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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

Abstract Aims Acute myocardial infarction (AMI) is a cardiovascular disease with high morbidity and mortality. We collected patients with AMI from the Medical Information Mart for Intensive Care IV (v2.0) database and explored the association between serum albumin‐corrected anion gap (ACAG) level and mortality in patients with AMI. Methods and results Data of adult patients with AMI were collected. According to the 360 day prognosis, patients were divided into survival and non‐survival groups. Based on the ACAG level, patients were then divided into normal and high ACAG groups. Cox hazard proportional models and restricted cubic splines (RCSs) were used to investigate the correlation between ACAG and mortality. Kaplan–Meier curves were created to compare the cumulative survival rates between the high and normal ACAG groups. The receiver operating characteristic (ROC) curve was used to analyse the predictive value of ACAG for the prognosis of patients with AMI. Sensitivity and subgroup analyses were conducted to revalidate the results. Finally, 1783 patients were included. Elevated ACAG (>20 mmol/L) was significantly associated with 30 and 360 day mortality (P 20 mmol/L) was an independent risk factor of increased all‐cause mortality in patients with AMI (hazard ratio 1.423, 95% confidence interval 1.206–1.678, P

Objective Clinical and radiographic degenerative spondylolisthesis (CARDS) classification was proposed to differentiate homogenous lumbar degenerative spondylolisthesis (LDS) subgroups. The sitting radiograph exhibited lumbar malalignment with maximum lumbar kyphosis, intervertebral kyphosis, and spondylolisthesis.This study aimed to assess the sitting radiograph for distribution of clinical and radiographic degenerative spondylolisthesis classification, and to elucidate its significance for exhibiting kyphotic alignment (CARDS type D) and segmental instability. Methods A cohort of 101 patients with symptomatic lumbar degenerative spondylolisthesis (LDS) between September 2018 and December 2020 were recruited. The distribution and relibility of CARDS classification with or without sitting radiograph was assessed. The translational and angular range of motion and segmental instability was also evaluated. Univariate analysis of variance was used for multiple groups, and the least significant difference for two groups. Kappa consistency test of intrarater and interrater was evaluated for CARDS classification with or without sitting radiograph. Chi‐square test was used to compare paried categorical data. Results Utility of sitting radiographs for CARDS classification revealed higher percentage of type D than that without the sitting radiograph (p

Objective Isthmic spondylolisthesis (IS) is distinguished by a congenital defect or acquired fracture of the pars interarticularis. Numerous studies on L5 low‐grade IS have been carried out; however, there is a paucity of data regarding the condition of L5 IS concomitant with L4/5 disc herniation. This study aimed to identify the incidence rate and to illustrate the possible risk factors for L4/5 disc herniation in L5 low‐grade IS patients. Methods A total of 268 consecutive patients diagnosed as L5/S1 low‐grade IS between May 2017 and May 2022 were retrospectively enrolled in this study. Depending on the presence of L4/5 disc herniation or not, patients were divided into an L4/5 disc herniation group (L4/5 DH) and an L4/5 non‐disc herniation group (L4/5 non‐DH). Radiographic parameters were measured, and the ratios of L4–S1 segmental lordosis (SL) to lumbar lordosis (LDI), L4 inferior endplate (IEP) to L5 superior endplate (SEP) (L4 IEP/L5 SEP), and L5 IEP to S1 SEP (L5 IEP/S1 SEP) were compared between groups. The Pfirrmann grade of the L4/5 disc and the L5/S1 disc, and Roussouly classifications of each patient were also recorded. Univariate analysis (including independent‐samples t‐test and χ2‐test) and multiple logistic regression analysis were performed to analyze the data. Results There were 40 patients (14.9%) in the L4/5 DH group. The Roussouly classification differed significantly between groups. As demonstrated by the Pfirrmann grade, the L4/5 DH group showed more advanced disc degeneration at L4/5 than the L4/5 non‐DH group. In contrast to the L4/5 non‐DH group, the L4/5 DH group had a significantly larger L4 IEP, L4 IEP/L5 SEP, S1 SEP, and LDI while smaller L4/5 disc angle, L4/5 disc height, slip percentage, lumbar lordosis, and sacral slope. Multivariate logistic regression analysis revealed that higher L4/5 disc Pfirrmann grade (p = 0.004), decreased L4/5 disc height (p

