Short-Term Exposure to Fine Particulate Matter and Ozone: Source Impacts and Attributable Mortalities.

Short-term exposure to particles with aerodynamic diameters less than 2.5 µm (PM2.5) and ozone (O3) are important risk factors for human health. Despite the awareness of reducing attributable health burden, region-specific and source-specific strategies remain less explored due to the gap between precursor emissions and health effects. In this study, we isolate the health burden of individual sector sources of PM2.5 and O3 precursors, nitrogen oxides (NOx) and volatile organic compounds (VOCs), across the globe. Specifically, we estimate mortalities attributable to short-term exposure using machine-learning-based daily exposure estimates and quantify sectoral impacts using chemical transport model simulations. Globally, short-term exposure to PM2.5 and O3 result in 713.5 (95% Confidence Interval: 598.8-843.3) thousand and 496.3 (371.3-646.1) thousand mortalities in 2019, respectively, of which 12.5% are contributed by fuel-related NOx emissions from transportation, energy, and industry. Sectoral impacts from anthropogenic NOx and VOC emissions on health burden vary significantly among seasons and regions, requiring a target shift from transportation in winter to industry in summer for East Asia, for instance. Emission control and health management are additionally complicated by unregulated natural influences during climatic events. Fire-sourced NOx and VOC emissions, respectively, contribute to 8.5 (95% CI: 6.2-11.7) thousand and 4.8 (3.6-5.9) thousand PM2.5 and O3 mortalities, particularly for tropics with high vulnerability to climate change. Additionally, biogenic VOC emissions during heatwaves contribute to 1.8 (95% CI: 1.5-2.2) thousand O3-introduced mortalities, posing challenges in urban planning for high-income regions, where biogenic contributions to health burden during heatwaves are 13% of anthropogenic contributions annually. Our study provides important implications for temporally dynamic and sector-targeted emission control and health management strategies, which are of urgency under the projection of continuously increasing energy consumption and changing climate.

Satellite NO2 Retrieval Complicated by Aerosol Composition over Global Urban Agglomerations: Seasonal Variations and Long-Term Trends (2001-2018).

Tropospheric nitrogen dioxide (NO2) poses a serious threat to the environmental quality and public health. Satellite NO2 observations have been continuously used to monitor NO2 variations and improve model performances. However, the accuracy of satellite NO2 retrieval depends on the knowledge of aerosol optical properties, in particular for urban agglomerations accompanied by significant changes in aerosol characteristics. In this study, we investigate the impacts of aerosol composition on tropospheric NO2 retrieval for an 18 year global data set from Global Ozone Monitoring Experiment (GOME)-series satellite sensors. With a focus on cloud-free scenes dominated by the presence of aerosols, individual aerosol composition affects the uncertainties of tropospheric NO2 columns through impacts on the aerosol loading amount, relative vertical distribution of aerosol and NO2, aerosol absorption properties, and surface albedo determination. Among aerosol compositions, secondary inorganic aerosol mostly dominates the NO2 uncertainty by up to 43.5% in urban agglomerations, while organic aerosols contribute significantly to the NO2 uncertainty by -8.9 to 37.3% during biomass burning seasons. The possible contrary influences from different aerosol species highlight the importance and complexity of aerosol correction on tropospheric NO2 retrieval and indicate the need for a full picture of aerosol properties. This is of particular importance for interpreting seasonal variations or long-term trends of tropospheric NO2 columns as well as for mitigating ozone and fine particulate matter pollution.

SARS-CoV-2 Omicron XBB subvariants exhibit enhanced fusogenicity and substantial immune evasion in elderly population, but high sensitivity to pan-coronavirus fusion inhibitors.

