Is traumatic brain injury a risk factor for neurodegeneration? A meta-analysis of population-based studies.

BACKGROUND: To determine the association of prior traumatic brain injury (TBI) with subsequent diagnosis of neurodegeneration disease. METHODS: All studies from 1980 to 2016 reporting TBI as a risk factor for diagnoses of interest were identified by searching PubMed, Embase, study references, and review articles. The data and study design were assessed by 2 investigators independently. A meta-analysis was performed by RevMan 5.3. RESULTS: There were 18 studies comprising 3,263,207 patients. Meta-analysis revealed a significant association of prior TBI with subsequent dementia. The pooled odds ratio (OR) for TBI on development of dementia, FTD and TDP-43 associated disease were 1.93 (95% CI 1.47-2.55, p < 0.001), 4.44 (95% CI 3.86-5.10, p < 0.001), and 2.97 (95% CI 1.35-6.53, p < 0.001). However, analyses of individual diagnoses found no evidence that the risk of Alzheimer's disease, and Parkinson's disease in individuals with previous TBI compared to those without TBI. CONCLUSIONS: History of TBI is not associated with the development of subsequent neurodegeneration disease. Care must be taken in extrapolating from these results because no suitable criteria define post TBI neurodegenerative processes. Therefore, further research in this area is needed to confirm these questions and uncover the link between TBI and neurodegeneration disease.

Risk of dementia in patients with primary insomnia: a nationwide population-based case-control study.

BACKGROUND: To investigate the association between primary insomnia and dementia using a Taiwanese population-based database. METHODS: This case-control study involved a subset of Taiwan's National Health Insurance Research Database of reimbursement claims. We included 51,734 patients who were diagnosed with primary insomnia from 2002 to 2004 as the test group and 258,715 nonprimary insomnia participants aged 20 years or older as the reference group. We excluded patients under 20 and those with depression, post-traumatic stress disorder, and/or sleep disorders caused by organic lesion(s), drugs, or alcohol. We used a Cox proportional hazards model to assess the primary insomnia on the risk of developing dementia after adjusting for sociodemographic characteristics and comorbidities. RESULTS: The primary insomnia cohort had a higher prevalence of diabetes, dyslipidemia, hypertension, coronary heart disease, chronic liver disease, and chronic kidney disease at baseline. After adjusting for select comorbidities, primary insomnia remained a significant predisposing factor for developing dementia, and was associated with a 2.14-fold (95% confidence interval, 2.01-2.29) increase in dementia risk. We also found a higher risk of dementia in younger patients. CONCLUSIONS: Taiwanese patients with primary insomnia, especially those under 40, had a higher risk of developing dementia than those without primary insomnia.

The risk of cataractogenesis after gamma knife radiosurgery: a nationwide population based case-control study.

BACKGROUND: Medical radiation is considered a factor responsible for cataractogenesis. However, the incidence of this ophthalmologic complication resulting from gamma knife radiosurgery (GKRS) has not yet been reported. The present study aimed to determine the risk of cataractogenesis associated with radiation exposure from GKRS. METHODS: This study used information from a random sample of one million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. The GK group consisted of patients who underwent GKRS between 2000 and 2009. The non-GK group was composed of subjects who had never undergone GKRS, but who were matched with the case group for time of enrollment, age, sex, history of coronary artery disease, hypertension, and diabetes. RESULTS: There were 277 patients in the GK group and 2770 matched subjects in the non-GK group. The GK group had a higher overall incidence of cataracts (10.11% vs. 7.26%; crude hazard ratio [cHR], 1.59; 95% CI, 1.07-2.36; adjusted hazard ratio [aHR], 1.25; 95% CI, 0.82-1.90) than the non-GK group. Patients who had undergone computed tomography and/or cerebral angiography (CT/angio) studies had a higher risk of developing cataracts than those who did not (10.82% vs. 6.64%; cHR, 1.74; 95% CI, 1.31-2.30; aHR, 1.65; 95% CI, 1.22-2.23). The age group between 30 and 50 years had the highest risk of cataractogenesis in both the GK and CT/angio groups (cHR, 3.50; 95% CI, 1.58-7.72; aHR, 2.43; 95% CI, 1.02-5.81; cHR, 2.96; 95% CI, 1.47-5.99; aHR, 2.27; 95% CI, 1.05-4.93, respectively). CONCLUSIONS: Radiation exposure due to GKRS and CT/angio study may be independently associated with increased risk of cataractogenesis. We suggest routine dosimetry measurement of eye lens and proper protection for patients with benign lesions during GKRS. Regular follow-up imaging studies should avoid the use of CT/angio, and particular care should be taken in the 30-50-year-old age group, due to their significantly increased risk of cataract formation.

