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Background Spinal cord ischemia-reperfusion injury (SCIRI) often leads to neurological damage and mortality. In this regard, understanding the pathology of SCIRI and preventing its development are of great clinic value. Methods Herein, we analyzed the role of bone marrow mesenchymal stem cell (BMMSC)-derived exosomal microRNA (miR)-124-3p in SCIRI. A SCIRI rat model was established, and the expression of Ern1 and M2 macrophage polarization markers (Arg1, Ym1, and Fizz) was determined using immunohistochemistry, immunofluorescence assay, RT-qPCR, and western blot analysis. Targeting relationship between miR-124-3p and Ern1 was predicted using bioinformatic analysis and verified by dual-luciferase reporter assay. Macrophages were co-cultured with miR-124-3p-containing BMMSC-derived exosomes. M2 macrophages were identified using flow cytometry, and the expression of Arg1, Ym1, and Fizz was determined. In addition, SCIRI rats were injected with miR-124-3p-containing exosomes, spinal cord cell apoptosis was observed using TUNEL assay, and the pathological condition was evaluated with H&E staining. Results In SCIRI, Ern1 was highly expressed and M2 polarization markers were poorly expressed. Silencing Ern1 led to elevated expression of M2 polarization markers. MiR-124-3p targeted and negatively regulated Ern1. Exosomal miR-124-3p enhanced M2 polarization. Highly expressed exosomal miR-124-3p impeded cell apoptosis and attenuated SCIRI-induced tissue impairment and nerve injury. miR-124-3p from BMMSC-derived exosomes ameliorated SCIRI and its associated nerve injury through inhibiting Ern1 and promoting M2 polarization. Conclusion In summary, exosomal miR-124-3p derived from BMMSCs attenuated nerve injury induced by SCIRI by regulating Ern1 and M2 macrophage polarization.

Abstract Osteosarcoma (OS) is the most common primary malignant bone tumor that more commonly occurs in children and adolescents. The most commonly used treatment for OS is surgery combined with chemotherapy, but the treatment outcomes are typically unsatisfactory. High rates of metastasis and post-treatment recurrence rates are major challenges in the treatment of OS. This underlines the need for studying the in-depth characterization of the pathogenetic mechanisms of OS and development of more effective therapeutic modalities. Previous studies have demonstrated the important role of the bone microenvironment and the regulation of signaling pathways in the occurrence and development of OS. In this review, we discussed the available evidence pertaining to the mechanisms of OS development and identified therapeutic targets for OS. We also summarized the available treatment modalities for OS and identified future priorities for therapeutics research.

Background Intraspinal cysticercosis , usually with serious neurological deterioration, is rarely diagnosed because its clinical manifestations are nonspecific, and most physicians might not be familiar with its imaging features. Case presentation A 50-year-old woman presented with a 2-month history of increasing pain in her right buttock, rectal tenesmus and uncontrolled micturition. Intradural extramedullary cystic lesion was found, and the characteristic MRI findings of a living cysticercus and a dying cysticercus were presented simultaneously. Finally, the giant intraspinal cysticercus was treated by surgery and antiparasitic treatment. Conclusions This case emphasizes that the characteristic imaging findings of different cysticercus cysts as well as the detailed personal history usually provide useful diagnostic clues. Cerebrospinal fluid analysis may aid in confirming the diagnosis.

