Cross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review.

BACKGROUND: The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a reliable and sensitive measure of disability to determine functional status and evaluate curative effects in low back pain, it has now been cross-cultural translated into many other languages and adapted for use in different countries. We aim to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the JOABPEQ. METHODS: Studies related to cross-cultural adaptation of the JOABPEQ in a specific language/culture were searched in PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, and Web of Science from their inception to March 2022. The Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Consensus-based Standards for the Selection of Health Status Measurement Instruments guideline were used for evaluation. RESULTS: Nine different versions of cross-cultural JOABPEQ adaptations in 8 different languages/cultures were included. The adaptation process was not strictly performed, such as standard forward translation and expert committee review were rarely reported. Content validity (8/9), floor and ceiling effects (3/9), reliability (4/9), and interpretability (6/9) were assessed in most of the adaptations, while agreement (2/9), responsiveness (2/9), and the internal consistency (2/9) were not. JOABPEQ can replace functional and quality of life score to reduce the burden of scientific research. CONCLUSION: We recommend Persian-Iranian, simplified Chinese-Chinese Mandarin, Thai and Gunaydin G's Turkish adaptations for application. The numerical pain rating scale/visual analogue scale in low back pain and lower extremities, as well as numbness in lower extremities could not be neglected in JOABPEQ adaptations.

Flexible Peripheral Nerve Interfacing Electrode for Joint Position Control in Closed-Loop Neuromuscular Stimulation.

Addressing peripheral nerve disorders with electronic medicine poses significant challenges, especially in replicating the dynamic mechanical properties of nerves and understanding their functionality. In the field of electronic medicine, it is crucial to design a system that thoroughly understands the functions of the nervous system and ensures a stable interface with nervous tissue, facilitating autonomous neural adaptation. Herein, we present a novel neural interface platform that modulates the peripheral nervous system using flexible nerve electrodes and advanced neuromodulation techniques. Specifically, we have developed a surface-based inverse recruitment model for effective joint position control via direct electrical nerve stimulation. Utilizing barycentric coordinates, this model constructs a three-dimensional framework that accurately interpolates inverse isometric recruitment values across various joint positions, thereby enhancing control stability during stimulation. Experimental results from rabbit ankle joint control trials demonstrate our model's effectiveness. In combination with a proportional-integral-derivative (PID) controller, it shows superior performance by achieving reduced settling time (less than 1.63 s), faster rising time (less than 0.39 s), and smaller steady-state error (less than 3 degrees) compared to the legacy model. Moreover, the model's compatibility with recent advances in flexible interfacing technologies and its integration into a closed-loop controlled functional neuromuscular stimulation (FNS) system highlight its potential for precise neuroprosthetic applications in joint position control. This approach marks a significant advancement in the management of neurological disorders with advanced neuroprosthetic solutions.

Why are some women with pelvic floor dysfunction unable to contract their pelvic floor muscles?

INTRODUCTION: Many women with pelvic floor dysfunction are unable to voluntarily contract their pelvic floor muscles. This study hypothesised that women who cannot contract their pelvic floor muscles, despite specialised pelvic floor physiotherapy, are likely to have avulsion defect of the levator ani muscle, visible on 3-dimensional ultrasound. METHODS: Pelvic floor muscle strength was assessed by modified Oxford scale in all women presenting to a tertiary urogynaecology clinic with a main complaint of urinary incontinence ± pelvic organ prolapse. Women who could not contract their pelvic floor muscles (PFM) after having training with a specialised pelvic floor physiotherapist, (modified Oxford score of 0 or 1), were invited to participate in 3-dimensional transperineal ultrasound. RESULTS: Of 625 women presenting with urinary incontinence and/or pelvic organ prolapse, 150 (24.0%) were unable to contract their PFM at initial assessment. After specialised pelvic floor physiotherapy, 20 of 150 (15.3%) could not contract and were termed 'noncontractors'. Of these, 12 agreed to participate in transperineal ultrasound. Levator avulsion defects were detected in 8 of 12 (66.7%). CONCLUSION: Our results show that 67% of women who cannot contract their PFM despite physiotherapy have levator avulsion defects. The mechanism affecting the remaining 33% is yet to be discovered.

