Research on the targeted improvement of the yield of a new VB12-producing strain, Ensifer adhaerens S305, based on genomic and transcriptomic analysis.

BACKGROUND: Vitamin B12 (VB12) has a wide range of applications and high economic value. In this study, a new strain with high VB12 production potential, Ensifer adhaerens S305, was identified in sewage. Because E. adhaerens strains have become the main strains for VB12 production via fermentation in recent years, the directional modification of the S305 strain to obtain a strain suitable for the industrial production of VB12 has great potential and commercial value. RESULTS: 16S rRNA and genome-wide phylogenetic tree analysis combined with average nucleotide identity (ANI) analysis showed that the high-yielding VB12 strain was a E. adhaerens strain and that its VB12 synthesis pathway genes were highly similar to related genes of strains of this and other species, including E. adhaerens Casida A, Pseudomonas denitrificans SC 510, and E. adhaerens Corn53. High-pressure liquid chromatography (HPLC) results indicated that the VB12 yields of the S305 strain were more than double those of the Casida A strain under different medium components. Multiple genes with significantly upregulated and downregulated transcription were identified by comparing the transcription intensity of different genes through transcriptome sequencing. KEGG enrichment analysis of the porphyrin metabolism pathway identified 9 significantly upregulated and downregulated differentially expressed genes (DEGs) in the VB12 synthesis pathway, including 7 transcriptionally upregulated genes (cobA, cobT, hemA, cobJ, cobN, cobR, and cobP) that were episomally overexpressed in the Casida A strain. The results showed that the VB12 yield of the overexpressed strain was higher than that of the wild-type strain. Notably, the strains overexpressing the cobA and cobT genes exhibited the most significant increases in VB12 yield, i.e., 31.4% and 24.8%, respectively. The VB12 yield of the S305 strain in shake-flask culture was improved from 176.6 ± 8.21 mg/L to 245.6 ± 4.36 mg/L by integrating the cobA and cobT genes into the strain. CONCLUSION: Phylogenetic tree and ANI analysis showed that the Ensifer and Sinorhizobium strains were quite different at the genome level; the overexpression and integrated expression of significantly upregulated genes in the VB12 synthesis pathway could increase the yield of VB12, further improving the VB12 yield of the E. adhaerens S305 strain.

Effect of blocking the haem synthesis pathway and weakening the haem synthesis pathway for sirohaem on the growth of and vitamin B12 synthesis in Ensifer adhaerens Casida A.

To block and weaken the bacterial branched VB12 synthetic metabolic pathway, homologous recombination technology was used to knock out the sirohaem synthase gene cysG located in the chromosome and the endogenous A plasmid of the Ensifer adhaerens Casida A strain, and the expression of the uroporphyrinogen III decarboxylase gene hemE was weakened by weak promoter substitution. The growth of the engineered strains and the production of VB12 and haem were analysed and measured in the engineered strains, aiming to provide a new strategy for enhancement of VB12 biosynthesis. The results showed that the chromosomal cysG gene knockout strain ΔcysG, endogenous A plasmid cysG gene knockout strain ΔpAcysG and cysG gene double knockout strain ΔcysGΔpAcysG grew normally, with VB12 yield increases of 19.9%, 11.2%, and 27.4% compared to the starting strain, respectively. In the background of the cysG gene knockout strain, the expression of the hemE gene was weakened, resulting in the generation of the strain ΔcysGΔpAcysG-E-pdnaD, and the VB12 yield of ΔcysGΔpA cysG-E-pdnaD reached 114.17 ± 5.77 mg L-1, an increase of 45.1% compared to the yield of the original strain. The above results indicate that the strategy of increasing VB12 production by knocking out the haem synthesis pathway and weakening the haem synthesis pathway is effective.

Identification of topoisomerase 2A as a novel bone metastasis-related gene in liver hepatocellular carcinoma.

