Silver Nanoparticle-Loaded Titanium-Based Metal-Organic Framework for Promoting Antibacterial Performance by Synergistic Chemical-Photodynamic Therapy.

The abuse of antibiotics leads to an increasing emergence of drug-resistant bacteria, which not only causes a waste of medical resources but also seriously endangers people's health and life safety. Therefore, it is highly desirable to develop an efficient antibacterial strategy to reduce the reliance on traditional antibiotics. Antibacterial photodynamic therapy (aPDT) is regarded as an intriguing antimicrobial method that is less likely to generate drug resistance, but its efficiency still needs to be further improved. Herein, a robust titanium-based metal-organic framework ACM-1 was adopted to support Ag nanoparticles (NPs) to obtain Ag NPs@ACM-1 for boosting antibacterial efficiency via synergistic chemical-photodynamic therapy. Apart from the intrinsic antibacterial nature, Ag NPs largely boost ROS production and thus improve aPDT efficacy. As a consequence, Ag NPs@ACM-1 shows excellent antibacterial activity under visible light illumination, and its minimum bactericidal concentrations (MBCs) against E. coli, S. aureus, and MRSA are as low as 39.1, 39.1, and 62.5 µg mL-1, respectively. Moreover, to expand the practicability of Ag NPs@ACM-1, two (a dense and a loose) Ag NPs@ACM-1 films were readily fabricated by simply dispersing Ag NPs@ACM-1 into heated aqueous solutions of edible agar and sequentially cooling through heating or freeze-drying, respectively. Notably, these two films are mechanically flexible and exhibit excellent antibacterial activities, and their antimicrobial performances can be well retained in their recyclable and remade films. As agar is nontoxic, degradable, inexpensive, and ecosustainable, the dense and loose Ag NPs@ACM-1 films are potent to serve as recyclable and degradable antibacterial plastics and antibacterial dressings, respectively.

Biomechanical evaluation of different oblique lumbar interbody fusion constructs: a finite element analysis.

BACKGROUND: Finite element analysis (FEA) was performed to investigate the biomechanical differences between different adjunct fixation methods for oblique lumbar interbody fusion (OLIF) and to further analyze its effect on adjacent segmental degeneration. METHODS: We built a single-segment (Si-segment) finite element model (FEM) for L4-5 and a double-segment (Do-segment) FEM for L3-5. Each complete FEM was supplemented and modified, and both developed two surgical models of OLIF with assisted internal fixation. They were OLIF with posterior bilateral percutaneous pedicle screw (TINA system) fixation (OLIF + BPS) and OLIF with lateral plate system (OLIF + LPS). The range of motion (ROM) and displacement of the vertebral body, cage stress, adjacent segment disc stress, and spinal ligament tension were recorded for the four models during flexion/extension, right/left bending, and right/left rotation by applying follower load. RESULTS: For the BPS and LPS systems in the six postures of flexion, extension, right/left bending, and right/left rotation, the ROM of L4 in the Si-segment FEM were 0.32°/1.83°, 0.33°/1.34°, 0.23°/0.47°, 0.24°/0.45°, 0.33°/0.79°, and 0.34°/0.62°; the ROM of L4 in the Do-segment FEM were 0.39°/2.00°, 0.37°/1.38°, 0.23°/0.47°, 0.21°/0.44°, 0.33°/0.57°, and 0.31°/0.62°, and the ROM of L3 in the Do-segment FEM were 6.03°/7.31°, 2.52°/3.50°, 4.21°/4.38°, 4.21°/4.42°, 2.09°/2.32°, and 2.07°/2.43°. BPS system had less vertebral displacement, less cage maximum stress, and less spinal ligament tension in Si/Do-segment FEM relative to the LPS system. BPS system had a smaller upper adjacent vertebral ROM, greater intervertebral disc stress in terms of left and right bending as well as left and right rotation compared to the LPS system in the L3-4 of the Do-segment FEM. There was little biomechanical difference between the same fixation system in the Si/Do-segment FEM. CONCLUSIONS: Our finite element analysis showed that compared to OLIF + LPS, OLIF + BPS (TINA) is more effective in reducing interbody stress and spinal ligament tension, and it better maintains the stability of the target segment and provides a better fusion environment to resist cage subsidence. However, OLIF + BPS (TINA) may be more likely to cause adjacent segment degeneration than OLIF + LPS.

