The nucleus pulposus is an aggrecan-rich hydrated tissue that permits the intervertebral disc to resist compressive loads. Adaptation to loading is achieved through an elevation in disc osmolarity mediated by the numerous charged glycosoaminoglycan side chains of the aggrecan molecule. The goal of this investigation was to determine the functional role of the osmoregulatory protein, TonEBP, in cells of the nucleus pulposus. We found that TonEBP and its downstream target genes were robustly expressed in the tissues of the disc. Above 330 mosmol/ kg, cultured nucleus pulposus cells up-regulated target genes TauT, BGT-1, and SMIT; above 450 mosmol/kg, there was raised expression of HSP-70. In hypertonic media there was activation of TauT and heat shock protein-70 (HSP-70) reporter activity and increased binding of TonEBP to the TonE motif. When cells were transfected with the dominant-negative form of TonEBP (DN-TonEBP) there was suppression of TauT and HSP-70 reporter gene expression; pTonEBP enhanced reporter gene expression. Moreover, in hypertonic media, forced expression of DN-TonEBP induced apoptosis. We suppressed TonEBP using small interfering RNA technique and noted a decrease in TauT reporter activity in isotonic as well as hyperosmolar media. Finally, we report that the aggrecan promoter contains two conserved TonE motifs. To evaluate the importance of these motifs, we overexpressed DN-TonEBP and partially silenced TonEBP using small interfering RNA. Both approaches resulted in suppression of aggrecan promoter activity. It is concluded that TonEBP permits the disc cells to adapt to the hyperosmotic milieu while autoregulating the expression of molecules that generate the unique extracellular environment.The intervertebral disc is a specialized biomechanical structure that permits movement between vertebrae and protects the vertebral bone from mechanical forces. It consists of an outer ligament, the annulus fibrosus that encloses a gel-like tissue, the nucleus pulposus. While sparse, cells in the nucleus pulposus secrete a complex extracellular matrix that contains fibrillar collagens and the proteoglycan, aggrecan. The numerous glycosaminoglycan side chains of the aggrecan molecule bind cations thereby raising the osmolarity of the disc tissues (1-4). While the hydration properties of the nucleus pulposus permits dynamic loading and unloading, the mechanism by which these cells adapt to elevated osmotic forces is poorly understood.In a number of tissues, cellular adaptation to hyperosmotic stress is mediated by the tonicity enhancer-binding protein (TonEBP), 2 also called OREBP (5) or NFAT5, (5, 6). Upon activation, TonEBP binds to the tonicity-responsive enhancer element (TonE) of genes required for osmotolerance and cell survival. These genes include the betaine/␥-aminobutyric acid transporter, sodium myo-inositol co-transporter (7-9), taurine transporter (10, 11), and aldose reductase (6). By regulating levels of betaine, myo-inositol, taurine, and sorbitol, these genes control the osmotic properties ...

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott's disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

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The presence of FGF-2 during culture expansion of nucleus pulposus cells in monolayer can sustain a differentiated cell phenotype by maintaining responsiveness to TGF-beta1. Our results suggest that FGF-2 should be tested for its ability to maintain the reactivity of the nucleus pulposus cells to other morphogenic factors that may be used for cell-based transplantation therapy.

Tourniquet-induced IR period in routine arthroscopic knee surgery resulted in oxidative stress by increasing MDA, SOD, GSH-Px, TOS and decreasing TAC. NAC and IPC had protective effect on occurrence of oxidative stress resulting from IR period by preventing MDA, SOD, GSH-Px, TAC, and TOS changes in routine arthroscopic knee surgery.

This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.

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