[Reversed halo sign: chest CT findings in 5 patients and cause analysis]

Objective: To describe diseases that may present with the reversed halo sign (RHS) on high-resolution CT, and therefore to improve the recognition of this thoracic radiological feature. Methods: We retrospectively reviewed the HRCT scans and medical records of 5 patients who presented with RHS on chest CT from Peking University Third Hospital. With "reversed halo sign, fairy ring, atoll sign" as the Chinese and English keywords, 420 cases from the literatures were also reviewed through PubMed, Wanfang and CNKI databases until August 2015. Results: The 5 patients were all males, aging 19-55 years. The diagnosis of the diseases included cryptogenic organizing pneumonia (patient 1), pulmonary tuberculosis (patient 2), pulmonary infarction (patient 3), pulmonary edema (patient 4) and mycoplasma pneumonia (patient 5). Literature review showed that RHS was observed in 206 cases of infectious pulmonary diseases and 219 cases of noninfectious pulmonary diseases. Invasive fungal infection (including 59 cases of mucormycosis and 27 aspergillosis) and pulmonary tuberculosis (79 cases) predominated in infectious pulmonary diseases. However, in non-infectious pulmonary diseases, RHS was most frequently observed in organizing pneumonia (66%), sarcoidosis, lung cancer, pulmonary infarction, pulmonary edema and other interstitial lung diseases. There were some differences in the morphologic findings of RHS among invasive fungal infection, pulmonary tuberculosis and organizing pneumonia. In addition, our patient with mycoplasma pneumonia was the first case reported to present with RHS on HRCT. Conclusions: Although a wide spectrum of pulmonary diseases may present with RHS on chest CT, this sign is still a characteristic thoracic radiological feature, which is more commonly found in organizing pneumonia, pulmonary tuberculosis and invasive fungal infection, and is helpful in differential diagnosis.

Preparation and evaluation of cefquinome-loaded gelatin microspheres and the pharmacokinetics in pigs

Cefquinome (CEF) is widely used for veterinary clinical applications because of its broad spectrum and high efficiency. However, frequent administrations are required due to its short elimination half-life. In this study, cefquinome sulfate gelatin microspheres (CEF-GMS) were prepared as a sustained-release formulation using emulsion chemical cross-linking technique. Physical properties, stability, sustained-release property in vitro, and pharmacokinetics in pigs were assessed. The morphology of CEF-GMS showed a good sphericity with porous structure on the surface, and the mean diameter was 8.80 ± 0.78 μm, with 90.60 ± 3.98% of the total in the range of 5-20 μm. There were no significant changes of all estimated indexes in the stability tests. In vitro drug release study showed that the release of CEF from CEF-GMS was much slower than that from crude CEF in a release medium. Pharmacokinetic characteristics were evaluated following intramuscular administration of CEF-GMS or Cefquinome sulfate injection (CEF-Inj) in pigs at a dosage of 4 mg CEF/kg body weight. The plasma drug concentration-time data of CEF-GMS and CEF-Inj were both best fitted by two-compartment models with first-order absorption, and the elimination half-life of CEF-GMS was almost 10 times that of CEF-Inj. Overall, CEF-GMS might be used as a sustained-release formulation of CEF for veterinary clinical applications.

The anatomy of Wassel type IV-D thumb duplication

We describe Wassel type IV-D thumb duplication anatomy after surgery on 11 affected children (12 hands, seven boys (eight hands) and four girls). We studied the structure and course of the flexor pollicis longus tendon and its action at the joint. Four patients had secondary deformity associated with an absent A2 pulley and a tendon that clung to the radial side of a small thumb. In patients with primary deformity, the flexor tendon sheath became membranous in the A2 area and attached to neighbouring sites on the opposite side of the proximal phalanx. In the proximal A2 area, the tendon divided - one division attached on the ulnar side of the distal phalanx base; the other, the base of the radial side. There was slight ulnar angulation of the distal phalanx on the radial portion of the duplication and slight ulnar angulation on the radial portion.

LEVEL OF EVIDENCE

V.

