Engineering Entropy-Driven Nanomachine-Mediated Morphological Evolution of Anisotropic Silver Triangular Nanoplates for Colorimetric and Photothermal Biosensing.

A DNA/RNA biosensor capable of single nucleotide variation (SNV) resolution is highly desirable for drug design and disease diagnosis. To meet the point-of-care demand, rapid, cost-effective, and accurate SNV detection is of great significance but still suffers from a challenge. In this work, a unique nonenzymatic dual-modal (multicolorimetric and photothermal) visualization DNA biosensor is first proposed for SNV identification on the basis of an entropy-driven nanomachine with double output DNAs and coordination etching of anisotropic silver triangular nanoplates (Ag TNPs). When the target initiates the DNA nanomachine, the liberated multiple output DNAs can be utilized as a bridge to produce a superparamagnetic sandwich complex. The incoming poly-C DNA can coordinate and etch highly active Ag+ ions at the tips of Ag TNPs, causing a shift in the plasmon peak of Ag TNPs from 808 to 613 nm. The more target DNAs are introduced, the more output DNAs are released and thus the more Ag+ ions are etched. The noticeable color changes of anisotropic Ag TNPs can be differentiated by "naked eye" and accurate temperature reading. The programmable DNA nanotechnology and magnetic extraction grant the high specificity. Also, the SNV detection results can be self-verified by the two-signal readouts. Moreover, the dual-modal biosensor has the advantages of portability, cost-effectiveness, and simplicity. Particularly, the exclusive entropy-driven amplifier liberates double output DNAs to bridge more poly-C DNAs, enabling the dual-modal visualization DNA biosensor with improved sensitivity.

Integrated MADM of low-carbon structural design for high-end equipment based on attribute reduction considering incomplete interval uncertainties.

With the increasingly severe energy supply and environmental pressures, high-end equipment is gradually adopted to reduce the carbon emissions of manufacturing industry which makes its low-carbon structural design a critical research hotspot. The best structural scheme can be got by multi-attribute decision-making (MADM) with design requirements. However, the decision-making attributes in the structural design of high-end equipment are too many at first and low-carbon attributes are seldom fully considered. Moreover, there are a large amount of related data with linguistic vagueness, interval uncertainty, and information incompleteness, which fail to be handled simultaneously. There, this paper proposes an integrated MADM method of low-carbon structural design for high-end equipment based on attribute reduction considering incomplete interval uncertainties. First, distribution reduction of low-carbon structural design is carried out to obtain the minimum attribute set and encompass low-carbon attributes comprehensively. Second, a collaborative filtering algorithm is utilized to complete the missing data in the subsequent design process. Third, interval rough numbers (IRNs) are integrated into DEMATEL-ANP (DANP) and multi-attribute border approximation area comparison (MABAC) to quickly rank the alternative schemes for high-end equipment and determine which is the best. The rationality and robustness of the proposed method are verified through the case study and comparative analysis of a hydraulic forming machine.

Assessing the ecological response plant and soil to the seawalls in the Laizhou bay coastal wetland, China.

Coastal wetlands are extremely vulnerable to both marine damage and human activities. In order to protect these wetlands, many artificial seawalls have been constructed. However, studies are required to understand how coastal wetlands will evolve under the influence of artificial seawalls. Therefore, to understand this succession process of plants and their adaptation to habitats divided by seawalls, two different habitats inside and outside the seawalls were selected in Laizhou Bay, China. The results showed that there were 5 plant species outside the seawalls that were lower than the 13 species inside. Additionally, the dominant plant species were varied between the two habitats, with mostly annual herbs observed outside the seawalls and perennial shrubs inside. Soil salinity was higher outside the seawalls, which was the key impact factor of soil nutrient differences. The distribution of annual and perennial species may be constrained by spatial differences in soil stoichiometry. Therefore, the plants in coastal wetlands vary significantly at a small scale in response to the disturbance of artificial seawalls. The differences in soil and plants between the two habitats divided by the artificial seawalls provide a new insight for evaluating the artificial coastal projects. The only way to reduce the effects of seawalls on natural coastal wetland vegetation and ecosystem functions is to restore connectivity of tidal flow inside and outside the seawalls.

