Single-level laminoplasty approach to selective dorsal rhizotomy with conus localization by rapid spine MRI.

INTRODUCTION: While selective dorsal rhizotomy (SDR) was originally described as a multilevel approach, single-level approaches are now popularized. Conus localization is beneficial for operative planning in single-level selective dorsal rhizotomy. Our approach to SDR involves minimal exposure for a single-level laminoplasty, preserving one attached interspinous ligament. Pre-operative conus localization is required for this tailored approach to determine the laminoplasty level and dictate rostral or caudal division of the superior spinus ligament. While rapid MRI sequences have been popularized for pediatric cranial imaging, its utility for spinal imagining is less well-described, and specific application for conus localization has not been reported. OBJECTIVE: Illustrate that rapid MRI without sedation is sufficient to identify conus level for tailored single-level laminoplasty SDR. MATERIAL AND METHODS: Patients undergoing SDR from 2014 to 2022 at one institution were reviewed for type of pre-operative MRI (rapid vs full), conus level, procedural time for MRI, and radiology report. The typical rapid MRI has four sequences utilizing single-shot technique (scout, sagittal T2, axial T2, and axial T1) that typically take less than 1 min each of acquisition time, with non-single-shot sequences added periodically in cooperative patients. To include time for patient positioning, pre-scan shimming, procedural incidentals, and other patient-specific variations, MRI procedure length was recorded as documented in the electronic medical record. RESULTS: N = 100 patients had documentation of an MRI for pre-operative imaging. Seventy-nine of these had a rapid MRI, and 21 required a full MRI with anesthesia for their treatment plan. Mean total procedure time for rapid MRI was 21.5 min (median 17). Mean procedure time for MRI under general anesthesia was 91.2 min (median 94). Of patients with rapid MRI imaging, 2/79 had an ambiguous conus level (1 from motion artifact, 1 from spinal hardware) vs 1/21 with a full MRI under anesthesia (due to spinal hardware). CONCLUSION: Rapid spinal MRI without sedation can be used for conus localization in a pediatric population. This may be routinely used as pre-operative imaging for a single-level approach to selective dorsal rhizotomy, without sedation or intubation procedures

Utility of the Framingham risk score to predict the presence of coronary atherosclerosis in patients with rheumatoid arthritis

The prevalence of ischemic heart disease and atherosclerosis is increased in patients with rheumatoid arthritis (RA). In the general population, but not in patients with systemic lupus erythematosus, the Framingham risk score identifies patients at increased cardiovascular risk and helps determine the need for preventive interventions. We examined the hypothesis that the Framingham score is increased and associated with coronary-artery atherosclerosis in patients with RA. The Framingham score and the 10-year cardiovascular risk were compared among 155 patients with RA (89 with early disease, 66 with long-standing disease) and 85 control subjects. The presence of coronary-artery calcification was determined by electron-beam computed tomography. The Framingham score was compared in patients with RA and control subjects, and the association between the risk score and coronary-artery calcification was examined in patients. Patients with long-standing RA had a higher Framingham score (14 [11 to 18]) (median [interquartile range]) compared to patients with early RA (11 [8 to 14]) or control subjects (12 [7 to 14], P < 0.001). This remained significant after adjustment for age and gender (P = 0.015). Seventy-six patients with RA had coronary calcification; their Framingham risk score was higher (14 [12 to 17]) than that of 79 patients without calcification (10 [5 to 14]) (P < 0.001). Furthermore, a higher Framingham score was associated with a higher calcium score (odds ratio [OR] = 1.20, 95% confidence interval [CI] 1.12 to 1.29, P < 0.001), and the association remained significant after adjustment for age and gender (OR = 1.15, 95% CI 1.02 to 1.29, P = 0.03). In conclusion, a higher Framingham risk score is independently associated with the presence of coronary calcification in patients with RA

Endothelial Function in Systemic Lupus Erythematosus: Relationship to Disease Activity, Cardiovascular Risk Factors, Corticosteroid Therapy, and Coronary Calcification

