Publications by authors named "Zifang Huang"

28 Publications

  • Page 1 of 1

Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis.

World Neurosurg 2021 Jun 12. Epub 2021 Jun 12.

Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address:

Background: Pedicle screw fixation (PSF) has been considered the preferred surgery for the treatment of severe osteoporotic vertebral compression fracture (sOVCF), and sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate has continued regarding the selection of the best surgical method for sOVCF. In the present study, we compared the efficacy and safety between PKP and PSF.

Methods: PKP was performed in 376 patients in group 1 and PSF in 121 patients in group 2. The visual analog scale (VAS), Oswestry disability index (ODI), local kyphotic angle, fractured vertebral body height, and complications were evaluated.

Results: In the immediate postoperative analysis, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score of 4.7 for group 2. The mean ODI score was 44.4% for group 1, lower than the ODI score of 57.1% for group 2. In addition, group 1 had had a significantly better ODI score at 1 year of follow-up. The local kyphotic angle and fractured vertebral body height had recovered better in group 2. In group 1, 113 patients had experienced cement leakage, and 29 patients had undergone PKP for adjacent new vertebral fractures. In group 2, 2 patients had developed wound infections, 4 had developed pneumonia, 2 had developed urinary tract infection, 3 had experienced asymptomatic screw loosening, and 7 had undergone PKP to treat new vertebral fractures and 1 had undergone removal of internal fixation because of back pain.

Conclusions: The results of the clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOVCF with kyphosis, with PKP having the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.
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http://dx.doi.org/10.1016/j.wneu.2021.06.030DOI Listing
June 2021

Quantitative determining of pre-operative osteotomy plan for severe spinal deformity: an analysis of 131 consecutive Yang's A type cases from single center.

Eur Spine J 2021 May 18. Epub 2021 May 18.

Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.

Purpose: This study aimed to quantify osteotomy protocol for severe spinal deformity correction based on pre-operative demographic, clinical and radiologic parameters.

Methods: A total of 131 Yang's A type severe spinal deformity patients were included. All patients received one of following osteotomies: Ponte/2 (Ponte osteotomy/Grade 2 osteotomy, n = 30), PSO/3 (pedicle subtraction osteotomy/Grade 3 osteotomy, n = 19), BDBO/4 (bone-disc-bone osteotomy/Grade 4 osteotomy, n = 26), SVCR/5 (single-level vertebral column resection/Grade 5 osteotomy, n = 38) and MVCR/6 (multilevel vertebral column resection/Grade 6 osteotomy, n = 18). Demographic, clinical and radiologic characteristics were compared among groups.

Results: Tukey's test identified 6 significant variables between paired groups: age for MVCR/6 versus Ponte/2 + PSO/3 + BDBO/4 + SVCR/5 groups; bending Cobb angle for Ponte/2 versus MVCR/6; sagittal deformity angular ratio (S-DAR) for Ponte/2 + PSO/3 versus BDBO/3 + SVCR/5 versus MVCR/6; pre-operative scoliosis for Ponte/2 versus SVCR/5; total-DAR (T-DAR) and pre-operative kyphosis for Ponte/2 + PSO/3 versus BDBO/4 + SVCR/5 + MVCR/6. Receiver Operating Characteristic (ROC) analysis showed the Area under the Curve (AUC) for the 6 variables ranged from 0.69 to 0.839. Multivariate k-means clustering analysis showed that Ponte/2 + PSO/3, BDBO/4 + SVCR/5, and MVCR/6 were three comparatively significant clusters, which could be discriminated by pre-operative kyphosis, T-DAR, age and S-DAR.

Conclusion: This study showed that osteotomy plan of severe spinal deformity could be determined as follows: Firstly, Ponte/2 + PSO/3 and BDBO/4 + SVCR/5 + MVCR/6 groups can be divided by either T-DAR (cutoff = 28) or the Cobb angle of pre-operative maximum kyphosis (cutoff = 100). Secondly, Ponte/2 + PSO/3 group could be further dichotomized into Ponte/2 and PSO/3 by age (cutoff = 18). Finally, BDBO/4 + SVCR/5 + MVCR/6 group could be divided into BDBO/4 + SVCR/5 and MVCR/6 groups by S-DAR (cutoff = 20).
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http://dx.doi.org/10.1007/s00586-021-06840-1DOI Listing
May 2021

Risk and Predictive Factors for Proximal Junctional Kyphosis in Patients Treated by Lenke Type 5 Adolescent Idiopathic Scoliosis Correction.

World Neurosurg 2021 03 15;147:e315-e323. Epub 2020 Dec 15.

Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Objective: Proximal junctional kyphosis (PJK) is a common sagittal complication of adolescent idiopathic scoliosis (AIS) after corrective surgery, leading to new deformities, pain, and, even, revision surgery. In the present study, we investigated the risk and predictive factors for PJK in patients who had undergone Lenke type 5 AIS correction to identify the parameters relevant to intraoperative guidance.

Methods: A total of 35 patients with Lenke type 5 AIS who had undergone corrective surgery at our hospital from January 2008 to February 2016 were divided into the PJK (n = 15) and non-PJK (n = 20) groups. Correlation and receiver operating characteristic curve analyses were performed to screen the parameters for significance and calculate the thresholds. A survival analysis was performed to examine the differences between the 2 groups.

Results: Independent t tests revealed significant differences between the 2 groups in the preoperative pelvic incidence, preoperative pelvic tilt, postoperative proximal junctional angle (PJA), and postoperative thoracic kyphosis (TK). The postoperative PJA, postoperative TK, and other parameters correlated significantly with changes in the PJA at the final follow-up. The receiver operating characteristic curves revealed that the postoperative PJA and postoperative TK effectively predicted for the occurrence of PJK, with a threshold of 9.45° and 25.25°, respectively. The estimated survival times were 14.7 months for a PJA >9.45° and TK >25.25°, 19.2 months for a PJA >9.45°, and 33.9 months for TK >25.25°.