BACKGROUND: Bone is the second most frequent site of metastasis for Liver hepatocellular carcinoma (LIHC), which leads to an extremely poor prognosis. Identifying novel biomarkers and therapeutic targets for LIHC patients with bone metastasis is urgently needed. METHODS: In this study, we used multiple databases for comprehensive bioinformatics analysis, including TCGA, GEO, ICGC, GTEx, TISIDB, and TIMER, to identify key genes related to bone metastasis of LIHC. Clinical tissues and tissue microarray were adopted to assess the expression of TOP2A through qRT-PCR and immunohistochemistry analyses in LIHC. Gene enrichment analysis, DNA methylation, gene mutation, prognosis, and tumor immunity associated with TOP2A in LIHC were investigated. In vitro and in vivo experiments were performed to explore the functional role of TOP2A in LIHC bone metastasis. RESULTS: We identified that TOP2A was involved in LIHC bone metastasis. Clinically, TOP2A was highly expressed in LIHC tumoral specimens, with the highest level in the bone metastasis lesions. TOP2A was an independent prognostic factor that higher expression of TOP2A was markedly associated with poorer prognosis in LIHC. Moreover, the abnormal expression of TOP2A might be related to DNA hypomethylation, often accompanied by TP53 mutation, immune escape and immunotherapy failure. Enrichment analysis and validation experiments unveiled that TOP2A stimulated the Hippo-YAP signaling pathway in LIHC. Functional assays confirmed that TOP2A could promote bone-specific metastatic potential and tumor-induced osteolysis in LIHC. CONCLUSIONS: These findings unveil that TOP2A might be a novel prognostic biomarker and therapeutic target for LIHC bone metastasis.

Mealybug salivary microbes inhibit induced plant defenses.

BACKGROUND: Phenacoccus solenopsis is a polyphagous invasive mealybug that caused serious damage to crops worldwide. Phloem-sucking hemipterans are known to carry symbiotic microbes in their saliva. However, the role of salivary bacteria of P. solenopsis in modulating plant defenses remains limited. Exploring the impact of salivary bacteria on plant defense responses will contribute to the development of new targets for efficient control of invasive mealybugs. RESULTS: Salivary bacteria of the invasive mealybug P. solenopsis can suppress herbivore-induced plant defenses and thus enhance mealybug fitness. Mealybugs treated with an antibiotic showed decreased weight gain, fecundity and survival. Untreated mealybugs suppressed jasmonic acid (JA)-regulated defenses but activated salicylic acid (SA)-regulated defenses in cotton plants. In contrast, antibiotic-treated mealybugs triggered JA-responsive gene expression and JA accumulation, and showed shortened phloem ingestion. Reinoculating antibiotic-treated mealybugs with Enterobacteriaceae or Stenotrophomonas cultivated from mealybug saliva promoted phloem ingestion and fecundity, and restored the ability of mealybugs to suppress plant defenses. Fluorescence in situ hybridization visualization revealed that Enterobacteriaceae and Stenotrophomonas colonize salivary glands and are secreted into the mesophyll cells and phloem vessels. Exogenous application of the bacterial isolates to plant leaves inhibited JA-responsive gene expression and activated SA-responsive gene expression. CONCLUSION: Our findings imply that symbiotic bacteria in the saliva of the mealybug play an important role in manipulating herbivore-induced plant defenses, enabling this important pest to evade induced plant defenses and promoting its performance and destructive effects on crops. © 2023 Society of Chemical Industry.

Direct and indirect damage zone of radiofrequency ablation in porcine lumbar vertebra.

Objectives: To explore the direct and indirect heat damage zone of radiofrequency ablation (RFA) in porcine vertebrae and to verify the safety of RFA in a vascularized vertebral tumor model. Methods: RFA was performed in the porcine lumbar vertebrae. Magnetic resonance (MR) imaging, hematoxylin and eosin (HE), and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) were used to assess the extent of direct and indirect injuries after RFA. The cavity of lumbar vertebrae was made, and the adjacent muscle flap was used to fill the cavity to make a vertebrae tumor model. RFA was performed in the vascularized vertebral tumor model. Results: T1-weighted images showed a hypointensive region in the center surrounded by a more hypointensive rim on day 0 and 14. T2-weighted images showed that RFA zone was hypointensive on day 0. On day 7, hypointensity was detected in the center surrounded by a hyperintensive rim. HE showed that the RFA zone could be clearly observed on day 14. Thin bone marrow loss areas were seen around the RFA zone, which was consistent with the hyperintensive rim on the T2-weighted images. TUNEL showed a large number of apoptotic cells in the RFA zone. During RFA in the vertebral tumor model, the temperature of all monitoring positions was less than 45 °C. Conclusion: Using in vivo experiments, the effective zone of RFA was evaluated by MR imaging and pathology, and the direct and indirect damage range were obtained. The safety of RFA was verified by RFA in a vascularized vertebral tumor model.

