Case report of a family with hereditary inclusion body myopathy with VCP gene variant and literature review

Background

Missense VCP gene variants lead to a disruption in protein homeostasis causing a spectrum of progressive degenerative diseases. Myopathy is the most frequent manifestation characterized by slowly progressing weakness of proximal and distal limb muscles. We present a family with myopathy due to c.277C > T variant in VCP gene.

Case presentation

The patient's phenotype includes symmetrical muscle wasting and weakness in the proximal parts of the limbs and axial muscles, a wide based gait, lordotic posture, positive Gowers' sign, mild calf enlargement, impaired mobility, elevated CK, and myopathy in proximal limb muscles. Whole body MRI revealed fatty replacement, predominantly affecting right vastus intermedius and medialis, gastrocnemius and soleus in calf, abdomen wall and lumbar muscles. Next-generation sequencing analysis revealed a pathogenic heterozygous variant c.277C > T (p.(Arg93Cys)) in exon 3 of the VCP gene. Segregation analysis showed that the detected variant is inherited from the affected father who developed symptoms at 60.

Conclusion

The patients described experienced muscle wasting and weakness in the proximal and distal parts of the limbs which is a common finding in VCP related disease. Nevertheless, the patient has distinguishing features, such as high CK levels, early onset of the disease, and rapid mobility decline.

Correlation between Preoperative MRI Parameters and Oswestry Disability Index in Patients with Lumbar Spinal Stenosis: A Retrospective Study

Background and Objectives: Lumbar spinal stenosis (LSS) is a degenerative condition posing significant challenges in clinical management. Despite the use of radiological parameters and patient-reported outcome measures like the Oswestry Disability Index (ODI) for evaluation, there is limited understanding of their interrelationship. This study aimed to investigate the correlation between preoperative MRI parameters and ODI scores in patients with LSS undergoing surgical treatment. Materials and Methods: A retrospective analysis was conducted on 86 patients diagnosed with LSS over a 5-year period. Preoperative MRI measurements, including the cross-sectional area of the psoas muscle, lumbar canal stenosis, neural foramina area, and facet joint osteoarthritis, were assessed. ODI scores were collected preoperatively and at a 1-year follow-up. Statistical analyses were performed using IBM SPSS Statistics software (version 26). Results: Weak to moderate correlations were observed between certain MRI parameters and ODI scores. The initial ODI score had a weak positive correlation with the severity of lumbar canal stenosis according to Schizas criteria (rho = 0.327, p = 0.010) and a moderate negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.498, p = 0.000). At 1-year follow-up, the ODI had a weak negative correlation with the relative cross-sectional area of the psoas muscle (rho = -0.284, p = 0.026). Conclusions: While the severity of LSS showed a weak correlation with initial ODI, it was not a predictor of 1-year postoperative ODI. Furthermore, although the cross-sectional area of the thecal sac, the sagittal area of the neural foramen, and the grade of facet joint osteoarthritis influence the imagistic severity, none of them correlate with ODI. These findings underscore the need for a comprehensive model that integrates multiple imaging and clinical parameters for a holistic understanding of LSS and its functional outcomes.

The Association of Cardiovascular and Neurological Comorbidities in Geriatric Patients Sustaining Ocular Trauma

Purpose

Falls are associated with ocular trauma in the elderly. However, it is unlikely for a fall to cause ocular injury unless there is a disruption in the protective maneuvers that shield the face. We suspect ocular injury may be an early indicator of systemic or neurologic degeneration. This study investigates the 5-year incidence of cardiovascular and neurodegenerative diseases in older patients who sustained ocular or periorbital injuries.

Patients and Methods

This was a retrospective cohort study. The study population included 141 patients over the age of 65 who sustained trauma to the eye, orbit, or eyelid between April 2011 and June 2016. The control population included 141 patients with a similar range of comorbidities who received cataract surgery during the same period. The study measured new diagnoses of various disorders during the 5-year period following presentation.

Results

There were a total of 180 females and 102 males in the study. The mean ages of the control and subject group were 76 and 81.8, respectively. Of our twelve tested comorbidity types, patients that suffered a periocular trauma were more likely to develop heart failure (p=0.00244), dementia (p=0.00002), Alzheimer's disease (p=0.00087), and vascular disease (p=0.00037).

Conclusion

Geriatric patients who sustained ocular and periocular injuries had a greater incidence of heart failure, dementia, Alzheimer's disease, and atherosclerosis diagnoses in the 5-year period following injury. The findings of this study suggest that periocular trauma may be an early indicator of underlying degenerative or systemic disease. Ophthalmologists should ensure proper primary care follow-up in conjunction with recovery from injury.

Spatial Transcriptomic Analysis Reveals Regional Transcript Changes in Early and Late Stages of rd1 Model Mice with Retinitis Pigmentosa

Retinitis pigmentosa (RP) is the leading cause of inherited blindness with a genetically heterogeneous disorder. Currently, there is no effective treatment that can protect vision for those with RP. In recent decades, the rd1 mouse has been used to study the pathological mechanisms of RP. Molecular biological studies using rd1 mice have clarified the mechanism of the apoptosis of photoreceptor cells in the early stage of RP. However, the pathological changes in RP over time remain unclear. The unknown pathology mechanism of RP over time and the difficulty of clinical treatment make it urgent to perform more refined and spatially informed molecular biology studies of RP. In this study, spatial transcriptomic analysis is used to study the changes in different retinal layers of rd1 mice at different ages. The results demonstrate the pattern of photoreceptor apoptosis between rd1 mice and the control group. Not only was oxidative stress enhanced in the late stage of RP, but it was accompanied by an up-regulation of the VEGF pathway. Analysis of temporal kinetic trends has further identified patterns of changes in the key pathways of the early and late stages, to help understand the important pathogenesis of RP. Overall, the application of spatial transcriptomics to rd1 mice can help to elucidate the important pathogenesis of RP involving photoreceptor apoptosis and retinal remodeling.

Factors Predisposing to The Formation of Degenerative Spondylolisthesis-A Narrative Review

The relationship between various factors predisposing to the formation of spondylolisthesis, including degenerative spondylolisthesis, has been analyzed by many authors. However, not all observations are consistent. In this review, we identified factors whose impact on the prevalence of spondylolisthesis was most often mentioned in the literature. These included gender, age, bone mineral density, ethnic origin, and oophorectomy. The results were inclusive in terms of physical activity, pregnancy status, and use of hormone replacement therapy. Associations between diabetes and smoking were very poorly marked. The literature so far has identified a number of factors significantly affecting the incidence of degenerative spondylolisthesis. These include age, gender, body weight, ethnic origin, bone mineral density, and hormonal balance. Radiological parameters, which include iliac crest, pelvic tilt, pelvic incidence, sacral slope, and lumbar lordosis, may also be of great importance for assessing changes in the occurrence and progression. However, the authors do not agree on the real significance of individual factors. The aim of this review was to identify the factors predisposing to the formation of degenerative spondylolisthesis, the importance of which has been suggested in the current literature. The systematization of knowledge in this field can allow a more accurate adjustment of the treatment plan for each patient affected by this condition.

Suppression of Inflamm-Aging by Moringa oleifera and Zingiber officinale Roscoe in the Prevention of Degenerative Diseases: A Review of Current Evidence

Inflammation or inflamm-aging is a chronic low-grade inflammation that contributes to numerous types of degenerative diseases among the elderly and might be impeded by introducing an anti-inflammatory agent like Moringa oleifera Lam (moringa) and Zingiber officinale Roscoe (ginger). Therefore, this paper aims to review the role of moringa and ginger in suppressing inflamm-aging to prevent degenerative diseases. Various peer-reviewed publications were searched and downloaded using the reputed search engine "Pubmed" and "Google Scholar". These materials were reviewed and tabulated. A comparison between these previous findings was made based on the mechanism of action of moringa and ginger against degenerative diseases, focusing on their anti-inflammatory properties. Many studies have reported the efficacy of moringa and ginger in type 2 diabetes mellitus, neurodegenerative disease, cardiovascular disease, cancer, and kidney disease by reducing inflammatory cytokines activities, mainly of TNF-α and IL-6. They also enhanced the activity of antioxidant enzymes, including catalase, glutathione, and superoxide dismutase. The anti-inflammatory activities can be seen by inhibiting NF-κβ activity. Thus, the anti-inflammatory potential of moringa and ginger in various types of degenerative diseases due to inflamm-aging has been shown in many recent types of research.

