Risk Factors Associated with Pain Severity in Patients with Non-specific Low Back Pain in Southern China

STUDY DESIGN: A prospective cross-sectional study. PURPOSE: To evaluate the risk factors associated with the severity of pain intensity in patients with non-specific low back pain (NSLBP) in Southern China. OVERVIEW OF LITERATURE: Low back pain (LBP) is the leading cause of activity limitation and work absence throughout the world, so a firm understanding of the risk factor associated with NSLBP can provide early and prompt interventions that are aimed at attaining long-term results. METHODS: Participants were recruited from January 2014 to January 2016 and were surveyed using a self-designed questionnaire. Anonymous assessments included Short Form 36-Item Health Survey (SF-36) and Visual Analogue Scale (VAS). The association between the severity of NSLBP and these potential risk factors were evaluated. RESULTS: A total of 1,046 NSLBP patients were enrolled. The patients with primary school education, high body mass index (BMI), those exposed to sustained durations of driving and sitting, smoking, recurrent LBP had increased VAS and Oswestry Disability Index (ODI) scores with lower SF-36 scores (p10 kg objects in a quarter of their work time for >10 years had higher VAS and ODI scores with lower SF-36 scores (p<0.01). Multiple logistic regression showed lower levels of education, LBP for 1–7 days, long-lasting LBP in last year, smoking, long duration driving, and higher BMI were associated with more severe VAS score. CONCLUSIONS: The severity of NSLBP is associated with lower levels of education, poor standards of living, heavy physical labor, long duration driving, and sedentary lifestyle. Patients with recurrent NSLBP have more severe pain. Reducing rates of obesity, the duration of heavy physical work, driving or riding, and attenuating the prevalence of sedentary lifestyles and smoking may reduce the prevalence of NSLBP.

Effectiveness of short segment pedicle screw fixation plus pecutaneous vertebroplasty for treatment of single thoracolumbar fracture with Kümmell disease / 中华创伤杂志

Objective To study the surgical indications and effectiveness of short segment pedicle screw fixation plus pecutaneous vertebroplasty (PVP) for single thoracolumbar fracture combined with Kümmell disease.Methods Between June 2012 and June 2014,a prospective case series analysis was made on the clinical data of 15 selected cases of single thoracolumbar fracture patients who were combined with Kümmell disease.There were three males and 12 females,with an average age of 62.5 years (range,48-80 years).The iujured vertebrae were located at T11 in 3 cases,at T12in 4,at L1 in 5 and at L2 in 3.All the patients were treated by short segment fixation plus PVP.Operative time,surgery-related complications and adjacent vertebral fracture during follow-up were recorded.The effectiveness of the treatment was appraised by visual analogue scale (VAS),Oswestry Disability Index (ODI),Cobb angle of operative segment,which were recorded preoperatively,one week post-operatively and at final follow-up.One-way ANOVA (Analysis of Variance) was employed for statistical analysis.Results The operative time was 0.8-2 hours (mean,1.35 hour).There was no observation of incision infection,nerve injury,cement leakage or other related operative complications.A total of 15 patients were followed up for 16-36 months (mean,22.4 months),which showed solid fusion and bone bridges in all patients,with no fracture of adjacent vertebra observed.VAS was improved from preoperative (5.93 ± 0.62) points to (1.80±0.64) points one week postoperatively and (2.60 ± 0.53) points at final follow-up.ODI was improved from preoperative 61.53 ± 4.30 to 19.93 ±3.26 one week postoperatively and 23.07 ± 4.06 at final follow-up.Cobb angle of operative segment was improved from preoperative (17.40 ± 6.73) ° to (9.53 ± 3.12) o one week postoperatively and (11.00 ± 3.20) ° at final follow-up.There was significant difference of all the indexes namely,VAS,ODI and Cobb angle,between preoperative and one week postoperative status as well as between preoperative and final follow-up (P ＜ 0.05 or 0.01).However,there was no significant difference between ODI and Cobb angle in one week postoperatively and at last follow-up (P ＞ 0.05).Conclusion For single thoracolumbar fracture with Kümmell disease,short segment fixation plus PVP can shorten the surgery time,reduce the rate of complications,relieve pain,recover the function and avoid loss of kyphosis correction,as is worthy of clinical recommendation.

