Impact of COVID-19 pandemic early response measures on myocardial infarctions and acute cardiac care in Singapore.

The COVID -19 pandemic impacted acute myocardial infarction (AMI) attendances, ST-elevation myocardial infarction (STEMI) treatments, and outcomes. We collated data from majority of primary percutaneous coronary intervention (PPCI)-capable public healthcare centres in Singapore to understand the initial impact COVID-19 had on essential time-critical emergency services. We present data comparisons from 'Before Disease Outbreak Response System Condition (DORSCON) Orange', 'DORSCON Orange to start of circuit breaker (CB)', and during the first month of 'CB'. We collected aggregate numbers of weekly elective PCI from four centres and AMI admissions, PPCI, and in-hospital mortality from five centres. Exact door-to-balloon (DTB) times were recorded for one centre; another two reported proportions of DTB times exceeding targets. Median weekly elective PCI cases significantly decreased from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (34 vs 22.5, P = 0.013). Median weekly STEMI admissions and PPCI did not change significantly. In contrast, the median weekly non-STEMI (NSTEMI) admissions decreased significantly from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (59 vs 48, P = 0.005) and were sustained during CB (39 cases). Exact DTB times reported by one centre showed no significant change in the median. Out of three centres, two reported significant increases in the proportion that exceeded DTB targets. In-hospital mortality rates remained static. In Singapore, STEMI and PPCI rates remained stable, while NSTEMI rates decreased during DORSCON Orange and CB. The severe acute respiratory syndrome (SARS) experience may have helped prepare us to maintain essential services such as PPCI during periods of acute healthcare resource strain. However, data must be monitored and increased pandemic preparedness measures must be explored to ensure that AMI care is not adversely affected by continued COVID fluctuations and future pandemics.

On the removal efficiency of copper ions in wastewater using calcined waste eggshells as natural adsorbents.

Eggshells offer many advantages as adsorbents, such as affordability without special preparations other than pulverization and calcination. However, the manufacturing industry generally has a severe problem with high concentrations of heavy metals in wastewater. The purpose of this study was to use eggshell byproducts and calcined eggshell treatment for the adsorption of copper in an aqueous solution. The reaction time, metal concentration, adsorbent dose, temperature, and pH were evaluated using primary factors followed by the response surface method (RSM) to investigate the optimum conditions for eggshell byproducts and calcined eggshell adsorption treatment. The results of the one-factor-at-a-time experiment showed that the optimal adsorption rate was obtained from treatment at 24 h, 25 mg/L, 10 mg, and 25 °C. In addition, the effect of pH on the adsorption rates of eggshells and eggshells with membrane were detected at pH values of 5 and 5.9 and found to be 95.2, 90.5, and 73.3%. The reaction surface experiment showed that the best adsorption rate reached 99.3% after calcination at 900 °C for 2 h and a 20 min reaction. The results showed that eggshells, eggshell membranes, eggshells with membrane, and calcined eggshells could be applied to remove copper ions from industrial wastewater. The adsorption capacity of the calcined eggshell is better than that of the non-calcined eggshell and has good neutrality in acidic industrial wastewater. Therefore, it is convenient and practical for practical production and application. Likewise, this study conveys promising findings in the context of improving wastewater treatment based on a circular economy approach to waste reuse in the food industry and represents a valuable direction for future research.

