Molybdesum selenide-based platelet-rich plasma containing carboxymethyl chitosan/polyvinyl pyrrolidone composite antioxidant hydrogels dressing promotes the wound healing.

Excess free radicals at the wound site can cause an inflammatory response, which is not conducive to wound healing. Hydrogels with antioxidant properties can prevent inflammatory storms by scavenging free radicals from the wound site and inhibiting the release of inflammatory factors. In this study, we prepared the carboxymethyl chitosan (CMCS)/polyvinyl pyrrolidone (PVP)/Molybdenum (IV) Selenide (MoSe2), and platelet-rich plasma (PRP) (CMCS/PVP/MoSe2/PRP) hydrogels for accelerating the repair of wounds. In the hydrogels, the MoSe2 can scavenge various free radicals to reduce oxidative stress at the site of inflammation, endowed the hydrogels with antioxidant properties. Interestingly, growth factors released by PRP assisted the tissue repair by promoting the formation of new capillaries. CMCS as a backbone not only showed good biocompatibility and biodegradability but also played a significant role in maintaining the sustained release of growth factors. In addition, incorporating PVP enhanced the tissue adhesion and mechanical properties. The multifunctional composite antioxidant hydrogels have good swelling properties and biodegradability, which is completely degraded within 28 days. Thus, the antioxidant CMCS/PVP/MoSe2/PRP hydrogels provide a new idea for designing ideal multifunctional wound dressings.

The effect of different screw-rod design on the anti-rotational torque: a biomechanical comparison of three conventional screw-rod constructs.

BACKGROUND: Screw-rod constructs have been widely used to correct spinal deformities, but the effects of different screw-rod systems on anti-rotational torque have not been determined. This study aimed to analyze the biomechanical effect of different rod-screw constructs on anti-rotational torque. METHODS: Three conventional spinal screw-rod systems (Legacy, RF-F-10 and USSII) were used to test the anti-rotational torque in the material test machine. ANOVA was performed to evaluate the anti-rotational capacity of different pedicle screws-rod constructs. RESULTS: The anti-rotational torque of Legacy group, RF-F-10 group and USSII group were 12.3 ± 1.9 Nm, 6.8 ± 0.4 Nm, and 3.9 ± 0.8 Nm, with a P value lower than 0.05. This results indicated that the Legacy screws-rod construct could provide a highest anti-rotation capacity, which is 68% and 210% greater than RF-F-10 screw-rod construct and USSII screw-rod respectively. CONCLUSIONS: The anti-rotational torque may be mainly affected by screw cap and groove design. Our result showed the anti-rotational torque are: Legacy system > RF-F-10 system > USSII system, suggesting that appropriate rod-screw constructs selection in surgery may be vital for anti-rotational torque improvement and preventing derotation correction loss.

From emerging modalities to advanced applications of hydrogel piezoelectrics based on chitosan, gelatin and related biological macromolecules: A review.

The rapid development of functional materials and manufacturing technologies is fostering advances in piezoelectric materials (PEMs). PEMs can convert mechanical energy into electrical energy. Unlike traditional power sources, which need to be replaced and are inconvenient to carry, PEMs have extensive potential applications in smart wearable and implantable devices. However, the application of conventional PEMs is limited by their poor flexibility, low ductility, and susceptibility to fatigue failure. Incorporating hydrogels, which are flexible, stretchable, and self-healing, providing a way to overcome these limitations of PEMs. Hydrogel-based piezoelectric materials (H-PEMs) not only resolve the shortcomings of traditional PEMs but also provide biocompatibility and more promising application potential. This paper summarizes the working principle of H-PEMs. Recent advances in the use of H-PEMs as sensors and in vitro energy harvesting devices for smart wearable devices are described in detail, with emphasis on application scenarios in human body like fingers, wrists, ankles, and feet. In addition, the recent progress of H-PEMs in implantable medical devices, especially the potential applications in human body parts such as bones, skin, and heart, are also elaborated. In addition, challenges and potential improvements in H-PEMs are discussed.

