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Liu F.-Y.,Hebei Medical University | Yang D.-L.,Hebei Medical University | Huang W.-Z.,Jizhong Energy Group Co. | Huo L.-S.,Hebei Medical University | And 5 more authors.
Medicine (United States) | Year: 2017

Background: Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery. Methods: PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR=2.30, 95% CI: 1.76-2.99, P<0.001), the use of anterior cervical plate (OR=1.66, 95% CI: 1.05-2.62, P=0.03), more than 1 surgical level (OR=2.07, 95% CI: 1.62-2.66, P<0.001), the upper surgical level at C3/4 (OR=3.08, 95% CI: 1.44-6.55, P=0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR=5.52, 95% CI: 2.16-14.10, P<0.001). However, no significant difference is found in revision surgery (OR=1.67, 95% CI: 0.60-4.68, P=0.33), the type of fusion (OR=1.02, 95% CI: 0.62-1.67, P=0.95), and cervical disc arthroplasty (OR=1.37, 95% CI: 0.75-2.51, P=0.30). Conclusion: Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required. © 2017 the Author(s).


Wei H.-K.,Hebei Medical University | Yang S.-D.,Hebei Medical University | Bai Z.-L.,Hebei Medical University | Zhang X.,Hebei Medical University | And 3 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

Levofloxacin was previously reported to induce apoptosis of rat annulus fibrosus (AF) cells by upregulating active caspase-3 and matrix metalloproteinase (MMP)-3 expression in vitro. However, the effects of levofloxacin on rat AF cells, as well as the related mechanism, have not been revealed completely. The purpose of this study was to further explore the changes in extracellular matrix and MMPs of rat AF cells based on levofloxacin-induced apoptosis. AF cells isolated from rat AF regions were cultured in monolayers and treated with levofloxacin in a dose- and time-dependent manner. To determine the cytotoxic effects of levofloxacin, inverted phase-contrast microscopy was used to perform morphological observation of apoptotic cells. The mRNA expression levels of MMP-2, -9 and -13 were quantified by reverse transcription and real-time quantitative polymerase chain reaction (RT-qPCR). Protein level of MMP-2 and MMP-13 were determined by western blot. The results showed that levofloxacin induced marked AF cell apoptosis, which was observed by inverted phase-contrast microscopy, and indicated by the increased expression of active caspase-3. Both RT-qPCR and western blot revealed that MMP-2 and MMP-13 expression were upregulated by levofloxacin treatment in a time- and dose-dependent manner. Moreover, cellular binding to type I collagen was found to be decreased by levofloxacin. In conclusion, the results above suggest that the possible cytotoxic effects of levofloxacin on AF cells in vitro may be attributed to the decreased cell binding to type I collagen and up-regulated expression of MMP-2 and MMP-13. © 2015 E-Century Publishing Corporation. All rights reserved.


Ning S.-H.,Hebei Medical University | Yang S.-D.,Hebei Medical University | Zhang X.,Hebei Medical University | Huan-Liu,Hebei Medical University | And 5 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2016

Background: It has been suggested that intervertebral disc (IVD) cell apoptosis playing a key role in promoting disc degeneration, and Oxidative stress has been proved to induce apoptosis of nucleus pulposus cells (NPCs) in contributing to the process of IVD degeneration. 17β-Estradiol (17β-E2) has been reported for its protective effect on NPCs in our previous studies. However, it is not yet clear whether 17β-E2 has the protective effect on NPCs against apoptosis induced by oxidative stress. Purpose: Based on apoptotic cell model induced by Hydrogen Peroxide (H2O2), the current research was design to explore the effect of 17β-E2 on rat NPCs against apoptosis. Methods: NPCs were isolated from male Sprague-Dawley rats and cultured in complete medium. After two weeks, the NPCs were treated with H2O2 (1, 10, 100, 500 and 1000 μM/L, respectively) for 6 h, and 500 μM/L H2O2 for (1, 3, 6, 12 and 24 h, respectively). Cell counting kit-8 assay was performed to determine cell viability. LDH assay was performed to assess cytotoxicity after different treatments. Apoptotic incidence was analyzed by Fluorescence Activating Cell Sorter (FACS), morphological changes, as well as western blot of active caspase-3. Results: The results showed that H2O2 induced notable apoptosis and over expression of active caspase-3 in a dose- and time-dependent manner. However, the adverse effect caused by H2O2 was obviously reversed by 17β-E2. Besides, cell viability was decreased after treatment with H2O2, which was then increased by the addition of 17β-E2. In particular, the dose-dependent effect of 17β-E2 was remarkable. During the experiments, it was found that all effects resulting from 17β-E2 were eliminated by estrogen receptor antagonist ICI182, 780. Conclusions: These results obtained in this study suggest that 17β-E2 can effectively protect rat NPCs from peroxide-induced apoptosis in a dose-dependent manner, implying the potential of 17β-E2 to prevent IVDD onset or slow its progression in the early stage. © 2016, E-Century Publishing Corporation. All rights reserved.