Differential Privacy Preservation for Continuous Release of Real-Time Location Data.

Continuous real-time location data is very important in the big data era, but the privacy issues involved is also a considerable topic. It is not only necessary to protect the location privacy at each release moment, but also have to consider the impact of data correlation. Correlated Laplace Mechanism (CLM) is a sophisticated method to implement differential privacy on correlated time series. This paper aims to solve the key problems of applying CLM in continuous location release. Based on the finding that the location increment is approximately stationary in many scenarios, a location correlation estimation method based on the location increment is proposed to solve the problem of nonstationary location data correlation estimation; an adaptive adjustment model for the CLM filter based on parameter quantization idea (QCLM) as well as its effective implementation named QCLM-Lowpass utilizing the lowpass spectral characteristics of location data series is proposed to solve the problem of output deviations due to the undesired transient response of the CLM filter in time-varying environments. Extensive simulations and real data experiments validate the effectiveness of the proposed approach and show that the privacy scheme based on QCLM-Lowpass can offer a better balance between the ability to resist correlation-based attacks and data availability.

Shape-memory sawtooth-arm embracing clamp used in complex femoral revision hip arthroplasty for stem stability: average 9-year follow-up study.

BACKGROUND: Nickel-Titanium shape-memory sawtooth-arm embracing clamps (SSECs) have been used in revision total hip arthroplasties (rTHAs) to protect stem stability. This study was to introduce this technique and report its mid to long-term clinical and radiographic outcomes. METHODS: We retrospectively reviewed all patients implanted with SSECs in our department from January 2008 to December 2015. 41 patients (41 hips) were finally included. Radiographs and Harris hip scores (HHS) were collected. Radiographs were blindly analyzed for evidence of loosening, subsidence and stress shielding. HHS were compared to previous records by student's t tests. The average follow-up period was 9.3 years. RESULTS: All stems were stably fixed with no signs of loosening. The mean stem subsidence was 0.9 mm (range, 0 to 3 mm). Only one patient (2.4%) demonstrated the fourth degree of stress shielding, with the others none or minor bone resorption. The mean HHS at the final follow-up was 84.2 (range, 81 to 91), which was improved from 17.4 (range, 0 to 37) before surgery. No implant failures or re-revisions occurred. Dislocation occurred in 1 case during the follow-up period. CONCLUSIONS: The SSEC protected stem fixation and achieved favorable clinical and radiographic outcomes in this 9-year follow-up study. It offered an additional extramedullary fixation option for surgeons to choose from in treating complex femoral revision arthroplasties.

Network Delay and Cache Overflow: A Parameter Estimation Method for Time Window Based Hopping Network.

A basic understanding of delayed packet loss is key to successfully applying it to multi-node hopping networks. Given the problem of delayed data loss due to network delay in a hop network environment, we review early time windowing approaches, for which most contributions focus on end-to-end hopping networks. However, they do not apply to the general hopping network environment, where data transmission from the sending host to the receiving host usually requires forwarding at multiple intermediate nodes due to network latency and network cache overflow, which may result in delayed packet loss. To overcome this challenge, we propose a delay time window and a method for estimating the delay time window. By examining the network delays of different data tasks, we obtain network delay estimates for these data tasks, use them as estimates of the delay time window, and validate the estimated results to verify that the results satisfy the delay distribution law. In addition, simulation tests and a discussion of the results were conducted to demonstrate how to maximize the reception of delay groupings. The analysis shows that the method is more general and applicable to multi-node hopping networks than existing time windowing methods.

B-DP: Dynamic Collection and Publishing of Continuous Check-In Data with Best-Effort Differential Privacy.

Differential privacy (DP) has become a de facto standard to achieve data privacy. However, the utility of DP solutions with the premise of privacy priority is often unacceptable in real-world applications. In this paper, we propose the best-effort differential privacy (B-DP) to promise the preference for utility first and design two new metrics including the point belief degree and the regional average belief degree to evaluate its privacy from a new perspective of preference for privacy. Therein, the preference for privacy and utility is referred to as expected privacy protection (EPP) and expected data utility (EDU), respectively. We also investigate how to realize B-DP with an existing DP mechanism (KRR) and a newly constructed mechanism (EXPQ) in the dynamic check-in data collection and publishing. Extensive experiments on two real-world check-in datasets verify the effectiveness of the concept of B-DP. Our newly constructed EXPQ can also satisfy a better B-DP than KRR to provide a good trade-off between privacy and utility.

