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Tang X, Li Q, Li ZH. Mediating effect of metabolic syndrome in the association of educational attainment with intervertebral disc degeneration and low back pain. Heliyon 2024; 10:e30272. [PMID: 38707474 PMCID: PMC11068810 DOI: 10.1016/j.heliyon.2024.e30272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
The causal association of educational attainment (EA) with intervertebral disc degeneration (IVDD) or low back pain (LBP), and the mediating effect of metabolic syndrome (MetS) in this association, is not studied to date. In this study, using summary statistics of genome-wide association studies primarily conducted in the individuals of European ancestry, Mendelian randomization (MR) analyses were performed to investigate: (1) the total and direct effects of EA on IVDD and LBP, (2) bidirectional associations of EA with MetS or the components of MetS, (3) causal effects of MetS or its components on IVDD and LBP, and (4) mediating effects of MetS or its components on the causal associations of EA with IVDD and LBP. Univariable MR analysis demonstrated that genetically proxied EA was inversely associated with IVDD (ORIVW: 0.90; 95 % CI: 0.87-0.92) and LBP (ORIVW: 0.86; 95 % CI: 0.84-0.89). Consistent results were obtained after adjusting for potential confounders (cognition, economic level, smoking traits, and metabolic factors). Mediation analysis proved that the effect of EA on IVDD mediated by MetS, waist circumference, and high-density lipoprotein cholesterol was 11.38 %, 9.22 %, and 2.17 %, respectively. Besides, MetS mediated 8.42 % and waist circumference mediated 5.81 % of the EA effects on LBP, respectively. Our findings provided support for MetS mediating the causal protective effects of EA on IVDD and LBP, which provided causal evidence to the etiology and intervention targets of IVDD and LBP.
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Affiliation(s)
- Xijie Tang
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430000, China
| | - Qiu Li
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China
| | - Zhang-Hua Li
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430000, China
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Guo D, Zeng M, Yu M, Shang J, Lin J, Liu L, Yang K, Cao Z. SSR1 and CKAP4 as potential biomarkers for intervertebral disc degeneration based on integrated bioinformatics analysis. JOR Spine 2024; 7:e1309. [PMID: 38222802 PMCID: PMC10782074 DOI: 10.1002/jsp2.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Intervertebral disc degeneration (IDD) is a significant cause of low back pain and poses a significant public health concern. Genetic factors play a crucial role in IDD, highlighting the need for a better understanding of the underlying mechanisms. Aim The aim of this study was to identify potential IDD-related biomarkers using a comprehensive bioinformatics approach and validate them in vitro. Materials and Methods In this study, we employed several analytical approaches to identify the key genes involved in IDD. We utilized weighted gene coexpression network analysis (WGCNA), MCODE, LASSO algorithms, and ROC curves to identify the key genes. Additionally, immune infiltrating analysis and a single-cell sequencing dataset were utilized to further explore the characteristics of the key genes. Finally, we conducted in vitro experiments on human disc tissues to validate the significance of these key genes in IDD. Results we obtained gene expression profiles from the GEO database (GSE23130 and GSE15227) and identified 1015 DEGs associated with IDD. Using WGCNA, we identified the blue module as significantly related to IDD. Among the DEGs, we identified 47 hub genes that overlapped with the genes in the blue module, based on criteria of |logFC| ≥ 2.0 and p.adj <0.05. Further analysis using both MCODE and LASSO algorithms enabled us to identify five key genes, of which CKAP4 and SSR1 were validated by GSE70362, demonstrating significant diagnostic value for IDD. Additionally, immune infiltrating analysis revealed that monocytes were significantly correlated with the two key genes. We also analyzed a single-cell sequencing dataset, GSE199866, which showed that both CKAP4 and SSR1 were highly expressed in fibrocartilage chondrocytes. Finally, we validated our findings in vitro by performing real time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) on 30 human disc samples. Our results showed that CKAP4 and SSR1 were upregulated in degenerated disc samples. Taken together, our findings suggest that CKAP4 and SSR1 have the potential to serve as disease biomarkers for IDD.
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Affiliation(s)
- Danqing Guo
- Institute of Orthopaedics and Traumatology, The 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
- Guangzhou University of Chinese Medicine the First Affiliated HospitalGuangzhou中国
| | - Min Zeng
- Pathology DepartmentThe 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Miao Yu
- Spinal Surgery DepartmentThe 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Jingjing Shang
- Spinal Surgery DepartmentThe 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Jinxing Lin
- Spinal Surgery DepartmentThe 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Lichu Liu
- Institute of Orthopaedics and Traumatology, The 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Kuangyang Yang
- Institute of Orthopaedics and Traumatology, The 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
| | - Zhenglin Cao
- Spinal Surgery DepartmentThe 8th Clinical Medical College of Guangzhou University of Chinese MedicineFoshanGuangdongChina
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Zhang X, Zhang Z, Zou X, Wang Y, Qi J, Han S, Xin J, Zheng Z, Wei L, Zhang T, Zhang S. Unraveling the mechanisms of intervertebral disc degeneration: an exploration of the p38 MAPK signaling pathway. Front Cell Dev Biol 2024; 11:1324561. [PMID: 38313000 PMCID: PMC10834758 DOI: 10.3389/fcell.2023.1324561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/28/2023] [Indexed: 02/06/2024] Open
Abstract
Intervertebral disc (IVD) degeneration (IDD) is a worldwide spinal degenerative disease. Low back pain (LBP) is frequently caused by a variety of conditions brought on by IDD, including IVD herniation and spinal stenosis, etc. These conditions bring substantial physical and psychological pressure and economic burden to patients. IDD is closely tied with the structural or functional changes of the IVD tissue and can be caused by various complex factors like senescence, genetics, and trauma. The IVD dysfunction and structural changes can result from extracellular matrix (ECM) degradation, differentiation, inflammation, oxidative stress, mechanical stress, and senescence of IVD cells. At present, the treatment of IDD is basically to alleviate the symptoms, but not from the pathophysiological changes of IVD. Interestingly, the p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway is involved in many processes of IDD, including inflammation, ECM degradation, apoptosis, senescence, proliferation, oxidative stress, and autophagy. These activities in degenerated IVD tissue are closely relevant to the development trend of IDD. Hence, the p38 MAPK signaling pathway may be a fitting curative target for IDD. In order to better understand the pathophysiological alterations of the intervertebral disc tissue during IDD and offer potential paths for targeted treatments for intervertebral disc degeneration, this article reviews the purpose of the p38 MAPK signaling pathway in IDD.