Numerous emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants have shown significant immune evasion capacity and caused a large number of infections, as well as vaccine-breakthrough infections, especially in elderly populations. Recently emerged Omicron XBB was derived from the BA.2 lineage, but bears a distinct mutant profile in its spike (S) protein. In this study, we found that Omicron XBB S protein drove more efficient membrane-fusion kinetics on human lung-derived cells (Calu-3). Considering the high susceptibility of the elderly to the current Omicron pandemic, we performed a comprehensive neutralization assessment of elderly convalescent or vaccine sera against XBB infection. We found that the sera from elderly convalescent patients who experienced with BA.2 infection or breakthrough infection potently inhibited BA.2 infection, but showed significantly reduced efficacy against XBB. Moreover, recently emerged XBB.1.5 subvariant also showed more significant resistance to the convalescent sera of BA.2- or BA.5-infected elderly. On the other hand, we found that the pan-CoV fusion inhibitors EK1 and EK1C4 can potently block either XBB-S- or XBB.1.5-S-mediated fusion process and viral entry. Moreover, EK1 fusion inhibitor showed potent synergism when combined with convalescent sera of BA.2- or BA.5-infected patients against XBB and XBB.1.5 infection, further indicating that EK1-based pan-CoV fusion inhibitors are promising candidates for development as clinical antiviral agents to combat the Omicron XBB subvariants.

Sensitivity of Venturia carpophila from China to Five Fungicides and Characterization of Carbendazim-Resistant Isolates.

Peach scab is a fungal disease caused by Venturia carpophila that can significantly reduce peach yield and quality. Fungicide application is the main control measure for peach scab worldwide. To better understand the fungicide-resistance status and devise suitable management strategies, the sensitivity of 135 single-spore V. carpophila isolates to the commonly used fungicides carbendazim, iprodione, propiconazole, azoxystrobin, and boscalid were determined using a microtiter plate test method. Results showed that the mean effective concentrations to cause inhibitions by 50% (EC50) of tested isolates to iprodione, propiconazole, azoxystrobin, and boscalid were 16.287, 0.165, 0.570, and 0.136 µg/ml, respectively. The EC50 values of V. carpophila isolates to four fungicides displayed unimodal frequency distributions, indicating no resistance occurred to these fungicides. On the contrary, bimodal frequency distribution was observed for carbendazim, indicating that V. carpophila developed resistance to carbendazim. Resistance was widely detected from all 14 provinces studied. Molecular analysis showed that the point mutation E198K of the TUB2 gene determined high resistance, whereas E198G conferred moderate resistance. Moderate and high resistances were stable, and the resistant isolates did not show significant fitness penalties. On the contrary, some resistant isolates showed better competitiveness under certain stresses. This is the first report to detect the sensitivity of V. carpophila to fungicides, which enables future monitoring of fungicide resistance and provides basic information to allow the design of suitable peach scab management strategies.

Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review.

BACKGROUND: The goal of this meta-analysis is to explore the overall efficacy as well as the safety of anterior versus posterior approach for the therapy of patients with multilevel cervical spondylotic myelopathy based on qualified studies. METHODS: Three electronic databases, PubMed, Cochrane, Embase were searched updated to January 2018 to identify all relevant and qualified studies using the index words. The qualified studies were including prospective or retrospective comparative studies. Relative risk (RR) and mean difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. RESULTS: In this meta-analysis, there were a total of 24 studies with 959 patients in the anterior approach group and 1072 patients in the posterior approach group. The final results showed, in comparison of the posterior approach group, the anterior approach group significantly increased the JOA score (SMD: 0.36, 95% CI 0.10-0.62), the operation time (WMD: 49.87, 95% CI 17.67-82.08), and the neurological recovery rate (WMD: 10.55, 95% CI 3.99-17.11) with higher complication rate (RR: 1.53, 95% CI 1.24-1.89). Besides, there was no significant difference of the blood loss (SMD: - 0.40, 95% CI - 1.12 to 0.32) and ROM (SMD: - 0.28, 95% CI - 0.78 to - 0.22) between posterior approach group and anterior approach group. CONCLUSIONS: Studies found a significant increase of JOA score as well as neurological recovery rate by the anterior approach treatment when compared with posterior approach treatment. However, increased operation time and complications could also occur through the anterior approach treatment. More high-quality randomized controlled trials with larger sample size, multi-centric and longer follow-ups are needed to support our current conclusions.

