Nguyen Tran Canh Tung

Increasing evidence suggests that inflammation and immune imbalance are associated with osteonecrosis of the femoral head (ONFH). This study aimed to investigate peripheral inflammatory biomarkers in patients with nontraumatic ONFH and assess their potential prognostic value. A retrospective analysis was conducted on 80 patients with nontraumatic ONFH and 110 control individuals without ONFH. Peripheral blood cell counts, C-reactive protein (CRP), and derived inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were compared between groups and among different disease stages. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. The results showed that ONFH patients showed significantly higher CRP, monocyte count (cM), monocyte percentage (pM), MLR, and platelet count (PLT). ROC analysis revealed that CRP (AUC = 0.700, sensitivity = 71.3%, specificity = 65.5%) and cM (AUC = 0.690, sensitivity = 82.5%) had the highest diagnostic accuracy. CRP levels differed significantly across disease stages, peaking at stage II (P = 0.0107), while other indices remained stable. These findings support the concept that both systemic and local inflammatory mechanisms contribute to the pathogenesis of ONFH. CRP and monocyte indices may serve as inexpensive, accessible adjuncts for early disease screening and monitoring.

Rationale: Peroneal tendon subluxation is an uncommon injury that is often overlooked during the acute phase, resulting in long-term instability. Patient concerns: We present a case involving a 25-year-old male soldier with a 2-year history of recurrent ankle pain and instability following an initial ankle injury. Diagnoses: Chronic peroneal tendon subluxation was diagnosed based on clinical examination and imaging findings. Interventions: Given the limitations of surgical instruments available at our institution in Vietnam, the patient was treated operatively using the Ellis Jones method, a traditional technique. The superior peroneal retinaculum was reinforced with a part of the Achilles tendon. Postoperatively, the leg was immobilized in a below-knee cast for 6 weeks. Outcomes: The patient experienced an uncomplicated recovery, returning to work without pain or need for braces within 2 months and resuming full physical activity 6 months postoperatively. Lessons: This case highlights that the Ellis Jones method remains a simple, cost-effective, and reliable surgical option for managing chronic peroneal tendon subluxation, particularly in resource-limited settings where specialized implants are unavailable.

Mục tiêu: Đánh giá sự thay đổi nồng độ albumin huyết thanh sau phẫu thuật thay khớp háng ở bệnh nhân (BN) cao tuổi. Phương pháp nghiên cứu: Nghiên cứu hồi cứu trên 142 trường hợp ≥ 60 tuổi, 86 khớp háng bán phần và 57 khớp háng toàn phần từ tháng 4/2022 - 12/2024 tại Bệnh viện Quân y 103. Nồng độ albumin huyết thanh được đo trước và sau phẫu thuật 24 giờ. Kết quả: Tuổi trung bình là 74,27 ± 6,99; tuổi trung bình của nhóm khớp háng bán phần cao hơn trong khi nồng độ albumin thấp hơn so với nhóm toàn phần. Nồng độ albumin giảm sau phẫu thuật ở cả hai nhóm, mức giảm có tương quan thuận với tuổi (r = 0,44; p < 0,0001) và giới tính nữ (p = 0,0037). Không ghi nhận mối liên quan giữa thay đổi albumin và thời gian phẫu thuật. Kết luận: Phẫu thuật thay khớp háng gây giảm albumin huyết thanh ở BN cao tuổi. Việc đánh giá, bổ sung dinh dưỡng phù hợp có vai trò quan trọng.

Fibrosis occurs during progression of osteoarthritis (OA), and myofibroblasts are considered a key effector to drive the fibrotic response. Macrophages also play critical roles in OA progression. However, whether macrophage polarization is involved in OA-related fibrosis has not been adequately defined. Here, we investigated the effect of M2-like macrophages compared to M1-like macrophages on the myofibroblast differentiation of human synovial fibroblasts (HSFs). M1- and M2-like macrophages differentiated from the human monocytic THP-1 cells were co-cultured with HSFs for 72 h. Alpha-smooth muscle actin (α-SMA) positive cells and gene expression of pro-fibrotic and anti-fibrotic factors were quantified. The concentration of transforming growth factor-beta1 (TGF-β1) in the culture supernatant was also analyzed, and its effect on the regulation of the TGF-β/SMAD signaling pathway was further investigated. We found that, cocultured with M2-like macrophages increased the number of α-SMA positive cells and expression of pro-fibrotic genes and decreased the expression of anti-fibrotic genes in HSFs. TGF‑β1 was highly secreted by M2‑like macrophages and accelerated the phosphorylation of SMAD2/3 in HSF cells. Our results indicate the pro-fibrotic effects of M2-like macrophages in myofibroblast differentiation of HSFs, in association with the TGF-β1/SMAD2/3 signaling pathway activation. Thus, M2-like macrophages may play a role in OA fibrogenesis and its progression.

