Cross-Cultural Adaptation of the Neck Bournemouth Questionnaire: A Methodological Systematic Review

OBJECTIVE

Neck pain is a common musculoskeletal disorder, and it affects the quality of life of patients. As an effective and reliable multidimensional measurement tool for neck pain, the Neck Bournemouth Questionnaire (NBQ) has been cross-culturally adapted into multiple languages for clinical practice. The aim of this study was to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the NBQ.

METHODS

Searches were conducted in the databases PubMed, Web of Science, Embase and Scopus using the keywords: "the Neck Bournemouth Questionnaire," "NBQ," "cross-cultural," and "adaptation." Methodological quality of cross-cultural adaptation processes and measurement properties were comprehensively assessed by the guidelines for Cross-cultural Adaptation Process of Self-Reporting Measures and the Consensus-based Standards for the Selection of Health Measurement Instruments.

RESULTS

There were 12 adaptations of NBQ in 10 different languages, including Dutch, simplified Chinese, and German. Among these studies, 11 adaptations completed all cross-cultural adaptation procedures. However, significant variations existed in the specific implementation plans, particularly regarding translator selection and expert committee composition. Most cross-cultural adaptations reported internal consistency, reliability, and construct validity. Only one study conducted factor analysis and hypothesis testing. Five adaptations examined floor and ceiling effects with one reporting a floor effect. A few studies reported protocol responsiveness and interpretability.

CONCLUSIONS

The Dutch, German, and Urdu adaptations demonstrate comparatively higher quality than other adaptations. Further research should comprehensively evaluate the measurement properties of the NBQ in the French, Portuguese-Brazilian, and Turkish adaptations.

Assessing Cross-Cultural Adaptation of the Spine Oncology Study Group Outcomes Questionnaire 2.0: A Methodological Systematic Review Regard to Consensus-Based Standards for the Selection of Health Measurement Instruments Guideline

STUDY DESIGN

systematic review of cross-cultural adaptation.

OBJECTIVES

SOSGOQ 2.0 was widely used to assess the HRQQOL of patients with spinal metastasis. Due to the lack of methodological quality assessment, it is a challenge to use the questionnaire in routine practice. This study aims to comprehensively evaluate the translation procedures and measurement attributes of SOSGOQ 2.0 according to COSMIN guidelines.

METHODS

The literature was reviewed adhering to the PRISMA guidelines. Each translation process and different cultural adaptation methods were classified according to the guidelines for Cross cultural Adaptation Process of Self Reporting Measures, and the methodological quality of the identified research was evaluated according to the consensus based on the selection criteria of health measurement tools.

RESULTS

6 publications finally met the inclusion criteria. As for the evaluation of translation procedures and cross-cultural adaptability, two adaptations did not report the detailed information in translation and cross-cultural adaptation (synthesis, back translation, review by expert committee, pre-test), factor analysis and sample size calculation were only mentioned in two studies, and only one adaptation met the minimum sample size standard. Regard to the methodological quality assessment of measurement attributes, all adaptations completed internal consistency, structural effectiveness and reliability. However, none of the adaptations reported measurement errors and only one reported response sensitivity.

CONCLUSIONS

We found that the methodological quality of the current adaptation was uneven, and the report of measurement attribute results was not comprehensive. We recommend higher quality German, Italian and Chinese adaptation.

Treatment and Diagnose of Spinal Phosphaturic Mesenchymal Tumor: A Case Report and a Systematic Literature Review

BACKGROUND

Spinal phosphaturic mesenchymal tumor (PMT) is a rare disorder but can be cured once the diagnosis is clear and a complete removal by surgery is performed. To the best of our knowledge, only 22 cases in the spine have been described, and we report a case with the largest number of spinal segments (T12-L5) affected among spine PMT cases.

METHODS

A comprehensive literature search was performed until May 23, 2023, following the Preferred Reporting Items for Systematic Reviews guidelines. Studies were chosen through relevant PubMed, Web of Science, and EMBASE searches to prioritize obtaining the largest studies. The Medical Subject Headings and Boolean operators employed for this search were ("PMT" or "TIO" or "Tumor-induced osteomalacia" or "phosphaturic mesenchymal tumor") and ("spine" or "spinal"). Two researchers (L.S.Z. and D.B.C) independently reviewed and evaluated the included articles. Any differing opinions were discussed until a consensus was reached. A total of 18 studies were included. A case report is also presented.

RESULTS

We report a case of spinal PMT. The full text of the relevant articles was construed. A total of 18 studies were reviewed and consolidated. These articles are roughly divided into the following 5 subcategories: 1) clinical features and baseline distribution, 2) laboratory and imaging findings, 3) pathological manifestations, and 4) surgical methods and treatment options.

CONCLUSIONS

Spinal PMT is very rare with a high rate of misdiagnosis and debilitating complications, so it is of significance to increase awareness of the disease among spine surgeons consulted by patients with spinal PMT. 68Ga-DOTATOC-PET/CT shows very high sensitivity to the spinal PMT but there is no way to exactly determine the location of the tumor. PMT has unique immunohistochemical characteristics and malignant PMT is rare. Once diagnosed, complete surgical excision is the recommended treatment. Burosumab is one of the available options, especially in cases that are recurrent and difficult to surgically resect.

An independent agreement study of modified Pfirrmann grading system for cervical inter-vertebral disc degeneration in cervical spondylotic myelopathy

OBJECTIVE

Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). For CSM surgery, it is necessary to evaluate preoperative inter-vertebral disc degeneration (IDD) which determines whether to adopt fusion strategy, and postoperative IDD which is one of the main reasons for reoperation. Modified Pfirrmann grading system is commonly used to evaluate IDD. The objective of this study is to evaluate its reliability and reproducibility on cervical IDD in CSM patients, and to explore its clinical application value.

METHODS

All 165 patients with CSM were enrolled. 6 physicians (3 spine surgeons and 3 radiologists) who have certain clinical experience were selected. They graded cervical inter-vertebral disc according to modified Pfirrmann grading system, we used intra-class correlation coefficient (ICC) and weighted kappa (wκ) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis.

