Spine Damage Research Articles

Atloido-Axoid Dislocation in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the most common inflammatory rheumatism, with a prevalence of up to one percent worldwide. Indeed, the classical presentation of the disease is generally a bilateral and symmetrical polyarticular involvement affecting small joints of the hand as well as the forefoot. Spinal involvement could be observed in RA, particularly after an average of 10 years of disease duration. It is a common event with a prevalence of 14–88%. This involvement is the third most frequent after that of hands and feet; however it is a very unusual form of RA presentation. Atlantoaxial subluxations dominates damage of the upper cervical spine, mainly related to the C1–C2 pannus and the rupture of the transverse ligament. Silent forms are common, but the clinical resentation is very polymorphic and can range from neck pain neglected by the patient to spinal cord compression.

MRI-based synthetic CT: a new method for structural damage assessment in the spine in patients with axial spondyloarthritis – a comparison with low-dose CT and radiography

ObjectiveTo investigate the ability of MRI-based synthetic CT (sCT), low-dose CT (ldCT) and radiography to detect spinal new bone formation (NBF) in patients with axial spondyloarthritis (axSpA).MethodsRadiography of lumbar and...

Schwann cell-derived extracellular vesicles promote memory impairment associated with chronic neuropathic pain.

The pathogenesis of memory impairment, a common complication of chronic neuropathic pain (CNP), has not been fully elucidated. Schwann cell (SC)-derived extracellular vesicles (EVs) contribute to remote organ injury. Here, we showed that SC-EVs may mediate pathological communication between SCs and hippocampal neurons in the context of CNP. We used an adeno-associated virus harboring the SC-specific promoter Mpz and expressing the CD63-GFP gene to track SC-EVs transport. microRNA (miRNA) expression profiles of EVs and gain-of-function and loss-of-function regulatory experiments revealed that miR-142-5p was the main cargo of SC-EVs. Next, luciferase reporter gene and phenotyping experiments confirmed the direct targets of miR-142-5p. The contents and granule sizes of plasma EVs were significantly greater in rats with chronic sciatic nerve constriction injury (CCI)than in sham rats. Administration of the EV biogenesis inhibitor GW4869 ameliorated memory impairment in CCI rats and reversed CCI-associated dendritic spine damage. Notably, during CCI stress, SC-EVs could be transferred into the brain through the circulation and accumulate in the hippocampal CA1-CA3 regions. miR-142-5p was the main cargo wrapped in SC-EVs and mediated the development of CCI-associated memory impairment. Furthermore, α-actinin-4 (ACTN4), ELAV-like protein 4 (ELAVL4) and ubiquitin-specific peptidase 9 X-linked (USP9X) were demonstrated to be important downstream target genes for miR-142-5p-mediated regulation of dendritic spine damage in hippocampal neurons from CCI rats. Together, these findings suggest that SCs-EVs and/or their cargo miR-142-5p may be potential therapeutic targets for memory impairment associated with CNP.

Comparison of Adult Female and Male PMHS Pelvis and Lumbar Response to Underbody Blast.

