SonoTransformers: Transformable acoustically activated wireless microscale machines.

Shape transformation, a key mechanism for organismal survival and adaptation, has gained importance in developing synthetic shape-shifting systems with diverse applications ranging from robotics to bioengineering. However, designing and controlling microscale shape-shifting materials remains a fundamental challenge in various actuation modalities. As materials and structures are scaled down to the microscale, they often exhibit size-dependent characteristics, and the underlying physical mechanisms can be significantly affected or rendered ineffective. Additionally, surface forces such as van der Waals forces and electrostatic forces become dominant at the microscale, resulting in stiction and adhesion between small structures, making them fracture and more difficult to deform. Furthermore, despite various actuation approaches, acoustics have received limited attention despite their potential advantages. Here, we introduce "SonoTransformer," the acoustically activated micromachine that delivers shape transformability using preprogrammed soft hinges with different stiffnesses. When exposed to an acoustic field, these hinges concentrate sound energy through intensified oscillation and provide the necessary force and torque for the transformation of the entire micromachine within milliseconds. We have created machine designs to predetermine the folding state, enabling precise programming and customization of the acoustic transformation. Additionally, we have shown selective shape transformable microrobots by adjusting acoustic power, realizing high degrees of control and functional versatility. Our findings open new research avenues in acoustics, physics, and soft matter, offering new design paradigms and development opportunities in robotics, metamaterials, adaptive optics, flexible electronics, and microtechnology.

Defect-Induced All-Solid-State Frustrated Lewis Pair on Metal-Organic Monolayer Accelerating Photocatalytic CO2 Reduction with H2O Vapor.

Understanding the structure-performance relationships of a frustrated Lewis pair (FLP) at the atomic level is key to yielding high efficiency in activating chemically "inert" molecules into value-added products. A sound strategy was developed herein through incorporating oxygen defects into a Zr-based metal-organic layer (Zr-MOL-D) and employing Lewis basic proximal surface hydroxyls for the in situ formation of solid heterogeneous FLP (Zr4-δ-VO-Zr-OH). Zr-MOL-D exhibits a superior CO2 to CO conversion rate of 49.4 µmol g-1 h-1 in water vapor without any sacrificing agent or photosensitizer, which is about 12 times higher than that of pure MOL (Zr-MOL-P), with extreme stability even after being placed for half a year. Theoretical and experimental results reveal that the introduction of FLP converts the process of the crucial intermediate COOH* from an endothermic reaction to an exothermic spontaneous reaction. This work is expected to provide new prospects for developing efficient MOL-based photocatalysts in FLP chemistry through a sound defect-engineering strategy.

Phase Engineering of Zirconium MOFs Enables Efficient Osmotic Energy Conversion: Structural Evolution Unveiled by Direct Imaging.

Creating structural defects in a controlled manner within metal-organic frameworks (MOFs) poses a significant challenge for synthesis, and concurrently, identifying the types and distributions of these defects is also a formidable task for characterization. In this study, we demonstrate that by employing 2-sulfonylterephthalic acid as the ligand for synthesizing Zr (or Hf)-based MOFs, a crystal phase transformation from the common fcu topology to the rare jmt topology can be easily facilitated using a straightforward mixed-solvent strategy. The jmt phase, characterized by an extensively open framework, can be considered a derivative of the fcu phase, generated through the introduction of missing-cluster defects. We have explicitly identified both MOF phases, their intermediate states, and the novel core-shell structures they form using ultralow-dose high-resolution transmission electron microscopy. In addition to facilitating phase engineering, the incorporation of sulfonic groups in MOFs imparts ionic selectivity, making them applicable for osmotic energy harvesting through mixed matrix membrane fabrication. The membrane containing the jmt-phase MOF exhibits an exceptionally high peak power density of 10.08 W m-2 under a 50-fold salinity gradient (NaCl: 0.5 M|0.01 M), which surpasses the threshold of 5 W m-2 for commercial applications and can be attributed to the combination of large pore size, extensive porosity, and abundant sulfonic groups in this novel MOF material.

Immune modulation in malignant pleural effusion: from microenvironment to therapeutic implications.

