The accuracy of cup anteversion measurement on postoperative pelvic radiographs: A comparative retrospective cohort study between DDH and non-DDH patients.

Rationale and objectives: Postoperative pelvic radiographs remain a vital tool for assessing cup orientation after total hip arthroplasty (THA), with the accuracy influenced by various factors. The objective of this study is to investigate the accuracy of cup anteversion measurement in developmental dysplasia of the hip (DDH) patients and others based on postoperative pelvic radiographs conducted under the current heavy workload conditions. Materials and methods: Patients who underwent THA at our hospital with both postoperative X-ray and CT images from January 2020 to December 2022 were included in this retrospective cohort study. Virtual X-ray films were generated using digitally reconstructed radiographs (DRR) technology from CT images, with pelvic position perfectly controlled. Radiographic anteversion (RA) was measured on 3D-CT, virtual X-rays, and actual postoperative X-rays, abbreviated as RA_3D, RA_DRR, and RA_Xray, respectively. A repeated-measures analysis of covariance (ANCOVA) was utilized to evaluate the variations in RA within and between different groups across three methods. The Bland-Altman plot analysis showed the variations among methods in DDH and non-DDH patients, setting a clinically acceptable limits of agreement (LOA) at ±5°. Results: This study included 154 hip cases, with 63 DDH and 91 other diseases. Repeated-measures ANCOVA revealed a descending trend in RA across three methods, with differences of 2.64° (DDH) vs. 2.74° (others) from 3D to DRR, and 4.89° (DDH) vs. 1.07° (others) from DRR to X-ray. The group by methods interaction effect were significant (p = 0.002). Significant statistical differences in RA_Xray (P = 0.035) were observed between DDH and non-DDH patients, but not in RA_3D and RA_DRR. Bland-Altman plots showed 71.4 % of DDH patients exceeded the clinically acceptable LOA, compared to 36.3 % of other patients. Conclusion: Our study indicated that under the current intense workload, the reliability of assessing cup anteversion using postoperative pelvic radiographs is challenged, especially in patients with DDH.

Construction of Shale Gas Oil-Based Drilling Cuttings Degrading Bacterial Consortium and Their Degradation Characteristics.

Oil-based drilling cuttings (OBDCs) contain petroleum hydrocarbons with complex compositions and high concentrations, which have highly carcinogenic, teratogenic, and mutagenic properties. In this study, three highly efficient petroleum hydrocarbon-degrading bacteria were screened from OBDCs of different shale gas wells in Chongqing, China, and identified as Rhodococcus sp. and Dietzia sp. Because of their ability to degrade hydrocarbons of various chain lengths, a new method was proposed for degrading petroleum hydrocarbons in shale gas OBDCs by combining different bacterial species. Results showed that the bacterial consortium, consisting of the three strains, exhibited the highest degradation rate for petroleum hydrocarbons, capable of degrading 74.38% of long-chain alkanes and 93.57% of short-chain alkanes, respectively. Moreover, the petroleum hydrocarbon degradation performance of the bacterial consortium in actual OBDCs could reach 90.60% in the optimal conditions, and the degradation kinetic process followed a first-order kinetic model. This study provides a certain technical reserve for the bioremediation of shale gas OBDCs.

A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non-knee Osteoarthritis Populations.

OBJECTIVES: Analyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non-KOA populations, employing a substantial sample size. METHODS: A cross-sectional retrospective analysis was performed on the Chinese non-KOA populations (n = 407; 49.9% females). The study employed an in-house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip-knee-ankle angle (HKAA), weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral-proximal-femoral angle (mLPFA), mechanical lateral-distal-femoral angle (mLDFA), mechanical medial-proximal-tibial angle (mMPTA), and mechanical lateral-distal-tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut-off point). RESULTS: HKAA and JLCA exhibited left-right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender-related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters. CONCLUSIONS: There were differences in lower limb coronal morphological parameters among Chinese non-KOA populations between left and right sides, different genders, and age.

