A multifunctional biomimetic nanoplatform for image-guideded photothermal-ferroptotic synergistic osteosarcoma therapy

Much effort has been devoted to improving treatment efficiency for osteosarcoma (OS). However, most current approaches result in poor therapeutic responses, thus indicating the need for the development of other therapeutic options. This study developed a multifunctional nanoparticle, PDA-MOF-E-M, an aggregation of OS targeting, programmed death targeting, and near-infrared (NIR)-aided targeting. At the same time, a multifunctional nanoparticle that utilises Fe-MOFs to create a cellular iron-rich environment and erastin as a ferroptosis inducer while ensuring targeted delivery to OS cells through cell membrane encapsulation is presented. The combination of PDA-MOF-E-M and PTT increased intracellular ROS and LPO levels and induced ferroptosis-related protein expression. A PDA-based PTT combined with erastin showed significant synergistic therapeutic improvement in the anti-tumour efficiency of the nanoparticle in vitro and vivo. The multifunctional nanoparticle efficiently prevents the osteoclasia progression of OS xenograft bone tumors in vivo. Finally, this study provides guidance and a point of reference for clinical approaches to treating OS.

[Determination of Perchloroethylene in blood by headspace gas chromatography-mass spectrometry]

Objective: To establish a method for determination of Perchloroethylene (PCE) in blood by headspace gas chromatography-mass spectrometry (HS/GC-MS) . Methods: From Dctober to December 2021, A total of 3 mL blood samples were taken into a 10 mL headspace bottle, after heated at 60 ℃ for 30 mins, PCE in the top air was separated by VF-WAXms capillary column and detected by GC-MS. The retention time and external standard method were used for qualitative and quantitative analysis of PCE in samples, respectively. Results: There was good linear relationship in the range of 5.09-200.17 μg/L. The linear correlation coefficient was 0.9993.The detection limit was 0.21 μg/L and the lower limit of quantitation was 0.70 μg/L. The recovery rates of samples with different concentrations were 95.3%-103.8%. The intra-batch relative standard deviations (RSD) were 3.2%-4.6%, and inter-batch RSD was 4.0%-6.1%. The samples can be stored at 4 ℃ for three days and at -20 ℃ for seven days. Conclusion: This method is proved to be simple, practical and highly sensitive, which is suitable for the determination of PCE in blood.

Machine learning-based surrogate model assisting stochastic model predictive control of urban drainage systems

Quantifying the uncertainty of stormwater inflow is critical for improving the resilience of urban drainage systems (UDSs). However, the high computational complexity and time consumption obstruct the implementation of uncertainty-addressing methods for real-time control of UDSs. To address this issue, this study developed a machine learning-based surrogate model (MLSM) that maintains high-fidelity descriptions of drainage dynamics and meanwhile diminishes the computational complexity. With stormwater inflow and controls as inputs and system overflow as the output, MLSM is able to fast evaluate system performance, and therefore stochastic optimization becomes feasible. Thus, a real-time control strategy was built by combining MLSM with the stochastic model predictive control. This strategy used stochastic stormwater inflow scenarios as input and aimed to minimize the expected overflow under all scenarios. An ensemble of stormwater inflow scenarios was generated by assuming the forecast errors follow normal distributions. To downsize the ensemble, representative scenarios with their probabilities were selected using the simultaneous backward reduction method. The proposed control strategy was applied to a combined UDS of China. Results are as follows. (1) MLSM fit well with the original high-fidelity urban drainage model, while the computational time was reduced by 99.1%. (2) The proposed strategy consistently outperformed the classical deterministic model predictive control in both magnitude and duration dimensions of system resilience, when the consumed time compatible is with the real-time operation. It is indicated that the proposed control strategy could be used to inform the real-time operation of complex UDSs and thus enhance system resilience to uncertainty.

The spatiotemporal assessments for tidal flat erosion associated with urban expansion in the conterminous coastal United States from 1985 to 2015

Tidal flats are of great importance to coastal residents and environments, which are recently facing unprecedented challenges due to massive urban expansions. While some case studies have been conducted in small areas, it is yet to come a picture to examine the issue at the nationwide level. To fill this void, it is necessary to reconsider whether the analytical and statistical methods used in the previous studies are still appropriate to the larger scales, which accordingly needs to be refined and updated. Aiming at this issue, this study implemented a justification for the conterminous United States, in which nearly 70 % of the counties by the seashore with intensified tidal flats in 1985 were selected to conduct a comprehensive assessment. Based on the 156 selected counties, this paper firstly analyzed the spatiotemporal change patterns of tidal flats and urban extents from 1985 to 2015, and then combined these results and implemented a series of correlation assessments between tidal flat loss and urban expansion. As a result, we found that urban expansions in the conterminous coastal United States have not only substantially squeezed the space of tidal flats, but also significantly affected the surrounding tidal flat environments during the three decades.

Spatial Variation Generation Algorithm for Motor Imagery Data Augmentation: Increasing the Density of Sample Vicinity

The imbalanced development between deep learning-based model design and motor imagery (MI) data acquisition raises concerns about the potential overfitting issue-models can identify training data well but fail to generalize test data. In this study, a Spatial Variation Generation (SVG) algorithm for MI data augmentation is proposed to alleviate the overfitting issue. In essence, SVG generates MI data using variations of electrode placement and brain spatial pattern, ultimately elevating the density of the raw sample vicinity. The proposed SVG prevents models from memorizing the training data by replacing the raw samples with the proper vicinal distribution. Moreover, SVG generates a uniform distribution and stabilizes the training process of models. In comparison studies involving five deep learning-based models across eight datasets, the proposed SVG algorithm exhibited a notable improvement of 0.021 in the area under the receiver operating characteristic curve (AUC). The improvement achieved by SVG outperforms other data augmentation algorithms. Further results from the ablation study verify the effectiveness of each component of SVG. Finally, the studies in the control group with varying numbers of samples show that the SVG algorithm consistently improves the AUC, with improvements ranging from approximately 0.02 to 0.15.