Objective: Using segmental dynamic and static factors, we aimed to elucidate the pathogenesis and relationship between ossification of the posterior longitudinal ligament (OPLL) and the severity of cervical myelopathy.Methods: Retrospective analysis of 163 OPLL patients' 815 segments. Imaging was used to evaluate each segmental space available for the spinal cord (SAC), OPLL diameter, type, bone space, K-line, the C2–7 Cobb angle, each segmental range of motion (ROM), and total ROM. Magnetic resonance imaging was used to evaluate spinal cord signal intensity. Patients were divided into the myelopathy group (M group) and the without myelopathy group (WM group).Results: Minimal SAC (p = 0.043), (C2–7) Cobb angle (p = 0.004), total ROM (p = 0.013), and local ROM (p = 0.022) were evaluated as an independent predictor of myelopathy in OPLL. Different from the previous report, the M group had a straighter whole cervical spine (p < 0.001) and poorer cervical mobility (p < 0.001) compared to the WM group. Total ROM was not always a risk factor for myelopathy, as its impact depended on SAC, when SAC > 5 mm, the incidence rate of myelopathy decreased with the increase of total ROM. Lower cervical spine (C5–6, C6–7) showing increased “Bridge-Formation,” along with spinal canal stenosis and segmental instability (C2–3, C3–4) in the upper cervical spine, could cause myelopathy in M group (p < 0.05).Conclusion: Cervical myelopathy is linked to the OPLL’s narrowest segment and its segmental motion. The hypermobility of the C2–3 and C3–4, contributes significantly to the development of myelopathy in OPLL.

Ossification of the posterior longitudinal ligament (OPLL) is considered a multifactorial condition characterized by ectopic new bone formation in the spinal ligament. Recently, its connections with inflammation as well as sacroiliac (SI) joint ankylosis have been discussed. Nevertheless, whether inflammation, spinal ligament ossification, and SI joint changes are linked in OPLL has never been investigated. In this study, whole-spinal computed tomography and serum high-sensitive C-reactive protein (hs-CRP) levels were obtained in 162 patients with cervical OPLL. Ossification lesions were categorized as plateau and hill shapes. Accordingly, patients were divided into plateau-shaped (51 males and 33 females; mean age: 67.7 years) and hill-shaped (50 males and 28 females; mean age: 67.2 years) groups. SI joint changes were classified into four types and three subtypes, as previously described. Interactions among ossification shapes, hs-CRP levels, and morphological changes in the SI joint were investigated. The plateau shape was more common in the vertebral segments (59.5%), compared to the hill shape, which was predominant in the intervertebral regions (65.4%). Serum hs-CRP levels in the plateau-shaped group (0.11 ± 0.10 mg/dL) were significantly higher than those in the hill-shaped group (0.07 ± 0.08 mg/dL). SI joint intra-articular fusion was the main finding in the plateau-shaped group and showed significantly higher hs-CRP levels compared to the anterior para-articular bridging, which more frequently occurred in the hill-shaped group. Our findings suggested a possible inflammation mechanism that might contribute to the new bone formation in OPLL, particularly the plateau shape.

The role of the ligamentum flavum (LF) in the pathogenesis of adolescent idiopathic scoliosis (AIS) is not well understood. Using magnetic resonance imaging (MRI), we investigated the degrees of LF hypertrophy in 18 patients without scoliosis and on the convex and concave sides of the apex of the curvature in 22 patients with AIS. Next, gene expression was compared among neutral vertebral LF and LF on the convex and concave sides of the apex of the curvature in patients with AIS. Histological and microarray analyses of the LF were compared among neutral vertebrae (control) and the LF on the apex of the curvatures. The mean area of LF in the without scoliosis, apical concave, and convex with scoliosis groups was 10.5, 13.5, and 20.3 mm², respectively. There were significant differences among the three groups (p < 0.05). Histological analysis showed that the ratio of fibers (Collagen/Elastic) was significantly increased on the convex side compared to the concave side (p < 0.05). Microarray analysis showed that ERC2 and MAFB showed significantly increased gene expression on the convex side compared with those of the concave side and the neutral vertebral LF cells. These genes were significantly associated with increased expression of collagen by LF cells (p < 0.05). LF hypertrophy was identified in scoliosis patients, and the convex side was significantly more hypertrophic than that of the concave side. ERC2 and MAFB genes were associated with LF hypertrophy in patients with AIS. These phenomena are likely to be associated with the progression of scoliosis.

