Application of 5G technology to conduct tele-surgical robot-assisted laparoscopic radical cystectomy.

BACKGROUND: The aim of this study was to test the effectiveness, safety and stability of the 5G communication technology in clinical laparoscopic telesurgery. METHODS: An ultra-remote radical cystectomy (network communication distance of nearly 3000 km) was performed on patient diagnosed with T2N0M0 stage bladder cancer using a domestically produced "MicroHand" surgical robot. RESULTS: The network delay, operative time, blood loss, intraoperative complications, postoperative recovery, and hospitalisation time were recorded. The 5G network was used throughout the operation, with an average total delay of 254 ms. The operation went well and the patient recovered smoothly. CONCLUSIONS: Ultra-remote clinical laparoscopic surgery can be performed safely and smoothly. More importantly, our model can provide insights for promoting the future development of telesurgery in China.

A New Molecular Recognition Concept: Multiple Hydrogen Bonds and Their Optically Triggered Proton Transfer in Confined Metal-Organic Frameworks for Superior Sensing Element.

We report a new sensing mechanism based on an indium-dihydroxyterephthalic acid metal-organic framework (MOF, SNNU-153), in which the spatially fitted analyte-MOF hydrogen-bond (H-bond) formation provides selective recognition while the analyte-H-bond assisted excited-state intramolecular proton transfer (ESIPT) and the resulting ratiometric emission act as a superior signal transducer with ultrafast response. The synergy of ESIPT signal transduction and confined MOF pore enables the SNNU-153 sensor selectively sensing hydrazine even among nitrogen-containing hydride analogs such as NH3, NH2OH, and (Me)2NNH2. The key of H-bond and associated ESIPT was further counter evidenced by an indium-2,5-dimethoxyterephthalic acid MOF (SNNU-152), where the hydroxyl protons were removed by methylation, showing near inertness to N2H4. The new molecular recognition concept thus makes SNNU-153 a powerful N2H4 sensor, which should be far-reaching to other sensing elements.

Comparison of clinical outcomes of expansive open-door laminoplasty with unilateral or bilateral fixation and fusion for treating cervical spondylotic myelopathy: a multi-center prospective study.

BACKGROUND: The present study evaluated the clinical outcomes and safety of expansive open-door laminoplasty, when securing with C4 - C6 lateral mass screw and fusion. METHODS: A total of 110 patients with cervical spondylotic myelopathy (CSM) were enrolled. There were 88 male and 22 female, with mean age at 60.55 ± 10.95 years. All of the patients underwent expansive open-door laminoplasty with unilateral or bilateral C4-6 lateral mass screws fixation and fusion. Clinical data, including age, gender, operation-related information, pre- and post-operation Japanese Orthopedic Association (JOA) scores, and cervical curvatures were collected. RESULTS: The mean follow-up time of the cohort was 13.61 ± 9.53 months. Among the 110 patients, 33 of them were allocated to Unilateral group, and 77 of them were in Bilateral group. The mean JOA score of the 110 patients before surgery was 10.07 ± 2.39, and the score was improved significantly to 12.85 ± 2.45 after surgery. There were no reported cases of neurological deterioration or symptom worsening. Patients in both the Unilateral group and Bilateral groups had significant improvement of JOA scores. Among all patients, the most frequently observed complications were axial symptoms (n = 7). The average preoperative cervical curvature among all patients was 15.17 ± 5.26, and the post-surgery curvature was 14.41 ± 4.29. Similar observations were found between Unilateral and Bilateral groups. CONCLUSION: The modified surgical approach provided satisfactory clinical outcome in patients with CSM. The unilateral and bilateral fixation appeared to provide similar outcomes, in terms of cervical curvature maintenance and improvement of clinical symptoms. However, the examination of the exact differences between the two fixation methods await further biomechanical studies.

A comparative theoretical study on the electrical and nonlinear optical properties of Li atom adsorbed on AlN and BN single-walled nanotubes.

The geometrical structures, electrical properties, and nonlinear optical (NLO) properties of AlNNT-Li and BNNT-Li nanotube systems were investigated by means of the density functional theory (DFT) method. Frontier molecular orbitals and density of states analyses show that adsorption of the Li atom can significantly narrow the wide HOMO-LUMO gaps of pure AlNNT and BNNT. The results reveal that AlNNT-Li and BNNT-Li systems containing diffuse excess electrons can be regarded as inorganic electrides. The formation of diffuse excess electrons leads to a decrease in transition energies, thereby increasing the first hyperpolarizabilities (ß 0) of AlNNT-Li and BNNT-Li. This work may contribute to the development of potential high-performance NLO materials. Graphical abstract The structural characteristics and nonlinear optical properties of the AlNNT-Li and BNNT-Li systems were studied by means of density functional theory. Introduction of Li atoms greatly enhances the static first hyperpolarizabilities of AlNNT-Li and BNNT-Li.

Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy.

The retrospective study aimed to investigate the indication for hypertrophy posterior longitudinal ligament (HPLL) removal in anterior decompression for cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were subdivided into 2 further subgroups, according to whether HPLL was removed or preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR (21 patients) and group NP (36 patients) in group N. The modified Japanese Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of life (QoL), and relevant clinical data were used for clinical and radiological evaluation. The mJOA scores improved from 7.3 ±â€Š2.2 to 15.0 ±â€Š1.8 in the SR group and from 7.9 ±â€Š2.3 to 14.2 ±â€Š1.5 in the SP group (P = .036), with postoperative QoL significantly higher in the SR group than the SP group. A reduction in the diameter of enlarged spinal canals occurred at a significantly faster rate in the SP group compared with the SR group (P = .002). Multivariate regression analyses showed removal of HPLL correlated with mJOA scores (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS (coefficient = 12.129, P < .001), and MCS (coefficient = 14.31, P < .001) in the S group at 24 months postoperatively, while removal of HPLL did not correlate with clinical outcomes in the N group. The HPLL should, therefore, be removed when mobility was reduced and the spinal cord remained compressed after anterior decompression procedures in the patients with DCS. However, in non-DCS patients, it remains unclear as to whether removal of HPLL provides any clinical benefit, thus, HPLL removal may not be necessary.

A Novel Approach for Percutaneous Vertebroplasty Based on Preoperative Computed Tomography-Based Three-Dimensional Model Design.

OBJECTIVE: To describe a new technique for the efficient use of preoperative planning based on preoperative computed tomography-based three-dimensional (3D) model design for percutaneous vertebroplasty (PVP) in a patient with osteoporotic vertebral compression fracture. METHODS: A 76-year-old woman with acute osteoporotic vertebral compression fracture (L1 level) accepted a novel precise PVP. A 3D model of thoracolumbar vertebrae (T12-L2) based on preoperative computed tomography scanning data and a simulative PVP (via a bilateral transpedicular approach) were built in MIMICS (Materialise Interactive Medical Image Control System) software. With the help of 3 radiopaque markers located at the skin of the back and preoperative digital design by MIMICS, bilateral skin entry points, needles direction including abduction angle and head inclination angle, and needle insertion depth were established. RESULTS: During surgery, only 1 shot of fluoroscopy was required to confirm the skin entry points. The operation took only about 23 minutes and total patient exposure dose was 4.5 mSv. The intraoperative radiologic results showed that the cement distribution in the L1 vertebra was good without any puncture-related complications. The patient's visual analog scale score improved from 9 points preoperatively to 2 points postoperatively. The patient's preoperative Oswestry Disability Index score was 80 points, which improved to 57.8 points postoperatively. CONCLUSIONS: The novel precise PVP based on preoperative 3D model design allows 1) visualization of the morphology of the fractured vertebral body, 2) increased precision of puncture with decreasing incidence of puncture-related complications and reduced radiation exposure, and 3) less operation time, decreasing the learning curve of beginners with limited experience.

Potential roles of microRNAs and their target genes in human multiple myeloma.

OBJECTIVES: The etiology of multiple myeloma (MM) is unknown and it remains incurable. We sought to elucidate the mechanisms underlying miRNAs involvement in MM pathogenesis. METHODS: Public mRNA and miRNA expression datasets for MM were collected from the Gene Expression Omnibus database. By integrated bioinformatics analysis, the expression signatures were identified and the miRNA-mRNA interaction network was constructed. The potential functions of target genes were then explored by functional enrichment analysis. RESULTS: Totally, 839 differentially expressed mRNAs and six differentially expressed miRNAs were identified. The context of miRNAs-mediated genes regulatory network consisted of 288 possible miRNA-mRNA target pairs. The hub miRNA was hsa-miR-92a, which can serve as the indicator for MM disease status. Another miRNA, hsa-miR-148a, could be useful for prognosis of MM. Functional annotation revealed that the miRNA targets may play important roles in viral infection and proteasome. Moreover, miRNA targets may be involved in renal cell carcinoma and other nervous system disease such as Huntington's disease, Alzheimer's disease and Parkinson's disease, which may be subsequent complications of MM. CONCLUSIONS: Infections could be a leading cause for the morbidity of MM patients. The crucial protein degradation machinery may be essential in the pathogenesis of MM.

