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Study Design A retrospective study.Objective To develop a new MRI scoring system to assess patients’ clinical characteristics, outcomes and complications.Methods A retrospective 1-year follow-up study of 366 patients with cervical spondylosis from 2017 to 2021. The CCCFLS scores (cervical curvature and balance (CC), spinal cord curvature (SC), spinal cord compression ratio (CR), cerebrospinal fluid space (CFS). Spinal cord and lesion location (SL). Increased Signal Intensity (ISI) were divided into Mild group (0-6), Moderate group (6-12), and Severe group (12-18) for comparison, and the Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS), numerical rating scale (NRS), Neck Disability Index (NDI) and Nurick scores were evaluated. Correlation and regression analyses were performed between each variable and the total model in relation to clinical symptoms and C5 palsy.Results The CCCFLS scoring system was linearly correlated with JOA, NRS, Nurick and NDI scores, with significant differences in JOA scores among patients with different CC, CR, CFS, ISI scores, with a predictive model (R2= 69.3%), and significant differences in preoperative and final follow-up clinical scores among the 3 groups, with a higher rate of improvement in JOA in the severe group (P< .05), while patients with and without C5 paralysis had significant differences in preoperative SC and SL (P< .05).Conclusion CCCFLS scoring system can be divided into mild (0-6). moderate (6-12), severe (12-18) groups. It can effectively reflect the severity of clinical symptoms, and the improvement rate of JOA is better in the severe group, while the preoperative SC and SL scores are closely related to C5 palsy.Level of Evidence III

ABSTRACTIntervertebral disc degeneration (IVDD), a widely known contributor to low back pain (LBP), has been proved to be a global health challenging conundrum. Hesperidin (hesperetin-7-O-rutinoside, HRD) is a flavanone glycoside that belongs to the subgroup of citrus flavonoids with therapeutic effect on various diseases due to its anti-inflammatory, antioxidant properties. However, the effect of HRD on IVDD remains elusive. The human nucleus pulposus tissues were harvested for isolating human nucleus pulposus (HNP) cells to verify the expression of Nrf2. The biological effect of HRD on HNP cells were assessed in vitro, and the in vivo therapeutic effects of HRD were assessed in mice. Firstly, we found that the expression of Nrf2 was decreased with the progression of degeneration in degenerated human nucleus pulposus tissue. Subsequently, we confirmed that HRD could mitigate oxidative stress-induced ferroptosis in nucleus pulposus cells via enhancing the expression of Nrf2 axis and suppressing the NF-κB pathway to protect intervertebral disc from degeneration in vitro. Finally, the therapeutic effects of HRD were confirmed in vivo. The current study proved for the first time that HRD may protect HNP cells from degeneration by suppressing ferroptosis in an oxidative stress-dependent via enhancing the expression of Nrf2 and suppressing the NF-κB pathway. The evidence will provide a possible basis for future targeted treatment for IVDD

Study Design: Retrospective single-arm study.Objective: To propose a novel technique named the gantry crane technique for treating severe thoracic spinal stenosis and myelopathy caused by thoracic ossification of the ligamentum flavum (TOLF) and investigate its clinical results.Methods: From June 2017 to January 2019, 18 patients presenting with severe spinal stenosis and myelopathy caused by TOLF were included in our study. All patients were treated with gantry crane technique, pre-operative JOA score, as well as 3 days-, 3 months-, 6 months-, 12 months-, 24 months after operation, and Hirabayashi recovery rate were reported. Pre- and post-operative image were utilized for the assessment of post-operative effect. Peri-operative complications were recorded to assess the safety of the gantry crane technique.Results: The JOA score increased from 10.56 ± 3.76 preoperatively to 12.94 ± 3.33, 13.56 ± 3.48, 13.94 ± 3.32, 14.17 ± 3.70 and 14.06 ± 3.54 in 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. The post-operative JOA scores were improved with statistical significance at the level of P< 0.05. The recovery rate was (39.09 ± 33.85) %, (51.35 ± 42.60) %, (55.79 ± 36.10) %, (64.98 ± 29.24) % and (60.98 ± 35.96) % for 3 days, 3 months, 6 months, 12 months and 24 months after surgery, respectively. There were 2 cases of SSI (surgical site infection), 1 case of NI (neurovascular injury) and 1 case of cerebrospinal fluid (CSF) leakage.Conclusions: This study highlights a safe and effective technique, the gantry crane technique, for treating severe thoracic spinal stenosis and myelopathy caused by TOLF.

