Supraclavicular Artery Island Flap for Treatment of Cervical Wound Defects and Persistent Cerebrospinal Fluid Leaks: A Technical Note and Systematic Review of the Literature.

BACKGROUND: Soft tissue defects and persistent cerebrospinal fluid (CSF) leaks can create complications after cervical spinal surgery. The supraclavicular artery island (SAI) flap is useful in closing tissue defects, particularly in these complex surgeries and multiple reinterventions. However, technical reports in this context are scarce. We describe application of the SAI flap technique to control persistent CSF leak in the first documented instance (to our knowledge) of a low-grade fibromyxoid sarcoma (LGFMS) in the cervical epidural space. Additionally, we conducted a comprehensive review of PubMed, Embase, and Google Scholar from their earliest records through December 17, 2023 using combined terms, "supraclavicular artery island flap AND spine" and "supraclavicular AND flap AND spine". TECHNICAL NOTE: A 56-year-old woman with arm pain and weakness presented with a cervical epidural mass extending from C4-C6 and associated spinal cord compression. She underwent a 3-level corpectomy and tumor resection. Primary dural closure was impossible due to the dural invasion, and reintervention with an SAI flap and definitive lumboperitoneal shunting were required to control and seal the CSF leak. SYSTEMATIC LITERATURE REVIEW: Seven case reports describing SAI flap for spinal surgery complications were identified. The indications in those cases were correcting esophageal and hypopharyngeal perforations after cervical fusion and discectomy and persistent soft tissue coverage after cervical instrumentation. CONCLUSIONS: The SAI flap technique provided wound defect coverage in this case and is suitable for addressing issues such as persistent CSF leaks or soft tissue coverage after cervical spine surgery.

A Novel Scientometrics Research on the Interaction between Oxidative Stress and Hematopoietic Stem Cell Transplantation Complications: From Graft-versus-Host Disease to Sepsis.

As major and serious complications after hematopoietic stem cell transplantation (HSCT), graft-versus-host disease (GVHD) and sepsis are the chief causes of low survival rates as well as mortality and for HSCT recipients. Although the overall treatment outcomes of HSCT have improved significantly in recent years, there is still an increased incidence rate of complications and mortality after transplantation. In the immediate past, with a deeper understanding of oxidative stress, more and more shreds of evidence have shown that it is closely related to transplantation-related sepsis. However, there is currently a precious little research on the interaction between oxidative stress and complications after HSCT, and the major mechanism has not yet been clarified. The objective of this study was to assess the internal connection between and potential mechanisms as well as visualized the scientometrics results of all important literature related to the topic. Through exhaustive scientometrics analysis, we searched and carefully screened 286 related publications from the Web of Science Core Collection (WoSCC) with "((HSCT) OR (hematopoietic stem cell transplantation)) AND (oxidative stress)" as the search strategy. Then, detailed visualization of the overall information analysis was made by scientific and rigorous bibliometrics software or website. Next, we analyzed retrieved articles extensively and then 59 publications that are relevant to this topic were selected for nuanced analysis and summary. The assessment of these studies proved the validity of the interaction between oxidative stress and complications after HSCT objectively and directly.

Do Multidisciplinary Spine Conferences Alter Management or Impact Outcome?

BACKGROUND: Multidisciplinary spine conferences (MSCs) are a strategy for discussing diagnostic and treatment aspects of patient care. Although they are becoming more common in hospitals, literature investigating how they impact patient care and outcomes is scarce. The aim of this study is to examine the impact of MSCs on surgical management and outcomes in elective spine surgical care. METHODS: A systematic review of the literature was conducted to evaluate the impact of MSCs on patient management and outcomes. PubMed and Cochrane databases were searched using combinations and variations of search terms "Spine Conferences," "Multidisciplinary," and "Spine Team." RESULTS: The literature search yielded 435 articles, of which 120 were selected for full-text review. Four articles (N = 529 patients) were included. Surgical plans were discussed in 211 patients. The decision was altered to conservative treatment in 70 patients (33.17%) and a different surgical strategy in 34 patients (16.11%). The differences were significant in 2 studies (P < 0.05). A 51% reduction in 30-day complications rates was observed when MSC was implemented in patients with adult complex scoliosis. Other spinal disorders showed a 30-day complication rate between 0% and 14% after MSC. CONCLUSIONS: To our knowledge, this is the first systematic review of outcomes of MSCs in elective spine surgery and it confirms that MSCs impact management plan and outcomes. Consistent MSCs that include surgeons and nonsurgeons have the potential to enhance communication between specialists, standardize treatments, improve patient care, and encourage teamwork. More analysis is warranted to determine if patient outcomes are improved with these measures.