Yang S.-D.,Hebei Medical University | Ding W.-Y.,Hebei Medical University | Ding W.-Y.,Hebei Provincial Key Laboratory of Orthopedic Biomechanics | Yang D.-L.,Hebei Medical University | And 6 more authors.
Medicine (United States) | Year: 2015

This cross-sectional study was designed to obtain the current prevalence of deep vein thrombosis (DVT) and analyze related risk factors in patients undergoing lumbar interbody fusion. Medical record data were collected from Department of Spinal Surgery, The Third Hospital of Hebei Medical University, between July 2014 and March 2015. Both univariate analysis and binary logistic regression analysis were performed to determine risk factors for DVT. A total of 995 patients were admitted into this study, including 484 men and 511 women, aged from 14 to 89 years old (median 50, IQR 19). The detection rate of lower limb DVT by ultrasonography was 22.4% (223/995) in patients undergoing lumbar interbody fusion. Notably, average VAS (visual analog scale) score in the first 3 days after surgery in the DVT group was more than that in the non-DVT group (Z=-21.69, P <0.001). The logistic regression model was established as logit P=-13.257 + 0.056∗X1-0.243∗X8 + 2.085∗X10 + 0.001∗X12, (X1 =age; X8=HDL; X10=VAS; X12=blood transfusion; x2=677.763, P<0.001). In conclusion, advanced age, high postoperative VAS scores, and blood transfusion were risk factors for postoperative lower limb DVT. As well, the logistic regression model may contribute to an early evaluation postoperatively to ascertain the risk of lower limb DVT in patients undergoing lumbar interbody fusion surgery. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Liu F.-Y.,Hebei Medical University | Wang T.,Hebei Medical University | Yang S.-D.,Hebei Medical University | Wang H.,Hebei Medical University | And 3 more authors.
European Spine Journal | Year: 2016

Purpose: To analyse the incidence and risk factors associated with proximal junctional kyphosis (PJK) following spinal fusion, we collect relative statistics from the articles on PJK and perform a meta-analysis. Methods: An extensive search of literature was performed in PubMed, Embase, and The Cochrane Library (up to April 2015). The following risk factors were extracted: age at surgery, gender, combined anterior-posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation, thoracoplasty, fusion to sacrum (S1), preoperative thoracic kyphosis angle (T5–T12) >40°, bone mineral density (BMD) and preoperative to postoperative sagittal vertical axis (SVA difference) >5 cm. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: A total of 14 unique studies including 2215 patients were included in the final analyses. The pooled analysis showed that there were significant difference in age at surgery >55 years old (OR 2.19, 95 % CI 1.36–3.53, p = 0.001), fusion to S1 (OR 2.12, 95 % CI 1.57–2.87, p < 0.001), T5–T12 >40° (OR 2.68, 95 % CI 1.73–4.13, p < 0.001), low BMD (OR 2.37, 95 % CI 1.45–3.87, p < 0.001) and SVA difference >5 cm (OR 2.53, 95 % CI 1.24–5.18, p = 0.01). However, there was no significant difference in gender (OR 0.98, 95 % CI 0.74–1.30, p = 0.87), combined anterior-posterior surgery (OR 1.55, 95 % CI 0.98–2.46, p = 0.06), use of pedicle screw at top of construct (OR 1.55, 95 % CI 0.67–3.59, p = 0.30), hybrid instrumentation (OR 1.31, 95 % CI 0.92–1.87, p = 0.13) and thoracoplasty (OR 1.55, 95 % CI 0.89–2.72, p = 0.13). The incidence of PJK following spinal fusion was 30 % (ranged from 17 to 62 %) based on the 14 studies. Conclusions: The results of our meta-analysis suggest that age at surgery >55 years, fusion to S1, T5–T12 >40°, low BMD and SVA difference >5 cm are risk factors for PJK. However, gender, combined anterior–posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation and thoracoplasty are not associated with PJK. © 2016 Springer-Verlag Berlin Heidelberg


