Degenerative Group Research Articles

Assessment of Condylar Changes in Patients with Degenerative Joint Disease of the TMJ After Stabilizing Splint Therapy: A Retrospective CBCT Study.

Degenerative joint disease (DJD) of the TMJ can impact patients' quality of life and complicate orthodontic treatment. Stabilizing splints are a common conservative treatment in managing TMDs symptoms, although their long-term effects on condylar morphology are poorly studied. This study aimed to assess the impact of stabilizing splints on condyle morphology using cone-beam computed tomography (CBCT) in patients with various stages of DJD. Forty-two condyles with pre- (T1) and post- (T2) splint therapy scans were analyzed. CBCT scans were sectioned into sagittal and coronal slices for condyle classification and measurement. T1 and T2 CBCTs were superimposed before linear and area measurements at different poles. Our results indicate that condyles in the normal group remain unchanged after splint therapy. The majority of subjects in the degenerative groups remained in the same classification group: six out of fourteen degenerative-active patients became degenerative-repair, while three out of twenty-two degenerative-repair patients progressed to degenerative-active. There is no significant remodeling of condylar width pre- and post-splint therapy. On average, there is more bone deposition than reduction in condylar height after splint therapy, although individual variation exists. Stabilizing splints offer a low-risk intervention for managing DJD and may contribute to favorable adaptive changes in the condyles.

Comparative proteomic analysis of regenerative mechanisms in mouse retina to identify markers for neuro-regeneration in glaucoma

The retina is part of the central nervous system (CNS). Neurons in the CNS and retinal ganglion cells lack the ability to regenerate axons spontaneously after injury. The intrinsic axonal growth regulators, their interaction and roles that enable or inhibit axon growth are still largely unknown. This study endeavored to characterize the molecular characteristics under neurodegenerative and regenerative conditions. Data-Independent Acquisition Mass Spectrometry was used to map the comprehensive proteome of the regenerative retina from 14-day-old mice (Reg-P14) and adult mice after lens injury (Reg-LI) both showing regrowing axons in vitro, untreated adult mice, and retina from adult mice subjected to two weeks of elevated intraocular pressure showing degeneration. A total of 5750 proteins were identified (false discovery rate < 1%). Proteins identified in both Reg-P14 and Reg-LI groups were correlated to thyroid hormone, Notch, Wnt, and VEGF signaling pathways. Common interactors comprising E1A binding protein P300 (EP300), CREB binding protein (CBP), calcium/calmodulin dependent protein kinase II alpha (CaMKIIα) and sirtuin 1 (SIRT1) were found in both Reg-P14 and Reg-LI retinas. Proteins identified in both regenerating and degenerative groups were correlated to thyroid hormone, Notch, mRNA surveillance and measles signaling pathways, along with PD-L1 expression and the PD-1 checkpoint pathway. Common interactors across regenerative and degenerative retinas comprising NF-kappa-B p65 subunit (RELA), RNA-binding protein with serine-rich domain 1 (RNPS1), EP300 and SIN3 transcription regulator family member A (SIN3A). The findings from our study provide the first mapping of regenerative mechanisms across postnatal, mature and degenerative mouse retinas, revealing potential biomarkers that could facilitate neuro-regeneration in glaucoma.

Prolonged operative time significantly impacts on the incidence of complications in spinal surgery

BackgroundIn spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery.MethodsWe retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications.ResultsA total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events.ConclusionsThis study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient’s safety, without compromising the technical achievement of the procedure.