Burst fractures of the fifth lumbar vertebra: Case series and systematic review.

BACKGROUND: Burst fractures of the fifth lumbar vertebra (L5) are rare injuries and typically occur because of high-energy axial compressive load. Their unique anatomy and biomechanical characteristics distinguish them from other lumbar spine injuries. To the best of our knowledge, the treatment strategies for L5 burst fractures have not been thoroughly described. The aims of this case series and systematic review were to highlight the treatment strategies and outcomes of the L5 burst fractures. METHODS: We performed a retrospective case series of 8 patients treated for burst L5 fractures in our institution between 2005 and 2020. Additionally, a systematic review via PubMed and Cochrane Library databases according to PRISMA guidelines was performed to review L5 burst fractures treatment strategies. Only Articles in English with full text available were included. The references of the selected studies were checked to find all possible related articles. Treatment strategies were conservative, posterior segmental instrumentation and fixation (PSIF), PSIF with anterior corpectomy (AC), and PSIF with posterior corpectomy (PC). Outcomes measures included neurological status, radiological regional alignment, and complications. RESULTS: A total of 1449 publications were found, and 29 articles were finally selected for analysis. Of those, 15 were retrospective case reports, and 14 were retrospective case series. One hundred and sixty-nine patients were found in the review. The author's eight cases were added to the found in the literature for a methodological quality assessment. There were 52 (29%) patients managed non-operative, and 125 (71%) underwent surgery. One-hundred-two patients were neurologically intact, of whom 46 were managed non-operative. Canal compromise in intact patients ranged between 20 and 90%. Posterior segmental fixation and instrumentation with decompression was the preferred surgical strategy in patients with neurological deficits. Patients with combined anterior column restoration and anterior approach showed vertebral height and lordosis restoration. A 79% of the operative treated group reported neurological improvement. Patients with pre-operative neurological deficit managed non-operative reported the highest rate of complications (33.3%). CONCLUSION: In the setting of L5 burst fractures, neurological injuries have a promising prognosis after surgery and are not correlated with the degree of canal stenosis. The compromise of the L5 vertebra affects the sagittal balance and its restoration can be achieved with an anterior corpectomy. Nonoperative management can be considered in cases of reasonable alignment, and no neurologic deficit.

Is the routine use of systemic antibiotics after spine surgery warranted? A systematic review and meta-analysis.

PURPOSE: To determine whether the published literature supports the current practice of utilizing antibiotics postoperatively in spine surgery. METHODS: A systematic review from PubMed and Cochrane Central Register of Controlled trials databases was performed. Search terms used: "Antibiotic Prophylaxis"[Mesh], antibiotic*, antibacterial*, "Spine"[Mesh], "Surgical Procedures, Operative"[Mesh]. Only comparative, clinical studies were included. Those studies with surgical site infection (SSI) criteria that were not similar to the CDC definition were excluded. A meta-analysis for overall SSI was performed. A subgroup analysis was also performed to analyze the outcomes specifically on instrumented groups of patients. A random-effects model was used to calculate risk ratios (RR). Forest plots were used to display RR and 95% confidence intervals (CI). RESULTS: Thirteen studies were included (four Randomized-Controlled Trials, three prospective cohorts, and six retrospective). Three different perioperative strategies were used in the selected studies: Group 1: preoperative antibiotic administration (PreopAbx) versus PreopAbx and any type of postoperative antibiotic administration (Pre + postopAbx) (n = 6 studies; 7849 patients); Group 2: Pre + postopAbx ≤ 24 h versus Pre + postopAbx > 24 h (n = 6; 1982); and Group 3: Pre + postopAbx ≤ 48 h versus. Pre + postopAbx ≤ 72 h (n = 1; 502). The meta-analysis performed on Groups 1 and 2 did not show significant effects (RR = 1.27, 95% CI = 0.77, 2.09, and RR = 0.97, 95% CI = 0.64, 1.46, respectively). CONCLUSION: A meta-analysis and comprehensive review of the literature show that the routine use of postoperative antibiotics in spine surgery may not be effective in preventing surgical site infections.

