National Center for Spinal Disorders

The incidence of bone metastases is increasing due to advancements in cancer treatment, making it essential to monitor patients' health-related quality of life (HRQOL). Patients diagnosed with spinal metastases often experience persistent pain and functional decline. The use of specific patient-reported outcome measures in spinal tumors can help assess quality of life and treatment outcome. This study aims to cross-culturally adapt and validate the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ) into Hungarian to accurately assess the HRQOL of patients diagnosed with spinal metastases. A prospective study was conducted at a tertiary referral hospital among patients treated for spinal metastases. 50 patients with spinal metastases were included into the study. The median age of the study population was 52 years, ranging from 30 to 82 years. The gender distribution was 27 men and 33 women. The most common primary tumor was breast cancer, followed by lung cancer and prostate cancer. SOSGOQ, EuroQol-5D index and EuroQol-VAS. After translation and cross-cultural adaptation of SOSGOQ, the validity of the SOSGOQ was assessed by correlating it with the EQ-5D index and VAS using Spearman's rank correlation. Reliability was evaluated with the calculation of intraclass correlation coefficient (ICC) and standard error of measurement (SEM), from which the minimal detectable change (MDC95%) was calculated (2.77*SEM). Responsiveness was expressed by the change in group mean scores from pre-surgery to three months post-surgery and the effect size (Cohen's d). Receiver operating characteristic (ROC) analysis was also performed considering different dimensions of clinical outcome. No significant floor or ceiling effect was observed for the total SOSGOQ score. The Spearman rank correlation between the SOSGOQ and the EQ-5D index showed a strong association (rho = 0.887, p < 0.001), as did the correlation between the SOSGOQ and the EQ-VAS (rho = 0.653, p < 0.001). Hungarian SOSGOQ proved to be a highly reliable PROM characterized by ICC = 0.95 SEM = 3.9 points, and MDC95 = 11 points. The responsiveness analysis indicates that the SOSGOQ can detect clinical changes in patients with spinal tumors performing better in this context than EQ-5D. The Hungarian SOSGOQ is a reliable and valid tool for assessing the quality of life in patients diagnosed with spinal metastases. The outstanding responsiveness of this condition-specific PROM was also demonstrated in our study.

Cervical total disc replacement (TDR) is intended to preserve motion and reduce adjacent segment degeneration compared to anterior cervical discectomy and fusion (ACDF). The Simplify Cervical Disc (Globus Medical, Audubon, Pennsylvania), a polyetheretherketone (PEEK)-on-ceramic device with titanium-coated endplates, was approved following encouraging short-term outcomes. However, emerging registries and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) reports suggest an increase in device failures and revision surgeries, raising concerns about the device's long-term durability and biological compatibility. We reviewed publicly available FDA MAUDE adverse event reports related to the Simplify disc replacement and the published literature on PEEK-on-ceramic wear mechanisms and titanium coating delamination. Representative clinical cases revised to ACDF procedures were also examined. Device bench testing data from the FDA summary were compared with real-world failure modes. Reported complications were categorized into wear, subsidence, migration, osteolysis, and revision outcomes. Analysis of 96 MAUDE reports revealed diverse complications: osteolysis, device migration, persistent or worsening pain, and intraoperative retrieval difficulties. Histological evaluation of revision specimens demonstrated benign bone and fibrocartilage with foreign material, consistent with PEEK, titanium, and zirconia wear debris, an associated inflammatory reaction, and osteolysis. In vitro data confirm that PEEK-on-ceramic couples generate volumetric wear rates of 0.7-2.1mm³/Mc, with titanium coating delamination further contributing to particulate load. Bench testing demonstrated mechanical adequacy under idealized conditions. However, retrieval findings highlight wear, coating failure, and osteolysis as potential failure pathways in real-world applications. Clinical outcomes after ACDF revision were favorable, suggesting effective salvage treatment. Despite promising early trial results, the Simplify disc demonstrates concerning failure mechanisms, including PEEK wear, titanium coating delamination, and subsequent osteolysis. The discrepancy between bench testing and retrieval analysis underscores the limitations of preclinical simulation in predicting in vivo wear. Vigilant post-market surveillance, independent registry reporting, and further long-term outcome studies are essential. Until durability is confirmed, cautious patient selection and readiness for revision remain critical in clinical practice.

Supramolecular ionicpolymers (SIPs) exhibit distinctive dynamicproperties, which arise from the synergistic combination of substantialstrength and pronounced reversibility of ionic interactions. However,conventional SIPs formed by coassembly using anionic and cationicseparated double monomers suffer from complicated synthesis and heterogeneousstructures, which obscure in-depth investigation of their dynamicbehaviors. In response, we developed a zwitterionic monomer, namelyTPE-2N2S, that incorporates both charged motifs into one fluorescenttetraphenylethylene (TPE) skeleton. This zwitterionic and single-componentmonomer design strategy enables the efficient formation of supramolecularzwitterionic polymers (SZIPs) with a uniform and orderly structure,and it can further enhance the understanding of structure–propertyrelationships. In this perspective, we examine the dynamic featuresof ionic interactions in SZIPs, emphasizing their structural advantages,controllable assembly, and ionic interaction characteristics. We furtherinvestigate the dynamic behavior driven by ionic interactions at theintramolecular, intermolecular, and supramolecular architecture levels.Finally, we discuss key challenges and future opportunities in thisemerging field, aiming to advance the design and application of SZIPs.

