Glycyrrhizic acid attenuates sorafenib resistance by inducing ferroptosis via targeting mTOR signaling in hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most malignant cancer worldwide. Sorafenib (SRF) is a common therapeutic drug used for patients with advanced HCC. Nevertheless, drug resistance frequently occurs in patients treated with sorafenib. Glycyrrhizic acid (GRA) is a natural compound that is identified to exhibit anti-cancer effects. In this work, we aimed to investigate the effects of GRA on SRF-resistant HCC cells and the potential regulatory mechanisms. METHODS: We established SRF-resistant HCC cell lines and administrated GRA treatment. We performed CCK-8 and colony formation experiments to detect cell proliferation. The accumulation of lipid reactive oxygen species (ROS) and iron levels were measured to evaluate ferroptosis. The protein levels of ferroptosis suppressor glutathione peroxidase 4 (GPX4) and SLC7A11, and the activation of AKT and mTOR were measured with western blotting assay. RESULTS: GRA treatment notably suppressed the viability and proliferation of SRF-resistant HCC cells. SRF-resistant HCC cells exhibited repressed ferroptosis level activated AKT/mTOR cascade, and GRA treatment reversed these effects. Inhibition of ferroptosis and activation of mTOR reversed the anti-proliferation effects of GRA on SRF-resistant HCC cells. CONCLUSION: Treatment with GRA could effectively reverse the SRF resistance of HCC cells via inducing ferroptosis and inactivating the AKT/mTOR cascade.

[Identification of cardioprotective substances in Panax ginseng/P. notoginseng based on mitochondrial morphological characteristics and UPLC-Triple-TOF-MS].

Panax ginseng is reputed to be capable of replenishing healthy Qi and bolstering physical strength, and P. notoginseng can resolve blood stasis and alleviate pain. P. ginseng and P. notoginseng are frequently employed to treat ischemic heart diseases caused by blockages in the heart vessels. Mitochondrial dysfunction often coexists with abnormal mitochondrial morphology, and mitochondrial plasticity and dynamics play key roles in cardiovascular diseases. In this study, primary neonatal rat cardiomyocytes were exposed to 4 hours of hypoxia(H) followed by 2 hours of reoxygenation(R). MitoTracker Deep Red and Hoechst 33342 were used to label mitochondria and nuclei, respectively. Fluorescence images were then acquired using ImageXpress Micro Confocal. Automated image processing and parameter extraction/calculation were carried out using ImagePro Plus. Subsequently, representative parameters were selected as indicators to assess alterations in mitochondrial morphology and function. The active compounds of P. ginseng and P. notoginseng were screened out and identified based on the UPLC-Triple-TOF-MS results and mitochondrial morphometric parameters. The findings demonstrated that RS-2, RS-4, SQ-1, and SQ-4 significantly increased the values of three key morphometric parameters, including mitochondrial length, branching, and area, which might contribute to rescuing morphological features of myocardial cells damaged by H/R injury. Among the active components of the two medicinal herbs, 20(R)-ginsenoside Rg_3, ginsenoside Re, and gypenoside ⅩⅦ exhibited the strongest protective effects on mitochondria in cardiomyocytes. Specifically, 20(R)-ginsenoside Rg_3 might upregulate expression of optic atrophy 1(OPA1) and mitofusin 2(MFN2), and ginsenoside Re and gypenoside ⅩⅦ might selectively upregulate OPA1 expression. Collectively, they promoted mitochondrial membrane fusion and mitigated mitochondrial damage, thereby exerting protective effects on cardiomyocytes. This study provides experimental support for the discovery of novel therapeutic agents for myocardial ischemia-reperfusion injury from P. ginseng and P. notoginseng and offers a novel approach for large-scale screening of bioactive compounds with cardioprotective effects from traditional Chinese medicines.

Dissection of mendelian predisposition and complex genetic architecture of craniovertebral junction malformation.

