Prediction Model for Lumbar Curve Correction after Selective Thoracic Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis.

STUDY DESIGN: A retrospective study. OBJECTIVE: To identify independent risk factors and construct a prediction model for lumbar curve correction (LCC) after selective thoracic fusion (STF) in patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: STF has been widely applied in Lenke 1 and 2 AIS patients. However, LCC after STF is still controversial. METHODS: 128 patients undergoing STF with at least 2 years follow-up were included. Cases were divided into high-LCC group and low-LCC group according to a rounded-up median of 65%. 49 variables were taken into account. Logistic regression was applied to identify independent predictive factors. Prediction model was established by backward stepwise regression, and its evaluation was implemented on R. RESULTS: Five parameters showed independent predictive value for low LCC: Right shoulder higher before surgery [right shoulder higher vs. balanced: odds ratio (OR)=0.244, P=0.014], postoperative Cobb angle of lumbar curve (LC) (OR=1.415, P=0.001, cut-off value=11°), lowest instrumented vertebra (LIV) distal to end vertebra (no vs. yes: OR=4.587, P=0.013), postoperative LIV tilt (OR=0.686, P=0.010, cut-off value=6.85°) and postoperative LIV+1 tilt (OR=1.522, P=0.005, cut-off value=6.25°). The prediction model included six variables: lumbar modifier, preoperative shoulder balance, postoperative Cobb angle of LC, LIV position, postoperative LIV tilt and postoperative LIV+1 tilt. Model evaluation demonstrated satisfactory capability and stability [area under curve=0.890, 10-fold cross-validation accuracy=0.782]. CONCLUSION: Preoperative shoulder balance, Cobb angle of LC, LIV position, postoperative LIV and LIV+1 tilt could be used to prognosticate LCC after STF. A model with solid prediction ability was established, which could further our understanding of LCC and assist in making clinical decisions.

Posterior Corrective Surgery for Type II Congenital Kyphosis: SRS-Schwab Grade 4 Osteotomy or Vertebral Column Resection?

OBJECTIVE: Surgical decision-making for congenital kyphosis (CK) with failure of anterior segmentation (type II) has been contradictory regarding the trade-off between the pursuit of correction rate and the inherent risk of the osteotomy procedure. This study was designed to compare the clinical and radiographic measurement in type II CK underwent SRS-Schwab Grade 4 osteotomy and vertebral column resection (VCR), the most-adapted osteotomy techniques for CK, and to propose the strategy to select between the two procedures. METHODS: This retrospective observational comparative study evaluated surgical outcomes in type II CK patients underwent VCR or SRS-Schwab Grade 4 osteotomy at our institution between January 2015 and January 2020. Patients operated with VCR and SRS-Schwab Grade 4 osteotomy were allocated to Group 1 and Group 2 respectively. Radiographic parameters and SRS-22 quality of life metrics were assessed at pre-operation, post-operation, and during follow-up visits for both groups, allowing for a comprehensive comparison of surgical outcomes. RESULTS: Thirty-one patients (19 patients in Group 1 and 12 patients in Group 2) aged 16.3 ± 10.4 years were recruited. Correction of segmental kyphosis was similar between groups (51.1 ± 17.6° in Group 1 and 48.4 ± 19.8° in Group 2, p = 0.694). Group 1 had significantly longer operation time (365.9 ± 81.2 vs 221.4 ± 78.9, p < 0.001) and more estimated blood loss (975.2 ± 275.8 ml vs 725.9 ± 204.3 mL, p = 0.011). Alert event of intraoperative sensory and motor evoked potential (SEP and MEP) monitoring was observed in 1 patient of Group 2. Both groups had 1 transient post operative neurological deficit respectively. CONCLUSION: SRS-Schwab Grade 4 osteotomy was suitable for kyphotic mass when its apex is the upper unsegmented vertebrae or the neighboring disc, or when the apical vertebrae with an anterior/posterior (A/P) height ratio of vertebral body higher than 1/3. VCR is suitable when the apex is located within the unsegmented mass with its A/P height ratio lower than 1/3. Proper selection of VCR and SRS-Schwab Grade 4 osteotomy according to our strategy, could provide satisfying radiographic and clinical outcomes in type II CK patients during a minimum of 2 years follow-up. Patients undergoing VCR procedure might have longer operation time, more blood loss and higher incidence of peri- and post-operative complications.

