The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis.

Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.

Oriental Medicine Samhwangsasim-tang Alleviates Experimental Autoimmune Encephalomyelitis by Suppressing Th1 Cell Responses and Upregulating Treg Cell Responses.

Oriental medicine Samhwangsasim-tang (SHSST) has traditionally been used in East Asia to treat hypertension and its complications. However, little is known about its potential value regarding the treatment of chronic inflammatory diseases such as multiple sclerosis (MS). In this study, we investigated whether SHSST has a beneficial effect in treating myelin oligodendrocyte glycoprotein-induced experimental autoimmune encephalomyelitis (EAE). Onset-treatment with SHSST was found to alleviate neurological symptoms as well as demyelination and glial activation in the spinal cords from the EAE mice. The SHSST also attenuated the mRNA or protein expression of pro-inflammatory cytokines (interleukin-1beta and tumor necrotic factor-alpha); chemokines (RANTES, monocyte chemotactic protein-1, and macrophage inflammatory protein-1alpha); inducible nitric oxide synthase; and cyclooxygenase-2 in correspondence with the down-regulation of the nuclear factor-kappa B and mitogen-activated protein kinases signal pathways in the spinal cords from EAE mice. Interestingly, the protective effect of the SHSST was related to a decreased number of Th1 cells and an increased number of Treg cells in spinal cords from EAE mice. Taken together, our finding firstly suggested that SHSST could delay or mitigate EAE with a wide therapeutic time-window by suppressing Th1 cell responses and upregulating Treg cell responses. Also, our findings are strong enough to warrant further investigation of SHSST as a treatment for chronic autoimmune diseases including MS.

Expression of caveolin-3 immunoreactivities in the developing sciatic nerve of the rat.

Caveolae are formed by the caveolin (CAV) family of proteins, CAV-1, -2, and -3. CAV-1 and -2 are co expressed in many cell types, whereas CAV-3 is muscle-specific and mutation of the CAV-3 gene causes muscular dystrophy. CAV-3 has also been detected in brain astroglial cells and in peripheral nerves along with CAV-1. Therefore, we sought to determine whether CAV-3 protein is expressed in developing peripheral nerves by using immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR). We found that CAV-3 immunoreactivities (IRs) were Localized in the myelin sheath during peripheral nerve development. CAV-3 IRs were intense during the early postnatal stage, but decreased as the peripheral nerves matured at postnatal weeks 3-5. CAV-3 mRNA expression was also markedly decreased during postnatal development. Because the expression pattern of CAV-3 IRs was opposite that of CAV-1 IRs. CAV-1 and -3 might be involved in different phases of peripheral nerve myelination and play complementary roles in myelin maturation and peripheral nerve development.

Magnesium therapy improves thromboelastographic findings before liver transplantation: a preliminary study.

PURPOSE: Patients undergoing liver transplantation may be predisposed to hypomagnesemia and present a bleeding tendency. There are evidences suggesting that magnesium is a crucial constituent of the blood coagulation cascade and has a pro-coagulant activity. The aim of this study was to investigate the effect of magnesium therapy on thromboelastography (TEG) in patients undergoing liver transplantation. METHODS: 27 patients scheduled for liver transplantation were enrolled. 1.5 g of magnesium sulfate, diluted in normal saline, were infused to all patients over five minutes in the operating room, before skin incision. The TEG findings immediately before and ten minutes after the magnesium infusion were compared. RESULTS: The TEG findings showed general hypocoagulability before magnesium therapy. The K time and coagulation times (r+k) were shortened significantly from 641.6 +/- 505.9 (mean +/- SD) to 464.6 +/- 387.7 sec and from 1664.7 +/- 772.5 to 1362.2 +/- 487.1 sec respectively (P < 0.05); the maximal amplitude, and TEG index showed significant increases from 38.5 +/- 13.5 to 45.3 +/- 12.2 mm and from -3.4 +/- 2.6 to -1.9 +/- 1.8 respectively after magnesium therapy (P < 0.01). R time, alpha angle and LY60 were not different after magnesium therapy. CONCLUSION: Magnesium therapy significantly improved TEG findings suggestive of a general hypocoagulable state towards normal in patients about to receive liver transplantation.

The Callander laryngoscope blade modification is associated with a decreased risk of dental contact.

PURPOSE: Dental damage may occur with laryngoscopy. The purpose of this study was twofold: to determine whether preoperative examination could predict the risk of contacting the teeth with the laryngoscope and to evaluate the effectiveness of a modified Macintosh blade on reducing dental contact. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were studied prospectively. Features that might predict difficult intubation were assessed preoperatively. Laryngoscopy was performed twice on each patient, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We calculated correlations between individual airway characteristics and the chance of hitting the upper teeth with the regular Macintosh 3 blade and compared the frequencies of contacting the teeth between the two blades. RESULTS: The chance of hitting the upper teeth when using the regular Macintosh 3 blade increased significantly with non-parametric scores for Mallampati classification, mandibular subluxation, head and neck movement, interincisor gap, and condition of the upper teeth. (P < 0.01) The frequency of direct contact varied significantly between the two blades: 20.3% vs 4.1% for Macintosh 3 and modified blades, respectively (P < 0.05). Laryngeal views were improved with the modified blade. CONCLUSION: Airway characteristics correlate with the risk of hitting the upper teeth during laryngoscopy. The modified Macintosh blade reduces the risk of contacting the teeth.