Epidural Injection With or Without Steroid in Managing Chronic Low-Back and Lower Extremity Pain: A Meta-Analysis of 10 Randomized Controlled Trials.

Chronic low-back and lower extremity pain is mainly caused by lumbar disc herniation and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat lumbar disc herniation or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the 2 interventions in managing various chronic low and lower extremity pain. A systematic literature search was conducted to identify randomized controlled trials, which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Ten randomized controlled trials (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief, and the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores [95% confidence interval (CI), -4.26 to -3.91] and 4.12 (95% CI, -4.35 to -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% in group 2 achieved significantly improved functional status. The Oswestry Disability Indices in the 2 groups were reduced by 14.5 (95% CI, -15.24 to -13.75) and 12.37 (95% CI, -16.13 to -8.62), respectively. The average procedures per year in group 1 were 3.68 ± 1.17 and 3.68 ± 1.26 in group 2, with an average total relief per year of 31.67 ± 13.17 and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI, -12.24 to -5.38) and 16.92 mg (95% CI: -22.71 to -11.12) in the 2 groups, respectively. This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low-back and lower extremity pain.

Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review.

Rhodococcus equi, predominantly recognized as an opportunistic pathogen affecting immunocompromised hosts, and Brucella, a widespread zoonotic bacterium, infrequently co-infect immunocompetent adults, thereby posing a distinctive diagnostic challenge. Here, we describe a case involving a 53-year-old male with a history of goat farming, who presented with persistent chest tightness, cough, and notable weight loss, absent fever. Radiological and bronchoscopic assessments showed a right hilar mass, extensive vertebral destruction, and bronchial lesions, deviating from the typical symptoms associated with either pathogen. Laboratory analyses confirmed a co-infection involving R. equi and Brucella. Initial therapy with levofloxacin and vancomycin proved ineffective; however, a subsequent treatment regimen comprising azithromycin, etimicin, minocycline, and moxifloxacin resulted in substantial clinical improvement. This case accentuates the intricacies involved in diagnosing and managing atypical co-infections in immunocompetent individuals and underscores the importance of careful microbiological testing to inform effective therapeutic strategies.

Observing network effect of shipping emissions from space: A natural experiment in the world's busiest port.

Maritime trade and associated emissions are dynamic in nature. Although shipping emissions contribute significantly to air quality and climate change, their trade-governed dynamics remain less explored due to the lack of observational evidence. Here, we use satellite measurements to capture the redistribution of shipping nitrogen oxides (NOx) emissions from Shanghai port, the world's busiest port, during a natural experiment posted by the localized COVID-19 lockdown in 2022. Viewing the ports as nodes in a network linked by ship journeys, we quantify a lockdown-induced -42% reduction in shipping NOx emissions for Shanghai port. We further identify an emission transfer to its neighboring connected ports, confirmed by comprehensive vessel activity observations. Our study highlights the socioeconomic drivers of shipping emissions, which may add additional layers of complexity to air quality management.

SARS-CoV-2 Omicron subvariants exhibit distinct fusogenicity, but similar sensitivity, to pan-CoV fusion inhibitors.