RESULTS

The inter-observer reliability of modified Pfirrmann grading system was excellent with an ICC value of 0.76 and near perfect with wκ value of 0.82. The intra-observer reproducibility of modified Pfirrmann grading system was excellent with ICC values ranging from 0.80 to 0.91, and near perfect with wκ values ranging from 0.83-0.92.

CONCLUSION

Modified Pfirrmann grading system has excellent inter-observer reliability and intra-observer reproducibility on cervical IDD in CSM. In addition, it indicates a good appliance among spine surgeons and radiologists, clinical and radiological studies applying it should be deemed accurate. Thus, modified Pfirrmann grading system can be widely used as an appropriate instrument in clinical care.

Intravoxel incoherent motion diffusion-weighted imaging of solitary pulmonary lesions: initial study with gradient- and spin-echo sequences

AIM

To evaluate the feasibility and image quality of intravoxel incoherent motion diffusion-weighted imaging (IVIM) using gradient- and spin-echo (GRASE) in solitary pulmonary lesions (SPLs) compared to echo planar imaging (EPI) and turbo spin-echo (TSE) at 3 T.

MATERIALS AND METHODS

Forty-two patients with SPLs underwent lung magnetic resonance imaging (MRI) using TSE-IVIM, GRASE-IVIM, and EPI-IVIM at 3 T. Signal ratio (SR), contrast ratio (CR), and image distortion ratio (DR) of three sequences were compared. The reproducibility and repeatability of the apparent diffusion coefficient (ADC) and IVIM-derived parameters were assessed using the interclass correlation coefficient (ICC) and coefficient of variation (CV). The repeatability of the ADC and IVIM-derived parameters between all sequences was evaluated using the Bland-Altman method.

RESULTS

EPI-IVIM had a higher SR, lower CR, and higher DR (p<0.05); however, there was no significant difference between TSE-IVIM and GRASE-IVIM (p>0.05). Compared to the D and f values of TSE-IVIM (ICC lower limit >0.90), GRASE-IVIM and EPI-IVIM showed poor reproducibility (ICC lower limit<0.90). The repeatability of the ADC and D values obtained by TSE-IVIM (CV, 1.93-2.96% and 2.44-3.18%, respectively) and GRASE-IVIM (CV, 2.56-3.12% and 3.21-3.51%, respectively) were superior to those of EPI-IVIM (CV, 10.03-10.2% and 11.30-11.57%). The repeatability of D∗ and f values for all sequences was poor. Bland-Altman analysis showed wide limits of agreement between the ADC and IVIM-derived parameters for all sequences.

CONCLUSION

GRASE-IVIM reduced the DR, improved the stability of the ADC and D values on repeated scans, and had the shortest scanning time.

The first intron of EIJ1 confers a specific response to wounding and herbivore stresses

Plants are constantly exposed to different kinds of biotic stress, such as herbivore attack and wounding. To deal with these stresses, plants have evolved sophisticated defence mechanisms to protect themselves. Previously, we found that EIJ1 (EDS1-interacting J protein 1) plays a negative regulatory role in plant disease resistance in Arabidopsis thaliana. Follow-up studies revealed that EIJ1 specifically responds to wounding and herbivore stresses. The expression of EIJ1 was specifically induced by wounding or herbivore stress, as demonstrated by similar results in EIJ1 protein assay. Interestingly, GUS staining found that the promoter of EIJ1 is not involved in the induction of expression under wounding stress. Instead, we identified the first intron of EIJ1 as a key factor in response to wounding stress. Deleting the first intron of EIJ1 resulted in a loss of response to wounding stress in plants. Our results broaden the role of EIJ1 in plant resistance to biotic stress and provide new insights into plant responses to biotic stress.

A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis

PURPOSE

As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.

METHODS

We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.

RESULTS

Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement.

CONCLUSION

Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.

Measurement properties of health-related quality of life measures for people living with metastatic disease of the spine: a systematic review

PURPOSE

Patients with spinal metastases (SM) suffer from a significant quality of life (QoL) deterioration. The measurement of QoL has garnered significant attention. In this study, the authors aimed to investigate the frequency of QoL measurement, systematically appraise the measurement properties of identified instruments, and facilitate the effective selection of an appropriate QoL instrument for patients with SM.

METHODS

This systematic review adhered to the newly revised Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. The methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria. Each measurement property was allocated a separate rating (excellent, good, fair, or poor). 'Best evidence synthesis' was performed using COSMIN outcomes and the quality of findings.

RESULT

Two hundred and nine publications were included, and 18 instruments were identified. ECOG, EuroQol-5D, SF-36, SOSGOQ, and EORTC-QLQ-C30 were the top five instruments used for patients with SM in published literature. The measurement properties evaluated included internal consistency (four instruments), reliability (three instruments), validity (five instruments), validity (nine measures), floor and ceiling effects (four instruments), responsiveness (four instruments), and interpretability (three measures). Based on the limited evidence, the Brief Pain Inventory (BPI) had the best methodological quality.

CONCLUSIONS

Owing to the limitations of BPI in assessment domains, we cannot fully support the use of BPI. For the lack of high-quality research, it is challenging to nominate a single appropriate measure. Additional studies are needed to explore the evidence before a confirmatory decision is made.

Diagnosis of spinal dural arteriovenous fistula: a multimodal MRI assessment strategy

AIM

To identify more specific screening indicators at magnetic resonance imaging (MRI) for the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) and to determine an efficient diagnostic strategy.

MATERIALS AND METHODS

This retrospective study analysed clinical and imaging data of patients diagnosed with SDAVF and alternative myelopathy who underwent conventional MRI examinations. Additionally, three-dimensional (3D) T2-weighted sampling perfection with application-optimised contrasts using different flip-angle evolutions (3D-T2-SPACE) and contrast-enhanced magnetic resonance angiography (CE-MRA) data from patients with SDAVF were compared with digital subtraction angiography (DSA) data.

