Imbalanced development of anterior and posterior thorax is a causative factor triggering scoliosis

In vivo kinematic study of lumbar center of rotation under different loads

BACKGROUND

Dual fluoroscopic imaging system (DFIS) was employed to identify the Center of Rotation(COR) in the lower lumbar spine and determine its relationship with weight bearing.

METHODS

In this study, twenty participants were recruited. A 3D model of each participant's lumbar spine was created using CT images, and their relative positions were determined through DFIS. By integrating CT imaging with DFIS, the kinematic data of the participants' spines during movement were captured. The lower lumbar spine's COR was calculated using the method of perpendicular bisectors.

RESULTS

While flexing and extending, the Center of Rotation (COR) initially moved downward with increasing load, followed by upward movement as the load further increased. During flexion and extension, the COR coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.3549 ± 0.2176,0.0177 ± 0.1317),(0.0598 ± 0.2095,-0.1806 ± 0.1719),(0.1427 ± 0.1440,-0.0911 ± 0.2722); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(0.0566 ± 0.2693,-0.0727 ± 0.2132),(0.0964 ± 0.2671,-0.2037 ± 0.2299),(0.1648 ± 0.1520,-0.0049 ± 0.1641). The anterior-posterior position of the COR shifted posteriorly with increasing weight-bearing. During lateral bending, the center of rotation coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.0745 ± 0.1229,0.0966 ± 0.3403) (-0.0438 ± 0.1281,0.1161 ± 0.1584), (-0.0464 ± 0.1517,0.1320 ± 0.2730); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(-0.0314 ± 0.1411,-0.0355 ± 0.2088), (-0.0764 ± 0.3135,0.0105 ± 0.3230),(-0.0376 ± 0.1701,0.0285 ± 0.2395). Throughout the lateral bending exercises, the upper and lower COR positions increased as the load increased, while the left and right COR positions remained unaffected by the load increment. The COR height differed between flexion and lateral bending. We observed variations in the COR position of the lumbar spine during lateral bending and flexion-extension movements. This enhanced our comprehension of coupled motion patterns within the lumbar spine.

CONCLUSIONS

Position of the lumbar spine COR changes with variations in the load. During different movements, the COR location of the lower lumbar spine varied. This finding suggests the presence of distinct motion patterns in the lower lumbar spine. As the load increases, the lumbar COR position changes significantly. Abnormal movement patterns of the lower lumbar spine under different loads may be one of the factors that accelerate lumbar disc degeneration.

Patients with Adolescent Idiopathic Scoliosis Have Higher Metabolic Cost during High-Intensity Interval Training

BACKGROUND

Patients with adolescent idiopathic scoliosis (AIS) are found to have a lower level of physical activity, and may have reduced exercise capacity due to spinal deformity. Previous study showed the benefits of high-intensity interval training (HIIT), named E-Fit, which is specifically designed for patients with AIS to improve musculoskeletal health and psychological well-being. To optimize the beneficial effects of training, the current study aimed to investigate the appropriate exercise intensity and metabolic demand in patients with AIS when performing E-Fit.

METHODS

In all, 22 female subjects, 10 diagnosed with AIS and 12 gender-matched healthy controls, aged between 10 and 16 years, were recruited. Subjects were instructed to perform two trials of a seven min E-Fit. Breath-by-breath gas exchange parameters including oxygen consumption (VO₂), heart rate (HR) and the rate of perceived exertion (PRE) were measured during exercise. Demographic data and clinical features of AIS and body composition were obtained. Metabolic demand between AIS and control groups was compared using MANOVA with covariates adjustment.

RESULTS

Patients with AIS had an earlier onset of menarche (p = 0.01), higher visceral adipose tissue (p = 0.04) and percentage body fat (p = 0.03) as compared to controls. Patients with AIS showed a significantly higher adjusted means of VO₂ average in both the first (p = 0.014) and second trials (p = 0.011) of E-Fit. The adjusted mean of the highest measured VO₂ was higher than healthy controls and reached statistical significance in the second trial (p = 0.004). Both the AIS and control group exercised at a similar percentage of VO₂ peak (64.26% vs. 64.60%).

CONCLUSION

Patients with AIS showed higher oxygen consumption during E-Fit than heathy controls, which might indicate a higher metabolic cost. Patients with AIS could carry out exercise at a moderate exercise intensity similar to that of healthy controls, but special considerations in designing an exercise program, such as frequent rest intervals, would be useful to avoid fatigue among patients with AIS.

