Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy

PURPOSE

Although cervical radiculopathy is very common, there is no standard treatment for this condition, with little high-level evidence available to guide the treatment choice. Thus, this study aimed to review the current data on the management of cervical radiculopathy; and, further, to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy using the Delphi method.

METHODS

First, a systematic review of the previously established treatment guidelines and of articles related to cervical radiculopathy was conducted to establish a protocol for the clinical consensus of the treatment for cervical radiculopathy. Second, from February 2012 to June 2014, we performed a modified Delphi survey in which the current professional opinions from 30 experienced experts, representing almost all of the Chinese provinces, were gathered. Three rounds were performed, and consensus was defined as ≥70% agreement.

RESULTS

Consensus of the treatments for cervical radiculopathy was reached on seven aspects, including the proportion of patients requiring only non-surgical therapies; the effectiveness of neck immobilization, physiotherapy, pharmacologic treatment; surgical indications; contraindications; surgery.

CONCLUSIONS

The modified Delphi study conducted herein reached a consensus concerning several treatment issues for cervical radiculopathy. In the absence of high-level evidence, at present, these expert opinion findings will help guide health care providers to define the appropriate treatment in their regions. Items with no consensus provide excellent areas for future research.

Identification of the man-made barium copper silicate pigments among some ancient Chinese artifacts through spectroscopic analysis

This article describes the complementary application of non-invasive micro-Raman spectroscopy and energy dispersive X-ray fluorescence spectrometry to the characterization of some ancient Chinese silicate artifacts. A total of 28 samples dated from fourth century BC to third century AD were analyzed. The results of chemical analysis showed that the vitreous PbO-BaO-SiO2 material was used to sinter these silicate artifacts. The barium copper silicate pigments including BaCuSi4O10, BaCuSi2O6 and BaCu2Si2O7 were widely identified from colorful areas of the samples by Raman spectroscopy. In addition, other crystalline phases such as Fe2O3, BaSi2O5, BaSO4, PbCO3 and quartz were also identified. The present study provides very valuable information to trace the technical evolution of man-made barium copper silicate pigments and their close relationship with the making of ancient PbO-BaO-SiO2 glaze and glass.

An in vivo swine study for xeno-grafts of calcium sulfate-based bone grafts with human dental pulp stem cells (hDPSCs)

The purpose of this in vivo study was to evaluate the effect of human dental pulp stem cells (hDPSCs) on various resorbable calcium sulfate/calcium phosphate bone grafts in bone regeneration. Granular particles of calcium sulfate dehydrate (CSD), α-calcium sulfate hemihydrate/amorphous calcium phosphate (α-CSH/ACP), and CSD/β-tricalcium phosphates (β-TCP) were prepared for in vitro dissolution and implantation test. The chemical compositions of specimen residues after dissolution test were characterized by XRD. The ratios of new bone formation for implanted grafts/hDPSCs were evaluated using mandible bony defect model of Lanyu pig. All the graft systems exhibited a similar two-stage dissolution behavior and phase transformation of poor crystalline HAp. Eight weeks post-operation, the addition of hDPSCs to various graft systems showed statistically significant increasing in the ratio of new bone formation (p<0.05). Null hypothesis of hDPSCs showing no scaffold dependence in bone regeneration was rejected. The results suggest that the addition of hDPSCs to calcium sulfate based xenografts could enhance the bone regeneration in the bony defect.

Conduction control at ferroic domain walls via external stimuli

Intriguing functionalities at nano-sized domain walls have recently spawned a new paradigm for developing novel nanoelectronics due to versatile characteristics. In this study, we explore a new scenario to modulate the local conduction of ferroic domain walls. Three controlling parameters, i.e., external electrical field, magnetic field and light, are introduced to the 90° domain walls (90° DWs) of BiFeO₃. Electrical modulation is realized by electrical transport, where the mobility of 90° DWs can be altered by gating voltage. We further use the ferromagnetic/antiferromagnetic coupling to reveal the inherent magnetism at the DWs. With an established magnetic nature, magnetotransport has been conducted to introduce magnetic controlling parameter, where a giant positive magnetoresistance change can be observed up to 200%. In addition, light modulated conduction, a core factor for multifunctional applications, is successfully demonstrated (current enhancement by a factor of 2 with 11 W white lamp). These results offer new insights to discover the tunability of domain wall nanoelectronics.

