BACKGROUND:Artificial intelligence (AI) has shown promise for automating spinal alignment assessment in adolescent idiopathic scoliosis (AIS). However, AI models typically exhibit reduced accuracy and robustness when deployed across multiple medical centers due to variability in imaging protocols and data characteristics, potentially compromising clinical diagnosis and treatment decisions. OBJECTIVE:This study aimed to develop a real-time, plug-and-play data transformation method to enhance the robustness of deep learning models against data heterogeneity in radiographs, thereby improving their performance in assessing AIS across multiple medical centers. METHODS:In this retrospective multicenter study, 3899 full-spine radiographs from 7 hospitals (2 from Hong Kong and 5 from Mainland China), collected between January 2012 and August 2024, were included. Data from 2 hospitals in Hong Kong (n=3034) were used for model training and internal validation, while radiographs from the 5 mainland hospitals (n=865) formed 5 independent external validation datasets. A novel pixel intensity-based data transformation method was developed to standardize image contrast and brightness across datasets and integrated into the model training process to enhance our previously developed AI model, SpineHRNet+. The enhanced model's accuracy and robustness for cobb angle (CA) prediction and severity classification were evaluated using both internal and external datasets. Data heterogeneity across centers was quantified by brightness and contrast differences. CA prediction accuracy was evaluated using residual analysis, linear regression (coefficient of determination [R²]), and Bland-Altman analyses. Model performance for disease severity classification was assessed using sensitivity, specificity, precision, negative predictive value, accuracy, and confusion matrix analysis. The transformation method aligns pixel intensity distributions across datasets using statistical profiling and optimization, ensuring consistent image characteristics while preserving anatomical integrity. RESULTS:The developed data transformation method significantly reduced contrast variability between datasets, improving consistency in image characteristics and enabling more reliable AI analysis. The enhanced SpineHRNet+ achieved consistent and accurate CA predictions across external validation datasets, with mean prediction errors within 4° (SD 3.12°), and maintained an R² greater than 0.90 for all centers. The sensitivity and negative predictive value for disease severity grading improved to 90.18% and 93.16%, respectively. Bland-Altman analyses demonstrated robust agreement, with 95% limits of agreement within 7.51° across all datasets. CONCLUSIONS:The proposed data transformation approach effectively addressed data heterogeneity, significantly improving the accuracy and robustness of SpineHRNet+ in multicenter AIS assessments. The real-time processing capability and preservation of anatomical integrity underscore the method's clinical practicality, enabling scalable and reliable AI applications in diverse health care environments.

BACKGROUND:Both genetic and environmental (e.g., mechanical stress) factors have been considered multifactorial components contributing to the development and progression of ossification of posterior longitudinal ligament (OPLL). Importantly, loss of cervical lordosis may change the mechanical stress on posterior longitudinal ligament. However, few studies have discussed the relationship between the cervical sagittal alignment and OPLL. The aim of this study is to quantify the cervical sagittal alignment and severity of ligament ossification in patients with cervical OPLL and to analyze their correlation. METHODS:Cervical sagittal alignment was measured in 142 patients and 90 healthy subjects. All patients underwent assessments of the degree of ligament ossification and the severity of cervical cord injury. Finite element models of cervical lordosis, straightness and kyphosis were established, and the mechanical tension of the posterior longitudinal ligament was compared among the different models. RESULTS:There was no difference of all measurements of cervical sagittal alignment between the normal control and patient groups (P > 0.05). Subgroup analysis demonstrated that the cervical OPLL patients in cervical kyphotic group showed greater OPLL ossification index (OP-index) and higher density [Hounsfeld unit (HU)] of ossified ligament compared to cervical lordotic group (P < 0.05). Furthermore, in the cervical kyphotic subgroup, the C2-7 Cobb angle was associated with both the OP-index (r=-0.61, P < 0.05) and the HU value (r=-0.78, P < 0.05), and there was a relationship between the C7 slope and HU value (r=-0.66, P < 0.05) in this subgroup. However, there was no relationship between the cervical sagittal alignment and OPLL severity in both cervical lordotic and straight groups (P > 0.05). Furthermore, the tension of posterior longitudinal ligament was greater in cervical kyphotic model than that in the other two models (P < 0.05). CONCLUSIONS:There was a relationship between the loss of cervical sagittal alignment and both the degree and size of cervical OPLL in the cervical kyphosis subgroups in patients with OPLL. Therefore, it is necessary for clinicians to be aware of cervical sagittal alignment during cervical OPLL treatment, especially in patients with kyphosis.