Clinical Outcomes After Mini-Open Subpectoral Biceps Tenodesis

Background Long head of the biceps tendon pathology is a common cause of shoulder pain. Current surgical treatment options for long head of the biceps tendon disorders include tenotomy and tenodesis. Younger and high-demand patients are usually treated with tenodesis since tenotomy is associated with increased biceps pain and cramping, cosmetic deformity and patient dissatisfaction. Previous studies have shown biomechanical advantages of subpectoral open approach over arthroscopic suprapectoral approach, with less biceps over tension and increased ultimate load to failure. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Methods We retrospectively reviewed all patients who underwent subpectoral biceps tenodesis with unicortical endo-button fixation between January 2015 and December 2019. Only patients who had a minimum of 24 months follow-up were included in the study. We reviewed patient demographics. The American Shoulder and Elbow Surgeons and Visual Analogue score were assessed and complications were recorded. Results A total of thirty-two patients were enrolled in this study. 15 were young patients and sports athletes with SLAP (Superior Labrum from Anterior to Posterior) lesions or isolated biceps instability and the remaining 17 were middle-age patients with degenerative biceps disease and concomitant pathology. The mean follow-up time was 36 months. SLAP lesions group average age was 24,3 and degenerative group average age was 53,8. The ASES score and the VAS score and were statically significative better in the isolated subpectoral tenodesis due to SLAP lesions 99,8 and 0,1 respectively in comparison with the degenerative group, 85,7 and 1,5 respectively. We recorded two complications. One case of superficial infection and one case of a patient that was concomitant submitted to arthroscopic rotator cuff tear repair with persisting shoulder pain. There was no case of failure of fixation or associated Popeye deformity. Conclusions Subpectoral biceps tenodesis with unicortical endo-button fixation is a viable treatment option for patients with symptomatic biceps disease. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion may have less favorable outcomes.

P-125 Relationship between ooplasmic fluidity and oocyte degeneration examined by image analysis after Piezo-intracytoplasmic sperm injection (ICSI)

Abstract Study question Can image analysis of ooplasmic fluidity in Piezo-ICSI predict unintentional membrane rupture (UMR) and subsequent oocyte degeneration? Summary answer Image analysis of ooplasmic fluidity using “optical flow” can be used to predict UMR and subsequent oocyte degeneration in Piezo-ICSI. What is known already UMR during Piezo-ICSI sometimes leads to oocyte degeneration, but not all oocytes degenerate. Leakage of ooplasm is often observed in degenerating oocytes after Piezo-ICSI. We speculated that the occurrence of ooplasmic leakage could relate to the ooplasmic fluidity. Optical flow is an image processing algorithm that analyses the movement of an object in a motion picture. In this study, the motion vectors for all pixels in the image were calculated using the dense optical flow method. Study design, size, duration We developed an image analysis system that detects the movement of the ooplasm on Piezo-ICSI videos using the OpenCV library. Videos of 96 oocytes recorded during Piezo ICSI (mean maternal age: 39.2±5.4 years) retrieved in our institute between January 2020 and September 2023 were retrospectively analyzed using the system. To minimize the potential influence of technical factors, Piezo-ICSI was performed by two embryologists. Participants/materials, setting, methods The oocytes were characterized by survival or degeneration and labeled with and without UMR. To evaluate the ooplasm fluidity, we analyzed the vertical motion vectors of all pixels between the start to puncture and the rupture of the oolemma (1st period) and between sperm injection and withdrawal of the pipette (2nd period). The velocity between groups was compared at the 95th, 99th, and 99.5th percentiles, followed by statistical analysis by the Mann-Whitney U test. Main results and the role of chance The 95th, 99th, and 99.5th percentiles of the survival group (n = 75) were significantly higher than those of the degeneration group (n = 21) in the 1st period (P &amp;lt; 0.01). Additionally, the 99th, and 99.5th percentiles of the survival group were significantly higher than those of the degenerative group in the 2nd period (P &amp;lt; 0.05). The 95th, 99th, and 99.5th percentiles without UMR (n = 52) were significantly higher than those with UMR (n = 44) in the 1st period (P &amp;lt; 0.001). Similarly, the 95th, 99th, and 99.5th percentiles without UMR were significantly higher than those with UMR in the 2nd period (P &amp;lt; 0.001). ROC curves were generated at the 95th, 99th, and 99.5th percentiles in the 1st period. The resultant areas under the curve (AUC) were 0.73, 0.75, and 0.73, respectively. Using a threshold of 0.75 for the 99th percentile, oocyte degeneration was predicted with a sensitivity of 85% and specificity of 57%. In the 2nd period, ROC curves at the same percentiles resulted in the AUCs of 0.63, 0.69, and 0.67, respectively. Using a threshold of 0.69 for the 99th percentile, oocyte degeneration was predictable with sensitivity as 57% and specificity as 86%. Limitations, reasons for caution This study did not control for variations among the embryologists performing Piezo-ICSI. The culture outcomes and clinical outcomes had not been evaluated. We only showed the relationship between ooplasmic fluidity and oocyte degeneration because it was a retrospective study. A prospective study using image analysis is needed. Wider implications of the findings Before the investigation, we expected that more ooplasmic fluidity (less viscosity) could increase UMR and oocyte degeneration. This study, however, indicated that more ooplasmic fluidity (less viscosity) decreased UMR and oocyte degeneration. Elucidation of the mechanism under this phenomenon may lead to reduced UMR and oocyte degeneration. Trial registration number Not Applicable

Investigating the characteristics of mild intervertebral disc degeneration at various age stages using single-cell genomics.