Cell-free fat extract-loaded microneedles attenuate inflammation-induced apoptosis and mitochondrial damage in tendinopathy.

Existing clinical treatments for tendinopathy mainly focus on reducing pain, whereas inhibiting or reversing disease progression remains challenging. Local therapeutic drugs, such as glucocorticoids, cause adverse effects on the metabolism of tendon tissues and injection-related complications. Therefore, new administration modalities for tendinopathy need to be developed. In this study, we designed a hydrogel-based microneedle (MN) system for the long-term transdermal delivery of our novel biological cell-free fat extract (CEFFE) to treat tendinopathies. We found that CEFFE-loaded MNs (CEFFE-MNs) had good biosafety and inhibited lipopolysaccharide (LPS)-induced apoptosis and matrix degradation in Achilles tendon cells of rats. The Achilles tendons of rats returned to their maximum mechanical strength after applying CEFFE-MNs. The administration of CEFFE-MNs had better anti-apoptosis and tendon repair-promoting effects than CEFEF injections in vivo. Transcriptome sequencing indicated that the anti-apoptosis effect of CEFFE-MNs was highly related to tumor necrosis factor (TNF) signaling. CEFFE-MNs inhibited the expression of TNF, TNF receptor 1, and downstream nuclear factor-kappa B signaling. Additionally, CEFFE-MNs rescued LPS-induced mitochondrial dynamics in tendon cells via the TNF-Drp1 axis. Our study reports a novel CEFFE-MN system that exhibits long-term anti-inflammatory and anti-apoptotic effects, suggesting it as a new treatment route for tendinopathy with broad clinical translation prospects.

Cartilage morphometry and magnetic susceptibility measurement for knee osteoarthritis with automatic cartilage segmentation.

Background: Automatic segmentation of knee cartilage and quantification of cartilage parameters are crucial for the early detection and treatment of knee osteoarthritis (OA). The aim of this study was to develop an automatic cartilage segmentation method for three-dimensional water-selective (3D_WATS) cartilage magnetic resonance imaging (MRI) and conduct cartilage morphometry and magnetic susceptibility measurements such as cartilage thickness, volume, and susceptibility values for knee OA assessment. Methods: Sixty-five consecutively sampled subjects, who had undergone health checks at our hospital, were enrolled in this cross-sectional study and were divided into three groups: 20 normal, 20 mild OA, 25 severe OA. Sagittal 3D_WATS sequence was used to image cartilage at 3T. The raw magnitude images were used for cartilage segmentation and the phase images were used for quantitative susceptibility mapping (QSM)-based assessment. Manual cartilage segmentation was performed by two experienced radiologists, and the automatic segmentation model was constructed using nnU-Net. Quantitative cartilage parameters were extracted from the magnitude and phase images based on the cartilage segmentation. Pearson correlation coefficient and intra-class correlation coefficient (ICC) were then used to assess the consistency of obtained cartilage parameters between automatic and manual segmentation. Cartilage thickness, volume, and susceptibility values among different groups were compared using one-way analysis of variance (ANOVA). Support vector machine (SVM) was used to further verify the classification validity of automatically extracted cartilage parameters. Results: The constructed cartilage segmentation model based on nnU-Net achieved an average Dice score of 0.93. The consistency of cartilage thickness, volume, and susceptibility values calculated using automatic and manual segmentations ranged from 0.98 to 0.99 (95% CI: 0.89-1.00) for the Pearson correlation coefficient, and from 0.91-0.99 (95% CI: 0.86-0.99) for ICC, respectively. Significant differences were found in OA patients; including decreases in cartilage thickness, volume, and mean susceptibility values (P<0.05), and increases in standard deviation (SD) of susceptibility values (P<0.01). Moreover, the automatically extracted cartilage parameters can achieve an AUC value of 0.94 (95% CI: 0.89-0.96) for OA classification using the SVM classifier. Conclusions: The 3D_WATS cartilage MR imaging allows simultaneously automated assessment of cartilage morphometry and magnetic susceptibility for evaluating the severity of OA using the proposed cartilage segmentation method.

