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Background The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI. Methods Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire. Results The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P 2 = 0.425, P = 0.514). For low PI patients, there is no significant difference where the UIV is located with regards to the TK apex between the PJK and Non-PJK subgroups (χ2 = 1.103, P = 0.401). For high PI patients, PJK was more likely to occur when UIV was cephalad to than caudal to the TK apex (31.25 % vs. 4.7 %, P = 0.038). There was no significant difference in the selection of LIV between the two groups. Conclusions There is no difference in the incidence of PJK between the Lenke 5 AIS patients with low PI (< 45°) and high PI (≥45°), but the main risk factor of PJK should be different. For patients with low PI, overcorrection of LL should be strictly avoided during surgery. For patients with high PI, the selection of UIV should not be at or cephalad to the apex of thoracic kyphosis to retain more mobile thoracic segments.

BACKGROUND CONTEXT Tranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction. PURPOSE The primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects. STUDY DESIGN Prospective, double-blinded, randomized controlled trial. PATIENT SAMPLE A total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study. OUTCOME MEASURES The primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL. METHODS Patients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo. RESULTS The mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1-786.1 mL, p

Titanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3-C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable.To compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system.Retrospective comparative study.Ninety-one patients who underwent unilateral open-door laminoplasty.Clinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle.Between April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared.Both groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p.05).Despite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method.

Background The optimal management of lumbar synovial cysts (LSCs) has always been controversial. Open or minimally invasive partial hemilaminotomy as a direct decompression approach has been widely studied, whereas to our knowledge, there has been no report of an indirect decompression method for LSC. Case Description A 60-year-old male complained of chronic low back pain for 2 years. He reported that the pain had been getting worse and started radiating to the bilateral posterior thighs and right lateral calf for 6 months. An ovoid lesion with a hyperintense center attached to the medial side of the right facet joint at the L4-5 level, as well as L4-5 dynamic instability, were found with magnetic resonance imaging and lumbar x-ray examinations, respectively. L4-5 oblique lumbar interbody fusion combined with anterior fixation was performed. After surgery, the patient felt distinct pain relief and was discharged on the third day postoperatively. Three months later, lumbar magnetic resonance imaging and 3-dimensional computed tomography were performed again. The L4-5 disk height and foraminal height recovered from 7.1–12.3 mm and 14.8–18.5 mm, respectively. No evidence of a cyst was disclosed. The patient did not complain of any low back pain or radicular pain during the 12-month follow-up. Conclusions Indirect decompression surgery may be a new option for the management of LSC, especially in those with lumbar instability and that communicate with the facet joint. Further research with a larger and more comprehensive sample population is required.

Background: Assessing the relation between arthritis and cognitive impairment could expand the understanding of health consequences of arthritis. The aim was to prospectively examine the association between arthritis and cognitive functions among middle-aged and elderly Chinese.Methods: Our analyses were based on data from the nationwide China Health and Retirement Longitudinal Study (2011–2016). Arthritis was ascertained by self-reported doctor diagnosis during the baseline survey. Cognitive functions were evaluated in three domains including episodic memory, mental status, and global cognition. Linear mixed models were employed to assess the association between baseline arthritis and cognition functions.Results: Of 7,529 Chinese adults, 49.79% were men, and mean age was 57.53 years. During a follow-up of 4 years, participants with baseline arthritis showed lower scores of episodic memory [β = −0.08; 95% confidence interval (CI): −0.14, −0.03], mental status (β = −0.14; 95% CI: −0.22, −0.05), and global cognition (β = −0.22; 95% CI: −0.34, −0.11), compared to those without arthritis. In addition, participants with arthritis showed increased rates of decline in mental status and global cognition by 0.04 (95% CI: 0.01, 0.08) and 0.05 (95% CI: 0.01, 0.09) units per year, respectively.Conclusion: Arthritis was associated with subsequent risk of poorer cognitive functions and slightly faster declines in cognitive functions among Chinese middle-aged and elderly adults. Our findings should be confirmed in future large prospective studies in Chinese and other populations.

Aims To prospectively examine the association between arthritis and type 2 diabetes (T2D) in the Chinese population and confirm this association through a comprehensive meta-analysis of cohort studies. Meterials and methods Data were from the China Health and Retirement Longitudinal Study which was started in 2011-2013 and followed up in 2013-2014 and 2015-2016. Arthritis was defined as self-reported physician diagnosis at baseline, and incident T2D was determined by self-reported physician diagnosis, fasting blood glucose ≥7.0 mmol/L or glycosylated haemoglobin ≥6.5% during the follow-ups. Cox proportional hazards regression models were used to assess the association between arthritis and risk for T2D. A meta-analysis was conducted to pool our effect estimate and those from other cohort studies using a random-effects model. Results Eleven thousand four hundred and eight participants (47.9% men; mean age: 59.3 years) were included in final analyses. During a 4-year follow-up, 981 participants reported incident T2D. Compared with individuals without arthritis, those with arthritis at baseline had an 18% higher risk for incident T2D (multivariable-adjusted hazard ratio: 1.18; 95% confidence interval: 1.04, 1.34). In the meta-analysis of 13 cohort studies including ours, a total of 2,473,514 participants were included with 121,851 incident diabetes. The pooling HR was 1.32 (95% CI: 1.21, 1.44) for the association between arthritis and diabetes. Conclusion Arthritis was associated with an increased risk of incident diabetes in Chinese adults, and the positive association was confirmed in the meta-analysis of cohort studies. Our work can inform clinical trials to assess the effectiveness of arthritis treatments in reducing risk of diabetes.

