The mechanical properties of the spinal cord: a systematic review.

BACKGROUND CONTENT: Spinal cord compression is a source of pathology routinely seen in clinical practice. However, there remain unanswered questions surrounding both the understanding of pathogenesis and the best method of treatment. This arises from limited real-life testing of the mechanical properties of the spinal cord, either through cadaveric human specimens or animal testing, both of which suffer from methodological, as well as ethical, issues. PURPOSE: To conduct a review of the literature on the mechanical properties of the spinal cord. STUDY DESIGN/SETTING: A systematic review of the literature on the mechanical properties of the spinal cord is undertaken. PATIENT SAMPLE: All literature reporting the testing of the mechanical properties of the spinal cord. OUTCOME MEASURES: Reported physiological mechanical properties of the spinal cord. METHODS: The methodological quality of the studies has been assessed within the ARRIVE guidelines using the CAMARADES framework and SYRCLE's risk of bias tool. This paper details the methodologies and results of the reported testing. RESULTS: We show that (1) the research quality of previous work does not follow published guidelines on animal treatment or risk of bias, (2) no standard protocol has been employed for sample preparation or mechanical testing, (3) this leads to a wide distribution of results for the tested mechanical properties, not applicable to the living human or animal, and (4) animal testing is not a good proxy for human application. CONCLUSIONS: The findings summarize the sum of current knowledge inherent to the mechanical properties of the spinal cord and may contribute to the development of a physical model which is applicable to the living human for analysis and testing in a controlled and repeatable fashion. Such a model would be the basis for further clinical research to improve outcomes from spinal cord compression.

[Update of knowledge on Neglected Diseases in Haiti: Mansonelliasis, Tungiasis, Leprosy, and Anthrax]. / Mise à jour des connaissances concernant quatre maladies délaissées en Haïti : mansonellose, tungose, lèpre, charbon.

Haiti, like most limited-resources countries in the world, faces numerous neglected infectious diseases. They represent a real public health issue with lethal consequences especially in children. We are reviewing here the available literature on four neglected infectious diseases, mansonelliasis, tungiasis, leprosy and anthrax. Filariasis, due to Mansonella ozzardi, has been totally neglected since its discovery in 1920 in Haiti; it persists in coastal homes with a high prevalence in adults when an effective treatment is available. The skin lesions caused by Tunga penetrans have existed since the pre-Columbian period in Haiti. They persist in the most retreated and hard-to-reach areas where the population lives in precarious conditions and in extreme poverty. New available research data show the importance of the problem with very high prevalence rates in some rural communities far away from any healthcare center. Cases of leprosy are recently reemerging as no monitoring program has been in place since 2004. Finally, anthrax is still endemic; small epidemics resurfacing periodically in families in rural areas. Screening of people for these diseases and managing the cases are necessary to improve health and reduce morbidity and mortality in Haiti.

Comme dans la plupart des pays pauvres de la planète, les maladies infectieuses négligées sont nombreuses en Haïti où elles représentent un réel problème de santé publique avec des conséquences létales, surtout pour les enfants. Nous faisons le point des données accessibles pour quatre d'entre elles. Totalement délaissée depuis la découverte de sa présence en Haïti en 1920, la filariose due à Mansonella ozzardi persiste en foyers côtiers avec une prévalence élevée chez les adultes alors qu'un traitement efficace est disponible. Connues depuis la période précolombienne dans l'île d'Hispaniola, les lésions cutanées dues à Tunga penetrans persistent dans les régions les plus reculées et difficiles d'accès où la population vit dans des conditions précaires et dans une très grande pauvreté. Nous rapportons les données d'enquêtes récentes qui montrent l'importance de cette ectoparasitose en Haïti où les taux de prévalence sont très élevés dans certaines communautés rurales isolées. Des cas de lèpre resurgissent en Haïti alors qu'aucun programme de surveillance n'est effectif depuis 2004. Enfin, la maladie du charbon est endémique dans les régions d'élevage où des épidémies familiales resurgissent périodiquement en milieu rural. Le dépistage des personnes atteintes de ces maladies et leur prise en charge sont nécessaires pour une amélioration de la santé et une baisse de la mortalité en Haïti.

Evaluation of serum MMP-9 as predictive biomarker for antisense therapy in Duchenne.

Duchenne Muscular Dystrophy (DMD) is a severe muscle disorder caused by lack of dystrophin. Predictive biomarkers able to anticipate response to the therapeutic treatments aiming at dystrophin re-expression are lacking. The objective of this study is to investigate Matrix Metalloproteinase-9 (MMP-9) as predictive biomarker for Duchenne. Two natural history cohorts were studied including 168 longitudinal samples belonging to 66 patients. We further studied 1536 samples obtained from 3 independent clinical trials with drisapersen, an antisense oligonucleotide targeting exon 51: an open label study including 12 patients; a phase 3 randomized, double blind, placebo controlled study involving 186 patients; an open label extension study performed after the phase 3. Analysis of natural history cohorts showed elevated MMP-9 levels in patients and a significant increase over time in longitudinal samples. MMP-9 decreased in parallel to clinical stabilization in the 12 patients involved in the open label study. The phase 3 study and subsequent extension study clarified that the decrease in MMP-9 levels was not predictive of treatment response. These data do not support the inclusion of serum MMP-9 as predictive biomarker for DMD patients.

Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease.

A significant number of elderly patients die during their first 3 months of dialysis. Because dialysis can impair the quality of both life and death, a personalized care plan based on both early prognosis and patient choices is required. We developed a prognostic screening tool to identify older patients in need of specific care based on a multidisciplinary approach. Our study included 24,348 patients aged 75 years and older from the French national renal epidemiology and information network (REIN) registry who began dialysis between 1 January 2005 and 30 September 2012. Our primary outcome was overall mortality during the first 3 months of renal replacement therapy. Multivariate logistic regression was used to construct a scoring system in a random half of the cohort (training set). This score, which included age, gender, specific comorbidities, albumin levels, and mobility, was then applied to the other half (validation set). In all, 2548 patients died during the first 3 months after dialysis initiation, 22% after dialysis withdrawal. Three risk groups were identified: low risk (score under 12 points, 3-month expected mortality under 20%), intermediate risk (score from 12 to 16, mortality between 20 and 40%, 9.5% of patients) and high risk (score 17 or more, mortality over 40%, 2.5% of patients). We developed a decision-making process that classifies patients according to their risk of early death in view of their potentially imminent need for supportive care or treatment.

Tailored CT: primum non nocere.

Despite its vital diagnostic utility, the ionizing radiation used in CT is not benign. Patients have an increased risk of dying from a radiation-induced cancer for every pass through a CT scanner. One way to reduce this risk is to tailor CT, especially follow-up scans, to specific areas of concern. By doing so, we can help to minimize the small but real risk from this essential technology.

Inhibition of proteasome activity sensitizes dopamine neurons to protein alterations and oxidative stress.

Impairment in the capacity of the ubiquitin-proteasome pathway to clear unwanted proteins has been implicated in the cell death that occurs in Parkinson's disease (PD). In support of this concept, defects in proteasomal structure and function, as well as protein aggregates and increased levels of oxidized proteins are found in the substantia nigra of PD patients. We have previously demonstrated that inhibition of proteasome activity in mesencephalic cultures induces degeneration of dopaminergic neurons coupled with the formation of proteinaceous intracellular inclusions. In this study we examined the effect of proteasome inhibition on cultured dopamine neurons when combined with oxidative stress and protein misfolding, in order to better simulate the condition in PD. We demonstrate that two structurally unrelated inhibitors of proteasome activity, lactacystin and carbobenzoxy-L-leucul-L-leucyl-L-leucinal (MG132), cause dose-dependent cell loss that preferentially affects dopaminergic neurons. Conditions that promote protein damage and misfolding such as oxidative stress, heat shock, and canavanine also induce neuronal degeneration with preferential loss of dopamine neurons and cell death is markedly increased when any of these is combined with a proteasome inhibitor. These studies demonstrate a synergistic effect between conditions that promote the formation of damaged proteins and those in which proteasomal function is impaired, and provide further support for the notion that cell loss in PD could be related to a defect in protein handling.

Effects of Valsalva maneuver on QT dispersion in patients with ischemic heart diseases.

Previous studies showed that increased QT dispersion (QTd) has been observed during episodes of myocardial ischemia or infarction and identify the patients at risk of arrhythmia or sudden death. The objective of this study is to investigate the relationship between coronary artery disease and QTd during the Valsalva maneuver. The study population included 85 subjects (21 with normal coronary arteries, 35 with stable angina pectoris, and 29 with unstable angina pectoris). Twelve-lead surface ECGs were recorded at 50-mm/sec paper speeds and were obtained before the Valsalva maneuver and during the strain phase. The results indicate a significant difference in mean time increase between the control group and the group with stable angina pectoris (mean difference = 16.10 milliseconds, p<0.000), and between the control group and the group with unstable angina pectoris (mean difference = 35.26 milliseconds, p<0.000). The mean difference in time between these groups was also compared (mean difference = 19.17 milliseconds), and was statistically significant (p<0.000). There are some conditions like constipation, severe coughing spells, nausea, vomiting, and carrying or lifting heavy objects that increase intrathoracic pressure and may increase QT dispersion. Therefore, all these conditions should be treated appropriately and carrying or lifting heavy objects is forbidden, especially in patients with coronary artery disease.

The Payment Error Prevention Program (PEPP): reducing Medicare payment errors in prospective payment system hospitals.

