Cervical Alignment and Range of Motion Change after Anterior 3-Level Hybrid Surgery Compared with Cervical Laminoplasty: A Matched Cohort Study.

OBJECTIVES: Cervical alignment and range of motion (ROM) changes after cervical spine surgery are related to cervical biomechanical and functions. Few studies compared these parameters between posterior laminoplasty and anterior 3-level hybrid surgery incorporating anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR). This study is aimed to detect the differences of cervical alignment and ROM changes of the two surgeries in a matched-cohort study. METHODS: From January 2018 and May 2020, 51 patients who underwent 3-level hybrid surgery incorporating ACDF with ACDR were included. A 1:1 match of the patients who underwent cervical laminoplasty based on age, gender, duration of symptoms, body mass index, and cervical alignment type was utilized as control group. General data (operative time, blood loss, etc.), Japanese Orthopaedic Association (JOA) score, VAS (Visual Analog Score), NDI (The Neck Disability Index), cervical sagittal alignment, and cervical range of motion (ROM) were recorded and compared. RESULTS: Both groups gained significant improvement in JOA, VAS, NDI scores postoperatively (p < 0.05). Cervical alignment significantly increased in hybrid group and decreased in control group after surgeries (p < 0.001). ROM decrease was similar in two groups. For cervical lordosis, though cervical alignment angle in control group decreased, the final follow-up cervical alignment and cervical alignment changes were not significantly different between hybrid and control groups. For cervical non-lordosis, cervical alignment decreased in control group while increased in hybrid group. At final follow-up, cervical alignment and the changes between the two groups were significantly different. Both control group and hybrid group had similar ROM decrease after the surgery no matter whether there was cervical lordosis or non-lordosis. Hybrid surgery showed cervical alignments significantly improved and similar ROM preservation compared with control group at final follow-up both for 1-level and 2-level disc replacement subgroups. CONCLUSIONS: The hybrid surgery demonstrated advantages of preserving cervical alignment and gaining similar cervical ROM preservation compared with cervical laminoplasty, especially for cervical non-lordosis. Given the importance of restoring lordotic cervical alignment, hybrid surgery may be preferred over laminoplasty to treat multilevel cervical disc herniation.

More anterior bone loss in middle vertebra after contiguous two-segment cervical disc arthroplasty.

BACKGROUND: Contiguous two-segment cervical disc arthroplasty (CDA) is safe and effective, while post-operative radiographic change is poorly understood. We aimed to clarify the morphological change of the three vertebral bodies operated on. METHODS: Patients admitted between 2015 and 2020 underwent contiguous two-level Prestige LP CDA were included. The follow-up was divided into immediate post-operation (≤ 1 week), early (≤ 6 months), and last follow-up (≥ 12 months). Clinical outcomes were measured by Japanese Orthopedic Association (JOA) score, visual analogue score (VAS), and neck disability index (NDI). Radiographic parameters on lateral radiographs included sagittal area, anterior-posterior diameters (superior, inferior endplate length, and waist length), and anterior and posterior heights. Sagittal parameters included disc angle, Cobb angle, range of motion, T1 slope, and C2-C7 sagittal vertical axis. Heterotopic ossification (HO) and anterior bone loss (ABL) were recorded. RESULTS: 78 patients were included. Clinical outcomes significantly improved. Of the three operation-related vertebrae, only middle vertebra decreased significantly in sagittal area at early follow-up. The four endplates that directly meet implants experienced significant early loss in length. Sagittal parameters were kept within an acceptable range. Both segments had a higher class of HO at last follow-up. More ABL happened to middle vertebra. The incidence and degree of ABL were higher for the endplates on middle vertebra only at early follow-up. CONCLUSION: Our findings indicated that after contiguous two-segment CDA, middle vertebra had a distinguishing morphological changing pattern that could be due to ABL, which deserves careful consideration before and during surgery.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study.

BACKGROUND: Patients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses. DESIGN: A retrospective, comparative study. METHOD: This study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region. RESULTS: A total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010). CONCLUSIONS: Nurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

[Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients].

Objective: To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. Methods: The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Results: Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up. Conclusion: Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery.