RESULTS

The age of onset, perimedullary flow voids (PFV), distribution of lesions, syringomyelia, degree of spinal oedema, and cauda equina disorder (CED) were factors that showed statistically significance in the identification of SDAVF with alternative myelopathy. After controlling for age, gender, PFV, degree of spinal cord swelling, and syringomyelia, the multivariable ordinal logistic regression model showed that the CED sign (OR = 32.46; 95% confidence interval [CI]: 2.47-427.15; p=0.008) was an independent predictor for SDAVF. The diagnostic model constructed using the PFV and CED signs had better diagnostic performance, with an area under the curve of 0.957 (p<0.001), maximum Youden index of 0.844, sensitivity of 92.9%, and specificity of 91.5%. Both 3D-T2-SPACE (77.8%) and CE-MRA (83.3%) sequences had good localisation values for SDAVF. Combining the two imaging examinations had better diagnostic accuracy than that of DSA.

CONCLUSION

CED and PFV on conventional MRI were specific indicators for the diagnosis of SDAVF. To compensate for the lack of fistula localisation on conventional MRI, 3D-T2-SPACE and CE-MRA can be used. Together they complement each other and have good diagnostic potential.

A systematic review and bibliometric study of Bertolotti's syndrome: clinical characteristics and global trends

PURPOSE

Bertolotti's syndrome is a prevalent congenital deformity. However, many physicians fail to include it in their differential diagnosis for low back pain (LBP), which results in missed diagnosis or misdiagnosis. There is still a lack of standardized treatment and management strategies for Bertolotti's syndrome. This study aimed to review the clinical characteristics and management of Bertolotti's syndrome and reports bibliometric insights in advancements in Bertolotti's syndrome research.

METHODS

Studies published until 30 September 2022 were systematically reviewed according to the PRISMA guidelines. Three independent reviewers extracted the data and assessed the quality and risk of bias of the studies based on the methodological index of non-randomized studies (MINORS). SPSS, VOS viewer, and the Citespace software were used for the systematic review, visual analysis, data mining, mapping, and clustering of the retrieved articles, which presented clear and visual presentations of the structural patterns of published research in graphs.

RESULT

A total of 118 articles, describing a total of 419 patients with Bertolotti's syndrome, were included. There was an upward trend with a steady increase in the number of publications. The world map distribution showed that most publications were predominantly from North America and Asia. The most cited articles were published in the following journals: Spine, J Bone Joint Surg, and Radiology. The mean age of the patients was 47.7 years, and 49.6% of them were male. A total of 159 (96.4%) patients had LBP symptoms. The mean symptom duration was 41.4 months (74.8%), and most of the patients had Castellvi type II. Disc degeneration was the most reported comorbid spinal diseases. The mean methodological index of non-randomized studies score was 4.16±3.95 points (range, 1-21). A total of 265 (68.3%) patients underwent surgical treatments. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration were the current main research areas of Bertolotti's syndrome.

CONCLUSIONS

The steady increase in the number of publications demonstrated the increased attention of researchers on this topic. Our results showed a significant prevalence of Bertolotti's syndrome in patients with LBP and a long symptom duration before the initiation of treatment. Surgical treatments were commonly used to treat patients with Bertolotti's syndrome after a non-effective conservative treatment. Minimally invasive surgical techniques, prevalence, image classification, and disc degeneration are the major research areas of Bertolotti's syndrome.

Meta-analysis of outcomes from drug-eluting stent implantation in femoropopliteal arteries

OBJECTIVE

In recent years, studies of drug-eluting stent (DES) for femoropopliteal artery diseases (FPADs) have been gradually published. To explore whether this type of stent is superior to the traditional bare metal stent (BMS), we performed this study.

METHODS

A systematic search for randomized controlled trials (RCTs) in Excerpta Medica Database (Embase), PubMed, Web of Science (WOS), and Cochrane Library was performed on November 29, 2022. We innovatively adopted the hazard ratio (HR), the most appropriate indicator, as a measure of the outcomes that fall under the category of time-to-event data. The HRs was extracted directly or indirectly. Then, the meta-analyses using random effects model were performed. The bias risks of included papers were assessed by the Cochrane Risk of Bias 2.0 tool. This study was registered on the PROSPER platform (CRD42023391944) and not funded.

RESULTS

Seven RCTs involving 1,889 participants were found. After pooled analyses, we obtained results without propensity on each of the following 3 outcomes of interest: in-stent restenosis (ISR) -free survival, primary patency (PP) survival, and target lesion revascularization (TLR) -free survival (P >0.05, respectively). Because the results of pooled analyses of the other two outcomes of interest (all-cause death free survival and clinical benefit survival) had high heterogeneity both, they were not accepted by us.

CONCLUSION

For FPADs, the DES has not yet demonstrated superiority or inferiority to BMS, in the ability to maintain PP, avoid ISR and TLR.

Construction and Validation of a Novel Web-Based Nomogram for Solitary Plasmacytoma of Bone of the Spine: A Real-World Analysis Based on the Surveillance, Epidemiology, and End Results Database

STUDY DESIGN

A Population-Based Cohort Study OBJECTIVE: Solitary plasmacytoma of bone of the spine (SPBS) was rarely detected in the past. However, its incidence has gradually increased with improvements in the diagnosis and understanding of the disease. We aimed to conduct a population-based cohort study to characterize the prevalence and factors associated with SPBS and develop a prognostic nomogram for predicting the overall survival of SPBS patients with a real-world analysis based on the surveillance, epidemiology, and end results (SEER) database.

METHODS

Patients with SPBS at diagnosis were identified using the SEER database from 2000 to 2018. Multivariable and univariate logistic regression analyses were used to identify factors for developing a novel nomogram. Nomogram performance was evaluated using the calibration curve, area under the curve (AUC), and decision curve analyses. Kaplan-Meier analysis was used to estimate survival durations.

