A nomogram model for predicting postoperative prognosis in patients with aneurysmal subarachnoid hemorrhage using preoperative biochemical indices.

OBJECTIVE: The nutritional status and inflammatory responses of patients with aneurysmal subarachnoid hemorrhage (aSAH) play a vital prognostic role. We investigated the relationship between preoperative prognostic nutritional index (PNI)、neutrophil/albumin ratio (NAR)、platelet/albumin ratio (PAR) and other factors and the clinical prognosis of patients who underwent clipping for aSAH and its predictive model. METHODS: The clinical data of 212 patients with aSAH who underwent neurosurgery at Nanyang Central Hospital between 2018 and 2023 were retrospectively analyzed. Based on the Glasgow Outcome Scale (GOS) score at 6 months postoperatively, the patients were categorized into two groups: poor (GOSI-III) and good (GOSIV-V) prognosis groups. Multivariate logistic regression analysis was performed to determine the predictive value of preoperative PNI、NAR、PAR、hyperlipidemia and Glasgow Coma Scale (GCS) for prognosis. Furthermore, nomograms and prognostic prediction models were constructed. Receiver operating characteristic curves and area under the curve (AUC) were utilized to determine the predictive values. RESULTS: Multivariate logistic regression analysis revealed that PNI (OR = 1.250, 95%CI 1.060 ~ 1.475, P = 0.008), NAR (OR = 0.000, 95%CI 0.000 ~ 0.004, P = 0.000), PAR(OR = 0.515, 95%CI 0.283 ~ 0.937, P = 0.030), hyperlipidemia (OR = 4.627, 95%CI 1.166 ~ 18.367, P = 0.029), and GCS(OR = 1.446, 95%CI 1.041 ~ 2.008, P = 0.028) are independent risk factors for poor postoperative prognosis. The total score of the nomogram was 200, and the AUC value was 0.972. CONCLUSIONS: PNI and NAR can reflect the nutritional status and inflammatory responses of patients.They are significantly associated with the postoperative prognosis of patients with aSAH. Comprehensively analyzing PNI and NAR combined with other clinical indicators can more effectively guide treatment and help predict prognosis.

The classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable.

STUDY DESIGN: Retrospective case-control radiographic study. OBJECTIVE: To identify main effects of preoperative pattern and global coronal malalignment (GCM) on postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients and evaluate the rationality of the classification of coronal deformity based on preoperative GCM. A classification of coronal deformity based on preoperative GCM (20 mm set as the threshold of coronal imbalance) has been proposed recently, but whether it is practical is unclear. METHODS: One hundred twelve DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included GCM and major Cobb angle. Based on relationship between C7 PL and major curve, preoperative patterns were classified into: Pattern 1(concave pattern), C7 PL shifted to the concave side of major curve; Pattern 2(convex pattern), C7 PL shifted to the convex side of major curve. Patients were separated into 4 groups (3 types): Type 0-1: GCM < 20 mm plus Pattern 1; Type 0-2: GCM < 20 mm plus Pattern 2; Type 1: GCM > 20 mm plus Pattern 1; Type 2: GCM > 20 mm plus Pattern 2. After comparison within patterns or among 4 groups, further factorial analysis was performed. RESULTS: Significant differences regarding postoperative GCM or coronal imbalance/balance ratio existed among 4 groups (F = 6.219, p = 0.001; x2 = 22.506, p < 0.001, respectively), despite no significant difference in intra-pattern 1(concave pattern) or intra-pattern 2(convex pattern) groups. Two-way analysis of variance showed preoperative pattern exhibited significant effect on postoperative GCM or imbalance/balance ratio (F(1,108) = 14.286, p < 0.001; F(1,108) = 30.514, p < 0.001, respectively) while neither preoperative GCM alone nor interaction of preoperative GCM with pattern did. CONCLUSION: In DLS patients, it's the preoperative pattern other than GCM that had main effects on postoperative coronal imbalance. Classification of coronal deformity based on preoperative GCM is questionable.

A novel integrated global coronal aligner helps prevent post-operative standing coronal imbalance in adult spinal deformity patients fused to pelvis: technical notes and preliminary results.