The craniovertebral junction (CVJ) is an anatomically complex region of the axial skeleton that provides protection of the brainstem and the upper cervical spinal cord. Structural malformation of the CVJ gives rise to life-threatening neurological deficits, such as quadriplegia and dyspnea. Unfortunately, genetic studies on human subjects with CVJ malformation are limited and the pathogenesis remains largely elusive. In this study, we recruited 93 individuals with CVJ malformation and performed exome sequencing. Manual interpretation of the data identified three pathogenic variants in genes associated with Mendelian diseases, including CSNK2A1, MSX2, and DDX3X. In addition, the contribution of copy number variations (CNVs) to CVJ malformation was investigated and three pathogenic CNVs were identified in three affected individuals. To further dissect the complex mutational architecture of CVJ malformation, we performed a gene-based rare variant association analysis utilizing 4371 in-house exomes as control. Rare variants in LGI4 (carrier rate = 3.26%, p = 3.3 × 10-5) and BEST1 (carrier rate = 5.43%, p = 5.77 × 10-6) were identified to be associated with CVJ malformation. Furthermore, gene set analyses revealed that extracellular matrix- and RHO GTPase-associated biological pathways were found to be involved in the etiology of CVJ malformation. Overall, we comprehensively dissected the genetic underpinnings of CVJ malformation and identified several novel disease-associated genes and biological pathways.

Gasification of coal and biomass as a net carbon-negative power source for environment-friendly electricity generation in China.

Realizing the goal of the Paris Agreement to limit global warming to 2 °C by the end of this century will most likely require deployment of carbon-negative technologies. It is particularly important that China, as the world's top carbon emitter, avoids being locked into carbon-intensive, coal-fired power-generation technologies and undertakes a smooth transition from high- to negative-carbon electricity production. We focus here on deploying a combination of coal and biomass energy to produce electricity in China using an integrated gasification cycle system combined with carbon capture and storage (CBECCS). Such a system will also reduce air pollutant emissions, thus contributing to China's near-term goal of improving air quality. We evaluate the bus-bar electricity-generation prices for CBECCS with mixing ratios of crop residues varying from 0 to 100%, as well as associated costs for carbon mitigation and cobenefits for air quality. We find that CBECCS systems employing a crop residue ratio of 35% could produce electricity with net-zero life-cycle emissions of greenhouse gases, with a levelized cost of electricity of no more than 9.2 US cents per kilowatt hour. A carbon price of approximately $52.0 per ton would make CBECCS cost-competitive with pulverized coal power plants. Therefore, our results provide critical insights for designing a CBECCS strategy in China to harness near-term air-quality cobenefits while laying the foundation for achieving negative carbon emissions in the long run.

Posterior fossa decompression with or without duraplasty for patients with chiari type I malformation and basilar impression: a meta-analysis.

BACKGROUND: To compare clinical effect and safety between posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) in treatment of Chiari type I malformation and basilar impression. METHODS: A comprehensive computer search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool. The clinical value of comparison between PFDD and PFD was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results. RESULTS: Finally, 468 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The PFDD and PFD groups were 282 and 186, respectively. The meta-analysis showed no significant difference in the Chicago Chiari Outcome Scale (COSS score) (MD = 0.14, 95% CI [-0.23, 0.50], P = 0.47; P = heterogeneity = 0.86, I2 = 0%). Meanwhile, Significant difference existed in length of stay (MD = -1.08, 95% CI [-1.32, -0.84], P = 0.001; heterogeneity P < 0.000001, I2 = 85%) and complications (OR = 0.35, 95%CI [0.20, 0.62], P = 0.0003; P for Heterogeneity = 0.04, I2 = 56%). CONCLUSION: PFD is a more efficient and safer therapy than PFDD in the treatment of Chiari type I malformation with basilar impression.

Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis.

BACKGROUND: The mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients. METHODS: A retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, the age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up. RESULTS: The average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6 cm/year during the follow-up. CONCLUSIONS: Posterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.

