Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study

PURPOSE

To evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP.

METHODS

A total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25-69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months.

RESULTS

At 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months.

CONCLUSION

Patients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain. These slides can be retrieved under Electronic Supplementary Material.

Differential expression of neuregulin 1 (NRG1) and candidate miRNA regulating NRG1 transcription in the chicken oviduct in response to hormonal changes

Neuregulin 1 (NRG1), a signaling protein that binds to members of the erythroblastoma (ErbB) family, is known to play essential biological roles in mediating cell-cell interactions and orchestrating vital cell functions in the heart and nervous system. NRG1 is closely associated with developmental processes in various organs and expression of several NRG1 isoforms are regulated by estrogen. However, expression and its hormonal regulation during development of the female reproductive tract remain unknown. The reproductive system of chickens undergoes dynamic morphological and functional changes in response to estrogen and the molting process. Therefore, in the current study, we found differential expression of and candidate microRNA regulating chicken transcription in response to estrogen stimulation and/or the molting process. The results revealed that relative expression of mRNA increased in the oviducts of chicks treated with diesthylstilbestrol (DES; a synthetic non-steroidal estrogen). Additionally, abundant NRG1 mRNA expression was primarily in the glandular (GE) and luminal (LE) epithelia of the magnum in the developing chick oviduct in response to exogenous estrogen. Also, expression decreased during regression of the oviduct following induced molting by feeding high levels of zinc in the diet, and then gradually resurged as the oviduct underwent remodeling and recrudescence in laying hens. In addition, the present results revealed changes in relative expression of candidate chicken microRNA (, and ) targeting transcription in chicken oviducts in response to exogenous estrogen. In conclusion, these results provide the first evidence that is a novel estrogen-responsive gene closely correlated with the estrogen-dependent development of the oviduct of chicks and regeneration of the oviduct after molting. Further, regulation of expression involving at least 3 chicken miRNA is likely a prerequisite for those estrogen regulated developmental events.

Augmentation Effects of Eye Movement Desensitization and Reprocessing (EMDR) Intervention in Pharmacotherapy-resistant PTSD

Aim

Both trauma-focused cognitive behaviour therapy and antidepressant medication are regarded as the first line treatments for post-traumatic stress disorder (PTSD). However, little is known about sequential or combined efficacy of these two different treatment options. This prospective study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with PTSD who continued to be symptomatic after antidepressant treatment.

Method

Adult patients with PTSD at a specialized trauma clinic who received treatment doses of antidepressants for more than 12 weeks were recruited; definition of symptomatic PTSD was a total score > 40 on the Clinician-administered PTSD Scale (CAPS). The CAPS and the global improvement from Clinical Global Impression (CGI) were rated prior to EMDR, after termination and six months follow-up.

Results

A total of 15 patients underwent an average of six sessions of EMDR and 7 (47%) of 15 no longer met the criteria for PTSD and 10 (67%) were given status of very much or much improved. The CAPS scores and significantly decreased after EMDR therapy (paired t = 7.38, df = 14, P < 0.0001).

Conclusion

These results indicate that EMDR or trauma-focused CBT can be successfully added to those who failed to improve after initial pharmacotherapy for PTSD. Further studies are needed to explore the best sequence or components of therapies in the treatment of PTSD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Direct Gingival Fibroblast/Osteoblast Transdifferentiation via Epigenetics

Alveolar bone resorption caused by trauma or periodontal diseases has represented a challenge for both dental clinicians and researchers. In this study, we evaluate the osteogenic potential of human gingival fibroblasts (HGFs) through a direct transdifferentiation from HGFs to functional osteoblasts via epigenetic modification and osteogenic signaling with bone morphogenetic protein 2 (BMP2) in vitro and in vivo. HGF treatment with 5-aza-2'-deoxycytidine (5-aza-dC) induced demethylation in the hypermethylated CpG islands of the osteogenic lineage marker genes RUNX2 and ALP, and subsequent BMP2 treatment successfully drove the fibroblasts to the osteoblasts' lineage. Cell morphological changes viewed under microscopy and alkaline phosphatase (ALP) and alizarin red S (ARS) staining confirmed the osteoblastic change mediated by epigenetic modification as did real-time polymerase chain reaction (PCR), methylation-specific PCR (MSP), and chromatin immunoprecipitation (ChIP) assay, which demonstrated the altered methylation patterns in the RUNX2 and ALP promoter regions and their effect on gene expression. Furthermore, micro-computed tomography (CT) analysis of in vivo mouse cell transplantation experiments showed high-density signal in the epigenetically modified HGF group; in addition, a significant amount of bone formation was observed in the transplanted material using hematoxylin and eosin (H&E) staining as well. Collectively, our results indicate that epigenetic modification permits the direct programming of HGFs into functional osteoblasts, suggesting that this approach might open a novel therapeutic avenue in alveolar bone regeneration.