Diagnostic value of combined diffusion-weighted imaging with dynamic contrast enhancement MRI in differentiating malignant from benign bone lesions

AIM

To determine the diagnostic value of combined diffusion-weighted imaging (DWI) with dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) in differentiating malignant from benign bone lesions.

MATERIALS AND METHODS

DWI and DCE-MRI were performed in 36 patients (14 were benign and 22 were malignant). The mean apparent diffusion coefficient (ADC) values and signal enhanced extent (SEE), slope value, and time-signal intensity curve (TIC) type were recorded by two observers. Between-group comparison was made using the independent sample t-test and receiver-operating characteristic (ROC) analysis.

RESULTS

There was a significant difference between the mean ADC value of the benign ([1.75±0.50]×10^-3 mm²/s) and malignant ([1.11±0.47]×10^-3 mm²/s) groups (p=0.001). The threshold ADC value of ≤1.10×10^-3 mm²/s resulted in a sensitivity of 77.3%, a specificity of 92.9%, and an accuracy of 85.1%. A type III curve was found in 23 cases (21 malignant and two benign), a type II curve was seen in six cases (one malignant and five benign), and a type I curve in seven cases (all were benign). The SEE and slope values in the benign and malignant groups were 227.96±172.08, 325.60±125.86 (p=0.058); 0.97±0.67%/s, 3.19±3.20%/s (p=0.016), respectively. ROC analysis showed a sensitivity of 95.5%, a specificity of 85.7%, and an accuracy of 90.6% for malignancy, based on a slope cut-off value of >1.46%/s. Combining ADC and slope values resulted in a sensitivity of 100%, a specificity of 85.7%, and an accuracy of 92.9%.

CONCLUSIONS

Both DWI and DCE-MRI showed promising results for differentiating malignant from benign bone lesions. A combination of DWI and DCE-MRI was the most valuable of the three.

Cobalt-zinc nitride on nitrogen doped carbon black nanohybrids as a non-noble metal electrocatalyst for oxygen reduction reaction

Bimetallic nitrides are now being considered as one of the emerging advanced functional materials due to their characteristic features and remarkable physicochemical properties. Herein, we report a new crystalline bimetallic nitride (Co₃ZnN) that belongs to the cubic crystal phase, which was successfully synthesized through direct nitridation of metallic salts as precursors. Co₃ZnN nanoparticles were then supported on nitrogen-doped XC-72 carbon black (N-CB), and this typical Co₃ZnN/N-CB nanohybrid discovered can serve as an efficient non-noble metal electrocatalyst with a 4e^- reaction pathway for ORR, and demonstrated excellent electrocatalytic performance with high activity and stability.

[Population pharmacokinetics of vancomycin from severe in patients with lower respiratory tract infection]

Objective: To develop a population pharmacokinetic (PPK) model of vancomycin in Chinese inpatients with severe lower respiratory tract infection. Methods: We gathered serum concentrations of vancomycin from inpatients who received vancomycin during Nov 2011 to Nov 2012.Vancomycin serum concentrations was measured by high performance liquid chromatography. Vancomycin PPK analysis was performed using nonlinear mixed effects model (NONMEM) program. Results: We gathered the data of 70 inpatients with lower respiratory tract infection at respiratory ward or respiratory intensive care unit(RICU) between Nov 2011 to Nov 2012 [58 males, 12 females; 78(23-91) years old; the mean of APACHⅡ score was 16.4±4.8]. A total of 267 concentrations of vancomycin were gathered from 70 patients. A 2-compartment model fit the concentration data best. The final vancomycin PPK model was: CL(i)=1.67×e(η1), V(1i)=33.04×[1-0.199×(60/Scr)] ×e(η2), Q(i)=7.08×2.053(AI)×e(η3), V(2i)=19.29×e(η4).(CL: vancomycin clearance; V(1): distribution volume of the central compartment; Q: intercompartment clearance; V(2): distribution volume of the intercompartment). The population mean values were 1.67 L/h, 33.04 L; 7.08 L/h and 19.29 L respectively. Serum creatinine was the covariate to affect vancomycin apparent distribution volume of the central compartment. Intercompartment clearance was 2.053 times larger in patients with albumin infusion than that in patients without. Conclusions: We found that a 2-compartment model fit the concentration data best in Chinese patients with severe lower respiratory tract infection. Serum creatinine and albumin infusion were the most significant covariates to affect vancomycin PK.

