Semantic segmentation for tooth cracks using improved DeepLabv3+ model.

Objective: Accurate and prompt detection of cracked teeth plays a critical role for human oral health. The aim of this paper is to evaluate the performance of a tooth crack segmentation model (namely, FDB-DeepLabv3+) on optical microscopic images. Method: The FDB-DeepLabv3+ model proposed here improves feature learning by replacing the backbone with ResNet50. Feature pyramid network (FPN) is introduced to fuse muti-level features. Densely linked atrous spatial pyramid pooling (Dense ASPP) is applied to achieve denser pixel sampling and wider receptive field. Bottleneck attention module (BAM) is embedded to enhance local feature extraction. Results: Through testing on a self-made hidden cracked tooth dataset, the proposed method outperforms four classical networks (FCN, U-Net, SegNet, DeepLabv3+) on segmentation results in terms of mean pixel accuracy (MPA) and mean intersection over union (MIoU). The network achieves an increase of 11.41% in MPA and 12.14% in MIoU compared to DeepLabv3+. Ablation experiments shows that all the modifications are beneficial. Conclusion: An improved network is designed for segmenting tooth surface cracks with good overall performance and robustness, which may hold significant potential in computer-aided diagnosis of cracked teeth.

Anterior atlantoaxial motion preservation fixation technique for axis complex fractures (odontoid process with Hangman's fractures) and technique notes.

This study aims to investigate the feasibility and efficacy of anterior atlantoaxial motion preservation fixation (AMPF) in treating axis complex fractures involving the odontoid process fracture and Hangman's fractures with C2/3 instability. A retrospective study was conducted on eight patients who underwent AMPF for axis complex fractures at the General Hospital of Central Theater Command from February 2004 to October 2021. The types of axis injuries, reasons for injuries, surgery time, intraoperative blood loss, spinal cord injury classification (American Spinal Injury Association, ASIA), as well as complications and technical notes, were documented. This study included eight cases of type II Hangman's fracture, five cases of type II and three cases of type III odontoid process fracture. Five patients experienced traffic accidents, while three patients experienced falling injuries. All patients underwent AMPF surgery with an average intraoperative blood loss of 288.75 mL and a duration of 174.5 min. Two patients experienced dysphagia 1 month after surgery. The patients were followed up for an average of 15.63 months. One case improved from C to E in terms of neurological condition, three cases improved from D to E, and four cases remained at E. Bony fusion and Atlantoaxial Motion Preservation were successfully achieved for all eight patients. AMPF is a feasible and effective way for simultaneous odontoid process fracture and Hangman's fractures with C2/3 instability, while preserving atlantoaxial movement.

Analysis of the clinical efficacy of visualization of percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture in lumbar disc herniation.

The objective of this study is to compare the clinical effectiveness of visualization of percutaneous endoscopic lumbar discectomy (VPELD) combined with annulus fibrosus suture technique and simple percutaneous endoscopic lumbar discectomy (PELD) technique in the treatment of lumbar disc herniation. A retrospective analysis was conducted on 106 cases of lumbar disc herniation treated with foraminoscopic technique at our hospital from January 2020 to February 2022. Among them, 33 cases were treated with VPELD combined with annulus fibrosus suture in group A, and 73 cases were treated with PELD in group B. The preoperative and postoperative visual analogue scale (VAS), functional index (Oswestry Disability Index, ODI), healing of the annulus fibrosus, intervertebral space height, and postoperative recurrence were recorded and compared between the two groups. All patients underwent preoperative and postoperative MRI examinations, and the average follow-up period was 12 ± 2 months. Both groups showed significant improvements in postoperative VAS and ODI scores compared to the preoperative scores (P < 0.05), with no statistically significant difference between the groups during the same period (P > 0.05). There was no significant decrease in intervertebral space between the two groups after surgery (P > 0.05). Group A showed significantly lower postoperative recurrence rate and better annulus fibrosus healing compared to group B (P < 0.05). The VPELD combined with annulus fibrosus suture technique is a safe, feasible, and effective procedure for the treatment of lumbar disc herniation. When the indications are strictly adhered to, this technique can effectively reduce the postoperative recurrence rate and reoperation rate. It offers satisfactory clinical efficacy and can be considered as an alternative treatment option for eligible patients.