Background Spinal tuberculosis accounts for more than 50% of bone tuberculosis cases. This study compared clinical, radiological and functional outcomes between anterior and posterior approaches for treatment of middle or lower thoracic spinal tuberculosis in elderly patients. Methods We retrospectively examined middle or lower thoracic spinal tuberculosis (T5–T12) in patients over 65 years. All procedures included debridement, decompression, autologous bone graft and fixation. Surgical procedure, surgical duration, estimated blood loss during surgery and laboratory results were recorded. Pleural effusion volume, thoracic cavity volume, Oswestry Disability Index score, neurological status, radiological parameters and complication rate were evaluated. Results No significant difference was found in surgical duration, blood loss, kyphosis angle correction, loss of correction, thoracic cavity volume, or complication rate between the two groups (P > 0.05). Average postoperative pleural effusion volumes were 605.9 ± 209.5 mL (377–1074 mL) and 262.9 ± 228.1 mL (0–702.4 mL) in the anterior and posterior groups, respectively (P = 0.004). Average hospitalization durations were 26.4 ± 10.5 days (17–53 days) and 19.2 ± 5.0 days (14–30 days) (P = 0.04). Average postoperative serum albumin levels were 24.19 ± 3.84 g/L (19–29.5 g/L) and 28.24 ± 2.52 g/L (24.4–31.6 g/L) (P = 0.01). No relapse or reinfection was observed in either group at the final follow-up. Surgical revision was not required in either group. Conclusions Both anterior and posterior surgeries can be used to treat middle or lower thoracic spinal (T5-T12) tuberculosis in elderly patients. In general, the posterior approach might be superior, especially for patients with poor general health.

Objective To build a model for proximal junctional kyphosis (PJK) prognostication in Lenke 5 adolescent idiopathic scoliosis (AIS) patients undergoing long posterior instrumentation and fusion surgery by machine learning and analyze the risk factors for PJK. Materials and methods In total, 44 AIS patients (female/male: 34/10; PJK/non-PJK: 34/10) who met the inclusion criteria between January 2013 and December 2018 were retrospectively recruited from West China Hospital. Thirty-seven clinical and radiological features were acquired by two independent investigators. Univariate analyses between PJK and non-PJK groups were carried out. Twelve models were built by using four types of machine learning algorithms in conjunction with two oversampling methods [the synthetic minority technique (SMOTE) and random oversampling]. Area under the receiver operating characteristic curve (AUC) was used for model discrimination, and the clinical utility was evaluated by using F1 score and accuracy. The risk factors were simultaneously analyzed by a Cox regression and machine learning. Results Statistical differences between PJK and non-PJK groups were as follows: gender (p = 0.001), preoperative factors [thoracic kyphosis (p = 0.03), T1 slope angle (T1S, p = 0.078)], and postoperative factors [T1S (p = 0.097), proximal junctional angle (p = 0.003), upper instrumented vertebra (UIV) - UIV + 1 (p = 0.001)]. Random forest using SMOTE achieved the best prediction performance with AUC = 0.944, accuracy = 0.909, and F1 score = 0.667 on independent testing dataset. Cox model revealed that male gender and larger preoperative T1S were independent prognostic factors of PJK (odds ratio = 10.701 and 57.074, respectively). Gender was also at the first place in the importance ranking of the model with best performance. Conclusion The random forest using SMOTE model has the great value for predicting the individual risk of developing PJK after long instrumentation and fusion surgery in Lenke 5 AIS patients. Moreover, the combination of the outcomes of a Cox model and the feature ranking extracted by machine learning is more valuable than any one alone, especially in the interpretation of risk factors.

Background Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. Methods We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. Results Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°–11.58°) and kyphosis of fixed segments (8.50°–9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser’s grade with larger scoliosis might be risk factors for correction loss. Conclusions Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.

Hepatocellular carcinoma (HCC) is one of the most common and most lethal malignant tumors in the world. Microvascular invasion (MVI) is a major risk factor for survival outcomes and intrahepatic metastasis after resection in patients with HCC. Relevant English literatures retrieved using PubMed on the research progress of MVI in patients with HCC were reviewed. For HCC patients, especially those with MVI, it is very important to develop a comprehensive and sequential treatment plan to support the long-term survival of patients. This manuscript reviewed and analyzed the risk factors for MVI; the preoperative prediction of MVI, which informs the selection of surgical strategies; and the current situation and future direction of comprehensive postoperative treatment strategies; to provide a basis for the comprehensive treatment of HCC patients with MVI. For HCC patients with MVI, the preoperative prediction of MVI may play a certain guiding role in planning procedures, and the comprehensive sequential postoperative pathological detection of HCC MVI may provide a basis for treatment decisions.

3D-printed titanium alloy orthopedic implants combine the dual advantages of 3D printing and titanium alloys implants, which not only have complex structures that cannot be manufactured by traditional techniques, but also inherit the excellent physical and chemical properties of titanium and its alloys, so they are widely used in the field of orthopedics in recent years. The inherent porous structure of 3D-printed implants and the original modification processes of titanium alloys provide the conditions for the functionalization of implants. To meet the needs of orthopedic surgeons and patients, functionalized implants with the ability of long-term stability promotion, anti-infection or anti-tumor have been developed, in which various methods of functionalization deserve to be summarized, compared and analyzed. Therefore, in this review, we will collect the existing knowledge on functionalization of 3D-printed titanium alloy orthopedic implants and give our own opinion.

The predecessor of endoscopic surgery, arthroscopic microdiscectomy (AMD) was first introduced to China in the 1990s after its introduction in Japan, Germany and the United States in the 1980s (1-3).

The paper aimed at exploring the current phenomenon regarding human translation with machine translation. Human translation (HT), by definition, is when a human translator—rather than a machine—translate text. It's the oldest form of translation, relying on pure human intelligence to convert one way of saying things to another. The person who performs language translation. Learn more about using technology to reduce healthcare disparity. A person who performs language translation. The translation is necessary for the spread of information, knowledge, and ideas. It is absolutely necessary for effective and empathetic communication between different cultures. Translation, therefore, is critical for social harmony and peace. Only a human translation can tell the difference because the machine translator will just do the direct word to word translation. This is a hindrance to machines because they are not advanced to the level of rendering these nuances accurately, but they can only do word to word translations. There are different translation techniques, diverse theories about translation and eight different translation services types, including technical translation, judicial translation and certified translation. The translation is the process of translating the sequence of a messenger RNA (mRNA) molecule to a sequence of amino acids during protein synthesis. The genetic code describes the relationship between the sequence of base pairs in a gene and the corresponding amino acid sequence that it encodes.