Responses of soil seed bank and its above-ground vegetation to various reclamation patterns.

Coastal land reclamation has become a primary strategy for alleviating conflicts between human development and land resource utilization. However, anthropogenic activities associated with land reclamation inevitably result in significant changes to coastal wetland ecosystems. Previous studies have mainly focused on the ecological consequences of land reclamation on above-ground vegetation, while overlooking the distinctions between different reclamation patterns and the critical role of soil seed bank in maintaining ecosystem stability. In this study, the responses of soil seed bank and vegetation to various reclamation patterns, as well as the factors influencing changes in seed bank characteristics, were analyzed in a natural coastal wetland (NCW), a reclaimed wetland with sea embankments constructed on native wetland (SEW), and another reclaimed wetland formed through land reclamation from the sea (LRW). These findings suggest that seed banks and their vegetation adopt different adaptation strategies under various reclamation patterns. In the NCW, the proportion of non-halophytes (1.39%), diversity, and density of the seed bank were at their lowest levels, whereas the species compositions derived from the seed bank and vegetation were very similar (similarity coefficient = 0.67). Conversely, the seed bank in the SEW demonstrated the highest species diversity, which differed significantly from the species composition of its above-ground vegetation (similarity coefficient = 0.21). However, the highest proportion of non-halophytes (36.60%), vegetation diversity, and seed bank density occurred in LRW. Furthermore, differences in seed bank characteristics under different reclamation patterns may be related to changes in soil salinity and plant reproductive strategies after reclamation. Adjusting reclamation patterns and restoring soil properties could potentially optimize the types of local plant species and their distribution in reclaimed areas.

Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy.

Purpose: One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique. Patients and Methods: This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients' preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected. Results: Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P<0.05) as well as a reduction in all perioperative-related indices. Conclusion: In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.

Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study.

BACKGROUND: We aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH. METHODS: This study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events. RESULTS: After surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups. CONCLUSION: Compared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.

Biomechanical assessment of different transforaminal lumbar interbody fusion constructs in normal and osteoporotic condition: a finite element analysis.

BACKGROUND CONTEXT: With the aging population, osteoporosis, which leads to poor fusion, has become a common challenge for lumbar surgery. In addition, most people with osteoporosis are elderly individuals with poor surgical tolerance, and poor bone quality can also weaken the stability of internal fixation. PURPOSE: This study compared the fixation strength of the bilateral traditional trajectory screw structure (TT-TT), the bilateral cortical bone trajectory screw structure (CBT-CBT), and the hybrid CBT-TT (CBT screws at the cranial level and TT screws at the caudal level) structure under different bone mineral density conditions. STUDY DESIGN: A finite element (FE) analysis study. METHODS: Above all, we established a healthy adult lumbar spine model. Second, under normal and osteoporotic conditions, three transforaminal lumbar interbody fusion (TLIF) models were established: bilateral traditional trajectory (TT-TT) screw fixation, bilateral cortical bone trajectory (CBT-CBT) screw fixation, and hybrid cortical bone trajectory screw and traditional trajectory screw (CBT-TT) fixation. Finally, a 500-N compression load with a torque of 10 N/m was applied to simulate flexion, extension, lateral bending, and axial rotation. We compared the range of motion (ROM), adjacent disc stress, cage stress, and posterior fixation stress of the different fusion models. RESULTS: Under different bone mineral density conditions, the range of motion of the fusion segment was significantly reduced. Compared to normal bone conditions, the ROM of the L4-L5 segment, the stress of the adjacent intervertebral disc, the surface stress of the cage, and the maximum stress of the posterior fixation system were all increased in osteoporosis. Under most loads, the ROM and surface stress of the cage and the maximum stress of the posterior fixation system of the TT-TT structure are the lowest under normal bone mineral density conditions. However, under osteoporotic conditions, the fixation strength of the CBT-CBT and CBT-TT structures are higher than that of the TT-TT structures under certain load conditions. At the same time, the surface stress of the intervertebral fusion cage and the maximum stress of the posterior fixation system for the two structures are lower than those of the TT-TT structure. CONCLUSION: Under normal bone mineral density conditions, transforaminal lumbar interbody fusion combined with TT-TT fixation provides the best biomechanictability. However, under osteoporotic conditions, CBT-CBT and CBT-TT structures have higher fixed strength compared to TT-TT structures. The hybrid CBT-TT structure exhibits advantages in minimal trauma and fixation strength. Therefore, this seems to be an alternative fixation method for patients with osteoporosis and degenerative spinal diseases. CLINICAL SIGNIFICANCE: This study provides biomechanical support for the clinical application of hybrid CBT-TT structure for osteoporotic patients undergoing TLIF surgery.

