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This article explores the electrochemical hydro- and deuterocarboxylation of allenes using carbon dioxide (CO2) and deuterium oxide (D2O) as starting materials. The authors discuss the challenges of activating CO2 and propose photochemical and electrochemical methods as potential solutions. They present their own findings on the electrochemical hydrocarboxylation and deuterocarboxylation of allenes, demonstrating good regioselectivity and high yields of carboxylic acids. The authors suggest possible mechanisms for these reactions and highlight their potential applications in reaction mechanism studies and drug development. The article also provides detailed experimental procedures and results, including information on the synthesis and characterization of various compounds. [Extracted from the article]

Alkenylboronates are highly versatile building blocks and valuable reagents in the synthesis of complex molecules. Compared with that of monosubstituted alkenylboronates, the synthesis of multisubstituted alkenylboronates is challenging. The copper‐catalyzed carboboration of alkynes is an operationally simple and straightforward method for synthesizing bis/trisubstituted alkenylboronates. In this work, a series of copper‐metallized N‐Heterocyclic Carbene (NHC) ligand porous polymer catalysts are designed and synthesized in accordance with the mechanism of carboboration. By using CuCl@POL‐NHC‐Ph as the optimal nanocatalyst, this study realizes the β‐regio‐ and stereoselective (syn‐addition) 1,2‐carboboration of alkynes (regioselectivity up to >99:1) with satisfactory yields and a wide range of substrates. This work not only overcomes the selectivity of carboboration but also provides a new strategy for the design of nanocatalysts and their application in organic synthesis. [ABSTRACT FROM AUTHOR]

Background/Aims: Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs. Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. Methods: We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. Results: Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753). Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. Conclusions: EMNs of >5 mm are associated with malignancy in patients with MD- and MTIPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines. [ABSTRACT FROM AUTHOR]

INTRODUCTION Nursing staff's assistance for smokers to quit smoking can increase the rate of quitting. The smoking cessation help can be affected by many factors. This study surveyed the use of the 5As (Asking, Advising, Assessing, Assisting, Arranging) approach to support smoking cessation by the nursing staff in Chongqing, China, and analyzed the corresponding influencing factors. METHODS A stratified random cluster sampling method was used to select nursing staff from 8 tertiary hospitals, 5 secondary hospitals, 12 community health centers, and 35 township health centers in different geographical regions of Chongqing. A questionnaire survey was conducted among the nursing staff to investigate their participation in smoking cessation. Binary logistic regression analysis was employed to analyze the influencing factors of smoking cessation 5As behavior of the nursing staff. RESULTS The 1669 participants were 44 males (2.6%) and 1625 females (97.4%), with an average age of 37.00 ± 10.89 years. Among the participants, 55.2% were from tertiary hospitals, 23.2% from secondary hospitals, 14.2% from township health centers, and 7.4 from community health centers. The often or always used behaviors were: Asking, 69.2%; Advising, 53.0%; Assessing, 39.5%; Assisting, 33.7%; and Arranging, 25.1%. The factors that affected all the 5As were: smoking cessation training (AOR=1.60; 95% CI: 1.22-2.11), knowledge of smoking cessation guidelines (AOR=1.75; 95% CI: 1.32-2.32) and the use of smoking cessation Apps (AOR=1.50; 95% CI: 1.09--2.06), and smokers' willingness to quit (AOR=2.20; 95% CI: 1.60-3.02). CONCLUSIONS Smoker's motivation to quit smoking and nurses' knowledge of tobacco cessation resources affected nurses' participation in smoking control behavior. While encouraging smokers to quit smoking, clinical nursing staff should be provided with related resources to advocate smoking cessation. Guided by the Chinese Clinical Tobacco Cessation Guidelines, smoking control knowledge and skills training should be provided for nursing staff to increase their positive attitude towards smoking control, so as to promote their active participation. [ABSTRACT FROM AUTHOR]

Background: Pathological neovascularization plays a pivotal role in the onset and progression of tumors and neovascular eye diseases. Despite notable advancements in the development of anti-angiogenic medications that target vascular endothelial growth factor (VEGF) and its receptors (VEGFRs), the occurrence of adverse reactions and drug resistance has somewhat impeded the widespread application of these drugs. Therefore, additional investigations are warranted to explore alternative therapeutic targets. In recent years, owing to the swift advancement of high-throughput sequencing technology, pan-cancer analysis and single-cell sequencing analysis have emerged as pivotal methodologies and focal areas within the domain of omics research, which is of great significance for us to find potential targets related to the regulation of pathological neovascularization. Methods: Pan-cancer analysis and scRNA-seq data analysis were employed to forecast the association between Actin filament-associated protein 1 like 1 (AFAP1L1) and the development of tumors and endothelial cells. Tumor xenograft model and ocular pathological neovascularization model were constructed as well as Isolectin B4 (IsoB4) staining and immunofluorescence staining were used to assess the effects of AFAP1L1 on the progression of neoplasms and neovascular eye diseases in vivo. Transwell assay, wound scratch assay, tube forming assay, three-dimensional germination assay, and rhodamine-phalloidin staining were used to evaluate the impact of AFAP1L1 on human umbilical vein endothelial cells (HUVECs) function in vitro; Dual luciferase reporting, qRT-PCR and western blot were used to investigate the upstream and downstream mechanisms of pathological neovascularization mediated by AFAP1L1. Results: Our investigation revealed that AFAP1L1 plays a crucial role in promoting the development of various tumors and demonstrates a strong correlation with endothelial cells. Targeted suppression of AFAP1L1 specifically in endothelial cells in vivo proves effective in inhibiting tumor formation and ocular pathological neovascularization. Mechanistically, AFAP1L1 functions as a hypoxia-related regulatory protein that can be activated by HIF-1α. In vitro experiments demonstrated that reducing AFAP1L1 levels can reverse hypoxia-induced excessive angiogenic capacity in HUVECs. The principal mechanism of angiogenesis inhibition entails the regulation of tip cell behavior through the YAP-DLL4-NOTCH axis. Conclusion: In conclusion, AFAP1L1, a newly identified hypoxia-related regulatory protein, can be activated by HIF-1α. Inhibiting AFAP1L1 results in the inhibition of angiogenesis by suppressing the germination of endothelial tip cells through the YAP-DLL4-NOTCH axis. This presents a promising therapeutic target to halt the progression of tumors and neovascular eye disease. [ABSTRACT FROM AUTHOR]

