Following spinal cord injury, astrocyte proliferation and scar formation are the main factors inhibiting the regeneration and growth of spinal cord axons, leading to motor and sensory function loss below the level of spinal cord injury.
Cell transplantation, bioengineering technology, drugs and other methods can reduce voids of injured spinal cord and suppress glial scar formation, but clinical application results show these methods used alone have no obvious effects. http://fortalent.com/blog/view/s/2014-02-03-face-masks-skin-care/
Liang Wu and
colleagues from Capital Medical University used rat models of T8 spinal cord contusion, which were subjected to combined transplantation of bone morphogenetic protein-4-induced glial-restricted precursor-derived astrocytes and human recombinant decorin transplantation.
This combined transplantation promoted axonal regeneration and growth of injured motor and sensory neurons by inhibiting astrocyte proliferation and glial scar formation, with astrocytes forming a linear arrangement in the contused spinal cord, thus providing axonal regeneration channels.
This combined transplantation provides a potential new therapy for experimental research and clinical transformation for the repair of spinal cord injury.
These findings were published in the Neural Regeneration Research (Vol. 8, No. 24, 2013).
Sunday, February 9, 2014
Analysis suggests saline shots may do just as well as steroids for lower back pain
New research from Johns Hopkins suggests that it may not be the steroids in spinal shots that provide relief from lower back pain, but the mere introduction of any of a number of fluids, such as anesthetics and saline, to the space around the spinal cord.
For decades, epidural steroid injections have been the most common nonsurgical treatment for lower back pain even though extensive research shows mixed results. Placebo-controlled studies have found benefit only 60 percent of the time and it remains unclear whether the epidural steroids provide long-term pain control or reduce the need for surgery. Meanwhile, experts warn, steroids are a less-than-ideal treatment for some as they can raise blood sugar in diabetic back patients, slow wound healing in those who need surgery and accelerate bone disease in older women. http://fortalent.com/blog/view/s/2014-02-03-tips-for-disposing-of-grease-from-your-face/
In a bid to lend some clarity, Johns Hopkins anesthesiologist Steven P. Cohen, M.D., and his colleagues reviewed dozens of published studies on the subject. As expected, they found that epidural steroid shots were more than twice as likely to bring relief as injections of steroids, saline or a local anesthetic like Lidocaine into muscle near the spinal canal. What was less expected, they report in the October issue of the journal Anesthesiology, was that epidural injections of any kind were also twice as good as intramuscular injections of steroids.
"Just injecting liquid into the epidural space appears to work," says Cohen, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "This shows us that most of the relief may not be from the steroid, which everyone worries about."
Cohen says concerns increased in 2012 when more than 740 people in 20 states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids made by a compounding pharmacy. Although better oversight might allay that concern, Cohen notes that patients can only get a limited number of steroid injections each year, even if their pain returns.
Cohen and Mark C. Bicket, M.D., an anesthesiology and critical care medicine chief resident at The Johns Hopkins Hospital, say it is too soon to recommend that patients stop receiving epidural steroids, but add that their analysis also suggests that smaller steroid doses can be just as beneficial. Larger studies are needed, they say, to determine whether steroid alternatives can be just as helpful for back pain patients.
"Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable," says Bicket, the study's first author.
Spinal pain is a leading cause of disability in the industrialized world, with lifetime prevalence for lower back pain ranging from 50 to 80 percent. Epidural steroid injections have been the standard treatment for debilitating back pain for over 50 years.
The Johns Hopkins review covered medical records of 3,641 patients from 43 studies conducted through October 2012. The studies compared epidural steroid injections to other sorts of epidural and intramuscular injections.
Cohen says his new analysis suggests that decades of mixed results of research on epidural steroid injections may have been due to the use of saline or anesthetic injections as the comparison "placebo" treatment. "It's likely that those studies were actually comparing two treatments, rather than placebo versus treatment," he says. "Researchers may be wasting millions of dollars and precious time on such studies."
For decades, epidural steroid injections have been the most common nonsurgical treatment for lower back pain even though extensive research shows mixed results. Placebo-controlled studies have found benefit only 60 percent of the time and it remains unclear whether the epidural steroids provide long-term pain control or reduce the need for surgery. Meanwhile, experts warn, steroids are a less-than-ideal treatment for some as they can raise blood sugar in diabetic back patients, slow wound healing in those who need surgery and accelerate bone disease in older women. http://fortalent.com/blog/view/s/2014-02-03-tips-for-disposing-of-grease-from-your-face/
In a bid to lend some clarity, Johns Hopkins anesthesiologist Steven P. Cohen, M.D., and his colleagues reviewed dozens of published studies on the subject. As expected, they found that epidural steroid shots were more than twice as likely to bring relief as injections of steroids, saline or a local anesthetic like Lidocaine into muscle near the spinal canal. What was less expected, they report in the October issue of the journal Anesthesiology, was that epidural injections of any kind were also twice as good as intramuscular injections of steroids.
"Just injecting liquid into the epidural space appears to work," says Cohen, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "This shows us that most of the relief may not be from the steroid, which everyone worries about."
Cohen says concerns increased in 2012 when more than 740 people in 20 states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids made by a compounding pharmacy. Although better oversight might allay that concern, Cohen notes that patients can only get a limited number of steroid injections each year, even if their pain returns.
Cohen and Mark C. Bicket, M.D., an anesthesiology and critical care medicine chief resident at The Johns Hopkins Hospital, say it is too soon to recommend that patients stop receiving epidural steroids, but add that their analysis also suggests that smaller steroid doses can be just as beneficial. Larger studies are needed, they say, to determine whether steroid alternatives can be just as helpful for back pain patients.
"Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable," says Bicket, the study's first author.
Spinal pain is a leading cause of disability in the industrialized world, with lifetime prevalence for lower back pain ranging from 50 to 80 percent. Epidural steroid injections have been the standard treatment for debilitating back pain for over 50 years.
The Johns Hopkins review covered medical records of 3,641 patients from 43 studies conducted through October 2012. The studies compared epidural steroid injections to other sorts of epidural and intramuscular injections.