[Evaluation of the determination of hydrogen sulfide in the air of workplace by the detection tube method]

Objective: To evaluate the accuracy and applicability of detection tube method for quantitative detection of hydrogen sulfide in workplace air. Methods: In September 2021, the lower limit of quantification, accuracy, precision, environmental factors, interfering gases and other performance indicators of the method for determining hydrogen sulfide in the air of workplace were verified by the detection tube, and the results were compared with those of GB 11742-89 "Standard method for hygienic examination of hydrogen sulfide in air of residential areas-methylene blue spectrophotometric method" to evaluate the application effect of the detection tube method for quantitative detection of hydrogen sulfide in workplace air. Results: There was no significant difference in the results of 2.83 mg/m(3), 4.25 mg/m(3) and 17.00 mg/m(3) hydrogen sulfide concentration between the two methods (P>0.05) , but there was significant difference in the results of 8.50 mg/m(3) concentration (P<0.05) . The lower limit of quantification of hydrogen sulfide in workplace air was 2.83 mg/m(3), the accuracy was 96.0%-111.0%, and the precision was 0.70%-6.64%. Under the condition of 4 ℃, the measured results decreased by 3.39%-13.10%. When the humidity was 50%-80%, the relative error of the average measured value was -1.67%-4.44%. Interference gases that may exist in the workplace (including carbon dioxide, carbon monoxide, mercaptans, nitrogen oxides, sulfur dioxide, etc.) did not interfere with the results of the test tube. Conclusion: The accuracy and precision of the detection tube method meet the detection requirements. The method is simple, rapid and easy to be popularized, and can be used for the rapid detection of hydrogen sulfide gas concentration in the workplace.

Identifying Genetic Signatures Associated with Oncogene-Induced Replication Stress in Osteosarcoma and Screening for Potential Targeted Drugs

Osteosarcoma is the most common type of primary malignant bone tumor. Due to the lack of selectivity and sensitivity of chemotherapy drugs to tumor cells, coupled with the use of large doses, chemotherapy drugs often have systemic toxicity. The use of modern sequencing technology to screen tumor markers in a large number of tumor samples is a common method for screening highly specific and selective anti-tumor drugs. This study aims to identify potential biomarkers using the latest reported gene expression signatures of oncogene-induced replication stress (ORS) in aggressive cancers, and potential anti-osteosarcoma drugs were screened in different drug databases. In this study, we obtained 89 osteosarcoma-related samples in the TARGET database, all of which included survival information. According to the median expression of each of six reported ORS gene markers (NAT10/DDX27/ZNF48/C8ORF33/MOCS3/MPP6), we divided 89 osteosarcoma gene expression datasets into a high expression group and a low expression group and then performed a differentially expressed gene (DEG) analysis. The coexisting genes of 6 groups of DEGs were used as replication stress-related genes (RSGs) of osteosarcoma. Then, key RSGs were screened using LASSO regression, a Cox risk proportional regression prognostic model and a tenfold cross-validation test. GSE21257 datasets collected from the Gene Expression Omnibus (GEO) database were used to verify the prognostic model. The final key RSGs selected were used in the L1000PWD and DGIdb databases to mine potential drugs. After further validation by the prognostic model, we identified seven genes associated with ORS in osteosarcoma as key RSGs, including transcription factor 7 like 2 (TCF7L2), solute carrier family 27 member 4 (SLC27A4), proprotein convertase subtilisin/kexin type 5 (PCSK5), nucleolar protein 6 (NOL6), coiled-coil-coil-coil-coil-helix domain containing 4 (CHCHD4), eukaryotic translation initiation factor 3 subunit B (EIF3B), and synthesis of cytochrome C oxidase 1 (SCO1). Then, we screened the seven key RSGs in two drug databases and found six potential anti-osteosarcoma drugs (D GIdb database: repaglinide, tacrolimus, sirolimus, cyclosporine, and hydrochlorothiazide; L1000PWD database: the small molecule VU-0365117-1). Seven RSGs (TCF7L2, SLC27A4, PCSK5, NOL6, CHCHD4, EIF3B, and SCO1) may be associated with the ORS gene signatures in osteosarcoma. Repaglinide, tacrolimus, sirolimus, cyclosporine, hydrochlorothiazide and the small molecule VU-0365117-1 are potential therapeutic drugs for osteosarcoma.

An observational study on the safety of COVID-19 vaccination in patients with myasthenia gravis

OBJECTIVE

There is concern that the coronavirus disease (COVID-19) vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of COVID-19 vaccination on symptom severity in patients with myasthenia gravis (MG).

METHODS

A total of 106 enrolled patients with MG who were vaccinated against COVID-19 were followed up, and a questionnaire was used to document in detail the exacerbation of muscle weakness after vaccination and all other uncomfortable reactions after vaccination. Demographic, clinical characteristics, medication, and vaccination data were collected by follow-up interview. The main observation outcome was whether the MG symptoms of patients were exacerbated. The definition of exacerbation is according to the subjective feeling of the patient or a 2-point increase in daily life myasthenia gravis activity score relative to before vaccination, within 30 days after vaccination.

RESULTS

Of 106 enrolled patients [median age (SD) 41.0 years, 38 (35.8%) men, 53 (50.0%) with generalized MG, 74 (69.8%) positive for acetylcholine receptor antibody, and 21 (19.8%) with accompanying thymoma], muscle weakness symptoms were stable in 102 (96.2%) patients before vaccine inoculation. Muscle weakness worsened in 10 (9.4%) people after vaccination, of which 8 patients reported slight symptom worsening that resolved quickly (within a few days). Two (1.9%) of patients showed serious symptom aggravation that required hospitalization.

CONCLUSION

Our results suggest that inactivated virus vaccines against COVID-19 may be safe for patients with MG whose condition is stable. Patients with generalized MG may be more likely to develop increased muscle weakness after vaccination.

Identification of a ceRNA Network Driven by Copy Number Variations in Esophageal Cancer

BACKGROUND

Copy number variation (CNV) is associated with progression of esophageal cancer (EC), a common gastrointestinal neoplasm.

METHODS

Using sequencing data, CNV data, and clinical data of EC transcriptome samples obtained from public databases, we performed differential expression analysis on sequencing data. Differentially expressed CNV-driven lncRNAs were screened using the chi-square test, and CNV-driven lncRNA-associated miRNAs and mRNAs were predicted. Cytoscape software was then used to construct ceRNA networks. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to investigate biological functions of mRNAs in the ceRNA network. Survival curves were plotted to explore correlations between lncRNAs in the ceRNA network and overall survival of CNV patients. Multiple databases were used to predict lncRNAs-related drugs.

