The Interrater and Intrarater Reliability of the Humeral Head Ossification System and the Proximal Femur Maturity Index Assessments for Patients with Adolescent Idiopathic Scoliosis.

Background: Skeletal maturity can evaluate the growth and development potential of children and provide a guide for the management of adolescent idiopathic scoliosis (AIS). Recent studies have demonstrated the advantages of the Humeral Head Ossification System (HHOS) and the Proximal Femur Maturity Index (PFMI), based on standard scoliosis films, in the management of AIS patients. We further assessed the HHOS and the PFMI method's reliability in the interrater and intrarater. Methods: The data from 38 patients, including the humeral head and proximal femur on standard scoliosis films, were distributed to the eight raters in the form of a PowerPoint presentation. On 38 independent standard spine radiographs, raters utilized the HHOS and PFMI to assign grades. The PPT sequence was randomly changed and then reevaluated 2 weeks later. For every system, the 95% confidence interval (95% CI) and intraclass correlation coefficient (ICC) were calculated to evaluate the interrater and intrarater reliability. Results: The HHOS was extremely reliable, with an intraobserver ICC of 0.802. In the first round, the interobserver ICC reliability for the HHOS was 0.955 (0.929-0.974), while in the second round, it was 0.939 (0.905-0.964). The PFMI was extremely reliable, with an intraobserver ICC of 0.888. In the first round, the interobserver ICC reliability for the PFMI was 0.967 (0.948-0.981), while in the second round, it was 0.973 (0.957-0.984). Conclusions: The HHOS and PFMI classifications had excellent reliability. These two methods are beneficial to reduce additional exposure to radiation and expense for AIS. There are advantages and disadvantages to each classification. Clinicians should choose a personalized and reasonable method to assess skeletal maturity, which will assist in the management of adolescent scoliosis patients.

Prevention of nosocomial COVID-19 infections in otorhinolaryngology-head and neck surgery.

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a pandemic, causing a global public health crisis. Many frontline healthcare workers providing ear, nose and throat services have been reported to contract COVID-19 at work. Early during the COVID-19 outbreak, several medical professionals in Otolaryngology-Head and Neck Surgery were infected in Wuhan, China. A series of measures were then taken immediately, which successfully halted the spread of the disease. Here we would like to share the lessons we have learned, and our experience to protect our health care workers during the COVID-19 pandemic.

Ca2+/Mg2+ homeostasis­related TRPM7 channel mediates chondrocyte hypertrophy via regulation of the PI3K­Akt signaling pathway.

Chondrocytes are specialized cells that form cartilage tissue, and are able to respond to their osmotic environment and exercise important roles in endochondral ossification via undergoing proliferation, hypertrophy and apoptosis. The transient receptor melastatin potential 7 (TRPM7) cation channel can modulate the intracellular and extracellular levels of Ca2+ and Mg2+, and therefore the cellular osmotic environment. However, the molecular pathways involved in TRPM7­mediated signal transduction have yet to be elucidated. In the present study, the expression and functionality of TRPM7 were investigated during chondrocyte proliferation and hypertrophy. The ATDC5 mouse cell line was employed and cellular viability was evaluated using the MTT assay, whereas hypertrophy was monitored via evaluating the expression of chondrogenic marker genes and the activity of alkaline phosphatase (ALP). Gene expression of TRPM7 appeared slightly upregulated during the proliferative stages of chondrocyte development, and significantly upregulated during the hypertrophic stages, suggesting the importance of Ca2+/Mg2+ homeostasis for chondrocyte growth. Low extracellular Ca2+/Mg2+ levels significantly reduced the expression of type X collagen, Indian hedgehog homolog (Ihh) and matrix metalloproteinase (MMP)­13 genes, as well as ALP activity; however, cell viability remained unaffected. Conversely, the gene expression levels of TRPM7 appeared upregulated in ATDC5 cells under low extracellular Ca2+ or Mg2+ conditions. Silencing TRPM7 expression during the chondrocyte differentiation period also reduced type X collagen, Ihh and MMP­13 gene expression, and ALP activity. Furthermore, the phosphatidylinositol­4,5­bisphosphate 3­kinase (PI3K)­Akt signaling pathway was activated following TRPM7 overexpression, and inhibited following TRPM7 silencing. Notably, the actions of TRPM7 on chondrocyte hypertrophy were abolished through the inhibition of PI3K­Akt signaling. The present results suggested that TRPM7 may be involved in Ca2+/Mg2+ homeostasis during chondrocyte hypertrophy, and contribute to endochondral ossification via interacting with the PI3K­Akt signaling pathway.

