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Purpose To compare the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion. Methods This study was registered on International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023484937). We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database, and Wei Pu Database by computer to collect controlled clinical studies on the efficacy and safety of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in the treatment of adjacent segment degeneration (ASD) after lumbar fusion from database establishment to November 2023. Two researchers screened the literature, extracted data and evaluated the risk of bias of the included studies, recorded the authors, and sample size, and extracted the intraoperative blood loss, operation time, Oswestry disability index (ODI), Visual analogue scale (VAS), disc height (DH), hospital length stay and complications in each study. Meta-analysis was performed using Revman 5.4 software provided by Cochrane Library. Results A total of 6 cohort studies (CS) and 1 randomized controlled study with a total of 420 patients were included in this study, including 188 patients in the CBT group and 232 patients in the PS group. The CBT group had lower intraoperative blood loss than the PS group [mean difference (MD) = -129.38, 95% CI (-177.22, -81.55), P  < 0.00001] and operation time was shorter than that of the PS group [MD = -1.42, 95% CI (-2.63, -0.20), P  = 0.02]. Early postoperative back and leg pain improved more significantly in the CBT group [MD = -0.77, 95% CI (-1.35, -0.19), P  = 0.01; MD = -0.24, 95% CI (-0.37, -0.10), P  = 0.0005]. Conclusion Compared with PS, CBT for adjacent segment degeneration after lumbar fusion has the advantages of less intraoperative blood loss, shorter operation time, and less back and leg pain in the early postoperative period.

Background: In this study, exosomes were engineered with anti-CD47 antibody and loaded with rifapentine to improve their ability to target macrophages for drug delivery. Methods: Exosomes from RAW264.7 cell supernatant were extracted by differential centrifugation, antibody-modified, and drug-loaded ultrasonically. After co-culturing with macrophages, transcriptomics and proteomics screened differentially expressed genes and proteins. Western Blot identified macrophage polarization, ELISA detected inflammatory indicators, and an apoptosis kit was used for fluorescence staining. Results: Transcriptome sequencing showed that 406 genes in the macrophages changed significantly, with pathways like TNF and NF-κB. Proteomics identified 7478 proteins, 433 with significant differences. Western Blot indicated M1 polarization. Fluorescence staining showed apoptosis in the antiMExo-RIF group. Conclusions: The study provides multi-omics evidence of the immune mechanism of the engineered exosome drug delivery system in inducing macrophage apoptosis, revealing potential molecular mechanisms and the great potential use of engineered exosomes in treating macrophage-related diseases.

Tuberculosis, caused by Mycobacterium tuberculosis (Mtb), remains one of the leading causes of death among infectious diseases. Enhancing the ability of anti-tuberculosis drugs to eradicate Mycobacterium tuberculosis within host cells remains a significant challenge. A mannosamine-modified nanoparticle delivery system was developed using poly(lactic-co-glycolic acid) (PLGA) copolymers to enhance the targeted delivery of rifapentine (RPT) to macrophages. D-mannosamine was conjugated to PLGA-polyethylene glycol (PLGA-PEG) copolymers through EDC/NHS coupling chemistry, and the resultant RPT-MAN-PLGA-PEG nanoparticles (NPs) were prepared through a combination of phacoemulsification and solvent evaporation methods. The physicochemical properties, toxicity, in vitro drug release profiles, stability, cellular uptake, and anti-TB efficacy of the NPs were systematically evaluated. The RPT-MAN-PLGA-PEG NPs had a mean particle size of 108.2 ± 7.2 nm, with encapsulation efficiency and drug loading rates of 81.2 ± 6.3% and 13.7 ± 0.7%, respectively. RPT release from the NPs was sustained for over 60 hours. Notably, the phagocytic uptake of the MAN-PLGA NPs by macrophages was significantly higher compared to PLGA-PEG NPs. Both NPs improved pharmacokinetic parameters without inducing significant organ toxicity. The minimum inhibitory concentration for the NPs was 0.047 μg/mL, compared to 0.2 μg/mL for free RPT. The engineered RPT-MAN-PLGA-PEG NPs effectively enhanced macrophage uptake in vitro and facilitated the intracellular clearance of Mtb. This nanoparticle-based delivery system offers a promising approach for improving the precision of anti-TB therapy, extending drug release, optimizing pharmacokinetic profiles, augmenting antimicrobial efficacy, and mitigating drug-related toxicities.