Conclusions: The results of the present study have shown that the postoperative PJA and postoperative TK can be used to effectively predict for the occurrence of PJK in patients with Lenke type 5 AIS after corrective surgery, with a threshold of 9.45° and 25.25°, respectively.
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http://dx.doi.org/10.1016/j.wneu.2020.12.044DOI Listing
March 2021

Fiber Type-Specific Morphological and Cellular Changes of Paraspinal Muscles in Patients with Severe Adolescent Idiopathic Scoliosis.

Med Sci Monit 2020 Jul 30;26:e924415. Epub 2020 Jul 30.

Spine Center, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).

BACKGROUND Paraspinal muscle (PSM) has been suggested to have a role in adolescent idiopathic scoliosis (AIS). Few studies have investigated the fiber type-specific changes of PSM in detail. MATERIAL AND METHODS Bilateral multifidus muscles were harvested from the apical vertebra level (T7-T10) of 12 AIS patients and 6 control individuals. Immunohistological staining was performed to evaluate the muscle fiber type composition, fiber type-specific cross-sectional area (CSA), myonuclei density, and the total and activated satellite cell (SC) density. The correlations between these characteristics and curve initiation/severity were analyzed. RESULTS In comparison with the PSM in convexity and the control group, PSM in concavity showed a significant reduction of CSA (concavity, 2601.1±574.1 μm²; convexity, 3732.1±545.1 μm²; control, 3426.5±248.4 μm²), myonuclei density (concavity, 2.0±0.3 myonuclei/fiber; convexity, 2.5±0.4 myonuclei/fiber; control, 2.2±0.2 myonuclei/fiber), and activated SC density (concavity, 0.7±0.4 cells/100 fibers; convexity, 1.5±0.7 cells/100 fibers; control, 1.2±0.3 cells/100 fibers) for fiber type I. The Cobb angle was positively correlated with the bilateral ratio of CSA (convexity/concavity) for both fiber types. The apical vertebral translation was positively correlated with bilateral difference of myonuclei density (type I), total SC density (types I and II), and activated SC density (type I). CONCLUSIONS The fiber type-specific pathological changes on the concave side seemed to be more severe. Some fiber type-specific characteristics (CSA, myonuclei density, total/activated SC density) were closely associated with curve severity. More attention should be paid to PSM physiotherapy treatment on the concave side.
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http://dx.doi.org/10.12659/MSM.924415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412933PMC
July 2020

Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis: A Prospective Controlled Cohort Study.

Spine (Phila Pa 1976) 2020 Aug;45(15):1039-1046

Department of Spine Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Study Design: A prospective controlled cohort study.

Objective: The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window.

Summary Of Background Data: Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role.

Methods: We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared.

Results: The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups (P < 0.05).

Conclusion: For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond.

Level Of Evidence: 2.
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http://dx.doi.org/10.1097/BRS.0000000000003451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373466PMC
August 2020

Immune-related prognosis biomarkers associated with osteosarcoma microenvironment.

Cancer Cell Int 2020 16;20:83. Epub 2020 Mar 16.

1Department of Medical Imaging, The First Affiliated Hospital of Guangdong Pharmaceutical University, No.19, Nong Lin Xia Road, Yuexiu District, Guangzhou, 510030 Guangdong China.

Background: Osteosarcoma is a highly aggressive bone tumor that most commonly affects children and adolescents. Treatment and outcomes for osteosarcoma have remained unchanged over the past 30 years. The relationship between osteosarcoma and the immune microenvironment may represent a key to its undoing.

Methods: We calculated the immune and stromal scores of osteosarcoma cases from the Target database using the ESTIMATE algorithm. Then we used the CIBERSORT algorithm to explore the tumor microenvironment and analyze immune infiltration of osteosarcoma. Differentially expressed genes (DEGs) were identified based on immune scores and stromal scores. Search Tool for the Retrieval of Interacting Genes Database (STRING) was utilized to assess protein-protein interaction (PPI) information, and Molecular Complex Detection (MCODE) plugin was used to screen hub modules of PPI network in Cytoscape. The prognostic value of the gene signature was validated in an independent GSE39058 cohort. Gene set enrichment analysis (GSEA) was performed to study the hub genes in signaling pathways.

Results: From 83 samples of osteosarcoma obtained from the Target dataset, 137 DEGs were identified, including 134 upregulated genes and three downregulated genes. Functional enrichment analysis and PPI networks demonstrated that these genes were mainly involved in neutrophil degranulation and neutrophil activation involved in immune response, and participated in neuroactive ligand-receptor interaction and staphylococcus aureus infection.

Conclusions: Our study established an immune-related gene signature to predict outcomes of osteosarcoma, which may be important targets for individual treatment.
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http://dx.doi.org/10.1186/s12935-020-1165-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075043PMC
March 2020

Development and validation of deep learning algorithms for scoliosis screening using back images.

Commun Biol 2019 25;2:390. Epub 2019 Oct 25.

2State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong China.

Adolescent idiopathic scoliosis is the most common spinal disorder in adolescents with a prevalence of 0.5-5.2% worldwide. The traditional methods for scoliosis screening are easily accessible but require unnecessary referrals and radiography exposure due to their low positive predictive values. The application of deep learning algorithms has the potential to reduce unnecessary referrals and costs in scoliosis screening. Here, we developed and validated deep learning algorithms for automated scoliosis screening using unclothed back images. The accuracies of the algorithms were superior to those of human specialists in detecting scoliosis, detecting cases with a curve ≥20°, and severity grading for both binary classifications and the four-class classification. Our approach can be potentially applied in routine scoliosis screening and periodic follow-ups of pretreatment cases without radiation exposure.
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http://dx.doi.org/10.1038/s42003-019-0635-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814825PMC
April 2020

Coronal deformity angular ratio may serve as a valuable parameter to predict in-brace correction in patients with adolescent idiopathic scoliosis.

Spine J 2019 06 7;19(6):1041-1047. Epub 2018 Dec 7.

Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Background Context: In-brace correction (IBC) plays an important role in curve progression of patients with adolescent idiopathic scoliosis (AIS) under brace treatment. We evaluated the coronal deformity angular ratio (C-DAR) as a potential predictor of IBC. Based on our experience, we postulated that a high C-DAR may result in low IBC. This relationship had not been previously studied.

Purpose: To evaluate the relationship of C-DAR and IBC in patients with AIS.

Study Design/setting: A retrospective study.

Patient Sample: A total of 119 patients with AIS treated with a Gensingen brace in our scoliosis center from July 2015 to October 2017 were included.

Outcome Measures: In-brace correction.

Methods: Data were collected before and upon brace placement. Correlation analyses between study variables and IBC were performed. A linear regression model was established on the basis of C-DAR.

Results: At brace fitting, the average age was 12.62±1.16 (range, 10-15) years and mean major curve Cobb angle was 32.14±4.66° (range, 25-40°). Mean IBC was 59.62%±22.03% (range, 16.2-100%). IBC had significant correlation with C-DAR (r=-0.69; 95% confidence interval, -0.77 to -0.61; p<.001). IBC was not significantly correlated with age, sex, height, weight, BMI, menstrual status, or Risser sign. A simple linear regression model established that in-brace correction=115.4-10.7×C-DAR.

Conclusions: C-DAR has strong negative correlation with IBC and may estimate the expected IBC. The usage of C-DAR may obviate the need for flexibility radiographs, such as supine or supine lateral bending radiographs.
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http://dx.doi.org/10.1016/j.spinee.2018.12.002DOI Listing
June 2019

Factors That Influence In-Brace Correction in Patients with Adolescent Idiopathic Scoliosis.

World Neurosurg 2019 Mar 7;123:e597-e603. Epub 2018 Dec 7.

Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address:

Objective: To identify the factors affecting in-brace correction in patients with adolescent idiopathic scoliosis (AIS).

Methods: We performed a retrospective analysis of patients with AIS receiving Gensingen brace treatment in our scoliosis center from July 2015 to October 2017 was performed. The selection of patients was in accordance with the Scoliosis Research Society inclusion criteria for a bracing study. Some radiographic and clinical parameters, including the Cobb angle, rib-vertebra angle difference, coronal and sagittal balance, lumbar-pelvic relationship (LPR), Risser sign, curve type, age, gender, height, weight, body mass index, and menstrual status were collected. The correlation and difference analyses were performed to identify the factors influencing in-brace correction.

Results: A cohort of 112 patients with AIS (94 girls and 18 boys) were included in the present study. The mean in-brace correction was 59.29% ± 22.33% (range, 16.22%-100.00%). In-brace correction showed a significantly negative correlation with the major curve Cobb angle, minor curve Cobb angle, total curve Cobb angle, and LPR (P < 0.05 for all). Sagittal and coronal imbalance could reduce the curve correction (P < 0.001 and P = 0.008, respectively). The remaining parameters were not related to in-brace correction.

Conclusions: In-brace correction in the present study was 59.29% ± 22.33% (range, 16.22%-100.00%). Some factors, including the Cobb angle, sagittal and coronal balance, and LPR, have an effect on in-brace correction. The results from the present study can provide some useful information for brace design and fabrication.
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http://dx.doi.org/10.1016/j.wneu.2018.11.228DOI Listing
March 2019

The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary?

Neurosurgery 2019 08;85(2):211-222

Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Background: Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited.

Objective: To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM.

Methods: A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups.

Results: The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr.

Conclusion: The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.
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http://dx.doi.org/10.1093/neuros/nyy237DOI Listing
August 2019

Is Vertebral Column Resection Necessary in Correcting Severe and Rigid Thoracic Kyphoscoliosis? A Single-Institution Surgical Experience.

World Neurosurg 2018 Aug 12;116:e1-e8. Epub 2017 Oct 12.

First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address:

Background: Three-column spinal osteotomies were developed to address severe and stiff kyphoscoliosis. However, the optimal choice of osteotomy in these patients is still unclear. This retrospective study aims to compare the outcomes and complications between grade 4 and grade 5 osteotomies in patients with severe and stiff thoracic kyphoscoliosis.

Methods: Forty-five patients with severe and stiff thoracic kyphoscoliosis who underwent 3-column osteotomy in the thoracic spine were classified into 2 groups according to the grade of osteotomy. The clinical data and radiologic parameters were collected and compared.

Results: Fourteen patients received grade 4 osteotomy, and 31 patients received grade 5 osteotomy. The spinal column shortening distances were similar between groups. The postoperative and latest follow-up radiologic parameters were not statistically significant between groups. Postoperative and follow-up results demonstrated greater correction of the regional kyphosis angle in the grade 4 osteotomy group, but did not reach significant level. The operative time and blood loss of grade 5 osteotomies were greater than those of grade 4, but showed no significant differences. Perioperative complication rates were also similar between groups.

Conclusions: Similar clinical outcomes can be achieved with grade 4 and grade 5 spinal osteotomies. This may enrich the basis on moving down to a lower osteotomy grade when treating patients with severe and rigid thoracic kyphoscoliosis.
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http://dx.doi.org/10.1016/j.wneu.2017.10.002DOI Listing
August 2018

The effect of different screw-rod design on the anti-rotational torque: a biomechanical comparison of three conventional screw-rod constructs.

BMC Musculoskelet Disord 2017 Jul 28;18(1):322. Epub 2017 Jul 28.

Department of Orthopaedics, The 1st Affiliated Hospital of Sun Yat-sen University, NO.58, Zhongshan Er Road, Guangzhou, Guangdong, China.

Background: Screw-rod constructs have been widely used to correct spinal deformities, but the effects of different screw-rod systems on anti-rotational torque have not been determined. This study aimed to analyze the biomechanical effect of different rod-screw constructs on anti-rotational torque.

Methods: Three conventional spinal screw-rod systems (Legacy, RF-F-10 and USSII) were used to test the anti-rotational torque in the material test machine. ANOVA was performed to evaluate the anti-rotational capacity of different pedicle screws-rod constructs.