Effect of umifenovir (arbidol) versus standard care on clinical outcome in patients with COVID-19: a retrospective cohort study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to spread quickly throughout the world, mainly due to the lack of effective drug therapies and vaccines. The effectiveness of the antiviral drug umifenovir needs to be further clarified. METHODS: This retrospective cohort study included 1254 patients who were diagnosed with COVID-19 between February 19 and April 5, 2020 in Hubei Maternity and Child Health Hospital. They were divided into umifenovir group (n = 760, 60.60%) and control group (n = 496) without using umifenovir. The primary endpoint was a composite of intubation or death in a time-to-event analysis. The clinical outcomes were compared between the two groups using multivariable Cox analysis with inverse probability weighting according to the propensity score. RESULTS: A total of 760 (60.60%) patients received umifenovir, and 496 patients did not do so. Of the enrolled patients, 1049 (83.65%) had mild or moderate COVID-19, and the remaining 205 had severe or critical COVID-19. The mortality rate in the umifenovir group was 2.76% (21/760) versus 2.02% (10/494) in the control group. In terms of treatment outcomes, the discharge status of the patients in the umifenovir group was no better than that in the control group after propensity score matching (n = 485 in each group). In addition, the respiratory rate, a severe condition, or critical condition of the disease were the three main risk factors affecting the endpoint of death (p = 0.0028, p = 0.0009 and p < 0.0001, respectively). CONCLUSION: This retrospective cohort study showed that oral administration of umifenovir alone did not improve outcomes for patients with COVID-19.

Sodium alginate hydrogel containing platelet-rich plasma for wound healing.

Recently, the healing of chronic wounds such as extensive burns has become a serious and intractable clinical problem. Avoiding wound infection and retaining an appropriate level of moisture around wounds are significant challenges in wound care. Herein, a dual-network hydrogel composed of sodium alginate (SA) and platelet-rich plasma (PRP) was designed to facilitate the wound healing. The preparation of hydrogel was achieved through a simple one-step thrombin activation process. The morphological characterization results revealed the three-dimensional network structure of the hydrogel. Then, certain levels of epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) were detected in phosphate buffer solution (PBS) cultured hydrogel, which led to the possibility of cell proliferation and vascular regeneration. When topically applied to the wound skin of rats, the hydrogel presented high wound closure effectiveness. In conclusion, this strategy provides a simple and feasible approach to overcoming the shortcomings of conventional wound dressings.

Highly absorbent bio-sponge based on carboxymethyl chitosan/poly-γ-glutamic acid/platelet-rich plasma for hemostasis and wound healing.

Stopping bleeding at an early stage and promoting wound healing are of great significance for efficient wound management. In this study, a carboxymethyl chitosan (CMCS)/poly-γ-glutamic acid (γ-PGA)/platelet-rich plasma (PRP) hydrogel (CP-PRP hydrogel) was firstly prepared by crosslinking of CMCS with γ-PGA and the enzymatic coagulation of PRP. Then, the CP-PRP hydrogel was freeze-dried and transformed into a sponge (CP-PRP sponge). A series of safety experiments with cells, blood, and tissues proved the biocompatibility of the CP-PRP sponge. Importantly, the CP-PRP sponge was able to adhere and condense red blood cells, which accelerated blood clotting. Therefore, the CP-PRP sponge showed an enhanced hemostasis effect compared to SURGIFLO® Hemostatic Matrix. Moreover, in vitro and in vivo experiments showed that the sponge was able to release epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF). Thus, in a mouse model of full-thickness skin defects, the wounds of the sponge-treated mice were significantly healed within two weeks. These results proved the transforming potential of the CP-PRP sponge as a novel bioactive wound dressing.

Roles of BMI1 in the Initiation, Progression, and Treatment of Hepatocellular Carcinoma.

Liver cancer has high rates of morbidity and mortality, and its treatment is a global health challenge. Hepatocellular carcinoma (HCC) accounts for 90% of all primary liver cancer cases. B-lymphoma Mo-MLV insertion region 1 (BMI1) has been identified as a proto-oncogene, which contributes to the initiation and progression of many malignant tumors. BMI1 expression is upregulated in HCC, and it influences the occurrence and development of HCC by various mechanisms, such as the INK4a/ARF locus, NF-κB signaling pathway, and PTEN/PI3K/AKT signaling pathway. In addition, the expression of BMI1 is related to prognosis and recurrence of HCC. Hence, there is clear evidence that BMI1 is a novel and valid therapeutic target for HCC. Accordingly, the development of therapeutic strategies targeting BMI1 has been a focus of recent research, providing new directions for HCC treatment. This review summarizes the role of BMI1 in the occurrence and treatment of HCC, which will provide a basis for using BMI1 as a potential target for the development of therapeutic strategies for HCC.

The regulation role and diagnostic value of fibrinogen-like protein 1 revealed by pan-cancer analysis.