The tectonic stress field of the southwestern Ordos Basin during the Late Triassic is controversial. The major controversy is whether the southwestern Ordos Basin was a compressional basin throughout the Late Triassic or whether it transformed from an extensional into a compressional basin during this period. We divided the Late Triassic into the early to middle and late to terminal periods. Two paleotectonic stress field simulation models of the southwestern Ordos Basin were constructed using finite-element software (ANSYS 10). Our results showed high consistency with regional geologic correlations, suggesting the credibility of the models. We found that the southwestern Ordos Basin was dominated by NE-SW extensional stress and strain during the early to middle Late Triassic, associated with strike-slip faulting along the western margin of the Ordos block. This is consistent with the development of syndepositional normal faults and was probably induced by the scissor collision from east to west between the North China craton and Yangtze block. The tectonic stress field of the southwestern Ordos Basin during the late to terminal Late Triassic mainly manifested as NE-SW compressive stress and strain. The dominant tectonic dynamics for the Ordos block during this period may have changed to northward compression of the Songpan-Ganzi and Qiangtang terranes. The southwestern Ordos Basin was characterized by compressional deformation and northeastward migration of the depocenter. The southwestern Ordos Basin transformed from an extensional basin associated with strike-slip faulting during the early to middle Late Triassic into a compressional depression basin during the late to terminal Late Triassic. [ABSTRACT FROM AUTHOR]

We introduce a sparse multivariate functional principal component analysis method by incorporating ideas from the group sparse maximum variance method to multivariate functional data. Our method can avoid the “curse of dimensionality” from a highdimensional dataset and enjoy interpretability at the same time. In particular, our unsupervised method can capture important latent factors to explain variability of the dataset, which can induce a clear distinction between important variables in the principal components and unnecessary features based on the sparseness structure. Furthermore, our method can be applied to functional data from a multidimensional domain that hinges on different intervals. In the numerical experiment, we show that our method works well in both low- and high-dimensional multivariate functional data regardless of the number and the type of basis. We further apply our method to stock market data and electroencephalography data in an alcoholism study to demonstrate the theoretical result. [ABSTRACT FROM AUTHOR]

A new aurone glycoside named licoagroaurone 6-O-α-ʟ-arabinopyranoside (1), together with six known compounds (2–7), was isolated from EtOAc-soluble extract of the aerial parts of Saussurea involucrata. Their structures were elucidated on the basis of spectroscopic methods. All compounds were evaluated for their inhibitory activities against α-glucosidase in vitro. Among them, compounds 1 and 6 showed significant inhibitory activities on α-glucosidase with the IC50 values of 47.1 and 57.7 μM, respectively. [ABSTRACT FROM AUTHOR]

In the present study, 2D Co(II) coordination polymers (CP‐1), which integrate terminal CoBrn (CoBr2 and CoBr3) sites immobilized on the framework, are synthesized at the gram level. As a special heterogeneous catalyst, CP‐1 shows regioselectivity (β:α>99:1) and stereoselectivity (only E configuration) in the hydroboration of alkynes. The hydroboration reaction conditions are mild and cover a broad substrate range (31 examples). In addition, the heterogeneous catalyst can be recycled for at least five times. [ABSTRACT FROM AUTHOR]

Study Design: Clinical case series.Objective: The aim of this study was to propose a novel posterior ligament-bone injury classification and severity (PLICS) score system that can be used to reflect the severity of subaxial cervical fracture dislocations (SCFDs) and predict the failure of anterior-only surgery; and to measure the intraobserver and interobserver reliability of this system.Summary Of Background Data: The approach selection for SCFDs is controversial. Although the anterior approach is familiar for most surgeons, postoperative hardware failure and/or delayed cervical deformity is a nonnegligible complication.Methods: Ten patients were randomly selected for intraobserver reliability evaluation on two separate occasions, one month apart. Another 30 patients were randomly selected, and the interobserver reliability was measured by comparing results of each case between each reviewer and averaging. To analyze the difference in the PLICS score, 354 patients fulfilled the follow-up were divided into stable and unstable groups according to whether radiologically stable was observed during follow-up.Results: For the intraobserver reliability, the mean intraclass correlation coefficient for the 10 reviewers was 0.931. For the interobserver reliability, the mean interobserver correlation coefficient for the three elements was 0.863. Among 16 patients with PLICS score ≥7, two patients in the stable group manifested with severe injury of the posterior ligamentous complex (PLC); extremely unstable lateral mass fractures with or without severe injury of PLC were detected in the 14 patients of the unstable group.Conclusion: The proposed PLICS score system showed excellent intraobserver and interobserver reliability. When a PLICS score is >7 or 7 accompanied by extremely unstable lateral mass fractures, the risk of postoperative failure after an anterior-only reconstruction is high and supplemental posterior strengthening can be considered.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy (appointed a Task Force to develope medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on indication for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbances in older adults with dementia are common. Light therapy may help in regulating their sleep or wake cycle. However, data in the literature on the effectiveness of light therapy for the people with the said condition remain inconclusive. Thus, further research is warranted.Objectives: This review aims to synthesize the best available evidence on the effectiveness of light therapy in reducing sleep disturbances among older adults with dementia.Methods: PubMed, Embase, Scopus, CINAHL, Cochrane Library, ALOIS, PsycInfo, Web of Science, ProQuest, OpenGrey, various trial registries and different journals specializing on sleep were searched without limitations on the year of publication. Cochrane's Risk of Bias Tool version 1 and GRADE criteria were used to assess risk of bias and certainty of evidence, respectively. Meta-analysis and meta-regression analyses were conducted using Stata software.Results: A total of 18 randomized controlled trials (RCTs) involving 1012 older persons with dementia were included. The meta-analysis revealed that light therapy significantly reduced night-time awakenings (p = 0.04), enhanced sleep quality (p = 0.01) and increased relative amplitude (p = 0.01) with a small to medium effect (g = 0.26-0.43). Subgroup analyses showed that studies conducted in the Western Pacific region had a larger effect size on sleep duration and efficiency than those conducted in other regions. Univariate random-effects meta-regression revealed that sample size was a significant covariate for the effect size of sleep duration and sleep efficiency.Conclusion: This study found that the majority of outcomes had a low level of certainty. Therefore, additional well-designed and large-scale trials must be conducted to achieve a more definitive conclusion. [ABSTRACT FROM AUTHOR]

Objective: Macrophages have been shown to play important roles in various pathophysiological processes of the central nervous system via neuroinflammation, leading to an increased interest in macrophage biology. Circulating blood monocytes are among the first cells to infiltrate the brain after ischemic stroke; however, the role of innate immune cells such as monocytes and macrophages remains to be elucidated. Here, we investigated the association between blood monocytes and infarct size following ischemic stroke. Methods: We induced stroke using a focal ischemia mouse model through middle cerebral artery suture occlusion. To deplete circulating blood monocytes, clodronate was injected intraperitoneally 24 h before the surgery. Animals were sacrificed at specified time points, and the infarct size and mRNA expression were then measured. Results: The clodronate-injected mice showed significantly smaller infarct size than the control mice. Immunohistochemical staining revealed that monocyte depletion significantly blocked the infiltration of macrophages and microglia. The mRNA expression levels of macrophage and microglia markers were higher in the left infarcted brain than in the right non-infarcted brain. Conclusions: In summary, monocyte depletion reduced the infarct size and mitigated neurological deficits in mice following ischemic stroke, likely by blocking the infiltration of inflammatory cells such as macrophages and microglia. [ABSTRACT FROM AUTHOR]

The article presents a study that explores about the soft artificial electroreceptors for noncontact spatial perception. It mentions the development of a soft artificial electroreceptor that can detect the relative positions of nearby objects in a noncontact manner by sensing the electric fields that originate from the objects.

