Do different pathologies of adult spinal deformity (idiopathic lumbar scoliosis against de novo lumbar scoliosis) affect preoperative and postoperative selfimage?

Study Design: Retrospective single-center study. Purpose: This study aimed to examine the factors associated with the self-image domain of the Scoliosis Research Society-22 revised (SRS-22r) in patients who underwent corrective surgery for adult idiopathic scoliosis (AdIS). Overview of Literature: Adult spinal deformity (ASD) can be classified into AdIS and de novo scoliosis. However, no studies have investigated the effect of different ASD pathologies on self-image. Methods: This study enrolled 60 patients who underwent corrective surgery and were followed up for >2 years postoperatively. AdIS was defined as adolescent idiopathic scoliosis in patients who had no history of corrective surgery, had a primary thoracolumbar/lumbar (TL/L) curve, and were ≥30 years old at the time of surgery. Results: The AdIS (n=23; mean age, 53.1 years) and de novo (n=37; mean age, 70.0 years) groups were significantly different in terms of the main thoracic and TL/L curves, sagittal vertical axis, thoracic kyphosis, and thoracolumbar kyphosis preoperatively. The scores in the self-image domain of the SRS-22r (before surgery/2 years after surgery [PO2Y]) were 2.2/4.4 and 2.3/3.7 in the AdIS and de novo groups, respectively, and PO2Y was significantly different between the two groups (p<0.001). Multivariate regression analysis revealed that AdIS was an independent factor associated with self-image at PO2Y (p=0.039). Conclusions: AdIS, a spinal deformity pathology, was identified as a significant factor associated with the self-image domain of SRS- 22r in patients who underwent corrective surgery. AdIS is not solely classified based on pathology but also differs in terms of the clinical aspect of self-image improvement following corrective surgery.

Assessing the Impact of Preoperative MRI-Based Vertebral Bone Quality Scores on 5-Year Prognosis in Lumbar Spine Surgery.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the 5-year clinical outcomes following lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking. METHODS: A total of 189 patients who underwent lumbar surgery (≤3-disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75 to 3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and 1, 2, and 5 years postoperatively. RESULTS: Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain (P=0.013), walking ability (P=0.005), social life function (P=0.010) of JOABPEQ, and physical component summary of the SF-36 (P=0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse 5-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score. CONCLUSION: A high preoperative VBQ score is a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and healthcare costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes. LEVEL OF EVIDENCE: 3.

A case of dupilumab-induced psoriasis-like eruption treated with baricitinib.

Dupilumab is a humanized monoclonal antibody against the interleukin (IL)-4 receptor alpha chain that inhibits IL-4 and IL-13 signalling. It is one of the systemic treatments for patients with moderate-to-severe atopic dermatitis (AD), which provides favourable safety and efficacy. We report a case of psoriasis-like eruption induced by dupilumab as an adverse effect in a patient with AD, immediately remitted after switching to baricitinib, which inhibits JAK1/2. Moreover, the atopic skin lesion also simultaneously went into remission upon baricitinib treatment. Baricitinib could be a favourable option for patients with AD who develop dupilumab-induced psoriasis-like eruption.

Variation of thoracolumbar vertebral morphology in anthropoid primates.

OBJECTIVES: Morphological variation among extant primates in the lumbar vertebral column is well studied. However, knowledge concerning the thoracic spine, an important region responsible for supporting and facilitating movement in the upper trunk, remains relatively scarce. Consequently, our comprehension of the functional differentiation exhibited throughout the thoracolumbar vertebral column among various primate species remains constrained. In this study, we examined patterns of morphological variation in the thoracolumbar vertebral column of extant hominoids, cercopithecoids, and Ateles. MATERIALS AND METHODS: We collected external shape data on 606 thoracic and lumbar vertebrae from Homo sapiens, Pan troglodytes, Hylobates lar, Macaca fuscata, Chlorocebus aethiops, Colobus guereza, Ateles geoffroyi, and A. belzebuth. Forty-four landmarks were obtained on the three-dimensional surface. Geometric morphometrics was used to quantify the centroid size and variation of the shapes of thoracic and lumbar vertebrae. RESULTS: Cercopithecoids exhibited greater variation in the size and shape of their thoracic and lumbar vertebrae compared to hominoids and Ateles. Although many vertebral features contributed to the observed variation throughout the thoracolumbar vertebral column within the taxon, the transverse and spinous processes exhibited relatively major contributions. DISCUSSION: Our results suggest that quadrupedal locomotion requires the functional differentiation between thoracic and lumbar vertebrae, and for hominoids, functional adaptation to orthograde posture necessitates a relatively more uniform shape of thoracic and lumbar vertebrae.