Results: The anti-rotational torque of Legacy group, RF-F-10 group and USSII group were 12.3 ± 1.9 Nm, 6.8 ± 0.4 Nm, and 3.9 ± 0.8 Nm, with a P value lower than 0.05. This results indicated that the Legacy screws-rod construct could provide a highest anti-rotation capacity, which is 68% and 210% greater than RF-F-10 screw-rod construct and USSII screw-rod respectively.

Conclusions: The anti-rotational torque may be mainly affected by screw cap and groove design. Our result showed the anti-rotational torque are: Legacy system > RF-F-10 system > USSII system, suggesting that appropriate rod-screw constructs selection in surgery may be vital for anti-rotational torque improvement and preventing derotation correction loss.
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http://dx.doi.org/10.1186/s12891-017-1683-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534095PMC
July 2017

Three-dimensional translations following posterior three-column spinal osteotomies for the correction of severe and stiff kyphoscoliosis.

Spine J 2017 12 7;17(12):1803-1811. Epub 2017 Jun 7.

Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan Er Rd, Guangzhou, Guangdong, China. Electronic address:

Background Context: Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature.

Purpose: This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis.

Study Design/setting: A retrospective study was carried out.

Patient Sample: Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included.

Outcome Measures: General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding.

Methods: The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed.

Results: The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with ST being or more than grade I (33.3%) was significantly higher than that with ST being less than grade I (9.8%). No linear correlations were found between spine shortening distance, deformity correction rate, and the degree of translation.

Conclusions: The 3D translations are common in posterior three-column spinal osteotomies regardless of anterior strut graft placement. The increase of translation will increase neurologic risks, with GT or FT less than grade II and ST less than grade I being relatively safe.
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http://dx.doi.org/10.1016/j.spinee.2017.06.003DOI Listing
December 2017

Radiologic Parameters Can Affect the Preoperative Decision Making of Three-Column Spinal Osteotomies in the Treatment of Severe and Stiff Kyphoscoliosis.

Spine (Phila Pa 1976) 2017 Dec;42(23):E1371-E1379

First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.

Study Design: Retrospective analysis.

Objective: To evaluate whether radiologic parameters affect spine surgeon's osteotomy choice in patients with severe and stiff thoracic kyphoscoliosis.

Summary Of Background Data: Three-column osteotomies were developed to address severe and stiff kyphoscoliosis. Current choice on osteotomies is based on the morphology of kyphosis, global balance, and locations of the main curvature; however, quantitative basis for decision making is still lacking.

Methods: Sixty patients with severe and stiff thoracic kyphoscoliosis who underwent three-column osteotomy in the thoracic spine were classified into four groups according to the grade of osteotomy. The radiologic parameters including maximum scoliosis, maximum kyphosis, deformity angular ratio (DAR; maximum Cobb angle divided by number of vertebrae involved), apical vertebral translation, coronal balance, and sagittal balance were measured and compared. Correlation analysis between the radiologic parameters and the osteotomy grades was conducted. Perioperative and long-term complications were reviewed.

Results: The overall scoliosis was corrected from a mean preoperative Cobb angle of 129.1° (range, 90-174°) to 56.4° (range, 14-100°), and overall kyphosis was corrected from 124.3° (range, 64-180°) to 54.3° (range, 11-95°). As the osteotomy grades increased, the mean preoperative maximum kyphosis increased from 104.5° to 151.8° and the mean sagittal DAR (S-DAR) increased from 16.4 to 24.9. Statistically significant between-group differences were found for preoperative maximum kyphosis (P = 0.001), S-DAR (P = 0.045), and total DAR (P = 0.033). Significant correlations were observed between the preoperative maximum kyphosis and the osteotomy grade (r = 0.454, P < 0.001). The S-DAR significantly correlated with the osteotomy grade (r = 0.322, P = 0.012).

Conclusion: The preoperative maximum kyphosis and the S-DAR may affect the surgeon's decision on the grade of osteotomies. This may enrich the theoretical basis on preoperative planning and help with patient counseling.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000002210DOI Listing
December 2017

Left Ventricular Mechanics Assessed by 2-dimensional Speckle Tracking Echocardiography in Children and Adolescents With Idiopathic Scoliosis.

Clin Spine Surg 2017 05;30(4):E381-E389

Departments of *Paediatric Cardiology †Spinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Study Design: A retrospective review of data collected prospectively.

Objective: The study aimed to assess the possible effects of idiopathic scoliosis on left ventricular (LV) myocardial performance in children and adolescent patients.

Summary Of Background Data: Spine anomaly may impair cardiorespiratory function. It has been confirmed that respiratory function decreased in patients with scoliosis. However, limited study of the effect of scoliosis on heart function has been published, and no assessment of myocardial deformation of these patients has been reported to our knowledge.

Methods: Forty-one patients with a median age of 16 years and a median Cobb's angle of 75 degrees were studied. LV myocardial deformation was evaluated using 2-dimensional speckle-tracking echocardiography. The results were compared with those of 33 controls. The correlations between Cobb's angle and echocardiographic parameters in patients were also explored.

Results: Compared with controls, patients had significantly lower global LV longitudinal systolic strain in all 3 views (4 chamber, 2 chamber, and 3 chamber views), lower global radial and circumferential strains in mitral valve (MV) level and papillary muscle (PM) level; reduced LV longitudinal early diastolic strain rate (SRe) in all 3 longitudinal views and reduced radial SRe in MV level and reduced circumferential SRe in apical (AP) level; decreased LV longitudinal late diastolic strain rate in 4-chamber view and decreased radial ones in all 3 short-axis levels. Among patients, Cobb's angle correlated negatively with LV global radial strain of MV level (r=-0.37, P=0.02), global circumferential strain of MV level (r=-0.35, P=0.03), and global circumferential strain of PM level (r=-0.49, P=0.001), whereas positively with LV longitudinal SRa of 4-chamber view (r=0.46, P=0.003), longitudinal SRa of 2-chamber view (r=0.49, P=0.001), and circumferential SRa of AP level (r=0.35, P=0.02).