The timing of cytokinesis relative to other mitotic events in the fission yeast Schizosaccharomyces pombe is controlled by the septation initiation network (SIN). During a mitotic checkpoint, the SIN is inhibited by the E3 ubiquitin ligase Dma1 to prevent chromosome mis‐segregation. Dma1 dynamically localizes to spindle pole bodies (SPBs) and the contractile ring (CR) during mitosis, though its role at the CR is unknown. Here, we examined whether Dma1 phosphorylation affects its localization or function. We found that preventing Dma1 phosphorylation by substituting the six phosphosites with alanines diminished its CR localization but did not affect its mitotic checkpoint function. These studies reinforce the conclusion that Dma1 localization to the SPB is key to its role in the mitotic checkpoint. [ABSTRACT FROM AUTHOR]

Objectives: The association between tachycardia and age in prehospital trauma mortality has not been thoroughly studied. The purpose of this study was to evaluate the interaction effects of age between prehospital tachycardia and mortality in adult trauma patients. Methods: Adult trauma patients during 2012, 2013, and 2015 who were treated and transported by emergency medical services (EMS) were analyzed. Main exposure was tachycardia (>90 beat/min) measured at the scene. The primary outcome was mortality, the secondary outcome was worsened disability. Multivariable logistic regression with interaction models between tachycardia and age was used to calculate the adjusted odds ratio (AOR) with 95% confidence intervals after adjusting for confounders. Results: A total of 35,542 patients were analyzed. Tachycardia had a significant association with mortality and worsened disability: 1.41 (1.28-1.54) for mortality and 1.25 (1.15-1.36) for worsened disability. In the interaction analysis, the AOR for mortality by tachycardia in age over 84 years was insignificant: 1.2 (1.11-1.3) for 15-64 years, 1.4 (1.29-1.52) for 65-84 years, 1.14 (0.92-1.42) for age over 85 years, respectively (p < 0.01 for interactions). Conclusion: Tachycardia had a significant association with mortality and worsened disability in prehospital trauma patients and age over 85 years old had a significantly different interaction effect. Prehospital trauma care protocol should include recognizing severe cases based on the patient's heart rate and age. It would be helpful in the decisionmaking at the scene such as trauma center transfer and advanced treatment. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies. [ABSTRACT FROM AUTHOR]

The rabbit has been recognized as a valuable model in various biomedical and biological research fields because of its intermediate size and phylogenetic proximity to primates. However, the technology for precise genome manipulations in rabbit has been stalled for decades, severely limiting its applications in biomedical research. Novel genome editing technologies, especially CRISPR/Cas9, have remarkably enhanced precise genome manipulation in rabbits, and shown their superiority and promise for generating rabbit models of human genetic diseases. In this review, we summarize the brief history of transgenic rabbit technology and the development of novel genome editing technologies in rabbits. [ABSTRACT FROM AUTHOR]

Objective: To propose a novel classification and scoring system called the posterior ligament-bone injury classification and severity score (PLICS) that offers a quantitative score to guide the need for posterior stabilization in addition to anterior reconstruction for subaxial cervical fracture dislocations (SCFDs). Methods: A total of 456 patients with SCFDs were prospectively included. Patients with PLICS ≥ 7 together with extremely unstable lateral mass fracture (EULMF) were classified as high-risk group, and the other patients were classified as low-risk group. For patients in the low-risk group, anterior-only reconstruction was performed; for patients in the high-risk group, additional posterior lateral mass fixation and fusion was performed after anterior reconstruction. Clinical outcome evaluation included using the visual analogue score (VAS), the Neck Disability Index (NDI), and the American Spinal Injury Association (ASIA) impairment scale. The change in the local sagittal alignment kyphosis Cobb angle was also recorded. Results: A total of 370 patients (81.1%) completed the minimal 12-month follow-ups, including 321 patients of low-risk group and 49 patients of high-risk group. Compared with the average VAS score preoperatively, the score at 12-month follow-up was significantly improved (from 6.1 + 0.3 to 1.1 + 0.2 in the low-risk group, P < 0.001; from 6.4 + 0.2 to 1.4 + 0.2 in the high-risk group, P < 0.001). The average NDI score at the 12-month follow-up was statistically low in the low-risk group (8.8 + 2.5 vs 13.8 + 3.4, P = 0.034). At least more than one grade improvement in the ASIA scale was observed in 80.5% of all patients. The local kyphosis Cobb angle at the injured segment averaged improved in both groups. Conclusion: A PLICS score ≥ 7 together with EULMF can be the threshold for posterior stabilization in addition to anterior reconstruction for the patients with SCFDs. [ABSTRACT FROM AUTHOR]

Organic reactions using metal–organic frameworks (MOFs) as catalysts are promising with regard to their environmentally friendly features and potential catalyst recyclability. A robust Co(II)-MOF {[Co2(L -mac)(4,4-bpt)(H2O)]·3.5H2O}n (1) and its enantiomer {[Co2(D -mac)(4,4-bpt)(H2O)]·3.5H2O}n (2) (L / D -mac = basic forms of L / D -malic acid, 4,4-Hbpt = 3,5-di(pyridin-4-yl)-4H-1,2,4-triazole) have been gram-scale prepared under solvothermal conditions. Structural analysis reveals that mac manages Co(II) ions to form 1-D chains, which are further extended via 4,4-bpt connectors into a noninterpenetrating 3D framework architecture. It was found that 1 can be as a heterogeneous catalyst for multiple organic reactions, such as azide-alkyne cycloaddition and Friedel–Crafts reactions with good isolated yields and good recycle runs (at least five times without substantial degradation). Additionally, 1 can promote hydrosilylation of alkynes under harsh conditions with moderate yield. [ABSTRACT FROM AUTHOR]

