Gold nanodots with stable red fluorescence for rapid dual-mode imaging of spinal cord and injury monitoring.

Spinal cord injury is one of the most devastating complications of spinal surgery, often resulting in numbness, pain or paralysis. Minor injuries in the spinal cord are hard to be identified and existing imaging modalities are unable to provide intraoperative monitoring. Monitoring pathological change at the site of injury is a key factor in staging and treatment decision making as well as prognosis of spinal cord injury. Herein, we offer the fluorescence imaging with intraoperative visualization and detection accuracy for bioimaging to resolve the problem. A novel red fluophore AuNDs caped with glutathione is prepared, which exhibits some advantages such as ultra-small size, negligible biotoxicity, superior water solubility and great biocompatibility. AuNDs fluorophore especially exhibit both of a remarkable photoluminescence stability and high attenuation coefficient to X-rays. In addition, AuNDs can be used as CT contrast agent for spinal cord, which avoid the high toxicity and weak CT signal of traditional iodine contrast. After intradural injection into the spinal cord, AuNDs are transported through the flow of cerebrospinal fluid and bound to the spinal cord parenchyma. not only the bioimage of the entire spinal cord can be achieved as quick as 15 min, but they are also particularly beneficial to long-term imaging of complex physiological environments in vivo, with negligible quenching. Comparing from the bright red fluorescence in adjacent normal spinal cord sites, there is almost no fluorescence in spinal cord at the areas of the injury. We suggest that AuNDs are unable to enter the injury sites of necrosis and ischemia, which promote a different contrast imaging from the normal one. The bright red fluorescence of the AuNDs significantly overcome the restriction of the blue autofluorescence of the biological tissues, providing a clear boundary for observation of the thin spinal cord injury. As a result, we developed the AuNDs with fluorescent and CT dual-mode bioimaging capability to clearly and effectively diagnose spinal cord injury, which are expected to provide a novel visualization imaging regent for clinical use.

Efficacy and safety of 18 anti-osteoporotic drugs in the treatment of patients with osteoporosis caused by glucocorticoid: A network meta-analysis of randomized controlled trials.

BACKGROUND: Glucocorticoids are widely used in a variety of diseases, especially autoimmune diseases and inflammatory diseases, so the incidence of glucocorticoid-induced osteoporosis is high all over the world. OBJECTIVES: The purpose of this paper is to use the method of network meta-analysis (NMA) to compare the efficacy of anti-osteoporosis drugs directly and indirectly, and to explore the advantages of various anti-osteoporosis drugs based on the current evidence. METHODS: We searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs), of glucocorticoid-induced osteoporosis (GIOP) and compared the efficacy and safety of these drugs by NMA. The risk ratio (RR) and its 95% confidence interval (CI) are used as the influence index of discontinuous data, and the standardized mean difference (SMD) and its 95% CI are used as the influence index of continuous data. The statistical heterogeneity was evaluated by the calculated estimated variance (τ2), and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking curve (SUCRA). The main outcome of this study was the incidence of vertebral fracture after taking several different types of drugs, and the secondary results were the incidence of non-vertebral fracture and adverse events, mean percentage change of lumbar spine (LS) and total hip (TH)bone mineral density (BMD) from baseline to at least 12 months. RESULTS: Among the different types of anti-GIOP, teriparatide (SUCRA 95.9%) has the lowest incidence of vertebral fracture; ibandronate (SUCRA 75.2%) has the lowest incidence of non-vertebral fracture; raloxifene (SUCRA 98.5%) has the best effect in increasing LS BMD; denosumab (SUCRA 99.7%) is the best in increasing TH BMD; calcitonin (SUCRA 92.4%) has the lowest incidence of serious adverse events. CONCLUSIONS: Teriparatide and ibandronate are effective drugs to reduce the risk of vertebral and non-vertebral fractures in patients with GIOP. In addition, long-term use of raloxifene and denosumab can increase the BMD of LS and TH.

Effect of non-invasive brain stimulation on neuropathic pain following spinal cord injury: A systematic review and meta-analysis.

BACKGROUND: In recent years, some studies indicated that repetitive transcranial magnetic stimulation (rTMS) could relieve neuropathic pain (NP) following a spinal cord injury (SCI), whereas some studies showed no pain relief effect. In addition, some studies showed the analgesic effect of transcranial direct current stimulation (tDCS) on NP post SCI, whereas other studies showed no effect. METHODS: We systematically searched on the PubMed, Web of Science, EMBASE, Medline, Google Scholar for studies exploring the analgesic effect of rTMS or tDCS on NP post SCI until November 2019. Meta-analysis was conducted to summarize results of these studies. RESULTS: The present quantitative meta-analysis indicated no significant difference in the effect of treatment on NP following SCI between rTMS and sham rTMS over the motor cortex at about 1 week after the end of the rTMS period (standardized mean difference (SMD) = 2.89, 95% confidence interval (CI) = -0.27 to 6.04). However, the study indicated that rTMS showed significantly better pain relief of treatment compared with sham rTMS between 2 and 6 weeks after the end of the rTMS period (SMD = 3.81, 95%CI: 0.80-7.52). However, no sufficient evidence could be provided to make a meta-analysis for the analgesic effect of tDCS on NP following SCI over the primary motor area (M1). CONCLUSIONS: In conclusion, the present meta-analysis suggested that rTMS did not show early analgesic effect on NP after SCI, but showed better middle-term analgesic effect, compared with sham rTMS. More large scale, blinded randomized controlled trials (RCTs) were needed to explore the analgesic effect of rTMS and tDCS on NP following SCI.