Long non-coding RNA PCAT7 regulates ELF2 signaling through inhibition of miR-134-5p in nasopharyngeal carcinoma.

While some long noncoding RNAs (lncRNAs) might promote nasopharyngeal carcinoma (NPC) initiation and progression, the involved molecular mechanisms remain largely unclear. Here, we discovered the novel LncRNA, prostate cancer associated transcript 7 (PCAT7), which was overexpressed and associated with worse prognosis in NPC. Decreased PCAT7 expression was found to significantly suppress tumor cell proliferation in vitro, and inhibited tumor growth and reduced the expression of proliferation antigen Ki-67 in vivo. Rescue assay was performed to further confirm that PCAT7 contributed to the progression of NPC through regulating miR-134-5p/ELF2 signal pathway. These results indicated that PCAT7 might contribute to the tumor progression in NPC by functioning as a ceRNA to sponge miR-134-5p.

Identification of key genes associated with Schmid-type metaphyseal chondrodysplasia based on microarray data.

This study aimed to gain a better understanding of the molecular circuitry of Schmid-type metaphyseal chondrodysplasia (SMCD), and to identify more potential genes associated with the pathogenesis of SMCD. Microarray data from GSE72261 were downloaded from the NCBI GEO database, including collagen X p.Asn617Lys knock-in mutation (ColXN617K), ablated XBP1 activity (Xbp1CartΔEx2), compound mutant (C/X), and wild-type (WT) specimens. Differentially expressed genes (DEGs) were screened in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively. Pathway enrichment analysis of these DEGs was performed. Transcription factors (TFs) of the overlapping DEGs were identified. Weighted correlation network analysis (WGCNA) was performed to find modules of DEGs with high correlations, followed by gene function analysis and a protein-protein interaction network construction. In total, 481, 1,530 and 1,214 DEGs were identified in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively. These DEGs were enriched in different pathways, such as extracellular matrix (ECM)-receptor interaction and metabolism-related pathways. A total of 7 TFs were found to regulate 19 common upregulated genes, and 4 TFs were identified to regulate 21 common downregulated genes. Two significant gene co-expression modules were enriched and DEGs in the 2 modules were mainly enriched in different biological processes, such as ribosome biogenesis. Moreover, Kras (downregulated), Col5a1 (upregulated) and Furin (upregulated) were both identified in the regulatory networks and protein-protein interaction (PPI) network. On the whole, our findings indicate that the Kras, Col5a1 and Furin genes may play essential roles in the molecular mechanisms of SMCD, which warrants further investigation.

PFKFB3 modulates glycolytic metabolism and alleviates endoplasmic reticulum stress in human osteoarthritis cartilage.

Glycolytic disorder has been demonstrated to be a major cause of osteoarthritis (OA) and chondrocyte dysfunction. The present work aimed to investigate the expression and role of the glycolytic regulator 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) in OA cartilage. It was found that PFKFB3 expression was down-regulated in human OA cartilage tissues and in tumour necrosis factor (TNF)-α- or interleukin (IL)-1ß-stimulated human chondrocytes. The glycolytic metabolism appeared as glucose utilization and adenosine triphosphate (ATP) generation, and lactate production was stunted in OA cartilage. However, the impaired glycolytic process in OA cartilage was improved by PFKFB3 overexpression, which was confirmed in TNF-α- or IL-1ß-treated chondrocytes. Furthermore, the expressions of endoplasmic reticulum (ER) stress-associated genes including PERK, ATF3, IRE1, phosphorylated eIF2α (p-eIF2α) and MMP13 were enhanced in OA cartilage explants, while they were decreased by AdPFKFB3 transfection. PFKFB3 also modulated the expressions of PERK, ATF3, IRE1, p-eIF2α and MMP13 in tunicamycin-exposed chondrocytes. Additionally, PFKFB3 improved the cell viability of OA cartilage explants and chondrocytes through the PI3K/Akt/C/EBP homologous protein (CHOP) signalling pathway. The transfection of AdPFKFB3 also significantly reduced caspase 3 activation and promoted aggrecan and type II collagen expressions in OA cartilage explants and chondrocytes. In all, this study characterizes a novel role of PFKFB3 in glycolytic metabolism and ER stress of OA cartilage explants and chondrocytes. The study might provide a potential target for OA prevention or therapy.

MicroRNA-9 regulates osteoblast differentiation and angiogenesis via the AMPK signaling pathway.