MR-Imaging in Osteoarthritis: Current Standard of Practice and Future Outlook

Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. Magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation and monitoring of OA due to its ability to visualize soft tissues and bone with high resolution. This review aims to provide an overview of the current state of MRI in OA, with a special focus on the knee, including protocol recommendations for clinical and research settings. Furthermore, new developments in the field of musculoskeletal MRI are highlighted in this review. These include compositional MRI techniques, such as T2 mapping and T1rho imaging, which can provide additional important information about the biochemical composition of cartilage and other joint tissues. In addition, this review discusses semiquantitative joint assessment based on MRI findings, which is a widely used method for evaluating OA severity and progression in the knee. We analyze the most common scoring methods and discuss potential benefits. Techniques to reduce acquisition times and the potential impact of deep learning in MR imaging for OA are also discussed, as these technological advances may impact clinical routine in the future.

Development and validation of a risk prediction model for cage subsidence after instrumented posterior lumbar fusion based on machine learning: a retrospective observational cohort study

Background

Interbody cage subsidence is a common complication after instrumented posterior lumbar fusion surgery, several previous studies have shown that cage subsidence is related to multiple factors. But the current research has not combined these factors to predict the subsidence, there is a lack of an individualized and comprehensive evaluation of the risk of cage subsidence following the surgery. So we attempt to identify potential risk factors and develop a risk prediction model that can predict the possibility of subsidence by providing a Cage Subsidence Score (CSS) after surgery, and evaluate whether machine learning-related techniques can effectively predict the subsidence.

Methods

This study reviewed 59 patients who underwent posterior lumbar fusion in our hospital from 2014 to 2019. They were divided into a subsidence group and a non-subsidence group according to whether the interbody fusion cage subsidence occurred during follow-up. Data were collected on the patient, including age, sex, cage segment, number of fusion segments, preoperative space height, postoperative space height, preoperative L4 lordosis Angle, postoperative L4 lordosis Angle, preoperative L5 lordosis Angle, postoperative PT, postoperative SS, postoperative PI. The conventional statistical analysis method was used to find potential risk factors that can lead to subsidence, then the results were incorporated into stepwise regression and machine learning algorithms, respectively, to build a model that could predict the subsidence. Finally the diagnostic efficiency of prediction is verified.

Results

Univariate analysis showed significant differences in pre-/postoperative intervertebral disc height, postoperative L4 segment lordosis, postoperative PT, and postoperative SS between the subsidence group and the non-subsidence group (p < 0.05). The CSS was trained by stepwise regression: 2 points for postoperative disc height > 14.68 mm, 3 points for postoperative L4 segment lordosis angle >16.91°, and 4 points for postoperative PT > 22.69°. If the total score is larger than 0.5, it is the high-risk subsidence group, while less than 0.5 is low-risk. The score obtains the area under the curve (AUC) of 0.857 and 0.806 in the development and validation set, respectively. The AUC of the GBM model based on the machine learning algorithm to predict the risk in the training set is 0.971 and the validation set is 0.889. The AUC of the avNNet model reached 0.931 in the training set and 0.868 in the validation set, respectively.

Conclusion

The machine learning algorithm has advantages in some indicators, and we have preliminarily established a CSS that can predict the risk of postoperative subsidence after lumbar fusion and confirmed the important application prospect of machine learning in solving practical clinical problems.

Ozone Environmental Pollution: Relationship between the Intestine and Neurodegenerative Diseases

Repeated exposure to environmental ozone causes a chronic state of oxidative stress. This state is present in chronic degenerative diseases and induces a loss of control of the inflammatory response. Redox system dysfunction and failures in control of inflammatory responses are involved in a vicious circle that maintains and increases the degenerative process. The intestine also responds to secondary reactive species formed by exposure to ozone doses, generating noxious stimuli that increase degenerative damage. This review aims to elucidate how environmental pollution, mainly by ozone, induces a state of chronic oxidative stress with the loss of regulation of the inflammatory response, both in the intestine and in the brain, where the functionality of both structures is altered and plays a determining role in some neurodegenerative and chronic degenerative diseases. For this purpose, we searched for information on sites such as the Cochrane Library Database, PubMed, Scopus, and Medscape. Reviewing the data published, we can conclude that environmental pollutants are a severe health problem. Ozone pollution has different pathways of action, both molecular and systemic, and participates in neurodegenerative diseases such as Parkinson's and Alzheimer's disease as well in bowel diseases as Inflammatory Bowel Disease, Crohn's Disease, and Irritable Bowel Syndrome.

Osseointegration of Dental Implants in Patients with Congenital and Degenerative Bone Disorders: A Literature Review

Aims and Objectives

The aim of this study was to describe the mechanism of dental implants osseointegration in patients with congenital and degenerative genetic bone disorders.

Materials and Methods

A PubMed and Scopus documents search was carried out between November 2021 in the, using words such as "osseointegration," "degenerative disease," "congenital disease," and "dental implants."

Results

The thirteen articles selected dealt with dental implants osseointegration in patients with congenital and degenerative bone disorders. The influence and repercussion of these diseases on the bone system, as well as the osseointegration process were described from healing to bone remodeling. In addition, certain articles described some considerations to improve the osseointegration process in patients suffering from these types of conditions.

Conclusions

Within the limitations of this literature review we can conclude that osseointegration in patients with ectodermal dysplasia and osteoporosis could be achieved. However, the planning process for dental implant placement in these patients should be more meticulous and individualized considering the degree of tissue involvement as well as the patient's age and skeletal development compared to systemically healthy patients.

Trifecta and Carpentier Edwards aortic bioprostheses: Comparison of six years follow-up outcomes

BACKGROUND

To compare mid-term clinical outcomes and hemodynamic performance of the stented pericardial Trifecta bioprosthesis for surgical aortic valve replacement (AVR) with a technically comparable commonly used surgical bioprosthesis.

METHODS

Data from consecutive patients implanted with the TF or the Carpentier Edwards Magna Ease valve were retrospectively analyzed. Primary analysis was performed on a propensity score-matched cohort. Primary endpoints included the composite of death or reoperation and structural valve deterioration. The comparison also included echocardiographic assessments at one-week post-AVR and at the last documented follow-up.

RESULTS

Two propensity score-matched groups of 170 patients each were identified from the overall population (n = 486). Incidence of postoperative mortality (2.9% vs. 7.1%, respectively, p = 0.08), and patient prosthesis mismatch (1.2% and 2.4%, p = 0.41) were similar. At mean follow-up of 5.84 (Trifecta) and 6.1 (Carpentier Edwards) years, the incidence of all-cause death/reoperation (15.3% vs. 15.9%, p = 0.88 for Trifecta and Carpentier Edwards, respectively) and structural valve disease (1.8% vs. 2.9%, p = 0.47) were similar. Overall, postoperative mean transvalvular pressure gradients were significantly lower in the Trifecta group than in the Carpentier Edwards group (7.7 ± 3.3 vs. 11.3 ± 3.6 mmHg, p < 0.01). Mean transvalvular gradient remained significantly lower through the last follow-up for small-sized Trifecta valves (19/21 mm; 10.5 ± 4.2 vs. 13.8 ± 5.9 mmHg, p = 0.039) but not for larger valves (10.3 ± 4.8 vs. 9.4 ± 3.5 mmHg, p = 0.31).

CONCLUSION

The Trifecta valve is a valuable alternative to the Carpentier Edwards valve in terms of safety, hemodynamic performance, and mid-term durability. Smaller-sized valves provide additional clinical benefits, given their persistent hemodynamic advantages through mid-term follow-up.

A bibliometric analysis of the application of imaging in sleep in neurodegenerative disease

Objective

The purpose of this study was to examine the current state of the application of imaging in sleep research in degenerative disease, as well as hotspots and trends.

Materials and methods

A search was conducted on the Web of Science Core Collection (WoSCC) between 1 September 2012, and 31 August 2022 for literature related to sleep imaging. This study analyzed 7,679 articles published in this field over the past 10 years, using CiteSpace to analyze tendencies, countries, institutions, authors, and hotspots.

Results

There were 7,679 articles on the application of imaging to sleep research published by 566 institutions located in 135 countries in 1,428 journals; the number of articles was increasing on a yearly basis. According to keyword analysis, the research direction of the application of imaging in sleep research focused on the effects of degenerative diseases on sleep, such as Parkinson's disease, Alzheimer's disease, and small vessel disease. A literature evaluation found that Parkinson's disease, insomnia, sleep quality, and rapid eye movement sleep behavior disorder were the top research trends in this field.

Conclusion

A growing body of research has focused on sleep disorders caused by degenerative diseases. In the application of imaging to sleep research, magnetic resonance functional brain imaging represents a reliable research method. In the future, more aging-related diseases may be the subject of sleep-related research, and imaging could provide convenient and reliable evidence in this respect.

