Development and validation of LCMM prediction algorithms to estimate recovery pattern of postoperative AKI in type A aortic dissection: a retrospective study.

Background: Postoperative acute kidney injury (PO-AKI) is a prevalent complication among patients with acute type A aortic dissection (aTAAD) for which unrecognized trajectories of renal function recovery, and their heterogeneity, may underpin poor success in identifying effective therapies. Methods: This was a retrospective, single-center cohort study in a regional Great Vessel Center including patients undergoing aortic dissection surgery. Estimated glomerular filtration rate (eGFR) recovery trajectories of PO-AKI were defined through the unsupervised latent class mixture modeling (LCMM), with an assessment of patient and procedural characteristics, complications, and early-term survival. Internal validation was performed by resampling. Results: A total of 1,295 aTAAD patients underwent surgery and 645 (49.8%) developed PO-AKI. Among the PO-AKI cohort, the LCMM identified two distinct eGFR trajectories: early recovery (ER-AKI, 51.8% of patients) and late or no recovery (LNR-AKI, 48.2% of patients). Binary logistic regression identified five critical determinants regarding poor renal recovery, including chronic kidney disease (CKD) history, renal hypoperfusion, circulation arrest time, intraoperative urine, and myoglobin. LNR-AKI was associated with increased mortality, continuous renal replacement therapies, mechanical ventilation, ICU stay, and hospital stay. The assessment of the predictive model was good, with an area under the curve (AUC) of 0.73 (95% CI: 0.69-0.76), sensitivity of 61.74%, and specificity of 75.15%. The internal validation derived a consistent average AUC of 0.73. The nomogram was constructed for clinicians' convenience. Conclusion: Our study explored the PO-AKI recovery patterns among surgical aTAAD patients and identified critical determinants that help to predict individuals at risk of poor recovery of renal function.

Application of Anchored Instructional Method in Cardiac Surgery ICU Nursing Education.

BACKGROUND: This study investigated the impact of applying the anchored teaching mode with nursing interns on the cardiac surgery intensive care unit (CSICU). METHOD: A total of 110 interns were divided into a control group (taught through traditional methods) and an experimental group (taught using the anchored teaching mode). The anchored mode, emphasizing student-centered learning, included creating scenarios, identifying problems, using self-directed and collaborative learning, and evaluating outcomes. RESULTS: Our study found that the experimental group showed significantly higher scores in emergency response ability, nursing skills, and teaching effectiveness compared with the control group at graduation. CONCLUSION: The findings suggest that implementing the anchored teaching mode can effectively enhance the education of nursing interns on the CSICU, emphasizing the need for further research across different departments and types of hospitals. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Relative band power in assessing temporary neurological dysfunction post- type A aortic dissection surgery: a prospective study.

Temporary neurological dysfunction (TND), a common complication following surgical repair of Type A Aortic Dissection (TAAD), is closely associated with increased mortality and long-term cognitive impairment. Currently, effective treatment options for TND remain elusive. Therefore, we sought to investigate the potential of postoperative relative band power (RBP) in predicting the occurrence of postoperative TND, with the aim of identifying high-risk patients prior to the onset of TND. We conducted a prospective observational study between February and December 2022, involving 165 patients who underwent surgical repair for TAAD at our institution. Bedside Quantitative electroencephalography (QEEG) was utilized to monitor the post-operative brain electrical activity of each participant, recording changes in RBP (RBP Delta, RBP Theta, RBP Beta and RBP Alpha), and analyzing their correlation with TND. Univariate and multivariate analyses were employed to identify independent risk factors for TND. Subsequently, line graphs were generated to estimate the incidence of TND. The primary outcome of interest was the development of TND, while secondary outcomes included intensive care unit (ICU) admission and length of hospital stay. A total of 165 patients were included in the study, among whom 68 (41.2%) experienced TND. To further investigate the independent risk factors for postoperative TND, we conducted both univariate and multivariate logistic regression analyses on all variables. In the univariate regression analysis, we identified age (Odds Ratio [OR], 1.025; 95% CI, 1.002-1.049), age ≥ 60 years (OR, 2.588; 95% CI, 1.250-5.475), hemopericardium (OR, 2.767; 95% CI, 1.150-7.009), cardiopulmonary bypass (CPB) (OR, 1.007; 95% CI, 1.001-1.014), RBP Delta (OR, 1.047; 95% CI, 1.020-1.077), RBP Alpha (OR, 0.853; 95% CI, 0.794-0.907), and Beta (OR, 0.755; 95% CI, 0.649-0.855) as independent risk factors for postoperative TND. Further multivariate regression analyses, we discovered that CPB time ≥ 180 min (OR, 1.021; 95% CI, 1.011-1.032), RBP Delta (OR, 1.168; 95% CI, 1.105-1.245), and RBP Theta (OR, 1.227; 95% CI, 1.135-1.342) emerged as independent risk factors. TND patients had significantly longer ICU stays (p < 0.001), and hospital stays (p = 0.002). We obtained the simplest predictive model for TND, consisting of three variables (CPB time ≥ 180 min, RBP Delta, RBP Theta, upon which we constructed column charts. The areas under the receiver operating characteristic (AUROC) were 0.821 (0.755, 0.887). Our study demonstrates that postoperative RBP monitoring can detect changes in brain function in patients with TAAD during the perioperative period, providing clinicians with an effective predictive method that can help improve postoperative TND in TAAD patients. These findings have important implications for improving clinical care in this population.Trial registration ChiCTR2200055980. Registered 30th Jan. 2022. This trial was registered before the first participant was enrolled.

