Improving the detection accuracy of the dual SERS aptasensor system with uncontrollable SERS "hot spot" using machine learning tools.

BACKGROUND: Simultaneous detection of food contaminants is crucial in addressing the collective health hazards arising from the presence of multiple contaminants. However, traditional multi-competitive surface-enhanced Raman scattering (SERS) aptasensors face difficulties in achieving simultaneous accurate detection of multiple target substances due to the uncontrollable SERS "hot spots". In this study, using chloramphenicol (CAP) and estradiol (E2) as two target substances, we introduced a novel approach that combines machine learning methods with a dual SERS aptasensor, enabling simultaneous high-sensitivity and accurate detection of both target substances. RESULTS: The strategy effectively minimizes the interference from characteristic Raman peaks commonly encountered in traditional multi-competitive SERS aptasensors. For this sensing system, the Au@4-MBA@Ag nanoparticles modified with sulfhydryl (SH)-CAP aptamer and Au@DTNB@Ag NPs modified with sulfhydryl (SH)-E2 aptamer were used as signal probes. Additionally, Fe3O4@Au nanoflowers integrated with SH-CAP aptamer complementary DNA and SH-E2 aptamer complementary DNA were used as capture probes, respectively. When compared to linear regression random forest, and support vector regression (SVR) models, the proposed artificial neural network (ANN) model exhibited superior precision, demonstrating R2 values of 0.963, 0.976, 0.991, and 0.970 for the training set, test set, validation set, and entire dataset, respectively. Validation with ten spectral groups reported an average error of 244 µg L-1. SIGNIFICANCE: The essence of our study lies in its capacity to address a persistent challenge encountered by traditional multiple competitive SERS aptasensors - the interference generated by uncontrollable SERS "hot spots" that hinders simultaneous quantification. The accuracy of the predictive model for simultaneous detection of two target substances was significantly improved using machine learning tools. This innovative technique offers promising avenues for the accurate and high-sensitive simultaneous detection of multiple food and environmental contaminants.

The development of posterior reduction forceps for atlantoaxial dislocation and its preliminary application in irreducible atlantoaxial dislocation.

OBJECTIVE: To develop posterior reduction forceps for atlantoaxial dislocation and evaluate the preliminary clinical application of this forceps in assisting simple posterior screw-rod system reduction and fixation in the treatment of irreducible atlantoaxial dislocation. METHODS: Based on the posterior atlantoaxial screw-rod system, posterior reduction forceps was developed to assist simple posterior screw-rod system for the treatment of irreducible atlantoaxial dislocation. From January 2021 to October 2022, 10 cases with irreducible atlantoaxial dislocation were treated with this technique. The Japanese Orthopaedic Association (JOA) score was applied before and after surgery to evaluate the neurological status of the patient, and the Atlanto-dental interval (ADI) was measured before and after surgery to evaluate the atlantoaxial reduction. X-ray and CT were performed to evaluate internal fixation, atlantoaxial sequence and bone graft fusion during regular follow-up. MRI was performed to evaluate the status of atlantoaxial reduction and spinal cord compression after surgery. RESULTS: All 10 patients were successfully operated, and there were no complications such as spinal nerve and vascular injury. Postoperative clinical symptoms were significantly relieved in all patients, and postoperative JOA score and ADI were significantly improved compared with those before surgery (P < 0.05). CONCLUSIONS: The developed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation to avoid the release in anterior or posterior approach and reduce the difficulty of surgery. The preliminary results of this technique are satisfactory and it has a good application prospect.

A Universal Strategy to Construct High-Performance Homo- and Heterogeneous Microgel Assembly Bioinks.

Three dimensional (3D) extrusion bioprinting aims to replicate the complex architectures and functions of natural tissues and organs. However, the conventional hydrogel and new-emerging microgel bioinks are both difficult in achieving simultaneously high shape-fidelity and good maintenance of cell viability/function, leading to limited amount of qualified hydrogel/microgel bioinks. Herein, a universal strategy is reported to construct high-performance microgel assembly (MA) bioinks by using epigallocatechin gallate-modified hyaluronic acid (HA-EGCG) as coating agent and phenylboronic acid grafted hyaluronic acid (HA-PBA) as assembling agent. HA-EGCG can spontaneously form uniform coating on the microgel surface via mussel-inspired chemistry, while HA-PBA quickly forms dynamic phenylborate bonds with HA-EGCG, conferring the as-prepared MA bioinks with excellent rheological properties, self-healing, and tissue-adhesion. More importantly, this strategy is applicable to various microgel materials, enabling the preparation of homo- and heterogeneous MA (homo-MA and hetero-MA) bioinks and the hierarchical printing of complicated structures with high fidelity by integration of different microgels containing multiple materials/cells in spatial and compositional levels. It further demonstrates the printing of breast cancer organoid in vitro using homo-MA and hetero-MA bioinks and its preliminary application for drug testing. This universal strategy offers a new solution to construct high-performance bioinks for extrusion bioprinting.