To compare clinical efficacy, radiographic outcome, and radiation exposure between mini-open pedicle screw (MPS) fixation with the Wiltse approach and percutaneous pedicle screw (PPS) fixation in treatment of young and middle-aged patients with thoracolumbar burst fractures. Of 60 patients with thoracolumbar vertebrae fractures treated in our hospital from January 2017 to January 2018, 30 were randomly assigned to the MPS group and 30 were randomly assigned to the PPS group. Clinical efficacy, radiographic outcome, and radiation exposure were compared between the 2 groups. The average age of patients was 42.2 ± 6.7 years in the MPS group and 43.0 ± 6.9 years in the PPS group (P = 0.668). There was no significant difference between the 2 groups in blood loss, hospital stay, postoperative visual analog scale score for back pain, and Oswestry Disability Index score. The vertebral body height and vertebral body angle of the MPS group were significantly better than those of the PPS group at the last follow-up. There was no significant difference in the accuracy rate of pedicle screw placement between the MPS group and the PPS group; the facet joint violation was significantly higher in the PPS group. The average radiation exposure dosage was lower in the MPS group. Both MPS fixation with the Wiltse approach and PPS fixation are safe and effective in the treatment of single-segment thoracolumbar vertebral fractures. Nevertheless, considering the surgical duration, radiation exposure, facet joint violation, vertebral body height, and vertebral body angle at the last follow-up, MPS fixation with the Wiltse approach is a better choice than PPS. [ABSTRACT FROM AUTHOR]

Background: During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well accepted by most surgeons when performing percutaneous endoscopic lumbar discectomy (PELD) via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient local anesthesia (LA) in patients with L5/S1 disc herniation. Methods: This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of local anesthetic compound (LAC) were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), complications, and adverse reactions. Results: The intraoperative satisfaction score was consistently over 7, with an average score of 9.3 ± 0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections, or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 h. Conclusions: Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications. [ABSTRACT FROM AUTHOR]

Hydrogen peroxide (H 2 O 2) solution is commonly used to irrigate wounds because of its hemostatic and antiseptic properties. Previous studies suggest that H 2 O 2 can result in toxicity to keratinocytes and fibroblasts, but complications after H 2 O 2 application, including oxygen embolism, which is one of the most severe, have rarely been reported. A 40-year-old woman was diagnosed with L4-5 lumbar spinal stenosis and subsequently underwent minimally invasive transforaminal lumbar interbody fusion treatment at another hospital. Hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occurred immediately after H 2 O 2 irrigation. After the operation, she was able to be extubated but remained comatose. Postoperative computed tomography scan revealed intracranial air trapping in the right frontal lobe and multiple cerebral infarction foci. When using a knee-prone surgical position or in cases of dural laceration, the application of undiluted H 2 O 2 solution should be avoided, especially in a surgical wound within a closed cavity. When hypotension, hypoxia, and a decrease in end-tidal carbon dioxide pressure occur immediately after H 2 O 2 irrigation, oxygen embolism should be strongly suspected. [ABSTRACT FROM AUTHOR]

The chemists' pursuit of the ideal synthesis and functionalization of indole derivatives has lasted over 150 years as their scaffolds have been widely found in natural products, pharmaceuticals, agrochemicals and organic materials. In this regard, the recent resurgence of adopting green and sustainable electrochemistry in organic synthesis suggests that electrosynthesis is a promising strategy. Indeed, many new intriguing applications of synthesis and functionalization of indole derivatives by direct and redox‐mediated electrochemical means have been disclosed. In this review, we highlight the fundamental aspects, reaction scopes, synthetic applications and reaction mechanisms of the electrochemical synthesis and functionalization of indole derivatives. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is compressing the timeline for Singapore's digital transformation in education. Reflecting on the implementation of Home-Based Learning (HBL) during the pandemic, we examine three barriers that inhibit digital transformation and technological implementation in education with leadership considerations: the first order barrier is infrastructural and can be mitigated by leadership foresight; the second order barrier concerns design capabilities of teachers which can be mitigated by tight-but-loose calibration; and the third order barrier deals with sustainability which can be mitigated by ecological leadership. The tight-but-loose calibration optimises the 'tight' system-led innovations such as Student Learning Space (SLS) for efficient deployment and for equitable access of high quality online resources for students; and 'loose' opportunities for teacher-led innovations on learning designs within and beyond system-led innovations to nurture teacher agency and professionalism. We posit that ecological leadership is key to sustaining deep change together with the 'tight-but-loose' system calibration. [ABSTRACT FROM AUTHOR]

We sought to compare the clinical and radiologic outcomes after anterior cervical surgery between zero-profile (Zero-P) cage and plate-cage construct (PCC). One-hundred and sixteen patients with single-level cervical disk herniation who underwent anterior cervical diskectomy and fusion between May 2015 and March 2017 were enrolled. They were divided into a Zero-P group (61 cases) and a PCC group (55 cases). At 1, 6, 12, and 24 months after the operation, routine follow-up evaluation was recommended including visual analog scale score and Japanese Orthopaedic Association score. The lateral x-ray film was performed at 1 and 24 months postoperatively. All 116 patients successfully completed the operation and achieved bone fusion. While there was no significant difference in the amount of bleeding between the 2 groups, the operation time of the Zero-P group was significantly shorter than that of the PCC group with statistically difference. The visual analog scale score and Japanese Orthopaedic Association score of the 2 groups at each follow-up interval postoperatively were significantly improved compared with that before operation; the difference was statistically significant (P < 0.05, respectively). While all the C2-7 cervical curvature, segmental Cobb angle, and height of adjacent vertebral body were lost at the 24-month follow-up, the significant difference was observed in the Zero-P group (P < 0.05, respectively). Compared with the Zero-P system, the PCC system provides a comparable clinical outcome. Although it showed the disadvantages in controlling the operation time and surgical bleeding, the radiologic outcome was better at the 2-year follow-up. [ABSTRACT FROM AUTHOR]

