Scale Changes Research Articles

Endoscopic Radiofrequency Ablation for Sacroiliac Joint Pain: A Systematic Review and Meta-analysis

Objective: The aim of this study was to investigate the efficacy of endoscopically visualized radiofrequency for treating sacroiliac joint pain.Methods: The study protocol was preregistered on INPLASY (INPLASY202450011). A systematic search was carried out across multiple databases, including PubMed, Embase, Cochrane CENTRAL, and Web of Science, from their inception until May 6, 2024. Peer-reviewed studies on human participants with low back pain diagnosed with sacroiliac joint pain and treated with endoscopically visualized radiofrequency ablation (RFA) were included. The study focused on evaluating changes in the visual analogue scale (VAS) and Oswestry Disability Index (ODI) from before the commencement of endoscopically visualized radiofrequency to postoperation. The quantitative syntheses employed a random-effects model, with effect sizes reported using the mean difference. Subgroup analyses were conducted based on 6-month and 12-month postoperative time points.Results: Four studies were ultimately included in this meta-analysis. Three of the studies were case series, while one was a retrospective cohort study. The mean difference of VAS scores between the preoperative and 6-month and 12-month postoperative assessments was -5.60 and -5.96, respectively. The mean difference of the ODI between preoperative and 6-month and 12-month postoperative assessments was -21.03 and -23.67, respectively. A subgroup analysis of both outcome measurement indices at the 2 follow-up time points did not reveal any statistically significant differences.Conclusion: Endoscopically visualized RFA demonstrates potential as a treatment modality for sacroiliac joint pain; however, there is currently insufficient evidence to substantiate its long-term efficacy.

A methodology to assess indicators of technological development of the industry: The electronics industry case

Subject. The article deals with assessing the technological development of the industry. Objectives. The focus is on development and testing of a methodology for evaluating indicators of technological development of the industry. Methods. The study rests on general scientific principles and research methods, like abstraction, generalization of approaches to industry’s technological development assessment, analysis, synthesis, systematization, and generalization of obtained results. Results. The developed methodology includes five stages: (1) assessment of preconditions for technological level change; (2) analysis of intensity of modernization; (3) analysis of staff development, growth of labor productivity and remuneration level; (4) assessment of innovation activity; (5) analysis of consequences of changes in the technological level as an increase in value added, return on capital, and sustainable growth. Conclusions. I tested the methodology on data from a sample of electronic industry enterprises (OKVED 26 Manufacture of Computer, Electronic and Optical Products). Calculations show that there are evolutionary, but not large–scale changes. However, there are no signs of noticeable innovative development. At the same time, there are significant changes in individual companies, like PAO Element, controlled by State Corporation Rostec Group. The analysis of the company's consolidated financial statements showed a significant inflow of resources, an increase in investment and innovation activity, staff development, an increase in value added, return on capital, and accelerated growth.

Efficacy of Nusinersen Treatment in Type 1, 2, and 3 Spinal Muscular Atrophy: Real-World Data from a Single-Center Study.

