Case report: DKRd regimen in the treatment of newly diagnosed POEMS syndrome and literature review.

POEMS syndrome, characterized as a rare multisystem paraneoplastic syndrome, arises from plasma cell abnormalities. Coined by Bardwick in 1980, the acronym POEMS delineates the distinctive features of the syndrome: Peripheral nerve Lesions, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes. The prevalence of POEMS syndrome stands at approximately 0.3 per 100,000 individuals. Owing to its low prevalence and the paucity of prospective studies, current treatment approaches largely hinge on retrospective studies and revolve around the use of plasma cell-directed therapy typically used in multiple myeloma treatments. This article presents the pioneering case of utilizing a four-drug combination regimen of DKRd (daratumumab, carfilzomib, lenalidomide, and dexamethasone) as a first-line treatment. This is succeeded by induction therapy and subsequently, autologous hematopoietic stem cell transplantation. A comprehensive review of related literature is conducted.

Automatic segmentation of spine x-ray images based on multiscale feature enhancement network.

BACKGROUND: Automatic segmentation of vertebrae in spinal x-ray images is crucial for clinical diagnosis, case analysis, and surgical planning of spinal lesions. PURPOSE: However, due to the inherent characteristics of x-ray images, including low contrast, high noise, and uneven grey scale, it remains a critical and challenging problem in computer-aided spine image analysis and disease diagnosis applications. METHODS: In this paper, a Multiscale Feature Enhancement Network (MFENet), is proposed for segmenting whole spinal x-ray images, to aid doctors in diagnosing spinal-related diseases. To enhance feature extraction, the network incorporates a Dual-branch Feature Extraction Module (DFEM) and a Semantic Aggregation Module (SAM). The DFEM has a parallel dual-branch structure. The upper branch utilizes multiscale convolutional kernels to extract features from images. Employing convolutional kernels of different sizes helps capture details and structural information at different scales. The lower branch incorporates attention mechanisms to further optimize feature representation. By modeling the feature maps spatially and across channels, the network becomes more focused on key feature regions and suppresses task-irrelevant information. The SAM leverages contextual semantic information to compensate for details lost during pooling and convolution operations. It integrates high-level feature information from different scales to reduce segmentation result discontinuity. In addition, a hybrid loss function is employed to enhance the network's feature extraction capability. RESULTS: In this study, we conducted a multitude of experiments utilizing dataset provided by the Spine Surgery Department of Henan Provincial People's Hospital. The experimental results indicate that our proposed MFENet demonstrates superior segmentation performance in spinal segmentation on x-ray images compared to other advanced methods, achieving 92.61 ± 0.431 for MIoU, 92.42 ± 0.329 for DSC, and 99.51 ± 0.037 for Global_accuracy. CONCLUSIONS: Our model is able to more effectively learn and extract global contextual semantic information, significantly improving spinal segmentation performance, further aiding doctors in analyzing patient conditions.

[Application of anterior subcutaneous internal fixator combined with posterior plate in treatment of unstable pelvic fractures].

OBJECTIVE: To investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures. METHODS: Between January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated. RESULTS: All patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%. CONCLUSION: For unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.

[Application of Prognostic Predication Model in Clinical Non-metastatic Renal Cell Carcinoma].

OBJECTIVE: To study and compare the practical use of three prognostic predication models in clinical non-metastatic renal cell carcinoma (RCC). METHODS: We retrospectively collected the data of 1 202 clinical non-metastatic RCC patients operated on between 1999 and 2012 at West China Hospital of Sichuan University. Survival analysis method was used to establish three prognostic prediction models including SSIGN, Leibovich and UISS based on different clinical and pathological indicators. The predictive ability was evaluated by the area under receiver operating characteristic curve (AUC). RESULTS: Of the 1 202 clinical non-metastatic RCC patients, 1 030 cases were limited RCC patients, and 172 cases were locally advanced RCC patients. The median follow-up time of the patients was 63.02 months. The 2-year and 5-year overall survival rate were 94.7% and 87.6%, respectively. The 5-year overall survival rates of patients with different clinical stages and grades were significantly different. The predictive accuracies for limited RCC of UISS, SSIGN and Leibovich model were 0.667, 0.785 and 0.758, respectively. For locally advanced RCC, the predictive accuracies of the three models were all lower than 0.6. CONCLUSIONS: SSIGN has certain predictive value in clinical non-metastatic RCC. However, for the advanced RCC, all the prognostic models demonstrate limited predictive value.