Immune microenvironment and immunotherapy have become the focus and frontier of tumor research, and the immune checkpoint inhibitors has provided novel strategies for tumor treatment. Malignant pleural effusion (MPE) is a common end-stage manifestation of lung cancer, malignant pleural mesothelioma and other thoracic malignancies, which is invasive and often accompanied by poor prognosis, affecting the quality of life of affected patients. Currently, clinical therapy for MPE is limited to pleural puncture, pleural fixation, catheter drainage, and other palliative therapies. Immunization is a new direction for rehabilitation and treatment of MPE. The effusion caused by cancer cells establishes its own immune microenvironment during its formation. Immune cells, cytokines, signal pathways of microenvironment affect the MPE progress and prognosis of patients. The interaction between them have been proved. The relevant studies were obtained through a systematic search of PubMed database according to keywords search method. Then through screening and sorting and reading full-text, 300 literatures were screened out. Exclude irrelevant and poor quality articles, 238 literatures were cited in the references. In this study, the mechanism of immune microenvironment affecting malignant pleural effusion was discussed from the perspectives of adaptive immune cells, innate immune cells, cytokines and molecular targets. Meanwhile, this study focused on the clinical value of microenvironmental components in the immunotherapy and prognosis of malignant pleural effusion.

A novel measure to summarize blood transfusion practice during critical illness.

BACKGROUND: Large-scale observational studies have summarized transfusion practice using traditional measures of central tendency (e.g., the mean hemoglobin concentration at the time of transfusion). However, the mean hemoglobin concentration fails to identify specific hemoglobin concentration thresholds that drive practice. In the following brief report, we propose a novel measure of "practice discontinuity" that identifies specific practice-defining hemoglobin thresholds. STUDY DESIGN AND METHODS: We used the PINC AI Database (2016-2022) to identify adult patients admitted to an intensive care unit with at least one hemoglobin concentration measurement. For each day that hemoglobin was measured, we identified whether the patient received a red blood cell transfusion using hospital charge codes. We defined the "practice discontinuity" measure as the hemoglobin concentration at which there was the largest increase in transfusion use going from a higher to an incrementally lower hemoglobin concentration. We also calculated the mean and median pretransfusion hemoglobin concentrations. RESULTS: We identified 1,298,367 patients and 4,905,839 patient-days for inclusion. RBC transfusion occurred in a total of 530,654 (10.8%) patient-days. The overall pre-transfusion mean and median hemoglobin concentrations were 8.4 and 8.0 g/dL, respectively. The practice discontinuity measure identified 7.0 g/dL as the hemoglobin concentration at which transfusion use increased the most, from 46.6% of patient-days at a concentration of 7.0 g/dL to 74.8% of patient-days at a concentration of 6.9 g/dL. DISCUSSION: We propose that future studies of red blood cell transfusion practice consider inclusion of the practice discontinuity measure to more fully summarize clinical practice.

Ba3Lu(BO3)3:Ce3+,Tb3+/Mn2+: Dual-Functional Material for WLEDs and Optical Pressure Sensing.

Ba3Lu(BO3)3(BLB):Ce3+,Tb3+/Mn2+ phosphors were designed to explore effective and multifunctional applications. Under the excitation of near-ultraviolet (n-UV) light, the BLB:Ce3+ phosphor showed broad-band blue emission. After codoping with Mn2+ ions, the single-phase white light phosphor is achieved through the energy transfer (ET) between Ce3+ and Mn2+. In addition, thermal stability is significantly enhanced by the addition of Tb3+ (BLB:0.02Ce3+,0.20Tb3+) compared to that codoped with Mn2+ (BLB:0.02Ce3+,0.10Mn2+). The light-emitting diode (LED) device with warm white light emission is fabricated with UV-chip-coated BLB:0.02Ce3+,0.05Tb3+ and Sr2Si5N8:Eu2+ phosphors, showing a good potential application value for LEDs. Additionally, the spectral properties of borate-based phosphors (BLB:0.02Ce3+) under high pressure were studied for the first time. Surprisingly, the change of pressure enabled the emission peak of BLB:0.02Ce3+ to be tuned from 485 to 552 nm, and dλ/dP is 3.51 nm GPa-1. The color changes from blue to yellow with an increase of pressure. Compared with the reported data, the pressure-sensing sensitivity based on the central peak shift in this work is the highest in all Ce3+ single-doped samples. In addition, the emitting color and intensity were gradually regained after decompression. The intensity can reach 80% of the initial intensity. All data demonstrate that the BLB:0.02Ce3+ phosphor has the potential to be utilized as an optical pressure sensor due to the high-pressure sensitivity and visible color tuning.

Pressure-Triggered Fluorescence Intensity Ratio Variations of YNbO4:Bi3+/Ln3+ (Ln = Eu or Sm) for High-Sensitivity Optical Pressure Sensing.

