Tailoring Interlayer Chiral Exchange by Azimuthal Symmetry Engineering.

Recent theoretical and experimental studies of the interlayer Dzyaloshinskii-Moriya interaction (DMI) have sparked great interest in its implementation into practical magnetic random-access memory (MRAM) devices, due to its capability to mediate long-range chiral spin textures. So far, experimental reports focused on the observation of interlayer DMI, leaving the development of strategies to control interlayer DMI's magnitude unaddressed. Here, we introduce an azimuthal symmetry engineering protocol capable of additive/subtractive tuning of interlayer DMI through the control of wedge deposition of separate layers and demonstrate its capability to mediate field-free spin-orbit torque (SOT) magnetization switching in both orthogonally magnetized and synthetic antiferromagnetically coupled systems. Furthermore, we showcase that the spatial inhomogeneity brought about by wedge deposition can be suppressed by specific azimuthal engineering design, ideal for practical implementation. Our findings provide guidelines for effective manipulations of interlayer DMI strength, beneficial for the future design of SOT-MRAM or other spintronic devices utilizing interlayer DMI.

Idiopathic multicentric Castleman disease (iMCD)-idiopathic plasmacytic lymphadenopathy: A distinct subtype of iMCD-not otherwise specified with different clinical features and better survival.

Idiopathic multicentric Castleman disease (iMCD) is subclassified into iMCD-thrombocytopenia, anasarca, reticulin fibrosis, renal dysfunction, organomegaly (TAFRO) and iMCD-not otherwise specified (NOS) according to the Castleman Disease Collaborative Network (CDCN) consensus criteria. With a deeper understanding of iMCD, a group of patients with iMCD-NOS characterised by polyclonal hypergammaglobulinaemia, plasmacytic/mixed-type lymph node histopathology and thrombocytosis has attracted attention. This group of patients has been previously described as having idiopathic plasmacytic lymphadenopathy (IPL). Whether these patients should be excluded from the current classification system lacks sufficient evidence. This retrospective analysis of 228 patients with iMCD-NOS identified 103 (45.2%) patients with iMCD-IPL. The clinical features and outcomes of patients with iMCD-IPL and iMCD-NOS without IPL were compared. Patients with iMCD-IPL showed a significantly higher inflammatory state but longer overall survival. No significant difference in overall survival was observed between severe and non-severe patients in the iMCD-IPL group according to the CDCN severity classification. Compared with lymphoma-like treatments, multiple myeloma-like and IL-6-blocking treatment approaches in the iMCD-IPL group resulted in significantly higher response rates and longer time to the next treatment. These findings highlight the particularities of iMCD-IPL and suggest that it should be considered a new subtype of iMCD-NOS.

Sirolimus is effective for refractory/relapsed idiopathic multicentric Castleman disease: A single-center, retrospective study.

Refractory/relapsed idiopathic multicentric Castleman disease (R/R iMCD) has limited treatment options. With studies showing increased mTOR activation in iMCD patients, sirolimus becomes an attractive and promising therapy for R/R iMCD. Here we report the results of a retrospective study involving 26 R/R iMCD patients treated with sirolimus-containing regimen. The median age at sirolimus initiation was 40.5 years (23-60), with a median prior treatment line of 2 (1-5). 18 patients (69.2%) achieved symptomatic and biochemical response, with a median time to at least overall partial remission of 1.9 months (0.5-14.6). The median follow-up time from sirolimus initiation was 11.7 months (1.6-50.7) and the median time to next treatment (TTNT) was 46.2 months. No patients died at the end of follow-up. Most of the patients in the cohort are in ongoing responses and continue sirolimus therapy. Sirolimus is well tolerated with minor adverse effects. In conclusion, sirolimus is effective for R/R iMCD patients with good tolerance.

Exosomes from hypoxic pretreated ADSCs attenuate ultraviolet light-induced skin injury via GLRX5 delivery and ferroptosis inhibition.

