Complications of the spine in ankylosing spondylitis with a focus on deformity correction

NKYLOSING spondylitis is a systemic inflammatory disease of unknown origin. Affected patients are predominantly but not exclusively male. Chronic inflammatory back pain is the most common presenting symptom and typically develops between the ages of 20 and 40 years. 65 Patients with AS can also have extra-articular manifestations such as ocular, cardiac, pulmonary, gastrointestinal, and renal involvement. A patient's susceptibility to the disease is largely genetically determined. 60 Because there is no single suitable laboratory test, clinicians must know as many of the characteristic signs and symptoms as possible to make a diagnosis. Even though AS is a systemic disease, the presenting symptoms, treatment, and morbidity are largely dependent on how the disease affects the spine. Thus, we believe that a review on spinal disease in AS will be of great value. In this review, we first describe the latest published algorithm to diagnose early disease and the classic inflammatory lesions. We then explore the diseased spine's susceptibility to noninflammatory lesions such as microfractures and deformity. We also describe other sequelae of AS, such as early osteoporosis and CES. Both the medical and surgical approaches to treatment are summarized. There is a special focus on osteotomy techniques. By the conclusion of the article, the clinician should have a better understanding of the diagnostic and treatment possibilities in AS spinal disease. Diagnosis of Inflammatory Back Pain and AS Because AS can markedly respond to the newer biological agents (discussed later), effective treatment of the disease requires early diagnosis. However, the high prevalence of back pain in the general population and the lack of radiographically demonstrated characteristic lesions in early AS often delay recognition of the disease. To make an early diagnosis, it is important to distinguish inflammatory from mechanical back pain on presentation. Factors consistent with inflammatory back pain include morning stiffness lasting longer than 30 minutes, onset of chronic back pain at an early age (before 35 years of age), improvement in pain with physical activity rather than with rest, awakening with back pain during the 2nd half of the night, alternating buttock pain, and a prolonged period of back pain. 48 One factor by itself does not have sufficient sensitivity or specificity to determine if the back pain is inflammatory. Note, however, that in a study of European patients with AS in which only 4 factors were considered, if 2 symptoms Abbreviations used in this paper: AS = ankylosing spondylitis; CES = cauda equina syndrome; DEXA = dual energy x-ray absorptiometry; HLA = human leukocyte antigen; MR = magnetic resonance; NSAID = nonsteroidal antiinflammatory drug; PSO = pedicle subtraction osteotomy; SPO = Smith-Peterson osteotomy; TNF = tumor necrosis factor

MOBIlity assessment with modern TEChnology in older patients' real-life by the General Practitioner: The MOBITEC-GP study protocol

Background: Mobility limitations in older adults are associated with poor clinical outcomes including higher mortality and disability rates. A decline in mobility (including physical function and life-space) is detectable and should be discovered as early as possible, as it can still be stabilized or even reversed in early stages by targeted interventions. General practitioners (GPs) would be in the ideal position to monitor the mobility of their older patients. However, easy-to-use and valid instruments for GPs to conduct mobility assessment in the real-life practice setting are missing. Modern technologies such as the global positioning system (GPS) and inertial measurement units (IMUs) - nowadays embedded in every smartphone - could facilitate monitoring of different aspects of mobility in the GP's practice. Methods: This project's aim is to provide GPs with a novel smartphone application that allows them to quantify their older patients' mobility. The project consists of three parts: development of the GPS- and IMU-based application, evaluation of its validity and reliability (Study 1), and evaluation of its applicability and acceptance (Study 2). In Study 1, participants (target N = 72, aged 65+, ≥2 chronic diseases) will perform a battery of walking tests (varying distances; varying levels of standardization). Besides videotaping and timing (gold standard), a high-end GPS device, a medium-accuracy GPS/IMU logger and three different smartphone models will be used to determine mobility parameters such as gait speed. Furthermore, participants will wear the medium-accuracy GPS/IMU logger and a smartphone for a week to determine their life-space mobility. Participants will be re-assessed after 1 week. In Study 2, participants (target N = 60, aged 65+, ≥2 chronic diseases) will be instructed on how to use the application by themselves. Participants will perform mobility assessments independently at their own homes. Aggregated test results will also be presented to GPs. Acceptance of the application will be assessed among patients and GPs. The application will then be finalized and publicly released. Discussion: If successful, the MOBITEC-GP application will offer health care providers the opportunity to follow their patients' mobility over time and to recognize impending needs (e.g. for targeted exercise) within pre-clinical stages of decline

Mono-, bi-, or tridentate ligands? The labeling of peptides with 99mTc-carbonyls.

The labeling of targeting peptides with (99m)Tc is a useful concept for the diagnosis of various diseases such as cancer. Although in research for at least one decade, only a very few radiopharmaceuticals based on peptides are in clinical use. The difficulty of labeling, and the resulting authenticity of the new vector, is largely responsible for this observation. In this overview, we present an alternate strategy based on the organometallic fac-[(99m)Tc(CO)(3)](+) core for introducing (99m)Tc in biomolecules in general and in peptides in particular. The three coordination sites available in [(99m)Tc(OH(2))(3)(CO)(3)](+) can be occupied with many different ligand types, pendant to a biomolecule and serving as the anchor group for labeling. This makes the appropriate choice difficult. We intend to present some useful concepts for the practice. Monodentate chelators are robust but bear the risk of multiple binding of biomolecules. Coordinating a bidentate ligand of choice prior to labeling bypasses this problem and enables a systematic drug discovery by variation of the bidentate ligand. Bidentate ligands attached to the biomolecule are stronger but occasionally require protection of the remaining site by a monodentate ligand. Both approaches refer to a mixed-ligand [2+1] approach. Tridentate chelators are the most efficient but need some protecting group chemistry in order to achieve selectivity for the coupling process. Examples with cysteine and histidine are presented. This article aims to provide versatile and reproducible approaches for the labeling of biomolecules while not focusing on particular systems. It should be left to the readers to derive a strategy for their own peptide

Biomarqueurs des pathologies neurodégénératives dans le diagnostic des troubles cognitifs - Revue et recommandations de Swiss Memory Clinics [Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]

Established cerebrospinal fluid (CSF) biomarkers allow for earlier and more accurate etiological diagnosis of cognitive impairment. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published consensus recommendations. The results must be interpreted in the context of the other available history information and assessments. Blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice soon. Consequently, a broader usage of biomarkers is expected and may accelerate the development of individually tailored prevention and treatment approaches. This article provides the recommendations of the Swiss Memory Clinics for the use of biomarkers in clinical practice

Biomarker in der Diagnostik kognitiver Störungen – Empfehlungen der Swiss Memory Clinics [Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]

Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice

Immunoisolation of adult porcine islets for the treatment of diabetes mellitus. The use of photopolymerizable polyethylene glycol in the conformal coating of mass-isolated porcine islets

Functional porcine islets, free of known pathogens, can serve as a source of insulin producing cells for the treatment of experimentally induced insulin dependent Diabetes Mellitus. Porcine islets can be conformally coated (microencapsulated) with a covalently linked, stable permselective membrane while maintaining islet viability and function. The PEG conformal coating is immunoprotective in a discordant xenograft animal model (porcine islets to rat). [on SciFinder (R)