Machine learning Reveals ATM and CNOT6L as critical factors in Cataract pathogenesis

OBJECTIVE

Cataract, a common age-related blinding eye disease, has a complex pathogenesis. This study aims to identify key genes and potential mechanisms associated with cataracts, offering new targets and insights for its prevention and treatment.

METHODS

Transcriptomic data analysis and machine learning identified ATM serine/threonine kinase (ATM) and CCR4-NOT transcription complex subunit 6 like (CNOT6L) as key differential genes. Their roles in oxidative stress and apoptosis were validated using overexpression experiments in a cataract cell model. Immune-related analyses explored their regulatory effects on the immune microenvironment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed potential mechanisms. In addition, in vitro experiments were conducted to evaluate the effects of ATM and CNOT6L overexpression on cell proliferation, oxidative stress, and apoptosis in lens epithelial cells.

RESULTS

We identified 14 aging-associated differentially expressed genes, and ATM and CNOT6L were screened as key genes through machine learning and external dataset validation. KEGG pathway analysis indicated their involvement in base excision repair, ERBB signaling, and fatty acid metabolism pathways. Immune infiltration analysis revealed that ATM and CNOT6L positively correlated with CD8 T cells and B cells, and negatively correlated with regulatory T cells (Tregs), natural killer (NK) cells, and M1 macrophages. In vitro, overexpression of ATM and CNOT6L in cataract cell models promoted cell proliferation, inhibited apoptosis, reduced reactive oxygen species (ROS) and malondialdehyde (MDA) levels, and enhanced glutathione peroxidase (GSH-PX) activity.

CONCLUSION

ATM and CNOT6L play protective roles in cataract progression by reducing oxidative stress, inhibiting apoptosis, and regulating the immune microenvironment. They represent promising molecular targets for cataract prevention and treatment.

What are mice teaching us about psoriatic arthritis?

PURPOSE OF REVIEW

This review summarizes important mouse models of psoriatic arthritis (PsA), shedding light on their advantages and disadvantages in modeling human disease.

RECENT FINDINGS

Two newly created mouse models of PsA validate NF-κB signaling as disease-causing and identify pathogenic roles for CD8 + and CD4 + FoxP3 + T cells in the development of specific PsA phenotypes. The IkbkbGoF/GoF model demonstrates that homozygosity for a gain-of-function mutation in Ikbkb results in expansion of FoxP3 + CD25 + IL-17A + Tregs that lead to the development of dactylitis, spondylitis and PsA-like changes to the nails and skin, and when transferred to wildtype mice, reproduce these outcomes. The humanized mouse PsA model (Hu-PsA) establishes that introduction of PsA patient sera and PBMCs into NSG-SGM3 mice has the capacity to elicit distinct subtypes of PsA and identifies a critical role for CD8 + IL-32 + CXCL14 + T cells and immunoglobulins in disease development.

SUMMARY

Mouse models of PsA are powerful research tools for elucidating pathogenesis of disease, biomarker identification and may assist in the discovery of a cure.

The Patients´ quality of life and outcome after surgical treatment for primary spinal infection

INTRODUCTION

Surgical intervention can be an option in the treatment of primary spinal infection as a means to control infection, improve severe paralysis and save lives. However, there is a knowledge gap regarding how the patients fare after restitution, in terms of patient-reported outcomes (PROMs). This study aims to assess the outcomes 1 year after surgical treatment for primary spinal infection using PROMs by analyzing data with available cases from the national Swedish spine registry (Swespine).

METHODS

This retrospective case-control cohort study included 907 patients who underwent surgery for primary spinal infection, registered in Swespine between 2006 and 2023. Among them, 82 patients had complete baseline and one-year follow-up data. Variables included age, sex, BMI, mortality rate, reoperation rate, and preoperative and one-year postoperative scores for the EQ-5D index, EQ-visual analogue scale (VAS), and Numerical Rating Scale (NRS) for back/neck and leg/arm pain. Patient status at one year post-surgery were calculated using ANCOVA analysis and compared with a cohort of healthy controls (n = 273) and with the I year follow-up of patients surgically treated for degenerative lumbar spine disease (n = 89,478). Patients' return to work 1 year after the surgery were also assessed via postal questionnaires.

RESULTS

One year post-surgery, spinal infection patients showed significant improvements in the EQ-5D index, EQ-VAS, and NRS scores (p-values: <0.001, < 0.001, 0.002, 0.001). The EQ-5D index improvement exceeded the minimum clinically important difference (MCID) of 0.24, but NRS improvements fell below the MCID threshold of 2.5. Despite improvements, the postoperative EQ-5D index remained significantly lower in the spinal infection group than in population-based controls (control: 0.93, infection: 0.49; p < 0.001). Additionally, EQ-5D and EQ-VAS improvements were less pronounced compared to degenerative disease patients (infection: 0.51, 57.3; degenerative: 0.65, 67.2; p < 0.001). The reoperation rate was 18.2%, and half of the working patients (20/40) had not resumed work within a year.

CONCLUSION

Surgical treatment for spinal infection improves life quality and pain. However, pain relief remains suboptimal, as the improvements do not reach the MCID. One year postoperatively, PROMs in spinal infection patients remain worse than those in population-based controls and degenerative disease patients, suggesting persistent symptoms despite healing and restitution of the spinal infection.

Cilia at the crossroad: convergence of regulatory mechanisms to govern cilia dynamics during cell signaling and the cell cycle

Cilia are versatile, microtubule-based organelles that facilitate cellular signaling, motility, and environmental sensing in eukaryotic cells. These dynamic structures act as hubs for key developmental signaling pathways, while their assembly and disassembly are intricately regulated along cell cycle transitions. Recent findings show that factors regulating ciliogenesis and cilia dynamics often integrate their roles across other cellular processes, including cell cycle regulation, cytoskeletal organization, and intracellular trafficking, ensuring multilevel crosstalk of mechanisms controlling organogenesis. Disruptions in these shared regulators lead to broad defects associated with both ciliopathies and cancer. This review explores the crosstalk of regulatory mechanisms governing cilia assembly, disassembly, and maintenance during ciliary signaling and the cell cycle, along with the broader implications for development, tissue homeostasis, and disease.

Lumbar Spondylolysis in the Pediatric Population: A Retrospective CT Review With Radiology Rereview

INTRODUCTION

Spondylolysis, a defect in the pars interarticularis, can be symptomatic or asymptomatic with an estimated prevalence of 4% by age 6 years and 6% by adulthood. This study's goal was to determine the prevalence of lumbar spondylolysis found on CT scans in children and to characterize patient-specific risk factors.

METHODS

Abdominopelvic CT scans done (2017 to 2020) in patients up to age 18 years were reviewed. The radiology report was retrospectively reviewed for a spondylolysis, and a radiologist rereviewed the CT scan. Patient demographics and indications for CT scan were included. Firth bias-reduced logistic regression was used to model spondylolysis with each demographic variable as a predictor.

RESULTS

One thousand nine hundred thirty-one CT reports and imaging were reviewed; abdominal pain (41.91%) and trauma (29.46%) were the most common reasons for CT scan. Spondylolysis was found in 42 patients (2.18%) per the radiology report and in 71 patients (3.68%) on radiologist overread. Median age was 13 years (interquartile range, 10 to 16 years). Age groups had the following prevalence: 0 to 6 years (0.41%); 7 to 10 years (1.58%); 11 to 13 years (3.59%); 14 to 18 years (5.1%). Increased prevalence was found in ages 14 to 18 years that was statistically significant (odds ratio 1; P = 0.0004). L5 was the most common level; most defects were bilateral. White patients had a higher rate of spondylolysis (5.06%) than Black patients (2.05%). Black patients were less likely to have a spondylolysis with an OR of 0.4 (0.22 to 0.69; P = 0.0007).

DISCUSSION

This study demonstrated a lower prevalence of lumbar spondylolysis (3.68%) in children compared with the previous literature. Increasing prevalence with age suggests that spondylolysis develops over time, likely because of repetitive stress. Future studies should characterize these age-related and race-related differences for better understanding.

LEVEL OF EVIDENCE

Level IV, retrospective.

Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years and Older Results in Improvements in Activity and Functional Outcome Measures, Whereas Reported Complication Rates Vary Widely: A Systematic Review

PURPOSE

To systematically review the contemporary literature and evaluate patient-reported outcome measures (PROMs), functional knee measures, and the incidence of complications in patients aged 50 years and older undergoing anterior cruciate ligament reconstruction (ACLR) at short- to mid-term follow-up.

METHODS

A literature search was conducted across the PubMed, Embase, and Scopus databases, spanning from database inception to November 2023, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The inclusion criteria consisted of clinical studies reporting PROMs, measures of knee stability, and complication rates after ACLR in patients aged 50 years and older with minimum 2-year follow-up. The Methodological Index for Non-randomized Studies criteria were used to assess study quality. Primary outcome measures consisted of changes in PROMs and complication rates after ACLR.

RESULTS

A total of 17 studies, consisting of 1,163 patients undergoing ACLR, were identified. Autografts were used in 90.3% of patients, whereas 9.7% of patients were treated using allografts. At minimum 24-month follow-up, mean International Knee Documentation Committee scores ranged from 67.4 to 92.96; mean Lysholm scores, from 84.4 to 94.8; and mean Tegner scores, from 0.3 to 5.4. The mean side-to-side difference at final follow-up ranged from 1.2 to 2.4 mm, and the rates of recurrent instability ranged from 0% to 18%. Complication and revision rates ranged from 0% to 40.4% and 0% to 37.5%, respectively, with the highest rates observed in studies noting a high incidence of intraoperative cartilage lesions.

CONCLUSIONS

ACLR in patients aged 50 years and older results in favorable International Knee Documentation Committee scores, Lysholm scores, and Tegner activity scores and improvements in functional knee measures. However, a wide range of reoperations and complications are reported, attributed to varying levels of chondral injury and osteoarthritis, which warrant consideration when discussing expectations in patients aged 50 years and older undergoing ACLR.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II to IV studies.

