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Although terahertz waves are susceptible to water of crystallization (bound water), we found that the terahertz absorption spectra of cysteine hydrochloride (LCH) and its monohydrate (LCHM) are highly similar. To explain this particular phenomenon, density functional theory (DFT) and the independent gradient model (IGM) were used to obtain the vibration mode and intermolecular interaction of LCH and LCHM. The molecular polarities of LCH and LCHM were then obtained by calculating their molecular polarity index (MPI). The characteristic peak positions in the terahertz spectra of LCH and LCHM basically corresponded, with the superimposed interference of vibration modes and the van der Waals interaction between molecules concealing the expression of hydrogen bonds produced by bound water in the LCHM terahertz spectrum. In addition, the intensity of the characteristic peaks in the LCHM terahertz spectrum was higher because of its higher molecular polarity. In general, the analysis method combining THz-TDS and MPI provides a new theoretical reference for studying the relationship between biomolecules and water.

The observed properties of crystalline polymers are determined by their internal structure, which in turn is the result of their different crystallization behaviors.

Terahertz (THz) resonance absorption originates from intermolecular interactions, which are suitable for identifying amino acids with multiple isomers. L-threonine and L-allo-threonine are diastereomers with two characteristic peaks in the effective spectrum range of 1.0–2.3 THz, which are located at 1.42 and 2.14 THz for L-threonine (L-thr) and 1.63 and 2.16 THz for L-allo-threonine (L-allo-thr). Based on the density functional theory (DFT) of the crystal structures of L-thr and L-allo-thr, the vibration frequencies of 1.56, 1.87, 2.16 THz, and 2.22 THz were obtained, corresponding to the THz characteristic peaks. Through vibration model analysis, it was found that lattice and skeleton vibrations mediated by intermolecular hydrogen bonds play a crucial role in the THz response. Studying the experimental absorption spectra of different proportions co-crystallized mixtures and 1:1 physical mixture of L-thr and L-allo-thr, it was found that the characteristic peaks of the physical mixture include the characteristic peaks of the two diastereomers in the THz band, while amino-acid co-crystallized mixtures formed their own characteristic peaks depending on the proportion. The results show that the co-crystallized mixture composition of diastereomers can be quantitatively analyzed by THz time-domain spectroscopy (THz-TDS).

Purpose: To analyze the perioperative risk factors related to lumbar spine fusion surgery in geriatric patients. Methods: 202 geriatric patients who have underwent lumbar spinal fusion surgeries between January 2019 and June 2021 were retrospectively investigated. Information of age, sex, comorbidity, fixation segments, operation time, surgical blood loss and periopera­tive complications in hospital were collected. Risk factors for complications were analyzed. Student’s t-test, chi-square test, Mann-Whitney U‑test and multivariate general­ized linear models were used. Results: In this study, 31 patients presented complications (15.3%) in these geriatric patients with an average age of 79.1 years, including 1 patient with intraoperative complication and 30 patients with postoperative complications; and 2 out of 31 patients (1%) died. The geriatric patients were divided into group A (24 patients) with major postoperative complications and group B (178 patients) without major postoperative complications. Major postoperative complications were significantly associated with age (univariate analysis, t=3.92, POR=1.323, 95 %CI 1.126-1.554, P=0.001), but not significantly associated with other factors tested (sex, comorbidity, fixation segments, operation time, surgical blood loss). Then 173 patients (range 77-81 years) were selected and the rate of major postoperative complications of each age from 78 to 81 years was compared with that of 77 years patients, respectively. We found that the ratios of complications at 80 years (OR=10.000, P=0.019) and 81 years (OR=10.000, P=0.009) were higher than the ratio at 77 years. Conclusions: Although with great progress of medical technology, increasing age was still the independent risk factor for major postoperative complications in geriatric patients undergoing lumbar spinal fusion surgery. As for the incidence of major postoperative complications, 80 and 81 years old patients was 10 folds higher than that of 77 years old patients, reminding us to pay more attention to 80 years old and even older patients.

d-Histidine (d-His), l-Histidine (l-His), and their racemic compound dl-Histidine (dl-His) have different stereo chirality, making them intrinsic diverse functionalities to the living system. Identifying the configuration and crystal structures of enantiomers and the racemic compound is always the foremost requirement in processing protein foods. Although these features can be analyzed by spectroscopic technologies individually, it remains challenging to incorporate these complex methods into a facile analytical strategy. Herein, we propose a terahertz spectroscopy with solid-state density functional theory to both distinguish the configurational difference and quantify the crystal transformation from l-His and d-His to dl-His. By comparison with X-ray diffraction analysis, the validity of the crystal transformation evaluation based on terahertz spectroscopy is verified. A normalized fitting line regarding the terahertz absorption frequency and intensity is calculated to quantitatively elucidate the crystal transformation from enantiomers to dl-His. Our findings provide a new analytical approach to the research on food chemistry.