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Affiliation(s)
- Xingmin Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Zilin Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Xiaosong Zou
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Yongjie Wang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Jinwei Qi
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Song Han
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Jingguo Xin
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Zhi Zheng
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Lin Wei
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
| | - Tianhui Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
| | - Shaokun Zhang
- Department of Spine Surgery, Center of Orthopedics, First Hospital of Jilin University, Changchun, China
- Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun, China
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Jess MA, Ryan C, Wellburn S, Atkinson G, Greenough C, Peat G, Coxon A, Roper H, Fatoye F, Ferguson D, Dickson A, Ridley H, Martin D. Does pain duration and other variables measured at baseline predict re-referral of low back pain patients managed on an evidence-based pathway? A cohort study. Physiotherapy 2023; 121:5-12. [PMID: 37591028 DOI: 10.1016/j.physio.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 04/02/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To explore the association between baseline pain duration and the likelihood of re-referral of patients with low back pain (LBP) managed on the evidence-based North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). STUDY DESIGN Longitudinal, observational cohort study. METHODS In all, 12,509 adults with LBP were identified as having been discharged from the pathway, between May 2015 and December 2019. To quantify any association between baseline pain duration and the likelihood of re-referral, two statistical modelling approaches, were used: logistic regression models for odds ratios and generalised linear models with a binomial link function in order to quantify risk differences. RESULTS Twenty-five percent of patients with LBP, who were discharged, re-referred for management over a 4.5-year period. A large difference in pain duration of 2 SD days was statistically associated with re-referral, with an odds ratio of 1.22 (95% CI: 1.03, 1.44) and a risk difference of 3.6% (95% CI: 0.6, 6.6). Nevertheless, the predictive value of an individual's pain duration was found to be weak for re-referral. Higher baseline disability [odds ratio of 1.40 (95% CI: 1.07, 1.83)] and a younger age at baseline [odds ratio of 0.73 (95% CI 0.61, 0.86)] were also associated with an increased risk of re-referral. CONCLUSIONS Baseline pain duration, disability and younger age are statistically associated with re-referral onto the NERBPP. However, the value of these variables for predicting an individual's risk of re-referral is weak. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
| | - Cormac Ryan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Glynis Peat
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Andrew Coxon
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Helena Roper
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK
| | - Diarmaid Ferguson
- Northumbria Healthcare NHS Trust, North Tyneside General Hospital, North Shields, UK; Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK
| | - Alastair Dickson
- Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK; The North of England Low Back Pain Pathway, NIHR Applied Research Collaboration (ARC) North East and North Cumbria, St Nicolas' Hospital, Newcastle Upon Tyne, UK; AD Outcomes Ltd, York, UK
| | - Helen Ridley
- Getting It Right First Time (GIRFT): Clinically led improvement programme delivered in partnership with the Royal National Orthopaedic Hospitals NHS Trust, NHS England and NHS Improvement, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK; NIHR Applied Research Collaboration for the North East and North Cumbria, UK
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Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep 2022; 71:1-95. [PMID: 36327391 PMCID: PMC9639433 DOI: 10.15585/mmwr.rr7103a1] [Citation(s) in RCA: 426] [Impact Index Per Article: 213.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1-49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1-3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient's circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.
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Li NH, Zou RQ, Zhao XG, Kong P, Yue C, Jia ML, Jiang P, Li YT, Li G, Xu ZW. Research of a Safe and Simplified Intertransverse Process Approach for the Lower Thoracic Interbody Surgery. Orthop Surg 2022; 14:1873-1883. [PMID: 35819089 PMCID: PMC9363745 DOI: 10.1111/os.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To assess a safe surgical approach for intertransverse process lower thoracic intervertebral body fusion (ITIF) based on measurements from enhanced three‐dimensional CT reconstruction, cadaver simulated operation, and patient operation. Methods Enhanced three‐dimensional CT image reconstruction was performed for 20 healthy volunteers on thoracic segments T8–T12. The length of the transverse process (LTP), distance between the upper and lower transverse processes (DULTP), remote distance of the transverse process (RDTP), height of the extraforaminal intervertebral space (HEIS), and oblique diameter of the intervertebral space (ODIS) were measured and recorded. The blood vessels of the intertransverse lower thoracic region were observed, and their internal diameters were measured. The rib‐intervertebral space relationship for T10/11 and T11/12 was measured in 104 patients of the thoracic skeleton. Then, based on the data from the CT measurements, simulated surgery was performed on six human cadavers at the T11/12 level. An ankylosing spondylitis (AS) patient with a fracture of the T10/11 level was eventually operated on with the ITIF technique. Results No significant difference was found between the lengths of the left and right thoracic transverse processes. The relationship of the values of the LTP and RDTP for the measured vertebrae were found to be as follows:T8 > T9 > T10 > T11 > T12. For HEIS and DULTP, T8–9 < T9–10 < T10–11 < T11–12. The results for the ODIS were as follows: T8–T9 < T9–T10 < T10–T11 < T11–T12. The blood vessel inner diameter of T11–12 was less than that of T10–11, while there was no significant difference between the diameters for T8–9 and T11–12. Almost half of the volunteer's T10/11 intervertebral spaces were covered posteriorly by the 11th rib (45.19% on left and 41.35% on right), while for most patients, the T11/12 intervertebral space was not covered by the 12th rib (98.08%). According to the cadaver experiments, intervertebral bone grafting and ipsilateral pedicle screw fixation were performed to simulate the operation. One patient with a combined AS and T10/11 fracture was then operated on with the ITIF technique and followed up for 3 years with satisfactory results. Conclusion As verified by 3D CT reconstruction measurements, cadaver simulation surgery and patient operation with follow‐up, the intertransverse process approach for some T10/T11 and almost all T11/T12 segments is a safe surgical pathway for operations such as ITIF, fracture bone grafting, clearance of focal lesions.