A biomechanical study on bilateral SAI annular fixation in the treatment of unilateral Denis Ⅱ sacral fractures

PURPOSE

To investigate the biomechanical properties of bilateral SAI annular internal fixation in the treatment of unilateral Denis type Ⅱ sacral vertical fracture, so as to provide a reference for clinical practice.

METHODS

The finite element approach was utilized to simulate the Denis type Ⅱ fracture of the right sacral (the entire fracture through the sacral foraminarum) as well as the fracture of the upper and lower ramus of the right pubic bone, which represents unilateral vertical instability of the pelvic ring. The posterior pelvic ring was fixed using three different methods: lumbopelvic fixation and S1 transsacral screw (LPF-S1), bilateral S1AI annular fixation and S2 transsacral screw (BS1AI-S2), bilateral S2AI annular fixation and S1 transsacral screw (BS2AI-S1), and the anterior pelvic ring was fixed with pubic ramus screws. Six different loading methods are used to simulate six conditions: standing, forward bending, left flexion, right flexion, left rotation and right rotation. The maximum Von Mises stress of the implant, the vertical displacement of the upper surface of the sacral, and the relative intrafragmentary displacement (RID) of the observation point on the anterior surface of the sacral were recorded and analyzed.

RESULTS

The maximum Von Mises stress of the implant in the three fixed models did not exceed the maximum yield stress of the titanium alloy under different motion conditions in the finite element model. The descending order from high to low was LPF-S1, BS1AI-S2, and BS2AI-S1. The RID of each observation point on the anterior surface of the sacral and the vertical displacement of the upper surface of the sacral were both lower in the BS2AI-S1 group than in the LPF-S1 group and the BS1AI-S2 group. In the standing, forward flexion, left flexion, right flexion, and left rotation conditions, the LSD test results indicated a statistically significant difference in the mean RID of observation points between the BS2AI-S1 and BS1AI-S2 groups (p < 0.05), but not in the LPF-S1 group. In the condition of right rotational motion, there was no statistically significant difference in the mean RID between the three groups (p > 0.05).

CONCLUSION

The biomechanical stability of the fixation of Denis type II sacral fractures was satisfactory in the LPF-S1, BS1AI-S2, and BS2AI-S1 groups, with the BS2AI-S1 group exhibiting the maximum level of stability. Bilateral SAI annular internal fixation is a viable alternative to the fixation of vertical sacral fractures, as it does not impair the lumbar spine's mobility and accomplishes satisfactory biomechanical stability.

Analysis of Nicotine Toxicity and Mechanisms of Senescence in Nucleus Pulposus Cells Using Network Toxicology and Molecular Docking Technique

Aim

Through the use of network toxicology, the research sought to determine whether cellular senescence and associated molecular mechanisms in nicotine-induced intervertebral disc degeneration (IVDD) were potentially harmful.

Methods

The primary chemical structure and 105 targets of action of nicotine were determined by using the Swiss Target Prediction, Cell Age, and PubChem databases. 855 IVDD senescence genes were found using the GEO and Cell Age datasets.

Results

After additional screening and Cytoscape development, 9 key targets were identified. Additionally, these targets' co-expression pattern analysis and protein interactions were confirmed to be identical. The core targets of nicotine-induced IVDD cellular senescence were found to be primarily enriched in the positive regulation of cell proliferation, telomere shortening, histone acetylation, and cellular senescence-related processes, according to gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). The KEGG signaling pathway also made it clear that the Apelin signaling route, nicotinate and nicotinamide metabolism, cell cycle, and apoptosis are all strongly linked to nicotine-induced IVDD cellular senescence. We chose four genes associated with the cellular senescence pathway-HDAC1, HDAC4, and NAMPT, MYLK-for molecular docking with the toxic substance nicotine. The findings validated nicotine's strong affinity for the primary targets.

Conclusion

All things considered, the current research indicates that nicotine may contribute to cellular senescence in IVDD via controlling the histone deacetylation process, telomere shortening, the Apelin signaling pathway, and pathways linked to the metabolism of nicotinate and nicotinamide. The theoretical foundation for investigating the molecular mechanisms of nicotine-induced senescence in IVDD is established.

Macrophage Changes and High-Throughput Sequencing in Aging Mouse Intervertebral Disks

Background

Intervertebral disk (IVD) degeneration is associated with lower back pain and aging; however, the mechanisms underlying age-related changes and the changes in macrophage polarization in aging intervertebral disks require further elucidation. The aim of this study was to evaluate changes in macrophages, the differential expression of senescence genes, and their relationship with hub genes in IVDs during aging in mice.

Methods

Twenty-eight male wild C57 mice aged 4 weeks were divided into two groups. Four mice per group were selected for high-throughput sequencing and 10 for tail IVD immunohistochemical analysis. Adult and aged mouse IVD specimens were stained with hematoxylin-eosin, Fast Green, and Alcian Blue to determine collagen (Col) 1, Col2, proteoglycan, P16, P21, P53, CD11b, CD86, CD206, IL-1, TGF-β, and IL-4 expression. High-throughput sequencing was performed on adult and aged mouse IVD tissues.

Results

Aged mouse IVDs showed reduced height and marked degeneration, with decreased Col2 and proteoglycan expression and increased Col1 expression. The expression of senescence markers, senescence-associated IL-1, TGF-β, and IL-4, and macrophage-related markers, CD11b, CD86, and CD206, increased markedly with age. High-throughput sequencing revealed 1975 differentially expressed genes in adult and aged mice, with 797 genes showing upregulated expression (top five: Kcna7, Mmp9, Panx3, Myl10, and Bglap) and 1178 showing downregulated expression (top five: Srd5a2, Slc38a5, Gm47283, Npy, and Pcdh8). Gene Ontology and pathway enrichment analyses highlighted aging-related cellular components, biological processes, and metabolic pathways. The identified hub genes included Cox5a, Ndufs6, and Ndufb9.

Conclusions

Disk senescence and reduced height in aged mice are linked to upregulated expression of senescence-associated phenotypes and macrophage polarization markers. These findings suggest that macrophages and differential gene expression play key roles in age-related IVD degeneration, indicating that they can be used as potential targets for therapeutic intervention.

Late (≥60 years old) and middle adulthood (40-59 years old) patients achieve similar improvement in patient-reported outcomes following ACL reconstruction

PURPOSE

This study aimed to compare the range of motion (ROM), surgical outcomes, and patient-reported outcome measures (PROMs) following anterior cruciate ligament (ACL) reconstruction outcomes in patients 60 years or older at the time of surgery to 40- to 59-year-old patients.

METHODS

In this retrospective cohort study from 2015 to 2022, a 3:1 propensity match was performed to match late adulthood patients (≥60 years old) undergoing ACL reconstruction with middle adulthood (40-59 years old) ACL reconstruction patients. Patients were matched based on sex, ACL graft utilized and concomitant procedures performed during ACL reconstruction. Statistical analysis compared demographics, preoperative injury management, surgical outcomes, PROMs, and minimal clinical important difference (MCID) and substantial clinical benefit (SCB) achievement rates for all ACL reconstruction patients included.

RESULTS

Twenty late adulthood and 60 middle adulthood patients who underwent ACL reconstruction were included in the final cohort. Patients who were 60 years or older experienced no difference in reoperation rate (n.s.), incidence of retears (n.s.) or ROM (n.s.) at 1 year post-operatively. There were also no differences in International Knee Documentation Committee (ΔIKDC) (31.3 ± 19.1 vs. 34.2 ± 18.2, n.s.) or ΔPCS-12 (12.4 ± 9.8 vs. 12.9 ± 10.8, n.s.) scores at 1 year post-operatively. Furthermore, the younger and older patient cohorts demonstrated similar rates of achieving the MCID (80.0% vs. 83.3%, n.s.) and SCB (50.0% vs. 61.7%, n.s.) scores for IKDC.

CONCLUSION

Patients 60 years or older and 40- to 59-year-old patients demonstrated similar outcomes after undergoing ACL reconstruction with allograft. This study concludes that ACL reconstruction in late adulthood can still be a successful treatment option and should allow surgeons to feel more comfortable when performing indicated surgical intervention for older patients who experience an ACL tear.

LEVEL OF EVIDENCE

Level III, Therapeutic III, retrospective cohort study.

Anti-senescence therapies: a new concept to address cardiovascular disease

Accumulation of senescent cells is an increasingly recognized factor in the development and progression of cardiovascular (CV) disease (CVD). Senescent cells of different types display a pro-inflammatory and matrix remodelling molecular programme, known as the 'senescence-associated secretory phenotype' (SASP), which has roots in (epi)genetic changes. Multiple therapeutic options (senolytics, anti-SASP senomorphics, and epigenetic reprogramming) that delete or ameliorate cellular senescence have recently emerged. Some drugs routinely used in the clinics also have anti-senescence effects. However, multiple challenges hinder the application of novel anti-senescence therapeutics in the clinical setting. Understanding the biology of cellular senescence, advantages and pitfalls of anti-senescence treatments, and patients who can profit from these interventions is necessary to introduce this novel therapeutic modality into the clinics. We provide a guide through the molecular machinery of senescent cells, systematize anti-senescence treatments, and propose a pathway towards senescence-adapted clinical trial design to aid future efforts.

Intra-Articular Injection of Bupivacaine and Adrenaline Reduces Intraoperative and Postoperative Blood Loss in Total Knee Arthroplasty: A Retrospective Case-Control Study

Objective: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. Methods: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. Results: The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; p = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; p = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; p = 0.038). Conclusions: Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty.

Challenges and limitations of the existing scoring systems for postoperative outcomes in thoracolumbar pyogenic spondylitis: a multicenter retrospective cohort study

PURPOSE

This study aimed to evaluate the predictive ability of existing scoring systems for postoperative outcomes in patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation.

