STUDY DESIGN:Retrospective matched case-control study. OBJECTIVE:To investigate whether lumbar muscle function is associated with reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH). SUMMARY OF BACKGROUND DATA:In addition to established risk factors, paraspinal muscle quality, which is measured by cross-sectional area (CSA) and fatty infiltration (FI), is related to lumbar degeneration but remains unknown as a predictor for rLDH recurrence after PELD. METHODS:Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. On T2 axial preoperative magnetic resonance images (MRI) at the L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 disc levels, a transformer-based segmentation algorithm was used to contour the psoas major (PS), multifidus (MF), and erector spinae (ES) muscles. The CSA of each muscle was subsequently calculated, and the Otsu method was applied to discriminate between muscle and fat tissue, thereby enabling quantitative assessment of FI. Statistical methods were used to compare whether there were statistical differences between the case and control groups. Spearman correlation analysis was performed. RESULTS:A total of 2603 patients were enrolled in this study. Fifty-seven patients underwent reoperation for rLDH, and 57 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Statistical analysis revealed significant differences between the case and control groups in: the CSA of PS at L3-L4 (P=0.041), L4-L5 (P=0.036), and L5-S1 (P=0.044); the CSA of ES at L1-L2 (P=0.049) and L2-L3 (P=0.026); and the FI of all muscles at all disc levels, except PS at L1-L2 (P=0.602) and ES at L1-L2 (P=0.227). CONCLUSION:This study showed that lumbar muscle function is associated with reoperation in rLDH patients after PELD. Smaller CSA and higher FI of core lumbar muscles were associated with an increased likelihood of rLDH after PELD.

This study aimed to investigate whether sarcopenia affects residual back pain (RBP) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). We retrospectively analyzed the clinical data of 231 patients with single-segment OVCF treated with PKP between January 2023 and December 2023. Postoperative RBP was assessed at 1 month using the visual analogue scale (VAS). Patients with a VAS score ≥ 4 were classified as the RBP group, while those with a score < 4 served as controls. Sarcopenia was diagnosed using the skeletal muscle mass index (SMI), calculated by dividing the cross-sectional muscle area at the T12 vertebral level (measured via chest CT) by height squared. Univariate analysis compared clinical and imaging data between groups, and binary logistic regression identified risk factors. No significant differences were observed between groups in gender, BMI, surgical segment, hypertension, diabetes, or coronary heart disease (P > 0.05). However, age, BMD, SMI, bone cement usage, and sarcopenia prevalence differed significantly (P < 0.05). Binary logistic regression identified BMD and sarcopenia as independent risk factors for RBP after PKP. OVCF patients with sarcopenia have a higher likelihood of postoperative RBP, with an incidence approximately twice that of non-sarcopenic patients. Preoperative sarcopenia screening should be prioritized, and postoperative anti-muscular atrophy therapy actively implemented.

Mitochondrial health is maintained in a steady state through mitochondrial dynamics and autophagy processes. Recent studies have identified healthy mitochondria as crucial regulators of cellular function and survival. This process involves adenosine triphosphate (ATP) synthesis by mitochondrial oxidative phosphorylation (OXPHOS), regulation of calcium metabolism and inflammatory responses, and intracellular oxidative stress management. In the skeletal system, they participate in the regulation of cellular behaviors and the responses of osteoblasts, osteoclasts, chondrocytes, and osteocytes to external stimuli. Indeed, mitochondrial damage or dysfunction occurs in the development of a few bone diseases. For example, mitochondrial damage may lead to an imbalance in osteoblasts and osteoclasts, resulting in osteoporosis, osteomalacia, or poor bone production, and chondrocyte death and inflammatory infiltration in osteoarthritis are the main causes of cartilage degeneration due to mitochondrial damage. However, the opposite exists for osteosarcoma, where overactive mitochondrial metabolism is able to accelerate the proliferation and migration of osteosarcoma cells, which is a major disease feature. Bone is a dynamic organ and osteocytes play a fundamental role in all regions of bone tissue and are involved in regulating bone integrity. This review examines the impact of mitochondrial physiological function on osteocyte health and summarizes the microscopic molecular mechanisms underlying its effects. It highlights that targeted therapies focusing on osteocyte mitochondria may be beneficial for osteocyte survival, providing a new insight for the diagnosis, prevention, and treatment of diseases associated with osteocyte death.

