A novel repair strategy using knotless squeeze anchors for lumbar disc herniation with endplate junction lesions under biportal endoscopic spinal surgery.

BACKGROUND: Annulus fibrosus-endplate (AF-EP) junction lesions are important determinants for lumbar disc herniation (LDH). Utilizing biportal endoscopic spinal surgery (BESS), we introduce a novel repair method using bioabsorbable PushLock anchors with suture fibers to stretch disconnected AF tissues to the vertebral cortex. METHODS: The viewing and working portals are established to excise herniated disc materials causing radiculopathy. Through the working portal, a suture strand is passed through the intact AF tissue near the lesion and retrieved using the Suture Crossing Device. Then, the knotless suture limbs are secured into the cortical bone socket of the vertebral body with a PushLock anchor. CONCLUSION: The procedure is a simple, safe, and feasible knotless suturing technique for the treatment of LDH with AF-EP junction lesions.

Liquid concrete as a gastrointestinal tract foreign body.

Gastrointestinal foreign bodies present a common clinical challenge. We present an unusual case of a 58-year-old construction worker who ingested liquid concrete that risked solidifying in his stomach. Gastroscopy revealed only partial solidification and pyloric obstruction, which were successfully resolved through endoscopic fragmentation and mechanical removal. To protect the gastric mucosa during elimination, liquid paraffin and a cellulose-based formula were administered. Complete gastrointestinal evacuation was achieved within 3 days, with no complications observed. This case emphasises the urgency of the early removal of concrete.

Comparison of Intraoperative Endplate Injury between Mini-Open Lateral Lumbar Interbody Fusion (LLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) and Analysis of Risk Factors: A Retrospective Study.

OBJECTIVE: The study aimed to compare the incidence of intraoperative endplate injury in patients who underwent Transforaminal interbody fusion (TLIF) and mini-open lumbar interbody fusion (LLIF) surgery. The independent risk factors related to endplate injury in LLIF procedure were analyzed. METHODS: A total of 199 patients who underwent LLIF (n = 106) or TLIF (n = 93) surgery from June 2019 to September 2021 were reviewed. The endplate injury was assessed by postoperative sagittal CT scan. A binary logistic analysis model were used to identify independent risk factors related to LLIF endplate injury based on univariate analysis. RESULTS: There was an obvious difference in the occurrence of intraoperative endplate injury between LLIF (42/106, 39.6%) and TLIF group (26/93, 28%), although it did not reach the significant level. L1 CT value (OR = 0.985, 95% CI = 0.972-0.998), cage position (OR = 3.881, 95% CI = 1.398-10.771) and height variance (OR = 1.263, 95% CI = 1.013-1.575) were independent risk factors for endplate injury in LLIF procedure. According to the cage settlement patterns, there 5 types of A to E. The severity of the facet joint degeneration was positively related to the occurrence of endplate injury. CONCLUSIONS: The incidence of intraoperative endplate injury is higher in LLIF than in TLIF procedures. Low bone quantity, cage posterior position and larger height variance are risk factors to induce endplate injury in LLIF surgery. The facet joint degeneration may be related to severe endplate injuries and even fractures.

Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer.

BACKGROUND: To assess the predictive values of primary tumor FDG uptake for patients with inoperable stage III non-small cell lung cancer (NSCLC) after concurrent chemoradiotherapy (CCRT). METHODS: A total of 107 patients with diagnosis of stage III NSCLC and CCRT were enrolled. The tumor maximum uptake value (SUVmax) was standardized by calculating several ratios between tumor and each background tissues. The receiver operating characteristics curve (ROC) was used to compare the predictive power of prognostic models. The tumor objective response rate (ORR) and overall survival (OS) were compared and analyzed by the Kaplan-Meier method and univariate and multivariate Cox regression models. RESULTS: The areas under ROC curve (AUCs) ranged from 0.72 to 0.81 among these tumor SUVmax and standardized SUVmax ratios, and the tumor SUVmax and tumor SUVmax-to-liver SUVmean ratio (TLMR) were more predictive of ORR (AUC, 0.81; 95% CI, 0.73-0.88 for tumor SUVmax and AUC, 0.84; 95%CI, 0.76-0.91 for TLMR) than any of other SUVmax ratios. The patients with lower tumor SUVmax, SUVmean and SUVmax ratios had a significantly better OS than those with their corresponding higher ones. Moreover, both univariate and multivariable analyses revealed that TLMR was significantly associated with better ORR and OS after adjustment with other prognostic variables. CONCLUSIONS: TLMR, a standardized tumor SUVmax, was an independent prognostic predictor for tumor ORR and OS of patients with stage III NSCLC after CCRT.