Introduction: Intervertebral disc degeneration often occurs in the elderly population, but in recent years, there has been an increasing incidence of disc degeneration in younger individuals, primarily with mild degeneration. Methods: In order to explore the underlying mechanisms of disc degeneration in both young and aging individuals, we collected four types of nucleus pulposus (NP) single-cell sequencing samples for analysis based on Pfirrmann grading: normal-young (NY) (Grade I), normal-old (NO) (Grade I), mild degenerative-young (MY) (Grade II-III), and mild degenerative-old (MO) (Grade II-III). Results: We found that most NP cells in NO and MY samples exhibited oxidative stress, which may be important pathogenic factors in NO and MY groups. On the other hand, NP cells in MO group exhibited endoplasmic reticulum stress. In terms of inflammation, myeloid cells were mainly present in the degenerative group, with the MY group showing a stronger immune response compared to the MO group. Interestingly, dendritic cells in the myeloid lineage played a critical role in the process of mild degeneration. Discussion: Our study investigated the molecular mechanisms of intervertebral disc degeneration from an age perspective, providing insights for improving treatment strategies for patients with disc degeneration at different age groups.

Comparison of the predictive values of MRI-based vertebral bone quality scores for the determination of osteoporosis in different diseases.

The study aimed to examine the consistency of vertebral bone quality (VBQ) scores for assessing osteoporosis across different etiologies and explore the predictive value of various VBQ scores for fragility vertebral fractures. Patients with fragility fractures were matched by age and sex to patients with lumbar degeneration. VBQ scores were calculated in T1- and T2-weighted magnetic resonance imaging. Differential analysis of bone quality was performed based on etiology. A total of 96 inpatients were retrospectively enrolled. VBQT1 scores were only sensitive to osteoporotic bone in degenerative group (p < 0.01), failing to identify osteoporosis in fractured group (p > 0.05). For the degenerative group, the area under the curve (AUC) using the VBQT1 scores to differentiate osteoporosis was 0.72. After controlling the confounding variables, only VBQT2 scores were significantly higher in fractured group than degenerative group, with a greater AUC of 0.82 predicting fragility fractures. VBQT1 scores moderately correlated with femoral neck T-scores in degenerative group (r = -0.45, p < 0.01) but not in fractured group (r = -0.24, p > 0.05). VBQT2 scores were not associated with femoral neck T-scores (p > 0.05). This study is the first to evaluate the effectiveness of VBQs scores in assessing osteoporosis post-fracture. Only non-fractured patients' bone quality is fully susceptible to VBQT1 scores. While VBQT1 scores may not correlate with fragility fractures, VBQT2 scores present a viable alternative.

Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology.

As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity. A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications. There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock. Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery. In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.

Evaluation of Optical Coherence Tomography Angiography in Degenerative and Tractional Lamellar Macular Hole.

This study aims to evaluate the optical coherence tomography angiography (OCTA) findings in cases with degenerative and tractional lamellar macular holes (LMH). Two subtypes of LMH cases were included. Seventeen patients had the degenerative subtype, whereas 18 patients had the tractional subtype of LMH. Twenty healthy individuals were enrolled as the control group. The foveal avascular zone (FAZ) and retinal vascular densities in the superficial, deep capillary, and choriocapillary plexuses were analyzed and compared with fellow eyes and healthy controls using OCTA. The mean FAZ area was wider in the degenerative subtype (0.33 ± 0.14 mm2) compared to the tractional subtype (0.24 ± 0.10 mm2) (p=0.04) and control eyes (0.26 ± 0.10 mm2) (p=0.03). Foveal vessel densities in the superficial and deep capillary plexuses were lower in the degenerative group than in the tractional group, (21.7 ± 9.8% vs. 26.8 ± 6.9%, p=0.01 and 28.5 ± 5.1% vs. 36.9 ± 6.2%, p=0.01). Choriocapillary vascular density in the parafoveal area was also lower in degenerative lamellar macular holes compared to the tractional group (60.4 ± 4.7% vs. 63.7 ± 3.9%, p=0.03). Compared to control eyes, eyes with degenerative and tractional LMH showed lower vessel densities in the parafoveal and perifoveal areas of the SCP, DCP, and all layers of CC (p < 0.05). In the foveal area, the LMH groups showed higher foveal vascular density (FVD) in the SCP than control eyes, while in the DCP, FVD was lower in the degenerative LMH eyes relative to the other groups. The finding of microvascular changes between degenerative and tractional LMH subtypes highlights their distinct pathologies and supports recent changes in the classification and terminology of this macular condition.

