of pain relief, the objective of the study is to determine the best combination of cement volume and cement distribution for PKP. Study Design: Retrospective study. Methods: There were 220 patients with 220 vertebra who received PKP in our hospital from January 2011 to January 2013. According to the different pain relief degrees, patients were divided into 2 groups. The epidemiological data, surgical outcomes, and complications were compared between the 2 groups. A receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of bone cement on patient recovery state. A correlation analysis was used to analyze the relationships between bone cement and surgery outcomes. Moreover, logistic regression was also used to assess the safety of cement injection. Results: There were 77 recuperators and 143 non-recuperators in our study. There were no differences in epidemiological data between the 2 groups. However, the surgery duration, cement volume, cement distribution, restoration rate of vertebral height, and improvement of kyphotic angle in the recuperator group were all higher than those in the non-recuperator group. The area under the ROC curve of cement distribution as a predictor of pain relief was better than that of cement volume (0.77 vs. 0.65, P < 0.05). Cement distribution had a sensitivity of 62% and a specificity of 84% when it was at 0.49. Cement volume had a sensitivity of 49% and a specificity of 82% when it was at 3.80 mL. All patients were then divided into 4 parts based on the 2 values. Extensive cement distribution (more than or equal to 0.49) was discovered to noticeably increase the recuperative rate both for a small cement volume (less than 3.80 mL) and a large cement volume (more than or equal to 3.80 mL). A small cement volume with an extensive distribution had the same recuperative effect as a large cement volume with a confined distribution (χ2 = 2.880, P = 0.090). When the cement volume was constant, cement distribution was positively correlated with the restoration rate of vertebral height and improvement of the kyphotic angle (r2 = 0.207, P < 0.01; r2 = 0.159, P = 0.02), but cement distribution was not a risk factor for cement leakage or adjacent vertebral fractures (OR = 35.760, 95%CI: 0.096 – 13291.207, P > 0.05; OR = 0.051, 95% CI: 0.011 – 1.032, P > 0.05). Although a large cement volume may contribute to the restoration of vertebral height (r2 = 0.153, P < 0.05), it was found to be a risk factor for adjacent vertebral fractures (OR = 1.733, 95% CI: 1.158 – 2.595, P < 0.05). Limitations: The distribution of cement in fractured vertebra was not calcuated accurately. Conclusions: The diagnostic value of cement distribution is better than that for cement volume in relieving patient pain. A cement distribution above 0.49 with a small cement volume should be suggested for PKP. An extensive cement distribution can improve the kyphotic angle and vertebral height effectively, and it does not cause cement leakage or adjacent vertebral fractures. Key words: Psteoporotic vertebral compression fractures percutaneous kyphoplasty cement volume cement distribution

N -methyladenosine (m A) modification is a pivotal transcript chemical modification of eukaryotics, which has been identified to play critical roles on tumor metabolic reprogramming. However, the functions of m A-reading protein YTH N -methyladenosine RNA-binding protein 3 (YTHDF3) in osteosarcoma is still unclear. This research planned to investigate the bio-functions and mechanism in osteosarcoma tumorigenesis. The aerobic glycolysis of osteosarcoma cells were calculated by glucose uptake, lactate production analysis, ATP analysis and metabolic flux analysis for extracellular acidification rate (ECAR). Molecular binding was identified by RIP-qPCR, RNA decay analysis. Results indicated that YTHDF3 is upregulated in the osteosarcoma tissue samples and cells, and closely correlated to the poor prognosis of osteosarcoma patients. Functionally, gain and loss-of-functional assays illustrated that YTHDF3 promoted the proliferation and aerobic glycolysis of osteosarcoma cells in vitro, and accelerated the tumor growth in vivo. Mechanistically, a m A-modified PGK1 mRNA functioned as the target of YTHDF3, and YTHDF3 enhanced the PGK1 mRNA stability via m A-dependent manner. In conclusion, these findings indicated that YTHDF3 functioned as an oncogene in osteosarcoma tumorigenesis through m A/PGK1 manner, providing a therapeutic strategy for human osteosarcoma.

The aim of the present study was to analyze the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis (TB) treated by application of transforaminal-lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter (TCLC). Posterior debridement and indwelling catheterization in the lesion area were performed for direct injection of anti-TB drugs, so as to reduce the recurrence rate. The present prospective study comprised 26 patients with active thoracolumbar spinal TB who underwent TCLC at Hong Hui Hospital affiliated to Xi'an Jiaotong University (Xi'an, China). The kyphotic Cobb angle at presentation, after surgery and at the final follow-up were 22.7±9.8, 9.8±7.3 and 10.3±8.8°, respectively, with an average correction of 13.1±5.4° after surgery, and a loss of correction of 1.8±1.0° at the final follow-up. The rate of correction and loss of correction were 56.6 and 8.3%, respectively. At six months after the surgery, all abnormal erythrocyte sedimentation rates and C-reactive protein levels had returned to normal. The average time to union was ~5 months. All patients had bony union and improved neurological function, with their daily activity returning to normal. In conclusion, in the present study, application of TCLC for the treatment of spinal TB achieved satisfactory healing of lesions. The surgical treatment for spinal TB comprised the removal of the disease as far as possible, and the local administration of anti-TB chemotherapy to the lesion is key to successful treatment.

Fertigation with microirrigation systems is increasing in popularity. Uniformity of fertigation is important for many reasons. Field experiments were conducted to evaluate the effects of injector types and emitters on fertigation uniformity by simultaneously measuring the distributions of water application, solution concentration, and fertilizer applied within a subunit of microirrigation system. Three conventionally used injectors, a water-driven piston proportional pump, a venturi device, and a differential pressure tank, were evaluated with three different emitters. The results indicated that both manufacturing variability of emitters and injector types had a very significant effect on the uniformity of fertilizer applied, while the uniformity of water application was mainly dependent on emitter type. The uniformity of solution concentration was dependent on injection methods. Emitters having a higher manufacturer's variation produced a more nonuniform distribution of water application and fertilizer applied. For a given emitter type, a differential pressure tank produced considerably higher coefficients of variation (Cv) for water application and fertilizer applied than a proportional pump or a venturi injector because a differential pressure tank released fertilizer in a decreasing rate with time. To obtain a uniform fertigation distribution, an injector that can inject fertilizers in a constant rate is recommended. The relationship between water application uniformity and fertigation uniformity for a microirrigation system was established for different injection methods. Cv for fertilizer applied was very close to water application Cv for a microirrigation system using a proportional pump or a venturi injector as an injection device. However, fertilizer Cv for a differential pressure tank was approximately double of the water application Cv. The injection method and injector performance should therefore be considered in the design of microirrigation systems.[PUBLICATION ABSTRACT]