Insights into the Microscopic Oil-Water Flow Characteristics and Displacement Mechanisms during Waterflooding in Sandstone Reservoir Rock Based on Micro-CT Technology: A Pore-Scale Numerical Simulation Study.

The low oil recovery rate observed in current oil fields is largely attributed to the presence of remaining oil trapped in the pores of porous media during waterflooding. To improve the recovery rate, it is imperative to gain an understanding of the oil-water flow characteristics and displacement mechanisms during waterflooding, as well as to elucidate the underlying mobilization mechanisms of residual oil at the pore scale. In this paper, we explore these issues in depth by numerically investigating the influence of factors such as water injection velocities, oil-water viscosity ratios, and wettability conditions on pore-scale oil-water flow characteristics and oil recovery rate. To this end, we employ a direct numerical simulation (DNS) method in conjunction with the volume of fluid (VOF) method to study the microscopic displacement mechanisms of waterflooding in a reconstructed two-dimensional digital rock core based on micro-CT technology. In addition, the particle tracing method is adopted to identify the flow path and dominant areas during waterflooding in order to mobilize the residual oil within the pores. The findings indicate that the oil-water flow characteristics in porous media are determined by the interplay between capillary and viscous forces. Furthermore, the oil recovery rate is 10.6% and 24.7% lower under strong water-wet and oil-wet conditions than that (32.36%) under intermediate wettability conditions, and the final oil recovery rate is higher under water-wet conditions than under oil-wet conditions. The seepage path and the dominant areas are directly linked to the capillarity formed during waterflooding. The findings of this study are significant in terms of enhancing the recovery rate of residual oil and provide a novel perspective for understanding the waterflooding process.

Using Piezosurgery in Anterior Cervical Discectomy and Fusion to Treat Complex Cervical Spondylotic Myelopathy Is Safe and Effective.

Objective: To investigate the safety and efficacy of piezosurgery in anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). Methods: 47 patients with complex CSM (cCSM) underwent ACDF surgery from 2014 to 2017. Among these patients, 26 underwent ACDF using piezosurgery (group A) and 21 underwent ACDF by using traditional tools such as high-speed air drill, bone curette, and Kerrison bone punch (group B). Average surgical time, intraoperative blood loss, surgical complications, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, and improvement rate were measured. Results: Average surgical time and intraoperative blood loss were significantly lower in group A than those in group B (P < 0.01). The incidences of surgical complications were 3.8% and 23.8% in the A and B groups (P < 0.05), respectively. There were no significant differences in JOA scores and improvement rates between data collection periods at preoperative, 3-day postoperative, and 1-year postoperative follow-ups (P > 0.05). Conclusion: For treating cCSM, both the piezosurgery and traditional tools led to significant neurological improvement. However, the piezosurgery was superior to the traditional tools in terms of surgical time, blood loss, and complication rate. Hence, piezosurgery was a safe and effective adjunct for ACDF treating cCSM.

PAK5-mediated AIF phosphorylation inhibits its nuclear translocation and promotes breast cancer tumorigenesis.