Extractions of steady-state auditory evoked fields in normal subjects and tinnitus patients using complementary ensemble empirical mode decomposition.

BACKGROUND: Auditory steady-state response (ASSR) induced by repetitive auditory stimulus is commonly used for audiometric testing. ASSR can be measured using electro-encephalography (EEG) and magnetoencephalography (MEG), referred to as steady-state auditory evoked potential (SSAEP) and steady-state auditory evoked field (SSAEF), respectively. However, the signal level of SSAEP and SSAEF are weak so that signal processing technique is required to increase its signal-to-noise ratio. In this study, a complementary ensemble empirical mode decomposition (CEEMD)-based approach is proposed in MEG study and the extraction of SSAEF has been demonstrated in normal subjects and tinnitus patients. METHODS: The CEEMD utilizes noise assisted data analysis (NADA) approach by adding positive and negative noise to decompose MEG signals into complementary intrinsic mode functions (IMF). Ten subjects (five normal and five tinnitus patients) were studied. The auditory stimulus was designed as 1 kHz carrier frequency with 37 Hz modulation frequency. Two channels in the vicinities of right and left temporal areas were chosen as channel-of-interests (COI) and decomposed into IMFs. The spatial distribution of each IMF was correlated with a pair of left- and right-hemisphere spatial templates, designed from each subject's N100m responses in pure-tone auditory stimulation. IMFs with spatial distributions highly correlated with spatial templates were identified using K-means and those SSAEF-related IMFs were used to reconstruct noise-suppressed SSAEFs. RESULTS: The current strengths estimated from CEEMD processed SSAEF showed neural activities greater or comparable to those processed by conventional filtering method. Both the normal and tinnitus groups showed the phenomenon of right-hemisphere dominance. The mean current strengths of auditory-induced neural activities in tinnitus group were larger than the normal group. CONCLUSIONS: The present study proposes an effective method for SSAEF extraction. The enhanced SSAEF in tinnitus group echoes the decreased inhibition in tinnitus's central auditory structures as reported in previous studies.

Delayed neurovascular inflammation after mild traumatic brain injury in rats.

INTRODUCTION: Experimental traumatic brain injury (TBI) elicits acute local inflammatory responses, including up-regulation of adhesion molecules and neutrophils in the injured brain. However, in clinical experiences there were at least three types of TBI, which included mild, moderate and severe types, and there would be different neuroinflammatory responses. This study investigated the inflammatory responses after mild TBI in rats. METHODS: Adult male Sprague-Dawley rats (n = 40) were group-housed and injured using an impact method. Motor function was assessed 1-4 days after the injury by using a grip test (Grip strength meter; Singa). Blood samples collected from the rats before the injury and after the injury and the Intercellular adhesion molecule-1 (ICAM-1) level were measured. RESULTS: The ICAM-1 expression from pre-injury to post-injury showed a significantly greater gradual elevation in the rats in the mild-injury group than in the moderate-injury group. The neurological function evaluated with grip test showed no deterioration of neurological function in the mild-injury group but gradual deterioration in the moderate-injury group. CONCLUSION: These findings showed a delayed inflammatory reaction in the mild-injury group without progressive deterioration of neurological function. Therefore, in the moderate-injury group, no progression phase was observed.

Connectome-based predictive modeling for functional recovery of acute ischemic stroke.

Patients of acute ischemic stroke possess considerable chance of recovery of various levels in the first several weeks after stroke onset. Prognosis of functional recovery is important for decision-making in poststroke patient care and placement. Poststroke functional recovery has conventionally been based on demographic and clinical variables such as age, gender, and severity of stroke impairment. On the other hand, the concept of connectome has become a basis of interpreting the functional impairment and recovery of stroke patients. In this research, the connectome-based predictive modeling was used to provide predictive models for prognosing poststroke functional recovery. Predictive models were developed to use the brain connectivity at stroke onset to predict functional assessment scores at one or three months later, or to use the brain connectivity one-month poststroke to predict functional assessment scores at three months after stroke onset. The brain connectivity was computed from the resting-state fMRI signals. The functional assessment scores used in this research included modified Rankin Scale (mRS) and Barthel Index (BI). This research found significant models that used the brain connectivity at onset to predict the mRS one-month poststroke and to predict the BI three-month poststroke for patients with supratentorial infarction, as well as predictive models that used the brain connectivity one-month poststroke to predict the mRS three-month poststroke for patients with supratentorial infarction in the right hemisphere. The connectome-based predictive modeling could provide clinical value in prognosis of acute ischemic stroke.