Spinal muscular atrophy (SMA) is an inherited neuromuscular disease characterized by progressive muscle weakness and atrophy due to the absence of the survival motor neuron 1 (SMN1) gene. SMA is classified into types 0 through 4 based on the age of symptom onset and the severity of motor function decline. Recent advances in SMA treatment, including nusinersen, onasemnogene abeparvovec, and risdiplam, have significantly improved the prognosis of SMA patients. This study evaluated the safety and efficacy of nusinersen in pediatric patients with SMA types 1, 2, and 3 in a real-world clinical setting. This prospective observational single-center study assessed the treatment effects of nusinersen in 23 pediatric patients with genetically confirmed SMA over a 22-month observation period. All the participants received intrathecal loading doses of 12 mg of nusinersen on days 1, 14, 28, and 63, followed by maintenance doses every four months. Functional assessments were conducted using the CHOP-INTEND scale. Data were collected during routine patient visits, including clinical laboratory tests and vital sign parameters, and adverse events were recorded. The inclusion criteria were defined by the national reimbursement program for nusinersen treatment in Poland. Initially, 37 patients ranging from 1 month old to 18 years old were included, but 23 were ultimately observed due to changes in treatment regimens or assessment scales. The patients showed significantly improved CHOP-INTEND scores over the 22-month period. At 6 months, the average increase was 4.2 points, continuing to 17.8 points at 22 months. By the end of the study, 100% of patients showed either stabilization or improvement, with significant clinical improvements observed in several patients. Nusinersen was generally well-tolerated, with post-lumbar puncture headache and lower back pain being the most common adverse events. Nusinersen treatment significantly enhances motor function in pediatric patients with SMA types 1, 2, and 3. This study demonstrates the importance of early and sustained treatment, with most patients showing the continuous improvement or stabilization of motor function. These findings support the use of nusinersen as an effective therapy for SMA; however, further research is needed to understand the long-term outcomes and optimize treatment strategies.

Trading Place for Space: Increasing Location Resolution Reduces Contextual Capacity in Hippocampal Codes.

Many animals learn cognitive maps of their environment - a simultaneous representation of context, experience, and position. Place cells in the hippocampus, named for their explicit encoding of position, are believed to be a neural substrate of these maps, with place cell "remapping" explaining how this system can represent different contexts. Briefly, place cells alter their firing properties, or "remap", in response to changes in experiential or sensory cues. Substantial sensory changes, produced, e.g., by moving between environments, cause large subpopulations of place cells to change their tuning entirely. While many studies have looked at the physiological basis of remapping, we lack explicit calculations of how the contextual capacity of the place cell system changes as a function of place field firing properties. Here, we propose a geometric approach to understanding population level activity of place cells. Using known firing field statistics, we investigate how changes to place cell firing properties affect the distances between representations of different environments within firing rate space. Using this approach, we find that the number of contexts storable by the hippocampus grows exponentially with the number of place cells, and calculate this exponent for environments of different sizes. We identify a fundamental trade-off between high resolution encoding of position and the number of storable contexts. This trade-off is tuned by place cell width, which might explain the change in firing field scale along the dorsal-ventral axis of the hippocampus. We demonstrate that clustering of place cells near likely points of confusion, such as boundaries, increases the contextual capacity of the place system within our framework and conclude by discussing how our geometric approach could be extended to include other cell types and abstract spaces.

Variation Characteristics of Actual Evapotranspiration and Uncertainty Analysis of Its Response to Local Climate Change in Arid Inland Region of China

Exploring the variation characteristics of actual evapotranspiration (ETa) and its response to climate change in the arid inland region of China is of great significance for strengthening regional water resources management and maintaining ecological environment security and stability. Taking the Dulan River Basin as the research area, based on the meteorological data from the Wulan Station and hydrological data from the Shanggaba Station from 1981 to 2020, the variation characteristics of ETa at the annual scale were analyzed. The ETa estimation model and joint distribution model of P and potential evapotranspiration (ET0) was constructed based on climate factors, and the uncertainty of ETa response to climate change was explored with the water balance method, multiple linear regression, marginal distribution function, Copula function, and Monte Carlo algorithm. The results showed that the multi-year mean value of ETa in the study area was 261.6 mm, and the interannual process showed an insignificant upward trend, and had no abrupt change during the period. There were two obvious main cycles, which were 19-year periodic changes on the 30-year time scale and 6-year periodic changes on the 9-year time scale. The ETa estimation model based on precipitation (P) and ET0 had good simulation accuracy. The optimal marginal distributions of P and ET0 were Pearson-III (P-III) distribution and Generalized Extreme Value (GEV) distribution, respectively. The Copula joint distribution probability density of P and ET0 was a symmetric saddle-shaped distribution. ETa showed an inverted ‘S’ distribution with the change in joint guarantee rate of P and ET0, ranging from 116.9 mm to 498.6 mm. ETa was an interval range under a certain joint guarantee rate. The research results can provide support for the assessment of ETa, and help to further understand the driving mechanism of climate change on ETa in the arid inland region of China.

