Clinical outcomes of short rod technique in posterior lumbar interbody fusion surgery: a minimum of 2-year follow-up.

PURPOSE: We present for the first time a novel entry point of pedicle screws (Short Rod Technique, SRT), which can avoid superior facet violation and has been verified as a safe screw placement method. The purpose of this study is to determine the clinical outcomes of SRT in posterior lumbar interbody fusion (PLIF) surgery. METHODS: We retrospectively analyzed the clinical outcomes of 89 patients who received SRT and 109 patients who received PLIF surgery with regular entry points of pedicle screws with a minimum of 2 years of follow-ups. Patients were divided into three groups according to the number of fusion segments, and the clinical outcomes of the three groups were compared. RESULTS: The length of the wound and the length of rods were significantly shorter in the each SRT group. Less intraoperative blood loss was observed in the SRT group in patients with a single segment and two segments fusions, but not in three segments fusions. Fewer degenerations of the upper adjacent segment were observed in the SRT group in patients with a single segment and three segments fusions. In addition, less postoperative wound pain related to PLIF surgery was observed in the SRT group in patients with two and three segments fusions. CONCLUSION: SRT has been validated as an effective technique with good clinical outcomes, especially for reducing the occurrence of upper ASD in PLIF surgery with a single segment and three segments. The present study provides spinal surgeons with a novel method for performing PLIF surgery.

Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients.

BACKGROUND: Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. OBJECTIVE: The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. DESIGN: This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. MAIN OUTCOME MEASURES: Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. RESULTS: The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24 h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). CONCLUSION: The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. REGISTRATION NUMBER: ChiCTR2100053991.

Thermal conductivity effect on thermophoresis of charged spheroidal colloids in aqueous media.

Thermophoresis of spheroidal colloids in aqueous media under the thermal conductivity effect is analyzed. The thermophoretic velocity and the thermodiffusion coefficient of spheroidal colloids have been formulated for extremely thin electric double layer (EDL) cases. Furthermore, a numerical thermophoretic model is built for arbitrary EDL thickness cases. The parametric studies show that the thermal conductivity mismatch of particle and liquid gives rise to a nonlinear temperature region around the spheroid, with the thickness close to the minor semiaxis. When the EDL region is thin relative to such nonlinear temperature region, the thermal conductivity effect on the thermophoresis of spheroidal colloids is significant, which strongly depends on the ratio of the minor semiaxis to the EDL thickness, the thermal conductivity ratio of particle to liquid, and the particle aspect ratio. Finally, to estimate the thermodiffusion coefficient of spheroidal colloids with arbitrary thermal conductivity, electrolyte concentration, and particle shape, the average dimensionless axial temperature gradient on the spheroidal equator plane in the EDL region is proposed.

Evaluation of Supraglottic Jet Oxygenation and Ventilation in 105 Patients During Bronchoscopy Using the Twinstream® Microprocessor-Controlled Jet Ventilator and the Wei Nasal Jet® Tube.

BACKGROUND The Twinstream® ventilator is a microprocessor-controlled electric jet ventilator that allows the simultaneous application of 2 different jet streams, one at low frequency and one at high frequency to result in pulsatile bi-level (p-BLV) mode of ventilation. This study aimed to evaluate supraglottic jet oxygenation and ventilation in 105 patients during bronchoscopy using the Twinstream® microprocessor-controlled jet ventilator and the Wei Nasal Jet® (WNJ) tube. MATERIAL AND METHODS Patients were randomly divided into 2 parallel groups (N=50 per group): group W using the WNJ tube and group M using an endoscopic face mask connected to Twinstream® microprocessor-controlled jet ventilator under monitored anesthesia care. Arterial blood gas was examined and recorded 15 minutes after the initiation of procedure. The demographic and clinical characteristics, procedure duration, doses of anesthetics, and adverse events in the 2 groups were also recorded. RESULTS The arterial partial pressure of carbon dioxide (PaCO2) (P=0.006) and lactic acid (P=0.001) were significantly lower, while pH (P=0.024) was significantly higher than in the group M. Pearson analysis showed that PaCO2 was significantly correlated with ventilation tools (P=0.006) and procedure duration (P=0.003). Multiple linear regression analysis showed that ventilation tools and procedure duration were both independent influencing factors (P=0.006, P=0.002). CONCLUSIONS Supraglottic jet oxygenation and ventilation using the WNJ tube can reduce PaCO2 and had advantages in enhancing oxygenation and ventilation function in patients during bronchoscopy intervention therapy under monitored anesthesia care.

