Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review

Title: Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review Authors: Lindsay Tetreault1, Mohammed Shamji1, John Rhee2, Heidi Prather3, Jeff Wilson1, Ian B. Andersson4, Anna H. Dembek4, Krystle Pagarigan5, Joseph R. Dettori5, Michael G. Fehlings1 Affiliations: 1. Toronto Western Hospital, Toronto 2. Emory clinic, Atlanta 3. School of Medicine, Washington University at St. Louis 4. School of Physical Therapy, University of Puget Sound 5. Spectrum Research, Tacoma Purpose: To perform a systematic review of the current literature to analyze (1) the change in pain, function, and quality of life resulting from structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) the variability of change in function, pain and quality of life after different nonoperative treatments; (3) the differences in outcomes observed among subgroups (i.e baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from physical therapy intervention. Materials and Methods: A systematic search was conducted in Embase, the Cochrane Collaboration, and PubMed for research published between January 1, 1950 and February 9, 2015. Articles were included if they evaluated outcomes related to structured nonoperative treatment, including manual therapy, therapeutic exercise, cervical bracing and/or traction. Outcomes of interest include functional status (Japanese Orthopedic Association (JOA), Nurick), upper extremity and neck pain, quality of life (Neck Disability Index), and/or surgical intervention. The quality of each study was assessed using the Newcaste-Ottawa Scale and the strength of evidence was rated using guidelines from the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results: Of the 570 citations, eight met the criteria for inclusion in this review. There is very low evidence implying that structured nonoperative treatment for DCM garners a positive or negative change in pain, function, and quality of life as interpreted by the JOA score. There is also limited evidence from three studies showing that early nonoperative treatment (symptoms \u3c1 year) is associated with positive clinical outcomes. No studies directly compared structured nonoperative treatment types nor explored outcomes based on patient subgroups. The incidence of conversion to surgery ranged from 23-54%; primarily involving cases of mild or moderate myelopathy (JOA≥12). Conclusion: There is a general lack of evidence to discern the role of nonoperative treatment for patients with DCM. In the majority of studies, however, patients did not achieve clinically significant gains in functional status with structured nonoperative treatment. Rates of failed conservative treatment among all included studies were between 23-54%. Clinical Relevance: The role of structured nonoperative treatment for the management of DCM is not well defined, and the typical recommendation for patients with moderate to severe DCM is surgical intervention. References: Fehlings MG, Ibrahim A, Tetreault L, et al. A Global Perspective on the Outcomes of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results from the Prospective Multicenter AOSpine International Study on 479 patients. Spine. 2015. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain : a journal of neurology. 1972;95(1):101-108. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine. 2015;40(12):E675-693. Key Words: cervical myelopathy, degenerative myelopathy, nonsurgical management, nonoperative, conservative, physical therapy, manual therapy, therapeutic exercise, cervical traction, OPLL, spondylotic myelopathy, cervical stenosi

Cemented carbides and theirs effective use

Tato diplomová práce je zaměřena na řezné nástroje vyráběné ze slinutých karbidů. Charakterizuje značení, výrobu a vlastnosti nepovlakovaných a povlakovaných slinutých karbidů a přibližuje nejnovější trendy v povlakování. Cílem této práce je porovnání sortimentu dvou významných světových výrobců a jednoho českého výrobce, z hlediska používaných technologií výroby, mikrostruktury produktů, typů povlaků, metod povlakování a možnosti jejich použití. Ze získaných technických poznatků, byly vyhodnoceny a porovnány pracovní podmínky, které vybraní výrobci doporučují pro efektivní soustružnické aplikace svých nástrojů. Doporučené řezné rychlosti byly zjišťovány pro určitý typ obráběného materiálu dle ISO, šířky záběru ostří a pro určité hodnoty posuvů na otáčku.This diploma thesis is aimed on cutting tools made of cemented carbides. It characterizes marking, production and properties of non-coating and coating cemented carbides and describes the latest trends in coating. Target of this diploma thesis is comparison of assortment of two important world’s producers and one Czech producer in term of used productive technologies, products microstructure, coatings types, coatings methods and possibilities of their usage. Cutting data were evaluated and compared from obtained technical knowledge, which were recommended by chosen producers for effective turning application of their cutting tools. Recommended cutting speeds were found out for specific type of cutting material according to ISO, width depth of cut and for specific values of feeds per revolution.