Follicular lymphoma research: an open dialogue for a collaborative roadmap.

Follicular lymphoma (FL) is the second most common type of lymphoma (20% of all non-Hodgkin lymphomas), derived from germinal centre (GC) B cells, and is characterised by its significant clinical, prognostic and biological heterogeneity, leading to complexity in management. Despite significant biological investigation and indisputable clinical progress since the advent of the immunotherapy era more than 20 years ago, much remains to be done to understand and cure this lymphoma. Today, FL is metaphorically a giant puzzle on the table with patches of sky, landscape and foliage clearly appearing. However, many of the remaining pieces are held by various stakeholders (e.g. clinicians, pathologists, researchers, drug developers) without global agreement on what the gaps are, or any clear blueprint on how to solve the puzzle of understanding the heterogeneity of this disease and create curative and tailored therapies. With the advent of new investigation and drug technologies, together with recent advances in our capacity to manage big data, the time seems ripe for a change of scale. More than ever, this will require collaboration between and within all stakeholders to overcome the current bottlenecks in the field. As for every investigator, we acknowledge that this first draft is necessarily biased, incomplete and some FL expert readers might recognise some remaining gaps not addressed. We hope they will reply to make this effort a collaborative one to assemble all the pieces in the most ideal fashion. As such, this review intends to be a first step and an interactive platform to a collaborative roadmap towards better understanding and care of FL.

Accelerated hazard prediction based on age time-scale for women diagnosed with breast cancer using a deep learning method

Breast cancer is the most common cancer in women. Previous studies have investigated estimating and predicting the proportional hazard rates and survival in breast cancer. This study deals with predicting accelerated hazards (AH) rate based on age categories in breast cancer patients using deep learning methods. The AH has a time-dependent structure whose rate changes according to time and variable effects. We have collected data related to 1225 female patients with breast cancer at the Mandarin University of Medical Sciences. The patients' demographic and clinical characteristics including family history, age, history of tobacco use, hysterectomy, first menstruation age, gravida, number of breastfeeding, disease grade, marital status, and survival status have been recorded. Initially, we dealt with predicting three age groups of patients: ≤ 40, 41–60, and ≥ 61 years. Then, the prediction of accelerated risk value based on age categories for each breast cancer patient through deep learning and the importance of variables using LightGBM is discussed. Improving clinical management and treatment of breast cancer requires advanced methods such as time-dependent AH calculation. When the behavioral effect is assumed as a time scale change between hazard functions, the AH model is more appropriate for randomized clinical trials. The study results demonstrate the proper performance of the proposed model for predicting AH by age categories based on breast cancer patients' demographic and clinical characteristics.

Key requirements for achieving EU-wide programme change

Abstract Issue Across the world, thousands of projects aim for equitable improvement in health for people who are experiencing ongoing avoidable stigma, discrimination and disadvantage however very little change is often achieved. Description of the problem In this presentation we explore key requirements for project-level change to ensure EU-wide programme change is achieved. Results The two most common causes of project failure are a) the innovation is not suitable, needed or wanted (also called theory failure) or b) implementation failure. This presentation shares strategies to mitigate risks of project failure through co-design processes and communication, drawing from 30 years of experience from the entire implementation process from ideation to scale up. These experiences include projects from over 30 countries, including partnerships with the World Health Organization, governments and industry focused on health literacy, self-management, care pathways, workplace health, hospital services redesign, First Nations health and migrant health. Common success factors include balancing top-down needs with co-designed inputs and with previous preferred or good practice (which may have come from controlled trial evidence generated in different contexts). The intervention must co-implemented to serve stakeholder’s needs at all levels, from citizens to decision makers. Lessons The United Nations (UN) and private sector apply system-wide approaches to affect large scale change. This knowledge is valuable for large public health programmes aiming to integrate equity and diversity in project processes to minimize implementation failure.