Lung isolation-a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage.

BACKGROUND: The current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount of bleeding as the only evaluation criterion cannot comprehensively evaluate magnitude of the effects and the severity. OBJECTIVE: To propose the concept of bronchoscopy-associated acute massive airway hemorrhage, analyze its impact on patients and highlight the treatment approach of acute massive airway hemorrhage without ECMO support. DESIGNS: A retrospective cohort study. SETTING: Include all patients who received bronchoscopy intervention therapy at Interventional Pulmonology Center of Emergency General Hospital from 2004 to December 2021. PATIENTS: 223 patients met the inclusion criteria. INTERVENTION: Patients were divided into two groups: acute massive airway hemorrhage group (n = 29) and non-acute massive airway hemorrhage group (n = 194). MAIN OUTCOME MEASURES: Perioperative adverse events between two groups were the main outcome. Secondary outcome was the impact of lung isolation on patient in group Acute. RESULTS: The incidence of acute massive airway hemorrhage was 0.11%, and the incidence of non-acute massive airway hemorrhage was 0.76% in this study. There were significant differences in the incidence of intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, intraoperative mortality, and transfer to ICU between acute group and non-acute group (P<0.05, respectively). Lung isolation was used in 12 patients with acute massive airway hemorrhage, and only 2 patients died during the operation. CONCLUSION: Bronchoscopy-associated acute massive airway hemorrhage had more serious impact on patients due to rapid bleeding, blurred vision of bronchoscopy, inability to stop bleeding quickly, blood filling alveoli, and serious impact on oxygenation of the lung lobes. Polyvinyl chloride single-lumen endotracheal intubation for lung isolation, with its characteristics of low difficulty, wide applicability and available in most hospitals, may reduce the intraoperative mortality of patients with bronchoscopy-associated acute massive airway hemorrhage. TRIAL REGISTRATION: Chinese Clinical Trial Registry on 13/03/2022. REGISTRATION NUMBER: ChiCTR2200057470.

RHOA inhibits chondrogenic differentiation of mesenchymal stem cells in adolescent idiopathic scoliosis.

PURPOSE: The etiology of adolescent idiopathic scoliosis (AIS) remains unclear. The chondrogenic differentiation of mesenchymal stem cells (MSCs) is important in AIS, and the Ras homolog gene family member A (RHOA) is associated with chondrogenesis. The purpose of this study was to explore the effect of RHOA on the chondrogenic differentiation of MSCs in AIS. METHODS: We isolated MSCs from patients with AIS (AIS MSCs) and individuals without AIS (control MSCs). The inhibitor Y27632 was used to inhibit the function of RHOA/ROCK signaling, and plasmid-based overexpression and siRNA-mediated knockdown were used to manipulate RHOA expression. CCK-8 was used to detect cell viability. The phosphorylation levels of LIMK1, MLC2 and cofilin were detected by Western blotting. The mRNA expression of aggrecan, SOX9, and COL2A1 were confirmed using RT-PCR. Immunofluorescence was used to analyze F-actin and collagen II. Alcian blue staining was performed to assess the secretion of glycosaminoglycans (GAGs). RESULTS: We found that RHOA was significantly upregulated in AIS MSCs, and the phosphorylation levels of LIMK1, MLC2, and cofilin were increased. The mRNA expressions of aggrecan, SOX9, and COL2A1 were notably reduced in AIS MSCs. However, these effects were abolished by Y27632 treatment and RHOA knockdown in AIS MSCs. In addition, RHOA knockdown in AIS MSCs increased the content of collagen II and GAGs. RHOA overexpression in the control MSCs markedly activated the RHOA/ROCK signaling and decreased the expression of aggrecan, SOX9, and COL2A1, F-actin, and GAGs. CONCLUSION: RHOA regulates the chondrogenic differentiation ability of MSCs in AIS via the RHOA/ROCK signaling pathway and this regulation may involve SOX9.

Lung injury induced by different negative suction pressure in patients with pneumoconiosis undergoing whole lung lavage.

