Jie Hao

Background: Percutaneous transforaminal endoscopic discectomy (PTED) is an increasingly popular technique for treating symptomatic lumbar disc herniation (LDH) worldwide. However, performing PTED demands a high level of surgical proficiency, which can only be achieved through structured and extensive training. Current training methods remain inadequate for equipping novice surgeons. Methods: By integrating medical image reconstruction, computer-aided design (CAD), programming, and three-dimensional (3D) printing, a high-fidelity physical simulator with interactive features was developed. An exploratory cross-sectional study involving 19 neurosurgeons and trainees was conducted to examine the preliminary feasibility of the simulator for assessing PTED portal-placement performance. Participants were categorized into three subgroups based on their prior PTED experience. Each participant then performed the simulated portal placement procedure on the simulator. Performance was evaluated using a task-specific checklist, a global rating scale (GRS), and key objective metrics. Participant feedback on the training experience and the simulator itself was collected via a participant feedback survey. Results: Significant between-group differences were observed in task-specific checklist scores [ F (2,16) = 32.05, P < 0.001, η² = 0.800, 95% confidence interval (CI) 0.628–0.892], GRS scores [ F (2,16) = 18.30, P < 0.001, η² = 0.696, 95% CI 0.412–0.841], procedural duration [ F (2,16) = 8.131, P = 0.004, η² = 0.504, 95% CI 0.150–0.726], and fluoroscopy count [ F (2,16) = 5.162, P = 0.019, η² = 0.392, 95% CI 0.026–0.633]. Kruskal–Wallis sensitivity analyses supported the checklist and GRS findings. Alarm activation counts did not differ significantly among groups ( H = 2.46, P = 0.293). Clinical experience was positively associated with checklist and GRS scores in exploratory Spearman analyses. Conclusion: This study presents a novel approach to developing a high-fidelity physical simulator for PTED training. The simulator distinguished participants across prior PTED experience levels in this exploratory cohort, providing preliminary evidence of its feasibility for assessing portal-placement performance. Favorable participant feedback also suggests its potential application in PTED training.

Background/Objectives: This study aimed to evaluate whether artificial intelligence-derived vertebral volumetric bone mineral density (AI-vBMD) and paraspinal intermuscular adipose tissue (IMAT) ratio from routine computed tomography (CT) could identify moderate-to-severe vertebral compression fractures (VCFs) in breast cancer survivors, and whether paraspinal IMAT ratio and routinely available clinical variables improved diagnostic performance. Methods: This retrospective study included 275 women with breast cancer who underwent routine non-contrast CT and lumbar quantitative computed tomography (QCT). Hounsfield unit-derived volumetric bone mineral density (HU-vBMD) was derived using a QCT-referenced HU-to-vBMD conversion equation, whereas AI-vBMD and paraspinal IMAT ratio were extracted using automated software. Moderate-to-severe VCF was defined as Genant grade ≥ 2. Agreement with QCT-vBMD was assessed using correlation, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Model discrimination was evaluated using receiver operating characteristic analysis and DeLong tests. Results: Moderate-to-severe VCF was present in 75 patients (27.3%). HU-vBMD and AI-vBMD showed excellent agreement with QCT-vBMD (ICC, 0.978 and 0.987, respectively). AI-vBMD outperformed HU-vBMD for identifying VCFs (AUC, 0.738 vs. 0.714; p < 0.001). IMAT ratio showed comparable standalone discrimination to AI-vBMD (AUC, 0.760 vs. 0.738; p = 0.604). Adding IMAT ratio to AI-vBMD improved discrimination (AUC, 0.786 vs. 0.738; p = 0.038). The full model incorporating clinical covariates achieved the highest AUC (0.828; 95% CI, 0.778–0.878). Conclusions: AI-vBMD and paraspinal IMAT ratio automatically extracted from routine CT improved the diagnostic assessment of prevalent moderate-to-severe VCFs in breast cancer survivors. This study supports an automated CT-based approach that integrates vertebral bone density and paraspinal muscle–fat information for opportunistic identification of clinically relevant VCFs.

