Background/Aims: Ankylosing spondylitis (AS) is an inflammatory and immune disease leading to disability. Autophagy has been identified as a potential player in understanding the pathogenesis of AS. Methods: MiRNA-199a-5p and autophagy-related gene expression were determined by qRT-PCR or Western blot. Cytokine production was determined using ELISA assays. Proliferation was determined by MTT assay. MiRNA-199a-5p and Ras homolog enriched in brain (Rheb) were upregulated or downregulated by overexpression of plasmid or siRNA transfection. Results: Expression of miRNA-199a-5p, and autophagy-related genes LC3, beclin1, and ATG5 was significantly decreased in T cells of AS patients. Serum concentrations of TNF-α, IL-17, and IL-23 were promoted in AS patients, compared to healthy controls. MiRNA-199a-5p expression levels also showed significant negative correlations with the Ankylosing Spondylitis Disease Activity Score (ASDAS) and modified Stoke Ankylosing Spon dylitis Spinal Score (mSASSS) of AS patients. In Jurkat T cells and T cells isolated from AS patients, miRNA-199a-5p overexpression promoted autophagy-related genes expression and decreased TNF-α, IL-17, and IL-23 levels, whereas inhibition of miRNA-199a-5p attenuated these effects. As a direct target of miRNA-199a-5p, Rheb inhibition led to a striking decrease in the phosphorylation of the mechanistic target of rapamycin (mTOR) and induced autophagy. Moreover, pcDNA3.1-Rheb effectively reduced the inhibiting effects of mTOR signaling caused by miRNA-199a-5p overexpression. All effects were offset by pretreating with rapamycin (an mTOR antagonist). Conclusions: AS patients with advanced spinal damage had decreased autophagy levels and that miRNA-199a-5p may induce autophagy and inhibit the pathogenesis of AS by modulating the mTOR signaling via direct targeting Rheb.

Objective:To discuss the significance of comprehensive rehabilitation training combined with multimodal analgesia (MMA) for the early knee function recovery of patients with knee bone tumor who underwent prosthesis replacement operation.Methods:Sixty patients with knee bone tumor who underwent prosthesis replacement operation were selected and randomly divided into two groups according to rehabilitation training and postoperative analgesic methods, namely, observation group and control group, 30 cases in each group. The control group was treated with symptomatic treatment (drugs were given based on pain before and after surgery) and continuous passive motion (CPM) functional training, while the observation group was treated with comprehensive rehabilitation training combined with MMA. The compliance of patients in the two groups was compared and the first-time off-bed activity time was recorded. Recovery conditions of wounds were observed, and recovery conditions of limb functions after operations were evaluated.Results:The compliance of patients in the observation group was significantly higher than that in the control group, and the difference was statistically significant (P<0.05). The first-time off-bed activity time of patients of the observation group was earlier than that of the control group. The wound recovery condition of the observation group 7 days after operation was better compared to that of the control group, and the difference between two groups two weeks after operation was not statistically significant. The Hospital for special surgery knee (HSS) score and evaluation result of range of motion (ROM) of knees of the observation group were both better than those of the control group in different periods after operation, and the differences were statistically significant (P<0.05).Conclusion:Comprehensive rehabilitation training combined with MMA can improve the compliance of patients and help patients off bed earlier, and remarkably promote the early recovery of knee functions; hence it deserves to be promoted clinically.

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Study Design. Retrospective radiographic study. Objective. To investigate the growth of the vertebrae around distal instrumented vertebra (DIV) in patients with early-onset scoliosis (EOS) who underwent dual growing rod (DGR) treatment. Summary of Background Data. Previous studies indicated that DGR was likely to preserve or even stimulate the spinal growth. However, report pertaining to the effect of growing rod on the growth of individual vertebral body is rare. Methods. The EOS patients treated with DGR who had at least four lengthenings and 5-year follow-up were enrolled. Spine radiographs at index surgery and final follow-up were reviewed. The height, width, and depth of vertebral body from DIV–2 to DIV+2, and the height of the adjacent intervertebral space (IVS) were measured. The percentage of growth was calculated. Results. Thirty-one patients (mean age, 6.2 ± 2.5 years old) met the inclusion criteria, 74.2% (23/31) of whom were female. The average follow-up was 6.2 years (range, 5.0–10.4 yr). The measured vertebrae were divided into DIV group (n = 65), DIV- group (DIV-1 and DIV-2, n = 60), and DIV+ group (DIV+1 and DIV+2, n = 47). There were 33, 90, and 78 measured IVSs in DIV, DIV–, and DIV+ group, respectively. The total percentage growth of vertebral height was significantly higher in DIV– group than that in DIV and DIV+ groups (56.6 ± 20.3% vs. 45.6 ± 18.0% and 42.7 ± 16.2%, respectively, P ≤ 0.001). The vertebrae in DIV– group also had the highest annual height growth rate (8.7 ± 2.6% vs. 7.0 ± 2.4% and 6.6 ± 2.0%, respectively, P ≤ 0.001). A significant decrease of IVS height was observed in DIV– and DIV groups (P ≤ 0.001). Conclusion. Traditional DGR with periodical distraction stimulated the longitudinal growth of the two segments immediately above DIV in patients with EOS. DGR technique had a negative effect on the development of intervertebral discs within distracted levels. Level of Evidence: 3