Effects of tetramethylpyrazine treatment in a rat model of spinal cord injury: A systematic review and meta-analysis.

Spinal cord injury (SCI) is a serious disabling condition that leads to the loss of motor, sensory, and excretory functions, seriously affecting the quality of life of patients and imposing a heavy burden on the patient's family and society. There is currently a lack of effective treatments for SCI. However, a large number of experimental studies have shown beneficial effects of tetramethylpyrazine (TMP). We performed a meta-analysis to systematically evaluate the effects of TMP on neurological and motor function recovery in rats with acute SCI. English (PubMed, Web of Science, and EMbase) and Chinese (CNKI, Wanfang, VIP, and CBM) databases were searched for literature related to TMP treatment in rats with SCI published until October 2022. Two researchers independently read the included studies, extracted the data, and evaluated their quality. A total of 29 studies were included, and a risk of bias assessment revealed that the methodological quality of the included studies was low. The results of the meta-analysis showed that the Basso, Beattie, and Bresnahan (BBB; n = 429, pooled mean difference [MD] = 3.44, 95% confidence interval [CI] = 2.67 to 4.22, p < 0.00001) and inclined plane test (n = 133, pooled MD = 5.60, 95% CI = 3.78 to 7.41, p < 0.00001) scores of rats treated with TMP were significantly higher than those in the control group at 14 days after SCI. TMP treatment also resulted in a significant reduction in malondialdehyde (MDA; n = 128, pooled MD = -2.03, 95% CI = -3.47 to -0.58, p < 0.00001) and increased superoxide dismutase (SOD; n = 128, pooled MD = 5.02, 95% CI = 2.39 to 7.65, p < 0.00001). Subgroup analysis indicated that different doses of TMP did not improve the BBB scale and inclined plane test angles. In conclusion, this review showed that TMP can improve SCI outcomes; however, in view of the limitations of the included studies, larger and high-quality studies are required for verification.

Improved early and late continence following robot-assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling).

Objective: To describe a novel RoboSling technique performed at the time of robot-assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively. Materials and Methods: The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra-vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V-Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)-urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes. Results: The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT. Conclusions: The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.

Ginseng extract and ginsenosides improve neurological function and promote antioxidant effects in rats with spinal cord injury: A meta-analysis and systematic review.

Spinal cord injury (SCI) is defined as damage to the spinal cord that temporarily or permanently changes its function. There is no definite treatment established for neurological complete injury patients. This study investigated the effect of ginseng extract and ginsenosides on neurological recovery and antioxidant efficacies in rat models following SCI and explore the appropriate dosage. Searches were done on PubMed, Embase, and Chinese databases, and animal studies matches the inclusion criteria were selected. Pair-wise meta-analysis and subgroup analysis were performed. Ten studies were included, and the overall methodological qualities were low quality. The result showed ginseng extract and ginsenosides significantly improve neurological function, through the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale (pooled MD = 4.40; 95% CI = 3.92 to 4.88; p < 0.00001), significantly decrease malondialdehyde (MDA) (n = 290; pooled MD = -2.19; 95% CI = -3.16 to -1.22; p < 0.0001) and increase superoxide dismutase (SOD) levels (n = 290; pooled MD = 2.14; 95% CI = 1.45 to 2.83; p < 0.00001). Both low (<25 mg/kg) and high dosage (≥25 mg/kg) showed significant improvement in the motor function recovery in SCI rats. Collectively, this review suggests ginseng extract and ginsenosides has a protective effect on SCI, with good safety and a clear mechanism of action and may be suitable for future clinical trials and applications.

Neuroinflammation and apoptosis after surgery for a rat model of double-level cervical cord compression.