High-frequency repetitive transcranial magnetic stimulation over the left DLPFC for major depression: Session-dependent efficacy: A meta-analysis

Background

Depression is a major debilitating psychiatric disorder. Current antidepressant drugs are often associated with side effects or treatment resistance. The aim of this meta-analysis was to evaluate therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in major depression (MD).

Methods

The medical data bases of PubMed, Medline, Embase and Cochrane Central Register were searched for randomized controlled trials (RCTs) reporting the therapeutic effects of high-frequency rTMS for depression, which were published in English between January 1990 and June 2016. The index terms were “depress*”, “depression” and “transcranial magnetic stimulation”. Depression outcome data of different sessions (5, 10, 15, and 20 sessions of rTMS treatment) were extracted and synthesized by calculating standardized mean difference (SMD) with 95% confidence intervals (CI) by using a random-effect model. Within each session group, the subgroup analyses based on the number of pulses (≤ 1000, 1200–1500, 1600–1800, and 2000–3000) were also conducted.

Results

Thirty RCTs with a total of 1754 subjects including 1136 in the rTMS group and 618 in the sham group were included in this meta-analysis. rTMS had a significant overall therapeutic effect on depression severity scores (SMD = −0.73, P < 0.00001). The five, 10, 15, 20 sessions of rTMS treatments yielded the significant mean effect sizes of −0.43, −0.60, −1.13, and −2.74, respectively. In the four groups (5, 10, 15, 20 sessions), the maximal mean effect size was all obtained in the subgroup of 1200–1500 pulses per day (−0.97, −1.14, −1.91, −5.47; P < 0.05).

Conclusions

The increasing of HF-rTMS sessions is associated with the increased efficacy of HF-rTMS in reducing depressed patients’ symptom severity. A total number of pulses of 1200–1500 per day appear to deliver the best antidepressant effects of HF-rTMS.

Treatment with hydrogen sulfide attenuates sublesional skeletal deterioration following motor complete spinal cord injury in rats

Treatment with hydrogen sulfide mitigates spinal cord injury-induced sublesional bone loss, possibly through abating oxidative stress, suppressing MMP activity, and activating Wnt/β-catenin signaling.

INTRODUCTION

Spinal cord injury (SCI)-induced sublesional bone loss represents the most severe osteoporosis and is resistant to available treatments to data. The present study was undertaken to explore the therapeutic potential of hydrogen sulfide (H₂S) against osteoporosis in a rodent model of motor complete SCI.

METHODS

SCI was generated by surgical transaction of the cord at the T3-T4 levels in rats. Treatment with NaHS was initiated through intraperitoneal injection of 0.1 ml/kg/day of 0.28 mol/l NaHS from 12 h following the surgery and over 14 subsequent days.

RESULTS

H₂S levels in plasma of SCI rats were lower, which was restored by treatment with exogenous H₂S. Treatment of SCI rats with exogenous H₂S had no significant effect on body mass but increased bone mineral density in femurs and tibiae, increased BV/TV, Tb.Th, and Tb.N and reduced Tb.Sp in proximal tibiae, and increased mineral apposition rate (MAR), bone formation rate (BFR), and osteoblast surface and reduced eroded surface and osteoclast surface in proximal tibiae. More importantly, H₂S treatment led to a significant enhancement in ultimate load, stiffness, and energy to max force of femoral diaphysis. Treatment of SCI rats with exogenous H₂S reduced malondialdehyde (MDA) levels in serum and femurs, decreased hydroxyproline levels, suppressed activities of matrix metallopeptidase 9 (MMP9), and upregulated Wnt3a, Wnt6, Wnt10, and ctnnb1 expression in femurs.