METHODS

We conducted a multicenter retrospective cohort study of 90 patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation between January 2014 and June 2024. We assessed the Brighton spondylodiscitis score (BSDS), spinal instability spondylodiscitis score (SISS), and spinal infection treatment evaluation (SITE) score. Patients were divided into success and failure groups based on infection control or implant failure. The predictive ability of each scoring system for treatment failure was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC).

RESULTS

The success and failure groups consisted of 78 (87%) and 12 patients (13%), respectively, with the failure group including seven and five patients due to infection control or implant failure. The failure group had higher BSDS, SISS, and SITE scores, but the ROC analysis showed low predictive accuracy (AUC: BSDS = 0.65, SISS = 0.64, SITE score = 0.56). Grading the BSDS into three categories revealed no failure in the low-risk patients, whereas 22% of the high-risk patients required unplanned additional surgeries for infection control or implant failure.

CONCLUSIONS

Existing scoring systems showed limited ability to predict postoperative outcomes in patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation. BSDS grading demonstrated some utility, with 22% of high-risk patients experiencing postoperative infection control failure and implant failure, highlighting the need for careful treatment planning.

Cervical Pyogenic Spondylitis: A Comprehensive Review of Diagnosis and Treatment Strategy

Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine's narrow canal and proximity to critical neurovascular structures. Early diagnosis relies on a high index of suspicion supported by MRI, inflammatory markers, blood cultures, and tissue biopsy. Empirical intravenous antibiotics remain the cornerstone of initial treatment, followed by pathogen-specific therapy. Surgical intervention is indicated in cases of neurological deterioration, spinal instability, or failure of conservative management. Anterior approaches, including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), are widely used, with anterior plating providing biomechanical advantages in select cases. Posterior or combined anterior-posterior approaches are recommended in multilevel disease, deformity, or posterior element involvement. Graft selection-typically autograft or titanium/PEEK cages-must consider infection severity and biomechanical demands. Challenges in CPS management include optimal debridement extent, graft choice in infected environments, the standardization of antibiotic protocols, and the prevention of recurrence. This narrative review synthesizes the cervical-spine-specific literature on diagnosis, treatment strategies, surgical techniques, and postoperative care and proposes the following practical clinical guidance: (1) early MRI for timely diagnosis, (2) prompt surgical intervention in patients with neurological deficits or mechanical instability, and (3) individualized graft selection based on infection severity and bone quality.

Comprehensive Transcriptomic Analysis in Wild-type and ATM Knockout Lung Cancer Cells: Influence of Cisplatin on Oxidative Stress-Induced Senescence

Genetic mutations and impaired DNA repair mechanisms in cancer not only facilitate tumor progression but also reduce the effectiveness of chemotherapeutic agents, particularly cisplatin. Combination therapy has emerged as a promising strategy to overcome resistance. Comprehensive transcriptomic analyses, supported by integrated comparative bioinformatics and experimental approaches, are essential for identifying biomarkers and novel therapeutic targets underlying drug resistance. In this study, we performed overall survival and mutation analyses, examining 23 double-strand break repair proteins across more than 7,500 tumors spanning 23 distinct cancer types. Our findings identify ATM (ataxia-telangiectasia mutated) as a key protein with the highest mutation frequency. Using CRISPR/Cas9, we investigated the effects of ATM mutations on signalling pathways that influence the cellular response to cisplatin. ATM knockout enhanced cisplatin cytotoxicity by activating alternative cell death pathways, including oxidative stress-induced senescence and necroptosis. Microarray analysis revealed a regulatory interplay between ATM and NRF2 in the activation of oxidative stress-induced senescence. Specifically, ATM knockoutpromoted senescence by increasing reactive oxygen species (ROS) accumulation and downregulating NRF2 expression. To enhance combination therapy, integrating genetic profiling with advanced tools such as CRISPR/Cas9 to target oxidative stress-induced senescence may provide innovative strategies to overcome drug resistance, thereby advancing personalized cancer treatment. These approaches lay the foundation for the development of personalized cancer therapies tailored to the unique mutational landscape of individual patients, offering promising prospects for improving treatment outcomes.

Intraosseous ultrasound for assessment of pedicle screw holes in the thoracolumbar spine based on endoscopic ultrasound: An experimental study

PURPOSE

Experimental assessment of the efficiency of intraosseous ultrasound (IOUS) utilizing the mini probe of endoscopic ultrasound (EUS) is performed to determine the accuracy of pedicle screw hole placements in thoracolumbar spine.

METHODS

Drill holes in 76 pedicles of thoracolumbar spines from 2 cases of goats. Each pedicle screw hole is subjected to a 360° circumferential IOUS scanning with a catheter-type mini ultrasound probe of EUS and to a CT examination. Subsequently, all ultrasound images were independently interpreted by 3 reviewers without knowledge of the real position of screw holes and the results of the CT examination for the assessment of screw hole malposition and pedicle cortex breach. Finally, according to the conclusion of CT, a Chi-square test is employed to assess the differences of interpretations of the screw hole malposition among the all reviewers and the relevant relationship between the recognition of the misplaced screw holes and imaging methods utilized.

RESULTS

CT revealed 13 correctly positioned holes and 63 holes deviating from correct position (including holes that penetrated the cortex). All ultrasound images with malposition identified by CT were correctly interpreted, with no false negatives and no intra-reviewer differences. There were no omissions of severe malposition (including the spinal canal was penetrated into). Excluding six false positives misjudged due to the intersection of screw holes on both sides, there was also no discrepancy between the EUS and CT imaging in the interpretation of screw hole malposition. The examination time of each pedicle screw hole with EUS took less than 15 s.

CONCLUSION

EUS-based IOUS is an immediate, reliable and lower-cost technique for accurate determination of pedicle screw hole malposition. With a probe that is both flexible and not easily bendable, the EUS is particularly suitable for IOUS, especially in the narrow space of the bone gaps or bone canals, and minimally invasive spine surgery (MISS).

Progress of melatonin in the treatment of intervertebral disc degeneration

The most common degenerative condition affecting the musculoskeletal system, and the leading cause of persistent low back pain, is intervertebral disc degeneration (IDD). IDD is increasingly common with age and has a variety of etiologic factors including inflammation, oxidative stress, extracellular matrix (ECM) degradation, and apoptosis that interact with each other to cause IDD. Because it is difficult to determine the exact pathogenesis of IDD, there is a lack of effective therapeutic agents. Melatonin has been intensively studied for its strong anti-inflammatory, antioxidant, and anti-apoptotic properties. Melatonin is a pleiotropic indole-stimulating hormone produced by the pineal gland, which can be used to treat a wide range of degenerative diseases. Therefore, melatonin supplementation may be a viable treatment for IDD. This article reviews the current mechanisms of IDD and the multiple roles regarding melatonin's anti-inflammatory, antioxidant, anti-apoptotic, and mitigating ECM degradation in IDD, incorporating new current research perspectives, as well as recent studies on drug delivery systems.

Local antibiotic carriers in the surgical management of pyogenic spondylodiscitis : First comparative evaluation of gentamicin-loaded versus vancomycin-loaded efficacy

OBJECTIVE

To evaluate the efficacy of intraoperative gentamicin versus vancomycin-loaded PerOssal (Osartis, Münster, Germany) carriers on interbody fusion rates and infection control in patients undergoing surgery for pyogenic spondylodiscitis.

METHODS

This retrospective study included 29 patients with pyogenic spondylodiscitis who underwent surgical debridement, interbody fusion, and pedicle screw fixation between February 2018 and March 2023. Patients received PerOssal carriers loaded with either gentamicin (Group A, n = 14) or vancomycin (Group B, n = 15). Clinical outcomes, including fusion rates, infection control, complications, and inflammatory markers, were analyzed.

RESULTS

Baseline characteristics between groups were comparable. Fusion rates at 3-6 months' follow-up were 92.8% (13/14) in Group A and 80.0% (12/15) in Group B, without significant differences (P > 0.05). Both groups showed significant reductions in white blood cell counts and C‑reactive protein levels postoperatively, without inter-group differences (P > 0.05). Complications included cerebrospinal fluid leakage, hematoma, pulmonary embolism, and wound infections, all managed successfully with no recurrent infections observed.

CONCLUSION

In the short term, PerOssal carriers loaded with either gentamicin or vancomycin demonstrated effective infection control for pyogenic spondylodiscitis and high interbody fusion rates. Moreover, no apparent adverse effects on bone healing were associated with the local administration of high-concentration antibiotics.

Current Trends and Future Directions in Lumbar Spine Surgery: A Review of Emerging Techniques and Evolving Management Paradigms

Background/Objectives: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools-including robotics, augmented reality, computer-assisted navigation, and artificial intelligence-have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. Methods: This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. Results: A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92-94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques-including endoscopic discectomy and MIS-TLIF-offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. Conclusions: Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care.

Posterior fixation for pyogenic spondylitis following osteoporotic vertebral fracture: A retrospective study of five challenging cases

BACKGROUND

Pyogenic spondylitis following osteoporotic vertebral fracture is rare but serious with a poor clinical outcome. Although posterior fixation is an effective treatment for pyogenic spondylitis, surgical outcomes following osteoporotic vertebral fractures remain largely unreported. We present the outcomes of five challenging cases treated with posterior fixation.

METHODS

We retrospectively evaluated patients who underwent posterior fixation for pyogenic spondylitis between January 2021 and July 2023. Five patients with pyogenic spondylitis following osteoporotic vertebral fracture were identified. We examined the age, sex, location of the vertebral fracture and infection, time from fracture to infection diagnosis, C-reactive protein levels, causative organisms, antibiotic therapy, operative procedures, and clinical outcomes.