RESULTS

A dysregulated lncRNA-associated ceRNA network driven by CNV in EC, including 11 lncRNAs, 11 miRNAs and 159 mRNAs, was constructed. Downstream enrichment of mRNAs was related to biological processes such as extracellular matrix organization, indicating that these mRNAs mainly participate in intercellular exchange between tumor cells. Additionally, expression of all lncRNAs in the ceRNA network, except LINC00950, LINC01270 and MIR181A1HG, was correlated with patients' CNV. In addition, none of the 11 lncRNAs was significantly correlated with overall survival of CNV patients. CH5424802 and PD-033299CNV mainly affected the RTK signaling pathway and the cell cycle of tumor cells via RP11-180N14.1 and RP11-273 G15.2 in the ceRNA network.

CONCLUSIONS

This study identified 11 CNV-driven lncRNAs that might affect EC development, 2 of which have promising effects if applied to drug treatment. These findings might assist in identifying novel treatments for EC.

One year into the pandemic: the impacts of social vulnerability on COVID-19 outcomes and urban-rural differences in the conterminous United States

This paper first explores spatial distributions and patterns of COVID-19 case rates (cases/100,000 people) and mortality rates (deaths/100,000 people) and their disparities between urban and rural counties in the contiguous US. A county-level social vulnerability index was created using principal component analysis. Social vulnerability components were regressed against both county case and mortality rates. Results suggest that hotspots of case and mortality rates are clustered in Midwest and Upper-Midwest US. We found substantial disparities in case and mortality rates between urban and rural counties. County social vulnerability was positively correlated with both case and mortality rates suggesting counties with higher social vulnerability had higher case and mortality rates. Relationships between social vulnerability components and case and mortality rates vary across the conterminous US. Additionally, counties with increased racial and ethnic minorities, higher percentages of minors, and lower median household income are associated with higher COVID-19 case and mortality rates.

Optimization of in-pipe storage capacity use in urban drainage systems with improved DP considering the time lag of flow routing

The active control of urban drainage systems (UDSs) is playing an increasingly important role in the world threatened by urban flooding and associated disasters caused by insufficient drainage capacity. However, little research has recognized the importance of the optimal use of in-pipe storage space. To address this issue, the use of the in-pipe storage capacity was optimized in this study. A novel approach, that is, dynamic programming with successive approximation considering the time lag of flow routing (DPSA-TL), was developed to determine the control policies, in addition to the commonly used passive, rule-based control (RBC), and evolutionary algorithm (EA) strategies. A real-life urban catchment considering flooding control and combined sewer overflow (CSO) reduction was used as the case study. First of all, the potential benefit of maximizing the use of in-pipe storage space was tested using the four control strategies in three storm events, including a 3-year, 2-hour design (46.5 mm), a 5-year, 2-hour design (56.0 mm) and a 7-h historical (152.5 mm) storm events. Results indicate that DPSA-TL performed best in all cases. Without compromising the goal of flooding control, it provided 16.5%, 12.6%, and 3.0% reductions in CSO volume for the three storm events when compared with the passive strategy. Due to the limited capacity of in-pipe storage, the relative improvement diminished as the total rainfall depth increased. Then, control strategies were further applicated to the real-time operation. DPSA-TL was found to be the best alternative for CSO control, with the CSO volume reduced by 14.7%, 11.4%, and 2.5% in the three storm events, respectively. The findings suggest that the performance of UDS can be significantly improved by optimizing the use of in-pipe storage capacity, and the proposed method is effective in the offline optimization and real-time control of UDSs.

Dynamic Spine Hyperflexion Is Related to Vertebral Compression Fractures in Postmenopausal Women

OBJECTIVE

Previous studies on osteoporotic vertebral fractures are usually based on the neutral posture of spine; however, the fractures are usually associated with the flexion posture of spine. Therefore, we aimed to ascertain the relationship between vertebral compression fractures and thoracolumbar hyperflexion Cobb angles (TLHCobb) and determine the clinical cut-off of the TLHCobb angle.

METHODS

In this retrospective case-control study, TLHCobbs were collected from 154 postmenopausal women (67.45 ± 6.68 years) with vertebral compression fractures (study group) and 310 postmenopausal women (66.57 ± 8.22 years) without vertebral compression fractures (control group) from June 2017 to July 2019. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, and Mann Whitney U were used to assess the group characteristics and proportions. Logistic regression was used to examine the association between vertebral compression fractures and TLHCobb. The cut-off of the TLHCobb was determined by ROC curve and Youden's index.

RESULTS

Fracture prevalence was higher in the higher TLHCobb study group than that in the control group [OR = 2.81 (2.15-3.67)] after adjusting for age, BMI, and QCT findings. TLHCobbs at and >20.05° were associated with an increased fracture prevalence and ORs of 2.79 (1.82-4.27) and 4.83 (3.24-7.20), respectively. TLHCobb, disk height (semiquantitative grading score) and QCT values differed between the study and control groups (p < 0.001 for all three). There were no significant differences in body mass index (BMI), or coronal TLCobb between the two groups.

CONCLUSION

There was an association between the prevalence of vertebral compression fractures and TLHCobbs in postmenopausal women, and a TLHCobb > 20.05° can be an indicator of vertebral fracture.

DJ-1 promotes osteosarcoma progression through activating CDK4/RB/E2F1 signaling pathway

Osteosarcoma (OS) is a primary malignant tumor of the bone characterized by poor prognosis due to chemotherapy resistance and high recurrence rates. DJ-1 (PARK7) is known as an oncogene and its abnormal expression is related to the poor prognosis of various types of malignant tumors. It was found in this study that upregulated expression of DJ-1 was closely correlated with the prognosis of OS patients by promoting the proliferation, migration and chemotherapy resistance of OS cells in vitro through regulating the activity of CDK4 but not through the oxidation mechanism or AKT pathway. The combination of DJ-1 and CDK4 promoted RB phosphorylation, leading to the dissociation of E2F1 into the nucleus to regulate the expression of cell cycle-related genes. The tumor xenograft mouse model demonstrated that DJ-1 knockout suppressed tumor growth in vivo. All these findings indicate that DJ-1 can affect the occurrence and progression of OS by regulating the CDK/RB/E2F1axis, suggesting a novel therapeutic opportunity for OS patients.