GIS and statistics to analyze scale change consequences on medical desert classification in France

Abstract Background Accessibility is a crucial way to overcome geographical restrictions and provides a path for alleviating the medical desert. Less attention has been paid to the choice of spatial unit in the effect of healthcare multi-accessibility. Inside the OASES European program, the France team proposes to create medical desert classification at the municipality level. The contribution of this study is to highlight the consequences of the choice of spatial scale on spatial distribution and the discrepancies between medical desert classifications. Methods Analyses were carried out in metropolitan France and overseas departments, at the commune scale and two other supra-communal scales used by public policies in France. For each spatial unit, a multidimensional and professional classification has been conducted using a three-step method: scores, principal component analysis and clustering. To demonstrate the presence of spatial dependence and to measure homogeneity between classifications joint count autocorrelation indicators and Theil’s indexes were applied. Results Our results present 7 classes of municipalities, and 5 classes of EPCI or living territories according to their level of healthcare accessibility, the dynamic of supply, and the needs of the population. Spatial representation of the classification demonstrates greater variability at the municipality level than other supra scales. Informative contrasted classes at the municipality level disappeared in favor of the middle class in all accessibility at supra scales. The results demonstrate that spatial dependence between areas at the municipality level reduced the scale effect. Conclusions Spatial approaches have become increasingly popular since they enable decision-makers to identify priority areas and allocate resources. Recognizing the instability across various scales is therefore crucial for thinking about the optimal unit of data aggregation when investigating the medical desert. Key messages • Choice of the scale is a mix between public policy decisions and data availability. • Contiguity constraint is a way to reduce the loss of information after aggregation.

Is ‘global’ warming concept consistent with thermodynamics according to ChatGPT?

Aim. Taking care of the environment on Planet Earth is still important and has be- come popular exceeding boundaries of science. Therefore description of climate changes has evolved into the concept of Global Warming since the 20th century. On the other hand, principles of thermodynamics where temperature is defined locally (not globally) are still valid. In my research I have applied tools like ChatGPT to detect possible contra- dictions and propose bridging gaps between statistical physics and the concept of global warming. Methods. The concept of temperature based on calculations of local particles’ kinetic energy in a microcanonical ensemble has been confronted with the concept of so called ‘average’ temperature in ‘global’ warming. The principles of Kinetic Theory and Statisti- cal Ensembles provided by statistical physics have been applied to ChatGPT based on natural language Results. Contradictions between the concept of average temperature in global warming and the concept of temperature based on local particle kinetic energy arise due to the different scales, heterogeneity, presence of feedback mechanisms, and boundary conditions. According to the chatGPT’s verdict, the concept of temperature based on calculations of local particles kinetic energy in the microcanonical ensemble is statistically more accurate. Conclusion. The concept of so called ‘global’ warming (confronted with the physics- based concept of temperature, providing a more accurate and nuanced understanding of temperature changes in different scales and contexts) should be replaced by the idea of local warming which is consistent with the concept of temperature based on calcula- tions of local particles kinetic energy in the microcanonical ensemble and experimental measurements provided by NASA. Therefore, talking about local (not global) warming is more reasonable when our goal is to prevent our coexistence with environment on Planet Earth from disasters.

Cellular Characteristics and Protein Signatures of Human Adipose Tissues from Donors With or Without Advanced Coronary Artery Disease.