BACKGROUND: Pneumoconiosis is a diffuse interstitial fibronodular lung disease, which is caused by the inhalation of crystalline silica. Whole lung lavage (WLL) is a therapeutic procedure used to treat pneumoconiosis. This study is to compare the effects of different negative pressure suction on lung injury in patients with pneumoconiosis undergoing WLL. MATERIALS AND METHODS: A prospective study was conducted with 24 consecutively pneumoconiosis patients who underwent WLL from March 2020 to July 2020 at Emergency General Hospital, China. The patients were divided into two groups: high negative suction pressure group (group H, n = 13, negative suction pressure of 300-400 mmHg) and low negative suction pressure group (group L, n = 11, negative suction pressure of 40-50 mmHg). The arterial blood gas, lung function, lavage data, oxidative stress, and inflammatory responses to access lung injury were monitored. RESULTS: Compared with those of group H, the right and left lung residual were significantly increased in the group L (P = 0.04, P = 0.01). Potential of hydrogen (pH), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), lactic acid (LAC) and glucose (GLU) varied from point to point in time (P < 0.01, respectively). There was statistical difference in the trend of superoxide dismutase (SOD) and interleukin-10 (IL-10) over time between the two groups (P < 0.01, P = 0.02). In comparison with the group H, the levels of IL-10 (P = 0.01) and SOD (P < 0.01) in WLL fluid were significantly increased in the group L. There was no statistical difference in the trend of maximal volumtary ventilation (MVV), forced vital capacity (FVC), forced expiratory volume in one second (FEV1%), residual volume (RV), residual volume/total lung capacity (RV/TLC), carbon monoxide dispersion factor (DLCO%), forced expiratory volume in one second/ forced vital capacity (FEV1/FVC%) over time between the two groups (P > 0.05, respectively). CONCLUSION: Low negative suction pressure has the potential benefit to reduce lung injury in patients with pneumoconiosis undergoing WLL, although it can lead to increased residual lavage fluid. Despite differing suction strategies, pulmonary function parameters including FEV1%, RV and DLCO% became worse than before WLL. Trial Registration Chinese Clinical Trial registration number ChiCTR2000031024, 21/03/2020.

Adipose-Derived Stem Cells-Derived Exosomes with High Amounts of Circ_0001747 Alleviate Hypoxia/Reoxygenation-Induced Injury in Myocardial Cells by Targeting MiR-199b-3p/MCL1 Axis.

Recent studies demonstrated that circular RNAs play important roles in exosome-mediated cardio-protective effects after acute myocardial infarction (AMI). A previous study reported that circ_0001747 level is down-regulated in mouse hypoxia/reoxygenation (H/R) injury model. However, its biological role and working mechanism in AMI remain largely unknown.Exosomes were isolated from the culture supernatant of adipose-derived stem cells (ADSCs) using an ExoQuick precipitation kit. We treated mouse myocardial cells HL-1 with H/R to explore the role of exosomal circ_0001747 in AMI pathology. Cell viability, proliferation, apoptosis, and inflammation were analyzed by Cell Counting Kit-8 assay, 5-ethynyl-2'-deoxyuridine assay, flow cytometry, and enzyme-linked immunosorbent assay. Dual-luciferase reporter assay and RNA immunoprecipitation assay were conducted to confirm the interaction between microRNA-199b-3p (miR-199b-3p) and circ_0001747 or MCL1 apoptosis regulator, BCL2 family member (MCL1).H/R-induced HL-1 dysfunction was attenuated by the incubation of exosomes derived from ADSCs, especially the exosomes with high amounts of circ_0001747. Circ_0001747 directly targeted miR-199b-3p in HL-1 cells. miR-199b-3p overexpression partly overturned exosomal circ_0001747-mediated protective effects in H/R-induced HL-1 cells. MCL1 was a direct target of miR-199b-3p in HL-1 cells. miR-199b-3p silencing alleviated H/R-induced damage in HL-1 cells partly by up-regulating MCL1. Circ_0001747 can elevate the messenger RNA and protein levels of MCL1 by sequestering miR-199b-3p.Overall, these results indicated that ADSCs-derived exosomes with high amounts of circ_0001747 attenuated H/R-induced HL-1 dysfunction partly by targeting miR-199b-3p/MCL1 signaling.

Analytical analysis of anisotropic thermophoresis of a charged spheroidal colloid in aqueous media for extremely thin EDL cases.