Accumulation studies have found that adipose-derived stem cell (ADSC) exosomes have anti-oxidant and anti-inflammatory characteristics. The current study verified their therapeutic potential to elucidate mechanisms of ADSC exosome actions in ultraviolet B (UVB) light-induced skin injury. Exosomes were isolated from ADSCs and hypoxic pretreated ADSCs. Next-generation sequencing (NGS) was applied to characterize differential mRNA expression. A UV-induced mice skin injury model was generated to investigate therapeutic effects regarding the exosomes via immunofluorescence and ELISA analysis. Regulatory mechanisms were illustrated using luciferase report analysis and in vitro experiments. The results demonstrated that exosomes from hypoxic pretreated ADSCs (HExos) inhibited UVB light-induced vascular injury by reversing reactive oxygen species, inflammatory factor expression and excessive collagen degradation. NGS showed that HExos inhibits UV-induced skin damage via GLRX5 delivery, while GLRX5 downregulation inhibited the therapeutic effect of HExos on UV-induced skin damage. GLRX5 upregulation increased the protective Exo effect on UV-induced skin and EPC damage by inhibiting ferroptosis, inflammatory cytokine expression and excessive collagen degradation. Therefore, the data indicate that HExos attenuate UV light-induced skin injury via GLRX5 delivery and ferroptosis inhibition.

Cu+-doped lead-free double perovskite quantum dots for enhancing the photovoltaic performance of carbon-based Cs2AgInCl6 perovskite solar cells.

Lead-free double perovskite solar cells (PSCs) have received widespread attention because of their non-toxic nature and three-dimensional structure. However, their photovoltaic efficiency is limited by their large bandgap, including indirect or direct forbidden. Herein, Cu+ ions are incorporated into Cs2AgInCl6 double perovskite quantum dots, following which the bandgap is effectively decreased from 3.6 to 2.9 eV. Meanwhile, a facile method of drop-coating is employed to fabricate Cs2AgInCl6 films and carbon electrodes. A carbon electrode derived from a by-product of the cane sugar industry (molasses) is used to replace the expensive hole-transport materials and metal electrodes. A 0.5% Cu+-doped Cs2AgInCl6, device fabricated using carbon-based PSCs with a stacked-architecture achieves a power conversion efficiency of 1.77%, which is 2.9 times higher than that of the original device, and displays a better stability compared with that of the control one. This study provides guidance for preparing PSCs using a low-cost, facile strategy.

Governance effects of pollution reduction and carbon mitigation of carbon emission trading policy in China.

China's carbon emission trading policy plays a crucial role in achieving both its "3060" dual carbon objectives and the United Nations Sustainable Development Goal 13 (SDG 13) on climate action. The policy's effectiveness in reducing pollution and mitigating carbon emissions holds significant importance. This paper investigated whether China's carbon emission trading policy affects pollution reduction (PM2.5 and SO2) and carbon mitigation (CO2) in pilot regions, using panel data from 30 provinces and municipalities in China from 2005 to 2019 and employing a multi-period difference-in-differences (DID) model. Furthermore, it analyzed the heterogeneity of carbon market mechanisms and regional variations. Finally, it examined the governance pathways for pollution reduction and carbon mitigation from a holistic perspective. The results indicate that: (1) China's carbon emission trading policy has reduced CO2 emissions by 18% and SO2 emissions by 36% in pilot areas, with an immediate impact on the "carbon mitigation" effect, while the "pollution reduction" effect exhibits a time lag. (2) Higher carbon trading prices lead to stronger "carbon mitigation" effect, and larger carbon market scales are associated with greater "pollution reduction" effects on PM2.5. Governance effects on pollution reduction and carbon mitigation vary among pilot regions: Carbon markets of Beijing, Chongqing, Shanghai, and Tianjin show significant governance effects in both "pollution reduction" and "carbon mitigation", whereas Guangdong's carbon market exhibits only a "pollution reduction" effect, and Hubei's carbon market demonstrates only a "carbon mitigation" effect. (3) Currently, China's carbon emission trading policy achieves pollution reduction and carbon mitigation through "process management" and "end-of-pipe treatment". This study could provide empirical insights and policy implications for pollution reduction and carbon mitigation, as well as for the development of China's carbon emission trading market.