Continuous emergence of the Omicron variant, along with its subvariants, has caused an increasing number of infections, reinfections, and vaccine-breakthrough infections, seriously threatening human health. Recently, several new Omicron subvariants, such as BA.5, BA.2.75, BA.4.6, and BF.7, bearing distinct mutation profiles in their spike (S) proteins, have significantly increased their capacity to evade vaccine-induced immunity and have shown enhanced infectivity and transmissibility, quickly becoming dominant sublineages. In this study, we found the S proteins of these Omicron subvariants to have 2- to 4-fold more efficient membrane fusion kinetics than that of the original Omicron variant (BA.1), indicating that these novel Omicron subvariants might possess increased pathogenicity. We also identified that peptide-based pan-CoV fusion inhibitors, EK1 and EK1C4, showed equal efficacy against membrane fusion mediated by S proteins of the noted Omicron subvariants and infection by their pseudoviruses. Additionally, either immune sera induced by wild-type (WT) SARS-CoV-2 RBD-based vaccine or BA.2 convalescent sera showed potent synergism with EK1 against both WT SARS-CoV-2 and various Omicron subvariants, further suggesting that EK1-based fusion inhibitors are promising candidates for development as clinical antiviral agents against the currently circulating Omicron subvariants.

Enhanced Chemo-Immunotherapy Strategy Utilizing Injectable Thermosensitive Hydrogel for The Treatment of Diffuse Peritoneal Metastasis in Advanced Colorectal Cancer.

Patients with colorectal cancer (CRC) and diffuse peritoneal metastasis (PM) are not eligible for surgical intervention. Thus, palliative treatment remains the standard of care in clinical practice. Systemic chemotherapy fails to cause drug accumulation at the lesion sites, while intraperitoneal chemotherapy (IPC) is limited by high clearance rates and associated complications. Given the poor prognosis, a customized OxP/R848@PLEL hydrogel delivery system has been devised to improve the clinical benefit of advanced CRC with diffuse PM. This system is distinguished by its simplicity, security, and efficiency. Specifically, the PLEL hydrogel exhibits excellent injectability and thermosensitivity, enabling the formation of drug depots within the abdominal cavity, rendering it an optimal carrier for IPC. Oxaliplatin (OxP), a first-line drug for advanced CRC, is cytotoxic and enhances the immunogenicity of tumors by inducing immunogenic cell death. Furthermore, OxP and resiquimod (R848) synergistically enhance the maturation of dendritic cells, promote the expansion of cytotoxic T lymphocytes, and induce the formation of central memory T cells. Moreover, R848 domesticates macrophages to an anti-tumor phenotype. OxP/R848@PLEL effectively eradicates peritoneal metastases, completely inhibits ascites production, and significantly prolongs mice lifespan. As such, it provides a promising approach to managing diffuse PM in patients with CRC without surgical indications.

Peroneal tenography to evaluate lateral hindfoot pain after calcaneal fracture.

BACKGROUND: Lateral hindfoot pain after union of a calcaneal fracture remains a challenge to orthopaedic surgeons. This study aimed to investigate the relationship between lateral calcaneal pain, calcaneal width and peroneal tendon sheath impingement in patients with lateral hindfoot pain. MATERIALS AND METHODS: Seventy-four consecutive patients with unilateral lateral hindfoot pain were identified from an institutional trauma registry. Regular followups were performed and the severity of lateral hindfoot pain was recorded. CT scans were conducted to measure calcaneal width at the level of sustentaculum tali. Bilateral peroneal tenography was performed to examine compression of the peroneal tendon sheath. The sheaths on the injured, painful side were compared to the contralateral sheath at the same level. The data was analyzed with bivariate correlation using SPSS 13.0 for Windows. RESULTS: The injured calcanei were wider in all patients and the peroneus longus and brevis tendon sheaths were compressed on peroneal tenography in 68.9% (51 of 74). Statistics demonstrated significant correlations between compression of tendon sheaths and lateral hindfoot pain (Rs = 0.93, p < 0.001), and between increasing calcaneal width and lateral hindfoot pain (Rs = 0.665, p < 0.001). The severity of lateral hindfoot pain was directly correlated to tendon sheath impingement and indirectly related to calcaneal widening. CONCLUSION: Calcaneal widening following fracture union was the cause of compression of the peroneal tendons. Increasing compression correlated with increasing levels of lateral pain. Our study demonstrated the utility of peroneal tenography in identifying the presence of peroneal tendon impingement in patients with lateral pain following calcaneal fractures.