Background Postoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients’ underlying medical conditions on the refracture of osteoporotic compression fractures following surgery. Methods A retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses. Results Among the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture ( P  = 0.018, OR = 0.548), while alcohol intake ≥ 10years ( P  = 0.003, OR = 2.165), mental abnormality ( P  < 0.001, OR = 4.093), scoliosis ( P  < 0.001, OR = 6.243), chronic kidney disease ( P  = 0.002, OR = 2.208), and traumatic injuries ( P  = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis. Conclusions Hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Spinal cord injury after surgical repair of the thoracic or thoracoabdominal aorta is a devastating complication that is associated with pathological changes, including inflammation, edema, and nerve cell damage. Recently, microRNA (miRNA)-modulated control of spinal cord injury has been actively investigated. This study aims to clarify the regulatory effect of miR-214-mediated inhibition of Kcnk2 following spinal cord ischemia-reperfusion injury (SCII) and the possible underlying mechanisms. SCII was induced in rats by occluding the aortic arch followed by reperfusion. Gain-of-function and loss-of-function experiments were conducted to explore the modulatory effects of Foxd3, miR-214 and Kcnk2 on PC12 cells under hypoxia/reoxygenation (H/R) conditions. MiR-214 and Kcnk2 were poorly expressed, while Foxd3 was highly expressed in the rat spinal cord tissues and H/R-treated PC12 cells. Kcnk2 overexpression enhanced the viability and inhibited the apoptosis of the H/R-treated PC12 cells. Notably, Foxd3 activated miR-214, and miR-214 targeted Kcnk2. In addition, upregulation of Kcnk2 or knockdown of Foxd3 promoted the cell viability and reduced the apoptosis of the H/R-treated PC12 cells. Overall, our study identified a novel mechanism of Foxd3/miR-214/Kcnk2 involving SCII, suggesting that either Foxd3 or miR-214 may be a novel target for the treatment of SCII.Neurology: Seeking salvation for spines after surgeryTherapeutic strategies that protect neurological function could prevent serious side effects associated with surgery of the aorta. Patients undergoing aortic surgery for aneurysm or other conditions are at risk of spinal cord damage associated with reduced blood flow during surgery and the subsequent restoration of normal circulation. Researchers led by Fei Yin at Jilin University in Changchun, China, have identified molecular mechanisms that can potentially increase this neurological harm. They show that the combination of low oxygen and reperfusion triggers production of a protein called Foxd3, which switches off cellular pathways that otherwise protect and repair vulnerable tissues. By interfering with this Foxd3-mediated response, Yin’s team was able to protect motor function and preserve the survival of spinal cord neurons in a rat model of this condition, suggesting a potential therapeutic avenue for heart surgery patients.

Understanding molecular mechanisms of intervertebral disc degeneration (IDD) and providing a novel target for the treatment of IDD have important implications. We sought to explore a new promising gene target for the treatment of IDD. This study integrated 19,678 genes of 38 IDD patients from two gene datasets. Differentially Expressed Genes (DEGs) of annulus fibrosus were analyzed in groups with mild disc degeneration (MDD) and severe disc degeneration (SDD). We screened the hub gene through biological information technology (bioinformatic) methods. Then, we further validated the hub gene using annulus fibrosus and nucleus pulposus tissues from 12 patients with qRT-PCR. In addition, we explored its underlying molecular mechanism with GO, KEGG and GSEA. Through multiple screening bioinformatics methods, the hub gene CD63 was identified. The qRT-PCR explored that CD63 decreased significantly in SDD group compared to that in MDD group (P < 0.001). The GO, KEGG and GSEA of CD63 explored significant enrichment of the molecular features (P < 0.001), including the cellular component (Extracellular matrix, P < 0.001), the molecular function (collagen binding, P < 0.001), the biological processes (protein targeting, collagen fibril organization and platelet degranulation, P < 0.001) and the signaling pathways. Our research explored and validated a new regulatory gene, CD63 for different degrees of IDD. A new novel form of therapeutic target for IDD may be developed.

Patients with lumbar degenerative diseases (LDD) are particularly susceptible to preoperative deep vein thrombosis (DVT) due to prolonged immobility and associated pathophysiological changes. If left undetected, preoperative DVT may progress postoperatively and lead to life-threatening complications such as pulmonary embolism, underscoring the importance of accurate risk assessment. This retrospective study aims to develop and validate a nomogram for predicting the risk of preoperative DVT in LDD patients using available clinical data. A total of 568 patients with LDD were included, of whom 39 (6.87%) were diagnosed with preoperative DVT. Variables were initially screened using the least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression to identify independent predictors. Five risk factors—age, walking impairment, diabetes mellitus, activated partial thromboplastin time (APTT), and D-dimer—were ultimately selected. Then, the dataset was randomly divided into a training cohort ( n  = 398) and a validation cohort ( n  = 170) in a 7:3 ratio. A predictive nomogram incorporating these risk factors was developed and validated. The predictive performance of the nomogram was evaluated using the concordance index (C-index), calibration curves, and the area under the receiver operating characteristic (ROC) curve (AUC). Decision curve analysis (DCA) was conducted to assess the clinical utility and applicability of the nomogram. The nomogram demonstrated excellent predictive accuracy (Training cohort AUC: 0.87, Validation cohort AUC: 0.97; Training cohort C-index: 0.874, Validation cohort C-index: 0.967), calibration, and clinical applicability. Additionally, a dynamic online nomogram was created for practical clinical application [ https://yangt.shinyapps.io/myDynNom/ ].

