Role of Pre-Operative Nutrition Status on Surgical Site Infection After Posterior Lumbar Interbody Fusion: A Retrospective Study.

Background: A retrospective case-control study to determine the role of pre-operative systemic and local nutritional factors on patients developing a surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). Surgical site infection after PLIF remains a substantial cause of morbidity. The literature demonstrates the prognosis of surgical patients is associated with pre-operative nutritional status that not only includes systemic nutritional factors, such as prognostic nutritional index (PNI), body mass index (BMI), and serum albumin, but also local nutritional factors, such as subcutaneous fat thickness at the surgical site, including absolute fat thickness and relative fat thickness. However, the role of pre-operative nutrition status in SSI after PLIF surgery remains unclear. Patients and Method: A retrospective review was performed on a consecutive cohort of 766 consecutive adult patients who underwent PLIF surgery for lumbar degenerative conditions between 2020 and 2021 at Second Xiangya Hospital. Previously identified risk factors as well as systemic and local nutritional factors nutritional factors were collected. Results: Among the 766 patients, 38 had post-operative SSI including 15 superficial SSI and 23 deep SSI. Univariable analysis showed that body weight, BMI, PNI, serum albumin, and relative fat thickness differed between the SSI and non-SSI groups. Multivariable logistic regression analysis showed that pre-operative PNI and relative fat thickness were independently associated with SSI after PLIF surgery. Conclusions: Lower pre-operative PNI and higher relative fat thickness are independent risk factors for developing deep SSI after PLIF.

Investigation Into Environmental Selenium and Arsenic Levels and Arseniasis Prevalence in an Arsenic-Affected Coal-Burning Area.

This study aims to explore whether selenium (Se) concentration correlates with arseniasis in a high-arsenic coal area in the southern Shaanxi Province, China. Herein, an epidemiological investigation was conducted among 100 arsenic (As)-poisoned patients in Ziyang County, an area with high soil As and Se levels. Fifty healthy subjects were selected from areas without endemic As poisoning. The subjects in the high-As coal area were diagnosed with either normal, suspicious, mild, moderate, or severe As poisoning. Local coal, water, soil, corn, and pepper samples, as well as hair, blood, and urine samples of subjects and patients were collected and analyzed for their As and Se contents. The contents of As and Se in coal, soil, corn, pepper, and hair samples from Ziyang County were significantly higher than those in the control area. The As content of hair in Ziyang County positively correlated with As poisoning, whereas the Se content of hair and urine negatively correlated with As poisoning. The Se content in the body was negatively correlated with the degree of As poisoning, indicating that Se may accelerate the metabolism and decumulation of As and antagonize As toxicity.

Comparative transcriptome analysis provides insight into nitric oxide suppressing lignin accumulation of postharvest okra (Abelmoschus esculentus L.) during cold storage.

In plants, NO has been proved the function of improving abiotic stress resistance. However, the role of NO in the lignin metabolism of okra under cold stress has not been clarified. Here, histochemical staining and lignin content analysis showed that cold stress promoted the lignin accumulation of cold stored okra pods, and NO inhibited the lignin accumulation and delayed lignification process. To better understand the roles of NO in okra cold stress resistance mechanism, the full-length transcriptome data of 'Hokkaido' was analyzed. The SNP-treated okra transcriptome and cPTIO-treated okra transcriptome were obtained. A total of 41957 unigenes were screened out from three groups at 10 d, among which, 33, 78 and 18 DEGs were found in ddH2O-treat, SNP-treat and cPTIO-treat group, respectively. Transcriptomic data suggested that the genes involved in lignin biosynthesis showed downregulation under SNP treatment. Transcriptomic data and enzyme activity showed that exogenous NO significantly promoted the biosynthesis of endogenous NO by enhancing NOS activity. Transcriptomic data and plant hormone data showed that NO played an important role in the process of inhibiting the ethylene and ABA synthesis mechanism of okra and thereby reducing the endogenous ethylene and ABA content under chilling stress. Relevant physiological data showed that NO helped to the protection of ROS scavenging system and removed the MDA and H2O2 induced by cold stress. These results provided a reference for studying the molecular mechanism of nitric oxide delaying the lignification of okra, and also provided a theoretical basis for postharvest storage of vegetables.

