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In vitro fabrication of 3D cell culture systems that could provide in vivo tissue-like, structural, and biochemical environments to neural cells is essential not only for fundamental studies on brain function and behavior, but also for tissue engineering and regenerative medicine applicable to neural injury and neurodegenerative diseases. In particular, for astrocytes-which actively respond to the surroundings and exhibit varied morphologies based on stimuli (e.g., stiffness and chemicals) in vitro, as well as physiological or pathological conditions in vivo-it is crucial to establish an appropriate milieu in in vitro culture platforms. Herein, we report the induction of in vivo-relevant, stellate-shaped astrocytes derived from cortices of Rattus norvegicus by constructing the 3D cell culture systems of brain-derived, decellularized extracellular matrices (bdECMs). The bdECM hydrogels were mechanically stable and soft, and the bdECM-based 3D scaffolds supplied biochemically active environments that astrocytes could interact with, leading to the development of in vivo-like stellate structures. In addition to the distinct morphology with actively elongated endfeet, the astrocytes, cultured in 3D bdECM scaffolds, would have neurosupportive characteristics, indicated by the accelerated neurite outgrowth in the astrocyte-conditioned media. Furthermore, next-generation sequencing showed that the gene expression profiles of astrocytes cultured in bdECMs were significantly different from those cultured on 2D surfaces. The stellate-shaped astrocytes in the bdECMs were analyzed to have reached a more mature state, for instance, with decreased expression of genes for scaffold ECMs, actin filaments, and cell division. The results suggest that the bdECM-based 3D culture system offers an advanced platform for culturing primary cortical astrocytes and their mixtures with other neural cells, providing a brain-like, structural and biochemical milieu that promotes the maturity and in vivo-like characteristics of astrocytes in both form and gene expression. STATEMENT OF SIGNIFICANCE: Decellularized extracellular matrices (dECMs) have emerged as strong candidates for the construction of three-dimensional (3D) cell cultures in vitro, owing to the potential to provide native biochemical and physical environments. In this study, we fabricated hydrogels of brain-derived dECMs (bdECMs) and cultured primary astrocytes within the bdECM hydrogels in a 3D context. The cultured astrocytes exhibited a stellate morphology distinct from conventional 2D cultures, featuring tridimensionally elongated endfeet. qRT-PCR and NGS-based transcriptomic analyses revealed gene expression patterns indicative of a more mature state, compared with the 2D culture. Moreover, astrocytes cultured in bdECMs showed neurosupportive characteristics, as demonstrated by the accelerated neurite outgrowth in astrocyte-conditioned media. We believe that the bdECM hydrogel-based culture system can serve as an in vitro model system for astrocytes and their coculture with other neural cells, holding significant potential for neural engineering and therapeutic applications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Phlebopus portentosus (Berk. and Broome) Boedijn is an attractive edible mushroom and is considered the only bolete for which artificial cultivation in vitro has been achieved. Gene expression analysis has become widely used in research on edible fungi and is important for elucidating the functions of genes involved in complex biological processes. Selecting appropriate reference genes is crucial to ensuring reliable RT‒qPCR gene expression analysis results. In our study, a total of 12 candidate control genes were selected from 25 traditional housekeeping genes based on their expression stability in 9 transcriptomes of 3 developmental stages. These genes were further evaluated using geNorm, NormFinder, and RefFinder under different conditions and developmental stages. The results revealed that MSF1 domain-containing protein (MSF1), synaptobrevin (SYB), mitogen-activated protein kinase genes (MAPK), TATA-binding protein 1 (TBP1), and SPRY domain protein (SPRY) were the most stable reference genes in all sample treatments, while elongation factor 1-alpha (EF1), actin and ubiquitin-conjugating enzyme (UBCE) were the most unstably expressed. The gene SYB was selected based on the transcriptome results and was identified as a novel reference gene in P. portentosus. This is the first detailed study on the identification of reference genes in this fungus and may provide new insights into selecting genes and quantifying gene expression., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Low temperature is the most common method used to maintain the freshness of Phlebopus portentosus during long-distance transportation. However, there is no information regarding the nutritional changes that occur in P. portentosus preserved postharvest in low temperature., Methods: In this study, the changes in flavor quality and bioactive components in fruiting bodies stored at 4 °C for different storage periods were determined through LC/MS and GC/MS analyses. Sampling was performed at 0, 3, 5, 7, and 13 days storage., Results and Discussion: Based on the results, the metabolites present in caps and stipes were different at the same period and significantly different after 7 days of storage. A total of 583 and 500 different metabolites were detected in caps and stipes, respectively, and were mainly lipids and lipid-like molecules, organic acids and derivatives, organic oxygen compounds and others. Except for prenol lipids and nucleotides, the expression levels of most metabolites increased with longer storage time. In addition, geosmin was identified as the major contributor to earthy-musty odors, and the level of geosmin was increased when the storage time was short., Conclusion: The variations in these metabolites might cause changes in flavor quality and bioactive components in P. portentosus . Variations in these metabolites were thoroughly analyzed, and the results revealed how storage processes affect the postharvest quality of P. portentosus for the first time., Competing Interests: K-PJ, YC, S-ZL, and G-YJ are employed by Hongzhen Agricultural Science and Technology Co. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Li, Hu, Li, Ji, Luo, Cao, Ji, Tan, Bao, Shang and Yang.)

Purpose: The purpose of the current study was to compare the outcomes of temporary stoma through the specimen extraction site (SSES) and stoma through a new site (SNS) after laparoscopic low anterior resection., Methods: The rectal cancer patients who underwent laparoscopic low anterior resection plus temporary ileostomy were recruited in a single clinical database from Jun 2013 to Jun 2020. The SSES group and the SNS group were compared using propensity score matching (PSM) analysis., Results: A total of 257 rectal cancer patients were included in this study, there were 162 patients in the SSES group and 95 patients in the SNS group. After 1:1 ratio PSM, there was no difference in baseline information (p > 0.05). The SSES group had smaller intraoperative blood loss (p = 0.016 < 0.05), shorter operation time (p < 0.01) and shorter post-operative hospital stay (p = 0.021 < 0.05) than the SNS group before PSM. However, the SSES group shorter operation time (p = 0.006 < 0.05) than the SNS group after PSM, moreover, there was no significant difference in stoma-related complications (p > 0.05). In the multivariate analysis, longer operation time was an independent factor (p = 0.019 < 0.05, OR = 1.006, 95% CI = 1.001-1.011) for the stoma-related complications., Conclusion: Based on the current evidence, the SSES group had smaller intraoperative blood loss, shorter operation time and shorter post-operative hospital stay before PSM, and shorter operation time after PSM. Therefore, SSES might be superior than SNS after laparoscopic low anterior resection for rectal cancer patients., (© 2022. The Author(s).)

