Fourth Lumbar Vertebra Research Articles

A preliminary study on the effect of renal function on the metabolism of 18F-FDG in the human cerebellum.

The cerebellum is less affected by normal aging or neurodegenerative diseases, the aim of this paper is to investigate the effect of renal function status on uptake of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in human cerebellum based on independent creatinine (CRE) or blood urea nitrogen (BUN) levels. A total of 253 patients who underwent 18F-FDG PET/CT scans were included. The patients were divided into groups according to renal function status: 201 patients with normal renal function, 16 patients with increase CRE, 36 patients with decrease CRE, and 31 patients with abnormal BUN. The maximum standardized uptake values were obtained in regions of interest (ROIs) for multiple tissue types (right cerebellum, right lobe of liver, right lung, bone marrow and psoas muscle at the level of the fourth lumbar vertebra). Moreover, the selected normal CRE groups were pair-matched with CRE decrease group with respect to age, sex, body mass index and glucose, respectively. Among 253 patients who met the inclusion/exclusion criteria, the final analysis included 967 ROIs (244 cerebellum, 191 lungs, 230 muscles, 145 bone marrow, and 157 liver) from 18F-FDG PET/CT scans. Among patients grouped by CRE or BUN levels, the uptake of 18F-FDG by cerebellum was significantly decreased in patients with CRE decrease level (P=0.001). There were no statistically significant differences between the other groups. Matched-pair analysis indicated there were no significant changes in outcomes between the CRE decrease group and the age-, sex-, BMI-, and glucose-matched controls compared to pre-matching. In patients with normal renal function and reduced CRE concentration, decrease cerebellar glucose metabolism was observed; however, no abnormal uptake of 18F-FDG was found in the cerebellum and other normal tissues of patients with impaired renal function. Consequently, in the study of cerebellar 18F-FDG metabolism, it may be necessary to consider the influence of blood CRE level.

Morphology and morphometry of the spinal cord and meninges in Egyptian Baladi goat (Capra hircus): Stereomicroscopy of blue-stained gray matter.

The study objective is to obtain normal morphology and morphometric data from Baladi goat spinal cord segments. Using Tompsett's technique for staining gray matter with a blue stain allowed us to calculate the quantity or area of gray and white matter and thus the total area of each segment. The spinal cord of the goat started at the extent of the middle-third of the occipital condyles, and the tapered end of the spinal cord terminated at the center of the first sacral vertebra. The total length of the spinal cord was 73.3 ± 2.5 cm on average. C3 was the longest spinal segment, measuring 3.95 cm. The gray matter area had a high value at the cervical and lumbar enlargements, with C8 having the highest value of gray matter cross sectional area at 12 mm2 and C7 having the highest value of white matter cross sectional area at 42 mm2 . The area of white matter of the cervical region was higher than that of the other spinal regions. At C7, the total cross section area reached its maximum of 53 mm2 . The cervical enlargement included segments from C6 to T1, while the lumbar enlargement included L5 to S1. The dura mater is connected cranially to the dens of the axis and caudally to the fourth and fifth lumbar vertebrae. The epidural space height between lumbar vertebrae was 2 mm in all lumbar spaces and 3 mm in the lumbosacral space. The normal morphology and morphometric data of the goat spinal cord segments may be useful in pathological conditions of the spinal cord and during epidural anaesthesia technique.

Pelvic insufficiency fractures after intensity modulated radiation therapy combined with chemotherapy for cervix carcinoma: Incidence and impact of bone mineral density