Bai Z.-L.,Hebei Medical University | Chen Q.,Hebei Medical University | Yang S.-D.,Hebei Medical University | Zhang F.,Hebei Medical University | And 4 more authors.
Medical Science Monitor | Year: 2014

Background: Fluoroquinolones are in wide clinical use as safe and effective antibiotics. Articular cartilage, tendons, and epiphyseal growth plates have been recognized as targets of fluoroquinolone-induced connective tissue toxicity. However, the effects of fluoroquinolones on annulus fibrosus (AF) cells are still unknown.Material/Methods: The main objective of this study was to investigate the effects of levofloxacin, a typical fluoroquinolone antibiotic drug, on rat AF cells in vitro. Rat annulus fibrosus (RAF) cells were treated with levofloxacin at different concentrations (0, 10, 20, 30, 40, 60, 80, and 90 μg/ml) and were assessed to determine the possible cytotoxic effects of levofloxacin. Inverted phase-contrast microscopy was used to accomplish the morphological observation of apoptosis of treated cells. Western blot and real-time quantitative RT-PCR (qPCR) was used to explore the expression of active caspase-3 and MMP-3. Flow cytometry was used to measure the apoptotic incidences.Results: Our study showed that levofloxacin, with concentrations at 30, 60, and 90 μg/ml, induced dose-dependent RAF cell apoptosis and higher expression of caspase-3 and MMP-3. More apoptotic cells were observed by inverted phase-contrast microscopy. Moreover, levofloxacin increased the activity of caspase-3, and it also reduced cell viability with different concentrations ranging from 10 to 80 μg/ml.Conclusions: Our study results suggest that levofloxacin has cytotoxic effects on RAF cells, characterized by enhancing apoptosis and reducing cell viability, and indicate a potential toxic effect of fluoroquinolones on RAF cells. © Med Sci Monit, 2014.


Xu J.-X.,Hebei Medical University | Yang S.-D.,Hebei Medical University | Wang B.-L.,Hebei Medical University | Yang D.-L.,Hebei Medical University | And 4 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

Background: Upper lumbar disc herniation (ULDH) is easy to be misdiagnosed due to its special anatomical and atypical clinical features. Few studies have identified the relationship between ULDH and adjacent wedge-shaped vertebrae (WSV). Hypothesis: WSV may have some indicative relations withULDH. Patients and methods: Between January 2003 and October 2013, 47 patients (27 males and 20 females; mean age, 41.2 years) with single-level ULDH (as study group) and 47 sex-and age-matched healthy volunteers (as control group) were studied by radiograph. The two groups were compared with respect to age, sexual proportion, body mass index (BMI), kyphotic angle, and the proportion of WSV. Also, correlative analyses were conducted in the study group to investigate the relation between the kyphotic angle of target vertebrae and other factors including age, BMI, Cobb angle, JOA score and bone mineral density (BMD). Results: The average kyphotic angle in the study group was 11° (4°-22°), while the average kyphotic angle in the control group was 2° (0°-7°). Obviously, the mean kyphotic angle in the study group was statistically larger than that in the control group (t=13.797, P<0.001). The proportion of WSV in the study group was significantly larger than that in the control group (x2=36.380, P<0.0001). The correlations between kyphotic angles and other items (i.e., age, BMI, BMD, Cobb angle and JOA score) in the study group and the control group were low or uncorrelated. Conclusions: WSV are indicatively associated with adjacent ULDH. Thus, ULDH should be alerted when WSV are first found in radiograph and accompanied by clinical symptoms. © 2015, E-Century Publishing Corporation. All rights reserved.


Yang S.-D.,Hebei Medical University | Yang S.-D.,Hebei Provincial Key Laboratory of Orthopedic Biomechanics | Ma L.,Hebei Medical University | Ma L.,Hebei Provincial Key Laboratory of Orthopedic Biomechanics | And 15 more authors.
Apoptosis | Year: 2014

Levofloxacin has been reported to have cytotoxicity to chondrocytes in vitro. And 17β-estradiol has been widely studied for its protective effects against cell apoptosis. Based on apoptotic cell model induced by levofloxacin, the purpose of this study was to explore the mechanism by which 17β-estradiol protects rat nucleus pulposus cells from apoptosis. Inverted phase-contrast microscopy, flow cytometry, and caspase-3 activity assay were used to find that levofloxacin induced marked apoptosis, which was abolished by 17β-estradiol. Interestingly, estrogen receptor antagonist, ICI182780, and functional blocking antibody to α2β1 integrin, both prohibited the effect of 17β-estradiol. Simultaneously, levofloxacin decreased cellular binding ability to type II collagen, which was also reversed by 17β-estradiol. Furthermore, western blot and real-time quantitative PCR were used to find that integrin α2β1 was responsible for estrogen-dependent anti-apoptosis, which was time-response and dose-response effect. 17β-estradiol was proved for the first time to protect rat nucleus pulposus cells against levofloxacin-induced apoptosis by upregulating integrin α2β1 signal pathway. © 2014 Springer Science+Business Media New York.