Background/Objectives: Perivascular adipose tissue (PVAT) exerts a paracrine effect on blood vessels and our objective was to understand PVAT molecular signatures related to cardiovascular disease. Methods: We studied two groups: those undergoing mitral valve repair/replacement (VR, n = 16) and coronary artery bypass graft (CABG, n = 38). VR donors did not have coronary artery disease, whereas CABG donors had advanced coronary artery disease. Clinical and tissue pathologies and proteomics from adipose tissue were assessed. Results: Donors undergoing VR had a lower body mass index (p = 0.01), HbA1C (p = 0.0023), and incidence of diabetes (p = 0.022) compared to CABG. VR donors were overall healthier, with higher cardiac function compared to CABG donors, based on ejection fraction. Although adipose histopathology between groups was not markedly different, PVAT had smaller and more adipocytes compared to subcutaneous adipose tissues. These differences were validated by whole specimen automated morphological analysis, and anisotropy analysis showed small (2.8-7.5 μm) and large (22.8-64.4 μm) scale differences between perivascular and subcutaneous adipose tissue from CABG donors, and small scale changes (2.8-7.5 μm) between perivascular and subcutaneous adipose tissue from VR donors. Distinct protein signatures in PVAT and subcutaneous adipose tissue include those involved in secretion, exosomes and vesicles, insulin resistance, and adipocyte identity. Comparing PVAT and subcutaneous adipose tissue from CABG donors, there were 82 significantly different proteins identified with log fold change ≥ 0.3 or ≤-0.3 (p < 0.05). Using this threshold, there were 36 differences when comparing PVAT and subcutaneous adipose tissue from VR donors, 58 differences when comparing PVAT from CABG or VR donors, and 55 when comparing subcutaneous adipose tissue from CABG vs. VR donors. Conclusions: Routine histopathology cannot differentiate between PVAT from donors with or without coronary artery disease, but multiscale anisotropy analysis discriminated between these populations. Our mass spectrometry analysis identified a cohort of proteins that distinguish between adipose depots, and are also associated with the presence or absence of coronary artery disease.

Tensor networks for p-spin models

We introduce a tensor network algorithm for the solution of p-spin models. We show that bond compression through rank-revealing decompositions performed during the tensor network contraction resolves logical redundancies in the system exactly and is thus lossless, yet leads to qualitative changes in runtime scaling in different regimes of the model. First, we find that bond compression emulates the so-called leaf-removal algorithm, solving the problem efficiently in the “easy” phase. Past a dynamical phase transition, we observe superpolynomial runtimes, reflecting the appearance of a core component. We then develop a graphical method to study the scaling of contraction for a minimal ensemble of core-only instances. We find subexponential scaling, improving on the exponential scaling that occurs without compression. Our results suggest that our tensor network algorithm subsumes the classical leaf removal algorithm and simplifies redundancies in the p-spin model through lossless compression, all without explicit knowledge of the problem’s structure.

Broad-line Region of the Quasar PG 2130+099. II. Doubling the Size Over Four Years?

Over the past three decades, multiple reverberation mapping (RM) campaigns conducted for the quasar PG 2130+099 have exhibited inconsistent findings with time delays ranging from ∼10 to ∼200 days. To achieve a comprehensive understanding of the geometry and dynamics of the broad-line region (BLR) in PG 2130+099, we continued an ongoing high-cadence RM monitoring campaign using the Calar Alto Observatory 2.2 m optical telescope for an extra four years from 2019 to 2022. We measured the time lags of several broad emission lines (including He ii, He i, Hβ, and Fe ii) with respect to the 5100 Å continuum, and their time lags continuously vary through the years. Especially, the Hβ time lags exhibited approximately a factor of 2 increase in the last two years. Additionally, the velocity-resolved time delays of the broad Hβ emission line reveal a back-and-forth change between signs of virial motion and inflow in the BLR. The combination of negligible (∼10%) continuum change and substantial time-lag variation (over 2 times) results in a significant scatter in the intrinsic R Hβ –L 5100 relationship for PG 2130+099. Taking the consistent changes in the continuum variability time scale and the size of the BLR into account, we tentatively propose that the changes in the measurement of the BLR size may be affected by “geometric dilution”

The Analgesic and Side Effects of Tramadol Hydrochloride Immediate-Release and Extended-Release Tablets in Patients With Chronic Low Back Pain.