De novo pyrimidine biosynthetic complexes support cancer cell proliferation and ferroptosis defence.

De novo pyrimidine biosynthesis is achieved by cytosolic carbamoyl-phosphate synthetase II, aspartate transcarbamylase and dihydroorotase (CAD) and uridine 5'-monophosphate synthase (UMPS), and mitochondrial dihydroorotate dehydrogenase (DHODH). However, how these enzymes are orchestrated remains enigmatical. Here we show that cytosolic glutamate oxaloacetate transaminase 1 clusters with CAD and UMPS, and this complex then connects with DHODH, which is mediated by the mitochondrial outer membrane protein voltage-dependent anion-selective channel protein 3. Therefore, these proteins form a multi-enzyme complex, named 'pyrimidinosome', involving AMP-activated protein kinase (AMPK) as a regulator. Activated AMPK dissociates from the complex to enhance pyrimidinosome assembly but inactivated UMPS, which promotes DHODH-mediated ferroptosis defence. Meanwhile, cancer cells with lower expression of AMPK are more reliant on pyrimidinosome-mediated UMP biosynthesis and more vulnerable to its inhibition. Our findings reveal the role of pyrimidinosome in regulating pyrimidine flux and ferroptosis, and suggest a pharmaceutical strategy of targeting pyrimidinosome in cancer treatment.

Clinical features and surgical outcomes of primary spinal anaplastic meningioma: a cases series and literature review.

Background: Primary spinal anaplastic meningioma (PSAM) is a very rare entity in the spinal canal. Therefore, the clinical features, treatment strategy, and long-term outcomes remain poorly studied. Case Description: Clinical data of six patients with PSAM treated at one single institution were retrospectively analyzed and all previously reported cases in the English literature were reviewed. There were three male and three female patients with a median age of 25 years. The duration of symptoms before initial diagnosis ranged from one week to one year. PSAMs occurred at cervical level in four, cervicothoracic in one and thoracolumbar in one. In addition, PSAMs presented isointensity on T1 weighted imaging (WI), hyperintensity on T2WI, and hetero- or homogeneously marked enhancement with contrast. Eight operations were performed in six patients. Simpson II resection was achieved in four (50%), Simpson IV in three (37.5%), Simpson V in one (12.5%). Adjuvant radiotherapy was performed in five patients. With a median survival time of 14 months (4-136 months), three patients had recurrence, two experienced metastases, and four died of respiratory failure. Conclusions: PSAMs are a rare disease, and there is limited evidence as to the management of these lesions. They may metastasize, recur, and portend a poor prognosis. A close follow-up and further investigation are therefore necessary.

Primary spinal anaplastic ependymoma: A single-institute retrospective cohort and systematic review.

Objective: Primary spinal anaplastic ependymoma (PSAE) is an extremely rare disease. We aim to report the largest PSAE cohort, evaluate the treatments, and investigate the prognostic factors for progression-free survival (PFS). Methods: Clinical data collected from the authors' institute and literature articles were pooled and described. Survival analysis and multivariable Cox regression analysis were performed to evaluate therapies and investigate prognostic factors for PFS. Results: Our cohort included 22 females and 16 males, with a median age of 33 years. PSAE developed mostly on cervical and cervicothoracic levels. The median length measured 3 segments. Half of PSAE were intramedullary. Pain was the most common symptom. The median duration of symptoms was 6 months. Neurological statuses were improved in 76% following treatments, whereas clinical tumor progression occurred in 41.7%. The estimated median progression-free survival was 132 months, and the estimated median survival was 192 months. The median Ki-67 index was 15%. Patients aged less than or equal to 25 experienced worse neurological statuses and more repeated progression. Age less than or equal to 25 (HR 10.312, 95%CI 1.535-69.260, p=0.016), gross total resection (HR 0.116, 95%CI 0.020-0.688, p=0.018), and radiotherapy (HR 0.084, 95%CI 0.009-0.804, p=0.032) are three prognostic factors for tumor progression. Conclusion: Tumor progression remains a big concern in the clinical course of PSAE. Being aged above 25, undergoing GTR, and accepting adjuvant radiotherapy put patients at lower risk for tumor progression. Younger patients might have worse neurological statuses compared with those aged over 25.

