Development and initial validation of classification for severe spinal deformity based on X-ray features.

PURPOSE: To develop a clinically feasible classification for severe spinal deformity based on X-ray features. METHODS: A total of 223 consecutive severe spinal deformity cases who underwent corrective operation were enrolled from 2004 to 2015 retrospectively. Based on X-ray features, a novel classification was developed containing three components: curve types, curve angle and apex location. There were five curve types as follows: single scoliosis (SS), kyphoscoliosis (KS), angular deformity (AD), long curve (LC), and double curves (DC). Curve angle subsection on coronal and sagittal planes including A:90-109, B:110-129, C:130-149, D: > 150. Apex location means the exact level of apex located. Reliability of the classification was tested. RESULTS: The kappa values for inter-observer and intra-observer reliability of the curve types, curve angle, and apex level were larger than 0.80. X-ray classification for overall patients with severe spinal deformity showed that there were 101 SS cases, 47 KS, 46 AD, 19 LC and 10 DC. For the curve angle, there were grade A 123 cases, B 43, C 18, D 15 on coronal plane and grade A 38, B 17, C 16, and D 19 on sagittal plane. Apex location showed there were 27 patients at T7 or upper levels, 31 on T8, 58 on T9, 45 on T10, 18 on T11, and 44 at T12 or lower levels. CONCLUSION: A novel classification for severe spinal deformity was described based on X-ray morphology. A high value for inter-observer and intra-observer reliability was shown. Each subgroup has its particular influence on decision-making and prognostic prediction.

Feasibility of microwave ablation of the vertebral growth plate for spine growth regulation: a preliminary study.

PURPOSE: To explore the feasibility of microwave ablation (MWA) of the vertebral growth plate as a minimally invasive treatment for early-onset scoliosis. MATERIALS AND METHODS: One side of the L1-L3 vertebral growth plates were ablated using different MWA powers. Ablation safety and size were examined. Subsequently, L1-L3 vertebral growth plates were ablated on one side for 40 s at 20 W. At 2, 4, and 6 weeks after the ablation, growth changes of the spine were observed. RESULTS: No piglets died during and after ablation, and all had modified Tarlov Grade 5. The safe MWA time (time for safely ablating the vertebral growth plate) was 17.0 ± 1.5 s at 50 W, 23.0 ± 2.3 s at 40 W, 31.0 ± 3.1 s at 30 W, 47.0 ± 3.7 s at 20 W, 70.0 ± 4.2 s at 15 W, and 158.0 ± 5.0 s at 10 W. With power <15 W, the vertebral growth plate could not be effectively ablated within the safe ablation time. Within the safe ablation times, the MWA size on hematoxylin and eosin slices on a transverse diameter was between 7 and 10 mm; and that on longitudinal diameter was mainly determined by the ablation needle length. Moreover, the growth plate and annulus fibrosus on the ablated side grew poorly over time, the vertebral body showed significant wedge-shaped changes, and the spine showed significant unbalanced growth. CONCLUSION: MWA of the vertebral growth plate can be performed safely when accompanied with appropriate thermometry, and could be a new minimally invasive strategy in regulating spine growth.

Resting-state brain activity predicts selective attention deficits during hyperthermia exposure.

Purpose: Environmental hyperthermia exerts detrimental effect on attention performance that might increase the probability of accidents for high risk occupation. Previously, we reported aberrant activations and selective attention deficits under task performing during hyperthermia. However, whether resting-state baseline during hyperthermia would contribute to the reported selective attention deficits remains unclear.Materials and methods: Here, we investigated the resting-state activity within two attention subsystems named dorsal attention network (DAN) and ventral attention network (VAN) using the conjoint analysis of functional connectivity (FC) and regional cerebral blood flow (CBF). Blood oxygenation level dependent (BOLD) and 3 D arterial spin labeling data were obtained from 25 healthy male participants under two simulated thermal conditions: normothermic (25 °C for 1 h) and hyperthermic condition (50 °C for 1 h).Results: Paired comparisons on the FC and CBF showed decreased activity in the bilateral frontal eye field (FEF) and intraparietal sulcus (IPS) in the DAN but increased activity in the ventral frontal cortex (VFC) in the VAN. The CBF-FC correlation analysis further confirmed decreased CBF-FC coupling in the bilateral FEF in the DAN and increased coupling in the VFC in the VAN. Additionally, the left IPS and FEF in the DAN showed altered CBF per unit functional connectivity in the CBF/FC ratio analysis. Multiple regression analysis revealed that the selectively altered performances were predicted by alterations of the multiple metrics within the DAN and VAN.Conclusions: These findings suggested that altered resting-state brain activity within the attention networks might provide potential neural basis of the selective deficits for different cognitive-demand attention tasks under hyperthermia.