Predicting potential distribution of the Rhinoncus sibiricus under climatic in China using MaxEnt.

In recent years, buckwheat (Fagopyrum spp.) is being increasingly damaged by the Siberian tortoise beetle (Rhinoncus sibiricus Faust). Adults and nymphs feed on leaf tissues and caulicles, thus damaging its stems and leaves. In this study, we investigated the habits, distribution, and environmental impact of R. sibiricus using MaxEnt, an ecological niche model. Geographic information about the infestation site from previous field surveys and climatic data from 2013 to 2018 were organized and optimized using R. The impact factors were calculated using MaxEnt software. The results indicate that population fluctuations in R. sibiricus are related to changes in temperature, humidity, and their spatial distribution. Under current climatic conditions, R. sibiricus is mainly distributed in northern China, with sporadic distribution in south-western China. The values for a survival probability threshold > 0.3 were: precipitation during the wettest month (bio13), 70.31-137.56 mm; mean temperature of the coldest quarter (bio11), -15.00-0.85°C; mean temperature of the warmest quarter (bio10), 11.88-23.16°C; precipitation during the coldest quarter (biol9), 0-24.39 mm. The main factors contributing > 70% to the models were precipitation during the wettest month and coldest quarter, and mean temperature during the warmest and coldest quarters. Under both future climate models, the center of the fitness zone moves northward. Our results will be useful in guiding administrative decisions and support farmers interested in establishing control and management strategies for R. sibiricus. This study could also serve as a reference for future research on other invasive pests.

Intra-operative Neurophysiological Monitoring in Patients Undergoing Posterior Spinal Correction Surgery with Pre-operative Neurological Deficit: Its Feasibility and High-risk Factors for Failed Monitoring.

OBJECTIVE: Considering spinal deformity patients with pre-operative neurological deficit were associated with more intra-operative iatrogenic neurological complications than those without, intra-operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. To analyze the performance of intra-operative neurophysiological monitoring (IONM) including somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) in patients with pre-operative neurological deficit undergoing posterior spinal correction surgery, and to identify the high-risk factors for failed IONM. METHODS: Patients with pre-operative neurological deficit undergoing posterior spinal correction surgery between October 2017 and January 2022 were retrospectively reviewed. The presence or absence of SEP and MEP of target muscles were separately recorded. The P37/N50 latency and amplitude of SEP, and the MEP amplitude were measured. Any IONM alerts were also recorded. The IONM performance was compared among patients with different etiologies, levels responsible for neurological deficit, and strength of IONM-target muscles. Patients' demographics were analyzed using the descriptive statistics and were presented with mean ± standard deviation. Comparison analysis was performed using χ2 -test and statistically significant difference was defined as p < 0.05. RESULTS: A total of 270 patients (147 males, 123 females) with an average age of 48.4 ± 36.7 years were involved. The SEP records were available in 371 (68.7%) lower extremities while MEP records were available in 418 (77.4%). SEP alerts were reported in 31 lower extremities and MEP alerts in 22, and new neurological deficit at post-operation was observed in 11. The etiologies of neuromuscular and syndromic indicated relatively lower success rates of IONM, which were 44.1% and 40.5% for SEP, and 58.8% and 59.5% for MEP (p < 0.001). In addition, patients with pre-operative neurological deficit caused by cervical spine and muscle strength lower than grade 4 suffered from higher risk of failed IONM waveforms (p < 0.001). CONCLUSION: Patients with pre-operative neurological deficit suffered from a higher incidence of failed IONM results. The high-risk for failed IONM waveforms included the neuromuscular and syndromic etiologies, neurological deficit caused by cervical spine, muscle strength lower than grade 4 in patients with pre-operative neurological deficit undergoing posterior spinal correction surgery.

Isolation and Identification of Herbicidal Active Compounds from Brassica oleracea L. and Exploration of the Binding Sites of Brassicanate A Sulfoxide.