Objective To investigate the clinical effect of vertebroplasty through unilateral upper edge of transverse process in the treatment of lumbar osteoporotic vertebral compression fracture (OVCF), and to explore the surgical indications and operation points of this technique. Methods Ninety patients with osteoporotic vertebral compression fractures of the lumbar spine treated in our hospital from June 2020 to June 2021 were retrospectively analyzed and divided into the experimental group and the control group for vertebroplasty according to the principle of randomization; the experimental group was treated with a lateral pedicle approach through the upper edge of the unilateral transverse process, and the control group was treated with a unilateral pedicle approach. After more than 1 year of follow-up, the operation time, intraoperative fluoroscopy times, bone cement injection volume, Oswestry disability index (ODI), Visual analogue scale (VAS) were compared between the two groups to assess the functional recovery of the patients. Results There was no significant difference in the general data (age, gender, location and number of fractured vertebral bodies, and follow-up time) between the two groups before surgery. In the experimental group, there were 42 OVCF patients (15 males and 27 females), and the operated segments were L1 vertebral body in 17 cases, L2 vertebral body in 13 cases, L3 vertebral body in 8 cases, L4 vertebral body in 3 cases, and L5 vertebral body in 1 case. The control group consisted of 48 OVCF patients (16 males and 32 females), and the operated segments were L1 vertebral body in 21 cases, L2 vertebral body in 15 cases, L3 vertebral body in 8 cases, L4 vertebral body in 2 cases, and L5 vertebral body in 2 cases. In terms of operation time and intraoperative fluoroscopy times, the experimental group was less than the control group, and the difference had statistical significance ( P  < 0.05); in terms of bone cement injection volume, the difference between the two groups had no statistical significance ( P  > 0.05); in terms of pain VAS score and dysfunction index ODI score, the scores of the two groups were improved with the extension of follow-up time compared with those before surgery, but the difference between the two groups had no statistical significance ( P  > 0.05). Conclusion Compared with the traditional approach, PVP via the unilateral extrapedicular approach at the upper edge of the transverse process has the advantages of less operation time and fluoroscopy times, uniform diffusion of bone cement, and is comparable to the traditional surgical approach in relieving pain and improving patient function, but due to the limitation of the length of the puncture needle, careful operation is required during the operation.

This research was developed to accurately evaluate the unstable fractures of thoracolumbar before and after surgery and discuss the treatment timing and methods. Three-dimensional (3D) finite element method was adopted to construct the T12-L5 segment model of human body. The efficiency of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP), two commonly used internal fixation procedures, was retrospectively compared. A total of 150 patients with chest fracture who received PKP or PVP surgery in our hospital, and 104 patients with the same symptoms who received conservative treatment were collected and randomly rolled into PVP group (75 cases), PKP group (75 cases), and control group (104 cases). Visual analog scale (VAS) score and Oswestry disability index (ODI) of patients were collected before and after surgery and 2, 12, and 24 months after surgery. Then, the anterior and central height of the patient’s cone and the kyphosis angle were calculated by X-ray. Lumbar minimally invasive fusion system and lumbar pedicle screw rod system were established by computer-aided design (CAD), and the biomechanical characteristics were analyzed. The results showed that there was no substantial difference in VAS score and ODI score between PKP and PVP (P>0.05), but they were higher than those of the control group (P<0.05). The anterior edge and middle height of vertebra in the two groups were higher than those in control group (P<0.05), and the increase in PKP group was more substantial (P<0.05). The kyphosis of the two groups was smaller than that of the control group (P<0.05), and the decrease of the kyphosis of the PKP group was more substantial (P<0.05). In summary, the thoracolumbar segment model established by 3D finite element method was an effective model, and it was verified on patients that both PKP and PVP could achieve relatively satisfactory efficacy. The implantation of the new internal fixation system had no obvious effect on the lumbar movement. This work provided a novel idea and method for the treatment of senile thoracolumbar unstable fracture, as well as experimental data of biomechanics for the operation of senile unstable fracture.

Citriodora A, 3β,25-dihydroxy-5α,6α-epoxy-7-oxocucurbita-(23E)-en-19-al, a new triterpenoid, has been isolated from the roots of Eucalyptus citriodora, together with five known analogues, which were reported for the first time from this plant. The structures were elucidated on the basis of spectral studies including mass spectroscopy and extensive 2D NMR. All components were tested for anticancer cytotoxic activity against osseous tumour cell line.