Thermophoresis of charged spheroids has been widely applied in biology and medical science. In this work, we report an analysis of the anisotropic thermophoresis of diluted spheroidal colloids in aqueous media for extremely thin EDL cases. Under the boundary layer approximation, we formulate the thermophoretic velocity, the thermophoretic force, and the thermodiffusion coefficient of a randomly dispersed spheroid. The parametric studies show that under the aforementioned conditions, the thermophoresis is anisotropic and its thermodiffusion coefficient should be considered as a vector, DT . The thermodiffusion coefficient values and directions of DT are strongly related to the aspect ratio and the angle θ between the externally applied temperature gradient and the particle's axis of revolution: The increasing aspect ratio enlarges the thermodiffusion coefficient value DT of prolate (oblate) spheroids to a constant value when θ < 60° (θ > 45°), and it reduces DT of prolate (oblate) spheroids to a constant value when θ > 60° (θ < 45°). The thermodiffusion coefficient direction of both prolate and oblate spheroids deviates slightly from -∇T∞ for a small aspect ratio, and such deviation becomes serious for a large aspect ratio.

High frequency jet ventilation through mask contributes to oxygen therapy among patients undergoing bronchoscopic intervention under deep sedation.

BACKGROUND: High frequency jet ventilation (HFJV) is an open ventilating technique to maintain ventilation for emergency or difficult airway. However, whether jet ventilation or conventional oxygen therapy (COT) is more effective and safe in maintaining adequate oxygenation, is unclear among patients with airway stenosis during bronchoscopic intervention (BI) under deep sedation. METHODS: A prospective randomized cohort study was conducted to compare COT (high flow oxygen) with normal frequency jet ventilation (NFJV) and HFJV in oxygen supplementation during BI under deep sedation from March 2020 to August 2020. Patients receiving BI under deep sedation were randomly divided into 3 parallel groups of 50 patients each: the COT group (fractional inspired oxygen (FiO2) of 1.0, 12 L/min), the NFJV group (FiO2 of 1.0, driving pressure of 0.1 MPa, and respiratory rate (RR) 15 bpm) and the HFJV Group (FiO2 of 1.0, driving pressure of 0.1 MPa, and RR of 1200 bpm). Pulse oxygen saturation (SpO2), mean arterial blood pressure and heart rate were recorded during the whole procedure. Arterial blood gas was examined and recorded 15 min after the procedure was initiated. The procedure duration, dose of anesthetics, and adverse events during BI in the three groups were also recorded. RESULTS: A total of 161 patients were enrolled, with 11 patients excluded. The clinical characteristics were similar among the three groups. PaO2 of the COT and NFJV groups was significantly lower than that of the HFJV group (P < 0.001). PaO2 was significantly correlated with ventilation mode (P < 0.001), body mass index (BMI) (P = 0.019) and procedure duration (P = 0.001). Multiple linear regression showed that only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2 (P = 0.040 and P = 0.002, respectively). The location of airway lesions and the severity of airway stenosis were not statistically correlated with PaCO2 and PaO2. CONCLUSIONS: HFJV could effectively and safely improve intra-operative PaO2 among patients with airway stenosis during BI in deep sedation, and it did not increase the intra-operative PaCO2 and the risk of hypercapnia. PaO2 was correlated with ventilation mode, BMI and procedure duration. Only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2. PaCO2 was not correlated with any preoperative factor. TRIAL REGISTRATION: Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110 , registered on March 22, 2020.

Effect of Pressure-Controlled Ventilation-Volume Guaranteed on One-Lung Ventilation in Elderly Patients Undergoing Thoracotomy.

BACKGROUND Volume-controlled ventilation (VCV) in one-lung ventilation (OLV) is most commonly used in thoracotomy, but pressure-controlled ventilation-volume guaranteed (PCV-VG) is used in elderly patients to improve arterial oxygenation, reduce inflammatory factors, and decrease acute lung injury (ALI). The purpose of this study was to investigate the effects of these 2 different ventilation modes - VCV versus PCV-VG - during OLV in elderly patients undergoing thoracoscopic lobectomy. MATERIAL AND METHODS Sixty patients undergoing thoracoscopic lobectomy from September 2018 to February 2019 at Cangzhou Central Hospital, Hebei, China were randomly assigned to a VCV group or a PCV-VG group. Pulmonary dynamic compliance (Cdyn), peak inspiratory pressure (PIP), arterial blood gas, and inflammatory factors were monitored to assess lung function. The Clinical Trial Registration Identifier number is ChiCTR1800017835. RESULTS Compared with the VCV group, PIP in the PCV-VG group was significantly lower (P=0.01) and Cdyn was significantly higher at 30 min after one-lung ventilation (P=0.01). MAP of the PCV-VG group was higher than in the VCV group (P=0.01). MAP of the PCV-VG group was also higher than in the VCV group at 30 min after one-lung ventilation (P=0.01). The concentration of neutrophil elastase (NE) in the PCV-VG group was significantly lower than in the VCV group (P=0.01). CONCLUSIONS Compared with VCV, PCV-VG mode reduced airway pressure in patients undergoing thoracotomy and also decreased the release of NE and reduced inflammatory response and lung injury. We conclude that PCV-VG mode can protect the lung function of elderly patients undergoing thoracotomy.

