Prognostic Factors for the Postoperative Improvement of Spinal Cord-Related Neuropathic Pain in Patients with Degenerative Cervical Myelopathy.

Introduction: The number of patients with degenerative cervical myelopathy (DCM) requiring surgical treatment has markedly increased in today's aging society. Such patients often exhibit impaired activities of daily living because of motor dysfunction as well as neuropathic pain (NeP). Although many studies have demonstrated the safety and efficacy of surgical treatment for DCM, residual postoperative NeP has not been well described. Therefore, this study aimed to identify the predictors of postoperative NeP improvement in patients with DCM. Methods: This retrospective study included 92 outpatients with postoperative chronic NeP (≥3 months) related to DCM. Data were obtained from clinical information, magnetic resonance imaging (MRI) findings, and patient-based questionnaires using the Neuropathic Pain Symptom Inventory (NPSI) and the Brief Scale for Psychiatric Problems in Orthopaedic Patients. Univariate and multivariate analyses were performed for patients with NPSI improvement rates <30% and ≥30% to identify prognostic factors. Results: Among 92 patients, 61 (66.3%) had residual NeP, with a low improvement rate even after surgery. The independent negative prognostic factors for NeP improvement after surgery were older age at operation (odds ratio (OR): 0.932), longer symptom duration before surgery (OR: 0.589), and higher preoperative NPSI score (OR: 0.932). The cut-off value of symptom duration before surgery for postoperative NeP improvement was 1 year. By contrast, the preoperative Japanese Orthopaedic Association score and MRI findings, including signal intensity change and the degree of spinal cord compression, were not associated with postoperative NeP improvement. Moreover, even in patients with an NPSI improvement rate ≥30%, the NPSI subscores for deep pain and paresthesia/dysesthesia remained high. Conclusions: Discrepancies between physician- and image-based assessments and patient-based assessments were identified as factors associated with improvement in postoperative NeP. Our findings are important for both spine surgeons and patients to manage patient expectations with respect to recovery during the postoperative course.

Clinical impact of short limited lumbar fusion for adult spinal deformity with postural and radiological abnormalities.

Extensive surgical spinopelvic fusion for patients with adult spinal deformity (ASD) to achieve optimal radiological parameters should be avoided. The aim of this study was to review clinical and imaging findings in patients with ASD with postural and radiological abnormalities who underwent a novel three-level limited lumbar fusion as two-stage surgery in an attempt to propose a better tolerated alternative to spinopelvic long fusion to the pelvis. The subjects were 26 patients with a minimum follow-up period of 2 years. Cobb angle, C7 sagittal vertical axis, and pelvic incidence (PI) minus lumbar lordosis (LL) were significantly improved after surgery and maintained at follow-up. Most radiological parameters were corrected with lateral interbody fusion (LIF) as the initial surgery, and few with posterior fusion. PI-LL remained high after limited lumbar fusion, but scores on patient-based questionnaires and sagittal and coronal tilt in gait analysis improved. In cases with postoperative progression of proximal junctional kyphosis (11.5%), residual L1-L2 local kyphosis after LIF was the most significant radiological feature. In some cases of ASD with postural abnormalities, short limited lumbar fusion gives sufficient postoperative clinical improvement with preservation of spinal mobility and activities of daily living. The range of fixation should be determined based on radiological parameters after LIF to avoid postoperative complications.

Combining transcranial direct current stimulation and peripheral electrical stimulation to improve upper limb function in a patient with acute central cord syndrome: a case report.

