[Curative effect of percutaneous microwave ablation therapy on hepatocellular carcinoma survival: a 15-year real-world study]

Objective: To evaluate the long-term efficacy of percutaneous microwave ablation (MWA) therapy for hepatocellular carcinoma. Methods: 2054 cases with Barcelona Clinic Liver Cancer (BCLC) stage 0~B at the Fifth Medical Center of the Chinese People's Liberation Army General Hospital from January 2006 to September 2020 were retrospectively collected. All patients were followed up for at least 2 years. The primary endpoint of overall survival and secondary endpoints (tumor-related survival, disease-free survival, and postoperative complications) of patients treated with ultrasound-guided percutaneous MWA were analyzed. Kaplan-Meier method was used for stratified survival rate analysis. Fine-and-Gray competing risk model was used to analyze overall survival. Results: A total of 5 503 HCC nodules [mean tumor diameter (2.6±1.6) cm] underwent 3 908 MWAs between January 2006 and September 2020, with a median follow-up time of 45.6 (24.0 -79.2) months.The technical effectiveness rate of 5 375 tumor nodules was 97.5%. The overall survival rates at 5, 10, and 15-years were 61.6%, 38.8%, and 27.0%, respectively. The tumor-specific survival rates were 67.1%, 47.2%, and 37.7%, respectively. The free tumor survival rates were 25.8%, 15.7%, and 9.9%, respectively. The incidence rate of severe complications was 2.8% (108/3 908). Further analysis showed that the technical effectiveness and survival rate over the passing three time periods from January 2006-2010, 2011-2015, and 2016-September 2020 were significantly increased, with P < 0.001, especially for liver cancer 3.1~5.0 cm (P < 0.001). Conclusion: Microwave ablation therapy is a safe and effective method for BCLC stage 0-B, with significantly enhanced technical efficacy and survival rate over time.

[Spatial distribution pattern of local tumor progression analysis after microwave ablation of hepatocellular carcinoma based on three-dimensional magnetic resonance imaging]

Objective: To investigate the spatial distribution pattern of local tumor progression (LTP) for hepatocellular carcinoma (HCC) ≤5 cm after microwave ablation. Methods: A retrospective analysis was performed on 169 HCCs with matched MRI before and after ablation from December 2009 to December 2019. A tumor MRI was reconstructed using three-dimensional visualization technology. LTP was classified as contact or non-contact, early or late stage, according to whether LTP was in contact with the edge of the ablation zone and the occurrence time (24 months). The tumor-surrounded area was divided into eight quadrants by using the eight-quadrant map method. An analysis was conducted on the spatial correlation between the quadrant where the ablative margin (AM) safety boundary was located and the quadrant where different types of LTP occurred. The t-test, or rank-sum test, was used for the measurement data. 2-test for count data was used to compare the difference between the two groups. Results: The AM quadrant had a distribution of 54.4% LTP, 64.2% early LTP stage, and 69.1% contact LTP, suggesting this quadrant was much more concentrated than the other quadrants (P < 0.001). Additionally, the AM quadrant had only 15.2% of non-contact type LTP and 17.1% of late LTP, which was not significantly different from the average distribution probability of 12.5% (100/8%) among the eight quadrants (P = 0.667, 0.743). 46.6% of early contact type LTP was located at the ablation needle tip, 25.2% at the body, and 28.1% at the caudal, while the location distribution probabilities of non-early contact LTP were 34.8%, 31.8%, and 33.3%, respectively. Conclusion: LTP mostly occurs in areas where the ablation safety boundary is the shortest. However, non-contact LTP and late LTP stages exhibit the feature of uniform distribution. Thus, this type of LPT may result from an inadequate non-ablation safety boundary.

[Correlation analysis between Pirani score and talo-navicular angle,calcaneo-cuboid angle and tibio-calcaneall angle of infant clubfoot under ultrasound]

Objective: To explore the evaluation effect of ultrasonography and Pirani score on tarsal deformity, treatment effect and pseudo-correction of congenital clubfoot in infants and young children, and the correlation between the two methods. Methods: This is a retrospective case series study. The clinical data of 26 children (40 feet) with congenital clubfoot who were evaluated by ultrasonography in the Third Affiliated Hospital of Zhengzhou University from January 2020 to January 2023 were retrospectively collected. There were 16 males and 10 females. The age at the first ultrasound examination was (M(IQR)) 9.0 (18.0) days (range: 1 to 46 days). All patients were treated with Ponseti method by the same physician. The Pirani scores before and after treatment and at the last examination, and the talonavicular angle, calcaneocuboid angle and tibiocalcaneal angle measured by ultrasound were collected, and the treatment and follow-up were recorded. Paired sample t test, repeated measures analysis of variance or Kruskal-Wallis test were used for data comparison, and Spearman correlation analysis was used for correlation analysis. The receiver operating characteristic curve was used to calculate the efficacy of ultrasound in evaluating different Pirani scores. Results: The number of plaster fixation in 26 children was 4.0 (1.0) times (range: 2 to 8 times). The medial talonavicular angle and posterior tibiocalcaneal angle were significantly improved after treatment and at the last follow-up compared with those before treatment, and the differences were statistically significant (all P<0.01). There was no difference in lateral calcaneocuboid angle before and after treatment and at the last follow-up (F=1.971, P>0.05). Pseudo-correction occurred in 2 cases (2 feet) during the treatment, with an incidence of 5%. Correlation analysis showed that there was a moderate positive correlation between talonavicular angle and Pirani midfoot score (r=0.480, P<0.01). There was no correlation between calcaneocuboid angle and Pirani midfoot score (r=0.114, P=0.105). There was a moderate negative correlation between tibial heel angle and Pirani hindfoot score (r=-0.566, P<0.01). The cut-off point of Pirani midfoot score of 1.5 was 38.78°, the sensitivity was 0.90, the specificity was 0.56, and the area under the curve was 0.75. The cut-off value of angle was 27.51 °, the sensitivity was 0.16, the specificity was 0.92, and the area under the curve was 0.44.The cut-off points of Pirani midfoot score of 3.0 were 45.08°and 9.96°, the sensitivity was 0.94 and 0.91, the specificity was 0.37 and 0.42, and the area under the curve was 0.59 and 0.62, respectively. The cut-off values of Pirani hindfoot score of 2.0 and 3.0 were 167.46° and 160.15°, respectively. The sensitivity was 0.75 and 0.67, the specificity was 0.81 and 0.83, and the area under the curve was 0.78 and 0.71, respectively. Conclusion: Ultrasound can complement with Pirani score, visually and dynamically observe the morphology and position changes of talonavicular joint, calcaneocuboid joint and tibiotalocalcaneal joint, monitor the recovery and pseudo-correction of tarsal bones, and better evaluate the therapeutic effect.