The refractive index (RI) of a sample as an endogenous contrast agent plays an important role in transparent live cell imaging. In tomographic phase microscopy (TPM), 3D quantitative RI maps can be reconstructed based on the measured projections of the RI in multiple directions. The resolution of the RI maps not only depends on the numerical aperture of the employed objective lens, but also is determined by the accuracy of the quantitative phase of the sample measured at multiple scanning illumination angles. This paper reports an analogous on-axis interference TPM, where the interference angle between the sample and reference beams is kept constant for projections in multiple directions to improve the accuracy of the phase maps and the resolution of RI tomograms. The system has been validated with both silica beads and red blood cells. Compared with conventional TPM, the proposed system acquires quantitative RI maps with higher resolution (420 nm @λ = 633 nm) and signal-to-noise ratio that can be beneficial for live cell imaging in biomedical applications.

Purpose: Systemic therapy has often been used for patients with advanced hepatocellular carcinoma (HCC). However, due to drug resistance, the use of cytotoxic chemotherapy in the treatment of patients with advanced HCC has typically demonstrated low response rates. Secretory clusterin (sCLU) is expressed in aggressive late-stage tumors and associated with resistance to chemotherapy, including that in HCC cases. The present research aimed to investigate the biological role of sCLU in HCC. Methods: sCLU expression in HCC and normal tissues was examined using immunohistochemical staining, followed by analysis of the correlation between sCLU expression and clinical indicators. In addition, the role and internal mechanism of sCLU in cell proliferation and apoptosis were investigated in HCC cells. Results: sCLU expression was significantly upregulated in HCC tissues; and was associated with histological grade and poor overall survival. The levels of sCLU were significantly increased in Bel7402, SMMC7721 and resistant HCC cells (Bel7404-OR). Inhibiting the activity of sCLU enhanced the chemosensitivity of Bel7402 and SMMC7721 cells. Downregulation of sCLU could increase the expression of Gadd45a in HCC cells. Overexpression of sCLU contributed to drug resistance in Bel7402, SMMC7721 and Bel7404-OR cells; whereas, overexpression of Gadd45a alone overcame drug resistance in the cells above. No significant expression changes of sCLU and Gadd45a were observed in HCC cells after the interference of a selective inhibitor of the PI3K/Akt signaling pathway. However, regulation of the expression of Gadd45a could influence the phosphorylation level of Akt; and further regulate the expression of Bcl-2 and Bax proteins involved in the mitochondrial apoptosis pathways. Conclusions: The results demonstrate that sCLU/Gadd45a/PI3K/Akt signaling represents a novel pathway that could regulate drug resistance in a one-way manner in HCC cells.

Total internal reflection fluorescence microscopy (TIRFM) provides high optical sectioning capability and superb signal-to-noise ratio for imaging of cell cortex structures. The development of multi-angle (MA)-TIRFM permits high axial resolution imaging and reconstruction of cellular structures near the cell surface. Cytoskeleton is composed of a network of filaments, which are important for maintenance of cell function. The high-resolution imaging and quantitative analysis of filament organization would contribute to our understanding of cytoskeleton regulation in cell. Here, we used a custom-developed MA-TIRFM setup, together with stochastic photobleaching and single molecule localization method, to enhance the lateral resolution of TIRFM imaging to about 100 nm. In addition, we proposed novel methods to perform filament segmentation and 3D reconstruction from MA-TIRFM images. Furthermore, we applied these methods to study the 3D localization of cortical actin and microtubule structures in U373 cancer cells. Our results showed that cortical actins localize ∼ 27 nm closer to the plasma membrane when compared with microtubules. We found that treatment of cells with chemotherapy drugs nocodazole and cytochalasin B disassembles cytoskeletal network and induces the reorganization of filaments towards the cell periphery. In summary, this study provides feasible approaches for 3D imaging and analyzing cell surface distribution of cytoskeletal network. Our established microscopy platform and image analysis toolkits would facilitate the study of cytoskeletal network in cells.

Total internal reflection fluorescence microscopy (TIRFM) has been widely used in biomedical research to visualize cellular processes near the cell surface. In this study, a novel multi-angle ring-illuminated TIRFM system, equipped with two galvo mirrors that are on conjugate plan of a 4f optical system was developed. Multi-angle TIRFM generates images with different penetration depths through the controlled variation of the incident angle of illuminating laser. We presented a method to perform three-dimensional (3-D) reconstruction of microtubules from multi-angle TIRFM images. The performance of our method was validated in simulated microtubules with variable signal-to-noise ratios (SNR) and the axial resolution and accuracy of reconstruction were evaluated in selecting different numbers of illumination angles or in different SNR conditions. In U373 cells, we reconstructed the 3-D localization of microtubules near the cell surface with high resolution using over a hundred different angles. Theoretically, the presented TIRFM setup and 3-D reconstruction method can achieve 40 nm axial resolution in experimental conditions where SNR is as low as 2, with ~35 different illumination angles. Moreover, our system and reconstruction method have the potential to be used in live cells to track membrane dynamics in 3-D.

We proposed a novel method to reconstruct images taken by array detected confocal microscopy without prior knowledge about its detector distribution. The proposed frequency domain phase-shifted confocal microscopy (FDPCM) shifts the image from each detection channel to its corresponding place by substituting the phase information in Fourier domain. Theoretical analysis shows that our method could approach the resolution nearly twofold of wide-field microscopy. Simulation and experiment results are also shown to verify the applicability and effectiveness of our method. Compared to Airyscan, our method holds the advantage of simplicity and convenience to be applied to array detectors with different structure, which makes FDPCM have great potential in the application of biomedical observation in the future.