Although the role of fibrinogen-like protein 1 (FGL1) in tumorigenesis is well known, a pan-cancer analysis of FGL1 lacks. We used bioinformatics techniques to analyze cancer data from publicly available datasets from The Cancer Genome Atlas, UALCAN, TIMER, Gene Expression Profiling Interactive Analysis, cBioPortal, Search Tool for the Retrieval of Interacting Genes, and DAVID. FGL1 expression was significantly regulated in various common tumors than in normal tissues; it was increased in lung adenocarcinoma and decreased in colon adenocarcinoma. Cox regression analysis demonstrated that the upregulation of FGL1 expression was correlated with poor overall survival (OS) and disease-free survival (DFS) in stomach adenocarcinoma, brain low-grade glioma, cervical squamous cell carcinoma, and endocervical adenocarcinoma. Decreased FGL1 methylation levels were observed in majority of tumor types. FGL1 expression was significantly associated with the levels of immune cell subtypes and immune checkpoint genes. Deep deletion was the most common genetic mutation in FGL1 that led to frame-shift mutations, which was closely associated with poor progression-free interval, disease-specific survival, and OS in patients with FGL1 mutations. Kyoto Encyclopedia of Genes and Genomes enrichment analysis showed that FGL1-related genes participate in diverse pathways. Ubiquitin-mediated proteolysis is significantly correlated to the function of FGL1, which was identified for the first time in the present study. This pan-cancer study provides a deep understanding of the functions of FGL1 in progression of many tumors and demonstrates that FGL1 may be a potential biomarker for the diagnosis, prognosis, and immune infiltration in cancer.

Risk and Predictive Factors for Proximal Junctional Kyphosis in Patients Treated by Lenke Type 5 Adolescent Idiopathic Scoliosis Correction.

OBJECTIVE: Proximal junctional kyphosis (PJK) is a common sagittal complication of adolescent idiopathic scoliosis (AIS) after corrective surgery, leading to new deformities, pain, and, even, revision surgery. In the present study, we investigated the risk and predictive factors for PJK in patients who had undergone Lenke type 5 AIS correction to identify the parameters relevant to intraoperative guidance. METHODS: A total of 35 patients with Lenke type 5 AIS who had undergone corrective surgery at our hospital from January 2008 to February 2016 were divided into the PJK (n = 15) and non-PJK (n = 20) groups. Correlation and receiver operating characteristic curve analyses were performed to screen the parameters for significance and calculate the thresholds. A survival analysis was performed to examine the differences between the 2 groups. RESULTS: Independent t tests revealed significant differences between the 2 groups in the preoperative pelvic incidence, preoperative pelvic tilt, postoperative proximal junctional angle (PJA), and postoperative thoracic kyphosis (TK). The postoperative PJA, postoperative TK, and other parameters correlated significantly with changes in the PJA at the final follow-up. The receiver operating characteristic curves revealed that the postoperative PJA and postoperative TK effectively predicted for the occurrence of PJK, with a threshold of 9.45° and 25.25°, respectively. The estimated survival times were 14.7 months for a PJA >9.45° and TK >25.25°, 19.2 months for a PJA >9.45°, and 33.9 months for TK >25.25°. CONCLUSIONS: The results of the present study have shown that the postoperative PJA and postoperative TK can be used to effectively predict for the occurrence of PJK in patients with Lenke type 5 AIS after corrective surgery, with a threshold of 9.45° and 25.25°, respectively.

Risk factors for recurrent positive results of the nucleic acid amplification test for COVID-19 patients: a retrospective study.

Positive retests of COVID-19 represent a public health concern because of the increased risk of transmission. This study explored whether factors other than the nucleic acid amplification test (NAAT) contribute to positive retest results. Patients with COVID-19 admitted to the Guanggu district of the Hubei Maternal and Child Health Hospital between February 17 and March 28, 2020, were retrospectively included. The patients were grouped into the negative (n = 133) and positive (n = 51) retest groups. The results showed that the proportion of patients presenting with cough was higher (P < 0.001) and the proportion of patients with dyspnea was lower (P = 0.018) in the positive than in the negative retest group. The positive retest group showed shorter durations between symptom onset and hospitalization (P < 0.001) and symptom onset and the first positive NAAT (P = 0.033). The positive retest group had higher basophil counts (P = 0.023) and direct bilirubin (P = 0.032) and chlorine concentrations (P = 0.023) but lower potassium concentrations (P = 0.001) than the negative retest group. Multivariable regression analysis showed that coughing (OR = 7.59, 95% CI 2.28-25.32, P = 0.001) and serum chloride concentrations (OR = 1.38, 95% CI 1.08-1.77, P = 0.010) were independently associated with a positive retest result. Coughing and serum chloride concentrations were independent risk factors for positive NAAT retest results. Patients with a hospital stay of < 2 weeks or a short incubation period should stay in isolation and be monitored to reduce transmission. These results could help identify patients who require closer surveillance.