Evaluation of long-term clinical outcomes and the incidence of adjacent proximal segment degenerative disease with algorithmic transforaminal interbody fusion: A multicenter prospective study

Study Design

This was a prospective multicenter study.

Background

Adjacent segment degenerative disease (ASDd) is a common complication of open transforaminal lumbar interbody fusion (O-TLIF), the leading cause of which is initial adjacent segment degeneration (ASD). To date, various surgical techniques for the prevention of ASDd have been developed, such as, simultaneous use of interspinous stabilization (IS) and preventive rigid stabilization of the adjacent segment. The use of these technologies is often based on the subjective opinion of the operating surgeon, or on the assessment of one of the predictors of ASDd. Only sporadic studies are devoted to a comprehensive study of risk factors of ASDd development and personalized performance of O-TLIF.

Purpose

The purpose of this study was to evaluate long-term clinical outcomes and the incidence of degenerative disease of the adjacent proximal segment using clinical-instrumental algorithm for preoperative planning to O-TLIF.

Materials and Methods

The prospective, nonrandomized, multicenter cohort study included 351 patients who underwent primary O-TLIF, and the adjacent proximal segment had initial ASD. Two cohorts were identified. The prospective cohort included 186 patients who were operated by using the algorithm of personalized O-TLIF performance. The control retrospective cohort consisted of patients (n = 165), from our own database who had been operated on previously without the algorithmized approach. Treatment outcomes were analyzed by Visual Analog Scale (VAS) assessment of pain syndrome, Oswestry Disability Index (ODI) scores, physical component score (PCS) and mental component score (MCS) scores of the Short Form 36 questionnaire, frequency of ASDd was compared between studied cohorts.

Results

Thirty-six months after follow-up, the prospective cohort had better SF36 MCS/PCS outcomes, less disability according to ODI, and lower pain level according to VAS (P < 0.05). The incidence of ASDd in the prospective cohort was 4.9%, which was significantly lower than in the retrospective cohort (9%).

Conclusions

The prospective use of a clinical-instrumental algorithm for preoperative planning of rigid stabilization, depending on the biometric parameters of the proximal adjacent segment, significantly reduced the incidence of ASDd and improved long-term clinical outcomes compared with the retrospective group.

[Analysis of preoperative risk factors of adjacent segment disease after transforaminal lumbar interbody fusion]

Currently, there is no information on the combined effect of body mass index (BMI), age, gender, main spinal-pelvic parameters and parameters of adjacent functional spinal unit (FSU) degeneration according to magnetic resonance imaging on development of adjacent segment degenerative disease (ASDd).

OBJECTIVE

To evaluate the effect of preoperative biometric and instrumental parameters of adjacent FSU on the risk of ASDd after transforaminal lumbar interbody fusion and determine personalized neurosurgical approach.

MATERIAL AND METHODS

We retrospectively studied patients after single-level transforaminal lumbar interbody fusion (group I, n=54), single-level transforaminal lumbar interbody fusion and interspinous stabilization of adjacent level (group II, n=55), preventive rigid fusion of adjacent segment (group III, n=56). Preoperative parameters and long-term clinical outcomes were assessed.

RESULTS

Paired correlation analysis established the main predictors of ASDd. Regression analysis determined absolute values of these predictors for each type of surgical intervention.

CONCLUSION

Surgical intervention at the level of asymptomatic proximal adjacent segment is recommended as interspinous stabilization for moderate degenerative lesions, BMI <25 kg/m2, difference between pelvic index and lumbar lordosis 10.5-15°, segmental lordosis 6.5-10.5°. In case of severe degenerative lesions, BMI 25.1-31.1 kg/m2, significant deviations of spinal-pelvic parameters (segmental lordosis 5.5-10.5°, difference between pelvic index and lumbar lordosis 15.2-20°), preventive rigid stabilization is indicated.

MTERF3 contributes to MPP+-induced mitochondrial dysfunction in SH-SY5Y cells

Parkinson's disease (PD) is a neurodegenerative disorder causing severe social and economic burdens. The origin of PD has been usually attributed to mitochondrial dysfunction. To this end, mitochondrial transcription regulators become attractive subjects for understanding PD pathogenesis. Previously, we found that the expression of mitochondrial transcription termination factor 3 (MTERF3) was reduced in MPP+-induced mice model of PD. In the present study, we probe the function of MTERF3 and its role in MPP+-induced cellular model of PD. Initially, we observe that MTERF3 expression is also reduced in MPP+-induced cellular model of PD, which can be mainly attributed to the increase of MTERF3 degradation. Next, we examine the effect of MTERF3 knockdown and overexpression on the replication, transcription, and translation of mitochondrial DNA (mtDNA). We show that knockdown and overexpression of MTERF3 have opposite effects on mtDNA transcript level but similar effects on mtDNA expression level, in line with MTERF3's dual roles in mtDNA transcription and translation. In addition, we examine the effect of MTERF3 knockdown and overexpression on mitochondrial function with and without MPP+ treatment, and find that MTERF3 seems to play a generally protective role in MPP+-induced mitochondrial dysfunction. Together, this work suggests a regulatory role of MTERF3 in MPP+-induced cellular model of PD and may provide clues in designing novel therapeutics against PD.

[A validated new classification for intervertebral disk degeneration]

OBJECTIVE

To develop a new validated classification of intervertebral disc degeneration.

MATERIAL AND METHODS

A retrospective observational single-center study included medical records of patients with and without degenerative disease of lumbar intervertebral discs. The interval values of apparent diffusion coefficient (ADC) of intervertebral discs were grouped into degeneration classes.

RESULTS

The study included medical records of 100 patients. A quantitative analysis of data showed that mean ADC has a significant correlation with severity of lumbosacral disc degeneration according to classification by Pfirrmann et al. Lumbar intervertebral discs with degeneration grade 3-4 were less homogeneous compared to grade 2-3. Among discs with degeneration grade 4, mean ADC was significantly higher in case of hernia (p=0.01). Conversely, mean ADC was significantly higher in the absence of hernia for discs grade 3 (p=0.04). Combination of all data is presented as original classification of lumbosacral disc degeneration based on mean ADC.

CONCLUSION

The developed classification can be recommended for radiologists, neurologists and neurosurgeons.

[Risk factors of unsatisfactory outcomes after percutaneous laser decompression of lumbar intervertebral discs]

OBJECTIVE

To study the risk factors of unsatisfactory clinical results after percutaneous laser decompression of the lumbar intervertebral disc (PLDD).

MATERIAL AND METHODS

A retrospective observational single-center study included medical records of patients who underwent lumbar PLDD for degenerative spine disease. We analyzed clinical and instrumental parameters potentially affecting the results of lumbar PLDD.

RESULTS

Clinical study included 82 patients who underwent PLDD for lumbar intervertebral disc degenerative disease. Mean postoperative follow-up period was 30.8±13.3 months. In 22 (26%) patients, unsatisfactory clinical outcomes were observed. According to binary logistic regression model, comorbidities (p=0.03), duration of disease over 12 months (p=0.03), low preoperative quality of life according to ODI score (more than 50%) (p=0.04), high body mass index (over 25 kg/m²) (p=0.02), severe intervertebral disc (p=0.04) and facet joint degeneration (p=0.01) and intervertebral disc height decrease more than 50% (p=0.01) were significantly associated with unsatisfactory clinical outcomes after lumbar PLDD for degenerative spine disease.

CONCLUSION

Identification of these risk factors of unsatisfactory clinical outcomes is important stage of preoperative preparation in patients scheduled for lumbar PLDD.

Impact of human immunodeficiency virus on 2-year revision rates following lumbar fusion for degenerative spinal conditions: a retrospective cohort study

BACKGROUND

To our knowledge, no studies exist that evaluate the impact of human immunodeficiency virus (HIV) on long-term revision rates following lumbar fusion. This study aims to understand how HIV impacts 2-year revision rates and 90-day postoperative complication rates following primary lumbar fusion for degenerative spine conditions.

METHODS

Data collection was done using PearlDiver Patient Records Database, a national insurance database from 2010-2019. Patients who underwent primary lumbar fusion for degenerative diseases were divided into a cohort of patients that are HIV positive (HIV), have asymptomatic HIV (AHIV), acquired immune deficiency syndrome (AIDS), and HIV-negative at the time of their procedure. Univariate and multivariable regression analyses were performed to determine rates of revision surgery, surgical site infection (SSI), neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies within two years of surgery as well as 90-day postoperative complications.

