Core planar cell polarity genes VANGL1 and VANGL2 in predisposition to congenital vertebral malformations.

Congenital scoliosis (CS), affecting approximately 0.5 to 1 in 1,000 live births, is commonly caused by congenital vertebral malformations (CVMs) arising from aberrant somitogenesis or somite differentiation. While Wnt/ß-catenin signaling has been implicated in somite development, the function of Wnt/planar cell polarity (Wnt/PCP) signaling in this process remains unclear. Here, we investigated the role of Vangl1 and Vangl2 in vertebral development and found that their deletion causes vertebral anomalies resembling human CVMs. Analysis of exome sequencing data from multiethnic CS patients revealed a number of rare and deleterious variants in VANGL1 and VANGL2, many of which exhibited loss-of-function and dominant-negative effects. Zebrafish models confirmed the pathogenicity of these variants. Furthermore, we found that Vangl1 knock-in (p.R258H) mice exhibited vertebral malformations in a Vangl gene dose- and environment-dependent manner. Our findings highlight critical roles for PCP signaling in vertebral development and predisposition to CVMs in CS patients, providing insights into the molecular mechanisms underlying this disorder.

Rare variant association analyses reveal the significant contribution of carbohydrate metabolic disturbance in severe adolescent idiopathic scoliosis.

BACKGROUND: Adolescent idiopathic scoliosis (AIS), the predominant genetic-influenced scoliosis, results in spinal deformities without vertebral malformations. However, the molecular aetiology of AIS remains unclear. METHODS: Using genome/exome sequencing, we studied 368 patients with severe AIS (Cobb angle >40°) and 3794 controls from a Han Chinese cohort. We performed gene-based and pathway-based weighted rare variant association tests to assess the mutational burden of genes and established biological pathways. Differential expression analysis of muscle tissues from 14 patients with AIS and 15 controls was served for validation. RESULTS: SLC16A8, a lactate transporter linked to retinal glucose metabolism, was identified as a novel severe AIS-associated gene (p=3.08E-06, false discovery rate=0.009). Most AIS cases with deleterious SLC16A8 variants demonstrated early onset high myopia preceding scoliosis. Pathway-based burden test also revealed a significant enrichment in multiple carbohydrate metabolism pathways, especially galactose metabolism. Patients with deleterious variants in these genes demonstrated a significantly larger spinal curve. Genes related to catabolic processes and nutrient response showed divergent expression between AIS cases and controls, reinforcing our genomic findings. CONCLUSION: This study uncovers the pivotal role of genetic variants in carbohydrate metabolism in the development of AIS, unveiling new insights into its aetiology and potential treatment.

Oxygenated Triazine-Heptazine Heterostructure Creates an Enormous Ascension to the Visible Light Photocatalytic Hydrogen Evolution Performance of Porous C3 N4 Nanosheets.

A highly efficient g-C3 N4 photocatalyst is developed by a novel one-pot thermal polymerization method under a salt fog environment generated by heating the aqueous solution of urea and mixed metal salts of NaCl/KCl, namely SF-CN. Thanks to the synergistic effect of the oxygenation and chemical etching of the salt fog, the obtained SF-CN is an oxygenated ultrathin porous carbon nitride with an intermolecular triazine-heptazine heterostructure, meanwhile, shows enlarged specific surface area, greatly enhanced absorption of visible light, narrowed band gap with a lower conduction band, and an increased photocurrent response due to the effective separation of photogenerated holes and electrons, comparing to those of pristine g-C3 N4 . The theoretical simulations further reveal that the triazine-heptazine heterostructure possesses better photocatalytic hydrogen evolution (PHE) capability than pure triazine and heptazine carbon nitrides. In turn, SF-CN demonstrates an excellent visible light PHE rate of 18.13 mmol h-1  g-1 , up to 259.00 times of that of pristine g-C3 N4 .

Unsuspected severe tracheal stenosis and tracheomalacia after correction surgery for congenital scoliosis: A case report.

Tracheal stenosis and tracheomalacia in patients with congenital scoliosis are serious and rare conditions caused by congenital dysplasia, postintubation injury, trauma, and tracheal tumor. Anesthesia of a child with tracheal stenosis is challenging for anesthesiologists. We describe an 8-year-old female patient developed severe tracheal stenosis and tracheomalacia after growing rod implantation for congenital scoliosis. Comprehensive assessment of preoperative pulmonary function and airway morphology, which can be neglected clinically, should be performed in congenital scoliosis patients.

