Is fatty infiltration in paraspinal muscles reversible with exercise in people with low back pain? A systematic review.

PURPOSE: Increased fatty infiltration in paraspinal muscles has been recognized as a feature of muscle quality loss in people with Low Back Pain (LBP) and is highly associated with the severity of LBP and dysfunction. Reducing fatty infiltration has been recognized as a rehabilitation aim. An earlier systematic review published in 2014 revealed conflicting evidence for the reversibility of paraspinal muscle quality by means of exercise and no updates have been published since. A new systematic literature search is warranted. METHOD: Pubmed, CINAHL and Embase were searched from inception to July 2022. Randomized, non-randomized controlled trials (RCT and non-RCT) and single-arm trials were included if they reported the effect of exercise on paraspinal fatty infiltration in people with LBP. Effect sizes and statistical power were calculated for (1) exercise versus control, and (2) pre-post exercise changes. Available data from the RCTs were pooled via meta-analysis when appropriate. Otherwise, data were synthesized qualitatively. RESULTS: Two RCTs, one non-RCT and three single-arm trials met the selection criteria. Data were not pooled due to substantial clinical heterogeneity. Effect sizes from the RCTs revealed no significant difference for exercise versus control. One single-arm trial with high risk of bias demonstrated a significant pre-post difference with moderate effect size, but only at one (T12-L1) of the investigated levels. CONCLUSION: Moderate quality evidence is available that paraspinal fatty infiltration is not reversible with exercise in people with LBP. More larger RCT's are needed to draw firmer conclusions.

Ambulatory function in motor incomplete spinal cord injury: a magnetic resonance imaging study of spinal cord edema and lower extremity muscle morphometry.

STUDY DESIGN: This research utilized a cross-sectional design. OBJECTIVES: Spinal cord edema length has been measured with T2-weighted sagittal MRI to predict motor recovery following spinal cord injury. The purpose of our study was to establish the correlational value of axial spinal cord edema using T2-weighted MRI. We hypothesized a direct relationship between the size of damage on axial MRI and walking ability, motor function and distal muscle changes seen in motor incomplete spinal cord injury (iSCI). SETTING: University-based laboratory in Chicago, IL, USA. METHODS: Fourteen participants with iSCI took part in the study. Spinal cord axial damage ratios were assessed using axial T2-weighted MRI. Walking ability was investigated using the 6-min walk test and daily stride counts. Maximum plantarflexion torque was quantified using isometric dynomometry. Muscle fat infiltration (MFI) and relative muscle cross-sectional area (rmCSA) were quantified using fat/water separation magnetic resonance imaging. RESULTS: Damage ratios were negatively correlated with distance walked in 6 min, average daily strides and maximum plantarflexion torque, and a negative linear trend was found between damage ratios and lower leg rmCSA. While damage ratios were not significantly correlated with MFI, we found significantly higher MFI in the wheelchair user participant group compared to community walkers. CONCLUSIONS: Damage ratios may be useful in prognosis of motor recovery in spinal cord injury. The results warrant a large multi-site research study to investigate the value of high-resolution axial T2-weighted imaging to predict walking recovery following motor incomplete spinal cord injury.

Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision.

BACKGROUND CONTEXT: Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE: To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING: A cohort study, single-center academic hospital. PATIENT SAMPLES: A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE: Neck disability at 12-months. METHODS: Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS: Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS: Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02157038.

[Medical supervision in rescue work--systematics and personal studies]. / Medizinalaufsicht im Rettungswesen--Systematik und eigene Untersuchungen.

All institutions of the organised public medical emergency services are functions of public health welfare and risk defence, hence they are subjects to the public health department in a supervisory capacity. Legal definitions and standards are the pertaining framework. Systematic and qualified improvements of areal plans, organization and realization, material and personal equipment, and hygienic standards in the public medical emergency service are Supervisory tasks that have to be tackled by public health departments. Planning requires random tests and local spatial analysis. This may be performed by the public health department itself or by external institutions. Therefore, organized public medical emergency service is part of (communal) health reports.

[Diphtheria--isolation of an endemic Corynebacterium diphtheriae strain in Southern Lower Saxony]. / Diphtherie--Isolierung eines endemischen Corynebacterium-diphtheriae-Stammes in Südniedersachsen.

After decades of only limited epidemiological and clinical importance diphtheria (especially of the upper respiratory tract) is regaining increasing interest of public health officials, as recent case reports in national and international publications clearly demonstrate. In March 1993 we observed a case of tracheobronchial Corynebacterium diphtheriae mitis infection in a 66-year old man from the South of Lower Saxony with clinical presentation of mucopurolent exacerbation of chronic bronchitis. The C. diphtheriae mitis strain was identified by microbiological and biochemical tests; however, its expression of toxin remains scientifically controversial. Investigations by the local public health officer suggest an endemic strain of C. diphtheriae. In this paper case report and results of investigations by the local public health officer are described in detail, stressing the need for widespread preventive inoculation not only in the younger but especially in the elderly population.