Surgical management of dropped head syndrome: A systematic review.

Background: Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line management consists of medical treatment targeted at diagnosing underlying pathologies. However, the surgical management of DHS has not been well studied. Methods: Here, we systematically reviewed the PubMed and Cochrane databases for DHS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All relevant articles up to March 31, 2022, were analyzed. The patient had to be ≥18 years with DHS and had to have undergone surgery with outcomes data available. Outcomes measurements included neurological status, rate of failure (RF), horizontal gaze, and complications. Results: A total of 22 articles selected for this study identified 54 patients who averaged 68.9 years of age. Cervical arthrodesis without thoracic extension was performed in seven patients with a RF of 71%. Cervicothoracic arthrodesis was performed in 46 patients with an RF of 13%. The most chosen upper level of fusion was C2 in 63% of cases, and the occiput was included only in 13% of patients. All patients neurologically stabilized or improved, while 75% of undergoing anterior procedures exhibited postoperative dysphagia and/or airway-related complications. Conclusion: The early surgery for patients with DHS who demonstrate neurological compromise or progressive deformity is safe and effective and leads to excellent outcomes.

Subtemporal Transcollateral Sulcus Approach for Temporal Horn Tumors: 2-Dimensional Operative Video and Description of the Technique.

INTRODUCTION: Purely temporal intraventricular tumors are uncommon. Given their deep location, access to these brain tumors can be challenging in terms of preserving brain tissue. The subtemporal approach spares the lateral temporal cortex and is a less traumatic corridor to reach intraventricular temporal tumors. OBJECTIVE: To describe and assess the feasibility of the subtemporal transcollateral approach for the removal of a temporal horn tumor. METHODS: We describe the subtemporal transcollateral sulcus operative technique detailed step-by-step and depicted through both video and illustrations to surgically resect a left intraventricular temporal mass in a 44-year-old woman who presented with worsening memory deficits. The surgery was performed under general anesthesia and with the use of a microscope and neuronavigation. RESULTS: The patient did not suffer from any postoperative complications. Her vision was intact, and her memory deficit was unchanged. A brain MRI showed complete removal of the tumor. The pathological examination revealed a World Health Organization grade I meningioma. CONCLUSION: The subtemporal transsulcal approach seems to be an efficient and safe way to access intraventricular lesions within the temporal horn while avoiding any disruption of the optic radiations and temporal language areas.

The Application of Three-Dimensional Technologies in the Improvement of Orthopedic Surgery Training and Medical Education Quality: A Comparative Bibliometrics Analysis.