STUDY DESIGN A laboratory study performed in a self-controlled fashion. OBJECTIVE The aim of this study was to examine whether "surgical smoke" generated by using the electrocautery on porcine spinal tissues could contain viable bacteria. SUMMARY OF BACKGROUND DATA The year 2020 has seen a surge in legislation regarding surgical smoke evacuation in the operating room across the United States. Surgical smoke contains numerous toxic and carcinogenic substances, which spine surgeons and operating room staff are regularly exposed to. Although the smoke's chemical toxicity has been extensively studied, little is known about its biohazard level. METHODS The electrocautery was used to "operate on" 20 segments of porcine spinal tissues on a clean bench. In each operation, the generated smoke was captured with a swab, which was positioned above the surgical site and within the smoke, to obtain bacteria cultures. Two other swabs-a tissue swab (swabbing the porcine tissue itself) and a blank swab (swabbing an empty sterile bowl)-were collected as controls. The culture results were compared among the three groups. An additional experiment was conducted to see whether using a mask can reduce the "infection rate" of the swab. RESULTS Although all blank swabs tested negative, 95% (19/20) of the smoke swabs tested positive, with a total of nine bacteria species identified. The most prevalent species observed in the smoke swabs included Serratia liquefaciens, Lactococcus garvieae, and Hafnia alvei, and so on. Among the positive smoke swabs, 84% (16/19) had one or more bacteria species that were consistent with the cultures of their corresponding tissue swabs. Using a surgical or N95 mask reduced the "infection rate" of the swab. CONCLUSION "Surgical smoke" generated by electrocauterization of porcine spinal tissues contains viable bacteria. Further research in actual spine surgery is needed next.Level of Evidence: N/A.

Background In China, traditional energy planning is subordinate to city planning, with a primary purpose of meeting the energy demand in urban areas by planning and designing an energy system. However, most of the current energy planning in China pertains to a low-efficient system and proves to be unfriendly to the environment, which is no longer appropriate for the future development of modern industrial parks and cities. Methods A combined cooling, heating, gas and power energy network with distributed cogeneration units and renewable energy sources provides an effective solution to the related problems. In this paper, a new energy planning method for the Eco-City is proposed, which is based on a Distributed Energy Network (DEN) system. The designed method of a four-stage energy integration mode is implemented, which includes prediction of the energy demand, optimization of the energy utilization, matching of the energy supply and the recovery side. Based on the planning and designing of the DEN, the technical and economic analysis draw reasonable results. Results As implemented in the practical case of the Sino-German Eco-Park, the procedure of the proposed energy planning method is comprehensively explained. Finally, by reviewing the planning, design and operation, the current state and problems of the Sino-German Eco-Park are described. Conclusions A new energy design for Eco-Parks is developed as a result of a thorough analysis of the planning process, which integrates city planning and energy planning together and provides energy solutions for high-level cities and industrial parks. The four-stage integrated energy model provides a guideline for the entire process and its detailed steps. Relevant experiences and lessons from the energy planning of the Sino-German Eco-Park are of significance for supporting similar projects in the future.

The terahertz (THz) band contains a wealth of information about vibration and rotational energy levels, most of the vibration modes between amino acid molecules are in the THz band, so it reflects many unique absorption characteristics in the THz band. The use of terahertz time-domain spectroscopy can not only effectively identify different kinds of amino acids but also distinguish various isomers of the same amino acid due to the varied vibration modes. The absorption spectra of four stereoisomers of threonine were investigated by terahertz time-domain spectroscopy (THz-TDS) and Fourier transform infrared spectroscopy. The results show that the isomers show similarity in the infrared band, while manifest evidently the similarity between enantiomers L-threonine and D-threonine, and between L-allo-threonine and D-allo-threonine, and the difference between diastereoisomer L-threonine/D-threonine and L-allo-threonine/D-allo-threonine in the terahertz band. In order to fully understand the origin of the terahertz absorption characteristics of isomer molecules, simulation calculations were carried out in combination with density functional theory to connect the vibrational modes and molecular structures, Furthermore, the unit cell configurations of L-thr and L-allo-thr and the differences between various low-frequency vibrational modes are analyzed from the perspective of hydrogen bond configuration. By further extracting terahertz optical parameters such as refractive index and imaginary part of the dielectric constant of threonine isomers, the results show that the refractive index spectrum and dielectric loss spectrum can clearly show the response characteristics of the orientation polarization of dipole inside threonine isomers in terahertz band.