Automated Cerebral Infarct Detection on Computed Tomography Images Based on Deep Learning.

The limited accuracy of cerebral infarct detection on CT images caused by the low contrast of CT hinders the desirable application of CT as a first-line diagnostic modality for screening of cerebral infarct. This research was aimed at utilizing convolutional neural network to enhance the accuracy of automated cerebral infarct detection on CT images. The CT images underwent a series of preprocessing steps mainly to enhance the contrast inside the parenchyma, adjust the orientation, spatially normalize the images to the CT template, and create a t-score map for each patient. The input format of the convolutional neural network was the t-score matrix of a 16 × 16-pixel patch. Non-infarcted and infarcted patches were selected from the t-score maps, on which data augmentation was conducted to generate more patches for training and testing the proposed convolutional neural network. The convolutional neural network attained a 93.9% patch-wise detection accuracy in the test set. The proposed method offers prompt and accurate cerebral infarct detection on CT images. It renders a frontline detection modality of ischemic stroke on an emergent or regular basis.

Gamma Knife Radiosurgery as a Salvage Treatment for Nasopharyngeal Carcinoma with Skull Base and Intracranial Invasion (T4b).

It is usually difficult to achieve good outcomes with salvage treatment for recurrent nasopharyngeal carcinoma (NPC) because of its deep-seated location, surrounding critical structures, and patient history of high-dose irradiation. Gamma Knife radiosurgery (GKS) is a treatment option for malignancies with skull base and intracranial invasion. We conducted a retrospective, observational, single-center study including 15 patients with recurrent NPC (stage T4b) involving the skull base and intracranial invasion, who underwent GKS as a salvage treatment. Patients were enrolled over 12 years. Per a previous study, the TNM classification T4b was subclassified into T4b1 and T4b2, defined as the involvement of the skull base or cavernous sinus with an intracranial extension of <5 mm and >5 mm, respectively. The effect of prognostic factors, including age, sex, survival period, magnetic resonance imaging (MRI) presentation, presence of other distant metastases, tumor volume, marginal dose, maximal dose, and Karnofsky Performance Status (KPS), on outcomes was analyzed. The patients with T4b1 NPC (p = 0.041), small tumor volume (p = 0.012), higher KPS (p < 0.001), and no other metastasis (p = 0.007) had better outcomes after GKS treatment, suggesting that it is a viable treatment modality for NPC. We also suggest that detailed brain imaging studies may enable the early detection of intracranial invasion.

Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks.

OBJECTIVE: The present study was performed to ascertain whether sacroiliac joint (SIJ) pain represents a potential source of pain in patients who have undergone lumbar or lumbosacral fusions. DESIGN: Prospective cohort study. PATIENTS AND METHODS: Between June 2007 and June 2009, 130 patients who underwent lumbar or lumbosacral fusions were evaluated for SIJ pain. Fifty-two patients for whom positive findings were obtained on at least three of the provocating tests for SIJ pain were selected to receive dual diagnostic blocks. OUTCOME MEASURES: A positive response was defined as characteristic pain reduction of 75% for 1-4 hours following the SIJ blocks. Predictive factors for a positive response to the SIJ blocks were also investigated. RESULTS: Among the 52 patients, 21 were considered to have SIJ pain on the basis of two positive responses to diagnostic blocks. Univariate analysis revealed that the predictive factors related to positive responses were unilateral pain (P = 0.002), more than three positive responses to provocating maneuvers (P = 0.02), and postoperative pain with characteristics different from those of preoperative pain (P = 0.04). CONCLUSIONS: SIJ pain is a potential source of pain after lumbar and lumbosacral fusion surgeries. Provocating SIJ maneuvers represent reliable tests for SIJ pain. The characteristics of postoperative SIJ pain frequently differ from those of preoperative pain.

