1.Allogeneic lung transplantation in miniature pigs and postoperative monitoring
Yaobo ZHAO ; Ullah SALMAN ; Kaiyan BAO ; Hua KUI ; Taiyun WEI ; Hongfang ZHAO ; Xiaoting TAO ; Xinzhong NING ; Yong LIU ; Guimei ZHANG ; He XIAO ; Jiaoxiang WANG ; Chang YANG ; Feiyan ZHU ; Kaixiang XU ; Kun QIAO ; Hongjiang WEI
Organ Transplantation 2026;17(1):95-105
Objective To explore the feasibility and reference value of allogeneic lung transplantation and postoperative monitoring in miniature pigs for lung transplantation research. Methods Two miniature pigs (R1 and R2) underwent left lung allogeneic transplantation. Complement-dependent cytotoxicity tests and blood cross-matching were performed before surgery. The main operative times and partial pressure of arterial oxygen (PaO2) after opening the pulmonary artery were recorded during surgery. Postoperatively, routine blood tests, biochemical blood indicators and inflammatory factors were detected, and pathological examinations of multiple organs were conducted. Results The complement-dependent cytotoxicity test showed that the survival rate of lymphocytes between donors and recipients was 42.5%-47.3%, and no agglutination reaction occurred in the cross-matching. The first warm ischemia times of D1 and D2 were 17 min and 10 min, respectively, and the cold ischemia times were 246 min and 216 min, respectively. Ultimately, R1 and R2 survived for 1.5 h and 104 h, respectively. Postoperatively, in R1, albumin (ALB) and globulin (GLB) decreased, and alanine aminotransferase increased; in R2, ALB, GLB and aspartate aminotransferase all increased. Urea nitrogen and serum creatinine increased in both recipients. Pathological results showed that in R1, the transplanted lung had partial consolidation with inflammatory cell infiltration, and multiple organs were congested and damaged. In R2, the transplanted lung had severe necrosis with fibrosis, and multiple organs had mild to moderate damage. The expression levels of interleukin-1β and interleukin-6 increased in the transplanted lungs. Conclusions The allogeneic lung transplantation model in miniature pigs may systematically evaluate immunological compatibility, intraoperative function and postoperative organ damage. The data obtained may provide technical references for subsequent lung transplantation research.
2.Integrated molecular characterization of sarcomatoid hepatocellular carcinoma
Rong-Qi SUN ; Yu-Hang YE ; Ye XU ; Bo WANG ; Si-Yuan PAN ; Ning LI ; Long CHEN ; Jing-Yue PAN ; Zhi-Qiang HU ; Jia FAN ; Zheng-Jun ZHOU ; Jian ZHOU ; Cheng-Li SONG ; Shao-Lai ZHOU
Clinical and Molecular Hepatology 2025;31(2):426-444
Background:
s/Aims: Sarcomatoid hepatocellular carcinoma (HCC) is a rare histological subtype of HCC characterized by extremely poor prognosis; however, its molecular characterization has not been elucidated.
Methods:
In this study, we conducted an integrated multiomics study of whole-exome sequencing, RNA-seq, spatial transcriptome, and immunohistochemical analyses of 28 paired sarcomatoid tumor components and conventional HCC components from 10 patients with sarcomatoid HCC, in order to identify frequently altered genes, infer the tumor subclonal architectures, track the genomic evolution, and delineate the transcriptional characteristics of sarcomatoid HCCs.
Results:
Our results showed that the sarcomatoid HCCs had poor prognosis. The sarcomatoid tumor components and the conventional HCC components were derived from common ancestors, mostly accessing similar mutational processes. Clonal phylogenies demonstrated branched tumor evolution during sarcomatoid HCC development and progression. TP53 mutation commonly occurred at tumor initiation, whereas ARID2 mutation often occurred later. Transcriptome analyses revealed the epithelial–mesenchymal transition (EMT) and hypoxic phenotype in sarcomatoid tumor components, which were confirmed by immunohistochemical staining. Moreover, we identified ARID2 mutations in 70% (7/10) of patients with sarcomatoid HCC but only 1–5% of patients with non-sarcomatoid HCC. Biofunctional investigations revealed that inactivating mutation of ARID2 contributes to HCC growth and metastasis and induces EMT in a hypoxic microenvironment.