撞树、倒走、走鹅卵石……大爷大妈的晨练项目五花八门,这些新奇的运动方式,是好处多多还是伤痕累累呢?其实,撞树、互拍等运动用力过猛极易受伤,爬行、赤脚走鹅卵石等存在危险因素,建议选择缓和的健身方式.

STUDY DESIGN:Retrospective study. OBJECTIVES:Our objective is to create comprehensible machine learning (ML) models that can forecast bone cement leakage in percutaneous vertebral augmentation (PVA) for individuals with osteoporotic vertebral compression fracture (OVCF) while also identifying the associated risk factors. METHODS:We incorporated data from patients (n = 425) which underwent PVA. To predict cement leakage, we devised six models based on a variety of parameters. Evaluate and juxtapose the predictive performances relied on measures of discrimination, calibration, and clinical utility. SHapley Additive exPlanations (SHAP) methodology was used to interpret model and evaluate the risk factors associated with cement leakage. RESULTS:The occurrence rate of cement leakage was established at 50.4%. A binary logistic regression analysis identified cortical disruption (OR 6.880, 95% CI 4.209-11.246), the basivertebral foramen sign (OR 2.142, 95% CI 1.303-3.521), the fracture type (OR 1.683, 95% CI 1.083-2.617), and the volume of bone cement (OR 1.198, 95% CI 1.070-1.341) as independent predictors of cement leakage. The XGBoost model outperformed all others in predicting cement leakage in the testing set, with AUC of .8819, accuracy of .8025, recall score of .7872, F1 score of .8315, and a precision score of .881. Several important factors related to cement leakage were drawn based on the analysis of SHAP values and their clinical significance. CONCLUSION:The ML based predictive model demonstrated significant accuracy in forecasting bone cement leakage for patients with OVCF undergoing PVA. When combined with SHAP, ML facilitated a personalized prediction and offered a visual interpretation of feature importance.

STUDY DESIGN:Retrospective, matched case-control study. OBJECTIVE:To investigate the risk factors of reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH) and to establish a set of individualized prediction models. METHODS:Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. Six methods of machine learning (ML) were used to establish an individualized prediction model for reoperation in rLDH patients after PELD, and these models were compared with logistics regression model to select optimal model. RESULTS:A total of 2603 patients were enrolled in this study. 57 patients had repeated operation due to rLDH and 114 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Multivariate logistic regression analysis showed that disc herniation type (P < .001), Modic changes (type II) (P = .003), sagittal range of motion (sROM) (P = .022), facet orientation (FO) (P = .028) and fat infiltration (FI) (P = .001) were independent risk factors for reoperation in rLDH patients after PELD. The XGBoost AUC was of 90.71%, accuracy was approximately 88.87%, sensitivity was 70.81%, specificity was 97.19%. The traditional logistic regression AUC was 77.4%, accuracy was about 77.73%, sensitivity was 47.15%, specificity was 92.12%. CONCLUSION:This study showed that disc herniation type (extrusion, sequestration), Modic changes (type II), a large sROM, a large FO and high FI were independent risk factors for reoperation in LDH patients after PELD. The prediction efficiency of XGBoost model was higher than traditional Logistic regression analysis model.