Dynamic Changes of Th1 Cytokines and the Clinical Significance of the IFN-γ/TNF-α Ratio in Acute Brucellosis.

BACKGROUND: T-helper type 1 (Th1) cells and Th1-produced cytokines play essential roles in the immune response to foreign pathogens, such as Brucella spp. The aim of this study was to evaluate the dynamic changes of Th1 cells and Th1-produced cytokines in patients with acute brucellosis and their impact on clinical decision-making. METHODS: Fifty-one individuals with acute brucellosis and 17 healthy subjects were enrolled in this study. The brucellosis patients were diagnosed based on clinical symptoms, laboratory tests, and clinical examination. The levels of serum gamma-interferon (IFN-γ) and tumor necrosis factor-alpha (TNF-α), along with the percentage of Th1 cells, were determined by flow cytometry bead arrays (CBA). RESULTS: The frequency of Th1 cells, along with the levels of IFN-γ and TNF-α, was negatively correlated with the clinical parameters. The mean serum levels of IFN-γ and TNF-α and the frequency of Th1 cells were significantly higher in the brucellosis patients in comparison with the healthy subjects (p < 0.05). Besides, the cytokine levels were not significantly different between the positive and negative blood culture groups. IFN-γ levels significantly decreased from 6 months to 12 months post treatment (p < 0.05). However, the IFN-γ levels remained higher than those of the healthy subjects by 12 months post treatment (p < 0.05). The IFN-γ/TNF-α ratio was significantly higher in severe cases than in nonsevere cases (p < 0.05). CONCLUSIONS: The IFN-γ levels secreted by Th1 cells remain significantly higher than those of healthy subjects more than 12 months after treatment with antibiotics. This finding is different from similar studies. The IFN-γ/TNF-α ratio may be a feasible parameter for assessing clinical severity, yet further longitudinal studies of the immunization and inflammatory reaction of brucellosis are needed in larger patient populations.

Postoperative shoulder imbalance in adolescent idiopathic scoliosis: risk factors and predictive index.

PURPOSE: Postoperative shoulder imbalance (PSI) is a common complication of adolescent idiopathic scoliosis (AIS). However, results regarding risk factors for PSI are contradictory. This study was performed to explore the risk factors associated with PSI in AIS and determine whether PSI could be predicted. METHODS: Medical records of AIS patients receiving correction surgery from January 2012 to January 2015 were reviewed. Anteroposterior films were evaluated before and after the surgery and at the 2-year follow-up. Patients were divided into two groups according to whether PSI was observed at 2-year follow-up. Risk factors for PSI were analyzed, and a PSI index was proposed and verified. RESULTS: A total of 114 AIS patients (PSI/non-PSI: 60/54) were included. The univariate analysis showed that PTC (proximal thoracic curve), preoperative PTC-to-MTC (main thoracic curve) ratio, preoperative bending Cobb angle of PTC, preoperative bending Cobb angle of the lumbar curve, postoperative PTC, postoperative AVT (apical vertebral translation) of PTC, AVT of PTC at follow-up, and adding-on angle were significantly different between two groups. Adjusted logistic regression analysis showed that postoperative AVT of PTC and adding-on angle were the primary contributors to PSI in patients with AIS. The PSI index was defined as 1.2 × postoperative AVT of PTC + 1.1 × adding-on angle. According to the receiver operating characteristic curve, the cutoff point for the PSI index in predicting the development of PSI was 15. The positive and negative predictive values were 80% and 87%, respectively. CONCLUSIONS: To prevent PSI, we recommend sufficient correction of AVT of PTC and prevention of adding-on. These slides can be retrieved under Electronic Supplementary Material.