Although p21 activated kinase 5 (PAK5) is related to the progression of multiple cancers, its biological function in breast cancer remains unclear. Apoptosis-inducing factor (AIF) is a vital apoptosis factor in mitochondria, which can be released from mitochondria and enter the nucleus, causing caspase-independent apoptosis. In this study, we reveal that PAK5 inhibits apoptosis by preventing the nuclear translocation of AIF. PAK5 inhibits the release of AIF from mitochondria in breast cancer cells by decreasing the mitochondria membrane permeability and increasing the membrane potential. Furthermore, PAK5 phosphorylates AIF at Thr281 site to inhibit the formation of AIF/importin α3 complex, leading to decrease AIF nuclear translocation. Functionally, we demonstrate that PAK5-mediated AIF phosphorylation promotes the proliferation of breast cancer cells and accelerates the growth of breast cancer in vivo. Significantly, PAK5 and AIF expression in breast cancer are positively correlated with poor patient prognosis. PAK5 expression is negatively correlated with AIF nuclear translocation. These results suggest that PAK5-AIF signaling pathway may play an essential role in mammary tumorigenesis, providing a new therapeutic target for the treatment of breast cancer.

Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China.

BACKGROUND: Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. METHODS: A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. RESULTS: A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the 'time-out' component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. CONCLUSION: The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.

PAK5 promotes RNA helicase DDX5 sumoylation and miRNA-10b processing in a kinase-dependent manner in breast cancer.

P21-activated kinase 5 (PAK5) plays an important role in tumors. However, the functional role of PAK5 in mammary tumorigenesis in vivo remains unclear. Here, we show that PAK5 deficiency represses MMTV-PyVT-driven breast tumorigenesis. DEAD-box RNA helicase 5 (DDX5) is a substrate of PAK5, which is phosphorylated on threonine 69. PAK5-mediated DDX5 phosphorylation promotes breast cancer cell proliferation and metastasis. The increased expression levels of PAK5 and phospho-DDX5 threonine 69 are associated with metastasis and poor clinical outcomes of patients. PAK5 facilitates the phosphorylation-dependent sumoylation of DDX5 to stabilize DDX5. Both the phosphorylation and sumoylation of DDX5 enhance the formation of a DDX5/Drosha/DGCR8 complex, thus promoting microRNA-10b processing. Finally, we verify decreased expression of DDX5 phosphorylation and sumoylation and mature miR-10b in PAK5-/-/MMTV-PyVT transgenic mice. Our findings provide insights into the function of PAK5 in microRNA (miRNA) biogenesis, which might be a potential therapeutic target for breast cancer.

Mitochondrial PAK6 inhibits prostate cancer cell apoptosis via the PAK6-SIRT4-ANT2 complex.

Rationale: P21-activated kinase 6 (PAK6) is a member of the class II PAKs family, which is a conserved family of serine/threonine kinases. Although the effects of PAK6 on many malignancies, especially in prostate cancer, have been studied for a long time, the role of PAK6 in mitochondria remains unknown. Methods: The expression of PAK6, SIRT4 and ANT2 in prostate cancer and adjacent non-tumor tissues was detected by immunohistochemistry. Immunofuorescence and immunoelectron microscopy were used to determine the subcellular localization of PAK6. Immunoprecipitation, immunofuorescence and ubiquitination assays were performed to determine how PAK6 regulates SIRT4, how SIRT4 regulates ANT2, and how PAK6 regulates ANT2. Flow cytometry detection and xenograft models were used to evaluate the impact of ANT2 mutant expression on the prostate cancer cell cycle and apoptosis regulation. Results: The present study revealed that the PAK6-SIRT4-ANT2 complex is involved in mitochondrial apoptosis in prostate cancer cells. It was found that PAK6 is mainly located in the mitochondrial inner membrane, in which PAK6 promotes SIRT4 ubiquitin-mediated proteolysis. Furthermore, SIRT4 deprives the ANT2 acetylation at K105 to promote its ubiquitination degradation. Hence, PAK6 adjusts the acetylation level of ANT2 through the PAK6-SIRT4-ANT2 pathway, in order to regulate the stability of ANT2. Meanwhile, PAK6 directly phosphorylates ANT2 atT107 to inhibit the apoptosis of prostate cancer cells. Therefore, the phosphorylation and deacetylation modifications of ANT2 are mutually regulated, leading to tumor growth in vivo. Consistently, these clinical prostate cancer tissue evaluations reveal that PAK6 is positively correlated with ANT2 expression, but negatively correlated with SIRT4. Conclusion: These present findings suggest the pivotal role of the PAK6-SIRT4-ANT2 complex in the apoptosis of prostate cancer. This complex could be a potential biomarker for the treatment and prognosis of prostate cancer.