Abstract Objective：We aimed to compare the degree of multifidus atrophy on lumbar spinal magnetic resonance imaging (MRI) between patients with degenerative lumbar spondylolisthesis (DLS) and controls. Methods：We retrospectively analysed the medical records of 213 DLS patients and recorded their baseline characteristics, including sex, age, height, weight, body mass index (weight/height2), slipped segment and presence of osteoporosis, hypertension and diabetes. The Meyerding classification system was used to categorise the patients into L3–5 spondylolisthesis groups. The L3 spondylolisthesis group consisted of 27 patients (24 and 3 with grades I and II, respectively; 6 males and 21 females) aged 43–83 years. The L4 spondylolisthesis group consisted of 140 patients (126 and 14 with grades I and II, respectively; 35 males and 105 females) aged 42–88 years. The L5 spondylolisthesis group consisted of 46 patients (40 and 6 with grades I and II, respectively; 15 males and 31 females) aged 37–91 years. In addition, we enrolled 20 young healthy volunteers aged 20–34 years as controls (12 males and 8 females). The lean and gross cross-sectional areas (LCSA and GCSA, respectively) of multifidus on both sides of L3/4, L4/5, and L5/S1 in the three groups were measured on lumbar spinal MRI. The LCSA/GCSA ratio indicated the degree of multifidus atrophy, with a larger value correlating with less multifidus atrophy. Quantitative variables were compared between the groups using independent samples t-test. Categorical data were analysed using chi-square test. Analysis of variance was performed to determine the differences in the degree of multifidus atrophy between the groups. Pearson’s linear analysis was performed to identify the correlation between slipped and non-slipped segments.Results: There was no statistically significant difference between the DLS groups in terms of baseline characteristics (p > 0.05 for all). The LCSA/GCSA ratio was significantly different between the DLS and control groups at the three levels (p < 0.001). There were significant differences in the LCSA/GCSA ratio between different levels of the same slipped segment, and between different slipped segments at the same level (p < 0.001). No statistically significant difference was observed in the LCSA/GCSA ratio between the three DLS groups with different degrees of slippage at the same segment (p > 0.05). A slight positive correlation was observed between the slipped and non-slipped segments in the L3 spondylolisthesis group (r = 0.357, p > 0.05; r = 0.078, p > 0.05, respectively). There was a significant positive correlation between the slipped and non-slipped segments in the L4 spondylolisthesis group (r = 0.686, p < 0.001; r = 0.744, p < 0.001), and a moderate positive correlation between the slipped and non-slipped segments in the L5 spondylolisthesis group (r = 0.482, p < 0.001; r = 0.448, p < 0.05).Conclusions: DLS patients demonstrated multifidus atrophy that is most prominent at the level of the slipped segment. There was a positive correlation in the degree of multifidus atrophy between the slipped and non-slipped segments, suggesting that multifidus atrophy at the level of the non-slipped segment accompanies that at the slipped segment. The multifidus atrophy was not worse in the grade II compared to the grade I spondylolisthesis group. However, the causality between DLS and multifidus atrophy remains unclear.

Background:Use of degradable magnesium (Mg)-based metal implants in orthopaedic surgeries can avoid drawbacks associated with subsequent removal of the non-degradable metallic implants, reducing cost and trauma of patients. Although Mg has been applied in the clinic for orthopaedic treatment, the use of Mg-based metal implants is largely in the research phase. But its application is potentially beneficial in this context as it has been shown that Mg can promote osteogenesis and inhibit osteoclast activity.Methods:A systematic literature search about "degradable magnesium (Mg)-based metal implants" was performed in PubMed and Web of Science. Meanwhile, relevant findings have been reviewed and quoted.Results:In this review, we summarize the latest developments in Mg-based metal implants and their role in bone regeneration. We also review the various molecular mechanisms by which Mg ions regulate bone metabolic processes, including osteogenesis, osteoclast activity, angiogenesis, immunity, and neurology. Finally, we discuss the remaining research challenges and opportunities for Mg-based implants and their applications.Conclusion:Currently, establishment of the in vitro and in vivo biological evaluation systems and phenotypic modification improvement of Mg-based implants are still needed. Clarifying the functions of Mg-based metal implants in promoting bone metabolism is beneficial for their clinical application.The Translational potential of this article:All current reviews on Mg-based implants are mainly concerned with the improvement of Mg alloy properties or the progress of applications. However, there are few reviews that provides a systematic narrative on the effect of Mg on bone metabolism. This review summarized the latest developments in Mg-based metal implants and various molecular mechanisms of Mg ions regulating bone metabolism, which is beneficial to further promote the translation of Mg based implants in the clinic and is able to provide a strong basis for the clinical application of Mg based implants.

Juglone, mainly isolates from the green walnut husks of Juglans mandshurica, exhibits anti-cancer and anti-inflammaroty activities. But its protection on ulcerative colitis (UC) has never been explored. In this study, we first evaluated whether juglone ameliorated UC, and investigated its effects on gut microbiota and Th17/Treg balance in DSS-induced UC mice model. The model was established by administrating 2.7% DSS for seven days. Juglone was given daily by gavage for ten days, once a day. The disease activity index (DAI) decrease and pathological characteristics improvement demonstrated that the UC in mice was alleviated by juglone. Juglone treatment significantly inhibited the protein levels of IL-6, TNF-α and IL-1β, improved the protein expression of IL-10. In addition, juglone altered microbial diversity and gut microbiota composition, including the enhancement of the ratio of Firmicutes to Bacteroidota and the abundance of Actinobacteriota, and decrease of the abundance of Verrucomicrobiota. Juglone treatment also inhibited the protein expressions of IL-6, STAT3 and RORγt, meanwhile improved the protein level of FOXP3. Furthermore, juglone inhibited Th17 development and increased Treg generation, beneficial to Th17/Treg balance. Together, we herein provided the first evidence to support that juglone, especially the high dose, possibly protected mice against UC by modulating gut microbiota and restoring Th17/Treg homeostasis.