MiR-9 has been found to be involved in the repair of spinal cord injury and regulates the proliferation and differentiation of mesenchymal stem cells. However, the role of miR-9 in repair of bone defects has not been well studied. The current study was designed to investigate its role and potential underlying mechanism in regulating osteoblast differentiation and angiogenesis. After treating the murine pre-osteoblast cell line MC3T3-E1 with BMP2, miR-9 expression was obviously down-regulated. Following transfection with miR-9 mimics, its overexpression enhanced the differentiation of MC3T3-E1 cells into osteoblasts as evidence that miR-9 up-regulated the mRNA levels of osteoblast differentiation-related protein, as well as increased differentiation and mineralization of osteoblasts. Further functional analysis has shown that miR-9 overexpression effectively increased human umbilical vein endothelial cell proliferation. Moreover, miR-9 up-regulation promoted cell migration, VEGF, and VE-cadherin concentrations, as well as tube formation in vitro. The mechanistic assay demonstrated that overexpression of miR-9-induced activation of the AMPK signaling pathway. Taken together, our findings suggested that miR-9 overexpression promoted osteoblast differentiation and angiogenesis via the AMPK signaling pathway, representing a novel and potential therapeutic target for the treatment of bone injury-related diseases.

Ulnar Rotation Osteotomy for Congenital Radial Head Dislocation.

PURPOSE: To evaluate an ulnar rotation osteotomy for congenital anterior dislocation of the radial head. METHODS: Nine patients (5 boys and 4 girls aged 6 to 13 years) with congenital anterior dislocation of the radial head were treated with ulnar rotation osteotomy. Magnetic resonance imaging of the elbow showed the proximal radioulnar joint on the anterior-lateral side of the ulna rather than on the lateral side in patients with congenital anterior dislocation of the radial head. On the basis of this finding, we performed an osteotomy on the ulna and laterally rotated the proximal radioulnar joint achieving radial head reduction and restoring the anatomical relationship between the radial head and the capitellum. Clinical and radiographical evaluation of the elbow was performed before surgery and at postoperative follow-up. RESULTS: All patients were followed for 13 to 45 months after surgery. Elbow radiography showed that the radiocapitellar joint was reduced in all patients at the last follow-up visit and that the carrying angle was decreased relative to that in the preoperative condition. Elbow stability and the range of elbow flexion motion were improved at the last follow-up. We did not observe ulnar osteotomy site nonunion or elbow osteoarthritis in these patients. Furthermore, radial head dislocation did not recur. CONCLUSIONS: At early follow-up, ulnar rotation osteotomy was a safe and effective method for the treatment of congenital anterior dislocation of the radial head. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[The application of the CO2 laser combined with pingyangmycin in the management of pharyngeal and laryngeal hemangioma].

OBJECTIVE: To review our experience with the use of the CO2 laser combined with pingyangmycin in the treatment of pharyngeal and laryngeal hemangioma. METHOD: A retrospective review of 18 patients with pharyngeal and laryngeal hemangioma treated with CO2 laser combined with pingyangmycin was carried out in our hospital: patients medical charts were evaluated for factors such as age, sex, location of hemangioma, number of laser procedures performed, and postoperative results, including short and long term complications. RESULT: All the 18 patients were underwent operation without any complications such as pharyngeal and laryngeal hemorrhage, infection of incisional wound,laryngeal edema, etc. Data of follow-up for 7 months to 5 years, showed that excellent local control was achieved in all cases with the exception of one case of recurrence. The one case recurred 4 months after operation and treated with CO2 laser again. CONCLUSION: With careful selection of patients, the CO2 laser combined with pingyangmycin pingyangmycin is a safe and effective treatment for pharyngeal and laryngeal hemangioma with the following advantages: precise location for treating, less bleeding, clear operating field, simple management, low risk of infection, less post-operation reaction, protection of laryngeal and pharyngeal structures and avoidance of tracheostomy.

Animal models of disc degeneration and major genetic strategies.

The establishment of a reliable animal model of lumbar disc degeneration (AMDD) is important for studying pathogenesis and evaluating treatment effectiveness. However, an ideal AMDD for use in laboratory studies has not yet been produced. This retrospective study reviews and compares several common AMDD and discusses their strengths and weaknesses. We also suggest a new method for establishing future AMDD. The identified genes associated with disc degeneration are susceptibility genes, which elevate risk but do not necessarily lead to disease occurrence. We propose to identify families with hereditary disc degeneration, find major casual genes with exome sequencing, and establish transgenic animal models. This approach may help us to build an improved AMDD.

A voice acoustic analysis of thyroid adenoma patients after a unilateral thyroid lobectomy.

