Traumatic Anterior Cervical Disc Herniation Presenting as Severe Dysphagia.

Due to the anatomical characteristics of the cervical spine, few cases of traumatic anterior cervical disc herniation have been reported in the literature. Here, we present a rare case of a traumatic anterior cervical disc herniation presenting as severe dysphagia. A 75-year-old male patient presented with severe dysphagia following an accident three days prior when he fell from a height of stairs. Cervical magnetic resonance (MR) imaging revealed a 1.3 × 1.0 cm extruded disc in the anterior aspect of the C4 level with the base at the C3-4 disc, which displaced the esophagus anteriorly. Esophagography revealed an extrinsic esophageal lesion that was considered to be responsible for the obstruction of the airway at the same level. He underwent a ruptured disc removal via the anterior approach. Preoperative dysphagia was resolved gradually after surgery, and he remained asymptomatic six months after surgery.

Risk Factors of Restenosis After Full Endoscopic Foraminotomy for Lumbar Foraminal Stenosis: Case-Control Study.

OBJECTIVE: To investigate risk factors associated with postoperative restenosis after full endoscopic lumbar foraminotomy (FELF) in patients with lumbar foraminal stenosis (LFS). METHODS: A single-center, retrospective case-control study was conducted on patients diagnosed with foraminal stenosis who underwent FELF between August 2019 and April 2022. The study included 56 patients, comprising 18 cases and 38 controls. Clinical data, radiologic assessments, and surgical types were compared between the groups. The cutoff values of radiologic parameters that differentiate the 2 groups were investigated. RESULTS: No significant difference in age, sex distribution, or presence of adjacent segment disease or grade I spondylolisthesis was observed between the groups. Cases had a higher degree of disc wedging angle (DWA) (3.0° ± 1.1° vs. 0.5° ± 1.4°, p < 0.001), larger coronal Cobb angle (CCA) (8.8° ± 5.1° vs. 4.7° ± 2.5°, p = 0.004), and smaller segmental lumbar lordosis (SLL) than controls (11.0 ± 7.4 vs. 18.0 ± 5.4, p = 0.001). Optimal cutoff values for DWA, CCA, and SLL were estimated as 1.8°, 7.9°, and 17.1°, respectively. A significant difference in surgical types was observed between cases and controls (p = 0.004), with the case group having a higher distribution of patients undergoing discectomy in addition to TELF. CONCLUSION: The study identified potential risk factors for restenosis after FELF in patients with LFS, including higher DWA, larger CCA, smaller SLL angle. We believe that discectomy should be perform with caution during FELF, as it can lead to subsequent restenosis.

Massive Epidural Hematoma Caused by Percutaneous Epidural Neuroplasty: A Case Report.

Percutaneous epidural neuroplasty (PEN) has been used to manage chronic back pain or radicular pain refractory to other conservative treatments, such as medication, injection, and physical therapy. However, similar to all invasive treatment modalities, it has serious complications, such as dural tears, infections, and hematoma formation. Herein, we present a rare case of an 81-year-old female patient on dementia medication who developed paraplegia 5 days after PEN. This is the first report of a poor outcome in a patient with dementia who developed paraplegia after PEN despite an emergency operation for spinal epidural hematoma.

Acute Paraparesis Caused by Spinal Epidural Fluid After Balloon Kyphoplasty for Traumatic Avascular Necrosis: A Case Report.

Minimally invasive procedures, such as percutaneous vertebroplasty or balloon kyphoplasty (BK), eliminate motion at the fracture site and relieve pain associated with traumatic avascular necrosis when conservative treatment fails. However, these are associated with complications, most of which are directly related to cement leakage. Herein, we report a rare case of acute paraparesis caused by spinal cord compression by epidural fluid following BK for the treatment of Kummell's disease in the absence of cement leakage. To the best of our knowledge, this is the first report describing this complication.

Open Surgery for Osteoporotic Compression Fracture Within One Month of Single Level Balloon Kyphoplasty.