A deep learning-based prediction model of college students' psychological problem categories for post-epidemic era-Taking college students in Jiangsu Province, China as an example.

For a long time, it takes a lot of time and energy for psychological workers to classify the psychological problems of college students. In order to quickly and efficiently understand the common psychological problems of college students in the region for real-time analysis in the post-epidemic era, 2,000 college students' psychological problems were selected as research data in the community question section of the "Su Xin" application, a psychological self-help and mutual aid platform for college students in Jiangsu Province. First, word segmentation, removal of stop words, establishment of word vectors, etc. were used for the preprocessing of research data. Secondly, it was divided into 9 common psychological problems by LDA clustering analysis, which also combined with previous researches. Thirdly, the text information was processed into word vectors and transferred to the Attention-Based Bidirectional Long Short-Term Memory Networks (AB-LSTM). The experimental results showed that the proposed model has a higher test accuracy of 78% compared with other models.

Nectin-4 promotes osteosarcoma progression and metastasis through activating PI3K/AKT/NF-κB signaling by down-regulation of miR-520c-3p.

PURPOSE: Nectin-4 is specifically up-regulated in various tumors, exert crucial effects on tumor occurrence and development. Nevertheless, the role and molecular mechanism of Nectin-4 in osteosarcoma (OS) are rarely studied. METHODS: The expression of Nectin-4 and its relationship with clinical characteristics of OS were investigated using OS clinical tissues, tissue microarrays, TCGA, and GEO databases. Moreover, the effect of Nectin-4 on cell growth and mobility was detected by CCK-8, colony formation, transwell, and wound-healing assays. The RT-qPCR, Western blotting, and luciferase reporter assays were performed to explore molecular mechanisms through which Nectin-4 mediates the expression of miR-520c-3p, thus modulating PI3K/AKT/NF-κB signaling. In vivo mice models constructed by subcutaneous transplantation and tail vein injection were used to validate the functional roles of Nectin-4 and miR-520c-3p. RESULTS: Nectin-4 displayed a higher expression in OS tumor tissues compared with normal tissues, and its overexpression was positively associated with tumor stage and metastasis in OS patients. Functionally, Nectin-4 enhanced OS cells growth and mobility in vitro. Mechanistically, Nectin-4 down-regulated the levels of miR-520c-3p that directly targeted AKT-1 and P65, thus leading to the stimulation of PI3K/AKT/NF-κB signaling. In addition, the expression of miR-520c-3p was apparently lower in OS tissues than in normal tissues, and its low expression was significantly related to tumor metastasis. Furthermore, ectopic expression of miR-520c-3p markedly blocked the effect of Nectin-4 on OS cell growth and mobility. Knockdown of Nectin-4 could suppress the tumorigenesis and metastasis in vivo, which could be remarkably reversed by miR-520c-3p silencing. CONCLUSIONS: Nectin-4 as an oncogene can promote OS progression and metastasis by activating PI3K/AKT/NF-κB signaling via down-regulation of miR-520c-3p, which could represent a novel avenue for identifying a potential therapeutic target for improving patient outcomes.