Unveiling the nexus of postoperative fever and delirium in cardiac surgery: identifying predictors for enhanced patient care.

Background: Postoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions. Methods: In a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation. Result: The overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763-0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively. Conclusion: This study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.

Base-Promoted Formal (3 + 2) Cycloaddition of α-Halohydroxamates with Electron-Deficient Alkenyl-iminoindolines To Synthesize Spiro-indolinepyrrolidinones.

Construction of pyrrolidinyl-spiroindoles with easily available starting materials has attracted considerable attention from the synthesis community and is in great demand. Here, we describe a base-promoted formal (3 + 2) cycloaddition of α-halohydroxamates with alkenyl-iminoindolines. The present methodology features mild reaction conditions and a broad substrate scope with up to 99% yield and excellent diastereoselectivity. The versatility of this approach is demonstrated through valuable synthetic transformations. Preliminary mechanistic studies shed light on the mechanism of this cycloaddition process.

[Dead heart of pith-decayed Scutellariae Radix: a study based on multi-omics].

Dead heart is an important trait of pith-decayed Scutellariae Radix. The purpose of this study was to clarify the scientific connotation of the dead heart using multi-omics. Metabolomics and transcriptomics combined with multivariate statistical analysis such as principal component analysis(PCA) and partial least squares discriminant analysis(PLS-DA) were used to systematically compare the differences in chemical composition and gene expression among phloem, outer xylem and near-dead xylem of pith-decayed Scutella-riae Radix. The results revealed significant differences in the contents of flavonoid glycosides and aglycones among the three parts. Compared with phloem and outer xylem, near-dead xylem had markedly lowered content of flavonoid glycosides(including baicalin, norwogonin-7-O-ß-D-glucuronide, oroxylin A-7-O-ß-D-glucuronide, and wogonoside) while markedly increased content of aglycones(including 3,5,7,2',6'-pentahydroxy dihydroflavone, baicalin, wogonin, and oroxylin A). The differentially expressed genes were mainly concentrated in KEGG pathways such as phenylpropanoid metabolism, flavonoid biosynthesis, ABC transporter, and plant MAPK signal transduction pathway. This study systematically elucidated the material basis of the dead heart of pith-decayed Scutellariae Radix with multiple growing years. Specifically, the content of flavonoid aglycones was significantly increased in the near-dead xylem, and the gene expression of metabolic pathways such as flavonoid glycoside hydrolysis, interxylary cork development and programmed apoptosis was significantly up-regulated. This study provided a theoretical basis for guiding the high-quality production of pith-decayed Scutellariae Radix.

"Drum Tower Hospital" strategy for acute type A aortic dissection with coma.

OVERVIEW: Acute type A aortic dissection (ATAAD) with persistent coma is a life-threatening condition associated with high mortality and poor neurological outcomes. The optimal timing for surgical intervention in these patients remains uncertain, and many patients are not eligible for surgery due to their poor prognosis. DESCRIPTION: In this case, a 53-year-old man with hypertension presented to the emergency department in a coma that had lasted for 9 hours. The patient was diagnosed with ATAAD and underwent the "Drum Tower Hospital" strategy, which involved preoperative assessments, including computed tomography angiography (CTA) and quantitative electroencephalogram (qEEG) monitoring. Surgical interventions, such as emergency stenting and aortic replacement, were performed to restore blood flow and repair the aorta. Postoperative monitoring, including qEEG, showed improvements in brain function. Despite the patient experiencing hemiplegia and a neurological deficit, the "Drum Tower Hospital" strategy, guided by comprehensive brain assessments, showed promise in managing ATAAD with coma. However, further research is needed to establish effective treatment strategies for these patients. Overall, ATAAD with persistent coma is a critical condition with limited treatment options. The "Drum Tower Hospital" strategy, supported by multimodal brain assessment, offers a potential approach to improve outcomes in these patients.