Autobiografizm we wczesnych grafikach Teresy Jakubowskiej

This article is devoted to the graphic artist Teresa Jakubowska and the first period of her artistic work. It focuses on the works, which are a reflection of the artist’sprivate life. The artist herself compares her work to a diary containing a record of life’s experiences, thoughts and feelings. The subjects and problems addressed by the artist, the way they were illustrated and formal solutions used have no analogy in the Polish graphic art of that time. Therefore, these works deserve a broader discussion in the context of autobiographism in women’s art and further in literature and arts. Jakubowska’s linocuts and woodcuts are analyzed for use of autobiography practices, the areas of these practices are identified and the ways these practices were carried out are then presented. Furthermore, this article highlights Teresa Jakubowska’s innovative methods of recognising and transmitting the content, as well as her in transigent works in the context of the Polish graphic art after 1945.Artykuł dotyczy pierwszego okresu twórczości graficzki Teresy Jakubowskiej, a konkretnie prac, będących zapiskami z prywatnego życia artystki, która sama mówi, że jej twórczość to pamiętnik jej osobistych przeżyć, przemyśleń i odczuć. Zasługują one na szersze omówienie, gdyż zarówno podejmowane problemy, sposób ich zobrazowania i rozwiązania formalne nie mają analogii w grafice polskiej tamtego okresu. Grafiki te zostały przedstawione w kontekście zagadnienia autobiografizmu w sztuce kobiet i szerzej autobiografizmu w literaturze i sztuce. Linoryty i drzeworyty Jakubowskiej zostały poddane analizie pod kątem praktyk autobiograficznych, wyłoniono obszary w zakresie tych praktyk, które można wyróżnić w grafikach artystki, oraz przedstawiono sposób w jaki je realizuje. Ponadto artykuł podkreśla pionierską postawę Teresy Jakubowskiej w sposobie ujęcia i przekazywania treści, oraz bezkompromisowość jej prac na gruncie polskiej grafiki polskiej po 1945 roku

Macrophage activation and desensitization pathways in inflammatory processes

Macrophages can adjust their phenotype and functions to the individual microenvironment. Aim of this work was to investigate the polarization of lung and liver macrophages under different pathophysiologically relevant conditions. Chronic exposure of human alveolar macrophages to bacterial endotoxin and/or a synthetic glu- cocorticoid induced the expression of the innate immune receptor TLR2. Despite its high abun- dance, though, the receptor was not functional. Instead, it was released in two different forms: a short and a full-length form. Full-length TLR2 was associated with extracellular vesicles and may contribute to immunosuppression by acting as a decoy receptor. Macrophages within the tumor microenvironment, i.e., tumor-associated macrophages (TAMs), usually exhibit tumor-promoting functions. An RNA sequencing approach revealed a multitude of significantly downregulated cholesterol metabolism-associated genes in TAMs from human lung tumors when compared with normal lung macrophages (alveolar macrophages). Moreover, TAMs adopted a mixed M1/M2 phenotype, as defined with the help of an in vitro model. In an endotoxin-tolerant state, macrophages fail to produce pro-inflammatory mediators. In the murine liver, though, the pro-inflammatory IL-6 was not subjected to a tolerance response but drove hepatic lipid accumulation, potentially causing steatosis. Kupffer cells, the tissue-resident macrophages of the liver, were identified as the main source of IL-6 by selective depletion.Makrophagen können Phänotyp und Funktionen an das jeweilige Mikromilieu anpassen. Ziel dieser Arbeit war die Untersuchung der Polarisierung von Lungen- und Lebermakrophagen unter diversen pathophysiologisch relevanten Bedingungen. Behandlung von humanen Alveolarmakrophagen mit bakteriellem Endotoxin und/oder einem synthetischen Glukokortikoid führte zu einer erhöhten Expression des Immunrezeptors TLR2. Dieser war jedoch funktionsunfähig und wurde in zwei verschiedenen Formen sezerniert: in einer verkürzten und einer langen Variante. Die längere Form war mit extrazellulären Vesikeln asso- ziiert und zeigte immunsuppressive Funktionen, die durch das Abfangen von TLR2 Liganden zustande zu kommen scheint. Makrophagen im Tumormikromilieu, d.h. tumorassoziierte Makrophagen (TAMs), sind meist tumorfördernd. RNA-Sequenzierungen zeigten, dass eine Vielzahl von Cholesterinmetabolis- mus-assoziierten Genen in TAMs im Vergleich zu normalen Lungenmakrophagen (Alveolarma- krophagen) herabreguliert wird. Zudem zeigten TAMs einen gemischten M1/M2-Phänotyp, der mit Hilfe eines in vitro-Modells definiert wurde. Endotoxin-tolerante Makrophagen produzieren keine pro-inflammatorischen Faktoren. In muri- nen Lebern unterlag das pro-inflammatorische Zytokin IL-6 jedoch keiner Toleranzreaktion, son- dern trieb die hepatische Lipidakkumulation voran, was zu Steatose führen kann. Kupffer-Zellen, die Gewebe-Makrophagen der Leber, wurden durch selektive Depletion als Hauptquelle von IL- 6 identifiziert