A Novel Ferroptosis-Related Long Non-Coding RNA Prognostic Signature Correlates With Genomic Heterogeneity, Immunosuppressive Phenotype, and Drug Sensitivity in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) with high heterogeneity is a common malignancy worldwide, but effective treatments are limited. Ferroptosis plays a critical role in tumors as a novel iron-dependent and reactive oxygen species-reliant type of cell death. Several studies have shown that long non-coding RNAs (lncRNAs) can drive HCC initiation and progression. However, the prognostic value of ferroptosis-related lncRNAs in patients with HCC has not been explored comprehensively. Gene set variation analysis (GSVA) based on gene set and RNA-seq profiles obtained from public databases indicated that ferroptosis is suppressed in HCC patients. Ferroptosis-related differentially expressed lncRNAs were screened by Pearson's test. Univariate Cox regression, least absolute shrinkage and selection operator (LASSO) regression, and multivariate Cox regression were performed to establish a novel five ferroptosis-related lncRNA signature in the training cohort with 60% patients, which was further verified in the testing cohort with 40% patients. Dimensionality reduction analysis, Kaplan-Meier curve, receiver operating characteristic (ROC) curve, independent prognostic analysis, and stratification analysis confirmed that our signature had a high clinical application value in predicting the overall survival of HCC patients. Compared to the clinicopathological factors and the other four published HCC prognostic signatures, the current risk model had a better predictive value. The comparison results of functional enrichment, tumor immune microenvironment, genomic heterogeneity, and drug sensitivity between the high- and low-risk groups showed that the risk score is associated with extensive genomic alterations, immunosuppressive tumor microenvironment, and clinical treatment response. Finally, cell experiments showed that silencing LNCSRLR expression inhibited the growth, proliferation, migration, and invasion of the HCC cell line. Thus, the model can function as an efficient indicator for predicting clinical prognosis and treatment of anticancer drugs in HCC patients.

Multi-omics analysis reveals the panoramic picture of necroptosis-related regulators in pan-cancer.

BACKGROUND: Unlike apoptosis, necroptosis is a tightly regulated form of programmed cell death (PCD) that occurs in a caspase-independent manner and is mainly triggered by receptor-interacting serine/threonine-protein kinases RIPK1 and RIPK3 and the RIPK3 substrate mixed-lineage kinase domain-like protein (MLKL). A growing body of evidence has documented that necroptosis, as a novel therapeutic strategy to overcome apoptosis resistance, has potential pro- or anti-tumoral effects in tumorigenesis, metastasis, and immunosurveillance. However, comprehensive multi-omics studies on regulators of necroptosis from a pan-cancer perspective are lacking. METHODS: In the present study, a pan-cancer multi-omics analysis of necroptosis-related regulators was performed by integrating over 10,000 multi-dimensional cancer genomic data across 33 cancer types from TCGA, 481 small-molecule drug response data from CTRP, and normal tissue data from GTEx. Pan-cancer pathway-level analyses of necroptosis were conducted by gene set variation analysis (GSVA), including differential expression, clinical relevance, immune cell infiltration, and regulation of cancer-related pathways. RESULTS: Genomic alterations and abnormal epigenetic modifications were associated with dysregulated gene expression levels of necroptosis-related regulators. Changes in the gene expression levels of necroptosis-related regulators significantly influenced cancer progression, intratumoral heterogeneity, alterations in the immunological condition, and regulation of cancer marker-related pathways. These changes, in turn, caused differences in potential drug sensitivity and the prognosis of patients. CONCLUSION: Necroptosis-related regulators are expected to become novel biomarkers of prognosis and provide a fresh perspective on cancer diagnosis and treatment.

Role of Nectin­4 protein in cancer (Review).

The Nectin cell adhesion molecule (Nectin) family members are Ca2+­independent immunoglobulin­like cellular adhesion molecules (including Nectins 1­4), involved in cell adhesion via homophilic/heterophilic interplay. In addition, the Nectin family plays a significant role in enhancing cellular viability and movement ability. In contrast to enrichment of Nectins 1­3 in normal tissues, Nectin­4 is particularly overexpressed in a number of tumor types, including breast, lung, urothelial, colorectal, pancreatic and ovarian cancer. Moreover, the upregulation of Nectin­4 is an independent biomarker for overall survival in numerous cancer types. A large number of studies have revealed that high expression of Nectin­4 is closely related to tumor occurrence and development in various cancer types, but the manner in which Nectin­4 protein contributes to the onset and development of these malignancies is yet unknown. The present review summarizes the molecular mechanisms and functions of Nectin­4 protein in the biological processes and current advances with regard to its expression and regulation in various cancer types.

Tumor expression of miR-448 is a prognostic marker in oral squamous cell carcinoma.