Elizabeth Turner2, Victor Dishy1, Cecilia P Chung2, Paul Harris4, Rosanna Pierce5, Yu Asanuma1, Annette Oeser1, Tebeb Gebretsadik3, Ayumi Shintani3, Paolo Raggi6, C Michael Stein1,21Division of Clinical Pharmacology, 2Division of Rheumatology, 3Department of Medicine; Center of Health Services Research, Department of Biostatistics; 4General Clinical Research Center; 5Department of Vascular Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA; 6Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USAObjectives: Endothelial dysfunction is frequently present in patients with systemic lupus erythematosus and may increase their risk of premature coronary artery disease. In this pilot study we have characterized the relationship between endothelial function, measures of disease activity, and cardiovascular risk factors in patients with lupus.Methods: Clinical characteristics and cardiovascular risk factors were evaluated in 20 patients with lupus. Flow-mediated dilation of the brachial artery was measured using high resolution ultrasound and the presence or absence of coronary calcification determined by electronbeam computed tomography. The relationship between these variables and flow-mediated dilation was determined using Spearman correlation coefficients (RHO) and Mann Whitney-Wilcoxon tests.Results: Twenty patients (17 female) median age (interquartile range) 42.5 (32.0&ndash;47.5) years were studied. The median flow-mediated vasodilation was 3.6% (1.7%&ndash;7.7%). In patients with coronary calcification (n = 6), flow-mediated dilation was 2.1% (&ndash;0.42%&ndash;3.6%) compared with 4.0% (3.5%&ndash;8.3%) in those without (p = 0.12). There was no significant relationship between flow-mediated dilation and markers of disease activity, duration of disease, and cardiovascular risk factors. Lower flow-mediated dilation was associated with duration of corticosteroid therapy (RHO = &ndash;0.44, p = 0.05).Conclusions: In these preliminary results, endothelial dysfunction is associated with longterm exposure to corticosteroids.Keywords: flow-mediated dilation, endothelium, inflammation, atherosclerosis, systemic lupus erythematosu

Qigong Exercise Alleviates Fatigue, Anxiety, and Depressive Symptoms, Improves Sleep Quality, and Shortens Sleep Latency in Persons with Chronic Fatigue Syndrome-Like Illness

Objectives:. To evaluate the effectiveness of Baduanjin Qigong exercise on sleep, fatigue, anxiety, and depressive symptoms in chronic fatigue syndrome- (CFS-) like illness and to determine the dose-response relationship. Methods:. One hundred fifty participants with CFS-like illness (mean age = 39.0, SD = 7.9) were randomly assigned to Qigong and waitlist. Sixteen 1.5-hour Qigong lessons were arranged over 9 consecutive weeks. Pittsburgh Sleep Quality Index (PSQI), Chalder Fatigue Scale (ChFS), and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, immediate posttreatment, and 3-month posttreatment. The amount of Qigong self-practice was assessed by self-report. Results:. Repeated measures analyses of covariance showed a marginally nonsignificant (P = 0.064) group by time interaction in the PSQI total score, but it was significant for the “subjective sleep quality” and “sleep latency” items, favoring Qigong exercise. Improvement in “subjective sleep quality” was maintained at 3-month posttreatment. Significant group by time interaction was also detected for the ChFS and HADS anxiety and depression scores. The number of Qigong lessons attended and the amount of Qigong self-practice were significantly associated with sleep, fatigue, anxiety, and depressive symptom improvement. Conclusion:. Baduanjin Qigong was an efficacious and acceptable treatment for sleep disturbance in CFS-like illness. This trial is registered with Hong Kong Clinical Trial Register: HKCTR-1380

Infliximab in patients with active ankylosing spondylitis: experience at Hospital Nacional Edgardo Rebagliati Martins