Tetrandrine alleviates oxaliplatin-induced mechanical allodynia via modulation of inflammation-related genes

Oxaliplatin, a platinum-based chemotherapy drug, causes neuropathic pain, yet effective pharmacological treatments are lacking. Previously, we showed that tetrandrine (TET), with anti-inflammatory properties, reduces mechanical allodynia in nerve-injured mice. This study explores the effect of TET on oxaliplatin-induced mechanical allodynia and gene changes in mice. Male C57BL/6J mice received oxaliplatin intraperitoneally to induce mechanical allodynia. Post-treatment with TET or vehicle, the mechanical withdrawal threshold (WMT) was assessed using von Frey filaments. TET alleviated oxaliplatin-induced mechanical allodynia. RNA sequencing identified 365 differentially expressed genes (DEGs) in the Control vs. Oxaliplatin group and 229 DEGs in the Oxaliplatin vs. TET group. Pearson correlation analysis of co-regulated DEGs and inflammation-related genes (IRGs) revealed 104 co-regulated inflammation-related genes (Co-IRGs) (|cor| > 0.8, P < 0.01). The top 30 genes in the PPI network were identified. Arg2, Cxcl12, H2-Q6, Kdr, and Nfkbia were highlighted based on ROC analysis. Subsequently, Arg2, Cxcl12, Kdr, and Nfkbia were further verified by qRCR. Immune infiltration analysis indicated increased follicular CD4 T cell infiltration in oxaliplatin-treated mice, reduced by TET. Molecular docking showed strong binding affinity between TET and proteins encoded by Arg2, Cxcl12, Kdr, and Nfkbia. In summary, TET may alleviate oxaliplatin-induced peripheral neuropathy in clinical conditions.

Ventral Hippocampal CA1 Pyramidal Neurons Encode Nociceptive Information

As a main structure of the limbic system, the hippocampus plays a critical role in pain perception and chronicity. The ventral hippocampal CA1 (vCA1) is closely associated with negative emotions such as anxiety, stress, and fear, yet how vCA1 neurons encode nociceptive information remains unclear. Using in vivo electrophysiological recording, we characterized vCA1 pyramidal neuron subpopulations that exhibited inhibitory or excitatory responses to plantar stimuli and were implicated in encoding stimuli modalities in naïve rats. Functional heterogeneity of the vCA1 pyramidal neurons was further identified in neuropathic pain conditions: the proportion and magnitude of the inhibitory response neurons paralleled mechanical allodynia and contributed to the confounded encoding of innocuous and noxious stimuli, whereas the excitatory response neurons were still instrumental in the discrimination of stimulus properties. Increased theta power and theta-spike coupling in vCA1 correlated with nociceptive behaviors. Optogenetic inhibition of vCA1 pyramidal neurons induced mechanical allodynia in naïve rats, whereas chemogenetic reversal of the overall suppressed vCA1 activity had analgesic effects in rats with neuropathic pain. These results provide direct evidence for the representations of nociceptive information in vCA1.

Dynamic Changes of the Infralimbic Cortex and Its Regulation of the Prelimbic Cortex in Rats with Chronic Inflammatory Pain

The prelimbic cortex (PL) is actively engaged in pain modulation. The infralimbic cortex (IL) has been reported to regulate the PL. However, how this regulation affects pain remains unclear. In the present study, we recorded temporary hyper-activity of PL pyramidal neurons responding to nociceptive stimuli, but a temporary hypo-function of the IL by in vivo electrophysiological recording in rats with peripheral inflammation. Manipulation of the PL or IL had opposite effects on thermal hyperalgesia. Furthermore, the functional connectivity and chemogenetic regulation between the subregions indicated an inhibitory influence of the IL on the PL. Activation of the pathway from the IL to the PL alleviated thermal hyperalgesia, whereas its inhibition exacerbated chronic pain. Overall, our results suggest a new mechanism underlying the role of the medial prefrontal cortex in chronic pain: hypo-function of the IL leads to hyperactivity of the PL, which regulates thermal hyperalgesia, and thus contributes to the chronicity of pain.

Deep brain stimulation in the lateral habenula reverses local neuronal hyperactivity and ameliorates depression-like behaviors in rats

Deep brain stimulation (DBS) is a promising therapy for treatment-resistant depression, while mechanisms underlying its therapeutic effects remain poorly defined. Increasing evidence has revealed an intimate association between the lateral habenula (LHb) and major depression, and suggests that the LHb might be an effective target of DBS therapy for depression. Here, we found that DBS in the LHb effectively decreased depression-like behaviors in rats experienced with chronic unpredictable mild stress (CUMS), a well-accepted paradigm for modeling depression in rodents. In vivo electrophysiological recording unveiled that CUMS increased neuronal burst firing, as well as the proportion of neurons showing hyperactivity to aversive stimuli in the LHb. Nevertheless, DBS downregulated local field potential power, reversed the CUMS-induced increase of LHb burst firing and neuronal hyperactivity to aversive stimuli, and decreased the coherence between LHb and ventral tegmental area (VTA). Our results demonstrate that DBS in the LHb exerts antidepressant-like effects and reverses local neural hyperactivity, supporting the LHb as a target of DBS therapy for depression.

[Surgical treatment for obstructive hypertrophic cardiomyopathy: a five-year single-center experience of 421 cases]

Objectives: To examine the short-term and mid-term effects of surgical treatment of obstructive hypertrophic cardiomyopathy (HCM) in one center. Methods: The perioperative data and short-term follow-up outcomes of 421 patients with obstructive HCM who received surgical treatment at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University from January 2017 to December 2021 were analyzed retrospectively. There were 207 males and 214 females, aged (56.5±11.7) years (range: 19 to 78 years). Preoperative New York Heart Association (NYHA) classification included 45 cases of class Ⅱ, 328 cases in class Ⅲ, and 48 cases in class Ⅳ. Fifty-eight patients were diagnosed with latent obstructive HCM and 257 patients had moderate or more mitral regurgitation with 56 patients suffering from intrinsic mitral valve diseases. All procedures were completed by a multidisciplinary team, including professional echocardiologists involving in preoperative planning for proper mitral valve management strategies and intraoperative monitoring. A total of 338 patients underwent septal myectomy alone, and 59 patients underwent mitral valve surgery along with myectomy. A single transaortic approach was used in 355 patients, and a right atrial-atrial septal/atrial sulcus approach was used in 51 other patients. Long-handled minimally invasive surgical instruments were used for the procedures. Student t test, Wilcoxon rank sum test, χ² test or Fisher exact test were used to compare the data before and after surgery. Results: The aortic cross-clamping time of septal myectomy alone was (34.3±8.5) minutes (range: 21 to 94 minutes). Eighteen patients had intraoperative adverse events and underwent immediate reoperation, including residual obstruction (10 patients), left ventricular free wall rupture (4 patients), ventricular septal perforation (3 patients), and aortic valve perforation (1 patient). Four patients died during hospitalization, and 11 patients developed complete atrioventricular block requiring permanent pacemaker implantation. After discharge, 384 (92.1%) patients received a follow-up visit with a median duration of 9 months. All follow-up patients survived with significantly improved NYHA classifications: 216 patients in class Ⅰ and 168 patients in class Ⅱ (χ²=662.73, P<0.01 as compared to baseline). At 6 months after surgery, follow-up echocardiography showed that the thickness of the ventricular septum ((13.6±2.5) mm vs. (18.2±3.0) mm, t=23.51, P<0.01) and the peak left ventricular outflow tract gradient ((12.0±6.3) mmHg vs. (93.4±19.8) mmHg, 1 mmHg=0.133 kPa, t=78.29, P<0.01) were both significantly lower than baseline values. Conclusion: The construction of the surgical team (including echocardiography experts), proper mitral valve management strategies, identification and management of sub-mitral-valve abnormalities, and application of long-handled minimally invasive surgical instruments are important for the successful implementation of septal myectomy with satisfactory short-and medium-term outcomes.