A cytokine study of pediatric Tourette's disorder without obsessive compulsive disorder

It has been suggested that post-infectious inflammation in central nervous system is a cause of tic disorder including Tourette's disorder (TD). Since pro-inflammatory cytokines are important mediators inducing inflammation, the cytokine levels are regarded as one of the important indicators of inflammation. Several studies have investigated the relationship of autoimmunity and the pathogenesis of TD by measuring the inflammatory cytokine levels of blood. However, when using human samples, the experimental results can be affected by the factors like size of sample, comorbidity, medication that patients take and the severity of the diseases. Thus, it is important to exclude the possibility that comorbidity and medication affects the level of inflammatory cytokines in the serum of TD patients. In our experiment, we recruited 29 patients without obsessive compulsive disorder (OCD) comorbidity and the majority of these patients did not take medication. The six pro-inflammatory cytokine levels of blood between patient and healthy groups were compared, considering the factors above, to determine more accurate results. Of the cytokines we investigated, the interleukin 12 p70 (IL-12p70) and tumor necrosis factor α (TNFα) levels increased in patient group compared to healthy controls and the patient group which have anti-streptolysin O (ASO) score under the 200 or YTGSS score from 10 to 19 also showed higher IL-12p70 or TNFα levels. In addition, the patients who did not take medication showed higher TNFα levels compared to healthy controls. In conclusion, we suggest that inflammatory pathways that involve IL-12p70 or TNFα are important to the pathogenesis of TD.

Physicians' attitude toward the withdrawal of life-sustaining treatment: A comparison between Korea, Japan, and China

End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians' perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status.

Sophorae radix reduces autoimmune response in NZB/w F1 systemic lupus erythematosus mouse model

The immunosuppressive effects of Sophorae radix (SR) make this plant an attractive agent for the treatment of autoimmune diseases. The effect of SR on systemic lupus erythematosus (SLE) in the New Zealand Black/White F1 (NZB/w F1) mouse model system was investigated. Three-month-old NZB/w F1 mice were separated into two groups: one treated with SR (1% SR solution by oral administration, daily for 15 weeks) and one with water as a control. Experimental parameters include proteinuria, anti-dsDNA antibody titers, T-cell response and renal histopathological analysis. Results in the SR-treated group showed a significant reduction in proteinuria and anti-dsDNA antibodies either in serum or in glomerular capillaries, along with significant recovery from renal glomerular damage. The lymphocyte population was significantly increased in the SR-treated mice compared with the control group. In the T helper (Th)1/Th2 cytokine secretion profile, interferon-γ in splenocyte culture was significantly reduced in the SR-treated mice, while interleukin-4 secretion was not altered. These results strongly suggest SR therapy corrects the deviated Th1/Th2 balance, thereby alleviating SLE-like symptoms in the NZB/w F1 mice. Therefore, SR may be useful in the clinical treatment of SLE. Lupus (2007) 16, 335—341.