Cohen says his new analysis suggests that decades of mixed results of research on epidural steroid injections may have been due to the use of saline or anesthetic injections as the comparison "placebo" treatment. "It's likely that those studies were actually comparing two treatments, rather than placebo versus treatment," he says. "Researchers may be wasting millions of dollars and precious time on such studies."
Brain abnormality 'predictor of chronic pain'
Scientists say that people who have a certain abnormality in their brain structure are more likely to develop chronic pain following a lower back injury, according to a study published in the journal Pain.
Researchers from the Northwestern University Feinberg School of Medicine say their findings may initiate changes to the way physicians treat patients for pain.
In their study, the researchers were able to identify a "specific irregularity" or "marker" in the axons of the brain. http://skincareprogram.soup.io/post/396174658/Erase-Eye-Wrinkles
These are pathways in the brain's white matter that connect brain cells, allowing them to communicate. Some of the axons surround the nucleus accumbens and medial prefrontal cortex. These are two areas of the brain responsible for processing emotion and pain.
The researchers say that the "marker" allowed them to predict patients' persistent back pain with up to 85% accuracy.
Previous research from the team showed that the psychological properties of these two regions can identify which patients will suffer persistent back pain. However, the researchers say that this new study reveals a "pre-existing culprit" for these psychological responses to injury.
Brain irregularities 'trigger vulnerability to pain'
For the study, the researchers conducted MRI scans on 46 patients who had developed a lower back injury within the past 4 weeks, and who had not experienced any back pain in the previous year.
In order for the participants to continue in the study, they had to report a minimum of 5 out of 10 on a pain scale. These patients were then followed for a year.
MRI scans were taken again at the baseline of the study and then again at the end.
After the 1-year follow-up period, around 50% of the patients showed improvements in their back pain, regardless of whether they took anything to treat it.
However, patients who were experiencing persistent back pain showed the same structural abnormality "markers" in their white matter, both at the onset of injury and 1 year later.
A. Vania Apkarian, professor of psychology at Northwestern University Feinburg School of Medicine and senior author of the study, explains:
"The abnormality makes them vulnerable and predisposes them to enhanced emotional learning that then amplifies the pain and makes it more emotionally significant.
We've found the pain is triggered by these irregularities in the brain. We've shown abnormalities in brain structure connections may be enough to push someone to develop chronic pain once they have an injury."
Research may 'reduce burden' of chronic pain in US
According to the researchers, almost 100 million Americans suffer from chronic pain, and the illness is one of the most expensive health care conditions to treat, costing up to $635 billion a year.
"Pain is becoming an enormous burden on the public. The US government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research," says Linda Porter, pain and policy advisor at the National Institute of Neurological Disorders and Stroke (NINDS) and leader of the National Institutes of Health (NIH) Pain Consortium, which funded the study.
"This study is a good example of the kind of innovative research we hope will reduce chronic pain, which affects a huge portion of the population."
Researchers from the Northwestern University Feinberg School of Medicine say their findings may initiate changes to the way physicians treat patients for pain.
In their study, the researchers were able to identify a "specific irregularity" or "marker" in the axons of the brain. http://skincareprogram.soup.io/post/396174658/Erase-Eye-Wrinkles
These are pathways in the brain's white matter that connect brain cells, allowing them to communicate. Some of the axons surround the nucleus accumbens and medial prefrontal cortex. These are two areas of the brain responsible for processing emotion and pain.
The researchers say that the "marker" allowed them to predict patients' persistent back pain with up to 85% accuracy.
Previous research from the team showed that the psychological properties of these two regions can identify which patients will suffer persistent back pain. However, the researchers say that this new study reveals a "pre-existing culprit" for these psychological responses to injury.
Brain irregularities 'trigger vulnerability to pain'
For the study, the researchers conducted MRI scans on 46 patients who had developed a lower back injury within the past 4 weeks, and who had not experienced any back pain in the previous year.
In order for the participants to continue in the study, they had to report a minimum of 5 out of 10 on a pain scale. These patients were then followed for a year.
MRI scans were taken again at the baseline of the study and then again at the end.
After the 1-year follow-up period, around 50% of the patients showed improvements in their back pain, regardless of whether they took anything to treat it.
However, patients who were experiencing persistent back pain showed the same structural abnormality "markers" in their white matter, both at the onset of injury and 1 year later.
A. Vania Apkarian, professor of psychology at Northwestern University Feinburg School of Medicine and senior author of the study, explains:
"The abnormality makes them vulnerable and predisposes them to enhanced emotional learning that then amplifies the pain and makes it more emotionally significant.
We've found the pain is triggered by these irregularities in the brain. We've shown abnormalities in brain structure connections may be enough to push someone to develop chronic pain once they have an injury."
Research may 'reduce burden' of chronic pain in US
According to the researchers, almost 100 million Americans suffer from chronic pain, and the illness is one of the most expensive health care conditions to treat, costing up to $635 billion a year.
"Pain is becoming an enormous burden on the public. The US government recently outlined steps to reduce the future burden of pain through broad-ranging efforts, including enhanced research," says Linda Porter, pain and policy advisor at the National Institute of Neurological Disorders and Stroke (NINDS) and leader of the National Institutes of Health (NIH) Pain Consortium, which funded the study.
"This study is a good example of the kind of innovative research we hope will reduce chronic pain, which affects a huge portion of the population."
Bracing 'effective in reducing adolescent scoliosis'
Scientists say that the use of bracing in adolescents suffering from idiopathic scoliosis may reduce the risk of the condition progressing to the point that surgery is needed.
Scoliosis is a condition in which the spine abnormally curves to the right or left. When it occurrs in a child or teen, the condition is referred to as adolescent idiopathic scoliosis (AIS).
It is unknown what causes the disorder, but severe cases of the condition, if untreated, may cause pain and disability, particularly if a child is still growing.
According to the National Scoliosis Foundation, scoliosis affects approximately 6 million people of all age groups in the US. There is no cure for the disorder, but bracing is the usual treatment for children and adolescents with a spine curvature of between 25-40 degrees. http://storify.com/maxwellrebecca/peeling-skin-naturally-combination-skin-tips
However, the researchers say that while this is the preferred treatment for AIS, evidence regarding its impact has been inconclusive.