Spinal cord injury (SCI) leads to a cascade of secondary damage responses, including inflammation, apoptosis, and oxidative stress. These processes are crucial in determining the extent of tissue damage and recovery. It is well-established that various molecular mechanisms, such as the regulation of gene expression by non-coding RNAs, contribute significantly to the pathophysiology of SCI. However, the processes behind miRNA-regulated secondary damage are not entirely understood. The SCI mouse model and the cellular model were developed to investigate the effects of miRNAs during SCI. The GEO miRNA expression profile (GSE158195) was retrieved, and the differentially expressed miRNAs were examined using bioinformatics tools. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to assess the expression levels of miRNA and programmed cell death protein 4 (PDCD4). The Basso, Beattie, and Bresnahan (BBB) scoring system was used to assess neurological function. The concentrations of inflammatory cytokines were quantified via ELISA, whereas the production of reactive oxygen species (ROS) was assessed utilizing commercial kits. Our findings revealed a significant down-regulation of miR-499-5p in the spinal cord tissue of SCI mice. According to the functional study, agomir-miR-499 treatment significantly improved locomotor recovery, reduced tissue damage and edema, and suppressed neuronal death. Agomir-miR-499 also reduced SCI-induced ROS and inflammatory responses in mice. In SCI mice and cell models, miR-499 was discovered to target programmed cell death 4 and regulated its expression at protein and mRNA levels. Furthermore, increasing PDCD4 reversed agomir-miR-499's suppressive effects on the inflammatory response, ROS, and cell death. Agomir-miR-499, meanwhile, has the ability to suppress PDCD4 expression and stimulate the PI3K/AKT signaling pathway in SCI mice. Overall, our research shows that miR-499, a potential therapeutic target for SCI, reduces ROS-induced neuronal death and inflammation through PI3K/Akt signaling in SCI mice.

To identify the frequency of facet tropism (FT) in patients with cervical spondylotic amyotrophy (CSA) and to analyze the correlation between FT and motor dysfunction in CSA. The side-to-side differences in facet orientation (FO) (≥ 7°) were measured from C3-4 to C7-T1 levels via 3D computed tomography to diagnose FT in 84 CSA patients (proximal- vs. distal-type: 36 vs. 48) and 363 patients with cervical spondylosis (CS). Both the motor unit number index (MUNIX) and Medical Research Council scores were assessed in CSA patients. Compared with CS patients, both CSA patient groups presented a greater frequency of FT at any cervical level in all different planes (axial, sagittal and coronal) (P < 0.05). Furthermore, more proximal-type CSA patients with FT presented axial FTS< less−S (smaller FO on the symptomatic side) at C4-5 level, and more distal-type CSA patients with FT exhibited both axial and sagittal FTS< less−S at C6-7 and C7-T1 levels. In addition, both compound muscle action potential (CMAP) and MUNIX values in proximal-type CSA patients with C4-5 axial FT were lower than those in patients without FT (P < 0.05), and both CMAP and MUNIX values were negatively associated with the side-to-side differences in axial FO at C4-5 and/or C5-6 levels in these patients (P < 0.05). The frequency of FT in CSA patients is greater than that in CS patients. Importantly, axial/sagittal FT may be positively associated with motor dysfunction of upper limbs in CSA patients. Thus, a cautious approach should be taken when treating CSA due to possible comorbid FT.