Determining the configuration and conformation of peptides is crucial for interpreting their structure-property relationships. In this work, we present nondestructive terahertz time-domain spectroscopy combined with density functional theory (DFT) and potential energy distribution (PED) analysis to identify the hierarchical structures of oligopeptides. The characteristic THz spectra of silk fibroin oligopeptides have been measured. Supported by DFT and PED analysis, the intrinsic differences among the dipeptides were identified by the collective vibrational modes of "R" groups and terminal groups linked by molecular chains of amido bonds or benzene rings. For tetrapeptides and hexapeptides, a few weak resonances and intensity differences were distinguished by the vibration mode of the molecular collective network formed by the interaction of amide planes and intramolecular hydrogen bond interactions. According to the THz absorption analyses of amide planes and intramolecular interactions within the molecular chains of silk fibroin oligopeptide isomer pairs, the formation and hierarchical structures were successfully interpreted using THz spectroscopy. This investigation develops a better understanding of the peptide formation mechanism, which further provides guidance in interpreting the formation of silk.

Terahertz (THz) spectroscopy is regarded as a professional technology to probe collective molecular vibrational modes and intensity of bio–molecules, which is potential to analyze amino acids and short peptides. In this study, THz spectroscopy is utilized to investigate the correlations of glycine (Gly), Serine (Ser), amino acid mixtures of Gly/Ser, and dipeptides (GS and SG) in the frequency range of 0.3–2.5 THz. The results manifest that the collective molecular vibrational intensity of Ser is larger than Gly, implying that the hydroxyl methyl group (–CH2–OH) on the side chain of Ser exhibits larger motions than that of –H in Gly. Additionally, the THz spectra of amino acid mixtures of Gly/Ser fit the linear addition of the individual amino acid absorption spectrum. Herein, the THz spectra of dipeptide GS and its isomer SG are distinguished according to the different collective molecular vibrations produced by the terminal groups on the carbon skeleton. Compared to physical amino acid mixtures of Gly/Ser, the dipeptides exhibit diverse THz spectra, indicating that the different collective vibrational modes are caused by peptide bonds and terminal groups. These solid evidences confirm that THz spectroscopy can be availably used to analyze the correlations of amino acids, amino acid mixtures, and dipeptides, as well as to identify dipeptide and its isomer from molecular level.

Objective Publications on hidden blood loss (HBL) after posterior lumbar interbody fusion (PLIF) for lumbar spine stenosis syndrome (LSS) have been reported, but the modified HBL (mHBL) was different from HBL obtained by classical formula and there are few studies on lumbar spine hemorrhage with rheumatoid arthritis (RA). Therefore, the aim of our study is to respectively evaluate the importance of hidden blood loss (HBL) and modified HBL (mHBL) after posterior lumbar interbody fusion (PLIF) in patients diagnosed with LSS and RA, to explore the correlation between RA activity and HBL as well as mHBL. Methods A total of 61 patients (nine males and 52 females) diagnosed with LSS and RA who underwent PLIF were included. Data contained demographics, RA‐related parameters such as duration of RA, Steinbrocker classification (used to evaluated RA activity), the disease‐modifying anti‐rheumatic drugs (DMARDs), osteoporosis and total knee arthroplasty; operation and hemorrhage parameters. Then HBL and mHBL were calculated by Gross formula and modified formula, respectively. Subgroup analysis on HBL and mHBL was performed based on gender, age (≤60 years and ˃60 years), different number of surgical segments (single segment, double segment, and ≥3 segments), and taking DMARDs or not. ANOVA analysis was performed on HBL and mHBL in different surgery segment number and Steinbrocker classification of RA. Independent sample t‐test was used in comparison of gender and age, as well as in comparison between HBL and mHBL based on whether the patient took DMARDs or not. Furthermore, paired t‐test was used to compare the volume between HBL and mHBL. Results The mean age and duration of RA was 65.2 ± 9.3 years and 14.3 ± 10.7 years, respectively. There were 13 grade I cases, 34 grade II cases, and 14 grade III cases as assessed by Steinbrocker classification and the most common anti‐RA drugs were DMARDs (57.4%). The mean intraoperative bleeding, drainage, and blood loss in drainage (DBL) was 453.3 ± 377.8 mL, 489.1 ± 253.8 mL, and 304.6 ± 156.3 mL, respectively. There was no difference on HBL and mHBL in gender. HBL and mHBL was larger in patients over 60 years (P = 0.040 and P = 0.023). There were differences in intraoperative blood loss, drainage, and DBL based on different number of segments but not in HBL and mHBL, or on Steinbrocker classification. DBL was lower in DMARDs group than non‐drugged group (P = 0.03), while HBL and mHBL were both of no significance. The comparison of HBL and mHBL showed statistical difference (P, 1. No statistical difference both in HBL and mHBL according to Steinbroker classification of three groups, which proposed no correlation between RA activity and HBL or mHBL. 2. DBL was of statistical difference (P = 0.03) between DMARDs‐taking group and non‐drug group with the mean volume of 415.8 and 261.8 mL, respectively, but yield no difference of HBL and mHBL between the two groups.