Immediate postoperative coronal imbalance in Lenke 5 and Lenke 6 adolescent idiopathic scoliosis: Is it predictable?

PURPOSE: Immediate postoperative coronal imbalance (IPCIB) is a common reason for worse postoperative appearance in adolescent idiopathic scoliosis (AIS) patients and rarely improves on its own at follow-up, thereby greatly influencing the patients' health-related quality of life. However, no studies have been performed to detect the primary risk factors for IPCIB and it remains unclear whether the condition can be predicted preoperatively. The purpose of this study is to detect the primary risk factors for IPCIB in Lenke 5 and Lenke 6 AIS patients and to explore whether IPCIB can be predicted preoperatively. METHODS: Medical records of Lenke 5 and Lenke 6 AIS patients who underwent correction surgery in our hospital from June 2017 to October 2018 were analyzed. Anteroposterior films were evaluated before and after surgery. Patients were divided into two groups, i.e., occurrence and non-occurrence of IPCIB. The risk factors for IPCIB were analyzed, and an IPCIB index was proposed and verified. RESULTS: Thirty-seven Lenke 5/Lenke 6 AIS patients with IPCIB and 48 patients without IPCIB were recruited. Univariate analysis showed that there were significant differences between the two groups in the number of unfused vertebrae, preoperative thoracic Cobb angle, preoperative lumbar Cobb angle, preoperative translation of lumbar apex, preoperative coronal balance, preoperative L5 tilt, preoperative bending L5 tilt, postoperative translation of thoracic apex, postoperative lumbar Cobb angle, postoperative translation of lumbar apex, postoperative radiographic shoulder height, and postoperative L5 tilt. Logistic regression analysis showed that the preoperative bending L5 tilt, postoperative translation of the thoracic apex, and postoperative lumbar Cobb angle were the primary risk factors for IPCIB. The IPCIB index was defined as 1.3 * preoperative bending L5 tilt + 1.5 * postoperative translation of thoracic apex - 0.8 * postoperative lumbar Cobb angle. The receiver operating characteristics curve indicated that the occurrence rate of IPCIB was 88% and the non-occurrence rate was 90% when the IPCIB index was greater than 16. CONCLUSION: The preoperative bending L5 tilt, postoperative translation of the thoracic apex, and the postoperative lumbar Cobb angle were the primary risk factors for IPCIB in Lenke 5 and Lenke 6 AIS patients. The IPCIB index can be used to predict the occurrence of IPCIB with high accuracy. Our results indicate that the thoracic curve should be adequately corrected during surgery; however, moderate correction of the lumbar curve is recommended. These slides can be retrieved under Electronic Supplementary Material.

Postoperative neck tilt in Lenke 1 and 2 AIS patients after correction surgery: a novel predictive index.

BACKGROUND: Postoperative neck tilt (PNT) is a phenomenon in adolescent idiopathic scoliosis (AIS) patients which is distinct form shoulder imbalance. There were scarce studies performed to explore the risk factors for PNT in Lenke 1 and 2 AIS patients, and whether it can be predicted after surgery remains unknown. The objective of this study is to explore the prevalence and risk factors for PNT, and introduce an index for prediction of PNT in Lenke 1 and 2 AIS patients after correction surgery. METHODS: Medical records of Lenke 1 and 2 AIS patients who received correction surgery were reviewed from February 2013 to February 2015. Posteroanterior films were evaluated before surgery and at 2 years' follow-up. Patients were divided into two groups according to whether PNT occurred at the 2 years' follow-up. Risk factors of PNT were analyzed, and PNT Index was proposed and verified. RESULTS: One hundred two Lenke 1 and 2 AIS patients were recruited in this study. The prevalence of PNT after correction was 40.2%. According to the postoperative CAT (Cervical Axis Tilt), patients were divided into two group: PNT group (CAT≧5°, n = 41) and non-PNT group (CAT< 5°, n = 61). Postoperative T1 tilt, preoperative proximal thoracic curve (PTC), postoperative PTC and postoperative coronal balance (CB) were significantly different between two groups. Logistic regression showed that postoperative PTC and postoperative CB were the primary risk factors for PNT, which could be predicted by the regression equation: PNT Index = 1.1 x postoperative PTC (degrees) - 0.9 x postoperative CB (millimeters). On the basis of ROC curve, if PNT Index was more than 10, the occurrence rate of PNT was 86%. On the contrary, the rate of no PNT phenomenon was 80%. CONCLUSION: Postoperative PTC and postoperative CB were the important factors for PNT in Lenke 1 and 2 AIS patients. Sufficient correction of PTC and moderate correction of CB should be recommended when operating on Lenke1 and 2 AIS patients.