The goal of this study was to gather and compare kinematic response and injury data on both female and male whole-body Post-mortem Human Surrogates (PMHS) responses to Underbody Blast (UBB) loading. Midsized males (50th percentile, MM) have historically been most used in biomechanical testing and were the focus of the Warrior Injury Assessment Manikin (WIAMan) program, thus this population subgroup was selected to be the baseline for female comparison. Both small female (5th percentile, SF) and large female (75th percentile, LF) PMHS were included in the test series to attempt to discern whether differences between male and female responses were predominantly driven by sex or size. Eleven tests, using 20 whole-body PMHS, were conducted by the research team. Preparation of the rig and execution of the tests took place at the Aberdeen Proving Grounds (APG) in Aberdeen, MD. Two PMHS were used in each test. The Accelerative Loading Fixture (ALF) version 2, located at APG's Bear Point range was used for all male and female whole-body tests in this series. The ALF was an outdoor test rig that was driven by a buried explosive charge, to accelerate a platform holding two symmetrically mounted seats. The platform was designed as a large, rigid frame with a deformable center section that could be tuned to simulate the floor deformation of a vehicle during a UBB event. PMHS were restrained with a 5-point harness, common in military vehicle seats. Six-degree-of-freedom motion blocks were fixed to L3, the sacrum, and the left and right iliac wings. A three-degree-of freedom block was fixed to T12. Strain gages were placed on L4 and multiple locations on the pelvis. Accelerometers on the floor and seat of the ALF provided input data for each PMHS' feet and pelvis. Time histories and mean peak responses in z-axis acceleration were similar among the three PMHS groups in this body region. Injury outcomes were different and seemed to be influenced by both sex and size contributions. Small females incurred pelvis injuries in absence of lumbar injures. Midsized males had lumbar vertebral body fractures without pelvis injuries. And large females with injuries had both pelvis and lumbar VB fractures. This study provides evidence supporting the need for female biomechanical testing to generate female response and injury thresholds. Without the inclusion of female PMHS, the differences in the injury patterns between the small female and midsized male groups would not have been recognized. Standard scaling methods assume equivalent injury patterns between the experimental and scaled data. In this study, small female damage occurred in a different anatomical structure than for the midsized males. This is an important discovery for the development of anthropomorphic test devices, injury criteria, and injury mitigating technologies. The clear separation of small female damage results, in combination with seat speeds, suggest that the small female pelvis injury threshold in UBB events lies between 4 - 5 m/s seat speed. No inference can be made about the small female lumbar threshold, other than it is likely at higher speeds and/or over longer duration. Male lumbar spine damage occurred in both the higher- and lower lower-rate tests, indicating the injury threshold would be below the seat pulses tested in these experiments. Large females exhibited injury patterns that reflected both the small female and midsized male groups - with damaged PMHS having fractures in both pelvis and lumbar, and in both higher- and lower- rate tests. The difference in damage patterns between the sex and size groups should be considered in the development of injury mitigation strategies to protect across the full population.

Joint and spine damage in patients with inflammatory bowel diseases

Joint and spine damage in patients with inflammatory bowel diseases

Clinical and imaging findings in enteropathic spondyloarthritis with special emphasize in diagnostic delay: a cross-sectional study.

Enteropathic spondyloarthritides (eSpAs) are chronic inflammatory joint diseases associated with inflammatory bowel disease (IBD). Limited data are available on the prevalence since arthritis in IBD patients may be underestimated because medications may hide disease activity with a possible diagnostic delay. We aimed to evaluate diagnostic delay in eSpA and explore associated demographic, clinical, and radiographic characteristics. Single-centre cross-sectional study conducted on consecutive out-patients referred to the combined Gi-Rhe clinic (November 2018-October 2019). We analysed eSpA patients for diagnostic delay, disease activity, inflammatory markers, conventional radiography (CR) and magnetic resonance images (MRI) of sacroiliac joints/spine. A total of 190 eSpA patients [118 peripheral SpA, 72 axial (Ax) SpA including 44 non-radiographic (nr)-axSpA] were enrolled. axSpA patients had a higher prevalence of men sex, HLA-B27 positivity, uveitis and pancolitis compared with peripheral eSpA. Median diagnostic delay in eSpA was 48 months (IQR 6-77) with no difference between axial and peripheral patients. Radiographic-axial SpA (r-axSpA) patients displayed a higher diagnostic delay compared with nr-axSpA (median/IQR 36/17-129 versus 31/10-57 months, p = 0.03) and were older, with longer disease duration, low education status and high rate of employment than patients with nr-axSpA. r-axSpA patients with sclerosis, syndesmophytes and bridge at CR had higher diagnostic delay than those without lesions. Men showed higher prevalence of spine damage lesions than women as sclerosis, squaring, syndesmophytes and bridges. Longer disease duration was detected in patients with radiographic damage as bridge and sacroiliitis grade 3. On MRI, sacroiliac bone oedema was associated with reduced diagnostic delay, whereas bone erosions were associated with higher diagnostic delay compared with that in patients without these lesions. Patients with psoriasis displayed a higher diagnostic delay compared to those without skin involvement. Diagnostic delay was higher in r-axSpA compared with nr-axSpA despite the same treatment. Demographic, clinical features and radiological lesions were associated with diagnostic delay.