RESULTS

Three male and two female patients were included; they had a mean age of 75.4 years (standard deviation [SD], 7.1; range, 65-83 years). The mean time from fracture to diagnosis was 37.0 days (SD, 15.9; range, 21-55 days). All causative organisms were identified. Initial posterior fixation proved insufficient in four of the five patients, and additional surgery was required. The remaining patient developed significant screw backout. Additional procedures included fixation extension, anterior vertebral replacement, and fibular strut grafting. Infection control was achieved in all patients, and the mean follow-up duration was 20.4 months (SD, 9.9; range, 15-38 months).

CONCLUSIONS

We encountered five patients in whom posterior fixation alone proved insufficient for treating pyogenic spondylitis following osteoporotic vertebral fracture. Treatment strategies for this condition should address both infection control and spinal reconstruction, incorporating anterior column support and posterior fixation techniques.

Early and late mortality in vertebral osteomyelitis: who dies within the first year after diagnosis

OBJECTIVE

Vertebral osteomyelitis (VO) is a severe clinical entity associated with high mortality rates, especially within the first year after diagnosis. The aim of this single-center prospective cohort study was to identify and compare predictive factors influencing early and late mortality in patients with conservatively and surgically treated VO.

METHODS

We conducted a single-center prospective cohort study including patients treated for VO between 2008 and 2020 in a tertiary center in Germany to determine early (death within 30 days after diagnosis) and late mortality (death between day 31 and 365 after diagnosis). Additionally, multivariable analyses were performed to analyze predictive risk factors for early and late mortality.

RESULTS

A total of 323 patients were included. 19% died within the first year after diagnosis. Early mortality occurred in 5% and late mortality in 14% of cases. Multivariable analysis revealed chronic kidney disease (CKD) (OR: 13.2, 95% CI 5.7-30.3; p < 0.001) and MSSA (OR: 4.0, 95% CI 1.4-11.1; p = 0.008) as independent risk factors for early mortality, whereas ASA score > 2 (HR: 5.2, 95% CI 2.6-10.6; p < 0.001), age > 70 years (HR: 2.4, 95% CI 1.6-3.7; p < 0.001), CKD (HR: 1.9, 95% CI 1.3-3.0; p = 0.003) and bacteremia (HR: 1.8, 95% CI 1.2-2.7; p = 0.002) were identified as independent risk factors for late mortality.

CONCLUSION

One out of five VO patients dies within the first year after diagnosis. Risk factors for mortality within the first year include CKD and bacteremia. As a consequence in particular those patients should be closely monitored within the first year after.

Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis

STUDY DESIGN

Systematic review and network meta-analysis.

OBJECTIVE

This study aimed to systematically review the literature on the management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations.

BACKGROUND

Primary osteomyelitis discitis is a challenging condition with varying management strategies.

MATERIALS AND METHODS

A comprehensive literature search was conducted. Studies reporting outcomes for the treatment of primary osteomyelitis discitis were included. A random-effect network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4 to 8 weeks, 8 to 12 weeks, and 12 to 16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness.

RESULTS

Sixty-three articles with 4233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4 to 8-week antibiotic duration ranked highest across fixed-effect and random-effect models (SUCRA: 0.8207 and 0.8343). The 12 to 16-week duration ranked highest in the fixed-effect model (SUCRA: 0.8460) but dropped substantially in the random-effect model (SUCRA: 0.3067). The <4-week duration showed mixed results. The 8 to 12-week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief.

CONCLUSION

Antibiotic therapy for 4 to 8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.

Lumbar facet angle tropism and hand and foot dominance in patients with isthmic spondylolysis

PURPOSE

Isthmic spondylolysis Early-stage lumbar spondylolysis (ESS) is common in adolescents. The facet joint tropism has been reported to affect spondylolysis in two-dimensional analyses. However, more detailed 3D analyses of facet joint tropism in unilateral spondylolysis are not reported. Here, we sought to investigate the relationship between facet joint tropism, hand and foot dominance, and very early to early stage isthmic spondylolysis ESS using a three-dimensional (3D) bone model.

METHODS

We studied 70 adolescent patients (55 males, 15 females) with unilateral very early spondylolysis using MRI and CT. We used CT images to create a 3D bone model and measured the intervertebral joint angles on an axial plane. We also examined hand and foot dominance, which were the affected sides of isthmic spondylolysis ESS. We used a paired t-test to determine differences between facet joint tropism, hand, foot dominance, and the affected side of isthmic spondylolysis ESS.

RESULTS

No significant differences were observed in the facet joint angles between the right and left sides, affected and unaffected sides in patients with isthmic spondylolysis ESS or between the dominant and non-dominant hands or feet. The measurements revealed that these angles had similar values across the different factors, indicating that the facet joint angles did not vary significantly with these variables.

CONCLUSION

This study found that facet joint tropism was not a predisposing factor for isthmic spondylolysis ESS and was not associated with the dominant hand or foot. Predicting isthmic spondylolysis ESS based on morphological differences in the intervertebral joints and dominant hand, or foot is challenging.

Similar two-year improvement in patient-reported outcomes in patients 40 years and older with outerbridge grade III and IV lesions following ACL reconstruction

PURPOSE

This study aims to evaluate clinical and patient-reported outcome measures (PROMs) of patients 40 years and older that underwent anterior cruciate ligament reconstruction (ACLR) and determine the influence of preexisting arthritis and chondral wear on ACLR outcomes. We hypothesized that patients aged 40+ with ACLR would have excellent clinical outcomes and PROMs regardless of preexisting arthritic changes.

METHODS

A total of 118 patients were included. Patients aged 40 years and older who underwent ACLR in a single healthcare system between 2009 and 2016 were eligible. Outcomes assessed include Knee Injury and Osteoarthritis Outcome Scores (KOOS), Single Assessment Numeric Evaluation (SANE) scores, intraoperative Outerbridge grading, preoperative Kellgren-Lawrence (KL) grading and postoperative complication rates over a 2-year period.

RESULTS

Average increase in KOOS and SANE scores were 21.2 ±  19.9 and 23.5 ±  31.3, respectively. Patients with Outerbridge grade III and IV lesions in weight-bearing compartments had lower baseline SANE and KOOS scores than those without (47.1 ± 22.0 vs. 64.5 ± 23.6 baseline SANE and 43.1 ± 18.1 vs. 63.5 ± 15.9 baseline KOOS; p = 0.002 and p < 0.001, respectively) with no significant difference in the amount of change in SANE or KOOS scores (p = 0.111 and p = 0.165 respectively). Patients with KL-grade 2+ osteoarthritis experienced similar changes in KOOS and SANE over the 2-year period to their counterparts (p = 0.598 and p = 0.643, respectively).

CONCLUSION

There is no correlation between preexisting osteoarthritic changes or chondral defects and PROs. KOOS and SANE scores both increased postoperatively. When treating older patients with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine appropriate treatment. Preexisting osteoarthritis does not correlate with patient-reported outcomes for ACLR.

LEVEL OF EVIDENCE

Level IV.

Approach to patients with metal allergies in foot and ankle surgery

Metal allergies in surgery are often underreported and under diagnosed. Oftentimes, the symptoms of metal allergy closely resemble those of infection and the protocol is removal of the offending implant. Identification of metal allergies in the preoperative workup is imperative to provide the best patient care and outcomes. The purpose of this report is to present considerations to approach to both preoperative and postoperative identification of patients with metal allergies. Utilizing published algorithms for total knee arthroplasty (TKA) and the author's experience, considerations for both preoperative and postoperative metal allergy have been developed to help the foot and ankle surgeon with the complicated task of addressing patients with metal allergies. To date, the authors have utilized this guidelines for total ankle arthroplasty, ankle fracture open reduction internal fixation, and first metatarsophalangeal joint arthrodesis. While literature has been published with metal allergy algorithms for total knee arthroplasty, this is the first of its kind for adaptation to foot and ankle surgery in general to the author's knowledge. To date, the authors have favorable outcomes utilizing these approaches to not only guide patient care but to help prevent future complications or address them if they present. With a thorough patient history, identification of metal allergies, a multidisciplinary approach and pre-operative planning, good outcomes can be achieved.

Germline-Somatic Interactions in BRCA-Associated Cancers: Unique Molecular Profiles and Clinical Outcomes Linking ATM to TP53 Synthetic Essentiality

PURPOSE

Germline alterations in homologous recombination repair (gHRR) genes affect the pathogenesis, treatment options, and survival of patients with cancer. However, distinct gHRR gene alterations may differentially affect treatment response and oncogenic signaling. In this study, we interrogated genomic and transcriptomic data and assessed clinical outcomes of patients with gHRR mutations across four BRCA-associated cancers (breast, ovarian, pancreatic, and prostate cancers) to identify therapeutic vulnerabilities.

EXPERIMENTAL DESIGN

We assessed 24,309 patients undergoing matched tumor/normal next-generation DNA and RNA sequencing. Annotated gHRR gene variants [germline BRCA1, germline BRCA2, germline PALB2, germline ATM (gATM), and germline CHEK2] were analyzed. HRs were used to assess survival outcomes comparing germline versus sporadic groups. Somatic alterations and their frequencies were compared across gHRR-altered groups. Differential gene expression and gene set enrichment analysis were used to compare transcriptomic profiles.

RESULTS

Somatic TP53 mutations were depleted in gATM carriers (P < 0.05) across all four BRCA-associated cancers by up to 2.5-fold. Tumors with germline BRCA1/2 mutations were associated with improved survival in patients with ovarian cancer and had consistent enrichment of TP53 mutations in all four cancers. gATM mutations displayed elevated p53 transcriptional activity in all four cancers, with significance reached in breast and prostate cancers (P < 0.01). In breast, ovarian, and prostate cancers, gATM tumors demonstrated significantly increased inflammatory pathways (P < 0.001). Finally, using gene dependency data, we found that cell lines that were highly dependent on ATM were co-dependent on canonical p53 function.