Molecular biomarker of inflammatory response is associated with rebleeding in spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Rebleeding in spontaneous intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality among stroke survivors. Due to the links between inflammation and rebleeding, we hypothesized that the biomarkers of inflammation are associated with the pathogenesis of rebleeding in ICH. We sought to investigate whether these biomarkers and clinical variables on admission can provide prognostic information on the risk of rebleeding. METHODS: This prospective study enrolled 59 consecutive patients with spontaneous ICH. We determined the concentrations of interleukin-10 (IL-10), intercellular adhesion molecule-1, and complement 3 in blood samples obtained on admission. RESULTS: Univariate analysis indicated that hematoma volume, leukocyte count, hydrocephalus, and plasma IL-10 levels were associated with rebleeding. Multivariate logistic regression analysis indicated that hydrocephalus (95% CI of OR, 1.6-26.7) and IL-10 (95% CI of OR, 1.03-1.22) were independently associated with an increased probability of rebleeding. CONCLUSION: These data suggest that IL-10, a molecular biomarker of inflammatory response in the early acute phase of ICH, is associated with subsequent rebleeding.

Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study.

BACKGROUND: After proper patient selection, anatomically correct pulsed radiofrequency of the lumbar facet joints provide long-term pain relief in a routine clinical setting. In the study, we performed an analysis of clinical and radiological predictive factors and provide the scientific basis for this promising modality. METHODS: The study included 198 patients with lower back pain due to lumbar facet joint disease who underwent medial branch block and pulsed radiofrequency during the period 2015-2019. According to the improvement in pain score, the patients were divided into good and poor outcome groups. Clinical and radiological data were collected and analyzed. RESULTS: The multivariable analysis revealed the predictive factors, including lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and post lumbar fusion procedures. CONCLUSION: With the results of this study, we demonstrated that the improved outcome after the surgery was related to lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and the lumbar fusion procedures. Old compression fractures and lumbar fusion would change the radiological factors and cause refractory lumbar facet joint pain.

Simvastatin-Ezetimibe enhances growth factor expression and attenuates neuron loss in the hippocampus in a model of intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a common and severe neurological disorder associated with high morbidity and mortality rates. Despite extensive research into its pathology, there are no clinically approved neuroprotective treatments for ICH. Increasing evidence has revealed that inflammatory responses mediate the pathophysiological processes of brain injury following ICH. Experimental ICH was induced by direct infusion of 100 µL fresh (non-heparinized) autologous whole blood into the right basal ganglia of Sprague-Dawley rats at a constant rate (10 µL/min). The simvastatin group was administered simvastatin (15 mg/kg) and the combination therapy group was administered simvastatin (10 mg/kg) and ezetimibe (10 mg/kg). Magnetic resonance imaging (MRI), the forelimb use asymmetry test, the Morris water maze test, and two biomarkers were used to evaluate the effect of simvastatin and combination therapy. MRI imaging revealed that combination therapy resulted in significantly reduced perihematomal edema. Biomarker analyses revealed that both treatments led to significantly reduced endothelial inflammatory responses. The forelimb use asymmetry test revealed that both treatment groups had significantly improved neurological outcomes. The Morris water maze test revealed improved neurological function after combined therapy, which also led to less neuronal loss in the hippocampal CA1 region. In conclusion, simvastatin-ezetimibe combination therapy can improve neurological function, attenuate the endothelial inflammatory response and lead to less neuronal loss in the hippocampal CA1 region in a rat model of ICH.

Inhibition of extracellular signal-regulated kinases 1/2 provides neuroprotection in spinal cord ischemia/reperfusion injury in rats: relationship with the nuclear factor-kappaB-regulated anti-apoptotic mechanisms.

Previously we demonstrated benefits of inhibiting the extracellular signal-regulated kinases 1/2 (ERK1/2) signaling pathway in spinal cord ischemia/reperfusion (I/R) injury. To further identify the underlying mechanisms, we investigated the impact of ERK inhibition on apoptosis and cellular protective mechanisms against cell death. Spinal cord I/R injury induced ERK1/2 phosphorylation, followed by neuronal loss through caspase 3-mediated apoptosis. Pre-treatment with U0126, a specific inhibitor of MAPK/ERK kinases 1/2 (MEK1/2), inhibited ERK1/2 phosphorylation, and significantly attenuated apoptosis and increased neuronal survival. MEK/ERK inhibition also induced I-kappaB phosphorylation and enhanced nuclear factor (NF)-kappaB/DNA binding activity, leading to expression of cellular inhibitors of apoptosis protein 2 (c-IAP2), a known nuclear factor-kappaB (NF-kappaB)-regulated endogenous anti-apoptotic molecule. Pyrrolidine dithiocarbamate, an NF-kappaB inhibitor, by blocking I-kappaB phosphorylation, NF-kappaB activation, and c-IAP2 synthesis, abolished the protective effects of U0126. The MEK/ERK pathway appears to mediate cellular death following I/R injury. The U0126 neuroprotection appears related to NF-kappaB-regulated transcriptional control of c-IAP2. MEK/ERK inhibition at the initial stage of I/R injury may cause changes in c-IAP2 gene expression or c-IAP2/caspase 3 interactions, resulting in long lasting therapeutic effects. Future research should focus on the possible cross-talk between the MEK/ERK pathway and the NF-kappaB transcriptional cascade.

