Anesthesia methods for full-endoscopic lumbar discectomy: a review.

Full-endoscopic lumbar discectomy under local anesthesia is major trends for the treatment of lumbar disc herniation in spine minimally invasive surgery. However, sometimes local anesthesia is not enough for analgesic in surgery especially in interlaminar approach. This study summarizes the current study of anesthesia methods in full-endoscopic lumbar discectomy. Local anesthesia is still the most common anesthesia method in full-endoscopic lumbar discectomy and the comparison group for other anesthesia methods due to high safety. Compared to local anesthesia, Epidural anesthesia is less applied in full-endoscopic lumbar discectomy but reports better intraoperative pain control and equivalent safety due to the motor preservation and pain block characteristic of ropivacaine. General anesthesia can achieve totally pain block during surgery but nerve injury can not be ignored, and intraoperative neuromonitoring can assist. Regional anesthesia application is rare but also reports better anesthesia effects during surgery and equivalent safety. Anesthesia methods for full-endoscopic lumbar discectomy should be based on patient factors, surgical factors, and anesthesiologist factors to achieve satisfactory anesthesia experience and successful surgery.

Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study.

AIMS/HYPOTHESIS: The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk. METHODS: We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes. RESULTS: During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age. CONCLUSIONS/INTERPRETATION: The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.

Red Blood Cell Membrane-Related Gene Variants and Clinical Risk Factors in Chinese Neonates with Hyperbilirubinemia.

INTRODUCTION: Neonatal hyperbilirubinemia is common and remains a clinical concern in China. Since neonatal hyperbilirubinemia is linked to genetic factors, we aimed to identify the gene variants of the red blood cell membrane (RBCM) and evaluate the clinical risk factors in Chinese neonates with hyperbilirubinemia. METHODS: 117 hyperbilirubinemia neonates (33 cases of moderate hyperbilirubinemia and 84 cases of severe hyperbilirubinemia) and 49 controls with normal bilirubin levels were selected as our study subjects. A customized 22-gene panel with next-generation sequencing (NGS) was designed to characterize genetic variations among the neonates. Sanger sequencing was used to verify the accuracy of the NGS. The clinical risk factors and potential effects of genetic variations in neonates with hyperbilirubinemia were subsequently assessed. RESULTS: After data filtering, suspected pathogenic variants of UGT1A1, SLCCO1B1, and RBCM-associated gene were identified in neonates, the combined numbers of RBCM-associated gene variants were found to have differences between the hyperbilirubinemia group and the controls (p = 0.008), they were also different between severe hyperbilirubinemia and moderate hyperbilirubinemia (p = 0.008), and were correlated with an increased risk of hyperbilirubinemia (odds ratio = 9.644, p = 0.006). The UGT1A1-rs4148323 variant in neonates with hyperbilirubinemia was significantly increased as compared with the controls (p < 0.001). However, there was no statistical difference for the SLCO1B1-rs2306283 variant between the hyperbilirubinemia group and the controls. In addition, breastfeeding contributed to an increased risk of hyperbilirubinemia. CONCLUSION: Our study highlights that the RBCM-related gene variants are an underestimated risk factor, which may play an important role in developing hyperbilirubinemia in Chinese newborns.

Estimation of cancer mortality attributable to excess body weight during 2006-2015 in China.

BACKGROUND: Cancer is one of the most common causes of death. Excess body weight (EBW), a risk factor for cancer, is highly prevalent in China. We aimed to estimate the number and proportion of cancer deaths attributed to EBW and their changes during 2006-2015 in China. METHODS: Population attributable fractions in 2006, 2010, and 2015 were calculated with 1) prevalence of overweight/obesity, exacted from the China Health and Nutrition Survey conducted in 8-9 provinces of China in 1997, 2000, and 2004; 2) relative risks for EBW and site-specific cancers, obtained from previous studies; 3) data on cancer deaths in 2006, 2010, and 2015, originated from the Chinese Cancer Registry Annual Report. RESULTS: In 2015, EBW contributed to 45,918 (3.1% of all) cancer deaths in China, with 24,978 (2.6%) in men and 20,940 (3.8%) in women. By region, the fraction of cancer deaths attributable to EBW ranged from 1.6% (West) to 4.1% (Northeast). Cancers of liver, stomach, and colorectum were the main EBW-attributable cancers. The fractions of cancer deaths attributable to EBW were 2.4% (95%CI: 0.8-4.2%) in 2006, 2.9% (95%CI: 1.0-5.2%) in 2010, and 3.1% (95%CI: 1.0-5.4%) in 2015, respectively, and increased for all gender, region, and cancer site during 2006-2015. CONCLUSIONS: The proportion of cancer deaths attributed to EBW was higher in women and Northeastern China, with an upward trend in the recent decade. A combination of comprehensive and individualized measures is necessary to reduce the prevalence of EBW and related cancer burden in China.