Development and application of reverse genetic technology for the influenza virus.

Influenza virus is a common virus in people's daily lives, and it has certain infectivity in humans and animals. Influenza viruses have the characteristics of a high mutation rate and wide distribution. Reverse genetic technology is primarily used to modify viruses at the DNA level through targeted modification of the virus cDNA. Genetically modified influenza viruses have a unique advantage when researching the transmission and pathogenicity of influenza. With the continuous development of oncolytic viruses in recent years, studies have found that influenza viruses also have certain oncolytic activity. Influenza viruses can specifically recognize tumor cells; activate cytotoxic T cells, NK cells, dendritic cells, etc.; and stimulate the body to produce an immune response, thereby killing tumor cells. This article will review the development and application of influenza virus reverse genetic technology.

Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis.

INTRODUCTION: Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied. METHODS: We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis. RESULTS: One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003). CONCLUSIONS: Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.

The Efficacy and Safety of Glucocorticoid on Periarticular Infiltration Analgesia in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The objective of this systematic review and meta-analysis was to examine the effect and safety of multimodal cocktail protocols implemented with or without glucocorticoids on periarticular infiltration analgesia (PIA) in patients undergoing total knee arthroplasty (TKA). METHODS: We comprehensively searched the PubMed, Medline, Embase, and Cochrane Library databases up to November 2020 for randomized controlled trials on glucocorticoids as a component of the cocktail protocol used in PIA for patients with TKA. RESULTS: Our meta-analysis included 11 randomized controlled trial studies with 1051 primary TKAs (930 patients). Visual analog scale scores at postoperative day (POD) 1 and POD 2 in the glucocorticoid groups were significantly lower than those in the control group (95% CI [-1.01--0.10], P = .02; 95% CI [-0.51--0.13], P = .001). Furthermore, the glucocorticoid group was associated with a statistically significant improvement in the range of motion at POD 1 (95% CI [3.20-8.05] P < .00001), reduction in total morphine consumption at 24 hours, and lower levels of C-reactive protein on POD 2/3 compared with the control group. However, neither the length of hospital stays nor the long-term Knee Society Knee Score showed any differences between the two groups. In addition, the results of subgroup analyses favored triamcinolone acetonide over betamethasone, methylprednisolone, and dexamethasone regarding the postoperative visual analog scale scores and range of motion. CONCLUSION: Glucocorticoid supplementation in PIA is effective and does not increase complications or side effects for patients with either unilateral or bilateral TKA. Moreover, triamcinolone acetonide could be recommended in multimodal cocktail protocols for glucocorticoid supplementation.

The mutational burden and oligogenic inheritance in Klippel-Feil syndrome.

BACKGROUND: Klippel-Feil syndrome (KFS) represents a rare anomaly characterized by congenital fusion of the cervical vertebrae. The underlying molecular etiology remains largely unknown because of the genetic and phenotypic heterogeneity. METHODS: We consecutively recruited a Chinese cohort of 37 patients with KFS. The clinical manifestations and radiological assessments were analyzed and whole-exome sequencing (WES) was performed. Additionally, rare variants in KFS cases and controls were compared using genetic burden analysis. RESULTS: We primarily examined rare variants in five reported genes (GDF6, MEOX1, GDF3, MYO18B and RIPPLY2) associated with KFS and detected three variants of uncertain significance in MYO18B. Based on rare variant burden analysis of 96 candidate genes related to vertebral segmentation defects, we identified BAZ1B as having the highest probability of association with KFS, followed by FREM2, SUFU, VANGL1 and KMT2D. In addition, seven patients were proposed to show potential oligogenic inheritance involving more than one variants in candidate genes, the frequency of which was significantly higher than that in the in-house controls. CONCLUSIONS: Our study presents an exome-sequenced cohort and identifies five novel genes potentially associated with KFS, extending the spectrum of known mutations contributing to this syndrome. Furthermore, the genetic burden analysis provides further evidence for potential oligogenic inheritance of KFS.

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report.

