Acupuncture, Nutritional Augmentation, and Physical Rehabilitation: Improving Recovery Following Spinal Fusion.

Spinal fusion is one of the most common procedures performed in spinal surgery. The increasing complexity and frequency with which this operation is performed has led to a rise in postoperative complications and delayed recovery. Perioperative care of patients with spinal conditions aims to adequately manage pain and accelerate the return to function following surgery. Traditional pharmaceutical interventions, especially opioid utilization, are associated with delayed recovery and significant adverse effects. As such, many studies are now evaluating the benefits and efficacy of non-pharmacological therapies for enhancing recovery after spinal fusion surgery. In this review, the mechanism of acupuncture relative to postoperative pain control and symptom reduction will be discussed. Additionally, this review examines the implications of malnutrition, current preclinical and clinical approaches for improving nutritional status, and various forms of physical rehabilitation that aim to combat postoperative complications and support recovery after spinal fusion surgery.

Treatment of Dissecting Vertebral Pseudoaneurysms: A Single-Center Experience.

Background: Dissecting vertebral artery pseudoaneurysms represent a unique clinical challenge with careful appreciation for location of the posterior inferior cerebellar artery. Limited data is available in terms of outcomes regarding the various treatment modalities. Methods: 11 patients with dissecting pseudoaneurysms were identified from 2013-2021. Pseudoaneurysm size and morphology, clinical presentation, and treatment approach was collected. Success of treatment was recorded based on post-operative imaging as well as documented overall patient outcomes. Three primary treatment modalities emerged: coil embolization, stent assisted coiling, and flow diversion. Results: Of the 11 patients, 5 were female and 6 were male with an age from 36 to 69.7. 7 had ruptured pseudoaneurysms at time of treatment. Size of pseudoaneurysm ranged from 3 to 6 mm. 8 were on the right and 3 were on the left vertebral artery. 8 were proximal to PICA and 3 were distal. Co-dominance of vertebral filling was seen in 5 patients, 5 with dominance through right vertebral artery, and 1 with dominance through left vertebral artery. Variability existed in treatment approaches with 4 patients undergoing coil occlusion, 5 patients undergoing flow diversion stenting, and 2 patients undergoing flow diversion stenting with jailed coiling. 1 patient had enlargement of pseudoaneurysm while inpatient and required a second flow diversion device. 1 patient had two flow diversion devices placed initially at time of treatment due to morphology of PA. 6 patients had repeat angiograms between 6 to 9 months with complete occlusion. 3 had CTA or MRA with complete occlusion for those that had flow diversion, they were transitioned from aspirin and clopidogrel to aspirin monotherapy after first repeat angiogram. 6 patients required shunt placement for hydrocephalus. 1 patient died prior to discharge due to sepsis. 2 patients died post discharge: 1 with myocardial infarction and the 2nd due to urosepsis.Dissecting vertebral pseudoaneurysm has high morbidity and mortality if rupture occurs. Location of PICA origin influences treatment approach. Patients with poor Hunt/Hess scores upon arrival had increased risk for systemic infection and mortality.

Epigenetics of Neurotrauma.

Epigenetic changes have been linked to a host of disease states. Besides the physiological function of epigenetic changes in regulating cellular function, recent data indicates that key changes in epigenetic activity also play an important pathophysiologic role following neurotrauma specifically. Such manifestations occur through the activation or silencing of different genes. Histone methylation has emerged as a critical component of this process and can be selectively modulated after injury. Pre-clinical studies have resulted in key discoveries regarding specific methylation sites of interest. This focused review highlights some of these early findings and their relationship to clinical outcomes. These findings suggest areas of future investigation and discovery in the quest to develop ideal biomarkers and methods to utilize them in developing therapeutic interventions.

Venous Outflow for Brain Arteriovenous Malformations: Overview and Treatment Implications.

Introduction: Recent evidence has demonstrated a close relationship between the cerebral venous and lymphatic systems. Venous congestion has been implicated in a host of neurologic disorders, with relevance for vascular etiologies. Objective: The authors aim to review the literature as it pertains to brain arteriovenous malformations' (BAVMs) venous hemodynamics and glymphatic pathways, as well as the implications of BAVM treatment. Results: BAVMs offer a unique challenge, with sudden alteration in flow dynamics leading to increased hemorrhage risk and difficult challenges post-treatment. Conclusion: Recent progress in the understanding of CNS fluid dynamics and glymphatic pathways have revealed important implications for BAVM pathology and treatment. As imaging techniques and treatment modalities advance, there is a need to further investigate this relationship as it relates to therapeutic options and post-treatment sequalae.