Diagnostic role of aortic valve calcium scoring in various etiologies of aortic stenosis

Most of the studies about aortic valve calcium (AVC) score in aortic stenosis (AS) were based on degenerative or bicuspid AS but not rheumatic AS. We aimed to study the diagnostic accuracy of AVC score to determine severe AS in various etiologies. Adult patients diagnosed with mild to severe AS were enrolled. AVC score were identified from multi-detector computed tomography (MDCT) scan. The AVC score was highest in bicuspid AS (3211.9 (IQR (1100.0–4562.4) AU) compared to degenerative AS (1803.7 (IQR (1073.6–2550.6) AU)), and rheumatic AS (875.6 (IQR 453.3–1594.0) AU), p < 0.001. For the ROC curve to identify severe AS, the AVC score performed well in degenerative and bicuspid AS with the area under the ROC curve (AuROC) 0.834 (95% CI, 0.730, 0.938) in degenerative group; and 0.820 (95% CI, 0.687, 0.953) in bicuspid AS. Whereas AVC score had non-significant diagnostic accuracy with AuROC 0.667 (95% CI, 0.357, 0.976) for male and 0.60(95% CI, 0.243, 0.957) for female in rheumatic AS. The cut-off AVC score values to identify severe AS were AVCS > 2028.9AU (male) and > 1082.5AU (female) for degenerative AS, and > 2431.8AU (male) and > 1293.5AU (female) for bicuspid AS. In conclusions, AVC score is the accurate test for assessing severity in patients with degenerative and bicuspid AS but performs poorly in rheumatic AS group.

Comparative outcomes of physician-modified fenestrated-branched endovascular repair of post-dissection and degenerative complex abdominal or thoracoabdominal aortic aneurysms

ObjectiveFenestrated-branched endovascular repair has become a favorable treatment strategy for patients with complex abdominal aortic aneurysms (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs) who are high risk for open repair. Compared with degenerative aneurysms, post-dissection aneurysms can pose additional challenges for endovascular repair. Literature on physician-modified fenestrated-branched endovascular aortic repair (PM-FBEVAR) for post-dissection aortic aneurysms is sparse. Therefore, the aim of this study is to compare the clinical outcomes of patients who underwent PM-FBEVAR for degenerative and post-dissection cAAAs or TAAAs. MethodsA single-center institutional database was retrospectively reviewed for patients that underwent PM-FBEVAR between 2015 and 2021. Infected aneurysms and pseudoaneurysms were excluded. Patient characteristics, intraoperative details, and clinical outcomes were compared between degenerative and post-dissection cAAAs or TAAAs. The primary outcome was 30-day mortality. The secondary outcomes included technical success, major complications, endoleak, target vessel instability, and reintervention. ResultsOf the 183 patients who underwent PM-FBEVAR in the study, 32 had aortic dissections, and 151 had degenerative aneurysms. There was one 30-day death (3.1%) in the post-dissection group and eight 30-day deaths (5.3%) in the degenerative aneurysm group (P = .99). Technical success, fluoroscopy time, and contrast usage were similar between the post-dissection and degenerative groups. Reintervention during follow-up (28% vs 35%; P = .54) and major complications were not statistically significantly different between the two groups. Endoleak was the most common reason for reintervention, with the post-dissection group having a higher rate of type IC, II, and IIIA endoleaks (31% vs 3%; P < .0001; 59% vs 26%; P = .0002; and 16% vs 4%; P = .03). During the mean follow-up of 14 months, all-cause mortality was similar between the groups (12.5% vs 21.9%; P = .23). ConclusionsPM-FBEVAR is a safe treatment for post-dissection cAAAs and TAAAs with high technical success. However, endoleaks requiring reintervention were more frequent in post-dissection patients. The impact of these reinterventions on long-term durability will be assessed with continued follow-up.

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases

PurposeTo explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration.MethodsA retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA.ResultsA total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = − 0.611 and − 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%).ConclusionsEmerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.

