A Comparison of Minimally Invasive Surgical Techniques and Standard Open Discectomy for Lumbar Disc Herniation: A Network Meta-analysis.

BACKGROUND: Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established. OBJECTIVES: We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations. STUDY DESIGN: Network meta-analysis. METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score. RESULTS: We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate. LIMITATIONS: First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results. CONCLUSIONS: Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.

Phase retrieval from single-shot square wave fringe based on image denoising using deep learning.

Fringe-structured light measurement technology has garnered significant attention in recent years. To enhance measurement speed while maintaining a certain level of accuracy using binary fringe, this paper proposes a phase retrieval method with single-frame binary square wave fringe. The proposed method utilizes image denoising through deep learning to extract the phase, enabling the use of a trained image denoiser as a low-pass filter, which adaptively replaces the manual selection of the appropriate band-pass filter. The results demonstrate that this method achieves higher reconstruction accuracy than the traditional single-frame algorithm while preserving more object details.

High accuracy, compact 3D face imaging method based on translational and online-switchable phase-shifting fringe projection.

In this paper, a compact, cost-effective, and fast translational online-switchable phase-shifting fringe (TOPF) projector is designed and fabricated for high accuracy three-dimensional (3D) face imaging. Compared with the conventional mechanical projectors, the main difference is that it utilizes a translational approach instead of a rotational one to achieve a better balance in terms of size, speed, accuracy, and cost. To mitigate the inconsistency of the motor's step size and ensure the stability of phase-shifting, an optical encoder-based feedback control mechanism is employed. Additionally, to address the random phase shift errors induced by mechanical motion, a fast, generalized phase-shifting algorithm with unknown phase shifts (uPSAs) that can calculate arbitrary phase shifts is proposed. Finally, a 3D imaging system consisting of the TOPF projector and two cameras is constructed for experimental validation. The feasibility, effectiveness, and precision of our proposed method are substantiated through the reconstruction of a static facial model and a dynamic real face.

Hydrogels Containing Chitosan-Modified Gold Nanoparticles Show Significant Efficacy in Healing Diabetic Wounds Infected with Antibiotic-Resistant Bacteria.

Purpose: Persistent Infections and inflammation are associated with impaired wound healing in diabetic patients. There is a pressing demand for innovative antimicrobial strategies to address infections arising from antibiotic-resistant bacteria. Polymer-modified gold nanoparticles (AuNPs) show broad-spectrum antibacterial properties and significant biocompatibility. This study investigated the antibacterial and wound healing efficacy of hydrogel dressings conjugated with chitosan-AuNPs in diabetic model rats. Methods: Chitosan (CS)-functionalized gold nanoparticles (CS-AuNPs) were incorporated into hydrogel dressings (Gel/CS-AuNPs), which were formulated through the chemical cross-linking of gelatin with sodium alginate (SA). The basic characteristics of Gel/CS-AuNPs were analyzed by TEM, SEM, XRD, and UV-visible spectra. Rheological, swelling, degradation, and adhesive properties of Gel/CS-AuNPs were also determined. In vitro anti-bactericidal effects of the Gel/CS-AuNPs were analyzed with E. coli, S. aureus, and MRSA. In vitro biocompatibility of the Gel/CS-AuNPs was evaluated using NIH3T3 cells. The in vivo antibacterial and wound healing efficacy of the Gel/CS-AuNPs was analyzed in the diabetic wound model rats. Histological and immunofluorescence staining were performed to determine the status of angiogenesis, epithelization, inflammation response, and collagen deposition. Results: Gel/CS-AuNPs demonstrated significant high biodegradability, water absorption bactericidal, and biocompatibility, and slight adhesiveness. Gel/CS-AuNPs exhibited pronounced antibacterial efficacy against gram-negative, gram-positive, and MRSA in a CS-AuNPs-dose-dependent manner. In the diabetic wound model rats, Gel/CS-AuNPs effectively killed MRSA, reduced inflammation, and promoted angiogenesis and collagen deposition and remodeling at the wound site. As a result, Gel/CS-AuNPs expedited the recovery process for infected diabetic wounds. Among the hydrogels with different CS-AuNPs concentrations, Gel/CS-Au25 with 25% CS-AuNPs showed the best bactericidal and wound healing performance. Conclusion: Gel/CS-AuNPs significantly improve the healing of MRSA-infected diabetic wounds in the rat model. Therefore, Gel/CS-AuNPs show great promise for the treatment of diabetic infection wound healing.