BACKGROUND: Prognosis is poor for patients with malignant progression such as distant metastasis of oral squamous cell carcinoma (OSCC). Evidence indicates that miR-448 promotes the proliferation and inhibits apoptosis of OSCC cells. Therefore, we aimed to investigate the function of miR-448 to predict tumor progression and prognosis of OSCC. METHODS: Real-time quantitative reverse transcription PCR was used to measure miR-448 expression in 221 pairs of OSCC tissues and the corresponding noncancerous tissues. Patients were diagnosed with OSCC from 2009 through 2011 at the Tianjin Medical University Cancer Institute and Hospital. Chi-squared tests were performed to assess the associations between miR-448 expression and clinicopathological parameters. Kaplan-Meier analysis was employed to evaluate the association of overall survival (OS) and disease-free survival (DFS) with miR-448 levels. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model. RESULTS: We show here that miR-448 expression was significantly up-regulated in OSCC tissues compared with noncancerous tissues (P < 0.01). High miR-448 expression was significantly associated with advanced T stage (P = 0.001), lymph node metastasis (P = 0.007) and higher TNM stage (P = 0.009). Moreover, Kaplan-Meier and univariate analyses revealed that patients with high expression of miR-448 experienced significantly shorter OS and DFS. Furthermore, multivariate analysis demonstrated that miR-448 expression was an independent prognostic factor for OS (P = 0.004) and DFS (P = 0.002). CONCLUSIONS: Our present data suggests that miR-448 may play an important role in tumor progression and serves as a prognostic marker for OSCC. Further studies are required to assess the potential value of miR-448 to contribute to personalized treatment of OSCC.

Interference Competition for Mutualism between Ant Species Mediates Ant-Mealybug Associations.

Ant-hemipteran mutualism has been well documented, and many studies have reported the interference competition between ant species for the mutualism. However, little is known on how this interference competition impacts the reciprocally beneficial association. Previous studies demonstrated that the invasive mealybug Phenacoccus solenopsis (Tinsley) has established close mutual relationship with the ghost ant Tapinoma melanocephalum (Fabricius). The sympatric ants, Paratrechina longicornis (Latreille) and Tetramorium bicarinatum (Nylander) were frequently observed to compete for nutrient honeydew produced by P. solenopsis with T. melanocephalum. Herein, we investigated the effects of interference competition between the ant species on the ant-mealybug interactions. Phenacoccus solenopsis benefited from the tending by T. melanocephalum and P. longicornis. Interference competition between T. melanocephalum and P. longicornis interrupted the mutualism, suppressed the trailing activity of both species, but negligibly influenced the parasitism of Aenasius bambawalei Hayat, a solitary endoparasitoid of P. solenopsis. Harmonia axyridis, a predator of P. solenopsis, showed a significant avoidance when encountering with T. melanocephalum or P. longicornis, but not T. bicarinatum. Ant workers showed higher aggressiveness and lower exploratory activity when T. melanocephalum encountered P. longicornis. However, competition between T. melanocephalum and T. bicarinatum seldom influenced the trailing and exploratory activity of T. melanocephalum. It is concluded that interference competition for mutualism between ant species can mediate ant-mealybug associations and the fitness of mealybug colony. Our results also demonstrate that the effects of interference competition between ant species on ant-mealybug mutualism are varied among ant species.

Incidence of scoliosis among junior high school students in Zhongshan city, Guangdong and the possible importance of decreased miR-30e expression.

OBJECTIVE: We investigated scoliosis incidence among junior high school students in Zhongshan city, Guangdong, China and the expression of miR-30e among those with scoliosis. METHODS: A total 41,258 students were included. From July 2015 to December 2017, all students underwent screening including routine observation of the standing and sitting posture, Adam's forward bend test, dorsal tilt angle measurement, and X-ray examination. Age, sex, height, weight, and body mass index (BMI) were recorded. Reverse transcription-quantitative polymerase chain reaction was used to assess miR-30e expression among students with scoliosis and 200 healthy students. RESULTS: Overall, 743 students were diagnosed with scoliosis, with an incidence rate of 1.80%. A total 646 (86.9%) students were diagnosed with idiopathic scoliosis, 38 (5.1%) with congenital scoliosis, and 59 (7.9%) with other scoliosis types. Compared with healthy students, height was significantly greater whereas weight and BMI were significantly lower among students with scoliosis, and expression of miR-30e was significantly lower. However, no significant difference was found in height, weight, BMI, and mean Cobb angle between high/low miR-30e groups. CONCLUSION: The incidence rate for scoliosis was 1.80%, Compared with healthy students, those with scoliosis were taller, had lower weight and BMI, and miR-30e expression was significantly downregulated.

