Exercise therapy including the cervical extensor muscles in individuals with neck pain: A systematic review

OBJECTIVE

To review the use (dosage parameters and combination with other therapeutic interventions) of cervical extensor muscle exercises and their effect on pain, disability (primary outcomes), range of motion, endurance and strength (secondary outcomes) in people with neck pain.

DATA SOURCES

An extensive literature search was conducted through MEDLINE (Ovid), Scopus (Elsevier) and Physiotherapy Evidence Database (PEDro) up to May 2023. The reference lists of all included studies and relevant reviews were screened for additional studies.

REVIEW METHODS

Randomised controlled trials reporting the use of cervical extensor muscle exercises (alone or combined) applied to adults with idiopathic or traumatic neck pain were included. Study selection, data extraction and critical appraisal (PEDro assessment scale) were performed by two blinded reviewers. Data extraction included dosage parameters, other modalities combined with these exercises and outcomes.

RESULTS

Thirty-five randomised controlled trails (eight of which were complementary analyses) with 2409 participants fulfilled the inclusion criteria. Twenty-six were of moderate to high quality. In most studies, cervical extensor muscle exercises were combined with various other therapeutic modalities and applied at different dosages. Only two studies (one high and one low quality) specifically assessed their effectiveness. The high-quality study showed significant improvements in neck pain and disability, pressure point threshold and neck mobility after both low load and high load training for 6 weeks.

CONCLUSION

The results suggest cervical extensor muscle exercises may reduce neck pain and disability; however firm conclusions cannot be drawn because of the few studies that addressed this question and the heterogeneity of the dosage parameters.

Reliability and difference in neck extensor muscles strength measured by a portable dynamometer in individuals with and without chronic neck pain

OBJECTIVE

There are limited reports about the reliability of measuring neck extensor muscle strength using a portable dynamometer in neck pain patients. The aims of the current study were 1) to investigate intra- and inter-rater reliability of neck extensor isometric strength measurement using a portable dynamometer in patients with chronic nonspecific neck pain (CNSNP) and 2) to compare neck extensor isometric strength in participants with and without CNSNP.

METHODS

Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were followed. Two examiners received a 15-minute training before enrollment. Inter-rater reliability was assessed with a 10-minute interval between measurements, and intra-rater reliability was assessed with a 10-day interval. Three trials were assessed and examiners were blind to the strength values (in Newtons) from other sessions of 20 individuals with CNSNP (mean±SD= 37.9 ± 9.8y; Neck Disability Index 29.2 ± 7.4%) and 20 individuals with other musculoskeletal disorders (mean ± SD = 32.8 ± 46.2y).

RESULTS

Intra-rater reliability was excellent with intraclass correlation coefficient (ICC)(3,1) of 0.95 (CI:0.90-0.97) and inter-rater reliability was good to excellent with ICC(2,1) of 0.88 (CI:0.77-0.94) in CNSNP. No significant difference of neck extensor strength was found between CNSNP (93.27N±31.94) and Individuals without CNSNP (111.43N±40.11) (p > 0.05).

CONCLUSION

A portable dynamometer is a reliable tool for measuring maximal isometric neck extension strength in individuals with CNSNP. Slightly but no significant differences of neck extensor strength values between individuals with and without CNSNP. Future studies are needed to assess the generalizability of the findings in patients with other muscle deconditioning.

Patulin production by Penicillium expansum isolates from apples during different steps of long-term storage

Penicillium expansum is the principal cause of blue mould rot and associated production of patulin, a weak mycotoxin, in apples worldwide. P. expansum growth and patulin production is observed during improper or long-term storage of apples. We have investigated the extent to which each successive step during long-term storage contributes to patulin production in various P. expansum isolates. Fungal isolates collected on apples from several Belgian orchards/industries were identified to species level. Random amplification of polymorphic DNA (RAPD) analysis and β-tubulin gene sequencing identified P. expansum and Penicillium solitum as the most prevalent Penicillium species associated with Belgian apples. All 27 P. expansum isolates and eight reference strains were characterised for their patulin production capacity on apple puree agar medium for five days under classical constant temperature and atmosphere conditions. Under these conditions, a large range of patulin production levels was observed. Based on this phenotypic diversity, five P. expansum isolates and one reference strain were selected for in vitro investigation of patulin production under representative conditions in each step of long-term apple storage. Patulin accumulation seemed highly strain dependent and no significant differences between the storage steps were observed. The results also indicated that a high spore inoculum may lead to a strong patulin accumulation even at cold temperatures (1 °C) combined with controlled atmosphere (CA) (3% O2, 1% CO2), suggesting that future control strategies may benefit from considering the duration of storage under CA conditions as well as duration of deck storage.