Weighted Gene Coexpression Network Analysis Reveals the Dynamic Transcriptome Regulation and Prognostic Biomarkers of Hepatocellular Carcinoma.

This study was aimed at revealing the dynamic regulation of mRNAs, long noncoding RNAs (lncRNAs), and microRNAs (miRNAs) in hepatocellular carcinoma (HCC) and to identify HCC biomarkers capable of predicting prognosis. Differentially expressed mRNAs (DEmRNAs), lncRNAs, and miRNAs were acquired by comparing expression profiles of HCC with normal samples, using an expression data set from The Cancer Genome Atlas. Altered biological functions and pathways in HCC were analyzed by subjecting DEmRNAs to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis. Gene modules significantly associated with disease status were identified by weighted gene coexpression network analysis. An lncRNA-mRNA and an miRNA-mRNA coexpression network were constructed for genes in disease-related modules, followed by the identification of prognostic biomarkers using Kaplan-Meier survival analysis. Differential expression and association with the prognosis of 4 miRNAs were verified in independent data sets. A total of 1220 differentially expressed genes were identified between HCC and normal samples. Differentially expressed mRNAs were significantly enriched in functions and pathways related to "plasma membrane structure," "sensory perception," "metabolism," and "cell proliferation." Two disease-associated gene modules were identified. Among genes in lncRNA-mRNA and miRNA-mRNA coexpression networks, 9 DEmRNAs and 7 DEmiRNAs were identified to be potential prognostic biomarkers. MIMAT0000102, MIMAT0003882, and MIMAT0004677 were successfully validated in independent data sets. Our results may advance our understanding of molecular mechanisms underlying HCC. The biomarkers may contribute to diagnosis in future clinical practice.

An 8 miRNA-Based Risk Score System for Predicting the Prognosis of Patients With Papillary Thyroid Cancer.

BACKGROUND: Dysregulation of microRNAs (miRNAs) in papillary thyroid cancer (PTC) might influence prognosis of PTC. This study is aimed to develop a risk score system for predicting prognosis of PTC. METHODS: The miRNA and gene expression profiles of PTC were obtained from The Cancer Genome Atlas database. PTC samples were randomly separated into training set (n = 248) and validation set (n = 248). The differentially expressed miRNAs (DE-miRNAs) in the training set were screened using limma package. The independent prognosis-associated DE-miRNAs were identified for building a risk score system. Risk score of PTC samples in the training set was calculated and samples were divided into high risk group and low risk group. Kaplan-Meier curves and receiver operating characteristic (ROC) curve were used to assess the accuracy of the risk score system in the training set, validation set and entire set. Finally, a miRNA-gene regulatory network was visualized by Cytoscape software, followed by enrichment analysis. RESULTS: Totally, 162 DE-miRNAs between tumor and control groups in the training set were identified. An 8 independent prognosis-associated DE-miRNAs, (including miR-1179, miR-133b, miR-3194, miR-3912, miR-548j, miR-6720, miR-6734, and miR-6843) based risk score system was developed. The area under ROC curve in the training set, validation set and entire set was all above 0.93. A miRNA-gene regulatory network involving the 8 DE-miRNAs were built and functional enrichment analysis suggested the genes in the network were significantly enriched into 13 pathways, including calcium signaling pathway and hedgehog signaling pathway. CONCLUSION: The risk score system developed this study might be used for predicting the prognosis of PTC. Besides, the 8 miRNAs might affect the prognosis of PTC via hedgehog signaling pathway and calcium signaling pathway.

Clinical implications of different specimen types for nucleic acid testing in two cases of COVID-19.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test is currently the gold standard for diagnosing coronavirus disease 2019 (COVID-19). This disease requires high-quality viral nucleic acid tests, and selecting the type of specimen from patients, who are at different disease stages, to use in the nucleic acid test is challenging. This article reports in detail the diagnosis and treatment process for two patients with confirmed COVID-19 and analyzes the results of the SARS-CoV-2 nucleic acid tests that were used for different types of specimens (sputum from deep cough, nasopharyngeal swab, and feces). The nucleic acid testing results of sputum from deep cough showed the best performance for positive detection. Our findings provide a reference for selecting the most suitable specimen for the clinical diagnosis of COVID-19 and improving the positive detection rate.