Comparison between surgical fusion and the growing-rod technique for early-onset neurofibromatosis type-1 dystrophic scoliosis.

BACKGROUND: Spinal deformities constitute one of the most common types of manifestations of neurofibromatosis type-1 (NF-1), which can lead to either dystrophic or non-dystrophic early-onset scoliosis (EOS). Surgical treatment for EOS with NF-1 is challenging, and the outcomes have rarely been reported. The anterior-posterior procedure is widely used, but posterior-only fusion is theoretically easier and safer to perform. Is it possible that a new surgery that accommodates growth is a better choice? A direct comparison between posterior fusion and growth-friendly surgery in terms of surgical outcomes has not yet been conducted in dystrophic EOS with NF-1 patients. METHODS: Baseline information was extracted from the NF-1 database at our institute with approval from the local ethics committee. All enrolled patients were diagnosed with NF-1. Clinical and radiographic data were recorded preoperatively, after the initial surgery, and at the final follow-up. Implant-related, alignment, neurological complication and unplanned revision surgery data were recorded. We compared the outcomes of these two groups in terms of curve correction, growth parameters, complications and unplanned revision surgeries. RESULTS: There were eight patients in the PF group and eight patients in the GR group, with a mean follow-up of 51.0 ± 17.5 months. The main curve size was similar (PF 67.38° ± 17.43° versus GR 75.1° ± 26.43°, P = 0.501), and there were no significant differences in the initial surgery correction rate or the rate of correction. However, the patients in the GR group exhibited more T1-S1 growth during the follow-up overall and per year than did those in the PF group. The operative time was significantly longer for the PF group than for the GR group (PF, 4.39 ± 1.38 vs. GR, 3.00 ± 0.42 h; p = 0.008). Significantly fewer segments were involved in the PF group (8.25 ± 3.20) than in the GR group (13.00 ± 1.60). CONCLUSION: For the initial treatment of dystrophic EOS in patients with NF-1, the GR technique is possibly a more appropriate treatment than is the PF technique in terms of trunk growth. However, the repeated procedures required for GR may be a considerable disadvantage. More studies with direct measurement of pulmonary function must be conducted to determine the effect of GR on pulmonary development. More studies with larger sample sizes and longer follow-up periods are needed to fully assess the treatment strategies.

The mutational burden and oligogenic inheritance in Klippel-Feil syndrome.

BACKGROUND: Klippel-Feil syndrome (KFS) represents a rare anomaly characterized by congenital fusion of the cervical vertebrae. The underlying molecular etiology remains largely unknown because of the genetic and phenotypic heterogeneity. METHODS: We consecutively recruited a Chinese cohort of 37 patients with KFS. The clinical manifestations and radiological assessments were analyzed and whole-exome sequencing (WES) was performed. Additionally, rare variants in KFS cases and controls were compared using genetic burden analysis. RESULTS: We primarily examined rare variants in five reported genes (GDF6, MEOX1, GDF3, MYO18B and RIPPLY2) associated with KFS and detected three variants of uncertain significance in MYO18B. Based on rare variant burden analysis of 96 candidate genes related to vertebral segmentation defects, we identified BAZ1B as having the highest probability of association with KFS, followed by FREM2, SUFU, VANGL1 and KMT2D. In addition, seven patients were proposed to show potential oligogenic inheritance involving more than one variants in candidate genes, the frequency of which was significantly higher than that in the in-house controls. CONCLUSIONS: Our study presents an exome-sequenced cohort and identifies five novel genes potentially associated with KFS, extending the spectrum of known mutations contributing to this syndrome. Furthermore, the genetic burden analysis provides further evidence for potential oligogenic inheritance of KFS.

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report.

BACKGROUND: Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. CASE PRESENTATION: We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. CONCLUSIONS: We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

Time-Resolved Intermediate-Volatility and Semivolatile Organic Compound Emissions from Household Coal Combustion in Northern China.