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Affiliation(s)
- Nian-Hu Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Rui-Qi Zou
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Xue-Gang Zhao
- Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Peng Kong
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Chen Yue
- TCM Hospital of Zhangdian District of Zibo City, Shandong, China
| | - Meng-Long Jia
- Weifang Hospital of Traditional Chinese Medicine, Shandong, China
| | - Ping Jiang
- Shanghai University of Traditional Chinese University, Shanghai, China
| | - Yu-Tong Li
- Experimental High School of Shandong Province, Shandong, China
| | - Gang Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Zhan-Wang Xu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
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Fan Y, Zhao L, Lai Y, Lu K, Huang J. CRISPR-Cas9-mediated loss of function of β-catenin attenuates intervertebral disc degeneration. MOLECULAR THERAPY - NUCLEIC ACIDS 2022; 28:387-396. [PMID: 35505959 PMCID: PMC9035381 DOI: 10.1016/j.omtn.2022.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/27/2022] [Indexed: 11/06/2022]
Abstract
Intervertebral disc degeneration is a very common medical condition causing pain and disability, and it cannot be reversed by available treatment options. Here we report that targeting β-catenin, a pivotal factor associated with disc degeneration, ameliorates disc degeneration in a mouse model of disc injury. Degenerative changes in the disc in response to disc injury include decompression of nucleus pulposus (NP), replacement of notochordal cells in the NP by chondrocyte-like cells, and disorganization of annulus fibrosus (AF). Importantly, downregulation of β-catenin through intradiscal injection of CRISPR-Cas9-expressing adeno-associated virus significantly mitigated all these pathological changes, by preserving notochordal cells and attenuating chondro-osteogenesis in the NP, as well as maintaining the AF structure. Moreover, β-catenin loss-of-function decelerated the rapid induction of catabolic reactions in disc matrix and attenuated pain-related neural events during disc degeneration. Thus, our data demonstrate that targeting β-catenin in disc cells through CRISPR-Cas9 has multifaceted therapeutic effects on disc degeneration, and we suggest that β-catenin plays a fundamental role in the remodeling and degenerative processes of the disc. In addition, this study proposes that CRISPR-Cas9 is a useful tool for identifying new drug targets and developing therapeutic strategies for disc degeneration.
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Zhang HJ, Liao HY, Bai DY, Wang ZQ, Xie XW. MAPK /ERK signaling pathway: A potential target for the treatment of intervertebral disc degeneration. Biomed Pharmacother 2021; 143:112170. [PMID: 34536759 DOI: 10.1016/j.biopha.2021.112170] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a chronic skeletal muscle degenerative disease, which is considered the main cause of low back pain. It seriously affects the quality of life of patients and consequently brings a heavy economic burden to their families and the society. Although IDD is considered a natural process in degenerative lesions, it is mainly caused by aging, trauma, genetic susceptibility and other factors. It is closely related to changes in the tissue structure and function, including the progressive destruction of extracellular matrix, cell aging, cell death of the intervertebral disc (IVD), inflammation, and impairment of tissue biomechanical function. Currently, the treatment of IDD is aimed at alleviating symptoms rather than at targeting pathological changes in the IVD. Furthermore, the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) signaling pathway is closely related to various pathological processes in IDD, and the activation of the MAPK/ERK pathway promotes the degradation of the IVD extracellular matrix, cell aging, apoptosis, and inflammatory responses. It also induces autophagy and oxidative stress that accelerate the IVD process. In our current review, we summarize the latest developments in the negative regulation of IDD after activation of the MAPK/ERK signaling pathway and emphasize on its influence on IDD. Targeting this pathway may become an attractive treatment strategy for IDD in the near future.
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Affiliation(s)
- Hai-Jun Zhang
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China
| | - Hai-Yang Liao
- Fist Affiliated Hospital of Ganan Medical University, 23 Qingnian Road, Ganzhou 342800, PR China
| | - Deng-Yan Bai
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China
| | - Zhi-Qiang Wang
- Fist Affiliated Hospital of Ganan Medical University, 23 Qingnian Road, Ganzhou 342800, PR China
| | - Xing-Wen Xie
- Second Provincial People's Hospital of Gansu, 1 Hezheng West Street, Lanzhou 730000, PR China; Affiliated Hospital of Northwest Minzu Univsity, Lanzhou 730000, PR China.