Effect of Spinal Shortening for Protection of Spinal Cord Function in Canines with Spinal Cord Angulation.

BACKGROUND Posterior vertebral column resection (PVCR) has been widely used as a treatment for severe spinal deformity. By using the canine model of vertebral column resection, this study explored the effect of spinal shortening on blood flow and function of the spinal cord during spinal cord angulation. MATERIAL AND METHODS The canine model of L1 vertebral column resection was constructed with the PVCR technique. The canines were divided into 5 groups according to the degree of shortening: the 0/4 group, the 1/4 group, the 2/4 group, the 3/4 group, and the control group. Spinal cord blood flow, neuroelectrophysiology, HE staining, nitric oxide, and endothelin-1 were measured during the procedure of vertebral column resection and spinal cord angulation. RESULTS The results showed that, in the 1/4 group and the 2/4 group, the blood flow of the spinal cord decreased by 16.5% and 10.6%, respectively, with no obvious damage in the spinal cord; in the 0/4 group and the 3/4 group, the blood flow decreased by 23.5% and 23.1%, respectively, with significant damage in the spinal cord. CONCLUSIONS When the spinal cord is shortened by 1/4 to 2/4, the tolerance of the spinal cord can increase and spinal cord injury resulting from angulation can be avoided. However, when the shortening reaches 3/4, it is harmful to the spinal cord. Proper shortening of the spinal cord by 1/4 to 2/4 may increase the tolerance of the spinal cord to the damage caused by angulation during PVCR.

The effect from different numbers of segmental arteries ligation to the spinal cord in the clinical practice of posterior vertebral column resection correction.

PURPOSE: In using posterior vertebral column resection (PVCR) to treat severe kyphoscoliosis, it is unavoidable to ligate and cut off several segmental arteries (SAs) of the spinal cord for exposure and hemostasis, but which would raise the neurological risks. The aim of this study is to explore the changes of intraoperative spinal cord monitoring (IOM) following ligating different numbers of SAs in PVCR. METHODS: Twenty-one consecutive patients with severe kyphoscoliosis were included and treated by PVCR correction. In operation, according to ligate different numbers of SAs, the IOM changes were recorded, respectively. Examinations of the covariance between different numbers of SAs ligations and IOM changes were performed to reveal the effect to the spinal cord by SAs ligations. RESULTS: In all the 21 cases, averaging 1.9 pairs of SAs were ligated. With the increased numbers of ligations, SSEP amplitudes and latencies were changed more obviously: from 1 to 3 pairs ligations, the mean decreased percentages of amplitudes were from 53.20 to 78.15%, the mean increased percentages of latency were from 1.23 to 1.40%, and the mean durations of decreased SSEP amplitudes were from 3.23 to 5.2 min; but without abnormal MEP changes. None occurred postoperative or delayed neurological deficit. Correlation analysis identified significant correlations between the number of SAs ligation and decreased percentage of SSEP amplitude (r = 0.945, P < 0.0001), and between the number of SAs being ligated and the duration of SSEP change (r = 0.945, P = 0.0002). CONCLUSIONS: Following the increased number of SAs ligation, the amplitude of SSEP is decreased more obviously with a much longer duration of recovery and the risk to spinal cord will be increased greatly. In the PVCR correction on the basis of spinal shortening, the numbers of SAs ligations should be as less as possible for neurological safety.

Preoperative short-term traction prior to posterior vertebral column resection: procedure and role.