RESULTS

A total of 1147 patients were selected for survival analysis. Multivariate analysis demonstrated that independent predictors for SPBS were as follows: ages: 61-74 and 75-94, marital status: unmarried, treatment: radiation alone and radiation with surgery. The 1-, 3-, and 5-year AUCs for OS were 0.733, 0.735, and 0.735 in the training cohort and 0.754, 0.777, and 0.791 in the validation cohort, respectively. The C-index values in the two cohorts were 0.704 and 0.729. The results indicated that nomograms could satisfactorily identify patients with SPBS.

CONCLUSIONS

Our model effectively demonstrated the clinicopathological features of SPBS patients. The results indicated that the nomogram had a favorable discriminatory ability, good consistency, and yielded clinical benefits for SPBS patients.

WITHDRAWN: Characteristics, Treatment and Research Development of Bertolotti's Syndrome: A Bibliometric Analysis and Systematic Review

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.

Identification and vitro verification of the potential drug targets of active ingredients of Chonglou in the treatment of lung adenocarcinoma based on EMT-related genes

Lung adenocarcinoma (LUAD) is the main histological type of lung cancer with an unfavorable survival rate. Metastasis is the leading LUAD-related death with Epithelial-Mesenchymal Transition (EMT) playing an essential role. The anticancer efficacies of the active ingredients in Chonglou have been widely reported in various cancers. However, the potential therapeutic targets of the Chonglou active ingredients in LUAD patients remain unknown. Here, the network pharmacology and bioinformatics were performed to analyze the associations of the clinical characteristics, immune infiltration factors and m⁶A-related genes with the EMT-related genes associated with LUAD (EMT-LUAD related genes), and the molecular docking, STRING, GO, and KEGG enrichment for the drug targets of Chonglou active ingredients associated with EMT (EMT-LUAD-Chonglou related genes). And, cell viability analysis and cell invasion and infiltration analysis were used to confirm the theoretical basis of this study. A total of 166 EMT-LUAD related genes were identified and a multivariate Cox proportional hazards regression model with a favorable predictive accuracy was constructed. Meanwhile, the immune cell infiltration, immune cell subsets, checkpoint inhibitors and the expression of m⁶A-related genes were significantly associated with the risk scores for EMT-LUAD related genes with independent significant prognostic value of all included LUAD patients. Furthermore, 12 EMT-LUAD-Chonglou related genes with five core drug targets were identified, which participated in LUAD development through extracellular matrix disassembly, collagen metabolic process, collagen catabolic process, extracellular matrix organization, extracellular structure organization and inflammatory response. Moreover, we found that the active ingredients of Chonglou could indeed inhibit the progression of lung adenocarcinoma cells. These results are oriented towards EMT-related genes to achieve a better understanding of the role of Chonglou and its targets in osteosarcoma development and metastasis, thus guiding future preclinical studies and facilitating clinical translation of LUAD treatment.

Construction and validation of a novel web-based nomogram for patients with lung cancer with bone metastasis: A real-world analysis based on the SEER database

Purpose

Patients with lung cancer with bone metastasis (LCBM) often have a very poor prognosis. The purpose of this study is to characterize the prevalence and associated factors and to develop a prognostic nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) for patients with LCBM using multicenter population-based data.

Methods

Patients with LCBM at the time of diagnosis were identified using the Surveillance, Epidemiology, and End Results (SEER) Program database of the National Cancer Institute (NCI) from 2010 to 2015. Multivariable and univariate logistic regression analyses were performed to identify factors associated with all-cause mortality and lung cancer (LC)-specific mortality. The performance of the nomograms was evaluated with the calibration curves, area under the curve (AUC), and decision curve analysis (DCA). Kaplan-Meier analysis and log-rank tests were used to estimate the survival times of patients with LCBM.

Results

We finally identified 26,367 patients with LCBM who were selected for survival analysis. Multivariate analysis demonstrated age, sex, T stage, N stage, grade, histology, radiation therapy, chemotherapy, primary site, primary surgery, liver metastasis, and brain metastasis as independent predictors for LCBM. The AUC values of the nomogram for the OS prediction were 0.755, 0.746, and 0.775 in the training cohort; 0.757, 0.763, and 0.765 in the internal validation cohort; and 0.769, 0.781, and 0.867 in the external validation cohort. For CSS, the values were 0.753, 0.753, and 0.757 in the training cohort; 0.753, 0.753, and 0.757 in the internal validation cohort; and 0.767, 0.774, and 0.872 in the external validation cohort.

Conclusions

Our study constructs a new prognostic model and clearly presents the clinicopathological features and survival analysis of patients with LCBM. The result indicated that the nomograms had favorable discrimination, good consistency, and clinical benefits in patients. In addition, our constructed nomogram prediction models may assist physicians in evaluating individualized prognosis and deciding on treatment for patients.

Cross-cultural adaptation and validation of simplified Chinese version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) 2.0 with its assessment in clinical setting

BACKGROUND CONTEXT

The treatment of spinal metastases (SM) has been significantly improved in recent years, which gives health-related quality of life (HRQOL) further significance in management of SM. The Spine Oncology Study Group Outcomes Questionnaire version 2.0 (SOSGOQ 2.0) was a specific targeted SM HRQOL criterion that was previously reported to pose good reliability and validity. However, there is no culturally adapted, reliable, and validated version of SOSGOQ 2.0 in mainland China.

PURPOSE

The current study aimed to translate the SOSGOQ 2.0 in a cross-cultural fashion, before evaluating the reliability and validity of the adapted simplified Chinese version of (SC-SOSGOQ 2.0) for patients with spinal metastases (SM).

STUDY DESIGN/SETTING

Translation, cross-cultural adaptation, and validation were performed on the Chinese version of the SOSGOQ 2.0.

PATIENT SAMPLE

Patients who were diagnosed with metastatic spinal disease, posing at least 6-years experience of education and the ability to read and speak Chinese.

OUTCOME MEASURES

Reliability and Validity of the SC-SOSGOQ 2.0 were measured to assess HRQOL in patients with SM.

