A Feasibility Study on Using Hanging Arm Test to Assess Elbow Stability During Surgical Treatment for Varus Posteromedial Rotatory Instability.

Objectives: The aim of this study to investigate the safety and effectiveness of performing the hanging arm test during surgical treatment for elbow varus posteromedial rotatory instability (VPMRI) to assess elbow stability and determine whether to repair the lateral ulnar collateral ligament (LUCL). Methods: In a retrospective study from August 2014 to March 2019, 27 patients with VPMRI who had a negative result in the hanging arm test after fixation of coronoid fracture were selected. Intraoperative bleeding, operative time, elbow range of motion (ROM), and complications were recorded. Elbow function was evaluated with the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score. Results: The operation time was 85.9 ± 11.06 min (range 65-110). The intraoperative blood loss was 70.7 ± 9.31 ml (range 60-100). At the last follow-up, the elbow joint averaged 73.8° ± 2.931° in pronation, 78.9° ± 2.941° in supination, 7.2° ± 3.207° in extension, and 123.3° ± 6.651° in flexion. The MEPS score was 90.7 ± 4.36 (range 74-95), and the DASH score was 9.8 ± 2.58 (range 6.67-13.3). One patient presented with symptoms of ulnar nerve entrapment 2 months after operation and was treated with ulnar nerve release. The symptom of numbness went away completely 1 week after operation. No complications such as wound infection, arthritis, or chronic instability of the elbow were found in the other patients. Conclusion: Our findings suggest that not all VPMRI patients need the LUCL to be repaired, and the hanging arm test is a safe and reliable method to assess whether to repair the LUCL in the treatment of elbow VPMRI. Level of evidence: Level IV; Retrospective studies.

Application of zone classification in multiple intracranial aneurysmal subarachnoid hemorrhage treatment strategies.

Background: The options of surgical approach and treatment stage are two challenging treatment strategy issues with multiple intracranial aneurysmal subarachnoid hemorrhage (MIA-SAH). Methods: We retrospectively analyzed data from patients with MIA-SAH who underwent surgery in our center between January 1, 2014 and September 1, 2022. To define "zone classification", the cranial cavity was divided into four zones by the planes of cerebral falx and tentorium cerebelli. Aneurysms isolated to one zone were defined as zone classification I; those crossing two zones were defined as zone classification II; those crossing three zones were defined as zone classification III; and those crossing four zones were defined as zone classification IV. General and aneurysmal-related characteristics of patients with different zone classifications were collected and compared between two surgical approaches. Multivariate logistic regression analysis was used to identify factors independently associated with multistage treatment options. Results: A total of 226 patients with 523 aneurysms were included. The proportion of patients undergoing endovascular treatment increased with higher zone classification (I: 85.4%; II: 94.0%; III: 100.0%; IV: 100.0%). The proportion of patients receiving one-stage treatment decreased with higher zone classification (I: 60.2%; II: 33.6%; III: 0.0%; IV: 0.0%). Compared with patients undergoing microsurgical clipping, more patients undergoing endovascular treatment had zone classification II-IV (56.9% vs. 31.8%, p = 0.025). Zone classification II-IV (odds ratio [OR] = 3.821, 95% confidence interval [CI]: 2.041-7.154, p < 0.001), endovascular treatment (OR = 8.756, 95% CI: 2.589-29.609, p < 0.001), and size of all unruptured aneurysms <3 mm (OR = 4.531, 95% CI: 2.315-8.871, p < 0.001) were each independently associated with multistage treatment. Conclusions: Zone classification provides a new idea in MIA-SAH treatment strategies, especially regarding surgical approach and treatment stage options.

Progress in the treatment of advanced hepatocellular carcinoma with immune combination therapy.