PURPOSE: Severe rigid spine deformity with sharp curve can be effectively corrected by posterior vertebral column resection (PVCR). Meanwhile, high risk of this procedure also has been recognized generally. The aim of this study is to review and evaluate the role of preoperative skull-femoral traction prior to PVCR for extremely severe rigid spinal deformity with sharp angular curve >150°. METHODS: Twelve cases with extremely severe rigid deformities and sharp curves were treated by skull-femoral traction before operation. For them, the mean preoperative major scoliotic curve and kyphosis were 153° (110°-168°) and 109° (61°-180°). Continuous skull-femoral traction in supine position was started 4 weeks before operation. In the process of traction, tolerance, neurologic status, deformity changes, etc., were reviewed and documented for analysis. PVCR were performed in all these patients for final and main correction. RESULTS: The final traction force in the 12 cases was 63% of body weight. After 4-week traction, the main scoliotic curve and kyphosis were decreased by 34 and 31%. In 1 week, main scoliotic curve and kyphosis were decreased by 19 and 15%. In 2 weeks, the major scoliosis curve was decreased by 11%, but kyphosis was unexpectedly increased by 4%. Deformity in the last 2 weeks was less significant than the first 2 weeks. After PVCR, the main scoliotic curve and kyphosis were improved 69 and 66%. No permanent neurological damage occurred. CONCLUSION: Preoperative skull-femoral traction effectively mitigates the neurological risks of PVCR for extremely severe rigid spinal deformity with sharp curve. During traction, scoliosis can be improved more significantly and easily than kyphosis.

A novel growth-friendly system alleviates pulmonary dysplasia in early-onset scoliosis combined with thoracic insufficiency syndrome: Radiological, pathological, and transcriptomic assessments.

Background: The posterior procedure utilizing growth-friendly techniques is the golden standard for patients with early-onset scoliosis combined with thoracic insufficiency syndrome (EOS + TIS). Pulmonary hypoplasia is the main cause of dying prematurely in the EOS + TIS. This study assessed the therapeutic impact of a novel growth-friendly system on the pulmonary development of piglet's EOS + TIS model. Methods: The animal procedure period lasts 12 weeks, of which the construction of the EOS + TIS was performed at 0-8 weeks, and implantation of a novel growth-friendly system was applied at 8-12 weeks. During the animal procedure, X-rays and CT were performed to observe scoliosis, thorax, and lungs. After 12 weeks, pathological changes in lung tissue were assessed using HE and IHC staining. RNA-seq characterized novel growth-friendly system-associated differentially expressed genes (DEGs) and validated using RT-qPCR, western blotting, and IHC. Results: Implantation of the novel growth-friendly system increased body weight, body length, and total lung volume, as well as decreased the coronal and sagittal Cobb angles for the EOS + TIS model. It also ameliorated EOS + TIS-induced thickening of the alveolar wall, increased alveolar spaces, and decreased alveolar number and diameter. In lung tissue, a total of 790 novel growth-friendly system-associated DEGs were identified, and they were mainly involved in the regulation of immune, inflammatory, calcium transport, and vascular development. Among these DEGs, BDKRB1, THBS1, DUSP1, IDO1, and SPINK5 were hub genes, and their differential expression was consistent with RNA-seq results in lung tissues. Conclusion: The novel growth-friendly system has mitigated scoliosis and pulmonary hypoplasia in the EOS + TIS model. We further elucidate the molecular mechanisms underlying the amelioration of pulmonary hypoplasia.

A porcine model of early-onset scoliosis combined with thoracic insufficiency syndrome: Construction and transcriptome analysis.

