Background context Inadequate osteogenesis is a crucial connection between vertebral bone destruction and osteoporosis in patients with spinal tuberculosis (STB). Bone marrow mesenchymal stem cells (BMSCs) play a vital role in osteogenesis. Nevertheless, the specific contribution of BMSCs to osteopenia in STB patients remains unclear. Study design A single-center retrospective study. Purpose To explore the role of BMSCs in osteopenia in spinal tuberculosis (STB) patients. Methods Bone mineral density (BMD) was measured in 53 STB patients and 55 controls. The migration and osteogenesis of BMSCs were assessed by wound healing assays and alizarin red staining, and osteoclast marker expression was measured. All quantitative comparisons were analyzed using independent samples t - tests (two-tailed) unless explicitly stated otherwise. To mitigate potential confounding effects, our analytical models incorporated age and gender as covariates through multivariate adjustment procedures. RNA-seq was performed on BMSCs, and the enriched signaling pathways were verified. Results The BMD of STB patients was significantly decreased, and BMSC migration and osteogenesis were significantly reduced. After verification, we found that the B-cell receptor signaling pathway, tuberculosis, osteoclast differentiation, Th17-cell differentiation, the Ras signaling pathway and the PI3K-Akt signaling pathway were affected. Of these pathways, B-cell receptor signaling, Th17-cell differentiation, the Ras signaling pathway and the PI3K-Akt signaling pathway were not previously known to be involved in osteopenia. MAPK signaling pathway activity and ECM-receptor interactions were correlated with STB prognosis. Conclusion Our study indicates that diminished migration and osteogenesis of BMSCs play pivotal roles in the development of osteopenia in STB patients, highlighting BMSCs as potential therapeutic targets. Clinical significance BMSCs may represent a novel therapeutic target for the clinical treatment of osteopenia in patients with spinal tuberculosis, and this study provides evidence for the refinement of treatment strategies for spinal tuberculosis.

PURPOSE:This study aimed to identify proteomic differences in the corneal epithelium of Neurotrophic Keratopathy (NK) patients with or without HSV-1 infection compared to normal donors. METHODS:Samples were divided into HSV-1-infected and non-infected NK groups, plus a control group. Corneal epithelial specimens were obtained via curettage/debridement, treated with TMT reagent, and analyzed by HPLC-MS/MS. Differentially expressed proteins underwent GO, KEGG, GSEA, and protein-protein interaction network analyses, with Western blotting validation. RESULTS:Compared to controls, non-HSV-1 NK patients showed 1228 differentially expressed proteins (771 downregulated, 457 upregulated), while HSV-1-infected NK patients had 939 (617 downregulated, 322 upregulated). Differential proteins play significant roles in many biological processes and pathways, such as epithelial-mesenchymal transition and interferon gamma response. Compared with the control group, there were 569 common differentially expressed proteins in HSV-1 infection and non-infection. We selected the top three upregulated proteins and the downregulated proteins. Their Western blotting results were consistent with the proteomics results. CONCLUSION:This study has laid the foundation for the research on the mechanism of NK. It has been discovered that the upregulated (S100A2, TGM1, RPS28) and downregulated (ADH1C, EZH1, CHP2) proteins, which are significantly downregulated in the corneal epithelium of NK patients, may be used as diagnostic markers or therapeutic targets for NK in clinical practice.