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Wu ZL, Xie QQ, Liu TC, Yang X, Zhang GZ, Zhang HH. Role of the Wnt pathway in the formation, development, and degeneration of intervertebral discs. Pathol Res Pract 2021; 220:153366. [PMID: 33647863 DOI: 10.1016/j.prp.2021.153366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Intervertebral disc degeneration (IVDD) is an age-related degenerative disease that is the main cause of low back pain. It seriously affects the quality of life of patients and places a heavy economic burden on families and society. The Wnt pathway plays an important role in the growth, development, and degeneration of intervertebral discs (IVDs). In the embryonic stage, the Wnt pathway participates in the growth and development of IVD by promoting the transformation of progenitor cells into notochord cells and the extension of the notochord. However, the activation of the Wnt pathway after birth promotes IVD cell senescence, apoptosis, and degradation of the extracellular matrix and induces the production of inflammatory factors, thereby accelerating the IVDD process. This article reviews the relationship between the Wnt pathway and IVD, emphasizing its influence on IVD growth, development, and degeneration. Targeting this pathway may become an effective strategy for the treatment of IVDD.
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Affiliation(s)
- Zuo-Long Wu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China
| | - Qi-Qi Xie
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China
| | - Tai-Cong Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China
| | - Xing Yang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China
| | - Guang-Zhi Zhang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China
| | - Hai-Hong Zhang
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China; Department of Orthopaedics, Second Hospital of Lanzhou University, Lanzhou, Gansu 730000, China; Key Laboratory of Orthopaedics Disease of Gansu Province, Lanzhou, Gansu 730000, China.
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Jess MA, Ryan C, Hamilton S, Wellburn S, Atkinson G, Greenough C, Peat G, Coxon A, Fatoye F, Ferguson D, Dickson A, Ridley H, Martin D. Does Duration of Pain at Baseline Influence Longer-term Clinical Outcomes of Low Back Pain Patients Managed on an Evidence-Based Pathway? Spine (Phila Pa 1976) 2021; 46:191-197. [PMID: 33079915 DOI: 10.1097/brs.0000000000003760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Nonrandomized longitudinal observational study. OBJECTIVE The aim of this study was to evaluate the association between baseline pain duration and medium-to-long term clinical outcomes, in low back pain (LBP) patients enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). SUMMARY OF BACKGROUND DATA The NERBPP is based upon National Institute for Health and Care Excellence (NICE) guidelines. These guidelines no longer differentiate management of LBP patients based on pain duration. Medium-to-long term data from the NERBPP is lacking. METHODS Between May 2015 and December 2019, 786 and 552 LBP patients from the NERBPP returned 6-month and 12-month follow-up outcome measures, respectively. Outcomes included pain (Numerical rating scale), function (Oswestry Disability Index) and quality-of-life (EuroQol five-dimension, five-level questionnaire), analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months. RESULTS Patients with <3 months duration demonstrated clinically important improvements on all outcomes, at both follow-ups. The improvements in outcomes from this group were larger than those in the ≥12 month's duration group (P < 0.05), these group differences in change, in some cases surpassed our threshold for clinical relevance. Functional improvements in those with ≥12 month's duration were not clinically relevant at either follow-up. All patients, regardless of baseline pain duration, reported similar levels of readiness to self-manage at the 12-month follow-up. CONCLUSION Baseline pain duration would appear to be of clinical importance. Patients with shorter baseline pain duration demonstrated better outcomes. Those with ≥12 month's duration of pain may need additional support during their management to achieve clinically relevant functional improvements in the medium-to-long term. These findings raise questions about the decision by NICE to move away from duration of pain to differentiate management of LBP patients.Level of Evidence: 3.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Greg Atkinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | | | - Glynis Peat
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Andrew Coxon
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Diarmaid Ferguson
- Northumbria Healthcare NHS Trust, North Tyneside General Hospital, North Shields, UK
- Primary Care Rheumatology & Musculoskeletal Medicine (PCRMM) Society, York, North Yorkshire, UK
| | - Alastair Dickson
- Primary Care Rheumatology & Musculoskeletal Medicine (PCRMM) Society, York, North Yorkshire, UK
- GP Lead for the North of England Back and Radicular Pain Pathway, UK
| | - Helen Ridley
- Getting It Right First Time (GIRFT): Clinically-led improvement programme delivered in partnership with the Royal National Orthopedic Hospitals NHS Trust, NHS England and NHS Improvement, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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11
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Chye A, Lin CWC, Hancock MJ, Harris I, Latimer J, Maher CG, McLachlan AJ, Mathieson S, Koes B, Day RO, Billot L, Jan S, Angell B. Healthcare expenditure and its predictors in a cohort of Australians living with sciatica. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:878-885. [PMID: 32970236 DOI: 10.1007/s00586-020-06605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the healthcare resource utilisation of an Australian cohort of people with sciatica and explore individual-level factors associated with expenditure. METHODS Healthcare utilisation (services and medication) data from a randomised, double-blind, placebo-controlled trial of pregabalin in patients with sciatica (n = 185) were analysed to estimate healthcare expenditure of participants over 12 months. Associations between key baseline socio-economic, pain and quality of life characteristics and healthcare expenditure were examined using generalised linear imputation models. RESULTS On average, participants accessed AUD$1,134 of healthcare over the year, predominantly made up of $114 of medication and $914 of health services, which included $418 of physiotherapy services. Participants randomised to receive pregabalin incurred higher expenditure ($1,263 compared to $1,001 for placebo), which was largely driven by pregabalin ($158) and greater health services ($107). Healthcare expenditure was significantly higher for participants prescribed pregabalin, earning greater than $1,700 per week ($88,400 per year) and reporting poorer quality of life (physical and mental). CONCLUSION Our results suggest inefficiency in the use of healthcare resources due to increased healthcare resource utilisation in people with sciatica treated with pregabalin, compared to placebo. Costs of treating sciatica varied based on individual quality of life and socio-economic characteristics.
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Affiliation(s)
- Alexander Chye
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia.
| | - Chung-Wei Christine Lin
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Ian Harris
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Jane Latimer
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher G Maher
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Stephanie Mathieson
- The Institute for Musculoskeletal Health, Sydney, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Richard O Day
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King Street, Newtown, Sydney, 2041, Australia
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12
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Hu S, Fu Y, Yan B, Shen Z, Lan T. Analysis of key genes and pathways associated with the pathogenesis of intervertebral disc degeneration. J Orthop Surg Res 2020; 15:371. [PMID: 32873329 PMCID: PMC7465721 DOI: 10.1186/s13018-020-01902-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) is widely known as the main contributor to low back pain which has a negative socioeconomic impact worldwide. However, the underlying mechanism remains unclear. This study aims to analyze the dataset GSE23130 using bioinformatics methods to identify the pivotal genes and pathways associated with IDD. MATERIAL/METHODS The gene expression data of GSE23130 was downloaded, and differentially expressed genes (DEGs) were extracted from 8 samples and 15 controls. GO and KEGG pathway enrichment analyses were performed. Also, protein-protein interaction (PPI) network was constructed and visualized, followed by identification of hub genes and key module. RESULTS A total of 30 downregulated and 79 upregulated genes were identified. The DEGs were mainly enriched in the regulation of protein catabolic process, extracellular matrix organization, collagen fibril organization, and extracellular structure organization. Meanwhile, we found that most DEGs were primarily enriched in the PI3K-Akt signaling pathway. The top 10 hub genes were FN1, COL1A2, SPARC, COL3A1, CTGF, LUM, TIMP1, THBS2, COL5A2, and TGFB1. CONCLUSIONS In summary, key candidate genes and pathways were identified by using integrated bioinformatics analysis, which may provide insights into the underlying mechanisms and offer potential target genes for the treatment of IDD.
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Affiliation(s)
- Shiyu Hu
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yucheng Fu
- Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Yan
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhe Shen
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Tao Lan
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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13
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Mishriky J, Stupans I, Chan V. The role of the pharmacist in low back pain management: a narrative review of practice guidelines on paracetamol vs non-steroidal anti-inflammatory drugs. Pharm Pract (Granada) 2020; 18:2075. [PMID: 32802218 PMCID: PMC7416311 DOI: 10.18549/pharmpract.2020.3.2075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Low back pain (LBP) is a common and costly condition and a leading cause of
disabilities across the globe. In Australia and other countries, there has been
changes in LBP management guidelines and evidence in recent years, including the
use of pharmacotherapy. Inadequately treated LBP is a burden with significant
health and economic impacts. Although there is some variability, non-steroidal
anti-inflammatory drugs (NSAIDs) have largely replaced paracetamol as the
first-choice analgesic for non-specific LBP in many international clinical
guidelines, including the current Australian Therapeutic Guidelines. More recent
clinical evidence also supports that targeting LBP with the use of NSAIDs can
provide superior and more effective relief of LBP symptoms compared with
paracetamol. Community pharmacists are one of the most accessible and frequently
visited health professionals that offer vital primary healthcare services aimed
to provide enhanced clinical outcomes for patients. The position of a community
pharmacist is pivotal in LBP assessment and management, from both a
pharmacological and non-pharmacological standpoint, including the use of
clinical guidelines, yet their roles are often not fully utilized in LBP
therapy. Studies investigating the community pharmacist’s views,
practices, knowledge, and roles, specifically in LBP management in Australia are
variable and limited. This narrative review will briefly cover the impacts of
LBP, and to provide a summary on recent evidence, updates and a comparison of
the Australian and international low back pain management guidelines on
paracetamol vs NSAIDs in LBP, as well as pharmacists’ roles and
interventions in a primary healthcare setting in this context.
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Affiliation(s)
- John Mishriky
- BPharm(Hons). Pharmacy, School of Health and Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- BPharm, PhD. Professor and Discipline Head. Pharmacy, School of Health and Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Vincent Chan
- BPharm, MPH, PhD. Senior Lecturer. Pharmacy, School of Health and Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
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Li Y, Ou Y, Zhu Y, He B, Xu S, Yu H. Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study. Med Sci Monit 2020; 26:e923656. [PMID: 32694499 PMCID: PMC7392055 DOI: 10.12659/msm.923656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There remains a great deal of controversy regarding the selection of long-segment fixation and short-segment fixation, especially for degenerative scoliosis (DS) patients with Cobb angle 20°~40°. The purpose of this study was to investigate the effects of different fixation levels in DS patients with Cobb angle 20°~40°. MATERIAL AND METHODS We enrolled 96 DS patients, divided into a long-segment fixation group (>3 segments) and a short-segment fixation group (≤3 segments). The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes. The spinal-pelvic parameters and complications were also collected and analyzed. RESULTS The short-segment fixation group had the advantages of less blood loss, shorter operation time and shorter fluoroscopy time (P<0.05). The 2 groups achieved similar effects in leg pain (VAS) and ODI after operation (P>0.05); however, there was a better relief of low back pain in the long-segment fixation group (P<0.05). The changes of Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) in the long-segment fixation group were more obvious than that in the short-segment fixation group at the final follow-up (P<0.05). The prevalence of complications in the long-segment fixation group was significantly higher than in the short-segment fixation group (P<0.01). CONCLUSIONS Short-segment fixation has less surgical trauma and fewer complications, whereas long-segment fixation has more advantages in improving spine-pelvis parameters and relieving low back pain.