Advanced hepatocellular carcinoma (HCC) is a severe malignancy that poses a serious threat to human health. Owing to challenges in early diagnosis, most patients lose the opportunity for radical treatment when diagnosed. Nonetheless, recent advancements in cancer immunotherapy provide new directions for the treatment of HCC. For instance, monoclonal antibodies against immune checkpoint inhibitors (ICIs) such as programmed cell death protein 1/death ligand-1 inhibitors and cytotoxic t-lymphocyte associated antigen-4 significantly improved the prognosis of patients with HCC. However, tumor cells can evade the immune system through various mechanisms. With the rapid development of genetic engineering and molecular biology, various new immunotherapies have been used to treat HCC, including ICIs, chimeric antigen receptor T cells, engineered cytokines, and certain cancer vaccines. This review summarizes the current status, research progress, and future directions of different immunotherapy strategies in the treatment of HCC.

Bioinformatics analysis and clinical significance of NRP-1 in triple-negative breast cancer.

Purpose: This study aimed to investigate the diagnostic and prognostic values of neuropilin-1 (NRP-1) in triple-negative breast cancer (TNBC) and analyze its immune function in the tumor microenvironment. Methods: Based on The Cancer Genome Atlas (TCGA), Gene Expression Omnibus, Genotype Tissue Expression, Immune Cell Abundance Identifier (ImmuCellAI), Reactome, and Genomics of Drug Sensitivity in Cancer databases, the cancer tissues from 50 patients with TNBC and corresponding adjacent noncancerous tissues from 10 patients (tissue microarrays were purchased from Shanghai Xinchao Biotechnology Co., Ltd.) were collected for validation. Bioinformatics combined with immunohistochemistry was used to analyze the relationship among NRP-1 expression, prognosis, tumor immune cell infiltration, immune genes, and drug resistance so as to investigate the role of NRP-1 in the development of TNBC. Results: A significant difference in NRP-1 gene expression was found between the cancerous and noncancerous tissues (p-value < 0.05); NRP-1 expression was high in carcinoma. No significant correlation was found between NRP-1 protein expression levels and each stage in the TCGA database. Prognostic expression survival analysis showed that the survival probability of patients with high NRP-1 expression was significantly lower than that of patients with low NRP-1 expression (p-value < 0.05), suggesting that the gene might be a pro-oncogene. The data from 50 clinical samples also confirmed that the NRP-1 expression was significantly higher in triple-negative breast cancer (TNBC) tissues than in adjacent noncancerous tissues. The NRP-1 expression significantly correlated with the tumor diameter and pathological grade (p-value < 0.05), but not with age, stage, and ki67 (p-value > 0.05). The Kaplan-Meier survival curves suggested that the median overall survival was significantly shorter in patients with high NRP-1 expression than in those with low NRP-1 expression (13.6 months vs 15.2 months, p-value < 0.05). The 300 genes most significantly positively associated with this gene were selected for Gene Ontology (including Biological Process, Molecular Function, and Cellular Component groups) and Kyoto Encyclopedia of Genes and Genomics enrichment analysis. The findings showed that NRP-1 was involved in immune regulation in TNBC. In addition, the NRP-1 expression in TNBC positively correlated with a variety of immune cells and checkpoints. Conclusion: NRP-1 can be used as a potential biomarker and therapeutic target in TNBC.

Comparing Safety and Efficacy of TACE + Apatinib in Combination with a PD-1 Inhibitor versus a Non-triple Therapy for Treating Advanced Primary Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: This meta-analysis was performed to compare the efficacy and safety of a triple therapy, involving transcatheter arterial chemoembolization (TACE) + apatinib combined with a programmed-cell death protein-1 (PD-1) inhibitor versus TACE + apatinib, a dual therapy with apatinib and PD-1 inhibitor, and TACE alone for the treatment of advanced primary hepatocellular carcinoma (HCC). METHODS: A computerized systematic search of databases, such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP e-Journals was performed to retrieve studies comparing TACE + apatinib combined with a PD-1 inhibitor versus a non-triple therapy for the treatment of advanced primary HCC. The literature search, quality assessment, and data extraction were performed independently by two researchers. Stata 16.0 software was employed to analyze the data. Heterogeneity was assessed utilizing the I2 statistic and p-value, followed by conducting sensitivity analysis. RESULTS: A total of 2,352 patients were enrolled from 8 studies, including 900 patients in the triple therapy group of TACE + apatinib combined with a PD-1 inhibitor, 877 patients in the TACE + apatinib group, 52 patients in the apatinib + a PD-1 inhibitor group, and 112 patients in the TACE group. The results revealed that the objective response rate (ORR) was significantly higher in the triple therapy group of TACE + apatinib combined with a PD-1 inhibitor than that in the non-triple therapy group [odds ratio (OR)=2.47, 95% confidence interval (95%CI): 1.61-3.78]. Besides, disease control rate (DCR) was greater in the triple therapy group of TACE + apatinib combined with a PD-1 inhibitor than that in the non-triple therapy group (OR=1.87, 95%CI: 1.44-2.44). Patients in the triple therapy group experienced a significant extension of overall survival (OS) (HR=0.42, 95%CI: 0.36-0.49). In addition, there was no significant difference in the overall rate of adverse events (AEs) between the two groups (OR=1.05, 95%CI: 0.89-1.22). CONCLUSIONS: Compared with the non-triple therapy group, the triple therapy group of TACE + apatinib combined with a PD-1 inhibitor outperformed in terms of tumor response and long-term survival with manageable AEs.

