Qingshen granules inhibits dendritic cell glycolipid metabolism to alleviate renal fibrosis via PI3K-AKT-mTOR pathway.

BACKGROUND: Qingshen exhibits anti-inflammatory and immunoregulation effects to renal damage. Dendritic cells (DCs) play a critical role in regulating the pathologic inflammatory environment in renal fibrosis (RF). PURPOSE: To investigate the immune modulation mechanism of qingshen granule (QSG) in RF, particularly focusing on the role of DCs. METHODS/STUDY DESIGN: Adenine-induced RF animal models were used to study the pharmacological effects of QSG and the immune cells differentiation and function. Glucose uptake, non-esterified fatty acids secretion, mitochondrial membrane potential (MMP) detection, and qPCR were used to explore the effect of QSG to glucose and lipid metabolism in DCs and T cells. The effect of QSG to PI3K-AKT-mTOR axis and the modulation of mTOR to PD-L1 were explored by co-culture experiments, co-immunoprecipitation and western blot assays. The interaction of DCs/CD8+T cells and renal tubular epithelial cells (RTECs) was investigated to demonstrate the direct action and/or the immune-mediated regulation of QSG to RF. The components of QSG in the serum were determined by HPLC. And the effect of active ingredients and formula to DCs and T cells was analyzed by cell experiments in vitro. RESULTS: QSG reduced nephritic histopathological damage and suppressed the release of proinflammatory cytokines in adenine-induced RF mice. Of note, QSG decreased the levels of CD86, MHC-II, and CCR7 on DCs, while, increased PD-L1 expression on DCs in RF. The results demonstrated that QSG promoted the maturation and inhibited the migration of DCs, and QSG decreased the antigen presenting of DCs to T cells. Additionally, QSG reduced the MMP and glucose/lipid utilization ratio in DCs. QSG also down-regulated the level of targeted metabolic genes included glucose transporter 1 (Glut1), sterol-regulatory element-binding protein 1 (Srebp1), acetyl-CoA carboxylase alpha (Acaca), phosphomevalonate kinase (Pmvk), and up-regulated sirtuin2 (Sirt2) in DCs. In terms of mechanism, QSG inhibited the metabolism-related PI3K-AKT-mTOR pathway, followed by regulating the interaction of mTOR with PD-L1 to enhance the membrane stability of PD-L1. Besides, HPLC analysis identified five active ingredients in QSG. The specific anti-inflammatory and immunosuppressive actions of these ingredients were found to be weaker than QSG as a whole. Finally, inhibiting DC function by QSG disrupted the communication among DCs, T cells, and RTECs. This disruption was associated with low expression of α-smooth muscle actin (α-SMA) and collagen type I (Col-I) in the kidney. CONCLUSIONS: QSG inhibits DC metabolism and function via the PI3K-AKT-mTOR pathway to alleviate RF. The study highlights the importance of the specific composition of the formula in targeting DC-mediated immune regulation.

Fingerprinting to trace sources of suspended solids in the transport of heavy metals in urban stormwater runoff.

Suspended solids are an important pollutant in urban stormwater runoff. Past studies have mainly focused on a single transport stage of pollutants, constraining source identification of suspended solids at the catchment scale. Therefore, identifying the sources of suspended solids in stormwater runoff for the formulation of effective pollution mitigation measures is an effective way to manage suspended solids pollution in receiving waters. Sediment source fingerprinting is a widely used technique to trace the sources of river sediments, which can accurately identify the source of sediment through widely used tracers. This study used six heavy metals including Cd, Cr, Ni, Cu, Zn and Pb as tracers to quantify the sources of suspended solids in stormwater runoff from urban catchments. The spatial and temporal distribution characteristics of suspended solids during stormwater transport were investigated. The study results showed that the concentration of suspended solids was the highest in road runoff and sewer flow, especially particles <44 µm. In addition, relatively large rainfall depth, high rainfall intensity and long antecedent dry periods can lead to higher concentrations of suspended solids in roof and road runoff whereas longer rainfall duration can result in more suspended solids in sewer runoff. Sediment source fingerprinting and principal component analysis confirmed that coarse (>105 µm) particles primarily originate from road deposited sediments (63.80%), while fine (<105 µm) particles primarily originate from stormwater grate sediments and soil. The outcomes derived can help to comprehensively understand the sources of suspended solids and provide guidance for the management of urban stormwater particulate pollution, as well as being a technical reference for pollutant source traceability in urban stormwater runoff.

