The morphological discrepancy of neuromuscular junctions between bilateral paraspinal muscles in patients with adolescent idiopathic scoliosis: A quantitative immunofluorescence assay.

Introduction: Prior studies suggested that neuromuscular factors might be involved in the pathogenesis of adolescent idiopathic scoliosis (AIS). The neuromuscular junction (NMJ) is the important pivot where the nervous system interacts with muscle fibers, but it has not been well characterized in the paraspinal muscles of AIS. This study aims to perform the quantitative morphological analysis of NMJs from paraspinal muscles of AIS. Methods: AIS patients who received surgery in our center were prospectively enrolled. Meanwhile, age-matched congenital scoliosis (CS) and non-scoliosis patients were also included as controls. Fresh samples of paraspinal muscles were harvested intraoperatively. NMJs were immunolabeled using different antibodies to reveal pre-synaptic neuronal architecture and post-synaptic motor endplates. A confocal microscope was used to acquire z-stack projections of NMJs images. Then, NMJs images were analyzed on maximum intensity projections using ImageJ software. The morphology of NMJs was quantitatively measured by a standardized 'NMJ-morph' workflow. A total of 21 variables were measured and compared between different groups. Results: A total of 15 AIS patients, 10 CS patients and 5 normal controls were enrolled initially. For AIS group, NMJs in the convex side of paraspinal muscles demonstrated obviously decreased overlap when compared with the concave side (34.27% ± 8.09% vs. 48.11% ± 10.31%, p = 0.0036). However, no variables showed statistical difference between both sides of paraspinal muscles in CS patients. In contrast with non-scoliosis controls, both sides of paraspinal muscles in AIS patients demonstrated significantly smaller muscle bundle diameters. Conclusions: This study first elucidated the morphological features of NMJs from paraspinal muscles of AIS patients. The NMJs in the convex side showed smaller overlap for AIS patients, but no difference was found in CS. This proved further evidence that neuromuscular factors might contribute to the mechanisms of AIS and could be considered as a novel potential therapeutic target for the treatment of progressive AIS.

Factors that influence in-brace derotation effects in patients with adolescent idiopathic scoliosis: a study based on EOS imaging system.

OBJECTIVE: To investigate the effects of bracing on apical vertebral derotation and explore the factors that influence in-brace derotation effects in adolescent idiopathic scoliosis (AIS) patients. For patients with AIS, vertebral rotation causes cosmetic appearance abnormalities and acts as an indicator for curve progression. However, there have been few studies investigating the precise derotation effects of bracing for apical vertebra. The application of EOS imaging system enables quantitative evaluation of vertebral rotation in the axial plane in a standing position. METHODS: There were 82 eligible patients enrolled in current study, who underwent EOS imaging evaluation before and immediately after bracing. The clinical demographic data (age, gender, Risser sign and menstrual status) were recorded. The correlation analyses between derotation effects and key parameters (age, pre-brace Cobb angle, thoracic kyphosis, lumbar lordosis, vertebral rotation, pelvis axial rotation and apical vertebral level) were performed. The in-brace derotation effects stratified by gender, Risser sign, apical vertebral level, menarche status, coronal balance and sagittal balance were also analyzed. RESULTS: The rotation of apical vertebra was decreased from 8.8 ± 6.0 degrees before bracing to 3.8 ± 3.3 degrees immediately after bracing (p < 0.001), and the derotation rate was 49.2 ± 38.3%. The derotation degrees in brace was significantly correlated with major curve Cobb angle (r = 0.240, p = 0.030), minor curve Cobb angle (r = 0.256, p = 0.020) and total curve Cobb angle (r = 0.266, p = 0.016). Both the pre-brace apical vertebral rotation and apical vertebral level were significantly correlated with derotation effects in brace (p < 0.001). Patients with thoracic major curve showed worse derotation effects than those with lumbar major curve (p < 0.001). In addition, patients with coronal balance showed better in-brace derotation effects than those with coronal decompensation (p = 0.005). CONCLUSIONS: A satisfactory apical vertebral derotation rate (approximately 50%) could be obtained immediately after bracing in AIS patients. Pre-brace Cobb angle of curve, pre-brace apical vertebral rotation, apical vertebral level and coronal balance exhibited close associations with in-brace derotation effects of apical vertebra.

[Research progress on the role of N6-methyladenosine methylation in the pathogenesis and development of respiratory diseases].

