Facet-occiput slope angle: A novel predictor of cage placement feasibility during surgery in basilar invagination patients.

Background and aim: Direct posterior reduction and manipulation of the C1-2 joints, accompanied by placement of spacers, is the state-of-the-art technique for treating basilar invagination (BI) and atlantoaxial dislocation (AAD). The hindrance of occiput to reaching up to the true atlantoaxial facets (AAF) during the surgery remains challenging for cage placement. The aim of this study was to explore an objective and precise method of measuring the effect of the hindrance of occiput to reaching up to the true AAF and cage placement during surgery. Method: We collected the clinico-imaging data of 58 patients with BI and AAD (Group A) who underwent surgery in our hospital, and 78 control cohorts (Group B) were retrieved retrospectively. We measured facet-occiput slope angle (FOSA) in midsagittal CT. Patients were positioned prone for surgery based on preoperative flexion O-C2a, and access to the true AAF was observed intraoperatively. The cut-off value of FOSA for the feasibility of cage placement in BI and AAD patients was appointed when access to the true AAF was impossible due to the hindrance of occiput during surgery. Results: The cut-off value of FOSA for the feasibility of cage placement was 34o with an area under the curve AUC of 0.800 (95 % CI: 0.672-0.928, P < 0.001) and the Youden index of 0.607. In patients with FOSA >34o, reaching up to the true AAF and 3D-printed cage placement was impossible. FOSA was negative in Group A and positive in Group B, significantly larger in females compared to males in both groups and significantly larger postoperatively in Group A. Conclusion: FOSA can objectively measure the feasibility of cage placement when the patient is positioned prone per preoperative flexion O-C2a. A FOSA >34o is contraindication for cage placement.

Chinese cross-culturally adapted patient-reported outcome measures (PROMs) for knee disorders: a systematic review and assessment using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) instrument.

BACKGROUND: Knee patient-reported outcome measures (PROMs) are widely used in research in China, but there is limited evidence on the quality of cross-culturally adapted and original Chinese PROMs. We investigated Chinese language knee PROMs to provide evidence for clinicians on their quality and to guide PROM choices. METHOD: A systematic literature search of databases: PUBMED, CINAHL, EMBASE, and CNKI, using adequate search strings and a three-step screen process identified relevant studies. An independent standardized assessment of the selected studies based on the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was performed. Inter-rater reliability was assessed using intraclass coefficients (ICC). RESULTS: Thirty-three articles corresponding to 23 knee PROMs were evaluated with EMPRO global scores (100) ranging from 11.11 to 55.42. The attributes 'reliability,' 'validity,' and 'cultural and language adaptation' were significantly better evaluated compared to the attributes 'responsiveness,' 'interpretability,' and 'burden' (for all comparisons p < 0.0001). Moderate-to-excellent inter-rater agreement was observed with ICC values ranging from 0.538 to 0.934. CONCLUSION: We identified six PROMs with a minimum acceptable threshold (> 50/100). The osteoarthritis of knee and hip quality of life, the lower extremity function scale, and the Western Ontario Meniscal Evaluation tool ranked highest. Nevertheless, no single PROM had evidence encompassing all EMPRO attributes, necessitating further studies, especially on responsiveness, interpretability, and burden. We identified duplication of effort as shown by repeated translations of the same PROM; this inefficiency could be ameliorated by rapid approval of Chinese language PROMs documented on original PROM developers' platforms.

Recent advances in cell-based and cell-free therapeutic approaches for sarcopenia.

Sarcopenia is a progressive loss of muscle mass and function that is connected with increased hospital expenditures, falls, fractures, and mortality. Although muscle loss has been related to aging, injury, hormonal imbalances, and diseases such as malignancies, chronic obstructive pulmonary disease, heart failure, and kidney failure, the underlying pathogenic mechanisms of sarcopenia are unclear. Exercise-based interventions and multimodal strategies are currently being considered as potential therapeutic approaches to prevent or treat these diseases. Although drug therapy research is ongoing, no drug has yet been proven to have a substantial safety and clinical value to be the first drug therapy to be licensed for sarcopenia. To better understand the molecular alterations underlying sarcopenia and effective treatments, we review leading research and available findings from the systemic change to the muscle-specific microenvironment. Furthermore, we explore possible mechanisms of sarcopenia and provide new knowledge for the development of novel cell-free and cell-based therapeutics. This review will assist researchers in developing better therapies to improve muscle health in the elderly.

Recent advances in the treatment of traumatic brain injury with autologous and non-autologous multipotent stem and progenitor cells: preclinical models and clinical trials.

Traumatic brain injury (TBI) is a global health issue which causes millions of deaths and disabilities every year. The survivors of TBI may suffer from sensorimotor dysfunction, memory and cognitive disturbances, hearing and vision deficits, and various psychological problems. The primary insult may damage neurons, cerebral vessels and the blood-brain barrier, causing reactive astrogliosis and immune response with further damaging consequences. TBI lacks effective therapy. The currently available clinical treatment options include hyperbaric oxygenation, brain stimulation and rehabilitation. In recent years, the research on stem cell treatment of TBI has received extensive attention. Various types of stem cells, such as four types of mesenchymal stem cells, neural stem cells and olfactory ensheathing cells have been tried to treat TBI in clinical trials and preclinical models. This article reviews the research of autologous and non-autologous multipotent stem and progenitor cells for the treatment of TBI in both clinical and preclinical settings.

Evaluation of the Combination of Methylprednisolone and Tranilast after Spinal Cord Injury in Rat Models.

OBJECTIVE: The aim of our study was to evaluate the neuroprotective functions of the combination therapy using methylprednisolone (MP) and tranilast (TR) after spinal cord injury (SCI) in adult rats. METHODS: Spinal cord compression injury model was achieved using Yasargil aneurysm clip. Rats were divided into control group, MP group, TR group, and combination therapy group using TR and MP. Rat models were assessed for locomotor functional recovery using Basso, Beattie, and Bresnahan (BBB) score, spinal cord water content and myeloperoxidase (MPO) activity 24 hours post SCI, haematoxylin and eosin staining and glial fibrillary acid protein (GFAP) staining at 7 and 14 days post SCI. RESULTS: The spinal cord water content and MPO activity in the combination therapy group was significantly lower than the control group and the individual therapy groups p<0.05. The combination therapy group had significantly higher BBB scores than control group and individual therapy groups (p<0.05). At one week after SCI, GFAP expression in the combination group was significantly lower than the control group (p<0.05) but there was no significant difference compared to the individual therapy groups (p>0.05). At 2 weeks after SCI there was a slight decrease in GFAP expression compared to the first week but the difference was not statistically significant (p>0.05), GFAP expression between the groups was not statistically significant p>0.05. CONCLUSION: Combining MP and TR is therapeutically more effective in improving functional recovery, inhibiting inflammation and glial scar formation after acute SCI.