Identification and validation of a novel signature based on cell-cell communication in head and neck squamous cell carcinoma by integrated analysis of single-cell transcriptome and bulk RNA-sequencing.

Background: The heterogeneous crosstalk between tumor cells and other cells in their microenvironment means a notable difference in clinical outcomes of head and neck squamous cell carcinoma (HNSCC). CD8+ T cells and macrophages are effector factors of the immune system, which have direct killing and phagocytosis effects on tumor cells. How the evolution of their role in the tumor microenvironment influences patients clinically remains a mystery. This study aims to investigate the complex communication networks in the HNSCC tumor immune microenvironment, elucidate the interactions between immune cells and tumors, and establish prognostic risk model. Methods: 20 HNSCC samples single-cell rna sequencing (scRNA-seq) data and bulk rna-seq data were derived from public databases. The "cellchat" R package was used to identify cell-to-cell communication networks and prognostic related genes, and then cell-cell communication (ccc) molecular subtypes were constructed by unsupervised clustering. Kaplan-Meier(K-M) survival analysis, clinical characteristics analysis, immune microenvironment analysis, immune cell infiltration analysis and CD8+T cell differentiation correlation analysis were performed. Finally, the ccc gene signature including APP, ALCAM, IL6, IL10 and CD6 was constructed based on univariate Cox analysis and multivariate Cox regression. Kaplan-Meier analysis and time-dependent receiver operating characteristic (ROC) analysis were used to evaluate the model in the train group and the validation group, respectively. Results: With CD8+T cells from naive to exhaustion state, significantly decreased expression of protective factor (CD6 gene) is associated with poorer prognosis in patients with HNSCC. The role of macrophages in the tumor microenvironment has been identified as tumor-associated macrophage (TAM), which can promote tumor proliferation and help tumor cells provide more nutrients and channels to facilitate tumor cell invasion and metastasis. In addition, based on the strength of all ccc in the tumor microenvironment, we identified five prognostic ccc gene signatures (cccgs), which were identified as independent prognostic factors by univariate and multivariate analysis. The predictive power of cccgs was well demonstrated in different clinical groups in train and test cohorts. Conclusion: Our study highlights the propensity for crosstalk between tumors and other cells and developed a novel signature on the basis of a strong association gene for cell communication that has a powerful ability to predict prognosis and immunotherapy response in patients with HNSCC. This may provide some guidance for developing diagnostic biomarkers for risk stratification and therapeutic targets for new therapeutic strategies.

Analysis and Validation of the Prognosis ability of the M7GRelated miRNAs in Lung Adenocarcinoma.

BACKGROUND: N7-methylguanosine (m7G) modification plays a crucial role in the development and progression of lung cancers. MicroRNAs (miRNAs) are closely involved in programmed cell death and the mechanism of tumor growth. The m7G-associated miRNAs genes in lung adenocarcinoma (LUAD), and their prognosis prediction ability of LUAD, however, had not been investigated. METHODS: The RNA transcriptomes, clinical indices, and immune scores of LUAD patients were searched and downloaded from The Cancer Genome Atlas (TCGA) and the ESTIMATE database. The miRNAs targeting METTL1 and WDR4 were extracted from the TargetScan database. Differentially expressed m7G-related miRNAs were identified and their prediction power of LUAD prognosis was systematically investigated. RESULTS: Among 40 the differentially expressed m7G-related miRNAs in LUAD, five (hsa-miR-31-5p, hsa-miR-5571-3p, hsa-miR-4697-3p, hsa-miR-6858-5p, and hsa-miR-873-3p) demonstrate significant predictive value for prognosis. The risk score constructed by these five miRNAs was an independent prognostic factor (univariate Cox regression results: hazard ratio (HR) = 1.6619, 95% confidential interval (CI) = 1.2103-2.2819, p = 0.0017; multivariate Cox regression results: HR = 1.6004, 95% CI = 1.1633-2.2017, p = 0.0039). The survival curves showed that patients with high-risk scores had a poor prognosis. Calibration curves indicated good predictability in a nomogram constructed combining the miRNA and the clinical indices of age, sex, chemotherapy, radiotherapy, stage, and risk score. GO and KEGG analysis of the overlapping genes showed that the prognostic miRNAs were closely associated with the neuropeptide signaling pathway. Besides, the immune infiltration analysis showed that the expression of the AMPD1 gene was strongly associated with immune cells and immunology functions in LUAD. CONCLUSION: This study identified DE m7G-related miRNAs and demonstrated their prediction ability in the prognosis of LUAD patients. The risk signature based on these miRNAs demonstrates high accuracy in predicting the prognosis of LUAD patients.