CONCLUSIONS

gATM-associated cancers seem to require intact p53 activity and this synthetic essentiality may be used to guide targeted therapies that perturb canonical TP53 function.

Exosomes inhibit ferroptosis to alleviate intervertebral disc degeneration via the p62-KEAP1-NRF2 pathway

Ferroptosis, an iron-dependent form of regulated cell death, has been reported to affect the activity of nucleus pulposus (NP) cells in the intervertebral disc (IVD), thereby contributing to intervertebral disc degeneration (IVDD). Exosomes (EXOs), extracellular nanovesicles that participate in intercellular communication, are potential therapeutic options for IVDD. Interestingly, while EXOs play an important role in inhibiting ferroptosis, whether EXOs from mesenchymal stem cells (MSCs) modulate the progression of IVDD through regulating ferroptosis is unclear. To reveal the role of ferroptosis in IVDD, IVD tissues with varying degrees of degeneration were collected and abnormal expression of ferroptosis markers was detected. Ferroptotic death was observed in TBHP-induced NP cell death in vitro, which can be specifically inhibited by the ferroptosis inhibitors DFO and Fer-1. Interestingly, MSC-derived EXOs alleviated TBHP-induced or RSL3-induced ferroptosis and rescued NP cell degeneration. Mechanistically, either an NRF2 inhibitor or p62 knockdown dampened the inhibitory effects of EXOs on ferroptosis, suggesting that EXOs attenuated oxidative stress-induced ferroptosis in NP cells by regulating the p62/KEAP1/NRF2 axis. Moreover, EXOs effectively alleviated IVDD in an in vivo rat model. The current study revealed that ferroptosis is associated with the development of IVDD. MSC-derived EXOs slowed IVDD progression by inhibiting NP cell ferroptosis through the p62/KEAP1/NRF2 signaling pathway, suggesting that EXOs are a potential therapeutic option for IVDD.

The Biopsy Site is Critical for Bacterial Culture After Percutaneous Biopsy in Patients with Pyogenic Spondylodiscitis

BACKGROUND

Previous studies have found that the positive rate of bacterial culture after percutaneous needle biopsy in patients with suspected pyogenic spondylodiscitis is influenced by a number of factors. At the same time, the choice of puncture site in percutaneous biopsy has been controversial. The objective of this study is to explore the factors influencing the positive rate of bacterial culture after percutaneous biopsy in patients with pyogenic spondylodiscitis.

METHODS

The medical records of 186 patients with suspected spinal infection who underwent C-type arm-guided percutaneous biopsy in Beijing Chest Hospital Affiliated to Capital Medical University from January 2023 to December 2023 were retrospectively analyzed. According to inclusion and exclusion criteria, a total of 116 patients with suspected pyogenic spondylodiscitis were included. The positive rate of bacterial culture was calculated, and the effects of age, gender, course of disease, preoperative fever, preoperative antibiotic use, preoperative white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate, and puncture site on the positive rate of culture were discussed. Logistic regression analysis was used to identify the relevant factors affecting the positive rate of culture.

RESULTS

Among the 116 patients, 63 were males and 53 were females. Age ranged from 13 to 87 years, with a median age of 59.5 years. The results of bacterial culture in 42 patients were positive, with a positive rate of 36.2% (42/116), including Staphylococcus aureus in 12 cases, streptococcus in 5 cases, Brucella in 5 cases, Escherichia coli in 4 cases, Staphylococcus epidermidis in 3 cases, Pseudomonas aeruginosa in 2 cases, Enterococcus faecalis in 2 cases, anaerobic bacteria in 2 cases, and other bacteria in 7 cases. The positive rate of bacterial culture was 22.6% (14/62) in patients with vertebral body puncture and 51.9% (28/54) in patients with intervertebral disc puncture, and there was a significant difference between the 2 groups (P = 0.001). Logistic regression analysis showed that the course of disease, the increase of CRP before puncture, and the site of puncture were the factors influencing the positive rate of culture.

CONCLUSIONS

The course of disease, the elevation of CRP before puncture, and the site of puncture were the factors influencing the positive rate of bacterial culture in percutaneous biopsy of pyogenic spondylodiscitis patients. The positive rate of obtaining intervertebral disc in percutaneous puncture was significantly higher than that of vertebral body, suggesting that intervertebral disc is a more critical puncture site.

Comparison of bilateral tibial lengthening with circular external fixator and simultaneous deformity correction with hexapod external fixator in Achondroplasia

Achondroplasia is a growth plate dysplasia caused by FGFR-3 gene mutation. In addition to dysmorphic short stature, genu varum is very common. Therefore, a certain part of the achondroplasic population is interested in extensive cosmetic limb lengthening and deformity correction to achieve a functional height so that they can attain total autonomy in everyday life. All patients who underwent bone lengthening treatment from March 2014 to December 2022, were retrospectively analyzed in terms of inclusion and exclusion criteria. To determine any angular deformity in the coronal plane, the Mechanical Axis Deviation was calculated. Patients were divided into two groups: group A included patients who had no angular deformity and therefore performed exclusively cosmetic bilateral tibial lengthening, group B included patients undergoing cosmetic lengthening and simultaneous bilateral multiplanar correction of tibial deformities with hexapod external fixator. The achieved distraction, the external fixator index and the consolidation index were calculated and compared for the two groups. Any adverse event was recorded. According to inclusion and exclusion criteria, 14 patients (28 tibias) diagnosed with Achondroplasia were included (20 tibias group A and 8 tibias group B). We found a statistically significant difference between the two groups regarding the mean age at the time of surgery (p 0.01). The mean MAD value within group B showed a substantial improvement from 56.50 ± 19.1 mm to 14.6 ± 5 mm. Comparing the two groups, we observed a statistically significant difference between both preoperative (p 0.0001) and postoperative (p 0.006) MAD values. The difference found between the two groups was significant also in terms of mean external fixator index (35.9 days/cm versus 52.5 days/cm) and consolidation index (24.2 days/cm versus 37.9 days/cm). Comparing the adverse events found in the two groups no significant differences emerged (p 0.7). In the context of cosmetic lower limb lengthening program for achondroplasic patients, most studies have focused on linear lengthening often underestimating the importance of any associated deformities correction. In our experience, the genu varum correction with the hexapod system showed relevant results in term of MAD improvement. Our results show a significant difference between the two groups in consolidation (p 0.002) and thus also in external fixation (p 0.001) time to the disadvantage of the hexapod group probably due to: higher age (p 0.01) with lower healing potential, greater difficulty in weightbearing and in dynamizing the fixator.

Management of Pyogenic Spondylodiscitis in Adults

High index of suspicion, MRI, multidisciplinary collaboration, and CT-guided biopsy are the cornerstones for an early diagnosis of infectious spondylodiscitis. The incidence of spondylodiscitis admissions is increasing. A notable proportion of patients present with neurological deficit. Unfortunately, IV drug users, frail and immunocompromised patients, and patients with HIV are most susceptible to have pyogenic spondylodiscitis and its complications. These infections have a mortality rate of up to 20%. Pyogenic spondylodiscitis should be managed with at least 6 weeks of IV antibiotics. It is best to involve an infectious disease specialist because of the wide variety of organisms involved and the emergence of resistance. Neurological deficits, instability, pain, deformity, and frailty are the factors that decide whether and when to perform surgery. Surgery can reduce morbidity, mortality, and length of hospital stay for these debilitating infections. Some studies have recommended stabilization without aggressive débridement, especially in frail patients. Implants (titanium and PEEK) as well as bone grafts (autograft and allograft) are safe in pyogenic spondylodiscitis. Minimally invasive spinal surgery reduces blood loss, surgical time, and hospital stay over classical open surgery. Endoscopic spine surgery is useful for debulking the infection and obtaining samples for diagnostic purposes.

Does methylene blue affect culture yield in total knee arthroplasty periprosthetic joint infection?

BACKGROUND

Methylene blue (MB), a phenothiazine dye with antimicrobial activity, is used to stain soft tissues and guide thoroughness of debridement during revision total knee arthroplasty (rTKA) for periprosthetic joint infection (PJI). The purpose of this study was to determine if instillation of MB prior to arthrotomy impacts culture yield in TKA PJI.

METHODS

We retrospectively reviewed 266 patients diagnosed with TKA PJIs according to the 2018 International Consensus Meeting (ICM) criteria from January 2018 - March 2023 at a single academic hospital. Demographics, perioperative outcomes, and preoperative and intraoperative culture positivity were compared between patients who received intraoperative MB (MB group; n = 26) and those who did not (nMB group; n = 241). A record of detected organisms was included in the analysis.

RESULTS

There was no difference in preoperative aspiration culture positivity between groups. However, the MB group had a higher percentage of preoperative to intraoperative culture concordance (89.5 vs. 69.9%; P = 0.04). Although the overall rate of intraoperative culture positivity did not differ significantly between groups, the MB group had more intraoperative cultures obtained per patient (4.9 vs. 4.5; P = 0.02) and higher numbers of positive intraoperative cultures per patient. Concordance rates for patients in both groups with positive preoperative and negative intraoperative cultures were similar (10.5 vs. 16.5%, P = 0.50). Among patients with negative preoperative cultures, intraoperative culture positivity was more discordant in the MB group (0 vs. 18.8%; P = 0.03). There was no difference in the number of patients that received antibiotics following aspiration (68.4 vs. 49.6%; P = 0.12).

CONCLUSION

While MB use did not affect overall culture positivity, it could interfere with intraoperative pathogen detection in patients with negative preoperative cultures. In these cases, MB should be avoided to decrease inaccuracies in intraoperative culture yield. If preoperative cultures are positive, MB may improve surgical debridement and likelihood of infection eradication.