New Nonwoven Fabrics for Pollination Control Bags for Oil Palm

Oil palm hybridisation requires the isolation of inflorescences with pollination control bags (PCBs) for which polyester duraweb® PCBs are used at the Dami Oil Palm Research Station in Papua New Guinea. For widening the choices of nonwoven PCBs we compared the performance of PCBs from three new types of nonwoven fabrics with the standard duraweb® PCB on 9-year-old clonal palms in one of the Dami SUPERFAMILY® seed gardens. The station typically experiences a humid climate and received weekly total rainfall ranging from 53 to 228 mm (total rainfall 1035 mm) during the reproductive phase in March and April 2020, when the trial was conducted. Analyses of variance of a number of traits such as time taken to install the bags, bag intactness, spine damage and water absorption of bags, bunch weight, healthy and total seed number and weight, seed health score, and 100-seed weight were all non-significant. The average number of healthy seeds per bunch was 1120 seeds with mean weight of 376 g per 100 seeds. Blank pollinations showed equal pollen-proofing ability among all bags without any noticeable insect entry. This study, for the first time, has identified three other nonwoven fabric PCBs with no statistical differences from the control duraweb® bags for most of the important traits, and provides new alternatives to reduce the dependency on only one type of fabric which, when in short supply, could adversely affect the plant breeding and seed production programmes.

Global Functioning in Axial Spondyloarthritis is Stronger Associated With Disease Activity and Function Than With Mobility and Radiographic Damage.

The Assessment of Spondyloarthritis International Society Health Index (ASAS HI) is a validated patient-reported outcome (PRO) for global functioning of patients with axial spondyloarthritis (axSpA). The Epionics SPINE (ES) is an electronic device for assessment of axial mobility that provides an objective measure of spinal mobility by assessing range of motion (RoM) and range of kinematics (RoK). The aim of this study is to investigate the relationship between global functioning and clinical measures of disease activity, physical function, spinal mobility, and radiographic damage. In a cross-sectional study design, consecutive patients with radiographic and nonradiographic axSpA were included, and the following established tools were assessed: Bath ankylosing spondylitis (AS) disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index (BASMI), ASAS HI, and RoM and RoK using ES. Structural damage of spine and sacroiliac joints (SIJ) were assessed by counting the number of syndesmophytes and by New York grading of sacroiliitis. Kendall's tau correlation coefficients were calculated. In 103 patients with axSpA, ASAS HI scores correlated significantly with PRO scores (BASDAI, r = 0.36; BASFI, r = 0.48; and back pain, r = 0.41; all P < 0.001). In contrast, no significant correlation between ASAS HI and RoM and RoK (r between -0.08 and 0.09) and radiographic damage in SIJ and spine (all r between 0.03 and 0.004) were seen, respectively. BASMI scores correlated weakly (r = 0.14; P = 0.05). This study shows that axSpA disease-specific PROs have an impact on global functioning, whereas spinal mobility scores, even if objectively assessed by the ES, have limited impact on patient reported-global functioning. The results also suggest that global functioning is, in this cohort, not much dependent on the degree of structural damage in the axial skeleton.

Modeling the behavior of the acetabular axis and the axis of the ischial tuberosities during the transition from a standing to a sitting position