BACKGROUND: Chieving postoperative coronal balance in adult spinal deformity correction surgeries can be challenging. Even with T square rod technique, there were still some cases with good intraoperative coronal alignment but unsatisfactory post-operative standing coronal imbalance. Thus, the novel techniques to obtain global coronal balance are still in great needs. The purpose of this study was to describe a novel integrated global coronal aligner (IGCA) and evaluate its efficacy on avoidance of post-operative coronal imbalance in adult spinal deformity patients fused to pelvis. METHODS: A detailed description of IGCA technique was presented. 52 ASD patients fused to pelvis were divided into two groups (IGCA group, n = 27; and non-IGCA group, n = 25) according to whether intraoperative IGCA was used or not. Preoperative demographics and postoperative outcomes were compared. RESULTS: There were no significant differences regarding coronal balance difference (CBD) and imbalance/balance ratio between IGCA and non-IGCA groups preoperatively. After surgery, CBD in IGCA group was significantly improved from 24.7 ± 20.3 mm preoperatively to 12.6 ± 6.4 mm postoperatively (t = 3.185 p = 0.004), and imbalance/balance ratio decreased significantly from 55.6% (15/27) preoperatively to 11.1% (3/27) postoperatively (χ2 = 12.000, p = 0.001), while CBD and imbalance/balance ratio in non-IGCA group were not significantly improved. Compared to non-IGCA group, the amount of correction in CBD was significantly larger in IGCA group (t = 3.274, P = 0.002), and imbalance/balance ratio in IGCA group was significantly lowered (χ2 = 8.606 p = 0.003). Further logistic regression analysis revealed IGCA technique was associated with increased odds ratio for postoperative coronal balance (odds ratio: 7.385; 95% confidence interval 1.760-30.980; P = 0.006). CONCLUSIONS: The novel intraoperative IGCA technique could help improve CBD and reduce imbalance/balance ratio. It could help prevent post-operative coronal imbalance in adult spinal deformity patients fused to pelvis. LEVEL OF EVIDENCE: 3.

[Retracted] Embelin-induced brain glioma cell apoptosis and cell cycle arrest via the mitochondrial pathway.

Following the publication of the above paper, it was drawn to the Editor's attention by a concerned reader that the flow cytometric data shown in Fig. 4A on p. 2475 were strikingly similar to data appearing in another article written by different authors at different research institutes which had already been published. Owing to the fact that the contentious data in the above article had already been published elsewhere prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Oncology Reports 29: 2473­2478, 2013; DOI: 10.3892/or.2013.2369].

Feasibility of noninvasive near-infrared spectroscopy monitoring in predicting the prognosis of spontaneous intracerebral hemorrhage.

Objective: This study aimed to assess the impact of multimodal monitoring on predicting the prognosis of patients with spontaneous intracerebral hemorrhage (SICH) and to examine the feasibility of using noninvasive near-infrared spectroscopy (NIRS) for monitoring clinical prognosis. Methods: Clinical data of 38 patients with SICH who underwent surgery in the Department of Neurosurgery of Shaanxi Provincial People's Hospital from May 2022 to December 2022 were retrospectively analyzed. The patients were categorized into two groups based on the Glasgow Outcome Scale (GOS) 3 months after operation: poor outcome group (GOSI-III) and good outcome group (GOSIV and V). Multimodal monitoring included invasive intracranial pressure (ICP), brain temperature (BT), internal jugular venous oxygen saturation (SjvO2), and noninvasive NIRS. NIRS monitoring comprised the assessment of brain tissue oxygen saturation (StO2), blood volume index (BVI), and tissue hemoglobin index (THI). The prognostic differences between the two groups were compared. The predictive values were evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results: ICP, BT, BVI, and THI in the good prognosis group were lower than those in the poor prognosis group. The SjvO2 and StO2 in the group with a good prognosis were higher than those in the group with a poor prognosis. Conclusion: The levels of ICP, BT, SjvO2, StO2, BVI, and THI reflect the changes in brain function and cerebral blood flow and significantly correlate with the prognosis of patients with SICH. NIRS monitoring has a high clinical utility in assessing the prognosis.

Risk Factors for Immediate Postoperative Coronal Imbalance in Degenerative Lumbar Scoliosis Patients Fused to Pelvis.