Optical pressure sensing by phosphors is a growing area of research. However, the main pressure measurement methods rely on the movement of the central peak position, which has significant drawbacks for practical applications. This paper demonstrates the feasibility of using the fluorescence intensity ratio (FIR) of different emission peaks for pressure sensing. The FIR (IBi3+/ILn3+) values of the synthesized YNbO4:Bi3+/Ln3+ (Ln = Eu or Sm) phosphors are all first-order exponentially related to pressure, and YNbO4:Bi3+/Ln3+ (Ln = Eu or Sm) phosphors have high pressure-sensing sensitivities (Sp and Spr), which are 6 times higher than those from our previously reported work. In addition, the changes in FIR values during the decompression process were also calculated, and the trend was similar to that during the compression process. The YNbO4:Bi3+,Eu3+ phosphor has better pressure recovery performance. In summary, the YNbO4:Bi3+/Ln3+ (Ln = Eu or Sm) phosphors reported in this paper are expected to be applied in the field of optical pressure sensing, and this study provides a new approach and perspective for designing new phosphors for pressure measurement.

A serial mediating effect of perceived family support on psychological well-being.

Family has a significant impact on individual mental health. Based on social support theory, family system theory and the Mental Health Continuum Short Form (MHC-SF), this research constructed a model of the pathway of perceived family support on psychological well-being and the results empirically clarified that perceived family support has a significant positive relationship with emotional well-being, social well-being, and psychological well-being (P < 0.001). Emotional well-being positively influences social well-being and psychological well-being (P < 0.001). Social well-being positively affects psychological well-being (P < 0.001). There were direct mediating effects of emotional well-being (13.45%), direct mediating effects of social well-being (32.82%) and a serial mediating effect (28.07%) between perceived family support and psychological well-being (P < 0.001).

Association of longitudinal trajectories of fasting plasma glucose with all-cause and cardiovascular mortality among a Chinese older population: a retrospective cohort study.

The association between fasting plasma glucose (FPG), an important indicator of overall glycemic status, and the risk of cardiovascular mortality has been well investigated. The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. This study aimed to identify long-term FPG trajectories and investigate the association between trajectory groups and cardiovascular and all-cause mortality. A latent class growth mixture modeling (LCGMM) was used to identify FPG trajectories. Cox proportional hazard models were used to estimate associations between FPG trajectories and the risk of all-cause and cardiovascular mortality. A U-shaped relationship between FPG and all-cause and cardiovascular mortality was observed in the restricted cubic spline regression models. Two FPG longitudinal trajectories of low-level (mean FPG = 5.12mmol/L) and high-level (mean FPG = 6.74mmol/L) were identified by LCGMM. After being adjusted for potential confounders, compared with the low-level category, the hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.23(1.16-1.30) and 1.25(1.16-1.35), respectively, for the high-level group. Long-term FPG trajectories are significantly associated with and potentially impact the risk of all-cause and cardiovascular mortality.

General Syntheses of High-Performance Thermoelectric Nanostructured Solids without Post-Synthetic Ligand Stripping.

Ligand-assisted wet chemical synthesis is a versatile methodology to produce controllable nanocrystals (NCs). The post-treatment of ligands is significant for the performance of functional devices. Herein, a method that retains ligands of colloidal-synthesized nanomaterials to produce thermoelectric nanomaterials is proposed, which differs from the conventional methods that strip ligands using multistep cumbersome processes. The ligand-retention method can control the size and dispersity of nanocrystals during the consolidation of the NCs into dense pellets, in which retained ligands are transformed into organic carbon within the inorganic matrices, establishing clear organic-inorganic interfaces. Characterizations of the nonstripped and stripped samples confirm that this strategy can affect electric transport slightly but reduce the thermal conductivity largely. As a result, the materials (e.g., SnSe, Cu2-xS, AgBiSe2, and Cu2ZnSnSe4) with ligands retained achieve higher peak zT and better mechanical properties. This method can be applied to other colloidal thermoelectric NCs and functional materials.

Covalent Organic Framework with Multiple Redox Active Sites for High-Performance Aqueous Calcium Ion Batteries.