Conclusions: LV mechanics are impaired in patients with idiopathic scoliosis, which correlate with the severity of scoliosis. Our findings suggest the need and provide a mechanical basis for further studies in these patients.
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http://dx.doi.org/10.1097/BSD.0000000000000219DOI Listing
May 2017

Convex-Rod Derotation Maneuver on Lenke Type I Adolescent Idiopathic Scoliosis.

Neurosurgery 2017 Nov;81(5):844-851

Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Background: Convex-rod derotation may have potential advantages for adolescent idiopathic scoliosis (AIS) correction; however, study of this technique has been limited.

Objective: To compare the radiographic outcomes of Lenke type I AIS patients treated by the convex- or concave-rod derotation maneuvers.

Methods: A retrospective study was designed to compare 2 cohorts, including 81 Lenke type I AIS patients treated with convex-rod derotation (n = 38) or concave-rod derotation (n = 43), between July 2008 and September 2012. All patients had complete clinical records and radiographic data, which were collected and compared between groups.

Results: In comparing 9 radiographic parameters, significant differences were found in the incidence of screw misplacement, the postoperative main-curve angle, and the corrective rate between groups. The major-curve angles in both the convex- and the concave-rod derotation groups were corrected from 54.0° ± 10.6° and 53.0° ± 11.1° preoperatively, to 8.5° ± 6.9° and 12.9° ± 6.8° postoperatively, with corrective rates of 85.3% and 76.0%, respectively (P = .001). Final T5-T12 kyphosis and appropriate coronal-to-sagittal balance were achieved in both groups. The incidence of screw misplacement in the convex and concave sides of all patients was 1.8% and 3.7%, respectively (P = .047), and 1.8% and 3.6%, respectively, in the convex- and the concave-rod derotation groups (P = .044).

Conclusion: Compared with concave-rod derotation, convex-rod derotation can potentially improve the major-curve corrective rate and tends to reduce the risk of pedicle breach in Lenke type I AIS patients.
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http://dx.doi.org/10.1093/neuros/nyx102DOI Listing
November 2017

Polymorphisms in promoter regions of MMP-3 and IL-6 genes are not associated to adolescent idiopathic scoliosis (AIS) gender bias.

J Back Musculoskelet Rehabil 2017 ;30(3):559-563

Study Design: A retrospective study in Chinese Han people.

Purpose: To explore whether promoter polymorphisms of matrix metalloproteinases-3 (MMP-3) (rs3025058) and interleukin-6(IL-6) (rs1800795) genes are associated to AIS gender bias.

Methods: A total of 200 patients (100 boys and 100 girls) with AIS and 200 healthy age-matched adolescents were recruited from July 2008 to August 2013 in our scoliosis center. All AIS patients had Cobb angles larger than 20°, average 43 ± 3.6° (range 24-72°). A case-control study using genotypic technique was conducted to explore whether promoter polymorphisms of MMP-3 and IL-6 were associated to AIS gender bias. In addition, to confirm the association between gene variants of MMP-3 and IL-6 and AIS. Statistical analysis of genotype frequencies between AIS patients and normal controls was performed by X^2 test.

Results: The frequency of 5A/5A genotype of MMP-3 gene in patients with AIS was higher than in controls (19% versus 9.5% p= 0.007), in the sub-divided groups depend on gender, no significant difference was found between AIS girls and boys in the frequency of 5A/5A genotype of MMP-3 (20% in girls versus 18% in boys p= 0.718). No significant difference was found between AIS and controls in the frequency of G/G genotype of IL-6 (97.5% versus 98%). In the sub-divided groups depend on gender, no significant difference was found between AIS girls and boys in the frequency of G/G genotype of the IL-6 gene (98% in girls versus 97% for boys).

Conclusions: The promoter polymorphism of the MMP-3 gene was confirmed to have an association with AIS and the promoter polymorphism of the IL-6 gene was lack of association with AIS. Besides, both gene variants of MMP-3 and IL-6 were not associated to AIS gender bias.
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http://dx.doi.org/10.3233/BMR-150309DOI Listing
January 2018

The Precise Bending Rod Technique: A Novel Method for Precise Correction of Ankylosing Spondylitis Kyphosis.

Clin Spine Surg 2016 11;29(9):E452-E456

*Department of Orthopedic Surgery, The 1st Affiliated Hospital of Sun Yat-Sen University †Department of Anatomy, Southern Medical University, Guangdong, China ‡Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, UK §Department of Orthopedic Surgery, Panyu Central Hospital, Guangdong, China.

Study Design: To report a new technique.

Objective: To introduce a new method of precise correction controlling for ankylosing spondylitis kyphosis.

Summary Of Background Data: The exact angle method is excellent for calculating the pedicle subtraction osteotomy angle but is difficult to perform during surgery. In this study, the precise rod bending technique was proposed as a new method for precise correction controlling for ankylosing spondylitis kyphosis through illustrative cases.

Methods: A preoperative plan using the exact angle method, with exact osteotomy angle and level determined, was prepared using a whole-spine lateral x-ray film. Then a precise contoured rod imitating the predicted spine correction was obtained using the lateral spine x-ray film that was of the actual size of the trunk. This rod model was disinfected and used for precisely controlling kyphosis correction in ankylosing spondylitis patients with good cervical spine and hip joints.

Results: Four ankylosing spondylitis kyphosis patients were successfully corrected using the precise bending rod technique. Their mean age was 31 years, the mean operative time was 247 minutes (160-320 min), the mean volume of bleeding was 1482 mL (727-2700 mL), and the average follow-up period was 13.8 months (9-17 mo). All patients regained their sagittal balance (all C7-SSVL≤2 cm). The predicted ostetomy degree was accurate to within 2 degrees compared with the achieved degree at the osteotomy site. No complications occurred during or after surgery.

