Intradural extramedullary spinal choristoma: A case report.

RATIONALE: A choristoma is a rare and benign neoplasm characterized by the presence of normal tissue in an anomalous anatomical location. In contrast, choristoma tend to occur in other body regions rather than within the spinal canal. Before our findings, only 4 cases of intraspinal choristoma had been recorded. Because its composition is complex and very rare, routine examinations, such as magnetic resonance imaging, are difficult to diagnose, and the possibility of its occurrence is often missed in clinical diagnosis. If there is no specificity in its components, such as in this case, even pathological examinations can only confirm the diagnosis as choristoma after eliminating other possibilities. Therefore, in clinical practice, when encountering patients with intraspinal tumors, it is essential to consider the possibility of choristoma. In this case, the choristoma lack of specific constituent composition sets it apart from previously reported intraspinal choristoma, significantly raising the diagnostic challenge, which offers valuable insights for clinical diagnosis. PATIENT CONCERNS: A female patient aged 48 years was admitted to our medical center due to experiencing persistent lower back pain accompanied by radiating pain in both legs for 5 months. Based on the findings from the neurological physical examination and magnetic resonance imaging, the patient was diagnosed with an intradural space-occupying lesion located at the level of the first lumbar vertebral body. We performed an enhanced magnetic resonance neurography examination to further determine the positional relationship between the occupation and nerves in preparation for surgery. Postoperative pathological biopsy showed that the mass was an intraspinal choristoma. DIAGNOSIS: Intradural extramedullary spinal choristoma. INTERVENTION: Occupied lesion is removed surgically. OUTCOMES: After surgery, all symptoms were significantly relieved, and when the patient was discharged, all symptoms disappeared completely. There was no sign of recurrence after 1 year of follow-up. LESSONS: Intraspinal choristomas are not specific and need to be diagnosed by pathologic examination. Early detection of and intervention for intraspinal tumors can mitigate nerve dysfunction.

Feasibility study of hallux valgus measurement with a deep convolutional neural network based on landmark detection.

OBJECTIVE: To develop a deep learning algorithm based on automatic detection of landmarks that can be used to automatically calculate forefoot imaging parameters from radiographs and test its performance. MATERIALS AND METHODS: A total of 1023 weight-bearing dorsoplantar (DP) radiographs were included. A total of 776 radiographs were used for training and verification of the model, and 247 radiographs were used for testing the performance of the model. The radiologists manually marked 18 landmarks on each image. By training our model to automatically label these landmarks, 4 imaging parameters commonly used for the diagnosis of hallux valgus could be measured, including the first-second intermetatarsal angle (IMA), hallux valgus angle (HVA), hallux interphalangeal angle (HIA), and distal metatarsal articular angle (DMAA). The reference standard was determined by the radiologists' measurements. The percentage of correct key points (PCK), intragroup correlation coefficient (ICC), Pearson correlation coefficient (r), root mean square error (RMSE), and mean absolute error (MAE) between the predicted value of the model and the reference standard were calculated. The Bland-Altman plot shows the mean difference and 95% LoA. RESULTS: The PCK was 84-99% at the 3-mm threshold. The correlation between the observed and predicted values of the four angles was high (ICC: 0.89-0.96, r: 0.81-0.97, RMSE: 3.76-6.77, MAE: 3.22-5.52). However, there was a systematic error between the model predicted value and the reference standard (the mean difference ranged from - 3.00 to - 5.08°, and the standard deviation ranged from 2.25 to 4.47°). CONCLUSION: Our model can accurately identify landmarks, but there is a certain amount of error in the angle measurement, which needs further improvement.

A comparison of long-term efficacy of K-rod-assisted non-fusion operation and posterior lumbar interbody fusion for single-segmental lumbar disc herniation.