OBJECTIVE: The objective of this study was to investigate the features of voice changes in thyroid adenoma patients secondary to a unilateral thyroid lobectomy that did not result in laryngeal nerve injury. STUDY DESIGN: Prospective study. METHODS: Pre- and postoperative fiberlaryngoscopic and voice acoustic analyses were performed on 32 adult patients (eight males and 24 females) with unilateral thyroid adenoma. Forty adults (20 women and 20 men) with normal voice function were grouped as controls. RESULTS: The vocal folds before and after surgery in all patients appeared to be normal under the fiberlaryngoscope. The preoperative voice was slightly abnormal in female patients and normal in male patients. One week after surgery, the F0 levels of both male and female patients decreased significantly from the values recorded before surgery (P<0.05). One month after the surgery, the F0 standard deviation, fundamental frequency perturbation, amplitude perturbation, noise/harmonic ratio, voice turbulence index, and degree of subharmonics in female patients decreased significantly from the values observed before surgery (P<0.05). Three months after surgery, the values of these indicators returned to normal. CONCLUSIONS: The preoperative voice was slightly abnormal in female patients and normal in male patients. After a unilateral thyroid lobectomy, which did not result in injury of the laryngeal nerve, the acoustic measures of male patients consequently became slightly abnormal and returned to normal within 1 month. The indicators of female patients improved from that demonstrated before surgery and returned to normal within 3 months.

[CO2 laser tenotomy and vocal process resection for treatment of bilateral vocal cord paralysis].

OBJECTIVE: To explore the clinical value of the treatment of bilateral vocal cord paralysis by tenotomy and vocal process resection with CO2 laser. METHOD: Eighteen cases of bilateral vocal cord paralysis after thyroidectomy from March 2004 to June 2006 were retrospectively analyzed. Preoperative tracheotomy and CO2 laser tenotomy and vocal process resection were performed. RESULT: All patients were able to breathe through the mouth and nose immediately after the operation. Fifteen patients were extubated within 8 weeks. Three patients were operated again after 4-6 weeks because of granulation hyperblastosis. All patients were followed up for 1.6 years to 2.3 years without breathing difficulties, aspiration and with satisfactory voice. CONCLUSION: The approach of CO2 laser tenotomy and vocal process resection can effectively relieve breathing difficulty resulted from bilateral vocal cord paralysis, achieve satisfactory voice and avoid aspiration.

[Clinical manifestation and laryngoscopic characteristics of laryngeal tuberculosis].

OBJECTIVE: To evaluate the clinical manifestations of laryngeal tuberculosis and its laryngoscopic characteristics. METHOD: Clinical analysis of 36 laryngeal tuberculosis cases confirmed pathologically was carried out retrospectively. RESULTS: The patients' ages ranged from 19 to 78 years old (median 39.5 years old). The male to female ratio was 1.8 to 1. The most frequent chief complaint was hoarseness (83.3%). The true vocal cord and the false vocal cord were usually found involved by fibrolaryngoscope observations. The lesions appearances were mainly the proliferation such as nodules or granules. The laryngostroboscopy demonstrated that the wave of the mucosa and vibration of the involved vocal cords were markedly reduced or disappeared. Among 24 patients with multiple lesions in the larynx, 19 (79.2%) had active pulmonary tuberculosis,while 9 (75.0%) had normal lung status among 12 patients with single lesions in the throat. All the patients received a full course of antituberculosis treatment. The results of the antituberculous medication was satisfactory in all 26 cases patients who can be followed up, while 10 cases were lost for the follow-up. CONCLUSIONS: The local clinical manifestations of laryngeal tuberculosis is nonspecific, while the whole manifestation is not apparent. The lesions commonly involve the true vocal cord and the false vocal cord. It can even occur without pulmonary tuberculosis.

[Postoperative rupture of carotid artery in head and neck neoplasms].

OBJECTIVE: To explore the treatment of neoplasms in head and neck invaded the carotid artery. METHODS: Four cases with postoperative rupture of carotid artery invaded by the head and neck cancer were reviewed. The tumours were taken off from the carotid arteries and the carotid artery remained. RESULT: Rupture of carotid artery occurred in 4 patients within one week after radical neck dissection. One patient died because of its rupture again after repair. The other three survived after ligating the artery. CONCLUSION: The carotid artery involved by tumour of head and neck should be prepared for resection before operation. If the artery was obviously invaded by the tumour, both the tumour and artery should be resected together. Once the rupture of the artery occurred after operation, the artery must be ligated instead of being repaired.