MRI findings of traumatic and degenerative rotator cuff tears and introduction of the “cobra sign”

A rotator cuff tear (RCT) is a common shoulder diagnosis and its etiology may be acute, traumatic, or chronic degenerative. Differentiation between the 2 etiologies may be important for multiple reasons, but remains difficult based on imaging. Further knowledge about radiographic and magnetic resonance findings to distinguish traumatic from degenerative RCT is needed. We analyzed magnetic resonance arthrograms (MRAs) of 96 patients with traumatic or degenerative superior RCT, which were matched according their age and the affected rotator cuff muscle into the 2 groups. Patients older than 66 years of age were excluded from the study to avoid including cases with pre-existing degeneration. In the case of traumatic RCT, the time between the trauma and MRA had to be less than 3 months. Various parameters of the supraspinatus (SSP) muscle-tendon unit were assessed (tendon thickness, presence of a remaining tendon stump at the greater tubercle, magnitude of retraction, layer appearance). The retraction of the 2 SSP layers were individually measured to determine the difference of retraction. Additionally, edema of the tendon and muscle, the tangent- and kinking-sign as well as the newly introduced Cobra-sign (bulging of the distal part of the ruptured tendon with slim configuration of the medial part of the tendon) were analyzed. Edema within the SSP muscle (sensitivity 13%, specificity 100%, P=.011) or the tendon (sensitivity 86%, specificity 36%, P=.014) are more frequent in traumatic RCT. The same association was found for the kinking-sign (sensitivity 53%, specificity 71%, P=.018) and the Cobra sign (sensitivity 47%, specificity 84%, P=.001). Even though not statistically significant, tendencies were observed toward thicker tendon stumps in traumatic RCT, and greater difference in retraction between the 2 SSP layers in the degenerative group. The cohorts had no difference in the presence of a tendon stump at the greater tuberosity. Muscle and tendon edema, as well as tendon kinking appearance and the newly introduced cobra-sign are suitable MRA parameters to distinguish between traumatic and degenerative etiology of a superior RTC.

Integrated proteome sequencing, bulk RNA sequencing and single-cell RNA sequencing to identify potential biomarkers in different grades of intervertebral disc degeneration.

Low back pain (LBP) is a prevalent health problem worldwide that affects over 80% of adults during their lifetime. Intervertebral disc degeneration (IDD) is a well-recognized leading cause of LBP. IDD is classified into five grades according to the Pfirrmann classification system. The purpose of this study was to identify potential biomarkers in different IDD grades through an integrated analysis of proteome sequencing (PRO-seq), bulk RNA sequencing (bRNA-seq) and single-cell RNA sequencing (scRNA-seq) data. Eight cases of grade I-IV IDD were obtained. Grades I and II were considered non-degenerative discs (relatively normal), whereas grades III and IV were considered degenerative discs. PRO-seq analysis was performed to identify differentially expressed proteins (DEPs) in various IDD grades. Variation analysis was performed on bRNA-seq data to differentiate expressed genes (DEGs) in normal and degenerated discs. In addition, scRNA-seq was performed to validate DEGs in degenerated and non-degenerated nucleus pulposus (NP). Machine learning (ML) algorithms were used to screen hub genes. The receiver operating characteristic (ROC) curve was used to validate the efficiency of the screened hub genes to predict IDD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to analyze function enrichment and signaling pathways. Protein-protein interaction (PPI) network was used to prioritize disease-related proteins. SERPINA1, ORM2, FGG and COL1A1 were identified through PRO-seq as the hub proteins involved in regulating IDD. ML algorithms selected ten hub genes, including IBSP, COL6A2, MMP2, SERPINA1, ACAN, FBLN7, LAMB2, TTLL7, COL9A3, and THBS4 in bRNA-seq. Since serine protease inhibitor clade A member 1 (SERPINA1) was the only common gene, its accuracy in degenerated and non-degenerated NP cells was validated using scRNA-seq. Then, the rat degeneration model of caudal vertebra was established. The expression of SERPINA1 and ORM2 was detected using immunohistochemical staining of human and rat intervertebral discs. The results showed that SERPINA1 was poorly expressed in the degenerative group. We further explored the potential function of SERPINA1 by Gene Set Enrichment Analysis (GSEA) and cell-cell communication. Therefore, SERPINA1 can be used as a biomarker to regulate or predict the progress of disc degeneration.