METHODS

The cross-cultural adaptation of the SOSGOQ 2.0 was conducted following international guidelines. The reliability and validity of the SC-SOSGOQ 2.0 was assessed in a multi-center, prospective observational study. The test-retest reliability was assessed by comparing the results of the first and final SC-SOSGOQ 2.0 scales, with 2 weeks apart. The discriminative, concurrent, and construct validity of the cross-culturally adapted questionnaire was individually evaluated. The relationship among the SC-SOSGOQ 2.0, SC-EQ-5D-5L and SC-SF-36 was assessed using the correlation coefficients.

RESULTS

One hundred and twenty patients were included in this study. No floor or ceiling effects were observed for the SC-SOSGOQ 2.0. The Cronbach's α for domains of neurological function, pain, mental health, social function, and post-therapy were 0.825, 0.876, 0.896, 0.897, 0.943, and 0.835, respectively. The value of inter-class correlation coefficient ranged from 0.55 to 0.83, which reflected a satisfactory test-retest reliability. Concurrent assessment of criterion validity demonstrated a moderate-to-strong correlation in all domains of SC-SOSGOQ 2.0 with the SC-EQ-5D-5L (0.34-0.74) and SC-SF-36 (0.33-0.76). The best-correlated domain was physical function (0.741 in the EQ-5D-5L and 0.722 in the SF-36).

CONCLUSIONS

The SC-SOSGOQ 2.0 demonstrated an excellent acceptability, score distribution, internal consistency, test-retest reliability and validity. It was therefore considered as a tool effective for evaluating HRQOL of Chinese patients with SM.

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

STUDY DESIGN

This is a meta-analysis and systematic review of the available literature.

OBJECTIVE

In the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF.

METHODS

The following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details.

RESULTS

10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: -1.85, -.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: -.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: -.59, -.01, P = .05), improvement of NDI (95% CI: -2.34, .33, P = .14), JOA (95% CI: -.24, .43, P = .56), change of C2-C7 lordosis (95% CI: -.87, 1.33, P = .68), C2-C7 SVA (95% CI: -.73, 5.08, P = .14), T1 slope (95% CI: -2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29).

CONCLUSION

ACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.

Integrative analysis of synovial sarcoma transcriptome reveals different types of transcriptomic changes

Background: Synovial sarcoma (SS) is a rare and aggressive cancer that can come from distinct soft tissue types including muscle and ligaments. However, the transcriptomic landscape of SS is still poorly understood. This study aimed to systematically dissect the changes in SS transcriptome from different perspectives.

Methods: We performed deep total RNA sequencing on ten paired Synovial sarcoma and tumor-adjacent tissues to systematically dissect the transcriptomic profile of SS in terms of gene expression, alternative splicing, gene fusion, and circular RNAs.

Results: A total of 2,309 upregulated and 1,977 downregulated genes were identified between SS and tumor-adjacent tissues. Those upregulated genes could lead to the upregulation of the cell cycle, ribosome, and DNA replication pathways, while the downregulated genes may result in the downregulation of a set of metabolic biological processes and signaling pathways. Moreover, 2,511 genes (including 21 splicing factors) were differentially alternative spliced, indicating that the deregulation of alternative splicing could be one important factor that contributes to tumorigenesis. Additionally, we identified the known gene fusions of SS18-SSX1/SSX2 as well as 11 potentially novel gene fusions. Interestingly, 49 circular RNAs were differentially expressed and their parental genes could function in muscle contraction and muscle system processes.

Conclusions: Collectively, our comprehensive dissection of the transcriptomic changes of SS from both transcriptional and post-transcriptional levels provides novel insights into the biology and underlying molecular mechanism of SS.

Customized Multilevel 3D Printing Implant for Reconstructing Spine Tumor: A Retrospective Case Series Study in a Single Center

Objective

To investigate the clinical efficacy and safety of 3D printed artificial vertebral body for patients who underwent multilevel total en bloc spondylectomy (TES) and analyze whether it could reduce the incidence of implant subsidence.

Methods

This is a retrospective study. From January 2017 to May 2018, eight consecutive cases with spine tumor undergoing multilevel TES were analyzed. All patients underwent X‐ray and CT examinations to evaluate the stability of internal fixation during the postoperative follow‐up. Demographic, surgical details, clinical data, and perioperative complications was collected. Visual analog scale, Frankel score, and spinal instability neoplastic score (SINS) classification were also recorded.

Results

There were six cases of primary spinal tumor and two cases of metastatic spinal tumor. All patients achieved remarkable pain relief and improvement in neurological function. Five patients underwent operation through the posterior approach, one patient underwent operation through the anterior approach and the remaining two patients through a combined anterior and posterior approach. At the last follow‐up period, X‐rays showed that the 3D printed artificial vertebral body of all cases matched well, and the fixation was reliable. Hardware failure such as loosening, sinking, breaking, and displacement wasn't observed during the follow‐up period.

Conclusion

3D printed customized artificial vertebral body can provide satisfying good clinical and radiological outcomes for patients who have undergone multilevel TES.

Global Trends Of The Researches On Ossification Of Posterior Longitudinal Ligament In Thoracic Spine: A Bibliometric And Visualization Study

STUDY DESIGN

Bibliometric analysis OBJECTIVE: Thoracic ossification of the posterior longitudinal ligament (TOPLL) was a rare but intractable disease, and was the second leading cause of thoracic myelopathy. This study aimed to illustrate the overall knowledge structure, and development trends of TOPLL, using a bibliometric analysis and newly developed visualization tools.

METHODS

Research datasets were acquired from the Web of Science. The literature search was also limited to articles that were published until Oct 30, 2021. VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-Index status, co-authorship status and research hotspots were analyzed.

RESULTS

206 publications met the requirement. Japan published most papers (92), both total citations (1574) and H-index (24) ranked first of all the countries. The most productive organizations were Peking University (22). The most productive authors were Yamazaki M (18). The most productive journals were Spine (33). Diagnosis and treatment on the accuracy of surgical segments, prognosis of patients, and gene research were the research hotspots in the recent years.

