Changes in neck pain and somatic symptoms before and after the adjustment of the pillow height.

[Purpose] The purpose of this study was to determine whether strict adjustment of the pillow height using the Set-up for Spinal Sleep method improves clinical outcomes like neck pain and somatic symptoms. [Participants and Methods] A total of 84 participants with chief complaints of stiff shoulders and neck pain were evaluated using the numerical rating scale and the Somatic Symptom Scale-8. Questionnaires were used to collect data at the baseline, after two weeks, and after three months of adjusting the pillow height. [Results] Forty-two participants (50%) achieved the minimal clinically important difference for neck pain with a decrease of three points or higher in the numerical rating scale. The baseline neck pain scores were significantly higher in the group that achieved the minimal clinically important difference. The three-month change in neck pain and the Somatic Symptom Scale-8 was significantly greater in participants who were satisfied with treatment. There was a significant positive association between improvement in the numerical rating scale score and improvement in the Somatic Symptom Scale-8 at three months. [Conclusion] Strict adjustment of the pillow height using the Set-up for the Spinal Sleep method significantly improved both physical neck pain and somatic symptoms related to psychological and social problems.

Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain?

BACKGROUND: Mechanical diagnosis and therapy (MDT) and the stratified approach using the Keele STarT Back Screening Tool (SBST) are examples of stratified low back pain (LBP) management. We investigated whether the medium-high risk in SBST can contribute to the time and sessions until discharge from MDT (Question 1) and to the loss of follow-up before identifying a promising management strategy (Question 2). METHODS: A retrospective chart study was conducted. Multiple regression modeling was constructed using 10 independent variables, including whether the SBST was medium-high risk or not for Question 1, and the 9/10 independent variables for Question 2. RESULTS: The data of 89 participants for Question 1 and 166 participants for Question 2 were analyzed. SBST was not a primary contributing factor for Question 1 (R2 = 0.17-0.19). The model for Question 2 included SBST as a primary contributing factor and the shortest distance from the patient address to the hospital as a secondary contributing factor (93.4% correct classification). CONCLUSION: SBST status was not a primary contributing factor for time and sessions until discharge from MDT, but was a critical factor for the loss of MDT follow-up before identifying a promising management strategy.

Thoracic Radicular Pain Caused by Extravertebral Gas and Fluid Collections Associated with Osteoporotic Vertebral Fracture Containing a Vacuum Cleft.

The present study documents a phenomenon, which has received little attention despite its potential clinical importance. An 87-year-old woman presented with barely reported extravertebral gas and fluid collections probably originating from the contents of the adjacent cleft within the T10 collapsed osteoporotic vertebra. Her chief complaint was intractable pain radiating over the left thorax suggestive of intercostal neuralgia. The pain intensified when sitting up from a lateral decubitus position, correlating with a posture-related radiologic change of the intravertebral cleft, which appeared with a decubitus position and disappeared with a sitting position. Because these extravertebral collections were located where the 10th thoracic nerve root just exits the intervertebral foramina, her chest pain of a posture-dependent nature most likely resulted from nerve root compression by extravertebral gas and fluid forced out of the vertebral cleft. Posterior spinal fusion with pedicle screw instrumentation resulted in a complete resolution of the chest pain with disappearance of the extravertebral gas and fluid accumulations. An awareness of the possibility that the intravertebral cleft could communicate with the extravertebral space close to the nerve root will help avoid neurologic complications caused by bone cement leakage during vertebroplasty.

Proposing a method of regional assessment and a novel outcome measure in rheumatoid arthritis.

We proposed a method of regional assessment in patients with rheumatoid arthritis. The utility of this method was demonstrated by assessing drug efficacy in patients who received infliximab (n = 31) or tocilizumab (n = 6). Joints were divided into four regions: upper/large, upper/small, lower/large, and lower/small. The total joint index was calculated as follows: the sum of tender and swollen joint counts divided by the number of evaluable joints in each region. At the baseline, the total joint index of the upper/small region was the lowest and that of the lower/large region was the highest compared with other regions. The change in the total joint index from the baseline to the 30-week point (Δ) did not differ among the four regions. There were significant close relations of Δ between the upper/small and the upper/large region and between the lower/small and the lower/large region. This method allows us to focus on a specific region and to compare and contrast among them.

Cross talk between COX-2 inhibitor and hyaluronic acid in osteoarthritic chondrocytes.