Plant-inspired multifunctional fluorescent cellulose nanocrystals intelligent nanocomposite hydrogel.

Intelligent hydrogel has great application potentials in flexible sensing and artificial intelligence devices due to its intrinsic characteristics. However, developing an intelligent hydrogel with favorable properties including high strength, superior toughness, excellent conductivity and ionic sensing via a facile route is still a challenge. Herein, inspired by biologically chelating interactions of phytic acid (PA) in plants, a plant-inspired versatile intelligent nanocomposite hydrogel was readily fabricated by incorporating PA into the interface of fluorescent cellulose nanocrystals (F-CNC). Under PA "molecular bridge", the hydrogel simultaneously realized superflexibility (1000 %), high strength, superb self-healing ability, remarkable fluorescence and chloride ion sensibility as well as good ionic conductivity (2.4 S/m). The hydrogel could be assembled as a flexible sensor for real-time monitoring of human motion with excellent sensitivity and stability since high sensitivity toward both strain and pressure. F-CNC acted as a functional trigger could confer the hydrogel good fluorescence and high sensitivity toward chloride ion. This design confirms the synergy of F-CNC in boosting strength, ionic sensing, and ionic conductivity, addressing a long-standing dilemma among strength, stretchability, and sensitivity for intelligent hydrogel. The one-step incorporating tactic under mild ambient conditions may open an innovative avenue for the construction of intelligent hydrogel with novel properties.

Endoscopic treatment of lumbar ligamentum flavum cyst by interlaminar approach: a minimally invasive and effective alternative to open surgery.

BACKGROUND AND OBJECTIVES: Lumbar ligamentum flavum cyst is a rare spinal condition that can cause significant morbidity and neurological deficits. Traditional surgical treatment involves open surgery, which can be associated with prolonged recovery time and significant morbidity. In recent years, endoscopic treatment of lumbar ligamentum flavum cyst has emerged as a minimally invasive and effective alternative to open surgery, but only a few cases have been reported in the literature. This paper describes our experience with endoscopic resection of an L4/5 ligamentum flavum cyst through an interlaminar approach and reviews the literature on the treatment of lumbar ligamentum flavum cyst. METHODS: An 87-year-old man presented with lameness in the left leg, and magnetic resonance imaging (MRI) showed nerve compression by a ligamentum flavum cyst at the L4/5 intervertebral plane. The patient underwent endoscopic resection of the ligamentum flavum cyst through a left interlaminar approach with the facet joint preserved. The present study was approved by the Ethics Committee of our hospital. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Text regarding patient consent is not applicable for this case. RESULTS: Postoperative clinical results improved significantly, and postoperative MRI showed complete cyst resection. CONCLUSION: Total endoscopic resection via an interlaminar approach provides a new minimally invasive approach for the surgical treatment of lumbar ligamentum flavum cyst, which can be used as a reference by clinicians.

[Clinical study of percutaneous double-segment lengthened sacroiliac screws internal fixation via three-dimensional navigation technology in treatment of Denis type â ¡ and â ¢ sacral fractures].

Objective: To investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Methods: A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S 1 and S 2 segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. Results: The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Conclusion: Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.

Zirconium Phosphate Assisted Phosphoric Acid Co-Catalyzed Hydrolysis of Lignocellulose for Enhanced Extraction of Nanocellulose.

The high mechanical strength, large specific surface area, favorable biocompatibility, and degradability of nanocellulose (CNC) enable it to be a potential alternative to petroleum-based materials. However, the traditional preparation of CNCs requires a large amount of strong acid, which poses a serious challenge to equipment maintenance, waste liquid recycling, and economics. In this study, a solid and easily recoverable zirconium phosphate (ZrP) was used to assist in the phosphoric acid co-catalyzed hydrolysis of lignocellulose for extracting CNCs. Due to the presence of acidic phosphate groups, ZrP has a strong active center with a high catalytic activity. With the assistance of ZrP, the amount of phosphoric acid used in the reaction is significantly reduced, improving the equipment's durability and economic efficiency. The effects of the process conditions investigated were the phosphate acid concentration, reaction temperature, and reaction time on the yield of CNCs. The Box-Behnken design (BBD) method from the response surface methodology (RSM) was applied to investigate and optimize the preparation conditions. The optimized pre-treatment conditions were 49.27% phosphoric acid concentration, 65.38 °C reaction temperature, and 5 h reaction time with a maximal cellulose yield (48.33%). The obtained CNCs show a granular shape with a length of 40~50 nm and a diameter of 20~30 nm, while its high zeta potential (-24.5 mV) make CNCs present a stable dispersion in aqueous media. Moreover, CNCs have a high crystallinity of 78.70% within the crystal type of cellulose Ⅰ. As such, this study may pioneer the horizon for developing a green method for the efficient preparation of CNC, and it is of great significance for CNCs practical production process.