Surgical efficacy and survival prediction of patients with unspecified malignant bone tumors

Background

The surgical efficacy and prognostic outcomes of patients with unspecific malignant bone tumors (UMBTs) remain unclear. The study is to address: 1) What are the clinicopathological features and prognostic determinants for patients with UMBTs? 2) Can a nomogram be developed for clinicians to predict the short and long-term outcomes for individuals with UMBTs? 3) Does surgery improve outcomes for UMBT patients who received radiotherapy or chemotherapy after balancing the confounding bias?

Methods

400 UMBT patients were filtrated from the Surveillance, Epidemiology, and End Results database to assess the clinicopathological features, treatments, and factors affecting prognosis. The optimal cutoff values of continuous variables were identified by the x-tile software. Kaplan-Meier method and multivariate Cox proportional hazard modeling were performed to evaluate the independent prognostic factors. Nomogram was further developed by using R software with rms package. The surgical efficacy was further assessed for patients receiving radiotherapy or chemotherapy after performing propensity score matching.

Results

The enrolled cohort included 195 (48.8%) female and 205 (51.2%) male patients. The 2- and 5-year cancer-specific survival (CSS) and overall survival (OS) rate were 58.2 ± 3.0%, 46.8 ± 3.2%, and 46.5 ± 2.6%, 34.4 ± 2.5%, respectively. Nomogram was finally developed for CSS and OS according to the identified independent factors: age, tumor extent, primary tumor surgery, tumor size, and pathology grade. For UMBT patients who received radiotherapy or chemotherapy, surgical intervention was associated with better CSS (pr = 0.003, pc = 0.002) and OS (pr = 0.035, pc = 0.002), respectively.

Conclusions

Nomogram was developed for individual UMBT patient to predict short and long-term CSS and OS rate, and more external patient cohorts are warranted for validation. Surgery improves outcomes for UMBT patients who received either radiotherapy or chemotherapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10153-x.

A Dynamic Neighborhood-Based Switching Particle Swarm Optimization Algorithm

In this article, a dynamic-neighborhood-based switching PSO (DNSPSO) algorithm is proposed, where a new velocity updating mechanism is designed to adjust the personal best position and the global best position according to a distance-based dynamic neighborhood to make full use of the population evolution information among the entire swarm. In addition, a novel switching learning strategy is introduced to adaptively select the acceleration coefficients and update the velocity model according to the searching state at each iteration, thereby contributing to a thorough search of the problem space. Furthermore, the differential evolution algorithm is successfully hybridized with the particle swarm optimization (PSO) algorithm to alleviate premature convergence. A series of commonly used benchmark functions (including unimodal, multimodal, and rotated multimodal cases) is utilized to comprehensively evaluate the performance of the DNSPSO algorithm. The experimental results demonstrate that the developed DNSPSO algorithm outperforms a number of existing PSO algorithms in terms of the solution accuracy and convergence performance, especially for complicated multimodal optimization problems.

A simple, universal and multifunctional template agent for personalized treatment of bone tumors

Bone tumors occur in bone or its accessory tissues. Benign bone tumors are easy to cure and have good prognosis, while malignant bone tumors develop rapidly and have poor and high mortality. So far, there is no satisfactory treatment method. Here, we designed a universal template vector for bone tumor therapy that simultaneously meets the needs of bone targeting, tumor killing, osteoclast suppression, and tumor imaging. The template is composed of a polydopamine (PDA) core and a multifunctional surface. PDA has excellent biosafety and photothermal performance. In this study, alendronate sodium (ALN) is grafted to enable its general bone targeting function. PDA core can carry a variety of chemotherapy drugs, and the rich ALN group can carry a variety of metal ions with an imaging function. Therefore, more personalized treatment plans can be designed for different bone tumor patients. In addition, the PDA core enables photothermal therapy and enhanced chemotherapy. Through template drug Doxorubicin (DOX) and template imaging ion Fe (Ⅱ), we systematically verified the therapeutic effect, imaging effect, and inhibition of bone dissolution of the agent on Osteosarcoma (OS), a primary malignant bone tumor, in vivo. In conclusion, our work provides a more general template carrier for the clinical treatment of bone tumors, through which personalized treatment of bone tumors can be achieved.

•

The PDA-ALN-DOX presented high bone targeting property, photothermal conversion efficiency, drug loading capacity, and multimodal imaging modalities.

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CPT is a more efficient and convenient therapy for bone tumors.

[Analysis of clinical characteristics and related genetic variation of juvenile myasthenia gravis]

Objective: To analyze the clinical characteristics and related genetic variation of juvenile myasthenia gravis (MG) patients. Methods: We collected the clinical data of adolescent MG patients who were treated in the Department of Neurology of the First Affiliated Hospital of Sun Yat-sen University from June 2019 to May 2020. After obtaining the patient's informed consent, the blood samples were collected. The Whole Exome Sequencing (WES) was performed on peripheral blood samples. And use biological information software and SPSS 22.0 for data processing and result analysis. Results: According to the inclusion and exclusion criteria, 54 patients with juvenile MG were included, 28 males and 26 females. And the average age of onset was (3.79±0.89) years. Among the enrolled patients, there were 52 (96.3%) patients with ocular MG, the MG-ADL scores of 54 patients were (3.44±0.44) points, and the titer of AChR antibody was (5.88±2.45) nmol/L. Two patients had thymic hyperplasia, and 5 patients had a family history of MG.A total of 169 variant genes were found in 54 patients, of which TTN gene variants had the largest number, with a total of 17 variants (31.5%). In the TTN gene variant group, 7(41.2%) patients had eye fixation symptoms, and 4 (10.8%) patients in the non-mutation group had eye fixation symptoms. And The difference between the two groups was statistically significant (P=0.016). In addition, the synaptic nucleus envelope protein-1 (SYNE1) and the ryanodine receptor-1 (RYR1) gene variations were also found in 7 cases (13.2%), and no clear relationship between these gene variations and clinical manifestations of MG was found. Conclusions: The incidence of juvenile MG was preschoolers with no gender difference, and ocular MG was more common. The proportion of TTN gene variation in adolescent MG was higher, suggesting that this gene may be a potential therapeutic target for juvenile MG patients.