Background and PurposeThe aim of this study was to evaluate the incidence and predictive factors of Pelvic Insufficiency Fractures (PIFs) occurring after Intensity Modulated Radiation Therapy (IMRT) combined with chemotherapy for locally advanced cervical cancer (CC).Material and methodsMedical records of patients receiving radio-chemotherapy with IMRT between 2010 and 2020 for advanced CC were reviewed. PIFs were detected during follow-up on pelvic Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The cumulative incidence rate of PIFs and its confidence interval were calculated at 2 and 5 years of follow-up. Pre-therapeutic Bone Mineral Density (BMD) (g/cm3) was evaluated on CT simulation for sacrum and the fourth lumbar (L4) vertebrae. Sacrum dosimetric parameters (V30Gy, V40Gy, D50%, Dmean) were analyzed.Results136 patients were included. The median follow-up was 4.4 years. Median dose of D50% and V40Gy sacrum were 35.2 Gy (20.6–46.4) and 32.2% (7.2–73.4) respectively. The 2-year and 5-year cumulative incidence rates were 15.7% (95% CI: 9.88–22.71) and 22% (95% CI: 14.58–30.45) respectively. Median time interval between RT completion and PIFs’ detection was 11.5 months (IQR: 7.4–22.3). Univariate analysis showed that older age (p < 0.01), postmenopausal status at baseline (p < 0.01), and lower sacral and spinal BMD at baseline (respectively p < 0.001 and p < 0.01) were significantly associated to all sites of PIFs, and lower sacral BMD with sacral fractures (p < 0.001).ConclusionPost-IMRT PIFs were detected in 18.4% of patients with locally advanced CC. Individual predisposing factors as older age, postmenopausal status, decreased bone density on the CT simulation were mainly predictive.

Finite element analysis of lattice designed lumbar interbody cage based on the additive manufacturing.

Additive manufacturing (AM) methods, which facilitate the production of complex structures with different geometries, have been used in producing interbody cages in recent years. In this study, the effects of Ti6Al4V alloy interbody lattice designed fusion cages between the third and fourth lumbar vertebrae where degenerative disc diseases occur were investigated using the finite element method. Face centered cubic (FCC), body centered cubic (BCC), and diamond structures were selected as the lattice structure suitable for the interbody cage. A kidney shaped interbody lumbar cage was designed. The designated lattice structures were selected by adjusting the cell sizes suitable for the designed geometry, and the mesh configuration was made by the lumbar lattice structure. 400 N Axial force and 7.5 N.m moments were applied to the spine according to lateral bending, flexion, and torsion. 400 N axial force and 7.5 N.m flexion moment is shown high strain and total deformation then lateral bending and torsion on BCC FCC and diamond lattice structured interbody cages. In addition, the effects of lattice structures under high compression forces were investigated by applying 1000 N force to the lattice structures. When von Mises stresses were examined, lower von Mises stress and strains were observed in the BCC structure. However, a lower total deformation was observed in the FCC. Due to the design of the BCC and the diamond structure, it is assumed that bone implant adhesion will increase. In the finite element analysis (FEA), the best results were shown in BCC structures.

The Role of Magnetic Resonance Imaging in the Diagnosis of Spinal Dumbell Neurofibromatosis: A Case Report from a Specialist Hospital in Port Harcourt

Neurofibromatosis occurring in the spine also known as spinal neurofibromatosis (SNF) is a rare disease entity and they occur either unilaterally or bilaterally at the spinal roots. The low prevalence rate of the disease and scarcity of previous literatures is the main aim for this report.&#x0D; Our case study is a 29-years-old lady who presented to the Radiology department for a lumbosacral spine MRI, on account of both lower limb weakness, paresthesia, unsteady gait and finally inability to walk. The symptoms have been there since she was 14 years (15 years of progressive symptoms). She also presented with multiple macules on the skin (café au lait spots). Magnetic Resonance Imaging (MRI) of the lumbosacral spine revealed bilateral spinal neurofibromas at the spinal roots of the fourth lumbar vertebra to the sacral/coccygeal vertebrae with destruction of the sacro-coccygeal bones. MRI of the brain revealed no abnormalities in the brain and optic tract. The patient fulfilled the National Institutes of Health (NIH) criteria and that of revised diagnostic criteria for Neurofibromatosis (NF1).&#x0D; The patient also presented with lack of pain which could be due to impairment in sensory neurons. We describe a case of spinal neurofibromatosis diagnosed by MRI in a young lady with progressive lower limb weakness, paresthesia, sensory loss, café-au- lait spots and paraplegia.

