Evaluation of different diagnostic methods for spinal tuberculosis infection.

BACKGROUND AND PURPOSE: Tuberculosis (TB) is the most fatal infectious disease worldwide. Approximately 24.6% of tuberculosis cases are extrapulmonary and predominantly affect the spine. It is difficult to diagnose spinal TB (STB). We aimed to evaluate the diagnostic performance of the Mycobacteria Growth Indicator Tube (MGIT)-960 culture, T-SPOT.TB, Xpert Mycobacterium tuberculosis complex (MTB)/resistance to rifampin (RIF), and Metagenomic Next-Generation Sequencing (mNGS) to detect STB. METHODS: We assessed 126 patients presumed to have STB using these four methods. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using clinical diagnosis as a reference. RESULTS: Of the patients, 41 were diagnosed with STB and 85 with non-STB. In the STB group, the sensitivity, specificity, PPV, and NPV of the MGIT-960 culture were 29.3% (12/41), 100% (85/85), 100% (12/12), and 74.6% (85/114), respectively. The sensitivity, specificity, PPV, and NPV of T-SPOT.TB were 92.7% (38/41), 82.4% (70/85), 58.5% (31/53), and 95.9% (70/73), respectively. The sensitivity, specificity, PPV, and NPV of the Xpert MTB/RIF assay were 53.7% (22/41), 100% (85/85), 100% (22/22), and 81.7% (85/104), respectively. The sensitivity, specificity, PPV, and NPV of mNGS were 39.0% (16/41), 98.8% (84/85), 94.1% (16/17), and 77.1% (84/109), respectively. The sensitivity, specificity, PPV, and NPV of mNGS + Xpert MTB/RIF were 73.2% (30/41), 100% (85/85), 96.8% (30/31), and 72.0% (85/118), respectively. The sensitivity, specificity, PPV, and NPV of the mNGS + T-spot assay were 97.6% (40/41), 100% (85/85), 67.9% (38/56), and 75.9% (85/113), respectively. Moreover, the sensitivity, specificity, PPV, and NPV of T-spot + Xpert MTB/RIF were 95.1% (39/41), 100% (85/85), 72.2% (39/54), and 81.0% (85/105), respectively. CONCLUSIONS: T-SPOT.TB is the most effective method for diagnosing STB; however, Xpert MTB/RIF is more reliable and can detect RIF resistance. Clinicians can use mNGS to identify pathogens in patients with spinal infections; these pathogens appeared to be more meaningful in guiding the clinical management of patients in the non-STB group. The combination of Xpert MTB/RIF and mNGS can improve the early diagnosis rate and drug resistance detection, reduce the diagnostic cycle, and provide early targeted anti-TB treatment for patients with STB.

The efficacy and safety of Chinese herbal medicine in the treatment of painful diabetic neuropathy: A systematic review and meta-analysis.

Objective: The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful diabetic neuropathy (PDN). Methods: We searched databases for randomized controlled trials (RCTs) of CHM in the treatment of PDN. Outcome indicators included nerve conduction velocity, clinical efficiency, pain score, TCM syndrome score, and adverse events. Stata 16.0 was used to carry out the Meta-analysis. Results: A total of 21 RCTs with 1,737 participants were included. This meta-analysis found that using CHM as adjuvant treatment or as monotherapy for PDN can improve SCV of median nerve [mean difference (MD) = 3.56, 95% Confidence interval (CI) (2.19, 4.92) ], MCV of median nerve [ MD = 3.82, 95% CI (2.51, 5.12) ], SCV of common peroneal nerve [ MD = 4.16, 95% CI (1.62, 6.70) ], MCV of common peroneal nerve [ MD = 4.37, 95% CI (1.82, 6.93) ], SCV of gastrocnemius nerve [ MD = 4.95, 95% CI (3.52, 6.37) ], SCV of tibial nerve [ MD = 3.17, 95% CI (-2.64, 8.99) ], MCV of tibial nerve [MD = 6.30, 95%CI (5.00, 7.60)] and clinical effective rate [ odds ratio (OR) = 4.00, 95% CI (2.89, 5.52) ] and reduce pain score [standardized mean difference (SMD) = -2.23, 95% CI (-3.04, -1.41) ], TCM syndrome score [ MD = -4.70, 95% CI (-6.61, -2.80) ]. In addition, compared to the control group, adverse events of Chinese medicine intervention occurred less. Conclusion: CHM as adjuvant therapy or single treatment has a good curative effect and is safe for patients with PDN, which is worthy of clinical promotion and use, however; higher quality clinical studies are still needed to prove. Systematic Review Registration: https://www.crd.york.ac.uk/, identifier CRD42022327967.

Automatic construction of coronary artery tree structure based on vessel blood flow tracking.