PURPOSE:The purpose of this study was to evaluate the efficacy of multirod constructs in the treatment of young patients (<20 years) with scoliosis accompanied by lumbosacral deformity and to compare the corrective outcomes and postoperative quality of life between 3-rod and 4-rod techniques. METHODS:Thirty-nine adolescent patients with lumbosacral anomalies underwent surgical treatment at our institution. Following application of the inclusion/exclusion criteria, 17 young patients with severe scoliosis and concomitant lumbosacral deformities were enrolled in this study. Preoperative, 1-week postoperative, and final follow-up standing whole-spine anterior-posterior/lateral radiographs were retrospectively analyzed. The following parameters were assessed: major curve Cobb angle, lumbosacral curve Cobb angle, trunk shift, thoracic kyphosis angle, lumbar lordosis angle, and sagittal vertical axis (SVA), In addition, Scoliosis Research Society-22 (SRS-22) questionnaire scores were collected and analyzed preoperatively and at the final follow-up. RESULTS:The lumbosacral Cobb angle improved from 33.6° ± 4.5° to 7.7° ± 2.8° postoperatively ( P < 0.05), maintained at 8.6° ± 2.6° during follow-up. The major curve decreased from 62.1° ± 8.3° to 19.6° ± 6.5° ( P < 0.05), with slight correction loss to 23.3° ± 6.1° at follow-up. Trunk shift reduced from 3.0 ± 1.5 cm to 1.1 ± 0.7 cm ( P < 0.05), stabilizing at 1.4 ± 0.6 cm. Sagittal measurements showed TK improved from 29.8° ± 6.0° to 33.3° ± 5.0° postoperatively ( P > 0.05), whereas lumbar lordosis increased from 34.2° ± 19.4° to 43.0° ± 7.3° ( P > 0.05). SVA changes were notable ( P < 0.05). SRS-22 self-image scores improved from 2.21 ± 0.64 to 3.79 ± 0.50 ( P < 0.001), with pain scores also enhanced from 4.02 ± 0.58 to 4.71 ± 0.17 ( P < 0.001). No statistically significant differences were observed in correction rates or final follow-up SRS-22 scores between 3-rod and 4-rod constructs ( P > 0.05). CONCLUSION:The multiple-rod technique effectively addresses severe scoliosis with lumbosacral deformities in young patients, providing sustained radiographic correction, reduced implant failure risk, and improved clinical outcomes. In long-segment lumbosacral fixation constructs, bilateral supplementary rod configuration may reduce rod fracture risk compared with unilateral reinforcement.

PURPOSE:Complications such as explosive choroidal hemorrhage, residual cortex, and capsule rupture often occur during intraocular surgery combined with penetrating keratoplasty (PKP) due to poor maintenance of the anterior chamber. To address these challenges, the authors have innovatively used a sterile polyethylene instrument cover to temporarily reconstruct the anterior chamber. METHODS:In this report, the authors describe a technique where a "temporary corneal patch" was created from a sterile instrument cover, using a trephine to ensure a diameter approximately 1 mm to 2 mm wider than the corneal bed or perforation. This patch was then sutured into the host corneal bed or the perforation with 10-0 nylon sutures during intraocular surgery combined with PKP. Each case was evaluated for surgical efficacy and complications. RESULTS:The authors successfully applied this technique in three cases of combined corneal transplantation surgery. In two cases, PKP, phacoemulsification, and intraocular lens implantation were successfully performed. In the third case, PKP, vitrectomy, and other intraocular procedures were performed. No intraoperative or postoperative complications were observed. CONCLUSION:The use of a sterile polyethylene material as a temporary corneal patch for anterior chamber reconstruction represents a safe, effective, and cost-efficient approach for intraocular surgery combined with PKP or posterior segment surgery as a keratoprosthesis.