Pre-Surgery Hip-Knee-Ankle Angle and Weightbearing Line Percentage Are Nearly Perfectly Correlated to the Miniaci Angle When Planning Open Wedge High Tibial Osteotomies.

PURPOSE: To investigate the conversion formulas between the Miniaci angle, presurgery parameters, and changes in presurgery parameters in open-wedge high tibial osteotomy (OWHTO), including hip-knee-ankle (HKA) angle, weightbearing line (WBL) percentage, mechanical medial proximal tibial angle (mMPTA), ΔHKA angle, ΔWBL percentage, ΔmMPTA, and other parameters. METHODS: From January 2012 to December 2019, 247 lower limbs of 144 patients with medial unicompartmental knee osteoarthritis combined with proximal tibia vara were enrolled. Inclusion criteria were adults, medial unicompartmental knee osteoarthritis, Kellgren-Lawrence classification grade ≤ III, mMPTA ≤ 85°, normal mechanical lateral distal femoral angle (85°-90°), and patella facing anterior in the bipedal standing position. Exclusion criteria were history of fracture, trauma, or orthopaedic surgery; developmental dysplasia of the hip or femoral head necrosis; femoral bowing deformity; deformity of the tibial shaft; and leg length discrepancy. Using standing whole-leg radiographs, an OWHTO simulation was performed to determine the Miniaci angle by delivering the WBL to the Fujisawa point. The relationship of the Miniaci angle, the presurgery parameters, and the changes in presurgery parameters were analyzed by Spearman's correlation and linear regression analyses. The relationship between the postsurgery HKA angle and presurgery parameters was analyzed by multiple linear regression model. RESULTS: The Miniaci angle showed a near-perfect correlation with the presurgery HKA angle (y = -1.05x + 192.10, r2 = 0.99), presurgery WBL percentage (y = -0.25x + 15.14, r2 = 0.97), ΔHKA angle (y = 1.04x - 0.03, r2 = 1.00), ΔWBL percentage (y = 0.25x - 0.52, r2 = 0.97), and ΔmMPTA (y = 1.04x - 0.03, r2 = 1.00). The ΔHKA angle showed nearly perfect correlation with the ΔmMPTA (y = 1.00x, r2 = 1.00), and ΔWBL percentage (y = 0.24x - 0.47, r2 = 0.97). CONCLUSIONS: The presurgery HKA angle, presurgery WBL percentage, ΔHKA angle, ΔWBL, and ΔmMPTA percentage are nearly perfectly correlated to the Miniaci angle, whereas the ΔmMPTA and ΔWBL percentage are nearly perfectly correlated to the ΔHKA angle. With the conversion formulas determined in the current study, surgeons can calculate the Miniaci angle based on the presurgery parameters without the assistance of digital software for complex surgical simulation. The Miniaci angle is closely related to the gap of the medial opening wedge. Based on the Miniaci angle and the depth of the osteotomy, surgeons can calculate the gap required before surgery using trigonometric functions and then simply measure the gap during surgery.

Lateral tibial intercondylar eminence is a reliable reference for alignment correction in high tibial osteotomy.