Organic materials are promising for cation storage in calcium ion batteries (CIBs). However, the high solubility of organic materials in an electrolyte and low electronic conductivity remain the key challenges for high-performance CIBs. Herein, a nitrogen-rich covalent organic framework with multiple carbonyls (TB-COF) is designed as an aqueous anode to address those obstacles. TB-COF demonstrates a high reversible capacity of 253 mAh g-1 at 1.0 A g-1 and long cycle life (0.01% capacity decay per cycle at 5 A g-1 after 3000 cycles). The redox mechanism of Ca2+/H+ co-intercalated in COF and chelating with C═O and C═N active sites is validated. In addition, a novel C═C active site was identified for Ca2+ ion storage. Both computational and empirical results reveal that per TB-COF repetitive unit, up to nine Ca2+ ions are stored after three staggered intercalation steps, involving three distinct Ca2+ ion storage sites. Finally, the evolution process of radical intermediates further elucidates the C═C reaction mechanism.

Topological Insulator Bi2 Se3 -Assisted Heterostructure for Ultrafast Charging Sodium-Ion Batteries.

The development of fast charging materials offers a viable solution for large-scale and sustainable energy storage needs. However, it remains a critical challenge to improve the electrical and ionic conductivity for better performance. Topological insulator (TI), a topological quantum material that has attracted worldwide attention, hosts unusual metallic surface states and consequent high carrier mobility. Nevertheless, its potential in promising high-rate charging capability has not been fully realized and explored. Herein, a novel Bi2 Se3 -ZnSe heterostructure as excellent fast charging material for Na+ storage is reported. Ultrathin Bi2 Se3 nanoplates with rich TI metallic surfaces are introduced as an electronic platform inside the material, which greatly reduces the charge transfer resistance and improves the overall electrical conductivity. Meanwhile, the abundant crystalline interfaces between these two selenides promote Na+ migration and provide additional active sites as well. As expected, the composite delivers the excellent high-rate performance of 360.5 mAh g-1 at 20 A g-1 and maintains its electrochemical stability of 318.4 mAh g-1 after 3000 long cycles, which is the record high for all reported selenide-based anodes. This work is anticipated to provide alternative strategies for further exploration of topological insulators and advanced heterostructures.

A spatial attention guided deep learning system for prediction of pathological complete response using breast cancer histopathology images.

MOTIVATION: Predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients accurately is direly needed for clinical decision making. pCR is also regarded as a strong predictor of overall survival. In this work, we propose a deep learning system to predict pCR to NAC based on serial pathology images stained with hematoxylin and eosin and two immunohistochemical biomarkers (Ki67 and PHH3). To support human prior domain knowledge-based guidance and enhance interpretability of the deep learning system, we introduce a human knowledge-derived spatial attention mechanism to inform deep learning models of informative tissue areas of interest. For each patient, three serial breast tumor tissue sections from biopsy blocks were sectioned, stained in three different stains and integrated. The resulting comprehensive attention information from the image triplets is used to guide our prediction system for prognostic tissue regions. RESULTS: The experimental dataset consists of 26 419 pathology image patches of 1000×1000 pixels from 73 TNBC patients treated with NAC. Image patches from randomly selected 43 patients are used as a training dataset and images patches from the rest 30 are used as a testing dataset. By the maximum voting from patch-level results, our proposed model achieves a 93% patient-level accuracy, outperforming baselines and other state-of-the-art systems, suggesting its high potential for clinical decision making. AVAILABILITY AND IMPLEMENTATION: The codes, the documentation and example data are available on an open source at: https://github.com/jkonglab/PCR_Prediction_Serial_WSIs_biomarkers. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Inhibition of hexokinase 2 with 3-BrPA promotes MDSCs differentiation and immunosuppressive function.

The adoptive transfer of ex vivo generated myeloid-derived suppressor cells (MDSCs) may be a promising therapeutic strategy for preventing allograft rejection after solid organ transplantation. Currently, the precise role of immune-metabolic pathways in the differentiation and function of MDSCs is not fully understood. Hexokinase 2 (HK2) is an isoform of hexokinase and is a key enzyme involved in the increased aerobic glycolysis of different immune cells during their activation and function. Here, we demonstrate that the addition of HK2 inhibitor 3-Bromopyruvic acid (3-BrPA) into traditional MDSCs induction system in vitro significantly promoted MDSCs production and enhanced their immunosuppressive function. Treatment with 3-BrPA increased the expression of MDSC-related immunosuppressive molecules, such as iNOS, Arg1, and CXCR2. Moreover, the adoptive transfer of 3-BrPA-treated MDSCs significantly prolonged the survival time of mouse heart allografts. This study provides a novel strategy to solve the problems of harvesting enough autologous cells for MDSC production from sick patients, and producing functionally enhanced MDSCs for preventing graft rejection and inducing tolerance.

Biology and Roles in Diseases of Selenoprotein I Characterized by Ethanolamine Phosphotransferase Activity and Antioxidant Potential.