Abstract Muling River, situated amidst cultivated lands in Heilongjiang Province, northeastern China, has long been subjected to sand‐digging activities, resulting in severe damage to its riverbed. However, little research has been conducted on the impact of this disturbance on the status of fish community structure and trophic guilds in this river. In this study, environmental factors, fish community structure, and fish trophic guild biomass distribution patterns from the Muling River basin were investigated among seasons (spring, summer, and autumn) and sections (upper, middle, and lower stream) in 2015 and 2017. During the six sampling times periods, 46 species of five orders and 12 families of fish were classified into seven trophic guilds. Fish species number and biomass were higher upper reaches of the watershed. The insectivores (16.26%), phytoplanktivores (10.09%), benthivores (40.17%), and omnivores (11.86%) were the dominant trophic guilds. We found that fish trophic guilds biomass and environmental factors such as transparency, water depth, pH value, total phosphorus, and chemical oxygen demand were highest in the upper section compared to other sections. Variation partitioning revealed that fish trophic guilds biomass was influenced more by environmental factors (61.2%), followed by section (0.7%) and season (0.1%). Partial RDA ordination showed that fish trophic guilds were positively correlated with water depth and transparency, while negative with turbidity. This study underscores the importance of considering trophic guilds of freshwater fishes to inform management strategies in regions experiencing significant environmental change.

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

Abstract Arbitrary‐oriented object detection is widely used in aerial image applications because of its efficient object representation. However, the use of oriented bounding box aggravates the imbalance between positive and negative samples when using one‐stage object detectors, which seriously decreases the detection accuracy. We believe that it is the anchor learning strategy (ALS) used by such detectors that needs to take the responsibility. In this study, three perspectives on ALS design were summarised and ALS—Performance Releaser with Smart Anchor Learning (PRSAL) was proposed. Performance Releaser with Smart Anchor Learning is a dynamic ALS that utilises anchor classification ability as an equivalent indicator to anchor box regression ability, this allows anchors with high detection potential to be filtered out in a more reasonable way. At the same time, PRSAL focuses more on anchor potential and it is able to automatically select a number of positive samples that far exceed that of other methods by activating anchors that previously had a low spatial overlap, thereby releasing the detection performance. We validate the PRSAL using three remote sensing datasets—HRSC2016, DOTA and UCAS‐AOD as well as one scene text dataset—ICDAR 2013. The experimental results show that the proposed method gives substantially better results than existing models.

Abstract Most unsupervised or semisupervised hyperspectral anomaly detection (HAD) methods train background reconstruction models in the original spectral domain. However, due to the noise and spatial resolution limitations, there may be a lack of discrimination between backgrounds and anomalies. This makes it easy for the autoencoder to capture the low‐level features shared between the two, thereby increasing the difficulty of separating anomalies from the backgrounds, which runs counter to the purpose of HAD. To this end, the authors map the original spectrums to the fractional Fourier domain (FrFD) and reformulate it as a mapping task in which restoration errors are employed to distinguish background and anomaly. This study proposes a novel frequency‐to‐spectrum mapping generative adversarial network for HAD. Specifically, the depth separable features of backgrounds and anomalies are enhanced in the FrFD. Due to the semisupervised approach, FTSGAN needs to learn the embedded features of the backgrounds, thus mapping and restoring them from the FrFD to the original spectral domain. This strategy effectively prevents the model from focussing on the numerical equivalence of input and output, and restricts the ability of FTSGAN to restore anomalies. The comparison and analysis of the experiments verify that the proposed method is competitive.

Objective Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by osteophytes in the anterior vertebrae, and the presence of aorta may have an impact on their formation. However, the anatomical positional relationship between the aorta and osteophytes in patients with DISH remains controversial. This study aimed to evaluate the position of osteophytes in relation to aorta in DISH, and the influence of aortic pulsation on the formation of osteophytes from the perspective of morphology. Methods We conducted a retrospective review of 101 patients diagnosed with DISH and symptomatic lumbar spinal stenosis between June 2018 and December 2021. A total of 637 segments with heterotopic ossification in DISH were used for quantitative measurements on CT scans. The Cartesian coordinate system was built up on the axial CT scans to reflect the relative position between aorta and osteophytes. Osteophytes were divided into adjacent aorta group (AD group) and non‐adjacent aorta group (N‐AD group). In terms of the morphology, osteophytes in the AD group were further divided into convex, flat, and concave types. The relative position between aorta and osteophytes, and the aorta‐osteophyte distance and morphology of osteophytes were compared. Univariate analysis of variance was performed for multiple groups, and two independent‐samples t‐tests were used for two groups. Results From T5 to L4, aorta gradually descended from left side to middle of vertebrae, and osteophytes gradually shifted from right side of vertebrae (T5‐T10) to bilateral sides (T11‐L4). Of 637 osteophytes in DISH, 60.1% (383/637) were in AD group, including convex type 0.6% (4/637), flat type 34.7% (221/637), and concave type 24.8% (158/637). The N‐AD group accounted for 39.9% (254/637). Flat osteophytes were concentrated in T5‐T12, while concave osteophytes in T11‐L4. Overall, the aorta‐osteophyte distance of concave type was significantly smaller than that of flat type. Conclusion Osteophytes are not always located on the right side of vertebrae, but move with the position of the descending aorta. Furthermore, the morphology of osteophytes varies by vertebral segment in DISH, which is related to aorta descending anteriorly in the spine.