PURPOSE: The purpose of the study is to determine whether the lateral tibial intercondylar eminence (LTIE) is a reliable reference for alignment correction in high tibial osteotomy (HTO). METHODS: A total of 1954 consecutive standing whole-leg radiography (WLR) examinations of 1373 adult patients with knee osteoarthritis between 2012 and 2019 were reviewed retrospectively; 145 patients were included, 53 males and 92 females, with a mean age of 63.3 years. Virtual simulation of HTO was performed to measure weight-bearing line (WBL) percentages and hip-knee-ankle (HKA) angles when the WBL passed through the Fujisawa, top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, and the positional relationship between the Fujisawa point and the lateral slope of the LTIE was determined. RESULTS: When the WBL passed through the top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, the mean WBL percentages were 57.7% ± 2.1%, 74.6% ± 3.3%, 63.4% ± 2.1%, and 66.2% ± 2.3%, respectively, and the mean HKA angles were 182.1° ± 0.5°, 185.9° ± 0.8°, 183.3° ± 0.5°, and 184.0° ± 0.5°, respectively. When the WBL passed through the Fujisawa point, it was passing through 28.6% ± 12.7% of the width of the lateral slope (the top and bottom points were defined as 0% and 100%, respectively). When the WBL passed through the middle and upper 1/3 points of the lateral slope of the LTIE, the majority of cases (96.1%-100%) were within the limits of acceptability, as defined by the widely accepted standard of a postoperative HKA angle ranging from 183° to 186°. CONCLUSION: The upper 1/3 and middle points of the lateral slope of the LTIE are reliable references for guiding the alignment correction in HTO. In clinical application, if 62%-66% of the postoperative WBL percentage is the acceptable target range, the upper 1/3 point of the lateral slope of the LTIE may be a better alternative than the midpoint. If the postoperative HKA angle between 183° and 186° is acceptable, the midpoint of the lateral slope of the LTIE may be better than the upper 1/3 point. These findings are crucial for the accuracy of the traditional intraoperative alignment assessment techniques. LEVEL OF EVIDENCE: IV.

Pyrolysis kinetics and environmental risks of oil-based drill cuttings at China's largest shale gas exploitation site.

Chongqing Fuling shale gas field, the largest shale gas exploration site in China, produces a large amount of oil-based drill cuttings (OBDC) every year, which is a hazardous waste. Traditional treatment methods such as solidification/stabilization did not recycle the valuable components such as petroleum hydrocarbons. Pyrolysis is proven to be an efficient method that can recover those components. This study firstly investigated the pyrolysis kinetics by two different methods on the basis of detailed material characterization, and then taking the workers and the surrounding ecological environment as the analysis object, the human health risk assessment (HHRA) and ecological risk assessment were evaluated respectively before and after pyrolysis. The results showed that the pyrolysis of OBDC was divided into three stages, and the cracking of light hydrocarbons stage was the key control step for pyrolysis process. The activation energy E increased gradually during the pyrolysis progress. The HHRA results showed that pyrolysis could greatly reduce the non-carcinogenic risk, carcinogenic risk and ecological risk by 59.6 %, 62.8 % and 75 % respectively. However, the carcinogenic risk after pyrolysis was still higher than the critical value 10-6.

Radiomics analysis using MR imaging of subchondral bone for identification of knee osteoarthritis.