Orthopedics is a medical specialty that focuses on the clinical treatment and care of the musculoskeletal system. Orthopedics is a medical specialty which specializing in the clinical treatment and nursing of musculoskeletal system. The education of orthopedics is often serious and difficult because of the high technical requirements, complicated anatomical knowledge and long study process. However, medical students or junior residents rarely have the opportunity to see such orthopedic surgery or attend preclinical practice, which limits the opportunities for training clinicians. Hopefully, with the increasing use of three-dimensional (3D) technologies in medical teaching, this situation can be alleviated. In this study, we demonstrate that different 3D technologies can effectively simulate orthopedic surgery with very high accuracy. We carefully evaluated the use of 3D technologies in primary medical teaching and proposed a vision for the future. We searched and screened 3,997 publications from the Web of Science Core Collection (WoSCC) on 22 Oct 2021 with (trauma) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)), (Joint) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)), (spine) AND ((education) OR (training) OR (teaching) OR (learning)) AND ((3D) OR (Three Dimensional)) as the search strategy. Then, we eliminated the publications irrelevant to "orthopedics" AND/OR "orthopaedic" (in United Kingdom English), the final number of publications are 440 for trauma surgery, 716 for joint surgery and 363 for spine surgery, a visual display of comprehensive information analysis was made by VOSviewer. Next, we read and analyzed retrieved articles extensively according to the selection criteria, 11 highly cited publications on three major branches of orthopedics were chosen. The extracted data included the authors, purpose, methods, results and benefits/limitations. The evaluation of these studies directly and objectively proved the superiority of 3D technologies in orthopedics. Furthermore, the material usage and strength of 3D technologies can be closer to the real situation, which will help improve their effectiveness in teaching. We hope that more relevant studies will be conducted to continue examining the effects of 3D technologies on orthopedic medical education as well as orthopedic surgery training, and we hope that this technique can be more widely used in the clinical teaching of orthopedics to train clinicians on learning medical theory and surgical technology quickly and efficiently.

A Versatile Pep-CPDs Nanoprobe for Rapid Detection of mTBI Biomarker in Clinical Instances and Safe Fluorescence Imaging In Vivo for Improved Weight-Drop Mouse Model.

Mild traumatic brain injury (mTBI) is the most common form of traumatic brain injury; however, it is the most difficult to be accurately identified in the early stage because it lacks more reliable biomarkers and detection methods. This study proposes a highly efficient system to detect a molecular biomarker for the early diagnosis of mTBI. The system was prepared by a lower cytotoxic peptide-modified fluorescent nanoprobe based on carbon polymer dots (pep-CPDs) with outstanding imaging capabilities. In vitro and in vivo tests were explored to the efficiency of pep-CPDs, inferring the good performances of cellular fluorescence imaging and in vivo imaging of mice. Moreover, an application of the versatile pep-CPDs on detecting the mTBI biomarker S100-ß detection in a novel improved weight-drop mTBI mouse model and human blood samples has been successfully established. Overall, all these results indicate that the pep-CPD system is sensitive, rapid, non-toxic, and reliable for mTBI diagnosis compared with traditional detection methods. It shows a great potential in clinical and translational research and practical applications.

A 4-Benzene-Indol Derivative Alleviates LPS-Induced Acute Lung Injury Through Inhibiting the NLRP3 Inflammasome.

Acute lung injury (ALI) is a common complication of critical illness that could frequently lead to acute respiratory distress syndrome and other serious clinical consequences. Sepsis is one of the major and most common inducements among all causes of ALI. Due to its high incidence and mortality rate and also the complexity in treatment, sepsis-related ALI has become an urgent clinical problem waiting to be solved effectively. At present, only the protective ventilation strategy, restrictive fluid management, and antibiotics application are measures that can improve the prognosis with evidence-based medical proof. No pharmacological treatment is currently available to protect or significantly reverse the prognosis. Seeking for effective interventions measures for sepsis-related ALI is one of the most necessitous research directions. In this research, a conspicuous discovery of treatment-related translational use for a 4-benzene-indol derivative was elaborated by screening a large number of chemical compounds. The results showed that 4-benzene-indol derivative could not only suppress the activation of NLRP3 inflammasome both in vitro and alleviate LPS-induced ALI in vivo but also suppress the NLRP3 inflammasome in human myeloid leukemia mononuclear cells (THP-1) cell lines. Mechanistically, 1,2-diol blocks the NLRP3 inflammasome activation by disrupting NLRP3-NEK7 interaction and the subsequent NLRP3 inflammasome assembly and activation. To summarize, this research indicated that the newly-discovered 4-benzene-indol derivative targets NLRP3 inflammasome signaling, which consequently alleviates sepsis-related ALI. Collectively, the 4-benzene-indol derivative may serve as a potential therapeutic drug and NLRP3 inflammasome signaling would be a novel pharmaceutical target for clinical treatment of sepsis-related ALI.