OBJECTIVE: Cable-dragged reduction and cantilever beam internal fixation can provide promising results in the treatment of atlantoaxial dislocation or instability. However, bilateral atlantoaxial joints bone autografting has not been conducted in this technique. We aim to evaluate the safety and effectiveness of bilateral atlantoaxial joints bone autografting in posterior cable-dragged reduction and cantilever-beam internal fixation. METHODS: In this retrospective study, we included 14 patients with a minimum 24-month follow-up from December 2019 to September 2020. The granular bone harvested from the iliac crest was packed into the bilateral atlantoaxial joints of 14 patients in posterior cable-dragged reduction and cantilever-beam internal fixation. X-ray imaging and cervical computed tomography (CT) were performed during follow-up. The time required for bone fusion was recorded. The clinical outcomes were evaluated using the JOA scores, NDI, and VAS scores. Mann-Whitney U test, the chi-squared test, or the Fisher exact test were used to compare the two groups regarding patient characteristics, clinical outcomes, bone fusion rates, and cervical sagittal alignment. RESULTS: The operations were successfully performed in all patients without any intraoperative complications. The mean operation time was (169.64 ± 20.91) minutes, and the intraoperative blood loss was (130.71 ± 33.62) mL. All patients received satisfactory reductions and firm bony fusion at the final follow-up. The fusion rates were 64.29% in the atlantoaxial joints and 21.43% in post bone graft area at 3 months postoperatively, and a significant difference was observed (p = 0.022). Besides, the cervical sagittal alignment in all patients was well maintained in the last follow-up compared to preoperatively. Importantly, a complete bony fusion in the atlantoaxial joints was observed in all patients. Moreover, the JOA, NDI, and VAS scores had improved significantly at the last follow-up. CONCLUSION: Bone autografting of the bilateral atlantoaxial joints is a safe and effective technique to increase bone fusion rates, shorten bone fusion time, and reduce complication rates when the cable-dragged reduction and cantilever beam internal fixation approach is used. Therefore, it is a cost-effective surgical procedure for treating patients with atlantoaxial dislocation or instability.

Lipid concomitant γ-oryzanol decreased oil absorbency of French fries by changing the microstructure of French fries and physical properties of frying oil.

BACKGROUND: The aim of this research was to evaluate the possibility of lipid concomitant γ-oryzanol reducing oil absorbency of fried foods and the underlying mechanism. Therefore, the influence of γ-oryzanol on moisture and oil content, and distribution and micromorphology of French fries and the viscosity, fatty acid composition and total polar compounds content of rice bran oil (RBO) after frying were studied. RESULTS: Our results showed that the incorporation of low concentration of γ-oryzanol [low addition group (LAG)] (5.754 g/kg) decreased the oil absorbency and porous structure of French fries during frying. Additionally, LAG incorporation inhibited the degradation of linoleic acid, decreased the growth rate of saturated fatty acids, total polar compounds and viscosity of frying oil. CONCLUSIONS: Consequently, it was recommended to incorporate a small amount of γ-oryzanol in frying oil because it could inhibit oil absorption behavior of French fries. © 2023 Society of Chemical Industry.

Anterior cervical X-shape-corpectomy and fusion vs. anterior cervical corpectomy and fusion for two-level cervical spondylosis.

PURPOSE: Anterior cervical X-shape-corpectomy and fusion (ACXF) is a novel cervical surgery, designed as partial alternative to the classic technique, anterior cervical corpectomy and fusion (ACCF). The aim of this study was to evaluate the early-stage outcomes of ACXF in treating two-level cervical spondylosis (CS) through comparisons with ACCF. METHODS: A retrospectively comparative study was conducted in two cohorts of patients who underwent single-vertebral ACXF or ACCF to treat two-level CS during September 2019 and October 2021. Clinical and radiological data of all the patients were collected from pre-operation to 1 year after the surgery, following by intra- and intergroup analyses and comparisons. RESULTS: Fifty-seven patients were included, with 24 undergoing ACXF and 33 undergoing ACCF. ACXF group had significantly shorter drainage duration (2.13 ± 0.61 days vs. 3.48 ± 1.30 days, P < 0.001) and less drainage volume (30.21 ± 26.88 ml vs. 69.30 ± 37.65 ml, P < 0.001) than ACCF group. Both techniques significantly improved all the clinical parameters (P < 0.01) with comparable effects (P > 0.05). Each complication rate in ACXF group was lower than that in ACCF group without significant difference (P > 0.05). ACXF showed a significantly smaller transverse decompression range than ACCF (11.93 ± 1.27 mm vs. 16.29 ± 1.88 mm, P < 0.001). Postoperatively, ACXF yielded a comparable fusion rate (P > 0.05) and a significantly lower subsidence rate (P < 0.01) than ACCF technique at all time points. CONCLUSIONS: ACXF is a potential surgical alternative for certain patients with two-level CS, as it provides both adequate decompression range and fewer adverse events than ACCF. The further modifications on ACXF worth exploration.