Intervertebral disc (IVD) diseases are common spinal disorders that cause neck or back pain in the presence or absence of an underlying neurological disorder. IVD diseases develop on the basis of degeneration, and there are no established treatments for degeneration. IVD diseases may therefore represent a candidate for the application of regenerative medicine, potentially employing normal human dermal fibroblasts (NHDFs) induced to differentiate into nucleus pulposus (NP) cells. Here, we used a three-dimensional culture system to demonstrate that ectopic expression of MYC, KLF4, NOTO, SOX5, SOX6, and SOX9 in NHDFs generated NP-like cells, detected using Safranin-O staining. Quantitative PCR, microarray analysis, and fluorescence-activated cell sorting revealed that the induced NP cells exhibited a fully differentiated phenotype. These findings may significantly contribute to the development of effective strategies for treating IVD diseases.

To characterize and clarify evidence as to whether the ectopic bone formations of DISH in patients with ossification of the posterior longitudinal ligament (OPLL) are caused by inflammatory or degenerative processes. Whole-spine CT and serum high-sensitivity CRP (hs-CRP) levels were obtained from 182 cervical OPLL patients (DISH+, n = 104; DISH−, n = 78). In the DISH+ group, ectopic bone formations were categorized into Flat and Jaggy types, then further divided into three subgroups: group 1 (Jaggy-dominant pattern), group 2 (Equivalence of pattern) and group 3 (Flat-dominant pattern). Data were compared between the DISH+ and DISH− groups, and among the three subgroups. The upper thoracic spine was most affected by the Flat type, whereas the Jaggy type was more frequent in the middle and lower thoracic regions. There was no difference in hs-CRP levels between the DISH+ and DISH− groups. Among the three subgroups, hs-CRP levels in group 3 [mean (s.d.) 0.16 (0.09) mg/dl] were significantly higher than in group 1 [0.04 (0.02) mg/dl] and group 2 [0.08 (0.06) mg/dl]. Higher levels of hs-CRP were associated with a greater number of vertebral units with Flat-type formations (β = 0.691, P < 0.0001) and with a lesser number of vertebral units with Jaggy-type formations (β = −0.147, P = 0.036). The Flat type in DISH might be caused by an inflammatory pathogenesis rather than a degenerative process presented in the Jaggy type.

Background: Ossification of the posterior longitudinal ligament (OPLL), characterized by ectopic new bone formation in the spinal ligament, causes neurological impairment due to narrowing of the spinal canal. However, the etiology has not been fully elucidated yet. Several biomarkers may be related to the pathogenesis of OPLL. The present study focused on the serum level of periostin, which is recognized as an important bone formation regulator. Methods: This study included 92 patients with OPLL and 54 control patients without OPLL. For the case-control analysis, 54 age and sex-matched patients were randomly included in the OPLL group. The serum fibroblast growth factor-23 (FGF-23), creatinine, inorganic phosphate, calcium, alkaline phosphatase, and periostin levels were assessed. Furthermore, the calcium, creatinine, and inorganic phosphate levels in urine and the percentage of tubular reabsorption of phosphate were also analyzed. Moreover, the relationship between the biomarkers and the extent of OPLL was analyzed. The data were compared between patients with OPLL progression (the progression group) and without OPLL progression (the non-progression group). Results: The mean serum FGF-23 and periostin levels in the OPLL group were higher than that in the control group. The serum inorganic phosphate level in the OPLL group was lower than that in the control group. No correlation was found between any of the biomarkers and the extent of ossification. The serum periostin level in the progression group was higher than that in the non-progression group. No significant difference in the serum FGF-23 level was noted between the progression and non-progression groups. Moreover, no correlation was found between serum periostin and FGF-23 levels. Conclusions: The serum periostin level is related to OPLL progression. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.