A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study

Objective

To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside‐out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH).

Method

A total of 135 patients with symptomatic LDH who were treated by inside‐out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved.

Results

The VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow‐up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64–21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29–6.51, P = 0.025), pre‐ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41–14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow‐up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551).

Conclusion

The PLL is recommended to be retained for inside‐out PETD surgery.

[Clinical characteristics and outcomes of myasthenia gravis patients with double positive antibodies against acetylcholine receptor and muscle-specific tyrosine kinase]

Objective: To investigate the clinical manifestations, treatment characteristics and outcomes of myasthenia gravis (MG) dually positive for anti-acetylcholine receptor antibody (AChR-Ab) and anti-muscle-specific tyrosine kinase antibody (MuSK-Ab). Method: MG patients hospitalized in the First Affiliated Hospital of Sun Yat-sen University from August 2017 to November 2020 were retrospectively collected. Thirty-four MuSK-Ab positive MG (MuSK-MG) patients, 11 double-antibodies positive MG (DP-MG) patients, and 80 AChR-Ab positive MG (AChR-MG) patients were included and allocated to three different groups. The clinical data of patients in the three groups were collected, and the differences of demographic characteristics, clinical manifestations and treatment outcomes between DP-MG patients and AChR-MG and MuSK-MG patients were analyzed. Result: The proportion of female and male patients in DP-MG group was 7/11 and 4/11 respectively, and the onset age of DP-MG was (41±27) years.The difference in gender distribution between DP-MG and AChR-MG groups was statistically significant (P<0.05). The proportion of extraocular muscle involvement in the DP-MG and MuSK-MG groups (8/11 and 52.9%) was lower than that in the AChR-MG group (83.8%), and the difference was statistically significant (P<0.05). The incidence of myasthenia crisis in DP-MG and MuSK-MG groups (54.5% and 61.8%) were higher than that in AChR-MG group (20.0%), with astatistically significant difference(P<0.05). The positive rate of neostigmine test in DP-MG and MuSK-MG groups(8/11 and 74.2%) were lower than that of AChR-MG group (96.8%), and the positive rate of low frequency repetitive nerve stimulation (RNS) in DP-MG group (5/10) was lower than that in AChR-MG group (85.1%), with statistically significant differences (all P<0.05). MuSK-Ab titer was positively correlated with the course of disease (r=0.466, P<0.05), and antibody titer decreased after symptom improvement (P<0.05). The response of patients in DP-MG and MuSK-MG groups to cholinesterase inhibitors (2/11 and 9.1%) was worse than that in the AChR-MG group (66.3%), and the incidence of side effects in the two groups (5/11 and 39.4%) was higher than that in the AChR-MG group (15.0%), with statistically significant differences (all P<0.05). There were 4 DP-MG patients underwent thymectomy, and the pathological results detected two cases of thymoma and two cases of thymic hyperplasia. Subsequent follow-up showed that 5 (5/11) DP-MG patients achieved minimal manifestation status or better status. Conclusion: The gender distribution, age of onset, pharmacological characteristics and electrophysiological examination of DP-MG patients were similar to those of MuSK-MG patients, but the severity of DP-MG patients was between that of AChR-MG and MuSK-MG patients.

Empower parameterized generative adversarial networks using a novel particle swarm optimizer: algorithms and applications

In this paper, a novel parameterized generative adversarial network (GAN) is proposed where the parameters are introduced to enhance the performance of image segmentation. The developed algorithm is applied to the image-based crack detection problem on the thermal data obtained through the non-destructive testing process. A new regularization term, which contains three tunable hyperparameters, embedded into the objective function of the GAN in order to improve the contrast ratio of certain areas of the image so as to benefit the crack detection process. To automate the selection of the optimal hyperparameters of the GAN, a new particle swarm optimization (PSO) algorithm is put forward where a neighborhood-based velocity updating strategy is developed for the purpose of thoroughly exploring the problem space. The proposed PSO-based GAN algorithm is shown to 1) work well in detecting cracks on the thermal data generated by the eddy current pulsed thermography technique; and 2) outperforms other conventional GAN algorithms.

A New GAN-Based Approach to Data Augmentation and Image Segmentation for Crack Detection in Thermal Imaging Tests

As a popular nondestructive testing (NDT) technique, thermal imaging test demonstrates competitive performance in crack detection, especially for detecting subsurface cracks. In thermal imaging test, the temperature of the crack area is higher than that of the non-crack area during the NDT process. By extracting the features of the thermal image sequences, the temperature curve of each spatial point is employed for crack detection. Nevertheless, the quality of thermal images is influenced by the noises due to the complex thermal environment in NDT. In this paper, a modified generative adversarial network (GAN) is employed to improve the image segmentation performance. To improve the feature extraction ability and alleviate the influence of noises, a penalty term is put forward in the loss function of the conventional GAN. A data preprocessing method is developed where the principle component analysis algorithm is adopted for feature extraction. The data argumentation technique is utilized to guarantee the quantity of the training samples. To validate its effectiveness in thermal imaging NDT, the modified GAN is applied to detect the cracks on the eddy current pulsed thermography NDT dataset.

[To attach great importance to the identification of refractory myasthenia gravis]

Refractory myasthenia gravis is an intractable state during treatment. The common causes of refractory treatment in most patients include: overwork, malnutrition, infections, insomnia, cognitive and emotional disorders, and so on. Only targeting the poor curative effect from the surface of the intractable state caused indecisive decisions and is difficult to win a success. Therefore, identifying "refractory state" can not only see the essence through the phenomenon, but also apply the right medicine, thereby killing two birds with one stone.