N6-methyladenosine (m6A) is one of the most common post-transcriptional modifications of eukaryotic mRNA. The m6A modification accelerates mRNA metabolism and translation, and plays an important role in cell differentiation, embryonic development and stress response. As a reversible epigenetic modification, m6A modification plays an important role in many physiological and pathological processes. The m6A modification is closely related to the occurrence and progression of respiratory diseases, and the m6A modification regulatory factor may be a potential target for regulating respiratory diseases. This article reviews the role of m6A modification in the development of respiratory diseases such as lung cancer, acute lung injury (ALI), asthma, pulmonary fibrosis, and chronic obstructive pulmonary disease (COPD). The purpose of m6A modification is to provide a reference for the pathogenesis of respiratory diseases and the study of targets.

Recent advances in the therapeutic potential of nobiletin against respiratory diseases.

BACKGROUND: Nobiletin is a natural polymethoxylated flavonoid widely present in citrus fruit peels. It has been demonstrated to exert the effects of anti-tumor, anti-inflammation, anti-oxidative, anti-apoptotic and improve cardiovascular function. Increasing evidences suggest that nobiletin plays an important role in respiratory diseases (RDs) treatment. OBJECTIVE: This review aimed to investigate the therapeutic potential of nobiletin against RDs, such as lung cancer, COPD, pulmonary fibrosis, asthma, pulmonary infection, acute lung injury, coronavirus disease 2019, and pulmonary arterial hypertension. METHODS: We retrieved extensive literature of relevant literatures in English until June 26, 2023 from the database of PubMed, Web of Science, and Scopus databases. The keywords of "nobiletin and lung", "nobiletin and respiratory disease", "nobiletin and chronic respiratory diseases", "nobiletin and metabolites", "nobiletin and pharmacokinetics", "nobiletin and toxicity" were searched in pairs. A total of 298 literatures were retrieved from the above database. After excluding the duplicates and reviews, 53 were included in the current review. RESULTS: We found that the therapeutic mechanisms are based on different signaling pathways. Firstly, nobiletin inhibited the proliferation and suppressed the invasion and migration of cancer cells by regulating the related pathway or key target, like Bcl-2, PD-L1, PARP, and Akt/GSK3ß/ß-catenin in lung cancer treatment. Secondly, nobiletin treats COPD and ALI by targeting classical signaling pathway mediating inflammation. Besides, the available findings show that nobiletin exerts the effect of PF treatment via regulating mTOR pathway. CONCLUSIONS: With the wide range of pharmacological activities, high efficiency and low toxicity, nobiletin can be used as a potential agent for preventing and treating RDs. These findings will contribute to further research on the molecular mechanisms of nobiletin and facilitate in-depth studies on nobiletin at both preclinical and clinical levels for the treatment of RDs.

[Effects of conditioned medium of alveolar epithelial cells on vascular endothelial cell damage].

OBJECTIVE: To observe the effect of lipopolysaccharide (LPS) induced conditioned medium of alveolar epithelial cells on the inflammatory response and cell damage of vascular endothelial cells, and explore its mechanism. METHODS: The LPS induced type II alveolar epithelial cells (A549) conditioned medium was used as a stimulus to induce human umbilical vein endothelial cells (HUVEC) damage. The cell counting kit-8 (CCK-8) was used to detect the effect of 0% (blank group), 12.5%, 25%, 50%, 75% and 100% A549 cell conditioned medium cultured for 6, 12, 24 and 48 hours on the cell viability of HUVEC. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and vasoactive substances [vascular endothelial growth factor (VEGF), endothelin-1 (ET-1)] in the supernatant. Phalloidin staining was used to observe the effects of A549 cells conditioned medium on cell morphology. The expressions of protein kinase B/nuclear factor-κB (AKT/NF-κB) pathway in HUVEC induced by conditioned medium was detected by Western blotting. RESULTS: Compared with the blank group, A549 cells conditioned medium with concentrations of 12.5%, 25%, and 50% had no significant effects on cell viability of HUVEC after 6, 12, and 24 hours, but the activity of HUVEC decreased significantly after 48 hours. Therefore, 12.5%, 25%, 50% A549 cell conditioned medium stimulated for 24 hours was selected as the induction condition for follow-up experiments. Compared with the blank group, the level of IL-6 was significantly increased in 12.5% and 50% conditioned medium groups (ng/L: 2 438.95±64.89, 3 036.41±96.69 vs. 1 736.75±20.99, both P < 0.05), the level of TNF-α was significantly increased in 12.5% and 25% conditioned medium groups (ng/L: 174.08±11.09, 81.37±8.17 vs. 50.03±0.26, both P < 0.01), the levels of VEGF and ET-1 were significantly increased in 12.5%, 25% and 50% conditioned medium groups [VEGF (ng/L): 173.60±41.44, 192.49±12.38, 318.89±27.90 vs. 66.68±19.65; ET-1 (ng/L): 54.88±1.37, 36.69±0.29, 24.07±0.73 vs. 10.67±0.25, all P < 0.01]. Phalloidin staining showed that HUVEC induced by 25% A549 cells conditioned medium were irregular in shape, uneven in size, disordered in arrangement, widened in gap, dense and unclear in microfilament structure and serrated in cell membrane. Furthermore, the average fluorescence intensity of 25% conditioned medium group significantly increased compared to the blank group (67 205.60±3 430.40 vs. 56 272.67±7 650.95, P < 0.05). Western blotting showed that compared with the blank group, the expression of HUVEC cells phosphonated inhibitor α of NF-κB (p-IκBα) was significantly decreased in the 12.5%, 25%, and 50% conditioned medium groups (p-IκBα/IκBα: 0.38±0.08, 0.67±0.12, 0.31±0.07 vs. 1.00±0.00, all P < 0.01), the expressions of phosphonated-AKT (p-AKT) and VEGF were significantly increased (p-AKT/AKT: 1.50±0.18, 1.42±0.27, 1.61±0.14 vs. 1.00±0.00, VEGF/GAPDH: 1.37±0.10, 1.53±0.22, 1.40±0.12 vs. 1.00±0.00, all P < 0.05), the expression of phosphonated NF-κB p65 (p-P65) was significantly increased in the 25% conditioned medium group (p-P65/P65: 1.45±0.14 vs. 1.00±0.00, P < 0.05). CONCLUSIONS: LPS induced conditional culture medium of alveolar epithelial cells induced endothelial cell damage via activating AKT/NF-κB pathway.