Self-Compositing: A Efficient Method of Improving the Electrical Conductivity of Graphene Nanoplatelet/Thermosetting Resin Composites.

Conductive composites based on thermosetting resins have broad applications in various fields. In this paper, a new self-compositing strategy is developed for improving the conductivity of graphene nanoplatelet/thermosetting resin composites by optimizing the transport channels. To implement this strategy, conventional graphene nanoplatelet/thermosetting resin is crushed into micron-sized composite powders, which are mixed with graphene nanoplatelets to form novel complex fillers to prepare the self-composited materials with thermosetting resins. A highly conductive compact graphene layer is formed on the surface of the crushed composite powders, while the addition of the micron-sized powder induces the orientation of graphene nanoplatelets in the resin matrix. Therefore, a highly conductive network is constructed inside the self-composited material, significantly enhancing the electrical conductivity. The composite materials based on epoxy resin, cyanate resin, and unsaturated polyester are prepared with this method, reflecting that the method is universal for preparing composites based on thermosetting resins. The highest electrical conductivity of the self-composited material based on unsaturated polyester is as high as 25.9 S m-1 . This self-compositing strategy is simple, efficient, and compatible with large-scale industrial production, thus it is a promising and general way to enhance the conductivity of thermosetting resin matrix composites.

Prognostic roles of a novel basement membranes-related gene signature in lung adenocarcinoma.

Background: The basement membranes (BMs) are involved in tumor progression, while few comprehensive analyses to date are performed on the role of BM-related gene signatures in lung adenocarcinoma (LUAD). Thus, we aimed to develop a novel prognostic model in LUAD based on BMs-related gene profiling. Methods: The LUAD BMs-related gene profiling and corresponding clinicopathological data were obtained from the basement membrane BASE, The Cancer Genome Atlas (TCGA) and gene expression omnibus (GEO) databases. The Cox regression and least absolute shrinkage and selection operator (LASSO) methods were used to construct a BMs-based risk signature. The concordance index (C-index), receiver operating characteristic (ROC), and calibration curves were generated to evaluate the nomogram. The GSE72094 dataset was used to validate prediction of the signature. The differences in functional enrichment, immune infiltration, and drug sensitivity analyses were compared based on risk score. Results: In TCGA training cohort, 10 BMs-related genes were found, (e.g., ACAN, ADAMTS15, ADAMTS8, BCAN, etc). The signal signature based on these 10 genes was categorized into high- and low-risk groups regarding survival differences (p < 0.001). Multivariable analysis showed that the signature of combined 10 BMs-related genes was an independent prognostic predictor. Such a prognostic value of BMs-based signature in validation cohort of the GSE72094 were further verified. The GEO verification, C-index, and ROC curve showed that the nomogram had accurate prediction performance. The functional analysis suggested that BMs were mainly enriched in extracellular matrix-receptor (ECM-receptor) interaction. Moreover, the BMs-based model was correlated with immune checkpoint. Conclusion: This study identified BMs-based risk signature genes and demonstrated their ability to predict prognosis and guide personalized treatment of patients with LUAD.

"Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report.

Background: Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL. Methods: A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated. Results: Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%. Conclusion: UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.

Exosomes Mediated Transfer of Circ_0000337 Contributes to Cisplatin (CDDP) Resistance of Esophageal Cancer by Regulating JAK2 via miR-377-3p.