TGF-β1 suppresses CCL3/4 expression through the ERK signaling pathway and inhibits intervertebral disc degeneration and inflammation-related pain in a rat model

The objective of this study was to investigate the regulatory effects of TGF-β1 on CCL3/4 expression and inflammation-related pain during intervertebral disc degeneration (IVDD). TGF-β1 and CCL3/4 expression patterns in different degenerative human nucleus pulposus (NP) tissues were measured by qPCR and immunohistochemistry (IHC), and the effects of TGF-β1 on CCL3/4 expression were measured by qPCR, ELISA and immunofluorescence. The roles of NF-κB and MAPK in TGF-β1-mediated CCL3/4 promoter activity were studied using siRNAs, western blotting and qPCR. After establishing an IVDD rat model in vivo, we administered intradiscal injections of TGF-β1. The effects of TGF-β1 on IVDD were determined by MRI and histological analyses, and the effects of TGF-β1 on dorsal root ganglion (DRG) inflammation and pain development were determined by IHC staining and pain-behavior testing, respectively. TGF-β1 and CCL3/4 expression was elevated in degenerative NP tissue. CCL4 expression was significantly inhibited by TGF-β1 treatment. Pharmacological inhibition or siRNA knockdown of the ERK1/2 signaling attenuated TGF-β1-mediated suppression of CCL4 expression. In vivo, TGF-β1 injection inhibited the development of degenerative features in the IVDD model. Moreover, TGF-β1 prevented the inflammatory response and pain development. The results of this study show that TGF-β1 downregulates CCL4 expression through ERK1/2 signaling activation in NP cells. Furthermore, TGF-β1 can prevent degenerative processes, inhibit inflammatory responses in the DRG and prevent pain development in the IVDD rat model. The results of this study indicate that TGF-β1 may represent a therapeutic target for the control of inflammation-related pain associated with IVDD.

Sagittal balance evaluation of spinal deformities using curve harmony angles / 中华骨科杂志

Objective To introduce Curve Harmony Angle (CHA)to quantify the relationship between adjacent curves of the spine and pelvis and evaluate sagittal balance in spinal deformities. Methods Radiographic analysis of 93 asymptomatic vol-unteers and 95 patients including Degenerative Scoliosis(DS), Adolescent Idiopathic Scoliosis(AIS)and Ankylosing Spondylitis (AS)was performed by measuring sagittal parameters. Correlation study among parameters was further conducted. Curve Harmony Angles(CHAs)including the following three parameters were measured. Cervical-Thoracic Angle (CTA), Thoracic-Lumbar Angle (TLA) and Lumbar-Sacral Angle (LSA). Comparative study between normal population and different spinal disorders were per-formed in order to describe the characteristic changes of CHAs. Besides, according to Schwab SRS adult deformity classification, comparative study of CHAs in different balance status was performed to test the reliability of CHA on sagittal balance evaluation. Results All subjects showed typical changes of sagittal parameters. Different spinal disorders showed characteristic patterns of CHAs. In Schwab-SRS Adult Deformity Classification, Compensatory Balance group showed smaller LSA compared to Balance group;Imbalance group showed significantly smaller CTA, LSA and significantly greater TLA. Conclusion CHAs are parame-ters used to quantify the relationship between adjacent curves. Comparative study of CHA between normal population and different spinal disorder or among different balance status showed specific characters respectively. It is feasible to use CHA to evaluate the clinical sagittal balance and the results of deformity correction.

Pupal morphogenesis of Lucilia cuprina in different constant temperatures and its significance in Forensic Medicine / 中国法医学杂志

Objective To study the chronology of development within puparia to determine the postmortem interval(PMI).Methods The necrophagous fly Lucilia cuprina was reared successively in constant temperatures(16℃,20℃,24℃,28℃,32℃).Sample,dissecte,and observe the pupal morphologic changes with the stereomicroscope.Results 7 morphological changes within the puparium can be used as age-markers and the pupal period of Lucilia cuprina can be divided into 9 developmental stages.The time required for each pupal stage was inversely proportional to the temperature.Conclusion Pupal developmental stages can be used as reference to the estimation of PMI.