Microrna363-5p targets thrombospondin3 to regulate pathological cardiac remodeling.

Cardiac remodeling is an end-stage manifestation of multiple cardiovascular diseases, and microRNAs are involved in a variety of posttranscriptional regulatory processes. miR-363-5p targeting Thrombospondin3 (THBS3) has been shown to play an important regulatory role in vascular endothelial cells, but the roles of these two in cardiac remodeling are unknown. Firstly, we established an in vivo model of cardiac remodeling by transverse aortic narrow (TAC), and then we stimulated a human cardiomyocyte cell line (AC16) and a human cardiac fibroblast cell line (HCF) using 1 µmol/L angiotensin II (Ang II) to establish an in vitro model of cardiac hypertrophy and an in vitro model of myocardial fibrosis, respectively. In all three of the above models, we found a significant decreasing trend of miR-363-5p, suggesting that it plays a key regulatory role in the occurrence and development of cardiac remodeling. Subsequently, overexpression of miR-363-5p significantly attenuated myocardial hypertrophy and myocardial fibrosis in vitro as evidenced by reduced the area of AC16, the cell viability of HCFs, the relative expression of the protein of fetal genes (ANP, BNP, ß-MHC) and fibrosis marker (collagen I, collagen III, α-SMA), whereas inhibition of miR-363-5p expression showed the opposite trend. In addition, we also confirmed the targeted binding relationship between miR-363-5p and THBS3 by dual luciferase reporter gene assay, and the expression of THBS3 was directly inhibited by miR-363-5p. Moreover, overexpression of miR-363-5p with THBS3 simultaneously partially eliminated the delaying effect of miR-363-5p on myocardial hypertrophy and myocardial fibrosis in vitro. In conclusion, Overexpression of miR-363-5p attenuated the prohypertrophic and profibrotic effects of Ang II on AC16 and HCF by a mechanism related to the inhibition of THBS3 expression.

Bulky Phosphazenium Salt Controlling Chemoselective Terpolymerization of Epoxide, Anhydride and CO2: From Well-Defined Block to Truly Random Copolymers.

Copolymers with precise compositions and controlled sequences are great appealing for high-performance polymeric materials, but their synthesis is very challenging. In this study, tetrakis[tris(dimethylamino)phosphoranylidenamino] phosphonium chloride (P5Cl) and triethylboron (TEB) were chosen as the binary catalyst to synthesize both well-defined block and truly random poly(ester-carbonate) copolymers via the one-pot/one-step terpolymerization of epoxide/anhydride/CO2 under metal-free conditions. The bulky nature of phosphazenium cation not only led to loose cation-anion pairs and enhanced the reactivity, but also provided the chain-end an appropriate protection and improved the controllability. In particular, P5Cl/TEB with a molar ratio of 1/0.5 showed an extraordinary chemoselectivity for ring-opening alternating copolymerization (ROAC) of cyclohexene oxide (CHO) and phthalic anhydride (PA) first and then ROAC of CHO/CO2. Thus, well-defined block polyester-polycarbonate copolymers were synthesized by CHO/PA/CO2 terpolymerization. The chemoselectivity was easily tuned and the ROAC of CHO/PA and ROAC of CHO/CO2 occurred simultaneously with P5Cl/TEB = 1/2, producing truly random poly(ester-carbonate) copolymers from CHO/PA/CO2. In addition, this P5Cl/TEB catalyst and the strategy to regulate its chemoselectivity are versatile for various anhydrides, epoxides and initiators. Thus, poly(ester-carbonate) copolymers with varying sequences, compositions, and topologies are successfully synthesized, making it possible to compare their properties and to expand their applications.

Changes in the Centers of Rotation in Different Prosthetic Segments Following Continuous Two-Level Cervical Disc Replacement: A Retrospective Study.