BACKGROUND: Early-onset scoliosis (EOS) is a scoliosis deformity caused by various reasons before the age of 10 years and is often combined with thoracic insufficiency syndrome (TIS) causing patients with difficulty in securing lung growth in the thoracic cage. Currently, there is a shortage of effective large animal models for evaluating EOS + TIS in therapeutic studies. Consequently, we propose to construct a porcine EOS + TIS model and evaluate its transcriptome changes by RNA sequencing. METHODS: Piglets were constructed using unilateral posterior spine-tethering and ipsilateral rib-tethering in the EOS + TIS model, and X-ray and computed tomography (CT) were performed to assess growth changes in the spine, thoracic cage and lungs. The H&E and Masson staining was performed for pathological analysis of lung tissue. After RNA sequencing of lung tissues, data were analyzed for differential expression of mRNA, functional enrichment analysis (GO, KEGG and GSEA) and protein-protein interaction (PPI) network construction, and differential expression of hub gene was verified by RT-qPCR. RESULTS: In the model group, growth (body weight and length) of piglets was significantly delayed; fusion of ribs occurred and cobb angle changes in the coronal and sagittal planes were significantly enlarged; total lung volume (TLV) was significantly reduced, especially at the T7-T10 level. Pathological analysis revealed that, in the model lung tissue, the alveolar wall of was poorly perfused, the alveolar space was enlarged, the number and size of alveoli were significantly reduced, and it was accompanied by collagen fiber deposition. Moreover, a total of 432 differentially expressed mRNAs (DE-mRNAs) were identified in model lung tissues, which contained 262 down-regulated and 170 up-regulated DE-mRNAs, and they were mainly involved in the regulation of immunity, inflammation, cell cycle and extracellular matrix. A PPI network containing 71 nodes and 158 edges was constructed based on all DE-mRNAs, and JUN, CCL2, EGR1, ATF3, BTG2, DUSP1 and THBS1 etc. were hub gene. CONCLUSIONS: Overall, we constructed a porcine model that was capable of replicating the common clinical features of EOS + TIS such as rib fusion, asymmetric thoracic cage, increased cobb angle, decreased TLV, and pulmonary hypoplasia. Also, we revealed transcriptomic changes in the EOS + TIS model that may cause pulmonary hypoplasia.

Scoliosis school screening of 139,922 multi-ethnic children in Dali, southwestern China: A large epidemiological study.

Idiopathic scoliosis (IS) primarily impacts adolescents and requires early intervention to prevent deformity. Early diagnosis and prediction of spine curvature in children could be aided by school scoliosis screening (SSS). In the Dali Bai Autonomous Prefecture, SSS, including 139,922 children from 18 ethnic groups in 8 counties ranging in age from 6 to 18, was carried out. A medical team conducted the screening with inspection, Adam's test, and angles of trunk rotation (ATR). The overall prevalence of suspected scoliosis was 2.37%, with girls (2.5%) more affected than boys (2.0%). Using penalized regression analysis of LASSO, the variable-selection process was conducted to determine the final regression model. The results showed that age, gender, height, BMI, altitude, latitude, ethnicity, and county were all influencing variables for suspected scoliosis, according to the adjusted final model of multi-factor regression analysis. These results provide substantial information and suggestions for preventative and person-centered healthcare interventions for IS.

Influence Mechanisms of Inclusion Types on Rotating Bending Fatigue Properties of SAE52100 Bearing Steel.

The rotating bending fatigue crack sources of SAE52100 high carbon bearing steel were studied in this paper. On the fatigue fracture surfaces, inclusions for crack initiation are mainly Ca-Al-O and TiN inclusions, and the size of TiN inclusions is much smaller than that of Ca-Al-O inclusions. The analysis of inclusions by Aspex shows that the number and size of Ca-Al-O inclusions in the matrix are much larger than those of TiN inclusions. Combined with the calculation of stress intensity factor and the analysis of stress concentration factor, the sharp angle characteristic of TiN inclusions is the main reason for its stronger deterioration to fatigue properties, and the damaging effect of TiN inclusions with the same size to the matrix fatigue properties is about 1.33-1.67 times that of Ca-Al-O inclusions.

Factors Associated with Postoperative Respiratory Complications following Posterior Spinal Instrumentation in Children with Early-onset Scoliosis.