Introduction The success of the treatment of patients with degenerative diseases of the spine and concomitant damage to the hip joint depends on the understanding of the biomechanics of movements in the spinal-pelvic segment. After a thorough analysis of the biomechanical processes occurring in the spine-pelvis system during the transition from a standing to a sitting position, it becomes clear that the acetabular axis of rotation of the pelvis in space is not the only one.The purpose of the study was to develop and test a virtual model of the pelvis to study the kinematics of the movement of the spinal-pelvic complex with a description of the emergence of the iscial axis of rotation by changing the position from standing to sitting.Materials and methods The problem was solved using the finite element method. The bones were modeled as absolutely rigid bodies. The main ligaments and muscles were modeled using finite element springs: elastic fragments with specified rheological characteristics. The study of contact interaction was carried out for pairs: "femoral head – acetabulum" and "ischial tuberosities - chair surface".Results A new axis of rotation was revealed, the ischial axis, which corresponded to the points of initial contact of the ischial tuberosities with the surface of the chair. The axis of the acetabulum rotated by 7.1° relative to the ischial axis and at the final moment shifted in the horizontal direction relative to the acetabular axis by 8.83 mm. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm.Discussion The study shows that the pelvis rotates depending on the position around two axes: acetabular and ischial ones, hence it follows that the acetabular axis oscillates back and forth during ante- and retroversion, that is, it is non-static. Shortcomings of the model: 1) muscles and ligaments were modeled using FE springs, the end and beginning of which were set by two points, and the muscles and ligaments in the real body are attached along the entire surface of the bones; 2) soft tissues were not modeled in real volume. The merit of the study is the contact interaction of the pelvis with the chair and its rotation relative to the ischial axis, while other studies consider the rotation of the pelvis only relative to the acetabular axis.Conclusion A new axis of rotation arises due to the contact interaction of the pelvic bone with the surface of the chair when the skeleton moves from a standing position to a sitting position, the ischial axis. The gap between the surfaces of the femoral head and the acetabulum was about 8 mm. It is advisable to conduct a clinical study.

Oral Antispasticity Drugs and Non-Progressive Neurological Diseases: A Meta-Analysis on Safety and Efficacy.

Spasticity is a pathophysiological outcome of impaired muscle motor activity, primarily the muscle tone. Muscle tone problems are signs of several neurological conditions, such as multiple sclerosis, movement disorders, spine damage, stroke, and traumatic brain injury. Antispasticity therapeutics belong to a class of treatments that restore motor function and muscle tone. There are several routes of therapeutic administration of antispastic medications; among them, the oral drug delivery system plays a significant role. The purpose of the study was to present a complete synthesis of the scientific evidence on the safety and efficacy of antispasticity medicines used orally for the management of nonprogressive neurological disorders. In order to carry out a comprehensive meta-analysis, the most pertinent scientific studies on the use of oral antispasticity medications to treat non-progressive neurological illnesses were identified. A search was conducted across a number of databases, including SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. MedCalc statistical software was used to perform a meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards for odds ratio across the studies, relative risk, and risk factor analysis. In the present study, a total of 252 original records were retrieved from different predefined databases on oral antispasticity drugs and their association with non-progressive neurological disorders. After several screening steps, 12 studies were found to be eligible for meta-analysis. These studies represented different antispasticity therapeutics that were administered via the oral route. Based on the meta-analysis, oral antispasticity drugs were found to be moderately effective (P < 0.001). The findings of the meta-analysis showed that the interventions of tizanidine, diazepam, dantrolene, baclofen, and gabapentin were more effective in tackling spasticity than the control. Therefore, in the treatment of non-progressive neurological diseases, oral antispasticity medications are only modestly effective.

Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean rating (k = 15), absolute agreement, a two-way random-effects model and Cronbach’s alpha. Results: Overall, the ICC correlation coefficient was 0.87 (95% confidence interval: 0.79–0.92), and the Cronbach’s alpha was 0.93 (95% confidence interval: 0.94–0.97). Global inter- and intra-observer agreement among the 15 readers with scores below or equal to 6 points and scores above 6 points were 0.81 (95% C.I.: 0.72–0.86) and 0.94 (95% C.I.:0.91–0.98), respectively. Conclusion: We present a consensus-based semiquantitative scoring systems for CT in MM with a complementary CT imaging atlas including detailed examples of relevant scoring techniques. We found substantial agreement among readers with different levels of experience, thereby supporting the role of the MSBDS for possible large-scale applications. Significance and Innovations • Based on previous work and definitions of the MSBDS, we present real-life reliability data for quantitative bone damage assessment in multiple myeloma (MM) patients on CT. • In this study, reliability for the MSBDS, which was tested on 15 readers with different levels of expertise and from different institutions, was shown to be moderate to excellent. • The complementary CT imaging atlas is expected to enhance unified interpretations of the MSBDS between different professionals dealing with MM patients in their routine clinical practice.

