Value of different preoperative bone evaluation methods in predicting intraoperative screw insertion torque-a prospective clinical comparative trial.

BACKGROUND CONTEXT: Establishing good screw-bone structural stability is conducive to reducing the risk of postoperative screw loosening. Screw insertion torque is an objective index for evaluating screw-bone structural stability. Therefore, accurate prediction of screw insertion torque can improve the preoperative evaluation of patients, optimize the surgical plan, and improve the surgical effect. At present, the correlation between different bone assessment methods and screw insertion torque is unclear. PURPOSE: The aim of this study was to evaluate the correlation between different bone assessment methods and screw insertion torque and to optimize the predictive performance of screw insertion torque through mathematical modeling combined with different radiology methods. DESIGN: Prospective cross-sectional study. PATIENT SAMPLES: 77 patients with preoperatively available DXA, CT and MRI data who underwent spinal fixation surgeries between October 2022 and September 2023 and 357 sets of screw data were included in this analysis. OUTCOME MEASURES: Spinal, vertebrae-specific and screw trajectory's BMD were measured preoperatively by different imaging modalities. Intraoperative screw insertion torque was measured using an electronic torque wrench. METHODS: Pearson linear correlation, scatter plots and univariate linear regression were used to evaluate the correlation between different bone evaluation methods and screw insertion torque. Different bone evaluation methods were fitted into the prediction model of screw torque and the related equations were obtained. RESULTS: Screw insertion torque had the strongest positive correlation with the volumetric bone mineral density (vBMD) of the screw trajectory (Pedicle screw insertion torque (PSIT): R = 0.618, p<.001; Terminal screw insertion torque (TSIT): R = 0.735, p<.001). A weak negative correlation was found between the screw insertion torque and level specific vertebral bone quality (VBQ) (PSIT: R = -0.178, p=.001; TSIT: R = -0.147, p=.006). We also found that the PSIT was strongly correlated with the TSIT (R = 0.812, p<.001). CONCLUSIONS: Compared to other bone quality assessment methods, screw trajectory vBMD may be better predict the magnitude of screw insertion torque. In addition, we further optimized preoperative assessments by constructing a mathematical model to better predict screw insertion torque. In conclusion, clinicians should select appropriate preoperative bone quality assessment methods, identify potential low-torque patients, optimize surgical plans, and ultimately improve screw insertion accuracy and reduce postoperative screw loosening rate.

Diagnostic performance of metagenomic next-generation sequencing and conventional microbial culture for spinal infection: a retrospective comparative study.

PURPOSE: The study evaluated the diagnostic performance of metagenomic next-generation sequencing (mNGS) as a diagnostic test for biopsy samples from patients with suspected spinal infection (SI) and compared the diagnostic performance of mNGS with that of microbial culture. METHODS: All patients diagnosed with clinical suspicion of SI were enrolled, and data were collected through a retrospective chart review of patient records. Biopsy specimens obtained from each patient were tested via mNGS and microbial culture. Samples were enriched for microbial DNA using the universal DNA extraction kit, whole-genome amplified, and sequenced using MGISEQ-200 instrument. After Low-quality reads removed, the remaining sequences for microbial content were analyzed and aligned using SNAP and kraken2 tools. RESULTS: A total of 39 patients (19 men and 20 women) were deemed suitable for enrollment. The detection rate for pathogens of mNGS was 71.8% (28/39), which was significantly higher than that of microbial culture (23.1%, p = 0.016). Mycobacterium tuberculosis complex was the most frequently isolated. Using pathologic test as the standard reference for SI, thirty-one cases were classified as infected, and eight cases were considered aseptic. The sensitivity and specificity values for detecting pathogens with mNGS were 87.1% and 87.5%, while these rates were 25.8% and 87.5% with conventional culture. mNGS was able to detect 88.9% (8/9) of pathogens identified by conventional culture, with a genus-level sensitivity of 100% (8/8) and a species-level sensitivity of 87.5% (7/8). CONCLUSION: The present work suggests that mNGS might be superior to microbial culture for detecting SI pathogens.

Assessment of Multivariate Information Transmission in Space-Time-Frequency Domain: A Case Study for EEG Signals.

OBJECTIVE: Multivariate signal (MS) analysis, especially the assessment of its information transmission (for example, from the perspective of network science), is the key to our understanding of various phenomena in biology, physics and economics. Although there is a large amount of literature demonstrating that MS can be decomposed into space-time-frequency domain information, there seems to be no research confirming that multivariate information transmission (MIT) in these three domains can be quantified. Therefore, in this study, we attempted to combine dynamic mode decomposition (DMD) and parallel communication model (PCM) together to realize it. METHODS: We first regarded MS as a large-scale system and then used DMD to decompose it into specific subsystems with their own intrinsic oscillatory frequencies. At the same time, the transition probability matrix (TPM) of information transmission within and between MS at two consecutive moments in each subsystem can also be calculated. Then, communication parameters (CPs) derived from each TPM were calculated in order to quantify the MIT in the space-time-frequency domain. In this study, multidimensional electroencephalogram (EEG) signals were used to illustrate our method. RESULTS: Compared with traditional EEG brain networks, this method shows greater potential in EEG analysis to distinguish between patients and healthy controls. CONCLUSION: This study demonstrates the feasibility of measuring MIT in the space-time-frequency domain simultaneously. SIGNIFICANCE: This study shows that MIT analysis in the space-time-frequency domain is not only completely different from the MS decomposition in these three domains, but also can reveal many new phenomena behind MS that have not yet been discovered.

Idiopathic short stature and scoliosis in children treated with growth hormone.

The prevalence of scoliosis is not known in patients with idiopathic short stature, and the impact of treatment with recombinant human growth hormone on those with scoliosis remains controversial. We investigated the prevalence of scoliosis radiologically in children with idiopathic short stature, and the impact of treatment with growth hormone in a cross-sectional and retrospective cohort study. A total of 2,053 children with idiopathic short stature and 4,106 age- and sex-matched (1:2) children without short stature with available whole-spine radiographs were enrolled in the cross-sectional study. Among them, 1,056 with idiopathic short stature and 790 controls who had radiographs more than twice were recruited to assess the development and progression of scoliosis, and the need for bracing and surgery. In the cross-sectional study, there was an unexpectedly higher prevalence of scoliosis (33.1% (681/2,053) vs 8.52% (350/4,106)) in children with idiopathic short stature compared with controls (odds ratio 3.722; p < 0.001), although most cases were mild. In the longitudinal study, children with idiopathic short stature had a higher risk of the development and progression of scoliosis than the controls. Among children with idiopathic short stature without scoliosis at baseline, treatment with growth hormone significantly increased the risk of developing scoliosis (p = 0.015) and the need for bracing (p < 0.001). Among those with idiopathic short stature and scoliosis at baseline, treatment with growth hormone did not increase the risk of progression of the scoliosis, the need for bracing, or surgery. The impact of treatment with growth hormone on scoliosis in children with idiopathic short stature was considered controllable. However, physicians should pay close attention to the assessment of spinal curves in these children.

Full-Endoscopic Approach Forchronic Low Back Pain from Baastrup's Disease: Interspinous Plasty.

The objective was to introduce a new endoscopic technique-interspinous plasty for low back pain from Baastrup's disease; based on clinical manifestations, imaging findings and diagnostic test, to discuss a detailed diagnostic procedure for Baastrup's disease; and to explore the mechanism of interspinous plasty in pain relief. To our knowledge, there is no report about the results of endoscopic lumbar technique for Baastrup's disease. This study described the successful full-endoscopic surgical treatment for Baastrup's disease, providing a brand-new therapeutic method for patients. Clinical manifestations, imaging findings, including X-ray, computed tomography (CT) and magnetic resonance imaging, and a "positive" diagnostic test with local anesthetic were used to confirm Baastrup's disease in the three included patients. The interspinous plasty procedure, which aimed to recover a physiological gap between the adjacent spinous processes, was performed by full-endoscopic resection of marginal osteophytes. The removal of local inflamed tissue and reducing inflammation via intraoperative saline irrigation also lead to pain relief. Clinical outcomes included visual analog scale (VAS) for low back pain and the Oswestry Disability Index (ODI). The distance between the adjacent spinous processes was measured from the preoperative and postoperative CT scan. We calculated and recorded the difference between preoperative and postoperative measurements. Technical procedures and advantages of interspinous plasty are introduced. The three patients showed improvement in terms of the postoperative VAS of low back pain (from 8 to 2, from 7 to 1 and from 8 to 2) and ODI (from 68.9% to 33.3%, from 77.8% to 28.9% and from 71.1% to 28.9%, respectively) at the 12-month follow-up. Compared postoperative ODI index, the ODI index increased from 26.7% to 33.3% and from 24.4% to 28.9% in two of the cases at the 12-month follow-up. At 1 week, CT confirmed an obvious reduction in the marginal osteophytes between the adjacent spinous processes. Compared with those on preoperative CT images, the distance between adjacent spinous processes on postoperative CT was enlarged from 1 to 4 mm, and a repeated CT scan 3 months later reconfirmed little recrudescent osteoproliferation. In selected cases, full-endoscopic surgical treatment for chronic mechanical back pain as part of the phenomena of Baastrup's disease may be beneficial. The operations in this study were performed under local anesthesia, with satisfactory early clinical outcomes and a low incidence of complications or adverse events. This may be a feasible therapeutic method or an alternative option for patients who cannot tolerate general anesthesia surgery.

miR-29b-3p inhibits post-infarct cardiac fibrosis by targeting FOS.

BACKGROUND: Cardiac fibrosis after myocardial infarction (MI) is a major cause of heart deterioration. Recently, the roles of microRNAs (miRNAs) in various cardiovascular diseases associated with cardiac fibrosis have been extensively investigated. The present study aimed to investigate the role and mechanism of miR-29b-3p in cardiac fibrosis after MI. METHODS: miR-29b-3p expression in TGF-ß1-activated cardiac fibroblasts (CFs) was detected by qRT-PCR. Cell Counting Kit-8 (CCK-8) and Trans-well assays were performed to evaluate CFs proliferation and migration ability, respectively. Protein expressions of α-SMA, collagen I, collagen III, MMP2, and MMP9 were examined by Western blot assay. Bioinformatics, luciferase, and RNA immunoprecipitation (RIP) assays were carried out to determine whether FOS was targeted by miR-29b-3p. RESULTS: TGF-ß1 treatment dose-dependently curbed miR-29b-3p expression in CFs. miR-29b-3p restrained the promotive impacts of TGF-ß1 on CFs proliferation, migration, and differentiation. FOS was affirmed to be a target of miR-29b-3p, elevated expression of FOS reversed the inhibitory effects of miR-29b-3p on cell proliferation, migration, and differentiation in TGF-ß1-activated CFs. CONCLUSION: miR-29b-3p degraded the pro-fibrosis effect induced by TGF-ß1 via targeting FOS, providing a prospective therapeutic avenue for cardiac fibrosis after MI.

Does It work in Clinical Practice? A Comparison of Colonoscopy Cleansing Effectiveness in Clinical Practice Versus Efficacy from Selected Prospective Trials.