K-rod-assisted non-fusion surgery for the treatment of lumbar disc herniation has been proven to have short-term clinical efficacy. Meanwhile, its long-term effects have not been examined. To observed the long-term clinical efficacy of K-rod-assisted non-fusion operation, this study retrospectively analyzed 22 patients with lumbar disc (L4/5) herniation who underwent K-rod-assisted non-fusion operation (n = 13) or PLIF (n = 9). They were followed-up for more than 5 years. The operation times and blood loss were significantly reduced in the K-rod group compared to the PLIF group. At the last follow-up, the clinical outcomes of the K-rod group were improved compared to those of the PLIF group as observed by the VAS score, JOABPEQ, and ODI. Imaging outcomes at the last follow-up indicated that the loss of height in the L3/4 and L5/S1 intervertebral space, the ROM of L3/4 and L5/S1, and the incidence of adjacent segment degeneration in the PLIF group were significantly higher than those in the K-rod group. According to Pfirrmann grading, Modic changes, and UCLA grading, the incidence of adjacent segment degeneration was 55.6% in the PLIF group and 15.4% in the K-rod group. Changes in spino-pelvic parameters between the two groups were as follows: pelvic index remained unchanged, pelvic tilt angle increased, and lumbar lordosis and sacral slope decreased. Therefore, compared to PLIF, single-segment lumbar disc herniation using K-rod-assisted non-fusion surgery resulted in better long-term clinical efficacy. Our results demonstrate that this procedure can delay adjacent segment degeneration after lumbar surgery.

Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study.

BACKGROUND: Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. METHODS: This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient's demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient's characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL. RESULTS: A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient's blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028). CONCLUSIONS: A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

[Retracted] Synergistic growth inhibition by sorafenib and cisplatin in human osteosarcoma cells.

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that certain of the western blotting data shown in Figs. 3A and 4A, and tumor images in Fig. 5A, bore unexpected similarities to data appearing in different form in other articles by different authors. Owing to the fact that some of the contentious data in the above article had already been published elsewhere, or were already under consideration for publication, prior to its submission to Oncology Reports, the Editor has decided that this paper should be retracted from the Journal. After having been in contact with the authors, they agreed with the decision to retract the paper. The Editor apologizes to the readership for any inconvenience caused. [the original article was published in Oncology Reports 33: 2537­2544, 2015; DOI: 10.3892/or.2015.3832].

Spinal dural arteriovenous fistula 8 years after lumbar discectomy surgery: A case report and review of literature.

BACKGROUND: Spinal dural arteriovenous fistula (SDAVF) is an extremely rare vascular malformation of the central nervous system that is often confused with degenerative spinal disorders due to similar early symptoms and clinical features. Here, we report a case of SDAVF recurrence 8 years after lumbar spine surgery and summarize relevant literature. CASE SUMMARY: A 54-year-old male was admitted to our hospital complaining of lower back pain, numbness in both lower extremities and intermittent claudication. Subsequent imaging identified lumbar spinal stenosis. Following surgical treatment, the patient's symptoms significantly resolved, and he was able to perform daily activities. However, similar symptoms appeared 8 years later, followed by confirmation of SDAVF diagnosis. The patient underwent neurosurgery 7 mo after symptom onset. The follow-up period lasted 14 mo, and the patient remains with marginal neurological symptoms. CONCLUSION: This case highlights the importance of prompt SDAVF diagnosis. Due to its nonspecific clinical presentation, the clinical experience of the surgeon and definitive imaging examination are indispensable. Additionally, timely neurosurgery is effective and may significantly improve patient outcomes.

Prediction of the risk of C5 palsy after posterior laminectomy and fusion with cervical myelopathy using a support vector machine: an analysis of 184 consecutive patients.

BACKGROUND: This study aimed to predict C5 palsy (C5P) after posterior laminectomy and fusion (PLF) with cervical myelopathy (CM) from routinely available variables using a support vector machine (SVM) method. METHODS: We conducted a retrospective investigation based on 184 consecutive patients with CM after PLF, and data were collected from March 2013 to December 2019. Clinical and imaging variables were obtained and imported into univariable and multivariable logistic regression analyses to identify risk factors for C5P. According to published reports and clinical experience, a series of variables was selected to develop an SVM machine learning model to predict C5P. The accuracy (ACC), area under the receiver operating characteristic curve (AUC), and confusion matrices were used to evaluate the performance of the prediction model. RESULTS: Among the 184 consecutive patients, C5P occurred in 26 patients (14.13%). Multivariate analyses demonstrated the following 4 independent factors associated with C5P: abnormal electromyogram (odds ratio [OR] = 7.861), JOA recovery rate (OR = 1.412), modified Pavlov ratio (OR = 0.009), and presence of C4-C5 foraminal stenosis (OR = 15.492). The SVM model achieved an area under the receiver operating characteristic curve (AUC) of 0.923 and an ACC of 0.918. Additionally, the confusion matrix showed the classification results of the discriminant analysis. CONCLUSIONS: The designed SVM model presented satisfactory performance in predicting C5P from routinely available variables. However, future external validation is needed.

