It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).

Background and Objectives: Spinal cord injury (SCI) is a severe affliction that can have a profound impact on a person’s ability to move and feel, affecting a significant number of individuals. However, rehabilitation after SCI treatment remains a critical method to improve motor–sensory functions, which improves the patient’s quality of life. This study aims to describe the epidemiological profile of SCI during the COVID-19 pandemic (“COVID-19 period”) and before and after the COVID-19 pandemic (“non-COVID-19 period”) in Wuhan City, Hubei Province, China. Materials and Methods: Medical records of 93 patients diagnosed with SCI admitted to the rehabilitation department of Wuhan Tongji Hospital from January 2019 to May 2023 were retrospectively reviewed. Basic demographics and clinical characteristics such as level of injury, American Spinal Injury Association (ASIA) Impairment Scale, treatment method, and concomitant injuries were analyzed. Results: Forty patients with SCI from the non-COVID-19 period and fifty-three patients from the COVID-19 period were identified. The mean ages were 38.80 ± 17.71 and 44.53 ± 13.27 years, respectively, with a consistent male-to-female ratio of 2:1 across both periods. Notably, falls accounted for the most prevalent mechanism of injury, constituting 50% of cases during the non-COVID-19 period and 37.74% during the COVID-19 period. The most common initial ASIA grade was B in the non-COVID-19 period and grade C in the COVID-19 period. In addition, the final ASIA grade after treatment was grade C in the non-COVID-19 period and grade D in the COVID-19 period. Conclusions: A greater proportion of males suffer from SCI, and the primary causes are falls and traffic accidents. Workers are the most vulnerable group to SCI among all patients. Prevention strategies should be customized based on the unique characteristics of SCI patients. This study highlights the importance of SCI rehabilitation.

Background. The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose. This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method. Between Jan 2017Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result. The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion. The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (1248 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.

Thioredoxin-Interacting Protein (TXNIP) is a multifaceted protein that regulates oxidative stress (OS) and redox balance by inhibiting the antioxidant protein thioredoxin (TRX). TXNIP also activates the NOD-like receptor family, pyrin domain containing (NLRP3), promoting pro-inflammatory cytokines that exacerbate inflammation. Elevated TXNIP levels promote apoptosis in nucleus pulposus cells and chondrocytes, leading to accelerated tissue degeneration in intervertebral disc degeneration (IVDD) and osteoarthritis (OA) are articular degeneration diseases characterized by the degradation of cartilaginous tissues, primarily driven by oxidative stress, apoptosis, and extracellular matrix (ECM) remodeling. Recently, there has been a growing body of research focused on the mechanisms of TXNIP and its regulation in the OA and IVDD. Importantly, strategies that regulate TXNIP have demonstrated beneficial effects in preclinical experiments. Given the significance and novelty of TXNIP's role in articular degeneration diseases, we present an overview of its mechanisms and discuss its contributions to IVDD and OA. Additionally, we highlight the effectiveness of targeting TXNIP as a valuable strategy for improving our insight into and treatment of degenerative joint diseases. HIGHLIGHTS Thioredoxin-Interacting Protein (TXNIP) inhibits the antioxidant protein thioredoxin (TRX), playing a vital role in regulating oxidative stress and redox balance. TXNIP activates the Nod-Like Receptor Protein3 (NLRP3) inflammasome, stimulating pro-inflammatory cytokines that worsen inflammation in joint tissues. Elevated levels of TXNIP result in apoptosis of nucleus pulposus cells and chondrocytes, contributing to tissue degeneration in intervertebral disc degeneration (IVDD) and osteoarthritis (OA). There is an increasing focus on the mechanisms of TXNIP in OA and IVDD, with promising approaches to modulate TXNIP demonstrating beneficial effects in preclinical studies. Targeting TXNIP is proposed as an important strategy for enhancing the understanding and treatment of degenerative joint diseases. GRAPHICAL ABSTRACT

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Osteoarthritis (OA) is characterized by the activation of nucleotide-binding and oligomerization domain-like receptor protein 3 (NLRP3) by thioredoxin-interacting protein (TXNIP), which promotes inflammation and pyroptosis. This study investigates whether treadmill exercise (TE) enhances melatonin-mediated regulation of the TXNIP/NLRP3 pathway and attenuates OA progression by modulating pyroptosis in a destabilization of the medial meniscus (DMM) rat model. A total of 32 male Sprague–Dawley rats (6 weeks old; 220 ± 20 g) were randomly assigned to four groups: Sham, DMM, DMM + melatonin, and DMM + melatonin + TE. The intervention lasted for 8 weeks. Morphological staining, immunofluorescence (IF), microcomputed tomography with three-dimensional reconstruction, Western blot, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay were used to assess protein and gene expression. Compared with the DMM + melatonin group, the DMM + melatonin + TE group showed greater reductions in cartilage–subchondral bone damage and OA progression through modulation of the pyroptosis pathway. IF staining revealed that TXNIP protein expression was significantly reduced in the DMM + melatonin + TE group. Both the DMM + melatonin and combination treatment groups significantly regulated TXNIP/NLRP3 signaling and inhibited OA progression through pyroptosis. Furthermore, combining TE with melatonin significantly reduced the expression of pyroptotic cytokines compared with the DMM + melatonin group. This study suggests a potential therapeutic approach for managing OA by combining melatonin treatment with moderate TE.