Microbiome and Neurotrauma: Emerging Innovations.

The gut-brain axis plays an important role in bidirectional communication that exists and can be altered by injury. Neurotrauma provides acute alteration in the GI tract and alters autonomic function. In this focused review, we highlight what is known about GI disruption following neurotrauma. We then delve into how this affects recovery. Areas of innovation and emerging pre-clinical results are addressed. Finally, we address the link between neurotrauma induced GI dysfunction and progression to neurodegenerative disease states.

Telemedicine visits in an established multidisciplinary central nervous system clinic for radiation oncology and neurosurgery (RADIANS) in a community hospital setting.

OBJECTIVE: To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic. METHODS: Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data. RESULTS: A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), women (9) and men (16), repeat telemedicine visits n=10, malignant CNS disease (17) and benign disease (5). Mean one-way distance traveled was 165.07 miles (median=114; range=0.8-358). Mean roundtrip travel time was estimated at 5h 5min. Mean telemedicine visit duration was 15.3 mins (range=4-46). Mean patient satisfaction score for telemedicine visits was 4.84. CONCLUSION: Patients who opted for the telemedicine visits found them just as effective as in-person visits, saving time and travel costs as well as ensuring patient safety during the current COVID-19 pandemic. The telemedicine visit platform facilitates the multidisciplinary clinic model and should be considered for more widespread utilization (Tab. 3, Fig. 1, Ref. 18).

Change in opioid and analgesic use for headaches after aneurysmal subarachnoid hemorrhage over time.

BACKGROUND: Severe headache, a hallmark of aneurysmal subarachnoid hemorrhage (aSAH), affects up to 90% of patients during hospitalization. Opioids remain the guideline recommended mainstay of acute therapy despite their significant side effects and potential for tolerance and addiction. We evaluated time trends in opioid prescriptions, hypothesizing a decline with increasing recognition of the opioid crisis. METHODS: We performed a retrospective review of patients with aSAH admitted to a single tertiary care center between 2012 and 2019 and included patients with Hunt-Hess-Grade≤3 who were able to verbalize pain scores. Collected variables included mean and maximum daily headache scores, aneurysm treatment modality, and daily analgesic medication doses. RESULTS: Of 340 patients with aSAH, 114 (86 from 2012-2016 and 28 from 2017-2019) were included. Of the included patients, 86/114 (75.4%) were female. Patients in the 2012-2016 had a median age of 55 compared to 63 in the 2017-2019 group (P=0.02). Otherwise, there was no significant difference in demographic data including time in hospital, treatment option utilized, or aneurysm characteristics. Maximal daily headache score ranged from 6 to 8 for 2012-2016 and 5 to 8 for 2017-2019 cohorts. Average oral morphine equivalents (in mg) administered during hospitalization were similar between groups (2012-2016: 251±345 95% CI [178,323]; 2017-2019: 207±237 95% CI [119,295]; P=0.319). When prescribed, doses of opioids provided at discharge were less in the more recent group (2012-2016: 84.4±78.9 95% CI [57.5, 111]; 2017-2019: 38.1±20.2 95% CI [33.7, 42.5]; P=0.004) CONCLUSION: Despite recognition of important drawbacks of opioid use for headache control, and efforts to reduce opioid use during hospitalization, we found that utilization during hospitalization for SAH did not decrease over time. Maximal headache scores remained similar in the studied time periods, indicative of insufficient pain relief. This points out a pressing need to further investigate alternative opioid and narcotic sparing strategies for patients with SAH.

Examining the Correlation between Acute Behavioral Manifestations of Concussion and the Underlying Pathophysiology of Chronic Traumatic Encephalopathy: A Pilot Study.

