Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis.

Objective Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.24 - 3.58; P=0.006) and bradycardia (OR: 2.48; 95%CI: 1.57 - 3.93; P=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR: 2.00; 95%CI: 1.06 - 3.79; P=0.03) and bradycardia (OR: 2.28; 95%CI: 1.42 - 3.66; P=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR: 2.90; 95%CI: 1.24 - 6.82; P=0.01) and bradycardia (OR: 2.66; 95%CI: 1.53 - 4.61; P=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR: 4.95; 95%CI: 1.41 - 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR: 2.57; 95%CI: 1.05 - 6.32; P=0.04), but not mild hypotension, was increased. Both mild (OR: 2.55; 95%CI: 1.06 - 6.15; P=0.04) and severe (OR: 2.45; 95%CI: 1.43 - 4.20; P=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD]: -82.97; 95%CI: -109.04 - -56.90; P<0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.

Knowledge-Based Recurrent Neural Network for TCM Cerebral Palsy Diagnosis.

Cerebral palsy is one of the most prevalent neurological disorders and the most frequent cause of disability. Identifying the syndrome by patients' symptoms is the key to traditional Chinese medicine (TCM) cerebral palsy treatment. Artificial intelligence (AI) is advancing quickly in several sectors, including TCM. AI will considerably enhance the dependability and precision of diagnoses, expanding effective treatment methods' usage. Thus, for cerebral palsy, it is necessary to build a decision-making model to aid in the syndrome diagnosis process. While the recurrent neural network (RNN) model has the potential to capture the correlation between symptoms and syndromes from electronic medical records (EMRs), it lacks TCM knowledge. To make the model benefit from both TCM knowledge and EMRs, unlike the ordinary training routine, we begin by constructing a knowledge-based RNN (KBRNN) based on the cerebral palsy knowledge graph for domain knowledge. More specifically, we design an evolution algorithm for extracting knowledge in the cerebral palsy knowledge graph. Then, we embed the knowledge into tensors and inject them into the RNN. In addition, the KBRNN can benefit from the labeled EMRs. We use EMRs to fine-tune the KBRNN, which improves prediction accuracy. Our study shows that knowledge injection can effectively improve the model effect. The KBRNN can achieve 79.31% diagnostic accuracy with only knowledge injection. Moreover, the KBRNN can be further trained by the EMRs. The results show that the accuracy of fully trained KBRNN is 83.12%.

Chinese Clinical Named Entity Recognition with ALBERT and MHA Mechanism.

Traditional clinical named entity recognition methods fail to balance the effectiveness of feature extraction of unstructured text and the complexity of neural network models. We propose a model based on ALBERT and a multihead attention (MHA) mechanism to solve this problem. Structurally, the model first obtains character-level word embeddings through the ALBERT pretraining language model, then inputs the word embeddings into the iterated dilated convolutional neural network model to quickly extract global semantic information, and decodes the predicted labels through conditional random fields to obtain the optimal label sequence. Also, we apply the MHA mechanism to capture intercharacter dependencies from multiple aspects. Furthermore, we use the RAdam optimizer to boost the convergence speed and improve the generalization ability of our model. Experimental results show that our model achieves an F1 score of 85.63% on the CCKS-2019 dataset-an increase of 4.36% compared to the baseline model.

An Alternative Strategy for Treatment of Distal Tibiofibular Syndesmotic Disruption: A Technical Note.

Metal screws are the most widely used in treating syndesmotic injuries; however, failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We performed open reduction and internal fixation of a fibula fracture followed by fixation of the tibiofibular joint with an olive wire and one half of an external fixator. We present a review of 1 patient treated with this material. We believe this method to be a physiologic fixation system with the advantage of being safe, inexpensive, adjustable, and effective; however, further clinical investigation and comparison to other methods is needed in order to better understand it clinical utility.

Effect of Surgery on Quality of Life of Patients with Spinal Metastasis from Non-Small-Cell Lung Cancer.