A highly integrated digital PCR system with on-chip heating for accurate DNA quantitative analysis.

Digital polymerase chain reaction (dPCR) is extensively used for highly sensitive disease diagnosis due to its single-molecule detection ability. However, current dPCR systems require intricate DNA sample distribution, rely on cumbersome external heaters, and exhibit sluggish thermal cycling, hampering efficiency and speed of the dPCR process. Herein, we presented the development of a microwell array based dPCR system featuring an integrated self-heating dPCR chip. By utilizing hydrodynamic and electrothermal simulations, the chip's structure is optimized, resulting in improved partitioning within microwells and uniform thermal distribution. Through strategic hydrophilic/hydrophobic modifications on the chip's surface, we effectively secured the compartmentalization of sample within the microwells by employing an overlaying oil phase, which renders homogeneity and independence of samples in the microwells. To achieve precise, stable, uniform, and rapid self-heating of the chip, the ITO heating layer and the temperature control algorithm are deliberately designed. With a capacity of 22,500 microwells that can be easily expanded, the system successfully quantified EGFR plasmid solutions, exhibiting a dynamic linear range of 105 and a detection limit of 10 copies per reaction. To further validate its performance, we employed the dPCR platform for quantitative detection of BCR-ABL1 mutation gene fragments, where its performance was compared against the QuantStudio 3D, and the self-heating dPCR system demonstrated similar analytical accuracy to the commercial dPCR system. Notably, the individual chip is produced on a semiconductor manufacturing line, benefiting from mass production capabilities, so the chips are cost-effective and conducive to widespread adoption and accessibility.

Predictive value of machine learning models for lymph node metastasis in gastric cancer: A two-center study.

BACKGROUND: Gastric cancer is one of the most common malignant tumors in the digestive system, ranking sixth in incidence and fourth in mortality worldwide. Since 42.5% of metastatic lymph nodes in gastric cancer belong to nodule type and peripheral type, the application of imaging diagnosis is restricted. AIM: To establish models for predicting the risk of lymph node metastasis in gastric cancer patients using machine learning (ML) algorithms and to evaluate their predictive performance in clinical practice. METHODS: Data of a total of 369 patients who underwent radical gastrectomy at the Department of General Surgery of Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) from March 2016 to November 2019 were collected and retrospectively analyzed as the training group. In addition, data of 123 patients who underwent radical gastrectomy at the Department of General Surgery of Jining First People's Hospital (Jining, China) were collected and analyzed as the verification group. Seven ML models, including decision tree, random forest, support vector machine (SVM), gradient boosting machine, naive Bayes, neural network, and logistic regression, were developed to evaluate the occurrence of lymph node metastasis in patients with gastric cancer. The ML models were established following ten cross-validation iterations using the training dataset, and subsequently, each model was assessed using the test dataset. The models' performance was evaluated by comparing the area under the receiver operating characteristic curve of each model. RESULTS: Among the seven ML models, except for SVM, the other ones exhibited higher accuracy and reliability, and the influences of various risk factors on the models are intuitive. CONCLUSION: The ML models developed exhibit strong predictive capabilities for lymph node metastasis in gastric cancer, which can aid in personalized clinical diagnosis and treatment.