Selection of approach for subaxial cervical fracture-dislocation (SCFD) is controversial. The questions of whether a posterior ligamentous structure (PLS) can be functionally healed in patients with SCFD and how long this healing process takes are critical in these patients. This study retrospectively enrolled 394 patients with SCFD who underwent anterior decompression, reduction, and fusion between January 2002 and December 2017. The definition of functional healing of PLS was based on evaluations of clinical function and radiographic stability of PLS. Follow-up was available for 354 patients (89.8%). The PLS of 339 cases was functionally healed at the first follow-up interval without any posterior surgical intervention. No hardware failure or progressive cervical kyphosis was observed at further follow-up. At 12 months postoperatively, interbody fusion was satisfactory. However, the other 15 patients experienced nonhealing PLS at 8 weeks postoperatively and developed cervical deformity at further follow-up. Five patients refused revision surgery; the other 10 patients obtained solid fusion after revision surgeries. Among 354 patients with SCFD and treated by single anterior reduction and fixation, simple PLS injury without any bony instability at the posterior column of the cervical spine can be functionally healed in 95.8% of patients by external fixation for 8 weeks. Whether this finding is applicable to various types of SCFD should be verified in further prospective studies with larger samples. [ABSTRACT FROM AUTHOR]

Azacycles such as indoles and tetrahydroquinolines are privileged structures in drug development. Reported here is an unprecedented regiodivergent intramolecular nucleophilic addition reaction of imines as a flexible approach to access N‐functionalized indoles and tetrahydroquinolines, by the control of reaction at the N‐terminus and C‐terminus, respectively. Using ketimines derived from 2‐(2‐nitroethyl)anilines with isatins or α‐ketoesters, the regioselective N‐attack reaction gives N‐functionalized indoles, while the catalytic enantioselective C‐attack reaction affords chiral tetrahydroquinolines featuring an α‐tetrasubstituted stereocenter. Mechanistic studies reveal that hydrogen‐bonding interactions may greatly facilitate such unusual N‐attack reactions of imines. The utility of this protocol is highlighted by the catalytic enantioselective formal synthesis of (−)‐psychotrimine, and the construction of various fused aza‐heterocycles. [ABSTRACT FROM AUTHOR]

Azacycles such as indoles and tetrahydroquinolines are privileged structures in drug development. Reported here is an unprecedented regiodivergent intramolecular nucleophilic addition reaction of imines as a flexible approach to access N‐functionalized indoles and tetrahydroquinolines, by the control of reaction at the N‐terminus and C‐terminus, respectively. Using ketimines derived from 2‐(2‐nitroethyl)anilines with isatins or α‐ketoesters, the regioselective N‐attack reaction gives N‐functionalized indoles, while the catalytic enantioselective C‐attack reaction affords chiral tetrahydroquinolines featuring an α‐tetrasubstituted stereocenter. Mechanistic studies reveal that hydrogen‐bonding interactions may greatly facilitate such unusual N‐attack reactions of imines. The utility of this protocol is highlighted by the catalytic enantioselective formal synthesis of (−)‐psychotrimine, and the construction of various fused aza‐heterocycles. [ABSTRACT FROM AUTHOR]

To explore the safety and efficacy of hydrogen peroxide H 2 O 2 in controlling blood loss and surgical site infection (SSI) after multisegmental lumbar spine surgery. A total of 2626 patients who had undergone multisegmental lumbar spinal surgery from January 2015 to January 2018 were included in the present study. Stratified by the use of H 2 O 2 irrigation, they were divided into 2 groups: the control group (n = 1345) and the experimental group (n = 1281). The demographic parameters, laboratory examination results, and surgery-related information (e.g., operative time, number of operated levels, intraoperative blood loss, postoperative drainage, postoperative SSI, extubation time), and perioperative complications were recorded. No significant differences were seen regarding the demographic parameters, laboratory examination results, comorbidities, and surgery-related information. The extubation time and postoperative drainage collection were lower in the experimental group (3.6 ± 0.5 vs. 4.1 ± 0.6 days, P = 0.402; 251.8 ± 67.5 vs. 291.8 ± 71.3 mL, P = 0.013). In the control group, the rate of SSI was 2.4% (32 of 1345) and included 17 superficial wound infections and 15 deep wound infections. In the experimental group, the SSI rate was 1.4% (18 of 1281; 15 with a superficial wound infection and 3 with a deep wound infection). Staphylococcus aureus was the most common organism, especially in the experimental group (66.7% vs. 50%). No statistically significant difference was found between the 2 groups in the perioperative complications, including hematencephalon, deep vein thrombosis, pulmonary embolism, and myocardial infarction (P > 0.05). Pneumocephalus was not observed in either group. The application of H 2 O 2 in posterior lumbar interbody fusion can reduce the blood loss and incidence of SSI after surgery and was quite beneficial for controlling the increasing number of vancomycin-resistant bacteria. [ABSTRACT FROM AUTHOR]

Besides the facet joints interlocking, the fibrous tissue or bony callus around the dislocated segments make the reduction for this kind of old injury to be more challenging and different from that of acute injuries. This study is aimed to present 4 cases of old subaxial cervical facet dislocations (SCFD) that were successfully treated with posterior unlocking under endoscopy followed by anterior decompression, reduction, and fixation. Between January 2017 and December 2017, 4 patients with old SCFD who underwent posterior unlocking of facet joints under endoscopy followed by anterior decompression, reduction, and fixation were enrolled. A cervical collar was prescribed for 4 weeks postoperatively. Postoperative follow-up evaluations were conducted at 2, 6, and 12 months, including neck visual analogue scale score and neck disability index, radiography, and computed tomography. The operative time averaged 145 minutes (range, 130–155 minutes). No deterioration of neural function, major vessel rupture, or iatrogenic injury to esophagus occurred. Intraoperative blood loss averaged 45 mL (range, 40–50 mL). Hospital stay for all patients was only 4 days. The neck visual analogue scale score and neck disability index were improved at the final follow-up, and interbody fusion was satisfactory without any radiologic sign of instability or internal failure. For patients with old SCFD, the unlocking of facet joints via the posterior approach under endoscopy followed by anterior decompression, reduction, and fixation is an alternative technique. [ABSTRACT FROM AUTHOR]

Study Design: A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.Objective: Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.Summary Of Background Data: Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.Methods: Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected.Results: In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R.Conclusion: The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

Bathymetric mapping is a prerequisite procedure to conduct assessments of water quality, habitat and environmental flow for riverine ecosystems using hydraulic modelling. This study evaluates the capability of a geographically weighted regression (GWR) model, which can capture a spatially heterogeneous relationship between inputs and an output, to retrieve bathymetry of a shallow stream, of which water depth is less than about 1 m from simple RGB imagery. A field experiment was performed for measuring water depth and simultaneously for acquiring remotely-sensed data with RGB digital numbers (DN) using a digital camera mounted on an unmanned aerial vehicle (UAV). A 2D shallow water model, which was validated by comparison with the field-surveyed data, was used to simulate the water depth of unmeasured regions. Band ratios of ln(DN G / DN R) was selected as an optimal spectral input of bathymetric inversion models through the principal component analysis (PCA). Results showed that global inversion models based on multiple linear regression (MLR) and artificial neural network (ANN) resulted in large discrepancy between estimation and observation due to the spatially varying response of the PCA-selected band ratio to water depth over the experimental channel. In contrast, the GWR model successfully alleviated the biases of the conventional models as R2 increased to 0.85 from 0.60 by accurately modelling the effect of spatial heterogeneity, which arose from variable bottom types attributed to submerged vegetation, on the remote-sensing radiance-water depth relationship. • Shallow stream bathymetry was derived from UAV-aided RGB imagery using a GWR model. • Response of water depth to a band ratio was heterogeneous due to bottom reflection. • The GWR model enhanced the estimation accuracy, resolving the heterogeneity effect. [ABSTRACT FROM AUTHOR]