Hematopoietic cell kinase enhances osteosarcoma development via the MEK/ERK pathway

Osteosarcoma (OS) is a sarcoma with high rates of pulmonary metastases and mortality. The mechanisms underlying tumour generation and development in OS are not well‐understood. Haematopoietic cell kinase (HCK), a vital member of the Src family of kinase proteins, plays crucial roles in cancer progression and may act as an anticancer target; however, the mechanism by which HCK enhances OS development remains unexplored. Therefore, we investigated the role of HCK in OS development in vitro and in vivo. Downregulation of HCK attenuated OS cell proliferation, migration and invasion and increased OS cell apoptosis, whereas overexpression of HCK enhanced these processes. Mechanistically, HCK expression enhanced OS tumorigenesis via the mitogen‐activated protein kinase (MEK)/extracellular signal‐regulated kinase (ERK) pathway; HCK upregulation increased the phosphorylation of MEK and ERK and promoted epithelial‐mesenchymal transition, with a reduction in E‐cadherin in vitro. Furthermore, HCK downregulation decreased the tumour volume and weight in mice transplanted with OS cells. In conclusion, HCK plays a crucial role in OS tumorigenesis, progression and metastasis via the MEK/ERK pathway, suggesting that HCK is a potential target for developing treatments for OS.

Modeling and Mapping High Water Table for a Coastal Region in Florida using Lidar DEM Data

Predicting and mapping high water table elevation in coastal landscapes is critical for both science application projects like inundation risk analysis and engineering projects like pond design and maintenance. Previous studies of water table mapping focused on the application of geostatistical methods, which cannot predict values beyond an observation spatial domain or generate an ideal pattern for regions with sparse measurements. In this study, we evaluated the multiple linear regression (MLR) and support vector machine (SVM) techniques for high water table prediction and mapping using fine spatial resolution lidar-derived Digital Elevation Model (DEM) data, and designed an application protocol of these two techniques for high water table mapping in a coastal landscape where groundwater, tide, and surface water are related. Testing results showed that SVM largely improved the high water table prediction with a mean absolute error (MAE) of 1.22 feet and root mean square error (RMSE) of 2.22 feet compared to the application of the ordinary Kriging method which could not generate a reasonable water table. MLR was also promising with a MAE of around 2 feet and RMSE of around 3 feet. The study suggests that both MLR and SVM are valuable alternatives to estimate high water table elevation in Florida. Fine resolution lidar DEMs are beneficial for high water table prediction and mapping.

A Novel Sigmoid-Function-Based Adaptive Weighted Particle Swarm Optimizer

In this paper, a novel particle swarm optimization (PSO) algorithm is put forward where a sigmoid-function-based weighting strategy is developed to adaptively adjust the acceleration coefficients. The newly proposed adaptive weighting strategy takes into account both the distances from the particle to the global best position and from the particle to its personal best position, thereby having the distinguishing feature of enhancing the convergence rate. Inspired by the activation function of neural networks, the new strategy is employed to update the acceleration coefficients by using the sigmoid function. The search capability of the developed adaptive weighting PSO (AWPSO) algorithm is comprehensively evaluated via eight well-known benchmark functions including both the unimodal and multimodal cases. The experimental results demonstrate that the designed AWPSO algorithm substantially improves the convergence rate of the particle swarm optimizer and also outperforms some currently popular PSO algorithms.

Disordered leptin and ghrelin bioactivity in adolescent idiopathic scoliosis (AIS): a systematic review and meta-analysis

Background

Adolescents with scoliosis consistently demonstrate lower body weight, lean muscle mass, and bone mineral density than healthy adolescent counterparts. Recent studies have focused on understanding how leptin and ghrelin signaling may play a role in adolescent idiopathic scoliosis (AIS). In our current study, we aim to evaluate the serum levels of leptin, soluble leptin receptor (sOB-R), and ghrelin in AIS patients through systematic review and meta-analysis.

Methods

We conducted our systematic review by searching the keywords in online databases including PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to January 2020. Inclusion criteria were studies that measure leptin, soluble leptin receptor (sOB-R), and ghrelin levels in AIS patients. Selection of studies, assessment of study quality, and data extraction were performed by two reviewers independently. Then, data was analyzed to calculate the mean difference and 95% confidence interval (CI).

Results

Seven studies concerning leptin/sOB-R and three studies concerning ghrelin were qualified for meta-analysis (one study concerning both leptin and ghrelin). Serum leptin of patients with AIS were significantly lower when compared with healthy controls, with the weighted mean difference (WMD) of − 0.95 (95% CI − 1.43 to − 0.48, p < 0.0001) after reducing the heterogeneity using six studies for meta-analysis, while sOB-R and ghrelin level was significantly higher in AIS group when compared with control group, with the WMD of 2.64 (95% CI 1.60 to 3.67, p < 0.001) and 1.42 (95% CI 0.48 to 2.35, p = 0.003), respectively.

Conclusion

Our current meta-analysis showed that serum level of leptin in AIS patients was significantly lower when compared with control subjects, while serum sOB-R and ghrelin levels were significantly higher in AIS patients. More clinical studies are still required to further validate the predictive value of leptin or ghrelin for the curve progression for AIS patients.

Customized "Whole-Cervical-Vertebral-Body" Reconstruction After Modified Subtotal Spondylectomy of C2-C7 Spinal Tumor Via Piezoelectric Surgery

BACKGROUND

Radical resection is the first-line option in managing cervical primary chondrosarcoma. Favorable anterior reconstruction is challenging after multilevel total spondylectomy in the cervical spine.

OBJECTIVE

To illustrate the application of piezoelectric surgery and three-dimensional (3D) printing techniques in spine surgery.

METHODS

A 27-yr-old patient was referred to our center with complaints of nocturnal neck pain and right upper extremity weakness. A 2-stage radical tumor resection was conducted using piezoelectric surgery with pathologically tumor-free margins. A 3D-printed titanium microporous prosthesis (3D-PTMP) was designed to reconstruct the anterior column of the cervical spine between C1 and T1 for stability.

RESULTS

The whole intraoperative blood loss was 2300 mL over the 2 procedures. The patient had an uneventful recovery, regaining ambulatory status 3 wk after the 2 operations without ventilator support or other severe complications. By the final 14-mo follow-up, the patient had achieved marked pain relief and favorable neurological improvement; a postoperative computed tomography scan indicated a good position of the 3D-printed construct between the endplates with no sign of tumor recurrence or implant subsidence.

CONCLUSION

The applications of piezosurgery in total spondylectomy and in 3D-PTMP in reconstruction can be a favorable alternative for managing multilevel cervical spinal tumors. Further studies are warranted to validate this surgical strategy.