BACKGROUND: Recently, more clinicians have realized the importance of quality of life in the treatment decision-making process. The goal of this study was to determine whether surgery for patients with spinal metastases from non-small-cell lung cancer (NSCLC) could improve their quality of life and prolong survival. METHODS: The study included 133 patients who had been treated for NSCLC spinal metastases between 2010 and 2014. These patients were divided into two groups according to whether or not they had received spinal surgery. Their quality of life was assessed with use of the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at the initial diagnosis (baseline) and at one, three, six, and nine months after the diagnosis. The survival times of all patients were also collected. RESULTS: Of the 133 patients, eighty-six (forty-five in the surgery group and forty-one in the non-surgery group) survived for nine months and were assessed at all of the follow-up intervals. The surgery group had significantly higher total, physical well-being, emotional well-being, and functional well-being quality-of-life scores at each follow-up time point as compared with baseline (p < 0.001) as well as compared with the non-surgery group (p < 0.001). A log-rank test demonstrated that the surgery group had longer survival than the non-surgery group (p = 0.020). CONCLUSIONS: The results of this study indicate that surgical treatment improved the quality of life of patients with NSCLC spinal metastases over the nine-month assessment period. The surgery group had a better quality of life and longer survival than the non-surgery group.

Metastatic Spinal Cord Compression from Non-Small-Cell Lung Cancer Treated with Surgery and Adjuvant Therapies: A Retrospective Analysis of Outcomes and Prognostic Factors in 116 Patients.

BACKGROUND: Metastatic spinal cord compression is a disastrous consequence of non-small-cell lung cancer (NSCLC). There have been few studies of the outcomes or prognostic factors in patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies. METHODS: From 2002 to 2013, 116 patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies were enrolled in this retrospective analysis. Kaplan-Meier methods and Cox regression analysis were used to estimate overall survival and identify prognostic factors for survival. RESULTS: Multivariate analysis suggested that the Eastern Cooperative Oncology Group performance status (ECOG-PS), preoperative and postoperative Frankel scores, postoperative adjuvant radiation therapy, and target therapy were independent prognostic factors. Ninety patients died at a median of twelve months (range, three to forty-seven months) postoperatively, and twenty-six patients were still alive at the time of final follow-up (at a median of fifteen months [range, five to fifty-four months]). CONCLUSIONS: The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival. Adjuvant radiation therapy and target therapy were also associated with a better prognosis. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Malignant Rhabdoid Tumor with Cervical Vertebra Involvement in a Teenage Child: Case Report and Review of the Literature.

Malignant rhabdoid tumor (MRT) is a highly malignant and aggressive tumor associated with the kidney that is mainly seen in children under 5 years old, resulting in a rapid fatal outcome. MRT invasion of the cervical vertebra is an extremely rare form of this malignancy. This study presents a case of MRT involving the C4 vertebra and its appendix. A 13-year-old girl was found to have vague neck pain and a mass in the left neck area of the mid-cervical spine. Percutaneous needle biopsy was performed and the histological and immunohistochemical analysis pointed towards a rhabdoid tumor. Chemotherapy and radiotherapy were performed, but the tumor mass progressively enlarged. Tumorectomy was conducted followed by another 6 courses of chemotherapy and (125)I radioactive seed implantation. Unfortunately, the C4 vertebra and its appendix were found to be abnormal 3 months after the end of therapy. The patient received an additional tumorectomy, internal fixation with C4 reconstruction by a combined anterior and posterior approach, and 6 courses of consolidation chemotherapy. She is still alive 40 months since the initial diagnosis and remains asymptomatic 31 months after the surgery.

Clinical characteristics and neurologic recovery of patients with cervical spinal tuberculosis: should conservative treatment be preferred? A retrospective follow-up study of 115 cases.