A novel clinical tool and risk stratification system for predicting the event-free survival of neuroblastoma patients: A TARGET-based study.

Neuroblastoma (NB), considered the most common non-intracranial solid tumor in children, accounts for nearly 8% of pediatric malignancies. This study aimed to develop a simple and practical nomogram to predict event-free survival (EFS) in NB patients and establish a new risk stratification system. In this study, 763 patients primarily diagnosed with NB in the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database were included and randomly assigned to a training set (70%) and a validation set (30%) in a 7:3 ratio. First, the independent prognostic factors of EFS for NB patients were identified through univariate and multivariate Cox regression analyses. Second, a nomogram was created based on these factors and was validated for calibration capability, discriminative, and clinical significance by C-curves, receiver operating characteristic (ROC) curves, and decision curve analysis. Finally, a new risk stratification system was established for NB patients based on the nomogram. The univariate Cox analysis demonstrated that NB patients with age at diagnosis >318 days, International Neuroblastoma Staging System (INSS) stage 4, DNA diploidy, MYCN amplification status, and children oncology group (COG) high-risk group had a relatively poor prognosis. However, according to the multivariate Cox regression analysis, only age, INSS stage, and DNA ploidy were independent predictive factors in NB patients regarding EFS, and a nomogram was created based on these factors. The area under the curve (AUC) values of the ROC curves for the 3-, 5-, and 10-year EFS of this nomogram were 0.681, 0.706, and 0.720, respectively. Additionally, the AUC values of individual independent prognostic factors of EFS were lower than those of the nomogram, suggesting that the developed nomogram had a higher predictive reliability for prognosis. In addition, a new risk stratification system was developed to better stratify NB patients and provide clinical practitioners with a better reference for clinical decision-making. NB patients' EFS could be predicted more accurately and easily through the constructed nomogram and event-occurrence risk stratification system, allowing clinicians to better differentiate NB patients and establish individualized treatment plans to maximize patient benefits.

A meet-up of acetyl phosphate and c-di-GMP modulates BldD activity for development and antibiotic production.

Actinobacteria are ubiquitous bacteria undergoing complex developmental transitions coinciding with antibiotic production in response to stress or nutrient starvation. This transition is mainly controlled by the interaction between the second messenger c-di-GMP and the master repressor BldD. To date, the upstream factors and the global signal networks that regulate these intriguing cell biological processes remain unknown. In Saccharopolyspora erythraea, we found that acetyl phosphate (AcP) accumulation resulting from environmental nitrogen stress participated in the regulation of BldD activity through cooperation with c-di-GMP. AcP-induced acetylation of BldD at K11 caused the BldD dimer to fall apart and dissociate from the target DNA and disrupted the signal transduction of c-di-GMP, thus governing both developmental transition and antibiotic production. Additionally, practical mutation of BldDK11R bypassing acetylation regulation could enhance the positive effect of BldD on antibiotic production. The study of AcP-dependent acetylation is usually confined to the control of enzyme activity. Our finding represents an entirely different role of the covalent modification caused by AcP, which integrated with c-di-GMP signal in modulating the activity of BldD for development and antibiotic production, coping with environmental stress. This coherent regulatory network might be widespread across actinobacteria, thus has broad implications.

Construction of a novel clinical nomogram to predict cancer-specific survival in patients with primary malignant adrenal tumors: a large population-based retrospective study.

Background: Primary malignant adrenal tumors were rare and had a poor prognosis. This investigation aimed to create a useful clinical prediction nomogram to anticipate cancer-specific survival (CSS) of patients with a primary malignant adrenal tumor. Method: This study included 1748 patients with malignant adrenal tumor diagnoses subjects from 2000 to 2019. These subjects were allocated randomly into training (70%) and validation (30%) cohorts. Patients with adrenal tumors underwent univariate and multivariate Cox regression analyses to identify the CSS-independent predictive biomarkers. Therefore, a nomogram was created depending on those predictors, and calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were used to assess the calibration capacity of the nomogram, discriminative power, and clinical efficiency, respectively. Afterward, a risk system for categorizing patients with adrenal tumors was established. Result: The univariate and multivariate Cox analysis demonstrated the CSS-independent predictive factors, including age, tumor stage, size, histological type, and surgery. As a result, a nomogram was developed using these variables. For the 3-, 5-, and 10-year CSS of this nomogram, the values of the area under the curve (AUC) of the ROC curves were 0.829, 0.827, and 0.822, respectively. Furthermore, the AUC values of the nomogram were higher than those of the individual independent prognostic components of CSS, indicating that the nomogram had stronger prognostic prediction reliability. A novel risk stratification method was created to further improve patient stratification and give clinical professionals a better reference for clinical decision-making. Conclusion: Through the developed nomogram and risk stratification method, the CSS of patients with malignant adrenal tumors could be predicted more precisely, assisting physicians to differentiate patients better and creating personalized treatment strategies to optimize patient benefits.