CONCLUSION

The study showed an upward trend with a stable rise in recent years. Japan is country with the highest productivity, not only in quality, but also in quantity. Peking University and Spine have been the largest contributor. Indeed, this study provides great insights to the growth and development of TOPLL. Moreover, it will contribute to the growth of the international frontier.

Oncogenetic Function and Prognostic Value of DNA Topoisomerase II Alpha in Human Malignances: A Pan-Cancer Analysis

Increasing studies have revealed significant associations between TOP2A with oncogenesis and prognosis of human cancers; however, pan-cancer analysis has not been reported. Here, we explored the potential carcinogenic function and the association with clinical outcomes of TOP2A in 33 different human cancers. The results showed that TOP2A was amplified in 31 investigated cancers; TOP2A expression was significantly associated with metastasis of six different cancers and significantly associated with the survival of patients in ten different cancers; TOP2A-encoded protein was obviously upregulated in five available cancers; phosphorylated TOP2A protein at S1106 was significantly upregulated in all six available cancers. Moreover, TOP2A expression was found to be associated with the cancer-associated immune cell infiltration, including fibroblasts, Tregs, and macrophages. In addition, the Kyoto encyclopedia of genes and genomes (KEGG) pathway and Gene Ontology (GO) enrichment analyses revealed a most significant association between TOP2A with the Wnt signaling pathway and DNA conformation change. This work provides a comprehensive knowledge of TOP2A in different cancers, including carcinogenic function, prognostic values for metastasis, and clinical outcomes.

Top 50 Most Cited Articles on Thoracic Ossification of Posterior Longitudinal Ligament

Study Design

Bibliometric analysis.

Objective

Over the last several decades, the field of thoracic ossification of the posterior longitudinal ligament (T-OPLL) has evolved unprecedentedly, and the literature on T-OPLL has increased significantly. The purpose of this study is to identify and review the top 50 most cited publications related to T-OPLL.

Methods

The most frequently cited 50 articles in this field until 30 October 2021 were identified by searching Web of Science. We ranked the articles based on the citation number. Through the bibliometric method, we evaluated the following information: article title, first author, year of publication, journal of publication, total number of citations, country, and study topic.

Results

The number of citations of included studies ranged from 20 to 108, with a mean number of 45.4. The journal Spine published most articles (20), followed by Spinal Cord (5), and European Spine (5). All of these articles were contributed by 38 first authors, Yamazaki (4), Fujimura (3), and Aizawa (3) who published more than 2 articles. In the respect of productive countries, Japan (39) contributed most papers. Tomita contributed the most cited article in 1990 on Spine, which was the first-ever report of circumferential decompression for thoracic myelopathy due to T-OPLL.

Conclusion

The top 50 influential articles on T-OPLL were identified and analyzed in this study. It will undoubtedly provide a comprehensive and detailed basis for the orthopedic and neurosurgery physicians to make a clinical decision and assimilate the research focus of spine surgery.

The 100 Most Cited Articles on Lumbar Spinal Stenosis: A Bibliometric Analysis

STUDY DESIGN

Bibliometric analysis.

OBJECTIVE

With the increasing literature of spine surgery, some pioneering research studies have had a significant impact on the field of lumbar spinal stenosis (LSS). The objective of the authors was to identify and analyze the most frequently cited 100 articles in this field.

METHODS

Web of Science was searched to identify 100 top-cited articles related to LSS from 2000 to 2019. Articles on the final list were filtered based on their titles and abstracts. The following information were recorded and analyzed with bibliometric method: article title, first author, year of publication, journal of publication, total number of citations, country, institution, and study topic.

RESULTS

The citation count for final articles on the list ranged from 71 to 2162, with a mean number of 207.7. The journal Spine contributed the maximum number of articles (37), followed by European Spine Journal (9) and Pain Physician (8). There were collectively 80 first authors contributing to articles on the final list. Twelve authors were represented multiple times in the top 100 articles. The most prolific years were 2008 and 2009, each had 11 articles published. With regard to country and region of origin, most articles were from the United States (58). The most cited article was published in Spine in 2000 by Fairbank and Pynsent, who discussed the role of the Oswestry Disability Index as an evaluation standard in spinal disorders, including LSS.

CONCLUSION

The current study analyzed the 100 most cited articles on LSS. It no doubt developed a useful resource with detailed information for many, particularly orthopedic and neurosurgery physicians who want to assimilate research focus and advance of LSS within a relatively short period. Researchers may benefit from emphasis on citation count while citing and evaluating articles and realize the deficiencies when high-level articles appear.

Research Progress of Ponticulus Posticus: A Narrative Literature Review

Study Design

Narrative review.

Objective

The purpose of this review was to consolidate the current literature related to ponticulus posticus (PP) and to improve the systematic understanding of this anatomical variant of atlas among spine surgeons.

Methods

Articles reviewed were searched in PubMed, Ovid MEDLINE, and Embase. All articles of any study design discussing on PP were considered for inclusion. Two independent authors read article titles and abstracts and included appropriate articles. The relevant articles were studied in full text.

Results

A total of 113 literatures were reviewed and consolidated in this narrative review. These articles are roughly divided into the following five subcategories: (1) epidemiology, (2) pathology and anatomy, (3) clinical presentation, (4) surgical significance, and (5) radiographic examination.

Conclusion

The PP is non-negligible with a high prevalence. The PP compresses the V3 segment of the artery, the suboccipital nerve, and the venous plexus, consequently contributing to the incidence of neurological pathologies. When a PP is observed or suspected on a lateral radiograph, we recommend that a computed tomography (CT) scan of a patient who is about to receive a C1 lateral mass screw (C1LMS) should be performed, which could determine a safe entry point and the right trajectory of screw insertion.

Global Trends of Researches on Lumbar Spinal Stenosis: A Bibliometric and Visualization Study

STUDY DESIGN

Bibliometric and visualization analysis.