Spectral parameters of gait differentiate diabetic patients from healthy individuals

BackgroundDiabetes mellitus (DM) is a clinical condition that affects gait performance and control in millions of individuals worldwide. Contrary to basic spatiotemporal parameters, gait-based spectral analysis may provide useful insights into gait neuromotor control. Hence, this study was set to investigate the spectral content of gait at the preferred speed in patients with DM. MethodsTotal 1117 individuals [658 DM and 649 healthy adults (HA)] performed a 10 m walk while wearing an inertial measurement unit over the fourth lumbar vertebra. Mann-Whitney-U test was used for between-group gait parameters comparisons. ResultsDM group had a slower step time (1.2%, p < 0.05) and gait speed (2.4%, p < 0.05) than HA. Additionally, DM individuals showed reduced dominant frequency (DM:0.24 Hz vs HA:0.25 Hz on average, p < 0.05). Increased antero-posterior and vertical dominant frequency width (DM:1.73 Hz vs HA:1.76 Hz on average, p < 0.05) and medio-lateral relative power spectral density at the dominant frequency (DM:6.19% vs HA:5.96%, p < 0.05). ConclusionsIt was demonstrated for the first time that the gait spectral content, not only corroborates spatiotemporal characteristics, but also provides further insight into their neuromotor control deficits in diabetic patients. Ultimately, this type of analysis in the diabetic population can help guide the therapeutic interventions to prevent diabetic foot.

Low bone mineral density is associated with fatty liver disease and respiratory illness in a pediatric mortality sample.

Chronic illness leads to decreased bone modeling and remodeling. This can be especially problematic during childhood and adolescence, since the majority of an individual's peak bone mass is achieved by the age of 20. In this study, we examine relationships between chronic illness and low bone mineral density (BMD) in a pediatric mortality sample (aged 0.5 to 20.9years) from New Mexico. We also test whether low BMD is related to decelerated linear growth by examining its relationship to growth stunting and arrest (Harris lines). Hounsfield units (HU), a proxy for trabecular BMD, were obtained at the fourth lumbar vertebra and the femoral neck from postmortem CT scans. Linear regression was used to examine associations between z-standardized HU and age, sex, medical conditions, Harris lines, and growth stunting. We find that lumbar HU is significantly lower for individuals with fatty liver disease and respiratory illness; femoral HU is significantly lower in individuals with Harris lines. The mechanisms of low BMD in individuals with fatty liver disease and respiratory illness are likely multifactorial and involve vitamin D deficiency (malnutrition, malabsorption), systemic inflammation, and sedentary lifestyles. However, better awareness of this relationship can provide clinicians with the ability to introduce nutritional and behavioral interventions early to mitigate deleterious effects on bone. Harris lines, on the other hand, mark temporary growth cessation due to physiological stress followed by a rapid resumption of growth. Low BMD in these individuals may be due to bone mineralization lagging behind relatively rapid linear growth.

Stabbed to death: an osteobiography example of violence among Longobards (Povegliano Veronese, Italy, 6th-8th c CE)

Herewe report the reconstruction of the osteobiography of an adult male buried in the Longobard cemetery of Povegliano Veronese (Northern Italy, late 6th – early 8th century CE), who shows signs of interpersonal violence. The palaeopathological investigation reveals sharp force traumas on the body of the fourth lumbar vertebra and on two right ribs. The absence of signs of healing or bone remodelling indicates that the defects were perimortem. The injuries probably affected vital organs, leading to death. Further macroscopic observations of the skeleton suggest horseback-riding activity. Strontium isotope data from tooth enamel indicate a non-local origin of the individual. X-ray and CT scan acquisition and Scanning Electron Microscopy analyses were performed to investigate the bone defects. His osteobiography was interpreted and contextualised in the complex socio-political scenario of post-classical Italy. The results document that he spent his childhood outside the Povegliano Veronese area, that during his life he was likely a horseback rider active in battle, but that his violent death did not happen during warfare/battle. This multi-layered approach, supported by archaeological information, osteological investigation, biomolecular analysis, and virtual imagery, allowed for the extensive reconstruction of an individual's life history.

Association between periodontitis and disc structural failure in older adults with lumbar degenerative disorders: A prospective cohort study