Coal combustion in low-efficiency household stoves results in the emission of large amounts of nonmethane organic compounds (NMOCs), including intermediate-volatility compounds (IVOCs) and semivolatile organic compounds (SVOCs). This conceptual picture is reasonably well established, however, quantitative assessment of I/SVOC emissions from household stoves is rare. We used a proton-transfer-reaction time-of-flight mass spectrometer (PTR-ToF-MS) to quantify the emissions of organic gases from a typical Chinese household coal stove operated with anthracite and bituminous coals. Most NMOCs (approximately 64-88%) were dominated by hydrocarbons and emitted during the ignition and flaming phases. The ratio of oxidized hydrocarbons increased during the flaming and smoldering stages due to the elevated combustion efficiency. The average emission factors of NMOCs were 121 ± 25.7 and 3690 ± 930 mg/kg for anthracite and bituminous coals, respectively. I/SVOCs contributed to approximately 30% of the total emitted NMOC mass during bituminous coal combustion, much higher than the contribution of biomass burning (approximately 1.5%). Furthermore, I/SVOCs may contribute over 70% of the secondary organic aerosol (SOA) mass formed from gaseous organic species emitted as a result of bituminous coal combustion. This study highlights the importance of inventorying coal-originated I/SVOCs when conducting SOA formation simulation studies.

Anthropogenic Emissions of Hydrogen Chloride and Fine Particulate Chloride in China.

Particulate chloride (Cl-) can be transformed to nitryl chloride (ClNO2) via heterogeneous reaction with nitrogen pentoxide (N2O5) at night. Photolysis of ClNO2 and subsequent reactions of chlorine radical with other gases can significantly affect the atmospheric photochemistry. In China, the only available integrated anthropogenic chloride emission inventory was compiled in the 1990s with low spatial resolution, which hinders assessment of impact of ClNO2 on current air quality. In this study, we developed an up-to-date and high-resolution anthropogenic inventory of hydrogen chloride (HCl) and fine particulate Cl- emissions in China for 2014 with 0.1° × 0.1° resolution. Detailed local data and county-level activity data were collected and complied. The anthropogenic emissions of HCl and fine particulate Cl- in 2014 were estimated to be 458 and 486 Gg, respectively. Biomass burning was the largest contributor, accounting for 75% of fine particulate Cl- emission and 32% of HCl emission. Northeast China and North China Plain were the largest chloride emitters. The monthly distribution varied in different regions, due to different agricultural activities and climate conditions. This work updates the chloride emission information and improves its spatial and temporal resolution, which enables better quantification of the ClNO2 production and its impact over China.

Residential Coal Combustion as a Source of Levoglucosan in China.

Levoglucosan (LG) has been widely identified as a specific marker for biomass burning (BB) sources and frequently utilized in estimating the BB contribution to atmospheric fine particles all over the world. However, this study provides direct evidence to show that coal combustion (CC) is also a source of LG, especially in the wintertime in Northern China, based on both source testing and ambient measurement. Our results show that low-temperature residential CC could emit LG with emission factors (EF) ranging from 0.3 to 15.9 mg kg-1. Ratios of LG to its isomers, mannosan and galactosan, differ between CC and BB emissions, and the wintertime ratios in Beijing ambient PM2.5 and source-specific tracers including carbon isotopic signatures all indicated a significant contribution from CC to ambient levoglucosan in winter in Beijing. The results suggest that LG cannot be used as a distinct source marker for biomass burning in special cases such as some cities in the northern China, where coal is still widely used in the residential and industrial sectors. Biomass burning sources could be overestimated, although such an over-estimation could vary spatially and temporally.

Impact of air pollution control policies on future PM2.5 concentrations and their source contributions in China.