[Separation of Chlorophyll Fluorescence from Scattering Light of Algal Water Based on the Polarization Technique].

Once chlorophyll molecules within the planktonic algae cells absorb light energy, they will release energy in the form of chlorophyll fluorescence emission. The elastic scattering light of particles in water is partially polarized, while chlorophyll fluorescence is unpolarized, so we can use the properties to separate the fluorescence signal from total scattering spectra for further retrieval the concentration of chlorophyll. But for coastal waters, the approach feasibility is still unclear. Based on this, we conducted the experiment in laboratory to analyze the influence of different concentrations of inorganic particles (IOP) and chlorophyll on the fluorescence extraction using polarization discrimination technique. The results indicate that, for algae water with different concentrations of IOP, the fluorescence peak will decrease while the concentration increase, but the retrieval result is still reliable when the concentration up to 300 mg·L(-1). For algae water with different concentrations of chlorophyll, the concentration of chlorophyll more higher, the efficiency of extracted fluorescence using polarization method is better, for common water, this approach can still work. The study proves that the polarization method is also applicable for complex water; it is of great importance for further detecting the concentration of chlorophyll in coastal waters using remote sensing.

Long-term outcomes and prognostic analysis of modified open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy.

OBJECTIVES: The purpose of the present study was to explore and analyze the long-term outcomes and factors that affect the prognosis of expansive open-door laminoplasty with lateral mass screw fusion in treatment of cervical spondylotic myelopathy (CSM). METHODS: We retrospectively reviewed 49 patients with multilevel CSM who had undergone expansive open-door laminoplasty with lateral mass screws fixation and fusion in our hospital between February 2008 and February 2012. The average follow-up period was 4.6 years. The clinical data of patients, including age, sex, operation records, pre- and postoperation Japanese Orthopedic Association (JOA) scores, cervical spine canal stenosis, and cervical curvature, were collected. Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging and ossification of the posterior longitudinal ligament were also observed. Paired t-test was used to analyze the treatment effectiveness and recovery of neuronal function. The prognostic factors were analyzed with multivariable linear regression model. RESULTS: Forty-nine patients with CSM with a mean age of 59.44 years were enrolled in this study. The average of preoperative JOA score was 9.14±2.25, and postoperative JOA score was 15.31±1.73. There was significant difference between the pre- and postoperative JOA scores. The clinical improvement rate was 80.27%. On follow-up, five patients had complaints of neck and shoulder pain, but no evidence of C5 nerve palsy was found. Developmental cervical spine canal stenosis was present in all patients before surgery. Before surgery, ISI was observed in eight patients, while ossification of the posterior longitudinal ligament was found in 12 patients. The average of preoperative cervical curvature was 21.27°±8.37° and postoperative cervical curvature was 20.09°±1.29°, and there was no significant difference between the pre- and postoperative cervical curvatures. Multivariable linear regression analysis results showed that the postoperation JOA scores were significantly affected by age, preoperative JOA scores, and preoperative ISI. Except one case of epidural hematoma, there were no complications associated with the surgery. CONCLUSION: Treatment of CSM with posterior open-door laminoplasty with lateral mass screw fusion is effective with few complications. In addition, the normal cervical lordosis was well maintained. Age, preoperative JOA scores, and preoperative ISI were the independent factors that significantly affect disease prognosis and surgical outcomes.

BFH-OST, a new predictive screening tool for identifying osteoporosis in postmenopausal Han Chinese women.