CONCLUSION

Treatment with H₂S mitigates SCI-induced sublesional bone loss, possibly through abating oxidative stress, suppressing MMP activity, and activating Wnt/β-catenin signaling.

Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease

Background:

Coronary computed tomographic angiography (CCTA) has been widely used in patients who are at intermediate risk for having stable coronary artery disease (SCAD), and 2013 European Society of Cardiology Guidelines on the Management of SCAD (2013G) recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice.

Methods:

A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model (UDFM). Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA.

Results:

Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time (P = 0.8701). The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before (22.29%) or after (19.98%) the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G (odds ratio, 1.002; 95% confidence interval, 0.982–1.021; P = 0.8678).

Conclusions:

These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.

[Airway oxidative stress and inflammation markers in chronic obstructive pulmonary diseases(COPD) patients are linked with exposure to traffic-related air pollution: a panel study]

OBJECTIVE

To investigate the effects of short-term exposure to traffic-related air pollution on airway oxidative stress and inflammation in chronic obstructive pulmonary diseases (COPD) patients.

METHODS

A panel of forty-five diagnosed COPD patients were recruited and followed with repeated measurements of biomarkers reflecting airway oxidative stress and inflammation in exhaled breath condensate (EBC), including nitrate and nitrite, 8-isoprostane, interleukin-8 and acidity of EBC (pH), between 5(th) September in 2014 and 26(th) May in 2015. The associations between air pollution and biomarkers were analyzed with mixed-effects models, controlling for confounding covariates.

RESULTS

The concentration of PM2.5, black carbon, NO2 and number concentration of particles with diameter less than 100 nm (PNC100), and particles in size ranges between 100 nm to 200 nm (PNC100-200) during the first follow-up were (156.5±117.7), (10.7±0.7), (165.9±66.0)μg/m(3) and 397 521±96 712, 79 421±44 090 per cubic meter, respectively; the concentration were (67.9±29.6), (3.4±1.3), (126.1±10.9) μg/m(3) and (295 682±39 430), (24 693±12 369) per cubic meter, respectively during the second follow-up. The differences were of significance, with t value being 3.10, 4.42, 2.61, 4.02, 5.12, respectively and P value being 0.005,<0.001, 0.016, <0.001 and <0.001, respectively. In our COPD-patient panel, per interquartile range (IQR) increase in PNC100-200, we observed an increase of 65% (95% CI: 8%-152%) in nitrate and nitrite in EBC reflecting airway oxidative stress. For an IQR increase in PM2.5, black carbon and PNC100-200, respective increases of 0.17 ng/ml (95% CI: 0.02-0.33), 0.12 ng/ml (95% CI: 0.01-0.24) and 0.13 ng/ml (95% CI:0.02-0.24) in interleukin-8 in EBC reflecting airway inflammation were also observed. An IQR increase in ozone was also associated with a 0.24 (95%CI: 0.05-0.42) decrease in pH of EBC reflecting increased airway inflammation. No significant association observed between air pollution and 8-isoprostane in EBC in COPD patients.

CONCLUSION

Our results suggested that short-term exposure to traffic-related air pollution was responsible for exacerbation of airway oxidative stress and inflammation in COPD patients.

Radioiodinated Capsids Facilitate In Vivo Non-Invasive Tracking of Adeno-Associated Gene Transfer Vectors

Viral vector mediated gene therapy has become commonplace in clinical trials for a wide range of inherited disorders. Successful gene transfer depends on a number of factors, of which tissue tropism is among the most important. To date, definitive mapping of the spatial and temporal distribution of viral vectors in vivo has generally required postmortem examination of tissue. Here we present two methods for radiolabeling adeno-associated virus (AAV), one of the most commonly used viral vectors for gene therapy trials, and demonstrate their potential usefulness in the development of surrogate markers for vector delivery during the first week after administration. Specifically, we labeled adeno-associated virus serotype 10 expressing the coding sequences for the CLN2 gene implicated in late infantile neuronal ceroid lipofuscinosis with iodine-124. Using direct (Iodogen) and indirect (modified Bolton-Hunter) methods, we observed the vector in the murine brain for up to one week using positron emission tomography. Capsid radioiodination of viral vectors enables non-invasive, whole body, in vivo evaluation of spatial and temporal vector distribution that should inform methods for efficacious gene therapy over a broad range of applications.