STUDY DESIGN:Retrospective analysis. PURPOSE:To evaluate preoperative bone mineral density (BMD), as quantified by computerized tomography (CT)-derived Hounsfield unit (HU) values, in patients who underwent lumbar fusion and to examine the link between BMD and failed back surgery syndrome (FBSS). OVERVIEW OF LITERATURE:FBSS is a serious complication affecting 10%-40% of patients undergoing lumbosacral spinal surgery. Given the detrimental impact of FBSS on the psychological and physiological wellbeing of patients, preoperative identification of those at risk for developing FBSS and the implementation of targeted interventions to minimize this complication are highly important. METHODS:Preoperatively, all 115 patients underwent BMD assessments using both CT-derived HUs and dual-energy X-ray absorptiometry and were administered multiple questionnaires, including the Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Index (BDI). Both pain intensity and pain-related disability were assessed before and after lumbar fusion surgery. RESULTS:Postoperatively, 14 patients (14/115, 12.2%) experienced FBSS. Multivariate logistic regression was used to examine all preoperative covariates with significant differences between the patients with and without FBSS. The numeric rating pain scale score at rest, BAI score, PCS score, and HU value were found to be independently associated with FBSS (p<0.05). CONCLUSIONS:This study revealed that preoperative BMD, as quantified by CT-derived HU values, may be associated with FBSS. Preoperative assessments of CT-derived HU values might provide additional details for identifying patients susceptible to FBSS, which could help prevent this complication.

STUDY DESIGN:A retrospective study design was adopted. PURPOSE:This study investigated the surgical modification of laminectomy, including piecemeal and en bloc resections, and compared this hybrid approach with conventional en bloc laminectomy for treating multilevel thoracic ossification of the ligamentum flavum (TOLF). OVERVIEW OF LITERATURE:En bloc laminectomy is the most commonly used method for managing symptomatic TOLF. However, this approach can easily cause intraoperative spinal cord irritation, dural tear, and cerebrospinal fluid leakage (CFL). METHODS:Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. RESULTS:The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). CONCLUSIONS:Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.

BACKGROUND CONTEXT: Surgical site infection (SSI) is a devastating complication that greatly increases the duration of hospital stays, health care costs and morbidity/mortality rates. Therefore, early diagnosis and treatment are also very important. Postoperative inflammatory markers are usually used to screen for SSI. However, the feasibility of these markers for the early detection of SSI remains unclear since it is not ideal to use a marker for which normative reference values do not exist. PURPOSE: To validate the use of the e-norms method for establishing a normative reference range for acute-phase inflammatory marker levels 3 days after lumbar fusion surgery for early screening of postoperative SSI. STUDY DESIGN: A retrospective analysis. PATIENT SAMPLE: This study included 907 patients who underwent lumbar fusion surgery (SSI vs non-SSI: 28 vs 879). OUTCOME MEASURES: White blood cell (WBC) count, neutrophils count, lymphocyte count, C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR). METHODS: We applied the e-norms method to calculate reference values for postoperative 3-day CRP, ESR, and differential WBC count in all 907 patients included in this study and compared these reference values with those calculated via conventional methods (data from non-SSI patients). RESULTS: According to the e-norms method, the normal WBC count was 10.8 +/- 1.2 (x10<^>9/L), neutrophils count was 8.7 +/- 1.1 (x10<^>9/L), lymphocyte count was 1.6 +/- 0.3 (x10<^>9/L), CRP concentration was 31.2 +/- 10.8 mg/L, and ESR was 23.6 +/- 4.7 mm/h. The mean values obtained via the enorms and conventional methods were almost identical, but the range of normative reference values obtained via the conventional methods was relatively wider. Importantly, the frequency of SSI patients with abnormal inflammatory markers identified by the e-norms method was higher than that of patients with abnormal inflammatory markers identified by the conventional methods (21/ 28, 75.0% vs 6/28, 21.4%; p<.05).

To quantify the dynamic F-waves in patients with degenerative lumbar spinal stenosis (DLSS) and to analyze the relationships between dynamic F-wave abnormalities and both the severity and surgical outcomes of DLSS. Preoperatively, peroneal F-waves were recorded bilaterally in 201 patients with DLSS and 52 healthy subjects before and after 10-minute walk tests, along with assessments of the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and 36-Item Short Form Survey (SF-36). Questionnaire scores were re-evaluated 1 year after operation in all patients. Unlike normal controls, patients with DLSS had longer mean durations on both sides and lower F/M ratios on symptomatic side after the 10-minute walk test than before (P < 0.05). According to normal reference values from healthy subjects, a total of 129 (129/201, 64.2

