Intervertebral disc degeneration (IVDD) is a common musculoskeletal degenerative disease worldwide, of which the main clinical manifestation is low back pain (LBP); approximately, 80% of people suffer from it in their lifetime. Currently, the pathogenesis of IVDD is unclear, and modern treatments can only alleviate its symptoms but cannot inhibit or reverse its progression. However, in recent years, targeted therapy has led to new therapeutic strategies. Cysteine-containing aspartate proteolytic enzymes (caspases) are a family of proteases present in the cytoplasm. They are evolutionarily conserved and are involved in cell growth, differentiation, and apoptotic death of eukaryotic cells. In recent years, it has been confirmed to be involved in the pathogenesis of various diseases, mainly by regulating cell apoptosis and inflammatory response. With continuous research on the pathogenesis and pathological process of IVDD, an increasing number of studies have shown that caspases are closely related to the IVDD process, especially in the intervertebral disc (IVD) cell apoptosis and inflammatory response. Therefore, herein we study the role of caspases in IVDD with respect to the structure of caspases and the related signaling pathways involved. This would help explore the strategy of regulating the activity of the caspases involved and develop caspase inhibitors to prevent and treat IVDD. The aim of this review was to identify the caspases involved in IVDD which could be potential targets for the treatment of IVDD.

Traumatic central nervous system injuries encompass brain and spinal cord injuries. Recent studies have identified hydrogen sulfide (H₂S) as a potent endogenous gasotransmitter with multifaceted roles in neuroprotection and central nervous system repair. In this systematic review, we explore the mechanisms and therapeutic potential of H₂S in traumatic central nervous system injuries, emphasizing its anti-inflammatory, antioxidant, and anti-apoptotic properties. H₂S suppresses inflammation by modulating the nuclear factor-kappa B pathway, shifting microglial polarization to a reparative phenotype. Further, it mitigates oxidative stress by activating the nuclear factor erythroid 2-related factor 2 and mechanistic target of the rapamycin pathway, and inhibiting glutamate-mediated damage. Additionally, H₂S regulates cell death by inhibiting apoptosis, ferroptosis, pyroptosis, and autophagy while promoting axonal growth and microvascular integrity. Emerging H₂S delivery strategies, including slow-releasing donors such as GYY4137 and advanced hydrogel-based systems, address challenges in achieving sustained and targeted therapeutic effects. Although preclinical evidence has demonstrated the promise of H₂S-based therapies, further research is required to optimize delivery methods, investigate concentration-dependent effects, and validate clinical efficacy. This review provides a comprehensive foundation for advancing H₂S as a therapeutic agent in traumatic central nervous system injuries.

Background: Low back pain (LBP) has emerged as a critical public health concern whose associated disability burden and healthcare expenditures have been persistently escalating among aging populations worldwide. Objective: This global study analyzed the disability burden of LBP among the older population for over three decades and identified interventions specifically targeting older adults. Methods: Repeated cross-sectional data on LBP among individuals aged ≥65 years from the Global Burden of Disease Study 2021 were extracted and compared to age-standardized rates of LBP incidence and disability adjusted life years (DALYs) across various demographic and geographic categories. Results: Countries with a high sociodemographic index (SDI), advanced health systems, and high incomes, including North America and the Latin America and Caribbean region, exhibited the highest incidence rates and DALYs of LBP. Occupational ergonomics is still the primary factor for LBP in countries with low SDI, and minimal health level countries. Body mass index (BMI) was substantially increased in all global subgroups, especially in countries with low–middle SDI, limited health systems, world bank low-income level groups. Conclusion: Advanced economic development and healthcare showed a non-linear correlation with LBP. High BMI is projected to become a predominant modifiable risk factor for LBP progression, highlighting the urgent need for the implementation of lifestyle strategies.

Background Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft. Methods The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left–right position. Results The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm. Conclusion To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left–right position due to anatomical differences. All data generated or analyzed during this study are included in this published article and its supplementary information files. ^* These authors contributed equally to this work. Received: 14 June 2023 Accepted: 18 December 2023 Accepted Manuscript online: 04 January 2024 Article published online: 15 February 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Background: Clinicians must be knowledgeable about osteoporosis so that they can convey information regarding the prevention of fragility fractures to their patients. The purposes of this study were to develop objective and subjective knowledge instruments for osteoporosis and fragility fractures and then test their reliability and validity among Chinese orthopaedic surgeons. Methods: A 2-round procedure was used to develop the objective and subjective knowledge instruments. A cross-sectional online survey was distributed to 293 orthopaedic surgeons; 189 surgeons returned the questionnaires. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity; we also compared the subjective knowledge level with the objective knowledge level among surgeons. Results: Our results showed that the Subjective Knowledge Scale (SKS) regarding Osteoporosis and Fragility Fractures had a high Cronbach alpha coefficient (0.915), and the objective Osteoporosis Knowledge Test for Clinicians (OKTC) had an adequate Kuder-Richardson 20 coefficient (0.64). Item analyses were conducted, and a short version of the OKTC (the OKTC-SF) was developed. The SKS, the OKTC, and the OKTC-SF all showed good test-retest reliability, criterion validity, and discriminant validity. The percentage of surgeons with a high subjective knowledge level was higher than the percentage of surgeons who selected the correct answer for several corresponding questions related to objective knowledge. Conclusions: The SKS, the OKTC, and the OKTC-SF all demonstrated good reliability and validity. However, the orthopaedic surgeons may have overestimated their knowledge level regarding osteoporosis. Targeted continuing medical education that is based on individual knowledge level is needed to improve the undertreatment of osteoporosis among patients with fragility fractures.