Sex life and low back pain: The impact of intradiscal ozone therapy in patients with herniated lumbar disc.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To assess the improvement of sexual impairment after percutaneous intradiscal ozone therapy in patients complaining of low back pain (LBP) due to lumbar disc herniation. METHODS: Between January 2018 and June 2021, 157 consecutive imaging-guided percutaneous intradiscal ozone therapies were performed on 122 patients with LBP and/or sciatic pain due to lumbar disc herniation. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-ups and the ODI Section 8 (ODI-8/sex life) values were retrospectively reviewed to evaluate the improvement of sexual impairment and disability. RESULTS: Mean age of patients was 54.63 ± 12.40. Technical success was achieved in all cases (157/157). Clinical success was registered in 61.97% (88/142) of patients at 1-month follow-up and in 82.69% (116/142) at 3-month follow-up. The mean ODI-8/sex life was 3.73 ± 1.29 before the procedure, 1.71 ± 1.37 at 1-month follow up and 0.44 ± 0.63 at 3-month follow-up. Compared to older patients, subjects under 50 years showed a significantly slower recovery of sexual impairment (p = 0.003). The treated levels were L3-L4, L4-L5, and L5-S1 in 4, 116, and 37 patients, respectively. Patients with L3-L4 disc herniation showed less sexual disability at presentation, with a significantly faster improvement of sexual life (p = 0.03). CONCLUSIONS: Percutaneous intradiscal ozone therapy is highly effective in reducing sexual impairment due to lumbar disc herniation, and the improvement is faster in older patients and in the case of L3-L4 disc involvement.

Radiation exposure and clinical outcome in patients undergoing percutaneous intradiscal ozone therapy for disc herniation: Fluoroscopic versus conventional CT guidance.

PURPOSE: To compare technical success, clinical success, complications and radiation dose for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation using fluoroscopic guidance versus conventional computed tomography (CT) guidance. MATERIALS AND METHODS: Between March 2018and March 2021, 124consecutive percutaneous intradiscal ozone therapies wereperformedon111 patients with low back pain (LBP) and/or sciatic pain due to lumbar disc herniation, using fluoroscopic or conventional CT guidance, respectively in 53 and 58 herniated lumbar discs, with at least 1-month follow up. Dose area product (DAP) and dose length product (DLP) were recorded respectively for fluoroscopy and CT, and converted to effective dose (ED). RESULTS: Fluoroscopic and CT groups were similar in terms of patient age (p-value 0.39), patient weight (p-value 0.49) and pre-procedure Oswestry Disability Index (ODI, p-value 0.94). Technical success was achieved in all cases. Clinical success was obtained in 83.02% (44/53) patients in fluoroscopic group and 79.31% (46/58) in CT group. Mean DAP was 11.63Gy*cm2 (range 5.42-21.61). Mean DLP was 632.49mGy-cm (range 151.51-1699). ED was significantly lower in the fluoroscopic group compared toCT group (0.34 vs. 5.53mSv, p = 0.0119). No major complication was registered. Minor complications were observed in 4 cases (2 in fluoroscopic group; 2 in CT group). CONCLUSIONS: Compared to conventional CT guidance, fluoroscopic guidance for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation shows similar technical and clinical success rates, with lower radiation dose. This technique helps sparing dose exposure to patients.

The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline.

BACKGROUND: Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially devastating complication of radiation therapy to the head and neck region. Treatment options include antimicrobial therapy, local sequestrectomy, resection, and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to compare because of the lack of a universally accepted classification and staging system, and the literature on the use of HBO to either prevent or successfully manage ORN is controversial and inconclusive. Therefore, we aimed to establish a standard approach for using HBO at our institution. MATERIALS AND METHODS: A literature search was conducted of articles published in the English language between January 1980 and January 2016. Retrieved articles were evaluated by two independent reviewers. Isolated case reports, abstracts, case series, review articles, and cohort studies without a control group were excluded; summary data were extracted from the remaining studies. A panel of experts from Head and Neck Oncology and Oral Medicine from the Dana-Farber Cancer Institute and Brigham and Women's Hospital reviewed the summary data and established multidisciplinary guidelines on the use of HBO for the prevention and management of ORN. RESULTS: Seven studies were evaluated and reviewed by the multidisciplinary panel. There was no consistent evidence in support of HBO for either the prevention or management of ORN. CONCLUSION: Based on the available evidence and expert opinion, routine use of HBO for the prevention or management of ORN is not recommended and is rarely used at our institution. The Oncologist 2017;22:343-350 IMPLICATIONS FOR PRACTICE: The Division of Head and Neck Oncology of Dana-Farber/Brigham and Women's Cancer Center does not recommend the routine use of HBO for the prevention or management of ORN. Adjunctive HBO may be considered for use on a case-by-case basis in patients considered to be at exceptionally high risk who have failed conservative therapy and subsequent surgical resection.

Paricalcitol for secondary hyperparathyroidism in renal transplantation.

Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum parathyroid hormone levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, crossover, open-label study compared the effect of 6-month treatment with paricalcitol (1 µg/d for 3 months and then uptitrated to 2 µg/d if tolerated) or nonparicalcitol therapy on serum parathyroid hormone levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum parathyroid hormone levels significantly declined on paricalcitol from 115.6 (94.8-152.0) to 63.3 (52.0-79.7) pg/ml (P<0.001) but not on nonparicalcitol therapy. At 6 months, levels significantly differed between treatments (P<0.001 by analysis of covariance). Serum bone-specific alkaline phosphatase and osteocalcin decreased on paricalcitol therapy only and significantly differed between treatments at 6 months (P<0.001 for all comparisons). At 6 months, urinary deoxypyridinoline-to-creatinine ratio and 24-hour proteinuria level decreased only on paricalcitol (P<0.05). L3 and L4 vertebral mineral bone density, assessed by dual-energy x-ray absorption, significantly improved with paricalcitol at 6 months (P<0.05 for both densities). Paricalcitol was well tolerated. Overall, 6-month paricalcitol supplementation reduced parathyroid hormone levels and proteinuria, attenuated bone remodeling and mineral loss, and reduced eGFR in renal transplant recipients with secondary hyperparathyroidism. Long-term studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes.

In vivo dynamics of estrogen receptor activity: the ERE-Luc model.

In recent years several studies demonstrated the presence of estrogen receptors in mammalian tissues and significantly improved our understanding of their ability to control biological processes in reproductive as well as non-reproductive organs. Considering the manifold mechanisms and organs that are involved in estrogen action and the implication of estrogens in human female physiology, innovative approaches are required to shed light on the widespread activities of estrogen receptors in woman physiology. This is particularly relevant for the definition of novel, more efficacious hormonal replacement therapies or for the evaluation of the risk associated with the exposure to endocrine disruptors. The introduction of genetic engineering and the development and application of in vivo imaging techniques offer new tools for pre-clinical studies. The generation of the ERE-Luc mouse, a reporter animal developed for in vivo studies of the estrogen receptor activity, allows assessing the activity state of the ER signaling pathway in all target tissues and organs at once, under physiological stimuli or as a result of a pharmacological treatment. This review summarizes the main steps in the generation and appraisal of the estrogen receptor reporter mouse ERE-Luc, designed for in vivo molecular imaging studies, and describes examples demonstrating the suitability of the ERE-Luc model for drug development and for the investigation of the effects of endogenous, environmental, and dietary estrogens in vivo. This article is part of a Special Issue entitled 'Phytoestrogens'.

Integration and transmission of distributed deterministic neural activity in feed-forward networks.

A ten layer feed-forward network characterized by diverging/converging patterns of projection between successive layers of regular spiking (RS) neurons is activated by an external spatiotemporal input pattern fed to Layer 1 in presence of stochastic background activities fed to all layers. We used three dynamical systems to derive the external input spike trains including the temporal information, and three types of neuron models for the network, i.e. either a network formed either by neurons modeled by exponential integrate-and-fire dynamics (RS-EIF, Fourcaud-Trocmé et al., 2003), or by simple spiking neurons (RS-IZH, Izhikevich, 2004) or by multiple-timescale adaptive threshold neurons (RS-MAT, Kobayashi et al., 2009), given five intensities for the background activity. The assessment of the temporal structure embedded in the output spike trains was carried out by detecting the preferred firing sequences for the reconstruction of de-noised spike trains (Asai and Villa, 2008). We confirmed that the RS-MAT model is likely to be more efficient in integrating and transmitting the temporal structure embedded in the external input. We observed that this structure could be propagated not only up to the 10th layer but in some cases it was retained better beyond the 4th downstream layers. This study suggests that diverging/converging network structures, by the propagation of synfire activity, could play a key role in the transmission of complex temporal patterns of discharges associated to deterministic nonlinear activity. This article is part of a Special Issue entitled Neural Coding.

Dynamic control for synchronization of separated cortical areas through thalamic relay.

Binding of features and information which are processed at different cortical areas is generally supposed to be achieved by synchrony despite the non-negligible delays between these areas. In this work we study the dynamics and synchronization properties of a simplified model of the thalamocortical circuit where different cortical areas are interconnected with a certain delay, that is longer than the internal time scale of the neurons. Using this simple model we find that the thalamus could serve as a central subcortical area that is able to generate zero-lag synchrony between distant cortical areas by means of dynamical relaying (Vicente et al., 2008). Our results show that the model circuit is able to generate fast oscillations in frequency ranges of the beta and gamma bands triggered by an external input to the thalamus formed by independent Poisson trains. We propose a control mechanism to turn "On" and "Off" the synchronization between cortical areas as a function of the relative rate of the external input fed into dorsal and ventral thalamic neuronal populations. The current results emphasize the hypothesis that the thalamus could control the dynamics of the thalamocortical functional networks enabling two separated cortical areas to be either synchronized (at zero-lag) or unsynchronized. This control may happen at a fast time scale, in agreement with experimental data, and without any need of plasticity or adaptation mechanisms which typically require longer time scales.

Deterministic neural dynamics transmitted through neural networks.

Precise spatiotemporal sequences of neuronal discharges (i.e., intervals between epochs repeating more often than expected by chance), have been observed in a large set of experimental electrophysiological recordings. Sensitivity to temporal information, by itself, does not demonstrate that dynamics embedded in spike trains can be transmitted through a neural network. This study analyzes how synaptic transmission through three archetypical types of neurons (regular-spiking, thalamo-cortical and resonator), simulated by a simple spiking model, can affect the transmission of precise timings generated by a nonlinear deterministic system (i.e., the Zaslavskii mapping in the present study). The results show that cells with subthreshold oscillations (resonators) are very sensitive to stochastic inputs, and are not a good candidate for transmitting temporally coded information. Thalamo-cortical neurons may transmit very well temporal patterns in the absence of background activity, but jitter accumulates along the synaptic chain. Conversely, we observed that cortical regular-spiking neurons can propagate filtered temporal information in a reliable way through the network, and with high temporal accuracy. We discuss the results in the general framework of neural dynamics and brain theories.