Epidural steroid injections in treatment of chronic lower back pain caused by degenerative-dystrophic spine damage

Background. The high incidence of degenerative-dystrophic spine damage with the variability of research results on the effectiveness of epidural steroid injections for treatment of chronic lower back pain is an urgent issue regarding treatment of this pain with epidural steroid injections only. Objective. The aim of the study is to improve the effectiveness of treatment of chronic lower back pain caused by degenerative spine damage with monotherapy – epidural steroid injections only. Material and methods. The early and long-term treatment outcomes with epidural steroid injections only of 120 patients with chronic lower back pain were analysed. The control group consisted of 36 patients with lower back pain treated conservatively. The results of treatment were assessed by the dynamics of pain regression using the visual analog scale (VAS), as well as the functional status by the Oswestry index. The assessment was performed three times: before treatment, after treatment and six months after it. Results. In the early post-treatment period, reliable results of treatment of chronic lower lumbar pain was evidenced in both the main and control groups. There was no significant difference in treatment outcomes between these groups in the early period, although both the Oswestry index and the VAS by the Student’s T-test showed that the differences were in favour of the main group. There was a significant difference in long-term treatment outcomes between the main and control groups both by the Oswestry index and the VAS in favour of monotherapy with epidural steroid injections. Conclusions. The study proved a high effectiveness of monotherapy with epidural steroid injections for chronic lower back pain caused by degenerative-dystrophic spine damage.

Epidemiological, clinical and therapeutic characteristics of metastatic spinal cord compression in prostate cancer patients in two tertiary hospitals in Cameroon

Introductionprostate cancer represents the 3rd primary neoplasia responsible for metastatic spinal cord compression (MSCC). MSCC is an extreme oncological emergency, because it involves both functional and vital prognosis. The present study aimed to establish a pattern of MSCC in prostate cancer patients in Douala and Yaoundé general hospitals (Cameroon).Methodsthis was a descriptive and retrospective study in the Radiotherapy and Medical Oncology services at both Douala and Yaoundé General Hospitals. The explored variables were general characteristics of the study population, clinical and paraclinical features, management and outcomes. Furthermore 5-year survival was analyzed by the Kaplan-Meier method. Logistic regression by determining the odd ratios and their 95% confidence was done using “Statistical Package for Social Sciences” (SPSS 23) software. The difference was considered significant at p < 0.05.Resultsour series consisted of 151 patients out of which the mean age was 66.88 (SD: 8.71) years (95% CI: 44-88). Pain was the most common clinical symptom (53.33%; n= 80) and fracture-settlement accounted for majority (60%; n= 90.61) of the pain. Thoracic spine damage was encountered by 47.02% (n= 71). Patients received a total doses of irradiation between 20 and 30 gray (Gy). The main toxicity due to radiotherapy were asthenia (45.70%; n= 69.11). The overall survival at 5 years was 90.11%. Factors associated with fracture-settlement were smoking (aOR 10.04, 95% CI: 2.09-48.12; p = 0.004) and the localization of MSCC occurred (aOR 0.21, 95% CI: 0.05-0.77; p = 0.02).Conclusionin summary the average age for developing the condition is 66.88 years and factors associated with fracture-settlement were smoking and the localization of MSCC. Back pain was the most common clinical sign and fracture-settlement was the first type of injury on medical magnetic resonance imaging. Therefore, we recommend that emphasis should be placed on increasing awareness of the population on the importance of early diagnosis.

EPIDURAL INJECTIONS IN THE TREATMENT OF RADICULAR SYNDROME AND CHRONIC LUMBAR PAIN IN DEGENERATIVE-DYSTROPHIC SPINE DAMAGE