In order to maximize the exploited wind power and benefit from a wide range of the wind speed, a novel combined maximum power point tracking (MPPT)-Pitch angle control is developed based on Neural Network (ANN), in order to solve the previous control strategy, heavy workload, complicated process and other issues. It allows the generator to work at the optimum speed when the wind speed is below the rated wind speed, and output the constant power when wind speed is higher than the rated wind speed. The whole process is realized by an artificial neural network controller. Based on Matlab, establish a variable speed constant frequency doubly fed wind turbine model. Simulation and analysis of the wind speed range changes near the rated, using combined maximum power point tracking (MPPT) - pitch control strategy can achieve fast and accurate tracking and constant output power, and has good dynamic performance and fast tracking characteristic.

Objective The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes. Methods A total of 65 patients had undergone single-level OLIF-AF at L2–L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively. Results The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%). Conclusions Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2–L5. Cage subsidence was the most common operative complication.

Dysphagia is a common postoperative complication in patients undergoing occipitocervical fusion (OCF). Previous studies had proposed the use of two measures-the occipital to C2 angle (O-C2a) and the occipital and external acoustic meatus to axis angle (O-EAa)-to predict postoperative dysphagia after OCF. However, these studies had small sample sizes and the predictive abilities of both measures are still not clear.To evaluate the predictive ability of O-EAa and O-C2a for dysphagia after OCF.A retrospective clinical study.A total of 109 consecutive patients who had undergone OCF.Presence of postoperative dysphagia, O-C2a, C2 tilting angle (C2Ta), O-EAa, and the narrowest oropharyngeal airway space (nPAS).Between April 2010 and June 2018, 109 consecutive patients who had undergone OCF were reviewed. Patients were divided into two groups according to the presence of postoperative dysphagia. Radiographic measurements, including O-C2a, C2Ta, O-EAa, and nPAS, were evaluated at preoperative and 1 month postoperative and the findings were compared. Simple linear regression was used to measure the correlations between the parameters and the presence of dysphagia, and the correlations within the parameters. Multiple regression analysis was used to examine the variables that affected the change of nPAS (dnPAS%). Sensitivity and specificity analyses were used to evaluate the effectiveness of the previously proposed measures ("O-C2a change≤-5°" and "postoperative O-EAa100°") for prediction of post-OCF dysphagia.The incidence of dysphagia after OCF was 26.6% (29/109). Preoperative values for the radiographic parameters were similar between patients with and without dysphagia. In the dysphagia group, both O-C2a and O-EAa values showed a dramatic decrease after surgery, which was accompanied by a decrease in nPAS. Postoperative O-C2a, O-EAa, and nPAS in the dysphagia group were significantly smaller than those in the nondysphagia group (p.05). The changes in O-EAa, O-C2a, and nPAS showed a linear correlation with the presence of dysphagia (p.05). In addition, linear correlations were found between two of the three parameters. Multiple regression showed the change of O-C2a and O-EAa were significant predictors for dnPAS% (β=0.200, p=.022 and β=0.549, p=.000). The sensitivity and specificity of "O-C2a change≤-5°" in predicting dysphagia were 75.9% and 80.0% respectively, and those of "postoperative O-EAa100°" were 75.9% and 62.5%, respectively. However, the sensitivity of the combination of these two values in predicting postoperative dysphagia was as high as 96.6%.Both O-EAa and O-C2a could be critical predictors for postoperative dysphagia. During surgery, ensuring that the O-EAa exceeds 100° and simultaneously avoiding an O-C2a reduction greater than 5° could effectively avert postoperative dysphagia.

Objective This study aimed to present a new endoscopic technique for osteoid osteoma (OO) of the lumbar spine and sacrum and to evaluate its safety and effectiveness. Methods Eleven consecutive patients with spinal OO underwent percutaneous endoscopic excision and ablation (PEEA) between March 2014 and May 2018. A cannula 0.7 cm in diameter was used for the procedure. According to the size of the nidus, whole-piece removal and piecemeal intralesional resection were used. Afterward, ablation was performed using an endoscopic radiofrequency electrode in the residual osteoma cavities. Clinical outcomes were assessed by Visual Analog Scale (VAS) scores. The efficacy of this technique was assessed using relevant clinical data and postoperative radiographs. Results The niduses of the 11 patients were all located in the posterior element of the lumbar spine and sacrum (10 in the lumbar spine and 1 in the sacrum). The preoperative VAS score was 7.18 (range, 6–9), the score on postoperative day 1 was 1 (range, 0–2), and the last follow-up VAS score was 0.27 (range, 0–1). All patients were discharged within 24 hours after surgery. The mean follow-up period was 21.8 months (range, 12–36 months). No serious complications were observed during the follow-up period. Conclusions PEEA is a safe and effective technique for OO in the lumbar spine and sacrum in which the nidus is located in the posterior element. However, it has a steep learning curve. Further research with a larger and more comprehensive sample population is warranted.

Recurrence and metastasis are the two leading causes of poor prognosis of hepatocellular carcinoma (HCC) patients. Cyclooxygenase (COX)-2 is overexpressed in many types of cancers including HCC and promotes its metastasis. Meloxicam is a selective COX-2 inhibitor that has been reported to exert an anti-proliferation and invasion/migration response in various tumors. In this study, we examined the role of meloxicam on HCC cell proliferation and migration and explored the molecular mechanisms underlying this effect. We found that meloxicam inhibited HCC cell proliferation and had a cell cycle arrest effect in human HCC cells. Furthermore, meloxicam suppressed the ability of HCC cells expressing higher levels of COX-2 and prostaglandin E2 (PGE2) to migration via potentiating expression of E-cadherin and alleviating expression of matrix metalloproteinase (MMP)-2 and -9. COX-2/PGE2 has been considered to activate the β-catenin signaling pathway which promotes cancer cell migration. We found that treatment with PGE2 significantly enhanced nuclear accumulation of β-catenin and the activation of GSK3β which could be reversed by meloxicam in HCC cells. We also observed that HCC cell migration and upregulation of the level of MMP-2/9 and downregulation of E-cadherin induced by PGE2 were suppressed by FH535, an inhibitor of β-catenin. Taken together, these findings provide a new treatment strategy against HCC proliferation and migration.

