Objective To observe the value of global and contextual dual attention U-Net model for segmenting thoracic and lumbar vertebrae in spinal sagittal X-ray images.Methods Totally 600 spinal sagittal X-ray images of 600 patients with adolescent idiopathic scoliosis were retrospectively enrolled.The images were preprocessed,and T4-T12 and L1-L5 were manually annotated as reference standards.The global attention refinement(GAR)module and attention-based atrous spatial pyramid pooling(A-ASPP)module were added to U-Net model,fivefold cross validation method was used for training and validation,and its performance for segmenting sagittal X-ray images was analyzed,and compared with pyramid scene parsing network(PSPNet),visual geometry group(VGG)-UNet and DeepLabv3+.Results The precision,sensitivity and Dice similarity coefficient of global and contextual dual attention U-Net model for segmenting thoracic and lumbar vertebrae in spinal sagittal X-ray images was 90.58％,89.51％,and 90.20％,respectively,which were superior to PSPNet,VGG-UNet and DeepLabv3+.The loss function and mean intersection over union curves showed that it converged quickly and had good generalization ability.Conclusion The global and contextual dual attention U-Net model could effectively segment thoracic and lumbar vertebrae in spinal sagittal X-ray images.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

This article reported a pregnant woman admitted to the hospital due to "25 +2 weeks of amenorrhea and a 1-day history of shortened cervical canal accompanied by vaginal bleeding". The patient with pregestational diabetes mellitus and suboptimal glycemic control required prolonged hospitalization for tocolytic therapy due to shortened cervical length. She developed a cough at 31 weeks and 4 days of gestation, followed by right-sided intercostal pain and hypotension after coughing at 31 weeks and 6 days of gestation. Bedside chest ultrasound showed a small anechoic fluid collection (approximately 1.1 cm in width) in the right pleural cavity. The emergency cesarean section was performed at 31 weeks and 4 days of gestation. However, the intraoperative bleeding and other conditions were inconsistent with the obstetric clinical presentations of blood loss. Subsequent repeated ultrasound and CT examinations confirmed the diagnosis of pulmonary sequestration and right-sided progressive hemopneumothorax. On the same day, an emergency right lower lobectomy was performed, achieving stable postoperative recovery. Both mother and infant had favorable outcomes. Hemopneumothorax complicated by pulmonary sequestration is uncommon, and its occurrence during pregnancy is exceedingly rare. Multidisciplinary consultations, aggressive, rapid, and accurate diagnosis, and combined treatment are critical to ensuring maternal-fetal survival. Hemopneumothorax caused by the rupture of pulmonary sequestration during pregnancy represents a life-threatening condition. Emergency thoracotomy can timely clarify the cause, arrest bleeding, relieve compression, and resect the lesion, thereby reducing mortality and the complications risk.

Objective To observe the value of global and contextual dual attention U-Net model for segmenting thoracic and lumbar vertebrae in spinal sagittal X-ray images.Methods Totally 600 spinal sagittal X-ray images of 600 patients with adolescent idiopathic scoliosis were retrospectively enrolled.The images were preprocessed,and T4-T12 and L1-L5 were manually annotated as reference standards.The global attention refinement(GAR)module and attention-based atrous spatial pyramid pooling(A-ASPP)module were added to U-Net model,fivefold cross validation method was used for training and validation,and its performance for segmenting sagittal X-ray images was analyzed,and compared with pyramid scene parsing network(PSPNet),visual geometry group(VGG)-UNet and DeepLabv3+.Results The precision,sensitivity and Dice similarity coefficient of global and contextual dual attention U-Net model for segmenting thoracic and lumbar vertebrae in spinal sagittal X-ray images was 90.58％,89.51％,and 90.20％,respectively,which were superior to PSPNet,VGG-UNet and DeepLabv3+.The loss function and mean intersection over union curves showed that it converged quickly and had good generalization ability.Conclusion The global and contextual dual attention U-Net model could effectively segment thoracic and lumbar vertebrae in spinal sagittal X-ray images.