Background: The purpose of enhanced recovery after surgery (ERAS) was to reduce surgical pressure and accelerate postoperative functional recovery. Although the application of biologics in treating inflammatory bowel disease (IBD) has changed treatment strategies, most patients with IBD still require surgery., Aim: To evaluate the advantage of ERAS in IBD surgery., Methods: The PubMed, EMBASE and Cochrane Library databases were searched from inception to March 21, 2021 to find eligible studies. The primary outcome was postoperative complications, and the secondary outcomes included operation time, time to first flatus, time to bowel movement, postoperative hospital stay and readmission. The PROSPERO registration ID of this meta-analysis is CRD42021238052., Results: A total of eight studies involving 1939 patients were included in this meta-analysis. There were no differences in baseline information between the ERAS group and the non-ERAS group. After pooling up all of the data, no significant difference was found between the ERAS group and the non-ERAS group in terms of postoperative overall complications [odds ratio = 0.82, 95% confidence interval (CI) = 0.66 to 1.02, P = 0.08]. The ERAS group had a lower prevalence of anastomotic fistula (odds ratio = 0.36, 95%CI = 0.13 to 0.95, P = 0.04), less time to first flatus [mean difference (MD) = -2.03, 95%CI = -3.89 to -0.17, P = 0.03], less time to bowel movement (MD = -1.08, 95%CI = -1.60 to -0.57, P < 0.01) and shorter postoperative hospital stays (MD = -1.99, 95%CI = -3.27 to -0.71, P < 0.01) than the non-ERAS group., Conclusion: ERAS was effective for the quicker recovery in IBD surgery and did not lead to increased complications., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To summarize data from a serological survey of high-risk populations in Guangdong Province, China, and to perform a meta-analysis to investigate the prevalence and seroprevalence of celiac disease (CD) in the Chinese general and high-risk populations., Methods: We collected data from the serological survey of high-risk population of CD in Guangdong Province, China (N = 1390) by testing their serum tissue transglutaminase immunoglobulin A (tTG-IgA), deamidated gliadin peptides immunoglobulin A (DGP-IgA) and deamidated gliadin peptides immunoglobulin G (DGP-IgG). Additionally, a literature search was performed on PubMed, EMBASE, Cochrane Library and three Chinese databases for articles published up to 20 December 2020 to estimate the pooled prevalence and seroprevalence of CD in China., Results: In the serological survey, 0.94% (13/1390) of individuals were positive for CD antibodies. In a meta-analysis of 18 studies, the seroprevalence of CD in the general Chinese population was 0.27% (95% confidence interval [CI] 0.02%-0.71%). While that in the high-risk population was 8.34% (95% CI 4.90%-12.54%) (odds ratio 7.27, 95% CI 4.06-13.04). The prevalence of biopsy-confirmed CD in high-risk Chinese populations was 4.44% (95% CI 1.53%-8.58%). The seroprevalence of CD varied with patients' geographical origin, being higher in northern China than in southern China., Conclusions: Early diagnosis of CD by serological screening in high-risk population and generous serological testing in those with vague symptoms, especially in northern China, are recommended., (© 2021 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Background: The prevalence of high serum uric acid is increasingly rising in recent years, and diet behavior is perceived to be associated with it. This study aimed to explore the relationship between eating away from home (EAFH) and the risk of high serum uric acid in adults in South China. Methods: The data utilized in this study were from Guangdong Nutrition and Health Survey (NHS) 2015. Serum uric acid concentration was detected. EAFH in the past week was investigated. We defined EAFH as food consumption away from home. Dietary data were collected by 24-h recalls on 3 consecutive days. A generalized linear mixed-effects model was applied to compute the odds ratio (OR) and its corresponding 95% CI. Results: A total of 3,489 individuals were included in this study. A 1.27-fold OR (95% CI: 1.05-1.52, P = 0.012) of high serum uric acid was identified in adults with EAFH in comparison with those without EAFH. With respect to men, a 1.66-fold OR (95% CI: 1.3-2.1, P < 0.001) of high serum uric acid was observed. We also observed that men with EAFH had higher intakes of red meat, poultry, vegetable, carbohydrate, protein, fat, and total energy, while a lower grain intake than those without EAFH. However, there was a lack of significant association between EAFH and the odds ratio of high serum uric acid in women. Women with EAFH did not have higher consumptions of red meat, vegetable, fish, fat, and water than those without EAFH. Conclusions: This study found that EAFH was associated with an increased odds ratio of high serum uric acid in men, but not in women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chen, Wang, Ji, Jiang, Hong, Ma, Huang, Chen and Peng.)

(‒)-Cannabidiol (CBD) is one of the major phytocannabinoids extracted from the Cannabis genus. Its non-psychoactiveness and therapeutic potential, partly along with some anecdotal-if not scientific or clinical-evidence on the prevention and treatment of neurological diseases, have led researchers to investigate the biochemical actions of CBD on neural cells. This review summarizes the previously reported mechanistic studies of the CBD actions on primary neural cells at the in vitro cell-culture level. The neural cells are classified into neurons, microglia, astrocytes, oligodendrocytes, and neural stem cells, and the CBD effects on each cell type are described. After brief introduction on CBD and in vitro studies of CBD actions on neural cells, the neuroprotective capability of CBD on primary neurons with the suggested operating actions is discussed, followed by the reported CBD actions on glia and the CBD-induced regeneration from neural stem cells. A summary section gives a general overview of the biochemical actions of CBD on neural cells, with a future perspective. This review will provide a basic and fundamental, but crucial, insight on the mechanistic understanding of CBD actions on neural cells in the brain, at the molecular level, and the therapeutic potential of CBD in the prevention and treatment of neurological diseases, although to date, there seem to have been relatively limited research activities and reports on the cell culture-level, in vitro studies of CBD effects on primary neural cells.

Phlebopus portentosus (Berk. and Broome) Boedijin, a widely consumed mushroom in China and Thailand, is the first species in the order Boletaceae to have been industrially cultivated on a large scale. However, to date, the lignocellulose degradation system and molecular basis of fruiting body development in P. portentosus have remained cryptic. In the present study, genome and transcriptome sequencing of P. portentosus was performed during the mycelium (S), primordium (P), and fruiting body (F) stages. A genome of 32.74 Mb with a 48.92% GC content across 62 scaffolds was obtained. A total of 9,464 putative genes were predicted from the genome, of which the number of genes related to plant cell wall-degrading enzymes was much lower than that of some saprophytic mushrooms with specific ectomycorrhizal niches. Principal component analysis of RNA-Seq data revealed that the gene expression profiles at all three stages were different. The low expression of plant cell wall-degrading genes also confirmed the limited ability to degrade lignocellulose. The expression profiles also revealed that some conserved and specific pathways were enriched in the different developmental stages of P. portentosus . Starch and sucrose metabolic pathways were enriched in the mycelium stage, while DNA replication, the proteasome and MAPK signaling pathways may be associated with maturation. These results provide a new perspective for understanding the key pathways and hub genes involved in P. portentosus development., Competing Interests: K-PJ, YC, S-ZL, and G-YJ are employed by Hongzhen Agricultural Science and Technology Co. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wan, Li, Guo, Ji, Luo, Ji, Cao, Tan, Bao and Yang.)

A design method and corresponding fabrication procedures are proposed for a dual frusto-conical reflector of a downlight luminaire. The profile of the dual frusto-conical reflector consists of two flat-slant reflective surfaces with slightly different slopes. The optimum dual frusto-conical reflector can be obtained with the proposed design method. The finished product of the dual frusto-conical reflector is fabricated by a 3D printer and followed by surface polishing and reflection paint spraying. The measurement results show that luminaires exhibited 70% optimum illuminance confined within an illumination area of 1.8 m 2 , and the optimum illumination intensity is at 252 lux. The optimum efficiency of the proposed luminaire can reach 158 lm/W for normal-white light-emitting diode (LED) and 119 lm/W for warm-white LED, respectively.

