Degenerative Findings Research Articles

Hypoxia and Normoxia Preconditioned Olfactory Stem Cells Against Noise-Induced Hearing Loss.

Noise-induced hearing loss is one of the leading causes of permanent hearing loss in the adult population. In this experimental study, the authors aimed to investigate the effectiveness of hypoxia and normoxia preconditioned olfactory stem cells against noise trauma. Twenty-seven female guinea pigs were enrolled. Two guinea pigs were sacrificed for harvesting olfactory tissue and 1 for examining the architecture of the normal cochlea. The remaining 24 guinea pigs were exposed to noise trauma for 1 day and then randomly divided into 3 groups: intracochlear injection of (i) normoxic olfactory stem cells, (ii) hypoxic olfactory stem cells, and (iii) physiological serum. Auditory brainstem response (ABR) measurement was performed before and 2 weeks after noise trauma and weekly for 3 weeks following intracochlear injection. Both click and 16kHz tone-burst stimuli were used for detection of ABR. No significant difference was noted between the groups before and 2 weeks after noise trauma. ABR thresholds detected after intracochlear injections were significantly higher in the control group compared with stem cell groups. However, no significant difference was detected between the stem cell groups. Fluourescence microscopy revealed better engraftment for hypoxic stem cells. Light and electron microscopy examinations were consistent with predominant degenerative findings in the control group, whereas normoxic group had more similar findings with normal cochlea compared with hypoxic group. Olfactory stem cells were demonstrated to have the potential to have beneficial effects on noise trauma.

P38. Correlating dynamic instability indices to degenerative findings on MRI in patient with chronic low back pain

P38. Correlating dynamic instability indices to degenerative findings on MRI in patient with chronic low back pain

The Spatial Relationship between Spinal Osteoarthritis and CSF Venous Fistulas in Patients with Spontaneous Intracranial Hypotension.

CSF venous fistula leads to spontaneous intracranial hypotension. The exact mechanisms underlying the development of CSF venous fistula remain unclear: Some researchers have postulated that underlying chronic intracranial hypertension may lead to damage to spinal arachnoid granulations, given that many patients with CSF venous fistulas have an elevated body mass index (BMI). However, individuals with higher BMIs are also more prone to spinal degenerative disease, and individuals with CSF venous fistulas also tend to be older. CSF venous fistula tends to occur in the lower thoracic spine, the most frequent location of thoracic degenerative changes. The current study aimed to examine whether CSF venous fistulas are more likely to occur at spinal levels with degenerative changes. Forty-four consecutive patients with CSF venous fistulas localized on dynamic CT myelography were included in analyses. Whole-spine CT was scrutinized for the presence of degenerative changes at each spinal level. The proportion of levels positive for CSF venous fistula containing any degenerative findings was compared to levels without CSF venous fistula using the Fisher exact test. The Pearson correlation coefficient was calculated to explore the association between the burden of degenerative disease and BMI and age and between BMI and opening pressure. Forty-four patients with 49 total CSF venous fistulas were analyzed (5 patients had 2 CSF venous fistulas). Mean patient age was 62.3 (SD, 9.5) years. Forty-seven CSF venous fistulas were located in the thoracic spine; 1, in the cervical spine; and 1, in the lumbar spine. Within the thoracic spine, 39/49 (79.6%) fistulas were located between levels T7-8 and T12-L1. Forty-four of 49 (89.8%) CSF venous fistulas had degenerative changes at the same level. The levels without CSF venous fistulas demonstrated degenerative changes at 694/1007 (68.9%) total levels. CSF venous fistulas were significantly more likely to be present at spinal levels with associated degenerative changes (OR = 4.03; 95% CI, 1.58-10.27; P = .001). Age demonstrated a positive correlation with the overall burden of degenerative disease (correlation coefficient: 0.573, P < .001), whereas BMI did not (correlation coefficient: 0.076, P = .625). There was a statistically significant positive correlation between BMI and opening pressure (correlation coefficient: 0.321, P = .03). Results suggest a potential association between spinal degenerative disease and development of CSF venous fistula.