Abstract In order to ensure the high precision and good dynamic characteristics of the dual‐axis linear motor when machining components, the tracking error and contour error should be reduced with more complex machining trajectory. In this study, the characteristic model of position control of the linear motor is established by using the modelling principle of the characteristic model, and the intelligent adaptive controller is designed. In addition, a new calculation method of the equivalent contour error is proposed innovatively, and the dual axis is compensated by proportional feedback control, to improve the contour accuracy of the permanent magnet synchronous linear motor dual‐axis control system. Finally, through the simulation and experiment of the dual‐axis motor platform, the effectiveness of the proposed contour error calculation method and the intelligent adaptive controller can make the dual‐axis motion control system have higher accuracy and strong robustness and can also make the motor run more smoothly.

Abstract Optimal transcriptional regulatory circuits are expected to exhibit stringent control, maintaining silence in the absence of inducers while exhibiting a broad induction dynamic range upon the addition of effectors. In the Plac/LacI pair, the promoter of the lac operon in Escherichia coli is characterized by its leakiness, attributed to the moderate affinity of LacI for its operator target. In response to this limitation, the LacI regulatory protein underwent engineering to enhance its regulatory properties. The M7 mutant, carrying I79T and N246S mutations, resulted in the lac promoter displaying approximately 95% less leaky expression and a broader induction dynamic range compared to the wild‐type LacI. An in‐depth analysis of each mutation revealed distinct regulatory profiles. In contrast to the wild‐type LacI, the M7 mutant exhibited a tighter binding to the operator sequence, as evidenced by surface plasmon resonance studies. Leveraging the capabilities of the M7 mutant, a high‐value sugar biosensor was constructed. This biosensor facilitated the selection of mutant galactosidases with approximately a seven‐fold improvement in specific activity for transgalactosylation. Consequently, this advancement enabled enhanced biosynthesis of galacto‐oligosaccharides (GOS).

Objective Three‐column osteotomy (3CO) is considered valuable and increasingly utilized in the surgical treatment of severe spine deformity while associated with high implant‐related complications and revision risks. This study aims to evaluate the feasibility and clinical outcomes of satellite rod fixation used around the rod‐fracture area in revision surgery due to rod fracture after 3CO. Methods Twenty‐five patients applying satellite rod fixation in revision surgery from August 2012 to May 2016 were retrospectively reviewed as the SR group. Patients undergoing revision surgery with traditional strategy after 3CO due to rod‐fracture were selected as the TR group. Cobb angle, distance between C7 plumb line and center sacral vertical line (C7PL‐CSVL), global kyphosis (GK) and sagittal vertical axis (SVA) were assessed. Patients were required to fulfill the Scoliosis Research Society‐22 questionnaire (SRS‐22) at pre‐revision and the last follow‐up. The paired t test was used to analyze the difference among pre‐revision, post‐revision and last follow‐up. Results There was no statistical difference in terms of age, gender, body mass index (BMI), fusion level at 1st surgery, and follow‐up period between SR and TR group (all P > 0.05). The operation time (1.5 ± 0.7 h vs 3.2 ± 0.9 h, P 0.05). All patients responded to the SRS‐22 questionnaire and all the domains showed improvements in different levels. As compared to the TR group, the SR group had significantly better pain and management satisfaction scores (all P

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.