REDOX Imbalance and Oxidative Stress in the Intervertebral Disc: The Effect of Mechanical Stress and Cigarette Smoking on ER Stress and Mitochondrial Dysfunction

Low back pain is a widespread condition that significantly impacts quality of life, with intervertebral disc degeneration (IDD) being a major contributing factor. However, the underlying mechanisms of IDD remain poorly understood, necessitating further investigation. Environmental risk factors, such as mechanical stress and cigarette smoke, elevate reactive oxygen species levels from both endogenous and exogenous sources, leading to redox imbalance and oxidative stress. The endoplasmic reticulum (ER) and mitochondria, two key organelles responsible for protein folding and energy production, respectively, are particularly vulnerable to oxidative stress. Under oxidative stress conditions, ER stress and mitochondrial dysfunction occur, resulting in unfolded protein response activation, impaired biosynthetic processes, and disruptions in the tricarboxylic acid cycle and electron transport chain, ultimately compromising energy metabolism. Prolonged and excessive ER stress can further trigger apoptosis through ER-mitochondrial crosstalk. Given the unique microenvironment of the intervertebral disc (IVD)-characterized by hypoxia, glucose starvation, and region-specific cellular heterogeneity-the differential effects of environmental stressors on distinct IVD cell populations require further investigation. This review explores the potential mechanisms through which environmental risk factors alter IVD cell activities, contributing to IDD progression, and discusses future therapeutic strategies aimed at mitigating disc degeneration.

Injectable bioactive scaffold able to stimulate oral bone regeneration on demand

Bone regeneration in oral surgery remains a challenge, due to the features of the oral environment, characterized by the presence of saliva and extensive interaction with external pathogens. Recent advances in this field highlighted that biomimetic apatites in which Ca2+ is replaced by Fe2+/Fe3+ ions are promising candidates to guide bone regeneration with on demand activation control. In this study the Fe-doped apatite nanoparticles (FeHA) were developed and compared with magnetite nanoparticles, as new magnetic bio-activator, to be embedded in apatitic injectable paste/cement. Upon self-hardening, the new injectable cement generates a mechanically competent 3D superparamagnetic scaffold, endowed with remote activation by using static magnetic fields. We investigated the alkaline phosphatase expression and activity, as well as the behaviour of cells, when seeded onto the scaffold. The results show the ability of the cement to stimulate cell colonization and differentiation and how, when magnetized, they can further boost such phenomena. The proposed devices, in association with a magnetic aligner, can represent a new approach in oral surgery, able to tune the bone remodelling on demand, when the regenerative potential is impaired by physiological conditions such as aging or chronic diseases.

Pyogenic Vertebral Osteomyelitis

Vertebral osteomyelitis is a general term for a heterogenous group of spine infections involving the vertebral bone, intervertebral discs, and facet joints. These infections can often spread contiguously to adjacent paraspinal structures, including paravertebral muscles and the epidural space and frequently presents with nonspecific and indolent symptoms, which can delay diagnosis. Treatment can be arduous, requiring prolonged courses of antibiotics often combined with surgical debridement. This review focuses primarily on pyogenic vertebral osteomyelitis in adults, reviewing the pathophysiology, epidemiology, microbiology, diagnosis, and treatment of this infection.

Exploring the Causes of Intervertebral Disc Annulus Fibrosus Impairment

Scope

The annulus fibrosus (AF), as an important component of the intervertebral disc (IVD), contributes to the structural integrity and functional normality of IVD. Degenerative disc diseases (DDD), due to AF impairment, are common problems that could lead to low back pain or neck pain, resulting in considerable disability and financial costs globally. The exact causes and underlying mechanisms of AF impairment, however, remain complex and unclear.

Methods

A literature search was conducted to identify relevant articles published between 1952 and 2024. We summarize the current literature on the potential etiologies of AF damage, while also providing a brief overview of the basic characteristics of the AF and current therapeutic strategies for AF impairment.

Results

The findings suggest that several factors could induce or exacerbate AF impairment. We categorize them into distinct groups as physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities.

Conclusion

Various factors could lead to AF impairment, such as particular physical and chemical stimuli, nutritional or metabolic disorders, immune and inflammatory responses, and genetic abnormalities. Meanwhile, enhancing our understanding and management of AF impairment could help discover potential preventive or therapeutic interventions for DDD.

High-grade medial femoral condyle and medial tibial plateau bone bruises predict ramp lesions of the medial meniscus in patients with anterior cruciate ligament tears: A prospective clinical and MRI evaluation

Purpose

The purpose of this study was to evaluate potential predictive diagnostic variables on magnetic resonance imaging (MRI) for medial meniscus ramp tears in the presence of an anterior cruciate ligament (ACL) tear.

Methods

Patients aged ≥16 years undergoing arthroscopic anatomic hamstring single-bundle ACL reconstruction between July 2016 and September 2020 from a single centre were prospectively enroled with a diagnosis based on clinical and MRI evaluations. Demographic data such as age, gender, dominant limb and time from injury to surgery were recorded. Clinical assessments included Lachman and pivot shift tests. Imaging assessments involved grading bone bruises on MRI using the International Cartilage Repair Society (ICRS) scale. Statistical analysis was conducted using parametric tests and regression analysis with a p value of less than 0.05, which is considered significant.

Results

The final sample consisted of 108 patients, with a concomitant ACL tear and medial meniscus ramp tear present in 53 (49.1%) patients. In the univariate regression analysis, a higher grade of the medial femoral condyle and medial tibial plateau bone bruises was highly associated with the diagnosis of an ACL tear with a concomitant ramp tear (p = 0.006, β = 0.151 and p < 0.001, β = 0.172, respectively). In the univariate regression analysis, a higher grade of the medial femoral condyle and medial tibial plateau bone bruise was associated with the diagnosis of ACL tear with a concomitant ramp tear (p = 0.006, β = 0.151 and p < 0.001, β = 0.172, respectively).

Conclusion

In this prospective series of patients with ACL tears, 49% were found to have concomitant medial meniscal ramp tears. The finding of medial tibial plateau or medial femoral condyle bone bruising was predictive of ramp tear. The presence of this bone bruising pattern along with a high-grade Lachman and/or pivot shift examination, a medial meniscus ramp tear should be suspected.

Level of Evidence

Level II, prospective cohort study.

Mitochondrial Dysfunction-Molecular Mechanisms and Potential Treatment approaches of Hepatocellular Carcinoma

Primary liver cancer (PLC), also known as hepatocellular carcinoma (HCC), is a common type of malignant tumor of the digestive system. Its pathological form has a significant negative impact on the patients' quality of life and ability to work, as well as a significant financial burden on society. Current researches had identified chronic hepatitis B virus infection, aflatoxin B1 exposure, and metabolic dysfunction-associated steatotic liver disease (MASLD) as the main causative factors of HCC. Numerous variables, including inflammatory ones, oxidative stress, apoptosis, autophagy, and others, have been linked to the pathophysiology of HCC. On the other hand, autoimmune regulation, inflammatory response, senescence of the hepatocytes, and mitochondrial dysfunction are all closely related to the pathogenesis of HCC. In fact, a growing number of studies have suggested that mitochondrial dysfunction in hepatocytes may be a key factor in the pathogenesis of HCC. In disorders linked to cancer, mitochondrial dysfunction has gained attention in recent 10 years. As the primary producer of adenosine triphosphate (ATP) in liver cells, mitochondria are essential for preserving cell viability and physiological processes. By influencing multiple pathological processes, including mitochondrial fission/fusion, mitophagy, cellular senescence, and cell death, mitochondrial dysfunction contributes to the development of HCC. We review the molecular mechanisms of HCC-associated mitochondrial dysfunction and discuss new directions for quality control of mitochondrial disorders as a treatment for HCC.

Uniportal endoscopic decompression and debridement for infectious diseases of spine with neurological deficits: a retrospective study in China

STUDY DESIGN

A retrospective study.

PURPOSE

To evaluate the clinical efficacy of uniportal endoscopic decompression and debridement (UEDD) in treating infectious diseases of the spine (IDS) with neurological deficits.

OVERVIEW OF LITERATURE

IDS patients with neurological deficits often require urgent surgical decompression. However, the efficacy of UEDD in this complex patient population is not well-characterized.

METHODS

This retrospective study analyzed 32 consecutive IDS patients who underwent UEDD surgery. Clinical features, laboratory data (erythrocyte sedimentation rate and C-reactive protein), and treatment outcomes were analyzed.

RESULTS

Definite microorganisms were identified in 27 patients (84.3%), with 24 (88.9%) meeting cure criteria. The cure rate was significantly higher in the detected pathogen group compared to the undetected pathogen group (88.9% vs. 80%; χ²=19.36, p<0.0001). Metagenomic next generation sequencing (mNGS) provided faster diagnosis (41.72±6.81 hours) compared to tissue culture (95.74±35.47 hours, p<0.05). The predominant causative pathogen was Mycobacterium tuberculosis, followed by Staphylococcus aureus. Significant improvements were observed in Visual Analog Scale pain scores, from a mean of 7.9 preoperatively to 1.06 at 1 year postoperatively. The Oswestry Disability Index revealed a similar trend, showing significant improvement (p<0.05).

CONCLUSIONS

UEDD is a viable alternative to traditional open surgery for managing IDS in high-risk patients. UEDD offers a dual therapeutic-diagnostic advantage during the initial admission phase, enabling simultaneous debridement, neurological decompression, and targeted biopsy in a single intervention. Compared with traditional tissue culture, mNGS enables rapid microbiological diagnosis and extensive pathogen coverage.

[Brucella spondylodiscitis and factors associated with prognosis: a case series from Sétif, Algeria]

Introduction and objectives

Spondylodiscitis is a serious and suggestive complication of brucellosis. Few studies have been devoted to it in Algeria, although the infection remains a public health problem. The aim of this study was to report the epidemiological and clinical aspects of brucellosis spondylodiscitis and to identify the neurological complications.