Performance Enhancement of Actual Wastewater Treatment and Electricity Generation Through Surface Modified TiO2 Nanotube Arrays Based Photoanode Photocatalytic Fuel Cell.

Herein, we report a surface modified TiO2 nanowire arrays (NAs) photoanode based photocatalytic fuel cell (PFC) towards simultaneous enhancement of actual wastewater treatment and electricity generation under visible light irradiation. TiO2 NAs were facile fabricated via two-step anodization process in ethylene glycol and glycerin solution, respectively. Actual wastewater samples were directly applied to evaluate the PFC performance in terms of wastewater degradation and electricity generation through the as-prepared TiO2 NAs photoanode without loading noble-metals or semiconductors. TiO2 NAs photoanode prepared from ethylene glycol solution demonstrated a highly ordered surface network, exhibiting short-circuit current density and fill factor nearly 4.3 times and 1.4 times higher than pristine TiO2 NAs photoanode prepared according to previous reports. The experimental results revealed that the fabrication of TiO2 NAs by a facile surface modification in ethylene glycol solution can be considered a low-cost and scalable routine for enhancing performance of PFC photoanode towards efficient actual wastewater treatment and electricity generation.

A convenient, rapid and efficient method for establishing transgenic lines of Brassica napus.

BACKGROUND: Brassica napus is an important oilseed crop that offers a considerable amount of biomass for global vegetable oil production. The establishment of an efficient genetic transformation system with a convenient transgenic-positive screening method is of great importance for gene functional analysis and molecular breeding. However, to our knowledge, there are few of the aforementioned systems available for efficient application in B. napus. RESULTS: Based on the well-established genetic transformation system in B. napus, five vectors carrying the red fluorescence protein encoding gene from Discosoma sp. (DsRed) were constructed and integrated into rapeseed via Agrobacterium-mediated hypocotyl transformation. An average of 59.1% tissues were marked with red fluorescence by the visual screening method in tissue culture medium, 96.1% of which, on average, were amplified with the objective genes from eight different rapeseed varieties. In addition, the final transgenic-positive efficiency of the rooted plantlets reached up to 90.7% from red fluorescence marked tissues, which was much higher than that in previous reports. Additionally, visual screening could be applicable to seedlings via integration of DsRed, including seed coats, roots, hypocotyls and cotyledons during seed germination. These results indicate that the highly efficient genetic transformation system combined with the transgenic-positive visual screening method helps to conveniently and efficiently obtain transgenic-positive rapeseed plantlets. CONCLUSION: A rapid, convenient and highly efficient method was developed to obtain transgenic plants, which can help to obtain the largest proportion of transgene-positive regenerated plantlets, thereby avoiding a long period of plant regeneration. The results of this study will benefit gene functional studies especially in high-throughput molecular biology research.

Radiologic measurement of lesser trochanter and its clinical significance in Chinese.

OBJECTIVE: Femoral fracture is a major cause of morbidity and mortality in elderly persons. Surgery, the main choice of treatment of femoral fracture, may result in some complications severely affecting patients' daily activities due to femoral malalignment. The lesser trochanter is an important anatomical structure of the femur which could be used as an anatomical landmark during and after operation to evaluate femoral alignment. To predict femoral rotational malalignment during surgery, the relationship between the height and width of the lesser trochanter and femoral rotation at different angles was investigated. METHODS: Fifty healthy adult volunteers (25 men and 25 women) were enrolled in this study and a total of 900 radiographs of proximal femurs were taken in the following positions: neutral position, 5 degrees, 10 degrees, 15 degrees, and 20 degrees internal rotation, and 5 degrees, 10 degrees, 15 degrees, and 20 degrees external rotation, respectively. The cranio-caudal and transverse diameters of the lesser trochanter were obtained on a PACS Workstation. RESULTS: The height and width of the lesser trochanter increased with external rotation and decreased with internal rotation and the values showed statistical significance between different positions or different genders. Between 20 degrees of internal rotation to 20 degrees of external rotation, the mean height increased from 0.58 cm to 1.23 cm in men and from 0.44 cm to 1.19 cm in women. The corresponding mean values for width were from 2.53 cm to 4.44 cm in men, and from 2.08 cm to 3.86 cm in women, respectively. The height and width of the lesser trochanter were both highly correlated to the position of femur and the linear relationship was established approximately. The morphological alteration of lesser trochanter also changed obviously when the femurs rotated. CONCLUSIONS: The height and width of the lesser trochanter is linearly related to femoral rotation and could be used as a reference for prevention of femoral malalignment during surgery.