Background Spinal cord injury (SCI) remains a severe condition with an extremely high disability rate and complex pathophysiologic mechanisms. Pyroptosis, an inflammatory form of cell death triggered by certain inflammasomes, has a key role in a variety of inflammatory diseases, including SCI. However, it is unclear whether microRNAs (miRNAs), novel regulators in the SCI, are involved in SCI-induced pyroptosis.Methods Two GEO miRNA expression profiles (GSE158195 and GSE90452) were downloaded, and the differentially expressed miRNAs were analyzed by bioinformatics methods. An in vivo animal model and an in vitro cellular model of SCI were constructed in female C57BL/6 mice and BV-2 cells for studying the possible roles of FOXO3, miR-128-3p and NLRP3-mediated pyroptosis in SCI. Markers of ROS, cell pyroptosis and inflammation were measured by RT-qPCR, Western blotting, immunofluorescence, flow cytometry, and enzyme-linked immunosorbent assays. Histopathological changes in spinal cord tissue were detected using hematoxylin and eosin and immunohistochemical. The Basso-Beattie-Bresnahan (BBB) score was used to evaluate the motor function of mice in each group.Results Bioinformatics analysis of GSE158195 and GSE90452 datasets revealed a significant downregulation of miR-128-3p, a phenomenon that was consistently observed in the SCI mice model. Functionally, miR-128-3p upregulation improved functional behavioral recovery, relieved pathological injury, repressed oxidative stress, and alleviated pyroptosis and inflammation in the mouse SCI models. We also confirmed that Thioredoxin-interacting protein (TXNIP) was the target gene of miR-128-3p, and overexpression of TXNIP can effectively reverse the improvement of miR-128-3p in SCI cell model. Moreover, we found that transcription factor FOXO3 facilitated miR-128-3p expression, and its overexpression resulted in similar effects of miR-128-3p in the SCI cell model.Conclusion To the best of our knowledge, this is the first report demonstrating miR-128-3p improved secondary injury in SCI through the modulation of cell pyroptosis pathway. Our results suggest that FOXO3/miR-128-3p/TXNIP/NLRP3-mediated pyroptosis axis may be a potential therapeutic target for SCI.

OBJECTIVE:To investigate the feasibility of the extrapolated norms (e-norms) method for establishing a reference range for the measurements of cervical sagittal alignment and to explore the differences in these ranges according to sex and age. METHODS:We applied the e-norms method to calculate reference values for the angle between occipital and C2 vertebrae, C2-7 Cobb angle, C2-7 sagittal vertical axis, and C7 slope in 1720 subjects. The e-norms values of these measurements were measured in different age subgroups of male or female subjects. RESULTS:According to the data points within the plateau obtained via e-norms method, normal angle between occipital and C2 vertebrae was 18.5± 2.6°, C2-7 Cobb angle was 8.8± 4.5°, C2-7 sagittal vertical axis was 1.5± 0.4 cm, and C7 slope was 20.1± 3.5°. These data points involved a total of 1617 (1617/1720, 94.0%) subjects, with only 191 (11.1%, 191/1720) subjects having all the cervical sagittal measurements included in the plateau. Both C2-7 Cobb angle and C7 slope e-norms values increase with age in females, whereas only C7 slope e-norms values increase with age in males. The males showed greater e-norms values in at least one of cervical sagittal measurements compared with females in different age subgroups (P < 0.05). CONCLUSIONS:This study demonstrated that e-norms may be a simple, reliable and cost-saving approach for establishing reference values for cervical sagittal measurements. This new method allows us to establish reference values for sex or age subgroups to study the sex differences and trends with age of cervical sagittal alignment.

Intervertebral disc degeneration (IVDD) is the primary cause of low back pain, with oxidative stress being a recognized factor that causes its development. Presently, low back pain imposes a significant global economic burden. However, the effectiveness of treatments for IVDD remains extremely limited. Therefore, this study aims to explore innovative and effective IVDD treatments by focusing on oxidative stress as a starting point. In this study, an injectable reactive oxygen species-responsive hydrogel (PVA-tsPBA@SLC7A11 modRNA) is developed, designed to achieve rapid loading and selective release of chemically synthesized modified mRNA (modRNA). SLC7A11 modRNA is specifically used to upregulate the expression of the ferroptosis marker SLC7A11. The local injection of PVA-tsPBA@SLC7A11 modRNA into the degenerated intervertebral disc (IVD) results in the cleavage of PVA-tsPBA, leading to the release of enclosed SLC7A11 modRNA. The extent of SLC7A11 modRNA release is directly proportional to the severity of IVDD, ultimately ameliorating IVDD by inhibiting ferroptosis in nucleus pulposus cells (NPCs). This study proposes an innovative system of PVA-tsPBA hydrogel-encapsulated modRNA, representing a potential novel treatment strategy for patients with early-stage IVDD.