Higher education institutions are facing an increasing demand to collaborate with each other in the knowledge economy. Yet, research on how higher education management enhances collaborative work is rare. This paper takes research collaboration as an example and presents a provisional exploration initiated by a higher education institution in Singapore to enhance collaborations among researchers within the institution. The paper first explores three key challenges (i.e., harnessing differences, avoiding counterproductive coercing of collaborations, and optimizing team size) and introduces a social network perspective as a means to understand research collaboration. It uses analytic tools from Social Network Analysis to provide insight into the patterns and dynamics of collaborations among researchers within the institution. The insights are used to inform the institution's formulation of strategies to enhance research collaboration, including strategies for research development, research community engagement and talent retention. Critical considerations are given to the ways in which management might adopt and adapt a social network perspective to facilitate collaborative work in higher education. Exploring the utility of social theories and tools for enhancing collaborative work in higher education contributes to 'importing' theories to higher education research, particularly the institutional management and the knowledge and research themes of higher education research. [ABSTRACT FROM AUTHOR]

Study Design: Clinical case series.Objective: The aim of this study was to explore the efficacy and safety of one-stage debridement, autogenous bone graft, and instrumentation for lumbar brucella spondylitis (LBS) via a posterior approach.Summary Of Background Data: Reports on LBS are sporadic, and the therapeutic effect and safety of surgical interventions have not been assessed in clinical studies.Methods: Between January 2012 and January 2014, 24 consecutive patients with symptomatic LBS who underwent a one-stage operation that combined debridement, autogenous bone graft, and instrumentation via a posterior approach were enrolled. Back pain was measured using the visual analog scale (VAS). The neurological status was evaluated with the American Spinal Injury Association (ASIA) scale. Bone healing was evaluated based on postoperative plain x-ray or computed tomography.Results: All cases were followed up for an average of 14.3 + 3.5 months. The VAS scores were significantly improved at every follow-up interval. An improvement of at least one grade level was observed in the ASIA score of each patient. The average time of bone fusion was 6.8 + 1.6 months. Significant improvements of the average segmental Cobb angle was observed from a preoperative value of 18.4° + 4.6° to a last follow-up value of 21.1° ± 3.7°. At the last follow up, the titers of antibodies against the standard tube agglutination test, erythrocyte sedimentation rate, and C-reactive protein were negative for all patients.Conclusion: For LBS, systemic antibrucellosis chemotherapy is the cornerstone of treatment. When cauda equine syndrome, radiculopathy, spinal instability, and severe back pain caused by extradural nonabsorbable abscess or progressive collapse are present, surgical intervention is inevitable. One-stage debridement, autogenous bone graft, and instrumentation via a posterior approach could represent an alternative treatment for LBS, and the efficacy and safety of these techniques are satisfactory.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background/Aims: Type 2 autoimmune pancreatitis (AIP) has been considered extremely rare in East Asia. This study aimed to clarify the prevalence, clinical characteristics and radiological findings of type 2 AIP highlighting patients presenting as acute pancreatitis in a single center. Methods: Type 2 AIP patients were classified according to International Consensus Diagnostic Criteria. Radiological findings were compared between type 2 AIP presenting as acute pancreatitis and gallstone pancreatitis. Results: Among 244 patients with AIP, 27 (11.1%) had type 2 AIP (definite, 15 [55.5%] and probable 12 [44.5%]). The median age of patients with type 2 AIP was 29 years (interquartile range, 20 to 39 years). Acute pancreatitis was the most common initial presentation (n=17, 63%) while obstructive jaundice was present in only one patient. Ulcerative colitis (UC) was associated with type 2 AIP in 44.4% (12/27) of patients. Radiological pancreatic imaging such as delayed enhancement of diffusely enlarged pancreas, homogeneous enhancement of focal enlargement/ mass, absent/minimal peripancreatic fat infiltration or fluid collection, and multifocal main pancreatic duct narrowings were helpful for differentiating type 2 AIP from gallstone pancreatitis. During follow-up (median, 32.3 months), two patients (2/25, 8%) experienced relapse. Conclusions: In South Korea, type 2 AIP is not as rare as previously thought. Overall, the clinical profile of type 2 AIP was similar to that of Western countries. Type 2 AIP should be considered in young UC patients with acute pancreatitis of uncertain etiology. [ABSTRACT FROM AUTHOR]

A female patient who underwent total knee arthroplasty presented with a snapping sensation over the left knee at 10 years postoperatively. Initially, the bony mass was visible on the medial femoral condyle radiographically at 5 years postoperatively. The mass had enlarged over time and her symptoms were progressive. The mass was excised at postoperative 18 years and confirmed as an osteochondroma histopathologically. The patient’s symptoms have been completely resolved for 3-year follow-up after excision. [ABSTRACT FROM AUTHOR]

We sought to explore whether additional bone grafting of the atlantoaxial joint increases the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion surgery. From January 2012 to January 2016, a total of 78 patients who had basilar invagination with occipitalization of the atlas came to our tertiary spine center. Except for those lost to follow-up (10 cases) or who had a follow-up time <2 years (20 cases), there were 48 patients retrospectively included in this study. In the control group, a piece of autogenous iliac corticocancellous bone was placed between the occipital and C2 vertebral lamina for fusion. In the hybrid fusion group, besides posterior occipitocervical autograft, some granular bone harvested from the iliac crest was packed into the bilateral atlantoaxial joint. X-ray imaging and cervical computed tomography (CT) were performed during follow-up. The operations were completed successfully in all patients without intraoperative complications. Only 21 (87.5%) patients in the control group had confirmed posterior bony fusion on CT, while 24 (100%) patients in the hybrid fusion group had confirmed posterior bony fusion. There were postoperative implant-related complications in 2 patients. Both cases belonged to the control group (8.3%). Three patients (12.5%) complained of transient numbness in the posterior occipital region: 2 patients in the hybrid group and 1 patient in the control group. The mean duration to posterior occipitocervical fusion was 5.5 months in the hybrid fusion group versus 6.1 months in the control group (P = 0.757). Of note, in the hybrid fusion group, the process of atlantoaxial joint fusion was faster than that of posterior occipitocervical fusion (5.1 months vs. 5.5 months, P = 0.823). Additional bone grafting of the atlantoaxial joint could increase the bone fusion rate of iliac crest autograft in posterior occipitocervical fusion. [ABSTRACT FROM AUTHOR]

