Combined spatial and frequency dual stream network for face forgery detection.

With the development of generative model, the cost of facial manipulation and forgery is becoming lower and lower. Fraudulent data has brought numerous hidden threats in politics, privacy, and cybersecurity. Although many methods of face forgery detection focus on the learning of high frequency forgery traces and achieve promising performance, these methods usually learn features in spatial and frequency independently. In order to combine the information of the two domains, a combined spatial and frequency dual stream network is proposed for face forgery detection. Concretely, a cross self-attention (CSA) module is designed to improve frequency feature interaction and fusion at different scales. Moreover, to augment the semantic and contextual information, frequency guided spatial feature extraction module is proposed to extract and reconstruct the spatial information. These two modules deeply mine the forgery traces via a dual-stream collaborative network. Through comprehensive experiments on different datasets, we demonstrate the effectiveness of proposed method for both within and cross datasets.

Risk Factors Associated with Cage Retropulsion After Lumbar Interbody Fusion.

AIM: To identify the cage retropulsion (CR)-associated risk factors following lumbar interbody fusion (LIF). MATERIAL AND METHODS: Clinical data of patients who underwent LIF between January 2014 and December 2018 at three medical centers were retrospectively analyzed. Patients were divided into CR group and non-CR (NCR) group according to whether they experienced CR or not. This study analyzed radiological and surgical parameters to identify the risk factors associated with CR. RESULTS: The enrolled 823 patients who underwent LIF had a total of 1205 disk levels. There were 387 men and 436 women, with a mean age of 58.8 (range, 33-86) years old. The average follow-up time was 16.6 (range, 12-27) months. CR was found in 21 patients (9 men and 12 women, 21 levels). Besides, 14 patients complained of radicular pain postoperatively, of whom 10 patients were recovered after conservative treatment, while the remaining 4 patients further required revision surgery. The mean age was 62.3 ± 8.1 (range, 44-74) years old in the CR group and 59.7 ± 9.7 (range, 33-86) years old in the NCR group. The incidence of CR was higher in patients with osteoporosis than those with a normal bone mineral density (BMD). Moreover, 12 of 21 patients had osteoporosis (57.1%), however, only 29.2% of patients without CR had osteoporosis. The cages of retropulsion were all placed at the posterior disk space by immediately postoperative X-ray or computed tomography (CT) scan. On the contrary, only 35.6% of cages were placed at the posterior disk space in the NCR group. Pear-shaped disk was found in 10 of 21 patients in the CR group (47.6%), whereas it was noted in only 13.4% of cases in the NCR group. Furthermore, 13 out of 21 patients in the CR group experienced intraoperative endplate injury (61.9%), while only 13.4% of patients experienced that in the NCR group. Risk factors for CR were osteoporosis [odds ratio (OR)=8.7, 95% confidence interval (CI) (3.42-34.6), P=0.01], posterior cage position [OR=5.8, 95%CI (2.12-24.6), p=0.03], pear-shaped disk [OR=9.9, 95%CI (6.21-46.42), p < 0.001], and intraoperative endplate injury [OR=9.9, 95%CI (6.21-46.42), p < 0.001]. CONCLUSION: Intraoperative endplate injury, pear-shaped disk, osteoporosis, and posterior cage position were noted as CRassociated risk factors after LIF.

Distributed Discrete-Time Convex Optimization With Closed Convex Set Constraints: Linearly Convergent Algorithm Design.

The convergence rate and applicability to directed graphs with interaction topologies are two important features for practical applications of distributed optimization algorithms. In this article, a new kind of fast distributed discrete-time algorithms is developed for solving convex optimization problems with closed convex set constraints over directed interaction networks. Under the gradient tracking framework, two distributed algorithms are, respectively, designed over balanced and unbalanced graphs, where momentum terms and two time-scales are involved. Furthermore, it is demonstrated that the designed distributed algorithms attain linear speedup convergence rates provided that the momentum coefficients and the step size are appropriately selected. Finally, numerical simulations verify the effectiveness and the global accelerated effect of the designed algorithms.

Clinical characteristics and prognosis of patients with glioblastoma: A review of survival analysis of 1674 patients based on SEER database.