BACKGROUND:The pedicle navigation template has many advantages,but there are still some problems.For example,poor soft tissue dissection leads to poor adhesion of the pedicle navigation template,resulting in screw path deviation;careful dissection of soft tissue to fit the pedicle navigation template leads to prolonged surgery time and increased bleeding;the design of the pedicle navigation template cannot predict the vertebral rotation and the impact of body position changes,resulting in the poor fitting. OBJECTIVE:To explore the utility of a new 5-point positioning point-contact pedicle navigation template in the case of scoliosis and complex pedicle. METHODS:A total of 20 patients with scoliosis and complicated pedicle admitted to the Department of Spinal Surgery,Guizhou Hospital,Beijing Jishuitan Hospital from February 2020 to February 2023 were selected for scoliosis orthopedics.During the operation,the 5-point positioning point-contact pedicle navigation template was used to guide the screws.According to the inclusion and exclusion criteria,34 cases were matched as the empirical nail placement group,and conventional barehanded nail placement was performed.The time of placement,the amount of bleeding,the number of fluoroscopies,the number of manual diversions,the level and accuracy of pedicle screws,the complications of placement,and the rate of correction of main curvature were compared between the two groups. RESULTS AND CONCLUSION:(1)There were no significant differences in sex,age,coronal Cobb's angle of the main curvature,bending Cobb's angle of the main curvature,pedicle variation,apex rotation,fusion segment,number of screws,level of screws,accuracy of screws,and rate of correction of main curvature between the navigation template group and the empirical nail placement group(P>0.05).(2)Compared with the empirical nail placement group,the navigation template group had more advantages in time of placement(P=0.034),amount of bleeding(P=0.036),number of fluoroscopies(P=0.000)and number of manual diversions(P=0.021).(3)There were 0 cases of screw-related complications in both groups.(4)In conclusion,the 5-point positioning point-contact 3D printing pedicle navigation template has a claw-like structure.It can firmly adapt to various deformities of the lamina articular process,avoid drift,and accurately place the screws.It has a point-like contact lamina structure to avoid extensive and complete dissection of the posterior structure,and reduce bleeding,operation time,and trauma.Pre-designed screw entry points and directions can reduce the number of fluoroscopy and operation time.Segmental design can avoid discomfort due to changes in anesthesia position.The operation is simple and the accuracy of screw placement is high.

Objective:To detect gene mutations in a pedigree with dominant dystrophic epidermolysis bullosa (DDEB) .Methods:A 20-year-old male proband presented with repeated blisters, ulceration, pigmentation, scars on the limbs, and deformation of the nails/toenails after birth. There were 5 patients in the 3-generation family, and they all presented with typical skin lesions. Peripheral blood samples were obtained from 14 members of the pedigree (including the 5 patients) and 100 unrelated healthy controls. Whole-exome sequencing was performed in the proband to identify relevant mutation sites, which were then confirmed in the family by Sanger sequencing.Results:Genetic testing indicated that the proband and the other 4 patients all carried a missense mutation (c.7885G>A) in exon 107 of the COL7A1 gene, resulting in the substitution of glycine by arginine at amino acid position 2629 (p.G2629R). The mutation was identified neither in the 9 healthy relatives nor in the 100 unrelated healthy controls. The mutation co-segregated with DDEB in the family, and was not included in databases such as Pubmed, HGMD or ClinVar, suggesting it was a novel missense mutation. The amino acid encoded by this mutation may alter the structure of type Ⅶ collagen, thereby affecting its function.Conclusion:A novel missense mutation was identified in exon 107 of the COL7A1 gene in the family with DDEB, expanding the spectrum of mutations in the COL7A1 gene.

OBJECTIVE: To explore the effectiveness of a new point contact pedicle navigation template (referred to as "new navigation template" for simplicity) in assisting screw implantation in scoliosis correction surgery. METHODS: Twenty-five patients with scoliosis, who met the selection criteria between February 2020 and February 2023, were selected as the trial group. During the scoliosis correction surgery, the three-dimensional printed new navigation template was used to assist in screw implantation. Fifty patients who had undergone screw implantation with traditional free-hand implantation technique between February 2019 and February 2023 were matched according to the inclusion and exclusion criteria as the control group. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, disease duration, Cobb angle on the coronal plane of the main curve, Cobb angle at the Bending position of the main curve, the position of the apical vertebrae of the main curve, and the number of vertebrae with the pedicle diameter lower than 50%/75% of the national average, and the number of patients whose apical vertebrae rotation exceeded 40°. The number of fused vertebrae, the number of pedicle screws, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were compared between the two groups. The occurrence of implant complications was observed. Based on the X-ray films at 2 weeks after operation, the pedicle screw grading was recorded, the accuracy of the implant and the main curvature correction rate were calculated. RESULTS: Both groups successfully completed the surgeries. Among them, the trial group implanted 267 screws and fused 177 vertebrae; the control group implanted 523 screws and fused 358 vertebrae. There was no significant difference between the two groups ( P>0.05) in terms of the number of fused vertebrae, the number of pedicle screws, the pedicle screw grading and accuracy, and the main curvature correction rate. However, the time of pedicle screw implantation, implant bleeding, fluoroscopy frequency, and manual diversion frequency were significantly lower in trial group than in control group ( P<0.05). There was no complications related to screws implantation during or after operation in the two groups. CONCLUSION The new navigation template is suitable for all kinds of deformed vertebral lamina and articular process, which not only improves the accuracy of screw implantation, but also reduces the difficulty of operation, shortens the operation time, and reduces intraoperative bleeding.
Humans ; Orthopedic Procedures ; Pedicle Screws ; Retrospective Studies ; Scoliosis/surgery* ; Spinal Fusion/methods* ; Spine ; Surgery, Computer-Assisted/methods*