BackgroundBacterial microbiome as a putative trigger of inflammation might indicate the cascade of mouth-gut-disc axis for causing intervertebral disc (IVD) structural failures (such as IVD degeneration and endplate change) processed. However, direct evidence for the mouth-gut-disc axis still unclear. Therefore, it is interesting to explore periodontal inflammation related to IVD structural failures and clinical outcomes.MethodsThis prospective cohort study enrolled older adults (aged ≥ 75 years) who scheduled to undergo elective open lumbar spine surgery. Demographic, radiological, clinical, and periodontal parameters were recorded. Independent samples t-test and Pearson’s correlation analysis were calculated.ResultsA total of 141 patients with lumbar degenerative disorders (56 males and 85 females; age 79.73 ± 3.34 years) were divided into edentulous group (19 patients), No/Mild group (84 patients), and Moderate/Severe group (38 patients). The incidence rates of IVD degeneration in each lumbar segmental level based on Pfirrmann grade and endplate change in the fourth and fifth lumbar vertebrae, and Visual Analogue Scale (VAS) low back pain (LBP) and leg pain of patients at preoperative in dentate group was significantly higher compared with edentulous group, especially the comparisons between Moderate/Severe and edentulous groups. There were no significant differences in the range of motion, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and disc height between dentate and edentulous groups. There was a positive association between plaque index (PLI) and pain scores (VAS LBP: r = 0.215, P = 0.030 and VAS leg pain: r = 0.309, P = 0.005), but no significant difference in Oswestry disability index (ODI) score.ConclusionResults show that the severity of periodontitis is associated with higher incidence rates of IVD degeneration and endplate change and clinical outcomes in older adults with lumbar degenerative disorders. Furthermore, the discovery of these relationships unveils a novel mechanism through which the alterations in oral microbiome composition potentially promote IVD degeneration and pain.

Biomechanical investigation of long spinal fusion models using three-dimensional finite element analysis

BackgroundThis study represents the first finite element (FE) analysis of long-instrumented spinal fusion from the thoracic vertebrae to the pelvis in the context of adult spinal deformity (ASD) with osteoporosis. We aimed to evaluate the von Mises stress in long spinal instrumentation for models that differ in terms of spinal balance, fusion length, and implant type.MethodsIn this three-dimensional FE analysis, FE models were developed based on computed tomography images from a patient with osteoporosis. The von Mises stress was compared for three different sagittal vertical axes (SVAs) (0, 50, and 100 mm), two different fusion lengths (from the pelvis to the second [T2-S2AI] or 10th thoracic vertebra [T10-S2AI]), and two different types of implants (pedicle screw or transverse hook) in the upper instrumented vertebra (UIV). We created 12 models based on combinations of these conditions.ResultsThe overall von Mises stress was 3.1 times higher on the vertebrae and 3.9 times higher on implants for the 50-mm SVA models than that for the 0-mm SVA models. Similarly, the values were 5.0 times higher on the vertebrae and 6.9 times higher on implants for the 100-mm SVA models than that for the 0-mm SVA models. Higher SVA was associated with greater stress below the fourth lumbar vertebrae and implants. In the T2-S2AI models, the peaks of vertebral stress were observed at the UIV, at the apex of kyphosis, and below the lower lumbar spine. In the T10-S2AI models, the peaks of stress were observed at the UIV and below the lower lumbar region. The von Mises stress in the UIV was also higher for the screw models than for the hook models.ConclusionHigher SVA is associated with greater von Mises stress on the vertebrae and implants. The stress on the UIV is greater for the T10-S2AI models than for the T2-S2AI models. Using transverse hooks instead of screws at the UIV may reduce stress in patients with osteoporosis.

Osteoporotic vertebral compression fractures caused by Cushing’s syndrome in young women: case report and literature review

BackgroundCushing’s syndrome is known as an important cause of secondary osteoporosis, characterized by reduction of bone mineral density and potential occurrence of fragility fractures before diagnosis in young population. Therefore, for young patients with fragility fractures, especially in young women, more attention should be paid on glucocorticoid excess caused by Cushing’s syndrome, due to relatively higher rate of misdiagnosis, distinct pathological characteristics and different treatment strategies compared with violent fractures and primary osteoporosis related fractures.Case presentationWe presented an unusual case of a 26-year-old woman with multiple vertebral compression fractures and pelvis fractures, subsequently diagnosed as Cushing’s syndrome. On admission, the radiographic results showed fresh second lumbar vertebra fracture, and old fourth lumbar vertebra and pelvic fractures. The dual energy X-ray absorptiometry of lumbar spine revealed marked osteoporosis, and her plasm cortisol was extremely high. Then, Cushing’s syndrome, caused by left adrenal adenoma, was diagnosed by further endocrinological and radiographic examinations. After receiving left adrenalectomy, her plasma ACTH and cortisol values returned to normal level. In term of OVCF, we adopted conservative treatments, including pain management, brace treatment, and anti-osteoporosis measures. Three months after discharge, the patient’s low back pain was in complete remission without new onset of pain, and returned to normal life and work. Furthermore, we reviewed the literatures on advancements in the treatment of OVCF caused by Cushing’s syndrome, and based on our experiences, proposed some additional perspectives to guide treatment.ConclusionIn term of OVCF secondary to Cushing’s syndrome without neurological damage, we prefer systematic conservative treatments, including pain management, brace treatment, and anti-osteoporosis measures, to surgical treatment. Among them, anti-osteoporosis treatment has the highest priority because of the reversibility of osteoporosis caused by Cushing’s syndrome.