RESULTS

In total, 216,587 patients were included in this study. Of these, 631 patients (0.29%) had HIV including 502 patients (0.23%) with asymptomatic HIV and 129 patients (0.06%) with AIDS. Relative to the control cohort, patients with HIV had no difference in odds of two-year revision surgery, SSI, neurological complications, sensory deficits, bowel/bladder dysfunction and myelopathies. Patients with HIV did have increased odds of postoperative pneumonia (OR 1.592; 95% CI: 1.048-2.314; P=0.021). AIDS patients had greater odds of respiratory complications (OR 2.585; 95% CI: 1.075-5.264; P=0.017) and septic complications (OR 2.702; 95% CI: 1.122-5.514; P=0.013) 90-day postoperatively.

CONCLUSIONS

Our study found that HIV positive status did not significantly affect two-year revision rates compared to the control group. However, there is a higher rate of pneumonia and respiratory complications among HIV positive patients. Before deciding to proceed with surgical intervention in HIV positive individuals, surgeons must carefully consider each patient's specific diagnosis, comorbidities, and risk factors.

Revisiting the Role of GSK3, A Modulator of Innate Immunity, in Idiopathic Inclusion Body Myositis

Idiopathic or sporadic inclusion body myositis (IBM) is the leading age-related (onset >50 years of age) autoimmune muscular pathology, resulting in significant debilitation in affected individuals. Once viewed as primarily a degenerative disorder, it is now evident that much like several other neuro-muscular degenerative disorders, IBM has a major autoinflammatory component resulting in chronic inflammation-induced muscle destruction. Thus, IBM is now considered primarily an inflammatory pathology. To date, there is no effective treatment for sporadic inclusion body myositis, and little is understood about the pathology at the molecular level, which would offer the best hopes of at least slowing down the degenerative process. Among the previously examined potential molecular players in IBM is glycogen synthase kinase (GSK)-3, whose role in promoting TAU phosphorylation and inclusion bodies in Alzheimer’s disease is well known. This review looks to re-examine the role of GSK3 in IBM, not strictly as a promoter of TAU and Abeta inclusions, but as a novel player in the innate immune system, discussing some of the recent roles discovered for this well-studied kinase in inflammatory-mediated pathology.

TDP43 ribonucleoprotein granules: physiologic function to pathologic aggregates

Ribonucleoprotein (RNP) assemblies are ubiquitous in eukaryotic cells and have functions throughout RNA transcription, splicing, and stability. Of the RNA-binding proteins that form RNPs, TAR DNA-binding protein of 43 kD (TDP43) is of particular interest due to its essential nature and its association with disease. TDP43 plays critical roles in RNA metabolism, many of which require its recruitment to RNP granules such as stress granules, myo-granules, and neuronal transport granules. Moreover, the presence of cytoplasmic TDP43-positive inclusions is a pathological hallmark of several neurodegenerative diseases. Despite the pervasiveness of TDP43 aggregates, TDP43 mutations are exceedingly rare, suggesting that aggregation may be linked to dysregulation of TDP43 function. Oligomerization is a part of normal TDP43 function; thus, it is of interest to understand what triggers the irreversible aggregation that is seen in disease. Herein, we examine TDP43 functions, particularly in RNP granules, and the mechanisms which may explain pathological TDP43 aggregation.

Spine Treatment Appraisal Report (STAR): Patient-Reported Outcomes Following Short-Segment Lumbar Fusion: Does Pelvic Incidence and Lumbar Lordosis (PI-LL) Mismatch Matter?

Divi SN, Kepler CK, Hilibrand AS, et al. Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch. Clin Spine Surg. Mar 1 2021;34(2):73-77.

Physical Activity Assessment in the Charcot Population

Charcot neuroarthropathy is a degenerative disorder that significantly impairs a patient's functional capacity. It has been reported that a Charcot patient's quality of life is significantly impacted by the disease state. The aim of this study is to compare measured energy expenditure to a patient's perceived quality of life and physical ability. The study enrolled 43 patients by set inclusion and exclusion criteria. Patients' total energy expenditure was measured with doubly labeled water. The patients also completed 2 quality of life assessments: 36-Item Short Form Survey (SF-36) and International Physical Activity Questionnaire-Long Form (IPAQ-LF). The measured energy expenditure was then compared to the patient's perceived functional capacity. Scores reaching statistical significance included general health (60 ± 21; p = .011), pain (62 ± 27; p = .025), emotional (61 ± 40; p < .017), physical limitation (45 ± 39; p < .0001), and physical function (50 ± 29; p < .001). SF-36 survey variables that did not reach statistical significance included mental (73 ± 26; p = .690), energy (55 ± 21; p = .205), and social (74 ± 26; p = .105). The IPAQ-LF and physical activity level (PAL) were compared. No identified variation was noted between the 2 test methods (p = .57). The patients' PAL was measured at 1.4 ± 0.42, which is comparable to the general population. Data from this study identify the Charcot population as comparable to the general population. The inferences taken from this study indicate that this population suffers from poor health outlooks compared with the general population but may be overestimating the level of perceived disability.

Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience With MI-TLIF

STUDY DESIGN

A prospective study.

OBJECTIVES

We present a largest study until date performed over a period of 10 years assessing the perioperative complications. The primary aim of this study was to review the incidence of perioperative complications of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in single-level lumbar degenerative diseases.

METHODS

A prospective study performed over a period of 10 years involving 560 patients who underwent single-level lumbar MI-TLIF. Perioperative clinical and radiological parameters, postoperative complications, and satisfactory outcomes in the form of Wang's criteria were evaluated. All patients were scrutinized into 5 different categories based on the descriptive classification for perioperative complications suggested by the authors.

RESULTS

The mean age was 61.8 ± 12.7 years and male to female ratio was 0.8:1. The overall incidence of the perioperative complication was 25.5%. In all, 19.64% patients developed single complication, 4.64% patients were with 2 complications, and 1.25% patients developed 3 complications from the described categories. A total of 16.78% patients developed early (<6 months postsurgery) and 8.75% patients developed late (>6 months postsurgery) complications.

CONCLUSION

This study showed 25.5% incidence of perioperative complications in MI-TLIF for degenerative lumbar disease over a period of 10 years with a higher incidence rate during the initial 3 years of practice. The described classification for perioperative complications is helpful to record, to evaluate and to understand the etiology based on its duration of occurrence in the perioperative period. MI-TLIF is an effective procedure with substantial clinical benefits in the form of excellent to good clinical-radiological outcomes.

CircSLC7A2 protects against osteoarthritis through inhibition of the miR-4498/TIMP3 axis

Objectives

Circular RNAs (circRNAs) are noncoding RNAs that compete against other endogenous RNA species, such as microRNAs, and have been implicated in many diseases. In this study, we investigated the role of a new circRNA (circSLC7A2) in osteoarthritis (OA).

Materials and Methods

The relative expression of circSLC7A2 was significantly lower in OA tissues than it was in matched controls, as shown by real‐time quantitative polymerase chain reaction (RT‐qPCR). Western blotting, RT‐qPCR and immunofluorescence experiments were employed to evaluate the roles of circSLC7A2, miR‐4498 and TIMP3. The in vivo role and mechanism of circSLC7A2 were also conformed in a mouse model.

Results

circSLC7A2 was decreased in OA model and the circularization of circSLC7A2 was regulated by FUS. Loss of circSLC7A2 reduced the sponge of miR‐4498 and further inhibited the expression of TIMP3, subsequently leading to an inflammatory response. We further determined that miR‐4498 inhibitor reversed circSLC7A2‐knockdown‐induced OA phenotypes. Intra‐articular injection of circSLC7A2 alleviated in vivo OA progression in a mouse model of anterior cruciate ligament transection (ACLT).

Conclusions

The circSLC7A2/miR‐4498/TIMP3 axis of chondrocytes catabolism and anabolism plays a critical role in OA development. Our results suggest that circSLC7A2 may serve as a new therapeutic target for osteoarthritis.

Spine Surgery in the Octogenarian Population: A Comparison of Demographics, Surgical Approach, and Healthcare Utilization With the PearlDiver Database

Background

With the recent advances in technology and healthcare, increasing numbers of individuals over the age of 80 will require surgical intervention for spinal pathology. Given the risk of increased complications in the elderly, a limited number of spinal surgeries are performed on octogenarians every year. This makes it difficult to generalize the trends and outcomes of these surgeries to a greater population. This study attempts to understand the trends in the safety profile and healthcare utilization across the United States for octogenarians undergoing spinal fusion and/or decompression surgery for spinal stenosis and/or degenerative disease using the PearlDiver database.