BACKGROUND: To fully understand the clinical features and prognosis of Glioblastoma (GBM), we extracted the data from the Surveillance, Epidemiology, and End Results (SEER) database and performed a series of analyses. METHODS: We retrospectively analyzed the data of 1674 patients with GBM obtained from the SEER database from 1983 to 2015. Kaplan-Meier analysis was performed to calculate the survival rate, and the log-rank test was used to analyze the survival outcomes. RESULTS: Older patients with GBM had a worse survival period (P < .05). Laterality had no effect on the prognosis (P > .05). Patients with high-grade gliomas may have a shorter lifespan (P < .05). In terms of overall survival (OS) and disease specificity, all 3 classical treatments failed to improve the life expectancy (P > .05). In adult patients with GBM, we found that age, tumor grade, surgery, radiotherapy, and chemotherapy were independent risk factors for all-cause mortality. In the univariate disease-specific analysis, age, tumor grade, surgery, radiotherapy, and chemotherapy were independent risk factors. However, in multivariate disease-specific analysis, the results showed that only tumor grade and surgery were independent risk factors for GBM. CONCLUSIONS: Older patients diagnosed with GBM have worse survival, and patients with glioma of higher grades have a shorter lifespan. Age, grade, surgery, radiation therapy, and chemotherapy were independent prognostic factors for patients with GBM.

S-MAT: Semantic-Driven Masked Attention Transformer for Multi-Label Aerial Image Classification.

Multi-label aerial scene image classification is a long-standing and challenging research problem in the remote sensing field. As land cover objects usually co-exist in an aerial scene image, modeling label dependencies is a compelling approach to improve the performance. Previous methods generally directly model the label dependencies among all the categories in the target dataset. However, most of the semantic features extracted from an image are relevant to the existing objects, making the dependencies among the nonexistant categories unable to be effectively evaluated. These redundant label dependencies may bring noise and further decrease the performance of classification. To solve this problem, we propose S-MAT, a Semantic-driven Masked Attention Transformer for multi-label aerial scene image classification. S-MAT adopts a Masked Attention Transformer (MAT) to capture the correlations among the label embeddings constructed by a Semantic Disentanglement Module (SDM). Moreover, the proposed masked attention in MAT can filter out the redundant dependencies and enhance the robustness of the model. As a result, the proposed method can explicitly and accurately capture the label dependencies. Therefore, our method achieves CF1s of 89.21%, 90.90%, and 88.31% on three multi-label aerial scene image classification benchmark datasets: UC-Merced Multi-label, AID Multi-label, and MLRSNet, respectively. In addition, extensive ablation studies and empirical analysis are provided to demonstrate the effectiveness of the essential components of our method under different factors.

Attenuation of Activated eIF2α Signaling by ISRIB Treatment After Spinal Cord Injury Improves Locomotor Function.

Following spinal cord injury (SCI), multiple signaling cascades are activated instantaneously in the injured segments of the spinal cord to create a complex and pathogenic microenvironment, making it difficult to treat SCI. Nevertheless, the significance of the integrated stress response (ISR) to the series of physiological and pathological changes that occur after SCI remains unclear. Through western blotting (WB), we determined that the autophosphorylation of stress receptors (GCN2, PERK, PKR, and HRI) was enhanced after SCI, leading to increased phosphorylation of eIF2α at Ser51. Strikingly, we found that eIF2α was highly phosphorylated at 1 day post injury (dpi) and that this hypophosphorylation was maintained thereafter in the spinal cord, especially in neurons, which suggests that intervening with eIF2α phosphorylation may be a treatment strategy for SCI. Therefore, we employed the small molecule ISRIB, which inhibits eIF2α phosphorylation when the ISR is activated at moderate or low levels but not when the ISR is highly activated. Daily intraperitoneal injection of ISRIB significantly inhibited ISR signaling after SCI, reduced the cytosolic localization of RNA-binding proteins, and decreased neuronal apoptosis. Histological and functional experiments further demonstrated that treatment with ISRIB after SCI effectively curbed morphological deterioration and promoted the recovery of locomotor function. In summary, the ISR plays an important role in SCI, and ISRIB is a promising drug for the treatment of SCI.

Discrete-Time Algorithms for Distributed Constrained Convex Optimization With Linear Convergence Rates.