Selenoprotein I (SELENOI) has been demonstrated to be an ethanolamine phosphotransferase (EPT) characterized by a nonselenoenzymatic domain and to be involved in the main synthetic branch of phosphatidylethanolamine (PE) in the endoplasmic reticulum. Therefore, defects of SELENOI may affect the health status through the multiple functions of PE. On the other hand, selenium (Se) is covalently incorporated into SELENOI as selenocysteine (Sec) in its peptide, which forms a Sec-centered domain as in the other members of the selenoprotein family. Unlike other selenoproteins, Sec-containing SELENOI was formed at a later stage of animal evolution, and the high conservation of the structural domain for PE synthesis across a wide range of species suggests the importance of EPT activity in supporting the survival and evolution of organisms. A variety of factors, such as species characteristics (age and sex), diet and nutrition (dietary Se and fat intakes), SELENOI-specific properties (tissue distribution and rank in the selenoproteome), etc., synergistically regulate the expression of SELENOI in a tentatively unclear interaction. The N- and C-terminal domains confer 2 distinct biochemical functions to SELENOI, namely PE regulation and antioxidant potential, which may allow it to be involved in numerous physiological processes, including neurological diseases (especially hereditary spastic paraplegia), T cell activation, tumorigenesis, and adipocyte differentiation. In this review, we summarize advances in the biology and roles of SELENOI, shedding light on the precise regulation of SELENOI expression and PE homeostasis by dietary Se intake and pharmaceutical or transgenic approaches to modulate the corresponding pathological status.

Access to N-Alkylazaheterocyclic Salts by Activation of Alkoxy C-O Bonds in Polyol Esters.

A wide variety of N-alkylazaheterocyclic salts are conveniently synthesized from polyol esters and azaheterocyclic salts under solventless conditions. In particular, paraquat-like derivatives showed comparable herbicidal activity toward several common weeds. Mechanistic studies suggest that polyesters likely underwent partial hydrolysis and neighboring group participating dehydration under the action of acidic salt to generate five-membered ring intermediates, which reacted with the azaheterocycle to accomplish the N-alkylation.

Eu2+-Doped Ca4Y3Si7O15N5 Phosphor with High Thermal Stability and Pressure Sensitivity for Dual-Functional Applications in W-LEDs and Pressure Sensors.

A novel green-light-emitting silicon-based oxynitride phosphor Ca4Y3Si7O15N5:Eu2+ with low thermal quenching and ideal pressure sensitivity is reported. The Ca3.99Y3Si7O15N5:0.01Eu2+ phosphor can be efficiently excited by 345 nm ultraviolet light and shows very low thermal quenching (integrated and peak emission intensities at 373 and 423 K were 96.17, 95.86, and 92.73, 90.66% of those at 298 K, respectively). The correlation between high thermal stability and structural rigidity is investigated in detail. The white-light-emitting diode (W-LED) is assembled by depositing the obtained green-light-emitting phosphor Ca3.99Y3Si7O15N5:0.01Eu2+ and commercial phosphors on a ultraviolet (UV)-emitting chip (λ = 365 nm). The CIE color coordinates, color rendering index (Ra), and corrected color temperature (CCT) of the obtained W-LED are (0.3724, 0.4156), 92.9, and 4806 K, respectively. In addition, when subjected to in situ high-pressure fluorescence spectroscopy, the phosphor exhibits an evident red shift of 40 nm with an increase in pressure from 0.2 to 32.1 GPa. The phosphor has the advantage of high-pressure sensitivity (dλ/dP = 1.13 nm GPa-1) and visualization with pressure changes. The possible reasons and mechanisms are deeply discussed in detail. Based on the above advantages, Ca3.99Y3Si7O15N5:0.01Eu2+ phosphor is expected to have potential applications in W-LEDs and optical pressure sensing.

Relationship between obesity indicators and hypertension-diabetes comorbidity in an elderly population: a retrospective cohort study.