Infliximab es un medicamento efectivo en el tratamiento de pacientes con espondilitis anquilosante (EA) activa. Sin embargo, debido a su alto costo, su uso indiscriminado es prohibitivo. Objetivo: Evaluar si un régimen de inducción con infliximab es efectivo en pacientes con EA activa. Diseño: Sólo expuestos. Lugar: Servicio de Reumatología del Hospital Nacional Edgardo Rebagliati. Participantes: Pacientes con espondilitis anquilosante activa refractaria. Intervenciones: infliximab a las 0, 2 y 6 semanas. Un paciente recibió dosis de 3 mg/kg y los restantes 5 mg/kg de infliximab. Todos los pacientes continuaron recibiendo sulfasalazina. Principales medidas de resultados: Se determinó la proporción de pacientes que alcanzaron mejoría de acuerdo a los criterios ASAS 20, ASAS 40 y BASDAI 50, en la última evaluación (mediana de 55 semanas). Resultados: En la última evaluación, cinco pacientes (71,4%) presentaban respuesta ASAS 20 sostenida. Cuatro (57%) y tres (43%) de los pacientes alcanzaron BASDAI 50 y ASAS 40, respectivamente. Tres pacientes (43%) recayeron en un tiempo promedio de 26,6 semanas. No se observó efectos adversos serios. Conclusiones: La infusión de tres dosis de infliximab es efectiva para controlar la actividad de la enfermedad de los pacientes con EA refractaria a AINEs y en algunos pacientes controla la enfermedad por periodos prolongados de tiempo.Infliximab is effective in treating patients with ankylosing spondylitis (AS). However, its cost makes its indiscrimate use prohibitive. Objective: To determine whether an induction regimen with infliximab remained effective over time in a group of patients with active AS. Design: Exposed only. Setting: Rheumatology Service, Hospital Nacional Edgardo Rebagliati. Participants: Patients with active and refractory ankylosing spondylitis. Interventions: Infliximab, administered at weeks 0, 2 and 6. One patient received doses of 3 mg/kg and the remaining patients received 5 mg/kg of infliximab. All patients continued their treatment with sulfasalazine. Main outcome measures: We determined the proportion of patients achieving ASAS 20, ASAS 40 and Bath ankylosing spondylitis disease activity index - BASDAI 50 at last assessment (median of 55 weeks). Results: At last observation, five patients (71,4%) had a sustained ASAS 20 response. Four (57%) and three (43%) patients remained responders according to the BASDAI 50 and ASAS 40 respectively.Three patients (43%) relapsed, with mean time of 26,6 weeks. No serious adverse events were observed. Conclusions: The infusion of three doses of infliximab is effective to control disease activity in patients with refractory AS. In some patients, effectiveness remained for a prolonged period of time

Etanercept withdrawal and retreatment in nonradiographic axial spondyloarthritis: results of RE-EMBARK, an open-label phase IV trial

Clinical trial[Abstract] Objective: RE-EMBARK investigated etanercept (ETN) withdrawal and retreatment in patients with nonradiographic axial spondyloarthritis (nr-axSpA) achieving inactive disease. Methods: Patients received ETN and a background nonsteroidal antiinflammatory drug for 24 weeks in period 1 (P1); those achieving inactive disease (Ankylosing Spondylitis Disease Activity Score [ASDAS] with C-reactive protein [CRP] < 1.3) discontinued ETN for 40 weeks or less (period 2 [P2]). Patients who flared (ASDAS with erythrocyte sedimentation rate [ESR] ≥ 2.1) were retreated for 12 weeks in period 3 (P3). The primary endpoint was the proportion of patients with inactive disease who flared within 40 weeks of ETN withdrawal. Baseline characteristics were analyzed post hoc as predictors of maintenance and regaining of inactive disease, respectively, using univariate logistic and stepwise multivariable logistic regression models. Results: The proportion of patients experiencing flare following ETN withdrawal (P2) increased from 22.3% (25/112) after 4 weeks to 67% (77/115) after 40 weeks; 74.8% (86/115) experienced flare at any time during P2. Median time to flare was 16.1 weeks. Most patients (54/87, 62.1%) who were retreated with ETN in P3 reachieved inactive disease. Absence of both sacroiliitis detected on magnetic resonance imaging (MRI) and high-sensitivity CRP (hs-CRP) > 3 mg/L at baseline predicted inactive disease maintenance in P2 following ETN withdrawal in multivariable analysis; male sex and age younger than 40 years predicted regaining of inactive disease in P3 after flare/retreatment. There were no unexpected safety signals. Conclusion: Approximately 25% of patients maintained inactive disease for 40 weeks after discontinuing ETN. Absence of both MRI sacroiliitis and high hs-CRP at baseline predicted response maintenance after ETN withdrawal