Impact of Incident Osteoporotic Vertebral Fractures on 5-Year Postoperative Outcomes and Spinal Alignment Following Lumbar Fusion Surgery.

Introduction: Osteoporotic vertebral fractures (OVFs) are a significant problem among older patients who are undergoing spine surgery. This study examined the influence of incident OVFs on clinical outcomes and spinal alignment 5 years following short-segment fusion (SSF) for lumbar spinal stenosis. Methods: We studied 88 patients who underwent SSF (≤2-disc level) for lumbar spinal stenosis with instability and were followed up for more than 5 years postoperatively. Those with prior OVFs were excluded. We evaluated incident OVFs with plain whole-spine lateral radiography preoperatively (before) and at 5 years postoperatively (after). Using preoperative lumbar computed tomography, Hounsfield unit (HU) values were evaluated. The patients were classified into two groups according to the presence of incident OVFs. Repeated-measures analysis of variance was utilized to compare the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the 36-item Short-Form Health Survey (SF-36), and spinal parameters were recorded before and after. Multiple linear regression analyses were employed to investigate the association between the incident OVFs and the clinical scores and spinal alignment recorded after. Results: In the fracture group, the clinical course of low back pain score on the JOABPEQ, physical component summary SF-36 score, and spinal alignment including C7 sagittal vertical axis (SVA), thoracic kyphosis (TK), and pelvic tilt were significantly worse. Multiple linear regression revealed a significant correlation between incident OVFs and worse 5-year postoperative spinal alignment, which includes SVA and TK. The optimal threshold for the HU values for predicting the incidence of OVFs within 5 years postoperatively was 83.0 (area under the curve 0.701). Conclusions: Incident OVFs in patients following SSF were significantly correlated with the 5-year clinical outcomes and spinal alignment. Patients at risk of OVFs, especially those with HU values below 83, must take preventive measures against OVFs, as this could prevent deteriorating midterm postoperative clinical outcomes and spinal alignment. Level of Evidence: 3.

Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery.

OBJECTIVE: Hounsfield Unit (HU) value has been associated with future osteoporotic fractures and postoperative complications. However, no studies on the impact of low HU values on mid-term clinical outcomes following lumbar spine surgery have been reported. We aimed to evaluate the usefulness of preoperative HU values for 5-year clinical outcomes following lumbar spine surgery. METHODS: We enrolled 200 patients who underwent lumbar surgery (≤ 3-disc levels) for lumbar spinal stenosis. HU values were assessed using preoperative lumbar computed tomography as part of routine preoperative planning for lumbar surgery. Patients were divided into two groups based on the cutoff value of the HU values obtained from the receiver operating characteristic curve for the incidence of vertebral fractures within five years postoperatively. Clinical scores preoperatively and 1, 2, and 5 years postoperatively, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were compared using a mixed-effects model. RESULTS: Comparative analysis indicated that all domains of JOABPEQ, except for lumbar function, and the physical component summary of the SF-36 were significantly worse in the low HU group than in the high HU group. Using multiple regression analysis, low HU values were significantly correlated with worse 5-year postoperative scores in all domains of JOABPEQ and SF-36. CONCLUSION: Low preoperative HU values are a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. HU values are not only a valuable tool for analyzing bone mineral density but also may be a valuable poor prognostic factor of postoperative clinical outcomes.

Range of rotation of thoracolumbar vertebrae in Japanese macaques.

In humans, the range of thoracic vertebral rotation is known to be greater than that of the lumbar vertebrae due to their zygapophyseal orientation and soft tissue structure. However, little is known regarding vertebral movements in non-human primate species, which are primarily quadrupedal walkers. To understand the evolutionary background of human vertebral movements, this study estimated the range of axial rotation of the thoracolumbar spine in macaque monkeys. First, computed tomography (CT) was performed while passively rotating the trunk of whole-body cadavers of Japanese macaques, after which the motion of each thoracolumbar vertebra was estimated. Second, to evaluate the influence of the shoulder girdle and surrounding soft tissues, specimens with only bones and ligaments were prepared, after which the rotation of each vertebra was estimated using an optical motion tracking system. In both conditions, the three-dimensional coordinates of each vertebra were digitized, and the axial rotational angles between adjacent vertebrae were calculated. In the whole-body condition, the lower thoracic vertebrae had a greater range of rotation than did the other regions, similar to that observed in humans. In addition, absolute values for the range of rotation were similar between humans and macaques. However, in the bone-ligament preparation condition, the upper thoracic vertebrae had a range of rotation similar to that of the lower thoracic vertebrae. Contrary to previous speculations, our results showed that the mechanical restrictions by the ribs were not as significant; rather, the shoulder girdle largely restricted the rotation of the upper thoracic vertebrae, at least, in macaques.

Ventricular fold oscillations lower the vocal pitch in rhesus macaques.