Yang S.-D.,Hebei Medical University | Chen Q.,Hebei Medical University | Wei H.-K.,Hebei Medical University | Zhang F.,Hebei Medical University | And 4 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2015

Objective: Recent studies suggested an increased risk of fractures with interaction between bisphosphonates (BPs) and proton pump inhibitors (PPIs). We performed a meta-analysis of fractures between patients taking BPs/PPIs and those taking BPs only. Methods: We conducted a PubMed database and Ovid database search, as well as Cochrane Library search (up to July 2014) for studies assessing the association between fractures and BPs or/and PPIs. We performed random effects meta-analysis of odds ratios (OR) according to fracture type and conducted subgroup analyses by race and BP subtypes. Heterogeneity was assessed using Q statistics and I2 statistic. Results: After study selection, 4 unique studies (5 comparisons) including 57259 patients were available for this meta-analysis. Pooled analysis of overall fracture risk of BP+PPI group versus BP group showed a significant increase in risk of fractures (OR = 1.52, P = 0.025), with substantial heterogeneity. However, heterogeneity was drastically reduced in subgroup of Asian (I2 = 24% and P = 0.251), and fracture risk showed a significant increase (OR = 1.75, P = 0.026). In contrast, heterogeneity was little eliminated in subgroup of European, and fracture risk was no statistical difference (OR = 1.42, P = 0.068). Three studies including 4 comparisons reported on spine fracture were included in the pooled analysis demonstrating an increased spine fracture risk associated with BP/PPI interaction (OR = 1.60, 95% CI 1.13-2.26, P = 0.008, I2 = 58.6%). Conclusions: This meta-analysis suggests that there is an interaction associated with increased fracture risk (particularly for spine and Asian race) between BP and PPI use. Clinicians should carefully evaluate such risk factors for osteoporosis in patients taking BPs, before routinely prescribing PPIs, and make a careful judgment as to whether PPIs may be safe for patients at high risk of fractures. © 2015, E-Century Publishing Corporation. All rights reserved.


Ma L.,Hebei Medical University | Ma L.,Hebei Provincial Key Laboratory of Orthopedic Biomechanics | Yang S.,Hebei Medical University | Yang S.,Hebei Provincial Key Laboratory of Orthopedic Biomechanics | And 6 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2016

Lumbar fusion surgery has been a gold standard for treating lumbar disc degenerative disease (LDDD). But the adjacent segment pathology (ASP) became a problem, which could have been caused by the increased motion and stress concentration at the adjacent segment. So, artificial total disc replacement (TDR) as an alternative to spinal fusion has recently been applied for treatment of LDDD. However, up to now, a controversy whether TDR is better than fusion still persists. We performed the research of database including Pubmed/Medline, EMBASE, and Ovid. Our studies were classified into short-term (2 years) and midterm (5 years) follow-up. Twelve randomized controlled trials involving 1479 cases were included in the study. The repetitive data from them were excluded. Significant difference in visual analogue scale (VAS) and Oswestry disability index (ODI) could be found at 2 year follow-up, and TDR group was better than fusion group in both of them (VAS: I2=0%, P<0.0006; ODI: I2=0%, P<0.00001). No difference was found in reoperation rate at 2 year follow-up (I2=18%, P=0.22). However, the reoperation rate at the index level in TDR group was significantly lower than that in fusion group at 5 year follow-up (I2=0%, P=0.006). The incidence of ASP in TDR group was lower compared with fusion group at 5 year follow-up (I2=0%, P<0.0002) but not at 2 year follow-up (I2=0%, P<0.08). TDR shows the efficacy and safety comparable to lumbar fusion at 2 and 5 year follow-up. Besides, TDR has significant superiority in a lower incidence of ASP at 5 year follow-up. © 2016, E-Century Publishing Corporation. All rights reserved.

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