To analyze the body composition of adolescents idiopathic scoliosis(AIS) patients at different stages of skeletal maturity and to explore the correlation between body composition and the severity of scoliosis. Data were collected from 243 patients diagnosed with AIS who fulfilled the specified inclusion and exclusion criteria at the Spine Surgery Outpatient Clinic of Xiangya Hospital, Central South University, during the period from 2023 to 2024. The data encompassed basic demographic information, radiological assessments, and body composition metrics. Patients were categorized based on Risser grade (0–5) and Cobb angle, with classifications of mild (< 20°), moderate (20–40°), and severe (≥ 40°) scoliosis. A comparative analysis of body composition across the different groups was conducted, alongside an investigation into its correlation with the severity of scoliosis. As the Risser sign grade increases, the age, height, weight, and BMI of AIS patients gradually increase (p < 0.05), while the muscle percentage of the whole-body, trunk, and limbs gradually decrease (p < 0.05). Patients in the mild group have significantly higher muscle percentage and significantly lower subcutaneous fat percentage compared to the moderate and severe groups (p < 0.05) ; the whole-body muscle percentage and the ratio of it to subcutaneous fat percentage have a weak negative correlation with the rotation of the apical vertebra (AVR) (r = − 0.131, p = 0.042; r = − 0.169, p = 0.009), and the whole-body subcutaneous fat percentage has a weak positive correlation with AVR (r = 0.150, p = 0.021). In AIS patients, as skeletal maturity progresses, there is a gradual decrease in both whole-body and local muscle percentage. The whole-body muscle percentage and whole-body subcutaneous fat percentage exhibit a weak correlation with the curvature associated with scoliosis. During conservative treatment, increasing the percentage of whole-body muscle mass while reducing the percentage of whole-body subcutaneous fat may be beneficial for patients with AIS.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb) infection, including pulmonary tuberculosis and extrapulmonary tuberculosis. About a quarter of the people in the world are infected with TB, but only 5-10% of them will progress to active TB, posing a major challenge to the eradication of TB. The study of the host immune response to Mtb infection is a key aspect of the development of effective vaccines and immunotherapies to eradicate tuberculosis. In this review, we delve into the overview of animal models of TB infection and the host's innate and adaptive immune responses to Mtb infection. We discuss how Mtb is recognized and phagocytosed by macrophages, how it evades immune responses, the recruitment and mobilization of neutrophils and monocytes, the role of natural killer cells during the infection process, how dendritic cells initiate adaptive immunity, the important roles of CD4+ T cells and their subtypes in TB infection, how CD8+ T cells exert cytotoxic functions, and how B cells produce antibodies and exhibit memory characteristics to eliminate pathogens. Furthermore, we review the tuberculosis vaccines currently entering clinical trials, emphasizing that studying the host's immune responses following Mtb infection is crucial for the development of more effective vaccines, providing a theoretical foundation and direction for the treatment of tuberculosis.

OBJECTIVES:The early imaging features of spinal tumors and spinal infections are similar, and the lack of specific early diagnostic indicators can lead to misdiagnosis or missed diagnosis. Although serum tumor markers have been widely used in early cancer screening, spinal tumors are mostly metastatic, lacking specific markers, and some patients with spinal tumors may even test negative for tumor markers. Therefore, the role of tumor markers in the early differential diagnosis of spinal tumors remains unclear. This study aims to investigate the value of tumor markers in the early differential diagnosis of spinal tumors and spinal infection. METHODS:We retrospectively analyzed the clinical data of 221 patients with spinal bone destruction admitted to Xiangya Hospital of Central South University between April 2017 and October 2022. Peripheral blood levels of 10 tumor markers were measured upon admission, including carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), neuron-specific enolase (NSE), cytokeratin 19 fragment antigen 21-1 (cyfra21-1), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), carbohydrate antigen 72-4 (CA72-4), pepsinogen I (PGI), pepsinogen II (PGII), and the PGI/PGII ratio (PGR). Univariate Logistic analysis was used to screen relevant variables, and the correlation between tumor markers was analyzed. Multivariate Logistic regression was then employed to identify risk and protective factors. The optimal cut-off values were calculated using the receiver operating characteristic (ROC) curve and Youden index, and a differential diagnosis model for early spinal tumors and spinal infections was constructed based on the selected indicators. Diagnostic performance was then evaluated. RESULTS:According to the pathological diagnosis, 91 patients had spinal tumors, and 130 patients had spinal infections. The levels of CEA, AFP, NSE, cyfra21-1, CA199, and CA72-4 were higher in the spinal tumor group than those in the spinal infection group, while PGR was lower, with statistically significant differences (all P<0.05). Univariate Logistic analysis showed significant differences in CEA, AFP, NSE, cyfra21-1, CA199, CA125, CA72-4, and PGR (all P<0.05). Correlation analysis indicated a strong positive correlation between CEA and cyfra21-1, CA199, and CA125, as well as a strong negative correlation of PGII with PGI and PGR. Multivariate Logistic analysis identified AFP and cyfra21-1 as risk factors (P<0.01) and PGR as a protective factor (P<0.05). When the standard cut-off values (AFP<20 ng/mL, cyfra21-1< 3.3 ng/mL, and PGR>3) were applied, AFP had a sensitivity of 3.3% and accuracy of 60.2%, cyfra21-1 had a sensitivity of 20.9% and accuracy of 66.1%, and PGR had a sensitivity of 2.2% and accuracy of 59.3%. The AUC of the early spinal tumor diagnosis model was 0.623. Using the optimal cut-off values (AFP<1.625 ng/mL, cyfra21-1<1.175 ng/mL, and PGR>11.05) from the ROC curve, AFP had a sensitivity of 69.2% and accuracy of 64.7%, cyfra21-1 had a sensitivity of 68.1% and accuracy of 70.1%, and PGR had a sensitivity of 62.6% and accuracy of 57.5%, with the model's AUC at 0.772. CONCLUSIONS:A comparative analysis of 10 serum tumor markers reveals that AFP, cyfra21-1, and PGR are significantly associated with spinal tumors. The diagnostic model constructed based on these 3 markers shows promising predictive performance and may be helpful to the differentiation for the early clinical diagnosis of spinal tumors and spinal infection.