Spinal degeneration and lumbar multifidus muscle quality may independently affect clinical outcomes in patients conservatively managed for low back or leg pain

Few non-surgical, longitudinal studies have evaluated the relations between spinal degeneration, lumbar multifidus muscle (LMM) quality, and clinical outcomes. None have assessed the potential mediating role of the LMM between degenerative pathology and 12-month clinical outcomes. This prospective cohort study used baseline and 12-month follow-up data from 569 patients conservatively managed for low back or back-related leg pain to estimate the effects of aggregate degenerative lumbar MRI findings and LMM quality on 12-month low back and leg pain intensity (0–10) and disability (0–23) outcomes, and explored the mediating role of LMM quality between degenerative findings and 12-month clinical outcomes. Adjusted mixed effects generalized linear models separately estimated the effect of aggregate spinal pathology and LMM quality. Mediation models estimated the direct and indirect effects of pathology on leg pain, and pathology and LMM quality on leg pain, respectively. Multivariable analysis identified a leg pain rating change of 0.99 [0.14; 1.84] (unstandardized beta coefficients [95% CI]) in the presence of ≥ 4 pathologies, and a disability rating change of − 0.65 [− 0.14; − 1.16] for each 10% increase in muscle quality, but no effect on back pain intensity. Muscle quality had a non-significant mediating role (13.4%) between pathology and leg pain intensity. The number of different pathologies present demonstrated a small effect on 12-month leg pain intensity outcomes, while higher LMM quality had a direct effect on 12-month disability ratings but no mediating effect between pathology and leg pain. The relations between degenerative pathology, LMM quality, and pain-related outcomes appear complex and may include independent pathways.

Significance of radiographic temporomandibular degenerative joint disease findings

The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: (a) the incidence and prevalence of TMJ degenerative diseases, (b) similarities and differences of TMJ vs knee degenerative diseases, and (c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.

Are degenerative findings detected on traction MR arthrography of the hip associated with failure of arthroscopic femoroacetabular impingement surgery?

ObjectivesTo identify preoperative degenerative features on traction MR arthrography associated with failure after arthroscopic femoroacetabular impingement (FAI) surgery.MethodsRetrospective study including 102 patients (107 hips) undergoing traction magnetic resonance arthrography (MRA) of the hip at 1.5 T and subsequent hip arthroscopic FAI surgery performed (01/2016 to 02/2020) with complete follow-up. Clinical outcomes were assessed using the International Hip Outcome Tool (iHOT-12) score. Clinical endpoint for failure was defined as an iHOT-12 of < 60 points or conversion to total hip arthroplasty. MR images were assessed by two radiologists for presence of 9 degenerative lesions including osseous, chondrolabral/ligamentum teres lesions. Uni- and multivariate Cox regression analysis was performed to assess the association between MRI findings and failure of FAI surgery.ResultsOf the 107 hips, 27 hips (25%) met at least one endpoint at a mean 3.7 ± 0.9 years follow-up. Osteophytic changes of femur or acetabulum (hazard ratio [HR] 2.5–5.0), acetabular cysts (HR 3.4) and extensive cartilage (HR 5.1) and labral damage (HR 5.5) > 2 h on the clockface were univariate risk factors (all p < 0.05) for failure. Three risk factors for failure were identified in multivariate analysis: Acetabular cartilage damage > 2 h on the clockface (HR 3.2, p = 0.01), central femoral osteophyte (HR 3.1, p = 0.02), and femoral cartilage damage with ligamentum teres damage (HR 3.0, p = 0.04).ConclusionJoint damage detected by preoperative traction MRA is associated with failure 4 years following arthroscopic FAI surgery and yields promise in preoperative risk stratification.Clinical relevance statementEvaluation of negative predictors on preoperative traction MR arthrography holds the potential to improve risk stratification based on the already present joint degeneration ahead of FAI surgery.Key Points• Osteophytes, acetabular cysts, and extensive chondrolabral damage are risk factors for failure of FAI surgery.• Extensive acetabular cartilage damage, central femoral osteophytes, and combined femoral cartilage and ligamentum teres damage represent independent negative predictors.• Survival rates following hip arthroscopy progressively decrease with increasing prevalence of these three degenerative findings.Graphical

The association between cervical degenerative MRI findings and self-reported neck pain, disability and headache: a cross-sectional exploratory study