Hepatocellular carcinoma (HCC) is a highly malignant disease with a poor prognosis and high mortality due to a low early diagnosis rate, resistance to systemic treatments and progression to late-stage liver disease. Owing to limitations in the detection of HCC and the lack of awareness of healthcare systems, fewer than 40% of HCC patients are eligible for surgery due to advanced stages of the disease at the time of diagnosis and the occurrence of multiple lesions in the cirrhotic or fibrotic liver. At present, the updated American Association for the Study of Liver Disease (AASLD) guidelines no longer recommend alpha-fetoprotein (AFP) testing as a part of diagnostic evaluation. Thus, it is imperative to establish a novel diagnostic strategy with high sensitivity and reliability to monitor risk factors to detect HCC at an early stage. In recent years, “liquid biopsy,” (including circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA)), has emerged as a technique for the characterization of circulating cells, providing a strong basis for the individualized treatment of patients. As a noninvasive detection method, liquid biopsy is expected to play an important role in the early diagnosis, dynamic monitoring of cancer patients and drug screening. In this review, we will focus on the clinical applications, recent studies and future prospects of liquid biopsy, particularly focusing on HCC.

The refractive index (RI) distribution can serve as a natural label for undyed cell imaging. However, the majority of images obtained through quantitative phase microscopy is integrated along the illumination angle and cannot reflect additional information about the refractive map on a certain plane. Herein, a light-field reconstruction method to image the RI map within a depth of 0.2 μm is proposed. It records quantitative phase-delay images using a four-step phase shifting method in different directions and then reconstructs a similar scattered light field for the refractive sample on the focus plane. It can image the RI of samples, transparent cell samples in particular, in a manner similar to the observation of scattering characteristics. The light-field reconstruction method is therefore a powerful tool for use in cytobiology studies.

In view of collaborative development environment web services supplier in ability, cost, time supplier relations and component relevance information under uncertainty problems. The fuzzy multi-objective task assignment model of web services are built in a collaborative development environment. Using

Tomography phase microscopy (TPM) is a new microscopic method that can quantitatively yield the volumetric 3D distribution of a sample׳s refractive index (RI), which is significant for cell biology research. In this paper, a controllable TPM system is introduced. In this system a circulatory phase-shifting method and piezoelectric ceramic are used which enable the TPM system to record the 3D RI distribution at a more controllable speed, from 1 to 40 fps, than in the other TPM systems reported. The resolution of the RI distribution obtained by this controllable TPM is much better than that in images recorded by phase contrast microscopy and interference tomography microscopy. The realization of controllable TPM not only allows for the application of TPM to the measurement of kinds of RI sample, but also contributes to academic and technological support for the practical use of TPM.

Here we report nonlinear focal modulation microscopy (NFOMM) to achieve super-resolution imaging. Abandoning the previous persistence on minimizing the size of Gaussian emission pattern by directly narrowing (e.g. Minimizing the detection pinhole in Airyscan, Zeiss) or by indirectly peeling its outer profiles (e.g., Depleting the outer emission region in STED, stimulated emission microscopy) in pointwise scanning scenarios, we stick to a more general basis------ maximizing the system frequency shifting ability. In NFOMM, we implement a nonlinear focal modulation by applying phase modulations with high-intensity illumination, thereby extending the effective spatial-frequency bandwidth of the imaging system for reconstructing super-resolved images. NFOMM employs a spatial light modulator (SLM) for assisting pattern-modulated pointwise scanning, making the system single beam path while achieving a transverse resolution of 60 nm on imaging fluorescent nanoparticles. While exploring a relatively simple and flexible system, the imagingperformance of NFOMM is comparable with STED as evidenced in imaging nuclear pore complexes, demonstrating NFOMM is a suitable observation tool for fundamental studies in biology. Since NFOMM is implemented as an add-on module to an existing laser scanning microscope and easy to be aligned, we anticipate it will be adopted rapidly by the biological community., 5 Figures, under review in PRL

In view of collaborative development environment web services supplier in ability, cost, time, supplier relations and component relevance information under uncertainty problems. The fuzzy multi-objective task assignment model of web services are built in a collaborative development environment. Using  cut sets and extension principle to simplify the fuzzy multi-objective assignment mode, we get the solution of simplified assignment model via the Genetic and simulated-annealing algorithm. Finally, the simulation results verify the feasibility of the proposed method, which can ensure the suppliers' tasking in successive software project in collaborative development environment.

Total internal reflection fluorescence microscopy (TIRFM) has been widely used in biomedical research to visualize cellular processes near the cell surface. In this study, a novel multi-angle ring-illuminated TIRFM system, equipped with two galvo mirrors that are on conjugate plan of a 4f optical system was developed. Multi-angle TIRFM generates images with different penetration depths through the controlled variation of the incident angle of illuminating laser. We presented a method to perform three-dimensional (3-D) reconstruction of microtubules from multi-angle TIRFM images. The performance of our method was validated in simulated microtubules with variable signal-to-noise ratios (SNR) and the axial resolution and accuracy of reconstruction were evaluated in selecting different numbers of illumination angles or in different SNR conditions. In U373 cells, we reconstructed the 3-D localization of microtubules near the cell surface with high resolution using over a hundred different illumination angles. Theoretically, the presented TIRFM setup and 3-D reconstruction method can achieve ∼40 nm axial resolution in experimental conditions where SNR is as low as 2, with ∼35 different illumination angles. Moreover, our system and reconstruction method have the potential to be used in live cells to track membrane dynamics in 3-D.

Based on STM32F407ZET6 microprocessor with ARM Cortex-M4 core, we designed a controller for servo motors and servo drivers of a 4-axis Selective Compliance Assembly Robot Arm (SCARA) robot. The forward and inverse kinematic equations are established, circular interpolation equations in three-dimensional space are derived by using the digital differential analyzer method. The adopted circular interpolation algorithm avoids to judge quadrant and feeding direction, which simplifies the program.