Peer Review Organizations (PROs) are charged by the Health Care Financing Administration (HCFA) to assist in protecting the integrity and solvency of the Medicare program. Recent audits of the Medicare program from the Office of Inspector General (OIG) revealed that more than $12 billion Medicare dollars in 1998 were spent in improper payments, with more than 25% attributed to prospective payment system (PPS) hospitals. The Payment Error Prevention Program (PEPP) is an initiative designed by HCFA in 1999 to assist PROs in meeting the goal of reducing payment errors in PPS hospitals. PEPP is implemented through the development of quality improvement (QI) methodologies. These projects are designed to achieve measurable improvements in processes and outcomes of payment errors. PEPP works to reduce payment errors at PPS hospitals through cooperative efforts with Ohio agencies and licensing boards, federal law enforcement organizations, HCFA contractors, hospital medical staffs, and medical and osteopathic associations.

Neighborhood care partners (NCP): a teaching case.

How can practitioners use self-collected data from a diabetic patient to achieve their group practice's goal of measured improvement in care. This is a hypothetical case study used to teach health professions' students about control chart methods.

Circulating interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and soluble ICAM-1 in patients with chronic stable angina and myocardial infarction.

The changes in serum concentrations of cytokines such as interleukin-1 (IL-1) beta, interleukin-6 (IL-6), tumor necrosis factor (TNF) alpha and a soluble-intercellular adhesion molecule (sICAM-1) has been investigated in patients with stable angina and acute myocardial infarction. Thirty-four patients with stable angina (SA), 15 with acute myocardial infarction (AMI), and 20 subjects in the control (C) group were included in the study. The mean serum concentrations of sICAM-1, IL-1-beta, IL-6, and TNF-alpha differed significantly among the three groups. Serum concentrations of IL-1 beta, sICAM-1, and TNF-alpha were comparable in the AMI and SA groups and higher than those found in the C group (p < 0.001). The serum concentration of IL-6 was more than twice as high in the AMI group as compared to the other two groups (p < 0.001). The mean serum concentrations of IL-1 beta, TNF-alpha, and IL-6 were comparable in the AMI and SA groups and higher than in the C group.

Elderly immigrants and the saga of welfare reform.

In 1996 Congress enacted legislation which, among other things, substantially cut off Supplemental Security Income payments and food stamps for present and future legal alien residents of the United States, and made it much harder for them to qualify for Medicaid. For low-income elderly immigrants, who constituted more than two-thirds of aliens on SSI, the adverse and potential impacts were substantial in terms of economic hardship and access to health care. In the months that followed, their plight received significant attention from the media and state and local politicians who now had greater economic and social responsibilities thrust upon them. One year later, Congress restored SSI benefits only for aliens who been receiving them before August 22, 1996 and made it easier for them to qualify for Medicaid. Food stamp benefits, however, were not restored. The limited scope of this restoration of benefits means that many of today's older immigrants, as well as those in the future, will be faced with serious problems in meeting their basic income and health care needs.

Dual-inflow great vessel aneurysm: delayed presentation after penetrating trauma.

Aneurysms constitute uncommon sequelae of injuries to the thoracic outlet. Most such aneurysms are secondary to blunt trauma and usually involve the great vessels at their take-off from the aortic arch. Penetrating injuries are more often identified in the more distal vessels and only very rarely present as pseudoaneurysms. Reported here is a single case of a chronic posttraumatic pseudoaneurysm arising from both the right common carotid artery and the right subclavian artery. The workup and surgical approach provide practical lessons, complemented with illustrations that aid in the understanding of the case. It is an unusual case because of the dual-inflow nature of the aneurysm.

Indolent epidemic of Pseudomonas cepacia bacteremia and pseudobacteremia in an intensive care unit traced to a contaminated blood gas analyzer.

An epidemic of Pseudomonas cepacia bacteremia and pseudobacteremia occurred in the medical intensive care unit at the Clinical Center of the National Institutes of Health. Sixteen patients in the intensive care unit became colonized or infected with this organism in a 21-month period; whereas P. cepacia had been isolated only 16 times in the preceding 90 months from the entire hospital. Further analysis demonstrated a significant association of the epidemic cases with bloodstream isolation of the organism (p less than 0.001, Fisher's exact test). Mortality associated with bacteremia caused by P. cepacia was 38 percent. Intensive investigation of the intensive care unit and its surrounding environment eventually demonstrated that a blood gas analyzer in a satellite laboratory adjacent to the intensive care unit was the reservoir for the outbreak. Replacement of the machine resulted in termination of the outbreak, P. cepacia continues to represent an environmental threat to hospitalized patients.

Nosocomial transmission of hepatitis A in an adult population.

Nosocomial transmission of hepatitis A from patients to staff members is an unusual event. Recently, several cases of occupational transmission of hepatitis A to health care workers have been reported in the literature. Most of these have occurred as a result of transmission from an infected child to a staff member involved in his or her care. We report an additional case of transmission of hepatitis A from an infected adult to a staff member and review the literature regarding nosocomial hepatitis A transmission. The review emphasizes several points that nearly all instances of nosocomial transmission of hepatitis A have in common, including the role of asymptomatic infection, the timing of hospitalization, and the fact that index patients often have an underlying illness that obscures the early diagnosis of hepatitis A. In addition, several other areas of controversy with respect to hepatitis A are discussed.