For the study, published in The New England Journal of Medicine, researchers from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) wanted to compare the risk of curve progression in adolescents with AIS who wore a brace, and those who did not.
The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health.
The research team analyzed 242 patients aged 10-15-years, from 25 institutions in the US and Canada between 2007 and 2011. Patients were recruited who were at high risk for continued worsening of their curved spines, based on their age, skeletal immaturity and the severity of their curvature.
The study originally began as a randomized study, the researchers say, but they later added a "preference cohort," meaning that the patients and their families were able to choose their own treatments.
Of the 242 patients included, 116 were randomly assigned to either bracing or observation - where they received no specific treatment. The other 126 chose between bracing and observation.
Patients in the bracing group were required to wear them 18 hours a day. The researchers defined the treatment as unsuccessful when a patient's curve progressed to 50 degrees or more.
This is a point at which surgery is usually recommended. If a child reached "skeletal maturity" with a spinal curve less than 50 degrees, the treatment was classed as successful.
Bracing 'significantly reduces progression of AIS'
The researchers say that in January 2013, the trial was stopped early due to the signifiant success the braces had on reducing the risk of curve progression and the need for surgery.
Of patients who wore braces, 72% were defined as having successful treatment. Furthermore, it was found that the more hours the patients wore the braces, the better the success rate. Wearing a brace for more than an average of 13 hours a day was linked to a 90-93% success rate.
Stuart Weinstein, of the University of Iowa and lead study author, says:
"This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS - to brace or not to brace. Now we can say with confidence that bracing prevents the need for surgery."
The researchers also report that 48% of patients in the observation group showed successful outcomes, as well as 41% of patients in the bracing group who wore the braces infrequently.
The study authors note that, as others have suggested, current bracing indications may be too broad, resulting in unnecessary treatment for many patients.
They add:
"It is important to identify patients at high risk for clinically significant curve progression who are also most likely to benefit from bracing."
Last year, Medical News Today reported a study that showed how magnetically controlled growing rods may be successful in treating scoliosis in children.
Scoliosis is a condition in which the spine abnormally curves to the right or left. When it occurrs in a child or teen, the condition is referred to as adolescent idiopathic scoliosis (AIS).
It is unknown what causes the disorder, but severe cases of the condition, if untreated, may cause pain and disability, particularly if a child is still growing.
According to the National Scoliosis Foundation, scoliosis affects approximately 6 million people of all age groups in the US. There is no cure for the disorder, but bracing is the usual treatment for children and adolescents with a spine curvature of between 25-40 degrees. http://storify.com/maxwellrebecca/peeling-skin-naturally-combination-skin-tips
However, the researchers say that while this is the preferred treatment for AIS, evidence regarding its impact has been inconclusive.
For the study, published in The New England Journal of Medicine, researchers from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) wanted to compare the risk of curve progression in adolescents with AIS who wore a brace, and those who did not.
The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health.
The research team analyzed 242 patients aged 10-15-years, from 25 institutions in the US and Canada between 2007 and 2011. Patients were recruited who were at high risk for continued worsening of their curved spines, based on their age, skeletal immaturity and the severity of their curvature.
The study originally began as a randomized study, the researchers say, but they later added a "preference cohort," meaning that the patients and their families were able to choose their own treatments.
Of the 242 patients included, 116 were randomly assigned to either bracing or observation - where they received no specific treatment. The other 126 chose between bracing and observation.
Patients in the bracing group were required to wear them 18 hours a day. The researchers defined the treatment as unsuccessful when a patient's curve progressed to 50 degrees or more.
This is a point at which surgery is usually recommended. If a child reached "skeletal maturity" with a spinal curve less than 50 degrees, the treatment was classed as successful.
Bracing 'significantly reduces progression of AIS'
The researchers say that in January 2013, the trial was stopped early due to the signifiant success the braces had on reducing the risk of curve progression and the need for surgery.
Of patients who wore braces, 72% were defined as having successful treatment. Furthermore, it was found that the more hours the patients wore the braces, the better the success rate. Wearing a brace for more than an average of 13 hours a day was linked to a 90-93% success rate.
Stuart Weinstein, of the University of Iowa and lead study author, says:
"This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS - to brace or not to brace. Now we can say with confidence that bracing prevents the need for surgery."
The researchers also report that 48% of patients in the observation group showed successful outcomes, as well as 41% of patients in the bracing group who wore the braces infrequently.
The study authors note that, as others have suggested, current bracing indications may be too broad, resulting in unnecessary treatment for many patients.
They add:
"It is important to identify patients at high risk for clinically significant curve progression who are also most likely to benefit from bracing."
Last year, Medical News Today reported a study that showed how magnetically controlled growing rods may be successful in treating scoliosis in children.
UCB receives CHMP positive opinion for Cimzia
UCB has announced that the European Medicines Agency's (EMA's) Committee for Medicinal Products for Human Use (CHMP) has adopted a positive opinion recommending extending the European Union marketing authorization for the use of Cimzia® (certolizumab pegol) in the treatment of adult patients with severe active axial spondyloarthritis (axSpA).
AxSpA is a form of spondyloarthritis that affects mainly the spine and sacroiliac joints, and comprises both ankylosing spondylitis (AS) and axSpA without X ray evidence of AS (non-radiographic axSpA [nr-axSpA]) sub-groups.[1] An approval for adult patients living with severe active axial spondyloarthritis would represent the second indication for Cimzia in countries of the European Union. In general, the European Commission follows the recommendations of the CHMP and usually delivers its final decision within two months of the CHMP recommendation. http://fortalent.com/blog/view/s/2014-02-03-tips-for-disposing-of-grease-from-your-face/
"The CHMP positive opinion is an important milestone since people living with severe active axSpA in Europe may soon have a new treatment option whether or not they have X ray evidence of structural damage to their sacroiliac joints," said Professor Dr. Iris Loew-Friedrich, Chief Medical Officer and Executive Vice President, UCB.