Conclusions
We offer a comprehensive description of the molecular basis for sarcomatoid HCC, and identify genomic alteration (ARID2 mutation) together with the tumor microenvironment (hypoxic microenvironment), that may contribute to the formation of the sarcomatoid tumor component through EMT, leading to sarcomatoid HCC development and progression.
3.Predicting Postoperative Progression of Ossification of the Posterior Longitudinal Ligament in the Cervical Spine Using Interpretable Radiomics Models
Siyuan QIN ; Ruomu QU ; Ke LIU ; Ruixin YAN ; Weili ZHAO ; Jun XU ; Enlong ZHANG ; Feifei ZHOU ; Ning LANG
Neurospine 2025;22(1):144-156
Objective:
This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery.
Methods:
This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression.
Results:
Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability.
Conclusion
Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.
4.Genomic characteristics of monkeypox virus from 8 cases in Changning District, Shanghai
Xiaoding HE ; Yang XU ; Ning YIN ; Zhenyu WANG ; Jiayin GUO
Shanghai Journal of Preventive Medicine 2025;37(4):332-335
ObjectiveTo investigate the epidemiological feature of Mpox infection and genetic characteristics of Mpox viruses (MPXVs), so as to understand the etiological evolution of the pathogen. MethodsThe cases infected with MPXVs were originated from Changning District, Shanghai from July 20 to August 24 in 2023. Epidemiological investigations were conducted, and throat swabs, anal swabs, or vesicle fluid were collected for MPXVs nucleic acid testing. High-throughput sequencing was performed using Miniseq of the Illumina sequencing platform, and thereafter the sequences were concatenated and analyzed using the online analysis tool Nextclade. An evolutionary tree was constructed using the MEGA 11 software. ResultsAll 8 cases were male, with an average age of (35.76±7.00) years. Among them, 6 cases were identified through active hospital visits, and 2 cases were discovered during contact tracing for Mpox cases. Within the 21 days preceding the disease onset, all cases had male-male sexual behaviors, and the incubation period ranged from 6 to 10 days. 3 cases had a history of sexually transmitted diseases (STDs). MPXVs nucleic acid testing indicated that the detection rate of MPXVs was found to be 25.00% for throat swabs, 87.50% for anal swabs, and 100.00% for vesicle fluid, with statistically significant differences (χ2=11.052, P=0.004). Sequencing analyses using the online tool Nextclade indicated that all 8 MPXVs belonged to the West African clade Ⅱb, 4 MPXVs were classified as C.1 sub-lineages, and 4 MPXVs were identified as C.1.1 sub-lineages. Phylogenetic analysis using MEGA 11 indicated that 5 MPXVs were classified as Lineage C.1.1, closely related to the prevalent strains in Portugal and other European regions. ConclusionThe MPXVs sequences from Changning District are clssified into clade Ⅱb, lineage C.1.1. The detection rates of vesicle fluid and anal swabs for MPXVs are significantly higher than that of throat swabs.