Posterior vertebral column resection for correction of thoracolumbar kyphosis after failed anterior instrumented fusion.

To explore the effectiveness of posterior vertebral column resection for failed thoracolumbar anterior instrumented fusion.Ten patients with anterior fusion with refractory pain, progressive neurological deficits, and kyphosis were recruited. Anterior removal of the implant and posterior vertebral column resection were performed. The mean operating time, intraoperative blood loss, kyphosis angle, visual analog scale pain score, Oswestry disability index, bone fusion time, and complications were assessed in a minimum 18-month follow-up.The mean operating time was 323.5 ±â€Š63.6 minutes, with a mean blood loss of 1189 ±â€Š253.4 mL. The mean preoperative kyphosis angle of 54.6°â€Š±â€Š8.0° immediately decreased to 4.8°â€Š±â€Š1.5° after revision surgery and eventually to 6.8°â€Š±â€Š1.3° at the final follow-up. The mean bone fusion time was 6.8 ±â€Š1.2 months. All patients had satisfactory sagittal and coronal balance with no implant failure at the last follow-up. The average visual analog scale score was 6.2 ±â€Š1.0 preoperatively, and it decreased to 2.6 ±â€Š0.5 at the last follow-up. No patient suffered from neurological deterioration. The Oswestry disability index decreased from 39.8% ±â€Š4.6% preoperatively to 24.5% ±â€Š4.7% at the final follow-up. Complications occurred in 4 patients: 3 experienced tearing of the lung, and 1 had a superficial wound infection.Anterior removal of the implant and posterior vertebral column resection constituted a safe and effective revision surgery for patients with prior anterior fusion with rigid postsurgical deformities.

Continuous Epidural Irrigation and Drainage Combined with Posterior Debridement and Posterior Lumbar Inter-Body Fusion for the Management of Single-Segment Lumbar Pyogenic Spondylodiscitis.

Purpose: To observe the clinical curative effect of continuous epidural irrigation combined with posterior debridement and posterior lumbar inter-body fusion with instrumentation for the therapy of single-segment lumbar pyogenic spongdylodiscitis. Methods: From June 2010 to November 2013, surgical treatment was performed in 18 patients with pyogenic spondylodiscitis. The surgical indications were progressive biomechanical instability, epidural abscesses, deterioration of neurologic status, and intractable back pain. All these patients received posterior decompression with posterior instrumentation, debridement of infected tissue, and inter-body fusion. Visual Analogue Scale (VAS) scores were used to assess clinical outcomes. The neural function was evaluated by the Frankel grading system. Laboratory and radiologic results were recorded during clinical follow-up for at least one year. Results: The average follow-up period was 18 months after the operation. The VAS scores decreased from an average of 7.1 points before the procedure to 2.6 points after operation. The neurologic deficits of all the patients were recovered to Frankel grade E. All of the examined laboratory parameters were normalized gradually. Imaging-documented fusion was achieved in each patient, and no implants failure was noted. No patients showed any evidence of recurrence or persistence of infection. Conclusion: In carefully selected patients, single-segment lumbar pyogenic spondylodiscitis can be cured successfully with continuous epidural irrigation and drainage combined with posterior debridement and posterior lumbar inter-body fusion. Instrumentation could provide immediate stability and reconstruction of the spine column, and the presence of instrumentation did not result in any persistence or recurrence of infection. Continuous epidural irrigation and drainage is an effective method facilitating the elimination of residual infection.

Socioeconomic and Environmental Determinants to Preterm Birth in Tibetan Women: An Analysis Based on the Hierarchically Conceptual Frame.

