Application of Metagenomic Next-Generation Sequencing in Suspected Spinal Infectious Diseases.

OBJECTIVE: This study aimed to explore the clinical efficacy of metagenomic next-generation sequencing (mNGS) in diagnosing and treating suspected spinal infectious diseases. METHODS: Between October 2022 to December 2023, a retrospective analysis was performed on patient records within the Department of Spinal Surgery at Guilin People's Hospital. The analysis included comprehensive data on patients with presumed spinal infectious diseases, incorporating results from mNGS tests conducted externally, conventional pathogen detection results, laboratory examination results, and imaging findings. The study aimed to assess the applicability of mNGS in the context of suspected spinal infectious lesions. RESULTS: Twenty-seven patients were included in the final analysis. Pathogenic microorganisms were identified in 23 cases. The included cases encompassed 1 case of tuberculous spondylitis, 1 case of fungal infection, 3 cases of Brucella spondylitis, 3 cases of viral infection, 9 cases of bacterial infection, and 6 cases of mixed infections. Pathogenic microorganisms remained elusive in 4 cases. The application of the mNGS method demonstrated a significantly elevated positive detection rate compared to conventional methods (85.19% vs. 48.15%, P < 0.05). Moreover, the mNGS method detected a greater variety of pathogen species than traditional methods (Z = 10.69, P < 0.05). Additionally, the mNGS method exhibited a shorter detection time. CONCLUSIONS: mNGS demonstrated significantly higher detection rates for bacterial, fungal, viral, and mixed infections in cases of suspected spinal infectious diseases. The clinical implementation of mNGS could further enhance the efficiency of diagnosing and treating suspected spinal infectious diseases.

Spinal disease diagnosis assistant based on MRI images using deep transfer learning methods.

Introduction: In light of the potential problems of missed diagnosis and misdiagnosis in the diagnosis of spinal diseases caused by experience differences and fatigue, this paper investigates the use of artificial intelligence technology for auxiliary diagnosis of spinal diseases. Methods: The LableImg tool was used to label the MRIs of 604 patients by clinically experienced doctors. Then, in order to select an appropriate object detection algorithm, deep transfer learning models of YOLOv3, YOLOv5, and PP-YOLOv2 were created and trained on the Baidu PaddlePaddle framework. The experimental results showed that the PP-YOLOv2 model achieved a 90.08% overall accuracy in the diagnosis of normal, IVD bulges and spondylolisthesis, which were 27.5 and 3.9% higher than YOLOv3 and YOLOv5, respectively. Finally, a visualization of the intelligent spine assistant diagnostic software based on the PP-YOLOv2 model was created and the software was made available to the doctors in the spine and osteopathic surgery at Guilin People's Hospital. Results and discussion: This software automatically provides auxiliary diagnoses in 14.5 s on a standard computer, is much faster than doctors in diagnosing human spines, which typically take 10 min, and its accuracy of 98% can be compared to that of experienced doctors in the comparison of various diagnostic methods. It significantly improves doctors' working efficiency, reduces the phenomenon of missed diagnoses and misdiagnoses, and demonstrates the efficacy of the developed intelligent spinal auxiliary diagnosis software.

Factors associated with the relapse in Ponseti treated congenital clubfoot.

OBJECTIVES: We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method. METHODS: We retrospectively reviewed all children with congenital clubfoot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples' Hospital Ethics Committee. RESULTS: In this study, there were 148 cases (164 ft) in total that underwent the Ponseti method, with the follow-up period at least 5 years. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50 ± 2.15 months. The average initial Pirani score was 4.98 ± 1.33, and the average number of casts was 5.71 ± 2.28 times. The mean age of mothers at birth was 25.81 ± 2.38 years old. The walking age of children was at a mean of 14.83 ± 1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 ft (76.4%). The average follow-up period was 7.27 ± 1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group . CONCLUSION: The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

Minimally invasive versus open transforaminal lumbar fusion: a systematic review of complications.

PURPOSE: The aim of this study is to compare mTLIF vs. oTLIF with regard to peri-operative complications, operative time, estimated blood loss, fluoroscopic time, and the length of hospital stay. METHODS: The PubMed and EMBASE databases were searched for relevant articles reporting patients undergoing TLIF, and a comparison between mTILF and oTLIF was performed. The database included patient demographic information, complications, operative time, fluoroscopic time, and the length of hospital stay. RESULTS: Fourteen studies were included in this systematic review. The total number of subjects included was 901, of which 455 underwent mTLIF (50 %) and 446 underwent oTLIF (50 %). The operating time for the mTLIF was ranged from 116 to 390 minutes, compared with 102 to 365 minutes for oTLIF, the operating time tended to be longer in the mTLIF group than the oTLIF group. The estimated blood loss was lower in the mTLIF group, ranging from 51 to 578 ml in mTLIF and 225 to 961 ml in oTLIF, respectively. Length of hospital stay was short for the mTLIF with a 2.3 to 10.6 days hospitalization compared to 2.9 to 14.6 days for oTLIF. However the fluoroscopic time was consistently higher in the mTLIF group with a 49 to 106 seconds of fluoroscopy compared to 16.4 to 44 seconds for oTLIF. The complications divided into technical complications and infection complications. The main technical and infection complications included dural tears, screw malposition, and wound infection. Systemic complications included pneumonia, urinary tract infection, and DVT. The numbers of patients with complication was 54 out of 455 (11.87 %) in the mTLIF, and 64 out of 446 (14.35 %) in the oTLIF. CONCLUSION: The review shows mTLIF offers several potential advantages in reducing blood loss and the length of hospital stay, especially lowering the complication rates for patients compared with oTLIF. However, it required much more operative time and radiation exposure. Class I evidence and high-quality randomized controlled trials are needed for further study.