Simplified Chinese version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire: cross-cultural adaptation, reliability, and validity for patients with cervical spondylotic myelopathy.

PURPOSE: This study aimed to validate the simplified Chinese version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) for Chinese patients with cervical spondylotic myelopathy (CSM). METHODS: The construct validity was conducted using confirmatory factor analysis (CFA). The convergent validity was based on factor loading, composite reliability (CR), and Pearson correlation coefficients (r). Internal consistency reliability was evaluated using Cronbach's α, test-retest reliability using intraclass correlation coefficients (ICC), and the ceiling and floor effects were also examined. RESULTS: A total of 168 native Chinese-speaking patients were enrolled. The CFA indicated that construct validity did not meet the preset criteria to be considered as good. Except for Q 4-1, the factor loading was higher than the standard of 0.5, and the CR values ranged from 0.70 to 0.85. Strong to moderate correlations were found between other scales and the simplified Chinese JOACMEQ. The scale showed good internal consistency reliability (Cronbach's α 0.639-0.821), and test-retest reliability (ICC 0.760-0.916). Moreover, the ceiling effect was displayed from Q1 to Q4. CONCLUSIONS: This study indicates that the simplified Chinese JOACMEQ is a reliable and valid measure of the functional status among Chinese patients with CSM.IMPLICATIONS FOR REHABILITATIONThe JOACMEQ was translated into the simplified Chinese and culturally adapted for Chinese-speaking patients with CSM for the first time.The simplified JOACMEQ demonstrated an excellent level of internal consistency and good test-retest reliability.The simplified Chinese JOACMEQ was reliable and valid for the measurement of the functional status among the patients with CSM.

A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness.

BACKGROUND: Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease. METHODS: LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach's α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC). RESULTS: A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = - 0.634 to - 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ. CONCLUSION: NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.

Muscone suppresses inflammatory responses and neuronal damage in a rat model of cervical spondylotic myelopathy by regulating Drp1-dependent mitochondrial fission.

Cervical spondylotic myelopathy (CSM) is a common cause of disability with few treatments. Aberrant mitochondrial dynamics play a crucial role in the pathogenesis of various neurodegenerative diseases. Thus, regulation of mitochondrial dynamics may offer therapeutic benefit for the treatment of CSM. Muscone, the active ingredient of an odoriferous animal product, exhibits anti-inflammatory and neuroprotective effects for which the underlying mechanisms remain obscure. We hypothesized that muscone might ameliorate inflammatory responses and neuronal damage by regulating mitochondrial dynamics. To this end, the effects of muscone on a rat model of chronic cervical cord compression, as well as activated BV2 cells and injured neurons, were assessed. The results showed that muscone intervention improved motor function compared with vehicle-treated rats. Indeed, muscone attenuated pro-inflammatory cytokine expression, neuronal-apoptosis indicators in the lesion area, and activation of the nod-like receptor family pyrin domain-containing 3 inflammasome, nuclear transcription factor-κB, and dynamin-related protein 1 in Iba1- and ßIII-tubulin-labeled cells. Compared with vehicle-treated rats, compression sites of muscone-treated animals exhibited elongated mitochondrial morphologies in individual cell types and reduced reactive oxygen species. In vitro results indicated that muscone suppressed microglial activation and neuronal damage by regulating related-inflammatory or apoptotic molecules. Moreover, muscone inhibited dynamin-related protein 1 activation in activated BV2 cells and injured neurons, whereby it rescued mitochondrial fragmentation and reactive oxygen species production, which regulate a wide range of inflammatory and apoptotic molecules. Our findings reveal that muscone attenuates neuroinflammation and neuronal damage in rats with chronic cervical cord compression by regulating mitochondrial fission events, suggesting its promise for CSM therapy.

Neurological recovery and antioxidant effects of resveratrol in rats with spinal cord injury: a meta-analysis.