Research on genetic model of keratoconus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the effect of genetic factors on the pathogenesis of keratoconus and its genetic model.METHODS: Genetic epidemiological methods were used to investigate the prevalence of keratoconus in 280 first-degree relatives of 100 patients with keratoconus who attended Henan Eye Hospital between July 2020 and April 2023. The heritability was estimated by Falconer regression method. The general genetic model was calculated using Penrose method, and the genetic model was confirmed by Falconer formula, Edwards approximation formula and the projection formula of San-Duo Jiang's threshold model theory.RESULTS: The results showed that there were 16(5.714%)first-degree relatives of keratoconus probands suffering from keratoconus, and the heritability of keratoconus was(86.100±7.400)%. The S/q score calculated by the Penrose method was 35.348, which was near to 1/(q)1/2, suggesting that the genetic model of keratoconus might be polygenic inheritance. The expected prevalence in first-degree relatives of keratoconus patients by Falconer formula, Edwards approximation formula and the projection formula of San-Duo Jiang's threshold model theory were 5.900%, 7.714% and 5.700%, respectively, which showed no significant differences from the actual prevalence(5.714%), suggesting that keratoconus was a polygenetic disease.CONCLUSION:Genetic factors might play an important role in the pathogenesis of keratoconus, and keratoconus is a polygenetic disease.

Expression of Thymic Stromal Lymphopoietin in Immune-Related Dermatoses.

Thymic stromal lymphopoietin (TSLP), long known to be involved in Th2 response, is also implicated in multiple inflammatory dermatoses and cancers. The purpose of this study was to improve our understanding of the expression of TSLP in the skin of those dermatoses. Lesional specimens of representative immune-related dermatoses, including lichen planus (LP), discoid lupus erythematosus (DLE), eczema, bullous pemphigoid (BP), psoriasis vulgaris (PsV), sarcoidosis, and mycosis fungoides (MF), were retrospectively collected and analyzed by immunohistochemistry. Morphologically, TSLP was extensively expressed in the epidermis of each dermatosis, but the expression was weak in specimens of DLE. In a semiquantitative analysis, TSLP was significantly expressed in the epidermis in LP, BP, eczema, PsV, sarcoidosis, and MF. TSLP expression was higher in the stratum spinosum in LP, eczema, BP, PsV, and MF and higher in the stratum basale in sarcoidosis and PsV. Moreover, we found positive TSLP staining in the dermal infiltrating inflammatory cells of BP, PsV, and sarcoidosis. Our observation of TSLP in different inflammatory dermatoses might provide a novel understanding of TSLP in the mechanism of diseases with distinctly different immune response patterns and suggest a potential novel therapeutic target of those diseases.

Quantitative analysis and prediction of urban heat island intensity on urban-rural gradient: A case study of Shanghai.

Urbanization causes enormous land use/land cover (LULC) changes, which have become significant drivers of land surface temperature (LST) change in rapidly urbanizing city, and the changes in LULC subsequently increase the LST to form urban heat island (UHI). This paper first identified the spatial distribution pattern of the LULC changes and surface urban heat island intensity (SUHII) in the study area in recent 20 years based on Landsat TM/OLI data. And later, the relationship between the distribution of impervious surface (IS) and vegetable coverage (VC) and SUHII was analyzed quantitatively. Then, the land cover and land surface temperature (LST) in Shanghai in 2027 under three development modes were simulated and predicted based on FLUS model and geospatial analysis. The results showed that (1) Regional land cover and LST had obvious differences in gradient distribution from urban to rural areas, and the outer ring road (Ring3) was an obvious dividing line; (2) the proportion of IS and VC were significantly positively (|R| > 0.695) and negatively (|R| > 0.328) correlated with LST; (3) under the three different scenario development models, the ecological space protection model effectively regulated the SUHII, which was 15.91% less than the SUHII in 2017 (34% inside Ring3 and 14% outside Ring3). The results could provide a reference for the rational allocation of urban land and landscape optimization in reducing SUHII` in typical urbanized areas.