Association between dietary carbohydrate intake percentage and epilepsy prevalence in the NHANES 2013-2018: a cross-sectional study.

BACKGROUND: Epilepsy is a neurological disorder characterized by recurrent seizures. We aimed to investigate the association between the percentage of dietary carbohydrate intake (DCI) and epilepsy prevalence among American adults. METHODS: We analyzed the data from 9,584 adults aged 20-80 years who participated in the National Health and Nutrition Examination Survey from 2013 to 2018. Logistic regression was applied to explore the association between the percentage of DCI and epilepsy prevalence. RESULTS: A total of 146 (1.5%) individuals with epilepsy were enrolled in this study. The average age of the participants was 56.4 years, and 5,454 (56.9%) individuals were female. A high DCI was associated with an increased prevalence of epilepsy (odds ratio [OR], 4.56; 95% confidence interval [CI], 1.11-18.69; P = 0.035) after adjusting for age, sex, marital status, race/ethnicity, educational level, family income, body mass index, smoking status, drinking status, hypertension, diabetes, and cardiovascular disease. Stratified analyses indicated a positive correlation between DCI and epilepsy prevalence in adults with different characteristics. Compared with individuals in quartile 1 of DCI (<40.5%), those in quartile 4 (>55.4%) had an adjusted OR for epilepsy of 1.72 (95% CI, 1.09-2.73, P = 0.02, P for trend = 0.012). CONCLUSIONS: A high percentage of DCI was associated with an increased prevalence of epilepsy. The risk of epilepsy increased 3.5-fold with a 1% increase in DCI. These results suggest an important role of DCI in the dietary management of epilepsy.

Enhanced chlorobenzene removal by internal magnetic field through initial cell adhesion and biofilm formation.

Magnetic fields (MF) have been proven efficient in bioaugmentation, and the internal MFs have become competitive because they require no configuration, despite their application in waste gas treatment remaining largely unexplored. In this study, we firstly developed an intensity-regulable bioaugmentation with internal MF for gaseous chlorobenzene (CB) treatment with modified packing in batch bioreactors, and the elimination capacity increased by up to 26%, surpassing that of the external MF. Additionally, the microbial affinity to CB and the packing surface was enhanced, which was correlated with the ninefold increased secreted ratio of proteins/polysaccharides, 43% promoted cell surface hydrophobicity, and half reduced zeta potential. Furthermore, the dehydrogenase content was promoted over 3 times, and CB removal steadily increased with the rising intensity indicating enhanced biofilm activity and reduced CB bioimpedance; this was further supported by kinetic analysis, which resulted in improved cell adhesive ability and biological utilisation of CB. The results introduced a novel concept of adjustable magnetic bioaugmentation and provided technical support for industrial waste gas treatments. KEY POINTS: • Regulable magnetic bioaugmentation was developed to promote 26% chlorobenzene removal • Chlorobenzene mineralisation was enhanced under the magnetic field • Microbial adhesion was promoted through weakening repulsive forces.

Combined microfocused ultrasound and delicate pulsed light for facial rejuvenation: A prospective, randomized, and split-face study.

