We determined quantitative and qualitative alterations in lipids during the occurrence and progression of spinal cord injury (SCI) in rats to identify potential clinical indicators of SCI pathology. Imaging mass spectrometry (IMS) was used to visualize twelve molecular species of phosphatidylcholine (PC) on thin slices of spinal cord with SCI. In addition, twelve species of phospholipids and five species of prostaglandins (PGs) were quantified by liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) of lipid extracts from control/injured spinal cords. Unique distribution patterns were observed for phospholipids with different fatty acid compositions, and distinct dynamic changes were seen in both their amounts and their distributions in tissue as tissue damage resulting from SCI progressed. In particular, PCs containing docosahexaenoic acid localized to the large nucleus in the anterior horn region at one day post-SCI and rapidly decreased thereafter. In contrast, PCs containing arachidonic acid (AA-PCs) were normally found in the posterior horn region and were intensely and temporarily elevated one week after SCI. Lysophosphatidylcholines (LPCs) also increased at the same SCI stage and in regions with elevated AA-PCs, indicating the release of AA and the production of PGs. Moreover, LC-ESI-MS/MS analysis of lipid extracts from the spinal cord tissue at the impact site demonstrated a peak in PGE2 that reflected the elevation/reduction pattern of AA-PCs and LPC. Although further investigation is required, we suggest that invasive immune cells that penetrated from the impaired blood-brain barrier at 1-2 weeks post-SCI may have produced LPCs, released AA from AA-PCs, and produced PGs in SCI tissue at sites enriched in AA-PCs/LPC.

Erythrocyte sedimentation rate and high-sensitivity C-reactive protein concentration were higher in patients with knee osteoarthritis and were related to clinical features. In knee osteoarthritis, high-sensitivity C-reactive protein concentration may increase in early-stage KL-II.

Purpose A frequent reason for revision surgery after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is periprosthetic joint infection (PJI). The efficacy of intrawound VP in preventing PJI after primary TKA or UKA is rarely reported. The purpose of this study was to investigate the efficacy and side effects of local high‐dose VP application to the joint to prevent PJI in TKA and UKA. Methods From 2010 to 2017, 166 consecutive patients that underwent primary TKA or UKA were enrolled. Seventy‐five patients (92 knees) did not receive VP (control group), while 90 patients (110 knees, VP group) received VP (intrawound, 1 g) before capsule closure during TKA and UKA. Aseptic wound complications, such as skin erosion, wound dehiscence, and prolonged wound healing, were evaluated within 3 months post‐operatively. PJI was assessed within a year post‐operatively. Results Seven patients (7.6%) in the control group and five patients (4.5%) in the VP group had PJI. No significant differences existed in the PJI rates between the groups. Aseptic operative wound complications occurred in 4 patients (4.3%) and 13 patients (11.8%), whereas prolonged operative wound healing occurred in 3 patients (3.3%) and 14 patients (12.7%) of patients in the control and VP group, respectively. Operative wound complications were significantly frequent in the VP group. Conclusions Intrawound VP administration does not decrease PJI occurrence in primary TKA and significantly causes aseptic wound complications. The use of intrawound VP for the prevention of PJI after primary TKA and UKA is not recommended. Level of evidence Level II.

Study Design: Large cohort study of volunteers.Purpose: The purpose of this study was to investigate the relationship between the severity of knee osteoarthritis, assessed using the Kellgren-Lawrence (KL) grading scale, and spinopelvic sagittal alignment in older adult volunteers.Overview of Literature: The relationship between spinopelvic alignment in the sagittal plane and knee osteoarthritis in the coronal plane is unclear.Methods: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, PI–LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated.Results: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI–LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI–LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades.Conclusions: Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.

Peripheral nerve injury (PNI) triggers cellular and molecular changes in the spinal cord. However, little is known about how the polyunsaturated fatty acid-containing phosphatidylcholines (PUFA-PCs) are regulated in the spinal cord after PNI and the association of PUFA-PCs with the non-neuronal cells within in the central nervous system (CNS). In this study, we found that arachidonic acid-containing phosphatidylcholine (AA-PC), [PC(16:0/20:4)+K]+, was significantly increased in the ipsilateral ventral and dorsal horns of the spinal cord after sciatic nerve transection, and the increased expression of [PC(16:0/20:4)+K]+ spatiotemporally resembled the increase of reactive microglia and the astrocytes. From the lipidomics point of view, we conclude that [PC(16:0/20:4)+K]+ could be the main phospholipid in the spinal cord influenced by PNI, and the regulation of specific phospholipid molecule in the CNS after PNI is associated with the reactive microglia and astrocytes.