Management of Unusual Atlantoaxial Dislocation.

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: The aim of this study was to describe the successful treatment of one posterior atlantoaxial dislocation without fracture and to review the relevant literature. SUMMARY OF BACKGROUND DATA: Posterior atlantoaxial dislocation without fracture of the odontoid process is extremely rare. Management of these patients is still unknown. METHODS: A posterior atlantoaxial dislocation without fracture in a 58-year-old man with incomplete quadriplegia was treated surgically with posterior atlantoaxial pedicle screws internal fixation and fusion after closed reduction. The images, treatment, and related literature are reviewed. RESULTS: The patient had complete recovery of neurologic deficit and bony fusion of the atlantoaxial joint was identified on the follow-up computed tomography taken 3 months after posterior fixation. To our knowledge, no case of posterior atlantoaxial dislocation with neurologic deficit has been previously reported in English medical literature. CONCLUSION: We described a rare case of posterior atlantoaxial dislocation with neurologic deficit. Treatment procedure of posterior atlantoaxial dislocation was presented. LEVEL OF EVIDENCE: 5.

Guideline for C1 Lateral Mass and C2 Pedicle Screw Choices in Children Younger Than 6 Years.

STUDY DESIGN: Prospective study. OBJECTIVE: To analyze the most feasible choice of C1 lateral mass (C1LM) and C2 pedicle (C2P) screw in upper cervical surgeries for children younger than 6 years. SUMMARY OF BACKGROUND DATA: The C1LM and C2P screw technique is a stable cervical vertebrae internal fixation method in upper cervical surgery. Some tomographic studies have indicated the feasibility of insertion of C1LM and C2P screws in children. Their results, however, varied widely, and no consensus was achieved regarding C1LM and C2P screw choices for different ages in the pediatric population, sex, and laterality. METHODS: The computed tomography images of 250 patients (age 2-6 yr) were studied. The inner diameter and length for each C1LM and C2P were measured in axial view. Height was measured in sagittal view. Screw choice was considered feasible when a sample maintained an additional 0.5 mm bone cortex at the inner diameter, length, and height at the same time. Analyses with the Student t test were performed for age, sex, and laterality. The screw choice was evaluated with a feasibility percentage. RESULTS: Statistical differences were found between different ages, sex, and laterality for C1LM length (P < 0.001) and C2P length (P < 0.001). Screws of different sizes were recommended for each age group, sex, and laterality, with a feasibility percentage. CONCLUSION: The use of a 3.5-mm lateral mass and pedicle screw in 2- to 6-year-old children was feasible in the majority of cases. Age, sex, and laterality should all be considered when choosing screw sizes in pediatric upper cervical surgeries. This information can be particularly helpful for preoperative planning for C1-C2 internal fixation. LEVEL OF EVIDENCE: 3.

miRNA-223 is a potential diagnostic and prognostic marker for osteosarcoma.

BACKGROUND: MicroRNA-223 (miR-223) has been shown to be a potential diagnostic and prognostic marker for several cancers. In addition, miR-223 has been reported to suppress osteosarcoma cell proliferation in vitro. However, the clinical value of miR-223 is still unknown. METHODS: We detected the expression of miR-223 expression in the serum of osteosarcoma patients and in osteosarcoma cancer cells using RT-PCR. We compared the serum expression of miR-223 with the clinicopathological characteristics and survival of osteosarcoma patients. Finally, we explored the role of miR-223 on the invasion of osteosarcoma cancer cells using cell migration and invasion assays. RESULTS: We observed that the expression of miR-223 was significantly decreased in the serum of osteosarcoma patients and osteosarcoma cancer cells compared to healthy controls (P<0.01). Moreover, a receiver operating characteristic (ROC) curve analysis indicated that serum miR-223 is a potential diagnostic marker of osteosarcoma with an area under the ROC curve (AUC) of 0.956. Importantly, the patients with a lower expression of miR-223 tended to have distant metastasis (P<0.001) and a more advanced clinical stage (P<0.001). In addition, the survival time of patients with low miR-223 expression was significantly shorter compared to patients with high miR-223 expression (P<0.001). Furthermore, we found that miR-223 could inhibit the migration and invasion of osteosarcoma cells. CONCLUSIONS: miR-223 might be related to the metastasis of osteosarcoma and could be used as a potential diagnostic and prognostic biomarker in osteosarcoma.