We carried out ex vivo and in vivo experiments to explore the functional role of the ventricular folds in sound production in macaques. In the ex vivo experiments, 29 recordings out of 67 showed that the ventricular folds co-oscillated with the vocal folds. Transitions from normal vocal fold oscillations to vocal-ventricular fold co-oscillations as well as chaotic irregular oscillations were also observed. The in vivo experiments indicated that the vocal-ventricular fold co-oscillations were also observed in two macaque individuals. In both ex vivo and in vivo experiments, the vocal-ventricular fold co-oscillations significantly lowered the fundamental frequency. A mathematical model revealed that the lowering of the fundamental frequency was caused by a low oscillation frequency inherent in the ventricular folds, which entrained the vocal folds to their low-frequency oscillations. From a physiological standpoint, the macaques may utilize the ventricular fold oscillations more frequently than humans. The advantages as well as disadvantages of using the ventricular folds as an additional vocal repertory are discussed.

Diagonal-couplet gaits on discontinuous supports in Japanese macaques and implications for the adaptive significance of the diagonal-sequence, diagonal-couplet gait of primates.

OBJECTIVES: Diagonal-sequence, diagonal-couplet (DSDC) gaits have been proposed as an adaptation to travel on discontinuously arranged arboreal branches. Only a few studies have examined primate gait adjustment to support discontinuity. We analyzed the gaits of Japanese macaques walking on the "ground" and two discontinuous conditions, "circle" and "point," to better understand the advantages of DSDC gaits on discontinuous supports. MATERIALS AND METHODS: Seventy-eight vertical posts, each with a circular upper surface, were arranged in four rows at a spacing of 200 mm. The diameter of the circular upper surface was 150 mm ("circle condition") or 50 mm ("point condition"). We calculated the limb phase, duty factor, and time interval from hindlimb touchdown to ipsilateral forelimb liftoff. The supports the fore- and hindlimbs landed on during walking were identified in the circle and point condition. RESULTS: The macaques predominantly used DSDC gaits in the ground and circle conditions and lateral-sequence, diagonal-couplet (LSDC) gaits in the point condition. The macaques usually placed their hindlimbs on the same supports as their ipsilateral forelimbs during the gait cycle. DISCUSSION: Japanese macaques overlapped the ipsilateral fore- and hindlimb stance phase in all DSDC and some LSDC gaits to proximate the ipsilateral limbs on the discontinuous support, allowing the forelimb to guide the hindlimb placement to the support. The overlap duration of the ipsilateral limb stance phases may be extended by DSDC gaits longer than by LSDC gaits, allowing for a direct pass of the support being held by the prehensile hand to the prehensile foot.

Characterizing Granulocytopenia Associated with Thiamazole in Patients with Hyperthyroidism Based on Real-World Data from the MID-NET in Japan.

Despite the requirement of routine blood tests during thiamazole treatment in Japan, granulocytopenia among patients treated with thiamazole has been occasionally reported to the Pharmaceuticals and Medical Devices Agency (PMDA). To characterize granulocytopenia in patients with thiamazole in Japan, the effects of routine blood tests were examined in a cohort of new users of thiamazole or propylthiouracil utilizing the MID-NET. The occurrence of granulocytopenia (neutrophil count ≤ 1,500/µL) in a given period was compared between patients with and without blood test results prior to the period. The trend in neutrophil count during thiamazole treatment was also compared between patients with and without granulocytopenia. A nested case-control study based on the cohort was conducted to identify potential risk factors for granulocytopenia during thiamazole treatment. In the new user cohort including 4,371 patients treated with thiamazole, the occurrence of granulocytopenia in patients who had undergone blood tests at all previous periods was similar or higher than that among those who had not undergone blood test in all previous periods (e.g., adjusted odds ratio in period 2 was 1.63). The neutrophil count was relatively lower in the group of patients with granulocytopenia even before the occurrence of granulocytopenia. In a nested case-control study, an upward tendency of the risk was observed when a patient was co-prescribed anti-arrhythmic drugs or antiulcer drugs with thiamazole. The characteristics of granulocytopenia during thiamazole treatment elucidated in this study should be recognized in clinical practice for the proper use of thiamazole.

Prescription trend and lactic acidosis in patients prescribed metformin before and after the revision of package insert for allowing metformin administration to patients with moderately decreased kidney function based on real-world data from MID-NET® in Japan.