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion.

BACKGROUND: The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL). METHODS: We conducted a retrospective, single-center study based on 885 patients receiving PSL, and data was obtained from May 2015 to September 2019. Univariable and multivariable logistics regression analysis were conducted to identify risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model. RESULTS: Of 885 patients, 885 were enrolled in the final study population, and 289 received blood transfusion. Statistical analyses showed that low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion > 1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI 0.847-0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility. CONCLUSIONS: In summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion can contribute to clinicians in making clinical decision. However, external validation is still needed in the further.

Development and Internal Validation of a Nomogram to Predict Mortality During the ICU Stay of Thoracic Fracture Patients Without Neurological Compromise: An Analysis of the MIMIC-III Clinical Database.

Background: This study aimed to develop and validate a nomogram for predicting mortality in patients with thoracic fractures without neurological compromise and hospitalized in the intensive care unit. Methods: A total of 298 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included in the study, and 35 clinical indicators were collected within 24 h of patient admission. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was established, and a nomogram was constructed. Internal validation was performed by the 1,000 bootstrap samples; a receiver operating curve (ROC) was plotted, and the area under the curve (AUC), sensitivity, and specificity were calculated. In addition, the calibration of our model was evaluated by the calibration curve and Hosmer-Lemeshow goodness-of-fit test (HL test). A decision curve analysis (DCA) was performed, and the nomogram was compared with scoring systems commonly used during clinical practice to assess the net clinical benefit. Results: Indicators included in the nomogram were age, OASIS score, SAPS II score, respiratory rate, partial thromboplastin time (PTT), cardiac arrhythmias, and fluid-electrolyte disorders. The results showed that our model yielded satisfied diagnostic performance with an AUC value of 0.902 and 0.883 using the training set and on internal validation. The calibration curve and the Hosmer-Lemeshow goodness-of-fit (HL). The HL tests exhibited satisfactory concordance between predicted and actual outcomes (P = 0.648). The DCA showed a superior net clinical benefit of our model over previously reported scoring systems. Conclusion: In summary, we explored the incidence of mortality during the ICU stay of thoracic fracture patients without neurological compromise and developed a prediction model that facilitates clinical decision making. However, external validation will be needed in the future.

Chitosan-Coated Titanium Dioxide-Embedded Paclitaxel Nanoparticles Enhance Anti-Tumor Efficacy Against Osteosarcoma.

OBJECTIVE: Titanium dioxide nanoparticles (TiO2) nanoparticles have been widely explored in the prevention of cancer risk. Due to the difficult solubility of TiO2 nanoparticles, it is essential to synthesize new surfactants to increase its bioavailability and anti-tumor activity and reduce its cytotoxicity. Furthermore, oxidative and inflammation are closely associated with the osteosarcoma risk. Chitosan has biocompatibility, antioxidant and anti-inflammatory properties. The effects of chitosan-coated TiO2-embedded paclitaxel nanoparticles on an osteosarcoma model were explored. METHODS: An osteosarcoma model was established and chitosan-coated TiO2-embedded paclitaxel nanoparticles were prepared using a freeze-drying strategy. The morphological characteristics of nanoparticles were observed using scanning electron microscopy (SEM). The physicochemical properties of nanoparticle were evaluated by X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. The cytotoxicity was tested by using human osteoblast cells hFob1.19 and osteosarcoma cells 143B. Osteosarcoma mice were treated with PBS buffer, paclitaxel, TiO2-embedded paclitaxel and chitosan-coated TiO2-embedded paclitaxel nanoparticles. The biomarkers of oxidative-inflammatory status, anti-tumor activities and survival rates of the model were measured. RESULTS: XRD analysis showed that the peaks of chitosan/TiO2 (anatase) were consistent with those of crystalline TiO2 and broad phase of chitosan. The FTIR spectrum indicated the relevant functional groups in TiO2. Chitosan-coated TiO2-embedded paclitaxel nanoparticles had good biocompatibility and improve antioxidant and anti-inflammatory properties in the osteosarcoma model. Chitosan-coated TiO2-embedded paclitaxel nanoparticles was less toxic to the cells hFob1.19 and more toxic to the cells 143B than TiO2-embedded paclitaxel nanoparticles. Chitosan-coated TiO2-embedded paclitaxel nanoparticles showed significant antitumor activity and increased the survival rate of the osteosarcoma model (P < 0.05). CONCLUSIONS: Chitosan improved anti-tumor potential of TiO2-embedded paclitaxel nanoparticles in the prevention of osteosarcoma.