BACKGROUND: The prevalence of obesity, hypertension and diabetes is increasing. Hypertension and diabetes are common complications. Additionally, obesity and hypertension-diabetes comorbidity (HDC) are both closely related to insulin resistance. The aim of this study was to determine the association of obesity indicators with HDC in elderly individuals. METHODS: This retrospective cohort study included 74,955 subjects aged ≥ 60 years living in Xinzheng, Henan Province, from January 2011 to December 2019. The data were collected from the annual health examination dataset. Cox proportional hazard regression models and competing-risk survival regression models were used to examine the relationships between the three indicators and HDC risk. RESULTS: After 346,504 person-years of follow-up, HDC developed in 9,647 subjects. After further adjustments for confounders and death competing risks, compared with a body mass index (BMI) of 18.5-23.9 kg/m2, the fully adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of BMI < 18.5, 24-27.9 and ≥ 28 kg/m2 for HDC morbidity were 0.651(0.538,0.788),1.00,1.396(1.336,1.459) and 1.769(1.666,1.878), respectively. Moreover, participants with abdominal obesity measured via waist circumference (WC) or waist-to-height ratio (WtHR) had a higher risk of HDC (HR:1.513; 95% CI: 1.45,1.578 and HR:1.412;95% CI: 1.353,1.473), respectively, than participants with low WC or with low WtHR. In the joint analyses, the highest risk was observed in participants who were overweight and who had central obesity (HR: 1.721; 95% CI: 1.635, 1.811) compared with the nonoverweight and noncentral obesity groups. CONCLUSIONS: Increased BMI, WC and WtHR were associated with an increased risk of HDC. There was an additive interaction between general body adiposity (as measured via BMI) and central obesity (as measured via WC and WtHR) for HDC. Therefore, reasonable control of BMI, WC and WtHR may be an effective measure to prevent HDC among elderly individuals.

Proliferative glomerulonephritis with monoclonal IgG Lambda deposits caused by plasmablastic lymphoma: a case report.

INTRODUCTION: As a very rare form of B-cell lymphoma, plasmablastic lymphoma (PBL) typically occurs in patients with underlying immunosuppression, including human immunodeficiency virus (HIV), organ transplantation, and autoimmune diseases. For HIV-positive patients, PBL normally originates in the gastrointestinal tract, especially from the oral cavity in most cases. It is extremely rare to find abdominal cavity involvement in PBL, and there has been no previously reported instance of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) attributed to monoclonal IgG (MIgG) lambda secreted by PBL. CASE PRESENTATION: We report the case of an HIV-negative female with nephrotic syndrome, renal insufficiency, and multiple swollen lymph nodes. Ascitic fluid cytology revealed a high level of plasmablast-like lymphocytes with the restriction of lambda light chains. Besides, the renal biopsy revealed PGNMID, which could presumably be secondary to MIgG-lambda-secreting by PBL. MIgG-lambda-restricted expression was discovered earlier in the kidney tissue than in the blood. CONCLUSION: The diagnostic landscape for PBL is notoriously intricate, necessitating a multifaceted and nuanced approach to mitigate the risks of erroneous identification.

Influence of the deviated center of rotation on the range of motion after cervical disc arthroplasty -an in vivo study with a minimum of 10-year follow-up.

BACKGROUND: Short-term researches have studied the change of the center of rotation (COR) after the Bryan Cervical disc arthroplasty (CDA). But there is a lack of long-term studies focusing on the location of COR and its influence after surgery. METHODS: Clinical and radiographic materials of patients who received CDA were retrospectively reviewed. Written informed consents were obtained. Clinical outcome was accessed by Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and Odom's scale. Radiographic evaluation underwent before surgery, at early (3 months) follow-up and final (minimal 10 years) follow-up. The ROM of the global cervical spine and index level, the functional spine unit (FSU) angle and C2-C7 angle were measured. COR was identified and its coordinates were calculated. The absolute change of COR-x and COR-y were compared in subgroup analysis. RESULTS: Sixty patients were included, with an average age of 55.9 ± 8.1 years old. The mean duration of follow up was 135.1 ± 16.1 (120-155) months. JOA, NDI and Odom's scale showed significant improvements at 10 years after surgery. The COR of index level was located in the posterior superior half of the caudal vertebral body. Following the implant of Bryan Disc, the COR shifted forward and downward. During the 10-year follow-up, the location of COR remained stable. ROM at the index level decreased from 10.6 ± 4.0° preoperatively to 9.3 ± 4.0° at the early follow-up (p = 0.03). The ROM at the index level remained unchanged from early follow-up to the final follow-up (9.3 ± 4.0° vs 9.5 ± 5.2°, p = 0.80). In subgroup analysis, larger changes of both COR-x and COR-y were related with decreased ROM. CONCLUSIONS: Our study illustrated that Bryan CDA could achieved favorable clinical and radiographic outcome over a minimal 10-year follow-up. The reduction of the flexion-extension ROM may be correlated with a more deviated postoperative COR. More attention should be paid to preoperative design and intraoperative technique to obtain a more native COR.