OBJECTIVE

Lumbar spinal stenosis (LSS) has become a common health problem and the most frequent indication for spinal surgery. This study aimed to illustrate the overall knowledge structure, and development trends of LSS, using a bibliometric analysis and newly developed visualization tools.

MATERIALS AND METHODS

Research data sets were acquired from the Web of Science. The time span was defined as "2000-2019". VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-index status, co-authorship status and research hotspots were analyzed.

RESULTS

A total of 1934 publications met the requirement. The United States published most papers (521, 26.9%), both total citations (17,626) and H-index (61) ranked first of all the countries. The most productive organizations on LSS is Seoul National University (50). Spine (43) published the most papers on LSS. Quality of life, risk factor, disability, double blind trials, and decompression surgery are the research hotspots in the recent years.

CONCLUSION

The number of publications showed an upward trend with a stable rise in recent years. The United States is a country with the highest productivity, not only in quality, but also in quantity. Seoul National University has been the largest contributor in this field. Spine is the best journal related to LSS. Quality of life, risk factor, disability, and decompression surgery are the research hotspots in the recent years. Indeed, this study provides a new insight to the growth and development of LSS. Moreover, it will contribute to the growth of the international frontier of LSS.

Research Progress of Atlantoaxial Osteoarthritis: A Narrative Literature Review

OBJECTIVE

The purpose of this review was to consolidate the current literature related to atlantoaxial osteoarthritis (AAOA) and improve the systematic understanding of this clinical syndrome among spine surgeons.

METHODS

Articles reviewed were searched in PubMed, Ovid MEDLINE, and EMBASE using search terms: [("C1-C2" OR "C1-2" OR "atlantoaxial" OR "atlanto-axial" OR "C2" OR "C1" OR "atlas" OR "axis") AND ("osteoarthritis")]. All articles of any study design discussing on AAOA were considered for inclusion. Two independent authors read article titles, abstracts and the included appropriate articles. The relevant articles were studied in full text.

RESULTS

A total of 54 literatures were reviewed and consolidated in this narrative review. These articles are roughly divided into the following five subcategories: (1) epidemiology and etiology, (2) clinical presentation, (3) radiographic findings, (4) conservative treatment and (5) surgical indications and treatment options.

CONCLUSION

AAOA was a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. The most common cause of AAOA was joint degeneration, which was closely related to age and occupation. Initial treatment for AAOA was conservative. Atlantoaxial fusion was an option for patients with severe pain who unresponsive to conservative management.

Correlation and Differences in Lumbopelvic Sagittal Alignment Parameters Between Lumbar Radiographs and Magnetic Resonance Images

STUDY DESIGN

Imaging parameter study.

OBJECTIVE

Though lumbar alignment is better evaluated using standing radiograph than supine magnetic resonance imaging (MRI), few studies have researched this. Our study aimed to observe the correlation and difference in alignment between standing radiograph and supine MRI, and assess whether the change of position affects the lumbopelvic parameters.

METHODS

We analyzed 105 patients, measuring lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Inter- and intraparameter analyses were performed to identify any difference between standing radiograph and supine MRI. Statistical differences between the lumbopelvic parameters were compared.

RESULTS

There was excellent interobserver agreement for each parameter (interclass correlation coefficient > 0.75), and significant differences were observed in each parameter between radiograph and MRI (P < .05). Strong correlations were noted between the equivalent parameters in radiograph and MRI, both SS and PI were strongly correlated with LL in radiograph and MRI image, both PT and SS were strongly correlated with PI in radiograph and MRI image (r = -1.0 to -0.5 or 0.5 to 1.0).

CONCLUSION

Supine MRI obviously underestimated the measurements of lumbopelvic sagittal alignment parameters in standing radiograph. Therefore, standing lumbar radiographs should be obtained preoperatively in all surgical patients, not only supine MRI. In addition, we observed that PI was not a constant morphological parameter.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol for elderly patients receiving surgery for intertrochanteric fracture: a propensity score-matched analysis

Purpose

Enhanced Recovery After Surgery (ERAS) is a multimodal approach to perioperative care that aims to reduce patient perioperative complications, accelerate patient recovery, and improve patient satisfaction by refining and optimizing all perioperative management processes. By comparing two groups of patients before and after the implementation of ERAS for intertrochanteric fracture (ITF) with a matching analysis of propensity score (PS), we aimed to demonstrate that the implementation of ERAS protocol shortens the length of hospital stay (LOS), reduces pain, decreases the incidence of postoperative complications, and promotes functional recovery of the joint.

Methods

We selected 2 periods of 1 year, before (n=98patients) and after ERAS implementation (n=92patients). Data were collected on patient demographics, operative and perioperative details, LOS, VAS score, Harris score, and 30-day complications. ERAS-trained nurses are engaged to support patients at each step of the pre/per/postoperative process, including completing a satisfaction survey, with the help of a mobile app. PS analyses were used for dealing with confounding bias in this retrospective observational study.

Results

After PS matching, the outcomes of 124 well-balanced pairs of patients were compared (conventional vs ERAS). LOS was significantly reduced from 24.3±3.9 to 15.2±2.9 days (P<0.001). With the same preoperative VAS scores, we found that patients in the ERAS group had significantly lower postoperative VAS scores than those in the conventional group at days 3 and 7 (P<0.001), but the difference was not statistically significant at day 14. patients in the ERAS group had higher Harris scores than those in the conventional group at 1 and 3 months, but the difference was not significant at 6 months. In addition, we found that only one patient in the ERAS group developed complications, while nine patients in the conventional group developed different complications. There was no significant difference concerning the satisfaction survey.

Conclusion

The introduction of ERAS for ITF in our institution has resulted in a significant decrease in LOS, alleviated patient pain, promoted early recovery of patient’s hip function while effectively preventing complications, and obtained patient satisfaction.