OBJECTIVES: Public's interest in noninvasive skin rejuvenation treatments continues to grow. The advantage of combination therapy lies in that it can target different aspects of skin rejuvenation. This study aimed to assess the efficacy and safety of microfocused ultrasound (MFU) combined with delicate pulsed light (DPL) for facial rejuvenation. METHODS: Twenty-one patients with facial relaxation were enrolled. All patients received whole-face MFU treatment, and one side of the face was randomly assigned to receive DPL. MFU treatment was performed at Months 0 and 3, while DPL treatment was performed at Months 1, 2, 4, and 5. The length and angle of the nasolabial fold and perioral wrinkles, melanin index (MI), erythema index (EI), transepidermal water loss (TEWL), and follow-up time were recorded at Months 0, 3, and 6. Side effects were recorded during treatment and each follow-up visit. RESULTS: Twenty patients successfully completed the study. At the sixth month, the average length of perioral wrinkles and nasolabial folds on the combined side decreased by 11.5% (pwithin < 0.001) and 6.5% (pwithin = 0.011), while 8.3% (pwithin = 0.012) and 3.8% (pwithin = 0.02) on the MFU side. Compared with MFU treatment alone, the combined treatment also showed significant improvements in nasolabial fold angle (from 28.8 ± 3.4° to 32.7 ± 5.0°) and perioral wrinkle angle (from 39.3 ± 5.0° to 43.7 ± 5.1°). In addition, the combined side had greater benefits than the MFU side in improving MI, EI, TEWL, and skin elasticity (pbetween < 0.05). Except for one patient who withdrew due to increased skin sensitivity after MFU treatment, other subjects did not experience permanent or serious side effects. CONCLUSIONS: The combination of MFU and DPL for facial rejuvenation treatment is safe and effective. The combined treatment has better efficacy in skin firmness, and improving skin tone.

Stem Cell and Regenerative Therapies for the Treatment of Osteoporotic Vertebral Compression Fractures.

Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional interventions such as vertebroplasty and kyphoplasty, despite their widespread use, are limited in addressing the secondary effects of vertebral fractures in adjacent areas and do not facilitate bone regeneration. This review paper explores the emerging domain of regenerative therapies, spotlighting stem cell therapy's transformative potential in OVCF treatment. It thoroughly describes the therapeutic possibilities and mechanisms of action of mesenchymal stem cells against OVCFs, relying on recent clinical trials and preclinical studies for efficacy assessment. Our findings reveal that stem cell therapy, particularly in combination with scaffolding materials, holds substantial promise for bone regeneration, spinal stability improvement, and pain mitigation. This integration of stem cell-based methods with conventional treatments may herald a new era in OVCF management, potentially improving patient outcomes. This review advocates for accelerated research and collaborative efforts to translate laboratory breakthroughs into clinical practice, emphasizing the revolutionary impact of regenerative therapies on OVCF management. In summary, this paper positions stem cell therapy at the forefront of innovation for OVCF treatment, stressing the importance of ongoing research and cross-disciplinary collaboration to unlock its full clinical potential.

Using CO2 and oxidants for in situ regeneration of permeable reactive barriers for leachate-contaminated groundwater.

Groundwater contamination near landfills is commonly caused by leachate leakage, and permeable reactive barriers (PRBs) are widely used for groundwater remediation. However, the deactivation and blockage of the reactive medium in PRBs limit their long-term effectiveness. In the current study, a new methodology was proposed for the in situ regeneration of PRB to remediate leachate-contaminated groundwater. CO2 coupled with oxidants was applied for the dispersion and regeneration of the fillers; by injecting CO2 to disperse the fillers, the permeability of the PRB was increased and the oxidants could flow evenly into the PRB. The results indicate that the optimum filler proportion was zero-valent iron (ZVI)/zeolites/activated carbon (AC) = 3:8:10 and the optimum oxidant proportion was COD/Na2S2O8/H2O2/Fe2+ = 1:5:6:5; the oxidation system of Fe2+/H2O2/S2O82- has a high oxidation efficiency and persistence. The average regeneration rate of zeolites was 72.71%, and the average regeneration rate of AC was 68.40%; the permeability of PRB also increased. This technology is effective for the remediation of landfills in China that have large contaminated areas, an uneven pollutant concentration distribution, and a long pollution duration. The purification mode of long-term adsorption and short-time in situ oxidation can be applied to the remediation of long-term high-concentration organically polluted groundwater, where pollution sources are difficult to cut off.