The genetic landscape and molecular subtypes of primary central nervous system lymphoma (PCNSL) remain inadequately characterized, presenting a major obstacle to the development of effective therapeutic strategies. We conducted a genomic study of 176 PCNSLs from five tertiary centers with long-term follow-up to expand the genomic landscape and identify new molecular subtypes. We first confirmed that the molecular subtyping of diffuse large B-cell lymphoma, as previously published, may not be fully applicable to Chinese PCNSL patients. We then identified (n = 58) and validated (n = 82) three prominent genetic subtypes related to different clinical and molecular features of PCNSL, and further confirmed by an independent external Chinese PCNSL cohort (n = 36). We called these BMIs (from the co-occurrence of mutations in two genes among BTG1, MYD88, and IRF4), which are associated with favorable outcomes; E3s (so-called EP300 mutations), which are associated with unfavorable outcomes; and UCs (unclassified, without characteristic mutations). Importantly, EP300 was mutated in more Asians (16.98%) than in Western PCNSLs (<4.53%), resulting in unfavorable outcomes independent of the specific mutation site. Our analysis comprehensively reveals the genomic landscape of Chinese PCNSL and emphasizes the clinical value of molecular classification for improving precision medicine strategies.

Abstract Background: There may be differences in disordered eating symptoms between healthy individuals and patients with obesity, and bariatric surgerymay influence postoperative disordered eating behaviors in patients with obesity. This study aims to explore the differences in network analysis structures of factors associated with disordered eating symptoms in healthy individuals versus patients with obesity, and further analyze changes in disordered eating symptoms in patients with obesity following BS. Methods: Between September 2020 and June 2023 in Shanghai, China, participants were stratified into two groups based on body mass index (BMI) criteria: a healthy control group (HC, n=61; BMI 18.5-24 kg/m²) and an obese group (OB, n=78; BMI ≥30 kg/m²). All participants completed the Eating Disorders Inventory-2. The OB group subsequently underwent laparoscopic sleeve gastrectomy at participating institutions, with monthly postoperative EDI-2 assessments conducted. Network analysis was employed to examine differences in factors associated with disordered eating symptoms between healthy individuals and patients with obesity, while linear mixed model combined with time series hierarchical cluster analysis were systematically applied to evaluate the interventional effects of BS on disordered eating. Result: EDI-2 total score was significantly higher in obese patients than in the healthy population (p &lt; 0.05). Network analysis showed that the core symptom nodes for disordered eating symptoms were Social Insecurity in the healthy population and Interoceptive Awareness, Ineffectiveness and Bulimia in the obese patients. The analysis of the postoperative follow-up data showed that the EDI-2 total score of obese patients decreased significantly from the 3rd month after surgery and remained stable (p &lt; 0.05). The factors related to disordered eating symptoms in obese patients showed three modes of improvement after surgery: Bulimia factor improved significantly in the early postoperative period (2nd month); Impulse regulation, Maturity Fears, Driver for Thinness and Body Dissatisfaction factors showed progressive improvement (3-24 months); Interpersonal Distrust, Social Insecurity, Perfectionism, Interoceptive Awareness, Ineffectiveness and Asceticism factors showed no significant change or even worsened. Conclusion: This study elucidates the network characteristics of disordered eating symptoms in obese patients prior to bariatric surgery, providing an evidence-based foundation for preoperative psychological interventions. Furthermore, by investigating postoperative trajectories of disordered eating symptoms and related factors, our findings highlight the critical need for future research to: (1) monitor long-term (&gt;2 years) evolution of disordered eating symptoms, and (2) systematically evaluate psychological factor dynamics during postoperative follow-up. These investigations should inform the development of tailored psychological therapies to optimize surgical outcomes.

Hospital pharmacists frequently face significant job stress, adversely impacting their well-being. Work schedule flexibility is often proposed as a potential buffer against job stress, yet its effectiveness among hospital pharmacists remains understudied. This study investigates the moderating effect of work schedule flexibility on the relationship between job stress and well-being among hospital pharmacists in Punjab, Pakistan. A cross-sectional survey was conducted between September 2023 and January 2024, involving 414 pharmacists working in public hospitals in Punjab province. The study utilized standardized scales to measure well-being, stress levels, and work schedule flexibility among the participants. Bivariate correlation and multiple regression analyses examined the relationships and interaction effects among the study variables. Bivariate correlation analysis revealed a negative association between job stress and well-being, a positive association between work schedule flexibility and well-being, and a negative association between work schedule flexibility and job stress. Multiple regression analysis indicated that work schedule flexibility significantly moderated the relationship between job stress and well-being, with the interaction term showing a significant effect. The findings underscore the importance of work schedule flexibility in mitigating the negative effects of job stress on the well-being of hospital pharmacists. Implementing policies that enhance work schedule flexibility may serve as an effective strategy to improve pharmacists’ well-being and job satisfaction. Further research is needed to explore these dynamics in healthcare settings and among diverse professional groups.