Background/Aims: We evaluated the efficacy and safety of daclatasvir (DCV) and asunaprevir (ASV) in patients with chronic hepatitis C virus (HCV) infection on hemodialysis. Methods: We performed a single-arm, multicenter prospective study. Twenty-one chronic hemodialysis patients with HCV infection were prospectively enrolled from February 2016 to April 2017. We evaluated the virological responses at weeks 4, 12, and 24 (end of treatment [EOT]) and the sustained virological response at 12 weeks after the EOT (SVR12). The tolerability and safety of the drugs were also assessed. Results: None of the 20 patients had the NS5A resistance-associated variant (NS5A RAV), and one patient was indeterminate for the NS5A RAV. Seventeen patients (80%) completed the 24 weeks of treatment with DCV and ASV. Four patients discontinued the study prior to week 12. In an intention-to-treat analysis, the SVR12 was 76.1%. In a per-protocol analysis, patients who completed DCV and ASV treatment achieved an SVR12 of 100%. DCV and ASV were well tolerated by the majority of patients. Three patients discontinued treatment due to adverse events (AEs) including dizziness, dyspnea, and neutropenia. The patient with indeterminate NS5A RAV showed viral breakthrough and discontinued treatment. Conclusions: DCV and ASV combination therapy in chronic hemodialysis patients with HCV infection achieved a high SVR12 rate with few AEs. To maximize the SVR12 rate, it is important to identify candidates by baseline RAV testing. Close monitoring of the safety and tolerability of DCV and ASV may be necessary in HCV-infected patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Objective To examine effects of percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation as treatment for single-level thoracic tuberculosis. Methods This multicenter retrospective analysis included 75 patients with single-level thoracic tuberculosis who underwent percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation and were followed for >36 months between January 2012 and December 2014. Results Follow-up was 36–48 months (average 41.1 ± 2.2 months). Intraoperative blood loss was low (average 30.5 ± 7.9 mL), and bed rest time was short (average 1.5 ± 0.3 days). No recurrence was observed in all 75 patients. Except for 3 patients, almost all patients (96%) achieved grade I or II fusion in interbody bone grafting. Segmental Cobb angle was 13.5° ± 4.1° before surgery, 10.5° ± 3.7° immediately after surgery, and 11.7° ± 3.9° at 36 months of follow-up. All patients achieved complete recovery of neurologic function (American Spinal Injury Association grade E), including 15 patients with spinal cord injury (American Spinal Injury Association grade D) before surgery. The visual analog scale and 36-Item Short-Form Health Survey scores significantly improved at 1, 3, 12, and 36 months of follow-up. No complications related to internal fixation occurred within the follow-up period; complication rate was 9.0%. Conclusions Median follow-up clinical experience with percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation indicates that the technique is safe, effective, feasible, and minimally invasive. [ABSTRACT FROM AUTHOR]

Objective. To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods. Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results. Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions. For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to compare clinical results after total knee arthroplasty (TKA) using the Attune and PFC Sigma knee designs and to investigate whether the use of the Attune prosthesis increased the risk of patellar injury in Asian patients. Materials and Methods: Three hundred knees that underwent TKA using Attune (group A) were compared to 300 knees that underwent TKA using PFC Sigma (group B). The Knee Society Knee Score (KS) and Function Score (FS), and range of motion (ROM) were compared. The residual patellar thickness was compared to evaluate the risk of patellar injury. Results: The postoperative KS and ROM of group A were better than those of group B (93.1 vs. 88.8, p<0.001 and 131.4° vs. 129.0°, p=0.008, respectively). The postoperative FS did not differ significantly between the two groups (80.9 vs. 78.7, p=0.427). The residual patella was thinner in group A (14.8 mm vs. 15.7 mm, p=0.003), which made up a higher proportion of the high-risk group for patellar fractures with a residual thickness of <12 mm (7.5% vs. 2.1%, p=0.003). Conclusions: TKA using the Attune prosthesis provided more favorable clinical results than TKA using PFC Sigma. However, the risk of injury in the residual patella was increased with use of the Attune prosthesis in Asian patients. [ABSTRACT FROM AUTHOR]

Background Currently, anterior transdiscal access and posterior interlaminar approach are the main approaches for percutaneous endoscopic cervical discectomy (PECD). To overcome access shortcomings, we previously described a novel anterior endoscopic transcorporeal approach on a migrated cervical disc. We innovatively introduced bone wax into endoscopic surgery to aid hemostasis and facilitate the process of drilling an intracorporeal tunnel. Methods Five patients with cervical intervertebral disc herniation (CIDH) were treated by PECD via the anterior transcorporeal approach. During the operation, we marked the punctured tunnel with bone wax containing indigo carmine as a guide and smeared bone wax on the endoscopic burr to aid hemostasis. Results A satisfactory clinical outcome was observed in all 5 patients postoperatively; pain and neurologic condition were dramatically improved. Surgery-related complications, such as esophageal injury, vascular rupture, hematoma, intervertebral disc infection, or postoperative headache, were not encountered. A computed tomography scan was used to observe the process of bone healing. At 3-month postoperative follow-up, the bone defect within the drilling tunnel had partially shrank and was completely healed at 6 months postoperatively. Conclusions The anterior endoscopic transcorporeal approach for PECD is a novel, valuable alternative for the treatment of CIDH. Bone wax could indeed facilitate the operation by guiding the drilling process and instantly controlling the bleeding without obvious interference with bone healing. Long-term follow-up is warranted in further clinical studies. Highlights • A transcorporeal approach to remove a herniated disc at the C4-5 level under endoscopy is introduced. • Bone wax was introduced into endoscopic surgery to aid hemostasis and facilitate the process of drilling a tunnel. • Satisfactory clinical outcome was observed in all 5 patients postoperatively, with improved pain and neurologic condition. • With the process of osteogenesis, a phenomenon of self-repair was observed in the bone defect within the drill tunnel. • Because injury to the residual disc is mild, the probability of further intervertebral space collapsing is low. [ABSTRACT FROM AUTHOR]