Brassica oleracea L. has strong allelopathic effects on weeds. However, the allelochemicals with herbicidal activity in B. oleracea L. are still unknown. In this study, we evaluated the activity of allelochemicals isolated from Brassica oleracea L. based on the germination and growth of model plant Lactuca sativa Linn., grass weed Panicum miliaceum, and broadleaf weed Chenopodium album. Additionally, we employed molecular docking to predict the binding of brassicanate A sulfoxide to herbicide targets. The results of this study showed that eight compounds with herbicidal activity were isolated from B. oleracea L., and the predicted results indicated that brassicanate A sulfoxide was stably bound to dihydroxyacid dehydratase, hydroxymethylpyruvate dioxygenase, acetolactate synthase, PYL family proteins and transport inhibitor response 1. This research provides compound sources and a theoretical foundation for the development of natural herbicides.

Indole-3-acetonitrile Is a Critical Molecule with Weed Allopathic Suppression Function in Broccoli (Brassica oleracea var. italica).

Cruciferous plants are frequently used for ecologically benign weed control in agricultural production. Most effective Broccoli varieties were screened using the entropy method-based topsis model at first. Result showed that varieties of Lvwawa and Lvbaoshiwere most effective in allelopathic suppression on radishes. Column and thin-layer chromatography were used to extract the allelopathic compounds from broccoli residues, which contained various herbicidal active substances; among them, purified single-molecule indole-3-acetonitrile has a stronger inhibitory effect than pendimethalin (commercial herbicide). The weed inhibition rate increased with increasing broccoli residue dosage, with a 40 g/m2 broccoli residue dose yielding the highest suppression rate. Its effect was similar to that of indole-3-acetic acid. Too much of this substance leads to the plant's death. Moreover, broccoli residues had effective control effect on weeds in natural soils in greenhouse and field trials. The results demonstrated that broccoli residue could be used for weed management in field for abundant allopathic suppression molecules to weeds, and that Indole-3-acetonitrile is one of the most important allopathic molecule.

Intra-Operative Neurophysiological Monitoring in Patients with Thoracic Spinal Stenosis: Its Feasibility and High-Risk Factors for New Neurological Deficit.

OBJECTIVE: Considering the high risk of postoperative neurological complications for patients with thoracic spinal stenosis (TSS), intra-operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. This article is designed to determine the test performance of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) during surgical thoracic decompression in patients with TSS, and to investigate the risk factors associated with deteriorated neurologic function at immediate postoperation. METHODS: Patients undergoing posterior spinal fusion from February 2009 to December 2020 were retrospectively reviewed. Patients were divided into the deteriorated neurologic function (DNF) group and the improved/intact neurological function (INF) group based on the postoperative neurological status. Demographic parameters such as gender, age, height, weight, etiology and IONM data were compared between groups. Demographics and IONM data between DNF and INF groups were compared by independent t or nonparametric tests. The incidence of abnormal SEP was analyzed by Chi-square test. RESULTS: A total of 108 patients (63 males, 45 females) with an average age of 53.5 ± 14.0 years were included. The SEP and MEP records were available in 94 and 98 patients, with the overall success rates being 87.0% and 90.7%, respectively. The sensibilities and specificities were 100% and 88.2% for SEP, 100% and 98.8% for MEP, respectively. There were 17 patients in DNF group and 91 patients in INF group. High weight (79.1 ± 14.6 vs 69.7 ± 15.7 kg, P = 0.024), high inter-side difference of MEP amplitude (899.1 ± 997.5 vs 492.3 ± 512.4 µV, P = 0.013) and high incidence of abnormal SEP (94.1% vs 64.8%, P = 0.024) were observed in the DNF group. Fourteen (82.4%) patients in the DNF group showed improvement in neurological status during follow-up. CONCLUSIONS: The overall success rates were 87.0% for SEP and 90.7% for MEP in patients with TSS.

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors.