There are no established treatments for low back pain. Conventional treatments includephysiotherapyand pharmacological treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs). Recently, analgesics with mechanisms of action different from those of NSAIDs have emerged. Tramadol formulations have especially attracted attention for being effective among patients in whom NSAIDs are not entirely effective. However, they are associated with side effects that can disrupt treatment. Tramadol hydrochloride immediate-release and extended-release tablets havebeen recently launched. Herein, we report our experience with these formulations in chronic low back pain patients. To investigate the incidence of side effects and the analgesic effect of tramadol hydrochloride immediate-release and extended-release tablets in patients with chronic low back pain. This was a multicenter retrospective observational study. The study included patients prescribed tramadol hydrochloride immediate-release and extended-release tablets for chronic low back pain at 13 facilities in Japan between January 2021 and December 2023. The primary outcome was the incidence of side effects observed during the study period. The secondary outcomes were changes in the visual analog scale (VAS) score. The incidence of side effects was 37.7% (40/106 cases), which included constipation, nausea, drowsiness, and dizziness in 23 (21.7%), 13 (12.3%), 4 (3.8%), and 2 (1.9%) cases, respectively. The rate of treatment discontinuation owing to side effects was relatively low (16/106 cases, 15.1%). Furthermore, after four weeks of treatment, we found a significant reduction in the VAS scores for low back pain from baseline. This study shows the incidence of side effects following the administration of tramadol hydrochloride immediate-release and extended-release tablets. Regarding the breakdown of side effects, constipation, nausea, drowsiness, and dizzinesswere noted. Regarding pain evaluation, we found a significant reduction in the VAS scores for low back pain from baseline after four weeks of treatment, suggesting that tramadol hydrochloride immediate-release and extended-release tablets may provide excellent analgesic effects owing to their pharmacokinetic properties that ensure stable tramadol concentrations in the bloodstream.

Factors influencing brain recovery from stroke via possible epigenetic changes.

Aim: To examine epigenetic changes leading to functional repair after damage to the central motor system.Data sources: A literature search was conducted using medical and health science electronic databases (PubMed, MEDLINE, Scopus) up to July 2023.Study selection: Data were summarized for type of intervention, study design, findings including human and animal studies.Data extraction: Data were extracted and double-checked independently for methodological quality. By means of the influence of environmental (calorie restriction or physical exercise) and other factors, epigenetic instructions were found to increase levels of BDNF and enhance synaptic neurotransmission, possibly leading to larger scale changes in structural and functional assets, which may end up to cognitive and motor repair after stroke.

A central and peripheral dual neuromodulation strategy in pain management of zoster-associated pain.

Spinal cord stimulation (SCS) has shown effectiveness in relieving zoster-associated pain (ZAP), but some patients still experience moderate or severe pain after SCS treatment. This study aims to evaluate the impact of SCS combined with dorsal root ganglion (DRG) pulsed radiofrequency (PRF) as a dual neuromodulation strategy on the prognosis of ZAP. The clinical records of patients diagnosed with ZAP who underwent SCS (SCS group) or SCS combined with PRF (SCS + PRF group) at The Third Xiangya Hospital, Central South University, were retrospectively analyzed to compare the effectiveness of the two treatment approaches for ZAP. Outcome measures included changes in Visual Analog Scale (VAS) scores before and after neuromodulation treatment, response rates, and incidence of progression to postherpetic neuralgia (PHN).13 SCS patients and 15 SCS + PRF patients were analyzed. Admission VAS scores were similar (P = 0.934). Upon discharge, no significant differences in VAS or response rates were observed (P > 0.05). However, at 6-month follow-up, the SCS + PRF group had lower VAS scores (1.53 ± 1.06 vs. 3.23 ± 1.50, P < 0.001) and a lower proportion of residual moderate pain (P = 0.041). None in the SCS + PRF group progressed to PHN in the acute/subacute phases, differing significantly from the SCS group (P = 0.038).Therefore, SCS combined with DRG PRF is feasible and effective in the treatment of ZAP. This dual neuromodulation strategy may be a more appropriate regimen for the treatment of ZAP.