"This is particularly important for patients living with axial spondyloarthritis without radiographic evidence of AS, whose symptoms may be just as debilitating as those with AS but for whom treatment options are currently limited."
The positive opinion for severe active axSpA comprising AS and axSpA without radiographic evidence of AS follows the EMA's review of data from the RAPID™-axSpA study which was the first randomized, controlled, Phase 3 study of an anti-TNF to enroll both AS and axSpA without radiographic evidence of AS patients.2 The study is an on-going, Phase 3, multicenter, randomized, double-blind, placebo-controlled trial that was designed to evaluate the efficacy and safety of certolizumab pegol in patients with active axSpA.[3] The primary endpoint of the RAPIDT™-axSpA study was ASAS20 at week 12, and was achieved with clinical and statistically significant improvements in ASAS20 responses in both dosing arms (200 mg every 2 weeks and 400 mg every 4 weeks) vs. placebo (p≤0.004).[2] The safety profile for axial spondyloarthritis patients treated with certolizumab pegol was consistent with the safety profile of certolizumab pegol reported in rheumatoid arthritis trials.[2]
In the European Union, certolizumab pegol is approved in combination with methotrexate (MTX) for the treatment of moderate to severe active rheumatoid arthritis in adult patients inadequately responsive to disease-modifying anti-rheumatic drugs, including MTX. Certolizumab pegol can be given as monotherapy in case of intolerance to MTX or when continued treatment with MTX is inappropriate.[4]
Ads by Google
How To Self-Publish - Download a Free Author's Guide and Learn How to Publish Your Book. - www.friesenpress.com/How-to-Publish
Worst Food For Joint Pain - Renowned Doctor Reveals The Worst Food for Joint Inflammation - medixselect.com
Discount Self-Load Moving - Cheaper Than Driving Yourself. Fuel & Tolls Included in Price. - www.upack.com/ABF
The EMA is currently reviewing another filing for certolizumab pegol in the treatment of adult patients with active psoriatic arthritis. In the US, both PsA and axSpA filings are currently under review by the US Food and Drug Administration (FDA).
About RAPID™-axSpA study[3]
The RAPID™-axSpA study is an ongoing Phase 3, multicenter, randomized, double-blind, placebo-controlled study designed to evaluate the efficacy and safety of certolizumab pegol in patients with active axSpA. Patients (n=325) were randomized 1:1:1 to placebo, or 400 mg certolizumab pegol at week 0, 2 and 4 loading dose followed by either 200 mg certolizumab pegol every two weeks or 400 mg certolizumab pegol every four weeks. Patients enrolled in the study must have active disease and failed at least one non-steroidal anti-inflammatory drug (NSAID). Within the placebo arm, patients who failed to achieve an ASAS20 response at weeks 14 and 16 were re-randomized at week 16 to receive certolizumab pegol 200 mg every 2 weeks or 400 mg every 4 weeks, following the loading dose.
AxSpA is a form of spondyloarthritis that affects mainly the spine and sacroiliac joints, and comprises both ankylosing spondylitis (AS) and axSpA without X ray evidence of AS (non-radiographic axSpA [nr-axSpA]) sub-groups.[1] An approval for adult patients living with severe active axial spondyloarthritis would represent the second indication for Cimzia in countries of the European Union. In general, the European Commission follows the recommendations of the CHMP and usually delivers its final decision within two months of the CHMP recommendation. http://fortalent.com/blog/view/s/2014-02-03-tips-for-disposing-of-grease-from-your-face/
"The CHMP positive opinion is an important milestone since people living with severe active axSpA in Europe may soon have a new treatment option whether or not they have X ray evidence of structural damage to their sacroiliac joints," said Professor Dr. Iris Loew-Friedrich, Chief Medical Officer and Executive Vice President, UCB.
"This is particularly important for patients living with axial spondyloarthritis without radiographic evidence of AS, whose symptoms may be just as debilitating as those with AS but for whom treatment options are currently limited."
The positive opinion for severe active axSpA comprising AS and axSpA without radiographic evidence of AS follows the EMA's review of data from the RAPID™-axSpA study which was the first randomized, controlled, Phase 3 study of an anti-TNF to enroll both AS and axSpA without radiographic evidence of AS patients.2 The study is an on-going, Phase 3, multicenter, randomized, double-blind, placebo-controlled trial that was designed to evaluate the efficacy and safety of certolizumab pegol in patients with active axSpA.[3] The primary endpoint of the RAPIDT™-axSpA study was ASAS20 at week 12, and was achieved with clinical and statistically significant improvements in ASAS20 responses in both dosing arms (200 mg every 2 weeks and 400 mg every 4 weeks) vs. placebo (p≤0.004).[2] The safety profile for axial spondyloarthritis patients treated with certolizumab pegol was consistent with the safety profile of certolizumab pegol reported in rheumatoid arthritis trials.[2]
In the European Union, certolizumab pegol is approved in combination with methotrexate (MTX) for the treatment of moderate to severe active rheumatoid arthritis in adult patients inadequately responsive to disease-modifying anti-rheumatic drugs, including MTX. Certolizumab pegol can be given as monotherapy in case of intolerance to MTX or when continued treatment with MTX is inappropriate.[4]
Ads by Google
How To Self-Publish - Download a Free Author's Guide and Learn How to Publish Your Book. - www.friesenpress.com/How-to-Publish
Worst Food For Joint Pain - Renowned Doctor Reveals The Worst Food for Joint Inflammation - medixselect.com
Discount Self-Load Moving - Cheaper Than Driving Yourself. Fuel & Tolls Included in Price. - www.upack.com/ABF
The EMA is currently reviewing another filing for certolizumab pegol in the treatment of adult patients with active psoriatic arthritis. In the US, both PsA and axSpA filings are currently under review by the US Food and Drug Administration (FDA).