Objective Junctional kyphosis is a common complication after corrective long spinal fusion for adult spinal deformity. Whereas there is still a paucity of data on junctional kyphosis, specifically among late posttraumatic thoracolumbar kyphosis (LPTK) patients. Thus, the aim of this study was to investigate the characteristics and risk factors of junctional kyphosis in LPTK patients receiving long segmental instrumented fusion. Methods We retrospectively reviewed a cohort of LPTK patients who had received long segmental instrumented fusion (>4 segments) in our center between January 2012 and January 2019. Radiographic assessments included the sagittal alignment, pelvic parameters, bone quality on CT images, and measurements of the cross‐sectional area (CSA, cross‐sectional area of muscle‐vertebral body ratio × 100) and fat saturation fraction (FSF, cross‐sectional area of fat‐muscle body ratio × 100) of paraspinal muscles. Patients in this study were divided into those with junctional kyphosis or failure (Group J) and those without (Group NJ) during follow‐up. Group J included patients with junctional kyphosis (Group JK) and patients with junctional failure (Group JF). Results A total of 65 patients (16 males and 49 females, average age 56.5 ± 23.4 years) were enrolled in this study. After (32.7 ± 8.5) months follow‐up, 15 patients (23.1%) experienced junctional kyphosis, and four of them deteriorated into junctional failure. Eighty percent (12/15) of junctional kyphosis was identified within 6 months after surgery. In comparison with Group NJ, Group J were older (P = 0.026), longer fusion levels (P

Abstract At present, the clinicopathological features, optimal treatment patterns, and prognosis of breast metaplastic squamous cell carcinoma (SCC) are not fully understood and are still controversial. Here, we report a 56‐year‐old female patient with breast infiltrating ductal carcinoma with axillary lymph node metastasis of metaplastic SCC admitted to our hospital. Their homology was clarified by comparing the gene mutation results of the two lesions, that is, the axillary lymph node lesion was a metastasis of breast metaplastic SCC. We treated the patient with Poly ADP‐ribose Polymerase (PARP) inhibitors in combination with immune checkpoint inhibitors (ICIs) and found that she could achieve clinical benefit from the combination regimen. We reported a successful diagnosis and treatment of this rare refractory disease and reviewed the literature on the characteristics, pathogenesis, and advances in the diagnosis and treatment of breast metaplastic SCC.

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.

Objective Growing rods surgery is the mainstay of treatment for early‐onset scoliosis (EOS) while proximal junctional kyphosis (PJK) is one of the most commonly reported postoperative complications. We sought to investigate the impact of the location of upper instrumented vertebra (UIV) in relation to the sagittal apex on proximal junctional kyphosis in EOS after traditional growing rods (GRs) treatment. Methods A total of 102 EOS patients who received traditional growing rods treatment with a follow‐up of at least 2 years between 2009 and 2020 were retrospectively reviewed. Radiographic measurements were performed before and after the index surgery and at the latest follow‐up. We investigated the coronal Cobb angle and spinopelvic parameters of the whole spine. The location of the UIV, apex, lower instrumented vertebra (LIV), inflection vertebra (IV), the number and distance of UIV‐apex, LIV‐apex and IV‐apex were also recorded. Risk factors for PJK were analyzed by logistic regression analysis. Results PJK was observed in 21 patients (20.6%) during the follow‐up period. The PJK group showed a younger age at the index surgery (5.9 vs. 7.1 years, P = 0.042), more lengthening procedure times (5.0 vs. 4.0, P = 0.032), larger preoperative coronal Cobb angle (82.0 vs. 75.6°, P = 0.038), higher correction rate (51.2% vs. 44.4%, P = 0.047) and larger postoperative proximal junctional angle (PJA) (13.9 vs. 5.5°, P

Objective To investigate the causes of failed primary surgery and the revision strategies for congenital scoliosis (CS) patients with lower lumbar/lumbosacral (LL/LS) hemi‐vertebra (HV). Methods Fifteen CS patients with LL/LS HV (seven females and eight males) with a mean age of 20.4 ± 10.4 years undergoing revision surgery in our center were retrospectively reviewed. The radiographic parameters including Cobb angle, distance between C7 plumb line and center sacral vertical line (C7PL‐CSVL), thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA) were assessed at pre‐revision, post‐revision and the last follow‐up. The causes of failure in primary operation, and radiographic and clinical outcomes of revision procedures were analyzed. Results The revision rate of patients undergoing LL/LS HV resection and correction surgery was 11.4%. The average time interval between primary surgery and revision surgery was 18.2 ± 10.6 months. The operation duration and estimated blood loss of revision surgery were 194 ± 56 min and 326 ± 74 ml, respectively. Reasons for failed primary operations were as follows: internal fixation fracture in 10 cases, curve progression in two cases, implant loose in two cases and post‐operative coronal imbalance in one case. The post‐revision Cobb angle was significantly improved from 29.9° ± 8.3° to 18.7° ± 6.7° (P 0.05). At the last follow‐up, no significant correction loss of above coronal and sagittal parameters were observed (all P > 0.05). The revision methods were individualized according to the primary surgical procedures and the reasons for revision. The recommended revision strategies include incision of pseudarthrosis with sufficient bone graft, fixation of satellite rods, thorough residual HV excision, prolonged fusion to S2 and transforaminal lumbar interbody fusion at lumbosacral region. Solid bony fusion and no implant‐related complication were detected during the follow‐up. Conclusions The causes of revision surgery for patients with congenital scoliosis (CS) due to lumbosacral HV were verified and implant failure with pseudarthrosis was the main reason for failed primary operation.