Recursive Partitioning Analysis (RPA) of Prognostic Factors for Overall Survival in Patients with Spinal Metastasis: A New System for Stratified Treatment.

BACKGROUND: Accurate survival estimate is necessary when determining the most appropriate treatment modality for metastatic spinal tumor. The main purpose of this study was to identify the prognostic factors of spinal metastasis and establish a decision tree model. METHODS: A consecutive cohort of 507 patients from 3 institutional clinical centers who were treated for metastatic spinal tumor between 2005 and 2015 were retrospectively reviewed. In total, 70% of the participants were randomly selected as a "training sample." The prognostic effect of preoperative factors was evaluated using the "training sample," and a decision tree model was established. Then, the accuracy of the new model, as well as the Tokuhashi and Tomita score, was tested by the "test sample," which consisted of the remaining 30% of participants. RESULTS: A decision tree model was generated based on the significant factors with an order of descending importance on predicting the prognosis. According to the new model, patients were classified into 3 groups, mean survival times of less than 6 months, 6-12 months, and more than 12 months, who were indicated for conservative therapy/palliative operation, palliative operation, and invasive excision, respectively. The newly established model was confirmed to be of high accuracy in predicting overall survival, whereas the Tokuhashi and Tomita scores were of modest accuracy and consistency. CONCLUSIONS: A new decision tree model for prognosis prediction in spinal metastasis was established with a satisfactory accuracy and consistency. However, the Tokuhashi and Tomita systems were presented to be less correlated between the scores and actual survival.

Prognostic Discrepancy on Overall Survival Between Ambulatory and Nonambulatory Patients with Metastatic Spinal Cord Compression.

BACKGROUND: Contradictory results have been reported regarding the prognostic effect of ambulatory status in patients with metastatic spinal cord compression (MSCC). The aim of this study was to investigate whether ambulatory status is a significant predictor of overall survival in patients with MSCC and to distinguish the differences of predictors between patients who were ambulatory and those who were not ambulatory before operation. METHODS: Three clinical centers were retrospectively reviewed to identify patients operated on for MSCC between 2005 and 2015. Fourteen prognostic factors were analyzed using Kaplan-Meier survival curves, univariate log-rank test, and multivariate Cox hazard regression model for the whole cohort and the subgroups of ambulatory and nonambulatory patients. RESULTS: In all, 169 patients were consecutively enrolled. Their mean age was 59.6 ± 10.5 years (range, 18-84 years). The median survival time in the whole cohort was 7.0 ± 0.5 months, whereas it was 7.0 ± 0.8 months and 5.0 ± 1.3 months in ambulatory and nonambulatory patients, respectively. Multivariate Cox regression analysis showed that ambulatory status was not a significant predictor of overall survival (P = 0.266), but primary tumor type and Karnofsky performance status were independent predictors of overall survival for the whole cohort. Primary tumor and metastatic site were significantly associated with survival in ambulatory patients. Gender and Karnofsky performance status were associated with survival in nonambulatory patients. CONCLUSIONS: Ambulatory status was not shown to predict the prognosis of patients with MSCC. prognostic factors should be distinguished between ambulatory and nonambulatory patients when choosing a therapeutic modality.

Prognostic effect of factors involved in revised Tokuhashi score system for patients with spinal metastases: a systematic review and Meta-analysis.