To investigate the impact of air pollutant control policies on future PM2.5 concentrations and their source contributions in China, we developed four future scenarios for 2030 based on a 2013 emission inventory, and conducted air quality simulations for each scenario using the chemical transport model GEOS-Chem (version 9.1.3). Two energy scenarios i.e., current legislation (CLE) and with additional measures (WAM), were developed to project future energy consumption, reflecting, respectively, existing legislation and implementation status as of the end of 2012, and new energy-saving policies that would be released and enforced more stringently. Two end-of-pipe control strategies, i.e., current control technologies (until 2017) and more stringent control technologies (until 2030), were also developed. The combinations of energy scenarios and end-of-pipe control strategies constitute four emission scenarios (2017-CLE, 2030-CLE, 2017-WAM, and 2030-WAM) evaluated in simulations. PM2.5 concentrations at national level were estimated to be 57 µg/m3 in the base year 2013, and 58 µg/m3, 42 µg/m3, 42 µg/m3, and 30 µg/m3 under the 2017-CLE, 2030-CLE, 2017-WAM, and 2030-WAM scenarios in 2030, respectively. Large PM2.5 reductions between 2013 and 2030 were estimated for heavily polluted regions (Sichuan Basin, Middle Yangtze River, North China). The energy-saving policies show similar effects to the end-of-pipe emission control measures, but the relative importance of these two groups of policies varies in different regions. Absolute contributions to PM2.5 concentrations from most major sources declined from 2017-CLE to 2030-WAM. With respect to fractional contributions, most coal-burning sectors (including power plant, industrial and residential coal burning) increased from 2017-CLE to 2030-WAM, due to larger reductions from non-coal sources, including transportation and biomass open burning. Residential combustion and open burning had much lower fractional contribution to ambient PM2.5 concentrations in the 2017-WAM/2030-WAM compared to the 2017-CLE/2030-CLE scenarios. Fractional contributions from transportation were reduced dramatically in 2030-CLE and 2030-WAM compared to 2017-CLE/2017-WAM, due to the enforcement of stringent end-of-pipe emission controls. Across all scenarios, coal combustion remained the single largest contributor to PM2.5 concentrations in 2030. Reducing PM2.5 emissions from coal combustion remains a strategic priority for air quality management in China.

Effect of current emission abatement strategies on air quality improvement in China: A case study of Baotou, a typical industrial city in Inner Mongolia.

The national Air Pollution Prevention and Control Action Plan required significant decreases in PM2.5 levels over China. To explore more effective emission abatement strategies in industrial cities, a case study was conducted in Baotou to evaluate the current national control measures. The total emissions of SO2, NOX, PM2.5 and NMVOC (non-methane volatile organic compounds) in Baotou were 211.2Gg, 156.1Gg, 28.8Gg, and 48.5Gg, respectively in 2013, and they would experience a reduction of 30.4%, 26.6%, 15.1%, and 8.7%, respectively in 2017 and 39.0%, 32.0%, 24.4%, and 12.9%, respectively in 2020. The SO2, NOX and PM2.5 emissions from the industrial sector would experience a greater decrease, with reductions of 37%, 32.7 and 24.3%, respectively. From 2013 to 2020, the concentrations of SO2, NO2, and PM2.5 are expected to decline by approximately 30%, 10% and 14.5%, respectively. The reduction rate of SNA (sulfate, nitrate and ammonium) concentrations was significantly higher than that of PM2.5 in 2017, implying that the current key strategy toward controlling air pollutants from the industrial sector is more powerful for SNA. Although air pollution control measures implemented in the industrial sector could greatly reduce total emissions, constraining the emissions from lower sources such as residential coal combustion would be more effective in decreasing the concentration of PM2.5 from 2017 to 2020. These results suggest that even for a typical industrial city, the reduction of PM2.5 concentrations not only requires decreases in emissions from the industrial sector, but also from the low emission sources. The seasonal variation in sulfate concentration also showed that emission from coal-burning is the key factor to control during the heating season.

Temporal Trend and Spatial Distribution of Speciated Atmospheric Mercury Emissions in China During 1978-2014.