Sirtuin4 suppresses the anti-neuroinflammatory activity of infiltrating regulatory T cells in the traumatically injured spinal cord.

The neuroinflammation following traumatic spinal cord injury (SCI) is a critical process that impacts both the injury and the recovery of spinal cord parenchyma. Infiltrating regulatory T (Treg) cells are potent anti-inflammatory cells that restrain post-SCI neuroinflammation. To understand the molecular mechanisms underlying the activity of infiltrating Treg cells, we used a mouse spinal cord compression injury model to analyze the role of Sirtuins (SIRTs) in the modulation of infiltrating Treg cell functions. We found that the expressions of SIRT4 and SIRT6 were up-regulated in infiltrating Treg cells. Using lentivirus-mediated gene expression or RNA interference, we revealed that SIRT4 substantially inhibited the expression of Foxp3, interleukin-10, and transforming growth factor-ß in Treg cells, whereas SIRT6 had little effect on Treg cells. Consistently, SIRT4 overexpression weakened the suppressive effect of Treg cells on lipopolysaccharide-stimulated spinal cord CD11b+ myeloid cells. Knock-down of SIRT4 enhanced the anti-inflammatory activity of infiltrating Treg cells in the parenchyma of injured spinal cords. Additionally, SIRT4 overexpression blocked in vitro Treg cell generation from conventional T cells. Furthermore, SIRT4 down-regulated 5' AMP-activated protein kinase (AMPK) signaling in Treg cells, whereas the AMPK agonist AICAR restored the expression of Foxp3 and interleukin-10 in SIRT4-overexpressing Treg cells. In conclusion, our research unveils a new mechanism by which the post-SCI neuroinflammation is regulated.

A comparative study of single-stage transpedicular debridement, fusion, and posterior long-segment versus short-segment fixation for the treatment of thoracolumbar spinal tuberculosis in adults: minimum five year follow-up outcomes.

DESIGN: This a retrospective study in single centre. OBJECTIVE: The objective of this retrospective clinical study is to compare the long-term clinical efficacy of posterior long-segment and short-segment fixation with single-stage transpedicular debridement and fusion for the treatment of thoracolumbar spinal tuberculosis in adults. METHODS: Sixty-six cases of thoracolumbar tuberculosis were treated by single-stage transpedicular debridement, bone graft fusion, and pedicle screw fixation. Thirty-five cases were under long-segment fixation (group A) and 31 cases were under short-segment fixation (group B). These patients were followed up for a minimum of five years. The clinical and radiographic results for these patients were analyzed and compared. RESULTS: All 66 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and visual analogue scale pain scores at the final follow-up. The average operation duration and blood loss in group A were more than that in group B. Kyphosis Cobb angle of both groups was significantly corrected after surgical management. The correction rate of Cobb angle in group A was significantly higher than that in group B at the time of immediate post-operative period or the last follow-up (P < 0.05). The correction loss of group A was significantly less than that in group B (P < 0.05). CONCLUSION: Both posterior long-segment and short-segment pedicle screw fixations for the treatment of thoracolumbar spinal tuberculosis have significant effects in the correction of kyphosis and the improvement of neurological function. Although the blood loss and operation time of long-segment fixation were more than that of short-segment fixation, long-segment fixation was superior to the short-segment fixation in the correction of kyphosis and the maintenance of spinal stability, especially in the prevention of long-term correction loss.

360-degree cervical spinal arthrodesis for treatment of pediatric cervical spinal tuberculosis with kyphosis.