BACKGROUND: Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. CASE PRESENTATION: We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. CONCLUSIONS: We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

Long noncoding RNAs expression signatures in chondrogenic differentiation of human bone marrow mesenchymal stem cells.

Long non-coding RNAs (lncRNAs) have been established to participate in various biological processes that are crucial for development and differentiation. However, the roles of lncRNAs in the mechanisms of human bone marrow mesenchymal stem cells (MSCs) differentiation are not completely understood. The purpose of the study was to investigate the expression profiles of lncRNAs during the chondrogenic differentiation of human bone marrow MSCs, with a view to studying the biological function of lncRNAs and their involvement in the mechanism of differentiation. We compared the lncRNAs expression profiles of undifferentiated and differentiated cells during chondrogenic differentiation by microarray. 3638 differentially expressed lncRNAs were identified (fold-change >2.0 or <-2.0, P<0.05), consisting of 2166 up-regulated and 1472 down-regulated. Microarray data were validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Bioinformatic analyses were applied for further study of these differentially expressed lncRNAs. Among these lncRNAs, ZBED3-AS1 and CTA-941F9.9 were further analyzed with co-expression network and target prediction analysis. The results showed that the two up-regulated lncRNAs are likely to play important roles in chondrogenic differentiation process. In conclusion, the expression profile of lncRNAs was significantly altered during differentiation process. It provided a new insight on complicated regulation mechanisms of human bone marrow MSCs chondrogenic differentiation.

Differential expression of long noncoding ribonucleic acids during osteogenic differentiation of human bone marrow mesenchymal stem cells.

PURPOSE: The purpose of this study was to investigate the differential expression and putative function of long noncoding RNAs (lncRNAs) during the osteogenic differentiation of human bone marrow mesenchymal stem cells (MSCs). METHODS: The differential lncRNAs expression profiles of undifferentiated and differentiated cells during osteogenic differentiation were established by lncRNA microarray. Microarray data were validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Bioinformatic analyses (gene ontology, pathway and co-expression network analysis) were applied for further study of these differentially expressed lncRNAs. RESULTS: A total of 1,206 differentially expressed lncRNAs were identified during the process of osteogenic differentiation. Among these lncRNAs, 687 were up-regulated and 519 were down-regulated more than two-fold. Bioinformatic analyses were applied for further study of these differentially expressed lncRNAs. Further analysis found 48 regulated enhancer-like lncRNA and 14 lincRNA. The dynamic expression trends H19 and uc022axw.1 were then observed using qRT-PCR. The results showed that the two up-regulated lncRNAs are likely to play important roles in osteogenic differentiation process. CONCLUSIONS: Taken together, our study first revealed the expression profiles of lncRNAs in osteogenic differentiation of human bone marrow MSCs. It provides an experimental basis for further research on lncRNAs functions during osteogenic differentiation of human bone marrow MSCs.

Surgical treatment for pelvic haemophilic pseudotumour: a retrospective analysis of 21 cases.

Background: Due to the rarity of pelvic haemophilic pseudotumour (PHPT) and demanding surgical technique for PHPT excision, no study reports the mid-term follow-up outcomes of surgical treatment of PHPT in a relatively large cohort. PHPT with varying degrees of bony pelvic involvement and infection status necessitates different operative procedures, yet there is currently no classification system for PHPT based on surgical practice. Methods: The study was conducted between June 25, 2004 and July 18, 2023, in Peking Union Medical College Hospital and Nanfang Hospital in China. We performed a retrospective analysis involving 21 patients with 24 PHPTs with a mean follow-up period of 7.1 years. The demographic information, PHPT characteristics, surgical data, and perioperative complications were analysed. Findings: 21 consecutive male patients with 24 PHPTs (21 primary PHPTs and three recurrent PHPTs) that underwent surgical treatment were involved in the study. A classification system including four subtypes was introduced as (I) PHPT confined to soft tissue; (II) PHPT involving bony pelvic without pelvic discontinuity; (III) PHPT causing pelvic discontinuity; (IV) Infectious PHPT. Of the 24 PHPTs, 11 (45.8%) were identified as Type I, five (20.8%) as Type II, three (12.5%) as Type III, and five (20.8%) as Type IV. At the time of surgery, the patients had a mean age of 37.0 ± 9.5 years (Range, 24-52 years). The mean maximum diameter of PHPTs upon surgery was 17.0 ± 7.7 cm (Range, 4.3-40.0 cm). The mean surgical duration was 192 ± 77 min (Range, 60-330 min) and the median intraoperative blood loss was 400 mL (IQR, 225-950 mL, Range, 100-3000 mL). One patient (4.8%) underwent intraoperative cardiopulmonary arrest and expired the following week. Four PHPTs (16.7%) presented postoperative wound infections and poor wound healing. During the follow-up period, five PHPTs (20.8%) experienced pseudotumour recurrence. Interpretation: Our findings suggest that surgical treatment for PHPTs is feasible and relatively safe. Symptomatic and progressive PHPTs should undergo surgical intervention as early as possible to minimise the surgical risks. Intraoperative use of abundant gelatin sponges in PHPT excision draws attention to severe embolism complications. Funding: There are no sources of funding for this manuscript.