Mercury pollution control has become a global goal. The accurate estimate of long-term mercury emissions in China is critical to evaluate the global mercury budget and the emission reduction potentials. In this study, we used a technology-based approach to compile a consistent series of China's atmospheric mercury emissions at provincial level from 1978 to 2014. China totally emitted 13 294 t of anthropogenic mercury to air during 1978-2014, in which gaseous elemental mercury, gaseous oxidized mercury, and particulate-bound mercury accounted for 58.2%, 37.1%, and 4.7%, respectively. The mercury removed during this period were 2085 t in coal-fired power plants (counting 49% of mercury input), 7259 t in Zn smelting (79%), 771 t in coal-fired industrial boilers (25%), and 658 t in cement production plants (27%), respectively. Annual mercury emissions increased from 147 t in 1978 to 530 t in 2014. Both sectoral and spatial emissions of atmospheric mercury experienced significant changes. The largest mercury emission source evolved from coal-fired industrial boilers before 1998, to zinc smelting during 1999-2004, coal-fired power plants during 2005-2008, finally to cement production after 2009. Coal-fired industrial boilers and cement production have become critical hotpots for China's mercury pollution control.

The timing of surgical intervention in the treatment of complete motor paralysis in patients with spinal metastasis.

PURPOSE: The timing of surgical intervention is important for ambulatory patients with metastatic epidural spinal cord compression (MESCC), while limited studies have focused on non-ambulant patients. The aim of this study was to investigate the proper timing of surgical intervention for paraplegic patients with MESCC. METHODS: Forty-three non-ambulant patients with MESCC who underwent posterior decompression were retrospectively reviewed. The neurological outcomes for pre-operative Frankel B patients with different interval window were further compared. RESULTS: Neurologic deficit improved by at least 1 Frankel grade in 37 patients who underwent surgery within 72 h (86.0 %). Overall, 18 pre-operative Frankel B patients became ambulatory again with an interval of less than 48 h, 15 pre-operative Frankel B patients remained non-ambulatory post-operatively with an interval longer than 48 h besides one with an interval of 8 h (P < 0.001). All nine pre-operative Frankel A patients remained non-ambulatory even though the interval window was less than 24 h. CONCLUSION: The timing of surgical intervention was key to predicting the post-operative outcome, and 48 h was suggested as the proper interval window for pre-operative Frankel B patients. These patients preserved sensory function which might be a predictor. And the sooner the surgery was performed, the better the result would be.

Environmental Justice Aspects of Exposure to PM2.5 Emissions from Electric Vehicle Use in China.

Plug-in electric vehicles (EVs) in China aim to improve sustainability and reduce environmental health impacts of transport emissions. Urban use of EVs rather than conventional vehicles shifts transportation's air pollutant emissions from urban areas (tailpipes) to predominantly rural areas (power plants), changing the geographic distribution of health impacts. We model PM2.5-related health impacts attributable to urban EV use for 34 major cities. Our investigation focuses on environmental justice (EJ) by comparing pollutant inhalation versus income among impacted counties. We find that EVs could increase EJ challenge in China: most (~77%, range: 41-96%) emission inhalation attributable to urban EVs use is distributed to predominately rural communities whose incomes are on average lower than the cities where EVs are used. Results vary dramatically across cities depending on urban income and geography. Discriminant analysis reveals that counties with low income and high inhalation of urban EV emissions have comparatively higher agricultural employment rates, higher mortality rates, more children in the population, and lower education levels. We find that low-emission electricity sources such as renewable energy can help mitigate EJ issues raised here. Findings here are not unique to EVs, but instead are relevant for nearly all electricity-consuming technologies in urban areas.

Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study.