Objective:To explore the effect of a new 5-point positioning point contact clamping fixation pedicle navigation template in treating cases of scoliosis and complex pedicle.Methods:From February 2019 to February 2023, 30 patients with scoliosis and complicated pedicle were admitted for orthopedic surgery. There were 11 males and 19 females, with an average age of 16.54±6.23 years (range 7 to 35 years). A total 60 cases treated before February 2019 were matched as a control group, including 23 males and 37 females, with an average age of 16.72±6.34 years (range 6 to 35 years). During the operation, the 5-point positioning point-contact clamping fixation pedicle navigation template was used to guide the screws. Screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual redirection frequency, Rao pedicle screw placement classification and accuracy, screw placement complications, and main curve correction rate were recorded.Results:All the 30 cases from the study group successfully underwent the surgery with a total of 354 screws placed, while in the control group a total of 727 screws were placed in 60 cases. The surgery times and intraoperative bleeding volumes for the study group and the control group were 279.45±57.72 min vs. 292.54±58.87 min and 921.57±371.32 ml vs. 932.83±376.65 ml with significant differences ( t=-2.13, P=0.022; t=-1.87, P=0.024). The time for screw placement from the start of skin incision to the placement of the last screw and the bleeding volume during screw placement in the study group and the control group was 82.87±24.46 min vs. 97.53±25.56 min and 72.25±43.66 ml vs. 106.53±61.22 ml with significant differences ( t=-2.66, P=0.031; t=-2.32, P=0.027). The screw placement fluoroscopy frequencies and manual redirection frequencies in the study group and the control group were 4.21±1.11 times vs. 6.32±1.81 times and 0.47±0.64 times vs. 0.93±0.86 times with significant differences ( t=-4.66, P<0.001; t=-2.78, P=0.018). According to the Rao pedicle screw placement classification, the study group had 329 screws classified as level I, 19 screws as level II, and 6 screws as level III. In the control group, there were 669 screws classified as level I, 45 screws as level II, 12 screws as level III, and 1 screw as level IV with no significant difference (χ 2=4.26, P=0.547). The screw placement accuracy and the main curve correction rate in the study group and the study group was 98.31%±3.10% vs. 98.21%±4.92% and 57.85%±9.46% vs. 6.64%±9.22% with no significant differences ( t=0.88, P=0.384; t=0.42, P=0.663). No complications of nerve damage, major vascular injury, cerebrospinal fluid leakage, infection, or death happened during surgery or postoperatively. There were no complications of internal fixation displacement, loosening, or breakage. The outcomes of the patients were good with significantly improved appearance and trunk balance after surgery. Conclusion:The new navigation template provided an accurate and safe way of placing screws in treating various deformities of the lamina articular process without extensive and complete dissection of the posterior structure, leading to reduced fluoroscopy and operation time.

