Nomogram for predicting venous thromboembolism after spinal surgery

PURPOSE

This study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery.

METHODS

A retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally.

RESULTS

Multivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01-1.

CONCLUSION

Patients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.

Cardiac Disease Associated Genetic Variants in Yi Nationality in Regions with High Incidence of Yunnan Sudden Unexplained Death

Abstract

Objective To explore the association of cardiac disease associated genetic variants and the high incidence of Yunnan sudden unexplained death （YNSUD） in Yi nationality. Methods The genomic DNA was extracted from peripheral blood samples collected from 205 Yi villagers from YNSUD aggregative villages （inpatient group） and 197 healthy Yi villagers from neighboring villages （control group）. Fifty-two single nucleotide variants （SNVs） of 25 cardiac disease associated genes were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS）. The SPSS 17.0 was used to analyze data. The pathogenicities of variants with differences between the two groups that have statistical significance were predicted by protein function prediction software PolyPhen-2 and SIFT. All villagers from inpatient group were given electrocardiogram （ECG） examination using a 12-lead electrocardiograph. Results The allele frequency and the genotype frequency of missense mutation DSG2 （rs2278792, c.2318G>A, p.R773K） of pathogenic genes of arrhythmogenic right ventricular cardiomyopathy （ARVC） in inpatient group was higher than that in control group （P<0.05）. Abnormal ECG changes were detected in 71 individuals （34.6%） in the inpatient group, among which 54 individuals carried R773K mutation, including clockwise （counterclockwise） rotation, left （right） axis deviation, ST segment and T wave alteration and heart-blocking. Conclusion Definite pathogenic mutations have not been found in the 52 cardiac disease genes associated SNVs detected in Yi nationality in regions with high incidence of YNSUD. The cause of high incidence of YNSUD in Yi nationality needs further study.

Morphometric Trajectory Analysis for Occipital Condyle Screws

Objectives

Occipitocervical fusion (OCF) is an effective treatment for instability of occipitocervical junction (OCJ). The occipital condyle screw serves as a novel surgical technique for occipitocervical fixation. However, the intraoperative procedures for the occipital condyle screw technique have relied on surgeons’ experience, so the pool of surgeons who are able to perform this surgery safely is limited. The present study aims to evaluate the feasibility and safety of the occipital condyle screw technique using human cadavers and to provide image anatomy for clinical application basis.

Methods

The scientific study comprised 10 fresh‐frozen cadaveric specimens from the anatomy department of Qingdao University. Placement of the occipital condyle screws (3.5 mm diameter and 20.0 mm length) was performed in the 10 fresh‐frozen cadaveric specimens with intact occipitocervical junctions, respectively. Occipitocervical CT was performed for all specimens and the DICOM data was obtained. Occipitocervical CT three‐dimensional (3D) reconstruction was performed for the cadavers. Morphometric analysis was performed on the bilateral occipitocervical junction of 10 cadaveric specimens based on the 3D reconstruction CT images. Detailed morphometric measurements of the 20 occipital condyles screws were conducted including the average length of the screw trajectory, inside and upper tilting angles of screws, distance to the hypoglossal canal, and to the medial wall of occipital condyle.

Results

Placement of the occipital condyle screws into the 20 occipital condyles of the 10 cadaveric specimens was performed successfully and the trajectory of implantation was satisfactory according to 3D CT reconstruction images, respectively. There was no obvious injury to the spinal cord, nerve root, and vertebral artery. The length of the bilateral screw trajectory was, respectively, 20.96 ± 0.91 mm (left) and 20.59 ± 0.77 mm (right) (t = 1.306, P > 0.05). The upper tilting angle of bilateral screws was, respectively, 11.24° ± 0.74° (left) and 11.11° ± 0.64° (right) (t = 0.681, P > 0.05). The inside tilting angle of bilateral screws was, respectively, 31.00° ± 1.32° (left) and 30.85° ± 1.27° (right) (t = 0.307, P > 0.05). The screw's distance to the bilateral hypoglossal canal was, respectively, 4.84 ± 0.54 mm (left) and 4.70 ± 0.54 mm (right) (t = 0.685, P > 0.05). The screw's distance to the medial wall of the bilateral occipital condyle was, respectively, 5.13 ± 0.77 mm (left) and 5.04 ± 0.71 mm (right) (t = 0.384, P > 0.05).

Conclusion

The occipital condyle screw technique can serve as a feasible and safe treatment for instability of the occipitocervical junction with meticulous preoperative planning of the screw entry point and direction based on individual differences. Morphometric trajectory analysis is also an effective way to evaluate the surgical procedure.

Effect of Matrix Metalloproteinase 3 Gene Silencing and SRY-Related High Mobility Group-Box Gene 9 Gene Overexpression on Human Degeneration Nucleus Pulposus Cells In Vitro

This study aims to detect the biological effects of matrix metalloproteinase 3 (MMP3) and SRY-related high mobility group-box gene 9 (SOX9) gene regulation in the human intervertebral disc degeneration of nucleus pulposus cells mediated by lentiviral vectors in vitro. The culture and development of human degenerated intervertebral disc nucleus pulposus cells was performed. The cell morphology and structure were observed, as identified by hematoxylin and eosin (H&E) staining. The experiment was divided into five groups: blank control group, SOX9 gene overexpression group, MMP3 gene silencing group, SOX9 gene overexpression+MMP3 gene silencing group, and blank vector group. RT-PCR and western blot were performed to detect the influence of MMP3 gene silencing and SOX9 gene overexpression on degenerated human intervertebral disc nucleus pulposus cells, include the secretion of polysaccharide and expression of type II collagen, at the mRNA and protein level. The originally generated degenerated human intervertebral disc nucleus pulposus cells had the same cellular morphology. The MTT assay revealed that the blank group and blank vector group had no statistical significance in cell proliferation. The MMP3 gene silencing and SOX9 gene overexpression could promote the proliferation of degenerated human intervertebral disc nucleus pulposus cells, when compared with the blank control group and blank vector group, and this more obvious in the MMP3 gene silencing group and SOX9 gene overexpression group. RT-PCR and western blot revealed that MMP3 gene silencing and SOX9 gene overexpression can promote cells to secrete polysaccharide and type-II collagen (P < 0.05). MMP3 gene silencing and SOX9 gene overexpression can promote the proliferation of degenerated human intervertebral disc nucleus pulposus cells, and their ability to secrete polysaccharide and type-II collagen.

Effects of AAV2-mediated co-transfection of CTGF and TIMP1 genes on degenerative lumbar intervertebral discs in rhesus monkeys in vivo

OBJECTIVE

This study aims to investigate the effects of co-transfection of the genes for connective tissue growth factor (CTGF) and tissue inhibitor of metalloproteinase-1 (TIMP1) mediated by adeno-associated virus 2 (AAV2) on degenerative lumbar intervertebral discs in a primate model.

METHODS

Twelve 4-7 year-old rhesus monkeys weighing 4.5-7.0 kg were utilized. CTGF and TIMP1 genes carried by AAV2 were injected into the degenerative lumbar intervertebral discs. Cytokine expression and biological effects were determined using quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and ³⁵S-sulfate incorporation assays. A rhesus monkey model of intervertebral disc degeneration was successfully established.

RESULTS

At post-transfection, CTGF mRNA expression was higher in the transfection group than in the control group (P < 0.05). Furthermore, TIMP1 mRNA expression in the transfection group was several times the levels observed in the control group (P < 0.05). Moreover, type-II collagen mRNA expression was higher in the transfection group than in the control group (P < 0.05). In addition, higher aggrecan mRNA expression and synthesis were observed in the transfection group, compared to that in the control group (P < 0.05).

CONCLUSION

The stable expression of CTGF and TIMP1 genes in vivo promoted the synthesis of aggrecan and type II collagen in the nucleus pulposus in the rhesus monkey model of intervertebral disc degeneration, which has a potential for intervertebral disc regeneration.

Sagittal Atlantoaxial Joint Inclination and Reduction Index Values for Diagnosis and Treatment of Irreducible Atlantoaxial Dislocation

BACKGROUND

Irreducible atlantoaxial dislocation (IAAD) is a disorder of atlantoaxial joint instability with various causes. The diagnostic criteria for IAAD are variable. The diagnosis of IAAD is mainly based on preoperative and intraoperative traction results, as well as the physician's experience, with no relatively uniform guidelines for the selection of treatment. This study evaluates sagittal atlantoaxial joint inclination (SAAJI) and reduction index (RI) values for diagnosis and treatment of IAAD.

MATERIALS AND METHODS

24 IAAD patients treated in our hospital from January 2008 to July 2014 were retrospectively analysed. Patients included were 13 males and 11 females, with a mean age of 43 years. The various causes for IAAD were atlantoaxial transverse ligament rupture (n=3), old dens fracture (n=15), occipitalization of the atlas (n=6). The patients were divided into two groups. group A underwent anterior release with posterior reduction and fixation; Group B underwent posterior reduction and fixation; 12 healthy individuals served as controls. SAAJI and atlas-dens interval (ADI) values before and after traction were measured, and RI was calculated. Imaging data were analyzed.

RESULTS

The mean SAAJI values were as follows: left, 5.6 ± 1.9° and right, 5.1 ± 2.1° in the control group; right, 39.5 ± 6.0° and left, 38.8 ± 5.8° in Group A; and right, 23.1 ± 7.0° and left, 23.9 ± 6.1° in Group B. There was no significant difference in the SAAJI values of the three groups (P < 0.05). The mean RIs in Groups A and B were 17.6 ± 9.3% and 34.4 ± 5.2%, respectively, and the difference was statistically significant (P < 0.05). There were obvious negative correlations between the SAAJI and RI values in Groups A and B.

CONCLUSIONS

SAAJI and RI can be used as important imaging indicators to determine the reversibility of IAAD. If the RI value is >27.9% and SAAJI value is <32.5°, reduction and fixation can be achieved by the posterior approach alone; otherwise, a combination of anterior and posterior approaches would be necessary.

One stage laminoplasty and posterior herniotomy for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation

The aim of the study was to introduce a method of one stage laminoplasty and posterior herniotomy for myelopathy caused by cervical stenosis with cervical disc herniation and to evaluate the clinical efficacy of this surgery. From 1999 to 2008, 18 patients with myelopathy caused by cervical stenosis with cervical disc herniation who underwent this procedure were included. The average age was 63 years (range 48-74 years), and the average follow-up period was 46 months (range 3-108 months). Neurologic status was evaluated using the JOA scoring system. Neurological symptoms improvement was seen in all patients after surgery. The average JOA score was 14.22±1.86 by final follow-up, which was higher than preoperative values (P<0.01), and the average improvement in neurological function was 76.63%. Neurologic examination showed that excellent results had been obtained by 10 patients, good results by 8 patients, with no fair or poor results. 2 patients developed cerebrospinal fluid leakage after surgery and recovered during the follow-up period. One patient with cervical disc herniation developed postoperative C5 palsy on the axle side on the third day after surgery. She completely recovered by 1 month after surgery. No other patients experienced postoperative neurologic complications. Complete anterior and posterior decompression of the spinal cord was achieved after surgery. We concluded that one stage laminoplasty and posterior herniotomy is an effective, reliable, and safe procedure for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation.

Effect of phytosterols on rumen fermentation in vitro

We investigated the effect of phytosterols on rumen fermentation in vitro using gas syringes as incubators. Phytosterols were dissolved in ethyl acetate (8.3%) and added at various concentrations to the common diet in rumen fluid. In vitro gas production (GP) was recorded after 3, 6, 12, 18, and 24 h incubation. Incubation was stopped at 6, 12, and 24 h and the inoculants were then tested for pH, dry matter digestibility (DMD), microbial protein yield (MCP), lactic acid, NH3-N, and volatile fatty acids (VFAs). GP was consistently higher than the control; particularly, treatments at 12, 18, and 24 h reached extremely significant levels (P < 0.01). Compared to the control group, the pH of ruminal fluid was slightly lower after incubation, and DMD and MCP increased with increasing phytosterol level except for the content of MCP at 6 h, which changed only minimally. Lactate was significantly lower after treatment compared to the control at 12 h (P < 0.01) and 24 h (P < 0.05), while NH3-N at 12 h (P < 0.05) and 24 h (P < 0.01) after treatment decreased significantly. Acetate, propionate, butyrate, and total VFA for all treatments were higher than those of the control, particularly for butyrate at 6 h (P < 0.01). These results suggest that phytosterols modify rumen fermentation by inhibiting released harmful products and promoting the release of beneficial product, which may be useful for improving nutrient utilization and animal health.

Single-stage combined anterior retropharyngeal and posterior approach for the resection and reconstruction of C2 metastatic tumors: A case report

This study reports the case of a 44-year-old male who had experienced severe neck pain for one month and was diagnosed with a metastatic tumor of the left C2 vertebral body and the left transverse process. The tumor was distributed to layers A–D and sectors 3–7 according to the Weinstein-Boriani-Biagini classification, and was in Category IV according to the Harrington classification system. A conventional posterior cervical approach was used to resect the left transverse process and part of the tumor in a piecemeal fashion, and spinal instrumentation was also performed. Gelfoam and absorbable hemostatic gauze were placed ventrally to the left vertebral artery and the left C3 nerve root over the tumor bed to prevent their accidental injury in the subsequent anterior approach. A high anterior retropharyngeal approach was then used to resect the tumorous C2 vertebral body by corpectomy and to perform anterior reconstruction. Six months after the surgery, the patient remained pain free. Therefore, C2 metastatic tumor resection and spinal reconstruction can be fulfilled by a single-stage combined high anterior retropharyngeal and posterior approach.

Co-transfection of adeno-associated virus-mediated human vascular endothelial growth factor165 and transforming growth factor-β1 into annulus fibrosus cells of rabbit degenerative intervertebral discs

Intervertebral disc degeneration is a common condition that may lead to low back pain and radiculopathy. Understanding the pathophysiology and cellular and molecular events of degenerative disc disease has resulted in the proposal of a gene therapy approach to halt and reverse disc degeneration. We explored the feasibility of reversing intervertebral disc degeneration using human vascular endothelial growth factor165 (hVEGF165) and transforming growth factor-β1 (TGF-β1) gene therapy. hVEGF165 complementary DNA was obtained from pcDNA3(+)-hVEGF165 and cloned into adeno-associated virus (AAV)-pSNAV plasmids to construct the recombinant plasmid, AAV-pSNAV-hVEGF165. After identification through restriction enzyme digestion and DNA sequencing, the AAV-pSNAV-hVEGF165 was transfected into HEK293 cells and vascular endothelial cells. Protein expression of hVEGF165 was detected using a fluorescent immunohistochemical assay, and the effect of hVEGF165 on vascular endothelial cell proliferation was determined with a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Packaged AAV-hVEGF165 and AAV-TGF-β1 were co-transfected into the annulus fibrosus cells of degenerative intervertebral discs. hVEGF165 and TGF-β1 expression by annulus fibrosus cells and the effect of the co-transfection on the level of collagen type I protein expression by annulus fibrosus cells were detected with Western blot. The results of restriction enzyme digestion and DNA sequencing confirmed that AAV-pSNAV-hVEGF165 plasmids were constructed. The fluorescent immunohistochemical results confirmed hVEGF165 protein expression. The MTT results showed that the hVEGF165 protein promoted vascular endothelial cell proliferation. Biologically active AAV-hVEGF165 and AAV-TGF-β1 were successfully constructed. Western blot confirmed hVEGF165 and TGF-β1 expression in annulus fibrosus cells and demonstrated that the level of collagen type I protein expression was significantly higher in annulus fibrosus cells co-transfected with both AAV-hVEGF165 and AAV-TGF-β1 compared with that in cells transfected with AAV-hVEGF165 or AAV-TGF-β1 alone. hVEGF165 has a synergistic effect with TGF-β1 that promotes the expression of collagen type I protein in annulus fibrosus cells from degenerative intervertebral discs.

Investigation of characteristics of feather follicle stem cells and their regeneration potential

Feather follicles have the extraordinary ability to regenerate and undergo molting cycles. Being tissue-specific stem cells, feather follicle stem cells (FFSCs) have a strong capacity for proliferation and are presumed to be progenitor cells for various epidermal organs. In order to characterize FFSCs and to understand how the feather epidermis and FFSCs produce such a reliable differentiation program resulting in the formation of complex feathers, We developed a culture scheme to select and expand FFSCs from chick feather follicles. FFSCs were examined with cell profiles, mutilpotential differentiation and immunocytochemical staining. FFSCs from a single clone were capable of self-renewal and proliferation. These cells expressed integrin β1, CD49c, cytokeratin 15 (K15), cytokeratin 19 (K19) and a neural-genic cell marker, nestin, but not a teminal differentiation-related keratinocyte marker, cytokeratin 10 (K10). FFSCs could trans-differentiate into adipocytes, neurocytes and keratinocytes. The formation of micro-feather like structures ex-vivo also revealed the potential of regeneration. These results demonstrate that FFSCs possess the properties of stem/progenitor cells and may therefore serve as a useful model for studying mechanisms of stem cell differentiation and their involvement in organ regeneration.

Proteomic analysis of human bone marrow mesenchymal stem cells transduced with human telomerase reverse transcriptase gene during proliferation

OBJECTIVES

Previous studies have reported immortalization and tumorigenicity of human mesenchymal stem cells (hMSCs) transduced with exogenous human telomerase reverse transcriptase (hTERT). We also have established a line of hMSCs transduced with hTERT (hTERT-hMSCs) and we have cultured these cells for 290 population doublings (PDs) during which they demonstrated a large proliferation potential but with no tumorigenicity. The aim of this study was to investigate the protein expression profile of hTERT-hMSCs with two-dimensional gel electrophoresis and peptide mass fingerprinting by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, to be able to analyse the effects of exogenous hTERT on protein expression in hMSCs.

MATERIALS AND METHODS

We generated proteome maps of primary hMSCs and hTERT-hMSCs at PD 95 and PD 275.

RESULTS

A total of 1543 +/- 145 protein spots in gels of primary MSCs at PD 12, 1611 +/- 186 protein spots in gels of hTERT-hMSCs at PD 95 and 1451 +/- 126 protein spots in gels of hTERT-hMSCs at 275 PD were detected. One hundred of these were successfully identified, including 20 which were differentially expressed.

CONCLUSIONS

The results suggest that sustaining levels of prohibitin and p53 expression along with differential expression of proteins in hTERT-hMSCs provide an insight into lack of transforming activity of hTERT-hMSCs during cell proliferation.

[Accuracy and related affecting factors of somatosensory evoked potential monitoring in cervical and thoracic surgery]

OBJECTIVE

To evaluate the accuracy and related affecting factors of the intra-operative somatosensory evoked potential monitoring in cervical and thoracic surgery.

METHODS

Cortical somatosensory evoked potential (CSEP) monitoring and sub cortical somatosensory evoked potential (Sub-CSEP) monitoring were performed in cervical and thoracic surgery. Somatosensory evoked potential (SEP) changes were recorded during anaesthesia and operation and postoperative, which could be used to evaluate accuracy of SEP.

RESULTS

Bilateral CSEP wave abnormalities were related to anaesthesia, decreasing wave amplitudes did not reach the alarming standard. Intra-operative manipulation to affect spinal cord would influence iso-lateral wave abnormality of CSEP and sub-CSEP, decreasing amplitudes reached the alarming standard. Local hypothermia such as cold water irrigating spinal cord would be to prolong the latent period. Low mean arterial pressure (MAP) mostly influenced amplitudes. Changes of SEP in local hypothermia and MAP did not reach the alarming standard.

CONCLUSIONS

CSEP and Sub CSEP can reflex physiopathological condition of spinal cord, it is useful in evaluating spinal cord function and providing the safety for cervical and thoracic surgery.

Comparative study on semen quality of one- and two-year-old ganders during the entire reproductive season

AIM

To evaluate the characteristics of semen produced by one- and two-years old White Italian ganders during the entire reproductive season, in order to clarify whether the young ganders are responsible for a low fertility rate in young geese.

METHODS

Males were kept individually in cages under natural light. Semen was collected by dorso-abdominal massage three times a week and routine examination was performed.

RESULTS

The mean ejaculate volume (2.1 and 1.6 mL, respectively) and sperm concentration (323 and 281 x 10(6)/mL, respectively) in one-year-old ganders were higher than those of two-year-old ones. The percentages viable spermatozoa of one- and two-year-old ganders were similar (91.4 and 92.3%, respectively), but the percentage of normally formed viable spermatozoa was significantly higher in the older ganders than in the younger (47.8 and 42.9%, respectively, P < 0.05).

CONCLUSION

The semina from one- or two-year-old Ganders were similar in regard to volume, sperm density and sperm motility, but the percentage of normally formed viable spermatozoa, which is critical for fertilization, was significantly higher in the older ganders. It appears that the ganders are responsible for the low fertility rate in young geese.