Multi-omics analysis of small RNA, transcriptome, and degradome to identify putative miRNAs linked to MeJA regulated and oridonin biosynthesis in Isodon rubescens.

Isodon rubescens has garnered much attention due to its anti-tumor or anti-cancer properties. However, little is known about the molecular mechanism of oridonin biosynthesis leveraging the regulatory network between small RNAs and mRNAs. In this study, the regulatory networks of miRNAs and targets were examined by combining mRNA, miRNA, and degradome. A total of 348 miRNAs, including 287 known miRNAs and 61 novel miRNAs, were identified. Among them, 51 miRNAs were significantly expressed, and 36 miRNAs responded to MeJA. A total of 3066 target genes were associated with 228 miRNAs via degradome sequencing. Multi-omics analysis demonstrated that 27 miRNA-mRNA pairs were speculated to be involved in MeJA regulation, and 36 miRNA-mRNA pairs were hypothesized to be involved in the genotype-dependence of I. rubescens. Furthermore, 151 and 7 miRNA-mRNA modules were likely engaged in oridonin biosynthesis as identified by psRNATarget and degradome sequencing, respectively. Some miRNA-mRNA modules were confirmed via RT-qPCR. Moreover, miRNAs targeting plant hormone signal transduction pathway genes were identified, such as miR156, miR167, miR393, and PC-3p-19822_242. Collectively, our results demonstrate for the first time that miRNAs are identified in I. rubescens, and laid a solid foundation for further research on the molecular mechanism of oridonin biosynthesis mediated by miRNA.

Descending Neurogenic Evoked Potentials Monitoring Is an Effective Alternative in Spinal Deformity Surgery Under Inhaled Anesthesia.

BACKGROUND: To evaluate the reliability of descending neurogenic evoked potentials (DNEP) monitoring in spinal deformity surgery under inhaled anesthesia. METHODS: A total of 180 consecutive patients who underwent spinal deformity surgery in our scoliosis center from July 2014 to August 2016 were reviewed. Intraoperative monitoring including somatosensory evoked potentials (SEP), motor evoked potentials (MEP), and DNEP was conducted routinely throughout operation. Patients were divided into 2 groups according to anesthesia methods: group A (n = 72, inhaled anesthesia, SEP/DNEP) and group B (n = 108, total intravenous anesthesia, SEP/MEP/DNEP). Intraoperative monitoring data were collected and analyzed. RESULTS: Positive alerts were observed in 26 patients (14.5%), of whom 18 (10%) were confirmed as true-positive events in the study population. No false-negative events were recorded. In group A, the sensitivity and specificity of SEP and DNEP were 100% and 93.8% and 100% and 98.5%, respectively. For group B, the sensitivity and specificity of SEP/MEP and DNEP were 100% and 95.9% and 100% and 98%, respectively. CONCLUSIONS: DNEP monitoring seemed to be effective for the detection and prevention of iatrogenic neurologic deficits during spinal deformity surgery. This study indicates that DNEP was an effective alternative in spinal deformity surgery under inhaled anesthesia.