Study Design A retrospective analysis. Purpose To investigate the occurrence of central sensitization (CS) in patients with osteoporotic vertebral compression fractures (OVCFs) and identify the association between CS and residual back pain (RBP). Overview of Literature RBP is a vexing complication that affects 6.3%–17.0% of patients with OVCFs who underwent percutaneous vertebroplasty (PVP). Given the negative effect of RBP on patients’ psychological and physiological statuses, efforts to preoperatively select patients who are at risk for RBP development have a high priority to offer additional treatment and minimize this complication. Methods Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. Results Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). Conclusions Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.

Purpose To investigate the occurrence of altered central pain modulation in patients with degenerative lumbar diseases (DLDs) and to analyze its association with physical activity (PA) 3 years after lumbar decompression and fusion. Methods Preoperative assessments of pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) and pain were, respectively, recorded in 304 patients. These patients further underwent International Physical Activity Questionnaire (IPAQ) and both pain-related and psychological assessments 3 years post-operation. Results Preoperatively, the patients had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy subjects ( P < 0.05). Postoperatively, 53.9% (164/304) patients showed PA below healthy-related thresholds (< 600 MET min/w). Low PA group showed a greater postoperative weight gain and bone loss and a higher postoperative prevalence of both moderate anxiety and marginal depression than high PA group ( P < 0.05). All covariates with differences between the high and low PA groups were subjected to multivariate logistic regression, and long preoperative disease duration, low preoperative PPT in pain-free area, high preoperative TS, revision surgery, severe postoperative low back pain and significant postoperative pain catastrophizing thought were independently associated with low postoperative PA ( P < 0.05). Conclusions This study supports the existence of central sensitization (CS) caused by abnormal central pain modulation in DLDs. Pre-existing CS in these patients may be associated with low PA after lumbar surgeries, and this low-activity lifestyle may predispose patients to multiple adverse health outcomes. Preoperative dynamic quantitative sensory testing may provide information for the identification of at-risk patients.

This prospective randomized controlled trial aimed to investigate the impact of early postoperative sequential motor control (starting first day post-operatively) and core stabilization training (starting fifth week post-operatively) compared to conventional exercise (starting fifth weeks post-operatively) on the risk of developing persistent spinal pain syndrome type-2 (PSPS-T2). 395 patients with lumbar degenerative diseases (LDDs) undergoing modified transforaminal lumbar interbody fusion and a 12-week postoperative exercise program (sequential vs. conventional exercise: 214 vs. 181) were evaluated for low back pain (LBP) intensity, Oswestry Disability Index (ODI), pressure pain threshold (PPT), temporal summation (TS), fatty infiltration of paraspinal muscles, transversus abdominis (TrA) activation capacity and Fear-Avoidance Beliefs Questionnaire (FABQ) pre-operatively, 3 months post-operatively, and 1 year post-operatively. At 3-month postoperative assessment, LBP in sequential exercise group were lower than those in conventional exercise group (P < 0.05), and sequential-exercise patients had greater local-area PPTs, lower TS, lower TrA activation capacities and less fatty infiltration of erector spinae than did the conventional-exercise patients (P < 0.05). At 1-year postoperative assessment, fewer sequential-exercise patients had PSPS-T2 compared with conventional-exercise patients (11/214 vs. 20/181; P < 0.05). LBP at rest and FABQ were lower in sequential-exercise patients than conventional-exercise patients (P < 0.05). Furthermore, both PPT and TS at 1-year postoperative assessment were associated with these measurements at 3-month postoperative assessment in patients with PSPS-T2 (P < 0.05). Postoperative sequential exercise has more positive effects to avoid PSPS-T2 than conventional exercise in patients with LDDs possibly because of its advantages in improving central and peripheral sensitization.