In this article, the constrained optimization problem with its global objective function being the sum of convex local cost functions and the constraint being a closed convex set is researched. The aim of this study is to solve the researched problem in a distributed manner, that is, using only local computations and local information exchanges. Toward this end, two gradient-tracking-based distributed optimization algorithms are designed for the considered problem over weight-balanced and weight-unbalanced graphs, respectively. Since the classical projection method is unsuitable to handle the closed convex set constraint under the gradient-tracking framework, a new indirect projection method is employed in this article to deal with the involved closed convex set constraint. Furthermore, two time scales are introduced to complete the convergence analyses. In addition, under the condition that all local cost functions are strongly convex and L -smooth, it is proved that the algorithms with well-selected fixed step sizes have linear convergence rates.

Topical Injection of Tranexamic Acid via a Drain Plus Drain-Clamping to Reduce Blood Loss in Degenerative Lumbar Scoliosis Surgery.

OBJECTIVE: The aim of the present study was to investigate whether an innovative way of administering tranexamic acid (TXA), that is, injecting it retrogradely through the drain and clamping it for 1 h, can reduce postoperative bleeding after degenerative lumbar scoliosis surgery. METHODS: Sixty degenerative lumbar scoliosis patients who underwent posterior lumbar decompression with fusion of three or more levels were retrospectively enrolled and categorized into three groups (TXA, Gelfoam, and control groups). The demographic distribution, operative parameters, length and amount of Hemovac drainage, blood transfusion rate, length of stay, laboratory results (complete blood count and coagulogram), and the postoperative complications were collected and analyzed. RESULTS: The age of patients in the Gelfoam group was significantly younger than in the TXA and control groups (59.75 ± 6.95 vs 66.10 ± 8.80, P = 0.016 and 59.75 ± 6.95 vs 67.90 ± 5.33, P = 0.000, respectively). There were no significant differences in sex, body mass index, comorbid medical status, and operation level between each of the two groups. The three groups did not differ significantly in estimated blood loss during surgery, the mean red blood cell transfusion requirement during hospitalization, and the entire perioperative allogenic blood transfusion rate. The postoperative total blood loss and total drainage were lower in the TXA group than in the control group (1027.14 ± 466.56 vs 1390.07 ± 314.85 mL, P = 0.006; 322.20 ± 187.32 vs 605.50 ± 184.70 mL, P = 0.000, respectively). The length of drainage retention in the TXA group was significantly shorter than in the Gelfoam and control groups (46.10 ± 9.00 vs 68.00 ± 12.31 h, P = 0.000 and 46.10 ± 9.00 vs 76.40 ± 10.97 h, P = 0.000, respectively). The TXA and Gelfoam groups also had significantly shorter hospital stays than the control group (7.50 ± 0.95 vs 9.80 ± 2.44 days, P = 0.000, and 7.90 ± 1.16 vs 9.80 ± 2.44 days, P = 0.003, respectively). At discharge, the mean hemoglobin and hematocrit level were significantly higher in the TXA group compared with the control group (11.77 ± 1.78 g/dL vs 10.67 ± 0.94 g/dL, P = 0.002; 34.82 ± 3.57% vs 31.79 ± 3.85%, P = 0.014). No significant difference was identified with respect to prothrombin time, activated partial thromboplastin time, and D-dimmer among groups (P > 0.05). The three groups were comparable in wound problem incidences. Symptomatic deep vein thrombosis and pulmonary embolism were not observed in this study. CONCLUSION: Topical injection of TXA retrogradely via a drain at the end of a degenerative lumbar scoliosis operation and clamping the drain for an hour can effectively decrease the postoperative blood loss and the length of hospitalization without increasing the complication rate.

Clinical effect observation of intravenous application of zoledronic acid in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion: A randomized controlled study.