Quantitative EEG as a diagnostic and prognostic tool in hemispheric stroke patients undergoing type A aortic dissection surgery.

OBJECTIVE: The diagnostic and prognostic value of quantitative electroencephalogram (qEEG) parameters, specifically the symmetry of amplitude-integrated electroencephalography (aEEG) and relative band power (RBP), in the postoperative stroke of the cerebral hemisphere following type A aortic dissection, remains an area of inquiry. METHODS: We analyzed and processed 56 patients with type A aortic dissection who underwent bedside qEEG monitoring and analyzed the qEEG indices, brain CT, and clinical data of these patients. qEEG (symmetry of aEEG and RBP, and affected/unaffected hemisphere) indices were analyzed at discharge and 60 days after discharge. RESULTS: A total of 56 patients were studied. The 60-day mortality rate was 12.5%. The affected hemisphere's diagnosis and mortality after 1-year follow-up were evaluated, and RBP beta demonstrated the highest area under the curve values with 95% confidence intervals (CI) of .849 (95% CI: .771-.928) and .91 (95% CI: .834-.986), respectively. According to the results of the logistic regression analysis, we have identified the strongest predictors for cerebral hemisphere stroke and 1-year mortality in stroke patients. Specifically, aEEGmin exhibited the highest predictive power with an odds ratio (OR) of .735 for cerebral hemisphere stroke, whereas DTABR was confirmed as one of the strongest predictors with an OR of 1.619 for 1-year mortality in stroke patients, indicating a high level of reliability. Spearman correlation coefficients showed that aEEGmax and aEEGmin were positively correlated with Alberta Stroke Program Early CT Score (aEEGmax: rho = .50, p < .001; aEEGmin: rho = .44, p < .001). CONCLUSIONS: QEEG has been proven to be a sensitive indicator for monitoring brain function and can be monitored continuously. It can help clinicians detect and treat these patients early and improve long-term prognosis.

A modified aortic arch "island anastomosis" with stent graft technique for acute type A aortic dissection: a retrospective analysis.

BACKGROUND: A modified aortic arch "island anastomosis" with a stent graft technique was used in 33 patients with acute type A aortic dissection. We retrospectively reviewed our experience of this procedure and the short-term follow-up results. METHODS: This retrospective analysis included 33 patients with acute type A aortic dissection undergoing the modified aortic arch island anastomosis with stent graft procedure. Postoperatively, computed tomography angiography images were obtained before discharge and at 12 months. RESULTS: All patients underwent successful surgery without intraoperative death. Three patients received dialysis because of postoperative renal insufficiency, 1 patient received tracheotomy because of postoperative respiratory insufficiency, and 5 patients had postoperative delirium. Surgery caused stroke in 1 patient. No paraplegia was found, and no re-exploration for bleeding was performed. One patient died in the hospital due to multiple organ failure, and the other patients were discharged as expected. Only 1 patient had a proximal endoleak, and the patient was stable under close follow-up. The diameter of the descending thoracic aorta was smaller at 12 months postoperatively than preoperatively (34.5±2.5 mm versus 36.7±2.9 mm, P<0.05). The average diameter of the true lumen of the descending thoracic aorta was larger at 12 months postoperatively than preoperatively (24.1±3.1 mm versus 14.9±2.3 mm, P<0.05). CONCLUSIONS: The modified aortic arch island anastomosis with stent graft technique is a feasible and safety surgical strategy for acute type A aortic dissection. Short-term outcomes are satisfactory.

Corrigendum: The neutrophil elastase inhibitor, Sivelestat, attenuates acute lung injury in patients with cardiopulmonary bypass.

[This corrects the article DOI: 10.3389/fimmu.2023.1082830.].

The neutrophil elastase inhibitor, sivelestat, attenuates acute lung injury in patients with cardiopulmonary bypass.