Radiolunate Arthrodesis in the Rheumatoid Wrist: A Retrospective Clinical and Radiologic Long-Term Follow-Up

This study aimed to determine the results of radiolunate arthrodesis for rheumatoid arthritis (RA) after a long-term follow-up period of up to 20 years under tight postoperative medical control of RA. We also compared the results between patients with and without degenerative changes in the midcarpal joints at follow-up. We determined the radiologic factors predictive of secondary degenerative changes in the midcarpal joint. This was a long-term retrospective analysis of 16 wrists of 14 patients with RA treated with radiolunate arthrodesis first reported in 2013. The mean follow-up period was 14 years (range, 8-23 years; SD, 4.6 years). Ten wrists had a Larsen classification of grade III, whereas 6 wrists had grade IV. The range of motion was assessed, and clinical outcomes were graded using the Mayo Wrist Score and Stanley classification system. The Carpal Height Index, Ulnar Translation Index, and changes in the midcarpal joint contour were determined from radiographs. We categorized the changes in the midcarpal joint as unchanged or degenerative. At final follow-up, the clinical scores improved; however, the extension and flexion range of motion was significantly reduced compared with that before surgery. The Carpal Height Index and Ulnar Translation Index improved immediately after surgery and remained stable at final follow-up. The changes in the midcarpal joint were categorized as unchanged in 6 wrists and degenerative in 10 wrists. The clinical outcomes were similar between the groups. The mean preoperative Ulnar Translation Index was significantly higher in the degenerative group than in the unchanged group. Radiolunate arthrodesis in patients with RA maintained good clinical results and corrected alignment, even during long-term follow-up. Preoperative severe ulnar translation deformity was a risk factor for postoperative degeneration of the midcarpal joint, and pre-existing degenerative changes at the midcarpal joint might lead to loss of wrist range of motion. Therapeutic IV.

Variations in lower limb alignments indicate pelvic tilt after total hip arthroplasty

ObjectiveWe sought to correlate various spinopelvic and lower limb alignments, and to examine the current spinopelvic theories on a Chinese cohort.MethodsWe retrospectively reviewed 166 patients undergoing THA. Among them, 138 patients with unilateral THA met the inclusion criteria. Sagittal alignments and cup orientations were measured on standing and sitting lateral EOS images. Patients were categorized into two groups with a scoring system for lumbar spine degeneration. Patients’ demographics including age, sex, lumbar spine degeneration and radiographic measurements were studied.ResultsPT, SS, LL and TK differed significantly between standing and sitting within each group except for TK in degenerative group (32.8 ± 13.9 vs. 32.9 ± 14.2, p = 0.905). Compared with degenerative spine group, non-degenerative spine patients have great pelvic mobility (ΔPT, -24.4 ± 12.5° vs. -17.6 ± 10.7, p = 0.0008), greater lumbar mobility (ΔLL, -34.8 ± 15.2 vs. -21.7 ± 12.2, p = < 0.0001) and compensatory cup orientation changes (ΔRA, -15.5 ± 11.1 vs. -12.0 ± 8.4, p = 0.00920; ΔRI, -10.8 ± 11.5 vs. -5.6 ± 7.5, p = 0.0055). Standing PT and ankle dorsiflexion angle correlated positively (R2 = 0.236, p = 0.005).ConclusionTHA patients in this cohort showed a spinopelvic motion paradigm similar to that from previous studies on Caucasians. Ankle dorsiflexion indicate greater posterior pelvic tilt on standing. Surgeons should beware of risks of instability in patients with lower limb compensations.Advances in knowledgeThis study provides new insights into the clinical relevance of lower limb alignments to spinopelvic motion after THA in a relatively young Chinese population.

Perioperative Complications of Open Spine Surgery in Older Adults over 90 Years of Age.

