Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review.

PURPOSE: To review and summarize the clinical features, diagnosis, treatment strategies, and prognosis of spinal Rosai-Dorfman disease (RDD). METHODS: RDD is also termed as sinus histiocytosis with massive lymphadenopathy. We searched the databases of PubMed, Elsevier ScienceDirect, SpringerLink, and OVID. The keywords were Rosai-Dorfman disease and spine/central nervous system. Research articles and case reports with accessibility to full texts regarding spinal RDD were eligible for the inclusion. A total of 62 articles were included, and they contained 69 cases. We extracted the information of interest and analyzed them using SPSS statistics package. RESULTS: The average age was 33.1 ± 18.3 years. The ratio of males to females was 1.9/1. Overall, 63 cases presented with spine-related symptoms. A total of 27 cases (39.1%) had multi-organ lesions, and 12 cases had records of massive lymphadenopathy. Among 47 cases who first manifested spine-related symptoms, 93.6% were preoperatively misdiagnosed. The disease had a predilection for cervical spine (38.8%) and thoracic spine (40.3%). 62.9% of lesions were dura-based. Surgery remained the mainstream treatment option (78.8%), with or without adjuvant therapies. Total lesion resection was achieved in 34.8% of cases. The rate of lesion recurrence/progression was 19.5%, which was marginally lower for total resection than for non-total resection. CONCLUSION: Spinal RDD has no pathognomonic clinical and imaging features. Most cases first present with spine-relevant symptoms. Massive lymphadenopathy is not common, but a tendency for multi-organ involvement should be considered. Spinal RDD has a high recurrence rate; thus, total resection is the treatment of choice. Adjuvant therapies are indicated for multi-organ lesions and residual lesions. A wait and watch strategy is recommended for asymptomatic patients. Herein, a workflow of diagnosis and treatment of the spinal RDD is established.

Enriched physical environment reverses spatial cognitive impairment of socially isolated APPswe/PS1dE9 transgenic mice before amyloidosis onset.

AIMS: Social isolation increases the onset of Alzheimer's disease (AD). Environmental enrichment, a complicated social and physical construct, plays beneficial effects on brain plasticity and function. This study was designed to determine whether physical enrichment can reduce the deleterious consequences of social isolation on the onset of AD. METHODS: One-month-old APPswe/PS1dE9 transgenic AD model mice were singly housed in the enriched physical environment for 8 weeks and then received behavioral tests, neuropathological analyses, and Western blot of the hippocampus. RESULTS: The enriched physical environment reversed spatial cognitive decline of socially isolated APPswe/PS1dE9 mice. The functional reversal was associated with decreases in cellular apoptosis, synaptic protein loss, inflammation, and glial activation in the hippocampus, without changes in amyloid ß neuropathology. CONCLUSION: These results suggest that the enriched physical environment may serve as a nonpharmacological intervention for delaying the onset of AD accompanied with social isolation.

Surgeries for Patients with Tandem Spinal Stenosis in Cervical and Thoracic Spine: Combined or Staged Surgeries?

BACKGROUND: Cervical and thoracic tandem spinal stenosis (ct-TSS) is a rare yet challenging degenerative disease. When the diagnosis is made, surgical decompression is indicated for both lesions. However, literature about the surgical approaches and prognosis of this disease is lacking. METHODS: From March 2005 to April 2013, 30 patients with ct-TSS and a mean age of 49.8 years were recruited. We outlined 2 types of ct-TSS lesions-adjacent and skip lesions. The surgical approach for ct-TSS with adjacent lesions was combined cervical and thoracic decompression via a single posterior incision; the approach for skip lesions was 2-stage sequential cervical and thoracic decompressions. Neurologic status was evaluated with the Japanese Orthopaedic Association scale for cervical myelopathy. RESULTS: Seventeen patients underwent 1-stage surgery, and 13 patients underwent the 2-stage procedure. After surgery, 27 patients (90%) experienced improvement. Main complications included transient neurologic deterioration in 7 patients, dural tears in 14 patients, and new radiculopathy in 4 patients. Combined and staged groups were comparable in terms of total length of decompression, occurrence of perioperative complications, and recovery rate (P > 0.05). The average Japanese Orthopaedic Association score increased significantly from 9.8 ± 1.9 to 13.7 ± 3.0 (P < 0.05), and the average recovery rate was 54.4%. CONCLUSIONS: The types of stenotic lesions should be considered when planning surgery for patients with ct-TSS. One-stage decompression is suitable for patients with adjacent stenotic lesions; staged procedures should be considered for other patients.

Decision-making Impairments in Primary Angle-closure Glaucoma Patients.

BACKGROUND: Primary angle-closure glaucoma (PACG) is a common eye disease and a common cause of blindness. Inappropriate medical decisions severely affect the prognosis. This study investigated decision-making under risk in PACG patients. METHODS: Thirty patients with first acute attack of PACG before surgery and thirty healthy controls were included in the study. Decision-making under risk was evaluated with the game of dice task (GDT). The results of Eysenck Personality Questionnaire (EPQ) and GDT between PACG patients and healthy controls were compared. RESULTS: Risky decisions in PACG patients were more than those in healthy controls as measured by mean score of GDT (12.47 ± 5.72 vs. 4.33 ± 3.30, P< 0.001). Higher neuroticism score in EPQ was found in PACG patients compared to healthy controls (14.97 ± 3.93 vs. 9.90 ± 4.49, P< 0.001). Neuroticism scores in EPQ were associated with decision-making performance (r = 0.417, P = 0.001). CONCLUSIONS: Neuroticism positively correlated with risky decisions. Decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients.