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Mitchell J, Abdelhakim N, Nagib P, Grossbach AJ, Bourekas E, Bhandary S, Bigelow G, Awad H. Reducing the Risk of Spinal Cord Injury in Patients With Asymptomatic Cervical Stenosis Undergoing Cardiac and Vascular Surgery. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00127-1. [PMID: 36966120 DOI: 10.1053/j.jvca.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Justin Mitchell
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nada Abdelhakim
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul Nagib
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Andrew J Grossbach
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric Bourekas
- Department of Neuroradiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Greg Bigelow
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
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Wang Y, Ma Y, Yang C, Huang X, Yang K, Lan F, Fu J, Song Z, Tian A, Feng Y, Tu T, Li H, Hong T, Wang Y, Zhang H. Potential biomarkers of spinal dural arteriovenous fistula: C4BPA and C1QA. J Neuroinflammation 2022; 19:165. [PMID: 35733178 PMCID: PMC9215050 DOI: 10.1186/s12974-022-02522-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background and purpose A major challenge in spinal dural arteriovenous fistula (SDAVF) is timely diagnosis, but no specific predictive biomarkers are known. Methods In the discovery cohort (case, n = 8 vs. control, n = 8), we used cerebrospinal fluid (CSF) and paired plasma samples to identify differentially expressed proteins by label-free quantitative proteomics. Further bioinformatics enrichment analyses were performed to screen target proteins. Finally, it was validated by ELISA in two of the new cohorts (case, n = 17 vs. control, n = 9), and univariate analysis, simple linear regression, and receiver operator characteristic (ROC) curve analysis were performed to evaluate the diagnostic potential. Results In the discovery cohort, the most overexpressed proteins were APOB and C4BPA in CSF samples of patients. The GO/KEGG enrichment analysis indicated that the upregulated proteins were mainly involved in the acute inflammatory response and complement activation. Hub-gene analysis revealed that APP might be the key protein in the molecular interaction network. In the validation cohort, C4BPA and C1QA were significantly overexpressed in the CSF of patients, averaging 3046.9 ng/ml and 2167.2 ng/ml, respectively. Simple linear regression demonstrated that levels of C1QA and C4 were positively correlated with total protein in CSF (R2 = 0.8021, p = 0.0005; R2 = 0.7447, p = 0.0013). The areas under the ROC curves of C4BPA and C1QA were 0.86 and 1.00, respectively. Conclusions This study was the first to identify C4BPA and C1QA as potential biomarkers for the diagnosis of SDAVF and revealed that complement pathway activation might be one of the molecular mechanisms for venous hypertension myelopathy. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02522-x.
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Affiliation(s)
- Yinqing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Chengbin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiahe Huang
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, No.1 West Beichen Rd., Beijing, 100101, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, China
| | - Fei Lan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, China
| | - Jingxuan Fu
- Department of Clinical Laboratory, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - An Tian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yueshan Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haifeng Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China.,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingchun Wang
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, No.1 West Beichen Rd., Beijing, 100101, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,China International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China.
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Wang C, Gu Z, Yu J, Zhang P, Yang F. Clinical observation of Long chiropractic treatment on patients with neurogenic cervical spondylosis: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2022; 101:e28861. [PMID: 35244040 PMCID: PMC8896486 DOI: 10.1097/md.0000000000028861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/15/2022] Open
Abstract
Neurogenic cervical spondylosis is the most common type of cervical spondylosis, accounting for approximately 60% percent of the incidence of cervical spondylosis. Cervical spine Long manipulation and sling exercise training (SET) have obtained good therapeutic results in clinical rehabilitation. The aim of this study was to evaluate the effect of Long manipulation combined with SET on neurogenic cervical spondylosis. In this assessor-blind, randomized controlled trial, 90 eligible patients will be randomized into a combination treatment group (Long manipulation combined with SET), a Long manipulation group and a conventional massage group. The visual analogue score, the Neck Disability Index score, and muscle fatigue in the bilateral upper oblique and Musculus sternocleidomastoideus, using mean power frequency and median frequency from the surface electromyography frequency domain index, will be assessed before and after the intervention at 0 and 4 weeks, respectively.Trial registration: Registered in the Chinese Clinical Trial Registration Center with the number ChiCTR2100054978. Registered December 30, 2021.
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Affiliation(s)
- Chen Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Zhongping Gu
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
| | - Junwu Yu
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
| | - Peizhen Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Faming Yang
- Department of Rehabilitation, Faculty of Health Services and Management, Ningbo College of Health Science, Ningbo, China
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Ding X, Wu J, Shen Q, Xu J, Mo W. Clinical control study of traditional Chinese medicine hot compress combined with traction in the treatment of cervical spondylotic radiculopathy: Study protocol. Medicine (Baltimore) 2021; 100:e23880. [PMID: 33530182 PMCID: PMC7850636 DOI: 10.1097/md.0000000000023880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Cervical spondylotic radiculopathy (CSR) is the most common type of cervical spondylosis, accounting for about 60% of the incidence of cervical spondylosis. Both cervical traction and traditional Chinese medicine hot compress are common and effective treatment for CSR. This study will be performed to investigate the effect of a combination of cervical traction and traditional Chinese medicine hot compress on CSR. In this non-blinded, randomized controlled trial, 100 eligible patients will be randomly divided into a treatment group (intermittent cervical traction combines with traditional Chinese medicine hot compress) and a control group (intermittent cervical traction combined with hot compresses). Before and after the intervention, the Visual Analog Scale score, Neck Disability Index score, and 20-score scale of symptoms will be evaluated at baseline and at 7, 14, 21, and 28 days. During the treatment period, any signs of acute adverse events, such as paralysis of aggravated pain, nausea, dizzy, and even syncope, will be recorded at each visit. Although intermittent cervical traction and traditional Chinese medicine hot compress have been used in the treatment of CSR in China for many years, there is no consensus on its effectiveness of combination therapy. This experiment will provide convincing evidence of the efficacy of intermittent cervical traction combined with traditional Chinese medicine hot compress in the treatment of CSR.
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Xie T, Pan L, Yang M, Xu Z, Wu T, Huang H, Li M, Ma L. Analysis of spinal angiograms that missed diagnosis of spinal vascular diseases with venous hypertensive myelopathy: the non-technical factors. 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; 29:2441-2448. [PMID: 32328790 DOI: 10.1007/s00586-020-06422-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/30/2020] [Accepted: 04/11/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Spinal DSA is the "gold standard" technique to identify the spinal vascular diseases with venous hypertensive myelopathy (VHM). However, sometimes spinal DSA can find nothing in patients with confirmed spinal vascular anomalies. Many of the reasons are avoidable technical factors. Nevertheless, there are also some non-technical factors. The objective of this study was to identify the non-technical factors. METHODS The cause of the missed findings was found as the non-technical factors in 14 patients. The clinical records and radiological findings of the 14 patients were reviewed. RESULTS The so-called standard spinal angiography can found nothing in the 14 patients. Additional angiography was performed and detected the lesions. Eight patients were found lesions supplied by carotid arteries or iliac arteries, including 2 cranial DAVF with internal carotid artery blood supply, 3 cranial DAVF with external carotid artery blood supply and 2 pelvic AVF with internal iliac artery blood supply and 1 pelvic AVM with internal iliac artery blood supply. Six patients were caused by stenosis of spinal draining vein, including 3 stenosis of the third lumbar veins and 3 stenosis of left renal veins combined with the reno-spinal trunk. CONCLUSIONS In order to avoid the missed findings of spinal vascular diseases with VHM, the technical factors should be reduced by performing a rigorous comprehensive angiography. To reduce the non-technical factors, the angiography of the internal iliac artery, the carotid artery systems and spinal draining veins should be performed in some special cases if the routine spinal angiography can find nothing.
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Affiliation(s)
- Tianhao Xie
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
| | - Li Pan
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
| | - Ming Yang
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
| | - Zhaoxi Xu
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
| | - Tao Wu
- Department of Neurosurgery, Shenzhen Hospital of Peking University, Shenzhen, China
| | - He Huang
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China
| | - Ming Li
- Department of Neurosurgery, Shenzhen Hospital, University of the Chinese Academy of Sciences, Shenzhen, China
| | - Lianting Ma
- Department of Neurosurgery, Central Theater General Hospital of Chinese PLA, No. 627 Wuluo Road, Wuhan, China.
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Tachibana N, Oichi T, Kato S, Sato Y, Hasebe H, Hirai S, Taniguchi Y, Matsubayashi Y, Mori H, Tanaka S, Oshima Y. Spinal cord swelling in patients with cervical compression myelopathy. BMC Musculoskelet Disord 2019; 20:284. [PMID: 31200693 PMCID: PMC6570955 DOI: 10.1186/s12891-019-2673-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Intramedullary hyperintense lesions associated with spinal cord edema on T2-weighted MR images (T2WI) are rare findings in patients with cervical spondylosis and are poorly characterized. We investigated the clinical characteristics of spinal cord edema due to cervical spondylosis (SCECS). Methods In total, 214 patients with cervical spondylotic myelopathy who underwent surgery between April 2007 and March 2017 were divided into SCECS and non-SCECS groups with SCECS defined as follows: (1) intramedullary signal intensity (ISI) of the cervical spinal cord in sagittal T2WI extending to more than one vertebral body height; (2) “fuzzy” ISI, recognized as a faint intramedullary change with a largely indistinct and hazy border; and (3) a larger sagittal diameter of the spinal cord segment with ISI just above or below the cord compression area compared with areas of the cervical spine without ISI. Radiographic parameters, demographic characteristics, and the Japanese Orthopedic Association (JOA) surgical outcomes score were compared between the groups. Results Seventeen patients (7.9%) were diagnosed with SCECS. These patients were younger than those in the non-SCECS group [median (interquartile range), 64 (20) vs. 69 (15) years, respectively, p = 0.016], and the disease duration from onset to surgery was significantly shorter in the SCECS group than in the non-SCECS group [6 (7) vs. 20 (48) months, respectively]. No significant difference was observed between groups with respect to sex, radiologic findings, or surgical outcomes. Conclusion The disease showed an earlier onset and more rapid progression in the patients with SCECS than in those without SCECS.
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Affiliation(s)
- Naohiro Tachibana
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takeshi Oichi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroyuki Hasebe
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shima Hirai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Harushi Mori
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27:417-433. [PMID: 28667382 DOI: 10.1007/s00062-017-0604-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022]
Abstract
Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) "polio-like", (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.
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