Anterior Full-endoscopic Single-port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two-segment Cervical Spondylotic Myelopathy: A Technical Note.

OBJECTIVE: In clinical practice, noncontinuous two-segment spinal cord cervical spondylosis is a particular form of cervical degenerative disease. Traditional anterior open surgery frequently comes with severe trauma, risks, and debatable treatment options. This study aimed to describe for the first time a novel minimally invasive technique, namely, anterior full-endoscopic single-port double transcorporeal spinal cord decompression for the treatment of patients with noncontinuous two-segment cervical spondylotic myelopathy. METHOD: From February 2020 to May 2021, five patients with noncontinuous two-segment cervical spondylotic myelopathy were treated with anterior full-endoscopic single-port double transcorporeal spinal cord decompression. Two bone channels were established by the trephine through the vertebral body oblique upward and downward to the herniated disc osteophyte complex, and the full-endoscopic system could decompress the spinal cord through the channels. All cases were followed up for over 2 years. The modified Japanese Orthopaedic Association (mJOA) score and visual analogue scale (VAS) score before and after operation and during follow-up were used to evaluate the clinical effectiveness. Radiological examinations, including CT and MRI, were utilized to evaluate the efficacy of spinal cord decompression and bone channel repair. RESULTS: All operations were successfully completed and the average operation time was 185 min, with no operation-related complications. Compared with the preoperative evaluation, the mJOA score and VAS score were improved at each time point after operation and follow-up. Postoperative CT and MRI scans showed that the intervertebral disc-osteophyte complex was removed through the vertebral bone passage, and the spinal cord was fully decompressed. After 24 months of follow-up, CT and MRI scans showed that the bone channel was almost repaired and healed. CONCLUSION: Anterior full-endoscopic single-port double transcorporeal spinal cord decompression is an effective minimally invasive technique for noncontinuous two-segment cervical spondylosis. It provides precise and satisfactory spinal cord decompression under endoscopic visualization with minimum trauma.

Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels for adjacent two-segment cervical spondylotic myelopathy: a technical note.

BACKGROUND: The current treatments for adjacent two-segment cervical spondylotic myelopathy (CSM) include two-segment anterior cervical discectomy and fusion (ACDF) and single-segment anterior cervical corpectomy and fusion (ACCF). Long-term follow-up has demonstrated that both procedures have complications such as reduced cervical mobility, accelerated degeneration of adjacent segments and loosening of internal fixation screws. The purpose of this study is to demonstrate the feasibility, safety, and efficacy of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels for the treatment of adjacent two-segment CSM and to present our surgical experience. METHODS: Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels was performed for 12 patients with adjacent two-segment CSM with follow-up care for at least 12 months. The Visual analog scale (VAS) and the Japanese Orthopedic Association Score (JOA) were recorded, and modified Macnab criteria were used to evaluate the treatment excellence rate. Radiological examinations, including X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), were used to evaluate spinal cord decompression, intervertebral stability and healing of the bony channel. RESULTS: All 12 patients completed the operation successfully. No postoperative complications, such as dysphagia, Horner's syndrome, or laryngeal recurrent nerve palsy, were found. The postoperative VAS and JOA scores were significantly improved compared with those before surgery(P < 0.001). According to the modified Macnab criteria, the clinical outcome was excellent in 8 cases, good in 3 cases and fine in 1 case at the final follow-up and the excellent and good rate was 91.7%. Postoperative and follow-up imaging showed significant spinal cord decompression, well-healed bony channels and no cervical instability. CONCLUSIONS: This study is the first report of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels. This procedure has the advantages of less trauma, faster recovery, fewer complications and no need to implant internal fixators. This is a minimally invasive, feasible and safe surgical procedure for patients with adjacent two-segment CSM.

DPDH-CapNet: A Novel Lightweight Capsule Network with Non-routing for COVID-19 Diagnosis Using X-ray Images.

COVID-19 has claimed millions of lives since its outbreak in December 2019, and the damage continues, so it is urgent to develop new technologies to aid its diagnosis. However, the state-of-the-art deep learning methods often rely on large-scale labeled data, limiting their clinical application in COVID-19 identification. Recently, capsule networks have achieved highly competitive performance for COVID-19 detection, but they require expensive routing computation or traditional matrix multiplication to deal with the capsule dimensional entanglement. A more lightweight capsule network is developed to effectively address these problems, namely DPDH-CapNet, which aims to enhance the technology of automated diagnosis for COVID-19 chest X-ray images. It adopts depthwise convolution (D), point convolution (P), and dilated convolution (D) to construct a new feature extractor, thus successfully capturing the local and global dependencies of COVID-19 pathological features. Simultaneously, it constructs the classification layer by homogeneous (H) vector capsules with an adaptive, non-iterative, and non-routing mechanism. We conduct experiments on two publicly available combined datasets, including normal, pneumonia, and COVID-19 images. With a limited number of samples, the parameters of the proposed model are reduced by 9x compared to the state-of-the-art capsule network. Moreover, our model has faster convergence speed and better generalization, and its accuracy, precision, recall, and F-measure are improved to 97.99%, 98.05%, 98.02%, and 98.03%, respectively. In addition, experimental results demonstrate that, contrary to the transfer learning method, the proposed model does not require pre-training and a large number of training samples.

Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation.

BACKGROUND: Disc herniation (DH) is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus. It is a common cause of lumbar and leg pains. Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis, imaging, and treatment of this condition. Total endoscopic discectomy is an alternative surgical technique that is less invasive. AIM: To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients. METHODS: This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021. All patients were randomly divided into the following two groups: The observation group, comprising 62 patients who underwent surgery using the interlaminar approach, and the control group, comprising 58 patients who were operated through the foramina approach. The treatment effects, perioperative indicators, functional recovery, pain, and quality of life were compared between the two groups. RESULTS: The treatment effect in the observation group (93.55%) was significantly better than that in the control group (77.59%). There was no difference in the operative time and intraoperative blood loss amount between the two groups (P > 0.05). The hospitalization time of the observation group (4.34 ± 1.33 d) was significantly shorter than that of the control group (5.38 ± 1.57 days) (P < 0.05). The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment, but the scores were lower in the observation group than in the control group. The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment, but scores were lower in the observation group (2.18 ± 0.88 in the lower back and 1.42 ± 0.50 in the leg) than in the control group (3.53 ± 0.50 in the lower back and 2.21 ± 0.52 in the leg). A short form of the Arthritis Impact Measurement Scales 2 measurement scale (AIMS2-SF) score and Barthel index of the lower back of the two groups increased significantly after treatment, with the observation group having a significantly higher AIMS2-SF score (95.16 ± 1.74) and Barthel index (97.29 ± 1.75) than the control group (84.95 ± 2.14 and 89.16 ± 2.71, respectively) (P < 0.05). CONCLUSION: Through total endoscopic discectomy with the interlaminar approach, the degree of pain in the waist and leg was reduced, and the lumbar function considerably recovered.

SnS@C nanoparticles anchored on graphene oxide as high-performance anode materials for lithium-ion batteries.

Tin (II) sulfide (SnS) has been regarded as an attractive anode material for lithium-ion batteries (LIBs) owing to its high theoretical capacity. However, sulfide undergoes significant volume change during lithiation/delithiation, leading to rapid capacity degradation, which severely hinders its further practical application in lithium-ion batteries. Here, we report a simple and effective method for the synthesis of SnS@C/G composites, where SnS@C nanoparticles are strongly coupled onto the graphene oxide nanosheets through dopamine-derived carbon species. In such a designed architecture, the SnS@C/G composites show various advantages including buffering the volume expansion of Sn, suppressing the coarsening of Sn, and dissolving Li2S during the cyclic lithiation/delithiation process by graphene oxide and N-doped carbon. As a result, the SnS@C/G composite exhibits outstanding rate performance as an anode material for lithium-ion batteries with a capacity of up to 434 mAh g-1 at a current density of 5.0 A g-1 and excellent cycle stability with a capacity retention of 839 mAh g-1 at 1.0 A g-1 after 450 cycles.

Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures.

BACKGROUND: Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. METHODS: From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. RESULTS: The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. CONCLUSION: The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

Treatment of L5 - S1 intervertebral disc herniation with posterior percutaneous full-endoscopic discectomy by grafting tubes at various positions via an interlaminar approach.

BACKGROUND: Depending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique. Achieving good clinical therapeutic efficacy through the natural gap of bones can maximally avoid related access complications, and the necessary techniques and relevant anatomical factors were analyzed. METHODS: Between August 2012 and August 2014, 98 patients with L5 - S1 intervertebral disc herniation were treated with posterior percutaneous full-endoscopic discectomy (PPFED) by grafting tubes at various positions via the interlaminar approach. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to assess the patients' back and leg pain and the improvements in daily function, and the modified Macnab standard was used to evaluate the treatment efficacy. RESULTS: All 98 patients successfully completed the surgery, 84 patients got out of bed and walked on the first postoperative day, and 14 patients got out of bed and walked on the second postoperative day. The preoperative ODI (56.032 ± 3.625) was significantly higher than the ODI score (8.147 ± 1.398) (F = 5343.054, P ≤ 0.001) 48 months after surgery. The preoperative VAS score (7.193 ± 0.875) was significantly higher than the postoperative VAS score (0.914 ± 0.500 points) (F = 1656.173, P ≤ 0.001). The differences in ODI and VAS scores before and after surgery were statistically significant (P < 0.05). Follow-up was conducted 1, 6, 12 and 48 months postoperatively, and the modified Macnab standard was used during the last follow-up to evaluate the efficacy: 67 cases were excellent, 20 cases were good, 7 cases were fair, and 0 cases were poor; the proportion of excellent and good cases was 92.6%. CONCLUSIONS: The treatment of L5 - S1 intervertebral disc herniation with PPFED by grafting tubes at various positions via an interlaminar approach is a safe, effective, and minimally invasive surgical method. Reaching the location of a disc herniation directly through the natural gap in the bones can maximally avoid collateral injury from spine surgery. TRIAL REGISTRATION: The registration number of this clinical study is ChiCTR1800014588; it has been retrospectively registered with a registration date of 05/01/2018.

The Bidirectional Interactions Between Inflammation and Coagulation in Fracture Hematoma.

IMPACT STATEMENT: The review leads to better understanding of the interrelation between inflammation mediators and coagulation factors in the early fracture hematoma, and their influences on hematoma formation in the beginning of fracture healing. Furthermore, development of therapies aimed at simultaneous modulation of both coagulation factors and inflammation factors that affect hematoma structure, rather than specific factors, may be most promising.

Percutaneous Total Endoscopic Resection of Partial Articular Processes for Treatment of Lateral Crypt Stenosis and Lumbar Spinal Stenosis: Technical Report and Efficacy Analysis.

OBJECTIVE: To observe the clinical curative effect of posterior total endoscopic precision decompression for the treatment of single-segment lateral crypt lumbar spinal stenosis (LSS). METHOD: A total of 27 patients with single-segment LSS satisfying the inclusion criteria were recruited from July 2013 to September 2015. There were 18 cases of unilateral stenosis of the L4-5 segments and 9 cases of unilateral stenosis of the L5-S1 segment. All patients were treated via the posterior approach with the precise lateral crypt decompression technique. Precise decompression was performed on the narrow areas causing clinical symptoms. Clinical efficacy was assessed at 3 days, 3 months, 6 months, and 2 years after surgery. Low-back pain and sciatic nerve pain assessed by visual analog scale (VAS) score and the functional Oswestry Disability Index (ODI) were used to evaluate lumbar function, and modified MacNab score criteria were used to investigate long-term efficacy. RESULT: All patients completed the operation successfully, and the follow-up time was 2 years. The VAS score of lumbago was lower after than before surgery (preoperative: 6.96±0.90; postoperative: 2.04±1.02, P<0.05). The VAS score of sciatica was also lower after than before surgery (preoperative: 7.19±0.88, postoperative: 1.93±0.92, P<0.05), and the ODI was improved at the last follow-up (29.62±4.26) % compared with before surgery (80.07±3.98) %. The MacNab efficacy evaluation showed improvement at the end of the follow-up period: 20 cases were excellent, 6 cases were good, and 1 case was satisfactory, with a good/excellent rate of 96%. No surgical site infections, iatrogenic nerve root injuries, epidural hematomas, or other complications occurred. CONCLUSION: Total endoscopic decompression of posterior facet arthrodesis for the treatment of single-segment lateral crypt LSS has the advantages of safety, reduced recurrence and trauma, and a satisfactory curative effect. This trial is registered with ChiCTR1800015628.