BACKGROUND: There is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK). This study retrospectively evaluates the safety, feasibility and efficacy of 360-degree arthrodesis combined with anterior debridement and decompression for treating PCSTK, while simultaneously emphasizing the role of posterior fixation for the correction and maintenance of the kyphosis angle. METHODS: From May 2006 to December 2012, a total of 12 children with PCSTK underwent 360-degree cervical spinal arthrodesis followed by debridement of focus and decompression of the spinal cord. Data on the angle of kyphosis correction, visual analogue scale scores of pain, the American Spinal Injury Association scoring system of nerve function scores, erythrocyte sedimentation rate (ESR) and body weight were collected at certain periods. Clinical efficacy was evaluated by statistical analysis based on collected data. RESULTS: Average follow-up period was 34.3 ± 8.6 months. No postoperative complications related to the instrumentation occurred, and neurologic function improved in various degrees. Preoperative kyphosis angle was 41.4 ± 5.2°, and significantly decreased to -4.9 ± 4.9° after surgery. The correction of kyphosis and loss of correction were 47.1 ± 4.9° and 0.6 ± 1.4°, respectively. Average pretreatment ESR was 49.8 ± 13.2 mm/h, which normalized (8.5 ± 0.6 mm/h) within three months in all patients. Average preoperative visual analogue scale was 6.6 ± 1.6, which decreased to 2.3 ± 1.4 postoperatively and 0.3 ± 0.5 during the final follow-up. Mean preoperative body weight was 25.9 ± 5.1 kg, and body weight was 33.5 ± 4.8 kg at the third month of post-operation. Bone healing was achieved in all patients after a mean period of 5.4 months. CONCLUSIONS: 360-degree arthrodesis combined with anterior debridement and decompression is a safe and effective method for the treatment of PCSTK. For the correction and maintenance of the kyphosis angle, additional posterior fixation is recommended.

Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults.

AIM: The aim of this retrospective clinical study is to evaluate the long-term outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. METHODS: Fifty-nine adult patients with thoracic and thoracolumbar spinal tuberculosis underwent single-stage transpedicular debridement, posterior instrumentation and fusion. These patients were followed for a minimum of 5 years. Patients were assigned to one of two groups according to the infected anatomic segment. In the thoracic spinal tuberculosis group, there were 28 cases (17 males, 11 females) with a mean age of 38.9 years; in the thoracolumbar spinal tuberculosis group, there were 31 cases (19 males, 12 females) with a mean age of 40.3 years. All cases were evaluated clinically using the visual analog scale (VAS), Kirkaldy-Willis criteria and the American Spinal Injury Association (ASIA) impairment scale. Radiographs were performed for measuring the angle of kyphosis and scoliosis. Complications related to surgery were recorded. RESULTS: All patients successfully resolved their infections, experienced one or more ASIA grades of improvement, and improved in their VAS pain scores at final follow-up. In both groups, patient-reported outcomes reached over 90% excellent or good results using Kirkaldy-Willis criteria. The loss of kyphotic angle correction was 2.6° in the thoracic spinal tuberculosis group and 3.2° in the thoracolumbar spinal tuberculosis group. No scoliosis was observed in either group. Fifty-eight (98.3%) cases achieved solid bony fusion. In the thoracolumbar spinal tuberculosis group, one patient experienced screw loosening, and another patient with nonunion and rod breakage underwent revision surgery. CONCLUSIONS: The technique of single-stage transpedicular debridement, posterior instrumentation and fusion is an effective method for the treatment of thoracic and thoracolumbar spinal tuberculosis in adults. Long-term postoperative clinical and radiological outcomes were satisfactory.

One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis.

PURPOSE: To investigate the clinical efficacy and feasibility of surgical treatment for lumbosacral junction tuberculosis by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage. METHODS: A total of 15 cases with lumbosacral junction tuberculosis treated by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage in our center from January 2005 to October 2011 were studied. Lumbosacral angle, visual analog scale (VAS), and neurological performance were assessed before and after surgery. RESULTS: All patients were followed for 28-56 months post-operation (average, 40.7 ± 7.7 months). No severe complications occurred. Bone fusion occurred in all patients at a mean of 8.4 months (range 6-12 months) after surgery. The mean lumbosacral angle was significantly increased from the mean preoperative angle (20.9° ± 1.8°) both post-operatively (26.5° ± 1.6°) and at final follow-up (25.3° ± 1.4°) (both P < 0.05). All patients had significant post-operative improvement in neurological performance and VAS scores. CONCLUSIONS: Our results suggest that one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage can be an effective and feasible treatment option for lumbosacral junction tuberculosis, offering fewer complications and a better quality of life.

One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases.