Proximal junctional kyphosis in adult spinal deformity: a novel predictive index.

PURPOSE: Proximal junctional kyphosis (PJK) is a devastating complication for adult spinal deformity (ASD) after correction surgery. However, there is no consensus on the risk factors of PJK, and whether it can be predicted remains unknown. The aim of this study is to detect the primary risk factors for PJK in ASD, and introduce a novel index for prediction of PJK. METHODS: Medical records of 62 ASD patients receiving correction surgery from January 2010 to January 2015 were analyzed. Spino-pelvic parameters were evaluated on lateral films before surgery, at 2 weeks' and at follow-up. Primary factors for PJK were evaluated. PJK index was proposed and verified. RESULTS: Cervical lordosis at follow-up, postoperative C2-C7 SVA, C2-C7 SVA at follow-up, postoperative T1 slope, T1 slope at follow-up, preoperative TLK, LL at follow-up, preoperative PT, postoperative PT, PT at follow-up, preoperative SS, postoperative SS, SS at follow-up, preoperative PT/SS, postoperative PT/SS and PT/SS at follow-up were significantly different between ASD with and without PJK. Adjusted logistic regression analysis showed that preoperative TLK, LL at follow-up, preoperative PT/SS and PT/SS at follow-up were primary factors for PJK. PJK index was defined as 0.160*LL at follow-up-0.121*preoperative TLK-4.625*preoperative PT/SS-3.315*PT/SS at follow-up. On the basis of ROC curve, if PJK index was smaller and larger than - 2, the occurrence rate of PJK and non-PJK was 82 and 95%, respectively. CONCLUSIONS: Preoperative TLK, LL at follow-up, preoperative PT/SS and PT/SS at follow-up were primary factors for PJK. PJK index could be used to predict occurrence of PJK effectively. These slides can be retrieved under Electronic Supplementary Material.

Proximal junctional kyphosis following correction surgery in the Lenke 5 adolescent idiopathic scoliosis patient.

BACKGROUND: To investigate the risk factors of proximal junctional kyphosis (PJK) in Lenke 5 AIS patients after all-pedicle instrumentation and correction, and to compare the difference of radiographic and clinical outcome between PJK and Non-PJK populations. METHOD: Medical records of Lenke 5 AIS patients were reviewed from January 2008 to January 2013, included posteroanterior and lateral full spine X-ray films preoperatively, postoperatively (4-7 days after surgery), and at final follow-up. Demographic data and radiologic parameters were evaluated. Based on the proximal junctional angle (PJA) at final follow-up, those patients were divided into 2 groups: PJK group (n = 35, PJA≧10°), and Non-PJK group (n = 52, PJA<10°). Comparisons analyses between PJK and Non-PJK groups were carried out. Binary logistic Regression analysis was performed to detect the risk factors of PJK at follow-up. RESULTS: The current study recruited 87 Lenke 5 AIS patients with average follow-up of 4.67 ± 1.17 years. Significant differences between PJK and Non-PJK groups were observed as follows: UIV(P = 0.010), the disruption of junctional ligaments (P < 0.001); preoperative variables [MTC (P = 0.001), TK(P < 0.001), LL (P = 0.017), SVA (P = 0.036), and PJA (P = 0.014)], postoperative variables [TLK(P = 0.004), and PJA (P < 0.001)], and follow-up [SVA (P = 0.014), C-SVA (P < 0.001), and PJA (P0.001). Binary logistic regression showed that the disruption of junctional ligaments, postoperative PJA and UIV (upper instrumented vertebra) at proximal or lower thoracic levels were the main risk factors of PJK [Odds Ratio (OR) = 5.114, 2.345, and 6.212, respectively]. However, the SRS-22 scores did not change significantly in PJK and Non-PJK groups. CONCLUSION: Greater postoperative PJA, disruption of junctional ligaments, UIV at lower thoracic levels were the main risk factors for PJK in Lenke 5 AIS patients. Recommedation: Preserve junctional ligaments in those individuals with UIV located in the lower thoracic region.