Deep learning in sex estimation from a peripheral quantitative computed tomography scan of the fourth lumbar vertebra—a proof-of-concept study

Sex estimation is a key element in the analysis of unknown skeletal remains. The vertebrae display clear sex discrepancy and have proven accurate in conventional morphometric sex estimation. This proof-of-concept study aimed to investigate the possibility to develop a deep learning algorithm for sex estimation even from a single peripheral quantitative computed tomography (pQCT) slice of the fourth lumbar vertebra (L4). The study utilized a total of 117 vertebrae from the Terry Anatomical Collection. There were 58 male and 59 female cadavers, all of the white ethnicity, with the average age at death 49 years and a range of 24 to 77 years. A coronal pQCT scan was taken from the midway of the L4 corpus. Sex estimation was performed in a total of 19 neural network architectures implemented in the AIDeveloper software. Of the explored architectures, a LeNet5-based algorithm reached the highest accuracy of 86.4% in the test set. Sex-specific classification rates were 90.9% among males and 81.8% among females. This preliminary finding advances the field by encouraging and directing future research on artificial intelligence-based methods in sex estimation from individual skeletal traits such as the vertebrae. Combining quickly obtained imaging data with automated deep learning algorithms may establish a valuable pipeline for forensic anthropology and provide aid when combined with traditional methods.

Using Peromyscus leucopus as a biomonitor to determine the impact of heavy metal exposure on the kidney and bone mineral density: results from the Tar Creek Superfund Site.

Human population growth and industrialization contribute to increased pollution of wildlife habitats. Heavy metal exposure from industrial and environmental sources is still a threat to public health, increasing disease susceptibility. In this study, I investigated the effects of heavy metals (cadmium (Cd), lead (Pb), and zinc (Zn)) on kidney and bone density. This study aims to determine the concentrations of Cd, Pb, and Zn in soil and compare them to the levels of the same metals in Peromyscus leucopus kidney tissue. Furthermore, the study seeks to investigate the impact of heavy metals on bone density and fragility using the fourth lumbar vertebra (L4) of P. leucopus. Cd, Pb, and Zn concentrations in soil specimens collected from Tar Creek Superfund Site (TCSFS), Beaver Creek (BC), and two reference sites (Oologah Wildlife Management Area (OWMA) and Sequoyah National Wildlife Refuge (SNWR)). Heavy metal concentrations were analyzed using inductively coupled plasma-mass spectroscopy (ICP-MS). Micro-computed tomography (µCT) was used to assess the influence of heavy metals on bone fragility and density. On the one hand, soil samples revealed that Pb is the most common pollutant in the sediment at all of the investigated sites (the highest contaminated site with Pb was TCSFS). Pb levels in the soil of TCSFS, BC, OWMA, and SNWR were found to be 1,132 ± 278, 6.4 ± 1.1, and 2.3 ± 0.3 mg/kg in the soil of TCSFS, BC and OWMA and SNWR, respectively. This is consistent with the fact that Pb is one of the less mobile heavy metals, causing its compounds to persist in soils and sediments and being barely influenced by microbial decomposition. On the other hand, the kidney samples revealed greater Cd levels, even higher than those found in the soil samples from the OWMA and SNWR sites. Cd concentrations in the kidney specimens were found to be 4.62 ± 0.71, 0.53 ± 0.08, and 0.53 ± 0.06 µg/kg, respectively. In addition, micro-CT analysis of L4 from TCSFS showed significant Pearson's correlation coefficients between Cd concentrations and trabecular bone number (-0.67, P ≤ 0.05) and trabecular separation (0.72, P ≤ 0.05). The results showed no correlation between bone parameters and metal concentrations at reference sites. This study is one of the few that aims to employ bone architecture as an endpoint in the field of biomonitoring. Furthermore, this study confirmed some earlier research by demonstrating substantial levels of heavy metal contamination in soil samples, kidney samples, and P. leucopus L4 trabecular bone separations from TCSFS. Moreover, this is the first study to record information regarding bone microarchitecture parameters in P. leucopus in North America.