Occipital Artery-Posterior Inferior Cerebellar Artery (PICA) Bypass for the Treatment of a Ruptured Fusiform Aneurysm of the Left PICA: 2-Dimensional Operative Video.

Posterior inferior cerebellar artery (PICA) aneurysms are usually complex to treat because of their deep location, frequent entanglement with the lower cranial nerves, the presence of perforating arteries to the brainstem, and their often dissecting or fusiform morphology.1 These aneurysms can require revascularization of the PICA.2 The length and size of the occipital artery (OA) make it an excellent donor.3,4 Video 1 shows the technical nuances of an OA-PICA bypass for the treatment of a ruptured fusiform aneurysm of the left PICA. The patient is a 34-year-old male presenting with an abrupt headache and confusion (Hunt and Hess grade III and World Federation Neurology Surgeons grade II). Computed tomography of the brain revealed hydrocephalus and subarachnoid hemorrhage (Fisher IV) and digital subtraction angiography revealed a fusiform aneurysm on the tonsillomedullary segment of the left PICA. Given the dissecting nature of this aneurysm and the fact that it was ruptured, we felt it would be safer to be prepared to perform revascularization and to secure the aneurysm using an open surgical approach.5 There were no complications associated with this procedure. The patient remained neurologically intact, and imaging showed good flow through the bypass and no evidence of stroke. OA-PICA bypass is a useful strategy to treat ruptured fusiform PICA aneurysms since it avoids sacrificing the PICA and the use of dual-antiplatelet therapy. This video is one of the few videos published on OA-PICA bypass.6,7 It explains the technical aspects, open and endovascular alternatives, and rationale for this procedure.

Antifibrinolytics use during surgery for oncological spine diseases: A systematic review.

Background: Data exist of the benefits of antifibrinolytics such as tranexamic acid (TXA) in general spine surgery. However, there are limited data of its use in oncological spine patients. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, OVID, and Embase databases were searched. Search terms: "tranexamic acid", "aprotinin," "aminocaproic acid," "spine surgery," "spine tumors," and "spine oncology." Included studies were full text publications written in English with patients treated with either agent or who had surgery for oncological spine disease (OSD). Results: Seven hundred results were reviewed form the different databases, seven were selected. A total of 408 patients underwent spine surgery for OSD and received antifibrinolytics. There was a male predominance (55.2%) and mean age ranged from 43 to 62 years. The most common tumor operated was metastatic renal cancer, followed by breast and lung. Most studies administered TXA as a bolus followed by an infusion during surgery. Median blood loss was of 667 mL (253.3-1480 mL). Patients with TXA required 1-2 units less of transfusion and had 56-63 mL less of postoperative drainage versus no TXA. The median incidence of deep venous thrombosis (DVT) was 2.95% (0-7.9%) and for pulmonary embolism (PE) was 4.25% (0-14.3%). The use of TXA reduced intraoperative blood loss, transfusions and reduced postoperative surgical drainage output compared to no TXA use in patients with OSD. Conclusion: In this review, we found that TXA may diminish intraoperative blood loss, the need for transfusion and postoperative drainage from surgical drains when used in OSD without major increase in rates of DVT or PE.

Nontraumatic atlantoaxial rotatory subluxation in adults: Report of two cases.

Background: Nontraumatic infectious atlantoaxial rotatory subluxation (AARS) is rare and less frequently encountered in adults versus children. We utilized a stepwise approach to treat two adults with nontraumatic infectious AARS and summarized the relevant literature. Case Description: Two patients, ages 35 and 66, presented with classic clinical and imaging findings for infectious nontraumatic AARS. Here, we summarized the management for these two patients along with the literature. Conclusion: Nontraumatic infectious AARS in adults requires prompt X-ray diagnosis and timely application of traction to minimize neurological deficits. MR/CT imaging next offers critical information regarding whether operative stabilization is warranted.

Is L5/S1 interbody fusion necessary in long-segment surgery for adult degenerative scoliosis? A systematic review and meta-analysis.