A titanium mesh cage (TMC) is a common device used for interbody fusion in anterior cervical corpectomy and fusion (ACCF) surgery, with postoperative subsidence being a common complication. Among the many influencing factors, there is a paucity of research on the end-covers of the TMC. A total of 62 patients with cervical spondylotic myelopathy were treated with single-level ACCF. TMC without end-covers (group A), traditional TMC with end-covers (group B) and new TMC with end-covers (group C) were used as the fusion device. We evaluated the surgery time, intraoperative blood loss, postoperative drainage volume, postoperative fusion, falling height of the fused segment, cervical curvature and severe subsidence rate (the number of falling height of the fused segment > 3 mm/total surgical cases in the group). In addition, the Japanese Orthopaedic Association score was used for neurological status assessment and a 10-point Visual Analog Scale for postoperative neck pain. The results showed that the falling height of the fused segment in group A (1.9 ± 0.6 mm) was significantly greater than in group B (0.9 ± 0.2 mm) and group C (0.8 ± 0.3 mm). The area of the end-covers increased gradually in group A, group B and group C, while the severe subsidence rate of group A (8/20, 40%), group B (5/22, 23%) and group C (2/20, 10%) gradually decreased. The surgery time and blood loss in group B (116.4 ± 12.2 min, 183.5 ± 36.4 mL) were higher than those in group A (90.22 ± 5.60 min, 110.4 ± 20.8 mL) and group C (92.8 ± 8.47 min, 114 ± 24.0 mL). These results showed that there was a correlation between the postoperative subsidence and the end-covers of TMC. The larger the end-cover area was, the lower the severe postoperative subsidence rate was. In addition, the design of the end-covers extending inward was more conducive to the operation.

瑜伽教练菲菲最近对学员发出公告,由于身体原因,瑜伽课暂停.实际上,菲菲腰腿疼痛已经半年多,最近,疼得连走路都困难.到医院脊柱外科就诊,并经过CT、磁共振等检查后,医生诊断她是腰椎提前老化,26岁的她腰椎老化度似50岁!医生发现,她腰椎椎体边缘有很多骨刺,腰背筋膜水肿,椎间盘突出压迫了神经,这些都导致了她腰腿疼痛不适等症状.她必须停止一切高难度的瑜伽动作,并接受手术治疗.

Multimodal molecular imaging probes have attracted much attention, and they possess great potential to accurately diagnose diseases due to the synergistic superiorities of multiple complementary imaging. Herein, a targeted biocompatible organic nanoplatform (IR-PEG-FA) with a strong optical absorption in the near-infrared window (NIR-I) for photoacoustic imaging (PAI) and excellent second near-infrared (NIR-II) fluorescence imaging property for NIR-II imaging is fabricated. The dual-modal nanoprobe is composed of the small organic dye molecule IR-1061, water-soluble poly(ethylene glycol) (PEG) and folic acid (FA) as the targeted ligands. Depending on the strength of high temporal resolution and preeminent spatial resolution, the targeted biocompatible dual-mode nanoprobe for PAI and NIR-II imaging can provide more detailed date of cancers and diseases, and enables us to specifically diagnose them through quite a precise way.

上班族李先生久坐后感到浑身僵硬,就到常去的按摩店推拿了一下,为了尽快见效,还嘱咐按摩人员加大力度,没想到得不偿失,伤害了自己的身体.被按摩伤到的李先生刚开始出现右腿麻木,紧接着右下肢竟然失去了知觉,是不是瘫痪了?李先生赶紧去当地医院,经CT检查后发现,他颈椎和胸椎的交界处疑似有肿瘤占位.