What is the optimal regimen for intravenous dexamethasone administration in primary total hip arthroplasty?: A protocol of randomized controlled trial

BACKGROUND

A number of recent studies have investigated the optimal dosage and timing of dexamethasone in total hip arthroplasty (THA) but have inconsistent findings. Therefore, we designed the randomized controlled research to look for the optimal intravenous dexamethasone dose for the treatment of early postoperative pain after the THA.

METHODS

The Declaration of Helsinki principles was followed and the Consolidated Standards of Reporting Trials guidelines for randomized controlled trials was adhered in this study. The First Medical Center in People's Liberation Army General Hospital approved the study (2020-089). After written informed consent was obtained, patients aged between 18 and 80 years with Physical Status I to III of American Society of Anesthesiologists, scheduled for primary unilateral THA, were included in this present work. Randomization is the use of a computer-formed list via a secretary, at a ratio of 1:1:1. The major end points were pain scores at 24 hours, 48 hours, and 72 hours after surgery, with visual analog scale (VAS) utilized at rest, and at 45 degrees passive hip flexion. The secondary outcomes involved the total consumption of morphine, opioid-related side effects, hip range of motion, inflammation markers, and the length of hospital stay.

RESULTS

We assumed that the patients who received 3 doses of dexamethasone intravenously possessed the best postoperative results compared to those who received 1 or 2 doses of the dexamethasone.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry5864).

[Characteristics of electromyography in 111 patients with generalized myasthenia gravis: a retrospective study]

Objective: To retrospectively analyze the characteristics of the electromyography (EMG) study in generalized myasthenia gravis (gMG) patients. Methods: A total of 111 gMG patients were enrolled. Patients were divided into two groups: 36 severe patients discontinuing pyridostigmine bromide (PB) for 8 hours were included in 8 h group, and 75 g MG patients discontinuing PB for at least 18 hours were included in>18 h group. The clinical information and EMG study data were collected and analyzed. Results: There were statistically significant differences in the initial location of the myasthenia muscle (P=0.027), the affected muscle detected by the EMG (P=0.015) and quantitative myasthenia gravis (QMG) score (P<0.01) between the two groups. Comparisons in each group revealed that the highest positive rate of low-frequency repetitive nerve stimulation (RNS) of facial in 8 h group and>18 h group was 94.4% and 60.0%, respectively. Comparisons between the two groups showed that the positive rate of low-frequency RNS in 8 h group was significantly higher than that in>18 h group (94.4% vs 70.7%, χ(2)=8.115, P=0.004). In particular, the positive rate of RNS in facial nerves and the extent of the amplitude decrease under different electrical stimulations (1 Hz, 3 Hz, and 5 Hz) were dramatically higher in the 8 h group (P<0.01). Conclusions: For gMG patients, the facial and accessory nerve detection can improve the positive rate of RNS. Different muscles had various sensitivity to PB, and orbicularis oculi muscle seemed the least sensitive muscle to PB. For suspect MG patients in severe condition, only discontinuing PB medication for 8 h before low-frequency RNS testing can avoid the deterioration and also obtain similar positive rate.

The exploration of mechanisms of comorbidity between migraine and depression

Migraine comorbid with depression is common and is often encountered in clinical practice. The comorbidity may lead to more serious conditions with other symptoms and a longer duration of treatment and it may impose heavy economic and social burdens, directly or indirectly, on patients and their families. Numerous studies have been published on the association of migraine with depression. Numerous literature have showed that the comorbidity may have a common complicated pathogenic mechanism involving biopsychosocial characteristics, including abnormal brain development and shared genetic basis, as well as neurotransmitters, sex hormones and stress. In addition, some studies have identified the multiple, bidirectional relationship between migraine and depressive disorder. We searched the literature for the possible common mechanisms between migraine and depression and classified the research results.

[A case of facial paralysis caused by granulocytic sarcoma of the external auditory canal]

Summary A male patients at 11 years of age, was hospitalized for the right ear pain and mouth deviation for five days on August 30, 2016, accompanied by right hypophasis, right ear hearing loss, tinnitus, without otorrhea and vertigo. Patient was diagnosed as acute promyelocytic leukemia in 2008. After standardized chemotherapy, it was completely relieved and the blood and bone marrow images were almost restored to normal. Physical examination: The skin of the right external auditory canal is obviously swollen, without rupture on the surface, and the tympanic membrane cannot be seen. The drooping of the left angle of the mouth, the right eyelid is not closed completely, the right nasolabial groove and forehead line is shallower. House-Brackmann facial nervous system Ⅲ. Routine blood: the leucocyte 10.31×10⁹/L, more than in the normal range. Pure tone measurement showed that right ear conductive deafness, air-bone conduction difference of each frequency range 50 to 75 dB.Mastoid CT showed that right mastoid gasification is good, the right external auditory canal, middle ear cavity and mastoid airway are filled with low-density soft tissue shadows, the bone wall of the external auditory canal was not significantly enlarged or damaged. The auditory bone is intact, surrounded by a large number of soft tissue shadows, no obvious abnormalities in the inner ear. Primary diagnosis: Middle ear cholesteatoma (right);External auditory canal tumor (right);Peripheral facial paralysis (right).

[Establishment of DNA Genetic Marker Identification System for Plant Evidence]

OBJECTIVES

To establish a species identification system based on DNA genetic markers for plant evidence.

METHODS

Two hundred common plants in Shanghai were collected and identified by morphological characteristics. The primers of gene segments rbcL, matK, and ITS were designed and amplified. The PCR amplicon was detected by agarose gel electrophoresis. After the sequencing, the universality and the identification capacity of the three markers were evaluated.

RESULTS

The success rate of amplification was in order of rbcL （99.5%） > matK （92.5%） > ITS （86.0%）. The identification capacity of the combination of rbcL and matK was better than that of rbcL or matK, by which most plant species could be identified to the genus or higher. ITS was not suitable to be a unique marker because of its unstable result, but it still could be a powerful supplement. The identification capacity of the combination of rbcL, matK and ITS was higher than that of rbcL and matK, by which most plant species could be identified to the genus or lower.

CONCLUSIONS

The identification system with the combination of rbcL, matK and ITS as markers has excellent universality for plant evidence, which can distinguish most plant species to the genus or lower.

