Beyond the aging spine - a systematic review of functional changes in the human brain in cervical spondylotic myelopathy

Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord integrity, typically affecting the aged population. Emerging fMRI-based evidence suggests that the brain is also affected by CSM. This systematic review aimed to understand the usefulness of brain fMRI in CSM. A comprehensive literature search was conducted until March 2023 according to PRISMA guidelines. The inclusion criteria included original research articles in English, primarily studying the human brain's functional changes in CSM using fMRI with at least 5 participants. The extracted data from each study included demographics, disease severity, MRI machine characteristics, affected brain areas, functional changes, and clinical utilities. A total of 30 studies met the inclusion criteria. Among the fMRI methods, resting-state fMRI was the most widely used experimental paradigm, followed by motor tasks. The brain areas associated with motor control were most affected in CSM, followed by the superior frontal gyrus and occipital cortex. Functional changes in the brain were correlated to clinical metrics showing clinical utility. However, the evidence that a specific fMRI metric correlating with a clinical metric was "very low" to "insufficient" due to a low number of studies and negative results. In conclusion, fMRI can potentially facilitate the diagnosis of CSM by quantitatively interrogating the functional changes of the brain, particularly areas of the brain associated with motor control. However, this field is in its early stages, and more studies are needed to establish the usefulness of brain fMRI in CSM.

EXTH-47. SAFETY AND EFFECTS OF TRANSCRANIAL MAGNETIC STIMULATION ON GLIOBLASTOMA MEASURED IN VITRO

BACKGROUND

Although gross total resection (GTR) with chemoradiation is the standard of care for treating glioblastoma (GBM), tumor infiltration and treatment sequelae can impair activity of eloquent regions. Transcranial magnetic stimulation (TMS) has been explored as an adjunct therapy to rehabilitation for post-stroke motor deficits. TMS could be effective for postoperative rehabilitation in GBM, but its effect on GBM cells has not been evaluated. While TMS utilizes magnetic fields to induce electrical currents at low frequencies to cause neuronal excitation or inhibition, tumor-treating fields (TTF) utilize electrical currents with intermediate frequency to exert anti-mitotic effects, demonstrating promise as an adjunctive therapy in recurrent GBM. Although similarities exist between electrical and magnetic fields, the effects of magnetically induced electrical currents at low frequencies via TMS must be studied systematically in vitro on GBM cell lines.

METHODS

We studied the effect of theta burst stimulation (TBS), a form of patterned TMS, on in vitro G55 cell viability using colony forming assays. We compared TMS-treated cells to controls using a combination of parameters: continuous versus intermittent TBS (cTBS and iTBS), 300 versus 600 pulses, stimulation intensity of 32% versus 60%, and no pre-TMS chemotherapy versus 100 nM or 100 µM temozolomide (TMZ). Viability measurements between controls and TMS were analyzed using analysis of variance (ANOVA). Independent t-tests were used to analyze effects of stimulation parameters on viability percent difference within each TMZ condition.

RESULTS

There was no statistically significant increase in viability between control and TMS conditions for any of the stimulation parameters (+/- TMZ) while some showed decreased viability of GBM cells.

CONCLUSIONS

TMS did not significantly increase GBM viability compared to controls. Future studies include validation in other cell lines and characterization of the effects of stimulation parameters in conjunction with TMZ and dexamethasone, (often administered concurrently with GBM treatment).

Use of frameless neuronavigation for bedside placement of external ventricular catheters

Neuronavigation for placement of ventricular catheters has been described. At our institution, electromagnetic neuronavigation is frequently utilized for difficult ventricular catheter placement. In patients who develop a trapped ventricle as a result of an intraparenchymal or intraventricular mass lesion, successful catheter placement may be difficult, as the location and trajectory are unfamiliar. The authors report their experience using electromagnetic neuronavigation for bedside placement of external ventricular catheters in patients with trapped ventricles. The technique for bedside placement of external ventricular catheters utilizing electromagnetic neuronavigation is reviewed. The benefits of this technique and those patients in whom it may be most useful are discussed. Utilization of bedside electromagnetic neuronavigation for placement of difficult external ventricular catheters into trapped ventricles is an option for accurate navigated catheter placement. Bedside electromagnetic neuronavigation offers accurate catheter placement in awake patients. This technique may be utilized in patients with high perioperative risk factors as it does not require general anesthesia. The procedure is well tolerated as it does not require rigid head fixation.