Despite perioperative risks in nonagenarian patients who undergo open spine surgery for degeneration disorder or spinal trauma being of great interest, the prevalence of complications in this group remains unclear. This study aims to examine the perioperative complications of open spine surgery in the elderly over 90 years of age. Preoperative and intraoperative characteristics including the American Society of Anesthesiologists Physical Status (ASA-PS) class, type of surgery, and complications within 30 postoperative days were retrospectively collected from the medical records of nonagenarians who underwent open spine surgery between April 2004 and July 2019 at our spine centers. A total of 48 patients met the inclusion criteria of this study. All belong to ASA-PS class 2 (69%) or 3. Preoperative American Spinal Injury Association Impairment Scale grades in trauma group were grade A in 4 cases, B in 1 case, C in 5 cases, D in 11 cases, and E in 1 case. Major complications (deep surgical site infection, cardiac event, respiratory disorder, gastrointestinal hemorrhage, and renal failure) occurred in 13 cases, and the rate of overall perioperative complications was 45.8%. One patient who underwent cervical stabilization for cervical fracture dislocation died at postoperative 13 days due to respiratory disorder. The rates of major complications and overall perioperative complications were 3.6% and 14.3% in the degenerative group and 45.5% and 81.8% in the trauma group, respectively. Especially in the trauma group, respiratory disorder occurred in 7 cases, delirium in 11 cases, and urinary tract infection in 5 cases. Although the perioperative complication rate reached 81.8% in spinal trauma cases, the complication rate in degenerative disorders was relatively low as 14.3%. Open spine surgery for degenerative disorders can be relatively safe even in nonagenarians, whereas the risks of perioperative complications, including respiratory disorder and delirium, were high in spinal trauma cases.

Radiological Characteristics of Low-Grade Lytic Spondylolisthesis: Similarity to Dysplastic Spondylolisthesis.

Retrospective case-control study. This study aimed to analyze the etiology of low-grade lytic spondylolisthesis based on the radiologic features of the vertebra. According to the Marchetti-Bartolozzi classification scheme, high-grade lytic spondylolisthesis (Meyerding grade 3-5) is classified as dysplastic. However, determination of the etiology for low-grade lytic spondylolisthesis as developmental or traumatic remains controversial. Patients admitted and treated for one-level (L4/5 or L5/S1) low-grade spondylolisthesis were included in the study. A total of 135 patients were divided into the degenerative or lytic spondylolisthesis groups according to their condition (81 patients [degenerative group] vs. 54 patients [lytic group]). To assess the level of similarity in the radiological findings between low-grade lytic spondylolisthesis and dysplastic spondylolisthesis, the pedicle diameters and vertebral heights of the L4 and L5 vertebrae were measured on computed tomography images. Measurements were then converted to each vertebra's ratio to reduce confounding factors among individuals. The affected vertebra had a smaller sagittal pedicle diameter/transverse pedicle diameter ratio in the low-grade lytic spondylolisthesis group compared to the degenerative group, and the posterior vertebral height/anterior vertebral height ratio of L5 was smaller in the L5/S1 lytic spondylolisthesis group compared to the degenerative spondylolisthesis group. Low-grade lytic spondylolisthesis and dysplastic spondylolisthesis demonstrated similar radiological findings. Hence, surgeons should be attentive to the morphology of the vertebral body and posterior column during preoperative planning for the treatment of low-grade lytic spondylolisthesis.

7. Does Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes) play a role in degenerative disc disease?

<h3>BACKGROUND CONTEXT</h3> Degenerative disc disease (DDD) is a major burden to society, leading to disability and loss in productivity. In 2005, an estimated $86 billion was spent in the United States for management of neck and back problems. Recent evidence suggests that Cutibacterium acnes (C. acnes), an anaerobic bacterium, may latently reside in intervertebral discs (IVDs) and contribute to DDD. <h3>PURPOSE</h3> To determine the presence of C. acnes in IVD specimens and to correlate this with Pfirrmann grading on MRI. <h3>STUDY DESIGN/SETTING</h3> The intervertebral discs of 63 DDD patients and 5 control patients were collected prospectively. <h3>PATIENT SAMPLE</h3> Sixty-eight patients presenting to a single academic center for spine surgery were enrolled. <h3>OUTCOME MEASURES</h3> Pfirrmann grading, presence of C. acnes based on taxonomic identification. <h3>METHODS</h3> We collected human IVD specimens from surgical patients undergoing discectomy and interbody fusion from a single institution from 8/2019 to 9/2020. Disc degeneration was graded according to the 5-level Pfirrmann grading system on MRI imaging taken prior to surgery. IVD specimens from trauma patients (Pfirrmann grades I-II) were included in the control group, and IVD specimens were included in the degenerative group with Pfirrmann grades III-V. IVD specimens were processed for DNA extraction, and 16S rRNA libraries were constructed and analyzed for taxonomic data. <h3>RESULTS</h3> There were 63 patients included within the DDD group and 5 patients within the control group. Within the degenerative group, IVD specimens were taken from patients who had undergone spine surgery within the lumbar spine (n = 42; 66.7%), cervical spine (n = 19; 30.2%), and thoracic spine (n = 2; 3.2%). The average age of the DDD group was 54.3 ±13.9 years old, 57.1% (36/63) were male, and 85.7% (54/63) were Caucasian. A total of 31.7% (20/63) of DDD specimens were identified with the presence of C. acnes. There were 28.6% (12/42) of lumbar spine IVD specimens, 42.1% (8/19) of cervical spine IVD specimens, 0% (0/2) of thoracic spine IVD specimens that were identified with C. acnes. There was no difference in the presence of C. acnes when comparing the cervical, thoracic, and lumbar spine specimens (p = 0.36). When stratifying the DDD specimens by MRI Pfirmann grading, there were 31.3% (5/16) of specimens with a Pfirmann grade of 3, 31.3% (10/32) of specimens with a Pfirrmann grade of 4, and 33.3% (5/15) of specimens with a Pfirrmann grade of 5 that were identified with C. acnes. There was no difference in the presence of C. acnes when comparing the DDD specimens based on Pfirrmann grading (p = 0.99). There were 5 IVD specimens included within the control group with an average age of 39.8 ±20.5 years old, and 80% (4/5) were Caucasian males. The control group included IVD specimens taken from two lumbar and three cervical spine surgerie. Four of five (80%) of the specimens had a Pfirrmann grade of 2 on MRI, and 1/5 (20%) had a Pfirrmann grade of 1. No control specimens were identified with the presence of C. acnes. <h3>CONCLUSIONS</h3> Of the DDD specimines, 31.7% (20/63) were identified with the presence of C. acnes, while none of the specimens of the control group were identified with this bacterium. These results suggest that indolent C. acnes infection may be one of the factors contributing to degenerative disc disease. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Evaluation of SS-31 as a Potential Strategy for Tendinopathy Treatment: An In Vitro Model