Sulfadiazine biodegradation by Phanerochaete chrysosporium: Mechanism and degradation product identification.

Antibiotic contaminants have become a severe environmental problem in recent years and finding effective ways to deal with this issue is of great importance. In this study, Phanerochaete chrysosporium was used to degrade sulfadiazine (SDZ), which is frequently detected in the culture medium of isolates from soil and surface water systems. The results demonstrate that 10 mg L-1 SDZ can be completely degraded by P. chrysosporium under conditions of pH 5.7 and 30 °C within 6 days. The Q-Exactive-MS/MS analysis identified and confirmed several different SDZ degradation intermediates, and four proposed degradation pathways of SDZ were deduced. Moreover, enzyme activity tests revealed that manganese peroxidase and ligninolytic peroxidase played important roles in SDZ degradation. Moreover, a transcriptome analysis method was performed to explore the mechanism and pathways of SDZ degradation by P. chrysosporium in greater detail. The results of GO and KEGG analysis strongly suggest that the metabolism pathway is significantly activated and plays an important role in antibiotic degradation. Further, this is the first study to identify SDZ degradation intermediates and two main intermediates were found to be involved in possible SDZ degradation pathways. This study is also the first report results from RNA sequencing to evaluate genome-wide changes of P. chrysosporium to further explore SDZ degradation mechanism.

Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review.

OBJECTIVE: To evaluate the overall diagnostic value related to magnetic resonance imaging (MRI) in patients with early osteonecrosis of the femoral head. METHODS: By searching multiple databases and sources, including PubMed, Cochrane, and Embase database, by the index words updated in December 2017, qualified studies were identified and relevant literature sources were also searched. The qualified studies included prospective cohort studies and cross-sectional studies. Heterogeneity of the included studies were reviewed to select proper effect model for pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were performed for meniscal tears. RESULTS: Forty-three studies related to diagnostic accuracy of MRI to detect early osteonecrosis of the femoral head were involved in the meta-analysis. The global sensitivity and specificity of MRI in early osteonecrosis of the femoral head were 93.0% (95% CI 92.0-94.0%) and 91.0% (95% CI 89.0%-93.0%), respectively. The global positive likelihood ratio and global negative likelihood ratio of MRI in early osteonecrosis of the femoral head were 2.74 (95% CI 1.98-3.79) and 0.18 (95% CI 0.14-0.23), respectively. The global DOR was 27.27 (95% CI 17.02-43.67), and the area under the SROC was 93.38% (95% CI 90.87%-95.89%). CONCLUSIONS: This review provides a systematic review and meta-analysis to evaluate the diagnostic accuracy of MRI in early osteonecrosis of the femoral head. Moderate to strong evidence indicated that MRI appears to be significantly associated with higher diagnostic accuracy for early osteonecrosis of the femoral head.

[Treatment of complex calcaneal fractures under computer navigation: report of 130 feet].

OBJECTIVE: To investigate the effects of computer navigation in the treatment of intra-articular calcaneal fractures. METHODS: 130 feet in 110 patients with intra-articular calcaneal fractures, 57 calcanei with fracture of Sander's type II, 45 of type III, and 28 cases of type IV, were treated with internal fixation under computer navigation, and were followed up for 16.3 months (6 - 24 months). RESULTS: According to the Maryland Foot Score system, excellent result was noted in 63 feet, good result in 57 feet, and fair result in 10 feet, with the excellent and good rates being 92.31% together. CONCLUSION: Using computer navigation to treat intra-articular calcaneal fractures is one of the best ways for treatment of calcaneal fractures.