Objective We sought to preliminarily explore the efficacy and safety of percutaneous endoscopic spinal surgery for epidural cement leakage. We report a case series of patients who underwent percutaneous retrieval of leaked epidural cement and achieved spinal decompression under endoscopy. Methods Five patients with neurologic impairment due to epidural cement leakage after percutaneous vertebroplasty were treated with percutaneous endoscopic spinal decompression. Computed tomography reconstruction and 3-dimensional imaging were used to evaluate the extruded material. During follow-up at 3, 6, and 12 months postoperatively, all patients were advised to undergo plain radiograph and computed tomography examinations. Results The leaked epidural cement was successfully removed in all patients under percutaneous endoscopy through a unilateral or bilateral approach. At the 12-month follow-up, the visual analog scale score of all patients improved. In addition, the neurologic function of each patient improved to at least 1 grade level, as evaluated using the American Spinal Injury Association. According to the modified MacNab criteria, 2 patients had excellent recovery, whereas the other 3 patients had good recovery. Conclusions We described a novel and minimally invasive procedure to ameliorate intractable epidural cement extrusion. As an alternative to conventional laminectomy, percutaneous endoscopic retrieval achieved the targeted decompression without damaging the posterior lamina. Moreover, the whole operation was performed under regional anesthesia accompanied with dexmedetomidine sedation, allowed real-time neural function evaluation, and had lower risks of anesthesia-related complications, compared with general anesthesia. Highlights • Generally, an urgent and extensive laminectomy was required to thoroughly remove the intraspinal extravasated comment. • Percutaneous endoscopic retrieval could achieve targeted decompression without damaging the posterior lamina. • It is not only capable of being monitored for efficacy but also avoids the risks associated with general anesthesia. [ABSTRACT FROM AUTHOR]

Objective : Ischemic postconditioning (IPostC), consisted of transient brain ischemia/reperfusion cycles, is considered to have neuroprotective effect. However, there is no best single protocol of IPostC, because varied factors like species tested and characteristics of the tissue may affect the efficacy of IPostC. Thus, we investgated whether different protocols of IPostC affect neuroprotective effects in experimental animal models. Materials and Methods : Through occlusion of middle cerebral artery (MCA) with intraluminal suture, stroke was induced in a transient focal ischemia model in mice. We conducted IPostC via brief and repeated MCA occlusion, 2 minutes after reperfusion, followed by different ischemia and reperfusion protocols. After procedure, functional neurological score and histological examination were evaluated. Results : IPostC with different protocols resulted in diverse effects. Among them, a protocol that consists of 3 cycle of IPostC significantly reduced the infarction size 3 days after stroke. Conclusion : IPostC was confirmed to reduce infarction size. The effects of IPostC are definitely affected by differences in the protocol used, including the number of cycles, the duration of individual ischemia/reperfusion episode and the entire duration of the IPostC stimuli [ABSTRACT FROM AUTHOR]

• This model investigates mixed convection of ferrofluids in a dimpled channel. • Finite element analysis has been carried out to study the heat and flow behaviour. • Reynolds and Rayleigh numbers enhance the average heat transfer rate. • Intensifying the magnetic field results in stronger isotherms in the dimpled cavity. • The rectangular obstacle helps in increasing the average Nusselt number. The water-based nanofluid analysis of a ferromagnetic fluid flow in a channel has been conducted over a dimpled cavity. The horizontal flat walls are assumed to be adiabatic, whereas the dimpled part and the inner rectangular-finned-shaped obstacle are heated. The system of Partial Differential Equations (PDEs) along with boundary conditions have been solved via Galerkin Weighted Residual Finite Element Method. To predict the streamlines isotherms, local and average Nusselt numbers, all the simulations are performed for various Reynold and Hartmann numbers. High Reynolds numbers, results in significant improvement in heat transfer at the dimpled surface. It is believed that such investigation might be helpful to make a base for finding the experimental results for mixed convection of ferromagnetic nanofluid problem over a dimpled cavity. [ABSTRACT FROM AUTHOR]

Wet age-related macular degeneration (wAMD) is the leading cause of blindness among the elderly in industrialized nations. Anti-vascular epidermal growth factor (VEGF) therapy via intravitreal injection is the most effective clinical treatment for wAMD due to high concentrations of VEGF that promote choroidal neovascularization. While PIWI proteins participate in various biological processes, their function in AMD remains unclear. In this study, we discovered that PIWIL4 expression is elevated in a laser-induced choroidal neovascularization (CNV) model and that it regulates angiogenesis in vitro and in vivo. Differentially expressed piwi-interacting RNAs (piRNAs) were identified in a CNV model and were shown to potentially regulate angiogenesis via bioinformatics analysis. PIWIL4 knockdown inhibits VEGF secretion and VEGFR2 phosphorylation. Overall, PIWIL4 may serve as a novel target to block pathological choroidal neovascularization, and the study of the PIWI-piRNAs pathway in wAMD highlights its broad function in somatic cells. • wAMD is a top cause of elderly blindness. • PIWIL4 could be a new target to block CNV. • PIWIL4 highly expressed in CNV model, regulates angiogenesis. • piRNAs potentially regulate angiogenesis in the development of wAMD. • PIWIL4 knockdown inhibits VEGF secretion and VEGFR2 phosphorylation. [ABSTRACT FROM AUTHOR]

Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. Additionally, we describe how investigators and key stakeholders in resuscitation science have formulated specific Utstein data element domains in an attempt to standardise the definitions and outcomes reported in OHCA research so that management pathways can be improved. Finally, we identify the predictors of survival after OHCA and what primary and secondary prevention strategies can be instigated to mitigate the devastating sequelae of this growing public health issue. [ABSTRACT FROM AUTHOR]

Research management is an emerging field of study and its development is significant to the advancement of research enterprise. Developing the science of research management requires investigating social mechanisms involved in research management. Yet, studies on social mechanisms of research management is lacking in the literature. To address this gap, this paper proposes importing methodologies and theories from other social science disciplines to study the social mechanisms of research management and to build the science of research management. The paper first articulates what constitutes the science of research management, then proposes to appropriate Design-Based Research (DBR), a methodology in education research, for building the science of research management while at the same time strengthening the theory-practice nexus. A study of education research is then presented to illustrate how DBR is used to enact the theory of homophily which is imported from sociology. It reveals an opportunity to use social designs to develop social relationships among teachers from different schools for networked learning. Such a research endeavour also has potential to advance theories of relationship-building in sociology. Inferring from the example as an analogue to what is suggested for research management, the paper advocates a way to reciprocally connect research management as an emerging research field with more established social science disciplines at large and to advance both the theory and practice of research management. [ABSTRACT FROM AUTHOR]