Research Progress on the Role and Mechanism of IL-37 in Liver Diseases.

Cytokines are important components of the immune system that can predict or influence the development of liver diseases. IL-37, a new member of the IL-1 cytokine family, exerts potent anti-inflammatory and immunosuppressive effects inside and outside cells. IL-37 expression differs before and after liver lesions, suggesting that it is associated with liver disease; however, its mechanism of action remains unclear. This article mainly reviews the biological characteristics of IL-37, which inhibits hepatitis, liver injury, and liver fibrosis by inhibiting inflammation, and inhibits the development of hepatocellular carcinoma (HCC) by regulating the immune microenvironment. Based on additional evidence, combining IL-37 with liver disease markers for diagnosis and treatment can achieve more significant effects, suggesting that IL-37 can be developed into a powerful tool for the clinical adjuvant treatment of liver diseases, especially HCC.

Exosomes from hypoxia-pretreated adipose-derived stem cells attenuate ultraviolet light-induced skin injury via delivery of circ-Ash1l.

BACKGROUND: An increasing number of studies have reported that exosomes from adipose-derived stem cells (ADSCs) have antioxidant and anti-inflammatory properties. In the present study, we aimed at elucidating the potential therapeutic mechanism underlying ADSC exosomes in ultraviolet B-light (UVB)-induced skin injury. METHODS: We isolated the exosomes from ADSCs and hypoxia-pretreated ADSCs. High-throughput sequencing was applied to identify differential circRNA expression. Then, a UV-induced murine skin injury model was constructed and the therapeutic effect of exosomes was determined using immunofluorescence and ELISA. The regulatory mechanism was demonstrated using luciferase reporter analysis and an in vitro experiment. RESULTS: Exosomes from hypoxia-pretreated ADSCs inhibited UVB light-induced vascular injury by reversing ROS and inflammatory factor expression. High-throughput sequencing showed that exosomes from hypoxia-pretreated ADSCs (HExo) improved UV-induced skin damage via delivery of circ-Ash1l. Downregulation of circ-Ash1l inhibited the therapeutic effect of HExo on UV-induced skin damage. It was further shown that GPX4 and miR-700-5p were circ-Ash1l downstream targets. MiR-700-5p overexpression or GPX4 downregulation inhibited the circ-Ash1l protective effects of UV-induced endothelial progenitor cell (EPC) damage. CONCLUSION: Thus, exosomes from hypoxia-pretreated ADSCs attenuated UV light-induced skin injury via circ-Ash1l delivery and ferroptosis inhibition.

Combining superpulse dynamic CO2 laser and supramolecular salicylic acid in the treatment of dense comedones with higher clearance in a shorter time: A prospective, randomized, split-face clinical trial.

OBJECTIVES: Dense comedones are common in patients with acne vulgaris, and promoting treatment can prevent the progression of acne lesions. However, the efficacy-time conflict makes the treatment challenging and the medication options are limited by the side effects. MATERIALS AND METHODS: Thirty-five patients with symmetrical dense comedones were enrolled and the two sides of the face were randomly assigned to receive 30% supramolecular salicylic acid (SSA) combined with CO2 laser or CO2 laser monotherapy at an interval of 2 weeks for six treatment sessions. Comedones count, porphyrin index (PI), texture index (TI), melanin index, erythema index, hydration index (HI), transepidermal water loss (TEWL), and side effects were recorded at each visit till the 12th week. RESULTS: Thirty-one patients completed the study. Comedones on the combined-SSA side were reduced more after six treatments, that the mean reduction rate of the combined-SSA side was 85.76%, and that of the CO2 laser-treated side was 62.32% (Pbetween < 0.001). Combining SSA also showed a better effect on reducing PI and TI than CO2 laser singly (Pbetween < 0.001). TEWL and HI between the two sides showed no significant differences after treatments. No permanent or severe side effects were observed on both side. CONCLUSIONS: The treatment combined CO2 laser with 30% SSA dealt with the efficacy-time conflict while significantly reducing comedones and improving skin texture in 12 weeks and no serious adverse reactions occurred. LIMITATIONS: It is a single-center study and the number of subjects was small.