Introduction:Tuberculosis is prevalent in high-burden countries. However, spinal multi-drug resistant tuberculosis (MDR-TB) in patients with normal immune function is a disease that is prone to misdiagnosis and even delayed diagnosis. Recently, we successfully treated one such patient. Case Presentation:A 46-year-old male patients with lower back pain associated with recurrent fever 2 months before admission. The patient was misdiagnosed as a suppurative spinal infection and failed to respond to treatment for 2 months. The muscle strength of both lower limbs decreased progressively. We performed two operations to clear the lesion and decompress the spinal canal, during which we found a fish-like inflammatory tissue mimicking a suppurative infection. Finally, the patient was diagnosed with lumbar MDR-TB by culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS). The second-line anti-tuberculosis treatment (ATT) is cycloserine + para-aminosalicylic acid + ethambutol + levofloxacin + linezolid. Finally, the patient's symptoms were relieved and the muscle strength of both lower limbs recovered. Conclusion:This case prompt MDR-TB of the spine is not a typical clinical symptoms and imaging examination is the lack of specificity, when for the diagnosis of patients with spinal bone destruction unclear or treatment is invalid, can diagnostic anti-tuberculosis treatment. For patients with spinal instability or spinal canal occupying, early surgical removal of lesions, tissue culture, Xpert MTB/RIF and mNGS to identify pathogens and drug resistance, timely diagnosis and treatment can maximize the prognosis of spinal MDR-TB.

PurposeTo report a rare case of fungal keratitis caused by Cryptococcus neoformans, highlighting its unique morphological features using in vivo confocal microscopy (IVCM). MethodsThis was a retrospective case report. A 66-year-old man presented with foreign body sensation and blurred vision in his left eye for over 10 months. ResultsHis best-corrected visual acuity was 20/20. Slit-lamp examination revealed a gray-white lesion approximately 4-5 mm in the superficial layer of the central cornea without epithelial defects. The IVCM images revealed numerous round or round-like pathogens, each with a central highly reflective body surrounded by a dark ring, ranging in size from 5 to 30 mu m, and to a maximum of 85 mu m, observed in the corneal epithelium and superficial stroma. No obvious inflammatory cell infiltration was observed in the lesions or endothelium. C. neoformans infection was confirmed. The round pathogens completely disappeared after 8 weeks of treatment with topical amphotericin B and voriconazole eye drops. ConclusionFungal keratitis caused by C. neoformans is rare and easily overlooked due to atypical clinical signs and symptoms. This case reports the unique morphological features of C. neoformans in the cornea using IVCM for the first time, facilitating rapid, noninvasive auxiliary diagnosis of C. neoformans keratitis and treatment follow-up.