Aim. To investigate the methodology and effectiveness of epidural steroid injection for radicular syndrome and lower back pain caused by degenerative-dystrophic process.&#x0D; Research methods: bibliosemantic, comparative, systemic.&#x0D; Results. A literature review and our study proved a high efficacy of both monotherapy and combined epidural steroid injections in treatment of chronic lumbar pain and radicular syndrome caused by degenerative-dystrophic spine damage. Epidural steroid injections are indicated for intervertebral disc herniation, spondyloarthritis, spinal canal stenosis, spondylolisthesis, which cause chronic lumbar pain, radicular syndrome. Epidural steroid blockades with stable remission were proved to have positive result in 20 to 100% of cases, averaging more than 80%. Anesthetics, corticosteroids, enzymes, and vitamins are administered to the epidural cavity to relieve pain and inflammation, but most authors still prefer steroids. Corticosteroids reduce the inflammatory response and oedema by inhibiting the synthesis and release of numerous anti-inflammatory mediators and cause the reverse local anaesthetic effect. Different approaches are used to introduce drugs into the epidural cavity: interlaminar, caudal and transforaminal; the method of long-term local pharmacotherapy is used. Interlaminar epidural steroid injection is as effective as transforaminal epidural injection. The middle interlaminar access is less traumatic. The choice of the administration technique depends on specialist experience and preferences. Epidural injections are performed both by a “blind method” (without imaging) and under control (fluoroscopy, ultrasound and CT) in order to improve the safety and carefulness of pharmacological drug administration. The equivalence of fluoroscopic, ultrasound and CT control of epidural injection in terms of treatment efficacy has been proved.&#x0D; Conclusions. Taking into account the high effectiveness of epidural steroid injections, the possibility of outpatient treatment in the absence of complications, makes it the method of choice in the treatment of radicular and lumbar pain caused by degenerative damage of the lumbar spine, after ineffective treatment.

Mechanism of valproic acid-induced dendritic spine and synaptic impairment in the prefrontal cortex for causing core autistic symptoms in mice

To investigate the mechanism of valproic acid (VPA) -induced impairment of the dendritic spines and synapses in the prefrontal cortex (PFC) for causing core symptoms of autism spectrum disorder (ASD) in mice. Female C57 mice were subjected to injections of saline or VPA on gestational days 10 and 12, and the male offspring mice in the two groups were used as the normal control group and ASD model group (n=10), respectively. Another 20 male mice with fetal exposure to VPA were randomized into two groups for stereotactic injection of DMSO or Wortmannin into the PFC (n=10). Open field test, juvenile play test and 3-chamber test were used to evaluate autistic behaviors of the mice. The density of dendrite spines in the PFC was observed with Golgi staining. Western blotting and immunofluorescence staining were used to detect the expressions of p-PI3K, PI3K, p-AKT, AKT, p-mTOR, mTOR and the synaptic proteins PSD95, p-Syn, and Syn in the PFC of the mice. Compared with the normal control mice, the mice with fetal exposure to VPA exhibited obvious autism-like behaviors with significantly decreased density of total, mushroom and stubby dendritic spines (P < 0.05) and increased filopodia dendritic spines (P < 0.05) in the PFC. The VPA-exposed mice also showed significantly increased expressions of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR/mTOR (P < 0.01) and lowered expressions of PSD95 and p-Syn/Syn in the PFC (P < 0.05 or 0.001). Wortmannin injection into the PFC obviously improved the ASD-like phenotype and dendritic spine development, down-regulated PI3K/Akt/mTOR signaling pathway and up-regulated the synaptic proteins in VPA-exposed mice. In male mice with fetal exposure to VPA, excessive activation of PI3K/Akt/mTOR signaling pathway and decreased expressions of the synaptic proteins PSD95 and p-Syn cause dendritic spine damage and synaptic development disturbance in the PFC, which eventually leads to ASD-like phenotype.

Non-invasive photobiomodulation treatment in an Alzheimer Disease-like transgenic rat model.

Alzheimer's disease (AD) is the most common form of dementia in the elderly, causing neuronal degeneration and cognitive deficits that significantly impair independence and quality of life for those affected and their families. Though AD is a major neurodegenerative disease with vast avenues of investigation, there is no effective treatment to cure AD or slow disease progression. The present work evaluated the therapeutic effect of long-term photobiomodulation (PBM) treatment with continuous-wave low-level laser on AD and its underlying mechanism.Methods: PBM was implemented for 2 min, 3 times per week for 16 months in 2-month-old transgenic AD rats. A battery of behavioral tests was performed to measure the effect of PBM treatment on cognitive dysfunction in AD rats. The effects of PBM therapy on typical AD pathologies, including amyloid plaques, intracellular neurofibrillary tangles, neuronal loss, neuronal injury, neuronal apoptosis, and neurodegeneration, were then assessed. The underlying mechanisms were measured using immunofluorescence staining, western blotting analysis, mass spectrometry, primary cortical and hippocampal cell cultures, and related assay kits.Results: PBM treatment significantly improved the typical AD pathologies of memory loss, amyloid plaques, tau hyperphosphorylation, neuronal degeneration, spine damage, and synaptic loss. PBM treatment had several mechanistic effects which may explain these beneficial effects, including 1) regulation of glial cell polarization and inhibition of neuroinflammation, 2) preservation of mitochondrial dynamics by regulating fission and fusion proteins, and 3) suppression of oxidative damage to DNA, proteins, and lipids. Furthermore, PBM enhanced recruitment of microglia surrounding amyloid plaques by improving the expression of microglial IL-3Rα and astrocytic IL-3, which implies a potential role of PBM in improving Aβ clearance. Finally, our results implicate neuronal hemoglobin in mediating the neuroprotective effect of PBM, as Hbα knockdown abolished the neuroprotective effect of PBM treatment.Conclusion: Collectively, our data supports the potential use of PBM treatment to prevent or slow the progression of AD and provides new insights into the molecular mechanisms of PBM therapy.