Both hyaluronic acid (HA) and cyclooxygenase-2 (COX-2) inhibitors are used in clinical practice in the treatment of osteoarthritis. There have been no reports regarding cross-talk between HA and COX-2 inhibitors in articular human chondrocytes. The purpose of this study was to investigate whether HA, COX-2 inhibitors or a combination of COX-2 inhibitors and HA have different effects in human articular between lower and highly degenerated chondrocytes. Isolated lower and highly degenerated chondrocytes were divided into 5 groups: ethanol (used as a control for the solvents), HA, COX-2 inhibitors, COX-2 inhibitors plus HA, or no additive. After incubating for 48 h, mitochondrial membrane potential analysis and western blotting of p38 and p44/42 mitogen-activated protein kinase (MAPK) were performed. Glycosaminoglycan, nitric oxide (NO) production and prostaglandin E2 (PGE2) concentrations were assessed. A combination of COX-2 inhibitors and HA resulted in dendritic, proliferating chondrocytes with strong red fluorescence enriched in the mitochondrial membrane, and indicated reduction of apoptosis in chondrocytes. COX-2 inhibitors alone, and a combination of COX-2 inhibitor and HA inhibited the activation of p38 in highly degenerated chondrocytes. A combination of COX-2 inhibitors and HA decreased NO production in highly degenerated chondrocytes. COX-2 inhibitors decreased PGE2 production, however, HA alone had no effect on PGE2 production. The present study demonstrated that COX-2 inhibitors and HA interacted synergistically the MAPK pathway and inhibition of NO production in highly degenerated chondrocytes. Administration of COX-2 inhibitors plus HA could be used as a new alternative way of treating osteoarthritis.

Metabolic effects of X-ray irradiation on adult human articular chondrocytes.

There have been few reports regarding the metabolic effects of X-ray irradiation on adult human articular chondrocytes. The purpose of this study was to evaluate whether exposure to X-ray irradiation during tumor surgery can cause impaired metabolism in adult articular cartilage. To achieve this we exposed cultured chondrocytes isolated from normal or degenerated cartilage to varying doses of X-ray irradiation, then measured apoptosis, and the production of chondroitin sulfates (CS), prostaglandin E2 (PGE2) and p38 mitogen-activated protein kinase (MAPK) in these cells. The number of apoptotic cells was not affected by irradiation in chondrocytes from normal or degenerated cartilage. Likewise, the production of C6S and C4S was not altered by irradiation in either group. The concentration of PGE2 in non-degenerated chondrocyte cultures did not change with radiation in a dose-dependent manner. However, the concentration of PGE2 in degenerated chondrocytes increased in a radiation dose-dependent manner. Irradiation at 10 Gy, in degenerated chondrocytes, induced remarkable activation of p38. This suggests that it is important to consider whether there is an osteoarthritic joint in the area that is to receive radiation therapy during tumor surgery.

Comparison of radiation-induced reactive oxygen species formation in adult articular chondrocytes and that in human peripheral T cells: possible implication in radiosensitivity.

Previously, we examined the formation of reactive oxygen species (ROS) in T lymphocytes following 5 Gy of irradiation. Using a CCD camera system, we monitored fluorescence in T lymphocytes loaded with the succinimidyl ester of dichlorodihydrofluorescein diacetate (H2DCFDA), which is non-fluorescent until oxidized by ROS. We found that ROS formation occurred immediately after irradiation, continued for several hours, and resulted in oxidative DNA damage. Therefore, the origin of the hyper-radiosensitivity of T lymphocytes seemed to be the high production of ROS in the mitochondrial DNA following irradiation. In this study, we examined radiation-induced ROS formation in adult articular chondrocytes, which were demonstrated to be highly resistant to apoptosis in our previous study. We found that ROS formation was actually scarcely seen after irradiation of up to 20 Gy in these cells. Therefore, the origin of the great difference of radiosensitivity between T lymphocytes and adult articular chondrocytes is considered to lie in the degree of ROS formation following irradiation, with this difference possibly resulting from the scavenging acuity of these two kinds of normal tissue cells for free radicals including hydroxyl radicals.

The role of apoptotic resistance in irradiated adult articular chondrocytes.

There have so far been no studies on the apoptosis of adult articular chondrocytes after X-ray irradiation. The purpose of this study was to assess the apoptotic resistance of articular chondrocytes in X-ray radiation, in order to examine the possibility of irradiated allogenic chondrocyte implantation. Adult human chondrocytes of the non-degenerated cartilage group without X-ray irradiation did not show positive cells of Annexin V and PI staining in a 48 h culture. The Annexin V positive chondrocytes did not increase in a radiation dose dependent manner, and the PI positive cells were slightly increased at 30 Gy irradiation. In the degenerated cartilage group, the PI positive chondrocytes without irradiation were present, and both the Annexin V and PI positive chondrocytes increased in a radiation dose dependent manner. The Annexin V and PI positive staining of chondrocytes in the non-degenerated cartilage group was less than that of the degenerated cartilage group in the same dose of X-ray irradiation exposure. Loss of the mitochondrial membrane potential, revealed in an early stage of apoptosis, did not show in the irradiated chondrocytes of the non-degenerated cartilage, but were demonstrated in those of the degenerated cartilage. These results demonstrated that the non-degenerated chondrocytes of X-ray irradiation were highly resistant for apoptosis, and this knowledge could be applied to allogenic chondrocytes implantation.