The association between penicillin allergy and surgical site infection after orthopedic surgeries: a retrospective cohort study.

Background: Cephalosporins are used as first-line antimicrobial prophylaxis for orthopedics surgeries. However, alternative antibiotics are usually used in the presence of penicillin allergy (PA), which might increase the risk of surgical site infection (SSI). This study aimed to analyze the relationship between SSI after orthopedic surgeries and PA among surgical candidates and related alternative antibiotic use. Methods: In this single-center retrospective cohort study, we compared inpatients with and without PA from January 2015 to December 2021. The primary outcome was SSI, and the secondary outcomes were SSI sites and perioperative antibiotic use. Moreover, pathogen characteristics of all SSIs were also compared between the two cohorts. Results: Among the 20,022 inpatient records, 1704 (8.51%) were identified with PA, and a total of 111 (0.55%) SSI incidents were reported. Compared to patients without PA, patients with PA had higher postoperative SSI risk (1.06%, 18/1704 vs. 0.51%, 93/18318), shown both in multivariable regression analysis (odds ratio [OR] 2.11; 95% confidence interval [CI], 1.26-3.50; p= 0.004) and propensity score matching (OR 1.84; 95% CI, 1.05-3.23; p= 0.034). PA was related to elevated deep SSI risk (OR 2.79; 95% CI, 1.47-5.30; p= 0.002) and had no significant impact on superficial SSI (OR 1.39; 95% CI, 0.59-3.29; p= 0.449). The PA group used significantly more alternative antibiotics. Complete mediation effect of alternative antibiotics on SSI among these patients was found in mediation analysis. Pathogen analysis revealed gram-positive cocci as the most common pathogen for SSI in our study cohort, while patients with PA had higher infection rate from gram-positive rods and gram-negative rods than non-PA group. Conclusion: Compared to patients without PA, patients with PA developed more SSI after orthopedic surgeries, especially deep SSI. The elevated infection rate could be secondary to the use of alternative prophylactic antibiotics.

A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors: The PUMCH Classification.

BACKGROUND: A hemophilic pseudotumor (HPT) is a rare and challenging complication of hemophilia for which there is no classification system that provides uniformity of descriptions or that can be used to guide management. We have developed such a classification based on anatomical site, HPT severity, and corresponding surgical treatment. METHODS: The PUMCH (Peking Union Medical College Hospital) classification was developed on the basis of clinical manifestations and imaging features. Extremity and pelvic HPTs were divided into 4 types and 6 subtypes according to anatomical site and whether or not there was destruction of adjacent bone. Associations between the PUMCH classification and surgical treatment, preoperative comorbidities, operative time, intraoperative bleeding, and postoperative complication rates were analyzed. RESULTS: Forty-five patients with 53 HPTs that were treated at PUMCH between December 2005 and October 2021 were included. The mean age at the time of surgery was 35.4 ± 11.9 years, and the median follow-up duration was 60.3 months. Twenty-eight HPTs were classified as type I (13 IA, 7 IB, 8 IC); 3, as type II; 6, as type III; and 16, as type IV. All 20 type-IA and IB HPTs were treated with excision, and the 3 type-II HPTs were treated with curettage and bone grafting. Fourteen type-IV pelvic HPTs underwent excision, 2 of which needed concomitant pelvic reconstruction. Six type-IC HPTs and 1 type-III HPT underwent excision and osseous reconstruction. Amputation was required for 1 type-IC and 3 type-III HPTs. Type-IC HPTs had the longest mean operative time (194.3 ± 28.2 minutes) and the greatest intraoperative bleeding (2,000 mL [interquartile range, 1,100 to 3,000 mL]). Postoperative infection was more common in patients with type-III (50.0%) and type-IC (28.6%) HPTs, but not significantly so. CONCLUSIONS: The PUMCH classification is based on the anatomic pathology and surgical strategy for HPTs. The classification of HPTs corresponds to surgical outcomes, and may be helpful for decision-making regarding their surgical treatment. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Photocatalytic CO2 Reduction Coupled with Oxidation of Benzyl Alcohol over CsPbBr3@PANI Nanocomposites.