Introduction: This study was conducted to understand the impact of package insert (PI) revision in Japan on 18 June 2019 to allow metformin use for patients with moderately decreased kidney function (30 ≤ estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2). Methods: A new user cohort design was employed to examine the prescription trend and the occurrence of lactic acidosis in patients prescribed metformin before and after PI revision using the Medical Information Database Network (MID-NET®). Results: From 12 May 2016 to 31 March 2020, 5,874 patients (before, n = 4,702; after, n = 1,172) were identified as new metformin users, including 1,145 patients (before, n = 914; after, n = 231) with moderately decreased kidney function. Although no marked changes in metformin prescription were observed before and after PI revision, the daily metformin dose at the first prescription decreased after PI revision. For both before and after PI revision, less than 10 cases of lactic acidosis occurred in all patients prescribed metformin, and no lactic acidosis was observed in patients with moderately decreased kidney function. Conclusion: The results of this study are useful for understanding the safety of metformin use in patients with decreased kidney function and suggest no worse impacts of PI revision in Japan, indicating no further safety concerns on metformin use in patients with moderately decreased kidney function under the situation with careful use and safety monitoring of metformin.

Prevalence, risk factors, and potential symptoms of hyponatremia after spinal surgery in elderly patients.

Old age and spinal surgery significantly increase the risk of postoperative hyponatremia. However, detailed analyses of postoperative hyponatremia after spinal surgery in elderly patients are lacking. Therefore, we retrospectively reviewed the records of 582 consecutive patients aged > 60 years who underwent spinal surgery to evaluate the frequency, risk factors, and symptoms of postoperative hyponatremia after spinal surgery in the elderly population. Postoperative hyponatremia was defined as a postoperative blood sodium level < 135 meq/L at postoperative day (POD)1, POD3, and/or after POD6. A total of 92 (15.8%) patients showed postoperative hyponatremia. On a multivariate analysis, a diagnosis of a spinal tumor/infection, decompression and fusion surgery, and lower preoperative sodium levels were significant independent factors of postoperative hyponatremia (p = 0.014, 0.009, and < 0.001, respectively). In total, 47/92 (51%) cases could have been symptomatic; vomiting was noted in 34 cases (37%), nausea in 19 cases (21%), headache in 14 cases (15%), and disturbances in consciousness, including delirium, in ten cases (21%); all incidences of these symptoms were significantly higher in elderly patients with postoperative hyponatremia than in the matched control group without postoperative hyponatremia (p < 0.05, respectively). Additionally, the length of stay was 2 days longer in patients than in the matched controls (p = 0.002).

Evolutionary loss of complexity in human vocal anatomy as an adaptation for speech.

Human speech production obeys the same acoustic principles as vocal production in other animals but has distinctive features: A stable vocal source is filtered by rapidly changing formant frequencies. To understand speech evolution, we examined a wide range of primates, combining observations of phonation with mathematical modeling. We found that source stability relies upon simplifications in laryngeal anatomy, specifically the loss of air sacs and vocal membranes. We conclude that the evolutionary loss of vocal membranes allows human speech to mostly avoid the spontaneous nonlinear phenomena and acoustic chaos common in other primate vocalizations. This loss allows our larynx to produce stable, harmonic-rich phonation, ideally highlighting formant changes that convey most phonetic information. Paradoxically, the increased complexity of human spoken language thus followed simplification of our laryngeal anatomy.

Circadian rhythms of the mRNA abundances of clock genes and glucose transporters in the jejunum of weanling-growing pigs.

BACKGROUND: Whether abundance of glucose transporter mRNAs in the small intestine of pigs shows circadian rhythms and its regulation by clock genes was still unknown. OBJECTIVES: We examined whether the abundance of glucose transporters and clock genes mRNAs in the small intestine of pigs shows circadian rhythms. METHODS: Twenty barrows (4 weeks old) were reared under 12 h bright and 12 h dark lighting conditions. During the 3-week feeding trial, pigs were allowed free access to feed. The abundances of the mRNA of glucose transporters (SGLT1 and GLUT2) and clock genes (Bmal1, Per1, Per2, and Cry2) in the intestine were measured at four time points (ZT2, ZT8, ZT14, and ZT20). RESULTS: In the jejunum, the abundance of SGLT1 mRNA was higher at ZT20 and ZT2 and lower at ZT8 and ZT14 (p < 0.05). The abundances of GLUT2 mRNA in the jejunum at ZTs 20 and 2 were tended to be higher than those at ZTs 8 and 14 (p = 0.05). In the jejunum, the abundance of Bmal1 mRNA was higher at ZT8 and ZT14 than at ZT20 and ZT2 (p < 0.05). Further, the abundance of Per1 mRNA at ZT2 was higher than those at the other sampling times (p < 0.05). The abundance of Per1 mRNA at ZT8 was higher than that at ZT14 (p < 0.05), while that of Per2 mRNA was higher at ZT2 than those at ZTs 20 and 14 (p < 0.05). CONCLUSION: We speculate that these circadian rhythms of abundances of glucose transporter mRNAs are regulated by the clock genes expressed in the jejunum.