OBJECTIVE: To quantify self-esteem in patients with Hirayama disease (HD) and investigate the impact of this psychosocial factor on surgical outcomes in HD.METHODS: The Rosenberg Self-Esteem Scale (RSES) was measured in 58 patients with HD before anterior cervical fusion. These patients further underwent motor unit -umber estimation, handgrip strength, disabilities of the arm, shoulder and hand (DASH), Beck Anxiety Inventory (BAI) and Beck Depression Index (BDI) before and 18 months after operation. Furthermore, the International Physical Activity Questionnaire (IPAQ) was administered to all patients at postoperative 18-month assessments.RESULTS: Compared with the general population, patients with HD showed a relatively lower RSES, and RSES was negatively associated with both postoperative DASH (r = L0.431, P < 0.05) and preoperative to postoperative changes (r = L0.295, P < 0.05) and positively associated with IPAQ (r = 0.472, P< 0.05). Similar to the difference in postoperative DASH scores, more patients with low self-esteem felt postoperative aggravated motor dysfunction than those with high/normal self-esteem (P < 0.05). Post -operative BDI exerted a partial mediating effect on the relationship between RSES and DASH scores (B = L0.30, P< 0.05), and postoperative BAI played a partial mediating effect on the relationship between RSES and IPAQ scores (B = 0.30, P < 0.05).CONCLUSIONS: The self-esteem of HD patients may be below the population norms. Importantly, relatively low self-esteem in HD patients may cause/worsen post-operative depression and anxiety, thereby resulting in poor self-reported surgical prognosis and an inactive lifestyle after operation. Therefore, perioperative treatment and rehabilitation efforts in HD patients, especially those with low self-esteem, should account for both physiological and psychological symptoms.

Abstract Background Surgical treatment has been increasingly performed in Hirayama disease (HD) patients to limit excessive neck flexion and restore cervical lordosis. However, postoperative recurrence of cervical lordosis loss may restart the progress of HD. Many studies have demonstrated a relationship between neck muscle strength and cervical lordosis, and it is widely accepted that leisure-time physical activity (LTPA) can increase muscle strength. However, there are few reports about the correlation between LTPA and maintenance of postoperative cervical curvature. Objective To quantify the cervical lordosis and motor function before and after operation in HD patients and to analyze the impact of postoperative LTPA levels on the changes in these measurements. Methods C2-7 Cobb were measured in 91 HD patients before, 2–5 days and approximately 2 years after operation. Motor unit number estimation (MUNE) and handgrip strength (HGS) were performed in all patients before and approximately 2 years after operation, and both cross-sectional area and fatty infiltration of posterior cervical muscles were measured in 62 patients. Long-form international Physical Activity Questionnaire and its different domains was administered to all patients at postoperative 2-year assessments. Results The C2-7 Cobb was larger immediately and approximately 2 years after operation than that at preoperative assessment (P < 0.05). The preoperative to postoperative change in C2-7 Cobb was associated with postoperative changes in the symptomatic-side HGS and bilateral MUNE measurements (P < 0.05). Importantly, the patients performing LTPA had greater improvements in C2-7 Cobb from immediate to approximately 2 years after operation and greater C2-7 Cobb at last follow-up than those without LTPA, and postoperative improvements in both symptomatic-side MUNE measurements and symptomatic-side HGS were also greater in the former than in the latter (P < 0.05). Conclusions Postoperative LTPA has a positive effect on recovery/maintenance of cervical lordosis after operation, which may alleviate the motor unit loss of distal upper limbs in HD patients. Therefore, postoperative LTPA may be beneficial for postoperative rehabilitation or early conservative treatment of HD patients.