We sought to propose an innovative vessel blood flow tracking (VBFT) method to extract coronary artery tree (CAT) and to assess the effectiveness of this VBFT versus the single-frame method. Construction of a CAT from a segmented artery is the basis of artificial intelligence-aided angiographic diagnosis. However, construction of a CAT using a single frame remains challenging, due to bifurcations and overlaps in two-dimensional angiograms. Overall, 13,222 angiograms, including 28,539 vessels, were retrospectively collected from 3275 patients and were then annotated. Coronary arteries were automatically segmented by a previously established deep neural networks (DNNs), and the skeleton lines were then extracted from segmentation images to construct CAT using the single-frame method and the VBFT method. Additionally, 1322 angiograms with 2201 vessels were used to test these two methods. Compared to the single-frame method, the VBFT method can significantly improve the accuracy of CAT as (84.3% vs. 72.3%; p < 0.001). Overlap (OV) was higher in the VBFT group than that in the Single-Frame group (91.1% vs. 87.5%; p < 0.001). The VBFT method significantly reduced the incidence of the lack of branching (7.30% vs. 13.9%, p < 0.001), insufficient length (6.70% vs. 11.0%, p < 0.001), and redundant branches (1.60% vs. 3.10%, p < 0.001). The VBFT method improved the extraction of a CAT structure, which will facilitate the development of artificial intelligence-aided angiographic diagnosis. Cardiologists can efficiently diagnose CAD using this method.

Linking Shifts in Bacterial Community Composition and Function with Changes in the Dissolved Organic Matter Pool in Ice-Covered Baiyangdian Lake, Northern China.

The relationship between CDOM (Chromophoric dissolved organic matter) and the bacterial community was investigated in ice-covered Baiyangdian Lake. The results showed that environmental parameters significantly differed in Baiyangdian Lake, whereas a-diversity was not significantly different. Moreover, the microbial and functional communities exhibited significant differences, and T (Temperature), pH, ORP (Oxidation-reduction potential), DO (Dissolved oxygen), NO3--N, NH4+-N, and Mn (Manganese) were the main environmental factors of these differences, based on redundancy analysis and the Mantel test. Biomarkers of the microbial and functional communities were investigated through linear discriminant analysis effect size and STAMP analysis. The number of biomarkers in the natural area was highest among the typical zones, and most top functions were related to carbohydrate metabolism. Two protein-like components (C1 and C2) and one humic-like component (C3) were identified by parallel factor analysis, and C1 was positively related to C2 (R = 0.99, p < 0.001), indicating the same sources. Moreover, CDOM significantly differed among the typical zones (p < 0.001). The high biological index, fluorescence index, ß:α, and low humification index indicated a strong autochthonous component and aquatic bacterial origin, which was consistent with the results of UV-vis absorption spectroscopy. Network analysis revealed non-random co-occurrence patterns. The bacterial and functional communities interacted closely with CDOM. The dominant genera were CL500-29_marine_group, Flavobacterium, Limnohabitans, and Candidatus_Aquirestis. Random forest analysis showed that C1, C2, and C3 are important predictors of α- and ß-diversity in the water bacterial community and its functional composition. This study provides insight into the interaction between bacterial communities and DOM (Dissolved organic matter) in ice-covered Baiyangdian Lake.

Biomechanical effects of over lordotic curvature after spinal fusion on adjacent intervertebral discs under continuous compressive load.

BACKGROUND: To investigate the effects of over-lordotic curvature after lumbar fusion on the stress and deformations of the adjacent intervertebral discs under constant compressive loads. METHODS: Two-level ovine specimens-including three vertebral bodies with two discs-were divided into two groups: Group A (to observe external deformation) and Group B (to observe internal stress and deformations of the discs). Each group consisted of three models: a) intact model, b) increased stiffness + unchanged curvature fusion model, and c) increased stiffness + curvature fusion model. Models were tested at a vertebral pressure of 0.4 MPa for 30 min. Creep deformations and stress distributions in the superior adjacent intervertebral discs were analysed using finite element models. FINDINGS: Stiffness angle of the curvature model was increased by 5° and compared with the intact and stiffness models. In Group A, there was no significant deformation in the superior and adjacent intervertebral discs (P > 0.05), whereas creep deformations of the Group B discs increased significantly. Maximum deformations, with increases of approximately 3.7-fold and 2.8-fold in the vertical and horizontal directions, respectively, occurred at the anterior annulus fibrosus. The vertical and sagittal stress concentrations at the anterior annulus fibrosus had maximum differences of 1.0 MPa and 1.2 MPa, respectively. INTERPRETATIONS: Under a continuous compressive load, over-lordotic fusion significantly increases the stress and deformation gradient of the nucleus polposus and annulus fibrosus in the superior, adjacent intervertebral disc, increasing the risk of damage and secondary degeneration of these discs when subjected to daily static loads.

Biomechanical effects of posterior pedicle fixation techniques on the adjacent segment for the treatment of thoracolumbar burst fractures: a biomechanical analysis.

Posterior pedicle fixation technique is a common method for treating thoracolumbar burst fractures, but the effect of different fixation techniques on the postoperative spinal mechanical properties has not been clearly defined, especially on adjacent segments. A finite element model of T10-L2 with moderate T12 vertebra burst fracture was constructed to investigate biomechanical behavior of three posterior pedicle screw fixation techniques. Compared with traditional short-segment 4 pedicle screw fixation (TS-4) and intermediate long-segment 6 pedicle screw fixation (IL-6), mono-segment 4 pedicle screw fixation (MS-4) provides a safer surgical selection to prevent the secondary degeneration of adjacent segments in the long-term.