Significant effect of posterior line treatment of HER2 positive advanced gastric cancer: A case report.

At present, there are few options for third line and above treatment of advanced gastric cancer and the single drug effect is poor. HER2 positive gastric cancer is an important subtype of gastric cancer and has certain immune characteristics. The combination of HER2 inhibitor and PD-1 inhibitor has a synergistic effect, and anti-tumor drugs targeting HER2 can play an anti-angiogenesis role by downregulating VEGF. We report a patient with HER2-positive gastric cancer who developed post-operative tumor recurrence and metastasis after adjuvant chemotherapy and radiotherapy. Trastuzumab combined with albumin paclitaxel was used as second-line treatment with progression-free survival for 9 months. In third line treatment, we retained trastuzumab and combined it with camrelizumab and apatinib. During the treatment period, although the patient stopped taking the drugs due to the side effects of camrelizumab and apatinib, he achieved a PFS of 10.4 months. Considering the good effect of the third line treatment, we added another PD-1 inhibitor and continued to combine trastuzumab treatment. We found that the patient still benefited from the treatment and continued to survive for another 4 months. At present, the patient is treated with DisitamabVedotin (HER2-ADC) combined with PD-1 inhibitor, and no overall survival outcome has been observed.

RGD-coated polymeric microbubbles promote ultrasound-mediated drug delivery in an inflamed endothelium-pericyte co-culture model of the blood-brain barrier.

Drug delivery to central nervous pathologies is compromised by the blood-brain barrier (BBB). A clinically explored strategy to promote drug delivery across the BBB is sonopermeation, which relies on the combined use of ultrasound (US) and microbubbles (MB) to induce temporally and spatially controlled opening of the BBB. We developed an advanced in vitro BBB model to study the impact of sonopermeation on the delivery of the prototypic polymeric drug carrier pHPMA as a larger molecule and the small molecule antiviral drug ribavirin. This was done under standard and under inflammatory conditions, employing both untargeted and RGD peptide-coated MB. The BBB model is based on human cerebral capillary endothelial cells and human placental pericytes, which are co-cultivated in transwell inserts and which present with proper transendothelial electrical resistance (TEER). Sonopermeation induced a significant decrease in TEER values and facilitated the trans-BBB delivery of fluorescently labeled pHPMA (Atto488-pHPMA). To study drug delivery under inflamed endothelial conditions, which are typical for e.g. tumors, neurodegenerative diseases and CNS infections, tumor necrosis factor (TNF) was employed to induce inflammation in the BBB model. RGD-coated MB bound to and permeabilized the inflamed endothelium-pericyte co-culture model, and potently improved Atto488-pHPMA and ribavirin delivery. Taken together, our work combines in vitro BBB bioengineering with MB-mediated drug delivery enhancement, thereby providing a framework for future studies on optimization of US-mediated drug delivery to the brain.

mRNA Sonotransfection of Tumors with Polymeric Microbubbles: Co-Formulation versus Co-Administration.

Despite its high potential, non-viral gene therapy of cancer remains challenging due to inefficient nucleic acid delivery. Ultrasound (US) with microbubbles (MB) can open biological barriers and thus improve DNA and mRNA passage. Polymeric MB are an interesting alternative to clinically used lipid-coated MB because of their high stability, narrow size distribution, and easy functionalization. However, besides choosing the ideal MB, it remains unclear whether nanocarrier-encapsulated mRNA should be administered separately (co-administration) or conjugated to MB (co-formulation). Therefore, the impact of poly(n-butyl cyanoacrylate) MB co-administration with mRNA-DOTAP/DOPE lipoplexes or their co-formulation on the transfection of cancer cells in vitro and in vivo is analyzed. Sonotransfection improved mRNA delivery into 4T1 breast cancer cells in vitro with co-administration being more efficient than co-formulation. In vivo, the co-administration sonotransfection approach also resulted in higher transfection efficiency and reached deeper into the tumor tissue. On the contrary, co-formulation mainly promoted transfection of endothelial and perivascular cells. Furthermore, the co-formulation approach is much more dependent on the US trigger, resulting in significantly lower off-site transfection. Thus, the findings indicate that the choice of co-administration or co-formulation in sonotransfection should depend on the targeted cell population, tolerable off-site transfection, and the therapeutic purpose.

Comparison of transoral anterior Jefferson-fracture reduction plate and posterior screw-rod fixation in C1-ring osteosynthesis for unstable atlas fractures.

Objective: To compare the clinical outcomes of transoral anterior Jefferson fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis. Methods: From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at our hospital; 30 males and 19 females were included. The visual analogue scale (VAS) score, neck disability index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMDs), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed. Results: Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (P<0.05). Conclusion: Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.

Correlates of supportive care needs among Asian Americans with colorectal, liver, or lung cancer from a web-based patient navigation portal intervention: The Patient COUNTS study.

BACKGROUND: Cancer is the leading cause of death among Asian Americans, who often face barriers to cancer care. Cancer supportive care needs among Asian Americans remain understudied. AIMS: We examined cancer supportive care needs and participant factors correlated with these needs, identified profiles of supportive care needs, and examined whether needs profiles are associated with quality of life among Asian American adults. METHODS AND RESULTS: We recruited 47 Asian American adults with colorectal, liver, or lung cancer who spoke Chinese, English, or Vietnamese, and were starting or undergoing cancer treatment. We assessed cancer supportive care needs in four domains: cancer information, daily living, behavioral health, and language assistance. Hierarchical cluster analysis was used to identify clusters of participants based on their supportive need profiles to further examine the association between need profiles and quality of life (QoL) assessed by the Functional Assessment of Cancer Therapy. Participants (mean age = 57.6) included 72% males and 62% spoke English less than very well. Older participants (age ≥ 65) and those with annual income <$50K reported higher daily living needs. Men and younger participants (age < 50) reported higher behavioral health needs. We found three clusters displaying distinct cancer supportive need profiles: Cluster 1 (28% of the sample) displayed high needs across all domains; Cluster 2 (51%) had low needs across all domains; and Cluster 3 (21%) had high needs for cancer information and daily living. Cluster 1 participants reported the lowest QoL. CONCLUSION: Cancer supportive care needs among Asian American patients with colorectal, liver, and lung cancer were associated with patient characteristics and QoL. Understanding cancer supportive care needs will inform future interventions to improve care and QoL for Asian American patients with cancer. CLINICALTRIALS: gov Identifier: NCT03867916.

Surgical Failure and Revision Strategy for Atlantoaxial Dislocation: A retrospective study of 109 Cases.

STUDY DESIGN: Retrospective study. OBJECTIVE: To classify surgical failures following atlantoaxial dislocation, present strategies for revisions and evaluate the clinical results of revision surgery. SUMMARY OF BACKGROUND DATA: With the increase in atlantoaxial dislocation surgery, the number of surgical failures has gradually risen. However, current reports on atlantoaxial surgical revision are limited in scope. There remains a lack of summary regarding the causes of surgical failure, a detailed classification system, and no proposed strategy for revision surgery. METHODS: 109 cases of failed surgery following atlantoaxial dislocation were classified according to the reduction immediately after surgery and the fusion status before revision. The reduction, decompression, fusion status and outcomes following revision surgery were evaluated by X-ray, CT, MRI and JOA score. The data were analyzed statistically with a paired-samples t test and multivaraible logistic regression analysis. RESULTS: The 109 patients were classified into three categories of failure: non-reduction with non-fusion (NR-NF, 73 cases), non-reduction with fusion (NR-F, 19 cases), and reduction with non-fusion (R-NF, 17 cases). Sixty-four patients underwent anterior revision, 21 posterior revision, and 24 anteroposterior revision. Postoperative complications were the primary cause of early revisions. After revision, complete decompression was achieved in all cases, anatomical reduction in 89 cases, significant improvement of JOA score in 77 cases, and fusion achieved in 86 cases. Twelve cases experienced surgical complications and 3 underwent a second revision. CONCLUSIONS: We found that NR-NF was the most common type of failure following surgery for atlantoaxial dislocation. Revision strategies can be guided according to our descriptive classification of failure, and revision surgery should focus on achieving adequate reduction, appropriate fixation and reliable fusion to optimize post-surgical outcomes.