[Cluster classification and clinical prognostic modeling based on m6A RNA methylation regulators in liver cancer]

Objective: Cluster classification based on m6A methylation regulators and construct prognostic evaluation model. Methods: Utilizing consensus cluster to classify the liver cancer samples form TCGA based on the expression of 13 m6A methylation regulators, and verify the function and prognostic significance of the clustered subtypes. Marker genes were further screened to construct a risk prediction model for evaluating the prognosis of liver cancer patients. Results: The two clustered subtypes based on m6A methylation regulators showed significant differences in the prognosis value of liver cancer patients (P=0.048), and 38 prognostic markers related to m6A methylation in liver cancer were screened from the subgroup with poor prognosis. Two m6A regulatory genes, YTHDF1 and YTHDF2, are proved with adverse prognosis by univariate cox analysis (P<0.05, Hazard ratio>1). We used Lasso regression method to build risk assessment model and effectively predicted the prognosis status of liver cancer patients within 4 years (4-year AUC=0.685, 3-year AUC=0.669). Moreover, the assessment model was validated in another dataset of Asia liver cancer patients. Conclusion: The study provided ideas for studying m6A methylation in liver cancer, and the risk prediction model can be used to evaluate the short-term prognosis of liver cancer patients.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

[Application of oral fluid in SARS-CoV-2 nucleic acid and antibody detection]

This study aimed to explore the application value of new biological specimen oral fluid in SARS-CoV-2 nucleic acid and antibody detection. Oral fluid and paired respiratory and blood specimens from 7 confirmed cases of two COVID-19 cluster epidemic were collected in Beijing from October to November 2021. SARS-CoV-2 virus and IgG antibody were detected by real time PCR kits and serum antibody detection reagents, and SARS-CoV-2 IgG antibody in oral fluids was detected by a new established method of magnetic particle chemiluminescence. The results showed that the nucleic acid amplification test of SARS-CoV-2 on nasopharyngeal swabs, throat swabs and oral fluid specimens from 3 confirmed cases of COVID-19 was positive, among which the Ct value for ORF1a/b and N gene of oral fluid samples in 2 cases was close to that of throat swab, and the Ct value of oral fluid sample for 1 case was higher than that of throat swab. The complete genome sequence of one oral fluid specimen was obtained, which belonged to the VOC/Delta variant strain. The SARS-CoV-2 IgG antibodies of the paired oral fluid and serum were all positive, and the S/CO values of oral fluid were all lower than those of serum. The series of oral fluid results showed that SARS-CoV-2 IgG antibody level increased from 11 to 32 days after the onset of the disease.

Suppression of ventral hippocampal CA1 pyramidal neuronal activities enhances water intake

Thirst is an important interoceptive response and drives water consumption. The hippocampus actively modulates food intake and energy metabolism, but direct evidence for the exact role of the hippocampus in modulating drinking behaviors is lacking. We observed decreased number of c-Fos-positive neurons in the ventral hippocampal CA1 (vCA1) after water restriction or hypertonic saline injection in rats. Suppressed vCA1 neuronal activities under the hypertonic state were further confirmed with in vivo electrophysiological recording and the level of suppression paralleled both the duration and the total amount of water consumption. Chemogenetic inhibition of vCA1 pyramidal neurons increased water consumption in rats injected with both normal and hypertonic saline. These findings suggest that suppression of vCA1 pyramidal neuronal activities enhances water intake.

Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy

BACKGROUND AND STUDY AIMS

 Although laminectomy with lateral mass screw fixation (LCSF) is an effective surgical treatment for cervical spondylotic myelopathy (CSM), loss of cervical curvature may result. This study aimed to investigate the effect of cervical curvature on spinal cord drift distance and clinical efficacy.

PATIENTS AND METHODS

 We retrospectively analyzed 78 consecutive CSM patients with normal cervical curvature who underwent LCSF. Cervical curvature was measured according to Borden's method 6 months after surgery. Study patients were divided into two groups: group A, reduced cervical curvature (cervical lordosis depth 0-7mm; n = 42); and group B, normal cervical curvature (cervical lordosis depth 7-17mm; n = 36). Spinal cord drift distance, laminectomy width, neurologic functional recovery, axial symptom (AS) severity, and incidence of C5 palsy were measured and compared.

RESULTS

 Cervical lordosis depth was 5.1 ± 1.2 mm in group A and 12.3 ± 2.4 mm in group B (p < 0.05). Laminectomy width was 21.5 ± 2.6 mm in group A and 21.9 ± 2.8 mm in group B (p > 0.05). Spinal cord drift distance was significantly shorter in group A (1.9 ± 0.4 vs. 2.6 ± 0.7 mm; p < 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased after surgery in both groups (p < 0.05). Neurologic recovery rate did not differ between the two groups (61.5 vs. 62.7%; p > 0.05). AS severity was significantly higher in group A (p < 0.05). C5 palsy occurred in three group A patients (7.1%) and four group B patients (11.1%), but the difference was not significant (p > 0.05).

CONCLUSION

 After LCSF, 53.8% of the patients developed loss of cervical curvature. A smaller cervical curvature resulted in a shorter spinal cord drift distance. Loss of cervical curvature was related to AS severity but not improvement of neurologic function or incidence of C5 palsy.

Improvement of 3-D Ultrasound Spine Imaging Technique Using Fast Reconstruction Algorithm

Three-dimensional (3-D) freehand ultrasound (US) imaging has been applied to the investigation of spine deformity. However, it is a challenge for the current 3-D imaging reconstruction algorithms to achieve a balance between image quality and computation time. The objectives of this article are to implement a new fast reconstruction algorithm that can fulfill the request of immediate demonstration and processing for high-quality 3-D spine imaging, and to evaluate the reliability and accuracy of scoliotic curvature measurement when using the algorithm. The fast dot-projection (FDP) algorithm was applied for voxel-based nearest neighbor (VNN), multiple plane interpolation (MPI), and pixel nearest neighbor (PNN) protocols to reduce the reconstruction time. The 3-D image volume was reconstructed from the datasets acquired from scoliotic subjects. The computational cost, image characteristics, and statistical analyses of curve measurements were compared and evaluated among different reconstruction protocols. The results illustrated that the 3-D spine images using the FDP-MPI4 algorithm showed higher brightness (20%), contrast (14%), and signal-to-noise ratio (SNR) (26%) than FDP-VNN. The measurement performed by trainee rater exhibited significant improvement in measurement reliability and accuracy using FDP-MPI4 in comparison with FDP-VNN ( ), and the intraclass correlation coefficient (ICC) of interrater measurement increased from 0.88 to 0.96. The FDP-PNN method could acquire and reconstruct spine images simultaneously and present the results in 1-2 min, which showed the potential to provide the approximate real-time visualization for fast screening.