BACKGROUND: To develop a magnetic resonance imaging (MRI)-based radiomics predictive model for the identification of knee osteoarthritis (OA), based on the tibial and femoral subchondral bone, and compare with the trabecular structural parameter-based model. METHODS: Eighty-eight consecutive knees were scanned with 3T MRI and scored using MRI osteoarthritis Knee Scores (MOAKS), in which 56 knees were diagnosed to have OA. The modality of sagittal three-dimensional balanced fast-field echo sequence (3D BFFE) was used to image the subchondral bone. Four trabecular structural parameters (bone volume fraction [BV/TV], trabecular thickness [Tb.Th], trabecular separation [Tb.Sp], and trabecular number) and 93 radiomics features were extracted from four regions of the lateral and medial aspects of the femur condyle and tibial plateau. Least absolute shrinkage and selection operator (LASSO) was used for feature selection. Machine learning-based support vector machine models were constructed to identify knee OA. The performance of the models was assessed by area under the curve (AUC) of the receiver operator characteristic (ROC). The correlation between radiomics features and trabecular structural parameters was analyzed using Pearson's correlation coefficient. RESULTS: Our radiomics-based classification model achieved the AUC score of 0.961 (95% confidence interval [CI], 0.912-1.000) when distinguishing between normal and knee OA, which was higher than that of the trabecular parameter-based model (AUC, 0.873; 95% CI, 0.788-0.957). The first-order, texture, and Laplacian of Gaussian-based radiomics features correlated positively with Tb.Th and BV/TV, but negatively with Tb.Sp (P < 0.05). CONCLUSIONS: Our results suggested that our MRI-based radiomics models can be used as biomarkers for the classification of OA and are superior to the conventional structural parameter-based model.

The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty.

Background: Precise preoperative planning improves postoperative outcomes in total hip arthroplasty (THA), especially in developmental dysplasia of the hip (DDH) cases. Previous studies used the T-line and midcortical-line as preoperative landmarks to predict postoperative stem anteversion (PSA). However, the most reliable landmark in predicting PSA in DDH patients remains unclear. To find the most reliable measurement to predict the PSA in DDH patients, this study compared the midcortical-line and T-line at different femoral neck levels. Methods: Pre- and postoperative Computed Tomography (CT) scans of 28 hips in 21 DDH patients who received THA were obtained for three-dimensional femoral models. The preoperative CT scan was used to measure the anteversion of the midcortical-line on the axial cross-sectional plane images (AM-CT), the anteversion of the midcortical-line from 3D models (AM-3D), and the T-line from 3D models (AT-3D) at simulated osteotomy planes at 5 and 10 mm heights proximal to the base of the lesser trochanter. The correlation between the preoperative femoral anteversion (AM-CT, AM-3D, AT-3D) and the PSA was assessed to evaluate the prediction accuracy. Results: The correlations between the AM-CT and the PSA were 0.86 (mean difference (MD) = 1.9°) and 0.92 (MD = -3.0°) at 5 and 10 mm heights, respectively. The correlation between the AM-3D and the PSA were 0.71 (MD = -11.6°) and 0.61 (MD = -12.9°) at 5 and 10 mm heights. The AT-3D was significantly greater (MD = 15.4°) than the PSA (p-value <0.01) at 5 mm cutting height, and the correlation between the AT-3D and the PSA was 0.57 (MD = 7.8°) at 10 mm cutting height. Conclusions: The AM-CT at the 10 mm height had the strongest correlation with the PSA and was more reliable in predicting the PSA when compared with the AM-3D and the AT-3D in DDH patients.

Roasting mechanism of lightweight low-aluminum-silicon ceramisite derived from municipal solid waste incineration fly ash and electrolytic manganese residue.

Municipal solid waste incineration (MSWI) fly ash and electrolytic manganese residue (EMR) belong to hazardous waste, and must be disposed of before processing. It was found that the low content of silicon and aluminum at low roasting temperature can meet the expansion mechanism of lightweight aggregates. A low-aluminum-silicon lightweight ceramisite was successfully prepared from MSWI fly and EMR, the formation mechanism of which was that the viscosity of molten stuffs in pellet was the function of temperature and chemical composition and had enough capacity of capturing the emerged gas over roasting. The resulting ceramisite met with the requirement of Lytag commercial lightweight aggregate. The content of heavy metal in ceramisite accorded with the requirement of soil environmental quality for development GB 36600-2018 Class I, and PCDD/Fs in ceramisite was 2.0 ng I-TEQ/kg, which was safe. The collaboration of thermal simulation and characterization (SEM-EDS, FTIR and XRD) elaborated the formation mechanism of ceramisite, with six stages provided.