Background The position of the head relative to the spine can be used to evaluate the true global balance in patients with degenerative spinal kyphosis (DSK). However, it is still not clear how the position of the head is related to the spinal-pelvic parameters and lumbar muscles, which are most commonly considered. Methods Sixty-seven patients with DSK admitted in the hospital from January 2017 to January 2019 were retrospectively analyzed. All patients had whole spine X-ray and lumbar MRI. The head position parameters include: the angles of both lines joining the center of acoustic meati (CAM) to the center of the bi-coxofemoral axis (BA) (CAM-BA) and the most superior point of dentiform apophyse of C2 odontoid (OD) to BA (OD-BA) with the vertical line; the distance between the vertical line passing CAM and the posterior upper edge of the S1 (CAM-SVA). The spinal parameters include: C7 sagittal vertical axis (C7-SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), and lumbar lordosis (LL). The pelvic parameters include: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The relative cross-sectional area (RCSA) of bilateral multifidus, erector spinae and psoas muscle at L3/4 and L4/5 segments were measured. The correlations between head position parameters and the spinal-pelvic parameters and RCSA of lumbar muscles were analyzed, respectively. Results Significant positive correlations were found between each two of CAM-SVA, C7-SVA, CAM-BA and OD-BA (p r = 0.377, p = 0.034) and OD-BA (r = 0.402, p = 0.023). CAM-BA was found to be significantly negatively correlated with TK (r = − 0.367, p = 0.039). Significant positive correlations were found between RCSA of multifidus at L3/4 level and CAM-SVA (r = 0.413, p = 0.021), CAM-BA (r = 0.412, p = 0.019) and OD-BA (r = 0.366, p = 0.04). Conclusions Our study showed that the head position relative to the spine were significantly correlated to some spinal-pelvic parameters, and the lower lumbar multifidus muscle. The compensatory mechanisms of the global sagittal balance status should also involve the head position area.

The study of secondary structure is essential for understanding peptides and proteins. Here, we measured the terahertz (THz) spectra of γ-polyglutamic acid (γ-PGA) dominated by α-helix and random coil (RC) respectively. The α-helix has two absorption peaks in the THz region, but no absorption peak is observed in the RC conformation. We believe this is because the hydrogen bonding effect leads to a higher orientation in the helix-dominated γ-PGA. At lower pH, the absorption intensity of γ-PGA increases with the induction time. Similar changes were obtained in the Fourier infrared spectroscopy (FTIR). Through the correlation analysis of THz and IR spectroscopy, it is found that the characteristic peak at 1.2 THz can be used as a sensitive indicator of the intermediate conformation of the α-helical structure. In addition, the transformation of α-helix-RC conformation is related to the peak intensity at 1.99 THz (R

Hydroxyproline (HYP) and pyroglutamic acid (PGA), as amino acid derivatives, are highly similar in structure to proline (Pro). However, their low-frequency vibrations show significant differences in the range of 0.25-2.6 THz. Therefore, this study investigated the reasons for the differences combined with terahertz time domain spectroscopy (THz-TDS) and density functional theory (DFT). The results show that HYP and PGA have stronger absorption of terahertz waves due to the existence of polar substituents. Furthermore, the absorption peaks of HYP and PGA are significant red shifted and blue shifted, respectively. We believe that this is caused by the change in the strength of intermolecular hydrogen bonds. Our findings demonstrate that dipole and hydrogen bond effects play a significant role in low-frequency vibrations.

Background The paraspinal and psoas muscles have been considered to be essentially important for stabilizing the spinal column, and the muscle degeneration was found to exist in degenerative spinal kyphosis (DSK) patients. However, it is still not clear the relationship between muscle degeneration and spinal-pelvic alignment. The purpose of this study was to determine the correlations between the individual muscle degeneration at each lumbar spinal level and spinal-pelvic parameters in DSK patients. Methods The imaging data of 32 patients with DSK were retrospectively analyzed. The fat infiltration (FI) and relative cross-sectional area of muscle (RCSA) were quantitatively measured for multifidus (MF), erector spinae (ES) and psoas (PS) at each spinal level from L1/2 to L5/S1. The correlations were analyzed between RCSA and the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). Results The FI of MF and ES at L3/4, L4/5 and L5/S1 were higher than that at L1/2 and L2/3. The FI of PS at L4/5 and L5/S1 were lower than that of L1/2, L2/3 and L3/4. The RCSA of ES and PS from L1/2 to L5/S1 gradually increased, whereas the RCSA of ES from L1/2 to S5/S1 gradually decreased. The RCSA of MF at the L1/2 level was negatively correlated SVA (r = − 0.397,p = 0.024); the RCSA at L3/4, L4/5 and L5/S1 levels were negatively correlated with TK (r = − 0.364, p = 0.04; r = − 0.38, p = 0.032; r = − 0.432, p = 0.014); the RCSA at L4/5 level was positively correlated with LL (r = 0.528, p = 0.002). The RCSA of ES at L3/4 and L4/5 levels were positively correlated with PI (r = 0.377, p = 0.037) and SS (r = 0.420, p = 0.019). Conclusions FI of MF and ES at lower lumbar level is higher than that at upper level, but FI of PS at upper lumbar level is higher than that at lower level. MF and ES have different roles for maintaining the sagittal spinal-pelvic balance.