Latent characteristics and influencing factors of stigma in rheumatoid arthritis: A latent class analysis.

To explore the latent classes of stigma in patients with rheumatoid arthritis, we analyzed the characteristics of the different categories. Adopting a convenient sampling method, socio-demographic and disease-related information from the outpatient clinics and wards of 3 tertiary care hospitals in China was collected. The Chinese version of the Internalized Stigma of Mental Illness scale-Rheumatoid Arthritis was used in this survey. Rheumatoid arthritis stigma was divided into 3 potential categories: Low Stigma-Strong Resistance (83, 41.5%), Medium Stigma-Strong Alienation (78, 39.0%), and High Stigma-Weak Resistance (39, 19.5%). Unordered multinomial logistic regression analysis showed that pain (OR = 1.540, P = .005; OR = 1.797, P < .001), elementary school education and below (OR = 4.051, P = .037), and duration of morning stiffness (OR = 0.267, P = .032) were risk factors for stigma, whereas family history was a protective factor against stigma (OR = 0.321, P = .046). Patients with longer morning stiffness, more severe pain, and less education have a greater risk of heavier stigma. Strong alienation is an early warning of heavy stigma. Resistance to stigma and family support can help patients overcome their psychological obstacles. More attention should be paid to constructing family centered support systems to help resist stigma.

Protein acylation links metabolism and the control of signal transduction, transcription regulation, growth, and pathogenicity in Actinobacteria.

Actinobacteria have a complex life cycle, including morphological and physiological differentiation which are often associated with the biosynthesis of secondary metabolites. Recently, increased interest in post-translational modifications (PTMs) in these Gram-positive bacteria has highlighted the importance of PTMs as signals that provide functional diversity and regulation by modifying proteins to respond to diverse stimuli. Here, we review the developments in research on acylation, a typical PTM that uses acyl-CoA or related metabolites as donors, as well as the understanding of the direct link provided by acylation between cell metabolism and signal transduction, transcriptional regulation, cell growth, and pathogenicity in Actinobacteria.

Anticancer Benefit of Metformin in Patients With Early-Stage Pancreatic Cancer: A Retrospective Cohort Study.

Background: Epidemiologic studies have produced conflicting results on the effects of metformin on pancreatic cancer. This study aimed to observe and analyze whether metformin use is associated with better prognosis in pancreatic cancer. Materials and Methods: In this retrospective cohort study, all baseline data were retrieved from The Chinese Medicine Information Retrieval System (https://dc.wzhospital.cn/vpn/index.html) of The First Affiliated Hospital of Wenzhou Medical University. Survival data were collected by follow-up visits and medical records. Overall survival was the primary endpoint, while progression-free survival and disease-free survival were secondary endpoints. Progression or recurrence was assessed with radiologic images. Results: Seventy-six metformin users and 92 metformin nonusers diagnosed with pancreatic cancer from 2012 to 2020 in this hospital were enrolled. The adjusted hazard ratio for overall survival for metformin users was 0.50 (95% confidence interval = 0.33-0.76), where median overall survival was 16.0 months for metformin users versus 11.5 months for metformin nonusers. The protective effect was also found by analyzing progression-free survival (adjusted hazard ratio = 0.39, 95% confidence interval = 0.18-0.86) and disease-free survival (adjusted hazard ratio = 0.30, 95% confidence interval = 0.14-0.68). In the subgroup analysis, metformin use had a statistically significant association with prolongation of survival in stage I to II pancreatic cancer patients (hazard ratio = 0.47, 95% confidence interval = 0.25-0.91), but not for advanced tumor stage (hazard ratio for IV stage = 0.62, 95% confidence interval = 0.33-1.19), after adjustment for other risk factors. Conclusion: Metformin use is related to favorable survival outcomes of pancreatic cancer, especially in early tumor stage.

Theoretical analysis and experimental investigation of the Floyd-Steinberg-based fringe binary method with offset compensation for accurate 3D measurement.