About RAPID™-axSpA study[3]
The RAPID™-axSpA study is an ongoing Phase 3, multicenter, randomized, double-blind, placebo-controlled study designed to evaluate the efficacy and safety of certolizumab pegol in patients with active axSpA. Patients (n=325) were randomized 1:1:1 to placebo, or 400 mg certolizumab pegol at week 0, 2 and 4 loading dose followed by either 200 mg certolizumab pegol every two weeks or 400 mg certolizumab pegol every four weeks. Patients enrolled in the study must have active disease and failed at least one non-steroidal anti-inflammatory drug (NSAID). Within the placebo arm, patients who failed to achieve an ASAS20 response at weeks 14 and 16 were re-randomized at week 16 to receive certolizumab pegol 200 mg every 2 weeks or 400 mg every 4 weeks, following the loading dose.
What is degenerative disc disease?
Degenerative disc disease refers to the degeneration of at least one of the intervertebral discs of the spinal column. Some people may call it degenerative disc disorder.
This Medical News Today article includes an introduction into degenerative disc disease, a brief description, some basic information on intervertebral discs, details on the most common signs and symptoms, its causes, how the disease is diagnosed, and possible treatment options.
What is degenerative disc disease?
Degenerative disc disease is a "disease of aging", an age related disease.
Over the years and decades, the repeated daily stresses on the spine and occasional minor, unnoticed injuries, as well as major ones, begin to take their toll. http://skincareprogram.soup.io/post/396174658/Erase-Eye-Wrinkles
For most people the gradual degeneration of the discs is not a problem. However, in some cases it eventually causes severe, chronic and debilitating discogenic pain. Back specialists refer to pain caused by a damaged intervertebral disc as "discogenic pain".
Some people have degenerative disc disease and never experience any related symptoms.
What are the intervertebral discs?
Spinal readjustment 3
Model of a healthy spine
The intervertebral discs (orange) act as cushions
between each vertebra (white)
Intervertebral discs, also known as intervertebral fibrocartilage or spinal discs, are the padding between each vertebra of the spine. They have an elastic structure, made of fibrocartilage tissue.
The outer part of the disc - annulus fibrosus - is tough and fibrous, and is composed of several overlapping layers.
The inner core of the disc - nucleus pulposus - is soft and gelatinous.
The intervertebral discs form the vertebrae's shock absorbers. They act as padding, and cushion the stress when the spine moves or bears weight.
These spinal discs also help the spine bend and then bend back to its normal curves.
In a healthy young adult the intervertebral discs consist of about 90% water. As we age the water content goes down, the padding becomes less thick and the spine becomes slightly shorter as a result. Sometimes the disc might bulge.
What are the signs and symptoms of degenerative disc disease?
A symptom is something the patient feels and describes, while a sign is something others can detect. Pain is an example of a symptom, and a rash is a an example of a sign.
Many people may have degeneration of the disc and have no symptoms. Others, on the other hand, may experience pain that is so intense that they are unable to carry out their daily activities.
The University of Maryland Medical Center1 explains that the most common early symptom is usually pain in the back that spreads to the buttocks and upper thighs (sciatica).
Apart from pain, there may also be tingling and/or numbness in the leg or foot.
Most patients find that the pain is worse when they are sitting. This is because the discs have more weight on them when the body is sitting.
When specialist doctors talk about degenerative disc disease, they are usually referring to a combination of spinal problems that start with damage to the disc, and eventually spread to other parts of the spine.
The Mayfield Clinic2 in Cincinnati, Ohio, says that degenerative disc disease pain frequently starts in one of three ways:
A major injury - which is followed by sudden and unexpected pain.
A minor injury - which is also followed by sudden and unexpected back pain.
Progressive pain - the patient starts feeling slight back pain, which over time gradually gets worse.
What are the causes degenerative disc disease?
As the human body ages, the intervertebral discs degenerate (break down), which leads to degenerative disc disease in some individuals.
The changes that occur, due to aging, include:
Loss of fluid - the intervertebral discs of a healthy young adult consist mainly of fluid, up to 90%. As we age the disc's fluid content decreases, making it thinner. This means the distance between each vertebra becomes smaller.
Put simply, the cushion or shock-absorber between each vertebra becomes less effective.
Disc structure is affected - very small tears or cracks develop in the annulus fibrous (outer layer) of the disc. The soft and gelatinous material in the nucleus pulposus (inner part of the disc) may make its way through the cracks or tears, resulting in a bulging or rupturing disc. Sometimes it may break into fragments.
This degeneration of the disc occurs more rapidly in obese individuals, people who do strenuous physical work, and regular tobacco smokers.
An acute (sudden) injury, as may occur after a fall, may accelerate the process of degeneration.
When the vertebrae have less padding between them the whole spine becomes less stable. The body tries to cope with this by building osteophytes, also called bone spurs. Bone spurs are small bony projections that develop along the edge of bones. These projections can press against the spinal cord or spinal nerve roots, which undermine nerve function and cause pain.
There is a condition called spinal stenosis, which occurs when the bone spurs grow into the spinal canal and press into the spinal cord and nerves.
Diagnosing degenerative disc disease
The doctor will ask the patient about symptoms, where pain, tingling or numbness is felt and when, and which situations cause the most pain. Questions will also be asked about the patient's medical history and whether he or she had any falls, injuries or accidents.
The doctor will also carry out a physical examination, which may include:
Checking nerve function - different areas are tapped with a reflex hammer. If there is poor or no reaction, it could mean there is a compressed nerve root.
Hot and cold stimuli may also be used to see how well the nerves sense temperature changes.
Checking muscle strength - the patient may be asked to undress so the doctor can view the muscles and check for atrophy (wasting) or abnormal movements.
Checking for pain with motion or palpation - palpation means examining or exploring by touching. The patient will also be made to move in specific ways. If pressure applied to the lower back causes pain, it could mean there is a degenerated disc.
The doctor may order the following diagnostic tests to either confirm a preliminary diagnosis, rule out some conditions or illnesses, or to gain more information:
CT (computerized tomography) scan - a medical imaging method that employs tomography, the process of generating a 2-dimensional image of a section/slice through a 3-dimensional object (tomogram).