PURPOSE: To determine the safety and efficacy of intraoperative cell salvage system in decreasing the need for allogeneic transfusions in a cohort of scoliosis patients undergoing primary posterior spinal fusion with segmental spinal instrumentation. METHODS: A total of 110 consecutive scoliosis patients undergoing posterior instrumented spinal fusion were randomized into two groups according to whether a cell saver machine for intraoperative blood salvage was used or not. Data included age, body mass index, perioperative hemoglobin levels, surgical time, levels fused, perioperative estimated blood loss, perioperative transfusions and incidence of transfusion-related complications. A Chi-square test and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates to investigate the predictive factors of perioperative transfusion. RESULTS: Perioperative allogenic blood transfusion rate was lower in the cell saver group (14.5 versus 32.7%, p = 0.025). Mean intraoperative red blood cell transfusion requirement was also lower (0.21 U/pt versus 0.58 U/pt, p = 0.032). A multivariate analysis demonstrated that no. of fused segments (OR: 1.472; p = 0.005), preoperative hemoglobin level (OR: 0.901; p = 0.001), and the use of cell saver system (OR: 0.133; p = 0.003) had a trend toward significance in predicting likelihood of transfusion. CONCLUSIONS: Cell saver use significantly reduces the need for allogeneic blood in spine deformity surgery, particularly in patients with low preoperative hemoglobin or longer operation time. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for scoliosis patients.

[Correlation between pelvic indices, pelvic spatial orientation and lumbar vertebrate instability].

OBJECTIVE: To explore the correlation between the stability of lumbar vertebrate and pelvic indices of pelvic incidence (PI), lumber lordosis (LL), pelvic tilt (PT) and sacrum slope (SS). METHODS: The preoperative imaging data were analyzed retrospectively for 78 patients with lumbar disc protrusion. The values of PI, PT, SS and LL were measured and compared between lumbar vertebrate stability and lumbar vertebrate instability groups. RESULTS: No inter-group statistical difference existed in PI, LL, PT or SS. The average PI of lumbar vertebrate instability group was higher than that of lumbar vertebrate stability group.In patients with L4/5 segmental lesion, SS of lumbar vertebrate instability group was higher than that of lumbar vertebrate stability group (38.7 ± 4.7)° vs (34.0 ± 6.6)°, P = 0.023. And PT in patients with L5/S1 segmental lesion was higher than those with L4/5 segmental lesion (17.5 ± 7.0 vs 14.9 ± 5.3, P = 0.027). CONCLUSION: No statistical inter-group difference exists in PI. However, higher SS and PT may be risk indicators of instability for L4/5 and L5/S1 segments respectively.

From the Destruction of Two Lumbar Segments to Thoracic-Lumbar-Pelvic Fusion: A Case Caused by Congenital Insensitivity to Pain with Anhidrosis and Literature Review.

BACKGROUND: Congenital insensitivity to pain with anhidrosis (CIPA) with Charcot arthropathy is a rare combination in orthopaedic clinical practice. The experience dealing with such patients is limited. Here with this case of approximately 10 years follow-up, we wish to shed light on the choices of strategies of surgeries and alerting clinicians with post-surgery complications. The possible underlying reasons for the recurrent Charcot arthropathies as well as strategies for peri-operative management for such surgical cases are also discussed. CASE PRESENTATION: The patient underwent a surgery to correct her severe kyphosis caused by CIPA-related Charcot spine. Multiple post-surgery complications occurred during her follow-up, including hardware migration, adjacent segment disease (ASD), and loosening pedicle screws. Five revision surgeries were conducted consequently. From the limited experience on the management of CIPA-related Charcot spine, surgical correction is still the first-line treatment. CONCLUSIONS: Of all the 16 cases reviewed (including our case), loosening pedicle screws, hardware migration, and ASDs are the common post-surgery complications. Large-scale removal of damaged vertebrae and subsequent reconstruction are not recommended, which might increase the risk of hardware migration. A 360° long-segment fusion might be of help to reduce the risk of ASDs. In the meantime, comprehensive management including careful nursing, proper rehabilitation exercises, and treatments targeting bone mineral metabolism is also critical.