Conclusions: The precise rod bending technique is a simple, effective method for precise correction of kyphosis caused by ankylosing spondylitis. The surgical result corresponded to the preoperative planning.
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http://dx.doi.org/10.1097/BSD.0b013e31828af6c4DOI Listing
November 2016

Comparison of Functional Outcome and Quality of Life in Patients With Idiopathic Scoliosis Treated by Spinal Fusion.

Medicine (Baltimore) 2016 May;95(19):e3289

From the 1st Affiliated Hospital of Sun Yat-sen University, Zhongshan Er Road, Guangzhou, China.

Longer spinal fusions have been shown to result in improved deformity correction; however, loss of normal flexibility in the fusion area should not be ignored. Current consensus was to achieve a shorter fusion in primary surgery, with the goal of preserving as much of the distal motion segment as possible. However, the correlation between the length of fusion and functional outcome remains controversial. To the best of our knowledge, a previous study has demonstrated the function outcomes and the differences in HRQoL with specific fusion levels.In this cross-sectional study, 172 patients (mean age, 17.8 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 29.7 mo) were included to measure lumbar spine mobility and quality of life using validated outcome instruments in the study population. Patients were assigned to 5 groups according to the lower instrumented vertebra (LIV) level: group A (fusion above L2) 26 patients; group B (fusion to L2) 21 patients; group C (fusion to L3) 46 patients; group D (fusion to L4) 53 patients; and group E (fusion to L5) 26 patients. At each follow-up, patients were asked to complete the Scoliosis Research Society 22 (SRS-22) Questionnaire. Lumbar mobility was assessed using a dual digital inclinometer.Average spinal range of motion (ROM) was 41.4 degrees (SD, 20.7), forward flexion was 29.2 degrees (SD, 15.0), and backward extension was 12.2 degrees (SD, 9.5). The total spinal range of motion and forward flexion dropped noticeably as the LIV got more distal. Statistically significant between-group differences (1-way ANOVA) were found for ROM (P < 0.001), forward flexion (P < 0.001), or backward extension (P < 0.001). The motion segments preserved significantly correlated with ROM (r = 0.76, P < 0.001), ROMF (r = 0.76, P < 0.001), and ROME (r = 0.39, P < 0.001). However, no significant between-group differences was found for each domain of SRS-22 questionnaire.The motion segments preserved strongly correlated with lumbar mobility. Less fusion levels can preserve better lumbar flexibility by keeping more motion segments.
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http://dx.doi.org/10.1097/MD.0000000000003289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902471PMC
May 2016

Spot14/Spot14R expression may be involved in MSC adipogenic differentiation in patients with adolescent idiopathic scoliosis.

Mol Med Rep 2016 Jun 12;13(6):4636-42. Epub 2016 Apr 12.

Department of Scoliosis, The First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China.

The aim of the present study was to evaluate the different expression levels of thyroid hormone responsive (THRSP; Spot14)/S14 related, Mig12 (S14R) during bone marrow mesenchymal stem cell (BM-MSC) adipogenesis in adolescent idiopathic scoliosis (AIS) patients. MSCs were retrospectively isolated from AIS patients and controls, and adipogenic differentiation was induced. Total RNA was extracted for Affymetrix 3'‑IVT expression profiling microarrays and compared with the results from healthy controls. The results were confirmed by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) validation and the protein expression levels of Spot14 and its paralogous gene S14R by western blotting and immunohistochemistry. A total of 300 significantly altered mRNAs were detected (111 upregulated and 189 downregulated) and confirmed by RT‑qPCR. The mRNA expression levels of seven genes, including Spot14, were altered by >2‑fold in AIS patients. Spot14/S14R was selected for further investigation. The results of the western blotting demonstrated that mRNA and protein expression levels of Spot14/S14R were significantly higher in AIS patients than the controls (P<0.05). Immunohistochemistry demonstrated Spot14 was expressed in 85% (17/20 cases) in adipose tissue samples from AIS patients and 23.1% (3/13 cases) of adipose tissue samples from controls. The positive ratio of Spot14 in adipose tissue samples from AIS was significantly higher than the controls (P<0.001). The results of the present study indicated that Spot14/S14R were differently expressed in MSC adipogenesis in AIS patients, and they may be important in the abnormal adipogenic differentiation in AIS.
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http://dx.doi.org/10.3892/mmr.2016.5109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878568PMC
June 2016

Vertebral Derotation by Vertebral Column Manipulator Improves Postoperative Radiographs Outcomes of Lenke 5C Patients for Follow-up of Minimum 2 Years.

Clin Spine Surg 2016 Apr;29(3):E157-61

*Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Southern Medical University†Department of Spine Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Study Design: This was a retrospective study.

Objective: The aim of this study was to compare radiographic outcomes of Lenke 5C adolescent idiopathic scoliosis (AIS) patients treated by vertebral column manipulator (VCM) or simple rod derotation (SRD) maneuver.

Summary Of Background Data: The direct vertebral rotation (DVR) technique has demonstrated better rotational and coronal correction than SRD, but clinical radiographic outcomes for Lenke 5C AIS following DVR using a VCM derotational device have not been described.

Materials And Methods: A retrospective study was carried out in 39 Lenke 5C AIS patients treated by VCM (n=20) or SRD (n=19) techniques between April 2008 and June 2011. All patients had complete clinical record and radiographic data. Nine radiographic variables were collected and compared at 3 time points (preoperative, immediate postoperative, and minimum 2-year follow-up) between both groups.

Results: Scoliosis was successfully corrected in both groups. All patients obtained good coronal and sagittal balance, and no severe complications occurred. The postoperative apical rotation corrective rate of the VCM and SRD groups were 55.1% and 25.5%, respectively (P < 0.05). Lowest instrumented vertebra and stable vertebra (LIV-SV) was statistically significant between the VCM and SRD groups, the mean values were 1.2 ± 0.4 level and 0.7 ± 0.5 level (P < 0.05). The main curve corrective rates and LIV-tilt angle correction rates were not significantly different between groups, but it showed a spontaneous correction for the coronal LIV-tilt angle for both groups at the last follow-up.