Kinetic and Reaction Pathway Analysis in the Application of Botulinum Toxin A for Wound Healing

A relatively new approach in the treatment of specific wounds in animal models and in patients with type A botulinum toxin is the focus of this paper. The indications or conditions include traumatic wounds (experimental and clinical), surgical (incision) wounds, and wounds such as fissures and ulcers that are signs/symptoms of disease or other processes. An objective was to conduct systematic literature searches and take note of the reactions involved in the healing process and identify corresponding pharmacokinetic data. From several case reports, we developed a qualitative model of how botulinum toxin disrupts the vicious cycle of muscle spasm, pain, inflammation, decreased blood flow, and ischemia. We transformed this model into a minimal kinetic scheme for healing chronic wounds. The model helped us to estimate the rate of decline of this toxin's therapeutic effect by calculating the rate of recurrence of clinical symptoms after a wound-healing treatment with this neurotoxin

Degradation of quinaldine by Alcaligenes sp. and by Arthrobacter sp.

AbstractTwo bacterial strains, which grew aerobically in mineral salt medium with quinaldine as sole carbon source, were isolated. These strains could be identified as Alcaligenes sp. and Arthrobacter sp. Alcaligenes sp. was adapted to higher concentrations of quinaldine in a continuous culture. Both strains accumulated one compound, identified as quinisatin, which decomposed chemically to anthranilic acid and isatin. Quinisatin spontaneously resulted from 3,4-dihydroxy-2-oxo-1,2-di-hydroquinoline

Plant traits explain the success of vacuum harvesting as a method of seed collection for the restoration of species-rich grasslands

Grassland restoration is a key measure for re-establishing damaged floral communities. As seed banks are often degraded, methods are needed to overcome dispersal limitation of the remnant vegetation. One approach is to vacuum harvest seeds from donor sites. While this is a cost-effective method, individual species’ traits describing reproduction methods and dispersal mechanisms may affect the success with which seeds are collected and subsequently germinate. We collected seeds using low-cost vacuum harvesters in species-rich meadows in Poland. We predicted the relative success with which seedlings emerged from this collected material with respect to their percentage cover in the donor sites on the basis of individual species’ functional traits. Prolific species that rely on seed as opposed to vegetative reproduction, and those that germinate in late summer/autumn, exhibited the highest level of emergence. To a lesser extent, drought-tolerant or shade-intolerant species were well represented in the collected material. There was also weak evidence that wind-dispersed seeds would have a higher likelihood of being collected by this method. Our results suggest that vacuum harvesting is a valuable method to collect seeds for use in grassland restoration; however, it has limitations. In particular, additional methods may be needed to introduce into grassland restoration sites the propagules of species that vegetatively reproduce or seed early. The overrepresentation of species that produce large numbers of seed may potentially introduce priority effects that could also have unintended long-term implications for the structure of the floral community