Containing the Spread of Coronavirus Disease 2019 (COVID-19): Meteorological Factors and Control Strategies

The novel coronavirus disease 2019 (COVID-19) has spread globally and the meteorological factors vary greatly across the world. Understanding the effect of meteorological factors and control strategies on COVID-19 transmission is critical to contain the epidemic. Using individual-level data in mainland China, Hong Kong, and Singapore, and the number of confirmed cases in other regions, we explore the effect of temperature, relative humidity, and control measures on the spread of COVID-19. We found that high temperature mitigates the transmission of the disease. High relative humidity promotes COVID-19 transmission when temperature is low, but tends to reduce transmission when temperature is high. Implementing classical control measures can dramatically slow the spread of the disease. However, due to the occurrence of pre-symptomatic infections, the effect of the measures to shorten onset-to-isolation time is markedly reduced and the importance of contact tracing and quarantine and social distancing increases. The analytic results also highlight the importance of early intervention to contain the spread of COVID-19.

Acute lethal and sublethal effects of four insecticides on the lacewing (Chrysoperla sinica Tjeder).

The lacewing, Chrysoperla sinica, is an important predatory insect, which plays an important role in the integrated pest management of agroforestry pests. However, the extensive use of insecticides negatively affects C. sinica. The acute toxicity, risk level, and, sublethal effects on growth and production, predation ability, protective enzyme activity and genotoxicity of four insecticides: indoxacarb, emamectin benzoate, imidacloprid and lambda-cyhalothrin to C. sinica were studied. The results showed that all four insecticides had lethal toxicity to larvae of C. sinica. Among them, emamectin benzoate had the highest toxicity with LC50 value of 7.41 mg/L. The insecticides also had different effects on the growth and reproduction of C. sinica, of which lambda-cyhalothrin had the greatest impacts. Even at a very low LC1 concentration (3.37 mg/L), it had strong impacts on the growth, reproduction and predatory ability of C. sinica. The four insecticides also caused a decrease in the predatory ability of the lacewing, of which lambda-cyhalothrin had the greatest effect. During the larval stage, the activities of superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) were significantly decreased by the four insecticides. At the pupal and adult stages, the effects of the four insecticides on the activities of protective enzymes were different, and the activities of SOD, CAT and POD decreased or increased. Indoxacarb and lambda-cyhalothrin exposure induced DNA damage in the haemocytes of C. sinica and produced obvious genotoxicity. These results provide important scientific basis for the rational use of these insecticides and the protection and utilization of lacewing.

A review on methods for offline removing of artifacts in electroencephalography induced by transcranial magnetic stimulation / 生物医学工程学杂志

Transcranial magnetic stimulation (TMS) combined with electroencephalography(EEG) has become an important tool in brain research. However, it is difficult to remove the large artifacts in EEG signals caused by the online TMS intervention. In this paper, we summed up various types of artifacts. After introducing a variety of online methods, the paper emphasized on offline approaches, such as subtraction, principal component analysis and independent component analysis, which can remove or minimize TMS-induced artifacts according to their different characteristics. Although these approaches can deal with most of the artifacts induced by TMS, the removal of large artifacts still needs to be improved. This paper systematically summarizes the effective methods for artifacts removal in TMS-EEG studies. It is a good reference for TMS-EEG researchers while choosing the suitable artifacts removal methods.

Two rare cases of synchronous and metachronous colonic metastases in patients with advanced gastric cancer.

BACKGROUND: Patients with advanced gastric cancer (GC) may ultimately die because GC mostly leads to synchronous or metachronous metastasis. However, colonic metastasis of GC is extremely rare. According to a PubMed search of papers published from May 1968 to March 2017, only 21 patients with GC (10 patients from 10 case reports and 11 patients from a retrospective study) have been found to have colonic metastasis. In this report, we present two cases of synchronous and metachronous colonic metastases of advanced GC. CASE PRESENTATION: Two patients with advanced GC received a diagnosis of colonic metastasis based on colonoscopic findings and computed tomography images, and the diagnosis was confirmed through pathological immunohistochemical analysis. Herein, we describe the management and outcomes of these metastases. CONCLUSIONS: Submucosal swelling and segmental bowel wall thickening observed through colonoscopy in patients with advanced GC might indicate colonic metastasis.