Microbially catalyzed nitrate-dependent oxidation of biogenic solid-phase Fe(II) compounds.

The potential for microbially catalyzed NO3(-)-dependent oxidation of solid-phase Fe(II) compounds was examined using a previously described autotrophic, denitrifying, Fe(II)-oxidizing enrichment culture. The following solid-phase Fe(II)-bearing minerals were considered: microbially reduced synthetic goethite, two different end products of microbially hydrous ferric oxide (HFO) reduction (biogenic Fe3O4 and biogenic FeCO3), chemically precipitated FeCO3, and two microbially reduced iron(III) oxide-rich subsoils. The microbially reduced goethite, subsoils, and chemically precipitated FeCO3 were subject to rapid NO3(-)-dependent Fe(II) oxidation. Significant oxidation of biogenic Fe3O4 was observed. Very little biogenic FeCO3 was oxidized. No reduction of NO3- or oxidation of Fe(II) occurred in pasteurized cultures. The molar ratio of NO3- reduced to Fe(II) oxidized in cultures containing chemically precipitated FeCO3, and one of the microbially reduced subsoils approximated the theoretical stoichiometry of 0.2:1. However, molar ratios obtained for oxidation of microbially reduced goethite, the other subsoil, and the HFO reduction end products did not agree with this theoretical value. These discrepancies may be related to heterotrophic NO3- reduction coupled to oxidation of dead Fe(III)-reducing bacterial biomass. Our findings demonstrate that microbally catalyzed NO3(-)-dependent Fe(II) oxidation has the potential to significantly accelerate the oxidation of solid-phase Fe(II) compounds by oxidized N species. This process could have an important influence on the migration of contaminant metals and radionuclides in subsurface environments.

[Surveillance of gastroenteritic infections in lower Saxony: results and experiences from a regional public-health project over six years]. / Gastroenteritis-Surveillance in Niedersachsen: Ergebnisse und Erfahrungen aus einem sechsjährigen OGD-Regionalprojekt.

In Lower Saxony, a regional public health project on a pathogen-specific surveillance of Enteritis infectiosa was carried out from 1994 to 2000. In a separate reporting procedure thirteen health departments transmitted data on the specific pathogen collected from laboratory reports for a joint analysis. The results were distributed among the participants, providing them with information on the situation and trends in their districts and in addition giving them the possibility to compare their data with those of other districts. The incidence of Enteritis infectiosa was 199 reported cases per 100,000 person years. Salmonella was reported most frequently (51 %; S. enteritidis: 33 %, S. TYPHIMURIUM: 14 %, 111 other serotypes: 4 %), followed by Campylobacter (18 %), Rotavirus (17 %), Yersinia enterocolitica (6 %) and Adenovirus (5 %). The incidences of Salmonella and Yersinia enterocolitica were found to be nearly constant over the project period while the incidences of Campylobacter, Rotavirus and Adenovirus increased. This, however, may be due to intensified diagnostics and better reporting behaviour rather than to a real increase. The incidence rates and their trends differed from other German states. This observation emphasizes the need for a regional analysis of infectious disease surveillance data.

Methionine metabolism: a window on carcinogenesis?

Recent experimental evidence links changes in methionine metabolism to the onset and progression of cancer. Aberrant methylation reactions and polyamine synthesis may alter genome stability, gene expression, and cell proliferation.

[Surveillance of viral hepatitis in Lower Saxony for investigating risk factors: results and experiences from a regional public health project 1999-2001]. / Virushepatitis-Surveillance in Niedersachsen zur Erhebung von Risikofaktoren: Ergebnisse und Erfahrungen aus einem OGD-Regionalprojekt 1999-2001.

In Lower Saxony, a regional public health project for an enlarged surveillance of viral hepatitis was carried out from 1999 to 2001. Five district public health authorities collected additional information on notified viral hepatitis cases in a standardised way, particularly regarding risk factors. In the survey, 270 hepatitis (hep.) cases were investigated, among them hep. A 51 (18.9%), hep. B 87 (32.2%) and hep. C 132 (48.9%). The proportion of chronic cases and healthy carriers was as follows: hep. A 0%, hep. B 47.1% and hep. C 79.5%. In approximately 50% of the cases of all three forms risk factors could be identified. The most frequent risk factors were in hep. A visits to foreign countries (29.4%), contacts to infected individuals (17.6%) and attendance at public institutions or care facilities (13.7%), in hep. B visits to foreign countries (24.1%), contacts to infected individuals (19.5%; sexual contacts 16.1%) and medical treatments (19.5%) and in hep. C injecting drug use (31.1%) and medical treatments (18.2%; 9.8% blood transfusion in the past in combination with chronic hep. C). The results are in accordance with current data under the new infection protection law, where reporting of chronic cases was mostly abolished. In the survey, the well-known risk factors were confirmed, but some risks were reported more frequently than in other surveys, e. g. sexual behaviour for hep. B or injecting drugs for hep. C.