Objective: This study aimed to analyze the reasons for open surgery performed within one month of balloon kyphoplasty (BKP) for osteoporotic compression fractures. Methods: This study included 15 patients treated with open surgery within one month of BKP in our institution from 2013 to 2020. Among them, 10 patients underwent BKP in our institution and 5 patients were transferred because of adverse events after undergoing BKP at another hospital. Clinical findings including main indications, neurological deficits, and clinical course were analyzed. Results: All patients were followed up for at least 12 months after surgery (average time 15.5 months, range 12-39 months). Their mean age was 73.7 years and the mean T-score of the spine on bone densitometry was -3.35. The main reasons for open surgery included dislodgement of the cement mass or spinal instability (7 cases, 47%), neural injury due to cement leakage (3 cases, 20%), and spinal cord injury caused by a puncture mistake (3 cases, 20%). Two patients developed acute spinal subdural hematoma, and spinal epidural fluid was pushed out at the back edge of the vertebral body following BKP without signs of major cement leakage into the spinal canal. At the final follow-up, 7 patients with cement mass dislodgement showed complete improvement of related symptoms after posterior fusion with screw fixation. Among the 8 patients with neural injury, 6 improved; however, 2 remained at the same American Spinal Injury Association level. Conclusion: The main reasons for open surgery were cement mass dislodgement and neural injury caused by puncture errors or cement leakage into the spinal canal. It should be noted that proper selection of cases, detailed imaging evaluation, and optimal surgical techniques are key to reducing open surgery after BKP.

NaCl-mediated strategies for the trade-off between Cd bioconcentration and translocation in Solanum nigrum L.

Salt interference significantly affects the behavior of heavy metals in the environment. This study compared and analyzed the response process, migration, and transformation of cadmium (Cd) in the hyperaccumulator Solanum nigrum (S. nigrum) under different NaCl levels to reveal the interference mechanisms of salt in plant remediation of Cd-contaminated soil. The results showed that Cd and salt stress significantly inhibited the growth of plants. The stress effect had more potent growth inhibition at the root than aboveground, thus inducing changes in the spatial configuration of the plants (decreased root-to-aboveground biomass ratio). Salt could activate Cd in plants, enhancing the inhibitory effect on plant growth. Salt increased Cd bioavailability due to the rhizosphere acidification effect, increasing plants' Cd accumulation. The Cd bioconcentration factor in plant roots peaked during the high Cd-high salt treatment (117.10), but the Cd accumulation of plants peaked during the high Cd-low salt treatment (233.04 µg plant-1). Salt additions and increased Cd concentrations enhanced root compartmentalization, inhibiting Cd transport to the aboveground. Changes in Fourier-transform infrared spectroscopy (FTIR) measurements confirmed that the functional groups in plants provided binding sites for Cd. These findings can help guide the phytoremediation of Cd contamination under saline soil conditions.

Complications of Cervical Endoscopic Spinal Surgery: A Systematic Review and Narrative Analysis.

BACKGROUND: There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various studies that examined endoscopic complications, such as cervical disc herniation and foraminal stenosis. This study aimed to investigate the efficacy and safety of endoscopic surgery in cervical radiculopathy. METHODS: We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and keywords were set as "endoscopic cervical spinal surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", and "percutaneous endoscopic cervical discectomy". We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic cervical surgery was divided into three categories: full endoscopic anterior, endoscopic posterior, and unilateral biportal approaches. We excluded duplicate publications, studies without full text, studies without complications or incomplete information, and studies that did not provide the necessary data for extraction, animal experiments, or reviews. RESULTS: Difficulties in swallowing, hematoma, and hoarseness are common complications associated with the anterior cervical approach. In contrast, complications of the posterior approach include nerve root injury, hematoma, and dysesthesia. However, endoscopic cervical spinal surgery, including the full endoscopic anterior, posterior, and unilateral biportal approaches, is a safe and effective treatment for cervical radiculopathy. CONCLUSIONS: Complications of full endoscopic cervical spinal surgery differ significantly depending on the anterior and posterior approaches. In the anterior approach, swallowing difficulty, recurrent disc, hematoma, and dysphonia are the common complications. In contrast, transient dysesthesia, dural tears, upper limb motor deficits, and persistent arm pain are commonly reported with the posterior approach.