Distinctive PSA-NCAM and NCAM hallmarks in glutamate-induced dendritic atrophy and synaptic disassembly

Dendritic and synapse remodeling are forms of structural plasticity that play a critical role in normal hippocampal function. Neural cell adhesion molecule (NCAM) and its polysialylated form (PSA-NCAM) participate in neurite outgrowth and synapse formation and plasticity. However, it remains unclear whether they contribute to dendritic retraction and synaptic disassembly. Cultured hippocampal neurons exposed to glutamate (5 µM) showed a reduced MAP-2 (+) area in the absence of neuronal death 24 h after the insult. Concomitantly, synapse loss, revealed by decreased synaptophysin and post-synaptic density-95 cluster number and area, together with changes in NCAM and PSA-NCAM levels were found. Dendritic atrophy and PSA-NCAM reduction proved NMDA-receptor dependent. Live-imaging experiments evidenced dendritic atrophy 4 h after the insult; this effect was preceded by smaller NCAM clusters (1 h) and decreased surface and total PSA-NCAM levels (3 h). Simultaneously, total NCAM cluster number and area remained unchanged. The subsequent synapse disassembly (6 h) was accompanied by reductions in total NCAM cluster number and area. A PSA mimetic peptide prevented both the dendritic atrophy and the subsequent synaptic changes (6 h) but had no effect on the earliest synaptic remodeling (3 h). Thus, NCAM-synaptic reorganization and PSA-NCAM level decrease precede glutamate-induced dendritic atrophy, whereas the NCAM level reduction is a delayed event related to synapse loss. Consequently, distinctive stages in PSA-NCAM/NCAM balance seem to accompany glutamate-induced dendritic atrophy and synapse loss.

A novel microRNA-132-sirtuin-1 axis underlies aberrant B-cell cytokine regulation in patients with relapsing-remitting multiple sclerosis [corrected]

Clinical trial results demonstrating that B-cell depletion substantially reduces new relapses in patients with multiple sclerosis (MS) have established that B cells play a role in the pathophysiology of MS relapses. The same treatment appears not to impact antibodies directed against the central nervous system, which underscores the contribution of antibody-independent functions of B cells to disease activity. One mechanism by which B cells are now thought to contribute to MS activity is by over-activating T cells, including through aberrant expression of B cell pro-inflammatory cytokines. However, the mechanisms underlying the observed B cell cytokine dysregulation in MS remain unknown. We hypothesized that aberrant expression of particular microRNAs might be involved in the dysregulated pro-inflammatory cytokine responses of B cells of patients with MS. Through screening candidate microRNAs in activated B cells of MS patients and matched healthy subjects, we discovered that abnormally increased secretion of lymphotoxin and tumor necrosis factor α by MS B cells is associated with abnormally increased expression of miR-132. Over-expression of miR-132 in normal B cells significantly enhanced their production of lymphotoxin and tumor necrosis factor α. The over-expression of miR-132 also suppressed the miR-132 target, sirtuin-1. We confirmed that pharmacological inhibition of sirtuin-1 in normal B cells induces exaggerated lymphotoxin and tumor necrosis factor α production, while the abnormal production of these cytokines by MS B cells can be normalized by resveratrol, a sirtuin-1 activator. These results define a novel miR-132-sirtuin-1 axis that controls pro-inflammatory cytokine secretion by human B cells, and demonstrate that a dysregulation of this axis underlies abnormal pro-inflammatory B cell cytokine responses in patients with MS.

Dynamics of presynaptic protein recruitment induced by local presentation of artificial adhesive contacts

In this study, we introduce a novel approach to induce and observe the formation of presynaptic compartments in axons through a combination of atomic force microscopy (AFM) and fluorescence microscopy. First, we use a poly-D-lysine-coated bead attached to an AFM tip to induce the recruitment of two synaptic proteins, bassoon and synaptophysin, and measure their absolute arrival times to the presynaptic department. We find that bassoon arrives before synaptophysin. Second, we observe the formation of very long (several 10s of μm), structured, protein-containing membranous strings as the AFM tip was withdrawn from the axon. It is conceivable that these strings might be a novel mechanism by which new neurites or branch points along existing neurites may be generated in situ.