Application of the suture anchor in the treatment of Hoffa fractures of the lateral femoral condyle.

BACKGROUND: To evaluate the feasibility and clinical effect of the suture anchor combined with external fixation in the treatment of the lateral femoral condyle Hoffa fracture. METHODS: In this study, a retrospective study was conducted to analyze the feasibility of treating fourteen patients (eight men and six women) with Hoffa fractures admitted to our Hospital from January 2016 to October 2021 with combined external fixation using incisional reduction anchor nailing. The age of the patients ranged from 23 to 45 years, with an average of 37.5 years. According to Letenneur's classification, there were eight cases of type I, three cases of type II, and three cases of type III. The functional assessment of Letenneur was used to measure the clinical outcome. RESULTS: All patients had one-stage wound healing, and all patients were followed up for 12 to 18 months after surgery, and all fractures healed well, with normal knee flexion and extension activities, and no complications such as fracture displacement, anchor nail loosening, or fracture malunion were observed. The clinical outcome was evaluated according to the functional evaluation criteria of Letenneur et al. The clinical outcome of fourteen patients: excellent in thirteen cases and good in one case, with an overall excellent rate of 100%. CONCLUSIONS: Our study results indicate that the use of anchor nailing combined with external fixation for Hoffa fractures of the femoral condyle has some clinical reference significance because it is less invasive, has fewer complications, does not require secondary removal, and is worthy of clinical application. TRIAL REGISTRATION: Retrospectively registered.

Treatment of Hoffa fracture of femoral condyle with anchor combined with auxiliary fixation.

BACKGROUND: A Hoffa fracture is an unstable intra-articular break that is generally treated with surgery. OBJECTIVE: To evaluate the feasibility and clinical outcomes of using a suture anchor combined with auxiliary fixation for the treatment of a lateral femoral condyle Hoffa fracture. METHODS: The study retrospectively reviewed 8 patients (5 males and 3 females) with a lateral femoral condyle Hoffa fracture who had been treated by combining a suture anchor with auxiliary fixation between January 2016 and April 2020. The mean age of patients was 37.5 years (ranging from 23 to 45). According to Letenneur's classification, there were 4 cases of type I, 2 cases of type II, and 2 cases of type III fractures. The clinical outcomes were assessed using Letenneur's functional assessment. RESULTS: The follow-up duration ranged between 14-24 months. All patients achieved primary healing of the incision and fracture union, as well as normal flexion and extension of the knee joint, with 7 cases showing excellent outcomes and 1 case showing a good outcome. No postoperative complications, such as fracture displacement, anchor loosening, or fracture malunion, occurred in this series. CONCLUSION: Our results indicated that a suture anchor, combined with external fixation, was an effective treatment for a lateral femoral condyle Hoffa fracture. Accordingly, this procedure is worthy of wider clinical application.

Management of Unstable C1 Fractures Involving the Lateral Mass: Posterior C1-C2 Screw-Rod Fixation and Fusion.

BACKGROUND Although most unstable C1 fractures can be effectively treated either by conservative treatment with external immobilization or by surgical procedure of C1-ring osteosynthesis, those fractures involving the lateral mass are likely to lead to traumatic arthritis and persistent neck pain. Specific reports of treatment of unstable C1 fractures involving the lateral mass are still scarce. We therefore present this report to evaluate the effectiveness of posterior C1-C2 screw-rod fixation and fusion for unstable C1 fractures involving the lateral mass. MATERIAL AND METHODS From June 2009 to June 2016 in our hospital, 16 cases were diagnosed with C1 fractures involving the lateral mass and treated by posterior C1-C2 screw-rod fixation and fusion from June 2009 to June 2016. The patients' clinical data were retrospectively analyzed. Preoperative and postoperative images were taken to evaluate cervical sequence, location of screws, and bone fusion. Neurological status and neck pain levels were evaluated clinically on follow-up. RESULTS All patients underwent surgery successfully. The mean follow-up duration was 15.3±4.9 months (range 9-24 months). All patients obtained satisfying clinical outcomes with good neck pain alleviation, appropriate screw placement, and reliable bone fusion. None of the patients developed vascular or neurological complications during the operation or follow-up. CONCLUSIONS Posterior C1-C2 screw-rod fixation and fusion is an effective management for unstable C1 fractures involving the lateral mass. This operation can provide reliable stabilization and satisfactory bone fusion.

