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Purpose To determine whether radiological, clinical, and demographic findings in patients with cervical spondylotic myelopathy (CSM) were independently associated with loss of cervical lordosis (LCL) after laminoplasty. Methods The prospective study included 41 consecutive patients who underwent laminoplasty for CSM. The difference in C2-7 Cobb angle between the postoperative and preoperative films was used to evaluate change in cervical alignment. Age, sex, body mass index (BMI), smoking history, preoperative C2-7 Cobb angle, T1 slope, C2-7 range of motion (C2-7 ROM), C2-7 sagittal vertical axis (C2-7 SVA), and cephalad vertebral level undergoing laminoplasty (CVLL) were assessed. Data were analyzed using Pearson and Spearman correlation test, and univariate and stepwise multivariate linear regression. Results T1 slope, C2-7 SVA, and CVLL significantly correlated with LCL ( P  < 0.001), whereas age, BMI, and preoperative C2-7 Cobb angle did not. In multiple linear regression analysis, higher T1 slope ( B  = 0.351, P  = 0.037), greater C2-7 SVA ( B  = 0.393, P  < 0.001), and starting laminoplasty at C4 level ( B  = − 7.038, P  < 0.001) were significantly associated with higher postoperative LCL. Conclusions Cervical alignment was compromised after laminoplasty in patients with CSM, and the degree of LCL was associated with preoperative T1 slope, C2-7 SVA, and CVLL.

Change detection (CD) with heterogeneous images is currently attracting extensive attention in remote sensing. In order to make heterogeneous images comparable, the image transformation methods transform one image into the domain of another image, which can simultaneously obtain a forward difference map (FDM) and backward difference map (BDM). However, previous methods only fuse the FDM and BDM in the post-processing stage, which cannot fundamentally improve the performance of CD. In this paper, a change alignment-based change detection (CACD) framework for unsupervised heterogeneous CD is proposed to deeply utilize the complementary information of the FDM and BDM in the image transformation process, which enhances the effect of domain transformation, thus improving CD performance. To reduce the dependence of the transformation network on labeled samples, we propose a graph structure-based strategy of generating prior masks to guide the network, which can reduce the influence of changing regions on the transformation network in an unsupervised way. More importantly, based on the fact that the FDM and BDM are representing the same change event, we perform change alignment during the image transformation, which can enhance the image transformation effect and enable FDM and BDM to effectively indicate the real change region. Comparative experiments are conducted with six state-of-the-art methods on five heterogeneous CD datasets, showing that the proposed CACD achieves the best performance with an average overall accuracy (OA) of 95.9% on different datasets and at least 6.8% improvement in the kappa coefficient.