Research progress of TNKS as drug target / 中国药理学通报

TNKSs are members of poly ( ADPribose) polymera-ses, which are different from other members of the PARP family with two unique structures: SAM domain and ankyrin repeat re-gion. TNKS participates in a variety of cellular function regula-tion, including telomere’ s dynamic balance, Wnt signaling pathways, glucose metabolism and spindle formation during mi-tosis. TNKS, as a very attractive drug target, regulates the sta-bility of target proteins via poly ( ADP-ribosylation). In recent years, the significant progress has been made for PARP inhibi-tors in cancer treatment. Multiple PARP inhibitors have entered different clinical evaluation stages. AstraZeneca's Olaparib, Clo-vis's Rucaparib, Merck's Niraparib come into existence in the market. This paper summarizes the recent studies of TNKS and its related inhibitors.

Specificity protein 1-modulated superoxide dismutase 2 enhances temozolomide resistance in glioblastoma, which is independent of O6-methylguanine-DNA methyltransferase.

Acquisition of temozolomide (TMZ) resistance is a major factor leading to the failure of glioblastoma (GBM) treatment. The exact mechanism by which GBM evades TMZ toxicity is not always related to the expression of the DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT), and so remains unclear. In this study, TMZ-resistant variants derived from MGMT-negative GBM clinical samples and cell lines were studied, revealing there to be increased specificity protein 1 (Sp1) expression associated with reduced reactive oxygen species (ROS) accumulation following TMZ treatment. Analysis of gene expression databases along with cell studies identified the ROS scavenger superoxide dismutase 2 (SOD2) as being disease-related. SOD2 expression was also increased, and it was found to be co-expressed with Sp1 in TMZ-resistant cells. Investigation of the SOD2 promoter revealed Sp1 as a critical transcriptional activator that enhances SOD2 gene expression. Co-treatment with an Sp1 inhibitor restored the inhibitory effects of TMZ, and decreased SOD2 levels in TMZ-resistant cells. This treatment strategy restored susceptibility to TMZ in xenograft animals, leading to prolonged survival in an orthotopic model. Thus, our results suggest that Sp1 modulates ROS scavengers as a novel mechanism to increase cancer malignancy and resistance to chemotherapy. Inhibition of this pathway may represent a potential therapeutic target for restoring treatment susceptibility in GBM.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study.

INTRODUCTION: Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network. METHODS: Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. RESULTS: A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported. CONCLUSION: Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.

[Effect of Rapamycin on Expression of Survivin and Caspase-3 and Its Influence on K562 Cell Ultrastructure].

OBJECTIVE: To investigate the effect of rapamycin on the expression of survivin and caspase-3 at mRNA level in K562 cells and the influence of rapamycin on K562 cell ultrastructure. METHODS: The effects of rapamycin at various concentration on K562 cell proliferation were analyzed by CCK8; the morphological characteristics of K562 cells was observed by transmission electron microscopy; the expression of survivin and caspase-3 at mRNA level in K562 cells treated with rapamycin was detected by RT-PCR. RESULTS: The proliferation of K562 cells was significantly inhibited by rapamycin. The apoptosis level of K562 cells increased with increase of rapamycin concentration, the expression of survivin at mRNA level decreased with increase of rapamycin concentration (P < 0.05). The expression of caspase-3 at mRNA level increased with increase of rapamycin concentration. CONCLUSION: Rapamycin can prornote K562 cell apoptosis through up-regulating caspase-3 level and reduceing survivin level.