Targeting autophagy overcomes Enzalutamide resistance in castration-resistant prostate cancer cells and improves therapeutic response in a xenograft model

Macro-autophagy is associated with drug resistance in various cancers and can function as an adaptive response to maintain cell survival under metabolic stresses, including androgen deprivation. Androgen deprivation or treatment with androgen receptor (AR) signaling inhibitor (ARSI), Enzalutamide (MDV-3100, ENZA) or bicalutamide induced autophagy in androgen-dependent and in castration-resistant CaP (castration-resistant prostate cancer (CRPC)) cell lines. The autophagic cascade triggered by AR blockage, correlated with the increased light chain 3-II/I ratio and ATG-5 expression. Autophagy was observed in a subpopulation of C4-2B cells that developed insensitivity to ENZA after sustained exposure in culture. Using flow cytometry and clonogenic assays, we showed that inhibiting autophagy with clomipramine (CMI), chloroquine or metformin increased apoptosis and significantly impaired cell viability. This autophagic process was mediated by AMP-dependent protein kinase (AMPK) activation and the suppression of mammalian target of rapamycin (mTOR) through Raptor phosphorylation (Serine 792). Furthermore, small interfering RNA targeting AMPK significantly inhibited autophagy and promoted cell death in CaP cells acutely or chronically exposed to ENZA or androgen deprivation, suggesting that autophagy is an important survival mechanism in CRPC. Lastly, in vivo studies with mice orthotopically implanted with ENZA-resistant cells demonstrated that the combination of ENZA and autophagy modulators, CMI or metformin significantly reduced tumor growth when compared with control groups (P<0.005). In conclusion, autophagy is as an important mechanism of resistance to ARSI in CRPC. Antiandrogen-induced autophagy is mediated through the activation of AMPK pathway and the suppression of mTOR pathway. Blocking autophagy pharmacologically or genetically significantly impairs prostate cancer cell survival in vitro and in vivo, implying the therapeutics potential of autophagy inhibitors in the antiandrogen-resistance setting.

The Structure-Property-Processing Relationship for Sintered Yttria-Stabilized Zirconia (YSZ)/Alumina Bioceramics

The objective of this research is to study the effects of alumina addition on the microstructure-mechanical property relationship and sintering behavior of yttria (3 mol%)-stabilized zirconia (YSZ) ceramics. Well-dispersed YSZ / Al 2 O 3 ceramics containing 10–40 wt.% Al 2 O 3 were prepared by solid state reaction method. The relative density, average grain size, lattice parameters, microhardness, and fracture toughness of YSZ / Al 2 O 3 ceramics system sintered in the temperature range of 1250~1500°C as a function of Al 2 O 3 content were investigated. Experimental results showed that the ceramics with high Al 2 O 3 content and low sintering temperature tended to reveal low bulk densities. But the Al 2 O 3 content dependence on relative density for YSZ / Al 2 O 3 ceramics becomed deminishing when increasing the sintering temperature. Dense ceramics with composition of (80/20) ( YSZ / Al 2 O 3) and sintered at temperature of 1400°C and 1450°C revealed the optimal Vickers hardness and fracture toughness properties. These ceramics with high Al 2 O 3 content tended to reveal small grain sizes. The high sintering temperature governs the slow grain growth and high hardness in materials indicating the good correlation between microstructure of fabricated dense and mechanical properties.

In vivo evaluation of resorbable bone graft substitutes in beagles: histological properties

Calcium phosphate cement (CPC) is a promising material for use in minimally invasive surgery for bone defect repairs due to its bone-like apatitic final setting product, biocompatibility, bioactivity, self-setting characteristics, low setting temperature, adequate stiffness, and easy shaping into complicated geometrics. However, even though CPC is stable in vivo, the resorption rate of this bone cement is very slow and its long setting time poses difficulties for clinical use. Calcium sulfate dehydrate (CSD) has been used as a filler material and/or as a replacement for cancellous bone grafts due to its biocompatibility. However, it is resorbed too quickly to be optimal for bone regeneration. This study examines the invivo response of a hydroxyapatite (HA), [apatitic phase (AP)]/calcium sulfate (CSD) composite using different ratios in the mandibular premolar sockets of beagles. The HA (AP)/CSD composite materials were prepared in the ratios of 30/70, 50/50, and 70/30 and then implanted into the mandibular premolar sockets for terms of 5 and 10 weeks. The control socket was left empty. The study shows better new bone morphology and more new bone area in the histological and the histomorphometric study of the HA (AP)/CSD in the 50/50 ratio.