Study Design: A retrospective study.Objectives: This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF).Methods: Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed.Results: The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate (P< 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage.Conclusion: The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.

•1044 questionnaires from China were used to analyze users’ ridesharing responses.•Basic needs and advanced needs affect users’ ridesharing responses differently.•Interventions on basic needs have a stronger impact than those on advanced needs.•Ridesharing responses vary by gender, age, income, and education level.•A framework for interventions to stimulate ridesharing responses is proposed.

ABSTRACTIntervertebral disc degeneration (IDD) is characterized by excessive inflammatory reaction, and neuropeptide Y (NPY) was reported to have anti-inflammatory effect. However, the effect of NPY on NP cells has not been investigated up to date. This study aimed to clarify the role of NPY on the process of IDD. Fourteen fresh human lumbar intervertebral discs were harvested, and degeneration-related proteins were examined. Pfirrmann grading system was used to evaluate IDD. Rat nucleus pulposus (NP) cells were used to investigate the effect of NPY on the proliferation, apoptosis, and extracellular matrix (ECM) in NP cell induced by IL-1βin vitro. The expression levels of NPY and its receptors (type 1 receptor, Y1R, and type 2 receptor, Y2R) were detected via immunohistochemical analysis, western blot, and quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability and proliferation were explored using cell counting kit-8 assay, western blot, and immunofluorescence analysis. Cell apoptosis was investigated by Hoechst staining, JC-1 Staining, annexin V-FITC/PI double staining, and western blot. The secretion of NPY from NP cells was determined via enzyme-linked immunosorbent assay (ELISA). The expression of anabolic and catabolic gene was analyzed by qRT-PCR, western blot, immunofluorescence analysis, and ELISA. The expression of Y2R was significantly increased in both human degenerative intervertebral discs and IL-1β-induced NP cells. Although no positive results for NPY indicated by western blot both in vivo and in vitro, ELISA results demonstrated that the secretion of NPY from NP cells was increased by low-concentration IL-1β, but was decreased when the concentration of IL-1β was 30 ng/ml and above. In addition, NPY could promote NP cells proliferation and protect NP cells against IL‑1β‑induced apoptosis via suppressing mitochondrial-mediated apoptosis pathway. What’s more, NPY can suppress the expression of catabolic gene and ameliorate IL-1β- induced matrix degeneration in NP cells. In conclusion, NPY could promote NP cell proliferation and alleviate IL‑1β‑induced cell apoptosis via mitochondrial pathway. In addition, NPY can suppress the expression of ECM‑catabolic proteinases and ameliorate IL-1β- induced ECM degeneration in vitro.

BackgroundCongenital vertebral malformations (CVMs) manifest with abnormal vertebral morphology. Genetic factors have been implicated in CVM pathogenesis, but the underlying pathogenic mechanisms remain unclear in most subjects. We previously reported that the human 16p11.2 BP4-BP5 deletion and its associated TBX6dosage reduction caused CVMs. We aim to investigate the reciprocal 16p11.2 BP4-BP5 duplication and its potential genetic contributions to CVMs.Methods and resultsPatients who were found to carry the 16p11.2 BP4-BP5 duplication by chromosomal microarray analysis were retrospectively analysed for their vertebral phenotypes. The spinal assessments in seven duplication carriers showed that four (57%) presented characteristics of CVMs, supporting the contention that increased TBX6dosage could induce CVMs. For further in vivo functional investigation in a model organism, we conducted genome editing of the upstream regulatory region of mouse Tbx6using CRISPR-Cas9 and obtained three mouse mutant alleles (Tbx6up1to Tbx6up3) with elevated expression levels of Tbx6. Luciferase reporter assays showed that the Tbx6up3allele presented with the 160% expression level of that observed in the reference (+) allele. Therefore, the homozygous Tbx6up3/up3mice could functionally mimic the TBX6dosage of heterozygous carriers of 16p11.2 BP4-BP5 duplication (approximately 150%, ie, 3/2 gene dosage of the normal level). Remarkably, 60% of the Tbx6up3/up3mice manifested with CVMs. Consistent with our observations in humans, the CVMs induced by increased Tbx6dosage in mice mainly affected the cervical vertebrae.ConclusionOur findings in humans and mice consistently support that an increased TBX6dosage contributes to the risk of developing cervical CVMs.