In recent years, geographically weighted regression (GWR) models have been widely used to address the spatial heterogeneity and spatial autocorrelation of PM2.5, but these studies have not fully considered the effects of all potential variables on PM2.5 variation and have rarely optimized the models for residuals. Therefore, we first propose a modified GWR model based on principal component analysis (PCA-GWR), then introduce five different spatial interpolation methods of radial basis functions to correct the residuals of the PCA-GWR model, and finally construct five combinations of residual correction models to estimate regional PM2.5 concentrations. The results show that (1) the PCA-GWR model can fully consider the contributions of all potential explanatory variables to estimate PM2.5 concentrations and minimize the multicollinearity among explanatory variables, and the PM2.5 estimation accuracy and the fitting effect of the PCA-GWR model are better than the original GWR model. (2) All five residual correction combination models can better achieve the residual correction optimization of the PCA-GWR model, among which the PCA-GWR model corrected by Multiquadric Spline (MS) residual interpolation (PCA-GWRMS) has the most obvious accuracy improvement and more stable generalizability at different time scales. Therefore, the residual correction of PCA-GWR models using spatial interpolation methods is effective and feasible, and the results can provide references for regional PM2.5 spatial estimation and spatiotemporal mapping. (3) The PM2.5 concentrations in the study area are high in winter months (January, February, December) and low in summer months (June, July, August), and spatially, PM2.5 concentrations show a distribution of high north and low south.

Background The surgical procedure of vertebral column decancellation (VCD) has been increasingly performed in orthopaedic surgery for those with spinal deformity. To investigate the results of single-segment VCD performed at different vertebra for correcting thoracolumbar kyphosis in ankylosing spondylitis (AS) and to guide the osteotomy strategy. Methods Eighty-six AS patients (77 males, 9 females) having thoracolumbar kyphosis underwent single-segment VCD (ranging from T12 to L3) between January 2016 and September 2019 were enrolled and divided into four groups according to the osteotomy vertebra: T12 in 9 cases (Group A), L1 in 15 cases (Group B), L2 in 47 cases (Group C), and L3 in 15 cases (Group D). Demographics, operational data, radiological and clinical data were compared among the four groups. Results All patients had significant improvements in spinopelvic alignments and health-related quality of life after correction surgeries. Having the similar demographics, patients in the group C obtained the maximum local kyphosis and global kyphosis correction of 45.05° ± 9.07° ( P  < 0.001) and 43.42° ± 11.24° ( P  < 0.001) respectively. However, those in the group A had the largest correction in thoracic kyphosis (41.88° ± 9.57°) and chin-brow vertical angle (24.74° ± 6.38°) respectively ( P  < 0.001). Moreover, the VCD of L2 or L3 would result in much larger correction in lumbar lordosis and sagittal vertical axis than those in the group A and B respectively ( P  < 0.001), patients in the group A and B suffered from much higher incidence of complications perioperatively although ( P  = 0.043). Conclusion Single-segment VCD performed among thoracolumbar segments can effectively restore spinopelvic alignments and improve the health related quality of life for AS patients with thoracolumbar kyphosis deformity. Moreover, L2 may be the optimal osteotomy vertebra for those patients. Trial registration Clinical trial number: not applicable. Level of evidence III, therapeutic study.

Background To investigate whether the coronal alignment (CA) will deteriorate, and identify the risk factors for coronal malalignment (CM) developing in adult spinal deformity (ASD) after long-fusion surgery. Methods A multi-center retrospective study was performed, which included a total of 161 ASD patients who had undergone the surgical procedure of long-fusion (≥ 5 vertebras) with instrumentations in three medical centers. All of the participants were retrospectively reviewed, and subsequently assigned into the consistency group (C7 plumb line (C7PL) shifting towards the convex side of the main curve), and the opposition group (C7PL shifting towards the concave side). CM was considered if the coronal balance distance (CBD) being over 30 mm. A Kaplan–Meier curve and log-rank test were used to analyze the differences in CM-free survival during follow-up. Multivariate analysis via a Cox proportional hazards test was used to analyze the risk factors. Results Patients showing CM equaled 35 (21.7%) at the pre-operation, and that increased significantly up to 51 (31.7%) at the final follow-up ( P  = 0.04). In the consistency group, the incidence of CM at the final follow-up was much higher than that preoperatively (35:16, P  = 0.002). CM-free survival time decreased significantly in patients with larger CBD correction, pelvic fixation and more instrumented segments, respectively, during follow-up ( P  < 0.05, log-rank test). Age ≥ 60 years, the consistency CA, pelvic fixation, CBD-correction ≥ 30 mm and fixed-vertebra ≥ 8 were risk factors for CM happening after surgery using multivariate regression analysis ( P  < 0.05). Conclusions The coronal alignments in ASD patients underwent long-fusion surgeries may deteriorate during follow-up, for which the risk factors include the consistency CA, age ≥ 60, fixed-vertebra ≥ 8, CBD-correction ≥ 30 mm and pelvic fixation.