Background Rotational alignment changes following high tibial osteotomy (HTO) can alter patellofemoral joint biomechanics, potentially leading to adverse clinical outcomes. This study aimed to compare rotational alignment changes and clinical outcomes between two different types of biplanar medial opening-wedge HTO: proximal tubercle osteotomy (PT-HTO) and distal tubercle osteotomy (DT-HTO). Methods A total of 178 patients who underwent medial opening-wedge HTO for medial compartment osteoarthritis between January 2020 and March 2023, with a minimum follow-up of two years, were retrospectively identified. Patients were stratified into two groups based on the direction of the second-plane osteotomy: PT-HTO ( n  = 136) and DT-HTO ( n  = 42). Propensity score matching was performed based on age, sex, body mass index, preoperative Kellgren–Lawrence grade, preoperative mechanical hip-knee-ankle angle, and correction angle, yielding 42 matched patients in each group. Radiological assessments were conducted using preoperative and postoperative lower extremity computed tomography scans. The primary outcome measure was the change in rotational alignment (tibial torsion angle, knee rotation angle, and knee-ankle rotation angle). Secondary outcomes included the tibial tuberosity–trochlear groove (TT–TG) distance and clinical outcomes assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala score. Results The mean tibial torsion angle significantly decreased in both groups compared to preoperative values, with reductions of − 3.8° in the PT-HTO group and − 1.4° in the DT-HTO group, with a marginally significant difference between the groups ( p  = 0.062). The knee rotation angle exhibited a greater reduction following PT-HTO than DT-HTO (− 2.4° vs. −1.4°; p  = 0.046), indicating increased external rotation of the proximal fragment after PT-HTO. The TT–TG distance increased in the PT-HTO group but was preserved in the DT-HTO group, with a significant difference in mean change between the groups (2.1 mm vs. −0.2 mm; p  < 0.001). Patellar height significantly decreased in the PT-HTO group, as reflected by reductions in the Blackburne–Peel ratio (− 0.14; p  = 0.001) and Caton-Deschamps index (− 0.16; p  < 0.001), whereas the DT-HTO group maintained preoperative patellar height. At a mean follow-up of 31.2 months, the DT-HTO group showed significantly better postoperative clinical outcomes, with higher KOOS pain scores (82.6 vs. 74.0; p  = 0.030) and Kujala scores (72.3 vs. 65.7; p  = 0.028) compared to the PT-HTO group. Conclusions DT-HTO resulted in reduced rotational alignment changes and superior patellofemoral joint alignment compared to PT-HTO, leading to improved clinical outcomes. Level of evidence Retrospective comparative study; Level III.

Background: Time-dependent changes in lower extremity alignment after an opening-wedge high tibial osteotomy (OWHTO) have been poorly investigated. Moreover, few studies have investigated risk factors of postoperative alignment change. Purposes: To investigate time-dependent alignment changes and identify predictive factors for postoperative alignment change after OWHTO. Study Design: Case-control study; Level of evidence, 3. Methods: This study included patients who underwent OWHTO between March 2010 and September 2018. A total of 142 knees with a mean follow-up of 42 months were included and classified as the change group when the amount of hip-knee-ankle (HKA) angle change was >1°; if otherwise, then as the no-change group. HKA angle was obtained at 6 time points: preoperatively and at 3 months, 6 months, 1 year, 2 years, and final follow-up postoperatively. Multiple regression analysis was performed to identify the factors that were correlated with the changes in the HKA angle from 3 months to the final follow-up. Results: Among the 142 knees, 59 (42%) were included in the change group. The overall postoperative HKA angles progressed serially toward varus after OWHTO. The mean angles of the 6 time points were 8.5°, –3.7°, –3.6°, –3.3°, –3.1°, and –2.7°, respectively. The mean HKA angles of the change and no-change groups were 9.1°, –4.3°, –3.4°, –2.8°, –2.0°, and –1.4° and 8.1°, –3.3°, –3.8°, –3.6°, –3.8°, and –3.7°, respectively. Greater change in the HKA angle was predicted by preoperatively greater valgus stress joint line convergence angles and less medial joint space width. Conclusion: Of the cases of OWHTO, 42% showed correction loss of >1° at a mean follow-up of 42 months. The overall postoperative HKA angles progressed serially to varus angles after OWHTO. Preoperative greater valgus stress joint line convergence angles and less medial joint space width were predictive factors for greater change in alignment toward varus after OWHTO.

Recent research has generated important new insights into the existence, behavior, and violent consequences of armed actors in civil wars. However, the lack of suitable information on actor relationships with the state means that studies have been forced to assume that armed groups are either pro-government or anti-government and remain that way for the duration of their existence. Both assumptions severely limit our understanding of the armed actors themselves, as well as the violent dynamics they produce. This article introduces the Government and Armed Actors Relations Dataset (GAARD), which provides detailed information on all major armed groups and their fluctuating alignment with the state between 1989 and 2007. GAARD identifies when armed groups fight with or against the government, and when they lack relationships with the government altogether. It further provides information on all changes in group alignments and documents when and how these occurred. We demonstrate that more than 25% of armed groups changed their alignments and showcase how this allows researchers to pursue original research on the drivers, dynamics, and outcomes of civil conflicts.