We report the immediate improvement of weakened muscles after combined treatment with transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) in a patient with acute central cord syndrome (CCS) who presented with severe upper limb motor dysfunction. A 70-year-old man sustained CCS with severe motor deficits in the left upper limb, which did not improve with conventional training until 6 days after injury. On the seventh day after the injury, the left upper limb was targeted with combined tDCS (1 mA for 20 minutes/day, anode on the right, cathode on the left) and PES (deltoid and wrist extensors, 20 minutes/day at the motor threshold), and his performance score immediately improved from 0 to 6 on the Box and Block test. After four sessions, the left upper limb function improved to 32 on the Box and Block test, and manual muscle test scores of the stimulated deltoid and wrist extensors improved from 1 to 2. This improvement of the left upper limb led to improved self-care activities such as eating and changing clothes. Exercise combined with tDCS and PES may be a novel treatment for upper limb movement deficits after acute CCS.

The Effect of Static Stretching Duration on Muscle Blood Volume and Oxygenation.

ABSTRACT: Matsuo, H, Kubota, M, Shimada, S, Kitade, I, Matsumura, M, Nonoyama, T, Koie, Y, Naruse, H, Takahashi, A, Oki, H, Kokubo, Y, and Matsumine, A. The effect of static stretching duration on muscle blood volume and oxygenation. J Strength Cond Res 36(2): 379-385, 2022-Muscle blood volume increases due to stretching; however, the minimum duration of stretching to sustainably increase the muscle blood volume after stretching has not yet been elucidated. This study examined whether the duration of static stretching influenced the muscle blood volume and oxygenation. Ten healthy male subjects participated in this controlled laboratory study. Static stretching of the gastrocnemius muscle was performed for 5 durations (20 seconds, and 1, 2, 5, and 10 minutes). Changes in both the total-Hb (ΔtHb), as an index of blood volume, and tissue oxygenation index (ΔTOI) from baseline were determined using near-infrared spectroscopy. Both the ΔtHb and ΔTOI decreased during stretching and increased after stretching. The minimum value of ΔtHb during stretching did not differ in each of the 5 durations, but minimum ΔTOI progressively decreased with longer durations of stretching. The peak value of ΔtHb after stretching increased with longer durations of stretching. The value of ΔtHb at 5 minutes after the end of stretching increased with more than 2 minutes of stretching compared with 20 seconds of stretching, although the value of ΔtHb did not significantly differ between the 2, 5, and 10 minutes' durations. These findings suggest that a longer duration of stretching elicits a decrease in muscle oxygenation during stretching, and an increase in both the muscle blood volume and oxygenation after stretching. The results indicated that the minimum duration of stretching to sustain an increase in the muscle blood volume after stretching is 2 minutes.

Center of pressure velocities in patients with body lateropulsion: three case report series of Wallenberg's syndrome.

PURPOSE: In patients with Wallenberg's syndrome who present with body lateropulsion (BL), whether the center of pressure (COP) position and velocity characterize postural dysregulation is unknown. We measured time-course changes in COP parameters in three BL patients. METHODS: Three patients with acute Wallenberg's syndrome presented with BL. COP was measured for time-course changes during first standing and every week thereafter. COP positions, which indicate the deviation in the center of gravity, were calculated. COP velocities associated with dynamic movements of the center of gravity were analyzed separately for the BL and non-BL sides. RESULTS: All patients showed that COP position shifted to the BL side in first standing and changed to the center over time. COP velocities to the BL side were fast in first standing. Two of the three patients had significantly faster COP velocities to the BL side than to the non-BL side (p < .05), and one did not. In all three cases, the faster COP velocities to the BL side decreased significantly after 2 weeks compared to the initial standing position (p < .001). The change seemed to be related to the time when independent walking became possible. CONCLUSIONS: Fast COP velocity to the BL side might reflect postural dysregulation in patients with BL. These findings might be useful information for devising effective rehabilitation in patients with BL.

Effects of knee extension exercise starting within 4 h after total knee arthroplasty.