Effectiveness of quantitative bone SPECT/CT for bone metastasis diagnosis.

This study was conducted to investigate the utility of standardized uptake value (SUV) derived from bone single photon emission tomography/computed tomography (SPECT/CT) for diagnosing bone metastasis. One hundred forty-seven patients with malignant cancer (breast or prostate cancer), joint disorders, primary skeletal disease, or cartilaginous bone neoplasms who underwent skeletal quantitative SPECT/CT were retrospectively investigated. Acquired data were classified as normal fourth lumbar vertebra, skeletal degenerative changes, or bone metastasis. Receiver operating characteristic (ROC) curves were used to determine the optimum cut-off value for SUVmax to distinguish among these diagnoses. Mean SUVmax values for the normal L4 bone (n=101), skeletal degenerative changes (n=47) and bone metastasis (n=64) groups were 4.47±1.66 (range 1.01-11.25), 6.99±2.58 (2.21-14.6), and 25.4±15.7 (3.88-98.87), respectively. Compared to the other two groups, SUVmax for the bone metastasis group was significantly higher (P<0.001). In the normal bone group, sensitivity, specificity and accuracy for discriminating bone metastasis were 96.3%, 95.1%, and 95.7% respectively, with a best SUVmax cut-off value of 7.40. For the skeletal degenerative changes group sensitivity, specificity and accuracy were 87.5%, 93.6%, and 90.4% respectively, with a best SUVmax cut-off value of 11.26. Quantitative bone SPECT/CT may be useful for bone metastasis diagnosis.

Contrast Spread After Erector Spinae Plane Block at the Fourth Lumbar Vertebrae: A Cadaveric Study.

In recent years, the erector spinae plane block (ESPB) has seen widespread use to treat acute and chronic pain in the regions of the thoracic spine. While limited data suggest its increasing utilization for pain management distal to the thoracic, abdomen and trunk, the anesthetic spread and analgesic mechanism of ESPB at the level of the lumbar spine has not been fully described or understood. This is an observational anatomic cadaveric study to assess the distribution of solution following an ESPB block performed at the fourth lumbar vertebrae (L4) using ultrasound guidance to evaluate the spread of a 20ml solution consisting of local anesthetic and methylene blue. The study was performed in an anatomy lab in a large academic medical center. Following injection of local anesthetic with contrast dye, cadaveric dissection was performed to better understand the extent of contrast dye and to determine the degree of staining to further predict analgesic potential. We reviewed the findings of other ESPB cadaveric studies currently available for comparison. Following cadaveric dissection in an anatomy lab, the contrast dye was observed in the ESP space, and staining was found most cranially at L2 and extending caudally underneath the sacrum. Evaluating the depth of its spread, we found it to be confined to the posterior compartment of the spine sparing the nerve roots bilaterally, which is consistent with the only other cadaveric study of ESPB performed at L4. Our results demonstrate the clinical utility of lumbar ESPB where posterior confinement of local anesthesia is preferred. However, further investigation is needed to determine the efficacy of ESPB in lower extremity analgesia which is predicated on ventral nerve root involvement.

Dynamic Postural Stability Among Individuals With Parkinson's Disease Following Performance-Based Overground Locomotor Training