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In recent years, electrohydraulic shockwave drilling technology has been widely studied to improve the drill rate of deep and ultra-deep wells. However, few studies have been conducted on coaxial electrodes that are more suitable for drilling. Therefore, it is of great significance to study the discharge characteristics of coaxial electrodes and the influence of various factors on their discharge effects. Firstly, the electric field models of the coaxial electrode were established and simulated using the CST software. The results showed that the electrical breakdown occur randomly on the circular edge of the coaxial electrode. Abnormal electrical breakdown may occur at the junction of anode and insulation layer, which may damage the insulation layer, and this has also been verified in the experiments. Secondly, the influence of various parameters on the discharge effect was further studied based on the model. The results showed that higher voltage and liquid dielectric constant can effectively enhance the electrical breakdown ability. Larger or smaller electrode spacing and insulation concave depth can reduce the discharge effect or more damage the insulating layer. A smaller anode diameter has a stronger electrical breakdown ability, but the final shock wave becomes smaller. Finally, electrical breakdown experiment and rock breaking experiment were conducted to verify the simulation results. In summary, this study conducted in-depth research on coaxial electrodes through CST electric field simulation and experiments, which provided a basis for coaxial electrode design and can effectively promote the practical application of electrohydraulic shockwave technology.

Patients with traumatic vertebral fractures often have major associated postoperative morbidities such as healing failure and kyphosis. Low‐intensity pulsed ultrasound (US) has been found to promote bone fracture healing. The objectives of our study were to determine whether low‐intensity pulsed US could promote traumatic vertebral fracture healing and to explore its inner mechanisms. A rat model of traumatic vertebral fracture was created and treated with low‐intensity pulsed US after surgery. At 4 weeks after surgery, radiographic, micro‐computed tomography, and 3‐dimensional reconstruction were used to assess the radiologic healing status; a histologic analysis was performed to evaluate the pathologic process and relationship between osteogenesis and type H microvessels. Well‐remodeled trabecular meshworks were found in the low‐intensity pulsed US treatment group compared to the control group. Micro‐computed tomography and 3‐dimensional reconstruction revealed more and thicker trabeculae after low‐intensity pulsed US treatment. Abundant chondrocytes, a newly formed bone marrow cavity, trabeculae, and microvessels were formed at the fracture sites. More osterix‐positive osteoblasts were circling the newly formed bone meshwork and were situated at the interface of chondrocytes in the low‐intensity pulsed US treatment group. Type H microvessels were spreading around the newly formed trabecula, bone marrow cavity, osteoblasts, and interface of chondrocytes, with a larger mean vascular density in the low‐intensity pulsed US group. Low‐intensity pulsed US could accelerate traumatic vertebral fracture healing by temporally and spatially increasing chondrogenesis and osteoblast‐induced osteogenesis coupled with angiogenesis of type H microvessels in a rat model of traumatic vertebral fracture.