MRI (magnetic resonance imaging) scan - a machine that uses a magnetic field and radio waves to create detailed images of the inside of the body on a monitor. MRIs scans give the doctor information on the state of the spinal nerves, discs and how they are aligned.
Discogram - a dye is injected into the nucleus pulposus, the soft center of the disc. Sometimes several disks are injected. The aim is to see whether the disc is painful. The dye shows up on a CT scan or X-ray. According to the Mayo Clinic3, discogram usage is controversial because cracked discs do not always cause symptoms.
What are the treatment options for degenerative disc disease?
Treatment for degenerative disc disease may include occupational and/or physical therapy, special exercises, medications, losing weight, stem cell therapy, and surgery.
Non-surgical therapies
Lifting-techniques
With proper lifting techniques patients will experience less severe and less frequent pain
Kneeling or reclining - rather than sitting is less painful. Patients can be taught how to position themselves so that their symptoms are less severe.
Lifting weights - this needs to be done without bending the body.
Medications - the patient may benefit from non-steroidal anti-inflammatory drugs (NSAIDs), steroids and sometimes muscle relaxers.
Examples of NSAIDs include celecoxib, ibuprofen, naproxen and aspirin.
Acetaminophen (paracetamol, Tylenol) is a painkiller but not an anti-inflammatory.
Steroids may help reduce swelling and inflammation around the nerves.
Wearing a corset or brace
Doing special exercises to build the back and stomach muscles - according to UCLA Neurosurgery4, yoga, Pilates, and swimming are effective, as are some other core strengthening programs.
Specialized health care professionals, such as physiatrists, neuroradiologists and pain management specialists can help with more aggressive treatments that do not require surgery.
The joints next to the bad disc can be injected with steroids and a local anesthetic. These are called facet joint injections and can provide effective pain relief.
Facet rhizotomy - a radiofrequency current deadens the nerves around the facet joint, preventing pain signals from reaching the brain. This may be recommended if the patient responded to facet joint injections. Facet rhizotomy may provide pain relief that lasts for more than a year.
Intradiscal electrothermal annuloplasty (IDET) - painful discs are heated up using discography CT with a copper coil; when the right temperature is reached the disc hardens, making it better at resisting weight-bearing movements. According to UCLA Neurosurgery, this procedure is effective in 70% of cases.
Surgery
Surgery may be recommended if the patient did not respond to conservative therapies within about three months.
Surgery may be considered as an option if:
Back or leg pain stops the patient from going about normal activity.
There is numbness in the legs.
There is weakness in the legs.
Standing or walking is difficult.
The patient did not respond to physical therapy.
Medication was not effective.
The following surgical options are available:
Stabilization surgery - spinal fusion - two vertebrae of the spine are fused together. This provides stability for the spine. The procedure can be done at any level of the spine, but is more common in the lower back area (lumbar region) and the neck area (cervical region) - these are the most movable parts of the spine.
Spinal fusion can be done from the back, with rods and screws in the spine and adjacent bone graft. If done from the front, the disc is removed and graph materials are placed.
This procedure is very effective for patients in extreme pain whose spine cannot bear their own weight. However, spinal fusion can speed up the degeneration of the discs next to the fused vertebrae.
Decompression surgery - examples include facectomy (removing the facet joint), foraminotomy (enlarging the opening of the foramen so the nerve is not compressed), laminectomy (removing all or part of the lamina to relieve pressure on the spinal cord), laminotomy (like a laminectomy, but the opening is larger, giving the nerves more room).
In the decompression procedures described above, the surgeon comes in from the back of the spine. Sometimes decompression surgery has to be done from the front (anterior), as may occur if the patient has a bulging disc or herniated disc that pushes into the spinal canal.
Anterior decompression techniques include discectomy (removal of all or part of the disc), corpectomy (the vertebral bodies and adjacent discs are removed in order to reduce the pressure on the spinal cord).
Stem cell therapy
Researchers at the University of Queensland, Australia, set out to determine whether a tissue engineering-based approach using stem cells, coupled with an advanced delivery system might encourage functional fibrocartilage generation.
The scientists developed an injectable hydrogel system based on enzymatically-crosslinked polyethylene glycol (gel) and hyaluronic acid.
After adding more substances to the hydrogel they injected it into patients. Their aim was to induce chondrogenesis (formation of cartilage) in mesnchymal precursor cells.
The researchers concluded in the journal Biomaterials5 that stem cell therapy has potential for intervertebral disc regeneration.
This Medical News Today article includes an introduction into degenerative disc disease, a brief description, some basic information on intervertebral discs, details on the most common signs and symptoms, its causes, how the disease is diagnosed, and possible treatment options.
What is degenerative disc disease?
Degenerative disc disease is a "disease of aging", an age related disease.
Over the years and decades, the repeated daily stresses on the spine and occasional minor, unnoticed injuries, as well as major ones, begin to take their toll. http://skincareprogram.soup.io/post/396174658/Erase-Eye-Wrinkles
For most people the gradual degeneration of the discs is not a problem. However, in some cases it eventually causes severe, chronic and debilitating discogenic pain. Back specialists refer to pain caused by a damaged intervertebral disc as "discogenic pain".
Some people have degenerative disc disease and never experience any related symptoms.
What are the intervertebral discs?
Spinal readjustment 3
Model of a healthy spine
The intervertebral discs (orange) act as cushions
between each vertebra (white)
Intervertebral discs, also known as intervertebral fibrocartilage or spinal discs, are the padding between each vertebra of the spine. They have an elastic structure, made of fibrocartilage tissue.
The outer part of the disc - annulus fibrosus - is tough and fibrous, and is composed of several overlapping layers.
The inner core of the disc - nucleus pulposus - is soft and gelatinous.
The intervertebral discs form the vertebrae's shock absorbers. They act as padding, and cushion the stress when the spine moves or bears weight.
These spinal discs also help the spine bend and then bend back to its normal curves.
In a healthy young adult the intervertebral discs consist of about 90% water. As we age the water content goes down, the padding becomes less thick and the spine becomes slightly shorter as a result. Sometimes the disc might bulge.
What are the signs and symptoms of degenerative disc disease?