Overloaded vertebral body: a unique radiographic phenomenon following multilevel anterior cervical discectomy and fusion.

PURPOSE: Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB) phenomenon following multilevel zero-profile anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on radiographic outcomes. METHODS: We conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height [anterior (AH) and posterior (PH)] and anterior-posterior vertebral diameter [upper (UD) and lower (LD)]. RESULTS: The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p < 0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p < 0.01). CONCLUSIONS: OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.

Cervical Disc Arthroplasty for the Treatment of Noncontiguous Cervical Degenerative Disc Disease: Results of Mid- to Long-Term Follow-up.

OBJECTIVE: The long-term results of cervical disc arthroplasty (CDA) for noncontiguous cervical degenerative disc disease (CDDD) are still uncertain. Moreover, it is unclear whether CDA delays or avoids the degeneration of the intermediate segment (IS), leading to controversy in the field. Therefore, this study aimed to investigate the mid- to long-term clinical and radiographic outcomes of CDA in treating noncontiguous CDDD and to explore whether the IS degenerated faster after CDA than other non-surgically treated adjacent segments. METHODS: We retrospectively analyzed patients with noncontiguous CDDD who underwent CDA in our department between January 2008 and July 2018. The patients were divided into the CDA and hybrid surgery (HS) groups, and clinical and radiographic outcomes were evaluated at routine postoperative intervals. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS), while radiographic outcomes included cervical lordosis (CL), C2-C7 range of motion (ROM), segmental ROM, and disc angle (DA) at the arthroplasty level. Complications were also evaluated.Pre- and postoperative values were compared using paired t-tests or Wilcoxon rank-sum tests. Independent Student t-tests or Mann-Whitney U tests analyzed continuous data between CDA and HS groups, while chi-square or Fisher exact tests assessed categorical data. RESULTS: Sixty-four patients with noncontiguous CDDD, with 31 in the CDA group and 33 in the HS group, were evaluated. The mean follow-up time was over 70 months. The most frequently involved levels were C4/5 and C5/6. Both groups showed significant improvements in JOA, NDI, and VAS values after surgery. Although CL was maintained, the CL in the CDA group was consistently lower than that in the HS group (p < 0.05). There was a significant decrease in C2-C7 ROM (p < 0.05), but at the last follow-up, the C2-C7 ROM in the CDA group was greater than that in the HS group (p < 0.05). At the last follow-up, 44.3% of arthroplasty levels had developed heterotopic ossification (HO), and 48.45% had developed anterior bone loss (ABL). In addition, adjacent segment degeneration (ASDeg) was observed in the IS (22.7%), superior adjacent segment (20.6%)and inferior adjacent segment (21.9%). CONCLUSION: CDA or CDA combined with fusion are viable treatments for noncontiguous CDDD, with satisfactory outcomes after mid-to-long-term follow-up. ASDeg is similar in non-surgical segments after 70 months of follow-up. ROM of the IS issimilar to preoperative levels, indicating CDA does not increase the risk of IS degeneration.

Toxic vascular effects of polystyrene microplastic exposure.

Polystyrene microplastics (PSMPs) are some of the most common microplastic components, and the resulting pollution has become a global problem. Extensive studies have been conducted on the toxic effects of PSMPs on the heart, lungs, liver, kidneys, nerves, intestines and other tissues. However, the impact of PSMPs on vascular toxicity is poorly understood at present. The aim of this study was to reveal the vascular toxicity of microplastics (MPs). Patients were assigned to a calcification group (25 patients) or a non-calcification group (22 patients) based on the presence or absence of calcification in the thoracic aorta wall. We detected 7 polymer types in human feces. Patients with vascular calcification (VC) had higher levels of total MPs, polypropylene (PP) and polystyrene (PS) in feces than patients without VC. The thoracic aortic calcification score was significantly positively correlated with the total MP abundance (Spearman r = 0.8109, p < 0.0001), PP (Spearman r = 0.7211, p = 0.0160) and PS (Spearman r = 0.6523, p = 0.0471) in feces. We then explored the effects of PSMP exposure on normal and vitamin D3 + nicotine (VDN)-treated rats. PSMP exposure induced mild VC in normal rats and aggravated VC in VDN-treated rats. PSMP exposure disturbed the gut microbiota, causing Proteobacteria and Escherichia_Shigella to be the dominant phylum and genus, respectively. It also induced intestinal inflammatory responses in normal rats, aggravated intestinal inflammation in VDN-treated rats, impaired the intestinal mucosal barrier, and increased intestinal permeability. This study provides a theoretical basis for the risk assessment of MP-induced cardiovascular disease.