To investigate the position of the aorta relative to the spine in patients with de novo lumbar scoliosis (DLS).This study enrolled 142 patients with DLS, including 80 cases of left thoracolumbar/lumbar scoliosis (left group) and 62 cases of right scoliosis (right group). In addition, 132 cases free of deformity were allocated to the control group. Parameters of the Cobb angle and apical vertebrae were measured by radiograph, whereas the left pedicle-vertebrae angle (α), rotation angle (γ), and left pedicle-vertebrae distance (d) of T12-L4 were obtained by magnetic resonance imaging. Independent sample t test was performed to compare α, γ, and d between the DLS and control groups, followed by a Pearson correlation analysis to study the correlation between Cobb angle and α, γ, and d.No difference was found between the right group and control group (P = 0.554). The value of mean d (4.62 ± 0.57 cm) gradually increased from T12 to L4 in the left group and showed significant difference with the corresponding value in the control group (4.44 ± 0.43 cm; P0.001). There was no significant difference between the right group and control group (P = 0.762). The value of mean d (4.54 ± 1.84 cm) showed no significant difference between the right group and control group (P = 0.530). The correlation analysis showed a significant correlation between rotation angle γ and Cobb angle (P0.001), but not in α and d with Cobb angle.Although the position of the aorta relative to the spine showed no significant difference between patients with DLS and normal subjects, great attention should still be paid to prevent DLS-induced aorta injury.

Under heating conditions, L-Glutamic acid (L-Glu) can be dehydrated to form L-pyroglutamic acid (L-PGA), and L-PGA can racemize to form DL-PGA. Here, we characterized this transformation at different temperatures and times by terahertz time domain spectroscopy (THz-TDS). By Powder X-ray diffraction (PXRD), the validity of THz spectroscopy is verified. The results prove that the reaction rate of dehydration and racemization is significantly affected by temperature. The THz spectra divided the reactions into three stages. At 150-155 °C, the reaction changes drastically. Furthermore, we found that the absorption intensity at 0.97 and 1.55 THz has a good dependence on the reaction temperature and time, showing a non-linear relationship (R

Use of short-segment or long-segment fusion is controversial in treatment of adult lumbar degenerative scoliosis (ALDS). The aim of this study was to explore efficacy and feasibility of precision treatment of ALDS with selective nerve root block.From January 2014 to January 2016, a retrospective study of 23 patients with ALDS treated with precision short-segment surgery with at least 2-year follow-up was performed. Fixation segment was determined by selective nerve root block. Visual analog scale and Oswestry Disability Index (ODI) were evaluated preoperatively and at 2-year follow-up. Radiographic measurements included Cobb angle of lumbar curve, lumbar lordosis, sacrum slope, and pelvic tilt. Radiographic evaluation of fusion integrity was performed based on Bridwell interbody fusion grading system at final follow-up.Mean follow-up time was 25.2 ± 1.4 months. Average lumbar curve was 21.6° ± 7.4° preoperatively and 11.2° ± 6.5° at final follow-up (P0.01), with correction rate of 48.1%. Lumbar lordosis changed from -37.1° ± 12.9° to -42.1° ± 10.5° at final follow-up (P0.01). Mean visual analog scale back pain scores decreased from 6.0 ± 1.8 preoperatively to 1.5 ± 0.8 at final follow-up (P0.01), and mean visual analog scale leg pain scores decreased from 8.1 ± 0.6 preoperatively to 1.3 ± 1.3 at final follow-up (P0.01). Oswestry Disability Index score improved from 60.9% ± 15.7% preoperatively to 22.1% ± 11.6% at final follow-up (P 0.01). All patients achieved grade I fusion at final evaluation. One patient (4%) needed further surgical intervention.Precision treatment of ALDS with selective nerve root block can achieve favorable clinical outcomes and good fusion with less surgical injury and low complications. Deformity correction is limited, which requires further study.