Ellagic acid and Sennoside B inhibit osteosarcoma cell migration, invasion and growth by repressing the expression of c-Jun

Osteosarcoma is a mesenchymally derived, high-grade bone sarcoma that is the most frequently diagnosed primary malignant bone tumor. Today, chemoprevention is regarded as a promising and realistic approach in the prevention of human cancer. Previous studies have suggested ellagic acid (EA) and Sennoside B have potential in this regard. The aim of the present study was to elucidate the anti-osteosarcoma effects of EA and Sennoside B by using Saos-2 and MG63 osteosarcoma cells. It was identified that EA or Sennoside B treatment could inhibit the growth, migration and invasion of the cells, and induce G₁ cell cycle arrest by repressing the transcription of c-Jun. These results may provide a cellular basis for the application of EA or Sennoside B in the treatment of patients with osteosarcoma.

Antifungal activity of the bioactive substance from Bacillus atrophaeus strain HAB-5 and its toxicity assessment on Danio rerio

The prevalence of pathogen inhibitors bacteria has motivate the study for antimicrobial compounds. Bioactive fungicide have always received considerable attention. A bacterial isolated strain HAB-5 showed antifungal activity against plant fungi. Based on morphological, physiological, biochemical and 16SrDNA sequence analysis, the strain was identified to be a Bacillus atrophaeus. This strain possessed a broad spectrum antifungal activity against various plant pathogenic fungi. Extraction of antifungal substance was performed and the crude extract had potent antifungal ability and showed great potential for swelling and inhibiting spore germination. This antifungal displayed heat stability and active in a wide pH range 5.0-10.0. Moreover no reduction was found in its activity after enzyme treatment. The toxicity test was evaluated in Danio rerio. The acute toxicity test indicated that the 24, 48, 72, 96h LC₅₀ values of UMTLS to the zebrafish were 14.4, 13.8, 13.4, and 12.9%, respectively. Based on the results obtained in this study, antifungal substance was not toxic to zebra. Analyses of disease suppression showed that HAB-5 was effective to reduce the incidence of anthracnose symptoms on mango fruits, also prevent disease infection and protect tobacco seedling from Phytophtora nicotianae. The bioactive substance from Bacillus atrophaeus HAB-5 could be a candidate in the generation of new antifungal agents in crop.

Physiological effects of weightlessness: countermeasure system development for a long-term Chinese manned spaceflight

The Chinese space station will be built around 2020. As a national space laboratory, it will offer unique opportunities for studying the physiological effects of weightlessness and the efficacy of the countermeasures against such effects. In this paper, we described the development of countermeasure systems in the Chinese space program. To emphasize the need of the Chinese space program to implement its own program for developing countermeasures, we reviewed the literature on the negative physiological effects of weightlessness, the challenges of completing missions, the development of countermeasure devices, the establishment of countermeasure programs, and the efficacy of the countermeasure techniques in American and Russian manned spaceflights. In addition, a brief overview was provided on the Chinese research and development on countermeasures to discuss the current status and goals of the development of countermeasures against physiological problems associated with weightlessness.

COL5A1 may contribute the metastasis of lung adenocarcinoma

BACKGROUND

Lung cancer leads to the largest number of cancer-related deaths worldwide and is usually accompanied with metastasis which is the primary cause of those death and correlated with poor prognosis. However, the mechanism of lung cancer metastasis is still lack of definition.

METHODS

We compared the primary lung adenocarcinoma (AD) and its metastasis tissues induced by overexpression of Kras^G12D and inactivation of P53 in mouse lungs by analyzing GSE40222 about the differentially expressed genes (DEGs), pathways and hub genes. And human lung AD databases are used to verify the conversed changes of identified key gene and then followed functional studies are performed to explore the functions of key gene.

RESULTS

We identified 165 genes differentially expressed in lung AD metastasis compared to primary AD. Pathway analysis identified 649 GO biological processes and 8 KEGG pathways, such as ECM-receptor interaction. Biological network interaction identified the hub genes during lung adenocarcinoma metastasis, such as the up-regulated COL5A1, a novel gene in AD metastasis. We found it's also increased in human AD and advanced stage. Knockdown of COL5A1 in human AD metastatic cells inhibited cell growth and invasion, and induced cell apoptosis. Notably, higher expression of COL5A1 was observed in the lung AD patients with recurrence and short survive.

CONCLUSION

By analyzing mouse lung AD and its metastases, we identified the potential key genes and pathways regulating lung AD metastasis, such as COL5A1. The following analysis of COL5A1 in human AD database and cells explores its functions, holding the implications of target therapy in AD metastasis and also providing more clues for future studies.

Single-stage multi-level construct design incorporating ribs and chest wall reconstruction after en bloc resection of spinal tumour

PURPOSE

Multi-level reconstruction incorporating the chest wall and ribs is technically demanding after multi-segmental total en bloc spondylectomy (TES) of thoracic spinal tumours. Few surgical techniques are reported for effective reconstruction. A novel and straightforward technical reconstruction through posterior-lateral approach was presented to solve the extensive chest wall defect and prevent occurrences of severe respiratory dysfunctions after performing TES. The preliminary outcomes of surgery were reviewed.

METHODS

Multi-level TES was performed for five patients with primary or recurrent thoracic spinal malignancies through posterior-lateral approach. The involved ribs and chest wall were removed to achieve tumour-free margin. Then titanium mesh with allograft bone and pedicle screw-rod system were adopted for the circumferential spinal reconstruction routinely. Titanium rods were modified accordingly to attach to the screw-rod system proximally, and the distal end of rods was dynamically inserted into the ribs.

RESULTS

The mean surgery time was 6.7 hours (range 5-8), with the average blood loss of 3260 ml (range 2300-4500). No severe neurological complications were reported while three patients had complaints of slight numbness of chest skin (no. 1, 3, and 5). No severe respiratory complications occurred during peri-operative period. No implant failure and no local recurrence or distant metastases were observed with an average follow-up of 12.5 months.

CONCLUSIONS

The single-stage reconstructions incorporating spine and chest wall are straightforward and easy to perform. The preliminary outcomes of co-reconstructions are promising and favourable. More studies and longer follow-up are required to validate this technique.