Factors associated with incomplete clinical improvement in patients undergoing transforaminal endoscopic lumbar discectomy for lumbar disc herniation.

PURPOSES: To analyze the clinical and radiographic risk factors that might predict incomplete clinical improvement after transforaminal endoscopic lumbar discectomy (TELD). METHODS: A retrospective analysis was conducted from 194 consecutive patients who underwent TELD due to lumbar disc herniation (LDH). Patients with incomplete clinical improvement were defined from patient-reported outcomes of poor improvement in pain or disability after surgery and patient dissatisfaction. Clinical and radiographic characteristics were evaluated to identify predicting factors of poor outcomes. RESULTS: Of 194 patients who underwent TELD procedures, 32 patients (16.5%) had incomplete clinical improvement and 12 patients (6.1%) required revision surgery. The mean ages were 46.4 years and most of the patients suffered from predominant leg pain (48.9%). The most common surgical level was L4-5 (63.9%). Overall, the Oswestry Disability Index (44.3-15), visual analog scores of back pain (4.9-1.8) and leg pain (7.3-1.6) were significantly improved after surgery. Multivariate logistic regression analysis demonstrated that high body mass index, history of previous surgery, preoperative disability, weakness, and disc degeneration were related to incomplete clinical improvement. There were 15 recurrent LDH (7.7%) with a total of 12 revision surgeries (6.2%). CONCLUSIONS: We identified independent risk factors associated with incomplete clinical improvement following TELD, including overweight, significant preoperative disability or weakness and history of previous surgery. Advanced age, disc degeneration, vacuum phenomenon, and spondylolisthesis were also possible risk factors. Recognizing these risk factors would help decide whether patients are good candidates for TELD, and optimize the surgical planning preoperatively to achieve good surgical results.

Endoscopic anterior to psoas lumbar interbody fusion: indications, techniques, and clinical outcomes.

PURPOSE: The retrospective study aimed to report the surgical technique and clinic-radiological outcomes of endoscopic anterior to psoas interbody lumbar fusion through the retroperitoneal approach with direct and indirect decompression. METHODS: We retrospectively analyzed the results of clinical parameters of patients who underwent endoscopic anterior to psoas interbody lumbar fusion between June 2013 and June 2022. Clinical outcomes were evaluated by the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The radiological outcomes were measured and statistically compared in disc height index (DHI), whole lumbar lordosis (WLL), pelvic Incidence (PI), pelvic tilt (PT), Segmental lordosis (SL), the sagittal vertical axis (SVA). RESULTS: A total of 35 patients were selected for the procedure ranging in age from 51 to 84 years with 17.83 ± 8.85 months follow-up. The mean operation time in lateral position for one level was 162.96 ± 35.76 min (n = 24), and 207.73 ± 66.60 min for two-level fusion. The mean endoscopic time was 32.83 ± 17.71 min per level, with a total estimated blood loss of 230.57 ± 187.22 cc. The mean postoperative VAS back, leg pain score and ODI improved significantly compared to the preoperative values; Radiological data showed significant change in WLL, SL, DHI, PI, PT, and SS; however, there is no significant difference in SVA postoperatively. Subgroup analysis for the radiographic data showed 50 mm length cage has significantly improved for the DHI, SS and SVA compare to 40 mm length cage. The subgroup analysis results showed that hypertensive patients had significantly higher proportion in the incomplete fusion group compare to complete fusion group at one-year follow-up. OUTCOMES: The endoscopic anterior to psoas interbody lumbar fusion achieves satisfactory indirect and direct decompression. This convergent technique presents an effective choice for treating lumbar instability associated with disc herniations and foraminal stenosis, thus complementing the indications for oblique lumbar interbody fusion.