Background: Chemoresistance remains a major obstacle to the treatment of esophageal cancer patients. Exosome-mediated transfer of circular RNAs (circRNAs) has been reported to be related to drug resistance in esophageal cancer. This study is designed to explore the role and mechanism of exosomal circ_0000337 on CDDP resistance in esophageal cancer. Methods: Cell viability, proliferation, colony number, apoptosis, migration, and invasion were assessed by Cell Counting Kit-8 (CCK-8), colony formation, flow cytometry, and transwell assays. Circ_0000337, microRNA-377 (miR-377-3p), and Janus kinase 2 (JAK2) levels were detected by real-time quantitative polymerase chain reaction (RT-qPCR). Exosomes were isolated and detected by differential centrifugation and a transmission electron microscope. Protein levels of CD9, CD63, and JAK2 were tested by Western blot assay. The binding relationship between miR-377-3p and circ_0000337 or JAK2 was predicted by circinteractome or Starbase and then verified by dual-luciferase reporter assay and RNA pull-down assay. The biological role of exosomal circ_0000337 and CDDP on esophageal cancer cell growth was examined by the xenograft tumor model in vivo. Results: Circ_0000337 and JAK2 were highly expressed, and miR-377-3p was decreased in CDDP-resistant esophageal cancer tissues and cells. Moreover, circ_0000337-containing exosomes secreted by CDDP-resistant esophageal cancer cells could promote CDDP resistance, cell growth, and metastasis in CDDP-sensitive esophageal cancer cells in vitro. The mechanical analysis discovered that circ_0000337 functioned as a sponge of miR-377-3p to regulate JAK2 expression. Exosomal circ_0000337 increased the drug resistance of esophageal cancer in vivo. Conclusion: Exosomal circ_0000337 accelerated CDDP resistance of esophageal cancer cells partly by regulating the miR-377-3p/JAK2 axis, hinting a promising therapeutic target for the esophageal cancer treatment.

Gastric emptying of preoperative drinks is slower in adults with chronic energy deficiency: A 2 hour cross-over study among Chinese.

BACKGROUND AND OBJECTIVES: To investigate the effects of oral preoperative regimens on gastric emptying time in relation to BMI in Chinese adults. METHODS AND STUDY DESIGN: The enrolled 56 adults were divided into three groups (normal-weight, underweight, and overweight) and completed a regimen of two drinks after a 2-week interval. After drinking a carbohydrate regimen (CD, 50 g carbohydrates) or a carbohydrate glutamine regimen (CGD, 44 g carbohydrates and 6 g glutamine) labelled with 99mTc-DTPA (99mTc-diethylenetriaminepentaacetic acid), gastric emptying times T50 and T90 were measured using a curve derived from scintigraphic images. RESULTS: T50 and T90 had no significant difference between the CD and CGD regimens. T50 was significantly delayed in the underweight participants (BMI <18.5 kg/m2, as Chronic Energy Deficiency, CED) compared with the normal-weight participants after drinking CD (p=0.003) or CGD (p=0.002), as well as T90 after CD (p=0.019). There was no difference in glucose concentrations between the three groups. There are negative correlations between body weight and gastric emptying time T50 (r=-0.461, p=0.016) or T90 (r=-0.553, p=0. 003) after drinking CD, as well as T50 (r=-0.553, p=0.003) after drinking CGD. CONCLUSIONS: Underweight adults should be careful to take oral preoperative regimens 2 hours before surgery and consider reducing the volume because of a slower gastric emptying rate.

Efficacy of balloon dilatation of the eustachian tube in patients with refractory otitis media with effusion after radiotherapy for nasopharyngeal carcinoma.

PURPOSE: To investigate the efficacy of balloon dilatation of the eustachian tube (BDET) in patients with refractory otitis media with effusion (OME) after radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS: A total of 58 patients (74 ears) who had received BDET for treatment of refractory OME after radiotherapy for nasopharyngeal carcinoma were enrolled. The efficacy was evaluated by seven-item eustachian tube scores (ETS-7), tympanogram type and air-bone gap, and the total effective rate was also calculated. All patients were followed up for 2 years. RESULTS: ETS-7 scores at every postoperative visit were significantly higher than preoperative scores (all P < 0.05). ETS-7 score 6 months after surgery was the highest, which declined sharply from the 6th to the 24th month after surgery. Air-bone gap from the 1st to the 18th month after surgery was significantly smaller than preoperative one (all P < 0.05). Air-bone gap 6 months after surgery was the smallest, followed by that 12 months after surgery. The improvement in tympanogram type 6 months after surgery was the highest. The improvement of tympanogram type declined sharply from 12 to 24 months after surgery. According to evaluation of efficacy, only one patient completely recovered, and five patients partially recovered during the 2-year follow-up. CONCLUSION: BDET can only significantly improve efficacy of refractory OME after radiotherapy for nasopharyngeal carcinoma for a certain period of time during the 2-year follow-up.