PRUPOSE: To analyze the incidence and risk factors of intraoperative neurophysiological monitoring (IONM) alerts in patients undergoing three-column osteotomy. METHODS: A total of 551 patients (340 males and 211 females) with an average age of 31.9 years undergoing posterior 3-column osteotomy were retrospectively reviewed. The coronal Cobb angle of main curve and sagittal global kyphosis were measured on preoperative standing whole spinal x-rays. The Frankel scores at preoperation, postoperation, and the last follow-up were recorded and applied for assessment of neurologic status. Surgical procedures and other factors associated with IONM alerts were analyzed. RESULTS: A total of 98 (17.8%) IONM alerts were reported during surgery, including 82 somatosensory evoked potential alerts and 91 motor evoked potential alerts. Positive wake-up test was revealed in 57 patients (10.3%) even after prompt managements, and new neurologic deficits were observed in 50 patients (9.1%) at immediate postoperation. Of the 50 patients with new neurologic deficits at postoperation, the Frankel scores were A in 5 patients, B in 4, C in 9, and D in 32. The χ 2 test showed that patients with congenital deformities, global kyphosis >90°, vertebral column resection procedure, cervicothoracic/thoracic osteotomy, blood loss >3,000 mL, and preoperative neurologic deficit were at a higher risk of IONM alerts. CONCLUSIONS: The incidence of IONM alerts in patients undergoing 3-column osteotomy was 17.8%. Congenital deformities, global kyphosis >90°, vertebral column resection, cervicothoracic/thoracic osteotomy, blood loss >3,000 mL, and preoperative neurologic deficit indicated high risk of IONM alerts.

Intra-Operative Neurophysiological Monitoring in Patients with Intraspinal Abnormalities Undergoing Posterior Spinal Fusion.

OBJECTIVE: To analyze the intraoperative neurophysiological monitoring (IONM) data of patients with intraspinal abnormalities undergoing posterior spinal fusion and to determine how intraspinal abnormalities influence IONM results. METHODS: Patients with severe kyphoscoliosis and intraspinal abnormalities who underwent posterior spinal correction and fusion between September 2015 and January 2019 were retrospectively reviewed. Candidate intraspinal abnormalities included Chiari malformation, syringomyelia, split cord malformation, and tethered cord syndrome. Total intravenous anesthesia was administered, and no muscle relaxant or inhalation anesthesia was used for maintenance. IONM data, including somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP), were recorded. The P37 and N50 latencies and amplitude were recorded for SSEP, whereas only the amplitude was recorded for MEP. The possible high-risk factors for abnormal IONM results were analyzed. RESULTS: The current study included 87 patients (40 men, 47 women) with an average age of 20.2 ± 10.4 years. The etiologies were neuromuscular in 45 patients, idiopathic in four, and congenital in 38. A total of 136 intraspinal abnormalities were detected, including Chiari malformation in 33 patients, syringomyelia in 55, split-cord malformation in 25, and tethered cord syndrome in 23. Forty patients had one intraspinal abnormality, whereas 47 patients had two or three intraspinal abnormalities. The monitorabilities were 87.4% and 97.7% for the SSEP and MEP, respectively. SSEP alerts were reported in five patients and MEP alerts in four patients, and new neurological deficits were observed in three patients postoperatively. The sensitivity and specificity were 100% and 97.3% for SSEP, and 100% and 98.8% for MEP, respectively. A significant difference in MEP amplitude between the concave and convex sides was observed, while significantly higher SSEP latency was observed on the concave side in patients with preoperative neurological deficits. There were 52 (59.8%) patients with abnormal IONM data. Preoperative neurological deficits (χ2  = 7.715, p = 0.005) and more than one intraspinal abnormality (χ2  = 9.186, p = 0.004) indicated a higher risk of abnormal IONM data. CONCLUSIONS: IONM can be effectively used in patients with intraspinal abnormalities who undergo posterior spinal fusion. Patients with preoperative neurological deficits and more than one intraspinal abnormality have a higher risk of abnormal IONM monitoring.

Failed Primary Surgery in Congenital Scoliosis Caused by a Single Hemivertebra: Reasons and Revision Strategies.