Individuals with Parkinson’s disease (PD) exhibit compromised dynamic postural stability with impaired gait and balance, which contribute to walking limitations. Performing turns while walking perturbs mediolateral stability, challenges the daily functioning of people with PD, and is attributed to altered thoracic movement patterns that include reducing peak turn velocity (°/s). Although previous studies in our lab demonstrated that individuals with neurological impairments improved walking capacity following performance-based overground locomotor training (OLT), dynamic postural stability changes following OLT in people with PD remain unknown. PURPOSE: Characterize changes in dynamic postural stability during turns while walking among individuals with PD following OLT, evidenced by peak turn velocity change. METHODS: Twelve participants with PD (7 Male / 5 Female; Age: 68.5 ± 6.4 years; Hoehn and Yahr: 1-3) completed 24 60-minute OLT sessions twice-weekly. Baseline (PRE) and follow-up (POST) assessments included the 10-minute walk test (10MWT) indoors along a 60-meter corridor while wearing inertial sensors around the fourth lumbar vertebra and the sternum. Angular velocity was collected from each sensor and processed offline. First, turns were identified using integrated lumbar data and extracted from the sternum sensor. Next, peak turn velocity was averaged across all turns at PRE and POST, respectively. Finally, the mean peak turn velocity changes were calculated in the frontal (PTVF) and transverse (PTVT) planes of motion. Positive (+) change reflects improved dynamic postural stability during turns. Statistical analysis included one-tailed t-tests and Cohen’s d effect size. RESULTS: Completed turns increased after OLT (+1.5 ± 1.51; p < 0.01). PTVF showed a moderate and significant increase following OLT (+1.59 ± 2.18 °/s; 95%CI: 0.20, 2.98; p = 0.014; Cohen’s d = 0.43) while PTVT change was small and not significant (+0.88 ± 3.18 °/s; 95%CI: -2.90, 1.14; p = 0.179; Cohen’s d = 0.25). CONCLUSION: This study provides preliminary evidence suggesting that participants moderately improved frontal plane dynamic postural stability during turns after OLT by adapting thoracic movement patterns in ways that likely attenuated perturbed mediolateral stability.

Human lumbar sympathetic blockade: An anatomical study to address potential block failure.

The lumbar sympathetic block is often used to treat complex regional pain syndrome, but it seems to have a high failure rate. This study seeks anatomical explanations for this apparent failure in order to refine our block procedure. Two simulated sympathetic trunk blocks were carried out on four fresh, cryopreserved unembalmed human cadavers under fluoroscopic control at the L2 vertebral body level, followed by two further simulated blocks at the L4 vertebral body level on the other side. Dye was injected, and the areas were dissected following a specific protocol. We then describe the anatomy and the spread of the dye compared to the spread of the contrast medium on fluoroscopy. The ganglia were differently located at different vertebral levels, and differed among the cadavers. Following this anatomical clarification, we now prefer to perform lumbar sympathetic blocks at the fourth lumbar vertebra level, using an extraforaminal approach at the caudal end of ​​the vertebra, avoiding the anterolateral margin of the vertebral body at the midpoint.

Adiponectin serum level is an independent and incremental predictor of all-cause mortality after transcatheter aortic valve replacement.

BackgroundQuantifiable biomarkers may be useful for a better risk and frailty assessment of patients referred for transcatheter aortic valve implantation (TAVI).HypothesisTo determine if adiponectin serum concentration predicts all‐cause mortality in patients undergoing TAVI.Methods77 consecutive patients, undergoing TAVI, were analyzed. The CT axial slices at the level of the fourth lumbar vertebra were used to measure the psoas muscle area, and its low‐density muscle fraction (LDM (%)). To assess the operative risk, the STS (Society of Thoracic Surgeons Predicted Risk of Mortality) score, Log. Euroscore, and Euroscore II were determined. A clinical frailty assessment was performed. ELISA kits were used to measure adiponectin serum levels. We searched for a correlation between serum adiponectin concentration and all‐cause mortality after TAVI.ResultsThe mean age was 80.8 ± 7.4 years. All‐cause mortality occurred in 22 patients. The mean follow‐up was 1779 days (range: 1572–1825 days). Compared with patients with the lowest adiponectin level, patients in the third tertile had a hazards ratio of all‐cause mortality after TAVI of 4.155 (95% CI: 1.364–12.655) (p = .004). In the multivariable model, including STS score, vascular access of TAVI procedure, LDM (%), and adiponectin serum concentration, serum adiponectin level, and LDM(%) were independent predictors of all‐cause mortality after TAVI (p = .178, .303, .042, and .017, respectively). Adiponectin level was a predictor of all‐cause mortality in females and males (p = .012 and 0.024, respectively).ConclusionAdiponectin serum level is an independent and incremental predictor of all‐cause mortality in patients undergoing TAVI.

Correlation Between Sacral Slope and Pedicle Morphology of the Fourth Lumbar Vertebra in Degenerative Lumbar Spondylolisthesis.

