Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score-Matched Comparison Between African and US Populations.

STUDY DESIGN: Retrospective analysis of propensity score-matched (PSM) observational cohorts. OBJECTIVES: To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated. METHODS: Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores. RESULTS: Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p < .05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)-Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p < .05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = -0.321), thoracic (r = -0.277), and thoracolumbar (r = -0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = -0.347, -0.346, respectively). CONCLUSIONS: Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly. LEVEL OF EVIDENCE: Level III.

When is compensation for lumbar spinal stenosis a clinical sagittal plane deformity?

BACKGROUND CONTEXT: Degenerative lumbar stenosis (DLS) patients have been reported to lean forward in an attempt to provide neural decompression. Spinal alignment in patients with DLS may resemble that of adult spinal deformity (ASD). No previous studies have compared and contrasted the compensatory mechanisms of DLS and ASD patients. PURPOSE: This study aimed to determine the differences in compensatory mechanisms between DLS and ASD patients with increasing severity of sagittal spinopelvic malalignment. Contrasting these compensatory mechanisms may help determine at what severity sagittal malalignment represents a clinical sagittal deformity rather than a compensation for neural compression. STUDY DESIGN/SETTING: This is a retrospective clinical and radiological review. PATIENT SAMPLE: Baseline x-rays in patients without spinal instrumentation, with the clinical radiological and diagnoses of DLS or ASD, were assessed for patterns of spinopelvic compensatory mechanisms. Patients were stratified by sagittal vertical axis (SVA) according to the Scoliosis Research Society-Schwab [SRS-Schwab] classification. OUTCOME MEASURES: Radiographic spinopelvic parameters were measured in the DLS and ASD groups, including SVA, pelvic incidence-lumbar lordosis mismatch (PI-LL), T1 spinopelvic inclination (T1SPi), T1 pelvic angle (TPA), and pelvic tilt (PT). METHODS: The two diagnosis cohorts were propensity-matched for PI and age. Each group contained 125 patients and was stratified according to the SRS-Schwab classification. Regional spinopelvic,lower limb, and global alignment parameters were assessed to identify differences in compensatory mechanisms between the two groups with differing degrees of deformity. No funding was provided by any third party in relation to carrying out this study or preparing the manuscript. RESULTS: With mild to moderate malalignment (SRS-Schwab groups "0," or "+" for PT, PI-LL, or SVA), DLS patients permit anterior truncal inclination and recruit posterior pelvic shift instead of pelvic tilt to maintain balance, while providing relief of neurologic symptoms. Adult spinal deformity patients with mild to moderate deformity recruit pelvic tilt earlier than DLS patients. With moderate to severe malalignment, no significant difference was found in compensatory mechanisms between DLS and ASD patients. CONCLUSIONS: Patients with DLS permit mild to moderate deformity without recruiting compensatory mechanisms of PT, reducing truncal inclination and thoracic hypokyphosis to achieve neural decompression. However, with moderate to severe deformity, their desire for upright posture overrides the desire for neural decompression, evident by the adaptation of compensatory mechanisms similar to that of ASD patients.

A highly selective, label-free, homogenous luminescent switch-on probe for the detection of nanomolar transcription factor NF-kappaB.

Transcription factors are involved in a number of important cellular processes. The transcription factor NF-κB has been linked with a number of cancers, autoimmune and inflammatory diseases. As a result, monitoring transcription factors potentially represents a means for the early detection and prevention of diseases. Most methods for transcription factor detection tend to be tedious and laborious and involve complicated sample preparation, and are not practical for routine detection. We describe herein the first label-free luminescence switch-on detection method for transcription factor activity using Exonuclease III and a luminescent ruthenium complex, [Ru(phen)(2)(dppz)](2+). As a proof of concept for this novel assay, we have designed a double-stranded DNA sequence bearing two NF-κB binding sites. The results show that the luminescence response was proportional to the concentration of the NF-κB subunit p50 present in the sample within a wide concentration range, with a nanomolar detection limit. In the presence of a known NF-κB inhibitor, oridonin, a reduction in the luminescence response of the ruthenium complex was observed. The reduced luminescence response of the ruthenium complex in the presence of small molecule inhibitors allows the assay to be applied to the high-throughput screening of chemical libraries to identify new antagonists of transcription factor DNA binding activity. This will allow the rapid and low cost identification and development of novel scaffolds for the treatment of diseases caused by the deregulation of transcription factor activity.

Characterization of an intraperitoneal ovarian cancer xenograft model in nude rats using noninvasive microPET imaging.