MASSIVE PULMONARY EMBOLISM: A RARE PRESENTATION OF ACUTE HIV-1 INFECTION

Acute HIV infection rarely presents as venous thromboembolism as evidenced by a paucity of medical literature. HIV predisposes to hypercoagulability by a number of pathways.

Virus-like particle vaccines for mucosal immunization

Viruses which infect the gastrointestinal tract are well suited for examining the immune response(s) to oral delivery of antigen and exploring the advantages and pitfalls of oral vaccines. We have used recombinant DNA techniques to produce nonreplicating self-assembled virus-like particles (VLPs) from two gastrointestinal viruses, rotavirus and Norwalk virus. Both of these viruses normally cause acute gastroenteritis in man or animals. The VLPs are morphologically and antigenically similar to the native virus and quite stable, features which are advantageous for their use as subunit vaccines. In addition, these VLPs could be useful as carriers of foreign epitopes from heterologous pathogens or of drugs which need to be delivered to the gastrointestinal track. This paper briefly reviews the properties of these VLPs made in insect cells and data showing their potential as subunit vaccines for parenteral or oral delivery.

Rotavirus subunit vaccines

We evaluated rotavirus subunit vaccines for use in humans and animals. Insect cells were co-infected with combinations of individual baculovirus recombinants expressing human, bovine or simian rotavirus VP2, VP4, VP6 or VP7 to produce virus-like particles (VLPs). To determine whether immunization with VLPs could induce active protective immunity, VLPs were administered parenterally to rabbits, and the immune response and protection from rabbit ALA rotavirus challenge were evaluated. Complete or partial protection was attained, showing that parenteral immunization with VLPs induces active protective immunity. We also examined whether heterotypic immune responses could be induced with a limited number of broadly reactive VP7 proteins or with chimeric particles (multiple VP7 types on individual particles). The feasibility of this approach was determined by immunizing mice with VLPs containing a G3 VP7 or G1 VP7 and chimeric G1/G3 VLPs. Broadly reactive neutralizing antibody was induced by the G1 VLPs. VLPs also have been successfully used to boost lactogenic (colostral and milk) immunity in dairy cows. Taken together, these results show that VLPs can be effective immunogens in rabbits, mice and dairy cattle when administered parenterally, a limited number of VLPs may be sufficient to produce a broadly protective vaccine, and G3 VLPs may serve as an effective subunit vaccine for use in bovines.

Managed care is in your future

Though Texas has been slower than most other large states to move into managed care, it is gaining ground. According to the Texas Health Maintenance Organization Association, 1.2 million Texans were enrolled in HMO plans in January 1990. Three years later, 1.5 million had signed on--a 24 percent increase. State enrollment in other managed care plans, which aren't required to file reports with state regulatory agencies, was estimated to be 6.9 million (41 percent of Texans) in 1991, according to Blue Cross/Blue Shield. While these state enrollment figures are large, the most recent numbers available indicate that Texas hospitals have a long way to go. A 1991 AHA survey found that 259 Texas hospitals (47 percent of those surveyed) do not have contracts with HMOs or PPOs. With changes coming at break-neck speed, how can these hospitals position themselves to survive and prosper in the managed care world? This month, HealthTexas presents three examples of hospitals and health care systems that have successfully made the transition to managed care. Their stories illustrate three very different approaches--developing a network, direct contracting, and establishing a health plan. And, those who have led these ventures offer advice to help other hospitals make the transition a little easier.