STUDY DESIGN:A retrospective study. PURPOSE:This study aimed to compare the clinical effectiveness of en-bloc direct vertebrae rotation (DVR) to non-DVR for the correction of Lenke 5C. OVERVIEW OF LITERATURE:The primary goal of posterior correction is to preserve the lumbar spine and achieve a well-balanced spine. However, very few studies have examined the effects of en-bloc DVR (ED) on Lenke 5C correction. METHODS:A retrospective study was conducted with a minimum follow-up of four years involving 95 patients (ED group, n=45; non-DVR [ND] group, n=50). Radiographic measurements included thoracic kyphosis, lumbar lordosis, sagittal vertical axis, coronal balance, and Cobb angles preoperatively and postoperatively. Flexibility curves and axial vertebral rotation were assessed using computed tomography before and after surgery. Clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. RESULTS:The preoperative major Cobb angles were comparable between the ED group (52.2°±2°) and the ND group (52.8°±3°), with no significant difference (p=0.327). At the last follow-up, the average Cobb angle was significantly lower in the ED group (4.6°±2°) compared to the ND group (6.1°±3°), indicating a significant difference (p=0.005). The postoperative radiographic shoulder height showed no significant difference at the last follow-up. The axial vertebral rotation was significantly greater in the ED group (8.4°±0°) than in the ND group (11.1°±1°) (p=0.001). Additionally, the ED group demonstrated substantial preservation of fusion levels with an average of 5.6 fused segments compared to 6.3 in the ND group. CONCLUSIONS:A significantly higher incidence of satisfactory outcomes was observed at the final follow-up, with the correction rate of the ED group superior to that of the ND group for adolescent idiopathic scoliosis Lenke 5C. Moreover, patients in the ED group reported better outcomes on the SRS-22 questionnaire and had a shorter hospital stay than those in the ND group.

1Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China. 2Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan 410011, China. Corresponding author: Liwei Zhang, M.D, PhD.: [email protected] None of the authors has any conflicting interests to disclose.

BackgroundEarly antimicrobial therapy is crucial regarding the prognosis of vertebral osteomyelitis, but early pathogen diagnosis remains challenging.ObjectiveIn this study, we aimed to differentiate the types of pathogens in iatrogenic vertebral osteomyelitis (IVO) and native vertebral osteomyelitis (NVO) to guide early antibiotic treatment.MethodsA total of 145 patients, who had confirmed spinal infection and underwent metagenomic next-generation sequencing (mNGS) testing, were included, with 114 in the NVO group and 31 in the IVO group. Using mNGS, we detected and classified 53 pathogens in the 31 patients in the IVO group and 169 pathogens in the 114 patients in the NVO group. To further distinguish IVO from NVO, we employed machine learning algorithms to select serum biomarkers and developed a nomogram model.ResultsThe results revealed that the proportion of the Actinobacteria phylum in the NVO group was approximately 28.40%, which was significantly higher than the 15.09% in the IVO group. Conversely, the proportion of the Firmicutes phylum (39.62%) in the IVO group was markedly increased compared to the 21.30% in the NVO group. Further genus-level classification demonstrated that Staphylococcus was the most common pathogen in the IVO group, whereas Mycobacterium was predominant in the NVO group. Through LASSO regression and random forest algorithms, we identified 5 serum biomarkers including percentage of basophils (BASO%), percentage of monocytes (Mono%), platelet volume (PCT), globulin (G), activated partial thromboplastin time (APTT) for distinguishing IVO from NVO. Based on these biomarkers, we established a nomogram model capable of accurately discriminating between the two conditions.ConclusionThe results of this study hold promise in providing valuable guidance to clinical practitioners for the differential diagnosis and early antimicrobial treatment of vertebral osteomyelitis.