Effective-component compatibility of Bufei Yishen formula alleviates chronic obstructive pulmonary disease inflammation by regulating GSK3ß-mediated NLRP3 inflammasome activation.

Glycogen synthase kinase 3ß (GSK3ß) has been associated with sensing many different stimuli to trigger the NLRP3 inflammasome, which plays a crucial role in promoting the inflammatory response in diseases, including chronic obstructive pulmonary disease (COPD). Bufei Yishen formula (BYF), a traditional Chinese herbal medicine, has beneficial effects on COPD. Effective-component compatibility of BYF (ECC-BYF), optimized from BYF, is equally effective as BYF in inhibiting COPD inflammation. However, the exact mechanism by which ECC-BYF regulates the activation of NLRP3 inflammasome to inhibit COPD inflammation remains unclear. Hence, we investigated the mechanisms underlying the alleviation of COPD inflammation by ECC-BYF through the inhibition of GSK3ß-mediated NLRP3 inflammasome activation by experimental rat model of COPD and lipopolysaccharide/adenosine triphosphate (LPS/ATP) induced macrophages. The data showed that ECC-BYF significantly improved the lung function, attenuated histopathological damage, and alleviated inflammatory cell infiltration and alveolar destruction. Further, it significantly inhibited inflammatory cytokine production and downregulated the phosphorylation of GSK3ß by inhibiting the activation of NLRP3 inflammasome in the rat model of COPD. Moreover, ECC-BYF suppressed the activation of the NLRP3 inflammasome by increasing the phosphorylation at serine 9 and decreasing the phosphorylation at tyrosine 216 of GSK3ß, followed by the inhibition of IL-1ß secretion in macrophages. Together, ECC-BYF effectively ameliorates COPD by suppressing inflammation, which is dependent on the regulation of GSK3ß-mediated NLRP3 inflammasome activation.

Type 3 bone-disc-bone osteotomy (grade 4+ osteotomy) combined with presurgical halo-pelvic traction: a safe and effective solution to correct severe angular-like kyphoscoliosis.

Background: Treatment of severe angular-like kyphoscoliosis is a technically demanding surgical challenge and requires high-risk spinal osteotomy, such as vertebral column resection. Preoperative halo-pelvic traction is commonly used to decrease the curve magnitude. However, few studies have utilized the potent method of bone-disc-bone osteotomy, which could theoretically provide correction up to 60°. This study aimed to evaluate the safety and effectiveness of type 3 bone-disc-bone osteotomy combined with presurgical halo-pelvic traction to correct severe angular-like kyphoscoliosis. Methods: This was a retrospective cohort study. Patients with severe angular-like kyphoscoliosis who underwent presurgical halo-pelvic traction and type 3 bone-disc-bone osteotomy from January 2017 to December 2019 were consecutively reviewed. Patient demographics and clinical data were recorded. The coronal and sagittal Cobb angles were measured preoperation, post-traction, post-operation, and at the final follow-up. Complications were also recorded. Patients' health-related quality of life was evaluated by the Scoliosis Research Society 22 (SRS-22) questionnaire. Paired Student's t test and one-way analysis of variance were used for comparisons among different groups. Results: Thirty patients (18 females and 12 males) with an average age of 20.2 years (range, 13-33 years) were included. The mean preoperative coronal and sagittal Cobb angles were 123.1°±16.4° (range, 90°-155°) and 120.3°±19.9° (range, 90°-156°), respectively. After 2.9±0.7 months (range, 2-4 months) of halo-pelvic traction, the coronal and sagittal Cobb angles decreased significantly to 81.9°±13.2° and 76.0°±12.6°, respectively. Postoperatively, the scoliotic and kyphotic angles further decreased to 42.4°±12.2° and 33.9°±8.8°, respectively. After a mean follow-up of 2.93±1.05 years, the correction rates were maintained at 64.3%±10.6% and 70.5%±6.3%, respectively. Nine patients experienced positive evoked potential events during surgery. Common complications after surgery included transient lower extremity weakness, pneumonia, and pleural effusion. The self-image scores were significantly improved from 2.66±0.27 to 3.36±0.23 compared to preoperation. Conclusions: This study proposes a novel strategy to correct severe angular-like spinal deformities. The combination of presurgical halo-pelvic traction and type 3 bone-disc-bone osteotomy (grade 4+ osteotomy) achieves substantial correction and satisfactory aesthetic outcomes without serious complications.

The asymmetrical ESR1 signaling in muscle progenitor cells determines the progression of adolescent idiopathic scoliosis.