Simplified MELD Score Accurately Classifies HBV-related Cirrhotic Patients with Acute Decompensation into Different Short-term Prognostic Groups / 胃肠病学

Background:For patients with liver cirrhosis and acute decompensation(AD),it is of great clinical importance to predict short-term mortality at admission. It has been reported that CLIF-C OF,MELD and MELD-Na score can accurately predict the short-term mortality,but all these scoring systems are complicated and have limits in their application. Aims:To define a simple and objective scoring system -- simplified MELD score for short-term mortality prediction in HBV-related cirrhotic patients with AD. Methods:A total of 890 consecutive HBV-related cirrhotic patients with AD hospitalized during Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled retrospectively. Clinical data and patients’outcome were collected,and simplified MELD score was calculated by using total bilirubin,international normalized ratio and creatinine values at admission. Patients were classified into different prognostic groups according to their 28-day mortalities and simplified MELD score. Kaplan-Meier survival curve was used to analyze the 1-year accumulate survival rate,and ROC curve was used to evaluate the performance of different scoring systems in predicting 28-day mortality. Results:Simplified MELD score at admission could classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups and different long-term prognostic groups;the score of low,moderate and high 28-day mortality group was 0-2,3 and 4-6,respectively,and the corresponding mortality was 5. 5% ,19. 8% and 48. 6% ,respectively. Simplified MELD score had the same good performance as compared with the CLIF-C OF,MELD and MELD-Na scores in predicting 28-day mortality,the area under ROC curve was 0. 828,0. 831,0. 828 and 0. 830,respectively. Conclusions:Simplified MELD score can accurately classify HBV-related cirrhotic patients with AD into low,moderate and high 28-day mortality groups at admission. It is convenient for using in clinical practice.

Establishment of Model of Dynamic Change of Immune Status of ACLF Induced by ConA Repeated Administration in Mice / 胃肠病学

Background:Acute-on-chronic liver failure( ACLF)is a commonly seen liver failure in China,and lacking an animal model that can effectively simulate the dynamic change of immune status of ACLF. Aims:To establish an animal model that can simulate dynamic change of immune status of ACLF by repeated administration of concanavalin A(ConA). Methods:Mice were randomly divided into normal control group and ConA repeated administration group. Mice in ConA repeated administration group were injected with ConA 15 mg/ kg through retrobulbar angular vein every 48 hours for 5 times,and mice in control group were injected with same volume of 0. 9% NaCl solution. Serum levels of IL-6,IL-10,IL- 12,TNF-α,IFN-γ,MCP-1 in peripheral blood were assessed by CBA assay,and the ratio of IL-10/ TNF-α was calculated. The expression of HLA-DR,number and proportion of CD4+ T cells and the expression of PD-1 of monocytes in peripheral blood were detected by flow cytometry. Results:Peripheral blood cytokines changed from predominated proinflammatory cytokines into predominated anti-inflammatory cytokines with the increasing in time of administration in ConA repeated administration group. Compared with control group,HLA-DR expression of monocytes in peripheral blood was significantly decreased(P <0. 05),number and proportion of CD4+ T cells were significantly decreased(P <0. 05), and PD-1 expression was significantly increased( P < 0. 05)in ConA repeated administration group. Conclusions:An animal model of ACLF immune status from systemic inflammatory response syndrome( SIRS) to compensatory antiinflammatory response syndrome(CARS)induced by repeated ConA stimulation is successfully established.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

<p><b>INTRODUCTION</b>Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.</p><p><b>METHODS</b>Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.</p><p><b>RESULTS</b>A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.</p><p><b>CONCLUSION</b>Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.</p>

STMN1 overexpression correlates with biological behavior in human cutaneous squamous cell carcinoma.

Stathmin 1 (STMN1) is an important molecule in regulating cellular microtubule dynamics and promoting microtubule depolymerization in interphase and late mitosis. Evidences showed that STMN1 was up-regulated in many cancers, but there was no report about the roles of STMN1 in human cutaneous squamous cell carcinoma (cSCC). Here, we confirmed significant upregulation of STMN1 in cSCC tissues and cell lines compared with non-tumor counterparts. STMN1 upregulation was associated with the proliferation, migration, invasion and apoptosis of cSCC cells. The results suggested that STMN1 may play an important role in the development and tumor progression of cSCC.

Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model.

OBJECTIVES/HYPOTHESIS: Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage. STUDY DESIGN: Prospective porcine model with continuous intraoperative neuromonitoring (CIONM). METHODS: Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration. RESULTS: In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55 °C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60 °C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70 °C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60 °C exposure showed slight EMG amplitude recovery (16%-35%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM. CONCLUSION: Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures. LEVEL OF EVIDENCE: N/A.

Expression and Function of HAX-1 in Human Cutaneous Squamous Cell Carcinoma.

HAX-1 is an anti-apoptotic factor and overexpressed in many types of cancers. However, the functional role of HAX-1 in human cutaneous squamous cell carcinoma (cSCC) remains unclear. Our aim was to investigate the expression of HAX-1 in cSCC and its relationship with the development of cSCC. HAX-1 expression in cSCC tissues and in-vitro cell models were evaluated by real-time quantitative PCR (RT-qPCR), Western blot and immunohistochemistry. And the RNAi strategy was used to observe the relationship of HAX-1 and cSCC in A431 cells. The mRNA and protein level of HAX-1 were significantly higher in cSCC compared with normal tissue. There were significant differences in thickness (P=0.014), differentiation (P=0.027) and TNM stages (P=0.007). After knockdown the expression of HAX-1 by siRNA, the proliferation and the motility of A431 cell was inhibited obviously, and the apoptosis of A431 cells were induced too. HAX-1 may be a risk factor for patients with cSCC. As a potential tumor promoter in cSCC, HAX-1 may be a novel potential therapeutic target for cSCC treatment and deserves further investigation.

Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes.

PURPOSE: Postoperative spinal implant infection (PSII) places patients at risk for pseudarthrosis, correction loss, spondylodiscitis, adverse neurological sequelae, and even death; however, prognostic factors that predict long-term treatment outcomes have not been clearly investigated. In addition, few studies concerning the feasibility of reconstructing the failed spinal events have been published. METHODS: We performed a cohort study of 51 patients who contracted PSII in the posterolateral thoracolumbar region at a single tertiary center between March 1997 and May 2007. Forty-seven patients (92.2 %) had one or more medical problems. Isolated bacterial species, infection severity, treatment timing, and hosts' defense response were evaluated to assess their relationship with management outcomes. The use of implant salvage, or removal subsequent with a revision strategy depended on the patient's general conditions, infection control, and implant status for fusion. RESULTS: The most common infective culprit was Staphylococcus spp. found in 35 of 60 (58.3 %) isolates, including 20 methicillin-resistant species. Gram-negative bacilli and polymicrobial infection were found significantly in patients presenting early-onset, deep-site infection and myonecrosis. Prompt diagnosis and aggressive therapy were responsible for implant preservation in 41 of 51 cases (80.4 %), while implant removal noted in 10 cases (19.6 %) was attributed to delayed treatment and uncontrolled infection with implant loosening, correction loss, or late infection with spondylodesis. The number of employed debridements alone was not significantly correlated with successful implant preservation. Delayed treatment for infection >3 months significantly led to implant removal (p < 0.05) and a higher number of failed spinal events. Patients with significant comorbidities, malnutrition, severe trauma, neurological deficits, long-level instrumentation, and delayed treatment had poor outcomes. Sixteen patients (31.4 %) exhibited probable nonunion or pseudarthrosis, and eight symptomatic patients among them underwent successful revision surgery. CONCLUSIONS: Retention of the mechanically sound implants in early-onset infection permits fusion to occur, while delayed treatment, severe malnutrition and multiple comorbidities will most likely result in a lack of effectiveness in eradicating the infecting pathogens. Restoring optimal physiological conditions is imperative in high-risk patients to allow for further healing. When loosened screws cause peridiscal erosion and incapacitating motion pain, premature implant removal possibly results in failed fusion and correction loss. Reconstruction for a failed spinal event is feasible following infection control.