The correlation between the sagittal lumbopelvic alignments in standing position and the risk factors influencing low back pain

Low back pain (LBP) is the most common health problem. Many factors have been demonstrated to be fundamental risk factors of LBP such as body mass index (BMI), age and sex. However, so far there have been few studies demonstrating the association between lumbo-pelvic alignment (LPA) and these factors. This present study was aimed to clarify the correlation between the LPA and the risk factors contributing to LBP. Standing lateral X-rays were taken from 100 healthy volunteers (70 males and 30 females) with no history of low back pain before their participation. Average age of subjects was 33.3±6.8 years (rang 21–50). Mean body weight was 59.1±7.9kg (range 40–82), mean body height was 163.6±7.2 cm (range 145–178) and mean BMI was 22.1±2.4 kg/m2 (range 18.0–29.3). The LPA was classified into 3 types according to the recently proposed pelvic orientation guidelines. No direct correlation was found between the pelvic orientation and age or BMI. Each LPA type was associated with sex but not BMI and age (P=0.00, 0.71, and 0.36, respectively). The results from this study demonstrated the differences in LPA between male and female, and also confirmed that the sagittal orientation of the pelvis remained constant in adults. The high prevalence of LPA type 1 in males may reduce the occurrence of LBP in obese male individuals

Outcomes of Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injections in Degenerative Lumbar Spondylolisthesis Patients

Study DesignA prospective cohort.PurposeTo report the short and long term outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injection (TFESI) in degenerative lumbar spondylolisthesis (DLS) patients.Overview of LiteratureTFESI has been widely used for the treatment of lumbosacral radicular pains. However, to our knowledge, there has been no study which has evaluated the outcomes of TFESI in patients with DLS.MethodsThe DLS patients received fluoroscopically guided lumbar TFESI with 80 mg of methylprednisolone and 2 mL of 1% lidocaine hydrochloride. Patients were evaluated by an independent observer before the initial injection, at 2 weeks, at 6 weeks, at 3 months, and at 12 months after the injections. Visual analog scale (VAS), Roland 5-point pain scale, standing tolerance, walking tolerance, and patient satisfaction scale were evaluated for outcomes.ResultsThirty three DLS patients treated with TFESI, who were completely followed up, were included in this study. The average number of injections per patient was 1.9 (range from 1 to 3 injections per patient). Significant improvements in VAS and Roland 5-point pain scale were observed over the follow up period from 2 weeks to 12 months. However, the standing and walking tolerance were not significantly improved after 2 weeks. At 2 weeks, the patient satisfaction scale was highest, although, these outcomes declined with time. The DLS patients with one level of spinal stenosis showed significantly better outcome than the DLS patients with two levels of spinal stenosis. Five patients (13%) underwent surgical treatment during the 3 to 12 months follow up.ConclusionsTFESI provides short term improvements in VAS and Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale in DLS patients. In the long term, it improves VAS but limits the improvements in Roland 5-point pain scale, standing tolerance, walking tolerance and patient satisfaction scale

Infrapatellar Fat Pad:An Alternative Source of Adipose-Derived Mesenchymal Stem Cells

Introduction. The Infrapatellar fat pad (IPFP) represents an emerging alternative source of adipose-derived mesenchymal stem cells (ASCs). We compared the characteristics and differentiation capacity of ASCs isolated from IPFP and SC. Materials and Methods. ASCs were harvested from either IPFP or SC. IPFPs were collected from patients undergoing total knee arthroplasty (TKA), whereas subcutaneous tissues were collected from patients undergoing lipoaspiration. Immunophenotypes of surface antigens were evaluated. Their ability to form colony-forming units (CFUs) and their differentiation potential were determined. The ASCs karyotype was evaluated. Results. There was no difference in the number of CFUs and size of CFUs between IPFP and SC sources. ASCs isolated from both sources had a normal karyotype. The mesenchymal stem cells (MSCs) markers on flow cytometry was equivalent. IPFP-ASCs demonstrated significantly higher expression of SOX-9 and RUNX-2 over ASCs isolated from SC (6.19 ± 5.56-, 0.47 ± 0.62-fold; p value = 0.047, and 17.33 ± 10.80-, 1.56 ± 1.31-fold; p value = 0.030, resp.). Discussion and Conclusion. CFU assay of IPFP-ASCs and SC-ASCs harvested by lipoaspiration technique was equivalent. The expression of key chondrogenic and osteogenic genes was increased in cells isolated from IPFP. IPFP should be considered a high quality alternative source of ASCs

The genetic epidemiology of joint shape and the development of osteoarthritis

Congruent, low-friction relative movement between the articulating elements of a synovial joint is an essential pre-requisite for sustained, efficient, function. Where disorders of joint formation or maintenance exist, mechanical overloading and osteoarthritis (OA) follow. The heritable component of OA accounts for ~ 50% of susceptible risk. Although almost 100 genetic risk loci for OA have now been identified, and the epidemiological relationship between joint development, joint shape and osteoarthritis is well established, we still have only a limited understanding of the contribution that genetic variation makes to joint shape and how this modulates OA risk. In this article, a brief overview of synovial joint development and its genetic regulation is followed by a review of current knowledge on the genetic epidemiology of established joint shape disorders and common shape variation. A summary of current genetic epidemiology of OA is also given, together with current evidence on the genetic overlap between shape variation and OA. Finally, the established genetic risk loci for both joint shape and osteoarthritis are discussed

Social media in undergraduate medical education: A systematic review.

INTRODUCTION: There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high-quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. METHODS: Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. RESULTS: 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self-reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. CONCLUSIONS: Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher-quality study is required to identify longer-term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms

Assessment of Prospective Physician Characteristics by SWOT Analysis

Background: Thailand is one of the developing countries encountering medical workforce shortage. From the national registry in 2006, there were 33 166 physicians: 41.5% worked in the government sector, 21.6% worked in the private sector, and the remaining worked in non-medical fields. There is no current data to confirm the effectiveness of the national policy to increase physician production. We demonstrate our findings from the strength, weakness, opportunity, and threat (SWOT) analysis in medical students and the potential impact on national workforce planning. Methods: We introduced SWOT analysis to 568 medical students during the 2008–2010 academic years, with the objective of becoming “a good physician in the future”. Results: Pertinent issues were grouped into 4 categories: not wanting to be a doctor, having inadequate medical professional skills, not wanting to work in rural or community areas, and planning to pursue training in specialties with high salary/low workload/low risk for lawsuit. The percentages of medical students who described themselves as “do not want to be a doctor” and “do not want to work in rural or community areas” increased from 7.07% and 25.00% in 2008 to 12.56% and 29.65% in 2010, respectively. Conclusion: Further intervention should be considered in order to change the medical students’ attitudes on the profession and their impact on Thai health system