OBJECTIVE: To critically assess the neurological recovery and antioxidant effects of resveratrol in rat models of spinal cord injury. DATA SOURCES: Using "spinal cord injury", "resveratrol" and "animal experiment" as the main search terms, all studies on the treatment of spinal cord injury in rats by resveratrol were searched for in PubMed, EMBASE, MEDLINE, Web of Science, Science Direct, China National Knowledge Infrastructure, Wanfang, VIP, and SinoMed databases by computer. The search was conducted from their inception date to April 2017. No language restriction was used in the literature search. DATA SELECTION: The methodological quality of each study was assessed by the initial Stroke Therapy Academic Industry Roundtable recommendations. Two reviewers independently selected studies according to the title, abstract and full text. The risk of bias in the included studies was also evaluated. Meta-analyses were performed with Review Manager 5.3 software. OUTCOME MEASURES: Neurological function was assessed by the Basso, Beattie, and Bresnahan scale score, inclined plane score and Gale's motor function score. Molecular-biological analysis of antioxidative effects was conducted to determine superoxide dismutase levels, malondialdehyde levels, nitric oxide synthase activity, nitric oxide levels, xanthine oxidase and glutathione levels in spinal cord tissues. RESULTS: The methodological quality of the 12 included studies was poor. The results of meta-analysis showed that compared with the control group, resveratrol significantly increased the Basso, Beattie, and Bresnahan scale scores after spinal cord injury (n = 300, mean difference (MD) = 3.85, 95% confidence interval (CI) [2.10, 5.59], P < 0.0001). Compared with the control group, superoxide dismutase levels were significantly elevated (n = 138, standardized mean difference (SMD) = 5.22, 95% CI [2.98, 7.45], P < 0.00001), but malondialdehyde levels were significantly diminished (n = 84, SMD = -3.64, 95% CI [-5.84, -1.43], P = 0.001) in the spinal cord of the resveratrol treatment group. CONCLUSIONS: Resveratrol promoted neurological recovery and exerted antioxidative effects in rat models of spinal cord injury. The limited quality of the included studies reduces the application of this meta-analysis. Therefore, more high-quality studies are needed to provide more rigorous and objective evidence for the pre-clinical treatment of spinal cord injury.

Effect of docosahexaenoic acid on the recovery of motor function in rats with spinal cord injury: a meta-analysis.

OBJECTIVE: Studies have shown that docosahexaenoic acid (DHA) has a beneficial effect in the treatment of spinal cord injury. A meta-analysis was used to study the effect of DHA on the neurological recovery in the rat spinal cord injury model, and the relationship between the recovery of motor function after spinal cord injury and the time and method of administration and the dose of DHA. DATA SOURCE: Published studies on the effect of DHA on spinal cord injury animal models from seven databases were searched from their inception to January 2019, including PubMed, MEDLINE, EMBASE, the China National Knowledge Infrastructure, Wanfang, VIP, and SinoMed databases. The search terms included "spinal cord injury" "docosahexaenoic acid", and "rats". DATA SELECTION: Studies that evaluated the influence of DHA in rat models of spinal cord injury for locomotor functional recovery were included. The intervention group included any form of DHA treatment and the control group included treatment with normal saline, vehicle solution or no treatment. The Systematic Review Centre for Laboratory animal Experimentation's risk of bias assessment tool was used for the quality assessment of the included studies. Literature inclusion, quality evaluation and data extraction were performed by two researchers. Meta-analysis was then conducted on all studies that met the inclusion criteria. Statistical analysis was performed on the data using RevMan 5.1.2. software. OUTCOME MEASURES: The primary outcome measure was the score on the Basso, Beattie, and Bresnahan scale. Secondary outcome measures were the sloping plate test, balance beam test, stair test and grid exploration test. RESULTS: A total of 12 related studies were included, 3 of which were of higher quality and the remaining 9 were of lower quality. The highest mean Basso, Beattie, and Bresnahan scale score occurred at 42 days after DHA treatment in spinal cord injury rats. At 21 days after treatment, the mean difference in Basso, Beattie, Bresnahan scores between the DHA group and the control group was the most significant (pooled MD = 4.14; 95% CI = 3.58-4.70; P < 0.00001). In the subgroup analysis, improvement in the Basso, Beattie, and Bresnahan scale score was more significant in rats administered DHA intravenously (pooled MD = 2.74; 95% CI = 1.41-4.07; P < 0.0001) and subcutaneously (pooled MD = 2.99; 95% CI = 2.29-3.69; P < 0.00001) than in the groups administered DHA orally (pooled MD = 3.04; 95% CI = -1.01 to 7.09; P = 0.14). Intravenous injection of DHA at 250 nmol/kg (pooled MD = 2.94; 95% CI = 2.47-3.41; P < 0.00001] and 1000 nmol/kg [pooled MD = 3.60; 95% CI = 2.66-4.54; P < 0.00001) significantly improved the Basso, Beattie, and Bresnahan scale score in rats and promoted the recovery of motor function. CONCLUSION: DHA can promote motor functional recovery after spinal cord injury in rats. The administration of DHA by intravenous or subcutaneous injection is more effective than oral administration of DHA. Intravenous injection of DHA at doses of 250 nmol/kg or 1000 nmol/kg is beneficial. Because of the small number and the low quality of the included studies, more high-quality research is needed in future to substantiate the results.