Concussion in athletes can contribute to early neuropsychological changes that may be indicative of future neurodegenerative disease. One of the hallmark findings of chronic traumatic encephalopathy is anxiety and impulsive behavior that often develops early in the course of the disease. The behavioral dysfunction can be grouped into a broader category referred to as cognitive disruption. The current gold standard for diagnosing chronic neurodegeneration is post-mortem evaluation of tauopathy to identify neurofibrillary tau tangles in neurons. Few studies, however, have looked at clinical correlations between acute injury and chronic neurodegeneration in terms of behavior. This lack of focus towards translational study has limited advancements towards treatment. In this pilot investigation, the acute cognitive and emotional (anger, impulsivity, and anxiety) affects of concussion in a cohort of collegiate athletes (n = 30) are examined and compared to findings in the post-mortem pathologic features of chronic traumatic encephalopathy. Specifically, the role of the seroternergic system with alpha synuclein and tauopathy staining and the potential for early clinically relevant behavioral and pharmaceutical interventions was investigated. The purpose was to determine if athletes began demonstrating cognitive disruption present in post-mortem evaluation during the acute phase of injury. The acute data was collected via questionnaires within ten days of the athletes' concussion diagnosis. Results demonstrated that 11 of 30 athletes (36%) scored in a diagnosable range of anxiety post-concussion, and athletes scored above the norm in state-anger (M = 22.9, SD = 9.99), indicating severe emotional disturbance. A limitation is that due to the long time frame from acute injury to the development of neurodegeneration individual athletes cannot be tracked in longevity thus limiting the findings to the realm of correlation. The findings from this pilot study warrant further investigation into the neuropsychological aspects for how to manage concussion and prevent degenerative disease.

Changes from 1986 to 2006 in reasons for liking leisure-time physical activity among adolescents.

Reasons for participating in physical activity (PA) may have changed in accordance with the general modernization of society. The aim is to examine changes in self-reported reasons for liking leisure-time physical activity (LTPA) and their association with self-reported LTPA over a 20-year period. Data were collected among nationally representative samples of 13-year-olds in Finland, Norway, and Wales in 1986 and 2006 (N = 9252) as part of the WHO cross-national Health Behaviour in School-aged Children (HBSC) study. Univariate ANOVAs to establish differences according to gender, year, and country were conducted. In all countries, 13-year-olds in 2006 tended to report higher importance in terms of achievement and social reasons than their counterparts in 1986, while changes in health reasons were minor. These reasons were associated with LTPA in a similar way at both time points. Health reasons for liking LTPA were considered most important, and were the strongest predictor of LTPA. The findings seem robust as they were consistent across countries and genders. Health education constitutes the most viable strategy for promoting adolescents' motivation for PA, and interventions and educational efforts could be improved by an increased focus on LTPA and sport as a social activity.

Evaluation of the Coaches Educators training implementation of the PAPA project: A comparison between Norway and France.

This study cross-culturally compares the implementation process of the Empowering Coaching™ training program to grassroots coaches (GCs) by trained Coach Educators (CEs) from the Promoting Adolescent Physical Activity project in Norway and France. This program targets children's health through coach training to create a more positive environment. Using the RE-AIM framework, indicators of implementation processes at staff level were defined for adoption, implementation, and maintenance. CEs (n = 18) were interviewed about their professional use of the training, and video-filmed delivering the intervention trial workshops. GCs (n = 185) responded to a questionnaire after the workshops. Results showed that CEs were keen to participate in this project (16/18; 89%), to stay involved (12/16; 75%), and to diffuse the principles after the research project (12/12; 100%). CE training seemed effective as results indicated that CEs applied the principles of the program during the workshops and covered a high degree of the content (78%). Cross-cultural differences were found as the French Football Federation CE dropped out of the program, as Norwegian CEs delivered the content with higher fidelity and had higher enjoyment and pace scores than French CEs. More indicators are needed to use the RE-AIM framework for cross-cultural comparison.

Socio-behavioural predictors of young adults' self-reported oral health: 15 years of follow-up in the The Norwegian Longitudinal Health Behaviour study.

OBJECTIVES: Few prospective studies have investigated the impacts of socio-behavioural position throughout adolescence on self-reported oral health in young adulthood. This study aimed to describe the development of oral health behaviours between age 15 years (1992) and age 30 years (2007) and to assess how changes in or stability of socio-behavioural characteristics during that period influences the oral impacts on daily performance (OIDP) and satisfaction with teeth assessed at age 30. METHODS: Self-administered questionnaires were included as part of a prospective cohort study. In 1992, a representative sample of 963 15-year-old adolescents participated in the study; 627 (64%) and 532 (55.2%) remained in the study at ages 23 and 30, respectively. A total of 394 (40.9% of baseline sample) participated at ages 15, 23 and 30. RESULTS: Cochrane's Q revealed that the proportions of individuals who were frequent performers regarding flossing, intake of nonsugared mineral water and use of snuff increased whereas the proportions who were frequent performers regarding consumption of sugared mineral water decreased in subjects with low and high parental education and in both sexes across the survey period. Smokers increased in males and decreased in females and in subjects with low parental education. Spearman's rank-order correlation ranged from 0.19 (nonsugared mineral water) to 0.36 (smoking). Multiple logistic regression analysis showed that participants with a stable advantaged socio-behavioural position were less likely to report OIDP at age 30. Participants with a stable disadvantaged socio-behavioural position were more likely to report OIDP at age 30. Participants who were stable satisfied with their health and who changed educational status were more likely to be satisfied with their teeth at age 30. CONCLUSIONS: Oral health behaviours tracked moderately from age 15 to 30. Continuity of an advantaged or disadvantaged socio-behavioural position across the survey years contributed to differing levels of oral health. Early and contemporary public health policies that target disadvantaged socio-behavioural groups may help prevent poor oral health perceptions in young adults in Norway.