BACKGROUND: Preterm birth is a common cause of death in newborns and may result from many determinants, but evidence for the socioeconomic and environmental determinants of preterm birth in Tibetan women of childbearing age is limited. The aim of this study was to understand the current status of preterm birth in native Tibetan women and investigate the socioeconomic and environmental determinants. METHODS: Data were drawn from a cohort study which was conducted from August 2006 to August 2012 in rural Lhasa, Tibet, China. A total of 1419 Tibetan pregnant women were followed from 20 weeks' gestation until delivery; the loss to follow-up rate was 4.69%. The incidence of preterm birth was estimated to show the status of preterm births in Tibet. Logistic regression models for longitudinal data were established, and odds ratios (ORs) together with 95% confidence intervals (CIs) were used to evaluate the association between the occurrence of preterm birth and 16 selected potential determinants based on the hierarchical conceptual frame. RESULTS: The incidence of preterm birth was 4.58% (95% CI = 3.55-5.80%). After adjusting for health-related variables of the mothers and newborns, socioeconomic and environmental determinants associated with preterm birth included season (spring: OR = 0.28, 95% CI = 0.09-0.84; autumn: OR = 0.21, 95% CI = 0.06-0.69; and winter: OR = 0.31, 95% CI = 0.12-0.82) and calendar year of delivery (2010: OR = 5.03, 95% CI = 1.24-20.35; 2009: OR = 6.62, 95% CI = 1.75-25.10; and 2007-2008: OR = 5.93, 95% CI = 1.47-23.90). CONCLUSIONS: The incidence of preterm birth among native Tibetan women was low and there was a decreasing trend in recent years; however, it is still essential to strengthen seasonal maternal care, extend the spacing between pregnancies, and reinforce adequate maternal nutrition.

Bronchogenic cyst of the conus medullaris with spinal cord tethering: a case report and review of the literature.

Bronchogenic cysts (BCs) are congenital malformations that originate from remnants of the primitive foregut. Intraspinal BCs, especially those of the conus medullaris are rare with only one case reported until now. To date, a bronchogenic cyst with spinal cord tethering has not been previously reported. We reviewed the clinical course of a 44-year-old woman, who presented with low back pain and leg weakness as well as sphincter disturbance. Magnetic resonance imaging showed an intradural oval mass located at the conus medullaris. A tethered cord was also observed, as well as a dermal sinus tract. The mass was totally removed after an L3-L4 laminectomy without detethering during operation. Pathologic examination confirmed the diagnosis of bronchogenic cyst. By six months after treatment, the patient had experienced nearly complete recovery. The review of literature indicated that detethering was performed in most reported cases of neurenteric cysts with spinal cord tethering, and one of six patients was diagnosed with a postoperative recurrence. The co-existence of bronchogenic cyst and a tethered spinal cord would imply associated developmental errors in embryogenesis. It is worth noting that whether detethering is necessary after the cyst removal.

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model.

OBJECTIVE: This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. METHODS: Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85%) of all 20 animals. The positive rate for bacteria presence was 45% by culture and 80% by pyrosequencing method. RESULTS: Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals. CONCLUSION: Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the "culprit" for the persistence or recurrence of infection.

[Association between the distribution of feeding index and physical development of infants and young children aged 6-35 months in rural areas of Lhasa in 2010].

OBJECTIVE: Using infant and child feeding index (ICFI) to evaluate the relationship between infant feeding and physical development indicators in rural areas of Lhasa. METHODS: In July and August 2010 in the rural areas of Lhasa, the multi-stage cluster random sampling method was adopted to select 540 Tibetan children who were between 6 to 35 months of age. There were 70, 79 and 391 cases in 6 to 8, 9 to 11 and 12 to 35-month-old group respectively. The basic status of infants, information about breastfeeding and complementary feeding were collected by using designed questionnaires. Their height and weight were measured to calculate the children's weight for age Z-score (WAZ), height for age Z-score (HAZ) and weight for height Z-score (WHZ) and assess feeding index score (out of 17 scores) and analyze the relationship between feeding index and HAZ, WAZ and WHZ. RESULTS: The mean ICFI score of 540 cases was 8.90 ± 2.82.It was 6.84 ± 3.16, 8.16 ± 2.78 and 9.41 ± 2.55 for 6 to 8, 9 to 11 and 12 to 35-month-old infants respectively. There was significant difference between the different month group (F = 30.99, P < 0.05).For the three month groups, the scores of WAZ were 0.10 ± 1.18, -0.09 ± 1.20 and -0.38 ± 0.96; HAZ were -0.60 ± 1.68, -1.02 ± 1.72 and -1.30 ± 1.30; WHZ were 0.62 ± 1.23, 0.69 ± 0.96 and 0.43 ± 0.95 respectively. The ICFI scores of 9 to 11, 12 to 35 and 6 to 35-month-old infants were positively correlated with HAZ (correlation coefficients were 0.25,0.12 and 0.09 respectively, all P values <0.05). There was no correlation with WAZ (correlation coefficients were 0.15,0.08 and 0.03 respectively, all P values >0.05) and WHZ (correlation coefficients were -0.08, -0.02, and -0.07 respectively, all P values >0.05). There were no correlation between ICFI score with HAZ, WAZ and WHZ for 6 to 8 month-old infants (correlation coefficient were 0.06,0.16 and -0.07 respectively, all P values >0.05). CONCLUSION: To some extent, the feeding index can effectively reflect the growth status of these infants and can serve as a comprehensive assessment of feeding situations among Tibetan children in rural areas of Lhasa.