Study Design: This was a prospective clinical study.Purpose: Previous studies have indicated that cervical lordosis is a parameter influenced by segmental and global spinal sagittal balance parameters. However, this correlation still remains unclear. Therefore, a better understanding of the normal values and interdependencies between inter-segmental alignment parameters is needed. This is a preliminary analysis that helps to understand these factors.Overview of Literature: Change in global sagittal alignment is associated with poor health-related quality of life. Questions regarding which parameters play the primary roles in the progression of spinal sagittal imbalance and which might be compensatory factors remain unanswered.Methods: Prospectively, 420 adults (105 asymptomatic, 105 cervical symptomatic, 105 lumbar symptomatic, and 105 post-surgical) were selected. Whole-spine standing lateral radiographs were taken, and spinopelvic, thoracic, and cervical parameters were measured. Then, the data were analyzed using correlation coefficient test and multiple regression analysis.Results: All the parameters showed a normal distribution. The mean values of the cervical parameters are as follows: C1C2 Cobb angle, −27.07°±4.3°; C2C7 Cobb angle, −16.4°±5.6°; OCC2 Cobb angle, −14.5°±3.8°; OCC7 Cobb angle, −29.8°±5.6°; C2C7 Harrison angle, 20.4°±4.3°; and C7 slope, −25.4°±5.6°. The analysis of these parameters revealed no statistically significant difference between asymptomatic, symptomatic, and post-surgical patients. C7 sagittal vertical axis (SVA) correlated with the C2C7 Cobb angle (r =0.7) in all groups. No significant correlation was noted between cervical and spinopelvic parameters in asymptomatic patients. However, C1C2 Cobb angle correlated significantly with pelvic incidence (PI, r =−0.2), lumbar lordosis (LL, r =0.2), and pelvic tilt (PT, r =−0.2) in cervical symptomatic patients. Irrespective of the patient symptom sub-group (n=420), C1C2 Cobb angle correlated with LL (r =0.1) and C2C7 Harrison angle correlated with PI and PT (r =0.1).Conclusions: Our results indicate significant interdependence between the spinopelvic and cervical alignment, especially in cervical symptomatic patients. In addition, strong correlation was found between the C7 SVA and C2C7 Cobb angle. Overall, the results of this study could help to better understand the cervical sagittal alignment and serve as preliminary data for planning surgical reconstruction procedures.

Background Cup malalignment increase impingement, dislocation, cup migration, and polyethylene wear. Screw fixation for enhanced stability is the preferred option in cases of doubtful primary cup stability. There have been few studies about alignment changes after screw fixation, which may be another cause of cup malalignment. This study aimed to evaluate cup alignment change after screw fixation. Materials and Methods Patients undergoing imageless navigation total hip arthroplasty using screws fixation for acetabular cup were corrected. After the press-fit cup was fully seated, the cup orientation was recorded. After screws were inserted, the cup orientation was recorded again to calculate the alignment change. Results There were 99 cases with a mean age 63.7 years (25–93). Alignment change after screw fixation was found in 73 cases (73.7%). There were 56 cases (56.6%) with inclination angle change and the mean change was 2.21° (0°–8°). The inclination angle increased in 47 cases (47.5%) with 9 cases (9.1%) increased by 5° or more and decreased in 9 cases (9.1%). There was statistically significant difference between patients using one screw and patients using two or more screws in inclination angle change, 1.56° (0°–5°) and 3.4° (0°–8°), respectively ( P = 0.0039). There was statistically significant correlation between inclination angle change and number of screws ( r = 0.5401, P < 0.01). There were 49 cases (49.5%) with anteversion angle change and the mean change was 1.67° (0°–5°). The anteversion angle increased in 31 cases (31.3%), decreased in 18 cases (18.2%) with two cases (2%) decreased by 5° or more. There was significant difference between patients using one screw and patients using two or more screws in anteversion angle change, 1.46° (0°– 5°) and 2.21° (0°–5°), respectively ( P = 0.009). There was significant correlation between anteversion angle change and number of screws ( r = 0.284, P = 0.048). Conclusions Changes in cup alignment after screw fixation were detected in most cases. It is one possible cause of cup malalignment.