BackgroundNeck pain and headache are highly prevalent conditions and leading causes of disability worldwide. Although MRI is widely used in the management of these conditions, there is uncertainty about the clinical significance of cervical MRI findings in patients with neck pain or headache. Therefore, this study aims to investigate the association between cervical degenerative MRI findings and self-reported neck pain, neck disability, and headache.MethodsThis study was a secondary analysis of a cohort of patients with low back pain aged 18–40 years recruited from a non-surgical outpatient spine clinic. The cervical MRI and outcome measures used in this analysis were collected at a four-year follow-up (2014–2017). Self-reported outcome measures included neck pain intensity, neck disability as measured by the Neck Disability Index, and headache as measured by a single NDI item. Cervical MRI findings included disc degeneration, disc contour changes, and vertebral endplate signal changes (VESC). Multivariable logistic regression analyses, adjusted for age and sex, were used to analyse the associations between MRI findings and neck pain, neck disability, and headache.ResultsA total of 600 participants who underwent MRI and completed the relevant questionnaires at follow-up were included. The median age was 37 years (interquartile range 31–41) and 325 (54%) were female. Of the included participants, 181 (31%) had moderate or severe neck pain, 274 (59%) had moderate or severe neck disability, 193 (42%) reported headaches, and 211 (35%) had one or more cervical degenerative MRI findings. Cervical disc degeneration and disc contour changes were positively associated with moderate or severe neck pain with odds ratio 1.6 (95% CI 1.1–2.4) and 1.6 (1.1–2.3), respectively. VESC was associated with moderate or severe neck disability with odds ratio 3.3 (1.3–8.4). No statistically significant associations were found between the MRI findings assessed and headache.ConclusionsIn this cross-sectional exploratory study, we found that cervical disc degeneration and disc contour changes were associated with neck pain, and VESC was associated with neck disability. None of the MRI findings were associated with headache. The results suggest that cervical degenerative changes may contribute to the aetiology of neck symptoms, but the associations are modest and cannot guide clinical decisions.

Clinical and radiomics feature-based outcome analysis in lumbar disc herniation surgery

BackgroundLow back pain is a widely prevalent symptom and the foremost cause of disability on a global scale. Although various degenerative imaging findings observed on magnetic resonance imaging (MRI) have been linked to low back pain and disc herniation, none of them can be considered pathognomonic for this condition, given the high prevalence of abnormal findings in asymptomatic individuals. Nevertheless, there is a lack of knowledge regarding whether radiomics features in MRI images combined with clinical features can be useful for prediction modeling of treatment success. The objective of this study was to explore the potential of radiomics feature analysis combined with clinical features and artificial intelligence-based techniques (machine learning/deep learning) in identifying MRI predictors for the prediction of outcomes after lumbar disc herniation surgery.MethodsWe included n = 172 patients who underwent discectomy due to disc herniation with preoperative T2-weighted MRI examinations. Extracted clinical features included sex, age, alcohol and nicotine consumption, insurance type, hospital length of stay (LOS), complications, operation time, ASA score, preoperative CRP, surgical technique (microsurgical versus full-endoscopic), and information regarding the experience of the performing surgeon (years of experience with the surgical technique and the number of surgeries performed at the time of surgery). The present study employed a semiautomatic region-growing volumetric segmentation algorithm to segment herniated discs. In addition, 3D-radiomics features, which characterize phenotypic differences based on intensity, shape, and texture, were extracted from the computed magnetic resonance imaging (MRI) images. Selected features identified by feature importance analyses were utilized for both machine learning and deep learning models (n = 17 models).ResultsThe mean accuracy over all models for training and testing in the combined feature set was 93.31 ± 4.96 and 88.17 ± 2.58. The mean accuracy for training and testing in the clinical feature set was 91.28 ± 4.56 and 87.69 ± 3.62.ConclusionsOur results suggest a minimal but detectable improvement in predictive tasks when radiomics features are included. However, the extent of this advantage should be considered with caution, emphasizing the potential of exploring multimodal data inputs in future predictive modeling.

Severe preeclampsia complicated by HELLP syndrome alters the structure of Hofbauer and syncytiotrophoblast cells: ultrastructural and immunohistochemical study.

Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is generally considered to be a variant or complication of preeclampsia. It is a life-threatening obstetric complication. To evaluate the immunohistochemistry and ultrastructural of syncytiotrophoblastand Hoffbauer cells in placental villi of patients with HELLP syndrome. Two groups of patients with a total of 50 full-term human placentas (n = 25 in each group) were assigned as the control (normotensive) and HELLP syndrome. Placental tissue samples were fixed in 10% neutral formalin and paraffin-embedding protocol was performed. We prepared 5 μm sections for histological and immunohistochemical staining. Sections were immunostained with Hoffbauer cell marker CD68. For transmission electron microscopy (TEM), placental tissue samples were fixed in 2.5% buffered glutaraldehyde and then, in 1% osmium tetroxide for routine ultrastructural examinations. When the HELLP group fetal placental sections were examined, intracytoplasmic edema in syncytiotrophoblast, degenerative vacuoles, and degenerative findings on cell surface membranes were observed. Moreover, villous edema was remarkable. The number of CD68-positive Hoffbauer cells per villus control group sections was 0.23 ± 0.02 and the number of CD68-positive cells per villus in HELLP group placenta sections was 0.83 ± 0.12. The increase in the number of Hoffbauer cells per villus in the HELLP group was significant (P < 0.001). Compared with the control group, there was a significant increase in the number of Hoffbauer cells and syncytiotrophoblasts in the HELLP group, and degenerative changes were also observed in the ultrastructure of these cells. Pathology of the HELLP syndrome is in relation to CD68-positive placental macrophages.

Pathogenesis of the Hallux Valgus: Enthesopathy of the Metatarsosesamoid Ligament

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: It is generally accepted that failure of the medial supporting soft tissue structure of the metatarsophalangeal joint plays an important role in the development of hallux valgus. The metatarsosesamoid ligament (MSL), a component of the medial soft tissue, is an important structure that connects the metatarsal head and the sesamoid complex. The sesamoid complex works as a dynamic stabilizer of the metatarsal head. We hypothesized that the failure of the medial MSL causes instability of the first metatarsal bone, which leads to hallux valgus deformities. Therefore, the present study aimed to describe the detailed structure and degenerative findings of MSL and to clarify the mechanical stress of the MSL enthesis, considering the mechanism of failure of the medial supporting soft tissue structure. Methods: The first metatarsal heads and sesamoid bones with soft tissue were collected from twelve cadavers. Serial 4-μm thick section4-μm intervals and stained with toluidine blue (Fig. 1a). We described the detailed histological structures and degenerative findings of MSL. In addition, morphometric comparisons were made between the medial and lateral MSL entheses at the metatarsal head to evaluate the mechanical stress they. First, we measured the thickness of the uncalcified fibrocartilage (UF thickness) following a protocol adopted previously (Fig. 1b). Second, the degree of irregularity of the interface between the zones of calcified fibrocartilage and bone (CFB) at each enthesis was assessed as the ratio between the lengths of the CFB and the enthesis (CFB/ E ratio) (Fig. 1c). The differences in these parameters were evaluated using the paired T test and Wilcoxon signed-rank test (P &lt; 0.05). Results: We identified that the MSL entheses were fibrocartilaginous entheses, which consisted of four tissue zones. The region in which the MSL wraps around the articular surface of the metatarsal head contains a metachromatic area accompanied by fibrocartilage cells at the deep surface of the MSL, called the sesamoid fibrocartilage. At the MSL enthesis, pathological findings indicating enthesopathy were observed. One specimen showed the tear of the MSL at the wrap around region. The MSL enthesis tear was observed in two specimens with hallux valgus. Both UF thickness (P = 0.12, effect size r = 0.89) and CFB/E ratio (P = 0.17, effect size d = 0.35) were significantly greater in the medial MSL enthesis than those in the lateral MSL enthesis. Conclusion: In the present study, the MSL showed enthesis protecting structures such as enthesis fibrocartilage which contributes to dissipating bending forces during insertional angle change, complexed CFB interface which guards an enthesis against shearing forces and wrap around region which contributes to dissipating the shearing force to the enthesis. However, the medial MSL subject to the greater forces and the degenerative findings of enthesopathy were observed. On top of that, all four hallux valgus specimens with sesamoid complex dislocation showed MSL enthesis tear. Enthesopathy, particularly at the medial MSL, may be the cause of hallux valgus.