Study on efficacy and safety of Tong-luo Qu-tong plaster treatment for knee osteoarthritis: study protocol for a randomized, double-blind, parallel positive controlled, multi-center clinical trial.

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic musculoskeletal disorder that seriously affects quality of life. Patients with KOA frequently develop one or more of the following typical symptoms: joint pain, stiffness, joint friction noise and impaired functionality. Traditional Chinese medicine (TCM) has been shown to have a superior effect and a particular advantage in the treatment of KOA; among TCM, the Tong-luo Qu-tong plaster is the convenient and most commonly used method in China to improve symptoms including pain, stiffness and limited mobility in patients with KOA, as it causes few adverse effects. But there is a lack of high-quality clinical evidences to support the therapeutic effect that Chinese adhesive plaster can have in relieving pain and stiffness. The purpose of this study will be to evaluate the efficacy and safety of Tong-luo Qu-tong plaster in patients with KOA. METHODS/DESIGN: This study will be a randomized, double-blind, parallel positive controlled, multi-center clinical trial, a non-inferiority trial design was adopted. A total of 2000 participants older than 40 years, with KOA, will be randomly allocated into an experimental group (n = 1500) and a control group (n = 500). All participants will receive a conventional conservative treatment lasting for 14 days as two courses, once daily. Tong-luo Qu-tong plaster will be administered externally to participants in the experimental group, while the control group will receive a Qi-zheng Xiao-tong plaster. The outcome of the total Western Ontario and McMaster Universities Arthritis Index scores, TCM syndrome quantitative score and visual analog scale scores will be measured during the assessment visits (baseline and 1-week and 2-week follow up). In addition, adverse events related to clinical symptoms and signs and results of laboratory tests will be documented during the clinical trials. DISCUSSION: This study will provide reliable evidence of the effectiveness and safety of Tong-luo Qutong plaster in patients with KOA. If the results are favorable, it is expected that the patients with KOA will benefit from this study, many patients may have a good alternative treatment for KOA. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03309501 . Registered on 8 November 2017.

Riluzole promotes neurological function recovery and inhibits damage extension in rats following spinal cord injury: a meta-analysis and systematic review.