[Investigation on high-frequency hearing loss of noise workers in an automobile factory]

Objective: To investigate the high-frequency hearing loss (HFHL) of workers in an automobile factory and its influencing factors, so as to provide a scientific basis for occupational health management of noise workers. Methods: From March to July 2019, 2647 workers from an automobile factory were selected as the research objects by cluster sampling method. The basic personal information (such as gender, age, education level, height, weight, etc.) , history of ear disease, the history of detonation, history of exposure to ototoxic drugs, history of exposure to occupational noise, etc., were investigated by questionnaire and occupational health examination. Chi-square test was used to compare the detection rates of HFHL in different populations, and multivariate logistic regression model was used to analyze the influencing factors of HFHL. Results: The noise level of 2647 individual workers ranged from 75.0 dB (A) to 92.0 dB (A) , with an average of (84.14±2.47) dB (A) . The detection rate of HFHL was 17.2% (456/2647) . There were significant differences in the the detection rate of HFHL among workers of different gender, age, educational level, working age, noise exposure level, diabetes history, detonation history, smoking and drinking workers (P<0.05) . Multivariate logistic regression analysis showed that male, age ≥30 years old, smoking and noise exposure were risk factors for HFHL (P<0.05) . Conclusion: The detection rate of HFHL in automobile factory workers is high. Gender, age, smoking and noise are the influencing factors of HFHL. It is necessary to strengthen the noise control in the workplace and guide workers to choose healthy lifestyle.

Automatic Hip Detection in Anteroposterior Pelvic Radiographs-A Labelless Practical Framework

Automated detection of the region of interest (ROI) is a critical step in the two-step classification system in several medical image applications. However, key information such as model parameter selection, image annotation rules, and ROI confidence score are essential but usually not reported. In this study, we proposed a practical framework of ROI detection by analyzing hip joints seen on 7399 anteroposterior pelvic radiographs (PXR) from three diverse sources. We presented a deep learning-based ROI detection framework utilizing a single-shot multi-box detector with a customized head structure based on the characteristics of the obtained datasets. Our method achieved average intersection over union (IoU) = 0.8115, average confidence = 0.9812, and average precision with threshold IoU = 0.5 (AP50) = 0.9901 in the independent testing set, suggesting that the detected hip regions appropriately covered the main features of the hip joints. The proposed approach featured flexible loose-fitting labeling, customized model design, and heterogeneous data testing. We demonstrated the feasibility of training a robust hip region detector for PXRs. This practical framework has a promising potential for a wide range of medical image applications.

[Study on the mechanism of resistance to cypermethrin in Culex pipiens pallens using proteomics]

OBJECTIVE

To compare the differentially expressed proteins between cypermethrin-resistant and -sensitive Culex pipiens pallens, so as to unravel the mechanism underlying the resistance to cypermethrin in Cx. p. pallens.

METHODS

A quantitative proteomic analysis was performed among cypermethrin-sensitive and -resistant isolates of Cx. p. pallens using isobaric tags for relative and absolute quantification (iTRAQ) labeling coupled with liquid chromatography with tandem mass spectrometry (LC-MS/MS).

RESULTS

A total of 164 differentially expressed proteins were identified between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens, including 54 up-regulated proteins and 110 down-regulated proteins. A large number of cuticular proteins, larval cuticular proteins, pupal cuticular proteins and cuticular structural constituent proteins, which are associated with cytoskeletal structure and components, were differentially expressed between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens. Thirteen proteins, which were involved in energy production and conversion, translation, ribosomal structure and biogenesis, lipid transport and metabolism, post-translational modification, protein turnover, chaperones, cytoskeleton and intracellular transportation, were validated to be differentially expressed between cypermethrin-sensitive and -resistant isolates of Cx. p. pallens, which may serve as potential markers of cypermethrin resistance.

CONCLUSIONS

Multiple insecticide resistance mechanisms contribute to the resistance to cypermethrin in Cx. p. pallens, including cuticular resistance and metabolic resistance, and the cuticular protein genes and cytochrome P450 enzymes may play an important role in the resistance of Cx. p. pallens to cypermethrin.

Comparing the efficacy of endovascular treatment for iliac vein compression syndrome with or without acute deep venous thrombosis: A single-center retrospective study

BACKGROUND

To compare the efficacy of endovascular treatment for iliac vein compression syndrome (IVCS) with or without acute deep venous thrombosis of lower extremity.

METHODS

This study retrospectively analyzed the clinical data of 300 IVCS patients, who received endovascular treatment between January 2013 and December 2017. According to whether IVCS was complicated by deep venous thrombosis or not, these patients were divided into non-thrombotic iliac vein lesion group (NIVL group, n = 127) and post-thrombotic iliac vein lesion group (PIVL group, n = 173). After endovascular treatment, all patients were followed up to assess the symptoms improvement and to evaluate the patency of iliac vein.

RESULTS

The technical success rate was 98% (294/300), and percutaneous transluminal angioplasty with stenting was adopted in 294 cases. The incidence of perioperative complications was 36.33% (109/300), but no severe complications occurred. During a mean follow-up of 22.3 months (range 6-30 months), 9(6.82%, 9/132) patients in PIVL group had recurrence of deep venous thrombosis, but nobody had deep venous thrombosis and varicose veins recurrence in NIVL group. The effective rate of endovascular treatment in NIVL group and PIVL group was 96.88% and 90.15% (P = 0.050), while the cumulative primary patency of iliac vein in NIVL group was significantly higher than that in PIVL group (P = 0.008).

CONCLUSIONS

The endovascular treatment is an effective, feasible, safe method for treating IVCS. There is no difference in the efficacy of IVCS patients with or without deep venous thrombosis, but the medium and long-term patency of patients with deep venous thrombosis is lower than that in patients without deep venous thrombosis.

Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: A retrospective study of 42 patients

Many surgical procedures have been developed for the treatment of post-traumatic thoracolumbar kyphosis. But there is a significant controversy over the ideal management. The aim of this study was to illustrate the technique of modified grade 4 osteotomy for the treatment of post-traumatic thoracolumbar kyphosis and to evaluate clinical and radiographic results of patients treated with this technique.From May 2013 to May 2018, 42 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of modified grade 4 osteotomy, and their medical records were retrospectively collected. Preoperative and postoperative sagittal Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) were recorded. The average follow-up period was 29.7 ± 14.2 months.The operation time was 185.5 ± 26.8 minutes, the intraoperative blood loss was 545.2 ± 150.1 mL. The Cobb angles decreased from 38.5 ± 3.8 degree preoperatively to 4.2 ± 2.6 degree 2 weeks after surgery (P < .001). The VAS reduced from 6.5 ± 1.1 preoperatively to 1.5 ± 0.9 at final follow-up (P < .001), and the ODI reduced from 59.5 ± 15.7 preoperatively to 15.9 ± 5.8 at final follow-up (P < .001). Kyphotic deformity was successfully corrected and bony fusion was achieved in all patients. Neurologic function of 7 cases was improved to various degrees.Modified grade 4 osteotomy, upper disc, and upper one-third to half of pedicle are resected, is an effective treatment option for post-traumatic thoracolumbar kyphosis. However, the long-term clinical effect still needs further studies.