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Antisense long chain noncoding RNA (lncRNA) is a new class of RNA molecules. In recent years, antisense lncRNA has been found to play an important role in many life activities including tumorigenesis and development. It has become a hot topic in biological research in recent years. Because of the special structure, many antisense lncRNAs have specific expression in tumor tissues and are closely related to the clinical data of the patients. Thus, antisense lncRNA is a potential tumor molecular marker. Further functional studies have shown that lncRNA can participate in gene regulation by means of miRNA sponge and RBP binding to play an important role in tumor cell cycle, apoptosis, angiogenesis, invasion and metastasis. More studies on the mechanisms of antisense lncRNA in cancer are of great theoretical significance in understanding the etiology and pathogenesis of malignant tumors and RNA language. At the same time, antisense lncRNA is a molecular marker or a potential target for the early diagnosis of malignant tumors. The antisense lncRNA may have a broad clinical application prospect in the evaluation of therapeutic effect, prognosis and even gene therapy.

Interface Fixation Using Absorbable Screws versus Plate Fixation in Anterior Cervical Corpectomy and Fusion for Two-Level Cervical Spondylotic Myelopathy.

BACKGROUND We compared the clinical and radiographic outcomes between interface fixation using absorbable screws and plate fixation in anterior cervical corpectomy and fusion (ACCF) to evaluate the effectiveness of these 2 fixation methods for the treatment of 2-level cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS From January 2014 to December 2016, a total of 220 patients who received 2-level ACCF were retrospectively collected. Among them, 108 patients were treated with interface fixation using absorbable screws (Group A) and 112 patients underwent plate fixation (Group B). Japanese Orthopedic Association (JOA) score and Neck Disability Index (NDI) score were employed to compare the clinical improvement. Operative time, blood loss, surgical cost, cervical lordosis, complications, and fusion rate were also evaluated. RESULTS The average follow-up time were 35.2±4.5 months in Group A and 35.9±3.9 months in Group B. There was no difference in operative time and blood loss for both groups. The JOA scores and NDI scores were similar in each follow-up (p>0.05 in all). Group A cost an average of 30% less than Group B for the operation. Both groups achieved 100% in the fusion rate with the same conditions in cervical lordosis. Group A (5/108) had a significantly lower complication rate than Group B (17/112) (p<0.05). CONCLUSIONS ACCF with interface fixation using absorbable screws achieved similar clinical outcomes compared to ACCF with plate fixation for 2-level CSM. Moreover, the interface fixation using absorbable screws presented far fewer complications and cost less for the operation.

Knockdown of LncRNA RHPN1-AS1 Inhibits Cell Migration, Invasion and Proliferation in Head and Neck Squamous Cell Carcinoma.

Previous studies have revealed that long non-coding RNAs (lncRNAs) are involved in head and neck squamous cell carcinoma (HNSCC) progression. However, the detailed roles of lncRNA RHPN1-AS1 remain to be elucidated. In this study, by analyzing online RNA-Seq data, we found that RHPN1-AS1 was upregulated in HNSCC tissues and that its expression level was associated with neoplasm histologic grade. High expression of RHPN1-AS1 was also confirmed in HNSCC tissues. Knockdown of RHPN1-AS1 inhibited tumor cell migration, invasion and proliferation in HNSCC. Furthermore, inhibition of RHPN1-AS1 suppressed the expression of epithelial-mesenchymal transition (EMT)-related genes (ß-Catenin, Claudin-1 and Vimentin) in HNSCC cells. Collectively, our results suggest that RHPN1-AS1, acting as an oncogene, may be a potential diagnostic and therapeutic target in HNSCC.

[In vivo measurement of three-dimensional motion of the upper cervical spine using CT three-dimensional reconstruction].