The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary?

BACKGROUND: Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE: To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS: A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. RESULTS: The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. CONCLUSION: The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.

Factors That Influence In-Brace Correction in Patients with Adolescent Idiopathic Scoliosis.

OBJECTIVE: To identify the factors affecting in-brace correction in patients with adolescent idiopathic scoliosis (AIS). METHODS: We performed a retrospective analysis of patients with AIS receiving Gensingen brace treatment in our scoliosis center from July 2015 to October 2017 was performed. The selection of patients was in accordance with the Scoliosis Research Society inclusion criteria for a bracing study. Some radiographic and clinical parameters, including the Cobb angle, rib-vertebra angle difference, coronal and sagittal balance, lumbar-pelvic relationship (LPR), Risser sign, curve type, age, gender, height, weight, body mass index, and menstrual status were collected. The correlation and difference analyses were performed to identify the factors influencing in-brace correction. RESULTS: A cohort of 112 patients with AIS (94 girls and 18 boys) were included in the present study. The mean in-brace correction was 59.29% ± 22.33% (range, 16.22%-100.00%). In-brace correction showed a significantly negative correlation with the major curve Cobb angle, minor curve Cobb angle, total curve Cobb angle, and LPR (P < 0.05 for all). Sagittal and coronal imbalance could reduce the curve correction (P < 0.001 and P = 0.008, respectively). The remaining parameters were not related to in-brace correction. CONCLUSIONS: In-brace correction in the present study was 59.29% ± 22.33% (range, 16.22%-100.00%). Some factors, including the Cobb angle, sagittal and coronal balance, and LPR, have an effect on in-brace correction. The results from the present study can provide some useful information for brace design and fabrication.

Surgical Outcome Comparison of Posterior Vertebral Column Resection with or without Anterior Column Support in Treatment of Yang's Type A Severe Thoracic Spinal Deformity.

BACKGROUND: The use of posterior vertebral column resection (PVCR) has extended the treatment of severe spinal deformity. However, the practice guidelines for anterior column support in patients treated by PVCR remain ill defined. The objective of the present study was to compare the clinical and radiographic outcomes of severe thoracic spinal deformity treated by PVCR with and without anterior column support (ACS). METHODS: We performed a prospective study of 57 patients with severe thoracic deformity (classified as Yang's A type) treated by PVCR with or without anterior column support from January 2010 to April 2015. The patient characteristics, radiographic parameters, intraoperative data, and complications were analyzed to clarify these 2 clinical series. RESULTS: The sex, age, diagnosis, curve magnitude, and curve type were similar between the PVCR with ACS group (n = 21) and non-ACS group (n = 36) preoperatively. Evaluation of the radiographic parameters, intraoperative data, and complications found no statistically significant intergroup differences, except for the osteotomy distance (non-ACS group, 4.0 cm; ACS group, 5.3 cm; P < 0.001) and shortening distance of the osteotomy gap (non-ACS group, 4.0 cm; ACS group, 3.5 cm; P = 0.005). CONCLUSIONS: The results of the present study have shown that PVCR without ACS seems to be a safe and effective technique for Yang's A type severe thoracic spinal deformity correction compared with PVCR with ACS. PVCR without ACS requires a relatively smaller osteotomy range and could potentially decrease the risk of implant failure due to bone to bone fusion.

A Pretreatment CT Model Predicts Survival Following Chemolipiodolization in Patients With Hepatocellular Carcinoma.