[Effects of maslinic acid on isoproterenol-induced myocardial fibrosis in mice]

Objective: To investigate the effect of maslinic acid (MA) on isoproterenol (ISO)-induced myocardial fibrosis in mice. Methods: ISO was used to induce myocardial fibrosis in adult male C57BL/6 mice, and MA was administered for two weeks to detect the effects of MA on cardiac function and fibrosis. Molecular changes of fibrosis markers and signaling pathways were detected by RT-PCR and western blotting. Phosphate buffer saline (PBS), PBS+SB203580 (p38 MAPK inhibitor), PBS+MA, ISO, ISO+SB203580, ISO+MA were added to the primary cultured rat fibroblasts. Cells were collected after 48 h for subsequent detection. Results: In this study, the mouse model of myocardial fibrosis was successfully established. The left ventricular faction shortening (FS) and maximum rate of rise and maximum rate of fall of pressure in left ventricular chamber (±dp/dt) of the ISO+MA group were significantly higher than those of the ISO group ((35.1±1.8)% vs (28.5±2.6)%, (7 256±153) mmHg/s vs (6 402±240) mmHg/s, (7 156±163) mmHg/s vs (6 319±219) mmHg/s, all P<0.05). The levels of interstitial and perivascular collagen deposition in the ISO+MA group were higher than those in the ISO group (P<0.05), the relative mRNA levels of COL-1, COL-3 and TGF-β in the ISO+MA group were significantly lower than those in the ISO group, with the relative expression levels of 1.70±0.24 vs 3.69±0.34, 1.72±0.56 vs 4.84±0.82, 1.52±0.19 vs 2.64±0.29, respectively (all P<0.05). The phosphorylation levels of p38 MAPK, Smad3 and protein expression level of TGF-β1 in ISO+MA group were lower than those in ISO group (relative expression levels were 1.67±0.35 vs 2.61±0.58, 1.68±0.23 vs 2.52±0.19,1.56±0.15 vs 2.48±0.26, respectively, all P<0.05). The results of in vitro cell experiments showed that the mRNA levels of COL-1, COL-3 and TGF-β in the SB203580 and MA groups were significantly lower than those in the ISO group (relative expression levels were 2.25±0.51, 2.16±0.48 vs 5.29±1.21; 1.58±0.34, 1.69±0.29 vs 4.97±1.32; 1.41±0.31, 1.55±0.38 vs 3.53±0.56, respectively, all P<0.05). The phosphorylation levels of p38 MAPK and Smad3 in the SB203580 MA groups was significantly lower than those in the ISO group, and the protein expression level of TGF-β1 was lower than that in the ISO group (1.81±0.18, 1.77±0.16 vs 2.56±0.32; 1.85±0.21, 1.81±0.17 vs 2.48±0.37; 1.84±0.24, 1.72±0.17 vs 2.52±0.29, all P<0.05). Conclusion: Maslinic acid can inhibit the phosphorylation of p38 MAPK, thereby preventing the canonical TGF-β1/Smads fibrosis signaling pathway to achieve an anti-fibrosis role.

Responses of Primary Afferent Fibers to Acupuncture-Like Peripheral Stimulation at Different Frequencies: Characterization by Single-Unit Recording in Rats

The pain-relieving effect of acupuncture is known to involve primary afferent nerves (PANs) via their roles in signal transmission to the CNS. Using single-unit recording in rats, we characterized the generation and transmission of electrical signals in Aβ and Aδ fibers induced by acupuncture-like stimuli. Acupuncture-like signals were elicited in PANs using three techniques: manual acupuncture (MAc), emulated acupuncture (EAc), and electro-acupuncture (EA)-like peripheral electrical stimulation (PES). The discharges evoked by MAc and EAc were mostly in a burst pattern with average intra-burst and inter-burst firing rates of 90 Hz and 2 Hz, respectively. The frequency of discharges in PANs was correlated with the frequency of PES. The highest discharge frequency was 246 Hz in Aβ fibers and 180 Hz in Aδ fibers. Therefore, EA in a dense-disperse mode (at alternating frequency between 2 Hz and 15 Hz or between 2 Hz and 100 Hz) best mimics MAc. Frequencies of EA output >250 Hz appear to be obsolete for pain relief.

Development of a CRISPR-SaCas9 system for projection- and function-specific gene editing in the rat brain

A genome editing technique based on the clustered regularly interspaced short palindromic repeats (CRISPR)-associated endonuclease Cas9 enables efficient modification of genes in various cell types, including neurons. However, neuronal ensembles even in the same brain region are not anatomically or functionally uniform but divide into distinct subpopulations. Such heterogeneity requires gene editing in specific neuronal populations. We developed a CRISPR-SaCas9 system-based technique, and its combined application with anterograde/retrograde AAV vectors and activity-dependent cell-labeling techniques achieved projection- and function-specific gene editing in the rat brain. As a proof-of-principle application, we knocked down the cbp (CREB-binding protein), a sample target gene, in specific neuronal subpopulations in the medial prefrontal cortex, and demonstrated the significance of the projection- and function-specific CRISPR-SaCas9 system in revealing neuronal and circuit basis of memory. The high efficiency and specificity of our projection- and function-specific CRISPR-SaCas9 system could be widely applied in neural circuitry studies.

Modified extrapedicular kyphoplasty for the treatment of lumbar compression fracture: Case report and technical note

RATIONALE

Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture.

PATIENT CONCERNS

A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%.

DIAGNOSIS

Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3.

INTERVENTIONS

We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle.

OUTCOMES

The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved.

LESSONS

Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.

A Novel 3D-Printed Multi-Drive System for Synchronous Electrophysiological Recording in Multiple Brain Regions

Extracellular electrophysiology has been widely applied in neural network studies. Local field potentials and single-unit activities can be recorded with high-density electrodes, which facilitate the decoding of neural codes. However, the chronic multi-regional recording is still a challenging task for achieving high placement accuracy and long-term stability. Here, we present a novel electrode design with low-cost 3D-printed parts and custom printed circuits boards. This new design could facilitate precise electrode placement in multiple brain regions simultaneously and reduce the working time for surgical procedures as well. In this paper, the design and fabrication of the 3D printed multi-channel microdrive are explained in detail. We also show the result of high-quality electrophysiological recordings in eight pain-related areas from rats and the electrode placement accuracy. This novel 3D-printed multi-drive system could achieve synchronous electrophysiological recording in multiple brain regions and facilitate future neural network research.

Use of In Vivo Single-fiber Recording and Intact Dorsal Root Ganglion with Attached Sciatic Nerve to Examine the Mechanism of Conduction Failure

Single-fiber recording has been a classical and effective electrophysiological technique over the last few decades because of its specific application for nerve fibers in the central and peripheral nervous systems. This method is particularly applicable to dorsal root ganglia (DRG), which are primary sensory neurons that exhibit a pseudo-unipolar structure of nervous processes. The patterns and features of the action potentials passed along axons are recordable in these neurons. The present study uses in vivo single-fiber recordings to observe the conduction failure of sciatic nerves in complete Freund's adjuvant (CFA)-treated rats. As the underlying mechanism cannot be studied using in vivo single-fiber recordings, patch-clamp-recordings of DRG neurons are performed on preparations of intact DRG with the attached sciatic nerve. These recordings reveal a positive correlation between conduction failure and the rising slope of the after-hyperpolarization potential (AHP) of DRG neurons in CFA-treated animals. The protocol for in vivo single fiber-recordings allows the classification of nerve fibers via the measurement of conduction velocity and monitoring of abnormal conditions in nerve fibers in certain diseases. Intact DRG with attached peripheral nerve allows observation of the activity of DRG neurons in most physiological conditions. Conclusively, single-fiber recording combined with electrophysiological recording of intact DRGs is an effective method to examine the role of conduction failure during the analgesic process.