Material and methods

This is a descriptive analysis of a cohort of adult patients with Brucella spondylodiscitis, based on data collected from patient records recruited between January 2016 and December 2022.

Results

Thirteen females and 24 males with a mean age of 48 ± 15 years [21 to 71 years] were included in the study. Diagnosis was made on average 120 days ± 100 [30-360] after the onset of clinical symptoms. Commonly reported symptoms were: back pain (100%), fever (46%), sweating (70%), asthenia (84%), chills (22%), and weight loss (27%). Neurological complications were numerous and sometimes varied in the same patient: one case of paraplegia, three cases of paraparesis, six cases of sensory disturbances, and one case of sphincter disorders. Involvement of the lumbar spine was predominant, observed in 22 patients, including 15 at the L4-L5 level.In addition to discovertebral lesions, imaging revealed 27 cases of epiduritis, 13 cases of spinal cord compression, 25 cases of radicular compression, and pre- or para-vertebral and psoas abscesses.Two treatment regimens were used: doxycycline-cotrimoxazole-gentamycin (22 cases) and doxycycline-rifampicin-gentamycin (15 cases). At the end of the one-year post-therapeutic follow-up, we observed one relapse, sequelae of paraparesis, and sequelae of spinal pain in 12 patients.

Discussion and conclusion

This study has allowed us to observe prognostic elements. Early spinal imaging is essential to combat the excessive delay in diagnosis in our patients. There is no clear consensus in the scientific literature regarding neurological complications, such as epiduritis, and optimal treatment. The results of our study may contribute to the development of more personalized management algorithms.

Inflammatory Biomarkers in Smokers: Implications for Ligamentum Flavum Hypertrophy

BACKGROUND Ligamentum flavum (LF) hypertrophy is a key contributor to spinal pathologies such as lumbar and cervical disc herniations and spinal stenosis. Smoking, as a modifiable lifestyle factor, is implicated in systemic inflammation and oxidative stress, potentially exacerbating LF hypertrophy. This study aimed to compare the expression of alpha-1 antitrypsin (AAT), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in the lumbar ligamentum flavum from 27 smokers and 31 non-smokers. MATERIAL AND METHODS LF tissue samples were collected during spinal surgeries. Demographic, anthropometric, and clinical data were recorded. ELISA was used to quantify levels of AAT, IL-1ß, IL-6, and TNF-alpha. Statistical analyses included t-tests, Mann-Whitney U tests, and receiver operating characteristic (ROC) curve analyses. Statistical significance was set at p<0.05. RESULTS Smokers exhibited significantly higher levels of IL-1ß (p<0.001), IL-6 (p=0.004), and TNF-alpha (p<0.001), while AAT levels were significantly lower (p<0.001) compared to non-smokers. ROC analysis identified IL-1ß (AUC=0.828; p<0.001) and TNF-alpha (AUC=0.801; p<0.001) as highly effective markers for distinguishing smokers from non-smokers, while IL-6 (AUC=0.730; p=0.003) showed moderate diagnostic accuracy. AAT (AUC=0.867; p<0.001) demonstrated excellent sensitivity (96.3%) for detecting smoking-related effects. CONCLUSIONS Smoking contributes significantly to systemic inflammation and oxidative stress, leading to biochemical changes that may drive LF hypertrophy. These findings underscore the importance of smoking cessation as a modifiable risk factor in the management of spinal pathologies.

Validation of the AOSpine-DGOU Osteoporotic Fracture Classification - Effect of Surgical Experience, Surgical Specialty, Work-Setting and Trauma Center Level on Reliability and Reproducibility

Study DesignCross-sectional survey.ObjectivesA cornerstone of classification systems is good reliability amongst different groups of classification users. Thus, the aim of this international validation study was to assess the reliability of the new AO Spine DGOU Osteoporotic Fracture Classification (OF classification) stratified by surgical specialty, work-setting, work-experience, and trauma center level.Methods320 spine surgeons were asked to rate 27 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2) in this online-webinar based validation process. The kappa statistic (κ) was calculated to assess the inter-observer reliability and the intra-rater reproducibility.ResultsA total of 7798 (90.3%) ratings were recorded in assessment 1 and 6621 (76.6%) ratings in assessment 2. Global inter-rater reliability was moderate in both assessments (κ = 0.57; κ = 0.58). Participants with a work-experience of >20 years showed the highest inter-rater agreement in both assessments globally (κ = 0.65; κ = 0.67). Participants from a level-1 trauma center showed the highest agreement (κ = 0.58), whereas participants working at a tertiary trauma center showed higher grade of agreement in the second assessment (κ = 0.66). Participants working in academia showed the highest agreement in assessment 2 (κ = 0.6). Surgeons with academic background and surgeons employed by a hospital showed substantial intra-rater agreement in the second assessment.ConclusionsThe AO Spine-DGOU Osteoporotic Fracture Classification showed moderate to substantial inter-rater agreement as well as intra-rater reproducibility regardless of work-setting, surgical experience, level of trauma center and surgical specialty.

Analysis of Safety and Efficacy of Unilateral Biportal Endoscopy Combined With Oblique Lumbar Interbody Fusion in the Treatment of Lumbar Infectious Spondylitis

STUDY DESIGN

Retrospective case series.

OBJECTIVE

To explore the clinical efficacy and safety of unilateral biportal endoscopy (UBE) combined with oblique lumbar interbody fusion (OLIF) in the treatment of lumbar infectious spondylitis (LIS).

BACKGROUND

In recent years, there has been a notable increase in the incidence of LIS. Patients typically present with back pain, tenderness, and stiffness, which may be accompanied by fever, which significantly reduces their quality of life.

PATIENTS AND METHODS

This study selected 25 patients with LIS treated by UBE with OLIF from January 2018 to March 2023 in our hospital, including 14 males and 11 females. During the perioperative phase, key indicators such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein were monitored to evaluate the efficacy of the infection treatment. Surgical-related indicators and the frequency of complications were systematically recorded. Functional and imaging indicators before and after the operation were compared.

RESULTS

The surgical intervention was successful in all 25 patients. The average operation time was 155.2 ± 23.5 minutes, the average blood loss was 265.6 ± 46.8 mL, and the average follow-up time was 18.8 ± 6.9 months. Bacterial cultures of 12 patients were positive, and postoperative pathologic examination of all patients showed inflammation. Postoperative patients exhibited significant clinical symptom improvement, characterized by a gradual decrease in erythrocyte sedimentation rate, C-reactive protein, and white blood cell count, ultimately returning to normal levels. The Visual Analog Scale scores, Japanese Orthopedic Association scores, and Oswestry Disability Index were significantly improved after the operation (P < 0.001). In addition, the height of the intervertebral space and the angle of lumbar lordosis were optimally restored. At the last follow-up, the fusion rate of bone graft was 96%.

CONCLUSION

The combined treatment of LIS with UBE and OLIF is effective, thereby establishing itself as an effective, safe, and viable surgical technique.

BMAL1 attenuates intervertebral disc degeneration by activating the SIRT1/PGC-1α pathway: evidence from vitro studies

To explore the potential effects and the corresponding mechanisms of brain and muscle arnt-like protein-1 (BMAL1) on the progression of intervertebral disc degeneration (IVDD) in vitro studies. The expression of BMAL1, SIRT1 and PINK1 were evaluated by the method of siRNA/pcDNA in the immortalized nucleus pulposus (NP) cells. The expression of SIRT1/PGC-1α pathway was assessed. The characteristics of NP cell, containing the activity and density, the level of apoptosis, inflammatory response, reactive oxygen species (ROS), senescence, and mitophagy were evaluated. The overexpression of BMAL1 was achieved with the pcDNA3.1, the expression of SIRT1 and PGC-1α were increased, the inflammatory response, the ROS, the level of apoptosis and senescence were decreased, however, the level of mitophagy, the activity and density of NP cell were enhanced. The BMAL1 inhibites the progression of IVDD by activating the SIRT1/PGC-1α pathway in the vitro studies.

Deep Learning Models to Detect Anterior Cruciate Ligament Injury on MRI: A Comprehensive Review

Magnetic resonance imaging (MRI) is routinely used to confirm the suspected diagnosis of anterior cruciate ligament (ACL) injury. Recently, many studies explored the role of artificial intelligence (AI) and deep learning (DL), a sub-category of AI, in the musculoskeletal field and medical imaging. The aim of this study was to review the current applications of DL models to detect ACL injury on MRI, thus providing an updated and critical synthesis of the existing literature and identifying emerging trends and challenges in the field. A total of 23 relevant articles were identified and included in the review. Articles originated from 10 countries, with China having the most contributions (n = 9), followed by the United State of America (n = 4). Throughout the article, we analyzed the concept of DL in ACL tears and provided examples of how these tools can impact clinical practice and patient care. DL models for MRI detection of ACL injury reported high values of accuracy, especially helpful for less experienced clinicians. Time efficiency was also demonstrated. Overall, the deep learning models have proven to be a valid resource, although still requiring technological developments for implementation in daily practice.

Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation

BACKGROUND

Pedicle screw instrumentation is a critical technique in spinal surgery, offering effective stabilization for various spinal conditions. However, the impact of intraoperative imaging quality-specifically the use of both anteroposterior (AP) and lateral views-on surgical outcomes remains insufficiently studied. Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre (URTT) within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.

AIM

To evaluate how intraoperative imaging adequacy influences unplanned return-to-theatre rates, focusing on AP and lateral fluoroscopic views.

METHODS

This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022. Data on intraoperative imaging adequacy, screw placement, and URTT events were collected and statistically analyzed using IBM SPSS v23. Imaging adequacy was assessed based on the presence of both AP and lateral views, and outcomes were compared between imaging groups.

RESULTS

A total of 9016 pedicle screws were inserted, with 82 screws identified as malplaced in 52 patients. Of these, 46 patients required URTT due to screw malplacement, with 37 returning within 90 days (URTT90). Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved, demonstrating the critical role of imaging adequacy in improving surgical outcomes.