Sequestrectomy versus microdiscectomy in the treatment of lumbar disc herniation: a meta-analysis.

BACKGROUND: It remains unknown whether sequestrectomy provides better outcomes than microdiscectomy for lumbar herniated discs (LHD). Therefore, we conducted a meta-analysis to compare the effects of sequestrectomy and microdiscectomy in the treatment of patients with LHD. METHODS: Clinical trials published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of sequestrectomy and microdiscectomy for LHD. Outcomes included reherniation rate, duration of surgery, length of hospital stay, and postoperative Visual Analog Scale (VAS) scales for leg and back pains. A fixed-effects or random-effects were used to pool the estimates, depending on the heterogeneity among the studies. RESULTS: Five cohorts and two randomized controlled trials (RCTs) with a total of 929 patients met the inclusion criteria and were included in this meta-analysis. All patients underwent sequestrectomy or microdiscectomy. Pooled estimates showed that patients treated with sequestrectomy had comparable effects in reherniation rate (RR = 1.36, 95% CI: 0.81, 2.27; P = 0.240), length of hospital stay (WMD = -0.22 days, 95% CI: -0.45, 0.01; P = 0.060), and postoperative VAS scales for leg pain (WMD = 0.53, 95% CI: -1.54, 2.60; P = 0.617) or back pain (WMD = 0.18, 95% CI: -1.64, 2.00; P = 0.846), but had a shorter duration of surgery (WMD = -6.97 minutes, 95% CI: -12.15, -1.78; P = 0.008), when compared with those treated with microdiscectomy. CONCLUSION: Based on the current evidence, sequestrectomy significantly reduced the operational time, but had similar effects on reherniation rate, length of hospital stay, and postoperative VAS scales for leg and back pains, when compared with microdiscectomy. Further well-designed randomized controlled studies are needed to identify our findings.

Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials.

BACKGROUND: Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain. METHODS: A systematic literature search was conducted to identify randomized controlled trials (RCTs) which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. RESULTS: 10 RCTs (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief. And the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores (95% CI: -4.26, -3.91), and 4.12 (95% CI: -4.35, -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% of patients in group 2 achieved significantly improved functional status. The Oswestry Disability Index in the two groups were reduced by 14.5 (95% CI: -15.24, -13.75) and 12.37 (95% CI: -16.13, -8.62), respectively. The average procedures per year in group 1 was 3.68 ± 1.17 and 3.68 ± 1.26 in group 2 with an average total relief per year of 31.67 ± 13.17 weeks and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI: -12.24, -5.38) and 16.92 mg (95% CI: -22.71, -11.12) in the two groups, respectively. CONCLUSION: This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low back and lower extremity pain.

[Relationship between hippocampal long term potentiation induction and activity of 26S proteasome].

The present study examined the changes in 26S proteasome activity and the signal molecule mechanism regulating 26S proteasome activity in long term potentiation (LTP) in rat hippocampal slices. The results are as follows: 26S proteasome activity was 190+/-14.3 cpm/(100 microg.2 h) before tetanus, a significant increase in 26S proteasome activity (273+/-18.3 cpm/(100 microg.2 h) was found 10 min after tetanus, when the slope of fEPSP was markedly increased. Interestingly, 26S proteasome activity returned to baseline level (210+/-12.8 cpm/(100 microg.2 h) 60 min after tetanus. Moreover, the N-methyl-D-aspartate (NMDA) receptor inhibitor AP-5, which blocked LTP, prevented the increase in the 26S proteasome activity. The results suggest that NMDA receptors contribute to the transient increase in 26S proteasome activity during induction of LTP in the hippocampal CA1 region.