OBJECTIVE: Using the CT three-dimensional reconstruction to measure the activity degree of atlanto-occipital joint and the atlantoaxial joint in different directions and its coupling movement in healthy volunteers, and three dimensional motion range of the maximum rotation position of the upper cervical spine of cervical spondylosis patients, and to analyze the differences, verifing the reliability of the method at the meantime. METHODS: From January 2014 to June 2015, 20 healthy adult subjects(healthy adult group), and 26 patients with cervieal spondylosis(cervical spondylosis group) were selected. In healthy adult group, there were 11 males and 9 females, aged from 22 to 26 years old with an average of (24.0±1.2) years, and in cervical spondylosis group, there were 24 males and 2 females, aged from 36 to 72 years old with an average of (52.8±8.6) years. Healthy adults underwent CT examination in neutral position, maximum right rotation, maximum right lateral bending, maximum flexion and extention, and cervical spondylosis patients underwent CT examination in neutral position, maximum right rotation. Then the software Mimics was used to reconstruct occiput (Oc), atlas(C1) and axial(C2) vertebral three-dimensional image. Three virtual non-collinear markers were positioned on prominent structures of foramen magnum, C1 and C2. The 3D spatial coordinates of these virtual anatomical markers entail the definition of an anatomical local coordinate system which represent the position and orientation of the bones. Segmental motions were calculated using Eulerian angle in three major planes, and the difference between cervical spondylosis group and healthy adult group were compared. Due to the inaccuracy in anatomical landmark idenrification, two groups were measured 3 times, and the reliability of the experimental metnod was verified by the intra-group correlation (intra-group ICC) and the inter-group correlation coefficient(inter-group ICC). RESULTS: Reliability verification results:the intra-group ICC and inter-group ICC results were all above 0.90, and the measurement method had high reliability. Three-dimensional activity of the upper cervical spine in healthy adults:the atlanto-occipital joint had(-6.8±1.5)° coupled left lateral bending and (8.9±2.0)° coupled extension in the maximum right rotation position, and the motion of atlanto-occipital joint had low activity[maximum was(5.3±2.6)°] in the remaining 3 positions; the rotation of atlanto-axial joint was(37.9±5.1)°, accounting for 52.34% of the total cervical spine activity[(72.4±5.0)°] in the maximum right rotation position, and rotational motion was still prominent in the remaining three positions. The relative translations of the upper cervical spine in all direction were small. The average axial rotation angle [(62.0±3.4)] ° of the total cervical spine in cervical spondylosis group was significantly lower than that in the healthy adult group, but the mean axial rotation angles of the atlanto-occipital and the atlantoaxial joint were not significantly different from those of the healthy adults(P>0.05). CONCLUSIONS: The three-dimensional CT reconstruction method has high reliability, which can be applied to measure the movement of spine. The upper cervical spine contributed the most to the direction of rotation, and the movement in all directions are accompanied by coupled motion in the other direction. There was no significant difference in the rotation of the upper cervical spine between cervical spondylosis patients and normal subjects.

[Validity study of Coda Motion Analysis System for measuring cervical lateral flexion in normal adults].

OBJECTIVE: To investigate the validity of Coda Motion Analysis System for measuring cervical lateral flexion in normal adults in order to explore a new measuring tool for clinical and research practice. METHODS: A total of 43 participants were involved in the study. Cervical range of lateral flexion were measured with Coda Motion Analysis System and "gold standard" X-ray simultaneously. The validity and agreement were assessed using the scatter diagram, the Pearson correlation coefficient and limits of agreement. RESULTS: Cervical range of lateral flexion measured by Coda Motion Analysis System had no statistical differences with those measured by X-ray(P>0.05). The Coda Motion Analysis System demonstrated a very good linear relation with the X-ray measurements in cervical range of right lateral flexion, left flexion and total lateral flexion, and the Pearson correlation coefficients were 0.72, 0.85 and 0.90 respectively. CONCLUSIONS: Coda Motion Analysis System showed good validity for measuring cervical lateral flexion in normal adults. Because the reliability of Coda Motion Analysis System was established previously, the results of this study suggest that the system has the potential to be used to measure cervical lateral flexion in clinical and research practice.

Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss.