Sema3A alleviates the malignant behaviors of gastric cancer cells by inhibiting NRP-1.

AIMS AND OBJECTIVES: Semaphorin3A (Sema3a) is lowly expressed in the peripheral blood of gastric cancer patients, suggesting Sema3a may be involved in the progression of gastric cancer. Nevertheless, the specific role and the potential regulatory mechanism of Sema3a in gastric cancer is still obscure. Neuropilin-1 (NRP-1) has been reported to interact with Sema3a; herein, we intended to reveal the role and regulatory mechanism of Sema3a/neuropilin-1 (NRP-1) in gastric cancer progression. METHODS: Cell transfection was carried out to regulate gene expression. CCK-8 and colony formation assays were applied to estimate cell proliferation. Scratch assay and transwell assay were conducted to assess the cell migration and invasion abilities. Angiogenesis ability was assessed using a tubule-forming assay. The expression of corresponding genes and proteins were detected by RT-qPCR and western blot, respectively. RESULTS: Data showed that Sema3a was downregulated in gastric cancer cells and NRP-1 was upregulated. Sema3a overexpression repressed NRP-1 level in AGS cells. Overexpression of Sema3a inhibited cell proliferation, migration, and invasion abilities as well as epithelial-mesenchymal transition (EMT) of AGS cells. Overexpression of Sema3a inhibited tube formation and reduced the expression of VEGFA/VEGFR2 in AGS cells. However, the effects of Sema3a overexpression on the malignant behaviors in AGS cells were partly reversed by NRP-1 overexpression. Additionally, Sema3a overexpression enhanced the inhibitory effects of Ramucirumab, an anti-VEGFR2 agent, on the proliferative, migratory, and invasive capabilities as well as EMT in AGS cells. CONCLUSION: In conclusion, Sema3a alleviates the proliferation, migration, invasion, and angiogenesis capabilities of gastric cancer cells via repressing NRP-1. This finding may provide potential targets for gastric cancer therapy.

Cervical collar use following anterior cervical hybrid surgery: protocol for a prospective randomized, time-controlled trial.

INTRODUCTION: Cervical hybrid surgery (HS) combines anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) to establish an individualized surgical plan for patients with multiple cervical disc degenerative diseases. In order to maintain the stability of the spine after HS, an external cervical collar is often used. However, there is still controversy regarding the importance of a cervical collar following surgery. This study aims to determine whether the cervical collar is effective and how long it should be worn after surgery. METHODS: This is a randomized, single-center, prospective, parallel-controlled trial. Eligible participants will be selected according to the inclusion and exclusion criteria. The primary outcome is the neck disability index, which will be evaluated before surgery and at one week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months following surgery. The secondary outcomes consist of the Japanese Orthopedic Association Scores, MOS 36-item short-form health survey (SF-36), visual analog scale, Pittsburgh Sleep Quality Index (PSQI), Bazaz dysphagia scoring system, Falls Efficacy Scale, cervical collar satisfaction score, neck soft tissue assessment, and Braden Scale, as well as radiologic assessments for cervical lordosis, disc height of the operative levels, fusion rate, range of motion (ROM), and complications including anterior bone loss, prosthesis migration, and heterotopic ossification. The clinical and radiologic examinations were performed by investigators with no therapeutic relationship with the individual patient. All radiographs were examined by one independent radiologist. ETHICS AND DISSEMINATION: The results of this study will be published in peer-reviewed journals and presented at conferences. Upon completion of this trial, our findings could provide an appropriate cervical collar-wearing guideline for patients receiving HS. TRIAL REGISTRATION: ChiCTR.org.cn ChiCTR2000033002. Registered on 2020-05-17.

Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience.