PURPOSE: To establish a computed tomography-based prognostic model for patients with hepatocellular carcinoma treated with transarterial chemoembolization. MATERIALS AND METHODS: Using prospectively collected data from 195 consecutive patients with hepatocellular carcinoma who underwent chemolipiodolization at the Eastern Hepatobiliary Surgery Hospital between 2013 and 2016, we established a prognostic model based on hepatocellular carcinoma enhancement patterns on computed tomography scans to predict the outcome of transarterial chemoembolization. Furthermore, a histopathology analysis was performed on 108 different patients undergoing resection between 2014 and 2016 to identify whether there was a correlation between enhancement pattern and microvessel density. RESULTS: The prognostic model classified hepatocellular carcinoma into 3 types: type I, which reached peak enhancement during the arterial phase and had a high mean microvessel density (101.5 vessels/0.74 mm2); type II, which reached peak enhancement during the portal venous or delayed phase and had an intermediate microvessel density (53.6 vessels/0.74 mm2); and type III, in which the tumor was insignificantly enhanced and had a low microvessel density (21.1 vessels/0.74 mm2). For type I, II, and III hepatocellular carcinoma, the post-transarterial chemoembolization 1-year tumor complete necrosis rates were 13.7%, 36.5%, and 0%, respectively (P < .001), and the 3-year overall survival rates were 14.1%, 38.6%, and 0%, respectively (P < .001). CONCLUSION: Our results indicate that hepatocellular carcinoma type is an independent predictor of complete necrosis and overall survival.

Predictive Value of Spinal Cord Function Classification and Sagittal Deformity Angular Ratio for Neurologic Risk Stratification in Patients with Severe and Stiff Kyphoscoliosis.

BACKGROUND: Three-column osteotomies were developed to treat severe spinal deformities but result in high neurologic complications and require further risk stratification. The present study investigated whether the combination of spinal cord function classification (SCFC) and deformity angular ratio (DAR) could further stratify the neurologic risks in the surgical correction of severe and stiff kyphoscoliosis. METHODS: The patients with kyphoscoliosis who had undergone posterior 3-column osteotomies at the spinal cord level were reviewed. Using our SCFC system, the preoperative neurologic function (type A, B, or C) was classified. The sagittal DAR (S-DAR), coronal, and total DARs were calculated. Intraoperative monitoring events and new neurologic deficits (NNDs) postoperatively were documented and analyzed using the SCFC and DAR or both combined. RESULTS: The NND rates increased significantly from type A to C (P = 0.000) and increased exponentially with an increase in S-DAR in types B and C but not type A. They also increased exponentially with aggravation of the SCFC in the medium and high but not low S-DAR group. All NNDs had recovered at 3 months for type A and most had recovered at 6 months for type B or C. CONCLUSIONS: The NNDs in type A SCFC usually experienced better recovery even with high S-DARs. Type B SCFC with an S-DAR >20° and type C SCFC with any S-DAR resulted in significantly greater intra- and postoperative neurologic risks. The combination of SCFC and S-DAR can further stratify the intra- and postoperative neurologic risks with these procedures.

Development and validation of deep learning algorithms for scoliosis screening using back images.

Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.

Hidden Blood Loss and Its Influential Factors After Laparoscopy-Assisted Gastrectomy for Gastric Cancer.

INTRODUCTION: Laparoscopy-assisted gastrectomy (LAG) is a minimally invasive procedure for the treatment of gastric cancer. It is generally thought that a minimally invasive technique results in less visible blood loss during the surgery. Nevertheless, a meaningful perioperative hidden blood loss (HBL) is often ignored. In this study, we investigated the amount of HBL and the influential factors after LAG for gastric cancer. METHODS: A retrospectively analyzed clinical data of 62 consecutive patients who underwent laparoscopy-assisted total or distal gastrectomy at our center from May 2016 to May 2017. The HBL was calculated according to Gross's and Nadler's formula. The data of patient gender, age, height, weight, body mass index, preoperative and postoperative hematocrit, postoperative drainage, albumin loss, diabetes mellitus, and hypertension were analyzed by multivariate linear regression analysis. The type of surgical reconstruction was analyzed by one-way analysis of variance. The difference between the preoperative blood pressure and postoperative blood pressure was measured by paired sample t-test and boxplot. RESULTS: The HBL was 322.2 ± 195.9 mL (64.3% ± 14.1% in total blood loss [TBL]), the TBL was 475.6 ± 222.8 mL, and the hemoglobin (HB) loss was 15.0 ± 8.7 (11.5% ± 6.1% of HB level loss). Multivariate linear regression analysis revealed that gender, hypertension, and albumin loss between preoperation and postoperation are influential factors of HBL in patients after LAG for gastric cancer. Compared to male patients, female patients are positively associated with HBL. CONCLUSION: In our study, we found HBL is a significant segment of TBL and is much larger than what we considered previously in LAG for gastric cancer. Gender, hypertension, and albumin loss are significantly correlated with HBL. Therefore, paying attention to HBL is significant for promoting clinical treatment and ensuring patients' safety.