Methodology

Patients who underwent fusion and/or decompression for stenosis and/or degenerative diseases were extracted using International Classification of Disease ninth and tenth revisions (ICD-9 prior to October 2015, ICD-10 after) from 2007 to 2016 in the PearlDiver database. Three comparative groups were considered: (1) primary fusion without concurrent decompression, (2) primary decompression with concurrent fusion, and (3) fusion with concurrent decompression. Outcomes of interest were patient characteristics, demographics, length of stay, surgery hospitalization payments, and discharge disposition. These outcomes were compared to patients over the age of 20 who also underwent spinal surgery.

Results

A total of 9,715 patients who underwent spinal surgery were identified in the search. Of the 9,139 patients, 503 were octogenarians and 73 were nonagenarians. Octogenarians and nonagenarians diagnosed with spinal stenosis were more likely to undergo decompression alone rather than fusion or both fusion and decompression (21 for both fusion and decompression; p < 0.0001). Patients diagnosed with both spinal stenosis and degeneration were more likely to undergo both fusion and decompression than fusion or decompression alone (239 for both, 208 for decompression alone, and 23 for fusion alone; p < 0.0001). No statistically significant difference was found in the percentage of patients discharged home following either fusion or decompression or both surgeries (p = 0.0737). The mean length of stay for patients in the 20-79-year age group was 2.79 days, whereas for the octogenarian and nonagenarian cohort it was 3.85 days. The index hospitalization pay for patients in the 20-79-year age group was $19,220, whereas for the octogenarians and nonagenarians cohort it was $15,091.

Conclusions

Patients over the age of 80 were more likely to undergo either a fusion procedure or a decompression procedure alone rather than both unless they were diagnosed with spinal degeneration. The PearlDiver database analysis indicates that the length of stay for octogenarians and nonagenarians is longer than that for patients in the 20-79-year age group, and that younger patients are more likely to be discharged earlier than patients over the age of 80. Moreover, we observed that the index hospitalization pay was higher for patients over the age of 20 than for octogenarians and nonagenarians in all cases except for a fusion procedure.

[Smoking as a risk factor of advanced heterotopic ossification in patients after lumbar total disk arthroplasty]

Smoking is an obvious risk factor of adverse events in early and long-term postoperative period after spine surgery including lumbar total disk arthroplasty. Objective. To study the effect of smoking on clinical and radiological outcomes after lumbar total disk arthroplasty.

MATERIAL AND METHODS

A single-center retrospective observational cohort study was performed. We have analyzed medical records of patients who underwent single-level lumbar total disk arthroplasty for degenerative disease.

RESULTS

The study included 57 medical records of respondents. The examined medical records were divided into two groups - smokers (n=26) and non-smokers (n=31). There were no significant between-group differences in clinical outcomes. Incidence of adverse events was similar too. Kaplan-Meier event-free survival was similar in both groups. There were no significant between-group differences in X-ray data. Development of heterotopic ossification after lumbar total disk arthroplasty was more active in smokers.

CONCLUSION

Smoking has no significant effect on clinical and radiological outcomes in patients after single-level after lumbar total disk arthroplasty. On the other hand, smoking significantly increases formation of heterotopic ossification after lumbar total disk arthroplasty.

Autologous conditioned serum for degenerative diseases and prospects

Autologous conditioned serum (ACS) is a blood-derived product that is prepared by the incubation of whole blood with medical-grade glass beads, resulting in serum enrichment in interleukin-1 receptor antagonist (IL-1Ra), anti-inflammatory cytokines (IL-4, IL-10, and IL-13), and high concentrations of growth factors. ACS has shown qualitatively and quantitatively better therapeutic effects than most established pharmacological treatments and surgery for joint diseases given its ability to both target the inflammatory cascade to decrease cartilage destruction as well as improve endogenous repair mechanisms. ACS application is simple and safe with limited adverse effects. This article reviews the role of ACS in degenerative joint disease, in addition to other inflammatory and autoimmune diseases, given its regenerative and immune-modulating properties.

Degenerative Joint Disease of the Upper Cervical Spines: A Cone Beam Computed Tomography Study

Objectives

To investigate the prevalence, imaging features, and predictors (age and gender) of upper cervical spine degenerative joint disease (DJD).

Methods

Two oral radiologists retrospectively reviewed the cone-beam computed tomography (CBCT) examinations conducted at a university-based imaging center over 1 year. They recorded the imaging findings related to the upper cervical spine (C1C2) and collected patient demographic data. Then the data of the patients with and without DJD findings in the upper cervical spine were compared.

Results

The prevalence of upper cervical DJD was 45.6%. There were no gender-based differences in upper cervical DJD. The prevalence of upper cervical DJD increased steadily with age. There was a statistically significantly difference in the prevalence of upper cervical DJD at all the age ranges.

Conclusions

DJD of the upper cervical spine is a relatively common incidental finding frequently captured in CBCT scans acquired for dental purposes.

Management of acromioclavicular joint disease by manual therapy versus corticosteroid injections: the protocol of a non-inferiority study

INTRODUCTION

Degenerative acromioclavicular joint pain accounts for about 4% of shoulder pain. Various medical and non-medical treatment strategies are available for acromioclavicular joint disease but it is difficult to conduct a comparative evaluation of these treatments. The few studies dealing with the medical management of the disease have conducted no comparative assessment of drug therapies, physiotherapy, joint manipulation and corticosteroid injections. The primary goal of this study is to determine whether manual therapy is not inferior to ultrasound-guided injection of a corticosteroid preparation to decrease acromiocalvicular joint pain at 3 months.

METHODS AND ANALYSIS

The acromioclavicular arthropathy managed by manual therapy is a monocentric, comparative, randomised, controlled, non-inferiority study conducted in the Rheumatology Department of Vendée Departmental Hospital, involving two parallel groups receiving either corticosteroid injections or manual therapy. The inclusion criteria are patients who suffer from pain in the shoulder or the proximal part of the arm, with pain located on palpation of the acromioclavicular joint associated with a positive cross-arm test and a positive O'Brien test. Randomisation will be at a 1:1 ratio. The injection group will receive a single ultrasound-guided injection of 1 mL of Diprostène and the manual therapy group will receive between one and three sessions at intervals of one per week. The primary outcome will be to compare the Visual Analogue Scale for pain-activity-related score at 3 months for both groups.

ETHICS AND DISSEMINATION

The study project has been approved by the appropriate ethics committee (Committee for the Protection of Patients Ouest II in Angers, 30 April 2019, with the registration number of 2019/22). In agreement with current French regulations, signed informed written consent will be obtained from each patient. Results of the main trial and of the secondary endpoints will be submitted for publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT03951480.

Spermatogonial stem cells are a promising and pluripotent cell source for regenerative medicine

Regenerative medicine has been shown to hold enormous potential to treat traumatic and degenerative diseases, and substantial advancements have been made in the recent decades. In particular, different cell types were evaluated in basic research and preclinical studies on cell-based therapy applications. Despite the extraordinary achievements made in experimental studies and clinical practice, a considerable number of obstacles, such as the cellular source, ethical and safety issues, hinder further clinical applications. Spermatogonial stem cells (SSCs) are gradually becoming the research focus of cell-based regenerative medicine owing to their unique merits over other types of stem cells, particularly the lack of ethical concerns and lower immunogenicity. In addition, SSCs have been successfully induced to differentiate into other cell types under different appropriate conditions in compelling studies. Based on these properties, we systemically reviewed the development of SSCs as an attractive cell source for cell-based regenerative medicine.

Should mast cells be considered therapeutic targets in multiple sclerosis?

Mast cells are immune cells of the myeloid lineage that are found throughout the body, including the central nervous system. They perform many functions associated with innate and specific immunity, angiogenesis, and vascular homeostasis. Moreover, they have been implicated in a series of pathologies (e.g., hypersensitivity reactions, tumors, and inflammatory disorders). In this review, we propose that this cell could be a relevant therapeutic target in multiple sclerosis, which is a central nervous system degenerative disease. To support this proposition, we describe the general biological properties of mast cells, their contribution to innate and specific immunity, and the participation of mast cells in the various stages of multiple sclerosis and experimental autoimmune encephalomyelitis development. The final part of this review is dedicated to an overview of the available mast cells immunomodulatory drugs and their activity on multiple sclerosis and experimental autoimmune encephalomyelitis, including our own experience related to the effect of ketotifen fumarate on experimental autoimmune encephalomyelitis evolution.

Primary lumbar decompression using ultrasonic bone curette compared to conventional technique

PURPOSE

The ultrasonic bone curette (Bone Scalpel) is a novel technique in neurosurgery for bony dissection. This study aimed to evaluate its use against conventional techniques for primary lumbar decompression.