BACKGROUND: Cancer patients' survival time has obviously improved, with the development of systemic treatment techniques. However, the probability of metastases to the vertebrae has also been increased which makes some adverse effects on patients' quality of life. The prediction of survival plays a key role in choosing therapeutic modality, and Tokuhashi Score was established as one of the most commonly used predictive systems for spinal metastases. Thus, this study was conducted to identify the prognostic effect of factors involved in revised Tokuhashi Score (RTS). METHODS: Two investigators independently retrieved relevant literature on platforms of PubMed, Embase and Cochrane Library. We identified eligible studies through title/abstract and full-text perusing. Data was extracted including general information of studies, participants' characteristics, therapeutic modality, overall survival and prognostic effect of factors. Hazard ratio (HR) for each factor was synthesized if available through fixed- or random-effect models as appropriate. RESULTS: A total of 63 eligible studies with 10,411 participants were identified. Overall, cases with thyroid cancer had the highest survival rate, while the ones with non-small cell lung cancer and hepatocellular carcinoma lived for the shorted survival time. Performance status, bone metastasis, number of involved vertebrae, visceral metastasis, primary tumor and neurological status were regarded as significant predictors in 71.4, 40.0, 18.2, 63.4, 73.1 and 44.7% of the involved studies respectively. Thirty-eight articles were included in meta-analysis, and prognostic effects of five factors (apart from primary tumor) were analyzed. Factors were all proved to be significant except comparisons between KPS (Karnofsky Performance Status) 10-40 VS. 50-70 and single VS. multiple spinal metastases. CONCLUSION: All factors of RTS were significant on prognosis predicting and should be considered when choosing therapeutic modality for spinal metastases. What's more, we believe that more accurate prognosis may be obtained after removal of the cut-offs for KPS 10-40 VS. 50-70 and single VS. multiple involved vertebrae.

Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta-analysis.

This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed-effects or random-effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non-ambulatory groups were pooled using a random-effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65-2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79-3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C-D were pooled using a fixed-effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27-2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant.

[Analysis of delayed infection of proximal junctional zone after posterior spinal internal fixation and its treatment strategy].

OBJECTIVE: To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation. METHODS: The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed. RESULTS: All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor. CONCLUSIONS: The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.

Prognostic Factors of Ambulatory Status for Patients with Metastatic Spinal Cord Compression: A Systematic Review and Meta-Analysis.

BACKGROUND: This study aimed to identify prognostic factors for functional outcome of metastatic spinal cord compression (MSCC). METHODS: All full texts in English regarding the prognostic factors for functional outcome of MSCC, published between January 2007 and October 2017, were identified using the electronic databases PubMed, Embase, and the Cochrane Library. An exploratory meta-analysis was also conducted when appropriate data were available. RESULTS: A total of 25 studies, involving 4897 patients, met the inclusion criteria. Overall, 69.7% of patients across all studies were able to walk postoperatively compared with 49.0% preoperatively. Moreover, 84.7% of the patients maintained ambulation after treatment. Motor function was significantly associated with ambulatory status before treatment, time of developing motor deficits, interval from symptom to surgery, and preoperative performance status. CONCLUSIONS: Ambulatory status before treatment, interval from symptom to treatment, and time of developing motor deficits can be considered as the most significant prognostic factors for posttreatment ambulatory status. Spinal metastasis should have a higher priority, and immediate intervention should be started before the development of irreversible neurologic deficits. Moreover, short-course radiotherapy might be a good option for patients with a limited life span. Consequently, the identified prognostic factors can be regarded as a preoperative assessment tool to predict neurologic outcome and guide clinical treatment for individual patients with MSCC. However, the retrospective nature of this study with low-quality evidence must be taken into account when interpreting these results, and further research is needed to identify prognostic factors.

[Analysis of postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation].

OBJECTIVE: To explore the postoperative complication and its preventive measure of cervical open-door expansive laminoplasty with lateral mass screw fixation in treating cervical canal stenosis. METHODS: From February 2008 to July 2011, 33 patients with cervical canal stenosis underwent cervical open-door expansive laminoplasty with lateral mass screw fixation. JOA score was used to evaluate clinical effects before and after operation. Of them, complications occurred in 6 cases, male in 2 cases and female in 4 cases. The reason of complications were analyzed. RESULTS: All the patients were followed up from 6 months to 2 years with an average of 10.3 months. The improvement rate of JOA was 78.8% and incidence rate of complication was 18.2% (6 cases). There were 2 cases of axiality symptoms, 1 case of lateral mass screw pulled-out, 2 cases of cerebrospinal fluid leakage with wound dehiscence, 1 case of nerve root parlysis. These complications correlated with operative design, manipulation,improved degree of cervical curvature,postoperative management and cooperation of patient. CONCLUSION: As an effective treatment, cervical open-door expansive laminoplasty with lateral mass screw fixation has lower incidence of axiality pain. Preoperative examination ,postoperative management ,meticulous surgical skill are very important to avoid complications.