Is the type and/or co-existence of degenerative spinal pathology associated with the occurrence of degenerative cervical myelopathy? A single centre retrospective analysis of individuals with MRI defined cervical cord compression

BackgroundDegenerative cervical myelopathy (DCM) arises from spinal degenerative changes injuring the cervical spinal cord. Most cord compression is incidental, referred to as asymptomatic spinal cord compression (ASCC). How and why ASCC differs from DCM is poorly understood. In this paper, we study a local cohort to identify specific types and groups of degenerative pathology more likely associated with DCM than ASCC. MethodsThis study was a retrospective cohort analysis (IRB Approval ID: PRN10455). The frequency of degenerative findings between those with ASCC and DCM patients were compared using network analysis, hierarchical clustering, and comparison to existing literature to identify potential subgroups in a local cohort (N = 155) with MRI-defined cervical spinal cord compression. Quantitative measures of spinal cord compression (MSCC and MCC) were used to confirm their relevance. ResultsELF (8.7 %, 95 % CI 3.8–13.6 % vs 35.7 %, 95 % CI 27.4–44.0 %) Congenital Stenosis (3.9 %, 95 % CI 0.6–7.3 % vs 25.0 %, 95 % CI 17.5–32.5 %), and OPLL (0.0 %, 95 % CI 0.0–0.0 % vs 3.6 %, 95 % CI 0.3–6.8 %) were more likely in patients with DCM. Comparative network analysis indicated loss of lordosis was associated with ASCC, whilst ELF with DCM. Hierarchical Cluster Analysis indicated four sub-groups: multi-level disc disease with ELF, single-level disc disease without loss of lordosis and OPLL with DCM, and single-level disc disease with loss of lordosis with ASCC. Quantitative measures of cord compression were higher in groups associated with DCM, but similar in patients with single-level disc disease and loss of lordosis. ConclusionsThis study identified four subgroups based on degenerative pathology requiring further investigation.

Clinical and Radiological Changes at the Adjacent Segments Following Cervical Spine Surgery: A Retrospective Study

Background and Aim: Adjacent segment disease (ASD), radiological and clinical, is observed in many of the patients who undergo cervical inter-body fusion with/without graft, and with/without plating. This study aims to evaluate the proportion of ASD among patients who underwent cervical spine fusion surgery, to study the severity of degenerative radiographic findings at adjacent levels, and to determine sites and patterns of ASD. Methods and Materials/Patients: A descriptive study was performed on patients who underwent a previous cervical arthrodesis procedure in the last 2-5 years and continued follow-up as neurosurgery outpatients. A total of 59 patients who qualified for the inclusion criteria were included in the study. Results: Spine fixation was commonly performed at a single level mostly with sample size (54.2%, n=32) then at two levels (42.4%, n=25) and three levels (3.4%, n=2). Adjacent segment degeneration was present in the spine fixation level subgroup at a single level of 9 cases (28.12%), two levels of 9 cases (36%), and three-level fixations of 2 cases (100%). Six patients (10.2%) out of 59 patients developed radiculopathy. Among twenty-two cases (37.3%) with new changes at adjacent levels, reduced disc height was the most common one (18.6%, n=11). Anterior and posterior osteophytes with reduced disc height were found in 2 cases. Therefore, actual new changes were present in 20 cases only. The most common level of C4-C5 was observed for the development of ASD (13.6%, n=8). ASD developed at cranial to fusion in 13 cases (22%), caudal to fusion in 5 cases (8.5%), and at both levels in 2 patients. Conclusion: Adjacent segment disease was observed in a significant number of patients who underwent cervical spine surgery as evident from the results but only 6 out of 20 cases with radiological evidence of ASD were symptomatic. Changes were observed commonly at the C4/C5 level.