Comparison of Machine Learning and Logic Regression Algorithms for Predicting Lymph Node Metastasis in Patients with Gastric Cancer: A two-Center Study.

OBJECTIVES: This two-center study aimed to establish a model for predicting the risk of lymph node metastasis in gastric cancer patients using machine learning (ML) and logistic regression (LR) algorithms, and to evaluate its predictive performance in clinical practice. METHODS: Data of a total of 369 patients who underwent radical gastrectomy in the Department of General Surgery of Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) from March 2016 to November 2019 were collected and retrospectively analyzed as the training group. In addition, data of 123 patients who underwent radical gastrectomy in the Department of General Surgery of Jining First People's Hospital (Jining, China) were collected and analyzed as the verification group. Besides, 7 ML and logistic models were developed, including decision tree, random forest, support vector machine (SVM), gradient boosting machine (GBM), naive Bayes, neural network, and LR, in order to evaluate the occurrence of lymph node metastasis in patients with gastric cancer. The ML model was established following 10 cross-validation iterations within the training dataset, and subsequently, each model was assessed using the test dataset. The model's performance was evaluated by comparing the area under the receiver operating characteristic curve of each model. RESULTS: Compared with the traditional logistic model, among the 7 ML algorithms, except for SVM, the other models exhibited higher accuracy and reliability, and the influences of various risk factors on the model were more intuitive. CONCLUSION: For the prediction of lymph node metastasis in gastric cancer patients, the ML algorithm outperformed traditional LR, and the GBM algorithm exhibited the most robust predictive capability.

Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip.

BACKGROUND: Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. METHODS: The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. RESULTS: Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. CONCLUSIONS: Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. LEVEL OF EVIDENCE: Level II, retrospective study.

Immobilizing arsenic-enriched wastewater from utilization of crude antimony oxides as scorodite using a novel multivalent iron source.

Arsenic-enriched wastewater (A-EW) is a hypertoxic sewage from the utilization of crude antimony oxides in lead anode slime metallurgy. In traditional methods, the H+ accumulation inhibits the arsenic immobilization during scorodite synthesis. In this study, a novel multivalent iron source comprised of Fe(OH)3 and FeSO4·7H2O was proposed to resolve the adverse effects of pH fluctuation during immobilizing A-EW as scorodite. Various approaches, such as scanning electron microscopy and X-ray photoelectron spectroscopy, were applied to characterize the synthesized scorodite. This work was divided into two parts. In thermodynamics, HnAsO4(3-n)- (n = 1, 2, 3) and Fe(OH)n(3-n)+ (n = 0, 1, 2, 3) can feasibly coprecipitate as scorodite according to their △rGm,Tθ ranged from -111.10 kJ mol-1 to -33.53 kJ mol-1. In experimental research, A-EW was immobilized as scorodite by optimizing conditions as initial pH = 2.0, molar ratio of Fe to As = 1.2, molar ratio of Fe(II) to Fe(III) = 4:6, arsenic concentration = 40 g/L, and temperature = 95 °C. The arsenic precipitation ratio is 99.60%, and the micromorphology of synthesized scorodite presents a regular octahedron having size of 5-10 µm. The low leachability of As (0.41 mg/L) in toxicity characteristic leaching procedure (TCLP) confirmed that the prepared scorodite is nonhazardous. The solution pH is stable at 2.0 as the H+ depletion (0.5660 mol) by Fe(OH)3 dissolution and Fe2+ oxidization balanced with that (0.5657 mol) generated from As(V)-Fe(III) coprecipitation. In general, the A-EW was effectively immobilized by proposed multivalent iron source, and can be potentially applied to safely dispose other industrial effluents, such as high arsenic leachates and arsenic-bearing waste acid from nonferrous metallurgy.

Systematic pan-cancer analysis identified neuropilin 1 as an immunological and prognostic biomarker.