OBJECTIVE: To investigate the incidence and risk factors of postoperative respiratory complications (PRCs) in children with early-onset scoliosis (EOS) following posterior spine deformity surgery (PSDS) based on growth-friendly techniques, so as to help improve the safety of surgery. METHODS: A retrospective study of children with EOS admitted for PSDS based on growth-friendly techniques from October 2013 to October 2018 was reviewed at a single center. There were 73 children (30 boys, 43 girls) who fulfilled the criteria in this research. The mean age of the patients was 7 ± 6.2 years. Patients were divided into the groups with and without PRCs. Variables that might affect the PRCs during the perioperative period, including general factors, radiographic factors, laboratory factors and surgical factors, were analyzed using univariate analysis to evaluate the potential risk factors. The variables that were significantly different were further analyzed by binary logistic regression analysis to identify the independent factors of PRCs. RESULTS: All the 73 children included 42 idiopathic scoliosis (57.5%), 12 congenital scoliosis (16.4%), 10 syndromic scoliosis (13.7%) and nine neuromuscular scoliosis (12.3%). PRCs were detected in 16 children (21.9%) with nine different PRCs. The total frequency of detected PRCs was 54, including pleural effusion (25.9%), postoperative pneumonia (20.4%), hypoxemia (18.5%), atelectasis (14.8%), prolonged intubation with mechanical positive pressure ventilatory support (PIMPPVS) (7.4%), bronchospasm (3.7%), reintubation (3.7%), delayed extubation (3.7%) and pneumothorax (1.9%). Results of univariate testing demonstrated that the following six variables were statistically different (P < 0.05): nonidiopathic scoliosis, combined with pulmonary comorbidities, pretransferrin < 200 mg/dL, prealbumin < 3.5 g/dL, anesthesia time ≥ 300 min and blood loss to total blood volume ratio (BL/TBV) ≥ 15%. Binary logistic regression analysis confirmed that BL/TBV≥15% (odd ratio OR = 29.188, P = 0.010), combined with pulmonary comorbidities (OR = 19.216, P = 0.012), pretransferrin < 200 mg/dL (OR = 11.503, p = 0.024), and nonidiopathic scoliosis (OR = 7.632, P = 0.046) were positively linear correlated with PRCs in children with EOS following PSDS. CONCLUSION: PRCs has a higher incidence in children with EOS following PSDS. BL/TBV ≥15%, combined with pulmonary comorbidities, pre-transferrin < 200 mg/dL, and nonidiopathic scoliosis play an important role for the development of PRCs in this population.

Posterior Injured Vertebra Column Resection and Spinal Shortening for Thoracolumbar Fracture Associated with Severe Spinal Cord Injury: A Retrospective Case-Control Observational Study.

Background: Thoracolumbar spinal fracture associated with severe spinal cord injury (sSCI) is a kind of severe traumatic spine injury. Although various approaches are currently used to treat sSCI-related thoracolumbar fractures, the neurological function of patients has not been significantly improved by surgery. Objective: To evaluate the therapeutic effects of the new procedure of posterior injured vertebra column resection (PIVCR) and spinal shortening for the treatment of thoracolumbar fracture associated with sSCI. Methods: In this retrospective case-control observational study, we included 66 patients with thoracolumbar fractures associated with sSCI in our institution from January 2015 to December 2017. According to the different surgical approaches, the patients were allocated to group A (n = 32, received simple posterior decompression and fixation) and group B (n = 34, received PIVCR and spinal shortening). All patients' clinical and radiologic outcomes were collected to evaluate retrospectively. The clinical outcomes were gathered, including the intraoperative blood loss, operative time, visual analog scale (VAS) score, and American Spinal Injury Association (ASIA) impairment scale. The radiologic outcomes were collected involving the range of spinal shortening, canal encroachment, heights of the anterior edge of the vertebral body, and the Cobb angle. Results: There was no significant difference in the two groups regarding preoperative demographic data, VAS scores, segmental kyphosis Cobb, canal encroachment, and neurological status. The range of spinal shortening in group B was an average 1.57 ± 0.40 cm and 36.45 ± 6.56% of the height of the single spinal motion segment. Due to the characteristics of the surgical procedure, group B got complete decompression of the spinal cord and better postoperative canal decompression than group A. Thus, better clinical outcomes, including neurological improvement, loss of corrective Cobb angle, and VAS improvement, were shown in group B at the follow-up investigation than those in group A (P < 0.05). Conclusion: PIVCR and spinal shortening surgical procedure is a safe, reliable, and effective approach to treating thoracolumbar fracture associated with sSCI.

A temperature-regulated circuit for feeding behavior.