PURPOSE: To develop a simple new clinical screening tool to identify primary osteoporosis by dual-energy X-ray absorptiometry (DXA) in postmenopausal women and to compare its validity with the Osteoporosis Self-Assessment Tool for Asians (OSTA) in a Han Chinese population. METHODS: A cross-sectional study was conducted, enrolling 1,721 community-dwelling postmenopausal Han Chinese women. All the subjects completed a structured questionnaire and had their bone mineral density measured using DXA. Using logistic regression analysis, we assessed the ability of numerous potential risk factors examined in the questionnaire to identify women with osteoporosis. Based on this analysis, we build a new predictive model, the Beijing Friendship Hospital Osteoporosis Self-Assessment Tool (BFH-OST). Receiver operating characteristic curves were generated to compare the validity of the new model and OSTA in identifying postmenopausal women at increased risk of primary osteoporosis as defined according to the World Health Organization criteria. RESULTS: At screening, it was found that of the 1,721 subjects with DXA, 22.66% had osteoporosis and a further 47.36% had osteopenia. Of the items screened in the questionnaire, it was found that age, weight, height, body mass index, personal history of fracture after the age of 45 years, history of fragility fracture in either parent, current smoking, and consumption of three of more alcoholic drinks per day were all predictive of osteoporosis. However, age at menarche and menopause, years since menopause, and number of pregnancies and live births were irrelevant in this study. The logistic regression analysis and item reduction yielded a final tool (BFH-OST) based on age, body weight, height, and history of fracture after the age of 45 years. The BFH-OST index (cutoff =9.1), which performed better than OSTA, had a sensitivity of 73.6% and a specificity of 72.7% for identifying osteoporosis, with an area under the receiver operating characteristic curve of 0.797. CONCLUSION: BFH-OST may be a powerful and cost-effective new clinical risk assessment tool for prescreening postmenopausal women at increased risk for osteoporosis by DXA, especially for Han Chinese women.

Five known tagging DLL3 SNPs are not associated with congenital scoliosis: A case-control association study in a Chinese Han population.

Genetic etiology hypothesis is widely accepted in the development of congenital scoliosis (CS). The delta-like 3 (DLL3) gene, a member of the Notch signaling pathway, was implicated to contribute to human CS. In this study, a case-control association study was conducted to determine the association of single nucleotide polymorphism (SNP) in the DLL3 gene with CS in a Chinese Han Population. Five known tagging SNPs of the DLL3 gene were genotyped among 270 Chinese Han subjects (128 nonsyndromic CS patients and 142 matched controls). CS patients were divided into 3 types: type I-failure of formation (29 cases), type II-failure of segmentation (50 cases), and type III-mixed defects (49 cases). The 5 SNPs were analyzed by the allelic and genotypic association analysis, genotype-phenotype association analysis, and haplotype analysis. Allele frequencies of 5 tagging SNPs (SNP1: rs1110627, SNP2: rs3212276, SNP3: rs2304223, SNP4: rs2304222, and SNP5: rs2304214) in CS cases and controls were comparable and there were no available inheritance models. The SNPs were not associated with clinical phenotypes. Moreover, the 5 makers in the DLL3 gene were found to be in strong linkage disequilibrium (LD). Both global haplotype and individual haplotype analyses showed that the haplotypes of SNP1/SNP2/SNP3/SNP4/SNP5 did not correlate with the disease (P >0.05). Together, these data suggest that genetic variants of the DLL3 gene are not associated with CS in the Chinese Han population.

Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool.

OBJECTIVE: This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs) in older Chinese men: bone mineral density (BMD), the Osteoporosis Self-Assessment Tool for Asians (OSTA), and the World Health Organization fracture risk assessment tool (FRAX) (without BMD). METHODS: Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111), or a control group of healthy men (n=385). Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1-L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC) curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. RESULTS: Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1-L4), and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9%) was 0.738, and the sensitivity and specificity were 82% and 62%, respectively. CONCLUSION: FRAX may be a valuable tool for identifying PNOVFs in older Chinese men.

Identification of upstream regulators for synovial expression signature genes in osteoarthritis.

OBJECTIVES: The detection of transcription factors (TFs) for OA signature genes provides better clues to the underlying regulatory mechanisms and therapeutic applications. METHODS: We searched GEO database for synovial expression profiling from different OA microarray studies to perform a systematic analysis. Functional annotation of DEGs was conducted, including gene ontology (GO) enrichment analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis. Based on motif databases and the results from integrated analysis of current gene expression data, a global transcriptional regulatory network was constructed, and the upstream TFs were identified for OA signature genes. RESULTS: Six GEO datasets were obtained. Totally, 805 genes across the studies were consistently differentially expressed in OA (469 up-regulated and 336 down-regulated genes) with FDR≤0.01. Supporting an involvement of ECM in the development of OA, we showed that ECM-receptor interaction was the most significant pathway in our KEGG analysis (P=5.92E-12). Sixty-one differentially expressed TFs were identified with FDR≤0.05. The constructed OA-specific regulatory networks consisted of 648 TF-target interactions between 51 TFs and 429 DEGs in the context of OA. The top 10 TFs covering the most downstream DEGs were identified as crucial TFs involved in the development of OA, including ARID3A, NFIC, ZNF354C, NR4A2, BRCA1, EHF, FOXL1, FOXC1, EGR1, and HOXA5. CONCLUSION: This integrated analysis has identified the OA signature, providing clues to pathogenesis of OA at the molecular level, which may be also used as diagnostic markers for OA. Some crucial upstream regulators, such as NR4A2, EHF, and EGR1 may be considered as potential new therapeutic targets for OA.