Objective:To investigate the expression, regulation, potential mechanism and clinical significance of microRNA(miRNA)-129-1 in colon cancer.Methods:The changes of expression and methylation of miRNA-129-1 were analyzed from the methylation, mRNA expression and miRNA expression data of colon cancer in the cancer genome atlas (TCGA) database. The target genes of miRNA-129-1 were predicted from miRwalk 2.0 and TargetScan database. DAVID 6.7 online software was used for gene oncology and Kyoto encyclopedia of genes and genomes enrichment analysis. STRING database was used for protein-protein interaction analysis. TCGA data were applied again to analyze the differential expression and prognosis of key target genes of miRNA-129-1. Paired t test and independent sample t test were used for statistical analysis. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of miRNA-129-1 gene methylation in colon cancer. Kaplan-Meier method and log-rank test were used to analyze the effects of miRNA-129-1 expression on survival. Results:The sequence of miRNA-129-1 among different species was conserved. After all colon cancer samples, and control samples of TCGA database were analyzed, the results showed that compared with those of control samples, the expression of miRNA-129-1 decreased in cancer samples (0.98±0.81 vs. 5.74±0.59), and the methylation levels of cg04524088, cg04840800, cg11364290, cg20734982 and cg24044186 locus of miRNA-129-1 significantly decreased (0.321±0.130 vs. 0.563±0.051, 0.432±0.123 vs. 0.624±0.064, 0.475±0.153 vs. 0.768±0.033, 0.659±0.180 vs. 0.816±0.037 and 0.862±0.096 vs. 0.916±0.019, respectively) in colon cancer tissues, and the differences were all statistically significant ( t=14.95, 11.36, 9.39, 11.74, 5.32 and 3.47, all P<0.01). The results of ROC analysis showed that the methylation levels of the above five locus of miRNA-129-1 gene had high diagnostic efficiency in colon cancer (area under curve=0.946, 0.915, 0.950, 0.758 and 0.667, all P<0.01). The results of survival analysis indicated that low expression of miRNA-129-1 was associated with poor prognosis (hazard ratio ( HR)=0.55, P=0.018). The results of bioinformatics analysis demonstrated that the target genes of miRNA-129-1 were enriched in serine / threonine kinase receptor, mitogen-activated protein kinase and other functional gene clusters closely related to tumor, and there was a complex interaction network among the target genes proteins. The high expression of ephrin type-B receptor2 ( EPHB2) gene, a potential key target gene of miRNA-129-1, was associated with the short overall survival and disease-free survival time ( HR=1.9 and 1.6, both P<0.01). Conclusions:The expression and methylation of miRNA-129-1 play an important regulatory role in the development and development of colon cancer. The methylation of miRNA-129-1 has potential value in the diagnosis of colon cancer, and miRNA-129-1 is an influencing factor for the prognosis of patients with colon cancer. EPHB2 may be a potential key target gene of miRNA-129-1.

Objective:To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation.Methods:The clinical data of 14 patients with severe scoliosis accompanied with split cord malformation admitted to the Department of Spinal Surgery, Guizhou Orthopedic Hospital from August 2015 to August 2019 were retrospectively analyzed.There were 6 males and 8 females, aged (19.8±5.0) years (range:13 to 34 years). All patients received spinal orthopedic surgery after halo pelvic traction for 3 to 7 weeks.The data of traction time, height, Cobb angle in the main curved coronal plane and sagittal plane, lung function and nutritional status of the patient were collected before and after the treatment. Paired t test was used to compare the evaluation indexes. Results:The traction time of the 14 patients was (35.2±8.3)days (range:20 to 49 days), and the height of them increased from (156.7±7.6)cm (range:141 to 166 cm) before traction to (167.0±6.4)cm (range:154 to 177 cm) after traction（ t=-10.49， P<0.01）. The Cobb angle on the main curved coronal plane decreased from (117.4±17.2) ° (range: 91°to 176°) before traction to (56.4±8.1) ° (range:44°to 68°) after traction（ t=13.90， P<0.01）. The sagittal Cobb angle decreased from (92.5±11.6) ° (range:62°to 132°) before traction to (41.7±7.7) °(range:29°to 51°) after traction（ t=12.11， P<0.01）. No complications such as loosening of nailing and infection occurred during traction, and no decrease of nerve function occurred. Nine patients underwent single segment acromial transpedicle osteotomy and five underwent double segment adjacent asymmetric shortening osteotomy. None of the patients underwent longitudinal fracture resection. The lung function and nutritional status were improved after traction and surgery(all P<0.01). Postoperative follow-up was (22.5±9.1)months (range:12 to 36 months). At the last follow-up, the coronal Cobb angle was (56.3±7.1) °, and the sagittal Cobb angle was (37.7±6.5) °, showing no statistically significant difference from the angle after traction( t=0.16, P=0.88; t=2.28, P=0.32). There was no loss of orthopedic angle. None of the patients had internal fixation displacement, loosening or fracture. Conclusion:The treatment of severe scoliosis with accompanied with split cord malformation by halo pelvic traction is safe and effective, which is worthy of further confirmation by large sample study.