INTRODUCTION:Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study was to compare revision and nonrevision surgery patients in cervical sagittal alignment (CSA) subsequent to ACFS; additionally, to identify the best CSA parameters for predicting clinical outcome after ACFS; and furthermore, to create an equation model to assist surgeons in making decisions on patients undergoing ACFS. METHODS:The data of 99 patients with symptomatic cervical myelopathy/radiculopathy who underwent ACFS were analyzed. Patients were divided into group A (underwent revision surgery after the first surgery failed) and group B (underwent only the first surgery). We measured and analyzed both preoperative and postoperative CSA parameters, including C2 slope, T1 slope, cervical lordosis C2-C7 (CL), C2-C7 sagittal vertical axis (C2C7 SVA), occiput-C2 lordosis angle (C0-C2), and chin brow vertical angle, and we further computed the correlation between the CSA parameters and created a prediction model. RESULTS:The (T1S-CL)-C2S mismatch differed significantly between groups A and B ([9.95 ± 9.95] 0 , [3.79 ± 6.58] 0 , P < 0.05, respectively). A significant correlation was observed between C2 slope and T1CL in group B relative to group A postoperatively (R 2 = 0.42 versus R 2 = 0.09, respectively). Compared with group B, patients in group A had significantly higher C2C7SVA values, more levels of fusion, and more smokers. The sensitivity, specificity, accuracy, and discrimination of the model were, respectively, 73.5%, 84%, 78.8%, and 85.65%. CONCLUSION:The causes of revision surgery in cervical myelopathic patients after anterior cervical corpectomy and fusion/anterior cervical diskectomy and fusion are multifactorial. (T1S-CL)-C2S mismatch and high C2C7SVA are the best cervical sagittal parameters that increase the odds of revision surgery, and the effect is more enhanced when comorbidities such as smoking, low bone-mineral density, and increased levels of fusion are taken into account.

ObjectiveTo investigate the differences in postoperative deep venous thrombosis (DVT) between patients with spinal infection and those with non-infected spinal disease; to construct a clinical prediction model using patients' preoperative clinical information and routine laboratory indicators to predict the likelihood of DVT after surgery. MethodAccording to the inclusion criteria, 314 cases of spinal infection (SINF) and 314 cases of non-infected spinal disease (NSINF) were collected from January 1, 2016 to December 31, 2021 at Xiangya Hospital, Central South University, and the differences between the two groups in terms of postoperative DVT were analyzed by chi-square test. The spinal infection cases were divided into a thrombotic group (DVT) and a non-thrombotic group (NDVT) according to whether they developed DVT after surgery. Pre-operative clinical information and routine laboratory indicators of patients in the DVT and NDVT groups were used to compare the differences between groups for each variable, and variables with predictive significance were screened out by least absolute shrinkage and operator selection (LASSO) regression analysis, and a predictive model and nomogram of postoperative DVT was established using multi-factor logistic regression, with a Hosmer- Lemeshow goodness-of-fit test was used to plot the calibration curve of the model, and the predictive effect of the model was evaluated by the area under the ROC curve (AUC). ResultThe incidence of postoperative DVT in patients with spinal infection was 28%, significantly higher than 16% in the NSINF group, and statistically different from the NSINF group (P < 0.000). Five predictor variables for postoperative DVT in patients with spinal infection were screened by LASSO regression, and plotted as a nomogram. Calibration curves showed that the model was a good fit. The AUC of the predicted model was 0.8457 in the training cohort and 0.7917 in the validation cohort. ConclusionIn this study, a nomogram prediction model was developed for predicting postoperative DVT in patients with spinal infection. The nomogram included five preoperative predictor variables, which would effectively predict the likelihood of DVT after spinal infection and may have greater clinical value for the treatment and prevention of postoperative DVT.