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Affiliation(s)
- Yuanqiang Li
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Yunsheng Ou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Yong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bin He
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Shuai Xu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Haoyang Yu
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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15
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Kahere M, Ginindza T. Mapping evidence on the prevalence, incidence, risk factors and cost associated with chronic low back pain among adults in Sub-Saharan Africa: a systematic scoping review protocol. Syst Rev 2020; 9:57. [PMID: 32183868 PMCID: PMC7077148 DOI: 10.1186/s13643-020-01321-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 03/06/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Globally, low back pain (LBP) is a major public health problem affecting mainly adults of the working class and is the leading cause of disability. The estimated lifetime prevalence of LBP is 50 to 80%. From 1990 to 2015, the years lived with disability caused by LBP have scaled up by 54% with the greatest increase observed in low-middle-income countries (LMICs). LBP poses a significant socio-economic burden to the society regardless of all the technological advancement in diagnosis and intervention approaches in recent years. Despite an increase in the literature of LBP in LMICs, chronic low back pain (CLBP) is poorly investigated yet it is responsible for the largest amount of burden. The purpose of this scoping review is to map the existing evidence on the prevalence, incidence, mortality, risk factors, and cost associated with CLBP among adults in Sub-Saharan Africa (SSA). METHODS We will conduct a scoping review to explore, describe, and map literature on the prevalence, incidence, mortality, risk factors, and costs associated with CLBP among adults in SSA. The search will be performed using the EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, Embase, PubMed, MEDLINE, Science Direct databases, Google Scholar, and the World Health Organization library databases. The search will include peer-reviewed, review articles, and gray literature. The first (title and abstract) and the second (full text) screening phases will be performed by two independent reviewers, with the third reviewer employed to adjudicate discrepancies. The reference list of all included articles will also be searched for eligible articles. This scoping review will be reported in accordance to the MOOSE and PRISMA-ScR guidelines. The NVivo 12 data analysis software will be used to generate themes, and a thematic content analysis will be used to give the narrative account of the review. DISCUSSION The study anticipates finding relevant literature on the prevalence, incidence, risk factors, mortality, and cost associated with CLBP among adults in SSA. The study outcomes will aid in identifying research gaps, planning, informing policy, commissioning of future research, and funding prioritization.
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Affiliation(s)
- Morris Kahere
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, Durban, 4041, South Africa.
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, Durban, 4041, South Africa
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16
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Pain-related Self-efficacy Among People With Back Pain: A Systematic Review of Assessment Tools. Clin J Pain 2020; 36:480-494. [PMID: 32080001 DOI: 10.1097/ajp.0000000000000818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Before an intervention can be implemented to improve pain-related self-efficacy, assessment is required. The aim of the present study was to provide a systematic review on which self-efficacy scales are being used among patients with back pain and to evaluate their psychometric properties. METHODS A systematic search was executed in January 2019 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist served as a guide for conducting the study. Electronic databases included Cinahl, Medline, PubMed, PsycINFO, PSYNDEX, and SportDiscus. Publications in English or German language that focused on the adult patient population with back pain and which provided validation or reliability measures on pain-related self-efficacy were included. RESULTS A total of 3512 records were identified resulting in 671 documents after duplicates were removed. A total of 233 studies were screened full-text, and a total of 47 studies addressing 19 different measures of pain-related self-efficacy were included in the quality analysis. The most commonly used instruments were the Pain Self-Efficacy Questionnaire and the Chronic Pain Self-Efficacy Scale. All studies reported internal consistency, but many studies lacked other aspects of reliability and validity. CONCLUSIONS Further research should focus on assessing validity and interpretability of these questionnaires, especially in pain-related target groups. Researchers should select questionnaires that are most appropriate for their study aims and the back pain population and contribute to further validation of these scales to best predict future behavior and develop intervention programs. This systematic review aids selection of pain-related assessment tools in back pain both in research and practice.
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17
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Schreijenberg M, Chiarotto A, Mauff KAL, Lin CWC, Maher CG, Koes BW. Inferential reproduction analysis demonstrated that "paracetamol for acute low back pain" trial conclusions were reproducible. J Clin Epidemiol 2020; 121:45-54. [PMID: 31982540 DOI: 10.1016/j.jclinepi.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/08/2020] [Accepted: 01/20/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to reanalyze and reinterpret data obtained in Paracetamol in Acute Low Back Pain (PACE), the first large randomized controlled trial evaluating the efficacy of paracetamol in acute low back pain, to assess the inferential reproducibility of the original conclusions. STUDY DESIGN AND SETTING Mixed effects models were used to reanalyze pain intensity (primary outcome; 11-point Numeric Rating Scale) and physical functioning, health-related quality of life, sleep quality, and time until recovery (as secondary outcomes), according to the intention-to-treat principle. The original authors of the PACE study were not involved in the development of the methods for this reanalysis. RESULTS The reproduction analyses indicated no effect of treatment on pain intensity and confidence intervals excluded clinically worthwhile effects (adjusted main effect for regular paracetamol vs. placebo 0.00 [-0.02, 0.01; P = 0.85]; adjusted main effect for paracetamol as-needed vs. placebo 0.00 [-0.02, 0.01; P = 0.92]). Similar results were obtained for all secondary outcomes. CONCLUSION This study indicates that the conclusions of the PACE trial are inferentially reproducible, even when using a different analytical approach. This reinforces the notion that the management of acute low back pain should focus on providing patients advice and reassurance without the addition of paracetamol.