OBJECTIVE: To present the clinical characteristics and prognostic factors of neurologic recovery in patients with cervical spinal tuberculosis (CST). METHODS: General description and multivariate analysis were used to detect possible predictors of the outcome of patients with neurologic deficit. Follow-up data were used to generate a Kaplan-Meier curve of neurologic recovery. RESULTS: Protective factors in neurologic recovery included less involved vertebrae, surgery, and higher Japanese Orthopaedic Association score before treatment; not shorter symptom duration was not a protective factor. Normal neurologic function was present in 30% of patients 6 months after treatment, in 56% of patients 12 months after treatment, and in 93% of patients 28 months after treatment. The cumulative complete neurologic recovery rates at 6 months, 12 months, and 28 months were 44%, 68%, and 91.7% in the surgery group and 16.7%, 38.8%, and 94.4% in the nonsurgery group. CONCLUSIONS: Surgery and Japanese Orthopaedic Association score before treatment are important predictors of neurologic recovery in patients with CST. A neurologic recovery curve could predict neurologic recovery in patients with CST and indicate in patients with neurologic deficit how long it will take to achieve complete neurologic recovery. The effect of surgery is quick, and the effect of conservative treatment is slower, but no difference in neurologic recovery was found in the long-term. Conservative treatment should be tried in every patient with CST with no obvious indication for surgery. In contrast to patients with tuberculosis without cervical spine involvement but with more complications, comprehensive conservative therapy should be preferred for patients with neurologic deficit to avoid unnecessary surgery and overtreatment and to conserve medical resources. Indications for surgical intervention for CST should be carefully selected.

[Osteogenetic capacity of cross-linked adjustable anti-tuberculosis drug sustained-release artificial composite].

OBJECTIVE: To explore the osteogenetic capacity of cross-linked adjustable anti-tuberculosis drug sustained-release artificial composite (TPB/SA-RFP/PLA). METHODS: The model of femur bone defect was established in rabbits.TPB/SA-RFP/PLA complex was implanted into defect parts in the experimental group while TPB/SA/PLA in the blank control group. At Weeks 4, 8 and 12, gross specimens received radiographic, histological and immunohistochemical examinations to determine the osteogenetic performance of TPB/SA-RFP/PLA. RESULTS: As compared with the control group, TPB/SA-RFP/PLA complex had excellent osteogenic capacities while the TPB/SA/PLA group had no obvious osteogenic difference. Lane-sandhu histological and radiographic ratings demonstrated significant difference between TPB/SA-RFP/PLA (8.3 ± 0.3) and blank groups (2.2 ± 0.4) (P < 0.05). And TPB/SA/PLA showed no significant intragroup significance (P > 0.05). Two groups immunohistochemical Alkaline phosphatase was strongly positive in two test groups and weakly positive in the control group. CONCLUSION: TPB/ SA-RFP/PLA has excellent profiles of bone conductivity and regeneration.And the incorporation of rifampin does not affect its osteogenetic capacity.

The prognostic value of elevated vascular endothelial growth factor in patients with osteosarcoma: a meta-analysis and systemic review.