Orthorhombic BiFeO3

A new orthorhombic phase of the multiferroic BiFeO3 has been created via strain engineering by growing it on a NdScO(3)(110)(o) substrate. The tensile-strained orthorhombic BiFeO3 phase is ferroelectric and antiferromagnetic at room temperature. A combination of nonlinear optical second harmonic generation and piezoresponse force microscopy revealed that the ferroelectric polarization in the orthorhombic phase is along the in-plane {110}(pc) directions. In addition, the corresponding rotation of the antiferromagnetic axis in this new phase was observed using x-ray linear dichroism.

Inorganic phosphorus fractionation and its translocation dynamics in a low-P soil

The translocation of different inorganic phosphorus (Pi) forms in a low-P soil (Langfang experimental station, Hebei province, China) over time was investigated using P fractionation extraction and a (32)P tracer technique. The L-value and P availability of the soil was assessed using 5 different maize genotype (Zea mays L.) cultivars. The results showed that the different Pi fractions in the soil increased in the order of H(2)SO(4)-extractable P (Ca(10)-P) > Na(3)C(6)H(5)O(7)-Na(2)S(2)O(4)-extractable P (O-P) > NH(4)Ac-extractable P (Ca(8)-P) > NaHCO(3)-extractable P (Ca(2)-P), NH(4)F-extractable P (Al-P), NaOH-Na(2)CO(3)-extractable P (Fe-P), and the content of plant-unavailable P (Ca(10)-P + O-P) was high, up to 79.1%, which might be an important reason for P deficiency in this low-P soil. The (32)P tracer results showed that after the addition of (32)P-Pi to the soil with no P fertilizer applied for 25 d, 29.0% of (32)P was quickly transformed into Ca(2)-P (rapidly available P), and 66.1% of (32)P was transformed into Al-P, Fe-P and Ca(8)-P (slowly available P). Only 5.0% of (32)P was transformed into O-P and Ca(10)-P (plant-unavailable P). Moreover, in the soil with P fertilizer applied, (32)P transformation into Ca(2)-P increased, and the transformation into Ca(8)-P + Fe-P + AL-P and O-P, Ca(10)-P significantly decreased compared to the soil with no P fertilizer applied (p < 0.05). This result suggested a higher rate for water-soluble P transformation to slowly available and plant-unavailable P in P deficient soil than in soil with sufficient P. The results of maize L-value determination showed that different genotype maize cultivars had different soil P-use efficiency and low-P tolerance mechanisms. Low-P tolerant cultivar DSY-32 regulated soil P-use efficiency and plant P content according to exogenous P fertilizer application. However, another low-P tolerant cultivar, DSY-2, used soil P more efficiently, regardless of the application of exogenous P.

Mass measurements of the neutron-deficient 41Ti, 45Cr, 49Fe, and 53Ni nuclides: first test of the isobaric multiplet mass equation in f p-shell nuclei

Isochronous mass spectrometry has been applied to neutron-deficient 58Ni projectile fragments at the HIRFL-CSR facility in Lanzhou, China. Masses of a series of short-lived T(z)=-3/2 nuclides including 41Ti, 45Cr, 49Fe, and 53Ni have been measured with a precision of 20-40 keV. The new data enable us to test for the first time the isobaric multiplet mass equation (IMME) in fp-shell nuclei. We observe that the IMME is inconsistent with the generally accepted quadratic form for the A=53, T=3/2 quartet. We perform full space shell model calculations and compare them with the new experimental results.

In vivo evaluation of resorbable bone graft substitutes in mandibular sockets of the beagle

Hydroxyapatite (Ca(10)(PO(4))(6)(OH)(2)), with its high biocompatibility and good bioaffinity, stimulates osteoconduction and is slowly replaced by the host bone after implantation. However, clinical use of HA as a bone substitute has proved problematic. It is difficult to prevent dispersion of the HA granules and to mold the granules into the desired shape. Calcium sulfate as a bone graft substitute is rapidly resorbed in vivo releasing calcium ions, but fails to provide a long-term, three-dimensional framework to support osteoconduction. The setting properties of calcium sulfate, however, allow it to be applied in a slurry form, making it easier to handle and apply in different situations. This study examines the in vivo response of a (Hydroxyapatite, apatitic phase)/calcium sulfate dehydrate (CSD) composite using different ratios in the mandibular premolar sockets of the beagle. The HA (AP)/CSD composite materials prepared in ratios of 30/70, 50/50, and 70/30 were implanted into the mandibular premolar sockets for 5 and 10 weeks. The control socket was empty. The authors compared the radiographic properties and the changes in height and width of the mandibular premolar sockets in the beagle. The composite graft in the 30/70 ratio had the best ability to form new bones.