Background: Studies in our laboratory have demonstrated mitochondrial dysfunction in human and animal models of supraspinatus tendinopathy. SS-31 (elamipretide) has been reported to improve mitochondrial function and to be effective in clinical trials for several diseases. The potential of SS-31 in treating tendinopathy has not been explored. Hypothesis: SS-31 would improve mitochondrial function in human tenocytes sampled from patients with tendinopathy. Study Design: Controlled laboratory study. Methods: Healthy tenocytes were obtained from normal hamstring tendon biopsy specimens in 9 patients undergoing anterior cruciate ligament reconstruction, and tenocytes were collected from degenerative supraspinatus tendon biopsy specimens in 9 patients undergoing rotator cuff repair. Tenocytes were cultured, used at passage 1, and assigned to 4 groups: healthy tenocytes, healthy tenocytes with 1μM SS-31 treatment for 72 hours, degenerative tenocytes, and degenerative tenocytes with 1μM SS-31 treatment for 72 hours. The outcomes included measurements of mitochondrial potential, mitochondrial morphology by transmission electron microscopy imaging, reactive oxygen species and superoxidative dismutase activity, gene expression, and cell viability. Results: An increase in the cell fraction with depolarized mitochondria was found in degenerative tenocytes (P = .014), followed by a decrease after SS-31 treatment (P = .018). Transmission electron microscopy images demonstrated morphological changes with a decreased number and size of mitochondria per cell in the degenerative tenocytes (P = .018) and with improvement after SS-31 treatment. There was no significant difference in the level of reactive oxygen species between healthy and degenerative tenocytes in culture, but superoxidative dismutase activity was significantly decreased in the degenerative group (P = .006), which then increased after SS-31 treatment (P = .012). These findings suggested that mitochondrial dysfunction may be reversed by SS-31 treatment. The gene expression of matrix metalloproteinase-1 (matrix remodeling, P = .029) and fatty acid–binding protein 4 (fatty infiltration, P = .046) was significantly upregulated in the degenerative tenocytes and reduced by SS-31 treatment (P = .048; P = .007). Gene expression for hypoxia-inducible factor1 α and the proapoptotic regulator Bcl-2–associated X protein was increased in the degenerative tenocytes. There was a significant decrease in cell viability in degenerative tenocytes as compared with the healthy tenocytes, with small improvement after treatment with SS-31. Conclusion: There are changes in mitochondrial structure and function in tenocytes derived from degenerative tendons, and SS-31, as a mitochondrial protectant, could improve mitochondrial function and promote the healing of tendinopathy. Clinical Relevance: Mitochondrial dysfunction appears to play a role in the development of tendinopathy, and SS-31, as a mitochondrial protective agent, may be a therapeutic agent in the treatment of tendinopathy.