INTRODUCTION: According to the different numbers and relative locations of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of this retrospective study was to compare the sagittal alignment parameters of HS and ACDF for cervical degenerative disc disease (CDDD) and the association of the respective parameters. METHODS: This study involved patients with three-level CDDD who underwent ACDF or HS at our institution between June 2012 and August 2021. This follow-up included one-level CDR and two-level ACDF (type I group), two-level CDR and one-level ACDF (type II group) and three-level ACDF. Cervical sagittal alignment parameters included cervical lordosis (CL), segment alignment (SA), T1 slope (T1S), C2-C7 sagittal vertical axis (SVA), T1S-CL, C2 slope (C2S), occipital to C2 angle (O-C2A) and segment range of motion (ROM). Postoperative complications included adjacent segment degeneration, imbalance, prosthetic subsidence and heterotopic ossification. RESULTS: The three groups with a total of 106 patients were better matched in terms of demographics. Patients who underwent HS had significantly higher CL than those who underwent ACDF at 1 week, 6 months, 12 months and the final follow-up after surgery, as well as significantly better SA at 12 months and the final follow-up. There was no significant difference in T1S, SVA, T1S-CL, C2S, O-C2A or segment ROM among the three groups after surgery. The T1S-CL was significantly associated with C2S in the type I and type II groups at the preoperative and final follow-up. There was no significant difference in postoperative complications among the three groups. CONCLUSIONS: Most improvements in cervical sagittal alignment (CL, SA, T1S, SVA, T1S-CL, C2S, O-C2A, and segmental ROM) were observed in all three groups postoperatively. HS was more advantageous than ACDF in the maintenance of postoperative CL and SA. Thus, three-level HS may be better for maintaining cervical curvature. The number of replacement segments differed in those who underwent HS but did not affect the correlation between T1S-CL and C2S, both of which are well balanced.

The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery.

Background: The cervical paraspinal muscle (CPM) has an essential role in positioning, stabilizing and directing the cervical spine. However, information is lacking regarding the influence of CPM on outcomes following anterior cervical surgery. This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes in patients undergoing hybrid surgery (HS) and analyze the relationship between FI and cross-sectional area (CSA) of CPM. Methods: A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level HS. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons. Results: Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p = 0.053). No statistically significant differences were presented among the three groups regarding pre- and postoperative clinical evaluation scores. The cervical lordosis was significantly higher in the normal group before surgery (p = 0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p = 0.046). The function spine unit angle and disc angle of arthroplasty levels were significantly lower in the severe group than the normal group at follow-ups. Moreover, after correction according to vertebral body area, no statistically significant relationship existed between CSA ratio and FI grade. Conclusion: CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and postoperative sagittal balance disorder, particularly in C2-7 SVA and segmental alignment of arthroplasty level. Meanwhile, FI of CPM appears to have no impact on clinical outcomes and reveals small correlations to CSA.

Cervical disc arthroplasty combined with two-level ACDF for the treatment of contiguous three-level cervical degenerative disc disease: A comparative study.

To compare the differences among constructs with one-level cervical disc arthroplasty (CDA) and two-level anterior cervical discectomy and fusion (ACDF). A retrospective study was conducted involving patients who underwent one-level CDA and two-level ACDF between June 2012 and July 2020. According to the different locations of CDA and ACDF, we divided the constructs into three types: type Ⅰa: CDA-ACDF-ACDF; type Ⅰb: ACDF-CDA-ACDF; type Ⅰc: ACDF-ACDF-CDA. The differences of clinical and radiological outcomes were evaluated. Fifty-three patients were included with 29 in type Ⅰa group, 11 in type Ⅰb group, and 13 in type Ⅰc group. After surgery, all groups showed significant improvement in apanese Orthopedic Association, Neck Disability Index, and Visual Analog Scale scores (p < 0.001). Range of motion (ROM) of the total cervical spine in type Ⅰc group decreased significantly compared with those in type Ⅰa and type Ⅰb groups (p < 0.05). No significant differences in ROM of the arthroplasty segment and the variations in ROM of the superior adjacent segment were observed among the three groups. The fusion rates of the superior ACDF segments were significantly higher at 6 and 12 months postoperatively than those of the inferior ACDF segments (p < 0.05). The clinical outcomes were similar among constructs concerning different locations of CDA and ACDF in three-level hybrid surgery. ROM of the cervical spine in type Ⅰc group decreased significantly compared with that in type Ⅰa and type Ⅰb groups. The fusion rates of superior ACDF segments were higher at early time points after surgery than those of inferior ACDF segments.