Organized youth sport as a predictor of physical activity in adulthood.

The aim of this study was to examine whether early and sustained organized youth sport during childhood and adolescence predicts the frequency of leisure-time physical activity (PA) at age 23 years. A 10-year longitudinal study of 630 adolescents was conducted. Data were collected from these participants eight times from the ages of 13 to 23 years and were analyzed by analysis of variance and regression. There was a high degree of consistency in participation in organized youth sport in terms of reporting to be a member of a sports club, especially from age 13 to 16 years. The correlation coefficients tended to be higher among males and decreased over time both in females and males. The age at becoming a member in organized sport and duration of participation in organized youth sports during adolescence predicted 9% of the variance of young adult PA. The correlations were higher in males than in females, but these differences were not significant. Organized youth sports during childhood and adolescence was positively related to frequency of leisure-time PA in young adulthood. Joining organized youth sports at an early age and continuing through adolescence appear to increase the likelihood for a physically active lifestyle in young adulthood.

[Psychological and somatic complaints among adolescents]. / Psykiske og somatiske plager blant ungdom.

BACKGROUND: Health promotion and disease prevention among adolescents should include efforts to reduce the burden of health complaints. In order to develop systematic preventive approaches, epidemiological research is needed. This study focuses on prevalence, gender differences, and intercorrelations among such complaints. MATERIAL AND METHODS: The data were drawn from a nationwide (Norwegian) survey among pupils in compulsory school grades 6, 8, and 10 (age 11, 13, and 15); response rate 79%. RESULTS: Among 15-year-olds, most health complaints were more prevalent among girls than among boys. A principal components analysis revealed a dimension from primarily psychological to primarily somatic complaints. Among 15-year-olds, 18% reported at least one daily psychological complaint and 14% reported at least one daily somatic complaint. Sum-scores for psychological and somatic complaints were constructed, the intercorrelation being 0.56 among 15-year-olds. Girls scored significantly higher than boys on both sum-scores. Among girls there was a marked increase in scores with age (particularly for somatic complaints). INTERPRETATION: The high prevalence of complaints among both genders and the increase with age among girls implies that preventive action is needed. The intercorrelations among complaints indicate common etiological processes.

Oxygen-mediated regulation of skeletal muscle satellite cell proliferation and adipogenesis in culture.

Major problems in stem cell biology revolve around defining the developmental potential of cell populations and understanding how their potential is maintained or progressively restricted. Oxygen (O(2)) is an obvious environmental factor which has received little attention in culturing skeletal muscle progenitor cells. In this work, we examine the effects of O(2) levels on the developmental potential, proliferative capacity, and phenotype of the adult skeletal muscle fiber progenitor population (satellite cells), and cell lines that model multipotential embryonic paraxial mesoderm from which skeletal muscle develops. Both satellite cell proliferation and survival of mature fibers increased in physiologic (6%) O(2) vs. non-physiologic 20% O(2) used in virtually all traditional cell culture. Six percent O(2) conditions also accelerated the up-regulation of multiple MyoD family myogenic regulatory factors (MRFs). An unexpected finding was that fiber-adherent satellite cells could assume a non-myogenic phenotype. By the criteria of molecular markers and gross lipid accumulation, satellite cells were found to assume an adipocyte phenotype, and did so more prominently in 20% O(2) than in physiologic O(2). Selection of the adipogenic fate and execution of adipogenesis by multipotential mesenchymal cell lines was also dramatically higher in traditional 20 vs. 6% O(2), and decreased adipogenesis in physiologic O(2) was associated with significantly less expression of the adipogenic regulator, PPAR gamma. These results suggest that regulatory pathways affected by O(2) are important for satellite cell proliferation, execution of cell fate, and parent muscle survival in culture, and so may play a role in vivo under normal or pathologic conditions.

Subjective health complaints in adolescence--reliability and validity of survey methods.