OBJECTIVE: There is no consensus regarding the best surgical strategy at the lumbosacral junction (LSJ) in long constructs for adult spinal deformity (ASD). The use of interbody fusion (IF) has been advocated to increase fusion rates, with additional pelvic fixation (PF) typically recommended. The actual benefit of IF even when extending to the pelvis, however, has not been vigorously analyzed. The goal of this work was to better understand the role of IF, specifically with respect to arthrodesis, when extending long constructs to the ilium. METHODS: A systematic review of the PubMed and Cochrane databases was performed to identify the relevant studies in English, addressing the management of LSJ in long constructs (defined as ≥ 5 levels) in ASD. The search terms used were as follows: "Lumbosacral Junction," "Long Constructs," "Long Fusion to the Sacrum," "Sacropelvic Fixation," "Interbody Fusion," and "Iliac Screw." The authors excluded technical notes, case reports, literature reviews, and cadaveric studies; pediatric populations; pathologies different from ASD; studies not using conventional techniques; and studies focused only on alignment of different levels. RESULTS: The PRISMA protocol was used. The authors found 12 retrospective clinical studies with a total of 1216 patients who were sorted into 3 different categories: group 1, using PF or not (n = 6); group 2, using PF with or without IF (n = 5); and group 3, from 1 study comparing anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion. Five studies in group 1 and 4 in group 2 had pseudarthrosis rate as primary outcome and were selected for a quantitative analysis. Forest plots were used to display the risk ratio, and funnel plots were used to look at the risk of publication bias. The summary risk ratios were 0.36 (0.23-0.57, p < 0.001) and 1.03 (0.54-1.96, p = 0.94) for the PF and IF, respectively; there is a protective effect of overall pseudarthrosis for using PF in long constructs for ASD surgeries, but not for using IF. CONCLUSIONS: The long-held contention that L5/S1 IF is always advantageous in long-construct deformity surgery is not supported by the current literature. Based on the findings from this systematic review and meta-analysis, PF with or without additional L5/S1 interbody grafting demonstrates similar overall construct pseudarthrosis rates. The added risk and costs associated with IF, therefore, should be more closely considered on a case-by-case basis.

10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review.

BACKGROUND: Spinal metastases are present in approximately 20% of patients with cancer, giving a risk for neurologic dysfunction and instability. In already frail patients, surgeons strive to improve quality of life. Our goal was to review a 10-year trend in the surgical management of spinal metastases. METHODS: A scoping review was performed systematically using PubMed to assess trends in surgical treatment for spinal metastases. The search terms used were: metastas∗, "neoplasm metastasis"[Mesh], "Spine"[Mesh], spine, spinal, "vertebral column," "vertebral body," laser, robot, radiofrequency, screws, fixation, "separation surgery," corpectomy, vertebrectomy, spondylectomy, vertebroplasty, kyphoplasty, surgery, "open surgery," "mini open surgery," "minimally invasive surgery," endoscopy, thoracoscopy, corpectom∗, vertebrectom∗, spondylectom∗, "en bloc," and MIS. The variables of interest were neurologic improvement, tumor recurrence, reoperation, and overall survival. RESULTS: A total of 2132 articles were found within the primary query. Fifty-six studies were selected for final review. The results were organized into main surgical practices: decompression, mechanical stabilization, and pain management. For separation surgery, clinical outcomes were overall 1-year survival, 40.7%-78.4%; recurrence rate, 4.3%-22%; reoperation, 5%; and complications, 5.4%-14%. For corpectomy, clinical outcomes were overall 1-year survival, 30%-92%; reoperation, 1.1%-50%; and recurrence rate, of 1.1%-28%. Complications and reoperations with spinal instrumentation were 0%-13.6% and 0%-15%, respectively. Cement augmentation achieved pain reduction rates of 56%-100%, neurologic improvement/stability 84%-100%, and complication rates 6%-56%. Laser achieved local tumor control rate of 71%-82% at 1 year follow-up, reoperation rate of 15%-31%, and complication rate of 5%-26%. CONCLUSIONS: Minimally invasive techniques for decompression and stabilization seem to be the preferred method to surgically treat metastatic spine disease, with good outcomes. More research with high level of evidence is required to support the long-term outcomes of these approaches.