OBJECTIVE: To observe the short-term to medium-term therapeutic effects and radiological outcomes of adjacent 2-level cervical spondylosis treated with artificial cervical disc replacement (ACDR) using Mobi-C and Bryan discs. To observe changes and discrepancies in the flexion-extension centers of rotation (FE-COR) of different ACDR segments. METHODS: Twenty-four patients undergoing 2-level (C4/5 and C5/6) ACDR were analyzed retrospectively (11 patients in the Mobi-C group and 13 patients in the Bryan group). Clinical outcomes were assessed using modified Japanese Orthopedic Association score, Neck Disability Index, and visual analog scale. Preoperative and 2 years' follow-up radiographs were collected to compare total cervical spine curvature (C2-C7) range of motion (ROM), upper and lower ACDR segmental ROM, and the operated adjacent segmental ROM. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The degree of disc degeneration in the adjacent segment was observed. RESULTS: At the 2 years' follow-up, in both group, the modified Japanese Orthopedic Association score increased significantly, and the Neck Disability Index and neck and upper extremity visual analog scale scores decreased significantly compared with preoperative (P < 0.05). There were no significant statistical differences in postoperative scores between the 2 groups (P > 0.05). The overall cervical ROM, the upper and lower segmental ROM at the 2 years' follow-up showed no significant statistical differences compared with the preoperative period (P > 0.05). There was no statistically significant difference in the adjacent segmental ROMs compared with the preoperative period (P > 0.05). Furthermore, the statistical analysis revealed no significant differences in the measurements of the ROM at each time points between the Mobi-C Group and the Bryan Group (P > 0.05). There was no significant difference in the preoperative FE-COR-X (indicating the horizontal position of the point in the coordinate system) and FE-COR-Y (indicating the vertical position of the point in the coordinate system) of upper or lower ACDR segments between the 2 groups (P > 0.05). At the 2 years' follow-up, there were significant differences both in FE-COR-X and FE-COR-Y between the 2 groups (P < 0.05). For the Mobi-C group, in both the upper and lower segment, the FE-COR-X significantly increased compared with preoperative (P < 0.05), while the FE-COR-Y decreased compared with preoperative (P < 0.05). For the Bryan group, no significant changes were observed in the upper or lower segment in both FE-COR-X and FE-COR-Y compared with preoperative (P > 0.05). Fourty-eight adjacent segments (24 superior and 24 inferior segments) were included in the studies of adjacent segment disease. Four segments showed imaging adjacent segment disease (4/48, 8.33%) in 4 patients, of which 2 were mild and 2 were moderate according to the grading criteria. Among them, 2 were from the Mobi-C group and 2 were from the Bryan group. No severe imaging degeneration was observed. CONCLUSIONS: In continuous 2-level cervical ACDR surgery, both Mobi-C and Bryan artificial cervical discs achieved satisfactory clinical outcomes in the short to medium term postoperatively. The FE-COR exhibited different trends of change. In the Mobi-C group, the FE-COR for both upper and lower segments shifted anteriorly and inferiorly, whereas in the Bryan group, whether upper or lower, the FE-COR remained closer to the preoperative state. The changes in FE-COR did not significantly affect the short-term to medium-term clinical outcomes postoperatively.

Potential active fractions and constituents in the flowers of Trollius chinensis Bunge responsible for treating acute pharyngitis.