Immediate effects of propofol on mood: a randomized comparison of two doses in a cohort with depression.

The intravenous anesthetic propofol is known to induce positive mood effects during routine clinical use, suggesting it might be repurposed as an antidepressant, but also raising concerns about abuse potential. How propofol's acute effects vary by dose and with repeated infusions is unknown. This exploratory analysis aimed to (1) compare the immediate mood effects of propofol administered at two different doses, (2) describe how those mood effects change with repeated infusions, and (3) evaluate whether acute mood improvement predicts later antidepressant response. Twenty-four adults with moderate-to-severe treatment-resistant depression were randomized into two dosing groups. Six low- or high-dose propofol infusions were administered under blinded conditions over a two-week period. Self-reported mood states were recorded before and after each infusion using the Positive and Negative Affect Schedule (PANAS-X). Abuse potential was evaluated with the Drug Effects Questionnaire (DEQ-5). At the first infusion, propofol induced acute improvements in PANAS-X Sadness, Fear, Joviality, and Serenity scales (p < 0.002), independent of dose. Over the series of six infusions, acute changes in Sadness, Fear, and Joviality, but not Serenity, diminished with infusion number (p < 0.002). The DEQ-5 "want more" rating decreased across infusions (p = 0.002). Changes in PANAS-X scales with the first infusion did not predict later improvement in depression severity (p > 0.05). Cumulative changes in mood states observed with repeated infusions suggest that propofolengages adaptive mechanisms in mood circuitry. Subjective responses with repeated infusions do not indicate increasing potential for abuse in this patient population.

RISKS AND OUTCOMES OF STROKE IN PATIENTS WITH PRIMARY BRAIN AND MENINGEAL TUMOURS

Abstract AIMS People with primary CNS tumours are at increased risk of stroke. However, there is little guidance on stroke management. We investigated the types and timing of stroke in primary brain and meningeal tumours to inform their treatment. METHOD Patient data on stroke aetiology, timing, management and outcomes was collected from electronic medical records at King’s College Hospital between April 2012 to April 2022. A primary brain tumour was defined using the 2021 World Health Organisation Classification of Tumours of the Central Nervous System. RESULTS We identified 244 patients with a brain tumour and a stroke with a total of 317 strokes in the 10-year period (male:female = 48:52; median age, 62 years [IQR 51 – 74]). The most common brain tumours were meningiomas (43%) and glioblastomas (21%). 56% of strokes were ischaemic. Ischaemic strokes were most frequent within 30 days of brain tumour surgery (38%). Haemorrhages were more common in malignant tumours (p=4.7 x10 35% of haemorrhages were intratumoural. Strokes in malignant tumours: occurred closer to diagnosis (p=0.032); caused greater functional loss (mean Modified Rankin Scale change 2.00 vs 1.17, p 0.001); and had a higher mortality rate (HR 5.87, CI 3.41 - 10.11, p=1.8x10 Recurrent strokes occurred in 64 (26%) patients and were associated with tumour malignancy (p=0.016), radiotherapy (p=0.023) and chemotherapy (p=0.009). CONCLUSION Strokes in malignant brain tumours are more lethal, disabling and often recurrent in patients undergoing chemo and radiotherapy. Clinical trials are needed to improve outcomes of stroke in neuro-oncology patients.