CT-derived relationship between low relative muscle mass and bone damage in patients with multiple myeloma undergoing stem cells transplantation.

Sarcopenia or low muscle mass is related to worse prognosis in cancer patients. We investigated whether muscle mass is related to bone damage on CT in patients with multiple myeloma (MM). Approval from the institutional review board was obtained. N = 74 consecutive patients (mean age, 60.8 years ± 9.24 [standard deviation]; range, 36-89 years) for MM who underwent transplant were included. Sarcopenia cut-off points defined as skeletal muscle index (SMI) used were<41 cm2/m2. To assess bone damage in MM the MSBDS (myeloma spine and bone damage score) was used. One-way analysis of variance and the X2 test were used. Kaplan-Meier analysis was performed to generate progression and survival curves according to SMI and MSBDS. The testing level was set at 0.05. The median SMI was 47.1 ± 14.2 and according to SMI 18/74 (24%) had sarcopenia which was more prevalent in females (p.001). A strong and significant association between patients with low muscle mass and elevated bone damage (24/74, 32.4%) and patients with normal/non-low muscle mass low bone damage (30/74, 40.5%) was present. Multiple Logistic regression did not show any significant relationship or confounding influence among SMI and MSBDS regarding sex (p.127), cytogenetic status (p.457), staging (p.756) and relapse (.126). Neither SMI nor MSBDS resulted significantly related to overall survival as shown in Kaplan-Meier analysis. Sarcopenia and bone damage affected MM patients undergoing stem cell transplantation and are significantly associated. Quantitative measurement of sarcopenia and bone damage on CT resulted present in MM patients undergoing stem cell transplantation and are significantly associated.

Bilateral facet effusion is a risk factor for segmental instability with cervical injury without vertebral fracture

Magnetic resonance imaging (MRI) is effective in identifying cervical spine injury after trauma. However, cervical instability without major bone injury or dislocation is challenging to assess. Hence, the current study aimed to investigate and compare the MRI and radiography findings of segmental instability in patients with cervical spine injury. We investigated 34 participants with cervical spine injury without vertebral fracture. Based on the radiography findings, the participants were categorized into two: group A with segmental instability (n = 11) and group B without segmental instability (n = 23). Both groups were compared in terms of the presence of segmental instability on radiography and MRI. Anterior longitudinal ligament (ALL) injury, disc injury, and bilateral facet effusion were observed in 6/11, 5/11, and 7/11 patients in group A and in 5/23, 2/23 and 7/23 patients in group B, respectively. The results showed significant differences (p < 0.05). Moreover, 2 and 10 of 11 patients in group A and 16 and 7 of 23 patients in group B presented with hemi lateral facet effusion and paravertebral muscle injury, respectively. However, the results did not significantly differ. According to a logistic regression analysis, bilateral facet effusion after trauma was associated with cervical segmental instability (odd ratio: 10.6, 95% confidence interval: 1.31–84.7). Facet joint effusion might be caused by capsule injury during trauma. Most participants with segmental instability had ALL, disc, and flavum injury and bilateral facet effusion. Therefore, we need to consider bilateral facet effusion with other soft tissue damage of the cervical spine as an association factor to show the instability.