A symptom is something the patient feels and describes, while a sign is something others can detect. Pain is an example of a symptom, and a rash is a an example of a sign.
Many people may have degeneration of the disc and have no symptoms. Others, on the other hand, may experience pain that is so intense that they are unable to carry out their daily activities.
The University of Maryland Medical Center1 explains that the most common early symptom is usually pain in the back that spreads to the buttocks and upper thighs (sciatica).
Apart from pain, there may also be tingling and/or numbness in the leg or foot.
Most patients find that the pain is worse when they are sitting. This is because the discs have more weight on them when the body is sitting.
When specialist doctors talk about degenerative disc disease, they are usually referring to a combination of spinal problems that start with damage to the disc, and eventually spread to other parts of the spine.
The Mayfield Clinic2 in Cincinnati, Ohio, says that degenerative disc disease pain frequently starts in one of three ways:
A major injury - which is followed by sudden and unexpected pain.
A minor injury - which is also followed by sudden and unexpected back pain.
Progressive pain - the patient starts feeling slight back pain, which over time gradually gets worse.
What are the causes degenerative disc disease?
As the human body ages, the intervertebral discs degenerate (break down), which leads to degenerative disc disease in some individuals.
The changes that occur, due to aging, include:
Loss of fluid - the intervertebral discs of a healthy young adult consist mainly of fluid, up to 90%. As we age the disc's fluid content decreases, making it thinner. This means the distance between each vertebra becomes smaller.
Put simply, the cushion or shock-absorber between each vertebra becomes less effective.
Disc structure is affected - very small tears or cracks develop in the annulus fibrous (outer layer) of the disc. The soft and gelatinous material in the nucleus pulposus (inner part of the disc) may make its way through the cracks or tears, resulting in a bulging or rupturing disc. Sometimes it may break into fragments.
This degeneration of the disc occurs more rapidly in obese individuals, people who do strenuous physical work, and regular tobacco smokers.
An acute (sudden) injury, as may occur after a fall, may accelerate the process of degeneration.
When the vertebrae have less padding between them the whole spine becomes less stable. The body tries to cope with this by building osteophytes, also called bone spurs. Bone spurs are small bony projections that develop along the edge of bones. These projections can press against the spinal cord or spinal nerve roots, which undermine nerve function and cause pain.
There is a condition called spinal stenosis, which occurs when the bone spurs grow into the spinal canal and press into the spinal cord and nerves.
Diagnosing degenerative disc disease
The doctor will ask the patient about symptoms, where pain, tingling or numbness is felt and when, and which situations cause the most pain. Questions will also be asked about the patient's medical history and whether he or she had any falls, injuries or accidents.
The doctor will also carry out a physical examination, which may include:
Checking nerve function - different areas are tapped with a reflex hammer. If there is poor or no reaction, it could mean there is a compressed nerve root.
Hot and cold stimuli may also be used to see how well the nerves sense temperature changes.
Checking muscle strength - the patient may be asked to undress so the doctor can view the muscles and check for atrophy (wasting) or abnormal movements.
Checking for pain with motion or palpation - palpation means examining or exploring by touching. The patient will also be made to move in specific ways. If pressure applied to the lower back causes pain, it could mean there is a degenerated disc.
The doctor may order the following diagnostic tests to either confirm a preliminary diagnosis, rule out some conditions or illnesses, or to gain more information:
CT (computerized tomography) scan - a medical imaging method that employs tomography, the process of generating a 2-dimensional image of a section/slice through a 3-dimensional object (tomogram).
MRI (magnetic resonance imaging) scan - a machine that uses a magnetic field and radio waves to create detailed images of the inside of the body on a monitor. MRIs scans give the doctor information on the state of the spinal nerves, discs and how they are aligned.
Discogram - a dye is injected into the nucleus pulposus, the soft center of the disc. Sometimes several disks are injected. The aim is to see whether the disc is painful. The dye shows up on a CT scan or X-ray. According to the Mayo Clinic3, discogram usage is controversial because cracked discs do not always cause symptoms.
What are the treatment options for degenerative disc disease?
Treatment for degenerative disc disease may include occupational and/or physical therapy, special exercises, medications, losing weight, stem cell therapy, and surgery.
Non-surgical therapies
Lifting-techniques
With proper lifting techniques patients will experience less severe and less frequent pain
Kneeling or reclining - rather than sitting is less painful. Patients can be taught how to position themselves so that their symptoms are less severe.
Lifting weights - this needs to be done without bending the body.
Medications - the patient may benefit from non-steroidal anti-inflammatory drugs (NSAIDs), steroids and sometimes muscle relaxers.
Examples of NSAIDs include celecoxib, ibuprofen, naproxen and aspirin.
Acetaminophen (paracetamol, Tylenol) is a painkiller but not an anti-inflammatory.
Steroids may help reduce swelling and inflammation around the nerves.
Wearing a corset or brace
Doing special exercises to build the back and stomach muscles - according to UCLA Neurosurgery4, yoga, Pilates, and swimming are effective, as are some other core strengthening programs.
Specialized health care professionals, such as physiatrists, neuroradiologists and pain management specialists can help with more aggressive treatments that do not require surgery.
The joints next to the bad disc can be injected with steroids and a local anesthetic. These are called facet joint injections and can provide effective pain relief.
Facet rhizotomy - a radiofrequency current deadens the nerves around the facet joint, preventing pain signals from reaching the brain. This may be recommended if the patient responded to facet joint injections. Facet rhizotomy may provide pain relief that lasts for more than a year.
Intradiscal electrothermal annuloplasty (IDET) - painful discs are heated up using discography CT with a copper coil; when the right temperature is reached the disc hardens, making it better at resisting weight-bearing movements. According to UCLA Neurosurgery, this procedure is effective in 70% of cases.
Surgery
Surgery may be recommended if the patient did not respond to conservative therapies within about three months.
Surgery may be considered as an option if:
Back or leg pain stops the patient from going about normal activity.
There is numbness in the legs.
There is weakness in the legs.
Standing or walking is difficult.
The patient did not respond to physical therapy.
