Association between lumbar endplate damage and bone mineral density in patients with degenerative disc disease.

BACKGROUND: To explore the independent association between lumbar endplate damage and bone mineral density (BMD) in patients with degenerative disc disease (DDD). METHODS: This retrospective investigation was based out of a prospectively collected database from the Affiliated Kunshan Hospital of Jiangsu University. Data from 192 DDD patients, collected between December 2018 and January 2022, were chosen for the final analysis. The average total endplate score (TEPS) of lumbar(L) 1-L4 was assessed by magnetic resonance imaging (MRI), and represents the extent of endplate damage. Osteoporosis severity was assessed via the L1-L4 BMD evidenced by dual-energy x-ray absorptiometry (DXA). Other analyzed information included gender, age, body mass index (BMI), and osteophyte score (OSTS). Uni- and multivariate linear regression analyses were employed to evaluate the association between average TEPS and BMD of L1-L4. Moreover, the generalized additive model (GAM) was employed for non-linear association analysis. RESULTS: Upon gender, age, BMI, and OSTS adjustments, a strong independent inverse relationship was observed between average TEPS and BMD (ß, -0.021; 95% CI, -0.035 to -0.007, P-value = 0.00449). In addition, the gender stratification analysis revealed a linear relationship in males, and a non-linear relationship in females. Specifically, there was a significantly stronger negative relationship between average TEPS and BMD in females, when the average TEPS was < 3.75 (ß, -0.063; 95% CI, -0.114 to -0.013; P-value = 0.0157). However, at an average TEPS > 3.75, the relationship did not reach significance (ß, 0.007; 95% CI, -0.012 to 0.027; P-value = 0.4592). CONCLUSIONS: This study demonstrated the independent negative association between average TEPS and BMD values of L1-L4. Upon gender stratification, a linear relationship was observed in males, and a non-linear association in females. The findings reveal that patients with osteoporosis or endplate damage require more detailed examinations and treatment regimen.

Nonlinear Disturbance Observer-Based Fault-Tolerant Sliding-Mode Control for 2-D Plane Vehicular Platoon With UTVFD and ANAS.

This article investigates a nonlinear disturbance observer (NDO)-based fault-tolerant sliding-mode control (SMC) for 2-D plane vehicular platoon systems subjected to actuator faults with unknown time-varying fault direction (UTVFD), asymmetric nonlinear actuator saturation (ANAS), nonlinear unmodeled dynamics, and unknown external disturbance. The Nussbaum-type function approach is adopted to solve the problem of actuator faults with UTVFD. The designed NDO not only can estimate the lumped disturbance accurately but also can reduce the control peaking and chattering phenomena caused by the Nussbaum-type function. Then, an adaptive saturation compensator is designed to compensate for the influence of actuator saturation on the system. In addition, by combining SMC technology with the prescribed tracking performance (PTP) approach, a distributed fault-tolerant control scheme is developed to not only ensure collision avoidance and communication connectivity but also realize a variety of driving scenarios, such as multilane vehicle merging and vehicular platoon lane changing. Finally, simulation results are presented to show the proposed scheme's effectiveness and advantages.

Fully Distributed Adaptive Fault-Tolerant Sliding-Mode Control for Nonlinear Leader-Following Multiagent Systems With ANASs and IQCs.

In this article, by combining the skills of the pseudo-PID sliding-mode control (SMC) method with adaptive control techniques, two novel fully distributed adaptive fault-tolerant control strategies are proposed to handle the leader-following consensus problem of nonlinear multiagent systems with integral quadratic constraints (IQCs) and actuator faults, with and without asymmetric nonlinear actuator saturations (ANASs). For the no-saturation case, the designed controller has a simple structure and low computation but requires the crude information of the system model. To overcome this weakness, for the saturation case, the controller is redesigned by introducing a novel anti-windup compensator and fuzzy-logic systems (FLSs), where the problem of reducing computational complexity is also considered. The controllers only need local neighbor information instead of global topology information and ensure the practical consensus of the leader-following systems in finite time. Finally, simulation results demonstrate the effectiveness of the proposed approaches.

Comparison of elastography based on transvaginal ultrasound and MRI in assessing parametrial invasion of cervical cancer.