Background: The sivelestat is a neutrophil elastase inhibitor thought to have an effect against acute lung injury (ALI) in patients after scheduled cardiac surgery. However, the beneficial effect of sivelestat in patients undergoing emergent cardiovascular surgery remains unclear. We aim to evaluate the effect of sivelestat on pulmonary protection in patients with ALI after emergent cardiovascular surgery. Methods: Firstly, a case-control study in 665 patients undergoing emergent cardiovascular surgery from January 1st, 2020 to October 26th, 2022 was performed. 52 patients who received sivelestat (0.2mg/kg/h for 3 days) and 613 age- and sex-matched controls. Secondly, a propensity-score matched cohort (sivelestat vs control: 50 vs 50) was performed in these 665 patients. The primary outcome was a composite of adverse outcomes, including 30-day mortality, ECMO, continuous renal replacement therapy (CRRT) and IABP, etc. The secondary outcome included pneumonia, ventricular arrhythmias and mechanical ventilation time, etc. Results: In propensity-matched patients, the 30-day mortality (16% vs 24%, P=0.32), stroke (2% vs 8%, P=0.17), ECMO(6% vs 10%, P=0.46), IABP(4% vs 8%, P=0.40) and CRRT(8% vs 20%, P=0.08) had no differences between sivelestat and control group; sivelestat could significantly decrease pneumonia (40% vs 62%, P=0.03), mechanical ventilation time (median: 96hours, IQR:72-120hours vs median:148hours, IQR:110-186hours, P<0.01), bilateral pulmonary infiltrates (P<0.01), oxygen index (P<0.01), interleukin-6(P=0.02), procalcitonin(P<0.01) and C-reactive protein(P<0.01). Conclusion: Administration of sivelestat might improve postoperative outcomes in patients with ALI after emergent cardiovascular surgery. Our results show that sivelestat may be considered to protect pulmonary function against inflammatory injury by CPB. Registration: http://www.chictr.org.cn/showproj.aspx?proj=166643, identifier ChiCTR2200059102.

Q-Learning-Based Hyperheuristic Evolutionary Algorithm for Dynamic Task Allocation of Crowdsensing.

Task allocation is a crucial issue of mobile crowdsensing. The existing crowdsensing systems normally select the optimal participants giving no consideration to the sudden departure of mobile users, which significantly affects the sensing quality of tasks with a long sensing period. Furthermore, the ability of a mobile user to collect high-precision data is commonly treated as the same for different types of tasks, causing the unqualified data for some tasks provided by a competitive user. To address the issue, a dynamic task allocation model of crowdsensing is constructed by considering mobile user availability and tasks changing over time. Moreover, a novel indicator for comprehensively evaluating the sensing ability of mobile users collecting high-quality data for different types of tasks at the target area is proposed. A new Q -learning-based hyperheuristic evolutionary algorithm is suggested to deal with the problem in a self-learning way. Specifically, a memory-based initialization strategy is developed to seed a promising population by reusing participants who are capable of completing a particular task with high quality in the historical optima. In addition, taking both sensing ability and cost of a mobile user into account, a novel comprehensive strength-based neighborhood search is introduced as a low-level heuristic (LLH) to select a substitute for a costly participant. Finally, based on a new definition of the state, a Q -learning-based high-level strategy is designed to find a suitable LLH for each state. Empirical results of 30 static and 20 dynamic experiments expose that this hyperheuristic achieves superior performance compared to other state-of-the-art algorithms.

LncRNAs induce oxidative stress and spermatogenesis by regulating endoplasmic reticulum genes and pathways.

Oligozoospermia or low sperm count is a leading cause of male infertility worldwide. Despite decades of work on non-coding RNAs (ncRNAs) as regulators of spermatogenesis, fertilization, and male fertility, the literature on the function of long non-coding RNAs (lncRNAs) in human oligozoospermia is scarce. We integrated lncRNA and mRNA sequencing data from 12 human normozoospermic and oligozoospermic samples and comprehensively analyzed the function of differentially expressed lncRNAs (DE lncRNAs) and mRNAs (DE mRNAs) in male infertility. The target genes of DE lncRNAs were identified using a Gaussian graphical model. Gene ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were primarily enriched in protein transport and localization to the endoplasmic reticulum (ER). The lncRNA-mRNA co-expression network revealed cis- and trans-regulated target genes of lncRNAs. The transcriptome data implicated DE lncRNAs and DE mRNAs and their target genes in the accumulation of unfolded proteins in sperm ER, PERK-EIF2 pathway-induced ER stress, oxidative stress, and sperm cell apoptosis in individuals with oligozoospermia. These findings suggest that the identified lncRNAs and pathways could serve as effective therapeutic targets for male infertility.

[Simulation of δ18O in Platycladus orientalis leaf water with different kinetic fractionation coefficients].