Oxidative stress (OS) induced by local reactive oxygen species (ROS) accumulation plays a vital role in initiating and accelerating intervertebral disc deg

Recent evidence has established a significant link between N4 acetylcytidine (ac4C) mRNA modification, mediated by N Acetyltransferase 10 (NAT10), and bone metabolism. Nonetheless, the precise role and regulatory targets of NAT10, along with its associated ac4C modification in human bone formation, remain inadequately characterized. This study employed bioinformatics analysis of transcriptomic datasets from primary osteoblasts of individuals with high versus low bone mineral density (BMD), alongside a curated set of ac4C-modified genes, to identify key differentially expressed genes (DEGs) regulated by this pathway within an osteogenic context. Overall, eleven key NAT10/ac4C-associated DEGs linked to BMD status were identified: CFD, CTSF, DCXR, FADS1, GOLIM4, IMPA2, MLEC, NCLN, NT5DC2, PTGFRN, and VASP. Notably, FADS1, NT5DC2, and PTGFRN emerged as crucial ac4C-modified genes across three machine learning models. Furthermore, the tri-gene signature (FADS1/NT5DC2/PTGFRN) showed excellent diagnostic performance in distinguishing different BMD statuses. In vitro validation using MC3T3-E1 osteoblastic cells revealed that the knockdown of NAT10 via lentiviral delivery markedly impaired cell proliferation and osteogenic differentiation. This impairment was evidenced by the results of the CCK-8 proliferation assay, alkaline phosphatase staining, and Alizarin Red staining. Additionally, qRT PCR analysis demonstrated a significant downregulation of FADS1 and NT5DC2 expression subsequent to NAT10 knockdown. These findings underscore the role of NAT10-mediated ac4C modification as a pivotal regulator of osteoblast activity and gene expression programs associated with BMD. This research offers novel insights into the regulation of bone metabolism and proposes potential diagnostic markers and therapeutic targets for osteoporosis.

Discogenic low back pain (DLBP) is a major cause of disability. Platelet-rich plasma (PRP) has shown regenerative potential in preclinical models, but clinical results remain heterogeneous and early biological responses in humans are incompletely understood. We conducted a prospective cohort study (November 2023–October 2024) to evaluate early clinical outcomes and quantitative MRI (qMRI) changes after intradiscal PRP injection for DLBP. Symptom scores (VAS, ODI and FRI) and qMRI measures (whole-disc T2 and vertebral marrow fat fraction in adjacent vertebrae) were assessed at baseline and at 1, 3 and 6 months. A composite minimal clinically important difference (MCID) was predefined as a ≥ 30% reduction from baseline in both VAS and ODI. Longitudinal changes were analyzed using linear mixed-effects models, and baseline-to-6-month changes were correlated using Pearson tests. Forty-five patients were recruited and 29 completed follow-up. VAS, ODI and FRI decreased significantly over time (all P < 0.001), and 79.3% achieved the composite MCID at 6 months. Vertebral marrow fat fraction adjacent to the treated disc declined significantly (P < 0.001) and correlated with improvements in VAS, ODI and FRI (r ≈ 0.46–0.56; P < 0.01), whereas changes in whole-disc T2 were small and not associated with symptom change. No treatment-related complications were observed. Intradiscal PRP appeared safe and clinically promising over 6 months, with qMRI suggesting an early effect on the peridiscal metabolic environment.

Rheumatoid arthritis (RA) is a chronic, immune-mediated disease with symmetric polyarticular pain and swelling. It includes seropositive RA, marked by specific antibodies, and seronegative RA, without these antibodies. The relationship between immune cells and both types of RA has not been fully elucidated. Therefore, we conducted a two-sample Mendelian randomization analysis with bidirection to evaluate the causal relationship between immune cells and both seropositive and seronegative RA. We utilized data from various genome-wide association studies and employed multiple analytical methods, including inverse-variance weighted and Wald ratio, as the primary method. Additionally, we employed supplementary approaches such as MR-Egger regression, weighted median, and weighted mode. Various sensitivity analyses were used to ensure the robustness of our results. Furthermore, we utilized the false discovery rate method to mitigate type 1 error. We identified 3 immune cell types linked to higher seropositive RA risk, and 16 immune cell types might be influenced by seronegative RA (4 increased and 12 decreased). Notably, HLA-DR ⁺ monocytes were strongly associated with seropositive RA, while changes in immune cell composition in seronegative RA suggest potential biomarkers for its diagnosis. These findings offer valuable insights into RA pathogenesis and highlight the potential for novel diagnostic and therapeutic strategies, particularly for seronegative RA, which lacks reliable biomarkers. Further research is needed to explore the underlying mechanisms and their clinical applications.