Both rodents and primates have evolved to orchestrate food intake to maintain thermal homeostasis in coping with ambient temperature challenges. However, the mechanisms underlying temperature-coordinated feeding behavior are rarely reported. Here we find that a non-canonical feeding center, the anteroventral and periventricular portions of medial preoptic area (apMPOA) respond to altered dietary states in mice. Two neighboring but distinct neuronal populations in apMPOA mediate feeding behavior by receiving anatomical inputs from external and dorsal subnuclei of lateral parabrachial nucleus. While both populations are glutamatergic, the arcuate nucleus-projecting neurons in apMPOA can sense low temperature and promote food intake. The other type, the paraventricular hypothalamic nucleus (PVH)-projecting neurons in apMPOA are primarily sensitive to high temperature and suppress food intake. Caspase ablation or chemogenetic inhibition of the apMPOA→PVH pathway can eliminate the temperature dependence of feeding. Further projection-specific RNA sequencing and fluorescence in situ hybridization identify that the two neuronal populations are molecularly marked by galanin receptor and apelin receptor. These findings reveal unrecognized cell populations and circuits of apMPOA that orchestrates feeding behavior against thermal challenges.

Spinal-Shortening Process Positively Improves Associated Syringomyelia in Patients with Scoliosis After Single-Stage Spinal Correction.

OBJECTIVE: Single-stage spinal correction without previous neurosurgical intervention has been attempted in patients with scoliosis associated with syringomyelia (SM). However, evidence to demonstrate its potential influence on associated SM from direct spinal correction is still lacking. The aim of the present study was to explore the role of spinal shortening in the prognosis of SM-associated scoliosis after single-stage spinal correction without previous neurosurgical intervention. METHODS: Patients with SM-associated scoliosis without previous neurological intervention, who had undergone posterior direct instrumental correction (PDIC) without osteotomy and posterior vertebral column resection (PVCR) at a single center, were selected for comparative analysis. The basic demographic and pre- and postoperative imaging data of the spinal deformity and SM at the final follow-up were compared separately for the 2 different spinal correction procedures. RESULTS: A total of 23 patients were included in the final analysis: 13 had undergone PDIC and 10 had undergone PVCR. The mean follow-up period was 6.2 years (range, 5-9 years). At the final follow-up, the mean corrective rate of scoliosis and kyphosis was 65.7% and 48.4%, respectively. Obvious SM reduction was achieved in 11 patients (47.8%), with an average reduction of 37.3%. No patient experienced neurologic deterioration or had required further neurosurgical intervention for SM during follow-up. The patients who had undergone PVCR had had much more severe scoliosis (98.8° vs. 60.5°; P = 0.000) and kyphosis (74.8° vs. 43.6°; P = 0.032). Moreover, 80.0% of the patients who had undergone PVCR had experienced obvious SM improvement compared with 23.1% of those who had undergone PDIC (P = 0.007). CONCLUSIONS: The reduction of spinal cord tension is an important factor influencing SM improvement. As the most powerful spinal-shortening osteotomy, PVCR can effectively correct severe spinal deformities and improve associated SM. Single-stage posterior spinal correction can be a potential choice for selected patients with scoliosis and untreated SM using strict inclusion criteria, which will not only achieve safe spinal correction but could also steadily improve and stabilize SM.

High Temperature Deformation Behavior and Microstructure Evolution of Low-Density Steel Fe30Mn11Al1C Micro-Alloyed with Nb and V.

The thermal processing parameters is very important to the hot rolling and forging process for producing grain refinement in lightweight high-manganese and aluminum steels. In this work, the high temperature deformation behaviors of a low-density steel of Fe30Mn11Al1C alloyed with 0.1Nb and 0.1V were studied by isothermal hot compression tests at temperatures of 850-1150 °C and strain rates between 0.01 s-1 and 10 s-1. It was found that the flow stress constitutive model could be effectively established by the Arrhenius based hyperbolic sine equation with an activation energy of about 389.1 kJ/mol. The thermal processing maps were developed based on the dynamic material model at different strains. It's shown that the safe region for high temperatures in a very broad range of both deformation temperature and deformation strain and only a small unstable high deformation region, located at low temperatures lower than 950 °C. The deformation microstructures were found to be fully recrystallized microstructure in the safe deformation region and the grain size decreases along with decreasing temperature and increasing strain rate. Whereas the deformation microstructures is composed by grain refinement-recrystallized grains and a small fraction of non-recrystallized microstructure in the unstable deformation region, indicating that the deformation behaviors controlled by continuous dynamic recrystallization. The Hall Petch relationship between microhardness and the grain size of the high temperature deformed materials indicates that high strength low-density steel could be developed by a relative low temperature deformation and high strain rate.