Bone and joint protection ability of ceramic material with biological effects

Ceramic materials with biological effects (bioceramic) have been found to modulate various biological effects, especially those effects involved in antioxidant activity and hydrogen peroxide scavenging. As arthropathy and osteopathy are the major chronic diseases of geriatric medicine, we explored the possible activity of bioceramic on these conditions using animal and cell models. Rabbits received intra-articular injections of lipopolysaccharides (LPS) to induce inflammation that mimic rheumatic arthritis. FDG isotopes were then IV injected for PET scan examinations at 16 hours and 7 days after the LPS injection. We examined and compared the bioceramic and control groups to see if bioceramic was capable of relieving inflammation in the joints by subtracting the final and initial uptake amount of FDG (max SUV). We studied the effects in prostaglandin E2 (PGE2) inhibition on the human chondrosarcoma (SW1353) cell line, and the effects on the murine osteoblast (MC3T3-E1) cell line under oxidative stress. All the subtractions between final and initial uptakes of FDG in the left knee joints of the rabbits after LPS injection indicated larger decreases in the bioceramic group than in the control group. This anti-arthritic or inflammatory effect was also demonstrated by the PGE2 inhibition of the SW1353 cells. We further proved that bioceramic treatment of the MC3T3-E1 cells resulted in increased viability of osteoblast cells challenged with hydrogen peroxide toxicity, and increased alkaline phosphatase activity and the total protein production of MC3T3-E1 cells under oxidative stress. Since LPS-induced arthritis is an experimental model that mimics RA, the potential therapeutic effects of bioceramic on arthropathy merit discussion. Bioceramic may contribute to relieving inflammatory arthritis and maintaining bone health.

The potential effects of cholecalciferol on bone regeneration in dogs

OBJECTIVES

The aim of this investigation was to evaluate the potential effects of the systemically delivered combination of calcium supplementation and cholecalciferol and of the locally applied biphasic calcium alloplast on the surgically produced alveolar sockets at the early healing stage in a dog model.

MATERIALS AND METHODS

The mandibular pre-molars of nine Beagle dogs were extracted first. Three months later, four standardized sockets with a 4 mm in diameter and 6 mm deep cylinder were created bilaterally at healed extraction sites. The sockets on one side were grafted with biphasic calcium phosphate alloplast, whereas the defects on the other side were left un-grafted. The dogs were then randomly divided into two groups; five dogs received oral calcium and cholecalciferol combination (Vit.D/Ca) and were assigned to the test group (Vit.D/Ca Group). The other four dogs without Vit.D/Ca supplement were distributed to the control group (Non-Vit.D/Ca Group). The bone density (Density) and the implant stability quotient (ISQ) at prepared sites were measured 4 weeks later. The drawn bone cores were examined by a histomorphometric analysis for measurement of new bone formation (NBF). The amount of vertical ridge resorption (VRR) was evaluated.

RESULTS

The Vit.D/Ca-treated subjects revealed significantly more NBF (P < 0.05), higher bone density (P < 0.05) and significantly less vertical ridge reduction (P < 0.05) in the healing sockets than those without Vit.D/Ca treatment. The non-grafted sockets demonstrated significantly more NBF (P < 0.05), higher bone density (P < 0.05), better ISQ value (P < 0.05) and more vertical ridge reduction (P < 0.05) than those in the grafted sockets. There was no significant difference between the serum data determined before and 4 weeks after experiment in Vit.D/Ca Group or Non-Vit.D/Ca Group. However, the changed value (post-op vs. pre-op) between the two groups was significant in the serum level of phosphate and parathyroid hormone (P = 0.05).

CONCLUSION

The results of the present study indicated that the examined calcium phosphate alloplast may perform a function in alveolar ridge preservation while reducing the potential of NBF potential in the healing extraction socket. Also, the combination of calcium supplementation and cholecalciferol may have systemic effects on accelerating bone regeneration.