Ferric citrate-induced colonic mucosal damage associated with oxidative stress, inflammation responses, apoptosis, and the changes of gut microbial composition.

Ferric citrate (FC) has been used as an iron fortifier and nutritional supplement, which is reported to induce colitis in rats, however the underlying mechanism remains to be elucidated. We performed a 16-week study of FC in male healthy C57BL/6 mice (nine-month-old) with oral administration of Ctr (0.9 % NaCl), 1.25 % FC (71 mg/kg/bw), 2.5 % FC (143 mg/kg/bw) and 5 % FC (286 mg/kg/bw). FC-exposure resulted in colon iron accumulation, histological alteration and reduce antioxidant enzyme activities, such as glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and total antioxidant capacity (T-AOC), together with enhanced lipid peroxidation level, including malondialdehyde (MDA) level and 4-Hydroxynonenal (4-HNE) protein expression. Exposure to FC was associated with upregulated levels of the interleukin (IL)- 6, IL-1ß, IL-18, IL-8 and tumor necrosis factor α (TNF-α), while down-regulated levels of IL-4 and IL-10. Exposure to FC was positively associated with the mRNA and protein expressions of cysteine-aspartic proteases (Caspase)- 9, Caspase-3, Bcl-2-associated X protein (Bax), while negatively associated with B-cell lymphoma 2 (Bcl2) in mitochondrial apoptosis signaling pathway. FC-exposure changed the diversity and composition of gut microbes. Additionally, the serum lipopolysaccharide (LPS) contents increased in FC-exposed groups when compared with the control group, while the expression of colonic tight junction proteins (TJPs), such as Claudin-1 and Occludin were decreased. These findings indicate that the colonic mucosal injury induced by FC-exposure are associated with oxidative stress generation, inflammation response and cell apoptosis, as well as the changes in gut microbes diversity and composition.

D-galactose protects the intestine from ionizing radiation-induced injury by altering the gut microbiome.

This article aims to investigate the protection of the intestine from ionizing radiation-induced injury by using D-galactose (D-gal) to alter the gut microbiome. In addition, this observation opens up further lines of research to further increase therapeutic potentials. Male C57BL/6 mice were exposed to 7.5 Gy of total body irradiation (TBI) or 13 Gy of total abdominal irradiation (TAI) in this study. After adjustment, D-gal was intraperitoneally injected into mice at a dose of 750 mg/kg/day. Survival rates, body weights, histological experiments and the level of the inflammatory factor IL-1ß were observed after TBI to investigate radiation injury in mice. Feces were collected from mice for 16S high-throughput sequencing after TAI. Furthermore, fecal microorganism transplantation (FMT) was performed to confirm the effect of D-gal on radiation injury recovery. Intraperitoneally administered D-gal significantly increased the survival of irradiated mice by altering the gut microbiota structure. Furthermore, the fecal microbiota transplanted from D-gal-treated mice protected against radiation injury and improved the survival rate of recipient mice. Taken together, D-gal accelerates gut recovery following radiation injury by promoting the growth of specific microorganisms, especially those in the class Erysipelotrichia. The study discovered that D-gal-induced changes in the microbiota protect against radiation-induced intestinal injury. Erysipelotrichia and its metabolites are a promising therapeutic option for post-radiation intestinal regeneration.

Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

PURPOSE: To investigate the relationship between the preoperative paraspinal Goutalier grade of fatty infiltration and postoperative cervical sagittal alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS: A total of 101 patients who underwent single-level ACDF with the Zero-profile implant system between March 2011 and April 2020 were included in this study. Cervical sagittal alignment parameters, including the C2-C7 Cobb angle, functional spinal unit (FSU) angle, cervical sagittal vertical axis (SVA), and T1 slope (T1S), were assessed. Preoperative magnetic resonance images were used to classify patients according to Goutalier grade. Clinical outcomes including Neck Disability Index (NDI) scores, Japanese Orthepaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores were collected and analyzed. RESULTS: According to the Goutalier grade, 33 patients were classified as Goutalier 0-1 (Group A), 44 were classified as Goutalier 1.5-2 (Group B), and 24 were classified as Goutalier 2.5-4.0 (Group C). The mean age among the three groups showed significant differences (P = 0.007). At the last follow-up, the C2-C7 Cobb angle, FSU angle, and T1S improved after the surgery among the groups. Although there were varying degrees of loss of curvature among the different groups during the follow-up period, the postoperative cervical sagittal alignment parameters demonstrated no statistical differences among the three groups (P > 0.05). In addition, patients in all groups experienced significant relief of their symptoms, and the clinical scores were comparable among the groups (P > 0.05). CONCLUSION: The complex nature of anterior cervical surgery requires surgical attention both in decompression and sagittal alignment. Our study demonstrates satisfactory postoperative cervical sagittal alignment of patients despite different grades of fatty infiltration of the multifidus muscle following single-level ACDF. Based on our results, the improvement and maintenance of cervical sagittal alignment after ACDF remains a complex problem that spine surgeons should consider before surgery.