PURPOSE: To determine the beneficial effects of knee extension exercise applied from 4 h after TKA. METHODS: Patients undergoing TKA for osteoarthritis were assigned to early rehabilitation (n = 41) and control rehabilitation (n = 39) groups. Rehabilitation of knee extension exercise was started within 4 h postoperative in the early group and 2 days after surgery in the control group. Joint range of motion and pain were assessed before surgery and at 3 days to 12 months after surgery. Muscle strength and gait parameters were assessed before and 3 weeks after surgery. RESULTS: Extension range of motion was significantly increased in the early group than the control at 3 days, 3 weeks and 6 months after surgery. In gait parameters, peak knee flexion and extension angles during stance phase were significantly improved in the early group than the control group at 3 weeks after surgery. Flexion range of motion was increased in the early group than the control at 12 months after surgery. CONCLUSION: Starting knee extension exercise within 4 h after TKA reduced the early loss of extension range of motion and improved gait pattern and seemed to contribute to be better functional outcome one year after surgery.

Carboxylative Cyclization of a Propargylic Amine with CO2 Catalyzed by a Silica-Coated Magnetite.

By employing a silica-coated magnetite as a catalyst, a silica-catalyzed carboxylative cyclization of propargylic amines with carbon dioxide (CO2) proceeded to afford the corresponding 2-oxazolidinones. Moreover, after the reaction, the silica-coated magnetic catalyst was readily recovered by use of an external magnet and could be reused up to six times without deactivation.

Stereoretentive Ligand Exchange Reactions of N-Fused Porphyrin Ruthenium(II) Complexes.

The ligand exchange reactions of the ruthenium(II) complex of N-fused tetraphenylporphyrin, Ru(NFp)(CO)2Cl (2), with various anions were investigated. The chloride ligand of the isomers 2a-c was stereoretentively exchanged with bromide (Br-), iodide (I-), and acetate (AcO-) anions in toluene at 100 °C, structures of which were confirmed by 1H NMR as well as single crystal X-ray diffraction analysis. The silver (AgOAc, AgOTf) and boron (NaBPh4) reagents also afforded the corresponding stereoretentive products. On the other hand, the reaction with NaBH4 afforded the hydride complex Ru(NFp)(CO)2H (7) with low stereospecificity, showing a higher reactivity of 2c than other isomers. The ligand dissociation mechanism was proposed with the help of theoretical calculations on the plausible five-coordinated intermediates.

Increased Anterior Pelvic Angle Characterizes the Gait of Children with Attention Deficit/Hyperactivity Disorder (ADHD).

BACKGROUND: Children with attention deficit/hyperactivity disorder (ADHD) frequently have motor problems. Previous studies have reported that the characteristic gait in children with ADHD is immature and that subjects demonstrate higher levels of variability in gait characteristics for the lower extremities than healthy controls. However, little is known about body movement during gait in children with ADHD. The purpose of this study was to identify the characteristic body movements associated with ADHD symptoms in children with ADHD. METHODS: Using a three-dimensional motion analysis system, we compared gait variables in boys with ADHD (n = 19; mean age, 9.58 years) and boys with typical development (TD) (n = 21; mean age, 10.71 years) to determine the specific gait characteristics related to ADHD symptoms. We assessed spatiotemporal gait variables (i.e. speed, stride length, and cadence), and kinematic gait variables (i.e. angle of pelvis, hip, knee, and ankle) to measure body movement when walking at a self-selected pace. RESULTS: In comparison with the TD group, the ADHD group demonstrated significantly higher values in cadence (t = 3.33, p = 0.002) and anterior pelvic angle (t = 3.08, p = 0.004). In multiple regression analysis, anterior pelvic angle was associated with the ADHD rating scale hyperactive/impulsive scores (ß = 0.62, t = 2.58, p = 0.025), but not other psychiatric symptoms in the ADHD group. CONCLUSIONS: Our results suggest that anterior pelvic angle represents a specific gait variable related to ADHD symptoms. Our kinematic findings could have potential implications for evaluating the body movement in boys with ADHD.

Ruthenocene-Type Complexes of N-Fused Porphyrins.