Anterior cingulate cortex modulates the affective-motivative dimension of hyperosmolality-induced thirst

Neuroimaging studies have shown that the anterior cingulate cortex (ACC) is consistently activated by thirst and may underlie the affective motivation of drinking behaviour demanded by thirst. But direct evidence for this hypothesis is lacking. The present study evaluated potential correlations between ACC neuronal activity and drinking behaviour in rats injected with different concentrations of saline. We observed an increased number of c-Fos-positive neurons in the ACC after injection of hypertonic saline, indicating strong ACC neuronal activation under hyperosmotic thirst. Increased firing rates of putative ACC pyramidal neurons preceded drinking behaviour and positively correlated with both the total duration of drinking and the total amount of water consumed. Chemogenetic inhibition of ACC pyramidal neurons changed drinking behaviour from an explosive and short-lasting pattern to a gradual but more persistent pattern, without affecting either the total duration of drinking or the total amount of water consumed. Together, these findings support a role of the ACC in modulating the affective-motivative dimension of hyperosmolality-induced thirst.

Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports

RATIONALE

The kyphosis caused by old osteoporotic vertebral compression fracture usually requires osteotomy to correct it. Various osteotomy techniques have been reported, but each has its own advantages and disadvantages.

PATIENT CONCERNS

We reviewed 2 cases of old osteoporotic vertebral compression fractures with kyphosis in our hospital. One patient complained of persistent low-back pain, another patient complained of low-back pain and weakness of both lower extremities.

DIAGNOSIS

Old osteoporotic vertebral compression fractures with kyphosis were diagnosed based on computer tomography and magnetic resonance imaging.

INTERVENTIONS

We performed modified grade 4 osteotomy for 2 patients.

OUTCOMES

Both patients said significant improvement in preoperative symptoms, and x-ray showed that the kyphosis was corrected. Both patients were satisfied with the treatment at the last follow-up, and the kyphosis was not aggravated.

LESSONS

Modified grade 4 osteotomy is an effective option for the treatment of old osteoporotic fracture with kyphosis. It can restore the spine sequence and achieve better clinical result.

[Clinical analysis of the double-wing flap for treatment of toe syndactyly]

Objective: To explore the clinical effect of double-wing flap for the treatment of toe syndactyly. Methods: Retrospective analysis of 47 patients (60 syndactyly toes) who underwent double-wing flap to reconstruct toe web space in orthopedics department of the Third Affiliated Hospital of Zhengzhou University from February 2010 to October 2017.There were 21 males and 26 females, with an average age of 18.9 months (range: 10-48 months). All patients were treated with zigzag incisions to separate the toe syndactylys without skin grafts.The condition of wound healing and appearance of toes were observed. Results: The average follow-up time was 62.3 months (range: 6 to 80 months). There were no complications such as hematoma, infection, flap necrosis and no flexion contracture and obvious scar hyperplasia in all the 47 cases, 4 of the 60 webs developed web creep.All webs had good appearance with 45 degrees inclination from the dorsal to the metatarsal side and had good flexion and abduction function. Conclusions: The double-wing flap is a simple and safe operation for toe syndactyly which has a good clinical effect.

Elevated Resting State Gamma Oscillatory Activities in Electroencephalogram of Patients With Post-herpetic Neuralgia

In acute and ongoing pain, the spontaneous oscillatory activity of electroencephalogram (EEG) has been characterized by suppression of alpha band oscillations and enhancement of gamma band oscillations. In pathological chronic pain which is more severe and common in clinic practice, it is of great interest to investigate the oscillatory activity especially at the broad gamma frequency bands. Our present study explored the resting state oscillatory activities of EEG in patients with post-herpetic neuralgia (PHN) over 3 months which is a typical neuropathic pain model in clinical researches. It was found that the PHN patients showed anxiety and depression revealed by Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) examinations. Power spectrum analysis revealed that the power at gamma frequency band (from 40 to 70 Hz) of EEG was significantly higher in the PHN patients, and positively correlated with pain intensity, anxiety, and depression indexes. Further, increased gamma activity derived from the prefrontal cortex and the cerebellum were revealed by cluster-based sensor level and the beamforming source level analyses. These results suggest the enhanced gamma oscillatory activity in the prefrontal cortex and cerebellum is a characteristic marker in chronic neuropathic pain patients.

Increased expression of CaV3.2 T-type calcium channels in damaged DRG neurons contributes to neuropathic pain in rats with spared nerve injury

Ion channels are very important in the peripheral sensitization in neuropathic pain. Our present study aims to investigate the possible contribution of Ca_V3.2 T-type calcium channels in damaged dorsal root ganglion neurons in neuropathic pain. We established a neuropathic pain model of rats with spared nerve injury. In these model rats, it was easy to distinguish damaged dorsal root ganglion neurons (of tibial nerve and common peroneal nerve) from intact dorsal root ganglion neurons (of sural nerves). Our results showed that Ca_V3.2 protein expression increased in medium-sized neurons from the damaged dorsal root ganglions but not in the intact ones. With whole cell patch clamp recording technique, it was found that after-depolarizing amplitudes of the damaged medium-sized dorsal root ganglion neurons increased significantly at membrane potentials of −85 mV and −95 mV. These results indicate a functional up-regulation of Ca_V3.2 T-type calcium channels in the damaged medium-sized neurons after spared nerve injury. Behaviorally, blockade of Ca_V3.2 with antisense oligodeoxynucleotides could significantly reverse mechanical allodynia. These results suggest that Ca_V3.2 T-type calcium channels in damaged medium-sized dorsal root ganglion neurons might contribute to neuropathic pain after peripheral nerve injury.

[A cohort study on body mass index and risk of all-cause mortality among hypertensive population]

Objective: To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods: All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results: Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m(2)<BMI<24.0 kg/m(2)) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m(2), 24-28 kg/m(2), and ≥28 kg/m(2)) were 0.83 (95%CI: 0.37-1.87), 0.81 (95%CI: 0.67-0.97), and 0.72 (95%CI: 0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion: Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon.

Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis

BACKGROUND

Laminoplasty (LP) and laminectomy with fusion (LF) were recognized as two reliable and effective way in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). However, there was no clear conclusion on which method is better. A meta-analysis was conducted to evaluate the clinical results between LP and LF in the treatment of multilevel cervical OPLL.

METHODS

An extensive search of literature was performed in PubMed, Embase, the Cochrane library, CNKI (Chinese database), and WANFANG (Chinese database). The following outcomes were extracted: the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS), cervical lordosis, cervical range of motion (ROM), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3.

RESULTS

A total of 11 studies were included in the final analysis. The results indicated that no significant differences between LP and LF group in terms of preoperative JOA scores (P = .58), postoperative JOA scores (P = .60), JOA scores improvement rate (P = 0.64), preoperative VAS (P = .34), postoperative VAS (P=.20), preoperative range of motion (ROM) (P = .10), postoperative ROM (P = .18), preoperative cervical lordosis (P = .56), C5 palsy (P = .16), and axial pain (P = .21). LF group showed larger postoperative cervical lordosis than LP group [standardized mean difference (SMD) = 1.13 (2.03, 0.24), P = .01]. However, LP group showed lower operation time [mean difference (MD) = 19.42 (26.87, 11.97), P < .001] and blood loss [MD = 94.78 (179.05, 10.51), P = .03] than LF group.