Objective: To determine the seroprevalence of celiac disease in susceptible population, and to analyze the relationship between demographic characteristics, dietary habits, lifestyle and serological positivity so as to provide guidance for the prevention and treatment of celiac disease in Southern China. Methods: A total of 1 273 individuals who participated in Guangdong Province Health Screening Program in 2015, were selected as serologically positive subjects of celiac disease, including people with irritable bowel syndrome, colitis, diarrhea, anemia, low BMI, short stature, type 1 diabetes mellitus (T1DM), rheumatoid arthritis (RA), ankylosing spondylitis, psoriasis and bristol grade=6 or 7. All subjects were tested for serum IgA anti-tissue transglutaminase antibodies (TTGA), IgA antibodies against deamidated gliadin peptides(DGPA) and IgG against deamidated gliadin peptides (DGPG). Dietary habits, lifestyle and demographic characteristics were compared in subgroups. Results: The seroprevalence of celiac disease in susceptible population was 0.94% (95% CI 0.54%-1.64%) including 0.08% (1/1 273) for TTGA, 0.47% (6/1 273) for DGPA, and 0.39% (5/1 273) for DGPG. The seropositive rate was 3.6% (1/28) in patients with psoriasis, 2.1% (2/95) in the low BMI group, 1.9% (1/53) in T1DM group, 1.8% (3/169) in diarrhea group and 1.1% (5/463) in RA group. No significant difference was found in age, gender, high carbohydrate diet or lifestyle between the negative and the positive subjects. Conclusions: In Southern China, the seropositive rate of celiac disease is 0.94% in susceptible population, which prompts an urgent need of serological screening for early diagnosis.

This study investigated risk factors for 30-day readmission of discharged patients who had undergone lumbar spinal surgery. This retrospective, case-control study reviewed 3,933 patients discharged after elective spinal surgery for lumbar degenerative diseases from 2005 to 2012 at a university hospital. Of these patients, 102 were re-hospitalized within 30 days of discharge. Patient medical records were reviewed. The incidence of readmission within 30 days was 2.6%, and uncontrolled pain was the most common reason for readmission. In the univariate analysis, age, mental illness, the number of medical comorbidities, previous spinal surgery, fusion surgery, number of fusion levels, estimated blood loss, operation time, intensive care unit (ICU) admission, length of hospital stays, and total medical expenses were associated with a higher risk of readmission within 30 days. Multiple logistic regression analysis revealed that previous spinal surgery, operation time, ICU admission, length of hospital stays, and total medical expenses were independent risk factors for 30-day readmission. Independent risk factors for readmission were longer operation time, a previous spinal surgery, ICU admission, longer hospital stays, and higher medical expenses. Further studies controlling these risk factors could contribute to reducing readmission and thus improving the quality of care.

Background: Contrast dispersion pattern on epidurography may be associated with clinical improvement after epidural neuroplasty. However, insufficient evidence supports this theory. The current study aims to evaluate the relevance of contrast dispersion and clinical improvement after percutaneous epidural neuroplasty using an inflatable balloon catheter., Methods: One hundred patients with lumbar spinal stenosis who underwent combined balloon decompression and epidural adhesiolysis between March 2015 to December 2015 participated in the present study. Participants were divided into two groups by contrast dispersion pattern on postprocedural epidurography: the complete contrast dispersion (CCD) and incomplete contrast dispersion (ICCD) groups. The numeric rating scale (NRS), Oswestry Disability Index (ODI), and global perceived effects (GPE) were each assessed before and one, three, six, nine, and 12 months after the intervention., Results: After combined balloon decompression and adhesiolysis, significant pain reduction and functional improvement were maintained up to 12 months in patients with lumbar spinal stenosis. NRS and GPE in the CCD group were significantly lower than in the ICCD group from six to 12 months after the intervention. The ODI in the CCD group was also significantly lower compared with that in the ICCD group from one to 12 months after the intervention., Conclusions: Combined balloon decompression and adhesiolysis with the inflatable balloon catheter can provide noteworthy pain reduction and improvement of physical function for a long-term period in patients with lumbar spinal stenosis. Because CCD showed better clinical improvement compared with ICCD, a contrast dispersion pattern may be associated with an improved clinical outcome., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

It was highlighted that in the original article [1] the data on categorical variables was wrongly arranged in Table 1 and there was an incorrect statement in the fourth paragraph of the Discussion section.

A cervicogenic headache (CEH) is difficult to diagnose due to its varied pathology. We evaluated the usefulness of single-photon emission computed tomography/computed tomography (SPECT/CT) in diagnosing CEH and its interventional treatment. Retrospectively, 23 patients diagnosed with CEH between March 2016 to August 2018 were allocated to SPECT/CT ( n = 11) and control ( n = 12) groups. The SPECT/CT group was further stratified into SPECT/CT(+) and SPECT/CT(-) groups according to the presence of positive findings. Patients in the SPECT/CT group underwent an intra-articular injection at a radiologically verified lesion site, whereas those in the control group underwent third occipital nerve block. Clinical outcomes were evaluated with the visual analog scale (VAS), neck disability index (NDI), and global perceived effect (GPE) scale at baseline, and at one, three, and six months postoperatively. The SPECT/CT group showed less VAS, NDI, and GPE scores at six months postoperatively (2.91 ± 2.30 vs. 4.42 ± 1.62, p = 0.08; 38.00 ± 16.54 vs. 48.7 ± 12.40, p = 0.093; 2.00 ± 1.41 vs. 3.17 ± 1.11, p = 0.039). Successful responders at six months postoperatively were higher in the SPECT/CT(+) group than in the control group (75% vs. 0%). SPECT/CT can identify arthritic changes and accurately define therapeutic targets., Competing Interests: The authors report no conflicts of interest.

Background: Dysregulated methylation of the promoter of lncRNA LINC00472 reduces the expression of LINC00472 and subsequently up-regulates the expression of its competing endogenous RNA miR-24. In addition, JP2 can stabilize the expression of RyR2, whereas the deregulation of RyR2 expression may contribute to the pathogenesis of atrial fibrillation (AF). In this study, we aimed to study the role of LINC00472 in the pathogenesis of AF., Methods: 125 AF patients and 168 healthy controls were enrolled to compare their expression of miR-24, LINC00472, JP2 and RyR2. A dual-luciferase reporter gene assay accompanied by real-time PCR, Western blot and IHC assay was subsequently conducted to evaluate the regulatory relationship among miR-24, LINC00472, JP2 and RyR2 in HCM and H9C2 cells., Results: AF patients were associated with an increased level of miR-24 expression and reduced level of LINC00472 expression. Also, the level of DNA methylation in LINC00472 was increased in AF patients. MiR-24 could negatively regulate the expression of LINC00472 and JP2 by directly binding to them., Conclusions: LINC00472 could regulate the progression of AF via modulating the LINC00472/miR-24/JP2/RyR2 signaling pathway., (Copyright © 2019. Published by Elsevier Masson SAS.)