OBJECTIVE: To observe the clinical effect of zoledronic acid (ZA) in patients with cervical spondylosis and osteoporosis after anterior cervical discectomy and fusion (ACDF) surgery. METHODS: All selected patients were divided into the study group and the control group according to the sequence of surgery time. In the study group, 5 mg (100 ml) of ZA was applied intravenously as intervention on the 5 day after ACDF surgery. Patients were followed up regularly after surgery. RESULTS: Forty-three cases completed the follow-ups (21/22), the neck disability index (NDI) score significantly decreased at the 3rd month after surgery in both groups, it came to a plateau at the 6th month after surgery, and it had some rise at the 12th month after surgery, but the NDI score was lower in the study group at the 12th month after surgery ( p < 0.05). C-telopeptide of type I collagen (CTX) and amino terminal propeptide of type I procollagen of bone turnover markers in the study group showed a downward trend after surgery, among which CTX decreased significantly and no significant changes in the control group. At the 12th month after surgery, the bone mineral density of lumbar spine area in the study group was significantly improved ( p < 0.05). During the 3rd and the 6th month follow-up after surgery, 1/2 osteogenesis rate of the study group was significantly higher ( p < 0.05). However, all patients in the two groups obtained stable fusion at the 12th month follow-up after surgery. CONCLUSIONS: For patients with cervical spondylosis and osteoporosis, intravenous application of ZA after ACDF surgery can shorten the time of cervical osteogenesis, promote local bone graft fusion, and improve the postoperative clinical effect to some extent.

Gossypol Promotes Wnt/ß-Catenin Signaling through WIF1 in Ovariectomy-Induced Osteoporosis.

Osteoporosis is one of the most frequent diseases related with age. Previously, we have reported a novel potential drug, gossypol, for the treatment of osteoporosis through its regulation of Wnt/ß-catenin signaling. This study aims to identify the detailed mechanism of gossypol in human osteoporosis. Mice injected with gossypol were subjected for RNA-seq analysis and the transcription level of WIF1 was shown to be decreased dramatically in gossypol-treated mice, which was further confirmed by qRT-PCR and western blot analysis. Luciferase reporter assay showed gossypol inhibited the activity of WIF1 and the methylation of WIF1 was significantly upregulated, evidenced by ChIP assay. Cell viability assays demonstrated that gossypol promoted cell proliferation while cotreatment with WIF1 expressing plasmid reversed the effect in a dose- and time-dependent manner. Similarly, cell apoptotic assays and TUNEL assays showed gossypol suppressed cell apoptosis, which was revised by WIF1 overexpression. The mouse model suggested gossypol injection ameliorated osteoporosis, while coinjection of AAV5-WIF1 eliminated the protection effects of gossypol, as evidenced by H&E staining, serum osteocalcin level, serum OPG level, serum RANKL level, bone density, ultimate strength, and postyield displacement. This study is a supplement to the former publication, which reinforced the protection effect of gossypol in human osteoporosis.

Protective effect of estrogen against intervertebral disc degeneration is attenuated by miR-221 through targeting estrogen receptor α.

Dysfunction of cartilaginous endplates (CEP) is an important etiologic aspect of intervertebral disc degeneration (IDD) because the endplate has nutritional and biomechanical functions in maintaining proper disc health. In this study, we investigated the regulatory effects of estrogen on degenerated human CEP cells and the involvement of miR-221 in these effects. Normal and degenerated human CEP tissues were collected from patients with idiopathic scoliosis and IDD, respectively. CEP cells were isolated from these tissues. Polymerase chain reaction (PCR) and western blot analysis were performed to detect the expression of specific genes and proteins, respectively. Apoptosis and cell cycle were analyzed by flow cytometry. The results showed that the levels of aggrecan, collagen II, TGF-ß and estrogen receptor α (ERα) were decreased in degenerated CEP tissues, while the levels of MMP-3, adamts-5, IL-1ß, TNF-α, IL-6, and miR-221 were increased. Treatment of degenerated CEP cells with 17beta-estradiol (E2) increased the expressions of aggrecan and collagen II, as well as the secretion of TGF-ß, but decreased IL-6 secretion. Moreover, E2 inhibited the apoptosis, resumed cell-cycle progression in G0/G1 phase, and improved the cell viability. These data indicate that estrogen has protective effect against degeneration of CEP cells. Furthermore, ERα was confirmed to be a target of miR-221 by the luciferase assay. The synthetic miR-221 mimics or knockdown of ERα attenuated the protective effects of E2, but miR-221 inhibitors promoted the protective effects of E2. These results suggest that miR-221 may impair the protective effect of estrogen in degenerated CEP cells through targeting ERα. This study reveals an important mechanism underlying the degeneration of CEP cells.