Herein, we successfully prepare conductive polyaniline (PANI)-encapsulated CsPbBr3 perovskite nanocrystals (PNCs) that demonstrate much improved photocatalytic performance and stability toward the CO2 reduction reaction (CRR) coupled with oxidation of benzyl alcohol (BA) to benzaldehyde. Due to the acid-base interaction between CO2 and PANI, CO2 molecules are selectively adsorbed on PANI in the form of carbamate. As a result, the rate of production of CO (rCO) reaches 26.1 µmol g-1 h-1 with a selectivity of 98.1%, which is in good agreement with the rate of oxidation (∼27.0 µmol g-1 h-1) of BA. Such a high reduction/oxidation rate is enabled by the fast electron transfer (∼2.2 ps) from PNCs to PANI, as revealed by femtosecond transient absorption spectroscopy. Moreover, because of the benefit of the encapsulation of PANI, no significant decrease in rCO is observed in a 10 h CRR test. This work offers insight into how to simultaneously achieve improved photocatalytic performance and stability of CsPbX3 PNCs.

Entropy-Stabilized Layered K0.6Ni0.05Fe0.05Mg0.05Ti0.05Mn0.725O2 as a High-Rate and Stable Cathode for Potassium-Ion Batteries.

Mn-based layered oxides have been considered the most promising cathode candidates for cost-effective potassium-ion batteries (PIBs). Herein, equiatomic constituents of Ni, Fe, Mg, and Ti have been introduced into the transition metal layers of Mn-based layered oxide to design a high-entropy K0.6Ni0.05Fe0.05Mg0.05Ti0.05Mn0.0725O2 (HE-KMO, S = 1.17R). Consequently, the experimental results manifest that the layered structure of HE-KMO is more stable than conventional low-entropy K0.6MnO2 (LE-KMO, S = 0.66R) during successive cycling and even upon exposure to moisture. Diffraction and electrochemical measurements reveal that HE-KMO undergoes a solid-solution mechanism, contrary to the multistage phase transition processes typically exemplified in K0.6MnO2. Benefiting from the stabilized high-entropy layered framework and the solid-solution K+ storage mechanism, the entropy-stabilized HE-KMO not only demonstrates exceptional rate capability but also shows excellent cyclic stability. Notably, a capacity retention ratio of 86% after 3000 cycles can still be sustained at a remarkable current density of 5000 mA g-1.

Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies.

BACKGROUND: There is conflicting clinical evidence whether platelet-rich plasma (PRP) therapies could translate to an increased meniscus healing rate and improved functional outcomes. The objective of this systematic review and meta-analysis was to compare the failure rate and patient-reported functional outcomes in meniscus repair augmented with and without PRP. METHODS: We comprehensively searched the PubMed, Web of Science, Medline, Embase, and Cochrane Library databases to identify studies that compared the clinical efficacy of meniscus repair performed with PRP versus without PRP. The primary outcome was the meniscus repair failure rate, while the secondary outcomes were knee-specific patient-reported outcomes, including the International Knee Documentation Committee (IKDC) score, Lysholm knee scale, visual analog scale, Tegner activity level score, Western Ontario and McMaster Universities Osteoarthritis Index score, Single Assessment Numeric Evaluation score, and Knee injury and Osteoarthritis Outcome Score. Furthermore, subgroup analyses were performed by stratifying the studies according to the PRP preparation technique to investigate the potential sources of heterogeneity among studies. RESULTS: Our meta-analysis included nine studies (two RCTs and seven non-RCTs) with 1164 participants. The failure rate in the PRP group was significantly lower than that in the non-PRP group [odds ratio: 0.64, 95% confidence interval (CI) (0.42, 0.96), P = 0.03]. Furthermore, the PRP group was associated with a statistically significant improvement in the visual analog scale for pain [Mean difference (MD): - 0.76, 95% CI (- 1.32, - 0.21), P = 0.007] and Knee injury and Osteoarthritis Outcome Score-symptom [MD: 8.02, 95% CI (2.99, 13.05), P = 0.002] compared with the non-PRP group. However, neither the IKDC score nor the Lysholm knee scale showed any differences between the two groups. In addition, the results of subgroup analyses favored PRP over platelet-rich fibrin matrix (PRFM) regarding the IKDC score. CONCLUSIONS: Although meniscus repairs augmented with PRP led to significantly lower failure rates and better postoperative pain control compared with those of the non-PRP group, there is insufficient RCT evidence to support PRP augmentation of meniscus repair improving functional outcomes. Moreover, PRP could be recommended in meniscus repair augmentation compared with PRFM. PRFM was shown to have no benefit in improving functional outcomes.

[Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis].

Objective: To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. Methods: The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L 3 level, SMI<45.4 cm 2/m 2 (men) and SMI<34.4 cm 2/m 2 (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups ( P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group ( t=-3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. Results: There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume ( P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group ( t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups ( χ 2=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up ( P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group ( P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups ( t=-1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups ( χ 2 =1.201, P=0.753). Conclusion: Patients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.

Severe complications and management of a patient with myasthenia gravis undergoing anterior cervical spinal surgery: a case report.

Surgical management of patients with comorbid long-term myasthenia gravis (MG) is particularly challenging and MG thus represents an independent risk factor for perioperative complications. However, few studies have reported on the perioperative assessment, prevention measures, and risks in MG patients undergoing major surgery, especially for anterior cervical spine surgery. We herein report the rare case of a 62-year-old man with a 20-year history of MG, who was admitted to our hospital with diagnosis of degenerative cervical spondylosis. He safely underwent anterior cervical corpectomy of C4, discectomy of C5-6, and fusion of C3-6. Intraoperative motor evoked potential was recorded to detect significant improvement after decompression. However, the patient suffered from progressive dysphagia, bucking, and hyperpyrexia 20 days after the initial operation. Imaging revealed titanium cage sliding and graft dislodgement. Secondary surgery was performed for posterior internal fixation from C2-7 and anterior revision from C3-6 after Halo-Vest traction, antibiotic treatment, and immunoglobulin therapy. He underwent a series of postoperative treatments, including cervicothoracolumbosacral orthosis, atomization inhalation, chest physiotherapy, antibiotics, and nutritional support. His condition improved markedly and he had no recurrence of symptoms during the 6-month follow-up. It is the rare reported case of anterior cervical spinal surgery in a patient with MG. This rare case indicates a relative contraindication to anterior-only approaches especially with multiple levels for MG patients with cervical spondylosis. Posterior approach, intraoperative monitoring, osteoporosis, postoperative strong brace protection, and supportive management should be considered for patients who were on large doses of steroids for long duration of time, given the lack of sufficient bone mineral density.

A Postoperative Phenomenon of Percutaneous Endoscopic Lumbar Discectomy: Rebound Pain.

OBJECTIVE: After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short-term full rest or conservative treatment. The aim of the study was to demonstrate this short-term recurrent phenomenon, termed rebound pain. METHODS: A retrospective study was conducted on 144 patients who underwent single-segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non-rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow-up. Logistic regression analysis was used to identify predictors for rebound pain. RESULTS: The VAS and ODI exhibited significant improvements at the last follow-up of average 15.4 months (P < 0.001). The successful outcomes according to the modified MacNab criteria reached 94.4%. A total of 15 patients (10.4%) experienced rebound pain. The typical feature was pain that usually began within 1 month after surgery and lasted for less than 1 month. The symptoms were mainly leg pain with or without low back pain. The range of pain was equal to or less than that before surgery. The symptoms were relieved after conservative treatment. In logistic regression model, postoperative return-to-work time > 45 days was found as a protective factor for rebound pain (p = 0.031). CONCLUSION: Although rebound pain with multiple characteristics and a short duration had no significant effect on long-term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed.