Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via Teleconference

The magnitude and potential duration of the current coronavirus disease 2019 (COVID-19) pandemic is something that most doctors currently in practice have yet to experience. While considerable information regarding COVID-19 is being published every day, it is challenging to filter out the most relevant or appropriate information for our individual practice. The Spine Society of Singapore convened via a teleconference on April 24, 2020 to collaborate on a national level and share collective wisdom in order to tackle the ongoing crisis. In the teleconference, 13 spine surgeons from across various hospitals in Singapore constituted the panel of experts. The following topics were discussed: repurposing of surgeons, continuity of spine services, introduction of telemedicine, triaging of spinal surgeries, preoperative testing, new challenges in performing spine surgery, and preparing for the post-pandemic era. While some issues required only the sharing of best practices, the Delphi panel method was adopted to form a consensus on others. Existing spine specific triage guidelines were debated and a locally accepted set of guidelines was established. Although preoperative testing is currently not performed routinely, the panel voted in favor of its implementation because they concluded that it is vital to protect themselves, their colleagues, and their patients. Solutions to operating room specific concerns were also discussed. This article reflects the opinions and insights shared during this meeting and reviews the evidence relevant to the issues that were raised. The rapid consensus reached during the teleconference has enabled us to be concerted, and thus stronger, in our national efforts to provide the best standard of care via our spine services in these challenging times. We believe that this article will provide some guidance for addressing COVID-19 in spine surgery and encourage other national/regional societies to conduct similar discussions that would help their navigation of this pandemic.

Co-transplantation of acellular allogeneic dermis and autologous split-thickness skin for burn repair at functional parts / 中国组织工程研究

BACKGROUND:Autologous split-thickness skin grafting is the main therapy for burn repair at functional sites, which has achieved certain effects, but there are stil some deficiencies, such as poor texture, stiffness and poor toughness, as wel as severer hyperplasia that is easy to result in contracture deformity and poor functional recovery. OBJECTIVE: To analyze the clinical efficacy of skin co-transplantation on burn repair at functional sites. METHODS:Sixty patients with burns at functional sites (n=84) were randomized into two groups: co-transplantation of acelular dermis and autologous split-thickness skin in experimental group and autologous split-thickness skin graft in control group. Survival rate of skin flap and rate of secondary operation were compared between two groups. At 1 month after transplantation, Vancouver Scar Scale was used to assess skin color, thickness, blood vessel distribution and flexibility, and meanwhile, the severity of scar was determined. RESULTS AND CONCLUSION:The survival rate of skin flap was significantly higher in the experimental group than the control group (93%vs. 70%,P < 0.05), and the rate of secondary operation was significantly lower in the experimental group compared with the control group (0vs. 13%,P < 0.05). At 1 month after transplantation, scores on the skin color, thickness, blood vessel distribution and flexibility were al lower in the experimental group than the control group (P < 0.05), but the incidence of mild hyperplasia in the experimental group was significantly higher than that in the control group (52% vs. 29%,P < 0.05). These findings indicate that co-transplantation of acelular alogeneic dermis and autologous split-thickness skin for burn repair at functional sites can effectively enhance the survival rate of skin flap, reduce the rate of secondary operation, contribute to wound healing and reduce the severity of hyperplasia.

Analysis of synonymous codon usage and evolution of begomoviruses / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Begomoviruses are single-stranded DNA viruses and cause severe diseases in major crop plants worldwide. Based on current genome sequence analyses, we found that synonymous codon usage variations in the protein-coding genes of begomoviruses are mainly influenced by mutation bias. Base composition analysis suggested that the codon usage bias of AV1 and BV1 genes is significant and their expressions are high. Fourteen codons were determined as translational optimal ones according to the comparison of codon usage patterns between highly and lowly expressed genes. Interestingly the codon usages between begomoviruses from the Old and the New Worlds are apparently different, which supports the idea that the bipartite begomoviruses of the New World might originate from bipartite ones of the Old World, whereas the latter evolve from the Old World monopartite begomoviruses.

Influence of skin-derived progenitor cell combining with hyaluronic acid on the wound healing of diabetic rat / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effect of skin-derived progenitor cell (SKP) combined with hyaluronic acid( HA) on the wound healing in diabetic rats.</p><p><b>METHODS</b>SKP of Spraque-Dawley (SD) neonate rats were isolated and cultured and mixed with HA. The differentiation characteristics of SKP in the culture were observed. Sixty SD rats were injected intraperitoneally with 65 mg/kg streptozotocin( STZ) to induce diabetes. Two symmetrical full-thickness cutaneous wounds( 1.0 cm in diameter) were made on the back of each SD rat and randomly divided into A (n = 20, with treatment of 100 mircol SKP-HA) , B (n = 20, with treatment of 100 mirol HA) , and C ( n = 20, with treatment of DMEM/F12 culture medium) groups. Tissue samples from wound in each group were harvested on 1, 2, 3, 4 weeks after the treatment. Wound healing rate, changes in histomorphology, the content of hydroxyproline ( HYP) , and immigration of labelled SKP were determined and analyzed.</p><p><b>RESULTS</b>SKP grew well when cultured with HA. The characteristics of SKP to differentiate into lipocyte, neuron, and neurogliocyte remained in the culture. Compared with that in C group, epithelization in the wounds of A and B groups appeared earlier. The wound healing rate in A group [ (72.1 +/- 2. 8)% ] and B group [ (53.7 +/- 2. 9)% ] were obviously higher at 2 post-treatment weeks(PTW) than that in group C [(42. 5 +/- 1.5)% ( P <0.05) , and that in A group was obviously higher compared with B and C groups at 3 PTW ( P < 0. 05 or 0. 01). The wound healing rates in A and B groups were (100. 00 +/- 0.00) % at 4 PIW, which were obviously higher than that of group C( P <0.01) . There was no obvious difference in the HYP content among the 3 groups at 1 PIW ( P > 0. 05) , but it was obviously higher in A and B groups than that in C group at 2,3,4 PTW( P <0.01) , and that in A group was significantly higher than that in B group at 3 and 4 PTW( P <0. 01). SKP survived well on the wound, and migrated towards the dermis as time elapses.</p><p><b>CONCLUSION</b>SKP-HA composition can promote wound healing in diabetic rats.</p>

Isolation and differentiation characteristics of dermal multipotent stem cells from humans of different ages cultured in vitro / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study isolation, identification and differentiation characteristics of dermal multipotent stem cells from human of different age in vitro culture.</p><p><b>METHODS</b>Skin samples( 1 cm x 1 cm) were harvested from fetus, infant, adult and elderly. The original clones were screened in stem cell medium. The diameter and number of clones were recorded. Analysis of each clone and determination of the expression of various related proteins were carried out.</p><p><b>RESULTS</b>The number of suspended clones from normal skins of fetus, infant, adult and the elderly were (20. 1 +/-2. 5) x 102 , (15. 8 +/-5. 7) x 102, (10. 8 +/-1.3) x 10(2), (6.2 +/- 1.4) x 10(2), respectively ( P <0.01), while the diameter of the clones from them were (83 +/-12) microm, (55 +/- 10) microm, (46 +/- 12) Lm, (42 +/-8) microm, respectively ( P <0.05). Cloned cells from fetus, infant, adult and elderly could differentiate into neuron cell , neuroglia cell, smooth muscle cell, and adipocyte. The clones from fetus were inclined to differentiate into neuron cells, but those from infant were inclined to differentiate into neuroglia cells, and those from adult and elderly were inclined to differentiate into adipocytes. After 1 month of culture, the clone forming rate of the cells from fetus, infant, adult and elderly were 41. 1% , 25.5% ,17.7% ,15.2% , respectively. The individual clone cells also showed ability of multidirectional differentiation. Nestin, fibronectin, c-Myc, STAT3 and hTERT protein were expressed in all clones.</p><p><b>CONCLUSION</b>Multipotent stem cells with multi-direction differentiation and proliferation can be efficiently isolated from dermis of human of different age in stem cell culture medium. The number, proliferation and differentiation of dermal multipotent stem cells can be affected by age.</p>

Thyroid Hormone Disrupting Activities of Tetrabromobisphenol-A:a Review / 环境与健康杂志

Tetrabromobisphenol A(TBBPA)is supposed to have potential thyroid disrupting activities due to its similar structure to thyroid hormones.TBBPA has been proved to show thyroid disrupting effects in vivo and in vitro studies.TBBPA might disrupt thyroid hormone system through transthyretin- and thyroid receptor-mediated pathways.The ability of TBBPA inducing the production of reactive oxygen species might be the extension of its thyroid disrupting activities.The thyroid disrupting effects of TBBPA might be closely related to its oxidative stress,reproduction toxicity and neurotoxicity.More experiments are required for the effects of TBBPA on the aquatic and amphibian animals.

