Cross-cultural adaptation and validation of the Traditional Chinese version of the Core Outcome Measures Index in patients with low back pain.

PURPOSE: This study aimed to carry out a cross-cultural adaptation of the Core Outcome Measures Index (COMI) for use in Traditional Chinese-speaking patients with low back pain (LBP) and to investigate its psychometric properties. METHODS: A total of 224 patients with LBP > 6 weeks who visited our spine center from May 2018 to May 2019 were included in the study. Patients completed a booklet of questionnaires including the following: (1) pain Numeric Rating Scale, (2) Oswestry Disability Index, (3) Roland-Morris Disability Questionnaire, (4) EuroQol-five dimension (EQ-5D), and (5) COMI. Patients were sent a second booklet (also containing a transition question to indicate any change in condition) to be completed again within one month after the first. Fifty-two patients did not receive any intervening treatment (group 1), while the other 172 patients received medical treatment (group 2) between the two questionnaires. RESULTS: The intraclass correlation coefficient (ICC) for the COMI summary score was 0.94 (95% CI 0.89-0.97); the standard error of measurement (SEM) was 0.41 and the minimum detectable change (MDC) score was 1.14. The COMI summary scores showed a low floor effect (1.8%) and ceiling effect (0.4%). All COMI item scores demonstrated the hypothesized correlations with their corresponding full-length questionnaires except for the pain item (correlation stronger than hypothesized). Standardized response means (SRM) for the COMI items in the treated group were between 0.58 and 1.30. Regarding the ability of the COMI change score to differentiate between good and poor outcomes, the area under the receiver operating characteristic (AUROC) curve was 0.77 [standard error (SE) 0.07, 95% confidence interval (CI) 0.68-0.84] and the minimal clinically important change (MCIC) score was ≥ 1.85 points. CONCLUSION: The Traditional Chinese COMI represents a practical and reliable tool for the assessment of Traditional Chinese-speaking patients with back problems.

Uniportal Endoscopic Interlaminar Decompression in Lumbar Spinal Stenosis: A Comprehensive Review.

BACKGROUND: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating variety lumbar spinal disorders. There is still much work to be done in overcoming the technical challenges and explicate relative advantages of endoscopic techniques in lumbar spine surgery. In this comprehensive literature review, we discuss the history, indications, contraindications, surgical techniques, learning curves, technical tips, adverse events, and examine peer-reviewed studies addressing uniportal endoscopic interlaminar decompression in lumbar spinal surgery. METHODS: This literature review was conducted with keywords "endoscopic," "minimally invasive," "uniportal endoscopic decompression," "interlaminar decompression," and "lumbar spinal surgery" using PubMed, Embase, ClinicalKey, and Google Scholar. RESULTS: Review of 423 patients who underwent uniportal endoscopic interlaminar lumbar decompression showed satisfying results with 82% of patients no longer having leg pain, and 13% of patients having only occasional pain, with no significant operation-related deterioration in leg or back pain. To compare the outcomes between endoscopic and microscopic technique, a comparative review of 192 lumbar lateral recess stenosis patients demonstrated the uniportal endoscopic group had 29% shorter operation duration, 1.2% fewer perioperative complications, and significantly reduced postoperative pain (visual analog scale) over 5 days, and reduced use of pain medications. Multiple retrospective studies echoed the outcomes of endoscopic decompression surgery, showed shorter hospitalization time, lower mean dural expansion, lower increment of horizontal displacement measured, and less elevated levels of postoperative serum CPK (creatine phosphokinase) and CRP (c-reactive protein). Lastly, a systematic review and meta-analysis that enrolled 994 patients found that patients who received the full-endoscopic decompression technique showed statistically lower levels of back pain and leg pain and a 40% lower chance of having complications compared with those receiving microscopic decompression in lumbar stenosis. CONCLUSIONS: Based on our literature review, there are multiple positive outcomes with endoscopic interlaminar lumbar decompression, which reduces operation duration, perioperative complications, and better postoperative outcomes. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field.

A comparison of methods for estimating quadratic effects in nonlinear structural equation models.

Two Monte Carlo simulations were performed to compare methods for estimating and testing hypotheses of quadratic effects in latent variable regression models. The methods considered in the current study were (a) a 2-stage moderated regression approach using latent variable scores, (b) an unconstrained product indicator approach, (c) a latent moderated structural equation method, (d) a fully Bayesian approach, and (e) marginal maximum likelihood estimation. Of the 5 estimation methods, it was found that overall the methods based on maximum likelihood estimation and the Bayesian approach performed best in terms of bias, root-mean-square error, standard error ratios, power, and Type I error control, although key differences were observed. Similarities as well as disparities among methods are highlight and general recommendations articulated. As a point of comparison, all 5 approaches were fit to a reparameterized version of the latent quadratic model to educational reading data.

Expression of Bcl-2 family modulated through p53-dependent pathway in human hepatocellular carcinoma.

The biological behavior of hepatocellular carcinoma (HCC) is, in part, relevant to apoptosis. A systematic investigation of the apoptosis-related Bcl-2 family modulated by p53 in HCC is lacking. A total of 22 HCC patients were studied. The expression of p53 protein in HCC was assessed using the immunohistochemical method, which categorized the HCC patients into two groups: group 1, with immunonegative p53 (N = 7); and group 2, with immunopositive p53 (N = 15). The expression of p53, p21, Bcl-2, Bax, Bcl-xL, and Bcl-xS in the 22 HCC cases detected by western bioting was quantified with a densitometer. The apoptosis of the 22 HCC cases was determined by terminal deoxynucleotidyltransferase-mediated UTP end-labeling (TUNEL). We found that Bcl-2 was remarkably up-regulated in group 2 (14 of 15), but was down-regulated in group 1 (5 of 7). Bax was up-regulated in both group 1 (6 of 7) and group 2 (13 of 15). Bcl-xL was up-regulated in both group 1 (5 of 7) and group 2 (9 of 15). Bcl-xS was remarkably down-regulated in group 2 (14 of 15) compared to group 1 (4 of 7). The apoptosis indexes of groups 1 and 2 were 0.82 +/- 0.26% and 0.33 +/- 0.17%, respectively (P = 0.023). The long-term survival of group 1 was superior to that of group 2 (log-rank test, P = 0.001). In conclusion, Bcl-2 and Bcl-xS represented the most significant anti- and proapoptotic proteins, respectively, modulated through a p53-dependent pathway in HCC.