STUDY DESIGN: Retrospective case-control radiographic study. OBJECTIVE: To identify risk factors for immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients fused to pelvis. METHODS: A total of 71 DLS patients treated with deformity correction surgery were reviewed. Measurements included coronal parameters such as global coronal malalignment (GCM), major Cobb angle, L4/L5 coronal tilt and sagittal parameters. Based on the orientation of L4 coronal tilt relative to C7 plumb line (PL) preoperatively, coronal patterns were subdivided into (1) consistency pattern, L4 coronally tilts toward C7 PL, and (2) opposition pattern, L4 coronally tilts opposite C7 PL; the proportion of these 2 patterns was analyzed. Also, the proportion of type C and surgical factors were recorded. According to postoperative GCM, patients were divided into imbalanced group and balanced group. RESULTS: Compared with the balanced group, the imbalanced group had a larger proportion of preoperative consistency pattern (79.17% vs 40.43%, P = .002), larger proportion of type C (29.17% vs 8.51%, P = .023), and lower amount of GCM correction (-4.92 ± 24.25 vs 14.52 ± 19.49 mm, P < .001). There were no significant intergroup differences regarding preoperative and postoperative major Cobb angle, preoperative and postoperative L4 or L5 coronal tilt, major Cobb correction, the amounts of correction of coronal tilt of L4/L5, osteotomy levels, osteotomy grades, instrumented levels, levels of interbody fusion, and distribution of upper instrumented vertebra. CONCLUSIONS: In addition to known risk factors such as type C, preoperative coronal consistency pattern might be a new risk factor for postoperative coronal imbalance in DLS patients fused to pelvis.

Directionality of Lumbosacral Fractional Curve Relative to C7 Plumb Line, A Novel Index Associated with Postoperative Coronal Imbalance in Patients with Degenerative Lumbar Scoliosis.

STUDY DESIGN: Retrospective case-control radiographic study. OBJECTIVE: The aim of this study was to explore whether directionality of lumbosacral fractional curve relative to C7 plumb line (PL) affected postoperative coronal imbalance in patients with degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA: The spatial relationship between lumbar main curve and C7 PL was reported to have impact on postoperative coronal imbalance in DLS. Although fractional curve played more important role than lumbar main curve in DLS, the spatial relationship between fractional curve and C7 PL and their impact on the postoperative coronal balance are still unknown. METHODS: One hundred one DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included C7 migration, fractional curve, L4/L5 coronal tilt, major Cobb angle. Based on directionality of fractional curve (orientation of L4 coronal tilt was used to represent it) relative to C7 PL preoperatively, coronal patterns was separated into: consistency pattern, L4 coronally tilts toward C7 PL; opposition pattern, L4 coronally tilts opposite C7 PL; the distributions of these two patterns and Type A, B,C were analyzed. According to postoperative C7 migration, patients were divided into imbalanced group and balanced group. RESULTS: Compared to balanced group, the imbalanced group had higher percentage of preoperative consistency pattern (80.6% vs. 33.8%, P < 0.001) and Type C (36.1% vs. 7.7%, P < 0.001); larger fractional curve or L4 coronal tilt pre- and postoperatively, larger L5 coronal tilt postoperatively. Logistic regression analysis showed predictors for postoperative coronal imbalance were consistency pattern (odds ratio [OR] 5.103, 95% confidence interval [CI]: 1.660-15.687, P = 0.004) and type C (OR 4.061; 95% CI: 1.056-15.618; P = 0.041). CONCLUSION: Directionality of fractional curve relative to C7 PL was associated with postoperative coronal imbalance in DLS patients. In addition to type C, consistency pattern might be an independent risk factor for postoperative coronal imbalance.Level of Evidence: 3.

Coronal T1 Pelvic Tilt, a Novel Predictive Index for Global Coronal Alignment in Adult Spinal Deformity.

STUDY DESIGN: A retrospective radiographic study. OBJECTIVES: The aim of this study was to examine the association between global coronal alignment (GCA) and L4/L5 coronal tilt, and to verify the validity of our new index for evaluating GCA. SUMMARY OF BACKGROUND DATA: The mechanism of coronal imbalance is still unknown. The ability to level coronal tilts of L4 and L5 has been reported to impact the ability to achieve coronal balance, but the relationship between GCA and coronal tilt of L4 or L5 is unclear. On the contrary, although C7 migration is widely used for evaluating GCA, it has inherent defects as distance parameter. We focused on a novel global coronal angular parameter for evaluating the association of GCA with coronal tilt of L4 or L5. METHODS: A total of 146 patients with adult spinal deformity were involved. The coronal measurements included C7 migration, fractional curve, L4 coronal tilt, L5 coronal tilt, major Cobb angle, and our novel global coronal parameter-coronal T1 pelvic tilt angle (CTPT, defined as the angle between a vertical line and the line connecting the middle point of S1 endplate to T1 centroid). We then determined the relationship between CTPT, C7 migration, and other coronal parameters. RESULTS: C7 migration had significant correlation with L4 coronal tilt, L5 coronal tilt or fractional curve, but not with major Cobb angle. CTPT resembled C7 migration regarding its relationships with L4 coronal tilt, fractional curve, L5 coronal tilt and major Cobb angle. Regression analysis showed CTPT strongly associated with C7 migration (R = 0.985), CTPT = 0.02+0.14* C7 migration and neither L4 coronal tilt nor L5 coronal tilt was an independent predictor of GCA. CONCLUSION: CTPT could be a practical index for evaluating GCA. Neither L4 coronal tilt nor L5 coronal tilt was an independent predictor of GCA. LEVEL OF EVIDENCE: 3.

Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis.

The study design is case-control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029-17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery.Level of evidence 3.

Can C2-6 Cobb Angle Replace C2-7 Cobb Angle?: An Analysis of Cervical Kinetic Magnetic Resonance Images and X-rays.

STUDY DESIGN: Retrospective study of consecutive 113 cervical kinetic magnetic resonance images (kMRIs) and 57 radiographs. OBJECTIVE: To elucidate the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters using kMRI, and evaluate the visibility of C6 and C7 inferior endplates on cervical radiographs. SUMMARY OF BACKGROUND DATA: Several studies have used C2-6 Cobb angle instead of C2-7 Cobb angle as C7 inferior endplate is not always visible because of overlying shadows. However, the relationship between C2-6 or C2-7 Cobb angle and cervical sagittal alignment parameters remains unclear. Moreover, visibility of C6 inferior endplate remains unknown. METHODS: C2-6 Cobb angle, C2-7 Cobb angle, occiput-C2 angle, Atlas-dens interval (ADI), narrowest oropharyngeal airway space (nPAS), cervical sagittal vertical axis (cSVA), cervical tilt, cranial tilt, neck tilt, thoracic inlet angle (TIA), and T1 slope were measured using kMRI, and analyzed for their relationship with C2-6 or C2-7 Cobb angle. Visibility rates of C6 or C7 inferior endplates were evaluated using cervical radiographs. RESULTS: Linear regression analysis showed high association between C2-6 and C2-7 Cobb angle (R = 0.696, P < 0.01). C2-6 Cobb angle was significantly correlated with occiput-C2 angle, TIA, T1 slope, neck tilt, cSVA, and cervical tilt; but not with nPAS, ADI, and cranial tilt. C2-7 Cobb angle resembled C2-6 Cobb angle regarding the relationships with other parameters. In our study, 94.7% C6 and 50.9% C7 inferior endplate were clearly visible; 1.8% C6 and 24.6% C7 inferior endplate were invisible. Chi-square test and residual analysis showed significant difference between the two groups (P < 0.01). CONCLUSION: C2-6 Cobb angle highly resembled C2-7 Cobb angle regarding its relationships with parameters of craniovertebral, cervical and thoracic inlet alignment. C2-6 Cobb angle could be an alternative to C2-7 Cobb angle because of its significantly higher visibility rate. LEVEL OF EVIDENCE: 3.

Embelin-induced brain glioma cell apoptosis and cell cycle arrest via the mitochondrial pathway.

Brain glioma is the most common malignant intracranial tumor and has become the focus of research on diseases of the central nervous system due to its high incidence and poor prognosis. As a small­molecule inhibitor of X-linked inhibitor of apoptosis protein (XIAP), embelin has the ability to specifically inhibit XIAP to control and regulate the apoptosis of various types of tumor cells. However, to date, the mechanism of action for this effect is not well understood. The aim of this study was to investigate the role that the mitochondrial pathway plays in embelin-induced brain glioma cell apoptosis and the effect of embelin on the cell cycle. Brain glioma cells were treated with different doses of embelin. The MTT method was used to determine cell proliferation, and flow cytometry was used to determine apoptosis, as well as changes in the cell cycle and cell mitochondrial membrane potential. Western blot analysis was performed to determine the expression levels of apoptosis­associated proteins, Bcl-2, Bcl-xL, Bax and Bak as well as cytochrome c. We found that embelin induced a time­ and dose­dependent apoptosis of brain glioma cells, and that it could arrest the cell cycle in the G0/G1 phase. Embelin also caused changes in brain glioma cell mitochondrial membrane potential. Additionally, embelin regulated the shifting of Bax and Bcl-2 to promote the mitochondrial release of cytochrome c, thus activating the caspase proteins to cause apoptosis. Thus, embelin induces apoptosis in brain glioma cells which is closely associated with the mitochondrial pathway.