Clinical Features, Treatments, and Prognosis of Intramedullary Spinal Cord Metastases From Lung Cancer: A Case Series and Systematic Review.

OBJECTIVE: Intramedullary spinal cord metastasis from lung cancer (ISCM-LC) are increasing in prevalence. We aim to investigate its clinical features, treatments and prognosis. METHODS: We reported 6 ISCM-LC cases and conducted a systematic review. Descriptive summarization, survival analysis, and multivariate Cox regression analysis were performed to comprehensively study the disease. RESULTS: All 6 patients had surgery. One used chemotherapy and the other had targeted drugs. Two patients died of ISCM-LC, 1 died of pulmonary embolism, 1 was alive, and 2 were lost to follow-up. We identified 197 ISCM-LC cases in literature with a mean age of 58 years and male preponderance. Small cell lung cancer accounted for 39.1%. The median interval from lung cancer to ISCM-LC was 7 months. Limb weakness was the most common symptom, and 45% cases progressed rapidly. Concomitant brain, leptomeningeal, and vertebral metastasis occurred to 55.8%, 20%, and 19.5%, respectively. Peritumoral edema appeared in 83.3%. Through survival analysis, we found sex, extraspinal metastasis, pathology, and improved symptoms affected the overall survival. Additionally, gross total resection (GTR) shared similar effectiveness with non-GTR, and other treatments following surgery hardly added extra effect. Surgery, improved symptoms, and sex were 3 independent prognostic factors after adjusting for confounding. The estimated median survival time was 5 months. CONCLUSION: The overall survival of ISCM-LC remains poor. Surgery is an independent protective factor for survival. Surgery should be considered once tolerated, and GTR might not be necessary. In addition, female patients with improved symptoms after intervention might have better overall survival.

HKA Angle-A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs.

High tibial osteotomy (HTO) is a recognized treatment for early-stage medial compartment knee osteoarthritis. Preoperative planning with standing whole-leg radiographs (WLRs) is essential for ensuring optimal postoperative alignment. The primary purpose of this study is to investigate the theoretical accuracy of the wedge opening required for two different preoperative planning parameters in open-wedge HTO. The second purpose is to theoretically determine which parameter is superior. Preoperative planning for HTO was performed with standing WLRs for 39 knees with isolated medial osteoarthritis. The Miniaci preoperative planning method was applied to correct the hip-knee-ankle (HKA) angle to 3to 6 degrees of valgus and the weight-bearing line (WBL) percentage within 60 to 70% of the width of the tibial plateau. To ensure that the HKA angle was between 3 and 6 degrees of valgus, the required accuracy window for the Miniaci angle was 3.25 ± 0.03 degrees (range, 3.20-3.30°). To ensure that the WBL percentage was between 60 and 70%, the accuracy window required for the Miniaci angle was 2.35 ± 0.13 degrees (range, 2.10-2.65°). This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci).

The dominant microbial metabolic pathway of the petroleum hydrocarbons in the soil of shale gas field: Carbon fixation instead of CO2 emissions.