A novel method of axial displacement measurement based on the double-helix (DH) beam is proposed in this paper. The DH point spread function (DH-PSF) with two prominent lobes which consist of optical beam modes superposing with each other in the Gauss–Laguerre (GL) modal plane has the characteristic that the two lobes can rotate like a binary star about the center of each other in the propagation of the light beam. We figure out the axial displacement with the variation of the rotated angle of the connection line of the two lobes. In this method, a CCD and a phase-only spatial light modulator (SLM) are used in a relatively reliable and simple experimental configuration, with which we can manage to realize high axial measuring resolution. One superb advantage is that the system is immune to the energy fluctuations of the laser source. As a result, the axial displacement measurement has a remarkable application prospect in modern engineering and scientific researches.

Study design An imaging anatomical measurement. Objective To investigate the anatomical feasibility of percutaneous kyphoplasty for lumbar osteoporotic vertebral compression fractures via a unilateral transverse process-pedicle approach (TPA). Summary of background data Kyphoplasty via a unilateral approach has been reported and good clinical results have been achieved. However, because of the lack of an anatomical study, these approaches have yet to be popularized. Methods A total of 150 lumbar vertebral bodies of 30 patients were simulated kyphoplasty on the computed tomographic scans through conventional transpedicle approach (CTA) and the TPA, respectively. Anatomical parameters including the distance between the entry point and the midline of the vertebral body, the puncture inclination angle, and the success rate of puncture were measured and compared. Results The distance between the entry point and the midline from L1 to L5 lumbar levels varied from 20.6 ± 2.2 mm to 28.6 ± 2.9 mm in the CTA group and from 23.6 ± 2.2 mm to 33.6 ± 2.9 mm in the TPA group. The entry point from L1 to L5 in the TPA group was 3.0 ± 2.1 mm to 5.1 ± 2.7 mm more lateral than that in the CTA group. The medial inclination angles from L1 to L5 were 30.2° ± 6.4° to 47.7° ± 5.4° in the TPA and 15.3° ± 6.0° to 22.8° ± 8.7° in the CTA group. The inclination angles in the TPA group were greater than that in the CTA group and the safe range of the puncture angles was also wider. The success rate was 51.7% in the CTA group and 87.7% in the TPA group. Conclusion The entry point through a TPA was localized at the midline of the transverse process, 3.0 to 5.1 mm outside the lateral margin of the pedicle projection. Compared with CTA, the puncture inclination angle in the TPA approach was much larger with a wider safe puncture range. The TPA approach allowed an easy puncture to meet or surpass the midline of the lumbar vertebral body. Level of evidence N/A.

Common path noise and disturbance in light source and ambient lighting affect detection accuracy of edge contours greatly in optical microscopy. In order to solve this problem, a lateral differential confocal microscopy is proposed based on principle of lateral difference and confocal microscopy. The approach proposed uses confocal dual-receiving light path arrangement and real-time heterodyne subtraction of two signals with lateral offsets by a differential detector to improve the system′s accuracy and detection sensitivity. Theoretical analyses have been presented. In addition, a simple prototype system has been built based on theoretical analyses. Related experiments have been performed under laboratory conditions. Different from former image processing methods, common path noise and additive disturbance in light source and ambient lighting are eliminated before they are recorded. Theoretical analyses and experimental results indicate a more accurate and sensitive result.

Based on the extended Huygens–Fresnel diffraction integral, the expressions for the average intensity and the effective size of Laguerre–Gaussian and Bessel–Gaussian Schell-model beams propagating through a paraxial ABCD optical system are obtained in the turbulent atmosphere. The influences of the source coherence and atmospheric turbulence on the propagation of Laguerre–Gaussian and Bessel–Gaussian Schell-model beams in the turbulent atmosphere are investigated in detail. It is found that the beam profile will eventually evolve into a Gaussian-like distribution through turbulence in contrast to ring-shaped far-field pattern in free space. The effective size of Laguerre–Gaussian and Bessel–Gaussian Schell-model beams with lower source coherence is less affected by turbulence. The parameter β and index n of the sources have some effects on intensity distribution and beam spreading through atmospheric turbulence.

The high resolution tomographic rotates the reference arm and the sample arm to detect the quantitative phase information and the result 3D image has higher resolution and SNR.

Study Design. A retrospective study. Objective. To evaluate the radiological and clinical results of simultaneous surgery with preservation of the posterior vertebral wall for rigid post-traumatic kyphosis in the thoracolumbar spine. Summary of Background Data. Management of rigid post-traumatic kyphosis has been a challenge for surgeons. Current widely used posterior osteotomy procedures have the disadvantages of significant invasiveness, spinal column shortening, and instrumentation-related complications. Methods. From 2004 to 2009, 21 patients with rigid post-traumatic kyphosis in the thoracolumbar spine (T11–L2) were managed in our hospital. Average kyphotic angle was 45.2° ± 11.2° (range, 31°–67°). The surgical technique used was posterior and anterior circumferential release and anterior corpectomy with posterior vertebral wall preservation and short segmental instrumentation. Preoperative and postoperative kyphotic angle was measured to assess the degree of kyphosis correction and maintenance. Changes in low back pain were assessed by Japanese Orthopaedic Association scores. Results. All patients were successfully managed with this procedure without major complications. Most patients (19 of 21) were instrumented with anterior-only fixation, while posterior interspinal wire was added in 2 patients with osteoporosis. The mean blood loss was 470 mL (range, 300–700 mL). Patients were followed for an average of 32 months (range, 6–70 mo) postoperatively. Back pain was relieved to some degree in all patients and the improvement in Japanese Orthopaedic Association scores was 76.9% ± 7.9. Average kyphotic angle was 6.0° ± 5.7° (range, −2 to 17) immediately after surgery and 7.2° ± 5.8° (range, −3 to 17) at final follow-up. Average of 1° of correction loss was documented and all patients obtained solid fusion uneventfully. Conclusion. This technique is indicated for most patients with rigid post-traumatic kyphosis in the thoracolumbar spine and can yield satisfactory clinical results not only in terms of pain relief, kyphosis correction, vertebral height restoration, and spinal canal integrity preservation, but also in reducing the risk of excessive bleeding and spinal cord injury.