This study aimed to evaluate the efficacy of the Primary Osteoporosis Screening Tool (POST) in identifying osteoporosis among Chinese adults aged 50 years and older. This retrospective cross-sectional study consecutively included patients from the University-Town Hospital of Chongqing Medical University. Osteoporosis was defined based on the T-scores of femoral neck bone mineral density (BMD) or lumbar spine BMD by dual-energy X-ray absorptiometry examinations. The POST scores were computed according to the subject information on age, sex, and weight. In addition, the performance of the POST was assessed and compared with the Osteoporosis Self-assessment Tool for Asians (OSTA) by area under the receiver operating characteristic curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI). A total of 2861 patients were included in the final analysis, of whom 78.43% were women, with a mean age of 65.67 ± 9.81 years. The POST exhibited superior performance compared to OSTA in osteoporosis screening, as evidenced by a higher area under curve, enhanced NRI/IDI metrics, and remarkable sensitivity. Subgroup analysis further highlighted the superior efficacy of POST in individuals aged 65 years and older. Additionally, sensitivity analysis confirmed that the POST maintained robust performance in identifying individuals with osteoporosis, even after the exclusion of underweight patients. The POST has been shown to be an effective instrument for osteoporosis screening among Chinese adults. Nonetheless, this study has limitations including its single-center retrospective design and imbalanced gender distribution, which may affect generalizability.

Anterior cervical discectomy and fusion (ACDF) is a technique mainly used to treat cervical spondylosis, which is associated with radiculopathy or myelopathy. It is difficult to perform and has been associated with many clinical complications. ACDF training is time-consuming and potentially detrimental to the quality of patient care, thus it is important to clarify the essential skills and optimal training methods for ACDF. The findings of this study will help medical educators and researchers develop more effective training programs for ACDF. In this study, three ACDF experts developed a 37-question online survey, which was shared on 4 social media groups and presented at 2 academic conferences. As a result, one hundred and sixty survey responses were collected from 109 hospitals or institutes located in 24 provincial administrative districts across China. Surgical skills directly related to the surgical procedure and the identification of important anatomical structures were rated as essential skills for ACDF trainees. The mean duration of simulated ACDF training was 19.26 ± 39.31 h. Notably, younger surgeons received more training time than senior counterparts.

Klotho, a protein known for its significant involvement in the aging process and age-related diseases, has been demonstrated to be inextricably linked to osteoporosis. Nevertheless, the relationship between serum Klotho levels and mortality risk among individuals with osteoporosis has not been definitively established. Therefore, the purpose of the current research is to examine the potential relationship between serum Klotho levels and mortality risk in individuals aged 40 and above with osteoporosis. The current study included adults aged 40 years and older diagnosed with osteoporosis from the National Health and Nutrition Examination Survey. Osteoporosis diagnosis was based on a history of osteoporosis or bone mineral density. Moreover, Cox proportional hazards regression, Kaplan–Meier (KM) curves, and restricted cubic spline (RCS) curves were utilized to assess the relationship between Klotho levels and mortality risk. In addition, subgroup analysis was performed using stratification and interaction analysis for all covariates. A total of 1004 participants (median age: 65 years) with a median follow-up of 9.33 years were included in the final analysis. This study found that serum Klotho levels established a U-shaped relationship with the risk of all-cause mortality in individuals with osteoporosis, with a nadir of Klotho levels was approximately 900 pg/mL, in which lower (< 850 pg/mL) or higher (> 950 pg/mL) Klotho levels were significantly associated with an increased risk of all-cause mortality. Moreover, the results of subgroup analysis indicated that the associations between Klotho levels and mortality risk were modified by several factors, especially a history of hypertension. Specifically, Klotho levels established an L-shaped relationship with the risk of all-cause mortality among participants with a history of hypertension, while a positive and linear relationship with the risk of all-cause mortality among those without a history of hypertension. For individuals with osteoporosis, it is necessary to be alert to cases with high or low Klotho levels, which may potentially indicate an increased mortality risk.