MRI Evaluation of Degenerative Lumbar Spine in Population Of Eastern Nepal

Introduction:Low back pain is the most commonly encountered symptom, with approximately 80% of individuals experiencing at least one instance of back pain throughout their lifetime. Magnetic resonance imaging is widely regarded as a highly effective diagnostic tool for assessing different factors contributing to back pain.Methods:The study included all patients who had a history of chronic low back pain and were referred for Magnetic resonance imaging at the Radiology Department of Nobel Medical College between September 1, 2020, and September 1, 2021. These patients were suspected to have degenerative diseases of the lumbar spine.Results:A total of 120 patients were included in the study, with ages ranging from 28 to 81 years (mean: 53.38 ± 11.5 years). Among these patients, 64 individuals (53.3%) were females. The most common finding observed was disc desiccation, which was present in 115 patients (95.8%). The prevalence of degenerative findings increased with age, indicating a correlation between age and degenerative changes in the lumbar spine.Conclusions:The study's conclusion states that Magnetic resonance imaging is the most sensitive imaging technique for evaluating low back pain related to degenerative changes. The use of Magnetic resonance imaging is recommended due to its lack of known side effects, absence of radiation exposure, and noninvasive nature. It was found that various types of degenerative changes can be present in symptomatic patients aged over40.

Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear.

The aim of the study was that the capsule remnant is a common indicator of sub-acromial impingement syndrome and bursal side onset rotator cuff tears. Sixty-three patients with capsule remnants in the rotator cuff footprint (Study group) were detected, while the 53 patients did not have any remnant on the tendon footprint (Control group) between 2015 and 2020 were included. Demographic data of patients, such as age, gender, and operated side information were obtained from the archive files. Acromion type, presence of osteophytes in the acromioclavicular joint, Acromiohumeral Distance (AHD), Acromial Index (AI), Critical Shoulder Angle (CSA), and Coracoacromial Ligament (CAL) degeneration values were evaluated from preoperative MRI, radiographic images, and arthroscopic video recordings. Severe stages of CAL degeneration were observed in 82.5% of the patients who had capsule remnant (p: 0.001). While type 2 acromion was found in 61.9%, and also acromioclavicular joint osteophyte was found in 58.7% of the patients in the study group. The mean AHD was 8.22 ± 1.56mm in the study group and 9.2 ± 1.3mm in the control group. The mean CSA was 43.3 ± 4.9 in the study group and 40.8 ± 4.2 in the control group. The AI was measured as 0.8 ± 0.1 in the study group and 0.8 ± 0.01 in the control group. As a result of these measurements, a statistical difference was found between the two groups in terms of type 2 acromion ratio (p < 0.001), presence of osteophytes in the acromioclavicular joint (p < 0.001), mean acromio-humeral distance (p < 0.001), critical shoulder angle (p = 0.004), and acromial index values (p < 0.001). The findings of sub-acromial impingement syndrome were found to be more prominent in patients with full-thickness degenerative tear and findings of capsular remnant in the footprint. If the presence of the current finding is detected during glenohumeral arthroscopy, sub-acromial impingement syndrome should be examined in more detail to reveal the underlying cause and prevent a recurrence.

Evaluation of Thermal Changes of the Sole Surface in Horses with Palmar Foot Pain: A Pilot Study.

Horses with palmar foot pain do not show a typical increase in temperature in the palmar aspect of the hoof and heel due to low blood flow. The objectives of the current study were to determine the changes and differences in the thermographic pattern of the sole surface in horses with unilateral palmar foot pain and non-lame horses before and after training. We hypothesized that the thermal pattern and the local temperature of the frog area and toe area would be similar, with an increased local temperature after training in both lame and non-lame horses. A pilot study was conducted to investigate the accuracy of thermography used to detect changes in local temperature and to compare the thermal patterns observed on the sole surface after training. The study group included eight horses with unilateral forelimb palmar foot pain (n = 8) and healthy contralateral limbs (n = 8). Four additional non-lame horses served as controls. The horses were selected for the study based on the following criteria: forelimb with unilateral chronic progressive lameness and positive reactions when performing the hoof test and frog wedge test, degenerative findings of the navicular bone, and improvement in lameness after perineural analgesia of the medial and lateral palmar digital nerve. The local temperatures of the frog and toe areas were measured before and after training in the affected and contralateral limbs in the study group and both forelimbs in the control group using an FLIR E50 thermal camera. Receiver operating characteristic (ROC) curve analysis was applied to check the sensitivity and specificity of the results for the studied groups. The thermal patterns of the hoof presented differences between the three groups of horse limbs. After training, the temperature of the sole surface increased, and its area increased in the limbs affected with palmar foot pain compared with the non-lame limbs in the study group and the limbs in the control group. The temperature of the frog area did not increase after training in the limbs affected with palmar foot pain compared with the same area in the other groups. The ROC curve analysis demonstrated the medical applicability of this tool and showed that thermography is a reliable diagnostic test to correctly discriminate between non-lame horses and those with palmar foot pain. We recommend thermographic scanning of the toe and frog area to detect changes in the local temperature of the sole surface after training to discriminate the horses with palmar foot pain from non-lame ones. Further investigation is required to clarify whether the observed thermographic imaging features of the sole surface are characteristic for horses with palmar foot pain.