Background: Higher dietary acid load (DAL) was considered to be associated with an elevated risk of hypertension, while related data from mainland China remains scarce and incomplete. We aim to evaluate the association between DAL and the risk of hypertension among adults from South China., Methods: We conducted a nutrition and health survey in Guangdong Province located in southern China from 2015 to 2017. A four-stage probability sampling method was utilized to select representative samples of citizens aged ≥18 years old. DAL was assessed by potential renal acid load (PRAL) and net endogenous acid production (NEAP). Participants were divided to 4 groups (Q1-Q4) according to the quartile points of PRAL or NEAP distributions. Generalized linear mixed effects models were applied to evaluate the association between DAL and the risk of hypertension., Results: A total of 3501 individuals were eligible for this study and 45.9% was male participants. Hypertension rate was 30.7%. A higher PRAL was associated with higher prevalence rate of hypertension among the male (P-trend = 0.03). OR for Q2 was 1.34 (95%CI, 0.94-1.91), Q3 was 1.53 (95%CI = 1.08, 2.16) and Q4 was 1.51 (95%CI, 1.08-2.16) among the male. However, as for total participants, the female, the participants with ≤55 years or participants with > 55 years, the associations were lack of significance. With respect to association between NEAP and hypertension, non-significant results were identified., Conclusions: The current study indicated male hypertension was associated with higher PRAL, while given to this study was cross-sectional design, further studies are warranted to verify the association.

Objective: To determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH., Methods: This study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom's criteria) were assessed at 1, 3, 6, and 12 months after treatment., Results: The mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom's criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1-3 (14.0-21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05)., Conclusion: Our findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

Objective: Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2-18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD)., Methods: In this prospective randomized controlled trial, we compared CLD with discectomy utilizing the Barricaid® (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation., Results: Sixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group (11.4±1.5 vs. 10.2±1.2 mm, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (χ2=4.04, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups., Conclusion: Lumbar discectomy with the Barricaid® (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from epidural steroid injection or even epidural neuroplasty with a balloon-less catheter. However, exact indications or predictive factors for epidural balloon neuroplasty have not been fully evaluated. Therefore, to assess associated factors that could affect a favorable outcome, we analyzed a prospectively collected multicenter cohort of patients with chronic refractory lumbar foraminal stenosis after balloon neuroplasty. At the 6-month point in follow-up, 92 (44.4%) patients among 207 subjects were classified as successful responders according to a robust combination of outcome measures. Multivariate logistic regression analysis also showed that mild grade lumbar foraminal stenosis may be an independent factor associated with a successful response 6 months after balloon neuroplasty (odds ratio = 2.829; 95% confidence interval = 1.351-5.923; p = 0.006). However, we found that there were 29.4% and 24.6% successful responders with moderate and severe foraminal stenosis, respectively. Attempting balloon neuroplasty in refractory lumbar foraminal stenosis, especially mild grade, may be worthwhile. &nbsp ., Competing Interests: One of the authors (J.-W.S.) invented the ZiNeu catheter and transferred the patent to JUVENUI Co., Ltd. before submitting this manuscript. The other authors have no conflict of interest to declare. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Phlebopus portentosus (Berk. and Broome) Boedijin is a popular edible mushroom found in China and Thailand. To date, P. portentosus is the only species in the order Boletales that can be successfully cultivated worldwide. The use of a casing layer or casing soil overlaying the substrate is a crucial step in the production of this mushroom. In this study, bacterial profiling and dynamic succession analyses of casing soil during the cultivation of P. portentosus were performed. One hundred and fifty samples were collected, and MiSeq sequencing of the V3-V4 region of the 16S rRNA gene was conducted. After performing a decontamination procedure, only 38 samples were retained, including 6 casing soil-originated samples (OS), 6 casing soil samples (FHCS) and 5 upper substrate samples (FHCU) from the period of complete colonization by mycelia; 6 casing soil samples (PCS) and 5 upper substrate samples (PCU) from the primordium period; and 6 casing soil samples (FCS) and 4 upper substrate samples (FCU) from fruit body period. The results revealed that bacterial diversity increased sharply from the hyphal to the primordium stage and then decreased during harvesting. The non-metric multidimensional scaling (NMDS) ordination and analysis of similarities (ANOSIM) analysis suggested that the community composition during different stages was significantly different in casing soil. The most abundant phyla in all of the samples were Proteobacteria , Chloroflexi , Acidobacteria , Actinobacteria , Saccharibacteria , and Bacteroidetes . Burkholderia was the most abundant genus in all the samples except the OS samples. The relative abundance of Burkholderia in the FHCS samples (55.79%) decreased to 35.14% in the PCS samples and then increased to 45.60% in the FCS samples. The abundances of Acidobacterium , Rhizobium , Acidisphaera , Bradyrhizobium , and Bacillus increased from the FHCS to PCS samples. The linear discriminant analysis (LDA) effect size (LEfSe) suggested that Acidobacterium and Acidisphaera are micromarkers for PCS, whereas Bradyrhizobium , Roseiarcus , and Pseudolabrys were associated with fruit body stages. The network analyses resulted in 23 edges, including 4 negative and 19 positive edges. Extensive mutualistic interactions may occur among casing soil bacteria. Furthermore, these bacteria play important roles in mycelial elongation, primordium formations, and the production of increased yields.

Background: IGF-binding protein 3（IGFBP-3）has previously been identified as tumor marker. The present study aimed to investigate the clinical significance of serum IGFBP-3 in colorectal cancer (CRC)., Methods: Serum was collected from 70 CRC patients and 50 healthy volunteer controls. Serum IGFBP-3 and carcinoembryonic antigen (CEA) levels were measured using electrogenerated chemiluminescence immunoassay and compared between groups. Relationships between serum IGFBP-3 level and the clinical characteristics of CRC were also analyzed. A receiver operator characteristic (ROC) curve was plotted to investigate diagnostic efficacy of serum IGFBP-3 and CEA, respectively, for CRC. Data were analyzed using SPSS 13.0., Results: Serum IGFBP-3 levels in CRC were lower than those of controls (4.68 [3.56, 5.77] vs 5.44 [4.77, 6.10] µg/mL, P < 0.05). Furthermore, serum IGFBP-3 levels were higher in early cancer stages (I and II) than those of advanced stages (III and IV) (4.78 [3.92, 5.49] vs 3.77 [2.65, 4.59] µg/mL, P < 0.05). In addition, patients with lymph node metastasis absent had elevated serum IGFBP-3 levels than those of patients with lymph node metastasis present (4.73 [3.92, 5.72] vs 4.11 [2.45, 4.83] µg/mL, P = 0.02). Finally, ROC curve indicated that serum IGFBP-3 had a better diagnostic power for CRC than CEA. When serum IGFBP-3 and carcinoembryonic antigen were used together to detect CRC, the AUC was 0.949, with a sensitivity of 75% and a specificity of 90%., Conclusions: Serum IGFBP-3 might be a potential biomarker for CRC., (© 2019 The Authors. Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc.)