Adolescent Idiopathic Scoliosis (AIS) is a common pediatric skeletal disease highly occurred in females. The pathogenesis of AIS has not been fully elucidated. Here, we reveal that ESR1 (Estrogen Receptor 1) expression declines in muscle stem/progenitor cells at the concave side of AIS patients. Furthermore, ESR1 is required for muscle stem/progenitor cell differentiation and disrupted ESR1 signaling leads to differentiation defects. The imbalance of ESR1 signaling in the para-spinal muscles induces scoliosis in mice, while reactivation of ESR1 signaling at the concave side by an FDA approved drug Raloxifene alleviates the curve progression. This work reveals that the asymmetric inactivation of ESR1 signaling is one of the causes of AIS. Reactivation of ESR1 signaling in para-spinal muscle by Raloxifene at the concave side could be a new strategy to treat AIS.

How to select the lowest instrumented vertebra in NF-1 non-dystrophic scoliosis.

PURPOSE: To investigate lowest instrumented vertebra (LIV) selection strategy for neurofibromatosis type 1 (NF-1) non-dystrophic scoliosis. METHODS: Consecutive eligible subjects with NF-1 non-dystrophic scoliosis were included. All patients were followed up at least for 24 months. Enrolled patients with LIV in stable vertebra were divided into stable vertebra group (SV group), and the other patients with LIV above the stable vertebra were divided into above stable vertebra group (ASV group). Demographic data, operative data, preoperative and postoperative radiographic data, and clinical outcome were collected and analyzed. RESULTS: There were 14 patients in SV group (ten males and four females, mean age 13.9 ± 4.1 years) and 14 patients in ASV group (nine males and five females, mean age 12.9 ± 3.5 years). The mean follow-up period was 31.7 ± 17.4 months for patients in SV group and 33.6 ± 17.4 months for patients in ASV group, respectively. No significant differences were found in demographic data between two groups. The coronal Cobb angle, C7-CSVL, AVT, LIVDA, LIV tilt and SRS-22 questionnaire outcome significantly improved at the final follow-up in both groups. However, significantly higher loss of correction rate and increasement of LIVDA were found in ASV group. Two patients (14.3%) in ASV group but none in SV group suffered adding-on phenomenon. CONCLUSIONS: Although patients in both SV and ASV groups obtained improved therapeutic efficacy at final follow-up, the radiographic and clinical outcome seemed more likely to deteriorate in ASV group after surgery. The stable vertebra should be recommended as LIV for NF-1 non-dystrophic scoliosis.

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies.

BACKGROUND: Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD. METHODS: We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS: This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD. CONCLUSION: The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

Intensive bracing management combined with physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis patients with a major curve ranging from 40-60° who refused surgery: a prospective cohort study.

BACKGROUND: Current guidelines for brace management of adolescent idiopathic scoliosis (AIS) are mostly recommended for curves between 25° to 40°. For AIS patients with curves >40°, surgery is often considered since bracing may be less effective; however, there are still some patients and families who refuse operation. Therefore, further research is necessary to determine optimal bracing management in this group. To date, few protocols for such have been reported in literature. AIM: The aim of this study was to introduce and evaluate the effectiveness of the treatment protocol comprising of intensive bracing management and physiotherapeutic scoliosis-specific exercises (PSSE) in AIS patients with a major curve of 40-60° who refuse surgery. DESIGN: This is a prospective cohort study. SETTING: The study was carried out in an outpatient clinic. POPULATION: 10-18-year-old AIS patients having 40-60°curves and a Risser grade of 0-3, but firmly refusing surgery were eligible. Patients who had a proximal thoracic curve or had undergone any other form of treatment previously were excluded from the study. METHODS: A total of 82 patients were recruited and received the treatment. The primary outcome was defined as "success" when the main curve was below 50° upon reaching skeletal maturity, and "failure" if otherwise. The secondary outcome was defined as improved (>5° reduction), unchanged (≤5° change) or progressed (>5° increase) based on the evolution of the main curve. The per protocol (PP) and intent to treat (ITT) analyses were performed to quantify success rates, while the dropouts were considered as failures. Risk factors associated with bracing failure were identified and a receiver operating characteristic (ROC) curve was used to determine the cut-off value. RESULTS: A total of 77 patients completed the treatment, while 5 dropped out. The average main curve was 47.40±5.93° at baseline and 38.56±11.85° at last follow-up (P<0.001). Our management was successful in 83% and 78% of patients based on the PP and ITT analyses, respectively. When compared with the curve magnitude at baseline, 65% patients improved, 30% remained unchanged, and 5% progressed when using a 5° threshold. Univariate comparison and logistic regression analysis demonstrated that patients with successful outcomes had a significantly smaller baseline curve, larger Risser Stage, and larger in-brace correction (IBC) rate. CONCLUSIONS: For AIS patients with 40-60° curves who refused surgery, our intensive bracing management along with PSSE was practical and effective, achieving success in 78% of patients based on an ITT analysis. A larger baseline curve, smaller Risser Stage, and smaller IBC rate were associated with treatment failure. CLINICAL REHABILITATION IMPACT: Our intensive management provides new insights into improving the effectiveness of bracing in patients with AIS who refuse surgery. This is a promising option for patients with 40-60° curves, since their scoliosis may be treated using a non-surgical technique instead of surgery in the future.