Clarifying 18O isotope composition of leaf water (δL,b) would provide theoretical refe-rence for the study of leaf physiology and forest hydrology. We continuously monitored the concentration of atmospheric water vapor (Wa) and 18O isotope composition of atmospheric water vapor (δv) at the canopy of Platycladus lateralis plantation in the mountain area of Beijing. We analyzed the effects of kinetic fractionation coefficients Δk1(32%) and Δk2(28%) on the prediction of δL,b by combining the measured leaf water 18O isotope (δx) and δL,b of P. lateralis. The results showed that the diurnal variation of Wa was irregular. Atmospheric relative humidity (RH) showed a "V" shape of diurnal variation, and stomatal conductance (gs) increased first and then decreased at the diurnal scale. Wa, RH, and gs showed a significant negative correlation with δL,b when isotopes approached a steady-state equilibrium around noon. The kinetic fractionation coefficient Δk1 and Δk2 were applied to the Craig-Gordon model to predict δL,b under the isotopic quasi-steady-state condition. The results showed that the predicted values of Δk2 approached the observed values of δL,b. This result indicated that the application of Δk2 to the model was more consistent with the change of water isotope concentration in the leaves of P. lateralis in the mountain area of Beijing. These results would improve our understanding of water isotope enrichment model and evapotranspiration resolution model in leaves.

LncRNA XIST acts as a ceRNA sponging miR-185-5p to modulate pancreatic cancer cell proliferation via targeting CCND2.

BACKGROUND: Long non-coding RNAs (lncRNAs) have been proved to be involved in the occurrence and progression of various tumors including pancreatic cancer (PC). Growing evidence shows that lncRNA X inactive-specific transcript (XIST) functions as an oncogene in multiple tumorigenesis. However, the underlying mechanism of lncRNA XIST in the progression of PC remains elusive. METHODS: Expression levels of XIST and miR-185-5p both in PC tissues or PC cells were determined using real-time quantitative PCR (qRT-PCR). Gain and loss-of-function of XIST or miR-185-5p was performed for further exploration. Moreover, colony formation assay was performed to assess cell proliferation. Flow cytometry analysis was performed to measure cell cycle and apoptosis. Dual-luciferase reporter assay was conducted to verify the correlation between XIST, miR-185-5p and CCND2, respectively. Additionally, western blot analysis was conducted to determine the expression pattern of apoptosis-related proteins and cell cycle-associated proteins. RESULTS: Herein, we found that XIST expression was up-regulated while miR-185-5p was down-regulated both in PC tissues and cell lines, compared with that of controls. Moreover, there was a negative correlation between XIST and miR-185-5p. Following that, functional experiments displayed that knockdown of XIST or overexpression of miR-185-5p inhibited cell proliferation, induced cell cycle arrest and promoted apoptosis in PC cells. Furthermore, mechanistic experiments displayed that XIST could negatively regulate miR-185-5p via direct binding. In addition, CCND2 was shown to be a downstream target of miR-185-5p. Importantly, overexpression or knockdown of XIST significantly increased or decreased the expression of CCND2, while these effects were reversed by miR-185-5p. CONCLUSIONS: Taken together, our study demonstrated that lncRNA XIST functions as an oncogene and exerts its regulation via miR-185-5p/CCND2 axis, promoting proliferation and inhibiting apoptosis in PC.

A comparative study for the usage of Fidji cervical cages after multilevel anterior cervical discectomy and fusion.

BACKGROUND: Postoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system. PURPOSE: To evaluate the influence of two types of surgery for multilevel cervical spondylotic myelopathy (CSM) on postoperative dysphagia, namely ACDF with cage alone (ACDF-CA) using Fidji cervical cages and ACDF with cage and plate fixation (ACDF-CP). METHODS: A retrospective study was performed in 62 consecutive patients with multilevel CSM, including 32 underwent ACDF-CA (group A) and 30 underwent ACDF-CP (group B). All enrolled patients were followed up at 48 h, 2 months and 6 months postoperatively, when the dysphagia rate, Swallowing-Quality of Life (SWAL-QOL) score and the thickness of prevertebral soft tissue were recorded. RESULTS: At 48 h and 2 months, the dysphagia rate and thickness of prevertebral soft tissue were both significantly lower in group A than in group B, while the SWAL-QOL score of group A was significantly higher than that of group B. No significant difference was observed at 6 months. CONCLUSION: Fidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.