Effects of citrus reticulata blanco extract on fibroblasts from human hypertrophic scar in vitro / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of citrus reticulata blanco extract on the proliferation and collagen metabolism of fibroblasts from human hypertrophic scar.</p><p><b>METHODS</b>Human hypertrophic scar fibroblasts from two burn patients obtained from plastic surgery were cultured in vitro and divided into experimental group (n = 12, with basic culture medium and 2.5, 5.0, 10.0,25.0 mg/L citrus reticulata blanco extract, respectively, 3 bottles for each concentration of citrus reticulata blanco extract ), control group 1 (n = 3, with basic culture medium) , and control group 2 ( n = 3, with basic culture medium and 5% ethyl alcohol). The cell proliferation in each group was observed with MTT method, then the inhibition rate was calculated. Apoptosis and its index ( AI) in each group were determined after TUNEL staining . The changes in the content of ICTP and PINP in each group were observed by radioimmunity.</p><p><b>RESULTS</b>The inhibition rate in the experimental group with the citrus reticulata blanco extract in concentration of 2. 5, 5.0, 10.0, 25. 0 microg/ ml were (7. 100+/-0.038)% , (8. 100+/- 0. 048)% , (10. 900+/-0. 055)%, (15.900+/-0. 097) %, respectively, which were significantly higher than those in other two groups ( P <0.05 ). The Al (69. 7% , 71.7%, 86.4% , 95.2% ), ICTP [(17.2+/-0.6), (18.3+/-0.6), (19.8+/-0.5), (23.2+/-0.6) microg/L] and PINP [ (101.7+/-1.4) , (107. 8+/-1. 1) , (111.6+/-1.2) , (124. 6+/-1.3) microg/L] in experimental group with the citrus reticulata blanco extract in concentration of 2.5, 5.0, 10.0 , 25.0 mg/L were also obviously higher than other two control groups( P <0.05) ,but these indices in control 1 group were similar to those in control 2 group( P >0. 05).</p><p><b>CONCLUSION</b>The citrus reticulata blanco extract might be beneficial for the management of hypertrophic scar through inhibition of the proliferation of fibroblasts in hypertrophic scar, by promoting apoptosis and collagen degradation.</p>

Experimental study and clinical applications of computer assisted navigation technique in spinal surgery / 中华骨科杂志

Objective To assess the accuracies and feasibility of spine surgery assisted by different types of navigation system.Methods In experiment study,40 human cadaveric cervical spines were employed and 3.5 mm screws were placed into the C 3 to C 7 pedicles following five kinds of insertion techniques:blind screw placement(Group 1),assisted by X-ray fluoroscopy(Group 2),assisted by virtual fluoroscopy navigation system(Group 3),assisted by CT-based navigation system(Group 4),assisted by Iso-C 3D navigation system(Group 5).Thereafter,cortical integrity of every sample was examined by anatomic dissection.In clinical study,163 cases of spine operations assisted by different types of navigation were reviewed.The accuracies of screw placement were evaluated by postoperative CT or Iso-C 3D scan.Results In experiment study,there were 398 pedicles inserted.Group 1,the average operation time per sample was 27 minutes;36.3% of the screws were excellent,26.3% good,and 37.5% bad.Group 2,the average operation time was 112 minutes;44.9% excellent,37.2% good,and 17.9% bad.Group 3,the average operation time was 69 minutes;42.5% excellent,45.0% good,and 12.5% bad.Group 4,the average operation time was 98 minutes;87.5% excellent,12.5% good.Group 5,the average operation time was 91 minutes;90% excellent,10% good.In clinical study,272 screws inserted with virtual fluoroscopy navigation system,89.3% excellent,10.7% good.571 screws inserted with CT-based navigation system,84.9% excellent,14.4% good,0.7% bad.142 screws inserted with Iso-C 3D navigation system,95.8% excellent,4.2% good.Conclusion Computer-assisted navigation system enhances accuracies and further improves the safety of spine surgery,especially utilizing CT-based navigation system and Iso-C 3D navigation system.Iso-C 3D navigation method is better than the other two navigation methods.