This paper proposes a diachronic analysis of the origin of the unusual alignment found in Formosan and Philippine languages commonly referred to as a ‘focus’ or ‘voice’ system. Specifically, I propose that Proto-Austronesian (PAn) was an accusative language, an alignment which is preserved in modern Rukai dialects, while the non-accusative alignment found in other Austronesian languages resulted first from the reanalysis of irrealis clause types in a daughter of PAn, which I term ‘Proto-Ergative Austronesian’ (PEAn). Modern Rukai dialects belong to the other primary subgroup and do not reflect the innovation. The main theoretical claim of the proposal is that ergative alignment arises from an accusative system when v is unable to structurally license the object in a transitive clause, and the subject does not value case with T. Since the external argument is licensed independently, T is able to probe past it and exceptionally value nominative case on the object. I propose that irrealis v, which is frequently detransitivized cross-linguistically, was likewise unable to license structural accusative case on an object in PAn and PEAn. Objects in irrealis clauses in PAn were case-marked with a preposition, but this preposition was incorporated to the verb in PEAn. This resulted in the emergence of ergative alignment in irrealis clauses in PEAn, because incorporation of the preposition deprived the object of its case licenser and forced it to be dependent on T for case. The embedded irrealis clause type, which I take to be a kind of subjunctive, was later reanalyzed as the basic transitive clause type in Puyuma and Tsou.

本文的主要目標是尋找南島語言作格性（焦點系統）的來源。本文假設原始南島語 言是賓格語言（沒有焦點系統），並且假設現代魯凱語保持了原始南島語的賓格性。其 他南島語言中的作格性源於另外一個創新。關於南島語言中作格句法特點的來源，本文 提出作格格局先出現在原始南島語言的子語原始作格南島語，是非現實句型中的賓語得 到主格的結果。具體來說，原始南島語言中非現實句型中的輕動詞V沒有賦予賓格的 能力。原始南島語言非現實句型中的賓語一定要帶介詞，並且通過介詞得到格。本文 提出作格南島語支的主要創新是介詞倂入動詞。介詞倂入導致了非現實句型中的賓語失 去了格的來源。因爲輕動詞沒有賦予賓格的能力，賓語只能由T賦予主格。這就是南島 語言中作格格局的來源

Background: The aim of this study was to investigate the differences in the involvement of whole-body compensatory alignment in different conditions of spinopelvic sagittal balance (compensated/decompensated). Methods: We enrolled 330 individuals who underwent medical checkups and divided them according to sagittal vertical axis (SVA): for the compensated group, this was <4 cm, (group C) and for the decompensated group, it was ≥4 cm, (group D). The correlation between the lack of ideal lumbar lordosis (iLL), which was calculated by using the Schwab formula, and the compensatory radiographic parameters in each group was analyzed. The threshold value of knee flexion (KF) angle, which indicated spinopelvic sagittal imbalance (SVA ≥ 4), was determined by a ROC-curve analysis. Results: The correlation analysis of the lack of iLL and each compensatory parameter showed a strong correlation for pelvic tilt (PT) (r = −0.723), and a weak correlation for thoracic kyphosis (TK) (r = 275) in Group C. In Group D, the correlations were strong for PT (r = −0.796), and moderate for TK (r = 0.462) and KF (r = −0.415). The optimal cutoff value for the KF angle was determined to be 8.4 degrees (sensitivity 89%, specificity 46%). Conclusions: The present study shows differences between compensated/decompensated spinopelvic sagittal balance in the correlation strength between lack of iLL and whole-body compensatory parameters.