BACKGROUND: There are quite a few controversies on the surgical management of single-segment thoracic spinal tuberculosis with neurological deficits (STSTND). In this study, the clinical efficacy and feasibility of one-stage posterior-only transpedicular debridement, interbody fusion, and posterior instrumentation for treating STSTND in adults were retrospectively evaluated. METHODS: Thirty-four cases with STSTND underwent one-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation at the same institution from January 2003 to January 2013. Follow-up time was 34.4 ± 10.2 months (range, 18-48 months), and kyphosis angle was 34.1 ± 12.3°. The American Spinal Injury Association (ASIA) classification of spinal cord injury was employed to evaluate neurological deficits, while visual analogue scale (VAS) was employed to assess the degree of pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the activity of tuberculosis (TB). RESULTS: All 34 patients with spinal tuberculosis (ST) were completely cured, and there was no recurrence of TB. Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up. Solid fusion was achieved and pain was relieved in all cases. Neurological condition in all patients improved after surgery. CONCLUSIONS: One-stage posterior-only transpedicular debridement, interbody fusion, and posterior fixation followed by chemotherapy seems to be adequate for obtaining satisfactory healing of single-segment thoracic spinal tuberculosis with neurological deficits. Careful patient selection is critical to the successful outcome with this technique.

Thoracolumbar spinal tuberculosis in children with severe post-tubercular kyphotic deformities treated by single-stage closing-opening wedge osteotomy: preliminary report a 4-year follow-up of 12 patients.

PURPOSE: The correction of severe post-tubercular kyphosis (PTK) is complex and has the disadvantage of being multistaged with a high morbidity. In this study, we evaluated the outcomes of children who underwent single-stage closing-opening wedge osteotomy as a surgical treatment of PTK of the thoracolumbar spine. METHOD: Our study group included 12 children with thoracolumbar PTK (seven boys and five girls) with an average age of 9.4 years (range 6-12 years), who were treated at our institution from January 2004 to October 2009. The American Spinal Injury Association Impairment Scale and visual analog scale score were used to classify neurologic function. All patients underwent halo-pelvic traction before surgery and were treated with single-stage closing-opening wedge osteotomy. RESULT: The duration of surgery averaged 99 min (range 70-150 min). Average blood loss was 782 ml (range 560-1,200 ml), and the average length of hospital stay was 12 days (range 8-16 days). The neurological function of all patients improved significantly after the procedure. The mean preoperative kyphotic angle was 83.3° (range 59-118°), which had reduced to 27.6° (range 20-38°) at the final follow-up visit. All patients had solid fusion, and no major complications were observed through the final follow-up visit. CONCLUSION: Single-stage closing-opening wedge osteotomy is an effective method to correct severe thoracolumbar PTK. A main advantage of the procedure is that it is a posterior-only, single-staged surgery, allowing for significant correction with minimal complications.

A novel heterozygous mutation in PTHLH causing autosomal dominant brachydactyly type E complicated with short stature.

BACKGROUND: Brachydactyly type E (BDE) is a general term characterized by variable shortening of metacarpals and metatarsals, with phalanges affected frequently. It can occur as an isolated form or part of syndromes and manifest a high degree of phenotypic variability. In this study, we have identified the clinical characteristics and pathogenic causes of a four-generation pedigree with 10 members affected by BDE and short stature. METHODS: After the informed consent was signed, clinical data and peripheral blood samples were collected from available family members. Karyotype analysis, array-CGH, next-generation sequencing, and Sanger sequencing were employed to identity the pathogenic candidate gene. RESULTS: No translocation or microdeletion/duplication was found in karyotype analysis and array-CGH; hence, a novel heterozygous mutation, c.146dupA. p.S50Vfs*22, was detected by next-generation sequencing in PTHLH gene, leading to a premature stop codon. Subsequently, the mutation was confirmed by Sanger sequencing and co-segregation analysis. CONCLUSION: In this study, we described a novel heterozygous mutation (c.146dupA. p.S50Vfs*22) of gene PTHLH in a Chinese family. The mutation could induce a premature stop codon leading to a truncation of the protein. Our study broadened the mutation spectrum of PTHLH in BDE.

Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

PURPOSE: Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. METHOD: A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time. RESULTS: The average follow-up period was 34 months (range 18-48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6-9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up. CONCLUSION: With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

Surgical treatment of thoracic spinal tuberculosis with adjacent segments lesion via one-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion, a clinical study.

PURPOSE: To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. MATERIALS AND METHODS: Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated. RESULTS: Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22-41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°-25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°-27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6-9 months after surgery. CONCLUSIONS: One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis.

Mechanical overloading leads to chondrocyte degeneration and senescence via Zmpste24-mediated nuclear membrane instability.