Cyclic electrohydraulic shockwaves drilling technology is expected to solve the problem of rapid drilling in deep and ultra-deep wells. It is expected to improve the rock-breaking efficiency by continuously changing shockwaves under stepped discharge. However, there is still a lack of research on the stepped discharge of cyclic electrohydraulic shockwaves. Therefore, experiments were carried out on eight different discharge modes composed of three voltages of 24, 28, and 32 kV by using self-developed equipment. The results showed that: (1) For modes composed of constant voltage, the higher the voltage, the fewer impact times and electric energy are required to break the rock sample, but it takes longer to break the rock. However, considerable internal cracks only appear after the mechanical strength decreases under a certain number of impacts when the constant discharge voltage is 24 or 28 kV. (2) For stepped modes composed of two or three voltages, such internal cracks appear under the initial impacts, including mode 6, which is composed of 24 and 28 kV. (3) For all the discharge modes, the mechanical strength of rock samples deteriorates linearly with the impact times, and the attenuation rate is also faster under the discharge mode with faster rock breaking speed. In conclusion, the stepped discharge modes can fully combine the advantages of different voltages, and has lower impact times, electric energy, and total time required to break rock samples. Finally, the comprehensive analysis showed that mode 7 (composed of 24, 28, and 32 kV) and mode 6 (composed of 24 and 28 kV) have the best performance in different aspects. In this study, the stepped discharge modes of cyclic electrohydraulic shockwaves were studied in depth, which provides a new idea for the development of this technology and can effectively promote its field application.

Study Design:Aretrospective study

AbstractAccording to the behavioral coordination and decision-making issues occurring in the process of inter-organizational knowledge innovation in real estate projects, we employed differential game method, chose the knowledge innovation behavior between owners and contractors for the study and made a comparative analysis on the result. The research result showed that: under the model of behavioral coordination and cooperation, the performance of knowledge innovation behavior of owners and contractors, relative gains and the increment of the overall project value of the supply chain of real estate projects were more favorable than the corresponding numbers under the model of non-cooperative decision-making. Then we analyzed the value range of distribution coefficient which enabled the relative gains of owners and contractors to achieve Pareto optimality and the project value increment of knowledge innovation behavior.

A retrospective clinical study was conducted.

Pedestrians are vulnerable road users of the traffic system. In China, many pedestrians lack a knowledge of traffic rules and are not fully aware of safety problems. A high-risk area for pedestrians, the unsignalized midblock crosswalk is a conflict zone between pedestrians and through vehicles. In this paper, behaviors and traffic characteristics of pedestrians walking through the unsignalized midblock crosswalk without being disturbed by other pedestrians are analyzed. The data, including pedestrian speed, waiting delay, and clustering, are obtained by counting and measuring with a video camera. Pedestrian behaviors are analyzed with the use of comparisons between various categories and through statistics analysis. Pedestrian behaviors are interpreted further by analyzing pedestrians' tactics when they cross the street and the valid gap in the vehicle flow, based on observations and measurements of pedestrians starting to walk across and of vehicle arrivals. Finally, the similarities and differences between this research and other research is explained by comparing pedestrian speed studies. Results of this research will not only help improve research on pedestrian characteristics at interrupted pedestrian facilities but will also help in developing traffic safety audit work and related countermeasures.

Objective. This present study aimed to explore the clinical effects of a novel capsule lumbar interbody fusion (CLIF) on foot drop due to lumbar degenerative diseases. Methods. Between June 2018 and January 2019, a total of 27 patients admitted to our department with lumbar degenerative diseases with associated foot drop were prospectively enrolled. Given the selection of surgical technique, patients were divided into traditional TLIF group and CLIF group. We assessed patients’ neurological status using JOA and VAS score, tibialis anterior muscle strength using MMT score, diameter and hemodynamic parameters of the L5 nerve root using intraoperative ultrasonography (IoUS), and related radiological parameters of the lumbar spine. Operation time, blood loss, and surgery-associated complications were also recorded. Results. The median duration of follow-up was 150 (6–1460) months. At the final follow-up, all patients acquired satisfactory improvement of neurological function. However, patients in the CLIF group showed better early recovery of foot drop three months after operation than those in the TLIF group, with 75% excellent rate. In addition, IoUS suggested that the diameter and hemodynamic parameters of the L5 nerve root were improved better in the CLIF group, which may suggest the correlation between the recovery of foot drop and the status of L5 nerve root. No severe complications were encountered with CLIF. Conclusions. Our preliminary study revealed that the axial tension of L5 nerve root may be involved in the pathological mechanism of foot drop. The novel technique of CLIF can shorten the lumbar spine and can be effective and safe for the treatment of foot drop due to lumbar degeneration-related diseases.