CONCLUSION

Both LP and LF can achieve clinical improvement in the treatment of multilevel cervical OPLL. LF was superior to LP in maintaining cervical lordosis. However, LP showed lower surgical trauma than LF. Kyphosis line (K-line) may be a good criterion in the selection of posterior surgery. LP was performed for the patients with K-line (+) and LF for K-line (-).

Contralateral radiculopathy after transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: A Case Series

RATIONALE

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for patients with degenerative lumbar disc disorder. Contralateral radiculopathy, as a complication of TLIF, has been recognized in this institution, but is rarely reported in the literature.

PATIENT CONCERNS

In this article, we report 2 cases of contralateral radiculopathy after TLIF in our institution and its associated complications.

DIAGNOSES

In the 2 cases, the postoperative computed tomography (CT) and magnetic resonance image (MRI) showed obvious upward movement of the superior articular process, leading to contralateral foraminal stenosis.

INTERVENTIONS

Revision surgery was done at once to partially resect the opposite superior facet and to relieve nerve root compression.

OUTCOMES

After revision surgery, the contralateral radiculopathy disappeared.

LESSONS

Contralateral radiculopathy is an avoidable potential complication. It is very important to create careful preoperative plans and to conscientiously plan the use of intraoperative techniques. In case of postoperative contralateral leg pain, the patients should be examined by CT and MRI. If CT and MRI show that the superior articular process significantly migrated upwards, which leads to contralateral foraminal stenosis, revision surgery should be done at once to partially resect the contralateral superior facet so as to relieve nerve root compression and avoid possible long-term impairment.

Hypersensitivity of Prelimbic Cortex Neurons Contributes to Aggravated Nociceptive Responses in Rats With Experience of Chronic Inflammatory Pain

Previous experience of chronic pain causes enhanced responses to upcoming noxious events in both humans and animals, but the underlying mechanisms remain unclear. In the present study, we found that rats with complete Freund's adjuvant (CFA)-induced chronic inflammatory pain experience exhibited aggravated pain responses to later formalin test. Enhanced neuronal activation upon formalin assaults and increased phosphorylated cAMP-response element binding protein (CREB) were observed in the prelimbic cortex (PL) of rats with chronic inflammatory pain experience, and inhibiting PL neuronal activities reversed the aggravated pain. Inflammatory pain experience induced persistent p38 mitogen-activated protein kinase (MAPK; p38) but not extracellular regulated protein kinase (ERK) or c-Jun N-terminal kinase (JNK) hyperphosphorylation in the PL. Inhibiting the p38 phosphorylation in PL reversed the aggravated nociceptive responses to formalin test and down-regulated enhanced phosphorylated CREB in the PL. Chemogenetics identified PL-periaqueductal gray (PAG) but not PL-nucleus accumbens (NAc) as a key pathway in inducing the aggravated formalin pain. Our results demonstrate that persistent hyperphosphorylation of p38 in the PL underlies aggravated nociceptive responses in rats with chronic inflammatory pain experience.

Accumulation of Cav3.2 T-type Calcium Channels in the Uninjured Sural Nerve Contributes to Neuropathic Pain in Rats with Spared Nerve Injury

Injuries to peripheral nerve fibers induce neuropathic pain. But the involvement of adjacent uninjured fibers to pain is not fully understood. The present study aims to investigate the possible contribution of Ca_v3.2 T-type calcium channels in uninjured afferent nerve fibers to neuropathic pain in rats with spared nerve injury (SNI). Aβ-, Aδ- and C-fibers of the uninjured sural nerve were sensitized revealed by in vivo single-unit recording, which were accompanied by accumulation of Ca_v3.2 T-type calcium channel proteins shown by Western blotting. Application of mibefradil, a T-type calcium channel blocker, to sural nerve receptive fields increased mechanical thresholds of Aβ-, Aδ- and C-fibers, confirming the functional involvement of accumulated channels in the sural nerve in SNI rats. Finally, perineural application of mibefradil or TTA-P2 to the uninjured sural nerve alleviated mechanical allodynia in SNI rats. These results suggest that axonal accumulation of Ca_v3.2 T-type calcium channels plays an important role in the uninjured sural nerve sensitization and contributes to neuropathic pain.

Short-segment fixation with a cement-augmented pedicle screw for Kummell disease: Case report

RATIONALE

Kummell disease is described as avascular necrosis of a vertebral body that occurred in a delayed fashion after a minor trauma. Anterior, posterior, and anterior-posterior approaches have been reported. Nevertheless, there is no standard treatment for patients with Kummell disease.

PATIENT CONCERNS

We reported a successful cement-augmented pedicle screw placement in a patient with Kummell disease. A 63-year-old woman with serious osteoporosis complained persistent back pain with progressive lower extremities weakness for almost 2 years.

DIAGNOSES

The diagnosis of Kummell disease was mainly depended on clinical symptoms and imaging examinations.

INTERVENTIONS

The application of a cement-augmented pedicle screw was designed to treat this illness.

OUTCOMES

The operation was successful without any complications. The patient stated that symptoms were obviously improved in 1 week after operation.

LESSONS

The application of a cement-augmented pedicle screw is an effective treatment option for Kummell disease.

Vertebral column decortication for the management of sharp angular spinal deformity in Pott disease: Case report

RATIONALE

Extremely sharp angular spinal deformity of healed tuberculosis can be corrected by vertebral column resection (VCR). However, the VCR techniques have many limitations including spinal column instability, greater blood loss, and greater risk of neurologic deficit.

PATIENT CONCERNS

We described a new spinal osteotomy technique to collect sharp angular spinal deformity in Pott disease. A 52-year-old woman presented with back pain and gait imbalance.

DIAGNOSIS

The kyphosis of healed tuberculosis was diagnosed based on history and imaging examinations.

INTERVENTION

A new posterior VCR was designed to treat this disease.

OUTCOMES

The neurological function improved from Japanese Orthopedic Association scale 3 to 7. The back pain and neurological function were significantly improved. The Oswestry Disability Index decreased from 92 to 34. There was also a significant decrease in back pain visual analog scale from 9 to 2.

LESSONS

For cases with extremely severe Pott kyphotic deformity, the technology of modified VCR offers excellent clinical and radiographic results.

[Extensive burns complicated with infective endocarditis and septic pulmonary embolism: case report and literature review]

Objective: To improve the clinical recognition of infective endocarditis (IE) and septic pulmonary embolism (SPE) in patients with extensive burns. Methods: A case of large area burn complicated with IE and SPE confirmed by blood cultures and echocardiography was described. A literature review was performed with "burn" and "infective endocarditis" as the Chinese key words in Wanfang database; with "burn" and "infective endocarditis" as Mesh terms in PubMed. Results: The patient was a 37-year-old male with large area burn, who presented with fever and hemoptysis. Blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA). Echocardiography disclosed vegetations located in the tricuspid valve. Multiple wedge-shaped lesions were found on chest CT. From January 1978 to December 2015, 26 related articles were retrieved and 134 burned patients complicated with endocarditis were reported, of which, 97 cases were IE and 1 case with SPE. Of the 134 cases, 120 cases were dead, 12 cases cured and 2 cases unknown. The mortality was 89.6%. Conclusions: There was a high mortality of burned patients complicated with IE. SPE should be considered for patients with multiple peripheral nodules in both lungs and a positive blood culture. Combination and prolonged anti-infective therapy may increase the treatment success and reduce the risk of recurrence.