Percutaneous Uniplanar Pedicle Screw-Rod System with Injured Vertebra Fixation for Thoracolumbar Burst Fracture and Technique Notes.

OBJECTIVE: To evaluate the efficacy of percutaneous uniplanar pedicle screw (PUPS) combined with injured vertebra fixation for treating thoracolumbar burst fracture and provide technique notes. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, China, from February 2019 to December 2021. METHODOLOGY: Patients who had undergone PUPS internal fixation for thoracolumbar burst fracture were followed up for more than 12 months in the General Hospital of Central Theater Command, Wuhan, China. The operation time, intraoperative blood loss, and hospital stay were recorded. Visual analysis scale (VAS), score of low back pain, ODI (oswestry disability endex), anterior vertebral height (AVH), Cobb angle were documented before and after the operation, Also, the complications and postoperative tail shank angles (TSA) were documented. RESULTS: All 23 patients were followed up for more than 12 months without re-fracture, loosening or breakage of the screw and rod. The operation time, intraoperative blood loss, and hospital stay were 51.34±8.30 minutes, 75.67±16.55 minutes, and 9.86±1.96 days respectively. VAS and ODI scores after the operation were significantly lower than before (p <0.05). The AVH and Cobb angle after operation were significantly better as compared with those before the operation (p <0.05), but no statistically significant difference was found in those two values at 1 week, 3 months, and 12 months after operation (p >0.05). No statistically significant difference was found in TSA after the operation (p >0.05). CONCLUSIONS: PUPS combined with injured vertebra fixation reveals satisfactory efficacy for thoracolumbar burst fracture with well reduction of the fracture, the AVH, and Cobb angle maintenance. KEY WORDS: Percutaneous uniplanar pedicle screw, Minimally invasive surgery, Thoracolumbar vertebral body fracture, Injured vertebra fixation.

Clinical efficacy of transforaminal endoscopic lumbar discectomy for lumbar degenerative diseases: A minimum 6-year follow-up.

Background: Transforaminal Endoscopic Lumbar Discectomy (TELD) is widely applied for lumbar degenerative disease (LDDs) and satisfactory short-term outcomes have been achieved. However, the mid-term and long-term follow-up of this technique is still lacking. Objective: To retrospectively analyze the mid-term clinical efficacy of TELD for single-level LDD and its effect on intervertebral disc degeneration with a minimum of 6-year follow-up. Methods: 64 patients with single-level LDDs (lumbar disc herniation, lumbar spinal stenosis) who underwent TELD under local anesthesia in our department from December 2014 to December 2015 were observed. Visual analog scale (VAS), Japanese Orthopaedic Association evaluation treatment (JOA) score and Oswestry Disability Index (ODI) were calculated and compared before operation, 3 months after operation, 6 months after operation, 1 year after operation and at the last follow-up. Disc Height (DH), disc range of motion (ROM) and disc degeneration on standard lumbar lateral radiographs before operation and at the last follow-up were determined. Recurrence rate and operation-related complications during follow-up were recorded. Results: 64 cases were followed up for 6.4 ± 0.1 years. There were no complications such as infection, epidural hematoma and nerve root injury. 1 patient (1.67%) was found to have dural rupture and cauda equina hernia during the operation. There were significant differences in VAS, JOA, ODI between preoperative and postoperative 3 months, 6 months, 1 year and last follow-up (P < 0 01), VAS, JOA, ODI at 3 months after operation were different from 6 months after operation (P < 0 05), and there were significant differences compared with preoperative, 1 year after operation and last follow up (P < 0 01). VAS, JOA and ODI at 6 months after operation were significantly different from those before operation (P < 0.01), but not significantly different from those at 1 year after operation and the last follow-up (P > 0.05). There was no significant difference in DH, ROM and the Pfirrmann grade of intervertebral disc preoperative and the last follow-up. During the follow-up period, 3 patients (4.69%) were recurrent, 13 patients (20.31%) had various degrees of postoperative dysesthesia (POD), and 3 patients (4.69%) had various degrees of muscle weakness. Conclusion: TELD has a satisfactory mid-term efficacy, and has no significant effect on the DH, the stability of the intervertebral disc space, or on intervertebral disc degeneration. However, as expected, TELD was associated with some complications including recurrent disc herniation and POD.