ETHNOPHARMACOLOGICAL RELEVANCE: Trollius chinensis Bunge has a long history of use in China as traditional Chinese medicine and functional tea for the treatment of respiratory infections, such as pharyngitis, tonsillitis and bronchitis. Pharyngitis can impact the entire throat and adjacent lymphoid tissues, and may lead to significant systemic complications. However, the active components and mechanism of Trollius chinensis Bunge for treating acute pharyngitis remains unclear. AIM OF THE STUDY: Trollius chinensis Bunge is recognized in China both as a medicinal herb and a functional tea. Research into its properties aimed to establish its effectiveness against pharyngitis and to pinpoint the active components and mechanism. MATERIALS AND METHODS: A 70% ethanol extract from the herb was prepared, which was refined using chromatography through a column containing D101 macroporous resin and varying ethanol solutions. The efficacy of the initial and refined extracts was tested using a rat model of ammonia-induced acute pharyngitis. Pathological examination, HE staining and ELISA were applied to screen activity fraction. The compounds were isolated by silica gel, sephadex LH-20 column chromatography and semi-preparative HPLC chromatography from active fraction. All of the isolated compounds were assessed for anti-inflammatory activity by acting on LPS-induced RAW 264.7 macrophage cells in vitro. Cytotoxicity of compounds was detected by CCK-8 assay. The Griess reaction was applied to evaluate the inhibitory effects of isolated compounds on NO production in RAW 264.7 cells induced by LPS. TNF-α, IL-6, IL-1ß and PGE2 levels in macrophage supernatant were detected by ELISA. Molecular docking and western blot analysis were applied to study the anti-inflammatory mechanism of active compound. RESULTS: The fraction extracted with 30% ethanol proved particularly effective, significantly reducing pharyngitis symptoms. This was evidenced by decreased levels of cytokines (TNF-α, IL-6, IL-1ß and PGE2) and visible improvements in the pharyngeal tissue histology. In pursuit of pharyngitis treatments, 23 phenolic acids and 13 flavonoids were isolated from the 30% ethanol fraction and identified using spectral analysis. Of these, three were newly discovered compounds and eight were first-time isolates from the Trollius genus. These compounds were further investigated for their ability to suppress nitric oxide production in RAW 264.7 cells triggered by lipopolysaccharide. Compounds 3, 19, and 26 exhibited strong anti-inflammatory properties. HPLC analysis of the 30% ethanol fraction revealed that orientin was the predominant component, accounting for 44.4% of this fraction. Western blot analysis demonstrated that orientin reduced the expression levels of the protein p-p65 relative to p65, p-IκBα relative to IκBα and iNOS, indicating an anti-inflammatory effect potentially through the modulation of the NF-κB signaling pathway. CONCLUSION: The finding of this study provided strong support for the use of T. chinensis as a potential functional food for treating pharyngitis.

Animal Models of Internal Endplate Injury-Induced Intervertebral Disc Degeneration: A Systematic Review.

OBJECTIVE: To systematically review relevant animal models of disk degeneration induced through the endplate injury pathway and to provide suitable animal models for exploring the intrinsic mechanisms and treatment of disk degeneration. DESIGN: PubMed, Web of Science, Cochrane and other databases were searched for literature related to animal models of disk degeneration induced by the endplate injury pathway from establishment to August 2024, and key contents in the literature were screened and extracted to analyze and evaluate each type of animal model using the literature induction method. RESULTS: Fifteen animal experimental studies were finally included in the literature, which can be categorized into direct injury models and indirect injury models, of which direct injury models include transvertebral injury models and transpedicular approach injury models, and indirect injury models include endplate ischemia models and vertebral fracture-induced endplate injury models. The direct injury models have a minimum observation period of 2 months and a maximum of 32 wk. All direct injury models were successful in causing disk degeneration, and the greater the number of interventions, the greater the degree of disk degeneration caused. The observation period for the indirect injury models varied from 4 wk to 70 wk. Of the 9 studies, only one study was unsuccessful in inducing disk degeneration, and this was the first animal study in this research to attempt to intervene on the endplate to cause disk degeneration. CONCLUSION: The damage to the direct injury model is more immediate and controllable in extent and can effectively lead to disk degeneration. The indirect injury models do not directly damage the endplate structure, making it easier to observe the physiological and pathological condition of the endplate and associated structures of the disk. None of them can completely simulate the corresponding process of endplate injury-induced disk degeneration in humans, and there is no uniform clinical judgment standard for this type of model. The most appropriate animal model still needs further exploration and discovery.

Glucose Oxidase-Immobilized Dually-Crosslinked Nanogels for Rapid-Responsive Insulin Delivery.