5.The effect of rutaecarpine on improving fatty liver and osteoporosis in MAFLD mice
Yu-hao ZHANG ; Yi-ning LI ; Xin-hai JIANG ; Wei-zhi WANG ; Shun-wang LI ; Ren SHENG ; Li-juan LEI ; Yu-yan ZHANG ; Jing-rui WANG ; Xin-wei WEI ; Yan-ni XU ; Yan LIN ; Lin TANG ; Shu-yi SI
Acta Pharmaceutica Sinica 2025;60(1):141-149
Metabolic-associated fatty liver disease (MAFLD) and osteoporosis (OP) are two very common metabolic diseases. A growing body of experimental evidence supports a pathophysiological link between MAFLD and OP. MAFLD is often associated with the development of OP. Rutaecarpine (RUT) is one of the main active components of Chinese medicine Euodiae Fructus. Our previous studies have demonstrated that RUT has lipid-lowering, anti-inflammatory and anti-atherosclerotic effects, and can improve the OP of rats. However, whether RUT can improve both fatty liver and OP symptoms of MAFLD mice at the same time remains to be investigated. In this study, we used C57BL/6 mice fed a high-fat diet (HFD) for 4 months to construct a MAFLD model, and gave the mice a low dose (5 mg·kg-1) and a high dose (15 mg·kg-1) of RUT by gavage for 4 weeks. The effects of RUT on liver steatosis and bone metabolism were then evaluated at the end of the experiment [this experiment was approved by the Experimental Animal Ethics Committee of Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences (approval number: IMB-20190124D303)]. The results showed that RUT treatment significantly reduced hepatic steatosis and lipid accumulation, and significantly reduced bone loss and promoted bone formation. In summary, this study shows that RUT has an effect of improving fatty liver and OP in MAFLD mice.
6.Components and Brain-protective Effect of Chuanxiong Rhizoma-Paeoniae Radix Rubra in Improving Ischemic Stroke Based on UPLC-Q-TOF-MS
Qizhong JIN ; Jie ZHANG ; Lijuan XIU ; Fan XU ; Lei WANG ; Ning WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):20-29
ObjectiveTo investigate the chemical constituents of Chuanxiong Rhizoma-Paeoniae Radix Rubra(CRPRR) that cross the blood-brain barrier in rats with ischemic stroke, their brain-protective effects, and their impact on inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-18 (IL-18) based on ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) and pharmacodynamic experiments. MethodsA focal cerebral ischemia-reperfusion injury model was established in rats via the middle cerebral artery occlusion/reperfusion (MCAO/R) method using intraluminal suture. Neurological function was evaluated using behavioral scoring. UPLC-Q-TOF-MS was employed to identify the chemical constituents of CRPRR that crossed the blood-brain barrier and entered the cerebrospinal fluid in MCAO/R model rats. Male Sprague-Dawley rats were randomly divided into six groups: sham operation group, model group, low-, medium-, and high-dose CRPRR groups (1.35, 2.7, 5.4 g·kg-1, respectively), and an edaravone group (5 mg·kg-1), with 12 rats in each group. The sham and model groups received normal saline, while the treatment groups received the respective doses of CRPRR once daily by gavage for three consecutive weeks. The brain-protective effects of CRPRR were assessed using the Longa five-point scoring method, open field test, Morris water maze, 2,3,5-triphenyltetrazolium chloride (TTC) staining, hematoxylin and eosin (HE) staining, and transmission electron microscopy. ResultsNine chemical constituents were identified in the cerebrospinal fluid containing CRPRR, namely paeoniflorin, senkyunolide F, senkyunolide G, paeonimetabolin Ⅰ, paeoniflorin derivative, senkyunolide H, benzoylpaeoniflorin, senkyunolide A, and ligustilide. Animal experiment results showed that compared with the sham operation group, the model group exhibited disordered neuronal arrangement, severe vacuolation, nuclear pyknosis, and evident mitochondrial swelling. Chromatin aggregation and peripheralization were also observed. Neurological scores and the number of crossings in the central region were significantly increased (P<0.01), while platform crossings were significantly decreased (P<0.01), and clear infarct areas were present (P<0.01). Serum levels and protein expression of TNF-α, IL-1β, and IL-18 were significantly elevated (P<0.01). Compared with the model group, all dose groups of CRPRR showed marked improvement in neuronal morphology which was close to the normal level, with mitochondrial swelling alleviated and chromatin distribution more uniform. The medium- and high-dose groups significantly reduced neurological scores (P<0.01), while the low-, medium-, and high-dose groups significantly reduced the number of central crossings (P<0.01) and infarct volume (P<0.01), and decreased TNF-α, IL-1β, and IL-18 levels (P<0.05, P<0.01) compared with the model group. Furthermore, the medium- and high-dose groups significantly reduced TNF-α protein expression (P<0.05,P<0.01), and the high-dose group significantly reduced IL-1β and IL-18 protein expression (P<0.01). ConclusionThis study confirmed that CRPRR improves neurological function and alleviates brain tissue damage in MCAO/R rats. Its mechanism may be associated with the downregulation of inflammatory factors TNF-α, IL-1β, and IL-18, as well as the presence of nine active chemical constituents in cerebrospinal fluid, namely paeoniflorin, senkyunolide F, senkyunolide G, paeonimetabolin Ⅰ, paeoniflorin derivative, senkyunolide H, benzoylpaeoniflorin, senkyunolide A, and ligustilide, which are closely related to their brain-protective effects.