OBJECTIVE: The purpose of this study was to evaluate the clinical value of transvaginal elastography (TVES) combined with high-resolution transvaginal ultrasound (TVS) in the detection of parametrial invasion in cervical cancer and to compare the diagnostic performance with magnetic resonance imaging (MRI). MATERIALS AND METHODS: 52 women with histologically confirmed cervical cancer over a 2-year period were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and TVES combined with TVS according to a standardized protocol before treatment. When assessing parametrial involvement with TVS, MRI, and combination of TVES and TVS, the findings were recorded and compared with histopathological results after surgery in early-stage disease (stage⩽IIa). Sensitivity, specificity accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method independently; subsequently, a matched-sample analysis was performed by using McNemar's test or chi-square test. RESULTS: Of 52 patients, 39 were early-stage disease (stage⩽IIa), and 13 were advanced-stage disease (stage⩾IIb) according to conventional FIGO staging. For the detection of parametrial infiltration, both the diagnostic sensitivity of MRI and the combination of TVS and TVES were statistically higher than alone TVS in early-stage of cervical cancer (P = 0.03 < 0.05). Both MRI and the combination of TVS and TVES had a sensitivity of 72.73%; specificity rates of 82.14% for MRI and 78.57% for the combination of TVES and TVS; and the diagnostic accuracy rates of 79.49% for MRI and 76.92% for the combination of TVES and TVS. A matched sample analysis revealed no statistically significant difference between the diagnostic performance of MRI and the combination of TVES and TVS in the assessment of parametrial invasion (all P values > 0.05). CONCLUSION: TVES combined with TVS performed by a dedicated gynecologic radiologist should be considered a promising and economic method for pre-operative work-up for cervical cancer.

Benefits of Intraaortic Balloon Support for Myocardial Infarction Patients in Severe Cardiogenic Shock Undergoing Coronary Revascularization.

BACKGROUND: Prior studies have suggested intraaortic balloon pump (IABP) have a neutral effect on acute myocardial infarction (AMI) patients with cardiogenic shock (CS). However, the effects of IABP on patients with severe CS remain unclear. We therefore investigated the benefits of IABP in AMI patients with severe CS undergoing coronary revascularization. METHODS AND RESULTS: This study identified 14,088 adult patients with AMI and severe CS undergoing coronary revascularization from Taiwan's National Health Insurance Research Database between January 1, 1997 and December 31, 2011, dividing them into the IABP group (n = 7044) and the Nonusers group (n = 7044) after propensity score matching to equalize confounding variables. The primary outcomes included myocardial infarction(MI), cerebrovascular accidents or cardiovascular death. In-hospital events including dialysis, stroke, pneumonia and sepsis were secondary outcomes. Primary outcomes were worse in the IABP group than in the Nonusers group in 1 month (Hazard ratio (HR) = 1.97, 95% confidence interval (CI) = 1.84-2.12). The MI rate was higher in the IABP group (HR = 1.44, 95% CI = 1.16-1.79), and the cardiovascular death was much higher in the IABP group (HR = 2.07, 95% CI = 1.92-2.23). The IABP users had lower incidence of dialysis (8.5% and 9.5%, P = 0.04), stroke (2.6% and 3.8%, P<0.001), pneumonia (13.9% and 16.5%, P<0.001) and sepsis (13.2% and 16%, P<0.001) during hospitalization than Nonusers. CONCLUSION: The use of IABP in patients with myocardial infarction and severe cardiogenic shock undergoing coronary revascularization did not improve the outcomes of recurrent myocardial infarction and cardiovascular death. However, it did reduce the incidence of dialysis, stroke, pneumonia and sepsis during hospitalization.

Efficacy of tripterygium glycosides tablet in treating ankylosing spondylitis: a systematic review and meta-analysis of randomized controlled trials.

Hundreds of randomized controlled trials (RCTs) on tripterygium glycosides tablet (TGT) in the treatment of ankylosing spondylitis (AS) have been published, but the therapeutic effects have never been systematically reviewed yet. The aim of this meta-analysis was to evaluate the efficacy of TGT on AS based on RCTs. PubMed, ScienceDirect, Cochrane Library, China Journals Full-text Database, and Wanfang Data were searched. The RCT quality was evaluated by the Cochrane Collaboration's tool for assessing risk of bias. The RCT characteristics including publication years, sample sizes, and follow-up periods as well as outcome measures including symptoms improvement, morning stiffness (MS), bath ankylosing spondylitis patient global score (BAS-G), pain index (PI), swelling index (SI), finger to floor distance (FFD), pillow wall distance (PWD), Schober test (Schober), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were extracted. The odds ratio (OR), mean difference (MD), and its 95% confidence interval (CI) were selected for overall effect sizes. Subgroup, sensitivity, and meta-regression analyses were conducted to confirm the results. Eleven RCTs with 807 participants were included, the quality of which was moderate. OR of TGT in treating AS was 0.46 (95% CI 0.24, 0.90]. MD of MS was 11.79 (95% CI 3.13, 20.45). MD of BAS-G was 0.13 (95% CI -19.73, 19.99). MD of PI was 0.78 (95% CI 0.22, 1.34). MD of SI was 0.80 (95% CI 0.06, 1.53). MD of FFD was 0.80 (95% CI 0.06, 1.53). MD of PWD was 1.37 (95% CI -0.64, 3.38). MD of Schober was -0.36 (95% CI -0.65, -0.07]. MD of ESR was 4.58 (95% CI 2.10, 7.06). MD of CRP was 1.86 (95% CI -2.03, 5.76). Subgroup, sensitivity, and meta-regression analyses found the robust results. In conclusion, TGT could not treat AS effectively, as suggested by the moderate RCT quality and meta-analysis evidence.