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Affiliation(s)
- Marco Schreijenberg
- Erasmus MC, Department of General Practice, University Medical Center Rotterdam, PO box 2040, 3000 CA, Rotterdam, South Holland, the Netherlands.
| | - Alessandro Chiarotto
- Erasmus MC, Department of General Practice, University Medical Center Rotterdam, PO box 2040, 3000 CA, Rotterdam, South Holland, the Netherlands
| | - Katya A L Mauff
- Erasmus MC, Department of Biostatistics, University Medical Center Rotterdam, PO box 2040, 3000 CA, Rotterdam, South Holland, the Netherlands
| | - Chung-Wei Christine Lin
- Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, PO Box M179, Sydney, New South Wales 2050, Australia
| | - Christopher G Maher
- Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, PO Box M179, Sydney, New South Wales 2050, Australia
| | - Bart W Koes
- Erasmus MC, Department of General Practice, University Medical Center Rotterdam, PO box 2040, 3000 CA, Rotterdam, South Holland, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, South Denmark, Denmark
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Fan Y, Zhao L, Xie W, Yi D, He S, Chen D, Huang J. Serum miRNAs are potential biomarkers for the detection of disc degeneration, among which miR-26a-5p suppresses Smad1 to regulate disc homeostasis. J Cell Mol Med 2019; 23:6679-6689. [PMID: 31338931 PMCID: PMC6787501 DOI: 10.1111/jcmm.14544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 12/26/2022] Open
Abstract
Disc degeneration is a common clinical condition in which damaged discs cause chronic pain; however, a laboratory diagnosis method for its detection is not available. As circulating miRNAs have potential as biomarkers, their application in disc degeneration has not been explored. Here, we prepared serum miRNAs from a mouse disc degeneration model and performed miRNA‐Seq and quantitative PCR to characterize disc degeneration–associated miRNAs. We identified three miRNAs, including miR‐26a‐5p, miR‐122‐5p and miR‐215‐5p, undergoing perturbation during the pathogenesis of disc degeneration. Specifically, the levels of miR‐26a‐5p in the serum demonstrated steady increases in the model of disc degeneration, compared with those in the pre‐injury samples of younger age or compared with normal controls of the same age but without disc degeneration, whereas the miRNAs miR‐122‐5p and miR‐215‐5p exhibited lower expression in post‐injury samples than in their counterparts without the surgery. Moreover, we found that miR‐26a‐5p targets Smad1 expression, and Smad1 negatively regulates Vegfa expression in disc cells, and thus, miR‐26a‐5p promotes disc degeneration. In summary, we established a method that consistently profiles circulating miRNAs and identified multiple miRNAs as promising biomarkers for disc degeneration, among which miR‐26a‐5p enhances VEGF expression during disc degeneration through targeting Smad1 signalling.
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Affiliation(s)
- Yunshan Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Lan Zhao
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Wanqing Xie
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dan Yi
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Di Chen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jian Huang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Mo S, Liu C, Chen L, Ma Y, Liang T, Xue J, Zeng H, Zhan X. KEGG-expressed genes and pathways in intervertebral disc degeneration: Protocol for a systematic review and data mining. Medicine (Baltimore) 2019; 98:e15796. [PMID: 31124977 PMCID: PMC6571259 DOI: 10.1097/md.0000000000015796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
miRNAs and genes play significant roles in the etiology and pathogenesis of intervertebral disc degeneration (IDD). This study aimed to identify aberrantly expressed miRNAs, genes, and pathways in IDD through a comprehensive bioinformatics analysis.Data of miRNAs expression microarrays (GSE63492) and genes microarrays (GSE23130) were obtained from GEO database. Similarly, aberrantly expressed miRNAs and genes were obtained using GEO2R. In addition, functional and enrichment analyses of selected miRNAs and genes were performed using the DAVID database. Meanwhile, protein-protein interaction (PPI) network was constructed using STRING, and then visualized in Cytoscape.A total of 98 upregulated miRNAs were identified. They were enriched in biological processes of response to organelle, ion binding, cellular nitrogen compound metabolic process, biosynthetic process, small molecule metabolic process, cellular protein modification process, catabolic process, molecular function, neurotrophin TRK receptor signaling pathway, and protein complex. In addition, 1405 high expression protein genes were detected. It indicated enrichment in biological processes, such as translational initiation, nonsense-mediated decay, viral transcription, cell-cell adhesion, rRNA processing, translation, RP-dependent cotranslational protein targeting to membrane, nuclear-transcribed mRNA catabolic process, regulation of mRNA stability, and mRNA splicing via spliceosome and extracellular matrix organization. In addition, pathway analysis exhibited the common enrichment in focal adhesion, Hippo signaling pathway, ECM-receptor interaction, Wnt signaling pathway, PI3K-Akt signaling pathway, endocytosis, proteoglycans in cancer, and so on. The top 10 central genes of PPI network were POTEE, PPP2CA, RPL17, HSP90AA1, POTEF, RPL13A, ACTB, RPL18, RPS24, and HSPA1A.In conclusion, our research proposed abnormally expressed miRNAs, genes, and pathways in IDD through bioinformatics methods, which may provide new insights into the pathogenesis of IDD. Thus, the Hub gene involving POTEE, PPP2CA, RPL17, HSP90AA1, POTEF, RPL13A, ACTB, RPL18, RPS24, and HSPA1A may be biomarkers for accurate diagnosis and treatment of IDD in the future.