How does phosphorus influence Cd tolerance strategy in arbuscular mycorrhizal - Phragmites australis symbiotic system?

To clarify how phosphorus (P) influences arbuscular mycorrhizal fungi (AMF) interactions with host plants, we measured the effects of variation in environmental P levels and AMF colonization on photosynthesis, element absorption, ultrastructure, antioxidant capacity, and transcription mechanisms in Phragmites australis (P. australis) under cadmium (Cd) stress. AMF maintained photosynthetic stability, element balance, subcellular integrity and enhanced antioxidant capacity by upregulating antioxidant gene expression. Specifically, AMF overcame Cd-induced stomatal limitation, and mycorrhizal dependence peaked in the high Cd-moderate P treatment (156.08%). Antioxidants and compatible solutes responded to P-level changes: the primary driving forces of removing reactive oxygen species (ROS) and maintaining osmotic balance were superoxide dismutase, catalase, and sugars at limited P levels and total polyphenol, flavonoid, peroxidase, and proline at abundant P levels, we refer to this phenomenon as "functional link." AMF and phosphorus enhanced Cd tolerance in P. australis, but the regulation of AMF was P-dependent. Phosphorus prevented increases in total glutathione content and AMF-induced GSH/GSSG ratio (reduced to oxidized glutathione ratio) by inhibiting the expression of assimilatory sulfate reduction and glutathione reductase genes. The AMF-induced flavonoid synthesis pathway was regulated by P, and AMF activated Cd-tolerance mechanisms by inducing P-dependent signaling.

Complications and Management of Endoscopic Spinal Surgery.

In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as "endoscopic spinal surgery," "endoscopic cervical foramoinotomy," "PECD," "percutaneous transforaminal discectomy," "percutaneous endoscopic interlaminar discectomy," "PELD," "PETD," "PEID," "YESS" and "TESSYS." We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.

Comparison of early clinical outcomes between SuperCap and direct anterior approaches for total hip arthroplasty / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy of SuperCap approach and direct anterior approach in total hip arthroplasty.@*METHODS@#Clinical data of 70 patients who underwent minimally invasive SuperCap approach and DAA THA in January 2016 to June 2017 were retrospective analyzed. These patients were divided into two groups:SuperCap approach group(SuperCap group) and direct anterior approach group(DAA group). There were 15 males and 15 females in SuperCap group, aged from 45 to 71 years old, and the follow-up time ranged from 24 to 30 months. There were 24 males and 16 females in Group B, aged from 51 to 76 years and the follow-up time ranged from 24 to 36 months. Hemoglobin level of the 3rd day after operation, transfusion rate, acetabular abduction angle, anteversion angle and creatine kinase level of the 3rd day after operation, Harris score of 3 months and the last time, VAS score of 1 week and the last time were recorded and compared. Complications were recorded at the final follow-up.@*RESULTS@#All patients were followed up, the follow-up time of SuperCap group ranged from 24 to 30 months, that of DAA group ranged from 24 to 36 months. No significant differences were found in hemoglobin level on the 3rd day after operation, transfusion rate, Harris score or VAS score between two group (P>0.05). There was no significant difference in Harris score between 3 months after operation and the final follow-up in both groups (P>0.05). There were no significant difference in VAS scores of 6 weeks after operation and on the final follow-up neither(P>0.05). The level of creatine kinase in SuperCap group was significant lower than that in DAA group(P<0.05). Until the final follow-up, there was no significant difference in the incidence of complications between the two groups(P>0.05).@*CONCLUSION@#The clinical effect of minimally invasive SuperCap approach after total hip arthroplasty is comparable to that of DAA approach with less soft tissue injury. Patients can recover rapidly after operation and it is a safe and effective surgical approach for surgeons with short learning curve.

Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review.

OBJECTIVE: The purpose of this study was to suggest appropriate indications and contraindications for full endoscopic surgery and to predict the prognosis for the incidence of complications by reviewing the literature on full endoscopic lumbar decompression for various spinal stenoses and systematically analyzing the contraindications and complications of endoscopic surgery. METHODS: We searched the PubMed/MEDLINE database to identify articles on full endoscopic decompression for lumbar spinal stenosis. The levels of evidence in all studies were classified according to the method adopted by the North American Spine Society (NASS) 2005. Full endoscopic lumbar decompression was divided into interlaminar and transforaminal decompressions. We selected articles that contained preoperative contraindications and complications during and after surgery. We analyzed the evidence level and classified the prescribed contraindications and complications according to the literature. RESULTS: We identified 362 articles, of which 57 met our criteria, with evidence ranging from levels I to V. After reviewing the literature on full endoscopic lumbar decompression, pure back pain without neurogenic symptoms and instability/deformities requiring stabilization were found to be contraindications. Also, in transforaminal decompression, central stenosis or complex foraminal stenoses were contraindications. Dysesthesia (most common), untreated pain, dural tear, disc herniation, infection, incomplete decompression, and other complications have been reported as complications of transforaminal decompression. On the other hand, dural tear (most common), epidural hematoma, transient dysesthesia, untreated pain, motor weakness, and other complications have been reported in interlaminar decompression. CONCLUSIONS: Full endoscopic lumbar surgery, including transforaminal and interlaminar decompression, is a safe and effective surgical option for treating lumbar spinal stenosis; however, it is important to select the transforaminal or interlaminar approach according to the indication.

Decomposed Entropy and Estimation of Output Power in Deformed Microcavity Lasers.

Park et al. showed that the Shannon entropy of the probability distribution of a single random variable for far-field profiles (FFPs) in deformed microcavity lasers can efficiently measure the directionality of deformed microcavity lasers. In this study, we instead consider two random variables of FFPs with joint probability distributions and introduce the decomposed (Shannon) entropy for the peak intensities of directional emissions. This provides a new foundation such that the decomposed entropy can estimate the degree of the output power at given FFPs without any further information.

Tracheostomy Following Anterior Cervical Discectomy and Fusion With Plating in Trauma Patients: Is It Safe?

Objective: This study aimed to evaluate the safety and necessity of tracheostomy after anterior cervical discectomy and fusion (ACDF) with plating, despite the close proximity of the two surgical skin incisions. Methods: Sixty-three patients with traumatic cervical fractures or spinal cord injury (SCI) who underwent single-level ACDF and plating between January 2014 and June 2019 were included in this study. The patients included 45 men and 18 women, with a mean age of 48.5 years. A retrospective analysis of the patients' demographic data, level of injury, radiological findings, and neurological status was performed based on the American Spinal Injury Association (ASIA), open tracheostomy, and decannulation rate. Additionally, risk factors necessitating tracheostomy were statistically analyzed. Results: Eighteen patients (28.5%) required subsequent open tracheostomy. Among them, 11 patients were successfully decannulated, four patients could not be decannulated during the follow-up period, and three patients died of unrelated complications. The median interval from ACDF with plating to open tracheostomy was 9.6 days (range, 5-23 days). On the basis of neurological status, ASIA A and B patients (p<0.001), high signal intensity on T2-weighted-magnetic resonance (MR) images (p=0.001), and major cervical fracture and dislocation were significant risk factors for tracheostomy (p=0.02). No patient showed evidence of significant soft tissue, bony infection, or nonunion during the follow-up period. Conclusion: Independent tracheostomy did not increase the risk of infection or nonunion despite the close proximity of the two surgical skin incisions.