OBJECTIVE: To analyze the factors causing failure of primary surgery in congenital scoliosis (CS) patients with single hemivertebra (SHV) undergoing posterior spinal fusion, and to elucidate the revision strategies. METHODS: In this retrospective study, a total of 32 CS patients secondary to SHV undergoing revision surgery from April 2010 to December 2017 due to failed primary surgery with more than 2 years follow-up were reviewed. The reasons for failure of primary surgery and revision strategies were analyzed for each patient. The radiographic parameters including coronal Cobb angle, segmental kyphosis (SK), coronal balance (CB), and sagittal vertical axis (SVA) were compared between pre- and post-revision. The complications during revision and follow-up were recorded. RESULTS: The mean age at revision surgery of the 32 CS patients was 15.8 ± 9.7 years and the average duration between primary and revision surgery was 31.0 ± 35.4 months. The reasons for failed primary surgery were severe post-operative curve progression of focal scoliosis in 14 cases (43.8%), implant failure in 17 (53.1%) and trunk imbalance in 12 (37.5%). The candidate revision strategies included thorough resection of residual hemivertebra and adjacent discs, extending fusion levels, complete pseudarthrosis resection, massive bone graft, replacement of broken rods, satellite rod fixation, horizontalization of upper/lower instrumented vertebrae and rigid fusion of structural compensatory curves were performed individually. After revision surgery, the coronal Cobb angle, SK, CB and SVA showed significant improvement (P < 0.05) with no significant correction loss during follow-up (P > 0.05). The intra-operative complications included alarming changes of neurologic monitoring in three (9.4%) patients and dual tear in two, while rod fracture re-occurred was detected in one patient at 18 months after revision. CONCLUSIONS: The common reasons for failed primary surgery in CS patients with SHV undergoing posterior spinal fusion were severe post-operative curve progression of focal scoliosis, implant failure and trunk imbalance. The revision strategies including thorough resection of residual hemivertebra and adjacent discs, extended fusion levels to structural curvature, complete pseudarthrosis resection, massive bone graft, replacement of broken internal fixation and horizontalization of upper/lower instrumented vertebrae should be individualized based on the causes of failed primary surgery.

Intra-operative neurophysiological monitoring in patients with dystrophic neurofibromatosis type 1 scoliosis.

OBJECTIVE: To analyse the intra-operative neurophysiological monitoring (IONM) data in patients with dystrophic neurofibromatosis type 1 (NF1) associated scoliosis, and to investigate the possible risk factors for failed IONM monitoring. METHODS: Patients undergoing posterior spinal fusion from September 2015 to December 2019 were retrospectively reviewed. The latency (P37, N50) and amplitude of somatosensory evoked potentials (SEP) in bilateral lower extremities, latency and amplitude of motor evoked potentials (MEP) in bilateral lower extremities and unilateral upper extremity were recorded. The neurological status, curve pattern, Cobb angle of main curve, vertebral rotatory subluxation and dystrophic features at pre-operation were assessed for each patient. The failed IONM monitoring was defined as no reliable SEP or MEP waveforms of all monitored muscles. RESULTS: A total of 92 patients (53 M, 39 F) with an average age of 14.1 ± 2.7 years were included. Failed IONM monitoring was identified in 17 patients with overall success rates being 87.0 and 94.6% for SEP and MEP. The average P37 latency, N50 latency, SEP amplitude and MEP latency showed no significant difference between concave and convex sides (p > 0.05 for all). The MEP amplitudes of lower extremities were lower on concave side than convex side (334.5 ± 291.9 µV VS 417.5 ± 380.5 µV, p = 0.030). Higher risk of failed IONM monitoring was found in patients with neurological deficit (p = 0.014) and more dystrophic features (p = 0.002) at pre-operation. CONCLUSIONS: The overall success rates were 87.0% for SEP and 94.6% for MEP in patients with NF1-associated scoliosis. Neurological deficit and more dystrophic features at pre-operation indicated higher risk of failed IONM monitoring.

Occurrence and Distribution of Rhinoncus sibiricus (Coleoptera: Curculionoidea) and Its Preference for Two Buckwheat Species in China.

Rhinoncus sibiricus Faust, a major pest of buckwheat, has invaded the buckwheat cultivation areas of China for years. This pest was first found in Russia in 1940, causing great damage during the entire buckwheat-growing season. In China, there are few records on R. sibiricus, and studies regarding pest damage on buckwheat are unknown. The occurrence and distribution of this species in China is still not clear. We therefore conducted field surveys for 6 yr to identify the distribution range and the degree of pest damage caused by R. sibiricus in the buckwheat-planting areas of China and tested its preference for two Fagopyrum species in common garden experiments. The results showed that R. sibiricus had a larger distribution range in the Northern rather than the Southern part of China, and that pest damage was more serious in northern China. The pest preferred F. tataricum (Tartary buckwheat, Polygonales: Polygonaceae) over F. esculentum (Common buckwheat, Polygonales: Polygonaceae), but caused damage to both, indicating its potential for distribution in southern China. This study clarified the occurrence, distribution, and damage traits of R. sibiricus in the buckwheat cultivation areas of China, which will help explain the pest attack traits and inform strategies for pest control and prediction.