Digital fringe projection (DFP) with defocused binary fringe patterns has the ability to overcome the projector nonlinearity and achieve a high-speed 3D measurement. The Floyd-Steinberg (FS) dithering technique is one of the most commonly adopted binary fringe coding methods due to its relatively high measurement accuracy. Nevertheless, we found that the FS binary fringe would cause a fixed error in the recovered phase, which is proven to be invariable for various defocusing levels and various phase-shift steps according to the analysis of the phase error based on noise model of phase-shifting profilometry. It means that FS binary fringe would have a certain offset in space, compared with standard sinusoidal fringe, which is verified to be essentially constant for different fringe pitches through simulation and experiment. This offset would distort the 3D geometry of the tested target for monocular systems relying on triangulation, which needs to be compensated to improve 3D measurement accuracy. Experiments are presented to demonstrate the enhanced 3D result after compensation.

Selective recruitment of stress-responsive mRNAs to ribosomes for translation by acetylated protein S1 during nutrient stress in Escherichia coli.

The chemical modification of ribosomes plays an important regulatory role in cellular translation adaptation in response to environmental stresses. Nevertheless, how the modified ribosome reprograms the translation machinery for the preferential expression of the specific mRNAs encoding stress-responsive proteins to stress remains poorly understood. Here, we find that AcP-induced acetylation of K411 and K464 in ribosomal protein S1 during carbon-nitrogen imbalance, which in turn impacts its binding with distinct mRNAs. S1 acetylation shows differential selectivity for recruiting subsets of mRNAs to ribosomes. Using the RNC-Seq method, we find that mimic acetylated S1 prefers transcripts related with the formation of flagella/biofilms, two-component systems, nitrogen assimilation, amino acid degradation, and lipopolysaccharide biosynthesis, whereas inhibits the translation of mRNAs involved in amino acid biosynthesis and most ribosomal proteins. Importantly, further characterization of S1-binding site (SBS) sequences of mRNAs with different translation efficiencies indicated that the presence of a conserved motif allows coordinated regulation of S1 acetylation-driven translation reprogramming for cell survival during nitrogen starvation. These findings expand the repertoire of ribosome heterogeneity to the acetylation level of S1 at specific sites and its role in the ribosome-mediated regulation of gene expression as a cellular response at the translational level to stress.

Enhanced Dielectric Energy Storage Performance of 0.45Na0.5Bi0.5TiO3-0.55Sr0.7Bi0.2TiO3/AlN 0-3 Type Lead-Free Composite Ceramics.

Na0.5Bi0.5TiO3 (NBT) ceramic is the promising dielectric material for energy storage devices due to its high maximum polarizability and temperature stability. However, its low breakdown strength limits its application. Here, we prepared 0-3 type composite 0.45Na0.5Bi0.5TiO3-0.55Sr0.7Bi0.2TiO3/x wt % AlN (NBT-SBT/xAlN) to increase the breakdown strength. The effects of the various AlN contents on the phase composition, microstructures, dielectric, and energy storage properties of NBT-SBT were systematically discussed. The result showed that the enhanced energy storage properties were obtained by introducing AlN particles. The NBT-SBT/6AlN composite ceramics showed a high breakdown strength of 360 kV/cm, large energy density of 5.53 J/cm3, and energy efficiency of 90%. Meanwhile, the excellent frequency (10-500 Hz) and temperature stability (25-125 °C) were exhibited with the fluctuation of energy storage within 9% and energy efficiency more than 87%, suggesting that the 0-3 composite NBT-SBT/xAlN is a candidate dielectric material for the dielectric energy storage.

Photoinduced evolution of optical properties and compositions of methoxyphenols by Fe(III)-carboxylates complexes in atmospheric aqueous phase.

The changes in optical properties and chemical compositions of methoxyphenols, which acted as an important aromatic compound from the biomass burning, were investigated in the presence of Fe(III)-carboxylates under aqueous phase conditions. The light was confirmed to be a key factor for stimulating the reaction of methoxyphenols and Fe(III)-carboxylates. The photoinduced evolution of optical properties of methoxyphenols was dependent on various factors, including irradiation intensity, types of carboxylates, dissolved oxygen and pH. The changes in the mass absorption efficiency at 306 nm (MAE306) positively relied on irradiation intensity and dissolved oxygen. The acceleration effects of carboxylates on the decreases in MAE306 of methoxyphenols followed the order of oxalate > citrate > malonate. The change amplitude of MAE306 decreased with an increasing pH (3.5-9), while that of the mass absorption efficiency at 364 nm (MAE364) increased with pH ranging from 3.5 to 7. The compositional evolutions of methoxyphenols by the photochemical aging were analyzed with the attenuated total reflection infrared spectroscopy (ATR-IR), confirming the decrease of CO groups and the increase of O-H and C-O groups. The photochemical reaction pathways of methoxyphenols with Fe(III)-carboxylates were proposed according to optical properties and compositions measurements.