INTRODUCTION: Cervical spondylotic myelopathy (CSM) is the most prevalent type of non-traumatic spinal cord injury. The pathological process of CSM is relatively complicated. Most of the chronic cervical cord compression animal models established using hydrophilic expanding polymer are single-segment compression, which was deviated from clinical practice with double-segment or multi-segment compression. This study aims to better mimic the actual clinical compression by using a new type of hydrophilic expanding polymer to establish an animal model of double-level cervical cord compression. MATERIALS AND METHODS: Progressive cord compression was done with implantation of polyvinyl alcohol-polyacrylamide hydrogel in the spinal canal at the C3-4 and C5-6 levels. Sprague-Dawley rats (n = 32) were divided into three groups: sham (no compression, n = 12) and screw compression group (n = 8), and hydrogel compression group (n = 12). Functional deficits were characterized using motor function scores, forelimb grip strength, hindlimb pain threshold, and gait analysis, while compression was imaged with magnetic resonance imaging. The apoptosis, inflammation, and demyelination were assessed by hematoxylin and eosin staining, Luxol fast blue staining, TUNEL assay, immunofluorescence staining, and Western blot analysis. RESULTS: Motor function scores for rats with cervical cord hydrogel compression were significantly decline in motor function scores, an increase in allodynia, neurons and oligodendrocytes apoptosis related to B cell lymphoma-2 (Bcl-2)/Bcl-2 associated X (Bax)/cleaved caspase-3, and impaired axonal conduction, as well as neuroinflammation zone related to microglia or macrophages aggregation related to the nucleotide-binding domain, leucine-rich-repeat-containing family, pyrin domain-containing 3 (NLRP3) inflammasome activation, and activation of astrocytes, as well as oxidative stress were observed. CONCLUSION: We believe that this model utilizing compression on double-level cervical cord will allow researchers to investigate of translationally relevant therapeutic methods for CSM.

Exploring the mechanism of Shenqisherong pill against cervical spondylotic myelopathy by network pharmacology and molecular docking.

BACKGROUND: Shenqisherong pill (SQSRP) has been used clinically to treat cervical spondylotic myelopathy (CSM) with satisfactory results; however, its active ingredients and mechanisms are unclear. The present study aimed to explore the active ingredients and molecular mechanisms of SQSRP against CSM using network pharmacology and molecular docking. METHODS: The compounds in SQSRP were obtained from public databases and related literature, and oral bioavailability (≥30%) and drug-likeness (≥0.18) were screened using absorption, distribution, metabolism, and excretion (ADME) criteria. Compounds-related and CSM-related target genes were identified using public databases, and the overlapping genes between compounds and CSM target genes were identified using a Venn diagram. Cytoscape and STRING were used to construct, visualize, and analyze the interaction network between these overlapping targets. Gene Ontology (GO) and KEGG pathway enrichment analysis of overlapping targets used Omicshare tools and constructed a compound-overlapping targets network, target-pathway network, and compound-target-pathway network using Cytoscape. Finally, molecular docking software was used to verify the targets. RESULTS: A total of 447 compounds in SQSRP were identified, and ADME screening identified 96 compounds as potentially active ingredients. A total of 249 compound-related genes and 280 CSM-related genes were identified using public databases, and 53 overlapping genes were identified. The results of compound targets and protein-protein interaction network analysis showed that the pharmacological effects of SQSRP against CSM involved 56 compounds and 53 genes. The results of GO and KEGG pathway enrichment analysis suggested that the therapeutic effects of SQSRP against CSM were exerted by reducing inflammation, inhibiting apoptosis, and protecting neurons. The molecular mechanisms may be strongly associated with PI3K-Akt, MAPK, IL-17, and TNF, which might be pivotal signaling pathways. CONCLUSIONS: The active ingredients and mechanisms of SQSRP against CSM were investigated using network pharmacology. The findings proved that the pill could treat CSM through multi-component, multi-target, and multi-pathway synergy and provide a theoretical basis for the subsequent extraction of active ingredients from SQSRP.

A Neuronal Apoptosis Model induced by Spinal Cord Compression in Rat.

As a severe progressive degenerative disease, cervical spondylotic myelopathy (CSM) has a poor prognosis and is associated with physical pain, stiffness, motor or sensory dysfunction, and a high risk of spinal cord injury and acroparalysis. Thus, therapeutic strategies that promote efficient spinal cord regeneration in this chronic and progressive disease are urgently needed. Effective and reproducible animal spinal cord compression models are required to understand the complex biological mechanism underlying CSM. Most spinal cord injury models reflect acute and structural destructive conditions, whereas animal models of CSM present a chronic compression in the spinal cord. This paper presents a protocol to generate a rat spinal cord compression model, which was further evaluated by assessing the behavioral score and observing the compressed spinal cord region. The behavioral assessments showed decreased monitor motor disability, including joint movements, stepping ability, coordination, trunk stability, and limb muscle strength. Hematoxylin and eosin (H&E) staining and immunostaining revealed considerable neuronal apoptosis in the compressed region of the spinal cord.