Tau proteins in serum predict outcome after severe traumatic brain injury.

BACKGROUND: The identification of reliable outcome predictors after traumatic brain injury (TBI) is crucial. The objective of our study was to investigate the role of tau protein as a serum marker of TBI. METHODS: Thirty-four patients with severe TBI (Glasgow Coma Scale [GCS] score at admission or= 114.5 pg/mL yielded 88% sensitivity and 94% specificity for predicting a poor outcome. CONCLUSIONS: These results suggest that in addition to GCS; serum tau protein levels may serve as indicators for the prediction of outcome following severe TBI. However; it should be viewed with caution because of the small sample size and wide standard deviations.

Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures.

OBJECTIVE: To compare the efficacy of percutaneous vertebroplasty (PV) with conservative therapy for patients with acute vertebral compression fractures. DESIGN: Prospective, nonrandomized, comparison study. BACKGROUND: The efficacy of PV has not been well established because there have been few comparative studies with conservatively treated control groups. PATIENTS AND METHODS: Fifty-five consecutive patients (8 men and 47 women, age 47-94) with osteoporosis and symptomatic acute vertebral compression fractures were enrolled. thirty-two patients received pv, whereas 23 received conservative therapy. OUTCOME MEASURES: Changes in pain intensity, physical functioning, and pain medication requirement were evaluated. RESULTS: Both PV and conservative therapy provided pain reduction (P < 0.001), improvements in physical functioning (P < 0.001), and decreased medication (P < 0.001). Reductions in visual analogue pain scores were more significant in the vertebroplasty group at 1 (P < 0.001) and 4 weeks (P < 0.001) but not at 12 months. Improvements in physical functioning were significant at 1 (P < 0.001) and 4 weeks (P < 0.001). Medication requirements were lower in the vertebroplasty group at all three time points. CONCLUSIONS: Pain relief, physical functioning improvement, and medication requirement after vertebroplasty are immediately and significantly better when compared with conservative therapy.

A pediatric chronic subdural hematoma after dodgeball head injury.

Chronic subdural hematoma is a subdural hematoma that is older than 3 weeks. Chronic subdural hematoma is predominantly a disease of the elderly and is rare in children. Its common manifestations are altered mental state and focal neurological deficits. We report here a rare case of chronic subdural hematoma in a 9-year-old child due to repeated minor dodgeball head injuries. Although such a case has never been reported in sport, the risk still exists. No altered mental state or focal neurological deficits were observed; the child presented with intermittent severe headache with nausea and vomiting. There was also no evidence of child abuse; however, the history of repeated minor head injuries during playing was significant.

Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study.

OBJECTIVES: The present nationwide population-based cohort study aims to assess the effectiveness of gamma knife radiosurgery (GKS) on ruptured and unruptured brain arteriovenous malformations (AVMs) by evaluating the haemorrhage rates. DESIGN: A nationwide, retrospective cohort study. SETTING: Taiwan National Health Insurance Research Database (NHIRD). PARTICIPANTS: An observational study of 1515 patients who were diagnosed with brain AVMs between 1997 and 2013 from the Taiwan NHIRD. PRIMARY OUTCOME AND SECONDARY OUTCOME MEASURES: We performed a survival analysis using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to explore the relationship between treatment modalities (GKS vs non-GKS) and haemorrhage, adjusted for age and sex. RESULTS: The GKS and non-GKS groups included 317 and 1198 patients, respectively. Patients in the GKS group (mean±SD, 33.08±15.48 years of age) tended to be younger than those in the non-GKS group (37.40±17.62) (p<0.001). The 15-year follow-up revealed that the rate of bleeding risk was lower in the GKS group than in the non-GKRS group (adjusted HR (aHR) 0.61; 95% CI 0.40 to 0.92). The bleeding risk of ruptured AVMs was significantly lower in GKS group than in the non-GKS group (aHR 0.34; 95% CI 0.19 to 0.62). On the other hand, the bleeding risk of unruptured AVMs was higher in the GKS group than in the non-GKS group (aHR 1.95; 95% CI 1.04 to 3.65). In the unruptured AVM group, the incidence of bleeding was significantly higher among patients in the GKS group that were of >40 years of age (aHR 3.21; 95% CI 1.12 to 9.14). CONCLUSIONS: GKS is safe and it reduces the risk of haemorrhage in patients with ruptured AVMs. The administration of GKS to patients with unruptured AVMs who are above the age of 40 years old male might increase the risk of haemorrhage.