MATERIALS AND METHODS

This study was a retrospective cohort comparison, using Spine Tango Registry data. All patients undergoing a primary procedure for lumbar decompression secondary to degenerative disease during a 2-year period (2014-2016) were identified, split into age and gender matched cohorts utilising either bone scalpel or conventional techniques intra-operatively.

RESULTS

Ninety-three patients were identified within each cohort, which did not differ significantly in terms of age, gender, BMI, number of operative vertebral levels or seniority of the principal surgeon. The incidence of intra-operative blood loss >100 ml was significantly reduced within the bone scalpel cohort (16.1% bone scalpel, 34.4% conventional, p = 0.04). There was no difference in the incidence of iatrogenic dural breach (9.7% bone scalpel, 16.1% conventional, p = 0.27). There was no significant difference in pre-operative Core Outcomes Measures Index (COMI) between the cohorts (7.91 bone scalpel, 8.02 conventional, p = 0.67) and both cohorts demonstrated a significant reduction in mean COMI at 24 months (bone scalpel p = 0.004, conventional p = <0.001). No difference in mean COMI existed between either cohort at any point across the 24-month post-operative period (p = 0.18).

CONCLUSIONS

The use of ultrasonic bone curette for primary lumbar decompression is associated with reduced intra-operative blood loss compared to conventional techniques, alongside a comparable safety profile and equivalent patient reported outcomes.

A Brief Review of the Degenerative Intervertebral Disc Disease

Introduction:

The degenerative processes of the intervertebral disc represent an important cause of morbidity in everyday clinical practice, exerting burden on patients and clinicians treating them. Numerous factors may initiate degenerative processes, which most commonly affect the nucleus pulposus and ultimately influence the biomechanics of the whole spine.

Aim:

This paper provides an overview from the literature about the process, causes and mechanisms of disc degeneration and the associated factors.

Methods:

The scientific literature was reviewed through PubMed, Medline and Science Direct. The articles were chosen in correlation with the study objective and their scientific relevance.

Results:

Many mechanical factors, such as mechanical, traumatic, genetic and nutritional, may affect the integrity of the intervertebral disc. The degenerative processes involve the structural damage of the intervertebral disc and the changes in number and composition of cells. The main factor in the degeneration of the intervertebral disc is the loss of proteoglycans. Degenerative changes of the disc are connected to damage of adjacent structures, leading to functional changes, higher susceptibility to injuries and clinical signs and symptoms.

Conclusions:

Degenerative disease of the intervertebral disc remains a significant health problem. Besides standard conservative and surgical treatment, techniques of regenerative therapy are becoming very promising, although still in the experimental phase.

The Potential of Computational Modeling to Predict Disease Course and Treatment Response in Patients with Relapsing Multiple Sclerosis

As of today, 20 disease-modifying drugs (DMDs) have been approved for the treatment of relapsing multiple sclerosis (MS) and, based on their efficacy, they can be grouped into moderate-efficacy DMDs and high-efficacy DMDs. The choice of the drug mostly relies on the judgment and experience of neurologists and the evaluation of the therapeutic response can only be obtained by monitoring the clinical and magnetic resonance imaging (MRI) status during follow up. In an era where therapies are focused on personalization, this study aims to develop a modeling infrastructure to predict the evolution of relapsing MS and the response to treatments. We built a computational modeling infrastructure named Universal Immune System Simulator (UISS), which can simulate the main features and dynamics of the immune system activities. We extended UISS to simulate all the underlying MS pathogenesis and its interaction with the host immune system. This simulator is a multi-scale, multi-organ, agent-based simulator with an attached module capable of simulating the dynamics of specific biological pathways at the molecular level. We simulated six MS patients with different relapsing-remitting courses. These patients were characterized based on their age, sex, presence of oligoclonal bands, therapy, and MRI lesion load at the onset. The simulator framework is made freely available and can be used following the links provided in the availability section. Even though the model can be further personalized employing immunological parameters and genetic information, we generated a few simulation scenarios for each patient based on the available data. Among these simulations, it was possible to find the scenarios that realistically matched the real clinical and MRI history. Moreover, for two patients, the simulator anticipated the timing of subsequent relapses, which occurred, suggesting that UISS may have the potential to assist MS specialists in predicting the course of the disease and the response to treatment.

Prognostic factors in the progression of intervertebral disc degeneration: Which patient should be targeted with regenerative therapies?

OBJECTIVE

Possible regenerative treatments for lumbar intervertebral disc degeneration (DD) are rapidly emerging. There is consensus that the patient that would benefit most has early-stage DD, with a predicted deterioration in the near future. To identify this patient, the aim of this study was to identify prognostic factors for progression of DD.

STUDY DESIGN

Systematic review.

METHODS

A systematic search was performed on studies evaluating one or more prognostic factor(s) in the progression of DD. The criteria for inclusion were (a) patients diagnosed with DD on MRI, (b) progression of DD at follow-up, and (c) reporting of one or more prognostic factor(s) in progression of DD. Two authors independently assessed the methodological quality of the included studies. Due to heterogeneity in DD determinants and outcomes, only a best-evidence synthesis could be conducted.

RESULTS

The search generated 3165 references, of which 16 studies met our inclusion criteria, involving 2.423 patients. Within these, a total of 23 clinical and environmental and 12 imaging factors were identified. There was strong evidence that disc herniation at baseline is associated with progression of DD at follow-up. There is limited evidence that IL6 rs1800795 genotype G/C male was associated with no progression of DD. Some clinical or environmental factors such as BMI, occupation and smoking were not associated with progression.

CONCLUSIONS

Disc herniation is strongly associated with the progression of DD. Surprisingly, there was strong evidence that smoking, occupation, and several other factors were not associated with the progression of DD. Only one genetic variant may have a protective effect on progression, otherwise there was conflicting or only limited evidence for most prognostic factors. Future research into these prognostic factors with conflicting and limited evidence is not only needed to determine which patients should be targeted by regenerative therapies, but will also contribute to spinal phenotyping.

Sex Moderates Amyloid and Apolipoprotein ε4 Effects on Default Mode Network Connectivity at Rest

Women are more likely to have Alzheimer's disease (AD) and decline more rapidly once diagnosed despite greater verbal memory early in the disease compared to men—an advantage that has been termed “memory reserve.” Resting state functional MRI (fMRI) investigations demonstrate interactions between sex and AD risk factors in default mode network (DMN) connectivity, a network of brain regions showing progressive dysfunction in AD. Separate work suggests connectivity of left prefrontal cortex (PFC) may correlate with more general cognitive reserve in healthy aging. It is unknown whether left prefrontal functional connectivity with anterior and posterior default mode network (aDMN, pDMN) might differ by sex in AD. This study employed group independent component analysis (ICA) to analyze resting state fMRI data from 158 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with baseline diagnoses of normal cognition or early mild cognitive impairment (eMCI). pDMN and aDMN were defined on a subject-specific basis; prefrontal areas were selected from the Brodmann atlas (BA 6, 44, 8, and 9). Moderation regression analyses examined whether sex and amyloid PET positivity (A+/–) moderated effects of apolipoprotein ε4 (APOE ε4) on connectivity between left PFC, aDMN, and pDMN; and between aDMN and pDMN. Significant analyses were followed up with partial correlations assessing relationship of connectivity to verbal memory on the Rey Auditory Verbal Learning Test (RAVLT), and with preliminary analyses within NC and eMCI groups separately. Results showed no sex moderation of effects of A+ and APOE ε4 on left prefrontal/DMN connectivity in the full sample. However, sex significantly moderated impact of A+ and APOE ε4 on connectivity between aDMN and pDMN (p < 0.01). Women with an APOE allele (ε4+) and A+ showed greater aDMN/pDMN connectivity than their ε4- counterparts. No significant results were observed in men. Subgroup analyses suggested the aDMN/pDMN finding was true for those with NC, not eMCI. Partial correlations controlling for age and education showed increased aDMN/pDMN connectivity related to better verbal learning in women (p < 0.01) and not men (p = 0.18). In women at risk for AD or in early symptomatic stages who also have evidence of amyloid burden, stronger aDMN/pDMN connectivity may support verbal learning.

Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14-year cohort study

BACKGROUND

Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease frequently complicated by bowel symptoms. Multiple sclerosis typically first manifests with a demyelination event, also known as a clinically isolated syndrome (CIS). We sought to examine the prevalence of prodromal bowel symptoms predating a CIS in patients with MS as part of a recently characterized prodromal phase of disease.

METHODS

We constructed a retrospective cohort of MS patients with bowel symptoms and an identifiable CIS at two tertiary care centers over 14 years using administrative and billing data. We determined the date of onset of reported bowel symptoms in comparison with the date of first CIS and determined the overall prevalence of prediagnosis bowel symptoms within 1, 2, 3, and >3 years from a CIS. We used multivariable modeling to determine demographic and clinical risk factors for prediagnosis bowel symptoms.

KEY RESULTS

Among 385 MS patients with reported bowel symptoms, 122 (31.6%) reported bowel symptoms prior to CIS. The most common first bowel symptom was constipation (50.0%), followed by diarrhea (29.5%). The average lead time between a first bowel symptom and a CIS event was 3.7 ± 3.4 years. Pre-CIS fatigue (OR 4.48, 95% CI: 2.68-7.51, P < 0.001) and pre-CIS sensory disturbances (OR 1.88, 95% CI: 1.15-3.08, P < 0.05) were all associated with bowel symptoms prior to a CIS event.

CONCLUSIONS AND INFERENCES

Nearly a third of MS patients with bowel symptoms reported bowel symptoms prior to a demyelinating event/CIS. Characterization of a prodromal phase of disease may provide important insights into understanding disease progression.

Recommendations for Anti-inflammatory Treatments in Alzheimer's Disease: A Comprehensive Review of the Literature

Alzheimer’s disease (AD) is the most common cause of dementia in elderly patients, affecting individuals older than 60 years. It is a complex degenerative brain disease characterized by progressive cognitive impairment. AD constitutes a major global health concern. A central role for inflammation has been implicated in the pathogenesis of AD. Despite the understanding of multiple molecular pathways in the pathophysiology of AD, novel treatment agents with a possible role in modifying the disease activity are still lacking. Our article provides a comprehensive review of various observational studies and randomized trials encompassing the use of anti-inflammatory agents in the management of AD patients and utilizes the conclusions derived therefrom to give recommendations in this regard. 

Hip joint arthroscopy in professionally active patients with osteoarthritis

OBJECTIVES

The primary endpoints of the study were to assess the effectiveness of hip joint arthroscopy in the treatment of femoroacetabular impingement (FAI) in patients with joint gap stenosis and to determine if and how quickly patients were able to return to work and physical activity.

MATERIAL AND METHODS

The prospective study of patients undergoing hip joint arthroscopy due to pain in FAI has been conducted. They were divided into 2 groups depending on the degree of the radiological examination. The criterion was the width of the joint gap. The study group involved 47 patients with hip joint gap of 2-3 mm, identified by means of the standardized X-ray examination. The control group consisted of 45 patients with hip joint gap > 3 mm. The post-operative follow-up period of the patients lasted at least 2 years. In addition, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire together with Harris Hip Score (HHS) were applied. The patients were also evaluated for the post-operative time period enabling return to work.

RESULTS

All the patients after hip joint arthroscopy returned to normal physical activity within 12 weeks after operation, enabling their return to work. However, it should be noted that during the post-operative follow-up, pain sensations either recurred or did not regress in 37 patients in the study group and 12 patients in the control group after treatment. The nearly equal results of the WOMAC questionnaire and HHS before operation significantly vary between both groups in the last follow up. In the study group they did not change expressively.

CONCLUSIONS

Despite the little invasiveness, hip joint arthroscopy in patients with joint gap stenosis brings about the far from satisfactory results. This procedure is not worth considering. Despite unsatisfactory pain relief, patients decided to returned to work, due to their occupational position and for fear of losing the job due to long absenteeism. Int J Occup Med Environ Health. 2019;32(1):115-120.

Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life

Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

[Comparison of the long-term outcomes of total arthroplasty and anterior spinal fusion in the treatment of cervical degenerative disc disease: a metaanalysis]

AIM

The study aim was to perform a meta-analysis based on the results of randomized clinical trials comparing long-term outcomes of total intervertebral disc arthroplasty (TA) and anterior cervical spinal fusion (ACSF) in the surgical treatment of cervical degenerative disc disease.

MATERIAL AND METHODS

We searched Pubmed, EMBASE, ELibrary, and Cochrane Library databases for randomized clinical trials reported between 2008 and August 2018. The relative risk and 95% confidence interval were calculated for dichotomous variables; for continuous variables, we used the standardized mean difference and their 95% CI with application of a random effects model.

RESULTS

The metaanalysis involved 9 randomized controlled clinical trials including the long-term outcomes of surgical treatment in 2,439 patients. A pooled analysis of the data showed that regression of neurological symptoms (p<0.00001), improvement in the quality of life of patients (Neck Disability Index), and lower pain severity (visual analogue scale for upper extremities) were significantly more often observed (p=0.02) in the group of TA patients. In addition, the TA technique was characterized by a statistically significantly lower rate of re-surgery (p<0.0005) and degeneration of the superjacent segment (p<0.0001), with the rate of adverse events being slightly increased (p=0.04).

CONCLUSION

Compared to anterior cervical spinal fusion, TA of cervical intervertebral discs is characterized by significantly better clinical efficacy in patients with cervical degenerative disc disease in the long-term postoperative follow-up.

Utility of the claw sign in spine magnetic nuclear resonance with diffusion to differentiate Modic type I changes for degenerative disease versus infection

BACKGROUND

In 1988, Modic and his colleagues described changes in the subchondral bone marrow of the vertebral plates in patients with degenerative disease or other pathologies, which were observed in the nuclear magnetic resonance (NMR) of the spine and were subdivided into three patterns of signal changes, called Modic type I, Modic type II and Modic type III. The main differential diagnosis of the Modic I changes of the vertebral plates due to degenerative disease in spine NMR, is infection in its early stages. In their study in 2014, Patel and collaborators, using a protocol and the concept of diffusion in spine MRI, were able to demonstrate that by means of the "claw sing", a degenerative disease with Modic type I changes, can be differentiated from an infection in early stages. In this series of cases, the algorithm used by Patel et al. was implemented.

METHODS

The clinical records of patients who consulted the emergency department for lumbar pain without clear etiology, between January 1, 2017 and December 31, 2017, were analyzed. Due to axial lumbar pain, subjects were hospitalized and studies were ordered, including contrasted MRI of the lumbosacral spine. Then, with laboratory tests and MRI findings of Modic type I changes, it was not possible to differentiate between degenerative disease vs. spondylodiscitis. Therefore, the algorithm used in the study by Patel and collaborators was applied.

RESULTS

There were 13 patients identified with lumbar or dorsal pain over 3 months of evolution, with nonspecific symptoms; 5 patients (38.46%) reported arterial hypertension, 4 patients (30.77%) diabetes mellitus, and 4 patients (30.77%) chronic kidney disease stage V in management with hemodialysis, 3 patients (23.08%) presented immunosuppressive conditions and 3 patients (23.08%) had a history of spinal surgery with instrumentation. All the patients were hospitalized and a lumbosacral and thoracic spine simple MRI was performed with Modic type I changes to perform contrast-enhanced MRI with diffusion and ADC. From the 13 cases studied for low back pain, there were 7 patients (53.85%) with confirmed findings of Modic type I changes due to degenerative disease for presenting claw sign in spinal MRI diffusion and 6 patients (46.15%) Modic type changes I due to infection in the absence of a claw sign in the column MRI diffusion.

CONCLUSIONS

Spinal column MRI with diffusion is useful to differentiate patients with type I changes due to degenerative disease with positive claw sign; of patients with type I changes due to infection with absent claw sign. In addition, in patients with compromised renal function, column MRI with diffusion without contrast could be a diagnostic alternative, since it does not require contrast media to confirm infection.

Prophylactic muscle flap reconstruction after complex spine surgery for degenerative disease: case series and institutional protocol

BACKGROUND

Wound complications can occur in up to 20% of patients following multilevel posterior spinal fusion. Currently, the use of local flaps has been reported in high-risk patients with a history of spinal neoplasm, radiation therapy, exposed hardware, multiple spine surgeries, or wound infections. However, there are no reports of prophylactic muscle flap wound closure in patients undergoing multi-level spinal fusion for degenerative pathology. Given the extensive soft tissue dissection for exposure compounded by patient comorbidities, there is potential to minimize the risk of wound complications with prophylactic trapezius and/or paraspinal flap coverage. We sought to describe the utility and outcomes of prophylactic muscle flaps for wound coverage after instrumented posterior spinal fusion for multi-level degenerative spine disease and spinal deformity.

METHODS

An institutional review board (IRB)-approved retrospective review of 26 consecutive patients who underwent a multi-level posterior spinal fusion for degenerative pathology with concurrent muscle flap coverage at a single institution (August 2016 to February 2017) was done. Patient demographics, clinical profile, procedures, and outcomes at a minimum 6-month post-operatively have been described.