Liver cancer, a large proportion of which is hepatocellular carcinoma (HCC), is diagnosed in more than 700000 people each year worldwide. Liver cancer is particularly prevalent in Asia, Sub-Saharan Africa and the South Pacific, where hepatitis B and hepatitis C infection rates are very high. However, due to resistance to chemotherapy, patients with intermediate and advanced-stage disease cannot benefit from this treatment. Clusterin, which is overexpressed in many different cancers, is a stress-induced cytoprotective protein that confers treatment resistance. Custirsen (OGX-011) is a novel 2'-methoxyethyl modified phosphorothioate antisense oligonucleotide that targets secretory clusterin protein expression and is currently in clinical trials for patients with different cancers. In recent years, a number of different clinical trials have been performed, and two phase III clinical trials of custirsen evaluating combinations with chemotherapy in patients with metastatic castration-resistant prostate cancer and metastatic non-small cell lung cancer are currently in progress. The aims of this review are to summarize the current state of research on clusterin, predict future research directions and analyze the potential of the clinical application of custirsen in HCC.

Fourier ptychographic microscopy (FPM) is a newly developed imaging technique which stands out by virtue of its high-resolution and wide FOV. It improves a microscope’s imaging performance beyond the diffraction limit of the employed optical components by illuminating the sample with oblique waves of different incident angles, similar to the concept of synthetic aperture. We propose to use an objective lens with high-NA to generate oblique illuminating waves in FPM. We demonstrate utilizing an objective lens with higher NA to illuminate the sample leads to better resolution by simulations, in which a resolution of 0.28[Formula: see text][Formula: see text]m is achieved by using a high-NA illuminating objective lens (NA[Formula: see text][Formula: see text]) and a low-NA collecting objective lens (NA[Formula: see text][Formula: see text]) in coherent imaging ([Formula: see text][Formula: see text]nm). We then deeply study FPM’s exact relevance of convergence speed to spatial spectrum overlap in frequency domain. The simulation results show that an overlap of about 60% is the optimal choice to acquire a high-quality recovery (520*520 pixels) with about 2 min’s computing time. In addition, we testify the robustness of the algorithm of FPM to additive noises and its suitability for phase objects, which further proves FPM’s potential application in biomedical imaging.

Sorafenib is a type of multikinase inhibitor that exhibits antiangiogenic and antiproliferative effects; in addition, sorafenib is a unique first-line drug recommended for the treatment of advanced hepatocellular carcinoma (HCC). However, the effectiveness of HCC treatment remains poor due to acquired drug resistance. It has been suggested that hypoxia, induced as a results of the antiangiogenic effects of sustained sorafenib treatment, may be an important factor in sorafenib resistance. The transcription factor hypoxia-inducible factor (HIF)-2α has been reported to be associated with cell proliferation under hypoxic conditions; therefore, it was hypothesized that hypoxia may enhance tumor cell proliferation via this mechanism. The present study aimed to evaluate whether the knock-down of HIF-2α was able to enhance the therapeutic efficacy of sorafenib in order to effectively treat HCC. The results demonstrated that hypoxia protected HCC cells against sorafenib; however, short hairpin RNA-HIF-2α transfection in combination with sorafenib treatment exhibited a significantly synergistic effect against HCC cell proliferation. In addition, HCC cells acquired increased β-catenin/C-Myc expression, which enhanced proliferation under hypoxic conditions; however, targeted knock-down of HIF-2α or C-Myc markedly decreased cell proliferation in HCC cells. In conclusion, the results of the present study indicated that the targeted knock-down of HIF-2α in combination with sorafenib may be a promising strategy for the treatment of HCC.

Congenital C2–3 fusion (C2–3CF) is often involved in patients with atlantoaxial dislocation, and posterior occipitocervical fixation surgery is usually required. Hypoplasia of C2 pedicle is common in such patients, making C2 pedicle screws (PS) instrumentation inapplicable. Because of congenital fusion, C3PS instrumentation would be an ideal alternative for it will not sacrifice an additional motion segment; however, the morphological and clinical feasibility has not been previously reported. We included 42 C2–3CF patients to this study and evaluated pedicle trajectories of C2 and C3 using a three-dimensional CT. Clinical applications of C3PS instrumentation were evaluated and followed. Among the 42 patients, 23 (54.8 %) and 8 (19.0 %) had C2 and C3 pedicle trajectory diameters

We report a series of simulation studies which extends pattern-illuminated Fourier ptychography microscopy by integrating with the nonlinearity arising from saturation of the fluorophore excited state for super-resolution fluorescence imaging. This extended technique, termed Saturated pattern-illuminated Fourier ptychography (SpiFP) microscopy, could achieve a resolution four times that of wide field when the illuminating light intensity approaches the saturation threshold in simulations. Increasing light intensity leads to further resolution enhancement. In order to demonstrate the performance of SpiFP, we make a comparison between SpiFP and saturated structure illumination microscopy in simulations, and prove that the SpiFP exhibits superior robustness to noise, aberration correcting ability, and pattern's flexibility. Introducing the saturation of the fluorescent emission brings in notable improvements in imaging performance, implying its potential in nanoscale-sized biological observations by wide-field microscopy.