Disrupted Anti-correlation Between the Default and Dorsal Attention Networks During Hyperthermia Exposure: An fMRI Study.

Environmental hyperthermia is a common risk factor for occupational safety in many situations due to decreased vigilance performances. Previously, we have reported that decreased resting-state functional connectivity within the default mode network (DMN) and decreased activations in dorsal attention network (DAN) such as dorsolateral prefrontal cortex (DLPFC) were correlated with selective attention deficits during hyperthermia. However, whether the inherent functionally organized anti-correlation between the DMN and DAN would contribute to the behavioral deficits remains unclear. In this study, we collected the resting-state fMRI data of 25 participants during two simulated thermal conditions: normothermic condition (25°C for 1 h) and hyperthermic condition (50°C for 1 h). Using group independent component analysis (ICA), we investigated the functional connectivity within the DMN and DAN, as well as the anti-correlations between both networks. Paired comparisons revealed that decreased intranetwork functional connectivity in the medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) in the DMN contributed to executive control performance during hyperthermia using multivariate linear regression analysis. Paired comparison on the DAN showed that increased one in the posterior part of the middle and inferior temporal gyrus nearby the temporal-parietal junction area contributed to preserved alerting performance. Lastly but most importantly, we found that decreased correlation between mPFC in the DMN and intraparietal sulcus (IPS) area in the DAN contributed to the executive control deficit, suggesting a weaker intrinsic anti-correlation between DMN and DAN during hyperthermia. These findings indicated that a functional reorganized architecture of DMN and DAN might provide a potential neural basis of the selective deficits for different cognitive-demand attention tasks in high-temperature environments.

A preliminary study of spinal cord blood flow during PVCR with spinal column shortening: A prospective clinic study in severe rigid scoliokyphosis patients.

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ±â€Š86 perfusion unite (PU), and the SCBF decreased to 228 ±â€Š68 PU after VCR (P = .008). The SCBF increased to 296 ±â€Š102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ±â€Š65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.

Continuous Hypodynamic Change of Cerebrospinal Fluid Flow as A Potential Factor Working for Experimental Scoliotic Formation.

Scoliosis is often associated with syringomyelia (SM). As an important role in SM formation, the influence from abnormal cerebrospinal fluid (CSF) flow is still unclear to scoliosis. The aim of this experimental work is to explore the connection between CSF flow and scoliosis through imaging and histological analysis on the basis of a kaolin-induced scoliotic rabbit model. For imaging observation, in 40 kaolin-induced rabbits by C7 spinal cord injection, through pre- and postoperative MRI and radiography, CSF flow and scoliosis formation were detected at consecutive phases. According to the final formation of scoliosis until postoperative week 12, the kaolin-induced rabbits were divided into 2 groups. Through comparing the 2 groups, the relationship between the changes of CSF flow velocity and scoliosis formation were reviewed and analyzed. For histological observation, another 20 kaolin-induced rabbits were used for consecutive histological observations of spinal cord at postoperative 3-day, 2-week, 4-week and 6-week. After kaolin-induction, abnormal spinal coronal curve was observed from postoperative week 6 in the 37 survived rabbits. At postoperative week 12, scoliosis formation was detected in 73.0% kaolin-induced rabbits and the mean Cobb angle was 27.4°. From the comparison between scoliotic and non-scoliotic groups, the difference of the velocities of CSF flow was more obviously from postoperative week 4 to 12, especially after week 6. In the scoliotic group, the peak velocity of CSF flow was diseased gradually following scoliosis formation after induction. Moreover, the decrease of the peak velocities of CSF flow from preoperation to postoperative 12 weeks (ΔVmax), including up-flow (ΔVUmax) and down-flow (ΔVDmax), were positively correlated to the final scoliotic Cobb angle (P < 0.01). Through histological observation at different phases, the distinctive pathological changes of the spinal cord included early inflammatory reaction, adhesion and blockage in the subarachnoid space and the central canal, perivascular space enlargement, central canal expansion, which suggested the CSF flow being blocked by multiple ways after kaolin-induction. In conclusion, experimental scoliosis can be successfully induced by intraspinal kaolin injection. In this model, continuous hypodynamic change of CSF flow was correlated to the formation of scoliosis, which could be an important factor of scoliotic pathogenesis being explored furtherly.