7.Components and Brain-protective Effect of Chuanxiong Rhizoma-Paeoniae Radix Rubra in Improving Ischemic Stroke Based on UPLC-Q-TOF-MS
Qizhong JIN ; Jie ZHANG ; Lijuan XIU ; Fan XU ; Lei WANG ; Ning WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(12):20-29
ObjectiveTo investigate the chemical constituents of Chuanxiong Rhizoma-Paeoniae Radix Rubra(CRPRR) that cross the blood-brain barrier in rats with ischemic stroke, their brain-protective effects, and their impact on inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-18 (IL-18) based on ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) and pharmacodynamic experiments. MethodsA focal cerebral ischemia-reperfusion injury model was established in rats via the middle cerebral artery occlusion/reperfusion (MCAO/R) method using intraluminal suture. Neurological function was evaluated using behavioral scoring. UPLC-Q-TOF-MS was employed to identify the chemical constituents of CRPRR that crossed the blood-brain barrier and entered the cerebrospinal fluid in MCAO/R model rats. Male Sprague-Dawley rats were randomly divided into six groups: sham operation group, model group, low-, medium-, and high-dose CRPRR groups (1.35, 2.7, 5.4 g·kg-1, respectively), and an edaravone group (5 mg·kg-1), with 12 rats in each group. The sham and model groups received normal saline, while the treatment groups received the respective doses of CRPRR once daily by gavage for three consecutive weeks. The brain-protective effects of CRPRR were assessed using the Longa five-point scoring method, open field test, Morris water maze, 2,3,5-triphenyltetrazolium chloride (TTC) staining, hematoxylin and eosin (HE) staining, and transmission electron microscopy. ResultsNine chemical constituents were identified in the cerebrospinal fluid containing CRPRR, namely paeoniflorin, senkyunolide F, senkyunolide G, paeonimetabolin Ⅰ, paeoniflorin derivative, senkyunolide H, benzoylpaeoniflorin, senkyunolide A, and ligustilide. Animal experiment results showed that compared with the sham operation group, the model group exhibited disordered neuronal arrangement, severe vacuolation, nuclear pyknosis, and evident mitochondrial swelling. Chromatin aggregation and peripheralization were also observed. Neurological scores and the number of crossings in the central region were significantly increased (P<0.01), while platform crossings were significantly decreased (P<0.01), and clear infarct areas were present (P<0.01). Serum levels and protein expression of TNF-α, IL-1β, and IL-18 were significantly elevated (P<0.01). Compared with the model group, all dose groups of CRPRR showed marked improvement in neuronal morphology which was close to the normal level, with mitochondrial swelling alleviated and chromatin distribution more uniform. The medium- and high-dose groups significantly reduced neurological scores (P<0.01), while the low-, medium-, and high-dose groups significantly reduced the number of central crossings (P<0.01) and infarct volume (P<0.01), and decreased TNF-α, IL-1β, and IL-18 levels (P<0.05, P<0.01) compared with the model group. Furthermore, the medium- and high-dose groups significantly reduced TNF-α protein expression (P<0.05,P<0.01), and the high-dose group significantly reduced IL-1β and IL-18 protein expression (P<0.01). ConclusionThis study confirmed that CRPRR improves neurological function and alleviates brain tissue damage in MCAO/R rats. Its mechanism may be associated with the downregulation of inflammatory factors TNF-α, IL-1β, and IL-18, as well as the presence of nine active chemical constituents in cerebrospinal fluid, namely paeoniflorin, senkyunolide F, senkyunolide G, paeonimetabolin Ⅰ, paeoniflorin derivative, senkyunolide H, benzoylpaeoniflorin, senkyunolide A, and ligustilide, which are closely related to their brain-protective effects.