Spinal cord injury (SCI) is a devastating condition that has few treatment options. Riluzole, a sodium channel blocker used to treat amyotrophic lateral sclerosis, has been initially trialed in human SCI. We performed a systematic review to critically assess the efficacy of riluzole in locomotor recovery and damage extension in SCI rat models, and the potential for clinical translation. PubMed, Embase, Cochrane Library, and Chinese databases were searched from their inception date to March 2018. Two reviewers independently selected animal studies that evaluated neurological recovery and lesion area following riluzole treatment in SCI rat models, extracted data and assessed methodological quality. Pairwise meta-analysis, subgroup analysis, and network meta-analysis were performed to assess the effects of riluzole on SCI. Ten eligible studies were included. Two studies had high methodological quality. Overall, the Basso, Beattie, and Bresnahan scores were increased in riluzole-treated animals versus controls, and effect sizes showed a gradual increase from the 1st (five studies, n = 104, mean difference = 1.24, 95% CI = 0.11 to 2.37, p = 0.03) to 6th week after treatment (five studies, n = 120, mean difference = 2.34, 95% CI = 1.26 to 3.42, p < 0.0001). Riluzole was associated with improved outcomes in the inclined plane test and the tissue preservation area. Subgroup analyses suggested an association of locomotor recovery with riluzole dose. Network meta-analysis showed that 5 mg/kg riluzole exhibited greater protection than 2.5 and 8 mg/kg riluzole. Collectively, this review suggests that riluzole has a protective effect on SCI, with good safety and a clear mechanism of action and may be suitable for future clinical trials or applications. However, animal results should be interpreted with caution given the known limitations in animal experimental design and methodological quality.

Cross-cultural adaptation of the Neck Pain and Disability Scale: a methodological systematic review.

BACKGROUND: Neck pain is a common and uncomfortable symptom, adversely affecting the work and life of those affected. The Neck Pain and Disability Scale (NPDS) is widely used in neck pain assessment. It has been cross-culturally adapted into several languages to extend its reach to non-English-speaking countries. The aim of this study was to comprehensively evaluate the translation procedures and measurement properties of cross-cultural adaptations of the NPDS. METHOD: We searched multiple databases, including PubMed, Embase, CINAHL, SciELO, PsycINFO, Medline, SinoMed, PsycINFO, Web of Science, and Scopus, using the keywords "Neck Pain and Disability Scale," "NPDS," "cross-cultural," and "translation". Cross-cultural adaptation and quality control of measurement properties of adaptation procedures were independently conducted by two reviewers in accordance with Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Quality Criteria for Psychometric Properties of Health Status Questionnaire. RESULTS: There are 15 adaptations of NPDS in 11 different languages with multiple versions in Korean, simplified Chinese and Turkish with 19 studies. In about half of these studies, forward and back translations were conducted. Specially, they mostly focus on the synthesis phase of the translations. Only the simplified-Chinese-2011 adaptation meets the standards of composition due to the existence of an expert committee. Internal consistency, reliability, and construct validity have been evaluated in most existing eligible articles. Half of these articles tested ceiling and floor effects, and only a few included agreement responsiveness and interpretability. CONCLUSION: The Italian (publication 1 and 2), Persian-Iranian, simplified-Chinese-2011, and Thai adaptations show better quality than others with regard to cross-cultural adaptation and measurement properties. Further studies should fully assess the measurement properties of the NPDS in the Dutch (publication 1 and 2), Hindi-Indian, Korean-2013, simplified-Chinese-2010, Turkish-2004, and Turkish-2007 adaptations.

[Mechanism of macrophage polarization on spinal cord injury].

Spinal cord injury is a serious trauma of the spinal and nervous system, local tissue destruction and microcirculation disturbance can lead to a more serious spinal cord injury and extensive necrosis of neurons. Spinal cord injury often accompany with Inflammation reaction producing a variety of cytokines and bioactive substances, result in macrophage polarization. M1 macrophages polarization are induced by IFN-γ, LPS, TNF-α and so on, it show the damage and proinflammatory effect. M2 macrophages polarization are caused by IL-4, IL-10, IL-13 and show the recovery and anti-inflammatory effect. However, clinical treatment after spinal cord injury is very limited, inhibition of proinflammatory and promotion of anti-inflammatory by regulating the M1 macrophages and M2 macrophages is a new direction for the treatment of spinal cord injury. The article will review different phenotype and function of macrophages after spinal cord injury.