Chest imaging of H7N9 subtype of human avian influenza.

BACKGROUND: Human infection with avian influenza A H7N9 virus is an acute respiratory infectious disease, which usually causes severe pneumonia with a high mortality. Chest radiographs and Computed Tomography (CT) are principal radiological modalities to assess the lung abnormalities. OBJECTIVES: The goal of this study was to investigate the chest images characteristic of H7N9 subtype of human avian influenza. MATERIALS AND METHODS: The clinical and imaging data of 11 cases diagnosed as H7N9 subtype of human avian influenza were collected from 4 cities in the southern region of the Yangtze River, China. The chest imaging manifestations were analyzed by the assigned expert group. The analyzed cases include 7 males and 4 females aged from 20 to 84 years, with a mean of 55.6 years. The clinical symptoms were mainly fever (100%, 11/11) and cough (72.7%, 8/11). RESULTS: Segmental or lobar ground-glass opacity (GGO) or consolidation was shown in 8 cases (72.7% or 8/11). Air bronchogram was found in 7 cases (63.6% or 7/11). The lesions developed into multiple or diffuse in both lungs rapidly at the progressive stage. The reticulation shadows were shown after some lesions absorbed at the stable stage. CONCLUSIONS: The characteristic imaging demonstrations of H7N9 subtype of human avian influenza are segmental or lobar exudative lesions at lungs at the initial stage, which rapidly progress into bilateral distribution at lungs at the progressive stage.

Pericardiocentesis adverse event risk factors: a nationwide population-based cohort study.

OBJECTIVES: Echocardiography-guided pericardiocentesis has been the leading procedure for diagnosis and therapy of pericardial effusion. We aimed to identify risk factors for recurrence, complications, and mortality in pericardial effusion patients treated with pericardiocentesis. METHODS: We identified and collected data from 8,101 patients receiving pericardiocentesis between 1997 and 2010 from the Taiwan National Health Insurance Research Database. A multivariate regression model was used to investigate risk factors for recurrence, complications, and death. RESULTS: There were 8,565 admissions among 8,101 patients. The most common underlying condition was malignancy (41%), especially lung cancer (23%), tuberculosis (9.0%), and acute pericarditis (8.2%). Surgical drainage was required in 12.7% of cases. Recurrence was more likely in patients with malignancy (HR 2.20, p < 0.001), but complications were less likely (OR 0.52, p = 0.003). In-hospital death numbers and complication risks (OR 2.38, p < 0.001; OR 1.27, p = 0.01) were greater in the catheter-related cardiac procedure group than in the other groups. CONCLUSIONS: Malignant neoplasms and catheter-based cardiac procedures have become major risk factors for adverse events in patients receiving pericardiocentesis in Taiwan. Malignancy leads to an increase in recurrence and in-hospital mortality but is associated with a lower rate of acute complications. Cardiac catheterization procedures and surgery increase both complications and in-hospital mortality.

[Complications of treatment of acromioclavicular joint dislocation and unstable distal clavicular fracture with clavicular hook plate].