Conclusions: VCM improved postoperative apical axial rotational correction and lessened the lumbar fusion segment compared with the SRD technique, which might have a potential trend to reserve lumbar mobility.
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http://dx.doi.org/10.1097/BSD.0000000000000123DOI Listing
April 2016

Prevalence of Idiopathic Scoliosis in Chinese Schoolchildren: A Large, Population-Based Study.

Spine (Phila Pa 1976) 2016 Feb;41(3):259-64

*The 1st Affiliated Hospital of Sun Yat-sen University†Primary and Secondary Schools Health Care Institute, Guangzhou, China.

Study Design: This is a population-based, cross-sectional study of school scoliosis screening program in mainland China.

Objective: The aim of this study was to assess current prevalence and distribution of idiopathic scoliosis (IS) in schoolchildren and to compare with the results of previous studies.

Summary Of Background Data: The feasibility and predictive values of scoliosis screening programs for school-age children remains controversial and many of these programs have recently been discontinued in different countries. Due to different race and medical model in China, it is not feasible to introduce these data without further study. Therefore, a reliable retrospective cohort study with a large sample size to ensure proper evaluation of school scoliosis screening is needed.

Methods: Schoolchildren were initially screened by visual inspection of clinical signs, the forward-bending test, and the measurement of the angle of trunk rotation (ATR). Students suspected were rescreened, and then were referred for radiography or dismissed. The diagnosis and treatment were based on the Cobb angle. The personal information, demographic information, and results of tests performed were recorded and analyzed.

Results: A total of 99,695 children were screened, with a female-to-male ratio of 1:1.03. Around 6.56% of children screened were referred for radiography, and 5125 of them had confirmed diagnosis. The overall scoliosis prevalence rate was 5.14%. According to age and gender, 14- to 15-year-old girls had the highest prevalence rates (13.81%). And, the prevalence of IS in need of treatment was 0.64%. A prevalence rate of 13.1% was observed in girls with BMI less than 18 kg/m².

Conclusion: The prevalence rate of IS was 5.14% in our study. Screening of 13- to 14- and 14- to 15-year-old girls identified a significant number who could benefit from preventive treatment. Low BMI may be a risk factor for IS. We present this study as a guide for studying the prevalence of IS and modifying our further research.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000001197DOI Listing
February 2016

Ventricular and atrial mechanics and their interaction in patients with congenital scoliosis without clinical heart failure.

Cardiol Young 2015 Jun 12;25(5):976-83. Epub 2014 Sep 12.

1Department of Paediatric Cardiology,The First Affiliated Hospital of Sun Yat-Sen University,Guangzhou,China.

Objectives: This study sought to evaluate left ventricular, right ventricular, and left atrial mechanics and their interactions in patients with congenital scoliosis without clinical heart failure.

Methods: A total of 23 patients with a median age of 14 years and a median Cobb's angle of 61° were studied. Ventricular and atrial myocardial deformation was measured using speckle tracking echocardiography. The results of the patients were compared with 22 controls.

Results: Compared with controls, the patients had a significantly greater annular a velocity (p=0.04) and lower e/a ratio (p=0.03); the left ventricular deformation significantly decreased in radial global (p=0.04) and segmental systolic strain and early diastolic strain rate (p=0.03); the left atrial deformation showed a significantly lower positive strain (p=0.02), greater negative strain (p=0.01), and active contractile strain rate (p=0.01). For the patients, the Cobb's angle was negatively correlated with the left ventricular global radial systolic strain (r=-0.65, p=0.001), left atrial positive strain (r=-0.68, p<0.001), and the left atrial negative strain was positively correlated with the left ventricular circumferential late diastolic strain rate (r=0.46, p=0.01). The left atrial conduit strain rate was positively correlated with the left ventricular circumferential early diastolic strain rate (r=0.42, p=0.03). The left atrial active contractile strain rate was positively correlated with the left ventricular longitudinal late diastolic strain rate (r=-0.4, p=0.03).

Conclusions: Impaired left ventricular and altered left atrial mechanics occur relatively early in patients with congenital scoliosis, and are correlated with the severity of their scoliosis. Our findings provide evidence of preclinical heart dysfunction in patients with this disorder.
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http://dx.doi.org/10.1017/S1047951114001504DOI Listing
June 2015

Knowledge-assisted sequential pattern analysis with heuristic parameter tuning for labor contraction prediction.

IEEE J Biomed Health Inform 2014 Mar;18(2):492-9

The optimal dosing regimen of remifentanil for relieving labor pain should achieve maximal efficacy during contractions and little effect between contractions. Toward such a need, we propose a knowledge-assisted sequential pattern analysis with heuristic parameter tuning to predict the changes in intrauterine pressure,which indicates the occurrence of labor contractions. This enables giving the drug shortly before each contraction starts. Asequential association rule mining based patient selection strategy is designed to dynamically select data for training regression models. A novel heuristic parameter tuning method is proposed to decide the appropriate value ranges and searching strategies for both the regularization factor and the Gaussian kernel parameter of leastsquares support vector machine with radial basis function (RBF) kernel, which is used as the regression model for time series prediction. The parameter tuning method utilizes information extracted from the training dataset, and it is adaptive to the characteristics of time series. The promising experimental results show that the proposed framework is able to achieve the lowest prediction errors as compared to some existing methods.
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http://dx.doi.org/10.1109/JBHI.2013.2281974DOI Listing
March 2014

Double-curve synchronous derotation with convex correction: a new corrective technique for adolescent idiopathic scoliosis with double curves.

J Spinal Disord Tech 2014 Feb;27(1):E32-6

*Department of Orthopedic Surgery, The 1st Affiliated Hospital of Sun Yat-Sen University †Department of Anatomy, Southern Medical University, Guangzhou, Guangdong, China ‡Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, United Kingdom §Department of Orthopedic Surgery, Panyu Central Hospital, Guangzhou, Guangdong, China.