8.Toxicity and sublethal effects of calcium cyanamide against susceptible strains of Aedes albopictus
Luyang ZHENG ; Huiyi XU ; Qingqiu WEN ; Ning ZHOU ; Xueli ZHENG
Chinese Journal of Schistosomiasis Control 2025;37(2):196-200
Objective To examine the toxicity and sublethal effects of calcium cyanamide against susceptible isolates of Aedes albopictus, so as to provide insights into rational use of calcium cyanamide for integrated management of Ae. albopictus. Methods The sublethal concentrations [30% lethal concentration (LC30) and median lethal concentration (LC50)] of calcium cyana mide against susceptible strains of Ae. albopictus were determined using the larval immersion test. With 100 mL of dechlorinated water as the control group, after the larvae of susceptible strains of Ae. albopictus were immersed in calcium cyanamide for 24 hours, the pupation rate, pupation duration, emergence rate, number of eggs laid, percentage of eggs hatched, and lifespan of Ae. albopictus were calculated and compared post-treatment with calcium cyanamide at different sublethal concentrations. The midgut tissues of larvae of susceptible strains of Ae. albopictus treated with 100 mg/L calcium cyanamide were sampled for pathological sectioning to observe midgut tissue damages. To evaluate the residual activity, 100 larvae of susceptible strains of Ae. albopictus were treated with 200 mg/L and 500 mg/L calcium cyanamide, and the mortality of larvae was calculated every 24 hour, with dead larvae replaced until no larval death. Results The regression equation for the toxicity of calcium cyanamide against larvae of susceptible strains of Ae. albopictus was y = -9.441 + 4.657x, with an LC50 of 106.42 mg/L [95% confidence interval (CI): (94.64, 118.36) mg/L] and an LC30 of 82.17 mg/L [95% CI: (94.64, 118.36) mg/L], respectively. After larvae of susceptible strains of Ae. albopictus were treated with sublethal concentrations (LC30 and LC50) of calcium cyanamide for 24 hours, there were reduced pupation and emergence rates of larvae (all P values < 0.000 1), prolonged pupal stage (both P values < 0.000 1), reduced numbers of eggs laid by survival female Ae. albopictus (both P values < 0.000 1), reduced percentages of eggs hatched by Ae. albopictus eggs (both P values < 0.000 1), and reduced median survival period of survival female Ae. albopictus (χ2 = 9.36 and 20.33, both P values < 0.01) in the LC30 and LC50 groups relative to the control group. There was a numerical decline in the median survival period of survival female Ae. albopictus in the LC30 groups relative to the control group (χ2 = 2.42, P > 0.05), and there was a significant decline in the median survival period of survival female Ae. albopictus in the LC50 group relative to the control group (χ2 = 11.42, P < 0.01). Histopathological examinations showed severe damages to the midgut tissues of larvae of susceptible strains of Ae. albopictus, and residual activity assay revealed that the mortality of larvae of susceptible strains of Ae. albopictus was both 0 on day 32 post-treatment with calcium cyanamide at a concentration of 200 mg/L and on day 70 post-treatment with calcium cyanamide at a concentration of 500 mg/L, showing complete loss of the larvicidal activity of calcium cyanamide. Conclusions Calcium cyanamide is highly toxic against susceptible strains of Ae. albopictus, and calcium cyanamide at sublethal concentrations (LC30 and LC50) may inhibit growth, development, and reproductive capability of susceptible strains of Ae. albopictus, and shorten the lifespan of adult mosquitoes.
9.Integrated molecular characterization of sarcomatoid hepatocellular carcinoma
Rong-Qi SUN ; Yu-Hang YE ; Ye XU ; Bo WANG ; Si-Yuan PAN ; Ning LI ; Long CHEN ; Jing-Yue PAN ; Zhi-Qiang HU ; Jia FAN ; Zheng-Jun ZHOU ; Jian ZHOU ; Cheng-Li SONG ; Shao-Lai ZHOU
Clinical and Molecular Hepatology 2025;31(2):426-444
Background:
s/Aims: Sarcomatoid hepatocellular carcinoma (HCC) is a rare histological subtype of HCC characterized by extremely poor prognosis; however, its molecular characterization has not been elucidated.