An Analysis of the Anti-Neuropathic Effects of Qi She Pill Based on Network Pharmacology.

BACKGROUND: Qi She Pill (QSP) is a traditional prescription for the treatment of neuropathic pain (NP) that is widely used in China. However, no network pharmacology studies of QSP in the treatment of NP have been conducted to date. OBJECTIVE: To verify the potential pharmacological effects of QSP on NP, its components were analyzed via target docking and network analysis, and network pharmacology methods were used to study the interactions of its components. MATERIALS AND METHODS: Information on pharmaceutically active compounds in QSP and gene information related to NP were obtained from public databases, and a compound-target network and protein-protein interaction network were constructed to study the mechanism of action of QSP in the treatment of NP. The mechanism of action of QSP in the treatment of NP was analyzed via Gene Ontology (GO) biological process annotation and Kyoto Gene and Genomics Encyclopedia (KEGG) pathway enrichment, and the drug-like component-target-pathway network was constructed. RESULTS: The compound-target network contained 60 compounds and 444 corresponding targets. The key active compounds included quercetin and beta-sitosterol. Key targets included PTGS2 and PTGS1. The protein-protein interaction network of the active ingredients of QSP in the treatment of NP featured 48 proteins, including DRD2, CHRM, ß2-adrenergic receptor, HTR2A, and calcitonin gene-related peptide. In total, 53 GO entries, including 35 biological process items, 7 molecular function items, and 11 cell related items, were identified. In addition, eight relevant (KEGG) pathways were identified, including calcium, neuroactive ligand-receptor interaction, and cAMP signaling pathways. CONCLUSION: Network pharmacology can help clarify the role and mechanism of QSP in the treatment of NP and provide a foundation for further research.

Echinacoside attenuates inflammatory response in a rat model of cervical spondylotic myelopathy via inhibition of excessive mitochondrial fission.

Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction with few treatment options. Although mitochondrial dynamics are linked to a wide range of pathological changes in neurodegenerative diseases, a connection between aberrant mitochondrial dynamics and CSM remains to be illuminated. In addition, mechanisms underlying the emerging anti-inflammatory and neuroprotective effects of echinacoside (ECH), the main active ingredient of Cistanche salsa, are poorly understood. We hypothesized that excessive mitochondrial fission plays a critical role in regulating inflammatory responses in CSM, and ECH might alleviate such responses by regulating mitochondrial dynamics. To this end, we assessed the effects of ECH and Mdivi-1, a selective inhibitor of dynamin-related protein (Drp1), in a rat model of chronic cervical cord compression and activated BV2 cells. Our results showed that rats with Mdivi-1 intervention had improved motor function compared with vehicle-treated rats. Indeed, Mdivi-1 treatment attenuated pro-inflammatory cytokine expression, as well as activation of the nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, nuclear transcription factor-κB (NF-κB), and Drp1 in lesions. Compared with vehicle-treated rats, compression sites of Mdivi-1-treated animals exhibited elongated mitochondrial morphologies and reduced reactive oxygen species (ROS). Similarly, ECH-treated rats exhibited neurological recovery and suppression of inflammatory response or related signals in the lesion area after treatment. Interestingly, ECH treatment partly reversed aberrant mitochondrial fragmentation and oxidative stress within the lesion area. In vitro data suggested that ECH suppressed activated microglia by modulating activation of the NLRP3 inflammasome and NF-κB signaling. Furthermore, we observed that ECH markedly inhibited Drp1 translocation onto mitochondria, whereby it regulated mitochondrial dynamics and ROS production, which act as regulators of NLRP3 inflammasome activation and NF-κB signaling. Thus, our findings reveal that mitochondrial dynamics modulate inflammatory responses during CSM. Moreover, ECH may attenuate neuroinflammation in rats subjected to chronic cervical cord compression by regulating Drp1-dependent mitochondrial fission and activation of downstream signaling.