Cervical Abnormalities in Severe Spinal Deformity: A 10-year MRI Review.

OBJECTIVE: To investigate the incidence of cervical anomalies (CA), including cervical intraspinal neural axis abnormalities (CIINAA) and/or cervical osseous abnormalities (COA), and the clinical relevance in severe spinal deformities (SSD) at a single center. METHODS: A retrospective study of SSD admitted for spinal surgery from January 2003 to January 2015 was conducted at a single center. INCLUSION CRITERIA: patients who present with coronal Cobb over 90° (and/or sagittal cobb ≥90°); and patients with complete imaging and clinical data preoperatively. EXCLUSION CRITERIA: ankylosing spondylitis, adult onset scoliosis, scoliosis secondary to bone destruction. There were 108 SSD patients who fulfilled the criteria in this research (41 males and 67 females). The mean age of the patients was 18.1 ± 2.7 years (range, 10-45 years). The clinical and radiological data of these patients were reviewed to identify CA and to analyze the relationship between clinical and radiographic characteristics in the population of SSD. RESULTS: The major curves of scoliosis and segmental kyphosis were 109.1° ± 24.7° and 91.2° ± 29.1°. Cervical abnormalities were detected in 56 patients (51.85%) with 9 different CA, including 28 patients (25.9%) with 6 different COA, 21 patients (19.4%) with 3 different CIINAA, and 7 patients (6.5%) with a combination of COA and cervical intraspinal neural axis abnormalities (CINAA). Basilar invagination and Klippel-Feil syndrome were the most frequent COA. Syringomyelia was the most frequent CINAA. SSD with COA in upper vertebral levels (UVL) had a higher incidence of CINAA than those in subaxial vertebral levels (SVL) (P = 0.024) and SSD with multiple COA (mCOA) in UVL had a higher incidence of CINAA than those with single COA (sCOA) (P = 0.029). In the present study, 83.9% of the SSD with CA were asymptomatic. CONCLUSION: The incidence of CA in SSD was 51.85%, with most presenting with intact neurologic status. As the diversity of COA increased, we found a higher incidence of CINAA, especially in UVL.

Atypical Response Properties of the Auditory Cortex of Awake MECP2-Overexpressing Mice.

Methyl-CpG binding protein 2 (MECP2) is a gene associated with DNA methylation and has been found to be important for maintaining brain function. In humans, overexpression of MECP2 can cause a severe developmental disorder known as MECP2 duplication syndrome. However, it is still unclear whether MECP2 overexpression also causes auditory abnormalities, which are common in people with autism. MECP2-TG is a mouse model of MECP2 duplication syndrome and has been widely used for research on social difficulty and other autism-like disorders. In this study, we used a combination of multiple electrophysiological techniques to document the response properties of the auditory cortex of awake MECP2-TG mice. Our results showed that while the auditory brainstem responses are similar, cortical activity patterns including local field potentials (LFPs), multiunit activity (MUA), and single-neuron responses differ between MECP2-TG and wild-type (WT) mice. At the single-neuron level, the spike waveform of fast-spiking (FS) neurons from MECP2-TG mice is different from that of WT mice, as reflected by reduced peak/trough ratios in the transgenic mice. Both regular-spiking (RS) and FS neurons exhibited atypical response properties in MECP2-TG mice compared with WT mice, such as prolonged latency and an elevated intensity threshold; furthermore, regarding the response strength to different stimuli, MECP2-TG mice exhibited stronger responses to noise than to pure tone, while this pattern was not observed in WT mice. Our findings suggest that MECP2 overexpression can cause the auditory cortex to have atypical response properties, an implication that could be helpful for further understanding the nature of auditory deficits in autism.