Ruthenocene-type hybrid complexes with N-fused porphyrinato ligands, [Ru(NFp)Cp] (NFp=N-fused porphyrin, Cp=cyclopentadienyl), have been prepared and characterized by NMR and UV/Vis/NIR spectroscopy, cyclovoltammetry, and X-ray crystallography. [Ru(NFp)Cp] is a common low-spin ruthenium(II) complex and shows strong aromaticity. The Ru-Cp distance (1.833 Å) in [Ru(NFp)Cp] is comparable to that in [RuCp2 ] (1.840 Å). DFT calculations on [Ru(NFp)Cp] showed the unequivocal contribution of the RuCp moiety as well as the NFp moiety to both the HOMO and LUMO, constructing a three-dimensional d-π conjugated system. The HOMO-LUMO gaps of [Ru(NFp)Cp] are insensitive to the substituents on the NFp ligand, which is illustrated spectroscopically as well as theoretically. This is in sharp contrast to the ligand precursor, the N-fused porphyrin, in which the HOMO-LUMO gap is affected by substituents in a similar manner to standard porphyrins and related macrocycles.

Early transplantation of mesenchymal stem cells after spinal cord injury relieves pain hypersensitivity through suppression of pain-related signaling cascades and reduced inflammatory cell recruitment.

Bone marrow-derived mesenchymal stem cells (BMSC) modulate inflammatory/immune responses and promote motor functional recovery after spinal cord injury (SCI). However, the effects of BMSC transplantation on central neuropathic pain and neuronal hyperexcitability after SCI remain elusive. This is of importance because BMSC-based therapies have been proposed for clinical treatment. We investigated the effects of BMSC transplantation on pain hypersensitivity in green fluorescent protein (GFP)-positive bone marrow-chimeric mice subjected to a contusion SCI, and the mechanisms of such effects. BMSC transplantation at day 3 post-SCI improved motor function and relieved SCI-induced hypersensitivities to mechanical and thermal stimulation. The pain improvements were mediated by suppression of protein kinase C-γ and phosphocyclic AMP response element binding protein expression in dorsal horn neurons. BMSC transplants significantly reduced levels of p-p38 mitogen-activated protein kinase and extracellular signal-regulated kinase (p-ERK1/2) in both hematogenous macrophages and resident microglia and significantly reduced the infiltration of CD11b and GFP double-positive hematogenous macrophages without decreasing the CD11b-positive and GFP-negative activated spinal-microglia population. BMSC transplants prevented hematogenous macrophages recruitment by restoration of the blood-spinal cord barrier (BSCB), which was associated with decreased levels of (a) inflammatory cytokines (tumor necrosis factor-α, interleukin-6); (b) mediators of early secondary vascular pathogenesis (matrix metallopeptidase 9); (c) macrophage recruiting factors (CCL2, CCL5, and CXCL10), but increased levels of a microglial stimulating factor (granulocyte-macrophage colony-stimulating factor). These findings support the use of BMSC transplants for SCI treatment. Furthermore, they suggest that BMSC reduce neuropathic pain through a variety of related mechanisms that include neuronal sparing and restoration of the disturbed BSCB, mediated through modulation of the activity of spinal-resident microglia and the activity and recruitment of hematogenous macrophages.

Early transcutaneous electrical nerve stimulation reduces hyperalgesia and decreases activation of spinal glial cells in mice with neuropathic pain.