Risk Factors for Surgical Site Infection After Spinal Surgery: A Meta-Analysis.

BACKGROUND: Surgical-site infection (SSI) after spinal surgery is the most common complication, which results in greater morbidity, mortality, and health care costs. Identifying risk factors of SSI is an important point for preventive strategies to reduce the incidence of SSI. The aim of this meta-analysis is to investigate the most important risk factors for SSI after spinal surgery. METHODS: PubMed, Embase, and Web of Science were systematically searched to identify cohort or case-control studies that investigated the risk factors for SSI following spinal surgery. A fixed-effects or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I2 and Cochran's Q test. RESULTS: Twelve studies with a total of 13,476 patients met the inclusion criteria were included in this meta-analysis. Of them, 1 was a nested case-control studies, 7 were case-control studies, and 4 were cohort studies. The most important predictors of SSI were diabetes (risk ratio [RR] = 2.22, 95% confidence interval [95% CI] 1.38-3.60; P = 0.001), prolonged operative times (>3 hours) (RR = 2.16, 95% CI 1.12-4.19; P = 0.009), body mass index more than 35 (RR = 2.36, 95% CI 1.47-3.80; P = 0.000), and posterior approach (RR = 1.22, 95% CI 1.05-1.41; P = 0.009). CONCLUSION: Diabetes, prolonged operative times (>3 hours), body mass index more than 35, posterior approach, and number of intervertebral levels (≥7) are associated with an increased risk of SSI after spinal surgery. Almost all these risk factors are in line with the known risk factors for SSI in patients who underwent spinal surgery.

A Hybrid Parallel Strategy Based on String Graph Theory to Improve De Novo DNA Assembly on the TianHe-2 Supercomputer.

' The de novo assembly of DNA sequences is increasingly important for biological researches in the genomic era. After more than one decade since the Human Genome Project, some challenges still exist and new solutions are being explored to improve de novo assembly of genomes. String graph assembler (SGA), based on the string graph theory, is a new method/tool developed to address the challenges. In this paper, based on an in-depth analysis of SGA we prove that the SGA-based sequence de novo assembly is an NP-complete problem. According to our analysis, SGA outperforms other similar methods/tools in memory consumption, but costs much more time, of which 60-70 % is spent on the index construction. Upon this analysis, we introduce a hybrid parallel optimization algorithm and implement this algorithm in the TianHe-2's parallel framework. Simulations are performed with different datasets. For data of small size the optimized solution is 3.06 times faster than before, and for data of middle size it's 1.60 times. The results demonstrate an evident performance improvement, with the linear scalability for parallel FM-index construction. This results thus contribute significantly to improving the efficiency of de novo assembly of DNA sequences.

B-MIC: An Ultrafast Three-Level Parallel Sequence Aligner Using MIC.

Sequence alignment is the central process for sequence analysis, where mapping raw sequencing data to reference genome. The large amount of data generated by NGS is far beyond the process capabilities of existing alignment tools. Consequently, sequence alignment becomes the bottleneck of sequence analysis. Intensive computing power is required to address this challenge. Intel recently announced the MIC coprocessor, which can provide massive computing power. The Tianhe-2 is the world's fastest supercomputer now equipped with three MIC coprocessors each compute node. A key feature of sequence alignment is that different reads are independent. Considering this property, we proposed a MIC-oriented three-level parallelization strategy to speed up BWA, a widely used sequence alignment tool, and developed our ultrafast parallel sequence aligner: B-MIC. B-MIC contains three levels of parallelization: firstly, parallelization of data IO and reads alignment by a three-stage parallel pipeline; secondly, parallelization enabled by MIC coprocessor technology; thirdly, inter-node parallelization implemented by MPI. In this paper, we demonstrate that B-MIC outperforms BWA by a combination of those techniques using Inspur NF5280M server and the Tianhe-2 supercomputer. To the best of our knowledge, B-MIC is the first sequence alignment tool to run on Intel MIC and it can achieve more than fivefold speedup over the original BWA while maintaining the alignment precision.

Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis.

BACKGROUND: Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. METHODS: PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People's Republic of China), and CNKI (China National Knowledge Infrastructure, People's Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. RESULTS: Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =-1.33, 95% confidence interval [CI]: -2.29, -0.27; P=0.014), operation time (WMD =-26.9, 95% CI: -46.13, -7.67; P=0.006), blood loss (WMD =-119.36, 95% CI: -166.94, -71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =-0.27, 95% CI: -0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: -1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. CONCLUSION: Evidence from the meta-analysis of 18 studies demonstrated that surgical options of cervical spondylotic myelopathy using ACDF or ACCF seemed to have similar clinical outcomes. However, ACDF was found to be superior to ACCF in terms of hospital stay, operation time, blood loss, and incidence of complications.

Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials.

BACKGROUND: Epidural injections of anesthetic with or without steroids are widely used for treating lumbar spinal stenosis, a common cause of chronic low back pain, but there is a lack of rigorous data comparing the effectiveness of epidural injections of anesthetic with and without steroids. This meta-analysis presents a current, comprehensive picture of how epidural injections of anesthetic with steroids compare with those using local anesthetic alone. METHODS: PubMed, Embase, Web of Science, and Cochrane Library databases were searched from their inception through February 5, 2015. Weight mean difference, risk ratio, and 95% confidence intervals were calculated. A random effects model or fixed effects model was used to pool the estimates, according to the heterogeneity between the included studies. RESULTS: We included 13 randomized controlled trials, involving 1,465 patients. Significant pain relief (≥50%) was demonstrated in 53.7% of patients administered with epidural injections of anesthetic with steroids (group 1) and in 56.4% of those administered with local anesthetic alone (group 2). Patients showed a reduction in numeric rating scale pain score of 3.7 and 3.6 in the two groups, respectively. Significant functional improvement was achieved in 65.2% of patients in group 1 and 63.1% of patients in group 2, with Oswestry Disability Index reductions of 13.8 and 14.5 points, respectively. The overall number of injections per year was 3.2±1.3 and 3.4±1.2 with average total relief per year of 29.3±19.7 and 33.8±19.3 weeks, respectively. The opioid intakes decreased from baseline by 12.4 and 7.8 mg, respectively. Among the outcomes listed, only total relief time differed significantly between the two groups. CONCLUSION: Both epidural injections with steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic alone.

A 1,2,4-diazaphospholyl radical and its nitrogen-phosphorus coupled dimer: synthesis, X-ray structural characterization, EPR analysis, and computational studies.

The oxidation of 1,2,4-diazaphospholide potassium (K(+)[]) produces a neutral 1,2,4-diazaphospholyl radical () which can subsequently afford the (N)-(P) dimer involving a N-P linkage.

Benefit of degenerative posterior longitudinal ligament removal during anterior decompression in cervical spondylotic myelopathy.

It remains controversial whether degenerative posterior longitudinal ligaments should be removed during anterior decompression procedures for cervical spondylotic myelopathy. Few data are available from studies that have compared removing and retaining the degenerative posterior longitudinal ligament. The goal of this retrospective study was to evaluate the benefit of degenerative posterior longitudinal ligament removal during such operations. Clinical data on 130 patients with confirmed degenerative posterior longitudinal ligament who underwent anterior cervical decompression surgery were retrospectively reviewed. All procedures were performed by the same senior orthopedic surgeon at the authors' spinal surgery center. The degenerative posterior longitudinal ligament was removed in 62 patients (group A) and retained in 68 patients (group B). The 130 patients were followed for 36 months. The Japanese Orthopedic Association score improved from 9.0±2.7 to 14.7±1.5 in group A and from 9.4±2.6 to 14.1±1.7 in group B (P=.028). The recovery rate for spinal cord neurologic function was 66.7% in group A and 61.3% in group B (P=.031). Operating time was longer (P=.002) and the sagittal median diameter of the vertebral canal was enhanced in group A (P<.001). Narrowing of previously enlarged canals occurred at a significantly higher rate in group B (P=.044). No significant difference was found in the rates of common complications between groups. Removal of the degenerative posterior longitudinal ligament in anterior decompression procedures for cervical spondylotic myelopathy appeared to be beneficial and provided more complete decompression and better postoperative outcomes than surgery without removal of the ligament. Although this procedure was generally safe, it required longer operating times, was more technically challenging, and required more experienced surgeons than surgery without removal of the ligament.