Retrospective Radiographic Review. The purpose of this study was to investigate the correlation between the sacral slope (SS) and pedicle morphological parameters of the fourth lumbar vertebra in degenerative lumbar spondylolisthesis (DLS). Our study included 134 patients with L4-5 DLS. We used preoperative multi-slice spiral computed tomography to measure a range of pedicle morphological parameters, and the SS and percentage of slip distance (SDP) of the L4 vertebra were measured on preoperative standing neutral lumbar radiography. Patients were divided into three groups based on their degree of SS: the low sacral slope (LSS) group with SS values of <35°, the mean sacral slope (MSS) group with SS of 35°-45°, and the high sacral slope (HSS) group with SS > 45°. As the SS increased across groups, the pedicles of L4 became longer and thinner and the pedicle camber angle was smaller. The SDP, pedicle length parameters were positively correlated with the SS, while pedicle width, height, and camber angle were negatively correlated with the SS in the three groups. SS had an impact on the degree of spondylolisthesis and on pedicle morphological parameters in patients with DLS, with greater slope resulting in greater impact. The progression of DLS occurred due to the increasing forward shear force of the vertebra being greater than the reverse resistance. The pedicle at the slip level adaptively remodeled, becoming slenderer and tilting inward due to the long-term traction of the two opposing forces.

Effect of moxibustion of "Ganshu"(BL18) and "Shenshu" (BL23) on musculoskeletal interaction in osteoporosis rats

To observe the effect of moxibustion of "Ganshu" (BL18)and "Shenshu" (BL23) on bone mineral density (BMD), biomechanics, bone metabolism and musculoskeletal morphology of osteoporosis (OP) rats, so as to explore its mechanism underlying treatment of OP via bone-muscle interaction. Thirty-two female SD rats were randomly divided into sham operation, OP model, moxibustion and medication (nilestriol) groups, with 8 rats in each group. For rats of the sham operation group, a small amount of fat around the ovaries was removed, and those of the other 3 groups received removal of bila-teral ovaries for establishing OP model. Moxibustion was applied to bilateral BL18 and BL23 for 30 min, once every other day, 3 times a week for 12 weeks. Rats of the medication group received gavage of nilestriol (1 mg/kg) once a week for 12 weeks.After the interventions, a dual-energy absorptiometry was used to determine the BMD and bone mineral content of the rats' right femur and the fourth lumbar vertebrae under anesthesia, and three-point bending test used to detect the biomechanical properties (including load, displacement, stiffness) of the right femur. The levels of serum type I collagen C-terminal peptide (CTX-I), acid-resis-tant tartrate phosphatase (TRACP) and estradiol (E2) were determined using enzyme-linked immunosorbent assay, and histopathological changes of the left femur and the quadriceps observed after hematoxylin-eosin (H.E.) staining. Compared with the sham operation group, the BMD and bone mineral contents of the right femur and the fourth lumbar vertebra, the load and stiffness of the right femur, and concentration of serum E2 were significantly decreased (P<0.01, P<0.05), and the displacement of the right femur, and concentrations of serum CTX-Ⅰ and TRACP notably increased in the model group (P<0.01). After the interventions, the decreased levels of BMD and bone mineral contents, the load and stiffness and concentration of serum E2, and the increased levels of the displacement, and concentrations of serum CTX-Ⅰ and TRACP were all reversed by both moxibustion (except the bone mineral content of the fourth lumbar vertebra) and medication (P<0.01,P<0.05). No signi-ficant differences were found between moxibustion and medication in up-regulating the levels of BMD and bone mineral contents, the load and stiffness (except serum E2) and down-regulating the levels of the displacement, and concentrations of serum CTX-Ⅰ and TRACP (P>0.05). H.E. staining revealed that rats in the sham operation group showed mild thinness of the bone cortex, uneven thickness of trabecular bone, with distortion, fracture and osteoporosis of the left femur, and different size of rhabdomyocytes in the right quadriceps femoris muscle, with obvious proliferation of interstitial fibrous tissue and inflammatory cell infiltration, which were relatively and clearly milder in both moxibustion and medication groups. Moxibustion of BL18 and BL23 can increase the BMD and bone mineral content, improve biomechanical performance, adjust bone metabolism, and mitigate bone and the attached muscle histopathological changes in OP rats, suggesting that modulating interaction between bones and muscles is probably one of the ideas in the treatment of OP.