Stimulated emission depletion microscopy (STED) has been proved to be a feasible and straightforward method of breaking the conventional diffraction barrier in the far-field. In this paper, we design and setup a home-built high speed STED microscope. Both the excitation beam (488nm) and the depletion beam (592nm) are provided by continuous wave lasers. By using a pair of galvo mirrors (TILL Yanus IV Digital Scan Head), we realize a pixel dwell time down to 2 μs in the experiment which enables an acquisition speed of 2 frames per second in an imaging field of 5*5 μm with an individual pixel size of 10nm. The image acquisition process is controlled by the software Imspector. In the manuscript, we give a clear description on how to build the microscope and also conduct several experiments to evaluate its performance in practice. A spatial resolution of

We propose a novel microscopy method, combining surface wave illumination and the Fourier ptychographic microscopy (FPM) algorithm to achieve super-resolution (SR) imaging. In our system, an oil-immersion objective lens is used to excite both the total internal reflection (TIR) evanescent waves and the surface plasmon waves (SPWs), which illuminate the sample with large wave vectors. Through the FPM algorithm, a resolution approximately twice that of conventional wide-field microscopy is obtained. Meanwhile, we could retrieve the sample's quantitative phase map in order to obtain its surface profile. Importantly, the field enhancement from a SPW has improved the contrast of the reconstructed images, which is critical for revealing the finer structural details of the specimen. In our experiments, we have imaged metallic gratings with a 120 or 150 nm wide line and trench features. We accurately retrieved their axial dimensions with a lateral resolution better than 240 nm that is close to the theoretical resolution of 215 nm, thus demonstrating the quantitative phase imaging capability of our technique. As this approach provides a label-free solution for intensity and phase imaging of samples with lateral resolution exceeding the limit introduced by the optical system, it can be potentially used in a wide range of noninvasive biological imaging applications.

What we believe is a novel method for improving confocal microscopy's resolution and contrast in 3D space is proposed. Based on a conventional confocal microscopy setup, we use an array detector composed of 32 photomultiplier tubes (PMTs) to replace one point-detector, where the location offset of each PMT caused a different effective point spread function (PSF). By applying array detection and the fluorescence emission difference method of an image with a solid PSF and another with a donut-shaped PSF, we can enhance lateral resolution about 27% in real time with only one scan, and improve the axial resolving ability by about 22% simultaneously. Experimental results of both fluorescent beads and living cells are presented to verify the applicability and effectiveness of our method.

Three-dimensional image reconstruction in multi-angle total internal reflection fluorescence microscopy relies on actual penetration depths of evanescent wave at various incidence angles. In this paper, we propose a simple and elegant calibration method to calculate the actual axial decay profile of a given evanescent field, for the analytical solution of theoretical equation is hard to solve in complicated conditions. The results calculated by the proposed method agree with the experimental demands in our research. Our calibration method, together with multi-angle TIRF imaging, permits 3D reconstruction of cell surface in superb axial resolution.

Study Design. A morphologic study of manubrium sterni using 3-dimensional computed tomography (3D-CT). Objective. To investigate the anatomic features of adult manubrium as a source of bone graft and to measure the sizes and available cancellous bone volume of manubrium. Summary of Background Data. Manubrium bone graft has been reported as a potential ideal material in anterior cervical fusion surgery, whereas the related applied anatomy is lacking in the literature. Methods. One hundred twenty adult manubria from 68 male and 52 female patients were scanned and reformatted with 3D-CT. Configurations of manubrium was observed on 3D volume–rendered images. The breadths, height, medullar thickness, and thickness distribution of manubrium were evaluated. A safe area for procurement of graft was proposed and the available cancellous bone volume of manubrium was measured. Results. Frontal manubrium bears a prominent pentagonal area, which was a bare area without muscle attachments. The breadths, height, and thickness of male manubrium were significantly larger than those of female manubrium. Maximal medullar thickness for male patient was 10.4 ± 1.1 (range, 8.8–12.8) mm, and for female patient it was 9.4 ± 1.4 (range, 6.6–11.9) mm. Minimal medullar thickness for male was 6.8 ± 1.1 (range, 4.9–9.4) mm, and for female it was 5.8 ± 0.9 (range, 4.2–7.4) mm. The thickest region of manubrium located at the level of lower clavicular notches, whereas the thinnest region located at the junction between upper two-thirds and lower third of manubrium. Available volume of cancellous bone was 10.1 ± 2.2 (range, 6.6–15.6) cm3 in male and 7.7 ± 2.5 (range, 3.6–12) cm3 in female. Conclusion. The size of male manubrium is significantly larger than that of female manubrium. Manubrium bone is far more sufficient for most adult anterior cervical fusion surgeries. Safe area for procurement of graft is defined as the upper two-thirds of manubrium, and the optimal site to access medullar cavity is suggested at bare area. However, because considerable variability of manubrium size exists, preoperative evaluation of manubrium is suggested to avoid pitfalls, especially when manubrium graft is intended in a female patient.

The prevalence of cardiac abnormalities in patients with adolescent idiopathic scoliosis in an Asian population has not been reported. A retrospective study was conducted to evaluate the incidence of cardiac abnormalities in these patients. From January 2007 to April 2009, echocardiography and pulmonary function tests were performed in 80 adolescent idiopathic scoliosis patients who required surgical intervention. A thorough analysis of cardiopulmonary functions and cardiac structures was performed. The risk factors, types of cardiac abnormalities, and associations between severity of scoliosis or pulmonary function and cardiac abnormalities were assessed. Cardiac abnormalities were detected by echocardiogram in 25 patients, including 14 with structural abnormalities and 11 with functional abnormalities. The most common functional abnormality was tricuspid regurgitation (9 of 80; 11.3%), whereas atrial septal defect was the most common structural abnormality (7 of 80). Altered hemodynamics occurred in 5 patients, including 3 with ventricular septal defect and 2 with mitral valve dysplasia. Abnormal electrocardiographic findings presented in only 9 of the 25 patients with cardiac abnormalities. No significant associations were found between severity of scoliosis or pulmonary function and cardiac abnormalities. A high incidence of cardiac abnormality exists in patients with adolescent idiopathic scoliosis in this region. Although most patients tolerated surgery, some patients were at risk of decompensation postoperatively. Electrocardiography is of limited value for detecting cardiac problems in patients with adolescent idiopathic scoliosis, we recommend echocardiography as a routine modality in the preoperative evaluation of patients with adolescent idiopathic scoliosis.