Background Context: Posterolateral fusion (PLF) with autogenous iliac bone graft is one of the most common surgical procedures for lumbar spinal disease. However, its limited success demands new biologically competent graft enhancers or substitutes. Although the use of direct current (DC) electrical stimulation has been shown to increase rate of successful spinal fusions, little is known about the effect of the type of current in DC stimulation., Purpose: To evaluate the effects of various DC stimulators on the strength and success rate of posterolateral fusion facilitated by using a nitinol mesh container, in rats., Study Design: This was an experimental animal study., Methods: A conductive, tubular nitinol mesh container was used to carry small pieces of bone grafts. The nitinol mesh container received electrical stimulation via a lead that connected the container to different types of DC stimulators. Sixty male Sprague-Dawley rats were divided into three groups (N=20 in each): a control group that underwent PLF with a nitinol container filled with autograft, a constant DC group that received a nitinol container and constant DC (100 μA), and a pulsed DC group that received a nitinol container and pulsed DC (100 μA, 100 Hz, 200 μs). The rats underwent PLF between L4 and L5, and transverse processes were grafted with bilateral iliac grafts. A stimulator was implanted subcutaneously. The rats were sacrificed 8 weeks postsurgery, and lumbar spines were removed. Spinal fusion was evaluated by microcomputed tomography, manual testing, biomechanical testing, histologic examination, and molecular analysis., Results: All animals in the DC stimulation groups displayed solid fusion, whereas only 70% of control animals showed solid fusion. Radiographic images, biomechanical testing, histologic examination, and molecular analysis revealed improved fusion in the order control group

Combined balloon decompression and epidural adhesiolysis has been reported to be effective in refractory lumbar spinal stenosis. Many cases of intractable stenosis have symptom-related multiple target sites for interventional treatment. In this situation it may not be possible to perform balloon adhesiolysis, or even only epidural adhesiolysis, for all target sites. Therefore, this multicenter prospective observational study aimed to evaluate the relationship of successful ballooning rate for multiple target sites with clinical outcome. Based on the ballooning success rate of multiple target sites, the patients were divided into three groups: below 50%, 50-85%, and above 85% ballooning. A greater ballooning success rate for multiple target sites provided a more decreased pain intensity and improved functional status in patients with chronic refractory lumbar spinal stenosis, and the improvement was maintained for 6 months. The estimated proportions of successful responders according to a multidimensional approach in the below 50%, 50-85%, and above 85% balloon success groups at 6 months after the procedure were 0.292, 0.468, and 0.507, respectively ( p = 0.038). Our study suggests the more successful balloon adhesiolysis procedures for multiple target lesions are performed, the better clinical outcome can be expected at least 6 months after treatment.

Background: This study aimed to evaluate the characteristics of faculty and research activities of basic stem cell research groups in China., Methods: A questionnaire was administered to persons who knew the information among 46 basic stem cell research groups in China. Multiple linear regression models and repeated-measures analyses of variance were used. Repeated-measures analyses of variance were used., Results: Of the 46 groups, 39.1% did not have any faculty recruited from abroad from 2009 to 2013, 37.0% did not have any faculty with junior-level title, 34.8% had ≤25.0% faculty with either M.D. or Ph.D. degree. Papers published in SCI journals per faculty and having faculty recruited from abroad were positively associated with research funding per faculty. The groups with faculty recruited from abroad had significantly higher research funding per faculty over time compared with the group without faculty recruited from abroad. Repeated-measures analyses of variance showed the group with faculty recruited from abroad had significantly higher research funding per faculty over time compared with the group without faculty recruited from abroad., Conclusion: To increase the development of basic stem cell research, some characteristics of human resources should be improved, and the groups should recruit more faculty with overseas experience., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Objective: To understand the cognition and attitudes of men who have sex with men (MSM) towards HIV testing and explore in-depth reasons preventing them from testing. Methods: The function of "opinion" in Blued, a gay geo-social networking application (GSN), was adopted to collect qualitative data of ideas and attitudes towards HIV testing of the users between December 2017 and January 2018. The data was analyzed based on grounded theory approach. Results: 28 269 Blued users participated in the activity and 1 977 posted comments. Four key themes were identified, i.e. no/low risk of contracting HIV, stigmatization of HIV testing, long-term relationship and conventional impediments of HIV testing. Conclusion: The cognition and attitudes of the target population derived from the analysis of "opinion" function in Blued, such as the stigmatization of the behavior of HIV testing influencing the attitude of HIV testing, could help researchers build a more accurate detection and promotion strategy instead of a very general intervention on the public.

Study Design: In-vitro biomechanical investigation., Purpose: To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels., Overview of Literature: Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear., Methods: A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4-C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5-C6 segment) and adjacent (C4-C5 segment) levels., Results: The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models., Conclusions: The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.

Background: The non-operative treatment of herniated intervertebral discs has long been a fundamental challenge. A novel technique of laser ablation to ablate the nucleus pulposus under a transforaminal epiduroscope (TELA system, Lutronics, Seoul, Republic of Korea) was recently developed., Objective: The purpose of this study was to evaluate the safety and effectiveness of transforaminal epiduroscopic laser ablation (TELA) for selective ablation of the nucleus pulposus in single-level disc disease., Study Design: Prospective case control studySETTING: Multicenter studyMETHODS: This study included a group of 56 patients who underwent transforaminal epiduroscopic laser ablation (TELA) and 56 patients who underwent selective transforaminal epidural block (STEB) for single-level disc disease. Visual analog scale (VAS), Oswestry Disability Index (ODI), and SF-12 were assessed at admission and at 1, 3, 6, and 12 months postoperatively., Results: The mean VAS of back pain was lower for the TELA group than for the STEB group 12 months postoperative (P < 0.05). The mean ODI was lower in the TELA group than in the STEB group at 12 months postoperatively (P < 0.05). There were no major complications related to the TELA and STEB procedures., Limitations: The primary limitation is a small sample size. The control group was created from a database which was prospectively collected in a different time line., Conclusions: The TELA procedure is superior to the STEB procedure in terms of patients reporting less pain and better quality of life over a year. TELA may be a reasonable alternative to conventional interventions or open surgery in single-level disc disease., Key Words: Laser-assisted spinal endoscopy, disc decompression, Nd:YAG laser, laser ablation, intervertebral disc disease, lumbar spine.

Dysbiosis, departure of the gut microbiome from a healthy state, has been suggested to be a powerful biomarker of disease incidence and progression 1-3 . Diagnostic applications have been proposed for inflammatory bowel disease diagnosis and prognosis 4 , colorectal cancer prescreening 5 and therapeutic choices in melanoma 6 . Noninvasive sampling could facilitate large-scale public health applications, including early diagnosis and risk assessment in metabolic 7 and cardiovascular diseases 8 . To understand the generalizability of microbiota-based diagnostic models of metabolic disease, we characterized the gut microbiota of 7,009 individuals from 14 districts within 1 province in China. Among phenotypes, host location showed the strongest associations with microbiota variations. Microbiota-based metabolic disease models developed in one location failed when used elsewhere, suggesting that such models cannot be extrapolated. Interpolated models performed much better, especially in diseases with obvious microbiota-related characteristics. Interpolation efficiency decreased as geographic scale increased, indicating a need to build localized baseline and disease models to predict metabolic risks.