Sagittal sequence and clinical efficacy of cervical disc replacement and hybrid surgery in the treatment of cervical spondylotic myelopathy: a retrospective study.

Background: Hybrid surgery (HS) combines anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR) is gradually being more frequently implemented, but there are few studies reporting the safety and effectiveness of hybrid surgery in three levels cervical spondylotic myelopathy. Methods: The clinical and radiographic data of patients with three-segment cervical spondylosis, who underwent CDR, ACDF and HS in our hospital from February 2007 to February 2013 were analyzed. The Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) were used to evaluate the clinical efficacy post surgery. Cervical spine x-rays were conducted to assess ROM, CL, T1S and relevant outcomes. Results: A total of 94 patients were included in the study: 26 in the CDR group, 13 in the HS1 group, 31 in the HS2 group, and 24 in the ACDF group. Most patients in the CDR group were younger. There was no difference in the follow-up duration, blood loss volume or surgery time (P > 0.05). Four groups reported improvements in JOA and NDI scores compared to baseline. There was no significant difference in the final JOA, final NDI or recovery rate among the 4 groups. The final ROM was smaller in the ACDF group than in the other 3 groups. There was no difference among the four groups in the final UROM, final LROM or their changes. There was no difference in the final T1S, final SVA or their change among the four groups. All groups showed similar changes in CL and T1S-CL. Conclusions: There was no difference in the clinical outcomes of ACDF, CDR, or hybrid surgery. CDR can better preserve the mobility of the cervical spine. Neither CDR nor hybrid surgery was significantly advantageous over ACDF in restoring the sagittal sequence in patients with three-level CSM.

Effect of Hydrothermal Media on the in-situ Whisker Growth on Biphasic Calcium Phosphate Ceramics.

BACKGROUND: There is still a big challenge to achieve a balance between mechanical characteristics and biological properties in biphasic calcium phosphate (BCP) ceramics. PURPOSE: The present study focused on the in-situ whisker growth on BCP ceramics via different hydrothermal treatments and investigated the influences of these whiskers on the mechanical property and biological performance of the ceramics. METHODS: Five kinds of BCP ceramics with in-situ whisker growth, ie, BCP-C, BCP-HNO3, BCP-Citric, BCP-NaOH, BCP-CaCl2 and BCP-Na3PO4 were fabricated by different hydrothermal treatments. The phase compositions, morphologies, crystal structures and mechanical strengths of the obtained BCP ceramics were firstly characterized. Then, the in vitro cell adhesion, proliferation and alkaline  phosphatase (ALP) activity of bone marrow stromal cells (BMSCs) on the BCP ceramics were evaluated. Lastly, the effects of in-situ whisker growth on the bone-like apatite formation abilities of BCP ceramics were also investigated by immersing them in simulated body fluid (SBF). RESULTS: The results demonstrated that the hydrothermal conditions, especially the hydrothermal media, were crucial to determine the phase composition and morphology of the in-situ whisker. Especially among the five media used (HNO3, Citric, NaOH, CaCl2 and Na3PO4), the Na3PO4 treatment resulted in the shortest whisker with a unique hollow structure, and kept the original biphasic composition. All five kinds of whiskers increased the mechanical strength of BCP ceramics to some extent, and showed the good ability of bone-like apatite formation. The in vitro cell study demonstrated that the in-situ whisker growth had no adverse but even positive effect on the adhesion, proliferation and ALP activity of BMSCs. CONCLUSION: Due to the growth of in-situ whiskers, the mechanical property and biological performance of the obtained BCP ceramics could increase simultaneously. Therefore, in-situ whiskers growth offers a promising strategy for the expanded application of BCP ceramics to meet the requirements of regenerative medicine.