Controllable Construction of Temperature-Sensitive Supramolecular Hydrogel Based on Cellulose and Cyclodextrin.

In temperature sensitive hydrogels, the swelling degree or light transmittance of the gel itself changes with variations in ambient temperature, prompting its wide application in controlled drug release, tissue engineering, and material separation. Considering the amphiphilic structure of ß-cyclodextrin (ß-CD), a cellulose-based supramolecular hydrogel with superior temperature sensitivity was synthesized based on a combination of cellulose and ß-CD as well as the host-guest interaction between ß-CD and polypropylene glycol (PPG). In the one-pot tandem reaction process, chemical grafting of ß-CD on cellulose and the inclusion complexation of ß-CD with PPG were performed simultaneously in a NaOH/urea/water system. The obtained supramolecular hydrogel had a lower critical solution temperature (LCST) of 34 °C. There existed covalent bonding between the cellulose and ß-CD, host-guest complexation between the ß-CD and PPG, and hydrogen bonding and hydrophobic interactions between the components in the network structure of the supramolecular hydrogel. The combination of various covalent and non-covalent bonds endowed the resulting supramolecular hydrogel with good internal network structure stability and thermal stability, as well as sensitive temperature responsiveness within a certain range-implying its potential as a smart material in the fields of medicine, biology, and textiles. This work is expected to bring new strategies for the fabrication of cellulose-based thermosensitive materials, benefitting the high-value utilization of cellulose.

Passivator-Free Microwave-Hydrothermal Synthesis of High Quantum Yield Carbon Dots for All-Carbon Fluorescent Nanocomposite Films.

Based on the self-passivation function of chitosan, an efficient, and green synthesis strategy was applied to prepare chitosan carbon dots (CDs). The quantum yield of carbon dots reached 35% under the conditions of hydrothermal temperature of 200 °C, hydrothermal time of 5 h, and chitosan concentration of 2%. Moreover, the obtained carbon dots had high selectivity and sensitivity to Fe3+. Based on the Schiff base reaction between the aldehyde groups of dialdehyde cellulose nanofibrils (DNF) and the amino groups of CDs, a chemically cross-linked, novel, fluorescent composite film, with high transparency and high strength, was created using one-pot processing. Knowing that the fluorescence effect of the composite film on Fe3+ had a linear relationship in the concentration range of 0-100 µM, a fluorescent probe can be developed for quantitative analysis and detection of Fe3+. Owing to their excellent fluorescent and mechanical properties, the fluorescent nanocomposite films have potential applications in the fields of Fe3+ detection, fluorescent labeling, and biosensing.

Macrophage migration inhibitory factor takes part in the lumbar ligamentum flavum hypertrophy.

The present study aimed to observe the content difference of macrophage migration inhibitory factor [MIF; novoprotein recombinant human MIF (n­6his) (ch33)], TGFß1 and MMP13 in patients with and without ligamentum flavum (LF) hypertrophy and investigate the roles of MIF in LF hypertrophy. The concentration of MIF, TGFß1 and MMP13 in LF were detected by ELISA in a lumbar spinal stenosis (LSS) group and a lumbar disc herniation (LDH) group. Culture of primary LFs and identification were performed for the subsequent study. Cell treatments and cell proliferation assay by CCK­8 was performed. Western blot and quantitative PCR analysis were used to detect the expression of TGFß1, MMP13, type I collagen (COL­1) and type III collagen (COL­3) and Src which were promoted by MIF. The concentration of MIF, TGFß1 and MMP13 were higher in the LSS group compared with the LDH group. Culture of primary LFs and identification were performed. Significant difference in LFs proliferation occurred with treatment by MIF at a concentration of 40 nM for 48 h (P<0.05). The gene and protein expression of TGFß1, MMP13, COL­1, COL­3 and Src were promoted by MIF (P<0.05). Proliferation of LFs was induced by MIF and MIF­induced proliferation of LFs was inhibited by PP1 (a Src inhibitor). MIF may promote the proliferation of LFs through the Src kinase signaling pathway and can promote extracellular matrix changes by its pro­inflammatory effect. MIF and its mediated inflammatory reaction are driving factors of LF hypertrophy.