Background: The metabolic syndrome (MetS) epidemic is associated with economic development, lifestyle transition and dysbiosis of gut microbiota, but these associations are rarely studied at the population scale. Here, we utilised the Guangdong Gut Microbiome Project (GGMP), the largest Eastern population-based gut microbiome dataset covering individuals with different economic statuses, to investigate the relationships between the gut microbiome and host physiology, diet, geography, physical activity and socioeconomic status., Results: At the population level, 529 OTUs were significantly associated with MetS. OTUs from Proteobacteria and Firmicutes (other than Ruminococcaceae) were mainly positively associated with MetS, whereas those from Bacteroidetes and Ruminococcaceae were negatively associated with MetS. Two hundred fourteen OTUs were significantly associated with host economic status (140 positive and 74 negative associations), and 157 of these OTUs were also MetS associated. A microbial MetS index was formulated to represent the overall gut dysbiosis of MetS. The values of this index were significantly higher in MetS subjects regardless of their economic status or geographical location. The index values did not increase with increasing personal economic status, although the prevalence of MetS was significantly higher in people of higher economic status. With increased economic status, the study population tended to consume more fruits and vegetables and fewer grains, whereas meat consumption was unchanged. Sedentary time was significantly and positively associated with higher economic status. The MetS index showed an additive effect with sedentary lifestyle, as the prevalence of MetS in individuals with high MetS index values and unhealthy lifestyles was significantly higher than that in the rest of the population., Conclusions: The gut microbiome is associated with MetS and economic status. A prolonged sedentary lifestyle, rather than Westernised dietary patterns, was the most notable lifestyle change in our Eastern population along with economic development. Moreover, gut dysbiosis and a Western lifestyle had an additive effect on increasing MetS prevalence.

Background: The correlation between epidurography contrast patterns and the clinical outcomes of percutaneous epidural neuroplasty (PEN) remains unclear., Objective: To analyze the correlation between postadhesiolysis epidurography contrast patterns and the clinical outcomes of patients who undergo lumbar PEN., Design: This study is a retrospective analysis of 78 consecutive patients who underwent lumbar PEN between April 2012 and March 2013., Setting: The analysis was done in the university hospital center., Method: The clinical outcomes of all patients were assessed before and 1, 3, 6, and 12 months after undergoing lumbar PEN. Specifically, the intensity of back and leg pain, quality of life, and procedural outcomes were evaluated using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the 12-Item Short-Form Health Survey (SF-12)., Results: The VAS scores for back and leg pain, ODI score, and SF-12 score exhibited a significant improvement during the follow-up period ( P < 0.01 versus preprocedural scores). At most follow-up time points, patients exhibiting extraforaminal contrast distribution ( n =22) on postadhesiolysis epidurograms exhibited a similar improvement in VAS scores and a significantly better improvement in ODI and SF-12 scores compared with patients exhibiting intracanal contrast distribution ( n =56)., Conclusion: Extraforaminal contrast distribution during lumbar PEN may be associated with better functional outcomes.

Anti-tuberculosis drug-induced liver injury (ATLI) is common during the treatment of tuberculosis (TB). As an important enzyme in the metabolism of many drugs, UGT2B7 (uridine diphosphate glucuronyl transferase 2B7) was associated with drug-induced liver disorder. This study investigated the association between the polymorphisms of UGT2B7 and ATLI in Chinese Han. Totally, 280 newly diagnosed TB patients had been followed up for 3 months after the prescription of anti-TB therapy. Tag-single-nucleotide polymorphism (tag-SNPs) (rs10028494 and rs7668282) were genotyped with the MassARRAY platform. The associations between tag-SNPs and ATLI risk were analyzed by logistic regression analysis adjusting for confounding factors. In this prospective study, 33 patients were lost to follow-up, and 24 patients were diagnosed with ATLI and considered as the case group. The remaining 223 subjects without ATLI were considered as the control group. No significant association was observed in allele and genotype frequencies of UGT2B7 between the two groups. This study is the first attempt to investigate the association of genetic polymorphisms of UGT2B7 with ATLI in Chinese Han. There is no significant association between UGT2B7 polymorphisms and ATLI in Chinese Han.

Background: Cervical disc disease is a common and occasionally disabling condition, occurring as a natural consequence of aging in the vast majority of the adult population. Percutaneous epidural neuroplasty (PEN) has been used to deliver highly concentrated drugs for chronic neck pain and to prevent scarring in cases refractory to conventional epidural blocks. However, the clinical course after PEN in cervical disc disease is not well-documented., Objective: The purpose of this study was to evaluate the efficacy of cervical PEN for single-level cervical disc disease., Study Design: A retrospective observational study., Methods: A consecutive series of 100 patients who underwent cervical PEN for single-level disc disease (bulging or protrusion) were included in this study. Preoperatively, all patients underwent magnetic resonance imaging (MRI), and visual analog scale (VAS) scores as well as Odom's criteria were measured preoperatively and at post-operative follow-up visits (one, 3, 6, and 12 months)., Limitations: The results of this study are limited by the lack of a control group that did not undergo treatment with PEN., Results: Additional block therapy was performed in 58 patients (58.0%). Subsequent surgery was performed in 10 patients (10.0%, excluded from data of clinical follow-up). Mean neck pain and VAS arm pain scores for all follow-up patients decreased from 6.82 and 4.74 preoperatively to 2.18 and 1.87 at 12 months after PEN (P < 0.001). More than 80% and 40% of all patients with and without additional block therapy after cervical PEN, respectively, showed good and excellent outcomes according to Odom's Criteria during 12 months of follow-up. During this follow-up period, no severe complications related to the procedure were observed., Conclusion: Cervical PEN was shown to be a safe and effective treatment for neck and arm pain in single-level disc disease during 12 months of follow-up. Key words: Neck pain, cervical disc disease, pain management, percutaneous epidural neuroplasty, adhesiolysis, clinical course.

Objective: Computed tomography (CT)-based method of three dimensional (3D) analysis (MIMICS ® , Materialise, Leuven, Belgium) is reported as very useful software for evaluation of OPLL, but its reliability and reproducibility are obscure. This study was conducted to evaluate the accuracy of MIMICS ® system, and inter- and intra-observer reliability in the measurement of OPLL., Methods: Three neurosurgeons independently analyzed the randomly selected 10 OPLL cases with medical image processing software (MIMICS ® ) which create 3D model with Digital Imaging and Communication in Medicine (DICOM) data from CT images after brief explanation was given to examiners before the image construction steps. To assess the reliability of inter- and intra-examiner intraclass correlation coefficient (ICC), 3 examiners measured 4 parameters (volume, length, width, and length) in 10 cases 2 times with 1-week interval., Results: The inter-examiner ICCs among 3 examiners were 0.996 (95% confidence interval [CI], 0.987-0.999) for volume measurement, 0.973 (95% CI, 0.907-0.978) for thickness, 0.969 (95% CI, 0.895-0.993) for width, and 0.995 (95% CI, 0.983-0.999) for length. The intra-examiner ICCs were 0.994 (range, 0.991-0.996) for volume, 0.996 (range, 0.944-0.998) for length, 0.930 (range, 0.873-0.947) for width, and 0.987 (range, 0.985-0.995) for length., Conclusion: The medical image processing software (MIMICS ® ) provided detailed quantification OPLL volume with minimal error of inter- and intra-observer reliability in the measurement of OPLL.