The use of a novel reduction plate in transoral anterior C1-ring osteosynthesis for unstable atlas fractures.

Background: Transoral anterior C1-ring osteosynthesis has been reported as an effective treatment for unstable atlas fracture, which aims to preserve important C1-C2 motion. However, previous studies have shown that the anterior fixation plates used in this technique were not suitable for the anterior anatomy of the atlas and lacked an intraoperative reduction mechanism. Objective: This study aims to evaluate the clinical effects of a novel reduction plate used in transoral anterior C1-ring osteosynthesis for unstable atlas fractures. Methods: 30 patients with unstable atlas fractures treated by this technique from June 2011 to June 2016 were included in this study. The patients' clinical data and radiographs were reviewed, and the reduction of the fracture, internal fixation placement, and bone fusion were assessed using pre- and postoperative images. The patients' neurological function, rotatory range of motion, and pain levels were evaluated clinically during follow-up. Results: All 30 surgeries were successfully performed, and the average follow-up duration was 23.5 ± 9.5 months (range 9-48 months). One patient suffered atlantoaxial instability during the follow-up and was treated with posterior atlantoaxial fusion. The remaining 29 patients had satisfactory clinical outcomes, with ideal fracture reduction, good screw and plate placement, well-preserved range of motion, neck pain alleviation and solid bone fusion. There were no vascular or neurological complications during the operation or follow-up. Conclusions: The use of this novel reduction plate in transoral anterior C1-ring osteosynthesis is a safe and effective surgical option in the treatment of unstable atlas fractures. This technique offers an immediate intraoperative reduction mechanism, which provides satisfactory fracture reduction, bone fusion, and preservation of C1-C2 motion.

CDK12 Promotes the Proliferation, Migration, and Angiogenesis of Gastric Carcinoma via Activating the PI3K/AKT/mTOR Signaling Pathway.

Cyclin-dependent kinase 12 (CDK12) has been found to regulate tumor progression. However, its function in gastric carcinoma (GC) remains controversial. This work aimed to explore the exact effect of CDK12 on GC progression. We detected the expression of CDK12 in GC cells and normal gastric mucosal epithelial cells. Then CDK12 function on GC cell proliferation, migration, and angiogenesis was researched by colony formation experiment, Transwell experiment, and angiogenesis assay. Moreover, CDK12 effect on the PI3K/AKT/mTOR pathway activity was explored by western blot. Further, we used LY294002 (10 µM) to treat GC cells to verify whether CDK12 regulates GC progression by activating the PI3K/AKT/mTOR pathway. Additionally, CDK12 effect on the expression of prognostic factors of GC was detected by western blot, including alkaline phosphatase (ALP) and Ki67. Quantitative real-time polymerase chain reaction and western blot were utilized to evaluate the expression of mRNAs and proteins. As a result, CDK12 was upregulated in GC cells. CDK12 overexpression facilitated the proliferation, migration, and angiogenesis of GC cells. However, CDK12 silencing showed an opposite result. CDK12 overexpression activated the PI3K/AKT/mTOR pathway, but CDK12 silencing inactivated it in GC cells. The blockage of the PI3K/AKT/mTOR pathway induced by LY294002 treatment counteracted the promotion of CDK12 on the proliferation, migration, and angiogenesis of GC. Further, CDK12 silencing suppressed the expression of ALP and Ki67 proteins in GC cells. Taken together, CDK12 promotes the proliferation, migration, and angiogenesis of GC by activating the PI3K/AKT/mTOR pathway. It may be a novel target for GC treatment.

Extreme lateral interbody fusion (XLIF) approach for L5-S1: Preliminary experience.