RESULTS

Patients had a mean age of 59.7±13.0 years with a mean body mass index (BMI) of 31.0±8.6 kg/m². Paraspinous muscle flap (61.5%), trapezius (3.8%), and combination flaps (34.6%) were used for coverage of an average wound defect of 325 cm² extending over average 10.2 vertebral levels. All wounds healed completely with no complications at an average of 9.1 months follow-up. Only 1 patient (3.8%) developed a seroma for which interventional radiology (IR)-drainage was sufficient.

CONCLUSIONS

Prophylactic trapezius and/or paraspinous muscle flap coverage using a team approach can reduce the risk of wound complications after extensive spinal fusion for multi-level degenerative disease or adult spinal deformity (ASD). Preliminary results from our institution suggest that routine use of such a protocol has the potential to improve quality of care and reduce healthcare expenditure associated with this relatively morbid procedure.

Application of Millifluidics to Encapsulate and Support Viable Human Mesenchymal Stem Cells in a Polysaccharide Hydrogel

Human adipose-derived stromal cells (hASCs) are widely known for their immunomodulatory and anti-inflammatory properties. This study proposes a method to protect cells during and after their injection by encapsulation in a hydrogel using a droplet millifluidics technique. A biocompatible, self-hardening biomaterial composed of silanized-hydroxypropylmethylcellulose (Si-HPMC) hydrogel was used and dispersed in an oil continuous phase. Spherical particles with a mean diameter of 200 μm could be obtained in a reproducible manner. The viability of the encapsulated hASCs in the Si-HPMC particles was 70% after 14 days in vitro, confirming that the Si-HPMC particles supported the diffusion of nutrients, vitamins, and glucose essential for survival of the encapsulated hASCs. The combination of droplet millifluidics and biomaterials is therefore a very promising method for the development of new cellular microenvironments, with the potential for applications in biomedical engineering.

Cervical sagittal balance parameters after single-level anterior cervical discectomy and fusion: Correlations with clinical and functional outcomes

Background:

Normal sagittal cervical alignment has been associated with improved outcome after anterior cervical discectomy and fusion (ACDF).

Objective:

The aim of this study is to identify alterations of cervical sagittal balance parameters after single-level ACDF and assess correlations with postoperative functionality.

Methods:

A retrospective chart review was performed between January 2010 and January 2014 to identify adult patients with no previous cervical spine surgery who underwent ACDF at any one level between C2 and C7 for the single-level degenerative disease. Tumor, infection, and trauma cases were excluded from the study. For the included cases, the following data were recorded preoperatively and 6 months–1 year after surgery: sagittal balance-marker measurements of the C1–C2 angle, C2–C7 angle, C7 slope, segmental angle at the operated level, and sagittal vertical axis (SVA) distance between C2 and C7, as well as the neck disability index and visual analog scale of pain.

Results:

The present study included 47 patients (average age: 51.2 years; range: 28–86 years). A moderate negative correlation between a smaller C2–C7 angle and the presence of right arm pain before treatment was found (P = 0.0281). Postoperatively, functionality scores significantly improved in all patients. C1–C2 angle increased with statistical significance (P = 0.0255). C2–C7 angle, segmental angle, C7 slope, and SVA C2–C7 distance did not change with statistical significance after surgery. C7 slope significantly correlated with overall cervical sagittal balance (P < 0.05).

Conclusions:

Single-level ACDF significantly increases upper cervical lordosis (C1–C2) without significantly changing lower cervical lordosis (C2–C7). The C7 slope is a significant marker of overall cervical sagittal alignment (P < 0.05).

Telomerase Reverse Transcriptase Polymorphism rs2736100: A Balancing Act between Cancer and Non-Cancer Disease, a Meta-Analysis

The enzyme telomerase reverse transcriptase (TERT) is essential for telomere maintenance. In replicating cells, maintenance of telomere length is important for the preservation of vital genetic information and prevention of genomic instability. A common genetic variant in TERT, rs2736100 C/A, is associated with both telomere length and multiple diseases. Carriage of the C allele is associated with longer telomere length, while carriage of the A allele is associated with shorter telomere length. Furthermore, some diseases have a positive association with the C and some with the A allele. In this study, meta-analyses were performed for two groups of diseases, cancerous diseases, e.g., lung cancer and non-cancerous diseases, e.g., pulmonary fibrosis, using data from genome-wide association studies and case-control studies. In the meta-analysis it was found that cancer positively associated with the C allele (pooled OR 1.16 [95% CI 1.09–1.23]) and non-cancerous diseases negatively associated with the C allele (pooled OR 0.81 [95% CI 0.65–0.99]). This observation illustrates that the ambiguous role of telomere maintenance in disease hinges, at least in part, on a single locus in telomerase genes. The dual role of this single nucleotide polymorphism also emphasizes that therapeutic agents aimed at influencing telomere maintenance should be used with caution.

Direct Reprogramming of Spiral Ganglion Non-neuronal Cells into Neurons: Toward Ameliorating Sensorineural Hearing Loss by Gene Therapy

Primary auditory neurons (PANs) play a critical role in hearing by transmitting sound information from the inner ear to the brain. Their progressive degeneration is associated with excessive noise, disease and aging. The loss of PANs leads to permanent hearing impairment since they are incapable of regenerating. Spiral ganglion non-neuronal cells (SGNNCs), comprised mainly of glia, are resident within the modiolus and continue to survive after PAN loss. These attributes make SGNNCs an excellent target for replacing damaged PANs through cellular reprogramming. We used the neurogenic pioneer transcription factor Ascl1 and the auditory neuron differentiation factor NeuroD1 to reprogram SGNNCs into induced neurons (iNs). The overexpression of both Ascl1 and NeuroD1 in vitro generated iNs at high efficiency. Transcriptome analyses revealed that iNs displayed a transcriptome profile resembling that of endogenous PANs, including expression of several key markers of neuronal identity: Tubb3, Map2, Prph, Snap25, and Prox1. Pathway analyses indicated that essential pathways in neuronal growth and maturation were activated in cells upon neuronal induction. Furthermore, iNs extended projections toward cochlear hair cells and cochlear nucleus neurons when cultured with each respective tissue. Taken together, our study demonstrates that PAN-like neurons can be generated from endogenous SGNNCs. This work suggests that gene therapy can be a viable strategy to treat sensorineural hearing loss caused by degeneration of PANs.

Re-education begins at home: an overview of the discovery of in vivo-active small molecule modulators of endogenous stem cells

INTRODUCTION

Degenerative diseases, such as Alzheimer's disease, heart disease and arthritis cause great suffering and are major socioeconomic burdens. An attractive treatment approach is stem cell transplantation to regenerate damaged or destroyed tissues. However, this can be problematic. For example, donor cells may not functionally integrate into the host tissue. An alternative methodology is to deliver bioactive agents, such as small molecules, directly into the diseased tissue to enhance the regenerative potential of endogenous stem cells. Areas covered: In this review, the authors discuss the necessity of developing these small molecules to treat degenerative diseases and survey progress in their application as therapeutics. They describe both the successes and caveats of developing small molecules that target endogenous stem cells to induce tissue regeneration. This article is based on literature searches which encompass databases for biomedical research and clinical trials. These small molecules are also categorized per their target disease and mechanism of action. Expert opinion: The development of small molecules targeting endogenous stem cells is a high-profile research area. Some compounds have made the successful transition to the clinic. Novel approaches, such as modulating the stem cell niche or targeted delivery to disease sites, should increase the likelihood of future successes in this field.

Synaptic aging disrupts synaptic morphology and function in cerebellar Purkinje cells

Synapses are key structures in neural networks, and are involved in learning and memory in the central nervous system. Investigating synaptogenesis and synaptic aging is important in understanding neural development and neural degeneration in diseases such as Alzheimer disease and Parkinson's disease. Our previous study found that synaptogenesis and synaptic maturation were harmonized with brain development and maturation. However, synaptic damage and loss in the aging cerebellum are not well understood. This study was designed to investigate the occurrence of synaptic aging in the cerebellum by observing the ultrastructural changes of dendritic spines and synapses in cerebellar Purkinje cells of aging mice. Immunocytochemistry, DiI diolistic assays, and transmission electron microscopy were used to visualize the morphological characteristics of synaptic buttons, dendritic spines and synapses of Purkinje cells in mice at various ages. With synaptic aging in the cerebellum, dendritic spines and synaptic buttons were lost, and the synaptic ultrastructure was altered, including a reduction in the number of synaptic vesicles and mitochondria in presynaptic termini and smaller thin specialized zones in pre- and post-synaptic membranes. These findings confirm that synaptic morphology and function is disrupted in aging synapses, which may be an important pathological cause of neurodegenerative diseases.