The blood-spinal cord barrier (BSCB), a physical barrier between the blood and spinal cord parenchyma, prevents the toxins, blood cells, and pathogens from entering the spinal cord and maintains a tightly controlled chemical balance in the spinal environment, which is necessary for proper neural function. A BSCB disruption, however, plays an important role in primary and secondary injury processes related to spinal cord injury (SCI). After SCI, the structure of the BSCB is broken down, which leads directly to leakage of blood components. At the same time, the permeability of the BSCB is also increased. Repairing the disruption of the BSCB could alleviate the SCI pathology. We review the morphology and pathology of the BSCB and progression of therapeutic methods targeting BSCB in SCI.

Objective The patients diagnozed degenerative thoracolumbar kyphosis (DTLK) with lumbar spinal syndrome (LSS) were enrolled, to identify the significance of spino-pelvic parameters in this group.Methods An overall 138 (M/F=53/85) patients were enrolled with a mean follow-up of 24.6±11.1 (m). All cases were performed short-segment posterior fusion on LSS region. Radiological parameters were TLK, LL, PI, PT and SVA obtained on the X-ray. Quality of life (QOL) were evaluated by the visual analogue scale (VAS) and the Oswestry disability index (ODI). Accorrding to age-related formula by Lafage, various thresholds on PI-LL, PT and SVA were determined, ensuing three pairs of normal and abnormal groups were respectively divided into based on these parameters. Results Both VAS and ODI statistically improved (P Conclusions The mean TLK decreased even a short-segment fusion purely performed on LSS. QOL was related to PI-LL and PT, but not to SVA in DTLK patients.

Purpose: To explore the relationship between thoracolumbar kyphosis (TLK), body mass index (BMI) and the content of lumbar posterior muscles in patients with degenerative thoracolumbar kyphosis (DTLK) combined with lumbar stenosis syndrome (LSS).Methods: 126 patients with DTLK and LSS (DTLK group) and 87 patients with simple LSS (control group) were retrospectively included with well-matched demographics. TLK and lumbar lordosis (LL) were obtained on the X-ray of the whole spine. Lumbar crossing indentation value (LCIV) was introduced to evaluate the content of the lumbar muscles, with was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Three subgroups of normal weight, overweight and obesity were respectively divided into in both groups according to BMI. Three subgroups of increased LL, normal LL normal and decreased LL were also divided into in DTLK group.Results: The mean LCIV (mLCIV) of the DTLK group was less than control group and LCIV showed an increasing trend in DTLK group from T12-L1 to L4-L5. Different from control group, there were no significances in gender and BMI distribution of mLCIV in DTLK group (P>0.05). LCIV in increased LL subgroup was larger than that of normal LL and less LL subgroup (PConclusion: LCIV in DTLK group was less than control group with no gender- and BMI-difference. LCIV and TLK were mutually predictable in DTLK with LCIV=13.75-0.48×TLK.

Comparative study.The aim of this study was to compare cervical alignment among three-level total disc replacement (TDR), two prosthesis with one cage (2D1C), one prosthesis with two cages (1D2C), and anterior cervical discectomy and fusion (ACDF), then identify the importance of cervical balance of cervical spondylotic myelopathy (CSM).There were few long-term comparisons on cervical alignment and cervical balance among three-level TDR, 2D1C, 1D2C, and ACDF for CSM.Twenty-eight patients with TDR, 15 with 2D1C, 36 with 1D2C, and 32 cases with ACDF were included with a mean follow-up of 90.9 ± 8.9 months. C2-C7 cervical lordosis (CL), C2-C7 sagittal vertical axis (SVA), T1 slope (T1S) were measured on x-ray at preoperation, immediate postoperation, and final follow-up, as well as range of motion (ROM), upper/lower adjacent ROM (UROM/LROM), and adjacent segment degeneration (ASD); cervical balance was assessed by T1S minus CL (T1SCL; 20°). Clinical outcomes included neck disability index (NDI) and Japanese Orthopedic Association (JOA) score.NDI and JOA improved (P 0.01)at postoperation and final-visit with no difference among four groups. ROM decreased mostly in ACDF group, although with a comparable inter-group UROM/LROM and ASD. All groups gained equal CL-improvement at final-visit. SVA and T1S together with their change were of no differences among groups (P0.05). There was a correlation among alignment parameters and between CL and ROM. The inter-group capacity of balance maintaining and imbalance correction was comparable (P0.05). The change of T1SCL was not correlated to NDI and JOA (P0.05).Adjacent segments were seldom affected. Cervical alignment was equivalently rebuilt among TDR, 2D1C, 1D2C, and ACDF. It was not essential to pay excessive attention to balance.3.