Neuropilin 1 (NRP1) is a transmembrane glycoprotein, nontyrosine kinase receptor that plays an important role in axonal growth and angiogenesis in the nervous system. Although currently more and more studies have shown that NRP1 plays an important role in some cancers, no systematic pan-cancer analysis of NRP-1 has been performed to date. Therefore, we aimed to investigate the associated immune function and prognostic value of NRP1 in 33 tumors of various cancer types. In this study, based on The Cancer Genome Atlas, Cancer Cell Line Encyclopedia, Genotype Tissue Expression, cBioportal for cancer genomics, and Human Protein Atlas (HPA databases), various bioinformatics analysis methods were used to investigate the potential carcinogenic effects of NRP1 activation, pan-cancer analysis of NRP1 expression, and the relationship between NRP1 expression and prognosis indicators including overall survival, disease-specific survival, disease-free interval, and progression-free interval, tumor mutational burden (TMB), and microsatellite instability (MSI). The results showed that NRP1 was highly expressed in most tumors. In addition, NRP1 was found to be positively or negatively correlated with the prognosis of different tumors. Also, the expression of NRP1 was associated with TMB and MSI in in 27 and 21 different types of tumors, respectively, and with DNA methylation in almost all the various types of tumors. The expression of the NRP1 gene was negatively correlated with the infiltration levels of most immune cells. In addition, the correlation between the level of immune cell infiltration and NRP1 expression varied according to immune cell subtype. Our study suggests that NRP1 plays an important role in tumor development and tumor immunity and could potentially be used as a prognostic indicator in a variety of malignancies.

Safety and Efficacy of TACE + Lenvatinib in Treating Advanced Hepatocellular Carcinoma: A Systematic Review and Meta- analysis.

BACKGROUND AND AIMS: To compare the efficacy and safety of transarterial chemoembolization (TACE) + lenvatinib (TACE+L) versus lenvatinib (L) monotherapy in the treatment of advanced hepatocellular carcinoma by a meta-analysis. METHODS: PubMed, Embase, the Cochrane Library, CNKI, VIP e-Journals Database, and Wanfang Data were systematically searched to collate literature comparing TACE+L with L alone for the treatment of advanced liver cancer. The literature search, quality assessment, and data extraction were performed independently by two reviewers. The Stata 16 software package was used to process and analyze the data. We assessed heterogeneity using both I2 and the p-value, performed a publication bias assessment, and conducted a sensitivity analysis. RESULTS: Five studies were finally included, including one randomized controlled study and four retrospective studies; these involved a total of 1,167 patients, including 523 patients in the TACE+L combination group and 644 patients in the L monotherapy group. In this meta-analysis, the TACE+L group showed a significantly better objective response rate (ORR) (OR=2.54, 95%CI: 1.34 - 4.80) and disease control rate (DCR) compared to the L monotherapy group (OR=2.68, 95%CI: 1.75 - 4.08). The combined group had significantly improved progression-free survival (PFS) (HR=0.47, 95%CI: 0.40 - 0.56) and overall survival (OS) (HR=0.48, 95%CI: 0.39-0.59). In addition, there was no significant difference found in the overall adverse events of any grade between the two groups (OR=1.13, 95%CI: 0.99 - 1.29). CONCLUSIONS: Compared to L alone, TACE+L treatment resulted in better tumor response, better long-term survival, and was accompanied by controllable adverse events.

Transarterial Chemoembolization plus Apatinib with or without Camrelizumab for the Treatment of Advanced HBV-related Hepatocellular Carcinoma.