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). 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.

Abstract This case highlights the importance of coordinating with cardiopediatricians or congenitalists in the evaluation and treatment of ASD.

Abstract Hematologic and neurological expression 1 (HN1) has been reported to involved in certain cancers, but its role in hepatocellular carcinoma (HCC) is largely unknown. The contribution of HN1 to HCC progression was investigated in the present study. We found that HN1 was significantly up‐regulated in HCC tissues, compared with normal tissues, by analyzing the Oncomine and Human Protein Atlas database; and found that high expression of HN1 was markedly associated with worse overall survival, relapse‐free survival, progression‐ free survival and disease‐specific survival in HCC patients via exploring the Kaplan‐Meier plotter database. Functional assays revealed that HN1 knockdown by siRNA induced G1 cell cycle arrest, and inhibited the growth and migration of HCC cells; accordingly, HN1 over‐expression promoted HCC cells proliferation and migration. Further studies indicated that HN1 knockdown reduced the expression of cyclin D1 and CDK4, while upregulated the cell cycle inhibitor p21WAF1/Cip1. Moreover, HN1 knockdown decreased c‐Met (receptor tyrosine kinase of hepatocyte growth factor) expression, and suppressed ERK activation, which is a common downstream signaling pathway triggered by c‐Met; consistently, HN1 over‐expression reversed these effects. Meanwhile, down‐regulation of c‐Met partly eliminated the effect of HN1 over‐expression in HCC cells. Thus, the present findings suggested that HN1 promotes the progression of HCC to some extent by up‐regulating the expression of c‐Met, and may act as a potential biomarker and therapeutic target for the treatment of HCC.

Pelvic acetabular fracture is a common kind of fracture, mostly caused by high energy injuries. It is associated with high mortality and disability rates. The aim of surgical treatment of pelvic acetabular fractures is to restore the symmetry and stability of the pelvic ring structure and the anatomical structure of acetabular. Open reduction internal fixation is often used for the treatment of such fractures, but open surgery is in cases of serious injury, more bleeding, and high risk of infection. With the development of minimally invasive technology and the concept of the bone channel structure, the percutaneous lag screw technique for the treatment of pelvic and acetabular fractures has been applied in clinical practice and has proven to be effective. However, the anatomical structure of the pelvis and acetabulum is complex, and there are many important nerves and vessels adjacent to it. Traditional fluoroscopy screw placement is prone to screw malposition, and even minor angle changes may lead to screw perforation and damage of nerve vessels. The problem of radiation exposure is also noteworthy. Robotic‐assisted surgery can be used to carry out screw position planning through preoperative imaging, intraoperative real‐time tracking, and mechanical arm assistance to ensure that the screw placement position is consistent with the planning. In this way, robotic‐assisted surgery can be used to accurately insert lag screws, and can reduce surgical risk and radiation exposure. This guide uses the TiRobot system as an example to describe the application of robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.

Femoral neck fractures are among the most common fractures in orthopaedics. There are many surgical methods for the treatment of femoral neck fracture. Percutaneous cannulated lag screw fixation for the treatment of femoral neck fractures is favored by orthopaedic doctors because of its characteristics of being minimally invasive, with less bleeding and firm fixation. However, traditional freehand screw placement is limited by many factors, and the screw malposition rate is very high, which directly leads to the reduction of its biomechanical stability, and even leads to the ischemic necrosis of the femoral head caused by damage to blood vessels. In addition, excessive attempts to drill holes can damage cancellous bone and affect the screw's holding force, which reduces the stability of internal fixation and increases the risk of failure. At the same time, too much radiation exposure to medical personnel and patients also causes great damage to the body. Robot‐assisted orthopaedic surgery combines the mechanical “eye” (an infrared ray tracking device) and the mechanical “hand” (six degrees of freedom mechanical arm), and through the process of preoperative planning, intraoperative assistance in screw placement, and postoperative confirmation, provides a more minimally invasive and precise treatment method for this kind of surgery, and significantly reduces radiation exposure. This guide uses the TiRobot system as an example to describe the robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.