A novel computer navigation model guided unilateral percutaneous vertebroplasty for vertebral compression fracture: A case report.

RATIONAL: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES: The patient was diagnosed with a L1 VCF. INTERVENTIONS: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.

Spontaneous spinal epidural hematoma masquerading as atypical abdominal pain in a child: A case report.

INTRODUCTION: There have been few case reports of abdominal pain as a symptom of spontaneous intraspinal hemorrhage. We herein describe a case involving a girl with paraplegia caused by spontaneous epidural hemorrhage in the thoracic spinal canal, characterized by abdominal pain. PATIENT CONCERNS: An 8-year-old girl with sudden abdominal pain and back pain was misdiagnosed as having an abdominal disease until she had the symptom of paralysis. DIAGNOSES: The patient was diagnosed with spontaneous intraspinal hemorrhage masquerading as atypical abdominal pain. INTERVENTIONS: When the patient developed symptoms of lower extremity paralysis, thoracic magnetic resonance imaging was performed and epidural hemorrhage was found in the thoracic spinal canal. Surgical treatment was performed after the diagnosis was confirmed. OUTCOMES: The patient could almost walk normally after 3 months. One year after surgery, the Frankel grade of spinal cord function was grade D. We continued to follow-up this patient. CONCLUSION: The symptoms caused by intraspinal hemorrhage are mainly back pain with or without neurological dysfunction. However, sometimes atypical symptoms, such as abdominal and chest pain, can be identified in clinical settings. Emergency surgery is recommended as the treatment of choice for intraspinal hemorrhage with neurological dysfunction.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures.

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability. Traditional open surgery has a large amount of bleeding, which is not suitable for patients with acute pelvic fracture. Navigation-guided, percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages, which include less trauma, faster recovery times, and less bleeding. However, due to the complexity of pelvic anatomy, doctors often encounter some problems when using navigation to treat pelvic fractures. This article reviews the indications, contraindications, surgical procedures, and related complications of this procedure for the treatment of sacral fractures, sacroiliac joint injuries, pelvic ring injuries, and acetabular fractures. We also analyze the causes of inaccurate screw placement. Percutaneous screw placement under navigational guidance has the advantages of high accuracy, low incidence of complications and small soft-tissue damage, minimal blood loss, short hospital stays, and quick recovery. There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones. However, computer navigation technology requires extensive training, and attention should be given to avoid complications such as screw misplacement, intestinal injury, and serious blood vessel and nerve injuries caused by navigational drift.

Predictive Nomogram for Midterm to Long-Term Prognosis in Patients with Papillary Renal Cell Carcinoma Based on Data from the Surveillance, Epidemiology, and End Results (SEER) Program.