A matter of atrophy: differential impact of brain and spine damage on disability worsening in multiple sclerosis

As atrophy represents the most relevant driver of progression in multiple sclerosis (MS), we investigated the impact of different patterns of brain and spinal cord atrophy on disability worsening in MS. We acquired clinical and MRI data from 90 patients with relapsing–remitting MS and 24 healthy controls (HC). Clinical progression at follow-up (mean 3.7 years) was defined according to the Expanded Disability Status Scale-Plus. Brain and spinal cord volumes were computed on MRI brain scans. After normalizing each participants’ brain and spine volume to the mean of the HC, z-score cut-offs were applied to separate pathologically atrophic from normal brain and spine volumes (accepting a 2.5% error probability). Accordingly, MS patients were classified into four groups (Group I: no brain or spinal cord atrophy N = 40, Group II: brain atrophy/no spinal cord atrophy N = 11, Group III: no brain atrophy/ spinal cord atrophy N = 32, Group IV: both brain and spinal cord atrophy N = 7). All patients’ groups showed significantly lower brain volume than HC (p < 0.0001). Group III and IV showed lower spine volume than HC (p < 0.0001 for both). Higher brain lesion load was identified in Group II (p = 0.049) and Group IV (p = 0.023) vs Group I, and in Group IV (p = 0.048) vs Group III. Spinal cord atrophy (OR = 3.75, p = 0.018) and brain + spinal cord atrophy (OR = 5.71, p = 0.046) were significant predictors of disability progression. The presence of concomitant brain and spinal cord atrophy is the strongest correlate of progression over time. Isolated spinal cord atrophy exerts a similar effect, confirming the leading role of spinal cord atrophy in the determination of motor disability.

Both structural damage and inflammation of the lumbar spine contribute to the sagittal imbalance in ankylosing spondylitis patients with thoracolumbar kyphosis.

The relationship between structural damage and inflammation of the spine and the sagittal imbalance in ankylosing spondylitis (AS) is not well understood. The present study aimed to investigate the correlation between structural damage and inflammation of the lumbar spine and the sagittal imbalance in AS patients with thoracolumbar kyphosis. Forty-five AS patients with thoracolumbar kyphosis were retrospectively reviewed. Six sagittal spinal parameters, including the C7 tilt (C7T), spino-sacral angle (SSA), global kyphosis (GK), the sagittal vertical axis (SVA), thoracic kyphosis (TK), and lumbar lordosis (LL), were measured. Structural damage of the lumbar spine was assessed by the modified Stoke AS Spine Score (mSASSS) on radiographs. Lumbar spinal inflammation was evaluated by the AS spinal magnetic resonance imaging (MRI) activity (ASspiMRI-a) on MRI. Correlation analysis was performed using the paired sample t-test. Multivariable linear regression models were constructed to analyze the contributions of mSASSS and ASspiMRI-a to the sagittal parameters. The average values of the sagittal parameters C7T, SSA, GK, SVA, TK, and LL were 68.1°, 80.1°, 77.3°, 168.7 mm, 47.7°, and -0.7°, respectively. The average mSASSS and ASspiMRI-a scores were 9.8 and 10.8, respectively. Correlation analysis showed that the mSASSS and ASspiMRI-a were correlated with C7T, SSA, SVA, and LL (the Spearman correlation coefficients were -0.439, -0.390, 0.424, and 0.530 for mSASSS; -0.406, -0.402, 0.378, and 0.486 for ASspiMRI-a; P<0.05). The C7T, SSA, and SVA were significantly correlated with LL (r=-0.696, -0.779, and 0.633, respectively; P<0.05). There was a weak correlation between the mSASSS and ASspiMRI-a (β=0.299, P=0.046). The multivariable regression models indicated that the sagittal imbalance was determined to a greater extent by the mSASSS than ASspiMRI-a (the β values were -1.550 vs. -0.649 for C7T, -1.865 vs. -1.231 for SSA, 9.161 vs. 3.823 for SVA, and 3.128 vs. 1.717 for LL). Both structural damage and inflammation of the lumbar spine contributed to the sagittal imbalance in AS patients with thoracolumbar kyphosis. In the late stages of AS, the sagittal imbalance was more attributable to the structural damage than the inflammation of the lumbar spine.