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.

Increased risk of hip fractures in patients with dementia: a nationwide population-based study.

BACKGROUND: Dementia has been associated with an increased risk of hip fracture. However, little research has been conducted on the impact of dementia on wrist or vertebral fracture development. The aim of this study was to investigate whether dementia is a risk factor for different types of fracture in Taiwan. METHODS: The study sample was drawn from Taiwan's National Health Insurance Research Database of reimbursement claims, and comprised 1408 patients who visited ambulatory care centers or were hospitalized with a diagnosis of dementia. The comparison group consisted of 7040 randomly selected individuals. Cox proportional hazard regression model was used to examine associations between dementia and the risk of different types of fracture. RESULTS: During a 3-year follow-up period, 264 patients with dementia (18.75%) and 1098 patients without dementia (15.60%) developed fractures. Dementia was independently associated with increased risk of hip fracture [adjusted hazard ratio (HR) 1.92, 95% CI 1.48-2.49]. Patients with dementia and osteoporosis had the highest risk of developing hip fracture (adjusted HR 2.27, 95% CI 1.28-4.01). Dementia did not increase wrist fracture or vertebral fracture risk when compared to the control group, even in patients with osteoporosis. CONCLUSIONS: Individuals with dementia are at greater risk of developing hip fracture, particularly if they also have osteoporosis. Early mental screening programs and health education should be initiated to decrease disability and dependence in patients with dementia.

Modified fluoroscopy-guided sacroiliac joint injection: a technical report.

BACKGROUND AND OBJECTIVE: Sacroiliac joint (SIJ) injection can occasionally be challenging. We describe our experience in using conventional technique, and we developed an adjustment to overcome difficulties incurred. METHODS: Conventional technique required superimposition of the posterior and anterior SIJ lines. If this technique failed to provide entry into the joint, fluoroscopy was slightly adjusted to obtain an oblique view. RESULTS: Of 50 SIJ injections, 29 (58%; 44-72%) were successfully performed using conventional technique. In another 21 procedures, 18 (85.7%; 64-99%) were subsequently completed using oblique view technique. The medial joint line, viewed from this angle, corresponded to the posterior joint line in 17 cases. The lateral joint line corresponded to the posterior joint line in one case. CONCLUSIONS: Oblique view technique can improve the success rate of SIJ injection.

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.

Ischemic preconditioning ameliorates spinal cord ischemia-reperfusion injury by triggering autoregulation.

OBJECTIVE: The mechanism underlying ischemic preconditioning (IPC) protection against spinal cord ischemia-reperfusion (I/R) injury is unclear. We investigated the role of spinal cord autoregulation in tolerance to spinal cord I/R injury induced by IPC in a rat model. METHODS: Sprague-Dawley rats were randomly assigned to four groups. IPC (P) group animals received IPC by temporary thoracic aortic occlusion (AO) with a 2F Fogarty arterial embolectomy catheter (Baxter Healthcare, Irvine, Calif) for 3 minutes. The I/R injury (I/R) group animals were treated with blood withdrawal and temporary AO for 12 minutes, and shed blood reinfusion at the end of the procedures. The P+I/R animals received IPC, followed by 5 minutes reperfusion, and then I/R procedures for 12 minutes. Sham (S) group animals received anesthesia and underwent surgical preparation, but without preconditioning or I/R injury. Neurologic function on postprocedure days 1, 3, 5, and 7 was evaluated by Tarlov scoring. Lumbar segments were harvested for histopathologic examination on day 7. To evaluate the role of autoregulation in IPC, spinal cord blood flow and tissue oxygenation were continuously monitored throughout the procedure duration. RESULTS: The Tarlov scores in the I/R group were significantly lower than those in the S, P, and P+I/R groups on days 1, 3, 5, and 7 (P < .001). No significant differences were noted between the S, P, and P+I/R groups. The numbers of surviving motor neurons in the S, P, and P+I/R groups were significantly higher than those in the I/R group (P < .001); however, the number of surviving motor neurons did not differ between the S, P, and P+I/R groups. The P group exhibited higher spinal cord blood flow (P = .001-.043) and tissue oxygenation (P = .032-.043) within the first 60 minutes after reperfusion than the S group. The P+I/R group exhibited higher spinal cord blood flow (P = .016-.045) and tissue oxygenation (P = .001-.038) within the first 60 minutes after reperfusion than the I/R group. CONCLUSIONS: IPC ameliorates spinal cord I/R injury in rats, probably mediated by triggering spinal cord autoregulation and improving local spinal cord blood flow and tissue oxygenation. This concept may be the new therapeutic targets in patients requiring aortic surgery.