Pedicle screw implantation in the thoracic and lumbar spine of 1-4-year-old children: evaluating the safety and accuracy by a computer tomography follow-up.

STUDY DESIGN: This was a retrospective clinical study. OBJECTIVE: To evaluate the safety and accuracy of pedicle screw placement in very young children and to observe its influence on vertebral and spinal canal growth. SUMMARY OF BACKGROUND DATA: Although widely used, it is not known if pedicle screw fixation is safe and effective in very young children. METHODS: Sixteen children, with an average age of 34 months, had received pedicle screw fixation from January 2003 to January 2010. Candidates for surgery were those patients who had hemivertebra deformity (11 patients), eosinophilic granuloma disease with spinal cord compression, and neurological deficit (2 patients), or spinal tuberculosis accompanied with kyphotic deformity (3 patients). The location of involved vertebrae was between T2 and L5. A total of 74 pedicle screws were implanted using a modified free-hand technique. The safety and accuracy of this method, and the influence on vertebral growth, was evaluated using postoperative x-ray and computer tomography scans. RESULT: The average follow-up was 30.6 months. No patient had any neurological or radicular symptoms related to the placement of pedicle screws. Postoperative computer tomography scans demonstrated a malposition of 5 of the 74 pedicle screws (6.8%). Two screws breached the anterolateral cortical bone of the vertebral body. One screw breached the lateral cortical bone of the pedicle, 1 passed through the anterior vertebral margin by 3 threads, and a third was so laterally placed that it entered into disk space. There was no vessel, visceral complications, or any other adverse effects resulting from these misplacements. No screw was placed so medially that injured the spinal cord. No retardation of vertebral growth was observed in 7 patients who were followed up for at least 3 and up to 7 years. CONCLUSIONS: The results indicate that in very young children, pedicle screws can be safely implanted using a modified free-hand implantation technique.

[Analysis on growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010].

OBJECTIVE: To understand the growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010. METHODS: Cross-sectional study and multistage sampling design were used to randomly select sampling units. A total of 640 children were studied. Height and weight were measured and nutritional status was evaluated with WHO reference in 2006 using Z-scores. Z-scores of weight-for-age (WAZ), Z-scores of height-for-age (HAZ) and Z-scores of weight-for-height (WHZ) were analyzed. RESULTS: At the age of 18 - 35 months, the children in rural Lhasa were 3.0 cm shorter as compared to the China national length reference. At the age of 6 - 11, 12 - 17 months, weight ((8.84 ± 1.23) and (10.20 ± 1.08) kg) and length ((70.45 ± 4.46) and (76.73 ± 4.78) cm) of boys were significantly higher than girls (weight: (8.42 ± 1.30) and (9.59 ± 1.26) kg; length: (67.61 ± 3.98) and (74.25 ± 4.50) cm) (all P values < 0.05). WAZ and HAZ were -0.17 ± 1.11 and -1.11 ± 1.46, respectively. The HAZ of 18 - 23 months children (-1.51 ± 1.24) was significantly different from the HAZ of 0 - 5, 6 - 11, 12 - 17 months children (HAZ: -0.75 ± 1.50, -0.83 ± 1.72, -1.07 ± 1.55, respectively) (all P values < 0.05), comparison with the HAZ of 24 - 29, 30 - 35 months children (HAZ: -1.41 ± 1.25, -1.24 ± 1.05), the results showed that there were no significant difference (all P values > 0.05), HAZ of 18 - 23 months children was the lowest. The prevalence of stunting, underweight, and wasting were 24.6% (155/630), 5.4% (33/616) and 1.0% (6/608), respectively. The malnutrition of boys was more serious than that of girls, the stunting of 18 - 23 and 24 - 29 months children had reached 35.0% (36/103) and 29.1% (25/86), respectively. CONCLUSION: The growth and development status of children in rural Lhasa under 3 years old was poor, and the malnutrition of local children should not be ignored with variations by gender and months of age.

Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity.

OBJECTIVE: The purpose of this study was to validate the efficacy and safety of single-stage posterior instrumentation and anterior debridement for treatment of active spinal tuberculosis with kyphotic deformity. METHOD: From January 2005 to January 2009, 13 males and 24 females were enrolled in this retrospective study. All patients underwent single-stage posterior instrumentation and fusion, combined with anterior radical debridement and bone grafting. Clinical and radiographic results were analysed. RESULTS: Patients were followed-up for 33.6 months on average. Bony fusion was achieved at six- to nine-month follow-up in all patients. The respective average kyphosis at the pre-operative and the last follow-up was 53.5° and 12.6°, with a mean correction of 40.9° (78.5%). Neurologic recovery averaged 1.5 grades on the Frankel scale. No recurrence of tuberculosis or instrumentation failure occurred. CONCLUSION: Single-stage posterior instrumentation and anterior debridement with fusion was demonstrated to be a safe and effective method to achieve spinal decompression and kyphosis correction in patients with Pott's disease.

[Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation].

OBJECTIVE: To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH). METHODS: From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed. RESULTS: All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01). CONCLUSIONS: Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.

[Study on the dietary pattern assessed with semi-quantitative food frequency questionnaire among rural Tibetan women with children younger than 2 years in Lhasa city].

OBJECTIVE: To explore the dietary pattern of rural Tibetan women with children under 2 years of age. METHODS: A cross-sectional survey on dietary pattern together with a semiquantitative food frequency questionnaire was conducted among Tibetan women in rural Lhasa in 2008. RESULTS: 386 women were investigated with the average age as 28.5 years old and average schooling-years as 4.6. For each member in the woman's family, daily intake of vegetable oil was 25.9 g on average. Daily intake of butter, sugar and salt were 27.8 g, 12.9 g and 14.8 g respectively, which were higher than figures from national nutrition and health survey (P < 0.01). Among 91 kinds of food under investigation, only 22 kinds with the frequencies of consumption more than 1 time per day. Three main factors were derived by factor analysis. The first factor represented vegetable pattern characterized with vegetables, grains, fruits and a few animal foods. It was a dominant pattern for the subjects, which explained nearly 10% variance. The second one was Tibetan style pattern in which Tibetan foods and a few vegetables were consumed. The last one called meats and milk products pattern also reflected the Tibetan dietary style. Daily intake of energy for women was 2097.02 kcal which met 91.2% of Chinese recommended nutrients intake (RNI). Daily intake of protein and fat reached 82% of RNI and vitamin A but only 34.7% on RNI. Daily intake of calcium, iron and zinc reached 64.6%, 174.1% and 150.7% of RNI, receptively. Grains provided 65% of energy but only 7.4% of the energy and 15.5% of protein were from animal foods. "Tsampa" provided 57.6% of iron. CONCLUSION: Vegetable pattern had been the dominant dietary pattern among Tibetan women in rural Lhasa. Intake of energy, protein and some micronutrients were not sufficient.

[Action mechanisms of plant growth-promoting rhizobacteria (PGPR): a review].

Plants during their growth may suffer from many biotic and abiotic stresses, resulting in a decrease of biological production. They may also establish some mechanisms to resist or tolerate the stresses under the stimulation or induction by a variety of factors, among which, plant growth-promoting rhizobacteria (PGPR) is an important one. In this paper, the recently published papers related to this subject were reviewed, and two categories of the action mechanisms of PGPR, namely, induced systemic resistance (ISR) and induced systemic tolerance (IST), were elaborated. The diversity of the action mechanisms of PGPR implied that PGPR could be applied in more agro-ecosystems.