Objective:To investigate the potential role of lymphatic system in gouty arthritis (GA) by integrating clinical observations in human draining lymph nodes with functional studies in a mouse model. Methods:We first conducted ultrasound examinations of draining lymph nodes in 30 GA patients and 30 healthy controls. Subsequently, we established mouse models of acute and chronic GA via monosodium urate (MSU) crystal injection. Lymphatic nodes were assessed using ultrasound, the structure and function of lymphatic vessels were assessed using histology and near-infrared imaging. We further employed a VEGFR-3 inhibitor to disrupt lymphatic function and evaluated its impact on inflammatory resolution in MSU-induced GA mouse model. Results:Patients with GA showed significantly larger draining lymph nodes compared with healthy controls, a finding also observed in MSU-induced GA mouse model. The concentration of uric acid in the draining lymph nodes after MSU injection was significantly elevated and exceeded that in the serum. The structure of lymphatic vessels in paw tissues was impaired, and the draining function was reduced during the inflammatory process induced by MSU injection at 1 and 4 weeks. Lymphatic vessel leakage was observed after 4 weeks of MSU treatment. Critically, pharmacological inhibition of VEGFR-3, which disrupted lymphatic integrity, subsequently delayed the resolution of MSU-induced inflammation. Conclusion:Our findings in humans demonstrate a clinical association between GA and lymphatic system engagement. Mouse studies highlight a dual and critical role of the lymphatic system in GA pathogenesis: it is involved in clearance but vulnerable to damage, which may perpetuate inflammation.
IntroductionThe correlation between the non-use of cooking oil fumes (COFs) extractors and bone mineral density (BMD) have not been clarified. Consequently, this study attempted to explore the impact of non-use COFs extractors on BMD in population aged 45 years and older based on a cross-sectional study.MethodsThis study was a cross-sectional study within the framework of an ongoing prospective population-based cohort study in China. The multivariate linear regression models were used to evaluate the correlation between the non-use of fume extractors in family cooking and total lumbar spine (LS), femoral neck (FN), total hip BMD and levels of bone metabolism markers.ResultsA total of 3433 participants were included in the final analyses, of which 2607 (75.93%) participants used fume extractors. The results of models indicated that there were significant correlations of the non-use of fume extractors on total LS BMD (β = -0.024, 95% CI, -0.036, -0.012, p < 0.001), PINP (β = 4.363, 95% CI, 2.371, 6.356, p < 0.001) and ALP (β = 4.555, 95% CI, 2.593, 6.517, p < 0.001) levels.ConclusionsThis study verified that the use of fume extractors is an efficacious measure to prevent LS bone loss. For the sake of public bone health, people should install a fume extractor in the kitchen and use it routinely when cooking.
OBJECTIVE:The aim of this paper was to evaluate the changes in radiographic spinopelvic parameters in a large cohort of patients undergoing the prone transpsoas approach to the lumbar spine. METHODS:A multicenter retrospective observational cohort study was performed for all patients who underwent lateral lumber interbody fusion via the single-position prone transpsoas (PTP) approach. Spinopelvic parameters from preoperative and first upright postoperative radiographs were collected, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT). Functional indices (visual analog scale score), and patient-reported outcomes (Oswestry Disability Index) were also recorded from pre- and postoperative appointments. RESULTS:Of the 363 patients who successfully underwent the procedure, LL after fusion was 50.0° compared with 45.6° preoperatively (p < 0.001). The pelvic incidence-lumbar lordosis mismatch (PI-LL) was 10.5° preoperatively versus 2.9° postoperatively (p < 0.001). PT did not significantly change (0.2° ± 10.7°, p > 0.05). CONCLUSIONS:The PTP approach allows significant gain in lordotic augmentation, which was associated with good functional results at follow-up.
Study Design/Setting: This was a retrospective cohort study. Background: Little is known of the intersection between surgical invasiveness, cervical deformity (CD) severity, and frailty. Objective: The aim of this study was to investigate the outcomes of CD surgery by invasiveness, frailty status, and baseline magnitude of deformity. Methods: This study included CD patients with 1-year follow-up. Patients stratified in high deformity if severe in the following criteria: T1 slope minus cervical lordosis, McGregor’s slope, C2–C7, C2–T3, and C2 slope. Frailty scores categorized patients into not frail and frail. Patients are categorized by frailty and deformity (not frail/low deformity; not frail/high deformity; frail/low deformity; frail/high deformity). Logistic regression assessed increasing invasiveness and outcomes [distal junctional failure (DJF), reoperation]. Within frailty/deformity groups, decision tree analysis assessed thresholds for an invasiveness cutoff above which experiencing a reoperation, DJF or not achieving Good Clinical Outcome was more likely. Results: A total of 115 patients were included. Frailty/deformity groups: 27% not frail/low deformity, 27% not frail/high deformity, 23.5% frail/low deformity, and 22.5% frail/high deformity. Logistic regression analysis found increasing invasiveness and occurrence of DJF [odds ratio (OR): 1.03, 95% CI: 1.01–1.05, P =0.002], and invasiveness increased with deformity severity ( P <0.05). Not frail/low deformity patients more often met Optimal Outcome with an invasiveness index <63 (OR: 27.2, 95% CI: 2.7–272.8, P =0.005). An invasiveness index <54 for the frail/low deformity group led to a higher likelihood of meeting the Optimal Outcome (OR: 9.6, 95% CI: 1.5–62.2, P =0.018). For the frail/high deformity group, patients with a score <63 had a higher likelihood of achieving Optimal Outcome (OR: 4.8, 95% CI: 1.1–25.8, P =0.033). There was no significant cutoff of invasiveness for the not frail/high deformity group. Conclusions: Our study correlated increased invasiveness in CD surgery to the risk of DJF, reoperation, and poor clinical success. The thresholds derived for deformity severity and frailty may enable surgeons to individualize the invasiveness of their procedures during surgical planning to account for the heightened risk of adverse events and minimize unfavorable outcomes.
Study Design: Retrospective review of a prospectively enrolled adult spinal deformity (ASD) database. Objective: To investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction. Background: Currently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased preoperative consideration and counseling. Materials and Methods: Patients >18 yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at two years: (1) clinical: deteriorating in ODI at two years follow-up (2) complications/reoperation: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients. Results: In all, 633 adult spinal deformity (59.9 yrs, 79% F, 27.7 kg/m2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% pelvic incidence and lumbar lordosis, 28.8% sagittal vertical axis, 28.9% PT. Overall, 15.5% of patients deteriorated in ODI by two years, while 7.6% underwent reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%), heart disease (36%), and kidney disease (18%), P<0.001. Surgically, HR had greater EBL (4431ccs) and underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P<0.050. The multivariate regression determined a combination of a baseline Distress and Risk Assessment Method score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R 2 value of 0.535 (P<0.001). Conclusions: When addressing adult spine deformities, poor outcomes tend to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment.