Risk factors of subsequent vertebral compression fractures after vertebroplasty.

OBJECTIVE: To elucidate the risk factors for a subsequent vertebral compression fracture following percutaneous vertebroplasty, we analyzed the potential predictors of vertebral compression fractures adjacent to or remote from fractures previously treated with percutaneous vertebroplasty. DESIGN: This is a retrospective cohort study. BACKGROUND: A major concern after percutaneous vertebroplasty in patients with osteoporosis is the occurrence of subsequent vertebral compression fractures in the untreated vertebral bodies. The risk factors for the development of subsequent vertebral compression fractures after percutaneous vertebroplasty are unclear. METHODS: Two hundred four consecutive patients underwent percutaneous vertebroplasty for acute vertebral compression fractures between January 2007 and December 2008. Forty-nine patients were excluded. Subsequent vertebral compression fractures were diagnosed by bone edema changes on magnetic resonance imaging. Patient's demographic data were used for univariate and multivariable binary logistic regression analyses. RESULTS: Forty-three (27.7%) of the 155 patients had subsequent vertebral compression fractures within 2 years of percutaneous vertebroplasty, with 21 (48.8%) of these patients having fractures detected within 3 months. Adjacent vertebral compression fractures tended to occur sooner, although not significantly (log-rank test, P = 0.112). On multivariate analyses, only the T-score of bone mineral density was significantly associated with subsequent vertebral compression fractures (P < 0.0001; odds ratio = 0.27; 95% confidence interval, 0.15-0.49). CONCLUSIONS: The only risk factor significantly associated with subsequent vertebral compression fractures following percutaneous vertebroplasty was a low bone mineral density T-score. Patients with lower bone mineral density have a higher incidence of vertebral compression fractures and thus need more intensive clinical and radiological follow-up.

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.

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.

Entrapment neuropathy results in different microRNA expression patterns from denervation injury in rats.

BACKGROUND: To compare the microRNA (miRNA) expression profiles in neurons and innervated muscles after sciatic nerve entrapment using a non-constrictive silastic tube, subsequent surgical decompression, and denervation injury. METHODS: The experimental L4-L6 spinal segments, dorsal root ganglia (DRGs), and soleus muscles from each experimental group (sham control, denervation, entrapment, and decompression) were analyzed using an Agilent rat miRNA array to detect dysregulated miRNAs. In addition, muscle-specific miRNAs (miR-1, -133a, and -206) and selectively upregulated miRNAs were subsequently quantified using real-time reverse transcription-polymerase chain reaction (real-time RT-PCR). RESULTS: In the soleus muscles, 37 of the 47 miRNAs (13.4% of the 350 unique miRNAs tested) that were significantly downregulated after 6 months of entrapment neuropathy were also among the 40 miRNAs (11.4% of the 350 unique miRNAs tested) that were downregulated after 3 months of decompression. No miRNA was upregulated in both groups. In contrast, only 3 miRNAs were upregulated and 3 miRNAs were downregulated in the denervated muscle after 6 months. In the DRGs, 6 miRNAs in the entrapment group (miR-9, miR-320, miR-324-3p, miR-672, miR-466b, and miR-144) and 3 miRNAs in the decompression group (miR-9, miR-320, and miR-324-3p) were significantly downregulated. No miRNA was upregulated in both groups. We detected 1 downregulated miRNA (miR-144) and 1 upregulated miRNA (miR-21) after sciatic nerve denervation. We were able to separate the muscle or DRG samples into denervation or entrapment neuropathy by performing unsupervised hierarchal clustering analysis. Regarding the muscle-specific miRNAs, real-time RT-PCR analysis revealed an approximately 50% decrease in miR-1 and miR-133a expression levels at 3 and 6 months after entrapment, whereas miR-1 and miR-133a levels were unchanged and were decreased after decompression at 1 and 3 months. In contrast, there were no statistical differences in the expression of miR-206 during nerve entrapment and after decompression. The expression of muscle-specific miRNAs in entrapment neuropathy is different from our previous observations in sciatic nerve denervation injury. CONCLUSIONS: This study revealed the different involvement of miRNAs in neurons and innervated muscles after entrapment neuropathy and denervation injury, and implied that epigenetic regulation is different in these two conditions.

MicroRNA profiling in ischemic injury of the gracilis muscle in rats.