Dynamic intracellular tracking nanoparticles via pH-evoked “off–on” fluorescence

Strong fluorescence induced by spiropyran isomerized into merocyanine in low pH was utilized as a probe for efficient dynamic intracellular tracking.

Causes of secondary deformity after surgery to correct Wassel type IV-D thumb duplication

This study was undertaken to document the causes of secondary deformities after surgery for correction of Wassel type IV-D thumb duplication. We carefully dissected and observed the flexor pollicis longus, and bone and joint anatomy in eight patients with secondary deformities after surgical correction. We transferred the flexor pollicis longus and thenar muscle attachments, reconstructed the A2 pulley, released and tightened the joint capsule, and performed osteotomies to correct skeletal malalignment. Kirschner wire fixation was used for 4-5 weeks, followed by brace fixation for 3 months. Patients were followed up for 13-34 months (mean 20 months). According to the Tada scores, the outcomes were good in six patients, and fair and poor in one patient each. The main causes of the secondary deformities were failure to reconstruct the A2 pulley, to transfer the flexor pollicis longus and thenar muscles, and incomplete resection of the radial metacarpal head. Brace fixation after Kirschner wire removal is crucial in preventing secondary deformities.

LEVEL OF EVIDENCE

IV.

Prolonged Ischemic Time, Delayed Graft Function, and Graft and Patient Outcomes in Live Donor Kidney Transplant Recipients

The association between prolonged cold ischemic time (CIT) and graft and patient outcomes in live donor kidney transplant recipients remains unclear. The aims of this study were to examine the association of CIT with delayed graft function and graft loss in live donor kidney transplant recipients and those who participated in the Australian Paired Kidney Exchange program using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Of 3717 live donor transplant recipients between 1997 and 2012 who were followed for a median of 6.6 years (25 977 person-years), 224 (25%) experienced CIT >4-8 h. Donor age was an effect modifier between CIT and graft outcomes. In recipients who received kidneys from older donors aged >50 years, every hour of increase in CIT was associated with adjusted odds of 1.28 (95% confidence interval [CI] 1.07-1.53, p = 0.007) for delayed graft function, whereas CIT >4-8 h was associated with adjusted hazards of 1.93 (95% CI 1.21-3.09, p = 0.006) and 1.91 (95% CI 1.05-3.49, p = 0.035) for overall and death-censored graft loss, respectively, compared with CIT of 1-2 h. Attempts to reduce CIT in live donor kidney transplants involving older donor kidneys may lead to improvement of graft outcomes.

Early supplementation of starter pellets with alfalfa improves the performance of pre- and postweaning Hu lambs

This study aims to determine the effects of alfalfa supplementation on the pre- and postweaning performance, rumen development, and feed transition in starter diet-fed lambs. Six of 66 male Hu lambs were slaughtered at the age of 10 d to serve as a control. The other 60 lambs were randomly allocated to 2 dietary treatments: milk replacer and starter pellets without (STA) or with free-choice chopped alfalfa (S-ALF). The animals were offered 300 g/d of the concentrate mixture and had free access to alfalfa after weaning at the end of wk 4 (age 38 d). The alfalfa inclusion in the S-ALF group tended to increase the starter intake before weaning, significantly increased the concentrate intake soon after weaning ( < 0.05), and increased the BW ( < 0.01) and ADG ( < 0.10) in pre- and postweaning lambs. The S-ALF group had heavier carcasses ( < 0.05), rumens ( < 0.05), reticula ( < 0.05), omasums ( < 0.10), abomasums ( < 0.05), and visceral organs ( < 0.10) than the STA lambs after weaning. Alfalfa supplementation increased ( < 0.05) the rumen papillae length and the ratio of the duodenal villus height to the crypt depth; it also decreased ( < 0.05) the concentration and molar proportion of propionate in wk 1 and 5. The STA lambs had higher ( < 0.01) blood concentrations of globulin and blood urea nitrogen and lower β-hydroxybutyrate after weaning. The STA group also had a higher incidence of feed plaque. From the above results, we infer that the free-choice addition of chopped alfalfa to starter diets is beneficial to rumen development, relieves weaning stress, and improves the performance of lambs.