Stereolithography-Based Additive Manufacturing of High-Performance Osteoinductive Calcium Phosphate Ceramics by a Digital Light-Processing System.

Digital light processing (DLP) is one of the additive manufacturing (AM) technologies suitable for preparation of high-performance ceramics. The present study provided an optimized formula to fabricate osteoinductive calcium phosphate (CaP) ceramics with high precision and controllable three-dimensional (3D) structure. Among the four surfactants, monoalcohol ethoxylate phosphate was the best one to modify the CaP powders for preparing the photocurable slurry with high solid loading and good spreading ability. By testing the photopolymerization property of the 60 wt % solid loading slurry, the appropriate processing parameters including the slice thickness (50 µm), exposure intensity (10.14 mW/cm2), and exposure time (8 s) were set to perform the 3D printing of the ceramic green body in the DLP system. After the debinding and sintering, the final CaP ceramics were acquired. The stereomicroscope and SEM observation confirmed the high precision of the ceramics. The average compressive strength of the ceramics with 64.5% porosity reached 9.03 MPa. On only soaking in simulated body fluid for 1 day, an even layer of apatite formed on the ceramic surface. The cell culture confirmed that the ceramics could allow the good attachment, growth, and proliferation of murine bone marrow mesenchymal stem cells. After implantation into the dorsal muscles of beagle dogs for 3 months, abundant blood vessels and obvious ectopic bone formation were observed clearly by the histological evaluation. Therefore, with good bioactivity and osteoinductivity as well as high precision and adjustable mechanical strength, the 3D printed CaP ceramics in the DLP system could have good potential in customized bone-repairing applications.

Effect of surface microstructure on the anti-fibrosis/adhesion of hydroxyapatite ceramics in spinal repair of rabbits.

Epidural adhesion is a great clinical challenge after laminectomy. In the present study, two types of hydroxyapatite (HA) laminas with distinct surface microstructures were prepared by cold isostatic pressing (CIP) and slip casting (SC) techniques, and investigated to their anti-fibrosis/adhesion effects by in vitro and in vivo evaluations. In contrast with the dense HA-CIP, HA-SC had a large number of micropores on the surface. After cultured on both HA ceramics, human skin fibroblasts presented the obvious senescent feature, and CCN1 gene expression was significantly up-regulated. HA-SC induced higher CCN1 gene expression than HA-CIP. After used for closing the lost vertebral after laminectomy in rabbits, both HA laminas promoted the recovery of the bony structure as well as prevented the hyperplastic fibrous tissue from penetration into the spinal canal area and inhibited the formation of scar-like tissue in laminectomy sites to some extent. Besides, thinner layer of fibrous tissue and smaller gap between the implant surface and paravertebral muscles were found in HA-CIP than HA-SC. Therefore, HA ceramics could have good anti-fibrosis/adhesion effect when used in spinal repair, and the dense HA-CIP could be an ideal choice. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2629-2637, 2019.

Study on an injectable biomedical paste using cross-linked sodium hyaluronate as a carrier of hydroxyapatite particles.

Exploring the long-term filler for minimally invasive plastic surgery has been widely concerned. In the present study, a series of injectable paste composed of hydroxyapatite (HAp) spherical particles and cross-linked sodium hyaluronate (cHA) solution were prepared. The physicochemical properties of cHA as a carrier of high content HAp microspheres (>50%) and as-obtained injectable HAp/cHA paste were studied. The cross-linking degree (DC), viscosity and molecular weight (Mw and Mn) of cHA increased with the increasing of the cross-linker dosage from 7.5 to 17.5 wt% under the certain conditions. HAp/cHA pastes were fabricated by homogeneously blending different sizes of HAp microspheres with cHA solution. The stability, rheological performance and push-out force of the pastes were studied, and the influence factors were discussed. The results indicated that moderate crosslinked cHA with 60% middle size HAp (HAp-M60/cHA-15.0) had appropriate comprehensive property. Finally, the in vitro cell culture approved the paste had no cytotoxicity. Although the biological performance of the pastes still need to be investigated, this preliminary study demonstrates that it is possible to carry high content HAp in cHA, expecting the better volumetric maintenance after long term implantation.