Background: Few study has been published for quantitative relation of the vertebrae rotation on the position of the aorta relative to spine in adult degenerative scoliosis (ADS). Thus, this study was to explore the effect of the vertebrae rotation on the position of the abdomial aorta relative to spine in patients with ADS and identify the risk factor of vertebrae rotation.Methods: A retrospective analysis was performed for 71 patients with ADS divided into left scoliosis (LS group, 40cases) and right scoliosis (RS group, 31cases). The two group were well-matched in demographics. Apical vertebrae, Cobb angle (°), coronal displacement and thoracolumbar kyphosis (TLK) were measured on X-ray. Aorta-vertebrae angle (α), aorta-vertebrae distance (d) and rotation angle (γ) for each level of T12-L4 on MRI were obtained within a Cartesian coordinate system.Result: There was no significant difference in apical vertebrae distribution between the LS and RS group, so were Cobb angle and coronal horizontal displacement distance (P˃0.05). There was no significance on mean γ of of apical vertebrae among different levels in LS group and RS group (P ˃0.05). Pearson correlation analysis showed γ was a positively correlated to Cobb angle and coronal horizontal displacement distance (PConclusion: Vertebral rotation could be predicted by Cobb angle or coronal movement by X-ray in ADS and aorta maintained a relatively normal position in patients with ADS.

Transforaminal lumbar interbody fusion (TLIF) via a fusion cage is widely carried out to treat degenerative lumbar spinal disease, and cage implantation plays a pivotal role in buttressing the vertebrae and promoting fusion. Clinically, the cage implantation is commonly placed in 2 different orientations: oblique and traverse. Therefore, this study aimed to explore the effects of different orientations of cage implantation on lumbar interbody fusion.From January 2016 to January 2018, a retrospective study of 98 patients with lumbar degenerative disease who were treated with lumbar interbody fusion with at least 2-year follow-up was performed. According to the different positions of cage implantation, the patients were divided into 2 groups: oblique group (OG) and traverse group (TG). The clinical and radiographic outcomes were compared preoperatively, postoperatively, and at last follow-up evaluation. Radiographic measurements included the height of intervertebral (HOI) disk, segment lordosis (SL), lumbar lordosis (LL), the distance between the posterior of cage and vertebrae postoperatively (D1), the distance at final follow-up (D2), and the distance of cage move (D3). Radiographic evaluation of fusion integrity was performed based on the Bridwell interbody fusion grading system at the final follow-up.There was no significant difference between the 2 groups in terms of sex, age, surgical levels, operative time, intraoperative blood loss, time to ambulation, and length of hospital stay (P0.05). The HOI disk, SL, and LL in the 2 groups were noticeably improved postoperatively compared with preoperatively (P0.05), and there was no significant difference between the 2 groups (P0.05). However, at the final follow-up, HOI disk, SL, and LL in the TG were larger than those in the OG (P0.05). D1 and D2 in the TG were larger than those in the OG, and there was a significant difference between the 2 groups (P0.05). D3 in the OG was larger than that in the TG (P0.05). All patients achieved grade I fusion at the final evaluation.The traverse cage implantation in TLIF had the same clinical effect as oblique cage implantation, but is superior in improving sagittal alignment. Therefore, we advise that the cage should be placed in traverse orientation in TLIF.

Purpose To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. Method The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2–C7 cervical lordosis (CL), C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. Results Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P P P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P P > 0.05). Conclusion Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.

Study design A retrospective analysis was conducted to analyze the position of the aorta by MRI in patients with adult degenerative scoliosis. Objective This study aimed to investigate the relative anatomic positions of the aorta and spine in patients with adult degenerative scoliosis (ADS). Summary of background data Aorta injury is a rare complication of spinal surgeries. However, there would be a disastrous consequence once it happened. Therefore, knowing about the position of aorta is of great importance. Methods A retrospective analysis was performed in 90 patients with ADS and 132 participants without spine deformity. ADS patients were divided into several groups such as left scoliosis, left scoliosis with thoracolumbar kyphosis, right scoliosis, and right scoliosis with thoracolumbar kyphosis. The aorta-vertebrae angle (α) and aorta-vertebrae distance (d) in each level of T12–L4 were measured by using a Cartesian coordinate system. t test of independent samples was performed, α and d were compared, and Pearson correlation analysis was employed for α, d, and X-ray radiographic measurements. Result The changes of α were not statistically significant (P > 0.05) in LS and LKS groups but d (P P > 0.05) in the abdominal aorta but longer d (P d in the RKS group compared with the RS group (P d and TLK (r = 0.439, P Conclusion In patients with ADS, a relative normal position is maintained between the aorta and vertebrae. While the aorta is slightly away from the left pedicle in RS patients and farther away in patients with kyphosis, the angle of kyphosis would become bigger and d becomes longer. Therefore, the surgeons should be aware of the changes of the aorta position to avoid the disastrous vessel injuries.