[Decompression by mini-open posterior approach assisted with microscope for thoracolumbar burst fracture with severe spinal canal stenosis].

Objective: To investigate the effectiveness of posterior microscopic mini-open technique (MOT) decompression in patients with severe spinal canal stenosis resulting from thoracolumbar burst fractures. Methods: The clinical data of 28 patients with severe spinal canal stenosis caused by thoracolumbar burst fractures, who were treated by posterior microscopic MOT, which performed unilateral or bilateral laminectomy, poking reduction, intervertebral bone graft via spinal canal, and percutaneous pedicle screw fixation between January 2014 and January 2016 were retrospectively analyzed. There were 21 males and 7 females with a mean age of 42.1 years (range, 16-61 years). The involved segments included T 11 in 1 case, T 12 in 4 cases, L 1 in 14 cases, and L 2 in 9 cases. According to AO classification, there were 19 cases of type A3, 9 of type A4. According to American Spinal Injury Association (ASIA) grading, 12 cases were grade C, 13 grade D, and 3 grade E. The time between injury and operation was 3-7 days (mean, 3.6 days). To evaluate effectiveness, the changes in the visual analogue scale (VAS), percentage of anterior height of injured vertebrae, Cobb angle, rate of spinal compromise (RSC), and ASIA grading were analyzed. Results: All patients were performed procedures successfully. The operation time was 135-323 minutes (mean, 216.4 minutes). The intraoperative blood loss was 80-800 mL (mean, 197.7 mL). The hospitalization time was 10-25 days (mean, 12.5 days). The incisions healed primarily, without wound infection, cerebrospinal fluid leakage, or other early complications. All the 28 patients were followed up 12-24 months (mean, 16.5 months). No breakage or loosening of internal fixation occurred. All fractures healed, and the healing time was 3-12 months (mean, 6.5 months). Compared with preoperative ones, the percentage of anterior height of injured vertebrae, Cobb angle, and RSC at immediate after operation and at last follow-up and the VAS scores at 1 day after operation and at last-follow were significantly improved ( P<0.05). There was no significant difference in the percentage of anterior height of injured vertebrae and Cobb angle between at immediate after operation and at last follow-up ( P>0.05). But the RSC at immediate after operation and VSA score at 1 day after operation were significantly improved when compared with those at last follow-up ( P<0.05). The ASIA grading at last follow-up was 1 case of grade C, 14 grade D, and 13 grade E, which was significantly improved when compared with preoperative ones ( Z=3.860, P=0.000). Conclusion: MOT is an effective and minimal invasive treatment for thoracolumbar AO type A3 and A4 burst fractures with severe spinal canal stenosis, and it is beneficial to early rehabilitation for patients.

The Early Clinical Outcomes of a Percutaneous Full-Endoscopic Interlaminar Approach via a Surrounding Nerve Root Discectomy Operative Route for the Treatment of Ventral-Type Lumbar Disc Herniation.

The objective of this study is to introduce a method using a percutaneous full-endoscopic interlaminar approach via a surrounding nerve root discectomy (SNRD) operative route that involves removing the protrusive disc via both the shoulder and the axilla of the corresponding nerve root for the treatment of ventral-type lumbar disc herniation (VLDH) and its early clinical symptoms. Twenty-two patients with VLDH satisfied the inclusion criteria and underwent the full-endoscopic interlaminar approach operation via a SNRD successfully during the period from November 2014 to June 2016. All operations were completed without conversion to other surgical techniques. The average operation time was 78.64 ± 25.97 min (50-145 min). The average removed disc tissue volume was 2.87 ± 0.48 ml (2-3.6 ml). No nerve root injury, infection, or other complications occurred. The postoperative ODI and VAS values of low back and sciatic pain were significantly decreased at each time point compared to preoperative measurements (P < 0.05). The MacNab scores at the 12-month follow-up included 15 excellent and 7 good scores. In summary, a percutaneous full-endoscopic interlaminar approach through SNRD is a safe and effective treatment option for patients with VLDH.

[MINIMALLY INVASIVE PASSAGE IN POSTERIOR LAMINOTOMY DECOMPRESSION AND INTERVERTEBRAL BONE GRAFTING COMBINED WITH PERCUTANEOUS PEDICLE SCREW FIXATION FOR TREATMENT OF Denis TYPE B THORACOLUMBAR BURST FRACTURES].

OBJECTIVE: To evaluate the feasibility and the effectiveness of minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation for the treatment of Denis type B thoracolumbar burst fractures. METHODS: Between January 2013 and March 2015, 53 patients with Denis type B thoracolumbar burst fractures were treated by minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation. There were 37 males and 16 females with a mean age of 43 years (range, 16-57 years). The causes included falling injury from height in 23 cases, traffic accident injury in 15 cases, heavy pound injury in 7 cases, and falling injury in 8 cases. The time between injury and operation was 7 hours to 12 days (mean, 6.7 days). The involved segments included T11 in 2 cases, T12 in 7 cases, L1 in 20 cases, L2 in 18 cases, and L3 in 6 cases; based on the neurological classification of spinal cord injury by American Spinal Injury Association (ASIA), 3 cases were rated as grade A, 5 cases as grade B, 12 cases as grade C, 24 cases as grade D, and 9 cases as grade E. The operation time, bleeding volume, and postoperative drainage were recorded; postoperative visual analogue scale (VAS) was used for pain evaluation, and ASIA for neurological function assessment; CT and X-ray films were taken to observe fracture healing, bone fusion, and grafted bone absorption; The vertebral canal patency rate was calculated; the relative height of fractured vertebrae and Cobb angle were measured. RESULTS: The operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between different time points after operation (P>0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000). CONCLUSIONS: Minimally invasive passage in posterior laminotomy decompression, bone graft in the injured vertebrae combined with percutaneous pedicle screw fixation is an effective method to treat Denis type B thoracolumbar burst fractures, which not only can fully decompression, but also can effectively maintain the postoperative injured vertebral height, reduce the postoperative failure risk of internal fixation and decrease operation trauma.

Decrease in the production of ß-amyloid by berberine inhibition of the expression of ß-secretase in HEK293 cells.

BACKGROUND: Berberine (BER), the major alkaloidal component of Rhizoma coptidis, has multiple pharmacological effects including inhibition of acetylcholinesterase, reduction of cholesterol and glucose levels, anti-inflammatory, neuroprotective and neurotrophic effects. It has also been demonstrated that BER can reduce the production of beta-amyloid40/42, which plays a critical and primary role in the pathogenesis of Alzheimer's disease. However, the mechanism by which it accomplishes this remains unclear. RESULTS: Here, we report that BER could not only significantly decrease the production of beta-amyloid40/42 and the expression of beta-secretase (BACE), but was also able to activate the extracellular signal-regulated kinase1/2 (ERK1/2) pathway in a dose- and time-dependent manner in HEK293 cells stably transfected with APP695 containing the Swedish mutation. We also find that U0126, an antagonist of the ERK1/2 pathway, could abolish (1) the activation activity of BER on the ERK1/2 pathway and (2) the inhibition activity of BER on the production of beta-amyloid40/42 and the expression of BACE. CONCLUSION: Our data indicate that BER decreases the production of beta-amyloid40/42 by inhibiting the expression of BACE via activation of the ERK1/2 pathway.