Morphometric analysis of the seventh cervical vertebra for pedicle screw insertion.

BACKGROUND: Anatomy of the pedicles of the seventh cervical vertebra (C7) at the cervicothoracic junction is different from other cervical vertebrae. Fixation of C7 is required during cervical vertebra and upper thoracic injuries in clinical practice. However, the typical pedicle screw insertion methods may have problems in clinical practice based on the anatomical features of C7. This study is to explore a new pedicle screw insertion technique for C7 and to provide anatomical and radiographic basis for clinical application. MATERIALS AND METHODS: C7 vertebral specimens from six human cadavers were observed for the relative position between the posterior bony landmark and the pedicle projection. Computed tomography (CT) was performed for 30 patients with cervical spondylosis (26-61 years old, mean age was 42.3 years old). The CT scan data were processed by Mimics 8.1 software for associated parameter measurement. Appropriate screw entry points (Eps) and insertion angles were selected. A total of 12 pedicle screws were inserted and then observed. The six specimens were observed after inserting the screw using this method. The junction site of the middle 1/3 and outer 1/3 segment of line G [The junction between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process)] was taken as the Ep. The screw insertion direction parallel horizontally to the upper terminal lamina of C7 and the sagittal angle was between 35° and 45°. RESULTS: Gross and imaging observations revealed that pedicle projection was on the line (line G) between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process) and located at the middle 1/3 and outer 1/3 segments of the line (point L[also it is the screw entry points (Eps)]. No significant difference in the measurements on the left and right sides were observed (P > 0.05). No penetration of the 12 screws through pedicle was observed. CONCLUSION: The junction site of the middle 1/3 and outer 1/3 segments of line G are the projection points of C7 pedicles on the lateral mass. The junction site anatomical position was simply and easy to be controlled during surgery, simultaneously avoided uncertainty of other methods. This study provides a new method for determining an Ep for C7 pedicle screw insertion.

Expression of programmed death-1 (PD-1) on CD4+ and CD8+ T cells in rheumatoid arthritis.

Rheumatoid arthritis (RA) is characterized by chronic inflammatory process that targets the synovial lining of diarthrodial joints. Programmed death 1 (PD-1) plays a key role in the negative regulation of the immune response. In the current study, we investigated the expression of PD-1 on peripheral CD4+ and CD8+ T cells in RA patients. Percentage of PD-1+ cells was measured by flow cytometry in 82 RA cases and 90 healthy controls. Results showed that PD-1 expression was significantly decreased in both peripheral CD4+ and CD8+ T cells in RA (p = 0.002 and p < 0.001, respectively). Similarly, serum levels of soluble PD-1 were also downregulated in RA cases. When comparing PD-1 level in RA patients with different clinical parameters, patients with positive C-reactive protein (CRP) revealed lower proportion of PD-1 on CD4+ and CD8+ T cells than those with negative CRP. Also, disease activity score of RA patients was inversely correlated with PD-1 expression on peripheral CD4+ and CD8+ T cells. These data suggested that PD-1 may act as a negative regulator in the pathogenesis and progression of RA.

A comparison of acute hospital charges after tubular versus open microdiskectomy.