The Multi-Modal Risk Analysis and Medical Prevention of Lumbar Degeneration, Fatigue, and Injury Based on FEM/BMD for Elderly Chinese Women Who Act as Stay-Home Grandchildren Sitters.

Background: An increasing number of Chinese elderly women stay at home and act as grandchildren sitters. In consequence of the frequent load-bearing, chronic lumbar fatigue probably caused a higher risk of lumbar degeneration, fatigue, and injury which has become one of the most important aging and health problems in China. In this study, a multi-mode lumbar finite element model (FEM) with specific bone mineral density (BMD) were developed and validated for further spine injury prevention and control. Methods: The material properties of lumbar vertebra were modified according to degenerated bone mineral density, and geometry was adjusted based on intervertebral disc height. The motion of lifting children was simulated by a 76 year-old Chinese women's FEM, and the stress distribution was calculated and predicted. Results: The pressure of L5-S intervertebral disc in the bending 3-year-old dummy lifting posture was significantly higher than the same posture without lifting, the maximum effective stress of endplate cartilage in the upright child lifting posture was 1.6 times that of the bending without lifting posture. And the fatigue risk limitation frequency of the upright with dummy posture was predicted with the functional equation of fatigue and stress which was deduced by genetic algorithm, which combined with the effective stress of lumbar vertebrae spongy bone calculated from FEM. Conclusions: The child-lifting motion could increase the risk of lumbar degeneration, fatigue, and injury in elderly women, and they should keep below the frequency limit of the motion of lifting children in their daily life. This study could put forward scientific injury prevention guidance to Chinese elderly women who lift children in daily life frequently.

Speech After Long Silence-An Appraisee-Based Comprehensive Analysis With Retrospective and Future Perspectives on Current ID Policy of Transpersons in China.

As the sexual minority in China, transpersons remain faced with various realistic challenges. In recent years, however, there has been a significant progress made in the protection given to the rights that transpersons deserve. Currently, the citizens who have changed their gender through sex reassignment surgery can make applications to the local police station for changing their gender registration and get issued a new ID card. This is regarded as a crucial milestone in reducing the bias against transpersons and protecting their legitimate rights in China. Highlighted by the case of an extraordinary appraisee who have received SRS to change from male to female and started a new life with a new ID, not only does this article construe the current ID policy and the detailed process of ID card change for transpersons in China, it also reveals the living and developmental conditions facing transpersons in China. Finally, the visibility of the community of transpersons is improved to eradicate the discrimination against transpersons.

Blocking HMGB1/RAGE Signaling by Berberine Alleviates A1 Astrocyte and Attenuates Sepsis-Associated Encephalopathy.

As a life-threatening multiple organ dysfunction attributable to maladjusted host immune responses to infection, sepsis is usually the common pathway to serious prognosis and death for numerous infectious diseases all over the world. Sepsis-associated encephalopathy (SAE) is frequently complicated by septic conditions, and is one of the most important reasons for increased mortality and poor outcomes in septic patients which is still an urgent clinical problem need to be solved. In this research, a conspicuously discovery of treatment-related translational use for berberine was elaborated. The results revealed that berberine treatment significantly restored cognitive impairment in sepsis mice. Reduced expression levels of TNF-α, IL-1α, and C1qA were exhibited in the hippocampus of the berberine treatment group, and attenuated effect of declining neo-neuron, activation of microglia and astrocytes in the hippocampus of mice with sepsis were also found. Moreover, berberine inhibits microglia-stressed A1 astrocytes by inhibiting HMGB1 signaling was revealed, then the molecular mechanism of HMGB1/RAGE signaling inhibition leads to the better outcome of SAE was elucidated. To summarize, this research indicated that berberine targets HMGB1/RAGE signaling to inhibit microglia-stressed A1 astrocyte and neo-neuron decline, which consequently alleviates sepsis-induced cognitive impairment. Collectively, berberine may serve as potential therapeutic drug and HMGB1/RAGE signaling would be a novel target for medicine development for treating SAE.