Study Design: Prospective study., Objective: The purpose of this study was to compare the long-term clinical and radiologic outcomes of hybrid surgery (HS) and 2-level anterior cervical discectomy and fusion (2-ACDF) in patients with 2-level cervical disk disease., Summary of Background Data: In a previous study with a 2-year follow-up, HS was shown to be superior to 2-ACDF, with a better Neck Disability Index (NDI) score, less postoperative neck pain, faster C2-C7 range of motion (ROM) recovery, and less adjacent ROM increase., Materials and Methods: Between 2004 and 2006, 40 patients undergoing 2-level cervical disk surgery at our hospital were identified as 2-level degenerative disk disease. Forty patients were included in the previous study; 35 patients were followed up for 5 years. Patients completed the NDI and graded their pain intensity before surgery and at routine postoperative until 5 years. Dynamic cervical radiographs were obtained before surgery and at routine postoperative intervals and the angular ROM for C2-C7 and adjacent segments was measured., Results: The HS group had better NDI recovery until 3 years after surgery (P<0.05). Postoperative neck pain was lower in the HS group at 1 and 3 years after surgery (P<0.05), but arm pain relief was not differently relieved. The HS group showed more angular ROM for C2-C7 at 2 and 3 years after surgery. The superior adjacent segment ROM showed hypermobility in the 2-ACDF group and hypomobility in the HS group at all follow-up periods without statistically significance, but the inferior adjacent segment ROM differed significantly (P<0.05)., Conclusion: HS is superior to 2-ACDF; it leads to better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase over a 2-year follow-up, but these benefits of HS become similar to those of 2-ACDF with 5 years of follow-up.

Purpose: Our purpose was to evaluate the efficacy of teriparatide for posterior lumbar interbody fusion (PLIF) in osteoporotic women., Methods: Forty-seven osteoporotic patients underwent PLIF with pedicle screw fixation for degenerative lumbar stenosis and instability. Patients were divided into two groups. The teriparatide group (n = 23) was injected subcutaneously with teriparatide (20 μg daily) for 3-month cycles alternating with 3-month periods of oral sodium alendronate for 12 months. The bisphosphonate group (n = 24) was administered oral sodium alendronate (91.37 mg/week) for ≥1 year. Serial plain radiography, computed tomography, and bone mineral densitometry (BMD) evaluations were performed. Fusion rate, bony fusion duration, and T score changes were evaluated. Clinical data [pain scores, Prolo's functional scale, and Oswestry disability index (ODI)] were also serially evaluated., Results: The teriparatide group showed earlier fusion than the bisphosphonate group. The average period of bone fusion was 6.0 ± 4.8 months in the teriparatide group but 10.4 ± 7.2 months in the bisphosphonate group. The bone fusion rate in the teriparatide group was higher than that in the bisphosphonate group at 6 months; however, there was no difference 12 and 24 months after surgery. Pain scores and ODI were not significantly different between groups. BMD scores in the teriparatide group were significantly improved compared with the bisphosphonate group 2 years after surgery., Conclusions: There was no significant improvement in overall fusion rate and clinical outcome in our patients after injection of teriparatide, but the teriparatide group showed faster bony union and highly improved BMD scores.

Objective: Antituberculosisdrug-induced hepatotoxicity (ATDH) is a common and sometimes serious side effect related to tuberculosis (TB) treatment. A number of risk factors and host genetics contribute to the development of ATDH. However, genetic factors of ATDH remain to be identified. Silent Information Regulator 1 (SIRT1), an essential metabolism gene, was proved to be involved in ATDH in mice. The aim of this investigation was to study the association between ATDH and tag-single nucleotide polymorphisms (tag-SNPs) of the SIRT1 gene in a prospective cohort study in patients with TB., Methods: 280 newly diagnosed TB patients were recruited in this study before starting first line anti-TB treatment and were followed up for 3 months after initiating anti-TB therapy. The tag-SNPs were selected by using Haploview 4.2 based on the HapMap database of Han Chinese Beijing. Genotyping was performed by polymerase chain reaction (PCR) and the Sequenom MassARRAY iPLEX platform., Results: 24 (9.8%) of the 245 patients included in the final analysis developed hepatotoxicity during the following up period. No significant differences in the allele, genotype, or haplotype frequency distributions of the tag- SNPs (rs7069102, rs2273773, rs4746720) of the SIRT1 gene were identified between the ATDH and non-ATDH groups (all p > 0.05)., Conclusions: The SIRT1 gene may not contribute to the risk for developing hepatotoxicity during anti-TB treatment in the Han Chinese population.

Objective: To investigate the prevalence and trend of overweight and obesity in children and adolescents aged 6-17 years between 2002 and 2012 in Guangdong province. Methods: A total of 7 075 children and adolescents aged 6-17 years were selected in Guangdong for nutritional survey in 2002 and a total of 2 319 children and adolescents aged 6-17 years were selected in nine counties/districts of Guangdong for nutritional survey during 2009-2012 through multi-stage random cluster sampling. The body height and weight of all the children and adolescents were measured. Results: The result of 2009-2012 survey indicated the average prevalence of overweight and obesity in the children and adolescents surveyed were 7.3% and 4.5 %, respectively. The prevalence of overweight and obesity were higher in boys (8.9% and 6.5%) than in girls (5.3% and 2.2%), in rural area (9.3% and 5.6%) than in urban area (4.7% and 3.2%). Children and adolescents aged 9-11 years had a higher overweight and obesity rates compared with other age groups. Compared with 2002, except for obesity rate in urban girls, the prevalence of overweight and obesity in children and adolescents obviously increased. The increase rate was higher in rural area than urban area and in boys than in girls. Conclusions: Compared with 2002, the prevalence of overweight and obesity in children and adolescents in Guangdong obviously increased. The prevalence was much higher in boys, those living in rural area and those aged 9-11 years, thus more attention should be paid to them.

Anti-tuberculosis drug-induced hepatotoxicity (ATDH) is a serious adverse reaction to anti-tuberculosis (TB) treatment. Thioredoxin reductase 1 (TXNRD1), encoded by the TXNRD1 gene, is an important enzyme involved in oxidant challenge. TXNRD1 plays a key role in regulating cell growth and transformation, and protects cells against oxidative damage. We investigated the association between TXNRD1 polymorphisms and ATDH susceptibility. In this prospective study, 280 newly diagnosed TB patients were followed-up for 3 months after beginning anti-TB therapy. Tag single-nucleotide polymorphisms (tag-SNPs) of TXNRD1 were selected using Haploview 4.2 based on the HapMap database of the Chinese Han in Beijing (CHB) panel. Genotyping was performed using the MassARRAY platform. Of the 280 patients enrolled in this study, 33 were lost to follow-up, 24 had ATDH, and 223 were free from ATDH. After adjusting for sex, age, smoking status, and body mass index, there were no significant differences in the allele and genotype frequency distributions of TXNRD1 SNPs between the ATDH and non-ATDH groups (all P > 0.05). The haplotype analysis showed that haplotype TCAGCC was associated with an increased risk of ATDH susceptibility [P = 0.024, OR (95%CI) = 6.273 (1.023-38.485)]. Further stratified analyses showed that the haplotype TCAGCC was associated with ATDH susceptibility in female subjects [P = 0.036, OR (95%CI) = 5.711 (0.917-35.560)] and non-smokers [P = 0.029, OR (95%CI) = 6.008 (0.971-37.158)]. Our results suggest that TXNRD1 variants may favor ATDH susceptibility in females and non-smokers. Further studies are required to verify this association., Competing Interests: The authors declare no conflict of interest.