The lipid components of high-density lipoproteins (HDL) are essential for the binding and transportation of antimicrobial peptides in human serum.

Antimicrobial peptides (AMPs) have been developed for the treatment of bacterial infections, but their applications are limited to topical infections since they are sequestered and inhibited in serum. Here we have discovered that the inhibition of AMPs by human serum was mediated through high-density lipoproteins (HDL) which are known to remove cholesterol from peripheral tissues. The susceptibility of AMPs to HDL varied depending on the degree of hydrophobicity of AMPs and their binding affinities to HDL. The phospholipids, such as phosphatidylcholine, of HDL were essential for AMP-binding. The dynamic binding interactions between AMPs and HDL were mediated through the hydrophobic interactions rather than by ionic strength. Interestingly, some AMPs, such as SMAP29, dissociated from the AMP-HDL complex and translocated to bacteria upon contact, while some AMPs, such as LL37, remained in complex with HDL. These results suggest that HDL binds AMPs and facilitates the translocation of them to the bacteria.

Acylation driven by intracellular metabolites in host cells inhibits Cas9 activity used for genome editing.

CRISPR-Cas, the immune system of bacteria and archaea, has been widely harnessed for genome editing, including gene knockouts and knockins, single-base editing, gene activation, and silencing. However, the molecular mechanisms underlying fluctuations in the genome editing efficiency of crispr in various cells under different conditions remain poorly understood. In this work, we found that Cas9 can be ac(et)ylated by acetyl-phosphate or acyl-CoA metabolites both in vitro and in vivo. Several modifications are associated with the DNA or sgRNA binding sites. Notably, ac(et)ylation of Cas9 driven by these metabolites in host cells potently inhibited its binding and cleavage activity with the target DNA, thereby decreasing Crispr genome editing efficiency. This study provides more insights into understanding the effect of the intracellular environment on genome editing application of crispr with varying efficiency in hosts.

Percutaneous endoscopic versus minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a meta-analysis.

Introduction: Transforaminal lumbar interbody fusion (TLIF) is commonly used in patients with lumbar degenerative disease (LDD). The most commonly used techniques include minimally invasive TLIF (MIS-TLIF) and percutaneous endoscopic TLIF (PE-TLIF). Aim: To compare the safety and clinical effectiveness of PE-TLIF and MIS-TLIF in treating LDD. Material and methods: We screened for related articles in multiple scientific databases, namely, PubMed, Embase, Cochrane Library, Wanfang, VIP, and CINK, and analyzed the relative outcomes. Results: Based on our inclusion criteria, we selected 8 studies for meta-analysis. There are a total of 229 patients who underwent PE-TLIF and 258 patients who underwent MIS-TLIF. MIS-TLIF and PE-TLIF have similar effectiveness in relieving leg pain and improving the Oswestry Disability Index. However, PE-TLIF is superior in relieving back pain. The pooled data of fusion rates, postoperative analgesic, and complication rates are comparable between the 2 groups. The pooled operation and intra-operative fluoroscopic time are both significantly higher in the PE-TLIF group than the MIS-TLIF group. The pooled intra-operative blood loss, incision length, duration from surgery to ambulation, and hospital stay are significantly lower in the PE-TLIF group than the MIS-TLIF group. Most of the endpoints reveal significant heterogeneity. The endpoints of operation time and intra-operative blood loss reveal significant publication bias. Conclusions: Both PE-TLIF and MIS-TLIF are safe and effective interventions for patients with LDD. When compared, although MIS-TLIF results in reduced operative time, less intra-operative blood loss and enhanced post-operative recovery can be achieved by PE-TLIF.

Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study.

PURPOSE: This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). MATERIALS AND METHODS: We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. RESULTS: There was no significant difference between the two groups in operative time and complication rate. The estimated blood loss and the length of hospital stay in the PETLIF group were significantly better than those in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. CONCLUSIONS: Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.