Background: Cooled radiofrequency procedure is a novel minimally invasive surgical technique and has been occasionally utilized in managing chronic sacroiliac joint (SIJ) pain. A meta-analysis was conducted to systematically assess the efficacy and safety of using cooled radiofrequency in treating patients with chronic SIJ pain in terms of pain and disability relief, patients’ satisfaction degree as well as complications. Methods: Studies of using cooled radiofrequency procedure in managing SIJ pain were retrieved from Medline and Web of Science according to inclusion and exclusion criteria. Quality evaluation was conducted using Cochrane collaboration tool for randomized controlled trials and MINORS quality assessment for noncomparative trials. Statistics were managed using Review Manager 5.3. Results: Totally 7 studies with 240 eligible patients were enrolled. The overall pooled results demonstrated that pain intensity decreased significantly after cooled radiofrequency procedure compared with that measured before treatment. The mean difference (MD) was 3.81 [95% confidence intervals (95% CIs): 3.29–4.33, P < .001] and 3.78 (95% CIs: 3.31–4.25, P < .001) as measured by the Numerical Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. Disability also relieved significantly after treatment compared with that measured before treatment. The MD was 18.2 (95% CIs: 12.22–24.17, P < .001) as measured by the Oswestry Disability Index (ODI). Seventy-two percent of the patients presented positive results as measured by the Global Perceived Effect (GPE). The OR was 0.01 (95% CIs: 0.00–0.05, P < .001). Only mild complications were observed in the 7 studies, including transient hip pain, soreness, and numbness. Conclusion: Cooled radiofrequency procedure can significantly relieve pain and disability with no severe complications, and majority of patients are satisfied with this technique. Thus, it is safe and effective to use this procedure in managing patients with chronic SIJ pain. More high-quality and large-scale randomized controlled trials (RCTs) are required to validate our findings. Limitations: The sample size of the included studies was small and various heterogeneity existed.

Background Development of the burgeoning number of photothermal therapy (PTT) agents has drawn a huge amount of interest, since PTT treatment is a powerful and effective alternative to traditional treatments. Optimal PTT agents should integrate some essential preconditions including negligible systemic toxicity, deep penetration into tumor tissues, and maximum laser energy absorbance. Unfortunately, only few of the PTT agents reported could meet all of the above mentioned conditions. Methods Here, we report a brand new PTT agent through the encapsulation of NaGdF4:Yb,Tm@ NaGdF4:Yb (UCNPs) and an organic compound (C3) into poly-e-caprolactone-polyethylene-polyglycol (PCL-PEG) (PL-UC-C3 NPs). Results UCNPs as an up-conversion material and C3 as a PTT agent both feature low cytotoxicity, and most importantly, UCNPs with superior conversion efficiency could efficiently absorb the energy of a 980 nm laser, transform the near-infrared laser light into visible light, and translate the palingenetic visible light to C3. The usage of a 980 nm laser ensures a deeper penetration and lower energy, while the highly efficient absorption and transformation process confers a cascade amplified hyperthermia for tumor treatment. Conclusion In this regard, our research provides a powerful and robust breakthrough for florescence/computed tomography imaging-guided PTT treatment, lighting up the clinical application in cancer treatment.

Objective: This study aimed to investigate the prognostic factors for recurrent lumbar disc herniation (rLDH) after transforaminal endoscopic lumbar discectomy (TELD). Methods: A total of 409 patients who underwent TELD from June 2013 to March 2015 were divided into two groups based on recurrence, with 37 patients in the recurrent group and 372 patients in the non-recurrent group. The baseline characteristics (sex, age, smoking, drinking, hypertension, diabetes, work intensity, and postoperative exercises), clinical parameters (durations of symptoms, hospital stay, operation time, preoperative visual analog scale (VAS), and VAS improvement rates) and radiologic parameters (adjacent level disc degeneration) of the two groups were compared. Results: Among all the 409 patients, 13 in the recurrent group (35.1%) exhibited a large annular defect, with a significantly higher incidence than in the non-recurrent group (19.6%). Moreover, 35.1% of the patients in the recurrent group underwent postoperative exercises for paraspinal muscles, which was significantly higher than that in the non-recurrent group (53.8%). Adjacent level disc degeneration was significantly correlated with rLDH after TELD. Multivariate analysis showed that adjacent level disc degeneration, large annular defect and postoperative exercises for paraspinal muscles were significantly related to rLDH after TELD. Conclusion: Adjacent level disc degeneration, large annular defect and postoperative exercises for paraspinal muscles were prognostic factors for rLDH after TELD.

The aim of the study was to investigate the curative effects of transplantation of bone marrow mesenchymal stem cells (BMSCs) on intervertebral disc regeneration and to investigate the feasibility of the quantitative T2 mapping method for evaluating repair of the nucleus pulposus after implantation of BMSCs.

后方入路手术是治疗胸腰椎骨折的经典术式，可以通过由后向前的椎弓根螺钉实现三柱固定，通过椎间撑开经椎弓根撬拨实现椎体骨折复位。通过椎体内植骨技术实现骨折的良好愈合，降低术后椎体高度丢失及内固定失败的风险。但后方入路手术有其适应证，应根据骨折情况来选择。在本文中作者就后方入路手术的适应证、固定节段的选择、微创等方面对近期的文献进行综述。