BACKGROUND This study aimed to develop a predictive nomogram for midterm to long-term prognosis in patients with papillary renal cell carcinoma (RCC) based on data from the US Surveillance, Epidemiology, and End Results (SEER) program. MATERIAL AND METHODS Clinical pathology data and follow-up information were obtained from the SEER database for patients with papillary RCC between 1997-2014. Univariate and multivariate Cox regression models evaluated the independent prognostic factors, and the nomogram was constructed to predict the 3-year, 5-year, and 10-year survival rates. Multiple parameters were estimated to evaluate the predictive values, including the concordance indices (C-indices), calibration plots, area under the receiver operator characteristics (ROC) curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). RESULTS The study included 13,926 patients with papillary RCC. Univariate and multivariate Cox regression analysis developed the nomogram that relied on the predictive variables of age, Fuhrman grade, TNM stage, surgery of the primary site, lymphadenectomy, and marital status. The C-indices of the novel model in the validation cohort were more satisfactory than those of the TNM classification. Accurate discrimination and calibration by the nomogram were identified in both cohorts. The NRI and IDI supported prediction improvements, and the DCA supported the nomogram's clinical significance. CONCLUSIONS A nomogram was developed to evaluate the prognosis of papillary RCC and to identify the patients who required specialized treatment. However, external validation of the predictive nomogram is required that also includes patients from other countries.

Long non-coding RNA Mirt2 prevents TNF-α-triggered inflammation via the repression of microRNA-101.

Parkinson's disease is normally accompanied by excessive inflammation. Myocardial infraction associated transcript 2 (Mirt2) has an activity to relieve inflammation in numerous cell types. Here, we aimed to investigate whether Mirt2 could elevate the resistance of SH-Sy5y cells to inflammation. Tumor necrosis factor alpha (TNF-α) was used to induce inflammation in SH-Sy5y cells. Mirt2 overexpressed or silenced cells were established. MicroRNA-101 (miR-101) mimic was used to up-regulate miR-101. Viable and apoptotic cells as well as reactive oxidative species (ROS) were detected after staining. Proteins associated with apoptosis, interleukin (IL) and signaling regulators were evaluated by Western blot. IL secretion was assessed by ELISA. Mirt2 and miR-101 were determined by qRT-PCR. We discovered that TNF-α weakened viability of SH-Sy5y cells and resulted in sensitivity to apoptosis with cleavage of PARP and caspase-3. Expression and secretion of IL-6 as well as generation of ROS were facilitated by TNF-α. However, Mirt2 overexpression moderated TNF-α-caused apoptosis associated with inflammation and oxidative stress. Mirt2 suppressed TNF-α-induced accumulation of miR-101, and based on this Mirt2 exhibited anti-inflammatory roles. Additionally, TNF-α-triggered phosphorylation of regulators was blocked by Mirt2 while restored by miR-101 mimic. In short Mirt2 overexpression exhibited anti-inflammatory properties through miR-101 suppression. Through down-regulating miR-101, Mirt2 blocked TNF-α-triggered NF-κB/p38MAPK pathway.

Percutaneous vertebroplasty with granulated allogeneic bone grafting using screw-view model of navigation for thoracolumbar compressive fracture: A case report.

RATIONALE: The aim of this study was to assess the accuracy of percutaneous puncture needle with screw view model of navigation (SVMN) and the effect of periacetabular vertebroplasty (PVP) with granulated allogeneic bone grafting in thoracolumbar compressive fracture (TCF). PATIENT CONCERNS: A 46-year-old female patient associated with high fall injury showed symptoms characterized by back pain and restricted movement of the right lower extremity. DIAGNOSES: The patient was diagnosed with a TCF, right femoral neck fracture, and lumbar vertebrae hyperosteogeny. INTERVENTIONS: A SVMN was used to guide our puncture needle insertion; and PVP was performed with granulated allogeneic bone grafting in this patient. OUTCOMES: The follow-up lasted for 29 months. It took 2.4 minutes to design the trajectory of puncture needle, 2.1 minutes to implant the puncture needle, and 6.3 minutes to undergone fluoroscopy. Postoperative visual analog scale and Oswestry disability index scores were improved obviously compared with those before the operation. The Cobb angle of fractured vertebrae improved from 9.3° to 7.3° after treatment. The height ratio of fractured vertebrae increased from 79.5% to 90.6% postoperatively. Intraoperative blood loss amounted to 11 ml. No clinical complications were observed, including neurovascular injury and new fracture of adjacent vertebra. LESSONS: Puncture needle placement under the guidance of SVMN is verified as a convenient, safe and reliable method, and PVP with granulated allogeneic bone grafting can effectively restore the height of anterior fractured vertebra, filling the gaps in the fractured vertebrae, and reconstructing the completeness of the fractured vertebrae.