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Imaging versus no imaging for low back pain: a systematic review, measuring costs, healthcare utilization and absence from work. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:937-950. [DOI: 10.1007/s00586-019-05918-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/18/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
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Zheng YL, Zhang ZJ, Peng MS, Hu HY, Zhang J, Wang XQ. Whole-body vibration exercise for low back pain: A meta-analysis protocol of randomized controlled trial. Medicine (Baltimore) 2018; 97:e12534. [PMID: 30235777 PMCID: PMC6160172 DOI: 10.1097/md.0000000000012534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low back pain (LBP) affects about 80% of the population at some time in their lives. Exercise therapy is the most widely used nonsurgical intervention for low back pain in practice. Thus, whole-body vibration (WBV) exercise is becoming increasingly popular in relieving musculoskeletal pain and in improving function. However, the efficacy of WBV exercise is not without dispute for low back pain. This meta-analysis, with its comprehensive and rigorous methodology, will provide better insight into this problem. METHODS Published articles will be identified using electronic searches from 1950 to 2018. The Cochrane Library, PubMed, Web of Science, Embase, CINAHL-Ebsco, PEDro, and China Biology Medicine will be searched for randomized controlled trials. Studies without a parallel comparison group will be excluded. Two reviewers will independently select relevant studies that investigate on WBV exercise for patients with LBP. Data extraction will be done independently by the same 2 reviewers who selected the studies. The primary outcome will be to assess pain, back-specific disability index, and adverse effect. Continuous data will be pooled by calculating the mean difference using the random-effects model. RESULTS The results of the final meta-analysis will provide an evidence of WBV exercise for low back pain. CONCLUSION This meta-analysis will provide a detailed summary of the evidence on the effects of WBV exercise on patients with LBP, in comparison with general exercise or without treatment. This review will benefit to researchers and policy makers who are interested in the treatment of LBP by WBV exercise.
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Affiliation(s)
- Yi-Li Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Henan Province Orthopedic Hospital, Luoyang, China
| | - Meng-Si Peng
- Department of Sport Rehabilitation, Shanghai University of Sport
| | - Hao-Yu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport
| | - Ju Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai
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Ouyang ZH, Wang WJ, Yan YG, Wang B, Lv GH. The PI3K/Akt pathway: a critical player in intervertebral disc degeneration. Oncotarget 2017; 8:57870-57881. [PMID: 28915718 PMCID: PMC5593690 DOI: 10.18632/oncotarget.18628] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/10/2017] [Indexed: 12/16/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is thought to be the primary cause of low back pain, a severe public health problem worldwide. Current therapy for IDD aims to alleviate the symptoms and does not target the underlying pathological alternations within the disc. Activation of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway protects against IDD, which is attributed to increase of ECM content, prevention of cell apoptosis, facilitation of cell proliferation, induction or prevention of cell autophagy, alleviation of oxidative damage, and adaptation of hypoxic microenvironment. In the current review, we summarize recent progression on activation and negative regulation of the PI3K/Akt signaling pathway, and highlight its impact on IDD. Targeting this pathway could become an attractive therapeutic strategy for IDD in the near future.
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Affiliation(s)
- Zhi-Hua Ouyang
- Department of Spine Surgery, The 2nd Xiangya Hospital of Central South University, Changsha, China.,Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Wen-Jun Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Bing Wang
- Department of Spine Surgery, The 2nd Xiangya Hospital of Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The 2nd Xiangya Hospital of Central South University, Changsha, China
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The Effectiveness of Classification-Specific Physical Therapy for People with Low Back pain Within Dominant Movement-Based Schemes: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.41959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Lo Martire R, Lis A, Skillgate E, Rasmussen-Barr E. Psychometric properties of the Swedish version of the Treatment Outcome Satisfaction Questionnaire. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:316-323. [PMID: 27888355 DOI: 10.1007/s00586-016-4876-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/17/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient satisfaction is an outcome measure for low-back pain (LBP) interventions which allows clinicians to design patient-oriented treatments. The Treatment Outcome Satisfaction Questionnaire (TOSQ) is an English instrument constructed for such evaluations, and no equivalent instruments exist for the Swedish population. This study, therefore, translated TOSQ into Swedish and assessed the translated version's psychometric properties for patients with LBP. METHODS A cross-cultural adaptation was used to translate TOSQ into Swedish. Subsequently, data from 131 patients with LBP whom undergone physiotherapy were consecutively aggregated and analyzed in a Rasch rating scale model with person measures standardized at 0-100 logits to evaluate the translated scale's validity. Finally, test-retest reliability of the Swedish version of TOSQ (TOSQ-S) was quantified via an intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) in 41 patients. RESULTS TOSQ was successfully translated into Swedish; however, while some Rasch model indices supported the translated scale's unidimensionality, one out of eight items and 12 out of 131 subjects misfitted the model. Scale optimization resulted in a 6-item subconfiguration, for which all items fitted the model, person misfits were reduced to ten subjects, and the person separation index increased from 1.86 to 2.04. ICC and SEM estimates suggested acceptable reliability for the six-item TOSQ-S at 0.66 and 6.6 logits, respectively. CONCLUSIONS A six-item TOSQ-S configuration showed acceptable psychometric properties and is suitable for measuring treatment outcome satisfaction of physiotherapy in patients with LBP.
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Affiliation(s)
- Riccardo Lo Martire
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, 141 83, Sweden. .,Centre for Naval Architecture, Department of Aeronautical and Vehicle Engineering, KTH Royal Institute of Technology, Teknikringen 8, Stockholm, 100 44, Sweden.
| | - Angela Lis
- Occupational and Industrial Orthopaedic Center (OIOC), Hospital for Joint Diseases, New York University Langone Medical Center, 63 Downing Street, New York, 100 14, NY, USA.,Department of Physical Therapy, Seton Hall University, 400 South Orange Ave, South Orange, 070 89, NJ, USA
| | - Eva Skillgate
- Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, 171 77, Sweden
| | - Eva Rasmussen-Barr
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, 141 83, Sweden.,Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, 171 77, Sweden
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