Functional studies of MLC1 mutations in Chinese patients with megalencephalic leukoencephalopathy with subcortical cysts

Megalencephalic leukoencephalopathy with subcortical cysts (MLC, MIM# 604004) is an autosomal recessive inherited disease mostly resulting from MLC1 mutations. In this study, we finished the functional analysis of MLC1 mutations identified recently in Chinese patients, including five newly described missense mutations (R22Q, A32V, G73E, A275T, Y278H), one known nonsense mutation (Y198X), and two known missense mutations (S69L, T118M). We found MLC1^wt was localized to the cell periphery, whereas mutant R22Q, A32V, G73E, S69L and T118M were trapped in the lumen of endoplasmic reticulum (ER) when we transfected the wild-type and mutant MLC1 in U373MG cells. Compared to wild type, the mutant G73E, T118M, Y198X and A275T transcript decreased and all mutants except R22Q had lower protein expression in transfected U373MG cells. Therefore, we propose that all these eight MLC1 mutations had functional effect either on their protein/mRNA expression, or on their intracellular protein localization, or both.

Disposition of axonal caspr with respect to glial cell membranes: Implications for the process of myelination

Neurofascin-155 (NF155) and caspr are transmembrane proteins found at discrete locations early during development of the nervous system. NF155 is present in the oligodendrocyte cell body and processes, whereas caspr is on the axonal surface. In mature nerves, these proteins are clustered at paranodes, flanking the node of Ranvier. To understand how NF155 and caspr become localized to the paranodal regions of myelinated nerves, we have studied their distribution over time in myelinating cultures. Our observations indicate that these two proteins are recruited to the cell surface at the contact zone between axons and oligodendrocytes, where they trans-interact. This association explains the early pattern of caspr distribution, a helical coil that winds around the axon, resembling the turns of the myelin sheath. Caspr, an axonal membrane protein, therefore seems to move in register with the overlying myelinating cell via its interactions with myelin proteins. We suggest that NF155 is the glial cell membrane protein responsible for caspr distribution. The pair act as interacting partners on either side of the axoglial contact area. Most likely, there are other proteins on the axonal surface whose distribution is equally influenced by interaction with the nascent myelin sheath. The fact that caspr follows the movement of the spiraling membrane has a direct affect on the interpretation of the way in which myelin is formed.

A thermodynamic model to predict the thermal response of living beings during pneumoperitoneum procedures

In this work, hypothermia associated with pneumoperitoneum procedures is studied. A thermodynamic model is developed to allow for the computational simulation of the thermal body response to pneumoperitoneum procedures, which are required by laparoscopic surgery. The numerical results predict the body temperature decay (or loss of energy) in time when the pneumoperitoneum procedures is conducted in patient. The influence of several operating parameters (e.g. inlet air mass flow rate and temperature) on the resulting hypothermia level is analysed. Therefore, the model allows the identification of parameters that have to be controlled to minimize the loss of energy, and consequently, the hypothermia level due to pneumoperitoneum procedures.

The origin of the myelination program in vertebrates

The myelin sheath was a transformative vertebrate acquisition, enabling great increases in impulse propagation velocity along axons. Not all vertebrates possess myelinated axons, however, and when myelin first appeared in the vertebrate lineage is an important open question. It has been suggested that the dual, apparently unrelated acquisitions of myelin and the hinged jaw were actually coupled in evolution [1,2]. If so, it would be expected that myelin was first acquired during the Devonian period by the oldest jawed fish, the placoderms [3]. Although myelin itself is not retained in the fossil record, within the skulls of fossilized Paleozoic vertebrate fish are exquisitely preserved imprints of cranial nerves and the foramina they traversed. Examination of these structures now suggests how the nerves functioned in vivo. In placoderms, the first hinge-jawed fish, oculomotor nerve diameters remained constant, but nerve lengths were ten times longer than in the jawless osteostraci. We infer that to accommodate this ten-fold increase in length, while maintaining a constant diameter, the oculomotor system in placoderms must have been myelinated to function as a rapidly conducting motor pathway. Placoderms were the first fish with hinged jaws and some can grow to formidable lengths, requiring a rapid conduction system, so it is highly likely that they were the first organisms with myelinated axons in the craniate lineage.

Multiple paths towards repair in multiple sclerosis

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS, affecting approximately 1/1000 individuals in the Western world. Available treatments limit CNS inflammation and strategies to repair damage in the CNS offer the potential of recovery of both tissue and function. With further fundamental knowledge developing, this area is ripe for 'translation' to clinical application.