One-Pot Synthesis of UPy-Functionalized Nanocellulose under Mechanochemical Synergy for High-Performance Epoxy Nanocomposites.

The high strength, high specific surface area, excellent biocompatibility, and degradability of nanocellulose (NCC) make it a potential reinforcing phase for composite materials. However, the polyhydroxyl property of NCC renders it prone to self-aggregation and it has weak interfacial compatibility with non-polar substrates, limiting its enhancement performance for composite materials. Therefore, based on the high reactivity of NCC, the chemical modification of NCC to introduce functional groups is the basis for effectively reducing its self-aggregation, improving its interfacial compatibility with the polymer matrix, and creating nanocellulose-based functional materials. The existing functional modifications of NCC have limitations; they require cumbersome steps, generate low yields, and are environmentally unfriendly. Herein, ureido-pyrimidinone (UPy) was introduced to NCC through a sustainable and high-efficiency avenue formed by the mechanochemical synergy of microwaves and ultrasonication. The obtained UPy-modified nanocellulose (NCC-UPy) exhibited a rod-like shape, with a length of 200−300 nm and a width of 20−30 nm, which presented oriented and stable dispersion in an aqueous medium, and the zeta potential reached −40 mV. Moreover, NCC-UPy had good thermostability (>350 °C) and high crystallinity (82.5%) within the crystal type of cellulose I. Using the as-prepared NCC-UPy as a molecular bridge, it was organically combined with epoxy resin through multiple hydrogen bonds to construct a nanocomposite membrane with superior mechanical strength and thermal stability. The results revealed that NCC-UPy dispersed uniformly in the epoxy matrix without aggregating and that the interfacial compatibility was good, leading to an 87% increase in the tensile strength of the formed nanocomposite membrane when 0.5 wt.% NCC-UPy was loaded. It was proved that NCC-UPy had remarkable reinforcing potential and effective stress transfer capacity for composites. Consequently, this study may open the door to the development of a one-pot green approach for undertaking the functional modification of NCC, and it is of great significance for the development of NCC-based nanocomposites.

One-Pot Green Preparation of Fluorescent Cellulose Nanofibers.

Fluorescent cellulose nanofibers (FCNFs), with a high yield, were prepared via one-pot hydrolysis and the grafting reaction of cellulose with thiazolipyridine carboxylic acid (TPCA). The hydrolysis and Fischer esterification of cellulose were conducted under microwave-hydrothermal conditions; meanwhile, TPCA formation was induced by the dehydration reaction between L-cysteine and citric acid. The effects of the reaction temperature and reaction time on the yield and performance of FCNF were investigated. The morphology and size, surface chemical property, crystal structure, thermostability, and fluorescent performance of FCNF were characterized. The results revealed that the yield of FCNF reached 73.2% under a microwave power of 500 W, reaction temperature of 110 °C, and reaction time of 5 h. The FCNF obtained presents a short rod-like morphology. The crystallinity of the FCNFs is 80%, and their thermal stability did not decline significantly. Additionally, the fluorescent performance of the FCNFs is excellent, which results in them having good sensitivity to chloride ions. The good fluorescent performance and significant responsiveness to chloride ions of FCNFs lead to them having broad prospects in bio-labeling, biosensing, information storage, chloride ion detection, among others.

Continuous-Flow Ammoxidation of 2-Methylpyrazine to 2-Cyanopyrazine with High Space-Time Yield in a Microreactor.