Study Design: Technical report. Objective: Evaluate technical feasibility of extreme lateral interbody fusion (XLIF) at the L5-S1 level and provide an elaborate description of the surgical technique. Summary of Background Data: With the development of surgical techniques, the indications for oblique lumbar interbody fusion (OLIF) surgery have been broadened to the L5/S1 segment. However, this technique also has limitations. Different from OLIF, the L5/S1 segment used to be considered the main contraindication for XLIF. To date, no authors have reported the application of XLIF at the L5/S1 level. Methods: Only patients whose preoperative lumbar MRI showed the position of the psoas major muscles and blood vessels at the L5/S1 level were similar to those seen at supra-L5 levels were seleted. By folding the operating table, the iliac crest was moved downward to expose the L5/S1 intervertebral space during the operation. The remaining surgical procedures were consistent with routine XLIF surgery. Results: 8 patients successfully underwent XLIF at the L5/S1 level. The L5/S1 disk spaces were always exposed sufficiently for disk preparation and cage insertion. The post operative radiographs showed a satisfactory L5/S1 reconstruction with good cage position. Only 1 patient (12.5%) felt thigh numbness, and the symptoms gradually resolved after surgery and were no longer present in a month. There were no cases of psoas hematoma, retrograde ejaculation or vascular injury. The postoperative VAS score showed that all the patients achieved satisfactory results. Conclusions: XLIF at L5-S1 is feasible in strictly selected cases after thorough preoperative preparation and careful intraoperative procedures. However, we did not recommend XLIF as a routine surgical option at the L5/S1 level.

Patient-reported supportive care needs among Asian American cancer patients.

PURPOSE: Cancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment. METHODS: Participants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I-III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months. RESULTS: Among 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants. CONCLUSION: In this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03867916.

A novel surgical management for pediatric patients with irreducible atlantoaxial dislocation: Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation.

Background: Currently, irreducible atlantoaxial dislocation (IAAD) can be treated by a single transoral approach in one stage to reduce surgical injuries to patients. However, the widely used fixation devices are not suitable for pediatric patients because of larger profile of devices. Objective: The purpose of this study is to report the preliminary clinical outcomes of a novel surgical technique by transoral intraarticular cage distraction and fusion with C-JAWS staple fixation for pediatric patients with IAAD. Methods: From June 2011 to June 2014, eight pediatric patients with IAAD were enrolled and treated by this technique in our department. Patients' clinical data were retrospectively analyzed, including neurological status, clinical symptoms, reduction, bone fusion, and complications. Results: The surgeries were successfully performed in all patients without injuries to spinal cord, nerve and blood vessel. Clinical symptomatic relief was presented on all 8 patients (100%). Satisfactory reduction was indicated by significant decrease of atlanto-dental interval postoperatively (P < 0.05). The remarkable improvement of postoperative neurological function has been proved by significant increase of Japanese Orthopaedic Association score (P < 0.05). The average follow-up duration was 19.4 ± 5.8 months (range 12-30 months). Bone fusion was achieved in all 8 cases. No complications were documented after operation and during follow-up. Conclusions: Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation is an effective treatment for pediatric patients with IAAD, which can achieve satisfactory reduction, fixation and bone fusion.

Assessment of CD27 expression on T-cells as a diagnostic and therapeutic tool for patients with smear-negative pulmonary tuberculosis.

BACKGROUND: There is a global focus on illness diagnosis in smear-negative and latent tuberculosis infectious populations (SN-TB and LTBI). CD27 has been suggested to play a direct role in active TB. Little is known about smear-negative individuals. Here, we tried to investigate whether it has a role in smear-negative populations. The expression of CD27 and MTB-specific CD27 in CD4+ T cells ("CD27-CD4+" and "CD27-IFN-γ+CD4+") was evaluated in MTB-unexposed controls (HC), TB contacts (TB-C) and SN-TB individuals by flow cytometry. The sensitivity, specificity and AUC (area under curve) of "CD27-IFN-γ+CD4+" cells to distinguish SN-TBs from HCs and TB-Cs were determined by receiver operating characteristic (ROC) curve analysis. The clinical index was selected from the clinical laboratory and evaluated for correlation with "CD27-IFN-γ+CD4+" cells by Spearman statistical analysis. RESULTS: We observed that the percentages of "CD27-IFN-γ+CD4+" cells were significantly increased in the SN-TB group compared with the HC and TB-C groups (AUC was 0.88, sensitivity was 82.14%, specificity was 80.00%, and P < 0.0001). The percentage of "CD27-IFN-γ+CD4+" cells was negatively correlated with WBC (white blood cell count) (r = - 0.3019, P = 0.0182) and positively correlated with IgE (immunoglobulin E) (r = 0.2805, P = 0.0362). Furthermore, "CD27-IFN-γ+CD4+" cells were significantly decreased, especially in the > 50 years group, after clinical treatment. CONCLUSION: The present results demonstrated that the percentage of "CD27-IFN-γ+CD4+" cells might be a conceivable molecular indicator in the diagnosis of SN-TB and was influenced by its outcome of therapy.