AIMS: To compare the effectiveness and safety of transarterial chemoembolization (TACE) combined with apatinib plus camrelizumab (TACE+AC) versus TACE combined with apatinib alone (TACE+A) for patients with advanced HBV-related hepatocellular carcinoma (HBV-HCC). METHODS: The clinical data of patients with HBV-HCC who received either TACE+AC or TACE+A treatment were retrospectively analyzed. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were compared between the two groups. Multivariate Cox proportional hazards model regression analysis was used to identify the independent prognostic factors of OS. RESULTS: Between March 2019 to January 2022, 76 patients were assigned to the TACE+AC group (n = 37) and the TACE+A group (n=39). The median OS and PFS in the TACE+AC group were significantly longer than those in the TACE+A group (OS, 15.4 vs. 11.3 months; p=0.008; PFS, 7.4 vs. 5.1 months; p=0.001) and the ORR and DCR in the TACE + AC group were significantly greater than those in the TACE+A group (ORR, 43.2% vs. 20.5%; p=0.033; DCR, 67.6% vs. 43.6%; p=0.036). There was no significant difference in the incidence of grade ≥3 AEs between the two groups (p=0.483). Multivariate regression analysis identified the treatment modalities, AFP level, and extrahepatic metastasis as independent prognostic factors (p<0.05). CONCLUSION: TACE+AC significantly improved the clinical outcomes of patients with HBV-HCC and elicited relatively controllable AEs.

Short-term outcomes of an enhanced recovery after surgery pathway for children with congenital scoliosis undergoing posterior spinal fusion: a case-control study of 70 patients.

Increasing evidence demonstrates the advantages of an enhanced recovery after surgery (ERAS) protocol; however, few studies have evaluated ERAS in pediatric patients. This study aimed to evaluate the effect of ERAS in pediatric patients with congenital scoliosis. Seventy pediatric patients with congenital scoliosis underwent posterior hemivertebra resection and fusion with pedicle screws and were prospectively randomly assigned to the ERAS group (n = 35) and control group (n = 35). ERAS management comprised 15 elements including a shortened fasting time, optimized anesthesia protocol, and multimodal analgesia. The control group received traditional perioperative management. Clinical outcome was evaluated by hospital stay, surgery-related indicators, diet, pain scores, laboratory tests, and complications. The surgical outcome showed a similar correction rate in the ERAS group (84.0%) and control group (89.0%; P = 0.471). The mean fasting time was significantly shorter in the ERAS group than in the control group. Compared with the control group, the ERAS group had significantly shorter mean times to postoperative hospital stay, first anal exhaust and defecation, significantly lower mean pain scores in the first 2 days postoperatively (P < 0.05), and a significantly lower mean interleukin-6 concentration on postoperative day 1 (P < 0.001). The incidence of complications was similar in the ERAS group and control group (P > 0.05). The ERAS protocol is effective and safe for pediatric patients with congenital spinal deformity and may significantly improve the treatment efficacy compared with traditional perioperative management methods. Levels of Evidence: III.

Clinical Analysis of Poor Outcomes After Surgery for Aneurysmal Subarachnoid Hemorrhage in Guizhou, China.

OBJECTIVE: To investigate poor outcomes of aneurysmal subarachnoid hemorrhage (aSAH) and compare the clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications of patients with good and poor outcomes to identify potential risk factors. METHODS: We retrospectively analyzed patients with aSAH who underwent surgery in Guizhou, China, between June 1, 2014, and September 1, 2022. The Glasgow Outcome Scale was used to evaluate outcomes at discharge, with scores of 1-3 and 4-5 considered poor and good, respectively. Clinicodemographic characteristics, imaging features, intervention strategies, laboratory tests, and complications were compared between patients with good and poor outcomes. Multivariate analysis was used to determine independent risk factors for poor outcomes. The poor outcome rate of each ethnic group was compared. RESULTS: Of 1169 patients, 348 were ethnic minorities, 134 underwent microsurgical clipping, and 406 had poor outcomes at discharge. Patients with poor outcomes were older, represented fewer ethnic minorities, had a history of comorbidities, experienced more complications, and underwent microsurgical clipping. The top 3 types of aneurysms were anterior, posterior communicating, and middle cerebral artery aneurysms. CONCLUSIONS: Outcomes at discharge varied according to ethnic group. Han patients had worse outcomes. Age, loss of consciousness at onset, systolic blood pressure on admission, Hunt-Hess grade 4-5 on admission, epileptic seizures, modified Fisher grade 3-4, microsurgical clipping, size of the ruptured aneurysm, and cerebrospinal fluid replacement were independent risk factors for aSAH outcomes.

Surgical Treatment of Severe Sprengel's Deformity: A Case Report.