Although transcutaneous electrical nerve stimulation (TENS) is widely used for the treatment of neuropathic pain, its effectiveness and mechanism of action in reducing neuropathic pain remain uncertain. We investigated the effects of early TENS (starting from the day after surgery) in mice with neuropathic pain, on hyperalgesia, glial cell activation, pain transmission neuron sensitization, expression of proinflammatory cytokines, and opioid receptors in the spinal dorsal horn. Following nerve injury, TENS and behavioral tests were performed every day. Immunohistochemical, immunoblot, and flow cytometric analysis of the lumbar spinal cord were performed after 8 days. Early TENS reduced mechanical and thermal hyperalgesia and decreased the activation of microglia and astrocytes (P<0.05). In contrast, the application of TENS at 1 week (TENS-1w) or 2 weeks (TENS-2w) after injury was ineffective in reducing hyperalgesia (mechanical and thermal) or activation of microglia and astrocytes. Early TENS decreased p-p38 within microglia (P<0.05), the expression levels of protein kinase C (PKC-γ), and phosphorylated anti-phospho-cyclic AMP response element-binding protein (p-CREB) in the superficial spinal dorsal horn neurons (P<0.05), mitogen-activated protein (MAP) kinases, and proinflammatory cytokines, and increased the expression levels of opioid receptors (P<0.05). The results suggested that the application of early TENS relieved hyperalgesia in our mouse model of neuropathic pain by inhibiting glial activation, MAP kinase activation, PKC-γ, and p-CREB expression, and proinflammatory cytokines expression, as well as maintenance of spinal opioid receptors. The findings indicate that TENS treatment is more effective when applied as early after nerve injury as possible.

Synthesis and isomerization of N-fused tetraphenylporphyrin ruthenium(II) complexes.

Three possible isomers of N-fused tetraphenylporphyrin ruthenium complexes, Ru(NFTPp)Cl(CO)2 (2a-c), were isolated and fully characterized by NMR, IR, CV, UV-vis-NIR absorption, and X-ray crystallographic analyses. Each isomer was stable at ambient conditions and isomerization among 2a-c occurred at elevated temperature both in solution and in a solid state, through the intramolecular rotational pathways. Electronic structures of 2a-c were analyzed in detail by DFT study to reveal appreciable differences in the interaction between the NFTPp ligand and the Ru-Cl moiety.

Postoperative gait analysis and hip muscle strength in patients with pelvic ring fracture.

The aims of present study were (1) to determine changes in kinematic and kinetic variables at 3 and 12 months after open reduction and internal fixation (ORIF) of pelvic ring fracture and (2) to determine the factor(s) associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. Nineteen patients with pelvic ring fractures underwent ORIF and examined at 3 and 12 months postoperatively. The study also included a similar number of age-matched control subjects. Peak hip abduction angle, peak hip extension moment in the stance, peak hip abduction moment, and peak ankle plantarflexion moment at 3 months after ORIF were significantly lower than the respective control values. At 12 months, complete recovery was noted in peak hip abduction moment and peak ankle plantarflexion moment, whereas the recovery in peak hip abduction angle and peak hip extension moment in the stance was partial. The existence of neurological lesions and strength asymmetry of hip abductor and adductor at 3 months post-ORIF correlated with decreased peak hip abduction moment after ORIF. Our results highlighted characteristic gait patterns up to 12 months after ORIF for pelvic fracture, and these patterns correlated with neurological lesion and weakness of hip abductor and adductor muscles.

Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture.

OBJECTIVES: To characterize changes in the gait pattern at 3 and 12 months after surgery for acetabular fracture, to assess the relationship between various gait parameters and hip muscle strength, and to determine the factors associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: Patients (N=19) with acetabular fractures were treated by open reduction and internal fixation (ORIF) and examined at 3 and 12 months postoperatively. The study also included a similar number of sex- and age-matched control subjects. INTERVENTIONS: Postoperative rehabilitation program. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic variables of gait and strength of hip flexor, adductor, and abductor muscles at 3 and 12 months after ORIF. RESULTS: Walking velocity at 3 months after ORIF was slower in the patients than in the control subjects; however, walking velocity at 12 months was similar in the 2 groups. Although most of the kinematic and kinetic variables showed recovery to control levels at 3 and 12 months after ORIF, recovery was incomplete for pelvic forward tilt and hip abduction moment even at 12 months after ORIF. The greatest loss of muscle strength was noted in the hip abductors, where the average deficit was 35.4% at 3 months and 24.6% at 12 months. There was a significant relationship between hip abductor muscle strength and hip abduction moment at 3 months (R(2)=.63); however, this relationship diminished at 12 months (R(2)=.14). The presence of associated injuries correlated with lack of recovery of the peak hip abduction moment. CONCLUSIONS: Pelvic forward tilt and peak hip abduction moment showed incomplete recovery at 12 months after ORIF with subsequent conventional and home exercise rehabilitation programs. Our results suggest that improvement of hip abductor muscle strength in the early postoperative period could improve the peak hip abduction moment.