Despite the potential benefits of close-looped insulin delivery systems in regulating glycemic homeostasis and effectively alleviating diabetes, they still encounter challenges such as limited effectiveness in preventing low glycemic episodes due to sluggish glucose response, and issues with the instability of enzymes and carriers. In this study, dually-crosslinked and glucose oxidase (GOx)-immobilized insulin nanogels (DC-NGs@Ins) are developed for rapid-responsive and sustained hypoglycemic therapy. The DC-NGs@Ins with the phenylborate ester linker enabled the insulin release in a close-looped fashion, and moreover, immobilized GOx-generated hydrogen peroxide (H2O2) by consuming the glucose, which can further bind to phenylborate ester for enhancing glucose response and accelerating the insulin release. The dually-crosslinked structure (phenylboronic ester and UV-crosslinking) effectively minimized the initial burst release of insulin, thus preventing the potential risk of hypoglycemia. More interestingly, GOx immobilized in the nanogels mitigated GOx leakage and enhanced its multiple utilization compared to free GOx. In vivo study demonstrated that DC-NGs@Ins effectively maintained glycemic levels (BGLs) below 200 mg dL-1 for at least 8 h compared to singly-crosslinked nanogels (SC-NGs@Ins). Therefore, this intelligent insulin delivery system shows potential applications in diabetes treatment.

Study on the Rapid Limit Test for Six Sulfonamide Residues in Food Based on the TLC-SERS Method.

Sulfonamides are not only widely applied in clinics but also highly valued in animal husbandry. Recently, it has become common for sulfonamide residues to exceed the standard limits in food, which can affect human health. Current regulations limit these residues. Therefore, we constructed a new limit test method to rapidly determine the levels of sulfonamide residues. Six sulfonamides were detected using the latest method called TLC-SERS, namely, sulfamethasone (A), sulfamethazine (B), sulfadoxine (C), sulfamethoxydiazine (D), sulfamethoxazole (E), and sulfathiazole (F). The optimal conditions for SERS detection were investigated for these six drugs, and the separation effects of different TLC spreaders on them were compared. Then, we successfully established a separation system using dichloromethane-methanol-ammonia in a ratio of 5:1:0.25 (v/v/v), which provided good separation effects on the six drugs. The residues were preliminarily separated via TLC. A silver sol solution was added to the spot on the silica gel G plate at the corresponding specific shift values, and SERS detection was performed. The sample solution was placed on the spot under a 532 nm laser, and the SERS spectrum was collected and analyzed for the six sulfonamides. The results showed obvious variations in the SERS spectrum among the six sulfonamides, with the LODs being 12.5, 6.4, 6.3, 7.1, 18.8, and 6.2 ng/mL from A to F, respectively, and an RSD of <3.0%. Within 48 h, the SERS signal for each sulfonamide drug was kept stable, with an RSD of <3.0%. The detection results of 20 samples using the TLC-SERS method were consistent with those obtained by UPLC-MS/MS. The established TLC-SERS method is simple and fast, providing a useful reference for the rapid detection of residue limits in food.

Size-tailored and acid-degradable polyvinyl alcohol microgels for inhalation therapy of bacterial pneumonia.

Administration of antibiotics via inhalation is considered an effective strategy for pneumonia treatment; however, it encounters challenges related to the development of drug formulations with precise particle sizes and controlled release profiles. Herein, size-tailored and acid-degradable polyvinyl alcohol (PVA) microgels are utilized for nebulized inhalation delivery of piperacillin (PIP) antibiotics to effectively treat pneumonia. These microgels loaded with PIP (G@PIP) were prepared through the UV-crosslinking of thermo-triggered vinyl ether methacrylate-functionalized PVA (PVAVEMA) micro-aggregates in aqueous solution. The size of G@PIP microgels could be tailored by adjusting concentrations during the crosslinking process above phase-transition temperature at 15 °C. Additionally, under simulated inflammatory acidic conditions, the G@PIP microgels degraded and released PIP with relatively high inhibition efficiency against E. coli. Furthermore, in vivo therapeutic outcomes revealed that inhalational delivery of G@PIP microgel with a medium-size of 3.5 µm (G-3.5@PIP) exhibited superior lung deposition compared to other microgel sizes owing to its reduced exhalation and enhanced diffusion capacity within the pulmonary system. The high accumulation of G-3.5@PIP significantly reduced E. coli infection and associated inflammation while maintaining the biocompatibility of the microgels. Overall, these acid-degradable PVA microgels offer a versatile and efficacious inhalation therapy for pneumonia-associated infections.