Minimally invasive endoscopy in spine surgery: where are we now?

INTRODUCTION: Endoscopic spine surgery (ESS) is a minimally invasive surgical technique that offers comparable efficacy and safety with less collateral damage compared to conventional surgery. To achieve clinical success, it is imperative to stay abreast of technological advancements, modern surgical instruments and technique, and updated evidence. PURPOSES: To provide a comprehensive review and updates of ESS including the nomenclature, technical evolution, bibliometric analysis of evidence, recent changes in the spine communities, the prevailing of biportal endoscopy, and the future of endoscopic spine surgery. METHODS: We conducted a comprehensive review of the literature on ESS for the mentioned topics from January 1989 to November 2022. Three major electronic databases were searched, including MEDLINE, Scopus, and Embase. Covidence Systematic Review was used to organize the eligible records. Two independent reviewers screened the articles for relevance. RESULTS: In total, 312 articles were finally included for review. We found various use of nomenclatures in the field of ESS publication. To address this issue, we proposed the use of distinct terms to describe the biportal and uniportal techniques, as well as their specific approaches. In the realm of technical advancement, ESS has rapidly evolved from addressing disc herniation and spinal stenosis to encompassing endoscopic fusion, along with technological innovations such as navigation, robotics, and augmented reality. According to bibliometric analysis, China, South Korea, and the USA have accounted for almost three-quarters of total publications. The studies of the biportal endoscopy are becoming increasingly popular in South Korea where the top ten most-cited articles have been published. The biportal endoscopy technique is relatively simple to adopt, as it relies on a more familiar approach, requires less expensive instruments, has a shorter learning curve, and is also well-suited for interbody fusion. The uniportal approach provided the smallest area of soft tissue dissection. While robotics and augmented reality in ESS are not widely embraced, the use of navigation in ESS is expected to become more streamlined, particularly with the emergence of recent electromagnetic-based navigation technologies. CONCLUSIONS: In this paper, we provide a comprehensive overview of the evolution of ESS, as well as an updated summary of current trends in the field, including the biportal and uniportal approaches. Additionally, we summarize the nomenclature used in ESS, present a bibliometric analysis of the field, and discuss future directions for the advancement of the field.

Full-endoscopic foraminotomy in low-grade degenerative and isthmic spondylolisthesis: a patient-specific tailored approach.

PURPOSE: To describe the surgical technique and methodology to successfully plan and execute an endoscopic foraminotomy in patients with isthmic or degenerative spondylolisthesis, according to each patient's unique characteristics. METHODS: Thirty patients with degenerative or isthmic spondylolisthesis (SL) with radicular symptoms were included from March 2019 to September 2022. Treating physician registered patients' baseline and imaging characteristics, as well as preoperative back pain VAS, leg pain VAS and ODI. Subsequently, authors treated the included patients with an endoscopic foraminotomy according to a "patient-specific" tailored approach. RESULTS: Nineteen patients (63.33%) had isthmic SL and 11 patients (36.67%) had degenerative SL. 75.86% of the cases had a Meyerding Grade 1 listhesis. One of the transforaminal foraminotomies with lateral recess decompression in degenerative SL had to be aborted because of intense osseous bleeding. Of the remaining 29 patients, one patient experienced recurrence of the sciatica pain that required subsequent reintervention and fusion. No other intraoperative or post-operative complications were observed. None of the patients developed post-operative dysesthesia. In 86.67% of the patients, the foraminotomy was implemented using a transforaminal approach. In the remaining 13.33% of the cases, an interlaminar contralateral approach was used. Lateral recess decompression was performed in half of the cases. Mean follow-up time was 12.69 months, reaching a maximum of 40 months in some patients. Outcome variables such as VAS for leg and back pain, as well as ODI, showed statistically significant reduction since the 3-month follow-up visit. CONCLUSION: In the presented case series, endoscopic foraminotomy achieved satisfactory outcomes without sacrificing segmental stability. The proposed patient-specific "tailored" approach allowed to successfully design and execute the surgical strategy to perform an endoscopic foraminotomy through transforaminal or interlaminar contralateral approaches.

Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades.

OBJECTIVE: The study aims to assess the current development status of transforaminal full-endoscopic spine surgery (TFES) by exploring and analyzing the published literature to obtain an overview of this field and discover the evolution and emerging topics that are underrepresented. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science Core Collection between January 2002 and November 2022. The descriptive and evaluative analyses of authors, institutes, countries, journals, keywords, and references are compiled. The quantity of research productivity was measured by the number of publications that were published. A quality indicator was thought to be the number of citations. In the bibliometric analysis of authors, areas, institutes, and references, we calculated and ranked the research impact by various metrics, such as the h-index and m-index. RESULTS: A total of 628 articles were identified in the field of TFES by the 18.73% annual growth rate of research on the subject from 2002 to 2022, constituting the documents are by 1961 authors affiliated with 661 institutions in 42 countries or regions and published in 117 journals. The USA (n = 0.20) has the highest international collaboration rate, South Korea has the highest H-index value (h = 33), and China is ranked as the most productive country (n = 348). Brown univ., Tongji univ., and Wooridul Spine represented the most productive institutes ranked by the number of publications. Wooridul Spine Hospital demonstrated the highest quality of paper publication. The Pain Physician had the highest h-index (n = 18), and the most cited journal with the earliest publication year in the area of FEDS is Spine (t = 1855). CONCLUSION: The bibliometric study showed a growing trend of research on transforaminal full-endoscopic spine surgery over the past 20 years. It has shown a significant increase in the number of authors, institutions, and international collaborating countries. South Korea, the United States, and China dominate the related areas. A growing body of evidence has revealed that TFES has leapfrogged from its infancy stage and gradually entered a mature development stage.

Study on Flame Retardancy Behavior of Epoxy Resin with Phosphaphenanthrene Triazine Compound and Organic Zinc Complexes Based on Phosphonitrile.

A novel flame retardant phosphorus-containing organozinc complex (Zn-PDH) was prepared using zinc and iron as the metal center and 4-aminopyridine, with low steric hindrance, as the organic ligand, then using phosphazene to modify the organometallic complex (Zn-4APD). The flame retardant properties and mechanism of Zn-PDH/Tris-(3-DOPO-1-propyl)-triazinetrione (TAD) in epoxy resin (EP) were investigated. Flame inhibition behavior was studied by the vertical combustion test (UL94), while limiting oxygen index (LOI) measurement and flame retardant properties were studied by the cone calorimeter test (CONE). The flame retardant modes of action were explored by using the thermogravimetry-Fourier transform infrared (TG-FTIR) test, X-ray photoelectron spectrometer (XPS), and Raman spectroscopy (LRS). When TAD and Zn-PDH were added to the epoxy resin in the ratio of 3:1, the system achieved a balance between the gas-phase and condense-phase actions of the flame retardant effects, and the 3%TAD/1%Zn-PDH/EP composite system achieved not only good flame inhibition but also obtained good smoke and heat suppression performance, showing a comprehensive flame retardant performance. The gas phase and Zn-PDH mostly promoted charring with a barrier and protective effect in the condensed phase. As for the mechanism, TAD released the phosphorus-containing radicals and phenoxy radicals during decomposition and mainly exerted a gas-phase quenching effect. While in the condense phase, Zn-PDH promoted the decomposition of the polymer matrix to produce more aromatic structures and rapidly formed a complete and dense carbon layer rich in P-O-C crosslinked structures at high temperatures. Meanwhile, more N entered the gas phase in the form of inert gas, which diluted the concentration of the combustible fuel and helped to inhibit the combustion reaction.