Cross-cultural adaptation of Roland-Morris Disability Questionnaire needs to assess the measurement properties: a systematic review.

OBJECTIVE: To assess the cross-cultural adaptations of the Roland-Morris Disability Questionnaire (RMDQ). STUDY DESIGN AND SETTING: English and Chinese databases were searched through December 2017. Cross-cultural adaptation and measurement properties were evaluated using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Quality Criteria for Psychometric Properties of Health Status Questionnaire. RESULTS: Among 34 studies, there were 31 RMDQ adaptations for 26 different languages/cultures. In the cross-cultural adaptation process, few studies reported expert committees completely constituted (3/31), and only 10 studies completed the test of the prefinal version (10/31) due to insufficient sample sizes. As for the measurement properties, content validity (31/31) and construct validity (24/31) were assessed in most of the adaptations, whereas internal consistency (0/31), agreement (5/31), responsiveness (3/31), interpretability (6/31), and floor and ceiling effects (6/31) were not. CONCLUSION: The Hungarian and Moon's Korean adaptations were the highest quality translations. Where there were multiple adaptations for a language/culture, the Moon's Korean and Fan's simplified Chinese-Chinese Mainland adaptations are recommended over the other Korean or simplified Chinese-Chinese Mainland adaptations. Further studies are required to fully assess the measurement properties of the Arabic-Moroccan, Arabic-Tunisian, German-Austrian, Greek, Gujarati, Kim's Korean, Persian-Iranian, Polish, He's simplified Chinese-Chinese Mainland, Spanish, Spanish-Chilean, Thai, traditional Chinese-Taiwan, and Turkish adaptations of the RMDQ.

Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: Cross-cultural Adaptation, Reliability, and Validity for Patients With Low Back Pain.

STUDY DESIGN: Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. OBJECTIVE: The aim of this study was to translate and adapt the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) into a simplified Chinese version, and assess its reliability and validity. SUMMARY OF BACKGROUND DATA: No simplified Chinese version of the JOABPEQ was previously available. METHODS: We translated and culturally adapted the original English JOABPEQ to develop a Chinese version, based on cross-cultural adaptation guidelines. Principal component analysis with varimax rotation was used to confirm the factor structure of each subscale. Internal consistency was evaluated with Cronbach alpha. Test-retest reliability was examined in stable patients, who completed the questionnaire again at 4 days to 2 weeks from baseline. The validity of the translated Chinese version was assessed by examining the relationship between the JOABPEQ and Chinese versions of the Roland-Morris Disability Questionnaire (RMDQ), the Oswestry Disability Index (ODI), the Short Form Health Survey (SF-36), and the Numerical Pain Rating Scale. Ceiling and floor effects were considered present if more than 15% of respondents achieved the lowest or highest possible total score. RESULTS: The JOABPEQ showed excellent internal consistency (α = 0.886). The test-retest reliability (intraclass correlation coefficients) ranged from 0.951 to 0.977. The convergent validity of the Chinese version was supported by its high correlation with other physical functional status measures (RMDQ, ODI, and SF-36 Physical Function; r values from -0.645 to -0.726), and moderate correlation with other measures (SF-36 Bodily pain and Social functioning subscales; r values 0.426-0.546). Q5 Mental health was highly correlated with SF-36 items (r values 0.337-0.640). There was a floor effect in Q1 low back pain (38, 20.65%). CONCLUSION: The results indicate that the simplified Chinese version of the JOABPEQ is a reliable and valid instrument to measure the multidimensional status in patients with low back pain. LEVEL OF EVIDENCE: 4.