This paper studies test-retest reliability and validity of one measure of adolescent health complaints. The test-retest included an eight-item symptom checklist developed for the survey of Health Behaviour in School-aged Children (n=344). Qualitative analysis showed adequate validity for most items. For the total sample, all items were found to have adequate intraclass correlation coefficients (ICC) in the range 0.61-0.75. There were inter-item differences and girls generally received the higher values. Most changes were within one category. Adolescents' understanding of 16 complaints was studied by interviews with 38 adolescents. A few items showed ambiguity in interviews despite adequate test-retest stability.

Sense of coherence and school-related stress as predictors of subjective health complaints in early adolescence: interactive, indirect or direct relationships?

The role of sense of coherence (SOC) on the relationship between adolescent school-related stress and subjective health complaints was tested with structural equation modelling. As part of the crossnational WHO-survey 'Health behaviour in school-aged children 1997/98' Norwegian representative samples of 1592 grade 6, 1534 grade 8, and 1605 grade 10 students completed measures on SOC, school-related stress and subjective health complaints. A test of nested structural models revealed that both stress-preventive (delta chi2 814. 86, p<0.001), stress-moderating (delta chi2 11.74, p<0.02) and main health-enhancing (delta chi2 1289.1, p < 0.001) effects of SOC were consistent with the data. A model including all these relationships fitted the data well (CFI = 0.91, RMSEA = 0.04). Age-group comparisons revealed that the association between SOC and stress grew weaker with age (p<0.05), whereas the direct association between SOC and health complaints grew stronger (p<0.001). The main effect of SOC accounted for between 39% (11 year olds) and 54% (15 year olds) of the variance in subjective health complaints. Findings indicate that SOC may potentially be a salutogenic factor in adolescents' adaptation to school-related stress, and that relationships between SOC and healthy adaptation, may be evident in younger age-groups than previously anticipated.

Subjective health complaints in adolescence. A cross-national comparison of prevalence and dimensionality.

BACKGROUND: The purpose of this work was to study the prevalence and dimensionality of subjective health complaints in a cross-national population of adolescents. METHODS: The analyses were based on data from a WHO cross-national survey, Health Behaviour in School-aged Children (HBSC). The study included a representative sample of 11, 13 and 15-year-old adolescents from Finland, Norway, Poland and Scotland. Data were collected in 1993-1994 and the total sample included 20,324 adolescents. Subjective health complaints were measured by the HBSC Symptom Checklist (HBSC-SCL), including headaches, abdominal pain, backache, feeling low, irritability, nervousness, sleeping difficulties and dizziness. Descriptive analyses, MANOVA and structural equation modelling (EQS) were conducted. RESULTS: Patterns of reporting were consistent for all four countries. A large number of students reported a high level of symptoms. The reporting of most symptoms increased with age. Girls reported significantly more symptoms than boys and the gender differences also increased with age. Structural equation modelling suggests a model of two correlated factors, which can be labelled psychological and somatic. CONCLUSION: The findings of this study indicate that students report a high level of subjective health complaints already at the age of 11 years. The reporting of most symptoms increases with age and more so for girls than for boys. The finding of two dimensions that differ qualitatively, suggests that these dimensions may have different etiologies.

School-related stress, support, and subjective health complaints among early adolescents: a multilevel approach.

This study investigated the relationship between shared psychosocial school environment and subjective health complaints. A representative sample of 1585 Norwegian grade 8 students (mean age 13.5 years) from 82 schoolclasses completed scales on health complaints, academic stress, the teacher and classmate support scale, decision control, and noise and disturbance in class. Multilevel analysis (MlwiN) revealed that level of health complaints varied across schoolclasses (ICC=5.6%). School class differences in psychosocial environment accounted for 40% of the between-schoolclass variance in health complaints. Tests of cross-level interaction showed a statistically significant interaction between mean schoolclass-level of classmate support and individual level of academic stress. Findings suggest that shared schoolclass contextual factors may have main and stress-moderating effects on adolescent health complaints.

Ligation-mediated PCR for genomic sequencing and footprinting.

This unit describes how PCR can be used to exponentially amplify segments of DNA located between two specified primer hybridization sites. A single-sided PCR method is used that initially requires specification of only one primer hybridization site; the second is defined by the ligation-based addition of a unique DNA linker. This linker, together with the flanking gene-specific primer, allows exponential amplification of any fragment of DNA. Because a defined, discrete-length sequence is added to every fragment, complex populations of DNA such as sequence ladders can be amplified intact with retention of single-base resolution. The ligation-based protocol was specifically designed for genomic footprinting and direct sequencing reactions, and is described in this context; it can, however, be used for other applications.