[A multicenter prospective controlled study of catheter ablation for patients with persistent atrial fibrillation using domestic 3D cardiac electrophysiological mapping system]

OBJECTIVE

To verify the safety and efficacy of the domestic 3D cardiac electrophysiological mapping system for catheter ablation of persistent atrial fibrillation (AF).

METHODS

From December 2011 to April 2014, 255 patients (184 male) with persistent AF in 13 centers were enrolled in this multicenter prospective controlled study.The patients were allocated to catheter ablation group (experiment group) and antiarrhythmics drugs cardioversion group (control group) with the ratio 2∶1 according to the patients' intention. Left atria were constructed with 3D cardiac electrophysiology mapping system, magnetic sensored saline irrigated radiofrequency ablation catheter (FireMagic™ Cool 3D) and surface reference (Columbus™). Pulmonary vein isolation and left atrial roof line, mitral annulus isthmus line, three tricuspid annulus isthmus line, superior vena cava, the coronary sinus and complex atrial fragmented potentials were targeted if necessary under the guidance of the 3D mapping system. Antiarrhythmics drugs (except amiodarone) were applied to patients for 2 to 3 months after ablation. The patients were followed up for 9 months after 3 months blanking period. The patients in the control group underwent cardioversion with amiodarone and electrical cardioversion if needed. Patients in the control group were also followed up for 9 months.

RESULTS

Of the 255 patients, 167 cases were in the experiment group and 88 cases were in the control group. In per protocol set (PPS), 155 cases were in the experiment group, 79 cases in the control group. Catheter ablation was successful for all patients in the experiment group under the guidance of the 3D cardiac electrophysiological mapping system. Pumononary veins isolation was achieved in all patients. After 9 months follow-up beyond blanking period, in full analysis set, the success rate was 66.5% (111/167) in the experiment group, which was significantly higher than that in the control group (21.6% (19/88), P<0.001). In PPS, the success rate was also significantly higher in the experiment group than in the control group (67.1% (104/155) vs. 22.8%(18/79), P<0.001). The incidence of adverse events was 19.8% in the experiment group and 13.6% in the control group(P=0.223). The adverse events associated with catheter ablation included 1 case of left subclavian hematoma, 1 case of left subclavian bleeding and 1 case of pericardial effusion, which was alleviated by pericardiocentesis. No pulmonary vein stenosis occurred.

CONCLUSION

Domestic 3D cardiac electrophysiological mapping system can safely and effectively guide catheter ablation of persistent AF.

The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty

Many previous studies have reported excellent clinical results with percutaneous kyphoplasty (PKP). In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture.

INTRODUCTION

This study is to evaluate the application and clinical outcomes of unilateral transverse process-pedicle and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCF).

METHODS

A total of 56 cases with two levels thoracolumbar OVCF were randomly assigned for treatment with unilateral transverse process-pedicle and bilateral PKP. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiologic outcomes. Clinical outcomes were evaluated with mainly the use of a visual analogue scale (VAS) for pain. Radiologic outcomes were assessed mainly on the basis of radiation dose and bone cement distribution.

RESULTS

The operation was completed successfully in 56 cases. In the unilateral level, the operation time, the volume of the injected cement, and radiation dose were significantly less than bilateral level. All patients had significantly improvement on VAS score after the procedures, compared with their preoperative period. In the bilateral level, 7 patients had obvious pain in the puncture sites at 1 month postoperatively caused by facet joint violation. With local block treatment, the pain disappeared in all patients at the last follow-up.

CONCLUSION

Both bilateral and unilateral PKP are relatively safe and effective treatments for patients with painful OVCF. But unilateral PKP received less radiation dose and operation time, offered a higher degree of deformity correction, and resulted in less complication than bilateral.