One-stage Spine-shortening Osteotomy Treated Severe Spinal Deformity Associated With Spinal Cord Malformations.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To evaluate the safety and efficacy of spine-shortening using 1-stage 3-column osteotomy for a severe rigid spinal deformity with a spinal cord malformation (SCM). SUMMARY OF BACKGROUND DATA: One-stage spine-shortening osteotomy has been suggested for the treatment of a tethered spinal cord. However, the safety and efficacy of 1-stage spine-shortening osteotomy for the treatment of a severe spinal deformity with an SCM is not known. METHODS: The records of 32 patients with a severe spinal deformity and SCM treated with spine-shortening using 3-column osteotomy from January 2010 to December 2016 were analyzed retrospectively. Intraoperative neurophysiological monitoring was used in all cases. Imaging parameters and neurological complications were analyzed to evaluate clinical safety and efficacy. RESULTS: Spine-shortening using a 3-column osteotomy was conducted successfully in all 32 patients. The mean main coronal curve and maximum kyphotic angle were corrected from 119.8 and 119.1 degrees to 58.6 and 53.9 degrees, respectively, with the corrective rate of 51.4% and 54.3%. The mean correction loss of the major coronal curve and maximum kyphosis was 2.3 and 2.6 degrees, respectively, at a mean follow-up of 73.6 months. Intraoperative monitoring events occurred in 9 patients; of these 9 patients, 3 suffered transient SC injury, and all recovered within 1 year without suffering permanent paralysis. CONCLUSIONS: Spine-shortening using a 3-column osteotomy seems to be safe and efficacious for treating a severe spinal deformity with an SCM. A deep understanding of the method and intensive intraoperative neuromonitoring improved the safety of this challenging and complex surgical procedure.

Efficacy and safety of Chinese herbal medicine Wuwei Xiaodu Drink for wound infection: A protocol for systematic review and meta-analysis.

BACKGROUND: Wound infection (WI) is a disease in which pathogenic bacteria invade and multiply in a wound after trauma or surgery, causing a systemic inflammatory response. WI triggers an immune response in the body, resulting in inflammation and tissue damage, as well as slowing down the healing process. The traditional Chinese medicine prescription of Wuwei Xiaodu Drink (WWXDD) has been widely used in clinical practice with good results. However, there is no high-level evidence to support this result. The purpose of this study was to evaluate the efficacy and safety of WWXDD in the treatment of WI. METHODS: We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), Chinese databases SinoMed (CBM), PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction on language and status, the time from the establishment of the database to October 2022. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software (Cochrane Collaboration). RESULTS: What this study will do is evaluate the efficacy and safety of WWXDD in the treatment of WI in order to provide high quality, evidence-based clinical recommendations. CONCLUSION: This research provides a trusted clinical foundation for the treatment of WI with WWXDD.

Postural habits and lifestyle factors associated with adolescent idiopathic scoliosis (AIS) in China: results from a big case-control study.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most prevalent type of scoliosis affecting children between the ages of 10-16 years. However, risk factors for AIS, particularly the modifiable ones, are still largely unknown. This study aims to investigate the associations of lifestyle and social environment factors with AIS in Chinese schoolchildren. METHODS: This is a matched case-control study based on survey data collected from school-based scoliosis screening program. We used conditional logistic regression models to describe the relative risk of AIS incidence for each variable in the analyses. To examine the independent effect of each factor on developing AIS, a multivariate conditional logistic regression was conducted and odds ratios (ORs) were adjusted for age and other significant variables. RESULTS: Overall, 2538 participants from 49 schools were included in this study, comprising 1269 AIS cases and 1269 controls. Mean age of the study population was 13.4 years ± 1.06 (range 10-18). One thousand five hundred and fifty (61.1%) of the study subjects were girls. After adjusting for other significant factors, inappropriate desk heights, either too low (OR = 1.40, 95% CI 1.04-1.90) or too high (OR = 1.61, 95% CI 1.09-2.38), standing with anterior pelvic tilt (OR = 2.73, 95% CI 1.41-5.28), and sleeping on the right side (OR = 1.38, 95% CI 1.00-1.91), remained associated with elevated AIS risks. In contrast, sitting normally and classroom sitting positions change regularly were associated with lower odds of AIS. The adjusted ORs were 0.69 (95% CI 0.50-0.96) for sitting normally, and 0.72 (95% CI 0.53-0.98) for sitting positions change. CONCLUSIONS: This is the first study to address the associations between desk heights and AIS and showed inappropriate desk heights were related to increased AIS risks. To protect school children from developing AIS, stakeholders are advised to consider introducing height-adjustable desks in the class, changing students' sitting positions in the classroom on a regular basis, and implementing educational programs to help students maintain correct sitting postures.