Clinical study on freehand of bicortical sacral screw fixation with the assistance of torque measurement device.

BACKGROUND: Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. OBJECTIVE: To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. METHODS: Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. RESULTS: The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. CONCLUSION: Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.

Prediction of Screw Loosening After Dynamic Pedicle Screw Fixation With Lumbar Polyetheretherketone Rods Using Magnetic Resonance Imaging-Based Vertebral Bone Quality Score.

OBJECTIVE: To investigate the correlation between magnetic resonance imaging-based vertebral bone quality (VBQ) score and screw loosening after dynamic pedicle screw fixation with polyetheretherketone (PEEK) rods, and evaluate its predictive value. METHODS: A retrospective analysis was conducted on the patients who underwent dynamic pedicle screw fixation with PEEK rods from March 2017 to June 2022. Data on age, sex, body mass index, hypertension, diabetes, hyperlipidemia history, long-term smoking, alcohol consumption, VBQ score, L1-4 average Hounsfield unit (HU) value, surgical fixation length, and the lowest instrumented vertebra were collected. Logistic regression analysis was employed to assess the relationship between VBQ score and pedicle screw loosening (PSL). RESULTS: A total of 24 patients experienced PSL after surgery (20.5%). PSL group and non-PSL group showed statistical differences in age, number of fixed segments, fixation to the sacrum, L1-4 average HU value, and VBQ score (p < 0.05). The VBQ score in the PSL group was higher than that in the non-PSL group (3.56 ± 0.45 vs. 2.77 ± 0.31, p < 0.001). In logistic regression analysis, VBQ score (odds ratio, 3.425; 95% confidence interval, 1.552-8.279) were identified as independent risk factors for screw loosening. The area under the receiver operating characteristic curve for VBQ score predicting PSL was 0.819 (p < 0.05), with the optimal threshold of 3.15 (sensitivity, 83.1%; specificity, 80.5%). CONCLUSION: The VBQ score can independently predict postoperative screw loosening in patients undergoing lumbar dynamic pedicle screw fixation with PEEK rods, and its predictive value is comparable to HU value.

Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF.

OBJECTIVE: To explore the feasibility of applying CT Hounsfield Units (HUs) for the assessment of preoperative paraspinal muscle fat infiltration (FI) in different segments in patients who underwent anterior cervical discectomy and fusion (ACDF). To compare the consistency of preoperative paraspinal muscle FI evaluations using MRI and those via CT HUs in patients who underwent ACDF surgery. METHODS: Ninety-five patients (45 males and 50 females, aged 37‒71 years) who received CT and MRI examinations and underwent ACDF surgery were retrospectively analyzed. In the axial T2-weighted MR images at the median level of the C3/4, C4/5, and C5/6 segments, regions of interests (ROIs) were delineated along the boundaries of the cervical multifidus (MF) and semispinalis cervicis (Scer) muscles. Using the threshold tool in ImageJ software, areas of fat tissue and intermuscular septa within the ROI were quantified. The effective cross-sectional area (ECSA) for each side was obtained by subtracting the areas of fat tissue and intermuscular septa from the total ROI area. The ratio of the fat tissue area to the CSA was then calculated to determine the initial FI value. The depth of subcutaneous fat from the midline spinous process to the epidermis at the median plane of the C4/5 intervertebral disc was measured. The initial FI values were then divided by the depth of fat to determine the post-correction FI value. Using the Picture Archiving and Communication System (PACS), at identical segments and planes, ROIs were delineated using the same method as in MRI under a standard soft tissue window (width of 500 HU, level of 60 HU). The CT HU values were measured within these defined areas. The CT HU values from both sides are summed to obtain the total HU value for the segment. According to whether the measurement results of two sets of data follow a normal distribution, Pearson's test or Sperman's test was used to analyze the correlation. RESULTS: On MRI, a statistically significant difference was observed in the post-correction FI only at the C3/4 segment compared to the other two segments (P < 0.05). No significant difference in the post-correction FI between the C4/5 and C5/6 segments was noted (P > 0.05). The CT HU results showed a substantial discrepancy between C3/4 and C4/5 segments and between C3/4 and C5/6 segments (P < 0.05), whereas no statistically significant difference was found in the CT HU value between the C4/5 and C5/6 segments (P > 0.05). The consistency analysis revealed a relatively strong correlation between the post-correction FI and CT HU values of the C3/4 and C4/5 segments. Furthermore, a strong correlation was detected in the variations in the measurement outcomes at the C5/6 segment. CONCLUSION: Patients requiring surgical treatment for the cervical spine exhibit varying degrees of FI in paraspinal muscles across different locations and segments. Evaluating the degree of FI in the paraspinal muscles of the cervical spine through CT HU values is feasible. There is considerable consistency between the post-correction FI assessed under MRI and the measurements of CT HU values in evaluating the FI of paraspinal muscles in the cervical spine.