A microreactor (MR) with a vaporization microchamber and a sinusoidal wave microchannel was fabricated to synthesize 2-cyanopyrazine (CP) directly with an aqueous 2-methylpyrazine (MP) solution. A continuous-flow process with high space-time yield was achieved under the premise of strong exothermality of this ammoxidation reaction. The vanadium metal oxide catalysts with four different supports (α-Al2O3, γ-Al2O3, ZSM-5(50), ZSM-5(80)) were evaluated by simply stacking in the wave microchannel from 350 to 540 °C. The process parameters (temperature, reactant ratio, and size of catalysts) were optimized with the selected CrVPO/γ-Al2O3 catalyst, and an optimal ammoxidation process with MP conversion (X MP) of 71.5% and CP selectivity (S CP) of 93.7% was obtained by a volume space velocity (GHSV) of 13 081 h-1 at 480 °C. Correspondingly, the space-time yield of CP (STYCP) was 1724-77 082 gCPkgcat -1h-1, which was the highest value ever reported for this reaction. Meanwhile, the ammoxidation reaction showed a great continuous-synthesis stability of 50-h running in the microreactor with the CP yield (Y CP) remaining 56%-68%.

Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery.

OBJECTIVE: To analyze the risk factors of cerebrospinal fluid leakage (CSFL) following lumbar posterior surgery and summarize the related management strategies. METHODS: A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation (LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor (LST). Data of gender, age, body mass index(BMI), duration of disease, diabete, smoking history, preoperative epidural steroid injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, drainage tube removal time, suture removal time, and complications were recorded. RESULTS: The incidence of 115 cases with cerebrospinal fluid leakage, was 3.6% (115/3179).One-way ANOVA showed that gender, body mass index (BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL (P > 0.05). Age, type of disease, duration of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery had effects on CSFL (P < 0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were significantly affected CSFL (P < 0.05).Drainage tube removal time of CSFL patients ranged from 7 to 11 days, with an average of 7.1 ± 0.5 days, drainage tube removal time of patients without CSFL was 1-3 days, with an average of 2.0 ± 0.1 days, and there was a statistical difference between the two groups (P < 0.05).The removal time of CSFL patients was 12-14 days, with an average of 13.1 ± 2.7 days, and the removal time of patients without CSFL was 10-14 days, with an average of 12.9 ± 2.2 days, there was no statistically significant difference between the two groups (P > 0.05). CONCLUSION: Type of disease, preoperative epidural steroid injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery. Once appear, CSFL can also be effectively dealt without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.

MiR-206 regulates the Th17/Treg ratio during osteoarthritis.

BACKGROUND: The present study aimed to determine the functional role of miR-206 in T helper 17 (Th17)/regulatory T (Treg) cell differentiation during the development of osteoarthritis (OA). METHODS: Patients with OA and healthy controls were recruited for investigating the association between miR-206 and Th17/Treg ratio. Transfection experiments were conducted in CD4+ T cells to verify the mechanism of miR-206 on the balance of Treg/Th17. OA model was constructed to detect the clinical score, histopathological changes and Treg/Th17 ratio. OA model was induced in rats to verify the effect of miR-206 inhibition on Th17/Treg immunoregulation. RESULTS: High expression of miR-206 was positively correlated with peripheral Th17/Treg imbalance in patients with OA. The interactions between miR-206 and the 3' untranslated regions (3'-UTR) of suppressor of cytokine signaling-3 (SOCS3) and fork head transcriptional factor 3 (Foxp3) were confirmed by luciferase reporter assays. MiR-206 disturbed the Th17/Treg balance by targeting SOCS3 and Foxp3. In vivo assay demonstrated that antagomiR directed against miR-206 restored Th17/Treg balance during the development of OA. CONCLUSION: MiR-206 contributed to the progression of OA by modulating Th17/Treg imbalance, suggesting that miR-206 inhibition might be a promising therapeutic strategy for the treatment of OA.

Ultrasound-assisted Percutaneous Vertebroplasty in Upper and Mid-thoracic Osteoporotic Fracture.