The mechanism of arbuscular mycorrhizal enhancing cadmium uptake in Phragmites australis depends on the phosphorus concentration.

Arbuscular mycorrhizal fungi (AMF) is a vital strategy to enhance the phytoremediation of cadmium (Cd) pollution. However, the function of AMF was influenced by phosphorus (P) concentration. To reveal the effect of AMF on the Cd accumulation of host plants under different P concentrations and how the AMF and P interact, this study comparatively analyzed the regulatory effects of AMF on the Cd response, extraction, and transportation processes of Phragmites australis (P. australis) under different P levels, and explored its physiological, biochemical and molecular biological mechanisms. The study showed that AMF could induce different growth allocation strategies in response to Cd stress. Moreover, AMF promoted plant Cd tolerance and detoxification by enhancing P uptake, Cd passivation, Cd retention in the cell wall, and functional group modulation. Under P starvation treatments, AMF promoted Cd uptake by inducing Cd to enter the iron pathway, increased the transport coefficient by 493.39%, and retained Cd in stems. However, these effects disappeared following the addition of P. Additionally, AMF up-regulated the expression of ZIP, ZIP, and NRAMP genes to promote cadmium uptake at low, medium, and high phosphorus levels, respectively. Thus, the Cd response mechanism of the AMF-P. australis symbiotic system was P dose-dependent.

Pyogenic Andersson Lesion in a Patient With Ankylosing Spondylitis.

Although the exact etiology of the Andersson lesion (AL) remains unclear, it is known to occur mostly in patients with long-standing ankylosing spondylitis (AS). Among the various theories for the etiology of AL, repetitive trauma and inflammatory causes are the most common. The histopathological appearance of the AL in this report was consistent with that of chronic inflammation without any infection. Pyogenic ALs in the context of AS are extremely rare; to the best of our knowledge, positive cultures of this lesion in bone biopsies have never been reported. Herein, we report a rare case of a pyogenic AL with a positive culture and discuss a relevant review of the literature.

Sphingosine-1-phosphate hinders the osteogenic differentiation of dental pulp stem cells in association with AKT signaling pathways / 国际口腔科学杂志·英文版

Sphingosine-1-phosphate (S1P) is an important lipid mediator that regulates a diverse range of intracellular cell signaling pathways that are relevant to tissue engineering and regenerative medicine. However, the precise function of S1P in dental pulp stem cells (DPSCs) and its osteogenic differentiation remains unclear. We here investigated the function of S1P/S1P receptor (S1PR)-mediated cellular signaling in the osteogenic differentiation of DPSCs and clarified the fundamental signaling pathway. Our results showed that S1P-treated DPSCs exhibited a low rate of differentiation toward the osteogenic phenotype in association with a marked reduction in osteogenesis-related gene expression and AKT activation. Of note, both S1PR1/S1PR3 and S1PR2 agonists significantly downregulated the expression of osteogenic genes and suppressed AKT activation, resulting in an attenuated osteogenic capacity of DPSCs. Most importantly, an AKT activator completely abrogated the S1P-mediated downregulation of osteoblastic markers and partially prevented S1P-mediated attenuation effects during osteogenesis. Intriguingly, the pro-inflammatory TNF-α cytokine promoted the infiltration of macrophages toward DPSCs and induced S1P production in both DPSCs and macrophages. Our findings indicate that the elevation of S1P under inflammatory conditions suppresses the osteogenic capacity of the DPSCs responsible for regenerative endodontics.

Anterior Approaches for Two-Level Cervical Degenerative Disease: A Comparative Study of at least 6-Year Follow-Up.