To evaluate the effectiveness of a digital medication system in improving adherence among patients with serious mental disorders (SMD), we conducted a cluster-randomized controlled trial across 30 communities in Beijing. Participants, aged 18–65 years, were diagnosed with schizophrenia or bipolar disorder and either received intermittent medication or refused treatment. Recruitment occurred from September 2, 2022, to January 12, 2023. The intervention group received a digital medication system. The control group used an online medication diary. The primary outcome was poor adherence, defined as missing 20% or more of prescribed doses at 12 months. Among 216 recruited patients, 206 completed the study. The intervention group showed significantly higher adherence (84/108 vs. 23/108), with an adjusted risk difference of 52.34% (95% CI: 34.65%–70.03%; P < 0.0001). This trial provides the first robust evidence that the digital medication system can significantly improve medication adherence in patients with SMD. Trial Registration: The trial was registered on the Chinese Clinical Trial Registry (chictr.org.cn) on May 29, 2022 (ChiCTR-ICR-2200060359).

20(S)-Protopanaxadiol (PPD) is a saponin derivative of ginsenoside, with more potent biological and pharmacological activities than Rg3 and Rh2. The lack of ionizable centers leads to low mass spectrometry reactions and internal cleavage of three hydroxyl groups, making it challenging to establish highly sensitive PPD mass spectrometry methods. The aim of this study is to establish and validate a quantitative detection method for PPD in multiple matrices using mass spectrometry. The methods used Rh2 as the internal standard and organic solvent liquid–liquid extraction under alkaline conditions for biological sample pretreatment. Isometric separation was achieved through methanol, acetonitrile, and a 10 mmol/L solution of acetic acid (45:45:10, v/v/v) at a flow rate of 0.4 mL/min. Finally, perform mass spectrometry quantification. Comprehensive method validation was conducted on rat plasma samples, and partial method validations were performed on three types of rat tissues (adipose tissue, smooth muscle, and skeletal muscle), bile, urine, fecal samples, and dog plasma samples. The results were in accordance with the requirements of NMPA for bioanalytical method validation, ensuring the accuracy and reliability of our analytical measurements. This study employed a conventional liquid–liquid extraction sample pretreatment scheme, utilizing multiple biological matrices commonly found in a single treatment protocol and liquid chromatography-tandem mass spectrometry detection parameters. The consistency of processing and detection across diverse samples eliminated the need for methodological changes, providing exceptional convenience. Up to 90% of the organic phase and a 50 mm short chromatographic column achieved rapid and effective separation of PPD. A key aspect of our work is the use of a “programmed injection” technique, which significantly reduces the analysis time from 4.2 min during method exploration to 2.4 min. These methods have achieved a relatively low quantification limit of 2.5 ng/mL. The methods established were successfully applied to the kinetic process of PPD in rats, and the pharmacokinetic characteristics of PPD in dogs were studied for the first time.

Surgery is typically indicated for mechanical pain in metastatic spine disease or severe neurological compromise, but how radicular pain responds to oncological treatment is not well described. The primary aim of this study was to describe how radicular pain responds to oncological treatment, while secondary aims included pain outcomes between patients with mechanical and tumoral pain and motor improvement in patients with weakness due to nerve root compression. Patients treated with surgery and/or radiotherapy for spinal metastases were identified from an international multicenter prospective cohort. The primary outcome was the numeric rating scale (NRS) score for pain at 3 months posttreatment. Motor recovery from radicular compression in patients with myotomic weakness and low-grade epidural compression was also analyzed. Of 284 patients, 129 (45%) had radicular pain ± axial pain and 155 (55%) had axial pain alone. The two groups did not significantly differ in age, comorbidities, tumor characteristics, or treatment. Two hundred two patients (71%) underwent surgery ± radiotherapy, whereas 82 (29%) had radiotherapy alone. The NRS score of patients with radicular pain improved from 6.7 to 3.4 at 3 months, a statistically significantly higher magnitude than in patients with isolated axial pain (p = 0.021). The NRS score at 3 months was similar for both groups (p = 0.876). Patients with radicular pain experienced a larger improvement with surgery compared with radiotherapy alone (p = 0.007) but had higher pretreatment pain (mean NRS score 7.0 vs 5.6, p = 0.013). Twenty-three patients identified with radicular/myotomic weakness (mean American Spinal Injury Association score 96.3 ± 3.2) at baseline improved 2.1 ± 3.8 points at 3 months. The magnitude of pain improvement for patients with radicular pain following surgery and radiotherapy for metastatic spine disease is higher than for patients with axial pain alone. Surgery is associated with a larger improvement in radicular pain than radiotherapy alone. These results will allow clinicians to tailor treatment options for patients with metastatic spine disease.