Medication was not effective.
The following surgical options are available:
Stabilization surgery - spinal fusion - two vertebrae of the spine are fused together. This provides stability for the spine. The procedure can be done at any level of the spine, but is more common in the lower back area (lumbar region) and the neck area (cervical region) - these are the most movable parts of the spine.
Spinal fusion can be done from the back, with rods and screws in the spine and adjacent bone graft. If done from the front, the disc is removed and graph materials are placed.
This procedure is very effective for patients in extreme pain whose spine cannot bear their own weight. However, spinal fusion can speed up the degeneration of the discs next to the fused vertebrae.
Decompression surgery - examples include facectomy (removing the facet joint), foraminotomy (enlarging the opening of the foramen so the nerve is not compressed), laminectomy (removing all or part of the lamina to relieve pressure on the spinal cord), laminotomy (like a laminectomy, but the opening is larger, giving the nerves more room).
In the decompression procedures described above, the surgeon comes in from the back of the spine. Sometimes decompression surgery has to be done from the front (anterior), as may occur if the patient has a bulging disc or herniated disc that pushes into the spinal canal.
Anterior decompression techniques include discectomy (removal of all or part of the disc), corpectomy (the vertebral bodies and adjacent discs are removed in order to reduce the pressure on the spinal cord).
Stem cell therapy
Researchers at the University of Queensland, Australia, set out to determine whether a tissue engineering-based approach using stem cells, coupled with an advanced delivery system might encourage functional fibrocartilage generation.
The scientists developed an injectable hydrogel system based on enzymatically-crosslinked polyethylene glycol (gel) and hyaluronic acid.
After adding more substances to the hydrogel they injected it into patients. Their aim was to induce chondrogenesis (formation of cartilage) in mesnchymal precursor cells.
The researchers concluded in the journal Biomaterials5 that stem cell therapy has potential for intervertebral disc regeneration.
Thursday, February 6, 2014
Scripps Research Institute scientists
Scientists at The Scripps Research Institute (TSRI) have invented a new method for designing artificial proteins, and have used it to make key ingredients for a candidate vaccine against a dangerous virus, respiratory syncytial virus (RSV), a significant cause of infant mortality. The virus has been resistant to current vaccine-design strategies.
With the help of collaborating laboratories, the scientists were able to apply the new method, which uses a "rational design" approach to making vaccines focused on specific binding areas (epitopes) on the virus. The result was designer vaccine proteins that the scientists showed stimulate the production of the desired virus-neutralizing antibodies in rhesus macaques. http://skincareprograms.tumblr.com/post/75567159015/skin-care-products-how-to-skin-care
"This was a proof-of-principle demonstration of a technology that could be very useful against HIV, influenza and other highly variable viruses that have been difficult to stop using traditional vaccine-design strategies," said William R. Schief, associate professor of immunology at TSRI.
The research is reported in by the journal Nature.
Folding from Loops
The new protein-design method represents a significant advance over previous methods.
"One approach we and others have taken has been to transplant a protein fragment of interest, for example one that mimics a particular structure on a virus, onto an existing protein 'scaffold,'" said TSRI Research Associate Bruno E. Correia, a member of the Schief laboratory at the time of the study and lead author of the new report. "While this approach often works well to mimic the structure of a viral epitope, it has never successfully induced neutralizing antibodies, and in some cases this method falls short of even producing viable vaccine candidates."
In these difficult cases, the scaffold structure fails to stabilize the transplanted fragment, resulting in an imperfect mimic of the virus and consequent loss of immune-stimulating properties.
The TSRI scientists wanted a way to design scaffold proteins from scratch - proteins that would fit around their functional fragments more naturally, and would do a better job of stabilizing them.
The result was a new software app, "Fold from Loops," for designing proteins that fold up around a functional fragment of interest. For a proof-of-principle demonstration, the scientists decided to attempt one of the most important current protein-design challenges: making a new protein that mimics a particular epitope on a virus, and thus can serve as a key component of a vaccine.
The Promise of Rational Vaccine Design
Researchers want to be able to stimulate antibody reactions against highly specific epitopes because some infectious agents seem unstoppable by traditional methods of immunization.
With the help of collaborating laboratories, the scientists were able to apply the new method, which uses a "rational design" approach to making vaccines focused on specific binding areas (epitopes) on the virus. The result was designer vaccine proteins that the scientists showed stimulate the production of the desired virus-neutralizing antibodies in rhesus macaques. http://skincareprograms.tumblr.com/post/75567159015/skin-care-products-how-to-skin-care
"This was a proof-of-principle demonstration of a technology that could be very useful against HIV, influenza and other highly variable viruses that have been difficult to stop using traditional vaccine-design strategies," said William R. Schief, associate professor of immunology at TSRI.
The research is reported in by the journal Nature.
Folding from Loops
The new protein-design method represents a significant advance over previous methods.
"One approach we and others have taken has been to transplant a protein fragment of interest, for example one that mimics a particular structure on a virus, onto an existing protein 'scaffold,'" said TSRI Research Associate Bruno E. Correia, a member of the Schief laboratory at the time of the study and lead author of the new report. "While this approach often works well to mimic the structure of a viral epitope, it has never successfully induced neutralizing antibodies, and in some cases this method falls short of even producing viable vaccine candidates."
In these difficult cases, the scaffold structure fails to stabilize the transplanted fragment, resulting in an imperfect mimic of the virus and consequent loss of immune-stimulating properties.
The TSRI scientists wanted a way to design scaffold proteins from scratch - proteins that would fit around their functional fragments more naturally, and would do a better job of stabilizing them.
The result was a new software app, "Fold from Loops," for designing proteins that fold up around a functional fragment of interest. For a proof-of-principle demonstration, the scientists decided to attempt one of the most important current protein-design challenges: making a new protein that mimics a particular epitope on a virus, and thus can serve as a key component of a vaccine.
The Promise of Rational Vaccine Design
Researchers want to be able to stimulate antibody reactions against highly specific epitopes because some infectious agents seem unstoppable by traditional methods of immunization.
Subscribe to:
Comments (Atom)