目的 应用阈值追踪技术评估肌萎缩侧索硬化症(ALS)患者肌肉束颤的轴突兴奋性及其与早期运动神经元变性的相关性.方法 纳入符合改良El Escorial诊断标准的47例ALS患者为ALS组;ALS组再依据受累肢体设立上肢未受累ALS亚组.同时纳入28例健康志愿者为正常对照组.记录ALS患者临床特征,进行肌电图以及阈值追踪检测.两组间比较采用独立样本t检验,并用Pearson进行相关性分析.结果 ALS组强度时程时间常数(SDTC)延长,提示郎飞结持续性钠通道功能上调.ALS组阈值电紧张TED40和TED90明显增高,提示结间区电压门控的慢钾通道功能障碍.ALS组超常期阈值改变增大,结间区电压门控的快钾通道功能障碍.在ALS亚组同样见正中神经SDTC增大、TED40和TED90增高,超常期阈值改变增大.相关性分析提示TED40和SDTC与疾病进展率具有显著相关性(TED40:P=0.02;SDTC:P=0.03).结论 阈值追踪是ALS早期诊断的电生理指标.ALS患者存在持续性钠离子通道上调;电压门控快钾通道和慢钾通道功能障碍、神经轴突兴奋性增高.上肢不受累的ALS患者同样存在钠通道和钾通道功能异常,并且早于临床症状和常规电生理异常出现;钠通道上调、钾通道功能障碍与ALS疾病进展率相关,是导致预后不良的因素.

Circular RNAs (circRNAs) are a class of noncoding RNAs that have been found to be involved in intervertebral disc degeneration (IVDD) progression, and N6-methyladenosine (m6A) broadly exists in circRNAs. Here, we identified circGPATCH2L with a low m6A methylation level to be upregulated in degenerative nucleus pulposus tissues. Mechanistically, as a protein decoy for tripartite motif containing 28 (TRIM28) within aa 402–452 region, circGPATCH2L abrogates the phosphorylation of TRIM28 and inhibits P53 degradation, which contributes to DNA damage accumulation and cellular apoptosis and leads to IVDD progression. Moreover, m6A-methylated circGPATCH2L is recognised and endoribonucleolytically cleaved by a YTHDF2-RPL10-RNase P/MRP complex to maintain the physiological state of nucleus pulposus cells. Thus, our data show the physiological significance of m6A modification in regulating circRNA abundance and provide a potentially effective therapeutic target for the treatment of IVDD.

Introduction/Aims: Some patients with Hirayama disease (HD) may have generalized joint hypermobility (GJH), which may excessively increase cervical range of motion (ROM) and then worsen the HD. The purpose of this study was to identify the frequency of GJH in HD patients and to analyze the effect of GJH on cervical ROM and the severity of HD.Methods: The Beighton scoring system (=4) was used to diagnose GJH in 84 HD patients. All patients underwent assessments of cervical-flexion/extension ROM; motor unit number estimation in bilateral abductor pollicis brevis (APB) muscles; handgrip strength; and the disabilities of the arm, shoulder, and hand assessments.Results: Concomitant GJH was identified in 20 (23.8%) HD patients. The HD patients with GJH exhibited greater cervical-flexion (P < .001) and cervical-extension (P = .033) ROM than those without GJH. Both greater single motor unit potential amplitudes (symptomatic side: P = .005; less-symptomatic side: P = .011) and lower motor unit numbers (symptomatic side: P = .008; less-symptomatic side: P = .013) in bilateral APB, along with lower compound muscle action potential amplitudes on the symptomatic-side APB (P = .039), were observed in patients with GJH than those without GJH. There was a mild negative correlation between motor unit number and cervical-flexion ROM in HD patients (symptomatic side: r = -0.239, P = .028; less-symptomatic side: r = -0.242, P = .027).Discussion: The frequency of GJH in HD patients may be higher than in the general population. Importantly, GJH may exacerbate excessive cervical-flexion ROM, thereby worsening motor unit loss in HD patients. A cautious approach should be taken when treating HD due to possible comorbid GJH.

To quantify the cervical sagittal alignment in patients with Hirayama disease (HD) and to investigate the effect of loss of cervical sagittal alignment upon the cervical spinal lesions in HD. Cervical sagittal alignments were measured in 253 HD patients and 63 healthy subjects by C2–C7 Cobb and a modified method of Toyama et al. Motor unit number estimation (MUNE) was performed in bilateral abductor pollicis brevis (APB) in all HD patients, and 31 patients further underwent cervical diffusion tensor imaging (DTI). Compared with healthy subjects, HD patients showed lower C2–C7 Cobb (P < 0.05), and 83.4