Background: It is well documented that epidural adhesion is associated with spinal pain. However, the underlying mechanism of spinal pain generation by epidural adhesion has not yet been elucidated., Objectives: To elucidate the underlying mechanism of spinal pain generation by epidural adhesion using a two-dimensional (2D) non-linear finite element (FE) analysis., Study Design: A finite element analysis., Setting: A two-dimensional nonlinear FE model of the herniated lumbar disc on L4/5 with epidural adhesion., Methods: A two-dimensional nonlinear FE model of the lumbar spine was developed, consisting of intervertebral discs, dura, spinal nerve, and lamina. The annulus fibrosus and nucleus pulpous were modeled as hyperelastic using the Mooney-Rivlin equation. The FE mesh was generated and analyzed using Abaqus (ABAQUS 6.13.; Hibbitt, Karlsson & Sorenson, Inc., Providence, RI, USA). Epidural adhesion was simulated as rough contact, in which no slip occurred once two surfaces were in contact, between the dura mater and posterior annulus fibrosus., Results: The FE model of adhesion showed significant stress concentration in the spinal nerves, especially on the dorsal root ganglion (DRG). The stress concentration was caused by the lack of adaptive displacement between the dura mater and posterior annulus fibrosus. The peak von Mises stress was higher in the epidural adhesion model (Adhesion, 0.67 vs. Control, 0.46). In the control model, adaptive displacement was observed with decreased stress in the spinal nerve and DRG (with adhesion, 2.59 vs. without adhesion, 3.58, P < 0.00)., Limitations: This study used a 2D non-linear FE model, which simplifies the 3D nature of the human intervertebral disc. In addition, this 2D non-linear FE model has not yet been validated., Conclusion: The current study clearly demonstrated that epidural adhesion causes significantly increased stress in the spinal nerves, especially at the DRG. We believe that the increased stress on the spinal nerve might elicit more pain under similar magnitudes of lumbar disc protrusion.

Background: The efficacy of lumbar percutaneous epidural neuroplasty (PEN) as a minimally invasive technique has been relatively well investigated, but the clinical effectiveness of cervical PEN (C-PEN) has yet to be established., Objective: The purpose of this study was to compare clinical outcomes between C-PEN and cervical epidural steroid injection (C-ESI)., Study Design: Randomized control study., Setting: University hospital center., Methods: Eighty patients with neck pain from single level cervical disease with and without radiculopathy were included in this study. Patients were randomly assigned into 2 groups: C-PEN or C-ESI. Clinical outcomes were assessed according to Neck Disability Index (NDI) score and Visual Analog Scale (VAS) score for arm pain until 12 months after treatment., Results: All C-PEN and C-ESI groups showed better NDI recovery and greater reduction in VAS score at postoperative 6 months (P < 0.001). The C-PEN group demonstrated better NDI score at postoperative 6 months than the C-ESI group (P = 0.014), while there were no differences at 2, 4, and 12 months. Additionally, the C-PEN group showed lower VAS scores at all follow-up intervals compared to the C-ESI group (P < 0.050). Symptom relief was sustained for a significantly longer duration in the C-PEN group than in the C-ESI group (23.4 vs. 20.5 weeks, P < 0.001)., Limitations: The follow-up period was relatively short with a small sample size, and the grade of cervical disc disease, root compression, and disc degeneration grade were could not considered in this study., Conclusions: C-PEN was superior to C-ESI in terms of better NDI recovery (at 6 months) and greater reduction in VAS score (until 12 months) in treating single level cervical disc herniation. Better outcomes with C-PEN may have been achieved via a more localized selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root.

Purpose: To investigate the prevalence of paralytic ileus after spinal operation in the supine or prone operative position and to determine the efficacy of prophylactic gastrointestinal motility medications in preventing symptomatic paralytic ileus after a spinal operation., Materials and Methods: All patients received spinal surgery in the supine or prone operative position. The study period was divided into two phases: first, to analyze the prevalence of radiographic and symptomatic paralytic ileus after a spinal operation, and second, to determine the therapeutic effects of prophylactic gastrointestinal motility medications (postoperative intravenous injection of scopolamine butylbromide and metoclopramide hydrochloride) on symptomatic paralytic ileus after a spinal operation., Results: Basic demographic data were not different. In the first phase of this study, 27 patients (32.9%) with radiographic paralytic ileus and 11 patients (13.4%) with symptomatic paralytic ileus were observed. Radiographic paralytic ileus was more often noted in patients who underwent an operation in the prone position (p=0.044); whereas the occurrence of symptomatic paralytic ileus was not different between the supine and prone positioned patients (p=0.385). In the second phase, prophylactic medications were shown to be ineffective in preventing symptomatic paralytic ileus after spinal surgery [symptomatic paralytic ileus was observed in 11.1% (4/36) with prophylactic medication and 16.7% (5/30) with a placebo, p=0.513]., Conclusion: Spinal surgery in the prone position was shown to increase the likelihood of radiographic paralytic ileus occurrence, but not symptomatic paralytic ileus. Unfortunately, the prophylactic medications to prevent symptomatic paralytic ileus after spine surgery were shown to be ineffective.

Study Design: Retrospective study., Objective: To evaluate the usefulness of 3-dimensional (3D) measurement of ossification of the posterior longitudinal ligament (OPLL), and identify the reliability of a novel 3D method of measurement., Summary of Background Data: OPLL is not a 2-dimensional (2D) disease, but rather a 3D disease. Therefore, conventional measurement of parameters using radiography may not be suitable for evaluating OPLL. However, there is no study that investigated the correlation between 3D parameters of OPLL and clinical outcomes., Methods: 50 patients (40 males and 10 females; mean age 57.2 yr) with symptomatic OPLL were enrolled. Neurological and clinical outcome scales were measured using the Japanese Orthopedic Association (JOA) score, visual analogue scale, short-form health survey (SF-36) and neck disability index. A 3D model was reconstructed with digital imaging and communications in medicine files from axial computed tomographic images using software (MIMICS; Materialise, Leuven, Belgium) to obtain the following parameters: 3D volume of OPLL, 3D volume of the spinal canal (confined to the vertebral level involving OPLL), spinal canal diameter, thickness of OPLL, and length of OPLL. All patients were divided into 2 different groups, the mild myelopathy group (JOA score ≥18, n = 11) and the severe myelopathy group (JOA score ≤17, n = 23)., Results: The 3D OPLL volume did not correlate with clinical outcomes (r =-0.275, P = 0.116). 3D OPLL ratio and OPLL thickness had a significant negative relationship with JOA score (r =-0.502, P < 0.005 and r =-0.437, P < 0.05, respectively). In particular, 3D OPLL ratio was an independent risk factor for increased severity of myelopathy (B =-29.71, P < 0.05). The mild myelopathy group showed lower 3D OPLL ratio than the severe myelopathy group (0.092 vs. 0.148, P < 0.05)., Conclusion: 3D method of measurement is superior to the conventional method in terms of evaluating the clinical state of symptomatic patients with OPLL. Higher 3D OPLL ratio has an adverse effect on the spinal cord., Level of Evidence: 3.