To minimize surgical complications and staged procedures halo-traction is often used during deformity corrections. But the use of halo-traction in the treatment of refractory cervical kyphosis secondary to infections has never been reported. This study investigated the role of halo-traction in the treatment of cervical infection patients associated with refractory kyphosis. We retrospectively reviewed 48 patients with cervical infection associated with refractory kyphosis who were treated in our spine department. Patients were divided into two groups, the traction group (A) and the non-traction group (B). Group A underwent preoperative halo-traction followed by surgery, while group B underwent surgery alone. Between the two groups, we analyzed the kyphosis deformity correction, level of fusions, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), functional improvement by Neck disability index (NDI) score, and complications. Group A had a better correction of kyphosis deformity compared to group B (27.01 ± 11.54) 0 versus (18.08 ± 10.04) 0 (P = 0.01, Z = − 2.44). No statistically significant differences between the two groups in terms of functional improvement, level of fusions, ESR and CRP. Group B had 3 revision surgery cases. Preoperative halo-traction followed by surgery is superior in kyphosis correction in the treatment of patients with cervical infections with refractory kyphosis.

This study aimed to evaluate the impact of precise treatment administered according to the results of metagenomic next-generation sequencing (mNGS) on the clinical outcomes of patients with spinal infections. In this multicenter retrospective study, the clinical data of 158 patients with spinal infections who were admitted to Xiangya Hospital Central South University, Xiangya Boai Rehabilitation Hospital, The First Hospital of Changsha, and Hunan Chest Hospital from 2017 to 2022 were reviewed. Among these 158 patients, 80 patients were treated with targeted antibiotics according to the mNGS results and were assigned to the targeted medicine (TM) group. The remaining 78 patients with negative mNGS results and those without mNGS and negative microbial culture results were treated with empirical antibiotics and assigned to the empirical drug (EM) group. The impact of targeted antibiotics based on the mNGS results on the clinical outcomes of patients with spinal infections in the two groups was analyzed. The positive rate of mNGS for diagnosing spinal infections was significantly higher than that of microbiological culture (X2=83.92, P<0.001), procalcitonin (X2=44.34, P<0.001), white blood cells (X2=89.21, P < 0.001), and IGRAs (Interferon-gamma Release Tests) (X2 = 41.50, P < 0.001). After surgery, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) showed a decreasing trend in the patients with spinal infections in both the TM and EM groups. The decrease in CRP was more obvious in the TM group than in the EM group at 7, 14 days, 3, and 6 months after surgery (P<0.05). The decrease in ESR was also significantly obvious in the TM group compared with the EM group at 1 and 6 months after surgery (P<0.05). The time taken for CRP and ESR to return to normal in the TM group was significantly shorter than that in the EM group (P<0.05). There was no significant difference in the incidence of poor postoperative outcomes between the two groups. The positive rate of mNGS for the diagnosis of spinal infection is significantly higher than that of traditional detection methods. The use of targeted antibiotics based on mNGS results could enable patients with spinal infections to achieve a faster clinical cure.

To assess the effectiveness and safety of continuous lavage with 1

Abstract The series of complications involved in hemivertebra resection has not yet led to a precise solution. Therefore, we aim to compare less invasive, partial hemivertebra resection versus total hemivertebra resection for this anomaly in children with a long-term follow-up. From 2011 to 2016, we did a retrospective study on 31 patients with congenital scoliosis associated with hemivertebrae who had a posterior-only approach comprising 16 patients with total hemivertebrae resection (TR), 15 patients with partial hemivertebrae resection (PR), and short-segment fusion. There was 31 congenital scoliosis associated with hemivertebrae patients in both the PR and TR groups, and the average mean age at the time of surgery was 6.3 ± 2.0 and 6.0 ± 1.9, respectively. The PR group had an equipotential correction rate of cobb angle at post-operation (4.3 ± 4.9 and 2.2 ± 3.2, P = 0.174) and the last follow-up (8.3 ± 5.4 and 5.5 ± 2.4, P = 0.087) as the TR group. Partial hemivertebra resection is efficient and secure. A less invasive technique obtained an equivalent well-maintained correction rate to the total hemivertebra resection with a better quality of life outcome of the patients.