Association between FTO gene polymorphism (rs9939609 T/A) and cancer risk: a meta-analysis.

Obesity is a risk factor of cancer. Several genes have been found to play an important role in aetiology of obesity and tumourigenesis. Recently, some studies suggested that rs9939609 polymorphism might be significantly associated with cancer risk, while the results of some other studies were controversial. Databases with time limitation from January 1984 to April 2015 were searched. The pooled odds ratio (OR) with 95% confidence interval was calculated to assess the associations, and subgroup meta-analyses were performed according to the type of cancer and ethnicity of the study populations. Overall, the significant association between rs9939609 polymorphism and cancer risk was found in homozygote model and recessive model. As to subgroup classified by cancer type, there was significant association in endometrial cancer and pancreatic cancer, while no statistical significance was detected in other kind of cancers. Besides, in the subgroup analysis of ethnicity, our results indicated that rs9939609 polymorphism was significantly associated with cancer risk in Asians. The rs9939609 polymorphism may be involved the susceptibility of endometrial cancer and pancreatic cancer, especially in Asian populations. Thus, rs9939609 may be a potential biomarker in early diagnosis or gene therapy target of endometrial cancer and pancreatic cancer.

The morphology of sagittal alignment in asymptomatic volunteers of East China: A novel radiological classification.

BACKGROUND: The morphology of sagittal alignment varies in normal population. Sagittal alignment was classified into four subgroups; however, this classification was performed based on senior authors' clinical experiences rather than scientific methods. The objective of this study is to classify the morphology of sagittal alignment in normal population and describe the characteristics of sagittal alignment in each subgroup. METHODS: Medical records of asymptomatic volunteers without known spinal diseases in our outpatient clinic from January 2015 to August 2015 were reviewed. Demographic data and radiological parameters were evaluated, and compared between males and females as well. Two-step cluster analysis was performed. Radiological parameters were compared among these subgroups and then, the characteristics of each group were described. Receiver-operating characteristics (ROC) curve was constructed to detect the optimal cut-off value of separation of individual spine. RESULTS: 230 healthy volunteers with mean age of 33.53 years old were recruited (male:female = 106:124). No significant difference of each demographic and radiological parameter was observed between males and females, except for maxLL and PT. Two types of sagittal alignment were classified by the two-step cluster analysis. Type I (57.8%): small sagittal curves with small maxTK (29.24° ± 4.99°), maxLL (43.99° ± 9.10°) and PI (43.49° ± 7.61°), and Type II (42.2%): large sagittal curves with large maxTK (43.10° ± 6.41°), maxLL (53.41° ± 9.59°) and PI (53.10° ± 11.82°). The mean value of age, SS, PT, SVA, TPA, T1 sagittal angle, maxLL-maxTK, SS-PT and PI-maxLL was 37.07 ± 11.54 years old, 31.64° ± 7.43°, 15.66° ± 7.34°, 4.57 ± 22.24 mm, 10.85° ± 7.45°, 16.77° ± 5.09°, 10.31° ± 9.58°, 15.97° ± 10.74° and 3.32° ± 8.91° in Type I, and 39.94 ± 12.73 years old, 37.88° ± 8.36°, 15.29° ± 7.89°, 4.19 ± 22.00 mm, 9.23° ± 7.28°, 23.37° ± 4.87° , 16.74° ± 9.42°, 22.59° ± 11.64° and -5.84° ± 10.70° in Type II, respectively. maxTK, maxLL, PI, SS, T1 sagittal angle, maxLL-maxTK, SS-PT and PI-LL in Type II were greater than those in Type I, while no significant difference was found in age, gender, PT, SVA and TPA between two groups. On the basis of the ROC curve, the optimal cut-off values of maxTK, maxLL and PI as indicators for classification of sagittal alignment were projected to be 37°, 52° and 49°, respectively. CONCLUSIONS: There were two subgroups of sagittal plane in normal population. The optimal cut-off values of maxTK, maxLL and PI as indicators for classification of sagittal alignment were projected to be 37°, 52° and 49°, respectively. This novel classification could provide guidelines for our further understandings of sagittal alignment and mechanisms of different spinal diseases more easily, which also help to restore sagittal balance in the correction surgery more accurately.