Purpose : Few study has been published for quantitative relation of the vertebrae rotation on the position of the aorta relative to spine in adult degenerative scoliosis (ADS). Thus, this study was to explore the effect of the vertebrae rotation on the position of the aorta relative to spine in patients with ADS and identify the risk factor of vertebrae rotation. Methods : A retrospective analysis was performed for 71 patients with ADS divided into left scoliosis (LS group, 40cases) and right scoliosis (RS group, 31cases). The two group were well-matched in demographics. Apical vertebrae, Cobb angle (°), coronal displacement and thoracolumbar kyphosis (TLK) were measured on X-ray. Aorta-vertebrae angle ( α ), aorta-vertebrae distance (d) and rotation angle (γ) for each level of T12-L4 on MRI were obtained within a Cartesian coordinate system. Results : There was no significant difference in apical vertebrae distribution between the LS and RS group, so were Cobb angle and coronal horizontal displacement distance (P˃0.05). There was no significance on mean γ of of apical vertebrae among different levels in LS group (P=0.337) and RS group (P=0.253). Pearson correlation analysis showed γ was a positively correlated to Cobb angle and coronal horizontal displacement distance (P

Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (PConclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

The thiol redox state (TRS) plays a key role in evaluating essential biochemical processes, such as evaluating intracellular enzymatic activity. The TRS, characterized by the kinetic parameters of the thiol (–SH)/disulfide bond (–SS–) redox process, was measured by the Fourier-transform Raman spectroscopy (FT–Raman) and the terahertz time-domain spectroscopy (THz–TDS) in this study. A good correlation was observed between the disulfide concentration in samples and the intensities of the disulfide characteristic peaks in the FT–Raman and THz–TDS spectra. And the linear regression analysis correlation coefficients had values of 92.2% for FT–Raman-derived data and 95.4% for THz–TDS-derived data. The dynamic response of the cysteine/cystine experimental spectrum and characteristic peaks were analyzed by solid-state density functional theory. It can be found that both Raman and terahertz vibrational spectroscopy techniques can quantitatively analyze the ratio of cysteine/cystine. This provides a new method for the biological analysis of sulfur-containing amino acids and other related mixtures in basic science.

Background Anterior cervical discectomy and fusion (ACDF) has been widely used in cervical spondylosis, but adjacent segment degeneration/disease (ASD) was inevitable. Cervical total disc replacement (TDR) could reduce the stress of adjacent segments and retard ASD in theory, but the superiority has not been determined yet. This analysis aimed that whether TDR was superior to ACDF for decreasing adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). Methods A meta-analysis was performed according to the guidelines of the Cochrane Collaboration with PubMed, EMBASE, Cochrane Library and CBM (China Biological Medicine) databases. It included randomized controlled trials (RCTs) that reported ASDeg, ASDis, and reoperation on adjacent segments after TDR and ACDF. Two investigators independently selected trials, assessed methodological quality, and evaluated the quality of this meta-analysis using the grades of recommendation, assessment, development, and evaluation (GRADE) approach. Results Eleven studies with 2632 patients were included in the meta-analysis. The overall rate of ASD in TDR group was lower than ACDF group (OR = 0.6; 95% CI [0.38, 0.73]; P

To assess the mid-long-term follow-up of the safety and efficacy of anterior cervical discectomy and fusion (ACDF), cervical artificial disc replacement (CADR) and hybrid surgery (HS) for bilevel cervical degenerative disc disease (cDDD).77 patients who underwent ACDF, HS, and CADR were retrospectively reviewed. Clinical effects were evaluated based on Neck Disability Index (NDI), Visual Analog Scale (VAS), and Japanese Orthopedic Association (JOA) scores and the Odom criteria. Radiographic outcomes were evaluated, including cervical range of motion (ROM), ROM in the operative and adjacent segments, incidence of degeneration in the adjacent segments (ASD), and heterotopic ossification (HO).NDI, VAS, and JOA scores significantly improved in all patients after surgery without significant differences between groups. The excellent-to-good ratio in the Odom scale was 28/30 for the HS group, 30/33 for the ACDF group, and 13/14 for the CADR group. No significant differences in clinical outcomes or complication were found between groups (P0.05). Furthermore, the HS and CADR groups had less decreased ROM in the cervical and operative segments and less compensatory ROM in adjacent segments (P0.05). By contrast, the ACDF group had decreased ROM in the cervical and operative segments and significantly increased ROM in adjacent segments (P 0.05). Moreover, the incidence of ASD was higher in the ACDF group, but the difference was not statistically significant (P0.05). HO was found in 10 patients (33.3%) in the HS group and 5 patients (35.7%) in the CADR group.HS was superior to ACDF with regard to equivalent clinical outcomes in the mid-long-term follow-up. Furthermore, HS was superior in the maintenance of ROM and had less impact on its adjacent segments. The efficacy of HS is similar to that of CADR.