A Bibliometric Analysis and Visualization of Current Research Trends in the Treatment of Cervical Spondylotic Myelopathy

STUDY DESIGN

Bibliometric analysis.

OBJECTIVE

Cervical spondylotic myelopathy (CSM) has become the most common cause of spinal cord dysfunction. Many topics of CSM still remain controversial. This study aimed to illustrate the overall knowledge structure and development trends of CSM.

METHODS

Research data sets were acquired from the Web of Science database and the time span was defined as "2000 to 2019." VOS viewer and Citespace software was used to analyze the data and generate visualization knowledge maps. Annual trends of publications, distribution, H-index status, co-authorship status, and research hotspots were analyzed.

RESULTS

A total of 2367 publications met the requirement. The largest number of articles was from the United States, followed by Japan, China, Canada, and India. The highest H-index was found for articles from the United States. The highest number of articles was published in Spine. The cooperation between the countries, institutes, and authors were relatively weak. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM may become a frontier in this research field.

CONCLUSION

The number of publications showed an upward trend with a stable rise. Most of the publications are limited to a few countries and institutions with relatively weak interaction. The United States, Canada, Japan, China, and India have made significant contributions to the field of CSM. The United States is the country with the highest productivity, not only in quality but also in quantity. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM are the research hotspots in the recent years.

Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: an independent inter- and intra-observer agreement study

BACKGROUND

Lumbar degenerative spondylolisthesis (DS) has been a common disease that makes increasing patients to suffer from different degrees of low back pain and radicular symptoms. The Spinal Deformity Study Group (SDSG) and the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to compare the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value.

METHODS/DESIGN

All 117 patients with L5/S1 lumbar DS were enrolled. Five experienced spine surgeons were selected to assess DS with SDSG and CARDS systems. Kappa (K) value was used to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, the analysis was repeated.

RESULTS

The inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878.

CONCLUSION

SDSG system had better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.

An independent inter- and intra-observer agreement assessment of Yeom classification for bone cement leakage following vertebroplasty/kyphoplasty

STUDY DESIGN

An inter- and intra-observer agreement study.

BACKGROUND

In recent years, vertebroplasty and kyphoplasty have been widely used in treating osteoporotic vertebral compression fractures (OVCF) though the clinical efficacy of them is still controversial. However, there are also inevitable complications, first and foremost is bone cement leakage (BCL). Yeom classification is commonly used to evaluate BCL. The objective of this study is to assess its reliability and reproducibility, and to explore its clinical application value.

METHODS

All 58 patients with BCL following vertebroplasty/kyphoplasty were involved. Six spine surgeons were selected to be evaluators as they were unaware of the identity of the patients and the treatment they received. They classified BCL according to Yeom system, we used kappa (K) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis.

RESULTS

The inter-observer reliability of Yeom classification was substantial with K value of 0.71 (1st assessment) and 0.73 (2nd assessment). The intra-observer reproducibility of Yeom classification was near perfect with K value of 0.88.

CONCLUSION

Yeom classification system has substantial inter-observer reliability and near perfect intra-observer reproducibility in BCL following vertebroplasty/kyphoplasty, which can be widely used in clinical care as an appropriate instrument for early observation, mechanism and severity cognition, and prognosis predicting of BCL. Besides, the adding of type M (the mixed type) may improve the classification.

Mapping Novel Biomarkers of Liver Injury by Tissue Proteomic Analysis

Liver damage is a dynamic process, and evaluation of liver injury degree is the key step in disease diagnosis. However, few common markers among different types of liver injury have been reported. Herein, we generated three liver injury mouse models, including Con A-induced, CCl₄-injected, and subjected bile duct ligation mouse models, to simulate different types of liver damage in humans and then performed a label-free mass spectrometry to identify differentially expressed proteins in liver tissues. Interestingly, two proteins, G3BP and ABCC6, were conserved regulated in different liver injury models and are proposed to be biomarkers in liver injury, with G3BP upregulated and ABCC6 downregulated. Overall, our study identified two novel biomarkers of liver injury, and they might be used as potential drug targets of liver damage research studies.

Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study

INTRODUCTION

This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial.

METHODS

Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations.

RESULTS

320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%).

CONCLUSION

After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.

LncRNA NR_027471 Functions as a ceRNA for miRNA-8055 Leading to Suppression of Osteosarcoma by Regulating the Expression of TP53INP1

Osteosarcoma is a malignancy with high aggressiveness and poor prognosis, which occurs mainly in children. The therapeutic strategy against osteosarcoma includes surgery combined with chemotherapy and radiotherapy. Although the treatment of osteosarcoma has been improved in recent years, there is a large proportion of patients with incurable osteosarcoma. Investigation of the mechanism of osteosarcoma progression would be of great help in discovering therapeutic targets for this disease. Long non-coding RNAs play critical roles in the pathogenesis of different types of cancer. The current study showed that long non-coding RNA NR_027471 was downregulated in osteosarcoma cells. In vitro and in vivo studies indicated that upregulation of NR_027471 impeded the viability, proliferation, and invasion of osteosarcoma, as well as induced cell cycle arrest at G1. In addition, binding of miR-8055 to NR_027471 was demonstrated, thereby influencing the expression of tumor protein p53 inducible nuclear protein 1 (TP53INP1). Knockdown of NR_027471 promoted epithelial–mesenchymal transition by inhibiting E-cadherin and increasing the expression of zinc finger E-box-binding homeobox 1 (ZEB1), Snail, and fibronectin. These results suggested that overexpression of NR_027471 upregulated TP53INP1 by sponging to miR-8055, leading to suppression of osteosarcoma cell proliferation and progression.

Interleukin-6 and severity of COVID-19 patients in Hefei, China

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Twenty-four out of 75 patients developed into severe condition in the course of the infection.

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The prominent laboratory abnormalities of COVID patients were lymphopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH).

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Elevated interleukin 6 (IL-6) correlated with decrease of LYM%, CD4⁺ and CD8⁺ T cell counts, and increase of CRP, LDH and Procalcitonin (PCT) levels.