CASE: An adolescent girl who presented with obviously impaired shoulder abduction due to untreated severe Sprengel's deformity underwent deformity correction surgery. Intraoperative neuromonitoring was used to warn of potential brachial plexus injury during a modified Woodward procedure. At 3-month follow-up, range of shoulder abduction had improved significantly. CONCLUSION: Sprengel's deformity is a rare congenital shoulder deformity, and the Woodward procedure could cause nerve injury in patients with severe Sprengel's deformity. Neuromonitoring can be performed intraoperatively to avoid brachial plexus injury.

Outcomes and Safety of Traditional Growing Rod Technique in the Treatment of Early-onset Dystrophic Scoliosis Secondary to Type 1 Neurofibromatosis With Intraspinal Rib Head Dislocation in Children.

PURPOSE: The purpose of this study was to investigate the outcomes and safety of traditional growing rod (TGR) in the treatment of early-onset dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-EOS) with intraspinal rib head dislocation (IRH) in children. METHODS: From September 2006 to June 2020, 21 patients with NF1-EOS were treated with TGR. The patients comprised 13 boys and 8 girls with a mean age of 7.1±1.5 years. Two patients had IRH-induced nerve injury [American Spinal Injury Association (ASIA) grade D]. No neurological symptoms were found in the other patients. The intraspinal rib proportion, apical vertebral rotation, apical vertebral translation, coronal main thoracic curve, trunk shift, thoracic kyphosis, lumbar lordosis, sagittal balance, and T1-S1 height were measured before and after TGR implantation and at the last follow-up. Complications were also evaluated. RESULTS: The mean follow-up time was 3.4±2.0 years. An average of 3.1 times (range: 1 to 8 times) lengthening procedures were performed in each patient. The intraspinal rib proportion was significantly lower postoperatively than preoperatively (22±11% vs. 33±18%, respectively; P <0.001), and no significant correction loss was found at the last follow-up (24±12%, P= 0.364). Compared with the measurements before TGR implantation, the major coronal curve and T1-S1 height after TGR implantation and at the last follow-up were significantly different ( P <0.05). Significant correction of apical vertebral translation, thoracic kyphosis, lumbar lordosis, and sagittal balance were noted after TGR implantation, and no significant correction loss was found at the last follow-up ( P >0.05). Ten complications occurred in 7 patients. Two patients with nerve injury recovered after the operation. No neurological complications were found during the follow-up. CONCLUSIONS: TGR is a safe and effective therapy for NF1-EOS with IRH where there was no direct compression of the spinal cord, which was confirmed by preoperative magnetic resonance imaging. Through this procedure, IRH could be partly removed from the spinal canal. LEVEL OF EVIDENCE: Level III.

Establishment of a prognostic model for gastric cancer patients who underwent radical gastrectomy using machine learning: a two-center study.

Objective: Gastric cancer is a prevalent gastrointestinal malignancy worldwide. In this study, a prognostic model was developed for gastric cancer patients who underwent radical gastrectomy using machine learning, employing advanced computational techniques to investigate postoperative mortality risk factors in such patients. Methods: Data of 295 patients with gastric cancer who underwent radical gastrectomy at the Department of General Surgery of Affiliated Hospital of Xuzhou Medical University (Xuzhou, China) between March 2016 and November 2019 were retrospectively analyzed as the training group. Additionally, 109 patients who underwent radical gastrectomy at the Department of General Surgery Affiliated to Jining First People's Hospital (Jining, China) were included for external validation. Four machine learning models, including logistic regression (LR), decision tree (DT), random forest (RF), and gradient boosting machine (GBM), were utilized. Model performance was assessed by comparing the area under the curve (AUC) for each model. An LR-based nomogram model was constructed to assess patients' clinical prognosis. Results: Lasso regression identified eight associated factors: age, sex, maximum tumor diameter, nerve or vascular invasion, TNM stage, gastrectomy type, lymphocyte count, and carcinoembryonic antigen (CEA) level. The performance of these models was evaluated using the AUC. In the training group, the AUC values were 0.795, 0.759, 0.873, and 0.853 for LR, DT, RF, and GBM, respectively. In the validation group, the AUC values were 0.734, 0.708, 0.746, and 0.707 for LR, DT, RF, and GBM, respectively. The nomogram model, constructed based on LR, demonstrated excellent clinical prognostic evaluation capabilities. Conclusion: Machine learning algorithms are robust performance assessment tools for evaluating the prognosis of gastric cancer patients who have undergone radical gastrectomy. The LR-based nomogram model can aid clinicians in making more reliable clinical decisions.