Palladium-catalyzed asymmetric [4 + 3] cycloaddition of methylene-trimethylenemethane: access to seven-membered exocyclic axially chiral allenes.

A palladium-catalyzed asymmetric [4 + 3] cycloaddition of the methylene-trimethylenemethane donor with an azadiene has been developed, affording benzofuro[3,2-b]azepine-derived exocyclic chiral allene with control of axial and point chirality. The target compounds were generated in good to excellent yields and with high diastereoselectivities and enantioselectivities (up to >20 : 1 dr, 99% ee). Furthermore, this cycloaddition reaction could be efficiently scaled-up and several synthetic transformations were accomplished for the construction of useful chiral allenol and chiral spirocyclic derivatives.

Correlation between axial symptoms and cervical sagittal alignment parameters in patients with two-level or three-level cervical spondylotic myelopathy: anterior cervcial discectomy and fusion versus hybird surgery.

OBJECTIVE: To comparatively analyze the correlation between axial symptoms (AS) and cervical sagittal alignment parameters after anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS). METHODS: From January 2018 to June 2023, 74 patients who underwent ACDF (n = 36) or HS (n = 38) for two-level or three-level cervical spondylotic myelopathy were retrospectively analyzed. The Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA), Neck Disability Index (NDI) were recorded to assess clinical outcomes. Cervical sagittal alignment parameters (Cobb's angle C2-7, C7 slope [C7S], and C2-7 sagittal vertical axis [C2-7 SVA]) were measured preoperatively, 3 days postoperatively, and at the last follow-up. The range of motion (ROM) of C2-7 and ROM of surgical segment were measured. The occurrence of AS was observed at the last follow-up. Logistic regression was used to analyze the correlation between postoperative AS and cervical sagittal alignment parameters. RESULTS: Both in ACDF group and HS group, VAS, JOA and NDI scores showed significant improvements at 3-day postoperation and at the last follow-up (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). The Cobb's angle C2-7 and C7S were significantly increased at 3 days postoperation compared with pre-operatively in both groups (P < 0.05). C2-7SVA was increased in both groups 3 days after surgery compared with pre-operatively, but there was no significant difference (P > 0.05). At the last follow-up, the ROM of C2-7 in ACDF group was significantly smaller than HS group (P < 0.05). The prevalence of postoperative AS in the ACDF group and HS group was 41.7 and 18.4%, respectively, with statistical difference between the two groups (P < 0.05). When simple Logistic regression analysis was used, the last Cobb's angle C2-7 (ß = -0.088), the last C2-7SVA (ß = 0.099) in ACDF group and the last C2-7SVA (ß = 0.222) in HS group were all correlated with the occurrence of postoperative AS. When multiple Logistic regression analysis was used, only the last C2-7SVA (ß = 0.181) in the HS group was positively correlated with the occurrence of postoperative AS. CONCLUSIONS: Both ACDF and HS can achieve satisfied clinical outcomes. ACDF and HS can improve cervical sagittal balance to a certain extent, and HS is superior to ACDF in maintaining ROM. The decrease of the last Cobb's angle C2-7 and the increase of the last C2-7SVA may be related to the occurrence of AS after ACDF. The increase of the last C2-7SVA was an independent risk factor for the occurrence of AS after HS.