Osteoporotic vertebral compression fracture (OVCF) is a common disease among the elderly individuals. With the aging of the population development, the incidence of OVCF is increasing. Cementation of vertebral body like percutaneous vertebroplasty (PVP) is a minimally invasive and effective treatment. However, the application in upper and mid-thoracic vertebrae is rare for poor fluoroscopy view caused by osteopenia vertebral body itself and scapula, sternum block. Inaccurate puncture and high radiation exposure of PVP in upper and mid-thoracic vertebrae still challenge surgeons. Owing to the ability of musculoskeletal ultrasound in revealing the clear real-time view of soft tissues and skeleton, the authors use intraoperative ultrasound-guided PVP to treat eight patients with upper or mid-thoracic vertebra body OVCFs, which has been tested to be a safe, feasible and satisfied technique after the operation and follow-up. To the authors' knowledge, this technique has not been reported elsewhere.   Key Words: Ultrasound, Percutaneous vertebroplasty, Osteoporotic vertebral compression fracture, Upper and mid-thoracic vertebra body.

A Post-Traumatic Osteoarthritic Model of Hip Following Fracture of Acetabulum in Rabbit: A Preliminary Study by Macroscopic and Radiographic Assessment.

OBJECTIVE: To develop a post-traumatic osteoarthritic model of hip following fracture of acetabulum in rabbit for revealing biochemical mechanism of post-traumatic osteoarthritis. METHODS: A total of 36 mature male New Zealand white rabbits were equally divided into sham group (n = 12), non-ORIF group (n = 12), and open reduction and internal fixation (ORIF) group (n = 12). Except for the sham group, rabbits had survival surgeries to create acetabular fractures of dorsal wall for simulating dashboard impaction mechanism. The ORIF group received open reduction and internal fixation, while fractures in the non-ORIF group were left as displaced but transverse fracture and dislocation was reduced. Besides intraoperative appearance and postoperative recovery, macroscopic and radiographic characteristics of the hips were recorded and assessed by a radiographic scoring scale at 3 weeks, 6 weeks, and 6 months, respectively. RESULTS: Out of 24 modeled acetabula, 21 (87.5%) were pure dorsal wall fractures as proposed and the remaining three were associated fractures (dorsal wall plus transverse fracture) accompanied by dorsal dislocation or not. All hips were stable, and no sciatic nerve injury was observed. One rabbit in the ORIF group died of deep infection 4 days after surgery. Rabbits in the sham and ORIF groups returned to normal gait in 2 weeks, but animals in the non-ORIF group suffered from limping and restricted movement. As the time progressed, the hips in the non-ORIF group experienced progressive and severe degeneration which exhibited dramatically malformed and hypertrophic joints at 6 months, but the ORIF group maintained much better morphological structure. Corresponding to morphological changes, the average radiographic scores of the non-ORIF group increased from 1.25 at 3 weeks to 2.75 at 6 months and showed statistically significant difference when compared to the sham group at all three time points (P = 0.011, 0.011, 0.015, respectively, <0.0167). Although the scores of the ORIF group showed apparent improvements (increased from 0.67 at 3 weeks to 2.00 at 6 months), there was no significant difference between the two modeled groups at all three time points. CONCLUSION: The fracture model with high consistency and reproducibility showed progressive post-traumatic osteoarthritic changes which could be improved by open reduction and internal fixation surgery and provided an alternative selection for investigating potential pathogenesis and pathology of post-traumatic osteoarthritis following fracture of acetabulum.

Risk factors and prevention strategies for the occupational exposure of medical staff during the coronavirus disease-19 pandemic (Review).

During the sudden epidemic of this novel coronavirus-induced pneumonia, a number of medical staff were infected and even succumbed to coronavirus disease-19 (COVID-19). Based on the experience of medical professionals from The Hubei 672 Orthopedics Hospital of Integrated Chinese and Western Medicine on this COVID-19 pandemic, the present review summarizes the risk factors associated with the occupational exposure of front-line medical staff. Challenges encountered include insufficient understanding, lack of early protection, environmental factors and routine procedures and the lack of adequate prevention strategies. Overcoming these challenges can potentially enhance awareness of COVID-19 prevention and control among medical staff, in addition to strengthening the personal protection of front-line medical staff, rational area layout, regular disinfection, standardization of daily procedures, reasonable scheduling and early psychological intervention. The present article may serve as a referencing point for the prevention and control of this epidemic.