BACKGROUND: To profile the expression of microRNAs (miRNAs) and their potential target genes in the gracilis muscles following ischemic injury in rats by monitoring miRNA and mRNA expression on a genome-wide basis. METHODS: Following 4 h of ischemia and subsequent reperfusion for 4 h of the gracilis muscles, the specimens were analyzed with an Agilent rat miRNA array to detect the expressed miRNAs in the experimental muscles compared to those from the sham-operated controls. Their expressions were subsequently quantified by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) to determine their expression pattern after different durations of ischemia and reperfusion. In addition, the expression of the mRNA in the muscle specimens after 4 h of ischemia and reperfusion for 1, 3, 7, and 14 d were detected with the Agilent Whole Rat Genome 4 x 44 k oligo microarray. A combined approach using a computational prediction algorithm that included miRanda, PicTar, TargetScanS, MirTarget2, RNAhybrid, and the whole genome microarray experiment was performed by monitoring the mRNA:miRNA association to identify potential target genes. RESULTS: Three miRNAs (miR-21, miR-200c, and miR-205) of 350 tested rat miRNAs were found to have an increased expression in the miRNA array. Real-time RT-PCR demonstrated that, with 2-fold increase after 4 h of ischemia, a maximum 24-fold increase at 7 d, and a 7.5-fold increase at 14 d after reperfusion, only the miR-21, but not the miR-200c or miR-205 was upregulated throughout the experimental time. In monitoring the target genes of miR-21 in the expression array at 1, 3, 7, 14 d after reperfusion, with persistent expression throughout the experiment, we detected the same 4 persistently downregulated target genes (Nqo1, Pdpn, CXCL3, and Rad23b) with the prediction algorithms miRanda and RNAhybrid, but no target gene was revealed with PicTar, TargetScanS, and MirTarget2. CONCLUSIONS: This study revealed 3 upregulated miRNAs in the gracilis muscle following ischemic injury and identified 4 potential target genes of miR-21 by examining miRNAs and mRNAs expression patterns in a time-course fashion using a combined approach with prediction algorithms and a whole genome expression array experiment.

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.

Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report.

OBJECTIVE: Chronic shoulder pain is difficult to treat, and the efficacy of most interventions is limited. This study was conducted to evaluate pulsed mode radiofrequency (PRF) lesioning of the suprascapular nerve for treating chronic shoulder pain. Interventions. Thirteen procedures using PRF lesioning of suprascapular nerve were performed under fluoroscopic guide in 11 patients (13 shoulder joints) with chronic shoulder pain for at least 3 months. OUTCOME MEASURES: The patients were evaluated for pain, shoulder disability function, and medication requirements prior to and after treatment. RESULTS: At 1-month follow-up assessment, 10 (76.9%) shoulder joints had significant pain relief (visual analog scale >or= 50% reduction), and at 6-month follow-up assessment, nine (69.2%) still had significant pain relief. The mean VAS score of 11 patients before PRF was 7.5 +/- 1.0, and the scores at 1-month and 6-month follow-up were 2.8 +/- 2.6 and 2.5 +/- 2.8, respectively. A significant pain reduction (P < 0.001) was observed. The mean Shoulder Pain and Disability Index scores at 6-month follow-up also showed a significant decrease compared with pre-PRF (P < 0.001). Medication requirements were evaluated 1 month and 6 months after the PRF. Nine (81.8%) patients had their medication requirement decreased. CONCLUSIONS: Pulsed mode radiofrequency lesioning to suprascapular nerve is a potential treatment option for patients suffering chronic shoulder pain. It provides long-lasting pain relief and decreases pain medication requirements.

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.

Fluoroscopically-Guided Superior Hypogastric Plexus Neurolysis Using a Single Needle: A Modified Technique for a Posterolateral Transdiscal Approach.

BACKGROUND: A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5. OBJECTIVE: We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle. STUDY DESIGN: A technical note describing interventional procedures. SETTING: The neurosurgery department of a cancer hospital. METHODS: The patient was placed in the prone position with a pillow beneath the iliac crest to facilitate opening of the intervertebral disc. The entry point for the needle was 7-8 cm to the left of the midline of the L45 level. The spinal needle was slightly advanced caudally toward the L5-S1 disc and at a 40° angle from the vertical plane. Using lateral fluoroscopic control, the needle was advanced beneath the inferior aspect of the facet joint. After entering the disc, the needle was then advanced until it passed the anterior annulus fibrosus of the L5S1 disc. After verifying adequate position using contrast, 3 mL of 75% ethanol was injected for neurolysis. RESULTS: During the follow-up, the patient reported reduction of pain in the lower abdomen and quality of life was significantly improved. LIMITATIONS: Sample size; no placebo control. CONCLUSION: Although different approaches exist, we prefer the posterolateral transdiscal approach for superior hypogastric plexus block and neurolysis using a single needle. This technique is a valuable alternative. KEY WORDS: Superior hypogastric plexus neurolysis, transdiscal approach, cancer pain.