Seattle Foundation

Spine surgery represents a dynamic and innovative specialty with a steady increase in annual publications since 1900. The introduction of large databases and registries marked a paradigm shift in research. Despite their quantitative superiority, databases are inherently limited in a number of ways. Spine surgery remains a somewhat controversial specialty with significant cost, population health, and outcomes implications, and has, not surprisingly, become more frequently associated with large-scale registry studies. The objective of this study was to descriptively characterize trends in large-database usage in spine surgery research over time, including publication volume, topic distribution, and geographic output.A database search in the Clarivate Analytics Web of Science (WoS) database with keywords (“big data” OR “large database” OR “registry” OR “national database”) AND “spine surgery” was conducted on July 7, 2025, and original and review articles published between 1993 and 2024 were included. Retrieved articles were categorized into seven areas based on primary research objectives, and data underwent descriptive quantitative analysis. Descriptive analyses were performed in Microsoft Excel (Microsoft® Corp., Redmond, WA, USA), and keyword co-occurrence network and overlay visualizations were generated using VOSviewer (Version 1.6.20, Centre for Science and Technology Studies, Leiden University, The Netherlands).A total of 633 articles were analyzed, revealing a more than 10-fold increase in publications from 2012 to 2024. The degenerative category was most common (189 articles), followed by public health (179) and infection (75). The United States dominated the research output (62.29%). Raw annual citation counts also significantly increased, from 146 in 2012 to 2,132 in 2024.The utilization of large databases in spine surgery research has substantially grown, reflecting a shift toward big data usage. Publications on spinal infections and public health outcomes have notably increased, while degenerative conditions consistently prevail. Geographic distribution remains skewed towards western countries, especially the United States. These trends suggest an expanding recognition of database studies as a critical tool for evidence-based research in spine surgery.

De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician. Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score. A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis. The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.

Paclitaxel-induced pneumonitis (PIP) is an immune-mediated disease resulting from a delayed hypersensitivity reaction (type IV) to paclitaxel, an anti-microtubule chemotherapeutic drug commonly used to treat breast cancer in both neoadjuvant and adjuvant settings. PIP is diagnosed by exclusion utilizing laboratory work-up, imaging, biopsy studies, and results of antibiotic therapy because there is no single diagnostic test. Ground-glass opacifications on CT, coupled with minimal restrictive disturbance with decreased diffusion on pulmonary function tests (PFTs), negative bronchoalveolar lavage (BAL), and bronchoscopy cultures, may assist physicians in diagnosing paclitaxel-induced pneumonitis. In this report, we describe a case of PIP present in Trinidad, West Indies, which has not been described previously in this region.

Chewing herbivores activate plant defense responses through a combination of mechanical wounding and elicitation by herbivore-associated molecular patterns (HAMPs). HAMPs are wound response amplifiers; however, specific defense outputs may also exist that strictly require HAMP-mediated defense signaling. To investigate HAMP-mediated signaling and defense responses, we characterized cowpea (Vigna unguiculata) transcriptome changes following elicitation by inceptin, a peptide HAMP common in Lepidoptera larvae oral secretions. Following inceptin treatment, we observed large-scale reprogramming of the transcriptome consistent with three different response categories: (i) amplification of mechanical wound responses, (ii) temporal extension through accelerated or prolonged responses, and (iii) examples of inceptin-specific elicitation and suppression. At both early and late timepoints, namely 1 and 6 h, large sets of transcripts specifically accumulated following inceptin elicitation. Further early inceptin-regulated transcripts were classified as reversing changes induced by wounding alone. Within key signaling- and defense-related gene families, inceptin-elicited responses included target subsets of wound-induced transcripts. Transcripts displaying the largest inceptin-elicited fold changes included transcripts encoding terpene synthases (TPSs) and peroxidases (POXs) that correspond with induced volatile production and increased POX activity in cowpea. Characterization of inceptin-elicited cowpea defenses via heterologous expression in Nicotiana benthamiana demonstrated that specific cowpea TPSs and POXs were able to confer terpene emission and the reduced growth of beet armyworm (Spodoptera exigua) herbivores, respectively. Collectively, our present findings in cowpea support a model where HAMP elicitation both amplifies concurrent wound responses and specifically contributes to the activation of selective outputs associated with direct and indirect antiherbivore defenses.

For various clinical/surgical procedures, it is important to accurately understand the location of the sinuatrial node (SAN). Therefore, this study's goal was to develop a new and simple method to visualize the SAN in human hearts. A total of 16 formalin-fixed human hearts were used in the study. After the epicardium was removed, the fat tissue on the myocardium's surface was brushed and removed in a solution of 40°C water with a surfactant to show the SAN's location. Once the structure considered to be the SAN was observed, histological observation was conducted with Masson's trichrome staining to confirm its identity. The working myocardium, SAN branch of the coronary artery, and the structure believed to be the SAN were observed in all specimens. Histological analysis confirmed this structure to be the SAN. We believe that the method described herein might contribute to a better understanding of the SAN's morphologic features and serve as an improved teaching aide. Clin. Anat. 33:232-236, 2020. © 2019 Wiley Periodicals, Inc.