Efficacy of Halo-Gravity Traction in the Perioperative Treatment of Severe Scoliosis and Kyphosis: A Comparison of Adolescent and Adult Patients.

OBJECTIVE: The objective of the study was to compare the efficacy of halo-gravity traction (HGT) with subsequent surgical treatment in adolescent and adult patients with severe scoliosis by evaluating the radiographic outcomes and clinical complications. METHODS: We performed a retrospective analysis of 51 patients with severe scoliosis who underwent a posterior spinal instrumented fusion with HGT during the perioperative period between March 2010 and June 2017. The patients were divided into 2 groups: adults (age >18 years) and adolescents (age 10-18 years). All patients were followed with full posteroanterior and lateral spine radiographs, bending films, neurological complications, and lung function tests for a minimum of 2 years. Deformity correction, pulmonary function testing, and clinical complications were compared between the 2 groups. RESULTS: We identified 29 adults (8 males and 21 females, mean age = 23.7 ± 8.7 years) and 22 adolescents (10 males and 12 females, mean age = 13.0 ± 4.5 years). In the adult group, the mean Cobb angle of the main curve before HGT was 141.7 ± 18.2°, which improved to 126.4 ± 8.6° and 67.5 ± 10.2° after traction and operation, respectively. The kyphotic angle was corrected from 137.1 ± 15.6° before traction to 122.5 ± 11.3° after traction to 67.6 ± 13.8° after operation. The mean functional vital capacity% and forced expiratory volume in one second% were 43.1% and 37.5%, which improved to 46.7% and 41.7% after traction, respectively. In the adolescent group, the mean correction of the main curve improved from 139.3 ± 12.6° before traction to 112.1 ± 8.3° after traction to 59 ± 13.1° after surgical intervention. The kyphotic angle was corrected from 130.7 ± 9.4° before traction to 101.5 ± 12.2° after traction and then to 48.2 ± 10.1° after surgical intervention. Overall, patients in both groups showed significant improvement in their main scoliosis and kyphosis (P < 0.05), while the correction rate of the main curve and kyphosis was significantly higher in the adolescent group than that in the adult group (P < 0.05). The functional vital capacity% increased from 44.8% to 55.0% and the forced expiratory volume in one second% increased from 44.0% to 51.0% after using HGT. In terms of surgical outcomes, the incidence of postoperative neurological complications was 27.6% and 18.2% in the 2 groups, respectively. CONCLUSIONS: HGT is an effective and safe method to correct spinal deformities and improve lung function, especially in adolescent patients with severe scoliosis. In addition, it can potentially reduce the risk of neurological complications and the level of osteotomy in posterior spinal instrumented fusion surgery.

Comparative analysis of chloroplast genomes reveals phylogenetic relationships and intraspecific variation in the medicinal plant Isodon rubescens.

Isodon rubescens (Hemsley) H. Hara (Lamiaceae) is a traditional Chinese medicine plant that has been used to treat various human diseases and conditions such as inflammation, respiratory and gastrointestinal bacterial infections, and malignant tumors. However, the contents of the main active components of I. rubescens from different origins differ significantly, which greatly affected its quality. Therefore, a molecular method to identify and classify I. rubescens is needed. Here, we report the DNA sequence of the chloroplast genome of I. rubescens collected from Lushan, Henan province. The genome is 152,642 bp in length and has a conserved structure that includes a pair of IR regions (25,726 bp), a LSC region (83,527 bp) and a SSC region (17,663 bp). The chloroplast genome contains 113 unique genes, four rRNA genes, 30 tRNA genes, and 79 protein-coding genes, 23 of which contain introns. The protein-coding genes account for a total of 24,412 codons, and most of them are A/T biased usage. We identified 32 simple sequence repeats (SSRs) and 48 long repeats. Furthermore, we developed valuable chloroplast molecular resources by comparing chloroplast genomes from three Isodon species, and both mVISTA and DnaSP analyses showed that rps16-trnQ, trnS-trnG, and ndhC-trnM are candidate regions that will allow the identification of intraspecific differences within I. rubescens. Also 14 candidate fragments can be used to identify interspecific differences between species in Isodon. A phylogenetic analysis of the complete chloroplast genomes of 24 species in subfamily Nepetoideae was performed using the maximum likelihood method, and shows that I. rubescens clustered closer to I. serra than I. lophanthoides. Interestingly, our analysis showed that I. rubescens (MW018469.1) from Xianyang, Shaanxi Province (IR-X), is closer to I. serra than to the other two I. rubescens accessions. These results strongly indicate that intraspecific diversity is present in I. rubescens. Therefore, our results provide further insight into the phylogenetic relationships and interspecific diversity of species in the genus Isodon.