Concurrent chemoradiotherapy followed by adjuvant chemotherapy versus concurrent chemoradiotherapy alone in locally advanced cervical cancer: A systematic review and meta-analysis.

Objective: This study aimed to assess the efficacy and safety of adjuvant chemotherapy (ACT) after concurrent chemoradiation (CCRT) in patients with locally advanced cervical cancer (LACC) via meta-analysis. Methods: A systematic literature search of MEDLINE, PubMed, Web of Science, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from January 10, 1966 to May 20, 2022. Randomized controlled trials and observational studies comparing the CCRT alone with CCRT plus ACT were included. The literature search, quality assessment, and data extraction were conducted by two reviewers independently. The primary endpoints were 3-year rates of overall survival (OS) and progression-free survival (PFS). Complete response rate, local recurrence, distant metastasis, and adverse events were secondary outcomes. The hazard ratios (HRs) and relative risk (RR) were pooled. Results: Nine studies with a total of 2732 patients were included in this meta-analysis, including 1411 patients in the CCRT group and 1321 in the CCRT plus ACT group. The HR for 3-year rates of OS and PFS of the CCRT group compared with the CCRT plus ACT group was 0.72 [95%confidence interval (CI) = 0.44-1.17] and 0.78 (95%CI = 0.5-1.75), respectively. No significant differences were observed between the two groups in the complete response rate (RR = 1.06, 95%CI = 0.96-1.16). However, local recurrence and distant metastasis were significantly lower in the CCRT plus ACT group than in the CCRT group (RR = 0.63, 95%CI = 0.44 -0.91 and RR = 0.64, 95%CI = 0.47-0.88). Grade 3-4 acute toxicities were more frequent in the CCRT plus ACT group (RR = 1.73, 95%CI =1.19-2.52). Conclusion: Although associated with a decreased risk of local recurrence and distant metastasis, ACT did not significantly improve the survival rate and the complete response rate with increasing grade 3-4 acute toxicities in patients with LACC. Thus, this ACT regimen cannot be recommended for patients with LACC. Systematic review registration: https://inplasy.com/inplasy-2022-9-0089/, identifier INPLASY202290089.

Comparison of Hepatic Arterial Infusion Chemotherapy and Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.

AIMS: To compare the efficacy, safety, and survival outcomes of hepatic arterial infusion chemotherapy (HAIC) versus transarterial chemoembolization (TACE) for the treatment of advanced hepatocellular carcinoma (HCC), a comprehensive meta-analysis was conducted. METHODS: MEDLINE, PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1966 to 20 February 2022, and relevant articles were retrieved. The literature search, quality assessment, and data extraction were conducted independently by two reviewers. The primary endpoints were objective response rate (ORR) and overall survival (OS), while the secondary endpoints were disease control rate (DCR), progression-free survival (PFS), and adverse events. The odd ratios (OR) and hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled. RESULTS: Seven studies with a total of 989 patients were included in this meta-analysis. The pooled results showed that HAIC significantly improved ORR (OR=4.94, 95%CI: 3.47-7.05, p<0.001) and DCR (OR=2.97, 95%CI: 2.16-4.08, p<0.001). In addition, HCC patients who received HAIC had significantly longer PFS (HR=0.54, 95%CI: 0.45-0.65, p<0.001) and OS (HR=0.55, 95%CI: 0.46-0.66, p<0.001) than those who underwent TACE. Compared with TACE, HAIC showed a lower incidence for grade 3-4 adverse events (OR=0.52, 95%CI: 0.30-0.88, p<0.001). CONCLUSIONS: HAIC may significantly improve survival benefits and exhibit higher local treatment responses with mild side effects in patients with advanced HCC compared to TACE.