Gossypol Promotes Bone Formation in Ovariectomy-Induced Osteoporosis through Regulating Cell Apoptosis.

Osteoporosis is among the most common forms of age-related diseases, especially for females, which has been a grave public health problem. Drug therapies have shown promising outcomes to promote bone formation and bone density. This study identified a novel potential drug, gossypol, for the treatment of osteoporosis. Treatments of ovariectomy-induced osteoporosis mice with gossypol significantly increased serum osteocalcin and osteoprotegerin (OPG) levels; meanwhile they decreased serum RANKL levels. Microcomputed tomography (microCT) analysis showed that treatment of gossypol improved bone density and strength and decreased bone postyield displacement for both medullar and cortical bones. In vitro experiments also showed that gossypol increased cell viability in a time- and dose-dependent manner. Furthermore, incubation of the osteoblast MC3T3-E1 cells with gossypol inhibited cell apoptosis through intrinsic apoptotic pathway as evidenced by the Annexin V/PI assay, TUNEL assay, biochemical analysis, and western blot assays. Moreover, the classical Wnt/ß-catenin signaling pathway was found to be regulated by gossypol treatments. Inhibition of Wnt/ß-catenin signaling reversed the prevention effects of gossypol in osteoporosis. Our findings provided novel clues for the treatment of osteoporosis in clinic.

Protective effect of estrogen against calcification in the cartilage endplate.

Clinical studies report that endogenous estrogen depletion is associated with disc degeneration. The present study aimed to investigate the effect and mechanism of estrogen on disc degeneration of the cartilage endplate. Three groups of mice with bilateral ovariectomy + 17ß-estradiol injection (OVX + E2 Group), bilateral ovariectomy + vehicle injection (OVX + vehicle), or sham operation + vehicle injection (Sham Group) were included in this study. The mice were sacrificed at 12 weeks and the cartilage endplate (CEP) were harvested. The calcification status was evaluated by Alizarin red staining and RT-PCR, which demonstrated the calcification level of the CEP gradually developed from the Sham Group, OVX + E2, to the OVX + vehicle group. The CEP cells were isolated, cultured, and treated with IL-1ß (75 ng/ml) for 24 h, with or without a pretreatment of 17ß-E2 for 1 h. RT-PCR analysis of calcification-related genes ALP, OCN, RUNX2, and COL-I were analyzed, and calcification of CEP cells induced by IL-1ß was reversed by pretreatment with 17ß-E2, in a dose-dependent manner. The protective effect of 17ß-E2 was abolished by estrogen receptor antagonist ICI182,780. These results suggest that decreased estrogen level may accelerate degeneration of the cartilage endplate by increasing calcification, which may be induced by IL-1ß, in a dose-dependent manner.

Osteochondroma: Review of 431 patients from one medical institution in South China.

BACKGROUND: The geographic distribution of osteochondroma (OC) varies greatly around the world. There has been no recent report on OC in a large Chinese population. The aim of this study was to characterize OC by an epidemiological analysis of the clinical data from one medical institution in South China. METHODS: We searched medical electronic records from January 2001 to January 2016 in one large hospital in South China to identify patients with a definite diagnosis of OC. Their epidemiological data were collected and analyzed statistically, including gender, tumor site, age at first diagnosis and symptoms, local recurrence and malignant transformation. Differences between genders and between solitary osteochondroma (SO) and multiple osteochondroma (MO) were particularly analyzed. RESULTS: A total of 431 OC patients (291 males and 140 females; 329 SOs and 102 MOs) were identified. The gender ratio was 2.08 with a male predominance. OCs were mostly located around the knee (250 cases). 280 patients were in their 0s to 20s upon first diagnosis. The average age at the time of first diagnosis was 20.63 years for all, 18.47 years for males and 25.11 years for females (P=0.000). OC recurred locally in 35 patients (15 SOs and 20 MOs), with a significant difference between SO/MO (P=0.000) but not between genders (P=0.100). The average interval from the primary surgery to local or malignant recurrence was 37.41 months. Malignant transformation was found in 5 patients (4 males and 1 female), showing no gender difference (P=0.549). CONCLUSIONS: OC may have a male predominance in Chinese population. It mostly occurred at 0-20 years of age and around the knee. Upon the first diagnosis of OC, the males tended to be younger than the females, and so did the MO patients than the SO ones. In addition, MO had a higher incidence of local recurrence. Intervals from primary surgery to local recurrence or malignant transformation in MO patients were longer than in SO patients.