Aquaporin 3 is regulated by estrogen in the chicken oviduct and is involved in progression of epithelial cell-derived ovarian carcinomas

Aquaporins (AQPs) are membrane proteins that passively deliver water across the plasma membrane to play an important role in maintaining cell shape. Members of the AQP family are distributed in most of the tissues in the human body and perform a variety of functions based on the water homeostasis suitable for each organ. However, there is little known about the expression and regulation of AQP family members in chickens. Therefore, we determined the expression of AQPs in various tissues of chickens. Among 13 isotypes, AQP3 was highly expressed in the chicken oviduct. Expression of AQP3 messenger RNA (mRNA) increased in the magnum (P < 0.001) and isthmus (P < 0.001) of chick oviducts treated with diethylstilbestrol. Consistent with these results, the localization of AQP3 was detected in the glandular and luminal epithelia of the magnum and isthmus of oviducts of diethylstilbestrol-treated chicks. In addition, the pattern of expression of AQP3 changed in an estrogen-dependent manner during the molting period. During the regenerative period of the oviduct after molting, expression of AQP3 mRNA increased coordinately with increasing concentrations of estradiol (P < 0.001), whereas expression of AQP3 mRNA decreased as concentrations of estradiol in plasma decreased in response to induced molting (P < 0.001). Also, expression of the AQP3 increased (P < 0.001) in cancerous ovaries of laying hens. In conclusion, AQP3 does not simply function to transport water into and out of cells but also appears to be closely involved in development of the chicken oviduct, which is regulated by estrogens. Furthermore, our results suggest AQP3 as a new diagnostic for early detection and treatment of epithelial cell-derived ovarian carcinomas.

Diethylstilbestrol regulates expression of avian apolipoprotein D during regression and recrudescence of the oviduct and epithelial-derived ovarian carcinogenesis

Apolipoprotein D (APOD) is a glycoprotein which is widely expressed in mammalian tissues. It is structurally and functionally similar to the lipocalins which are multiple lipid-binding proteins that transport hydrophobic ligands and other small hydrophobic molecules, including cholesterol and several steroid hormones. Although multiple functions for APOD in various tissues have been reported, its expression, biological function, and hormonal regulation in the female reproductive system are not known. Thus, in this study, we focused on correlations between APOD and estrogen during development, differentiation, regression, and regeneration of the oviduct in chickens and in the development of ovarian carcinogenesis in laying hens. Results of the present study indicated that APOD messenger RNA (mRNA) expression increased (P < 0.001) in the luminal and glandular (GE) epithelia of the chicken oviduct in response to diethylstilbestrol (a nonsteroidal synthetic estrogen). In addition, the expression of APOD mRNA and protein decreased (P < 0.001) as the oviduct regressed during induced molting, and gradually increased (P < 0.001) with abundant expression in GE of the oviduct during recrudescence after molting. Furthermore, APOD mRNA and protein were predominantly localized in GE of cancerous, but not normal ovaries from laying hens. Collectively, results of the present study suggest that APOD is a novel estrogen-stimulated gene in the chicken oviduct which likely regulates growth, differentiation, and remodeling of the oviduct during oviposition cycles. Moreover, up-regulated expression of APOD in epithelial cell-derived ovarian cancerous tissue suggests that it could be a candidate biomarker for early detection and treatment of ovarian cancer in laying hens and in women.

BCL11A enhancer haplotypes and fetal hemoglobin in sickle cell anemia

BACKGROUND

Fetal hemoglobin (HbF) levels in sickle cell anemia patients vary. We genotyped polymorphisms in the erythroid-specific enhancer of BCL11A to see if they might account for the very high HbF associated with the Arab-Indian (AI) haplotype and Benin haplotype of sickle cell anemia.

METHODS AND RESULTS

Six BCL112A enhancer SNPs and their haplotypes were studied in Saudi Arabs from the Eastern Province and Indian patients with AI haplotype (HbF ~20%), African Americans (HbF ~7%), and Saudi Arabs from the Southwestern Province (HbF ~12%). Four SNPs (rs1427407, rs6706648, rs6738440, and rs7606173) and their haplotypes were consistently associated with HbF levels. The distributions of haplotypes differ in the 3 cohorts but not their genetic effects: the haplotype TCAG was associated with the lowest HbF level and the haplotype GTAC was associated with the highest HbF level and differences in HbF levels between carriers of these haplotypes in all cohorts were approximately 6%.

CONCLUSIONS

Common HbF BCL11A enhancer haplotypes in patients with African origin and AI sickle cell anemia have similar effects on HbF but they do not explain their differences in HbF.