OBJECTIVE: This study aimed to compare the efficacy of intratympanic dexamethasone (ITD) therapy and hyperbaric oxygen(HBO) therapy for the salvage treatment of patients with high-frequency sudden sensorineural hearing loss (SSNHL) after the failure of conventional therapy. MATERIALS AND METHODS: 104 refractory high-frequency SSNHL patients were enrolled in our study. Among them, 31 received ITD alone (ITD group), 32 received HBO alone (HBO group) and 41 received no salvage therapies (control group). Hearing outcomes were determined by pure-tone average measured by audiometry. The total effective rates in the hearing recovery and improvement of tinnitus were calculated before and after salvage treatment. RESULTS: There was no significant difference of the total effective rates in the hearing recovery between ITD and HBO group (p = 0.368). However, ITD therapy showed much better improvements of tinnitus than HBO therapy (p = 0.039). After ITD and HBO therapy, there were no significant differences in hearing gains at 2 and 4 KHz between ITD and HBO group (p = 0.468 and 0.934, respectively). Nevertheless, ITD therapy showed significant improvements of hearing gains at 8 KHz (p = 0.049) compared to that of HBO therapy. CONCLUSION: ITD therapy may have better improvements of tinnitus and hearing gains at 8 KHz than HBO therapy in patients with refractory high-frequency SSNHL.

Characteristics and Management of Free Flap Compromise Following Internal Jugular Venous Thrombosis.

PURPOSE: Free flap compromise after internal jugular venous thrombosis (IJVT) occurs fairly infrequently in oral and maxillofacial rehabilitation and reconstruction but could seriously affect the patient's postoperative recovery. The aim of this study was to analyze and discuss the characteristics and management of such flap compromise. PATIENTS AND METHODS: The authors performed a retrospective case series of 13 patients who underwent reconstruction of oral and maxillofacial defects with anterolateral thigh flaps and developed flap compromise from IJVT from July 2014 through December 2016 at the Second Xiangya Hospital of Central South University (Changsha, China). The clinical features of flap compromise are described, and the precautions and improvement measures are reported. RESULTS: All 13 patients were men with an average age of 50.3 years. Flap compromise caused by IJVT occurred on postoperative days 3 to 7, of which 2 flaps were salvaged (15.4%) and 11 flaps failed completely after immediate urgent re-exploration. Four patients presented with orocutaneous fistula after salvage surgery that healed well after a period of wound dressing. CONCLUSIONS: Because of the late occurrence and low salvage rate of flap compromise caused by IJVT, intensive flap monitoring after reconstruction surgery is necessary for patients with free flap transfer.

Comparing the measured basal metabolic rates in patients with chronic disorders of consciousness to the estimated basal metabolic rate calculated from common predictive equations.

BACKGROUND: Accurately predicting the basal metabolic rate (BMR) of patients in a vegetative state (VS) or minimally conscious state (MCS) is critical to proper nutritional therapy, but commonly used equations have not been shown to be accurate. Therefore, we compared the BMR measured by indirect calorimetry (IC) to BMR values estimated using common predictive equations in VS and MCS patients. METHODS: Body composition variables were measured using the bioelectric impedance analysis (BIA) technique. BMR was measured by IC in 82 patients (64 men and 18 women) with VS or MCS. Patients were classified by body mass index as underweight (<18.5 kg/m2, n = 34) or normal-weight (18.5 ≤ BMI < 25 kg/m2, n = 48). BMR was estimated for each group using the Harris-Benedict (H-B), Schofield, or Cunningham equations and compared to the measured BMR using Bland-Altman analyses. RESULTS: For the underweight group, there was a significant difference between the measured BMR values and the estimated BMR values calculated using the H-B, Schofield, and Cunningham equations (p < 0.05). For the normal-weight group, the BMR values estimated using the H-B and Cunningham equations were different significantly from the measured BMR (p < 0.05 and p < 0.01 respectively). Of the predictive equations, only Schofield was not significantly different from the measured BMR in the normal-weight group. The Schofield equation showed the best concordance (only 41.5%) with the BMR values measured by IC. CONCLUSIONS: None of the commonly used equations to estimate BMR were suitable for the VS or MCS populations. Indirect calorimetry is the preferred way to avoid either over or underestimate of BMR values.