Simvastatin and Simvastatin-Ezetimibe Improve the Neurological Function and Attenuate the Endothelial Inflammatory Response after Spinal Cord Injury in Rat.

During a spinal cord injury (SCI), mechanical trauma rapidly leads to a blood-spinal cord barrier (BSB) disruption, neural cell damage, axonal damage, and demyelination, followed by a cascade of secondary inflammatory reactions. These inflammatory responses spread the damage to the neural cells and impair the recovery of neurological functions. In the present study, we evaluated the efficacy of simvastatin and a simvastatin-ezetimibe combination therapy in managing the endothelial inflammatory response in an SCI rat model. Adult male Sprague-Dawley rats were group-housed and SCI was induced by using the modified weight-drop method. The animals were divided into 4 groups: (1) sham group, laminectomy only (n=6); (2) no-treatment group, SCI without therapy (n=8); (3) simvastatin group (n=8), and (4) ezetimibe and simvastatin combination therapy group (n=8). A high dose (15 mg/kg) of simvastatin was given to the simvastatin group, and 10 mg/kg simvastatin and 10 mg/kg ezetimibe were given to the combination group. Neurological function was assessed using the Basso, Beattie, and Bresnahan locomotor scale score. Intercellular adhesion molecule-1 (ICAM-1) level was used as an SCI biomarker. ICAM-1 level was the highest at 72 hours after SCI in the no-treament group. The treatment groups showed significant reduction in ICAM-1 levels at 72 hours. The treatment groups, especially the combination treatment group, showed better neurological function scores. Simvastatin and simvastatin- ezetimibe all could improve the neurological function and attenuate the endothelial inflammatory response after spinal cord injury in rat.

Pulsed radiofrequency of cervical medial branches for treatment of whiplash-related cervical zygapophysial joint pain.

BACKGROUND: The aim of this study is to assess the efficacy of pulsed RF lesioning of cervical medial branches in patients with whiplash-related chronic cervical zygapophysial joint pain in whom other conservative treatments failed. METHODS: Cervical zygapophysial joint pain was confirmed in 14 patients undergoing double diagnostic blocks. These patients underwent pulsed RF lesioning of the cervical medial branches. Pulsed RF procedures were performed in 2 cycles of 180 seconds after localization under fluoroscopy guide. RESULTS: Twelve (85.7%) patients had substantial pain relief at 1 month. Eleven (78.3%) patients still had more than 60% pain relief at 6 months. Only 5 (35.7%) patients recurred within 12 months. At 12-month follow-up, 9 (64.3%) patients had significant pain improvement. Medication requirements decreased in 13 (92.8%) patients at 1 month, 12 (85.7%) patients at 6 months, and 10 (71.4%) patients at 12 months. CONCLUSIONS: Pulsed RF of cervical medial branches is a potential treatment for patients with chronic whiplash-related cervical zygapophysial joint pain that failed other conservative treatments. This treatment provides long-lasting pain relief and reduces pain medication requirements.

Population-based study suggests an increased risk of Alzheimer'sdisease in Sjögren's syndrome.

This population-based study was designed to estimate and compare the risk of Alzheimer's disease (AD) between patients with primary Sjögren's syndrome (SS) and non-SS patients during a 10-year follow-up period. This is a retrospective cohort study. Data were obtained from the Taiwan's National Health Insurance Research Database. We identified 4463 primary SS patients and 22,315 non-SS patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied to identify the subsequent manifestation of AD. Cox proportional hazard regression was used to study the subsequent manifestation of AD, and Kaplan-Meier survival curves were used to compare survival probability. During the 10-year follow-up period, 7 primary SS and 13 non-SS patients developed AD. During the 10-year follow-up period, the risk of AD was 2.68-fold higher in the primary SS cohort with an overall adjusted hazard ratio (HR) of 2.69 (95% CI 1.07-6.76), after adjusting for demographics and comorbidities. Within the 10-year period, patients with primary SS showed a 2.69-fold increased risk of developing AD. This risk increases with time, and the relative risk of AD is higher in older patients with primary SS.