Ameliorating Effects of TRIM67 against Intestinal Inflammation and Barrier Dysfunction Induced by High Fat Diet in Obese Mice.

Tripartite Motif 67 (TRIM67) is an important member of TRIM family proteins, which participates in different cellular processes including immune response, proliferation, differentiation, carcinogenesis, and apoptosis. In recent years, a high fat diet (HFD) has remained one of the main causes of different metabolic diseases and increases in intestinal permeability as well as inducing intestinal inflammation. The current study investigated the protective effects of TRIM67 in the ileum and colon of obese mice. 4-week-old wild-type (WT) C57BL/6N mice and TRIM67 knockout (KO) C57BL/6N mice were selected and randomly divided into four sub-groups, which were fed with control diet (CTR) or HFD for 14 weeks. Samples were collected at the age of 18 weeks for analysis. To construct an in vitro obesity model, over-expressed IPEC-J2 cells (porcine intestinal cells) with Myc-TRIM67 were stimulated with palmitic acid (PA), and its effects on the expression level of TRM67, inflammatory cytokines, and barrier function were evaluated. The KO mice showed pathological lesions in the ileum and colon and this effect was more obvious in KO mice fed with HFD. In addition, KO mice fed with a HFD or CTR diet had increased intestinal inflammation, intestinal permeability, and oxidative stress compared to that WT mice fed with these diets, respectively. Moreover, IPEC-J2 cells were transfected with TRIM67 plasmid to perform the same experiments after stimulation with PA, and the results were found consistent with the in vivo evaluations. Taken together, our study proved for the first time that HFD and TRIM67 KO mice have synergistic damaging effects on the intestine, while TRIM67 plays an important protective role in HFD-induced intestinal damage.

Is there a difference in the outcomes of anterior cervical discectomy and fusion among female patients with different menopausal statuses?

BACKGROUND: The surgical outcomes of anterior cervical discectomy and fusion (ACDF) in female patients according to menopausal status remain unclear. The objective of this study was to investigate the differences in these outcomes among female patients with different menopausal statuses. METHODS: Ninety-one patients undergoing single-level or consecutive two-level ACDF with a minimum 12-month postoperative follow-up were included in this study. There were 38 patients in the premenopausal group, 28 patients in the early postmenopausal group, and 25 patients in the late postmenopausal group. The clinical outcomes were evaluated by means of the neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, and visual analog scale (VAS) scores. Radiological parameters included cervical lordosis (CL), the functional spinal unit (FSU) angle, range of motion (ROM) of the total cervical spine, ROM of the FSU, anterior and posterior FSU height, implant subsidence, adjacent segment degeneration (ASD), and Hounsfield unit (HU) values. RESULTS: All groups showed significant improvements in their JOA, VAS, and NDI scores (P < 0.05). The differences in preoperative and final follow-up CL, ROM of C2-7, FSU angle, and ROM of FSU were not statistically significant among the three groups (P > 0.05). The anterior FSU height loss rate showed a significant difference (P = 0.043), while there was no difference in the posterior FSU height loss rate (P = 0.072). The fusion rates in the early and late postmenopausal groups were consistently lower than those in the premenopausal group during the follow-up period. All patients had satisfactory outcomes at the final follow-up. CONCLUSION: There were no significant differences in clinical or other related outcomes of single-level or consecutive two-level ACDF in the long term among female patients with different menopausal statuses. However, the early bony fusion rates and anterior FSU height loss rates were poorer in late postmenopausal patients than in premenopausal or early postmenopausal patients. Hence, importance should be attached to the protection of late postmenopausal patients in the early postoperative period to guarantee solid bony fusion.