Spinal cord injury without radiographic abnormality with diffuse idiopathic skeletal hyperostosis: A case report.

INTRODUCTION: Spinal cord injury without fracture dislocation (SCIWORA) is relatively rare, and spastic paralysis for more than 2 months with Diffuse diopathic skeletal hyperoseosis (DISH) is even rarer. CASE PRESENTATION: A 70-year-old male patient presented with quadriplegia for more than 2 months after a fall. He's incontinent of stool and urine. An MRI was performed and the diagnosis was "SCIWORA, DISH". After surgical treatment, there was a significant recovery of postoperative related symptoms. CLINICAL DISCUSSION: The timing of SCIWORA surgery remains controversial, with most studies suggesting that early surgery (within 24 h) is more effective. Anterior cervical discectomy and fusion (ACDF) is one of the main surgical procedures that directly and completely removes compression from the anterior aspect of the spinal cord. Patients with SCIWORA combined with DISH may have fractures due to low-energy injuries and should be treated aggressively with surgery to avoid secondary injury to the spinal cord. CONCLUSION: Adult SCIWORA patients should be aggressively treated surgically when vital signs are stable and relatively calm. To avoid secondary injury, titanium plates combined with self-stabilizing fusions provide reliable immediate stabilization and can be used as one of the internal fixation modalities.

Timing of decompression in central cord syndrome: a systematic review and meta-analysis.

PURPOSE: This study compared the recovery of motor function and the safety of early and delayed surgical intervention in patients with central cord syndrome (CCS). METHODS: PubMed, Embase, Cochrane Library, and Web of Science were employed to retrieve the targeted studies published from inception to February 19, 2023. Comparative studies of early versus delayed surgical decompression in CCS based on American Spinal Injury Association motor score (AMS) recovery, complication rates, and mortality were selected. The statistical analyses were performed using STATA 16.0 and RevMan 5.4. RESULTS: Our meta-analysis included 13 studies comprising 8424 patients. Results revealed that early surgery improved AMS scores significantly compared with delayed surgery, with an increase in MDs by 7.22 points (95% CI 1.98-12.45; P = 0.007). Additionally, early surgery reduced the complication rates than delayed surgery (OR 0.53, 95% CI 0.42-0.67, P < 0.00001). However, no significant difference was observed in mortality between the two groups (OR 0.97; 95% CI 0.75-1.26; P = 0.84). CONCLUSIONS: Early surgical decompression for CCS can improve motor function and reduce the incidence of complications without affecting the mortality rate in patients. Future research should focus on investigating and analyzing the optimal window period for early CCS surgery. Additionally, the timing of surgery should be determined based on the patient's condition and available medical resources.

Algorithm of face anti-spoofing based on pseudo-negative features generation.

Introduction: Despite advancements in face anti-spoofing technology, attackers continue to pose challenges with their evolving deceptive methods. This is primarily due to the increased complexity of their attacks, coupled with a diversity in presentation modes, acquisition devices, and prosthetic materials. Furthermore, the scarcity of negative sample data exacerbates the situation by causing domain shift issues and impeding robust generalization. Hence, there is a pressing need for more effective cross-domain approaches to bolster the model's capability to generalize across different scenarios. Methods: This method improves the effectiveness of face anti-spoofing systems by analyzing pseudo-negative sample features, expanding the training dataset, and boosting cross-domain generalization. By generating pseudo-negative features with a new algorithm and aligning these features with the use of KL divergence loss, we enrich the negative sample dataset, aiding the training of a more robust feature classifier and broadening the range of attacks that the system can defend against. Results: Through experiments on four public datasets (MSU-MFSD, OULU-NPU, Replay-Attack, and CASIA-FASD), we assess the model's performance within and across datasets by controlling variables. Our method delivers positive results in multiple experiments, including those conducted on smaller datasets. Discussion: Through controlled experiments, we demonstrate the effectiveness of our method. Furthermore, our approach consistently yields favorable results in both intra-dataset and cross-dataset evaluations, thereby highlighting its excellent generalization capabilities. The superior performance on small datasets further underscores our method's remarkable ability to handle unseen data beyond the training set.