Comparison of magnetic resonance imaging findings among sciatica patients classified as centralizers or non-centralizers

ABSTRACT Objective To compare if the degenerative findings from MRI differ between the sciatica patients classified as centralizers (CEN) and non-centralizers (Non-CEN) according to the McKenzie Method of mechanical diagnosis and therapy. Study Design A cross-sectional study. Methods Patients (N = 100) referred to a spine clinic of a single tertiary hospital for specialist consultation for sciatica. The McKenzie-based assessment was performed by the mechanical diagnosis and therapy-trained physiotherapists. Clinical data and prevalence of lumbar MRI findings were compared between the groups. Results There was no significant difference in leg pain intensity between the groups. The Non-CEN had significantly more intense back pain, mean 56 (SD 30) and were more disabled 44 (SD 15) compared to the CEN mean 41 (SD 25) and mean 31 (11), measured with a visual analogue scale (0–100), and the Oswestry Disability Index (0–100), respectively. The CEN had more severe degenerative findings on MRI than the Non-CEN: vertebral end-plate changes were 63% and 43%; mean Pfirrmann’s disc degeneration lumbar summary score was 12.8, and 10.6; and severity score of total damage was 12.0 and 10.1, respectively. There were differences neither in disc contour changes nor nerve root stenosis on MRI. Conclusions Sciatica patients classified as non-centralizers had significantly more severe back pain, and were significantly more disabled than centralizers, who instead had more severe degenerative findings on MRI. Thus, classification to non-centralizers by the McKenzie method seems not predict higher incidence of degenerative findings on MRI compared to centralizers.

SEVERE PRE-ECLAMPSIA COMPLICATED BY HELLP SYNDROME IN THE HOFFBAUER AND SYNCYTIOTROPHOBLAST CELLS (ULTRASTRUCTURAL AND IMMUNOHISTOCHEMICAL STUDY)

The aim of this study was to evaluate the immunohistochemistry and ultrastructural of syncytiotrophoblast and Hoffbauer cells in placental villi of HELLP syndrome patients. Placental samples with twenty control (normotensive) and twenty HELLP syndrome were fixed in 10% neutral formalin solution for paraffin-embedding wax protocol. Placental samples were fixed in 2.5% buffered glutaraldehyde and then, in 1% osmium tetra oxide for routine electron microscopic procedure. When the HELLP group fetal placental sections were examined, intracytoplasmic edema in syncytiotrophoblast, degenerative vacuoles and degenerative findings on cell surface membranes were observed. Moreover, villous edema was remarkable. The number of CD68 positive Hoffbauer cells per villus control group sections was 0.23 ± 0.02 and the number of CD68 positive cells per villus in HELLP group placenta sections was 0.83 ± 0.12 . The increase in the number of Hoffbauer cells per villus in the HELLP group was statistically significant (p

Assessment and nonsurgical management of low back pain: a narrative review.

Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.

Has Arthroscopic Meniscectomy Use Changed in Response to the Evidence? A Large-database Study From Spain.

Several randomized clinical trials on the treatment of meniscal tears have shown that surgery is not superior to nonoperative treatment in middle-aged and older adults. However, clinical practice has not changed consistently worldwide in response to this evidence, and arthroscopic meniscectomy remains one of the most frequently performed operations. (1) How has the use of arthroscopic meniscectomy changed in Spain between 2003 and 2018, particularly in middle-aged (35 to 59 years) and older patients (over 60 years) relative to younger patients? (2) How have surgical volumes changed across different healthcare areas in the same health system? (3) How has the proportion of outpatient versus inpatient arthroscopic procedures changed over time? Data on all 420,228 arthroscopic meniscectomies performed in Spain between 2003 and 2018 were obtained through the Atlas of Variations in Medical Practice project (these years were chosen because data in that atlas for 2002 and 2019 were incomplete). This database has been promoted by the Spanish Health Ministry since 2002, and it collects basic information on all admissions to public and public-private partnership hospitals. The Spanish population of 2003 was used to calculate age- and sex-standardized rates of interventions per 10,000 inhabitants and year. To assess the change in standardized rates among the age groups over the study period, a linear regression analysis was used. Standard small-area variation statistics were used to analyze variation among healthcare areas. Data on outpatient surgery and length of stay for inpatient procedures were also included. The standardized rate of arthroscopic meniscectomy in Spain in 2003 was 4.8 procedures per 10,000 population (95% CI 3.9 to 5.6), while in 2018, there were 6.3 procedures per 10,000 population (95% CI 5.4 to 7.3), which represents an increase of 33%. Standardized rates increased slightly in the age group < 35 years (0.06 interventions per 10,000 inhabitants per year [95% CI 0.05 to 0.08]), whereas they increased more markedly in the age groups of 35 to 59 years (0.14 interventions per 10,000 inhabitants per year [95% CI 0.11 to 0.17]) and in those 60 years and older (0.13 interventions per 10,000 inhabitants per year [95% CI 0.09 to 0.17]). The variability among healthcare areas in the meniscectomy rate progressively decreased from 2003 to 2018. In 2003, 32% (6544 of 20,384) of knee arthroscopies were performed on an outpatient basis, while in 2018, these accounted for 67% (19,573 of 29,430). We observed a progressive increase in arthroscopic meniscectomies in Spain; this procedure was more prevalent in older patients presumed to have degenerative pathologic findings. This increase occurred despite increasing high-level evidence of a lack of the additional benefit of meniscectomy over other less-invasive treatments in middle-aged and older people. Our study highlights the need for action in health systems with the use of financial, regulatory, or incentive strategies to reduce the use of low-value procedures, as well as interventions to disseminate the available evidence to clinicians and patients. Research is needed to identify the barriers that are preventing the reversal of interventions that high-quality evidence shows are ineffective. Level III, therapeutic study.

Lateral elbow tendinopathy and artificial intelligence: Binary and multilabel findings detection using machine learning algorithms.

BackgroundUltrasound (US) is a valuable technique to detect degenerative findings and intrasubstance tears in lateral elbow tendinopathy (LET). Machine learning methods allow supporting this radiological diagnosis.AimTo assess multilabel classification models using machine learning models to detect degenerative findings and intrasubstance tears in US images with LET diagnosis.Materials and methodsA retrospective study was performed. US images and medical records from patients with LET diagnosis from January 1st, 2017, to December 30th, 2018, were selected. Datasets were built for training and testing models. For image analysis, features extraction, texture characteristics, intensity distribution, pixel-pixel co-occurrence patterns, and scales granularity were implemented. Six different supervised learning models were implemented for binary and multilabel classification. All models were trained to classify four tendon findings (hypoechogenicity, neovascularity, enthesopathy, and intrasubstance tear). Accuracy indicators and their confidence intervals (CI) were obtained for all models following a K-fold-repeated-cross-validation method. To measure multilabel prediction, multilabel accuracy, sensitivity, specificity, and receiver operating characteristic (ROC) with 95% CI were used.ResultsA total of 30,007 US images (4,324 exams, 2,917 patients) were included in the analysis. The RF model presented the highest mean values in the area under the curve (AUC), sensitivity, and also specificity by each degenerative finding in the binary classification. The AUC and sensitivity showed the best performance in intrasubstance tear with 0.991 [95% CI, 099, 0.99], and 0.775 [95% CI, 0.77, 0.77], respectively. Instead, specificity showed upper values in hypoechogenicity with 0.821 [95% CI, 0.82, −0.82]. In the multilabel classifier, RF also presented the highest performance. The accuracy was 0.772 [95% CI, 0.771, 0.773], a great macro of 0.948 [95% CI, 0.94, 0.94], and a micro of 0.962 [95% CI, 0.96, 0.96] AUC scores were detected. Diagnostic accuracy, sensitivity, and specificity with 95% CI were calculated.ConclusionMachine learning algorithms based on US images with LET presented high diagnosis accuracy. Mainly the random forest model shows the best performance in binary and multilabel classifiers, particularly for intrasubstance tears.