Study Design: Report of a new technique.

Objective: We describe a new technique of double-curve synchronous derotation with convex correction for double-major adolescent idiopathic scoliosis (AIS) and is highlighted through illustrative cases.

Summary Of Background Data: Rotational deformity is a significant component of scoliosis, which causes a secondary rib hump, and adversely affects patients' psychological and social well-being, and long-term functional results. For AIS, direct vertebral rotation is confirmed as a better and effective method for apical rotational correction and rib hump improvement than rod rotation technique, avoiding the need for an adjuvant thoracoplasty. However, this technique is mainly applied to Lenke I type thoracic curves with derotation of the main curve. There are no reports applying this technique in double-major scoliosis.

Operative Technique: With the patient lying prone, a standard posterior incision exposure and segmental screws placement was performed, 2 vertebral column manipulator devices were installed on the apical region of both curves, then both curves were synchronously derotated and following convex correction at both the curves, the concave rods were secured in situ.

Results: There were 11 double-curve cases divided into 3 groups: double-curve derotation group (A group, 3 cases), single-curve derotation group (B group, 4 cases), and rod derotation group (C group, 4 cases); all cases had minimum 2-year follow-up. Three illustrative cases corrected by double-curve synchronous derotation with convex correction are presented with better apical rotational and correction in thoracic and lumbar curves than single-curve derotation and rod derotation cases. The mean apical derotational corrective rates were 95.3%, 46.7%, and 38.8% in the lumbar curve, 66%, -35.1%, and -38.9% in thoracic curve. The 3-dimensional correction was maintained at a minimum 2-year follow-up.

Conclusions: Double-curve synchronous derotation with convex correction is a safe and effective technique for rotational and coronal correction in AIS with double curves, which can avoid apical rotation aggravation in minor curve induced by major curve derotaion.
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http://dx.doi.org/10.1097/BSD.0b013e31828af893DOI Listing
February 2014

Right ventricular function impaired in children and adolescents with severe idiopathic scoliosis.

Scoliosis 2013 Jan 14;8(1). Epub 2013 Jan 14.

Department of Paediatric Cardiology, the First Affiliated Hospital of Sun Yat-sen University, No,58 2nd Zhongshan Road, Guangzhou 510080, China.

Unlabelled:

Background: Although it is speculated that scoliosis may induce cardiac dysfunction, there is no report about evaluation of cardiac function, especially right cardiac function in patients with scoliosis. Therefore, we evaluated right ventricular function in idiopathic scoliotic patients with mild to severe curves and compared them with healthy children and adolescents matched in age, then explored relationship between scoliosis and right ventricular function.

Methods: Thirty-seven patients diagnosed with idiopathic scoliosis with a mean age of 16y/o (range, 8-25y/o) and an average spine curve of 77.5°Cobb (range, 30-157°) were studied by echocardiography. TAD was obtained using M-mode echocardiography. Similar examination was performed in a control group of 17 healthy individuals in matched-age. According to the different curve degree, all patients were divided into 3 groups (mild, moderate and severe). Comparison was done among the groups and the relationship between TAD and spine curve of Cobb was analyzed.

Results: Patients with severe scoliosis showed depressed TAD. There was good correlation between TAD and spine curve of Cobb.

Conclusions: Patients with severe scoliosis showed a significant lower right ventricular systolic function.
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http://dx.doi.org/10.1186/1748-7161-8-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558379PMC
January 2013

Prediction of uterine contractions using knowledge-assisted sequential pattern analysis.

IEEE Trans Biomed Eng 2013 May 10;60(5):1290-7. Epub 2012 Dec 10.

Department of Electrical and Computer Engineering, University of Miami, Coral Gables, FL 33124, USA.

The usage of the systemic opioid remifentanil in relieving the labor pain has attracted much attention recently. An optimal dosing regimen for administration of remifentanil during labor relies on anticipating the timing of uterine contractions. These predictions should be made early enough to maximize analgesia efficacy during contractions and minimize the impact of the medication between contractions. We have designed a knowledge-assisted sequential pattern analysis framework to 1) predict the intrauterine pressure in real time; 2) anticipate the next contraction; and 3) develop a sequential association rule mining approach to identify the patterns of the contractions from historical patient tracings (HT).
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http://dx.doi.org/10.1109/TBME.2012.2232666DOI Listing
May 2013

Improving successful rate of transcranial electrical motor-evoked potentials monitoring during spinal surgery in young children.

Eur Spine J 2012 May 30;21(5):980-4. Epub 2011 Aug 30.

Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Introduction: This prospective study was to investigate the successful rate of intraoperative motor evoked potentials (MEP) monitoring for children (<12 years old) with congenital scoliosis.

Materials And Methods: A consecutive series of 27 young children (7 girls and 20 boys; from 1 to 11 years old) between September 2007 and November 2009, were enrolled to this study. 12 patients received general anesthesia based on TIVA, induced with propofol 2-4 mg/kg and fentanyl 3-5 µg/kg followed by a continuous infusion of propofol (20-150 µg/kg/min, at mean of 71.7 µg/kg/min). The other 15 patients received combined inhalation and intravenous anesthesia, induced with sevoflurane and fentanyl 3-5 µg/kg and maintained by sevoflurane (0.5-1%). The maintenance of anaesthesia management was performed with stable physiological parameters during surgery.

Results: Intraoperative MEP monitoring was successfully performed in all patients, while SEP was successfully performed in 26 of 27 patients. There was no significant difference of successful rates between SEP and MEP monitoring (P > 0.05). As well, no difference in MEP successful rates was observed in two groups with different anesthetic techniques. No wake-up test and no post-operative neurological deficits occurred in this series of patients.

Conclusion: Low dose anesthesia by either TIVA with propofol or sevoflurane-based mixture anesthesia protocol can help the intraoperative spinal cord monitoring to successfully elicit MEP and perform reliable monitoring for patients below 12 years of age.
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http://dx.doi.org/10.1007/s00586-011-1995-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337921PMC
May 2012
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