Electromyographic Analysis of Paraspinal Muscles of Scoliosis Patients Using Machine Learning Approaches

A large number of studies have used electromyography (EMG) to measure the paraspinal muscle activity of adolescents with idiopathic scoliosis. However, investigations on the features of these muscles are very limited even though the information is useful for evaluating the effectiveness of various types of interventions, such as scoliosis-specific exercises. The aim of this cross-sectional study is to investigate the characteristics of participants with imbalanced muscle activity and the relationships among 13 features (physical features and EMG signal value). A total of 106 participants (69% with scoliosis; 78% female; 9–30 years old) are involved in this study. Their basic profile information is obtained, and the surface EMG signals of the upper trapezius, latissimus dorsi, and erector spinae (thoracic and erector spinae) lumbar muscles are tested in the static (sitting) and dynamic (prone extension position) conditions. Then, two machine learning approaches and an importance analysis are used. About 30% of the participants in this study find that balancing their paraspinal muscle activity during sitting is challenging. The most interesting finding is that the dynamic asymmetry of the erector spinae (lumbar) group of muscles is an important (third in importance) predictor of scoliosis aside from the angle of trunk rotation and height of the subject.

Model constructions of chemosensitivity and prognosis of high grade serous ovarian cancer based on evaluation of immune microenvironment and immune response

BACKGROUND

The prognosis of high grade serous ovarian cancer (HGSOC) patients is closely related to the immune microenvironment and immune response. Based on this, the purpose of this study was to construct a model to predict chemosensitivity and prognosis, and provide novel biomarkers for immunotherapy and prognosis evaluation of HGSOC.

METHODS

GSE40595 (38 samples), GSE18520 (63 samples), GSE26712 (195 samples), TCGA (321 samples) and GTEx (88 samples) were integrated to screen differential expressed genes (DEGs) of HGSOC. The prognosis related DEGs (DEPGs) were screened through overall survival analysis. The DEGs-encoded protein-protein interaction network was constructed and hub genes of DEPGs (DEPHGs) were generated by STRING. Immune characteristics of the samples were judged by ssGSEA, ESTIMATE and CYBERSORT. TIMER was used to analyze the relationship between DEPHGs and tumor-infiltrating immunocytes, as well as the immune checkpoint genes, finally immune-related DEPHGs (IDEPHGs) were determined, and whose expression in 12 pairs of HGSOC tissues and tumor-adjacent tissues were analyzed by histological verification. Furthermore, the chemosensitivity genes in IDEPHGs were screened according to GSE15622 (n = 65). Finally, two prediction models of paclitaxel sensitivity score (PTX score) and carboplatin sensitivity score (CBP score) were constructed by lasso algorithm. The area under curve was calculated to estimate the accuracy of candidate gene models in evaluating chemotherapy sensitivity.

RESULTS

491 DEGs were screened and 37 DEGs were identified as DEPGs, and 11 DEPHGs were further identified. Among them, CXCL13, IDO1, PI3, SPP1 and TRIM22 were screened as IDEPHGs and verified in the human tissues. Further analysis showed that IDO1, PI3 and TRIM22 could independently affect the chemotherapy sensitivity of HGSOC patients. The PTX score was significantly better than TRIM22, PI3, SPP1, IDO1 and CXCL13 in predicting paclitaxel sensitivity, so was CBP score in predicting carboplatin sensitivity. What's more, both of the HGSOC patients with high PTX score or high CBP score had longer survival time.

CONCLUSIONS

Five IDEPHGs identified through comprehensive bioinformatics analysis were closely related with the prognosis, immune microenvironment and chemotherapy sensitivity of HGSOC. Two prediction models based on IDEPHGs might have potential application of chemotherapy sensitivity and prognosis for patients with HGSOC.

Incidentally Detected Pericardial Defect in a Patient with Pneumothorax as Confirmed on Video-Assisted Thoracoscopic Surgery

Congenital defects of the pericardium, which are generally asymptomatic, are rare disorders characterized by complete or partial absence of the pericardium. Here, we report a rare case of a 19-year-old male who was incidentally diagnosed with congenital absence of the left pericardium during examination for symptoms of pneumothorax. Chest radiography and computed tomography revealed a collapsed left lung without any evidence of trauma, no unusual findings of free air spaces along the right side of the ascending aorta, heart shifted toward the left side of the thorax, and a shallow chest. Subsequent thoracoscopy confirmed the absence of the left pericardium and displacement of the heart toward the left thoracic cavity. We further discuss the correlation between radiologic images and surgical findings of a congenital pericardial defect associated with spontaneous pneumothorax.

Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis

Etiology of adolescent idiopathic scoliosis (AIS), a complicated three-dimensional spinal deformity with early-onset, receives continuous attention but remains unclear. To gain an insight into AIS pathogenesis, this review searched PubMed database up to June 2019, using key words or medical subject headings terms including "adolescent idiopathic scoliosis," "scoliosis," "pathogenesis," "etiology," "genetics," "mesenchymal stem cells," and their combinations, summarized existing literatures and categorized the theories or hypothesis into nine aspects. These aspects include bone marrow mesenchymal stem cell studies, genetic studies, tissue analysis, spine biomechanics measurements, neurologic analysis, hormone studies, biochemical analysis, environmental factor analysis, and lifestyle explorations. These categories could be a guidance for further etiology or treatment researches to gain inspiration.