Brain-derived neurotrophic factor in the infralimbic cortex alleviates inflammatory pain

In chronic pain, it has been reported that the medial prefrontal cortex (mPFC) takes important regulatory roles, and may change functionally and morphologically in result of chronic pain. Brain-derived neurotrophic factor (BDNF) is well known as a critical modulator of neuronal excitability and synaptic transmission in the central nervous system. The aim of the present study is to investigate the role of BDNF in the infralimbic cortex and the prelimbic cortex of the mPFC in complete Freund's adjuvant (CFA)-induced inflammatory pain. We found that the BDNF level decreased in the infralimbic cortex, but not in the prelimbic cortex, 3days after the CFA induction of the inflammatory pain. BDNF infusion into bilateral infralimbic cortices to activate neuronal activities could alleviate inflammatory pain and accelerate long-term recovery from pain. In conclusion, BDNF in the infralimbic cortex of the mPFC could accelerate recovery from inflammatory pain.

Unilateral versus bilateral pedicle screw fixation with posterior lumbar interbody fusion for lumbar degenerative diseases: A meta-analysis

BACKGROUND

Both unilateral pedicle screw fixation with posterior lumbar interbody fusion (PLIF) and bilateral pedicle screw fixation with PLIF are used to treat lumbar degenerative diseases (LDD). However, which one is a better treatment for LDD remains considerable controversy. Therefore, the focus of this meta-analysis was to assess the merits and shortcomings of efficacy of these 2 surgical procedures for LDD.

METHODS

An extensive search of literature was performed in Pubmed/MEDLINE, Embase, CNKI, and WANFANG databases on unilateral versus bilateral pedicle screw fixation with PLIF fusion for LDD, from January 2007 to January 2017 and language was restricted to Chinese or English. The following variables were extracted: blood loss, operation time, length of hospital stay, Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) and Oswestry disability index (ODI) scores, fusion rate, total complications, infection, dural injury, and nerve injury. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

RESULTS

A total of 11 studies containing 844 patients were included in our study. The results showed that unilateral is better than bilateral pedicle screw fixation with PLIF in blood loss (P < .00001), operation time (P < .00001), the length of hospital stay (P = .003), and the final follow-up ODI scores (P = .04). However, there are no significant differences in JOA, VAS, and preoperative ODI scores. There are also no significant differences in fusion rate and complications (all P > .05).

CONCLUSION

Based on our meta-analysis, our results suggest that both unilateral pedicle screw fixation with PLIF and bilateral pedicle screw fixation with PLIF for LDD have effective results in clinical outcomes. Both 2 methods may result in clinical improvement and similar outcomes of fusion rate and complications; However, compared with bilateral fixation, unilateral fixation produces more satisfactory efficacy in the blood loss and the operation time.

Risk factors for dysphagia after anterior cervical spine surgery: A meta-analysis

BACKGROUND

Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery.

METHODS

PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

RESULTS

The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76-2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05-2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62-2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44-6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16-14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60-4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62-1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75-2.51, P = 0.30).

CONCLUSION

Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required.

Reduced GABAergic transmission in the ventrobasal thalamus contributes to thermal hyperalgesia in chronic inflammatory pain

The ventrobasal (VB) thalamus is innervated by GABAergic afferents from the thalamic reticular nucleus (TRN) and participates in nociception. But how the TRN-VB pathway regulates pain is not fully understood. In the present study, we reported decreased extracellular GABA levels in the VB of rats with CFA-induced chronic inflammatory pain, measured by microdialysis with HPLC analysis. In vitro whole-cell patch-clamp recording showed decreased amplitudes of tonic currents, increased frequencies of mIPSCs, and increased paired-pulse ratios in thalamic slices from chronic inflammatory rats (7 days). Microinjection of the GABA_AR agonist muscimol and optogenetic activation of the TRN-VB pathway relieved thermal hyperalgesia in chronic inflammatory pain. By contrast, microinjecting the extrasynaptic GABA_AR agonist THIP or selective knockout of synaptic GABA_AR γ2 subunits aggravated thermal hyperalgesia in the chronic stage of inflammatory pain. Our findings indicate that reduced GABAergic transmission in the VB contributes to thermal hyperalgesia in chronic inflammatory pain, which could be a synaptic target for pharmacotherapy.

Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty: A meta-analysis

BACKGROUND

Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy.

METHODS

PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses.

RESULTS

A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34-0.99, P < 0.001), JOA scores improvement rate (MD = 4.00, 95% CI: 2.51-5.50, P < 0.001), postoperative Visual Analogue Score (VAS) (MD = -0.81, 95% CI: -1.36 to -0.26, P = 0.004), postoperative range of motion (ROM) (MD = 4.15, 95% CI: 2.06-6.23, P < 0.001), postoperative cervical lordosis (MD = 3.1, 95% CI: 2.02-4.18, P < 0.001), postoperative anteroposterior diameter of the spinal canal (MD = 1.53, 95% CI: 0.11-2.95, P = 0.03), postoperative open angle (MD = 1.93, 95% CI: 0.14-3.71, P = 0.03), postoperative cross-sectional area of the spinal canal (MD = 37.10, 95% CI: 26.92-47.29, P < 0.001), axial symptoms (OR = 0.28, 95% CI: 0.20-0.37, P < 0.001), operation time (MD = 4.46, 95% CI: 0.74-8.19, P = 0.02), and blood loss (MD = 9.24, 95% CI: 6.86-11.62, P < 0.001). However, there was no statistically significant difference in C5 palsy (OR = 0.82, 95% CI: 0.37-1.84, P = 0.63).

CONCLUSIONS

As compared with suture suspensory fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, mini-plate fixation is associated with bigger surgical trauma. This conclusion should be interpreted cautiously and more high-quality, randomized controlled trials are needed in the future.

Modified posterior vertebral column resection for Kümmell disease: Case report

RATIONALE

Kümmell's disease is defined as delayed traumatic vertebral collapse disease in which patients develop a kyphosis after asymptomatic minor spinal trauma. Both anterior approach and posterior approach have been reported, however, there is no standard treatment for Kümmell's disease.

PATIENT CONCERNS

We described a successful modified posterior vertebral column resection in a patient with Kümmell's disease. A 65-year-old woman reported persistent back pain for almost three months.

DIAGNOSES

Kümmell's disease was diagnosed based on computer tomography (CT) and magnetic resonance imaging (MRI).

INTERVENTIONS

Modified posterior vertebral column resection combined with short-segment fixation was designed to treat this disease.

OUTCOMES

The procedure was successful without any complications. Patient reported that symptoms were obviously improved in one week after operation.

LESSONS

Modified posterior vertebral column resection combined with short-segment fixation is an effective treatment option for Kümmell's disease.