Methods:
In this study, we conducted an integrated multiomics study of whole-exome sequencing, RNA-seq, spatial transcriptome, and immunohistochemical analyses of 28 paired sarcomatoid tumor components and conventional HCC components from 10 patients with sarcomatoid HCC, in order to identify frequently altered genes, infer the tumor subclonal architectures, track the genomic evolution, and delineate the transcriptional characteristics of sarcomatoid HCCs.
Results:
Our results showed that the sarcomatoid HCCs had poor prognosis. The sarcomatoid tumor components and the conventional HCC components were derived from common ancestors, mostly accessing similar mutational processes. Clonal phylogenies demonstrated branched tumor evolution during sarcomatoid HCC development and progression. TP53 mutation commonly occurred at tumor initiation, whereas ARID2 mutation often occurred later. Transcriptome analyses revealed the epithelial–mesenchymal transition (EMT) and hypoxic phenotype in sarcomatoid tumor components, which were confirmed by immunohistochemical staining. Moreover, we identified ARID2 mutations in 70% (7/10) of patients with sarcomatoid HCC but only 1–5% of patients with non-sarcomatoid HCC. Biofunctional investigations revealed that inactivating mutation of ARID2 contributes to HCC growth and metastasis and induces EMT in a hypoxic microenvironment.
Conclusions
We offer a comprehensive description of the molecular basis for sarcomatoid HCC, and identify genomic alteration (ARID2 mutation) together with the tumor microenvironment (hypoxic microenvironment), that may contribute to the formation of the sarcomatoid tumor component through EMT, leading to sarcomatoid HCC development and progression.
10.Predicting Postoperative Progression of Ossification of the Posterior Longitudinal Ligament in the Cervical Spine Using Interpretable Radiomics Models
Siyuan QIN ; Ruomu QU ; Ke LIU ; Ruixin YAN ; Weili ZHAO ; Jun XU ; Enlong ZHANG ; Feifei ZHOU ; Ning LANG
Neurospine 2025;22(1):144-156
Objective:
This study investigates the potential of radiomics to predict postoperative progression of ossification of the posterior longitudinal ligament (OPLL) after posterior cervical spine surgery.
Methods:
This retrospective study included 473 patients diagnosed with OPLL at Peking University Third Hospital between October 2006 and September 2022. Patients underwent posterior spinal surgery and had at least 2 computed tomography (CT) examinations spaced at least 1 year apart. OPLL progression was defined as an annual growth rate exceeding 7.5%. Radiomic features were extracted from preoperative CT images of the OPLL lesions, followed by feature selection using correlation coefficient analysis and least absolute shrinkage and selection operator, and dimensionality reduction using principal component analysis. Univariable analysis identified significant clinical variables for constructing the clinical model. Logistic regression models, including the Rad-score model, clinical model, and combined model, were developed to predict OPLL progression.
Results:
Of the 473 patients, 191 (40.4%) experienced OPLL progression. On the testing set, the combined model, which incorporated the Rad-score and clinical variables (area under the receiver operating characteristic curve [AUC] = 0.751), outperformed both the radiomics-only model (AUC = 0.693) and the clinical model (AUC = 0.620). Calibration curves demonstrated good agreement between predicted probabilities and observed outcomes, and decision curve analysis confirmed the clinical utility of the combined model. SHAP (SHapley Additive exPlanations) analysis indicated that the Rad-score and age were key contributors to the model’s predictions, enhancing clinical interpretability.
Conclusion
Radiomics, combined with clinical variables, provides a valuable predictive tool for assessing the risk of postoperative progression in cervical OPLL, supporting more personalized treatment strategies. Prospective, multicenter validation is needed to confirm the utility of the model in broader clinical settings.

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