CONCLUSION

This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns, improves outcomes, enhances precision, and offers a cost-effective approach for better spinal surgery results.

Seneca Valley virus infection exploits DNA damage response to facilitate viral replication

Seneca Valley virus (SVV) is an emerging pathogen that causes severe vesicular diseases in swine, posing a significant threat to the global pork industry. DNA and RNA viruses manipulate the host DNA damage response (DDR) to modulate cellular machinery and facilitate their life cycles. However, the interaction between the host DDR and SVV infection remains unexplored. Here, we aimed to comprehensively investigate the DDR and DNA repair signaling pathways during SVV infection. We found that SVV infection causes DNA damage and triggers distinct DDR signaling pathways, including ataxia telangiectasia-mutated (ATM) kinase, ATM-Rad3-related kinase, and DNA-dependent protein kinase. However, it failed to induce the formation of γH2AX and 53BP1 foci, resulting in unrepaired DNA damage. Furthermore, we found that SVV 2B and 2C proteins can activate DDR signaling pathways and impair DNA repair. SVV-induced DDR triggered NF-κB signaling accompanied by upregulation of pro-inflammatory cytokines, as evidenced by the inhibition of ATM kinase, abolished SVV-induced NF-κB activation. Inhibition of the ATM pathway attenuated SVV replication. These findings expand our understanding of host DDR manipulation during viral infection and provide crucial insights into a novel mechanism exploited by SVV to regulate the inflammatory response for efficient replication.IMPORTANCEDDR is a cellular machinery that senses and repairs host DNA lesions to maintain genome integrity. Viruses have evolved diverse strategies to manipulate host DDR for replicative efficiency. SVV is an emerging virus that causes vesicular diseases in pigs and severely threatens the swine industry. However, the interaction between SVV and DDR remains unclear. Here, we found that SVV modulates host DDR pathways to facilitate viral replication. Our results demonstrated that SVV infection causes DNA damage, activates ATM-mediated DNA double-strand break response, and impedes DNA repair. SVV 2B and 2C proteins induced DNA damage and activated the DDR pathway while impairing repair mechanisms. This study revealed a fine-tuned molecular mechanism of SVV-modulated DDR that contributes to viral replication, facilitating deeper insight into SVV replication.

Percutaneous pedicle screw fixation in the surgical treatment of monosegmental pyogenic spondylodiscitis

OBJECTIVE

The study assessed the efficacy of percutaneous pedicle screw fixation (PPSF) as a treatment approach for monosegmental pyogenic spondylodiscitis (PS), particularly in patients with compromised health conditions that reduce their ability to endure extensive surgical procedures.

METHODS

From January 2019 and December 2021, a total of 38 patients with PS who underwent PPSF at our hospital were included in the study. Clinical outcomes were assessed using physical examinations, serological tests, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and imaging assessments.

RESULTS

The mean duration of PPSF among all patients was 73.9 ± 13.9 min, with an average intraoperative blood loss of 52.4 ± 18.4 mL. Pathogenic bacteria were identified in 17 out of 38 cases, representing a detection rate of 44.7%. The mean follow-up period was 21.3 ± 8.3 months. Postoperative assessment of inflammatory markers indicated that infections were effectively controlled in 33 patients, resulting in symptomatic improvement. However, within 2 to 4 weeks postoperatively, 5 patients required a two-stage anterior debridement-fusion following the initial internal fixation. Compared to those who underwent posterior internal fixation alone, these patients had significantly higher Spinal Instability Spondylodiscitis Scores (12.000 ± 1.000 vs. 9.030 ± 2.114, p < 0.05) and a significantly greater prevalence of preoperative epidural abscesses (80% vs. 12.1%, p < 0.01).

CONCLUSIONS

PPSF may serve as a viable option for patients with monosegmental PS, providing a minimally invasive surgical approach for patients who are unable to tolerate traditional open surgery due to compromised health or advanced age. For patients with significant spinal instability or abscess formation, a two-stage anterior debridement-fusion may be required. However, single-stage posterior internal fixation can effectively relieve pain and improve the overall condition of patients, thereby enhancing their ability to tolerate subsequent anterior surgical interventions.

A systematic review and meta-analysis of radiation exposure in spinal surgeries: Comparing C-Arm, CT navigation, and O-Arm techniques

INTRODUCTION

Advanced imaging techniques, such as C-arm fluoroscopy, O-arm, and CT navigation, are integral to achieving precision in orthopedic surgeries. However, these technologies also expose patients, surgeons, and operating room staff to varying levels of radiation. This systematic review and meta-analysis evaluate the radiation exposure (RE) associated with these imaging modalities and their impact on surgical outcomes.

METHODS

A comprehensive literature search was conducted following PRISMA guidelines, resulting in 2,725 identified articles. After removing duplicates and screening for eligibility, 24 studies were included in the analysis. Radiation exposure data, measured in milliSieverts (mSv) and milliGray (mGy), were standardized using conversion formulas. Quality assessments were performed using the Newcastle-Ottawa Scale (NOS) and ROB2 tools. Statistical analysis was conducted using random-effects models for comparing radiation exposure and fixed-effects models for secondary outcomes.

RESULTS

The meta-analysis included 11 studies: 8 studies comparing C-arm and CT navigation, and 3 studies comparing C-arm and O-arm technologies. The analysis revealed that CT navigation is associated with significantly higher RE compared to C-arm (Standardized Mean Difference (SMD): 4.73, 95% Confidence Interval (CI): 2.44 to 7.03; p < 0.0001). In contrast, there was no significant difference in RE between O-arm and C-arm (SMD: 1.34, 95% CI: -0.17 to 2.85; p = 0.082). Secondary analyses showed no significant differences in surgery duration or hospitalization length between CT navigation and C-arm techniques.

DISCUSSION

The results of this meta-analysis underscore the trade-offs between radiation exposure and surgical precision. While CT navigation significantly increases RE compared to C-arm fluoroscopy, it offers superior accuracy, particularly in critical precision surgeries such as spinal interventions. The lack of significant difference in RE between O-arm and C-arm technologies suggests that O-arm may provide a balanced approach, offering enhanced accuracy with radiation levels similar to C-arm. However, the significant heterogeneity among studies and inconsistent reporting of secondary outcomes indicate the need for further research. Future studies should focus on refining imaging techniques to optimize the balance between radiation safety and surgical accuracy.

CONCLUSION

C-arm imaging generally results in lower radiation exposure compared to CT navigation, making it preferable for standard procedures where extreme precision is not as critical. However, CT navigation's superior accuracy justifies its use in precision surgeries despite the higher radiation exposure. O-arm technology, with its comparable RE to C-arm and enhanced accuracy, represents a beneficial option where available. Ongoing research should aim to optimize imaging techniques, balancing the need for radiation safety with the demands for surgical precision.

Influence of disease activity and gonadal status on bone mineral density and turnover in acromegaly

INTRODUCTION

The purpose of this study was to evaluate the impact of disease activity and gonadal status on bone mineral density (BMD) and turnover markers (BTMs) in individuals with acromegaly.

MATERIALS AND METHODS

Subjects underwent laboratory tests for PTH, 25-hydroxyvitamin D, calcium, phosphorus, osteocalcin (OC) and C-telopeptide (CTX-1) and bone densitometry at the lumbar spine (LS), femoral neck (FN) and total hip (TH).

RESULTS

Sixty participants (48.6 ± 11.0 years; 66,7% female) were included in this cross-sectional study. Phosphorus, OC, CTX-1, and LS BMD were greater in the active disease group than in the controlled/cured disease group (P = 0.025, P < 0.001, P = 0.007, and P = 0.016, respectively). When analyzing gonadal status, phosphorus, OC and CTX-1 were greater in the hypogonadal group than in the eugonadal group (P = 0.017, P = 0.015, and P = 0.033, respectively). Patients with hypogonadism had a higher prevalence of reduced bone mass compared to eugonadal patients (44 vs. 17%, P = 0.023).

CONCLUSION

This study revealed increased levels of phosphorus and BTMs in patients with active acromegaly. In this group, the greater LS BMD values are likely due to the anabolic effects of GH and IGF-1 and/or to the influence of LS arthropathy. Moreover, hypogonadism negatively impacts bone metabolism in acromegaly, leading to elevated BTMs and a higher prevalence of reduced bone mass in individuals affected by both conditions.

Ball Tip Feeler vs. Depth Gauge: Detection of Bony Pedicle Defects Before Pedicle Screw Insertion

BACKGROUND/AIM

The objective of this study was to investigate whether the detection rates of pedicle breaches depended on the surgeon's experience level and whether different instruments resulted in varied palpation quality.

MATERIALS AND METHODS

Experienced surgeons (ES) (n=8) and inexperienced surgeons (IS) (n=10) were compared. The study was performed using a sawbone model of the spine. Pedicle defects were created at various positions and levels. Participants detected and located the bony defects using a depth gauge and a straight ball tip feeler. After the first measurement, the IS group underwent training focused on identifying bone defects. The experiment was repeated after three weeks under identical conditions.

RESULTS

A significant difference was found between ES and IS in the time required to palpate pedicles and bony defects using the ball tip feeler during the first measurement (297.2±114.4 s vs. 202.1±77.9 s; p=0.05). However, after training and during the second measurement three weeks later, these differences were no longer observed (223.7±65.1 s vs. 212.2±73.6 s; p=0.73). Notably, no significant differences were found in the accuracy in detecting bony pedicle defects between the two groups, regardless of the device used. Furthermore, no improvement was found in the IS group after training, regardless of the device used.

CONCLUSION

ES and IS accurately detected pedicle breaches without significant differences. Training did not affect detection rates between the groups, and the choice of device did not affect the accuracy of pedicle breach detection.