Microvascular system of the lumbar dorsal root ganglia in rats. Part I: a 3D analysis with scanning electron microscopy of vascular corrosion casts.

OBJECT: So far, the morphological features of the vascular system supplying the dorsal root ganglion (DRG) have been inferred only from microangiograms. However, in the past most of these studies lacked 3D observations. This study presents the details of the microvasculature of the lumbar DRG visualized by scanning electron microscopy of vascular corrosion casts. METHODS: Wistar rats were anesthetized with intraperitoneal sodium pentobarbital. After thoracotomy, the vascular system was perfused with heparinized saline, and Mercox resin was injected into the thoracic aorta. After polymerization of the resin, the vascular casts were macerated with potassium hydroxide, washed with water, and dried. The casts were examined with a scanning electron microscope. RESULTS: The vascular cast of the DRG was observed to have a higher density of vessels than the nerve root. Bifurcation or anastomoses of capillaries took place at approximately right angles, in a T-shaped pattern. Within the DRG, both the arterial supply and the capillary network contained blood flow control structures (ring-shaped constrictions in the cast probably representing a vascular sphincter in the microvessel). Three types of vessels could be distinguished: tortuous, straight, and bead-like capillaries. The dilations, bulges, and tortuousness of capillaries could serve the function of locally increasing the capillary surface area in a sensory neuron. CONCLUSIONS: The results of this study suggest a causal relationship between the metabolic demands of local neuronal activity and both the density of the capillary network and the placement of the blood flow control structures.

Diagnosis and discrimination of autoimmune Graves' disease and Hashimoto's disease using thyroid-stimulating hormone receptor-containing recombinant proteoliposomes.

Graves' disease (GD) is an autoimmune disease of the thyroid gland caused by autoantibodies against thyroid-stimulating hormone receptor (TSHR). Currently, the diagnostic test for TSHR autoantibodies is based on an indirect competitive binding assay that measures the ability of TSHR autoantibodies to inhibit the binding of thyroid-stimulating hormone (TSH) to TSHR. Here, we have developed a specific and direct diagnostic method for autoantibodies in GD that incorporates immobilized TSHR-containing recombinant proteoliposomes into an enzyme-linked immunosorbent assay (ELISA). To reduce non-specific binding of autoantibodies to recombinant proteoliposomes, we investigated the effect of polyethylene glycol (PEG)-lipid on the binding of commercially available anti-TSHR antibodies (aTSHRAb). The incorporation of PEG-lipids into liposomes decreased non-specific binding, as compared to liposomes that did not contain PEG-lipids, and the addition of blocking reagents further decreased non-specific reactivity. aTSHRAb exhibited higher reactivity towards PEG-modified TSHR recombinant proteoliposomes than PEG-modified liposomes without TSHR (bare liposomes). Importantly, serum autoantibodies from patients with GD, which is associated with hyperthyroidism, exhibited remarkably specific binding to TSHR recombinant proteoliposomes. Serum autoantibodies from patients with Hashimoto's disease (HD), which is associated with hypothyroidism, also reacted specifically with proteoliposomal TSHR. These results suggest that immobilized TSHR recombinant proteoliposomes can serve as a direct diagnostic test for GD and HD. Furthermore, given that there is no competition test currently available for detecting autoantibodies in HD, the combination of TSHR recombinant proteoliposome ELISA and indirect competitive TSHR binding assay might be an effective way to discriminate between GD and HD.