Objective: New vertebral compression fracture (NVCF) occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture is very common. Preoperative baseline characteristics and surgical treatment parameters have been widely studied as a risk factor, but the importance of the patients' laboratory indicators has not been thoroughly explored. We aimed to explore the relationship between laboratory indicators and NVCF, and attempt to construct a clinical prediction model of NVCF together with other risk factors.Methods: Retrospective analysis was performed for 200 patients who underwent bone cement injection (percutaneous kyphoplasty or vertebroplasty) for vertebral compression fractures between January 2019 and January 2020. We consulted the relevant literature and collated the factors affecting the occurrence of NVCF. Feature selection of patients with NVCF was optimized using the least absolute shrinkage and selection operator regression model, which was used to conduct multivariable logistic regression analysis, to create a predictive model incorporating the selected features. The discrimination, calibration, and clinical feasibility of the predictive model were assessed using the concordance index (C-index), calibration plots, and decision curve analysis. Internal validation was performed using Bootstrap resampling verification.Results: Time from injury to surgery exceeding 7 days, low osteocalcin levels, elevated homocysteine levels, osteoporosis, mode of operation (percutaneous vertebroplasty), lack of postoperative anti-osteoporosis treatment, and poor diffusion of bone cement were independent risk factors for NVCF in middle-aged and elderly patients with vertebral compression fracture after bone cement injection. The C-index of the nomogram constructed using these seven factors was 0.895, indicating good discriminatory ability. The calibration plot showed that the model was well calibrated. Bootstrap resampling verification yielded a significant C-index of 0.866. Decision curve analysis demonstrated that the greatest clinical net benefit for predicting NVCF after bone cement injection could be achieved with a threshold of 1%-91%. Conclusion:This nomogram can effectively predict NVCF incidence after bone cement injection in middle-aged and elderly patients with vertebral compression fracture, thus aiding clinical decision-making and postoperative management, promoting effective postoperative rehabilitation, and improving the quality of life.

These results could indicate a brand-new biological marker which may be applied to estimate the features and prognosis of osteosarcoma.

Astragaloside IV (AS IV) and tanshinone (TS IIA) are the main natural components of Salvia miltiorrhiza and Radix Astragali, respectively. The amalgam of TS IIA and AS IV has potential therapeutic value in many inflammation-related diseases. However, the aftereffect of TS IIA and AS IV for lumbar disc herniation is not clear. Although the function of miR-223 in the inflammation-related JAK/STAT pathway is unknown, it is particularly expressed in human degenerative nucleus pulposus cells. This study has investigated the efficacy of the combined application of TS IIA and AS IV in the treatment of intervertebral disc nucleus pulposus cells (NP cells) injured by lipopolysaccharide (LPS). After miR-223 inhibitor imitated NP cells, the state of the JAK family and STAT family was recognized by Western blotting (Western blot, WB) and reverse transcriptase quantitative polymerase chain reaction (qPCR). The shRNA lentivirus interference vector targeting the STAT family was constructed, and the NP cell line stably interfering with the STAT gene was established after transfection. The expression of TNF-α, IL-6, MMP-9, MMP-3, caspase-1, and caspase-3 was detected by lipopolysaccharide (WTNP cells), control virus NP cells, STAT downregulation NP cells, enzyme-linked immunosorbent assay (ELISA), Western blot, and qPCR, respectively. The cell survival rate was detected by flow cytometry and TUNEL staining reverse transcriptase-polymerase chain reaction (qPCR). NP cells were treated with TS IIA and AS IV which had been made into different concentrations, and then, the expression of miR-223, p-STAT1, and p-JAK families was detected by WB Western blotting and qPCR. MiR-223 selectively acts on JAK2/STAT1 pathway, increases the expression of TNF-α, IL-6, MMP-9, MMP-3, caspase3-1, and caspase-3, and induces apoptosis, which can be eliminated by silencing STAT1. TS IIA combined with AS IV could inhibit the expression of miR-223, p-STAT1, and p-JAK2 in NP cells, and they showed a dose-dependent tendency to p-STAT1 and p-JAK2. This study shows that miR-223 promotes the inflammatory response and induces cell injury of NP cells by acting on the JAK2/STAT1 pathway, and the combination of TS IIA and AS IV may protect NP cells by downregulating miR-223 and inhibiting the expression of JAK2 and STAT1.

Wang et al. [1] conducted a meta-analysis to assess the effects of murine double minute 2 (MDM2) polymorphisms on osteosarcoma risk and survival of patients with osteosarcoma. They calculated the pooled odds ratio (OR) or hazard ratio (HR) with 95 % confidence intervals (95 % CIs) by using different effects models and concluded that MDM2 polymorphisms have some effects on the risk of osteosarcoma but have no effect on the survival of patients with osteosarcoma. Before their results can be accepted, we would like to express some concerns in relation to their meta-analysis.Firstly, the investigators clarified that "PubMed, Web of Science, and Wanfang databases were searched for eligible studies" in the "Abstract" section. However, they searched the PubMed and EMBASE databases for eligible studies in the "Methods" section. We would like to know the possible reason for this difference. To make the article more credible, the investigators should give us the real search issues. The small number of required papers would be an important limitation of the review. We suggest that more electronic databases be systematically searched.Secondly, the investigators included only one study on the association between MDM2 rs2279744 polymorphism and the overall survival of patients with osteosarcoma, which could not reflect the real association between them. In our opinion, the investigators should search more electronic databases to find more studies.Thirdly, with respect to the data extraction, two investigators independently extracted data and reached a consensus. We would like to know how problems were solved if there were discrepancies between the two investigators.Fourthly, we suggest that the investigators evaluate the methodological quality of the selected studies, which could avoid potential bias in the meta-analysis. Each included paper could be independently assessed by two investigators using a standardized electronic form of predefined criteria. Also, the investigators could describe how to evaluate the quality of all studies in the meta-analysis.Finally, the departure of frequencies of MDM2 polymorphisms from expectation under Hardy-Weinberg equilibrium in the control population should be assessed using the goodness-of-fit chi-square test with a P <0.05 considered as significant disequilibrium. A significant difference between the observed and expected genotype frequencies under Hardy-Weinberg equilibrium (HWE) may indicate genotyping error [2]. Departure from HWE can be caused by factors such as inbreeding caused by consanguinity, assortative mating, i.e., nonrandom mating, selection, or migration [3]. Although exceptions to the conditions of HWE may explain deviation, it is critical that investigators recognize the need to perform a test of HWE and then evaluate the reasons for any observed deviation.Thanks go to the authors for their contribution of supplying us with an assessment of the effects of MDM2 polymorphisms on osteosarcoma risk and survival of patients with osteosarcoma. However, further studies with l...