OBJECTIVE: To determine if tubular microdiskectomy is associated with differences in hospital charges compared with open microdiskectomy. METHODS: A retrospective review of patients who underwent tubular microdiskectomy or open microdiskectomy performed by the senior authors from 2007-2010 was performed. The primary outcome was inflation-adjusted total hospital charges for each procedure using itemized charge data obtained from the hospital finance department. Secondary outcomes included length of stay, complications, and operative times. RESULTS: There were 76 eligible patients (33 open microdiskectomy and 48 tubular microdiskectomy) identified during the study period. The mean total charge was $27,811 (standard deviation $11,198) in the open group compared with $22,358 (standard deviation $8695) in the tubular group. Total charges in the tubular group were on average $5453 less than in the open group (P = 0.02). There were no significant differences in operative times or complications. Length of stay was significantly shorter in the tubular group (mean 1.5 days open vs. 0.9 days tubular, P = 0.01). CONCLUSIONS: This analysis revealed significantly lower acute hospital charges associated with tubular microdiskectomy versus open microdiskectomy at an academic tertiary care hospital. These differences appear to the related to decreased use of postoperative resources in the tubular group.

Bicyclic cyanothiazolidines as novel dipeptidyl peptidase 4 inhibitors.

The synthesis and biochemical evaluation of novel cyanothiazolidine inhibitors of dipeptidyl peptidase 4 (DPP4) is described. Their main structural feature is a constrained bicyclic core that prevents the intramolecular formation of inactive cyclic species. The inhibitors show good to moderate biochemical potency against DPP4 and display distinct selectivity profiles towards DPP7, DPP8 and DPP9 depending on their substitution.

[Dipyridamole preconditioning protects against ischemia/reperfusion injury of rat liver].

OBJECTIVE: To investigate the protective mechanism of dipyridamole preconditioning against hepatic ischemia/reperfusion injury. METHODS: Thirty SD rats were randomly divided into normal control group, ischemia/reperfusion group, and dipyridamole group, with 10 rats in each group. Using 45-minute ischemia/reperfusion rat model at normal temperature, 10 mg/kg of dipyridamole normal saline were injected into portal vein before ischemia. Only normal saline was injected in the ischemia/reperfusion group. An hour later, blood was obtained from the portal vein to determine the enzyme levels, including alanine aminotransferase (ALT) , lactate dehydrogenase (LDH) and tumor necrosis factor-alpha (TNF-alpha), and endothelin-1 (ET-1). The alteration in pathological morphology of the ischemia lobe was observed. The content of adenosine phosphates in the liver was determined. RESULTS: The ALT and LDH activity, TNF-alpha, ET-1 levels were significantly higher in the ischemia/reperfusion group than those in the control group (all P<0.01). The levels of these variables were much lower in the dipyridamole group than those of the ischemia/reperfusion group (P<0.01), but little higher than those of the control group (P>0.05). The adenosine phosphates levels of ischemia/reperfusion group were significantly lower than those of the control group (P<0.01). They were much higher in the dipyridamole group than those of the ischemia/reperfusion group (P<0.01), but little higher than those of the control group (P>0.05). The control group had obvious alteration in pathological morphology, but only slight alteration was found in dipyridamole group, compared with control group. CONCLUSION: Dipyridamole preconditioning protects against ischemia/reperfusion injury of the liver.

Investigation of elemental content distribution in femoral head slice with osteoporosis by SRXRF microprobe.

A synchrotron radiation X-ray fluorescence microprobe analysis technique was used to scan a slice of the femoral head from its periphery to its center, via cartilage, compact, and spongy zones in order to determine the distribution and the way inorganic substances are lost in bone tissue. The sample preparation and experimental apparatus are described in detail. The quantitative computerized tomography of elemental distribution, such as Ca, P, K, Fe, Zn, Sr, and Pb in bone slice tissue, including cartilage, substantial compact, and substantial spongy, is investigated. Combined with the correlation among P, K, Zn, Sr, and Ca, the route of loss of minerals and the physiological functions of some metal elements in bone are also discussed.

First total synthesis of a natural product containing a chiral, beta-diketone: synthesis and stereochemical reassignment of siphonarienedione and siphonarienolone.

The first total syntheses of siphonarienolone and siphonarienedione are described. The development of a stereoselective synthesis of beta-diketones facilitated the synthesis of the latter compound. The synthesis of the structures proposed for the natural products afforded compounds whose spectral data did not match those of the natural products. However, the synthesis of compounds isomeric to the proposed structures at C(4) and C(5) afforded compounds identical to the natural products, thereby reassigning the stereochemistry of the natural products.