Comparison of outcomes between minimally invasive transforaminal lumbar interbody fusion and traditional posterior lumbar intervertebral fusion in obese patients with lumbar disk prolapse.

OBJECTIVE: The aim of this study was to compare the curative effect between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and the posterior lumbar interbody fusion (PLIF) in obese patients with lumbar disk prolapse. PATIENTS AND METHODS: In this study, 72 patients who underwent lumbar disk prolapse therapy in the Third Hospital of Hebei Medical University between March 2011 and 2015 were retrospectively analyzed and were divided into two groups, MIS-TLIF group (n=35) and PLIF group (n=37), according to different surgical procedures. Several clinical parameters were compared between these two groups. RESULTS: Compared with PLIF, MIS-TLIF was associated with longer operative time, less blood loss, less postoperative drainage and shorter postoperative time in bed; moreover, patients in the MIS-TLIF group had lower levels of serum creatine kinase on 1, 3 and 5 postoperative days. At the 3- and 6-month follow-up, Visual Analog Scale (VAS) scores of low back pain of patients in the MIS-TLIF group were significantly reduced and Japanese Orthopaedic Association (JOA) scores were increased, whereas the Oswestry Disability Index (ODI) showed no significant difference between the two groups. CONCLUSION: Obese patients can achieve good efficacy with MIS-TLIF or PLIF treatment, but MIS-TLIF surgery showed longer operative time, fewer traumas and bleeding volume, less incidence of short-term pain, low complication rate and faster postoperative recovery.

Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients.

BACKGROUND: Very few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis. MATERIALS AND METHODS: The clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded. RESULTS: Three patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all P<0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (P<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%. CONCLUSION: TED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH.

Role of tripartite motif protein 27 as a gametogenesis-related protein in human germ cells.

BACKGROUND: The distribution and functional integrity of members of the tripartite motif (TRIM) protein family are essential for cell proliferation, development and apoptosis, and TRIM proteins have been linked to various cancers. To explore the diagnostic potential and mechanisms of TRIM27 in human spermatogenesis and oogenesis, we analyzed its localization pattern and putative roles in human testes and ovaries. METHODS: TRIM27 mRNA and protein levels in human testes and ovaries were investigated using RT-PCR and western blotting, respectively. TRIM27 was abundantly transcribed in human testes and ovaries, particularly during the early stages of spermatogenesis, and localized in the nuclei of primary spermatocytes. Immunofluorescence also revealed a diffuse distribution in the cytoplasm of round spermatids, and the protein was abundant in ovary tissue during various stages of oogenesis development. RESULTS: TRIM27 mRNA and protein was abundantly transcribed in male and female human germ cells by RT-PCR and western blotting in the human testes followed by the ovary. Immunohistochemical results revealed TRIM27 protein was abundant in the sex body of primary spermatocytes undergoing meiotic prophase during the first cycle of spermatogenesis. Moreover, Trim27 was diffusely localized in the cytoplasm of spermatids and round spermatids. Furthermore, TRIM27 was localized to both the nucleus and cytoplasm of human ovary cells. CONCLUSIONS: TRIM27 as a gametogenesis-related protein could play multiple roles in the regulation of sex body formation and germ cell proliferation during spermatogenesis and oogenesis. The identification and characterization of TRIM27 enhances our understanding of the molecular mechanisms underpinning its functions, and provides insight into its potential role in the pathogenesis of germ cell differentiation and infertility.

[Microdissection testicular sperm extraction for patients with nonmosaic Klinefelter syndrome: A report of 143 cases].

OBJECTIVE: To investigate the clinical application and outcomes of microdissection testicular sperm extraction (micro-TESE) in patients with nonmosaic Klinefelter syndrome (KS). METHODS: A total of 143 nonmosaic KS patients underwent micro-TESE in the Center of Reproductive Medicine of Peking University Third Hospital between July 2012 and August 2016. We analyzed their clinical and follow-up data and evaluated the outcomes. RESULTS: Spermatozoa were successfully retrieved from the testicular tissue in 44.76% (64/143) of the patients, 84.4% (54/64) by unilateral and 15.6% (10/64) by bilateral micro-TESE. Seventy-five of the KS patients were followed up in the years of 2014 and 2015. Of the 34 patients with successful sperm retrieval, 73.52% (25/34) achieved clinical pregnancy and 8 boys and 8 girls were already born in 14 of the 25 cases. CONCLUSIONS: The micro-TESE is a useful method for sperm retrieval in nonmosaic KS patients, with high rates of sperm retrieval, clinical pregnancy, and birth of biological offspring.