Patients with OA and varus knees are subject to abnormal mechanical environment and objective of this study was to investigate the molecular mechanisms underlying chondrocyte senescence caused by mechanical overloading and the role of Zmpste24-mediated nuclear membrane instability in varus knees. Finite element analysis showed that anteromedial region of tibial plateau experienced the most mechanical stress in an osteoarthritis patient with a varus knee. Immunohistochemistry exhibited lower Zmpste24 expression and higher expression of senescence marker p21 in the anteromedial region. Animal experiments and cell-stretch models also demonstrated an inverse relationship between Zmpste24 and mechanically induced senescence. Zmpste24 overexpression rescued cartilage degeneration and senescence in vitro by scavenging ROS. In conclusion, anteromedial tibial plateau is exposed to abnormal stress in varus knees, downregulation of Zmpste24, and nuclear membrane stability may explain increased senescence in this region. Zmpste24 and nuclear membrane stability are potential targets for treating osteoarthritis caused by abnormal alignment.

Laparoscopic extended pelvic lymph node dissection during radical cystectomy: technique and clinical outcomes.

OBJECTIVE: • To study the surgical techniques and clinical results of laparoscopic extended pelvic lymph node dissection during radical cystectomy. PATIENTS AND METHODS: • From July 2007 to October 2009, 43 patients with bladder carcinoma received laparoscopic radical cystectomy with extended pelvic lymphadenectomy and urinary diversion. • Pelvic lymph node dissection (PLND) was first performed within extended template. • The lower part of aorta and vena cava were isolated from the bifurcation of common iliac artery to the level of the inferior mesenteric artery. • The standard template PLND was continued along the external iliac vessels, internal iliac vessels and obturator nerve. The bladder was then removed laparoscopically and urinary diversion was performed. RESULTS: • All procedures were performed successfully and no open conversion occurred. The duration of the procedure for extended PLND was 90-185 min (mean 125 min) and total duration was 280-470 min (mean 329 min). • Intra-operative blood loss was 200-1500 mL (mean 325 mL) and eight cases received transfusion. Pathological study identified transitional cell carcinoma and a negative margin in all cases. A range of 19-53 lymph nodes were dissected in the patients with a mean of 31.3. • In total, 17 positive nodes were confirmed in 11 cases. Postoperative complications included two cases of bowel obstruction, two cases of mild urine leakage and 17 cases of lymphatic leakage. CONCLUSIONS: • Laparoscopic radical cystectomy with extended pelvic lymphadenectomy is indicated in selected patients with bladder cancer. • It is safe, minimally invasive and more lymph nodes can be retrieved with a higher success rate by extended pelvic lymphadenectomy.

Comparison of two different suture methods in laparoscopic dismembered pyeloplasty.

OBJECTIVE: Anastomosis of ureteropelvic junction with a laparoscope for the treatment of ureteropelvic junction obstruction (UPJO) is a time-consuming and technically challenging procedure. We present our experience of laparoscopic dismembered pyeloplasty and compare clinical outcomes of two different suture techniques. METHODS: From September 2003 to June 2010, 105 laparoscopic dismembered pyeloplasties were performed in our department. All procedures were done using the retroperitoneal approach. According to the suture methods (interrupted or running), the patients were divided into two groups. An indwelling stent was placed intraoperatively in an antegrade manner. Data on operation time, blood loss and complications were collected. RESULTS: All procedures were completed without open conversion. Mean operation time and anastomotic time were 96 (55-150) and 36 min (15-70), respectively. A significant decrease of operation and anastomosis time was seen when running sutures were applied. Mean blood loss was 54 ml (30-100). The total complication rate was 7.6%. No anastomotic stricture occurred. The average hospitalization stay was 7 days. During 5-85 months of follow-up, hydronephrosis was alleviated in all cases. CONCLUSIONS: Laparoscopic dismembered pyeloplasty for the treatment of UPJO can provide satisfactory clinical outcomes. Higher surgical efficiency and lower complication rates can be obtained by using the running suture method.

[Modified transperitoneal laparoscopic radical prostatectomy: technique and clinical outcomes].

OBJECTIVE: To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. METHODS: A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13.6 µg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. RESULTS: Mean operative time was 93 min (65 - 150 min). Intraoperative blood loss was 115 ml (50 - 400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. CONCLUSIONS: Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.