The role of single-stage posterior debridement, interbody fusion with titanium mesh cages and short-segment instrumentation in thoracic and lumbar spinal tuberculosis.

BACKGROUND: The aim of this paper was to retrospectively analyze the clinical efficacy and feasibility of thoracic and lumbar spinal tuberculosis treated by single-stage posterior debridement, interbody fusion with titanium mesh cages (TMC), and combined short-segment instrumentation. METHODS: Fifteen patients with no more than two vertebral bodies involving thoracic and lumbar tuberculosis were collected from January 2006 to January 2010, performed by single-stage posterior debridement, interbody fusion with TMC and posterior short-segment fixation. The clinical efficacy was evaluated based on the data of the 10-point Visual Analogue Scale (VAS), neurological status, kyphosis angle, erythrocyte sedimentation rate, and C-reactive protein, which were collected at a certain time. RESULTS: The average duration of surgery was 135 minutes. All the patients were followed up for a period ranging from 18 to 48 months (mean 28.9±6.44 months). The VAS score was improved from 8.47±1.13 (range 7-10) before surgery to 2.1±1.7 (range 0-2) after surgery. Correction of segmental kyphotic deformity was 24.2±6.59°. Neither the postoperative change of the position of titanium mesh cage nor any posterior instrumentation failure was recorded. The situation of 13 patients with incomplete neurologic lesions before surgery was improved after surgery. CONCLUSIONS: Patients with thoracic and lumbar spinal tuberculosis can be successfully treated by posterior debridement, interbody fusion with TMC combining short-segment instrumentation. The presence of the TMC anteriorly at the site of tubercular spondylitis has no negative influence on the course of infection healing, and additionally they stabilize the affected segment maintaining sufficient sagittal profile.

Supporting Regularized Logistic Regression Privately and Efficiently.

As one of the most popular statistical and machine learning models, logistic regression with regularization has found wide adoption in biomedicine, social sciences, information technology, and so on. These domains often involve data of human subjects that are contingent upon strict privacy regulations. Concerns over data privacy make it increasingly difficult to coordinate and conduct large-scale collaborative studies, which typically rely on cross-institution data sharing and joint analysis. Our work here focuses on safeguarding regularized logistic regression, a widely-used statistical model while at the same time has not been investigated from a data security and privacy perspective. We consider a common use scenario of multi-institution collaborative studies, such as in the form of research consortia or networks as widely seen in genetics, epidemiology, social sciences, etc. To make our privacy-enhancing solution practical, we demonstrate a non-conventional and computationally efficient method leveraging distributing computing and strong cryptography to provide comprehensive protection over individual-level and summary data. Extensive empirical evaluations on several studies validate the privacy guarantee, efficiency and scalability of our proposal. We also discuss the practical implications of our solution for large-scale studies and applications from various disciplines, including genetic and biomedical studies, smart grid, network analysis, etc.

Using tranexamic acid soaked absorbable gelatin sponge following complex posterior lumbar spine surgery: A randomized control trial.

OBJECTIVES: This paper aims to determine whether the use of Tranexemic Acid (TXA) - soaked absorbable gelatin sponge could more effectively reduce post-operative blood loss and blood transfusion requirements among low-risk adult patients undergoing lumbar spine surgery. METHODS: A total of 90 consecutive patients undergoing surgery for multilevel posterior lumbar degenerative procedures were prospectively randomized into one of three groups: - TXA Soaked Gelfoam group, absorbable gelatin sponge group or control group. Demographic distribution, total drain output, blood transfusion requirement, length of hospital stay, the number of readmissions, and postoperative complications were analyzed. RESULTS: In the TXA Soaked Gelfoam, Gelfoam, and control groups, the respective hemovac drainage at the first 8h postoperatively was 81.06±61.21, 166.73±76.76, and 155.67±92.94ml respectively. The second 8h period drainage for the same groups postoperatively was 46.67±40.09, 55.10±43.43, and 82.50±56.67ml and 23.73±25.56, 32.43±25.81 and 44.20±32.44ml for the third 8h period postoperatively. The duration of the post-operative drain left in the TXA Soaked Gelfoam group was significantly shorter than the Gelfoam and control groups (p=0.019 and 0.000, respectively). The TXA Soaked Gelfoam and Gelfoam also had a significantly shorter hospital stay than the control group (p=0.014, and 0.036, respectively). No patient developed adverse reactions attributable to the tranexamic acid soaked absorbable gelatin sponge. CONCLUSIONS: TXA-soaked absorbable gelatin sponge is a safe, effective treatment for reduction of post-operative blood loss and blood transfusions among low-risk adult patients undergoing lumbar spine surgery.

Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis.

There are quite a few controversies on surgical management of single-segment thoracic spinal tuberculosis (STB) with neurological deficits. The present study was to compare single-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of single-segment thoracic STB with neurological deficits and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment. Sixty patients with single-segment thoracic STB with neurological deficits were treated with one of two surgical procedures in our center from January 2003 to January 2013. Thirty patients were treated with posterior-only surgery (Group A) and thirty were treated with combined posterior-anterior surgery (Group B). The American Spinal Injury Association (ASIA) score system to evaluate the neurological deficits, the visual analogue scale (VAS) to assess the degree of pain, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to judge the activity of tuberculosis (TB), surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, and kyphosis correction of the two groups were compared. The average follow-up period was 36.5 ± 9.2 months for Group A and 34.6 ± 10.2 months for Group B. Under the ASIA score system, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The kyphosis deformity was significantly corrected after surgical management. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B. In conclusions, posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.

Surgical treatment of selected patients with multilevel contiguous thoracolumbar spinal tuberculosis by only posterior instrumentation without any bone fusion.

The retrospective clinical study is to determine the feasibility and efficacy of surgical management of multilevel contiguous thoracolumbar spinal tuberculosis (MCTLST) by only posterior instrumentation without posterior or anterior bone fusion and without anterior fixation in the study of eleven selected cases. Eleven selected cases with MCTLST were treated with combined posterior instrumentation and debridement and/or decompression without any bone fusion. The mean follow-up was 33.1 months (range 20-48 months). The kyphosis angle ranged from 9.2 to 40.4° before operation, 27.8° in average. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocytesedimentationrate (ESR) used to judge the activity of tuberculosis, which were collected at certain time. Spinal tuberculosis (STB) was completely cured in all eleven patients. There was no recurrent tuberculosis infection. The postoperative kyphosis angle was 7.1° to 12.5°, 9.6° in average and there was no significant loss of the correction at the final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. In conclusions, combined posterior instrumentation and debridement and/or decompression without any bone fusion can be a feasible and effective method in treatment of patients with MCTLST. However, the strict selection of patients was the critical of the surgery success.

miR-21 promotes human nucleus pulposus cell proliferation through PTEN/AKT signaling.

The precise role of nucleus pulposus cell proliferation in the pathogenesis of intervertebral disc degeneration remains to be elucidated. Recent findings have revealed that microRNAs, a class of small noncoding RNAs, may regulate cell proliferation in many pathological conditions. Here, we showed that miR-21 was significantly upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues that were isolated from patients with idiopathic scoliosis and that miR-10b levels were associated with disc degeneration grade. Moreover, bioinformatics target prediction identified PTEN as a putative target of miR-21. miR-21 inhibited PTEN expression by directly targeting the 3'UTR, and this inhibition was abolished through miR-21 binding site mutations. miR-21 overexpression stimulated cell proliferation and AKT signaling pathway activation, which led to cyclin D1 translation. Additionally, the increase in proliferation and cyclin D1 expression induced by miR-21 overexpression was almost completely blocked by Ly294002, an AKT inhibitor. Taken together, aberrant miR-21 upregulation in intervertebral disc degeneration could target PTEN, which would contribute to abnormal nucleus pulposus cell proliferation through derepressing the Akt pathway. Our study also underscores the potential of miR-21 and the PTEN/Akt pathway as novel therapeutic targets in intervertebral disc degeneration.