[Long-term effectiveness of posterior lumbar interbody fusion of retaining posterior ligamentous complex].

Objective: To compare the long-term effectiveness of wheather posterior ligamentous complex (PLC) preserved between posterior fenestration decompression interbody fusion and posterior total laminectomy interbody fusion. Methods: The clinical data of 89 patients who suffered from single segmental degenerative diseases of lower lumbar spine and followed up more than 10 years after receiving lumbar spinal fusion between January 2000 and January 2005 were retrospectively analysed. The patients were divided into two groups according to the different surgical methods, the 33 patients in group A were treated with posterior lumbar fenestration decompression, interbody fusion, and internal fixation, while 56 patients in group B were treated with posterior total laminectomy resection decompression, interbody fusion, and internal fixation. There was no significant difference in gender, age, body mass index, type of lesion, disease duration, lesion segment, and preoperative Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of lumbar lordosis between the two groups ( P>0.05). The effectiveness was evaluated by JOA score, and the improvement of pain was evaluated by VAS score. The incidence of adjacent segment degeneration (ASD) at last follow-up was recorded. Results: Both groups were followed up 10-17 years (mean, 12.6 years). There were 3 cases (9.1%) in group A and 5 cases (8.9%) in group B complicated with cerebrospinal fluid leakage, showing no significant difference ( χ2=0.001, P=0.979). There was no complication such as infection, nerve root injury, internal plant loosening or transposition in both groups. Intervertebral fusion was satisfactory in both groups. The fusion time in groups A and B was (3.4±1.2) months and (3.7±1.6) months respectively, and there was no significant difference between the two groups ( t=0.420, P=0.676). At last follow-up, the JOA score and VAS score of the two groups were significantly improved when compared with preoperative ones ( P<0.05); there was no significant difference in Cobb angle of lumbar lordosis before and after operation in group A ( t=0.293, P=0.772), but the Cobb angle of lumbar lordosis in group B was significantly lost at last follow-up ( t=14.920, P=0.000). At last follow-up, the VAS score and Cobb angle of lumbar lordosis in group A were significantly superior to those in group B ( P<0.05); there was no significant difference in JOA score between the two groups ( t=0.217, P=0.828). There were 3 cases (9.1%) in group A and 21 cases (37.5%) in group B complicated with ASD, showing significant difference between the two groups ( χ2=8.509, P=0.004). Conclusion: Long-term effectiveness of both groups was satisfactory, but in terms of maintaining lumbar lordosis and reducing the incidence of ASD, the lumbar fusion retaining PLC is superior to total laminectomy and lumbar fusion removing PLC.

[Clinical study of percutaneous vertebroplasty through extreme extrapedicular approach in the treatment of osteoporotic vertebral compression fracture].

OBJECTIVE: To evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF) through unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement. METHODS: The clinical data of 156 patients with OVCF who met the selection criteria between January 2014 and January 2016 were retrospectively analyzed. All patients were treated with PVP through unilateral puncture. According to different puncture methods, the patients were divided into two groups. In group A, 72 cases were performed PVP through the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement, while in group B, 84 cases were performed PVP through the unilateral puncture of transpedicular approach. There was no significant difference in general data of gender, age, weight, bone mineral density, lesion segment, and disease duration between the two groups ( P>0.05). The radiation exposure time, operation time, volume of bone cement injection, rate of bone cement leakage, pre- and post-operative visual analogue scale (VAS) score and local Cobb angle were recorded and compared between the two groups. RESULTS: There was no significant difference in radiation exposure time and operation time between the two groups ( P>0.05), but the volume of bone cement injection in group A was significantly more than that in group B ( t=20.024, P=0.000). Patients in both groups were followed up 24-32 months (mean, 26.7 months). There were 9 cases (12.5%) and 10 cases (11.9%) of cement leakage in group A and B, respectively. There was no significant difference in the incidence ( χ 2=0.013, P=0.910). No neurological symptoms and discomfort was found in the two groups. The VAS scores of the two groups were significantly improved after operation ( P<0.05). There was no significant difference in local Cobb angle between before and after operation in group A ( P>0.05); but the significant difference was found in local Cobb angle between at 2 years after operation and other time points in group B ( P<0.05). The VAS score and local Cobb angle in group A were significantly better than those in group B at 2 years after operation ( P<0.05). CONCLUSION: It is simple, safe, and feasible to use the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement to treat OVCF. Compared with the transpedicular approach, the bone cement can be distributed bilaterally in the vertebral body without prolonging the operation time and radiation exposure time, and has an advantage of decreasing long-term local Cobb angle losing of the fractured vertebrae.

[Treatment of benign tumors in thoracic spinal canal by modified replanting posterior ligament complex applying piezoelectric osteotomy].

OBJECTIVE: To investigate the feasibility and effectiveness of modified replanting posterior ligament complex (PLC) applying piezoelectric osteotomy in the treatment of primary benign tumors in thoracic spinal canal. METHODS: The clinical data of 38 patients with primary benign tumors in thoracic spinal canal between March 2014 and March 2016 were retrospectively analyzed. There were 16 males and 22 females, aged from 21 to 72 years (mean, 47.1 years). The disease duration ranged from 6 to 57 months (mean, 32.6 months). Pathological examination showed 24 cases of schwannoma, 6 cases of meningioma, 4 cases of ependymoma, 2 cases of lipoma, and 2 cases of dermoid cyst. The lesions located in 18 cases of single segment, 15 cases of double segments, and 5 cases of three segments. The length of the tumors ranged from 0.7 to 6.5 cm. There were boundaries between the tumors and the spinal cord, cauda equina, and nerve roots. The preoperative Japanese Orthopaedic Association (JOA) score was 12.2±2.3 and the thoracic Cobb angle was (11.7±2.7)°. Modified PLC replantation and microsurgical resection were performed with piezoelectric osteotomy. Continuity of uniside supraspinal and interspinous ligaments were preserved during the operation. The PLC was exposed laterally. After removing the tumors under the microscope, the pedicled PLC was replanted in situ and fixed with bilateral micro-reconstruction titanium plate. X-ray film, CT, and MRI examinations were performed to observe spinal stability, spinal canal plasty, and tumor resection after operation. The effectiveness was evaluated by JOA score. RESULTS: The operation time was 56-142 minutes (mean, 77.1 minutes). The intraoperative blood loss was 110-370 mL (mean, 217.2 mL). The tumors were removed completely and the incisions healed well. Three cases complicated with cerebrospinal fluid leakage, and there was no complications such as spinal cord injury and infection. All the 38 patients were followed up 24-28 months (mean, 27.2 months). There was no internal fixation loosening, malposition, or other related complications. At last follow-up, X-ray films showed no sign of kyphosis and instability. CT showed no displacement of vertebral lamina and reduction of secondary spinal canal volume, and vertebral lamina healed well. MRI showed no recurrence of tumors. At last follow-up, the thoracic Cobb angle was (12.3±4.1)°, showing no significant difference when compared with preoperative value ( t=0.753, P=0.456). JOA score increased to 23.7±3.8, showing significant difference when compared with preoperative value ( t=15.960, P=0.000). Among them, 14 cases were excellent, 18 were good, 6 were fair, and the excellent and good rate was 84.2%. CONCLUSION: Modified replanting PLC applying piezoelectric osteotomy and micro-reconstruction with titanium plate for the primary benign tumors in thoracic spinal canal can reconstruct the anatomy of the spinal canal, enable patients to recover daily activities quickly. It is an effective and safe treatment.