OBJECTIVE: To compare the clinical and radiogrincaphic results of a hybrid surgery (HS) and cervical artificial disc replacement (ADR) for contiguous two-level cervical spondylosis. METHODS: A total of 56 patients with contiguous two-level degenerative cervical spondylosis who underwent cervical HS and ADR via an anterior approach and completed at least 6 years of follow-up were included in this study. Patients were divided into two groups: group I, comprising 22 patients who underwent ADR, and group II, comprising 34 patients who underwent HS combined ADR and anterior cervical discectomy and fusion using a cage. Clinical outcomes were evaluated based on the visual analog scale (VAS) scores for arm pain, neck disability index (NDI), and modified MacNab criteria. Radiological parameters were assessed by measuring the bone fusion status, cervical range of motion (ROM C2-C7), heterotopic ossification (HO), adjacent segment disease (ASD) incidence, and fused segment height (FSH). RESULTS: The VAS scores and NDI significantly improved in both groups, without significant differences between the groups. The incidences of HO, ROM C2-C7, and FSH were similar between groups, without significant differences. New osteophyte formation and osteophyte enlargement at adjacent segments were more frequently found in the HS group; however, the difference was not significant. CONCLUSION: Clinical results of this study showed that the clinical efficacy and radiological changes in HS were similar to those of ADR. HS can be an alternative procedure for the treatment of two-level cervical spondylosis.

Treatment of Extensive Spinal Epidural Abscess with Skipped Laminotomy Using a Pediatric Feeding Tube: A Case Report.

Spinal epidural abscess (SEA) is an unusual form of spinal infection. Performing multilevel laminectomies is controversial in cases of extensive SEA considering the long surgical time and mechanical instability. Here, we report the case of an older woman with extensive SEA and poor general condition who was successfully treated with a less invasive treatment, namely skipped laminotomy using a pediatric feeding tube. A 79-year-old woman complained of progressive weakness in both legs, fever, and back pain. An extensive epidural abscess from the T3 to L5 vertebrae was observed on thoracic and lumbar magnetic resonance imaging (MRI). We performed skipped laminotomy at the T8 and T12 levels, and a 5-Fr pediatric feeding tube was advanced from the caudal level toward the rostral area and rostral level toward caudal level into the dorsal epidural space. Subsequently, regurgitation was performed with saline through the pediatric feeding tube at each level. Following this, to further irrigate the unexposed epidural abscess through laminotomy, the epidural space was washed by continuous irrigation, and the irrigation system was maintained for 48 hours. Follow-up MRI performed 3 weeks after the procedure confirmed near complete removal of the abscess in the thoracic spine, with a small residual abscess in the lumbar spine.

Multi-level methods to quantify risk assessment, source apportionment and identifying key risk areas of soil toxic elements in Ashi River watershed, China.

With the advancement of small watershed governance in agricultural production process, soil toxic element pollution issue in watersheds constitutes a recent research hot spot. The Ashi River watershed is an agriculture-dominated small watershed which is exposed to toxic element sources, posing high risk of toxic element pollution to the planting areas. In this study, collection of soil samples was carried out along the periphery of the river network, and the soil physicochemical parameters and toxic elements (As, Cd, Cr, Cu, Pb, and Zn) were analyzed. The results showed that: (1) The geo-accumulation index (Igeo) and potential ecological risk index were used to evaluate the pollution degree, and the contents of As, Cd, and Zn in some sampling sites exceeded risk screening values. Moreover, soils closer to mining sources were found to be more polluted; (2) Redundancy analysis confirmed the contribution rate relationship between environmental factors and toxic elements. C/N ratio, total carbon (C), and total potassium (K) exhibited significant relationships with toxic elements (P < 0.01 or P < 0.05), respectively. Moreover, geographic locations (longitude, latitude, and elevation) showed significant impacts on toxic element contents (except for Cu); (3) The apportionment of toxic element pollution sources by using principal component analysis showed that Pb, Zn, Cu, and Cd were mainly related to mining activities, while As was closely related to insecticide and herbicide, and Cr was mainly related to soil parent material and electroplating factory; (4) Through the integrated resistance base surface and toxic element sources combined with minimum cumulative resistance model, the toxic element risk areas were identified. The middle reaches corresponded to the extremely high risk zone, which undeniably requires the strengthening of the environmental management.