In shale gas mining areas, indigenous microorganisms degrade organic pollutants such as petroleum hydrocarbons into carbon dioxide (CO2) and water (H2O) through aerobic metabolism. A large quantity of CO2 emissions will exacerbate the "Greenhouse effect". Based on the clean sieved soil and oil-based drilling fluid in the shale gas mining area, this experiment set three concentration gradients (3523 ± 159 mg/kg, 8715 ± 820 mg/kg and 22,031 ± 1533 mg/kg) to treat the soil, and each group was disposed for the same amount of time (63 days). By analyzing the dynamic changes of microbial diversity and the abundance of key functional genes for carbon fixation, the impact of petroleum hydrocarbons on carbon fixation potential was discovered, and the natural attenuation law of petroleum hydrocarbons in contaminated soil was explored. It provided the scientific research basis of ecology for the carbon cycle, carbon allocation, and carbon fixation in microbial remediation of petroleum hydrocarbon contaminated soil. The results obtained indicated the following: i) The removal rate of petroleum hydrocarbons under high-concentration pollution (45.33 ± 3.90%) was significantly lower than low and medium-concentration pollution. The TPH concentration removal rate of each group was the largest in the early stage of culture (1-5d), and there was no significant correlation between the TPH content and the community composition (R2 = 0.0736, P > 0.05). ii) Composition and function of Carbon Fixation associated microbiota were assessed by 16S rRNA sequencing and PICRUSt (phylogenetic investigation of communities by reconstruction of unobserved states) analysis. The main carbon fixation pathway in this study is the reductive citric acid cycle, because there was no shortage of enzymes that can affect subsequent reactions.

Associations of osteoclastogenesis and nerve growth in subchondral bone marrow lesions with clinical symptoms in knee osteoarthritis.

BACKGROUND/OBJECTIVE: Subchondral bone marrow lesions (BMLs) are common magnetic resonance imaging (MRI) features in joints affected by osteoarthritis (OA), however, their clinical impacts and mechanisms remain controversial. Thus, we aimed to investigate subchondral BMLs in knee OA patients who underwent total knee arthroplasty (TKA), then evaluate the associations of osteoclastogenesis and nerve growth in subchondral BMLs with clinical symptoms. METHODS: Total 70 patients with primary symptomatic knee OA were involved, then separated into three groups based on MRI (without BMLs group, n â€‹= â€‹14; BMLs without cyst group, n â€‹= â€‹37; BMLs with cyst group, n â€‹= â€‹19). Volume of BMLs and cyst-like lesions was calculated via the OsiriX system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess clinical symptoms. Histology and immunohistochemistry were deployed to assess subchondral osteoclastogenesis and nerve distribution. Pearson's correlation coefficient was used to evaluate the associations between volume of BMLs and joint symptoms, and to assess the associations of osteoclastogenesis and nerve growth in subchondral BMLs with joint symptoms. RESULTS: In BMLs combined with cyst group, patients exhibited increased osteoclastogenesis and nerve distribution in subchondral bone, as shown by increased expression of tartrate resistant acid phosphatase (TRAP) and protein gene product 9.5 (PGP9.5). Volume of subchondral cyst-like component was associated with joint pain (p â€‹< â€‹0.05). Subchondral osteoclastogenesis and nerve distribution were positively associated with joint pain in BMLs with cyst group (p â€‹< â€‹0.05). CONCLUSION: The subchondral cyst-like lesion was an independent factor for inducing pain in OA patients; osteoclastogenesis and nerve growth in subchondral cyst-like lesions could account for this joint pain. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Our results indicated that the increased osteoclastogenesis and nerve growth in subchondral cyst-like lesions could account for the pain of OA joints. These findings may provide valuable basis for the treatment of OA.

Experts' consensus on perioperative management of tooth extractions in patients receiving oral antithrombotic treatment.

Thromboembolic diseases, which comprise venous thromboembolic diseases and arterial thromboembolic diseases, have become the number one cause of death worldwide. To prevent or treat thrombosis, patients with thromboembolic diseases need to take antithrombotic drugs, which would increase the risk of bleeding during and after surgery. Tooth extraction is the most common operation in oral and maxillofacial surgery clinics. Although patients given oral antithrombotic drugs do not need to undergo drug withdrawal, the perioperative management of such patients remains confusing to most clinicians. Moreover, the potential risk factors for bleeding warrant further study. To improve the clinicians' knowledge of perioperative management for patients subjected to tooth extractions with oral antithrombotic drugs, experts have drafted this consensus focusing on preoperative bleeding risk assessment, intraoperative operating norms, and postoperative care to summarize the points needing attention.