BACKGROUND: Osteosarcoma is a primary malignancy of bone. Although new therapies continue to emerge, osteosarcoma-related morbidity and mortality remain high. Various studies have evaluated the prognostic value of VEGF levels in osteosarcoma patients, but they have yielded conflicting results. METHODS: The 5-year survival of each study was aggregated following a methodological assessment, and a systematic review of eligible studies with meta-analysis and univariate analysis was performed to quantitatively review the correlation of VEGF overexpression with 5-year survival in patients with osteosarcoma. RESULTS: A total of 387 patients in eleven papers were finally considered to be eligible for inclusion in our analysis. Aggregation of the 6 positive results in Kaplan-Meier curve showed a risk ratio of 2.84 (95% CI: 1.39-5.83, P = 0.004) associated with VEGF-positive conditions in comparison with VEGF-negative conditions, suggesting that there was significant association between VEGF positive and the 5-year mortality. But univariate analysis of eleven studies showed that there was a small inverse but not significant relationship between VEGF expression level and the 5-year survival of osteosarcoma patients, but stage III, neo-chemotherapy, the primary tumor location, osteoblastic histological subtype and the source of patients showed a significant impact on the 5-year survival of patients. CONCLUSIONS: The prognostic significance of VEGF expression in all its isoforms is still unknown based on the limited data available, but we find VEGF165 may play an important role. Future studies should examine the relationship between VEGF isoform expression and patients' survival and the relationship between VEGF isoform expression and EMMPRIN expression, which could be helpful for predicting the prognosis of patients with osteosarcoma. Once the conclusion of whether the VEGF and its isoforms playing a role in osteosarcoma were reached, it would help guide clinical decision-making regarding therapy and outcomes. In addition, we recommend a >25% positive staining of the cells as a VEGF-positive cut-off value in immunohistochemistry, since we find a relatively strict detecting method is likely to yield significant result in the 5-year survival of patients.

Inverse association between eczema and meningioma: a meta-analysis.

BACKGROUND AND PURPOSE: The pathogenesis of primary brain tumors may be related to immune response. Prior studies have shown a strong association between allergy and glioma; however, so far no significant association has been established between allergy and meningioma. Here, we conducted a meta-analysis of published studies to investigate the association of meningioma with the overall and specific allergic conditions. METHODS: PubMed, EMBASE database, and Cochrane Library were searched for pertinent citations published between January 1979 and October 2009. We used the following searching strategy (brain tumor [Text Word] OR meningioma [Text Word]) AND (allergy [Text Word] OR atopy [Text Word] OR asthma [Text Word] OR eczema [Text Word] OR hay fever [Text Word]) to search for relevant studies. Random effect model was used to estimate the association between allergic conditions and meningioma. RESULT: A total of 7 studies (5 case-control studies and 2 cohort studies) were included in the analysis, involving 54,391 participants, of whom 2,656 had meningioma. When compared to non-allergic conditions, the pooled odds ratio (OR) with any allergic conditions for meningioma was 0.91 (95% CI: 0.79-1.04, p = 0.163), suggesting that there is no significant association between meningioma and allergic conditions. Interestingly, further analysis showed that eczema had significantly inverse association with meningioma (OR, 0.75; 95% CI: 0.65-0.87, p < 0.05). On the other hand, no significant association was found for asthma (OR, 0.88; 95% CI: 0.75-1.04, p = 0.126) and hay fever (OR, 0.90; 95% CI: 0.79-1.03, p = 0.137). CONCLUSION: In conclusion, there was a significantly negative association between eczema and meningioma, suggesting that eczema may reduce the risk of meningioma. Although it was not statistically significant association between meningioma and other specific allergic conditions such as asthma and hay fever, further studies with large sample size may be needed to determine its relationship.

HMGN5: a potential oncogene in gliomas.

Gliomas are the most common primary brain tumors in the central nervous system and a leading cause of tumor-related death. High-mobility group nucleosome binding domain 5 (HMGN5/NSBP1), which is highly expressed in breast cancer and in hormone-induced mouse uterine adenocarcinoma, acts as a potential oncogene in gliomas. In this study, the role of HMGN5 in the proliferation of human glioma cells was investigated by lentivirus-mediated RNA interference (RNAi). The decrease in HMGN5 expression in human glioma U251 and U87 cells caused cell cycle arrest in the G1 phase and a delay in cell proliferation, as well as resulting in more apoptosis and an inhibition of clonogenic growth in soft agar in U251 cells; these results suggest that HMGN5 is required for tumorigenesis in vitro. Furthermore, HMGN5 was highly expressed in both high-grade and low-grade glioma tissue samples compared with normal brain tissues. Collectively, our data suggest that HMGN5 may play a critical role in the development of gliomas.