BACKGROUND: Adequate bowel preparation is essential for a high-quality colonoscopy. Many randomized controlled trials (RCTs) have investigated bowel preparation protocols, including split-dose and low-volume regimens. However, RCTs are conducted in an ideal, controlled setting, and translation of trial results to clinical practice is challenging. In this study, we compared the quality of bowel preparations of real-world patients from clinical practice with those enrolled in several prospective trials. METHODS: Bowel preparation quality, defined by the Ottawa Bowel Preparation Scale (OBPS), from four RCTs and one prospective trial were compared with two observational diary studies. Bowel preparations were polyethylene glycol preparation (PEG) or sodium picosulfate plus magnesium citrate (P/MC) taken via traditional or split-dose timing regimen. Age, sex, average number of bowel movements per day, comorbidities, colonoscopy indication and colonoscopy completion rates were also collected. RESULTS: Patients enrolled in prospective trials had a better OBPS by one point when compared with those in observational clinical practice studies (P<0.049), after controlling for age, sex, colonoscopy indication and type of bowel preparation used. We also found that each 10-year increase in age was associated with a 0.2 point increase in OBPS (P=0.008), and men were associated with a 0.5 increase in OBPS when compared with women P=0.014). CONCLUSION: Patients from clinical practice have higher OBPS than prospective trial patients. Increased age and male sex were also associated with increased OBPS. We believe increased patient motivation and education around bowel preparation regimen plays an important role in the success of bowel preparations.

Occipital Alpha Connectivity During Resting-State Electroencephalography in Patients With Ultra-High Risk for Psychosis and Schizophrenia.

Schizophrenia patients always show cognitive impairment, which is proved to be related to hypo-connectivity or hyper-connectivity. Further, individuals with an ultra-high risk for psychosis also show abnormal functional connectivity-related cognitive impairment, especially in the alpha rhythm. Thus, the identification of functional networks is essential to our understanding of the disorder. We investigated the resting-state functional connectivity of the alpha rhythm measured by electroencephalography (EEG) to reveal the relation between functional network and clinical symptoms. The participants included 28 patients with first-episode schizophrenia (FES), 28 individuals with ultra-high risk for psychosis (UHR), and 28 healthy controls (HC). After the professional clinical symptoms evaluation, all the participants were instructed to keep eyes closed for 3-min resting-state EEG recording. The 3-min EEG data were segmented into artefact-free epochs (the length was 3 s), and the functional connectivity of the alpha phase was estimated using the phase lag index (PLI), which measures the phase differences of EEG signals. The FES and UHR groups displayed increased resting-state PLI connectivity compared with the HC group [F(2,74) = 10.804, p < 0.001]. Significant increases in the global efficiency, the local efficiency, and the path length were found in the FES and UHR groups compared with those of the HC group. FES and UHR showed an increased degree of connectivity compared with HC. The degree of the left occipital lobe area was higher in the UHR group than in the FES group. The hypothesis of disconnection is confirmed. Furthermore, differences between the UHR and FES group were found, which is valuable for producing clinical significance before the onset of schizophrenia.

Slow digestion property of octenyl succinic anhydride modified waxy maize starch in the presence of tea polyphenols.

The in vivo slow digestion property of octenyl succinic anhydride modified waxy corn starch (OSA-starch) in the presence of tea polyphenols (TPLs) was studied. Using a mouse model, the experimental results showed an extended and moderate postprandial glycemic response with a delayed and significantly decreased blood glucose peak of OSA-starch after cocooking with TPLs (5% starch weight base). Further studies revealed an increased hydrodynamic radius of OSA-starch molecules indicating an interaction between OSA-starch and TPLs. Additionally, decreased gelatinization temperature and enthalpy and reduced viscosity and emulsifiability of OSA-starch support their possible complexation to form a spherical OSA-starch-TPLs (OSAT) complex. The moderate and extended postprandial glycemic response is likely caused by decreased activity of mucosal α-glucosidase, which is noncompetitively inhibited by tea catechins released from the complex during digestion. Meanwhile, a significant decrease of malondialdehyde (MDA) and increased DPPH free radical scavenging activity in small intestine tissue demonstrated the antioxidative functional property of the OSAT complex. Thus, the complex of OSAT, acting as a functional carbohydrate material, not only leads to a flattened and prolonged glycemic response but also reduces the oxidative stress, which might be beneficial to health.