Intraoperative Neuromonitoring Auxiliary Significance of DNEP for MEP-positive Event During Severe Spinal Deformity Surgery.

STUDY DESIGN: This was a retrospective analysis. OBJECTIVE: The objective of this study was to assess the intraoperative neuromonitoring auxiliary significance of descending neurogenic-evoked potential (DNEP) for motor-evoked potential (MEP) during severe spinal deformity surgery when MEP-positive event occurs. SUMMARY OF BACKGROUND DATA: MEP detection is the most widely applied neurological monitoring technique in spinal deformity surgery. MEP is quite vulnerable to anesthesia, blood pressure, and other intraoperative factors, leading to a high false-positive rate of MEP (3.2%-45.0%), which has greatly interfered with the surgical process. At present, the widely used "presence-or-absence" alarm criteria of MEP is not enough to solve the problem of false positive of MEP. METHODS: A total of 205 cases undergoing severe spinal deformity correction were retrospectively studied. Overall, 74 MEP-positive cases were classified as 2 subgroups: DNEP (+) and DNEP (-) groups. The MEP recovery, wake-up test, and Frankle grade were used to assess the neurological functions. The perioperative and long-term neurological outcomes were assessed. RESULTS: There were significant differences in preoperative scoliosis angle and kyphosis angle between DNEP (-) and DNEP (+) groups. Patients in DNEP (-) group showed more MEP improvement (81.5%), compared with the DNEP (+) group (53.2%). The Wake-up test showed 59.3% motor function deficit cases in DNEP (-) group, which was lower than the 87.2% in DNEP (+) group. More patients in DNEP (-) group had normal nerve function (Frankel level E) than those in DNEP (+) group immediately after surgery, as well as at follow-up. CONCLUSIONS: MEP-positive cases with intraoperative DNEP (-) showed superior prognosis after severe spinal deformity surgery. Intraoperative DNEP could be regarded as an important quantitative tool to assist MEP to monitor neurological injury and can serve as a temporary substitution monitoring technique after MEP is lost.

Efficacy and safety for combination of t-EMG with O-arm assisted pedicle screw placement in neurofibromatosis type I scoliosis surgery.

BACKGROUND: Due to the characteristics of neurofibromatosis type I (NF-1) scoliosis, the precise placement of pedicle screws still remains to be a challenge. Triggered screw electromyography (t-EMG) has been proved to exhibit high sensitivity to identify mal-positioned pedicle screws, but no previous study assessed the combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery. OBJECTIVE: To evaluate efficacy and safety for combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery. MATERIALS AND METHODS: From March 2018 to April 2020, sixty-five NF-1 scoliosis patients underwent t-EMG and O-arm-assisted pedicle screw fixation were retrospectively reviewed. The channel classification system was applied to classify the pedicle morphology based on pedicle width measurement by preoperative computed tomography scans. The minimal t-EMG threshold for screw path inspection was used as 8 mA, and operative screw redirection was also recorded. All pedicle screws were verified using a second intraoperative O-arm scan. The correlation between demographic and clinical data with amplitude of t-EMG were also analyzed. RESULTS: A total of 652 pedicle screws (T10-S1) in 65 patients were analyzed. The incidence of an absent pedicle (channel classification type C or D morphology) was 150 (23%). Overall, abnormal t-EMG threshold was identified in 26 patients with 48 screws (7.4%), while 16 out of the 48 screws were classified as G0, 14 out of the 48 screws were classified as G1, and 18 out of the 48 screws were classified as G2. The screw redirection rate was 2.8% (18/652). It showed that t-EMG stimulation detected 3 unacceptable mal-positioned screws in 2 patients (G2) which were missed by O-arm scan. No screw-related neurological or vascular complications were observed. CONCLUSIONS: Combination of t-EMG with O-arm-assisted pedicle screw placement was demonstrated to be a safe and effective method in NF-1 scoliosis surgery. The t-EMG could contribute to detecting the rupture of the medial wall which might be missed by O-arm scan. Combination of t-EMG with O-arm could be recommended for routine use of screw insertion in NF-1 scoliosis surgery.