MicroPET is a noninvasive imaging modality that can potentially track tumor development in nude rats using the radiotracer fluorine 18-fluorodeoxyglucose ((18)F-FDG). Our goal was to determine whether microPET, as opposed to more invasive techniques, could be used to noninvasively monitor the development of ovarian cancer in the peritoneal cavity of nude rats for monitoring treatment response in future studies. Female nude rats were inoculated intraperitoneally with 36 million NIH:OVCAR-3 cells. Imaging was carried out at 2, 4, 6, or 8 weeks postinoculation. Each rat was fasted overnight and intravenously injected with 11.1 MBq (300 microCi) of (18)F-FDG in 0.2 mL of saline. Thirty minutes following injection, the rats were placed in the microPET and scanned for 30 min. After imaging, rats were euthanized for ascites and tissue collection for biodistribution and histopathologic correlation. Standard uptake values (SUVs) of (18)F-FDG within the peritoneal cavity were also calculated from regions of interest analysis of the microPET images. MicroPET images showed diffuse increased uptake of (18)F-FDG throughout the peritoneal cavity of tumor rats (mean SUV=4.64) compared with control rats (mean SUV=1.03). Ascites gathered from tumor-bearing rats had increased (18)F-FDG uptake as opposed to the peritoneal fluid collected from control rats. Biodistribution data revealed that the percent injected dose per gram (% ID/g) was significantly higher in tumor-bearing rats (6.29%) than in control rats (0.59%) in the peritoneal lymph nodes. Pathology verified that these lymph nodes were more reactive in tumor-bearing rats. By 6 weeks, some rats developed solid masses within the peritoneum, which could be detected on microPET images and confirmed as tumor by histopathology. (18)F-FDG uptake in these tumors at necropsy was 2.83% ID/g. These results correlate with previous invasive laparoscopic studies of the same tumor model and demonstrate that microPET using (18)F-FDG is a promising noninvasive tool to localize and follow tumor growth in an intraperitoneal ovarian cancer model.

Flexural wave propagation velocity and bone mineral density in females with and without tibial bone stress injuries.

STUDY DESIGN: Case-control nonexperimental design. OBJECTIVES: To compare flexural wave propagation velocity (FWPV) and tibial bone mineral density (BMD) in women with and without tibial bone stress injuries (BSIs). BACKGROUND: Physical therapists, particularly in military and sports medicine settings, routinely diagnose and manage stress fractures or bone stress injuries. Improved methods of preparticipation quantification of tibial strength may provide markers of BSI risk and thus potentially reduce morbidity. METHODS AND MEASURES: Bone mineral density, FWPV, bone geometry, and historical variables were collected from 14 subjects diagnosed with tibial BSIs and 14 age-matched controls; all 28 were undergoing military training. RESULTS: No difference was found between groups in FWPV and tibial BMD when analyzed with t tests (post hoc power = 0.89 and 0.81, respectively). Furthermore, no difference was found in tibial length, tibial width, femoral neck BMD, and lumbar spine BMD among the groups. There were no differences between the 2 groups in smoking history, birth control pill use, and onset of menarche. Finally, sensitivity and positive likelihood ratios for FWPV (0.14 and 0.63), tibial BMD (0.0 and 0.0), and lumbar BMD (0.18 and 2.0) were low, while specificity was high (0.77, 0.93, and 0.91, respectively). CONCLUSION: Current bone analysis devices and methods may not be sensitive enough to detect differences in tibial material and structure; local stresses on bone may be more important in the development of BSIs than the overall structural stiffness.

Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography.

PURPOSE: To evaluate the efficacy of magnetic resonance (MR) arthrography in identification of the glenohumeral ligaments (GHLs) and to determine the location of abnormalities of the GHL, joint capsule, and labrum. MATERIALS AND METHODS: MR arthrograms were evaluated retrospectively in 46 patients with a history of shoulder instability, impingement syndrome, or pain of unknown cause. Imaging findings were correlated with surgical observations. RESULTS: The superior, middle, and inferior GHLs were identified on MR arthrograms in 39 (85%), 39 (85%), and 42 (91%) of the 46 patients, respectively. In diagnosis of tears of the superior, middle, and inferior GHLs, MR arthrography had a sensitivity of 100%, 89%, and 88% and a specificity of 94%, 88%, and 100%, respectively. CONCLUSION: Findings at MR arthrography can help accurate identification and demonstration of the integrity of the GHL and labrum and can help in staging of abnormalities. The large number of abnormalities depicted in the middle and inferior GHLs suggests that both might be important in the maintenance of glenohumeral joint congruity.

Partial thickness supraspinatus tears: diagnosis by magnetic resonance arthrography.

Two patients, with clinical symptoms of advanced impingement syndrome, presented for radiologic evaluation. The magnetic resonance (MR) images of each patient were interpreted as representing a full thickness tear of the supraspinatus tendon. Magnetic resonance arthrography was performed on both patients to further determine the extent of the tear. Using this technique, both patients were diagnosed correctly as having partial thickness tears; one on the articular surface and the other on the bursal surface of the tendon. This information is useful in surgical planning and in patient outcome.

Achilles tendon and miscellaneous tendon lesions.

Abnormalities of the tendons of the foot and ankle are quite common and their number seems to be increasing. Commonly involved tendons include the Achilles and peroneal tendons; the tibialis anterior and flexor hallucis longus tendons are involved less commonly. Magnetic resonance imaging is well suited to imaging these abnormalities. It is a noninvasive modality that uses no ionizing radiation. It has the capability of imaging in any plane, which is well suited to imaging the tendons of the ankle because their course is not in standard orthogonal planes. MR imaging provides excellent soft tissue contrast and is well able to differentiate the tendons from surrounding fat as well as to detect the presence of hemorrhage and edema. Abnormalities of these tendons include complete and partial tears as well as tendinitis and tenosynovitis. These abnormalities are usually secondary to trauma or to mechanical irritation or synovial inflammation. They can be diagnosed routinely and confidently by MR imaging. Complete tears may be seen as a discontinuity within the substance of a tendon with interposed edema or hemorrhage. Partial tears may be seen as increased signal within a tendon that extends to a surface. Tendinitis is manifested by thickening of the tendon with intratendinous signal that does not extend to its surface.