A dynamic visualization clinical tool constructed and validated based on the SEER database for screening the optimal surgical candidates for bone metastasis in primary kidney cancer.

The implementation of primary tumor resection (PTR) in the treatment of kidney cancer patients (KC) with bone metastases (BM) has been controversial. This study aims to construct the first tool that can accurately predict the likelihood of PTR benefit in KC patients with BM (KCBM) and select the optimal surgical candidates. This study acquired data on all patients diagnosed with KCBM during 2010-2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was utilized to achieve balanced matching of PTR and non-PTR groups to eliminate selection bias and confounding factors. The median overall survival (OS) of the non-PTR group was used as the threshold to categorize the PTR group into PTR-beneficial and PTR-Nonbeneficial subgroups. Kaplan-Meier (K-M) survival analysis was used for comparison of survival differences and median OS between groups. Risk factors associated with PTR-beneficial were identified using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC), area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to validate the predictive performance and clinical utility of the nomogram. Ultimately, 1963 KCBM patients meeting screening criteria were recruited. Of these, 962 patients received PTR and the remaining 1061 patients did not receive PTR. After 1:1 PSM, there were 308 patients in both PTR and non-PTR groups. The K-M survival analysis results showed noteworthy survival disparities between PTR and non-PTR groups, both before and after PSM (p < 0.001). In the logistic regression results of the PTR group, histological type, T/N stage and lung metastasis were shown to be independent risk factors associated with PTR-beneficial. The web-based nomogram allows clinicians to enter risk variables directly and quickly obtain PTR beneficial probabilities. The validation results showed the excellent predictive performance and clinical utility of the nomograms for accurate screening of optimal surgical candidates for KCBM. This study constructed an easy-to-use nomogram based on conventional clinicopathologic variables to accurately select the optimal surgical candidates for KCBM patients.

Extensive spinal epidural abscess caused by Staphylococcus epidermidis: A case report and literature review.

Background: Extensive spinal epidural abscess (SEA) is an exceptional and threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. We aimed to find key elements of early diagnosis and rational treatments for extensive SEA. Case presentation: A 70-year-old man complained of intense pain in the cervical-thoracic-lumbar spine that radiated to the lower extremity. Laboratory test results revealed a marked increase in all indicators of infection. The spinal magnetic resonance imaging (MRI) revealed a ventral SEA extending from C2 to L4. Owing to the patient's critical condition, laminectomy, drainage, and systemic antibiotic therapy were administered. And the multidrug-resistant Staphylococcus epidermidis was detected in the purulent material from this abscess. Results: Postoperative MRI revealed diminished epidural abscess, and the clinical symptoms were dramatically and gradually relieved after two rounds of surgery and systemic antibiotic therapy involving the combination of ceftriaxone, linezolid, and rifampicin. Conclusions: A comprehensive emergency assessment based on neck or back pain, neurological dysfunctions, signs of systemic infection, and MRI are important for early diagnosis of extensive SEA. Further, the combination of laminectomy, drainage, and systemic antibiotic therapy may be a rational treatment choice for patients with SEA, especially for extensive abscess or progressive neurological dysfunction.

Effect of N Fertilization Pattern on Rice Yield, N Use Efficiency and Fertilizer-N Fate in the Yangtze River Basin, China.

High N loss and low N use efficiency (NUE), caused by high N fertilizer inputs and inappropriate fertilization patterns, have become important issues in the rice (Oryza sativa L.) growing regions of southern China. Changing current farmer fertilizer practice (FFP, 225 kg ha-1 N as three applications, 40% as basal fertilizer, 30% as tillering fertilizer and 30% as jointing fertilizer) to one-time root-zone fertilization (RZF, 225 kg ha-1 N applied once into 10 cm deep holes positioned 5 cm from the rice root as basal fertilizer) will address this problem. A two-year field experiment covering two rice growing regions was conducted to investigate the effect of urea one-time RZF on rice growth, nutrient uptake, and NUE. The highest NH4+-N content for RZF at fertilizer point at 30 d and 60 d after fertilization were 861.8 and 369.9 mg kg-1 higher than FFP, respectively. Rice yield and total N accumulation of RZF increased by 4.3-44.9% and 12.7-111.2% compared to FFP, respectively. RZF reduced fertilizer-N loss by 56.3-81.9% compared to FFP. The NUEs following RZF (mean of 65.8% for the difference method and 43.7% for the labelled method) were significantly higher than FFP (mean of 35.7% for the difference method and 14.4% for the labelled method). In conclusion, RZF maintained substantial levels of fertilizer-N in the root-zone, which led to enhanced rice biomass and N uptake during the early growth stages, increased fertilizer-N residual levels and reduced fertilizer-N loss at harvest. RZF produced a higher yield increment and showed an increased capacity to resist environmental threats than FFP in sandy soils. Therefore, adopting suitable fertilizer patterns plays a key role in enhancing agricultural benefits.