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk

Sciatica is commonly caused by herniated lumbar disc and contributes to severe pain and prolonged disability. Although acupuncture is widely used by patients with chronic sciatica, the evidence of its efficacy is scarce. To investigate the efficacy and safety of acupuncture compared with sham acupuncture in patients with chronic sciatica from herniated disk. This was a multicenter 2-arm randomized clinical trial conducted in 6 tertiary-level hospitals in China of patients with chronic sciatica from herniated disk. Participants were recruited from March 25, 2021, to September 23, 2021, with a final follow-up through September 22, 2022. Data analyses were performed from December 2022 to March 2023. Participants were randomly assigned to receive 10 sessions of acupuncture (n = 110) or sham acupuncture (n = 110) over 4 weeks. Participants, outcome assessors, and statisticians were blinded. The 2 coprimary outcomes were changes in visual analog scale (VAS) for leg pain and Oswestry Disability Index (ODI) from baseline to week 4. Secondary outcomes were adverse events. A total of 216 patients (mean [SD] age, 51.3 [15.2] years; 147 females [68.1%] and 69 males [31.9%]) were included in the analyses. The VAS for leg pain decreased 30.8 mm in the acupuncture group and 14.9 mm in the sham acupuncture group at week 4 (mean difference, -16.0; 95% CI, -21.3 to -10.6; P < .001). The ODI decreased 13.0 points in the acupuncture group and 4.9 points in the sham acupuncture group at week 4 (mean difference, -8.1; 95% CI, -11.1 to -5.1; P < .001). For both VAS and ODI, the between-group difference became apparent starting in week 2 (mean difference, -7.8; 95% CI, -13.0 to -2.5; P = .004 and -5.3; 95% CI, -8.4 to -2.3; P = .001, respectively) and persisted through week 52 (mean difference, -10.8; [95% CI, -16.3 to -5.2; P < .001; and -4.8; 95% CI, -7.8 to -1.7; P = .003, respectively). No serious adverse events occurred. This randomized clinical trial found that in patients with chronic sciatica from herniated disk, acupuncture resulted in less pain and better function compared with sham acupuncture at week 4, and these benefits persisted through week 52. Acupuncture should be considered as a potential treatment option for patients with chronic sciatica from a herniated disk. Chictr.org Identifier: ChiCTR2100044585.

Evaluation of Safety and Efficacy of Cell Therapy Based on Osteoblasts Derived from Umbilical Cord Mesenchymal Stem Cells for Osteonecrosis of the Femoral Head: Study Protocol for a Single-Center, Open-Label, Phase I Clinical Trial.

Although mesenchymal stem cells (MSCs) insertion has gained recent attention as a joint-preserving procedure, no study has conducted direct intralesional implantation of human umbilical cord-derived MSCs (hUCMSCs) in patients with ONFH. This is a protocol for a phase 1 clinical trial designed to assess the safety and exploratory efficacy of human umbilical cord-derived osteoblasts (hUC-Os), osteogenic differentiation-induced cells from hUCMSCs, in patients with early-stage ONFH. Nine patients with Association Research Circulation Osseous (ARCO) stage 1 or 2 will be assigned to a low-dose (1 × 107 hUC-O cells, n = 3), medium-dose (2 × 107 cells, n = 3), and high-dose group (4 × 107 cells, n = 3) in the order of their arrival at the facility, and, depending on the occurrence of dose-limiting toxicity, up to 18 patients can be enrolled by applying the 3 + 3 escalation method. We will perform hUC-O (CF-M801) transplantation combined with core decompression and follow-up for 12 weeks according to the study protocol. Safety will be determined through adverse event assessment, laboratory tests including a panel reactive antibody test, vital sign assessment, physical examination, and electrocardiogram. Efficacy will be explored through the change in pain visual analog scale, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index, ARCO stage, and also size and location of necrotic lesion according to Japanese Investigation Committee classification before and after the procedure. Joint preservation is important, particularly in younger, active patients with ONFH. Confirmation of the safety and efficacy of hUC-Os will lead to a further strategy to preserve joints for those suffering from ONFH and improve our current knowledge of cell therapy.