OBJECTIVE: To investigate the causes and prevention of the complications about treatment of acromioclavicular joint dislocation (Tossy III) and unstable distal clavicular fracture (Neer II) with clavicular hook plate. METHODS: From January 2001 to December 2011, 246 patients with acromioclavicular joint dislocation (Tossy III) and 222 patients with unstable distal clavicular fracture (Neer II) were treated with acromioclvicular hook plate fixation,including 348 males and 120 females with an average age of 45.4 years old ranging from 21 to 80 years old. The mean time from injury to operation was 30.8 hours (ranged from 1 h to 15 d). All patients had normal shoulder function before injury. According to Karlsson evaluation standard, the cases with excellent and good function of the shoulder joint were regarded as the normal group, and the cases with poor function of shoulder joint as the abnormal group. The comparison of the range of forward flexion,backward stretch, adduction, abduction and elevation of shoulder joints between two groups was performed. The data of impingement, subacromial osteolysis, acromioclavicular arthritis, clavicular stress fracture, downward acromioclavicular joint subluxation, hook cut-out and hook break were summarized. RESULTS: All patients were followed up from 8 to 48 months with an average of 12.5 months. The results were excellent in 308 cases,good in 76,and poor in 84 according to Karlsson evaluation. The excellent and good rate was 82.1%. The difference of the range of forward flexion, backward stretch, adduction, abduction and elevation of shoulder joints between two groups had a statistically significant difference (P < 0.01). Among 84 poor cases, there were 41 (8.76%) in acromial impingement or inadequate place of plate hook, 12 (2.56%) with subacromial osteolysis or/and bursitis, 10 (2.14%) with acromioclavicular arthritis or painful shoulder caused by delayed dirigation,7 (1.50%) with clavicular stress fracture or interal plate upward, 6 (1.28%) with downward acromioclavicular joint subluxation, 5 (1.07%) with hook cut -out and 3 (0.64%) in hook break. CONCLUSION: The clavicular hook plate is useful for the treatment of acromioclavicular joint dislocation (Tossy III) and unstable distal clavicular fracture (Neer II). The correct place and suitable preflex of plate hook,the restoration of fiber structure around the acromioclavicular joint and the advisable dirigation contribute to the modified rate of complications.

Paraoxonase-1 is not a major determinant of stent thrombosis in a Taiwanese population.

BACKGROUND: Clopidogrel is a prodrug that undergoes in vivo bioactivation to show its antiplatelet effects. Recent studies have shown that cytochrome P450 (CYP), ATP-binding cassette transporters (ABCB1), and paraoxonase-1 (PON1) play crucial roles in clopidogrel bioactivation. Here, we aim to determine the effects of genetic polymorphisms of CYP (CYP 2C19*2, CYP 2C19*3, and CYP 2C19*17), ABCB1 (ABCB1 3435C>T, ABCB1 129T>C, and ABCB1 2677G>T/A), and PON1 (PON1 Q192R, PON1 L55M, and PON1 108C>T) on the development of stent thrombosis (ST) in patients receiving clopidogrel after percutaneous coronary intervention (PCI). METHODS AND RESULTS: We evaluated the incidence of ST (0.64%) in 4964 patients who were recruited in the CAPTAIN registry (Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions). The presence of genetic polymorphisms was assessed in 20 subjects who developed ST after aspirin and clopidogrel therapy and in 40 age- and sex-matched control subjects who did not develop ST, which was documented after 9 months of angiographic follow-up. ST was acute in 5 subjects, subacute in 7, late in 7, and very late in 1. The presence of CYP 2C19*2 allele was significantly associated with ST (adjusted odds ratio [ORadj]: 4.20, 95% confidence interval [CI], 1.263-9.544; P = 0.031). However, genetic variations in PON1 and ABCB1 showed no significant association with ST. CONCLUSION: We conclude that in a Taiwanese population, PON1 Q192R genotype is not associated with ST development after PCI. However, the presence of CYP 2C19*2 allele is a risk factor for ST development after PCI.

Exendin-4 attenuates lipopolysaccharides induced inflammatory response but does not protects H9c2 cells from apoptosis.

BACKGROUND: Glucagon-like peptide-1 (GLP-1) and its analogues are reported to exert wide-ranging cardiovascular actions in preclinical and clinical studies. We thus investigated whether the GLP-1 receptor agonist, exendin-4, has inhibitory effects on LPS-stimulated inflammatory response in cardiomyoblasts. METHODS: H9c2 cardiomyoblasts were exposed to LPS and treated with exendin-4. Expressions of proinflammatory mediators were assessed using quantitative real-time PCR. Nuclear localization of NF-κB was examined using immunoblotting. mRNA expression of inducible nitric oxide synthase (iNOS) and nitric oxide (NO) production were evaluated by q PCR and NO assay. Furthermore, anti-apoptotic effect of exendin-4 in LPS-stimulated H9c2 cells was determined using qPCR and immunoblot. RESULTS: Exposure to LPS increased mRNA expressions of TNF-α, COX-2 and MMP-9 in H9c2 cells. It also caused increases in iNOS mRNA expression and NF-κB nuclear translocation. Exendin-4 dose-dependently downregulated mRNA levels of TNF-α, COX-2 and MMP-9 in LPS-stimulated H9c2 cells. It also reduced NF-κB nuclear translocation. Treatment with exendin-4 showed no effect on LPS-induced apoptosis in H9c2 cells. CONCLUSIONS: Exendin-4 exerts an effect on cardiomyoblast exposed to LPS by inhibiting mRNA expression of inflammatory mediators and suppressing NF-κB activation. These effects are consistent with some of the observed anti-inflammatory properties of exendin-4, as well as its beneficial actions on the cardiovascular system.