scholarly journals Study protocol: effect of infection, Modic and inflammation on clinical outcomes in surgery for radiculopathy (EIMICOR)

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Niek Djuric ◽  
Geraldine Lafeber ◽  
Sjoerd G. van Duinen ◽  
Sandra Bernards ◽  
Wilco C. Peul ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Inflammatory Cells ◽  
Pain Scale ◽  
Radicular Pain ◽  
Leg Pain ◽  
Herniated Disc ◽  
Major Influence ◽  
Womac Questionnaire ◽  
Negative Effect ◽  
Inflammatory Processes

Abstract Background Evidence indicates that inflammatory processes are involved in radicular pain as well as in resorption of herniated disc tissue. Furthermore there are indications that the presence of vertebral end plate pathology (Modic changes; MC) is associated with a negative effect on inflammation. It is hypothesized that in patients with MC, the (possibly bacterial induced) inflammation will be accompanied by pro inflammatory cytokines that worsen the outcome, and that in patients without MC, the inflammation is accompanied by cytokines that induce a resorption process to accelerate recovery. Methods This prospective cohort study will include 160 lumbar and 160 cervical patients (total of 320), which are scheduled for surgery for either a lumbar or cervical herniated disc with ages between 18 and 75. The main and interaction effects of local bacterial infection (culture), inflammatory cells in disc material (immunohistology), MC (MRI), and blood biomarkers indicating inflammation or infection (blood sample evaluation) will be evaluated. Clinical parameters to be evaluated are leg pain on the 11 point NRS pain scale, Oswestry (lumbar spine) or Neck (cervical spine) Disability Index, Global Perceived Recovery, Womac Questionnaire, and medication status, at baseline, and after 6, 16, 26 and 52 weeks. Discussion Gaining insight in the aetiology of pain and discomfort in radiculopathy caused by a herniated disc could lead to more effective management of patients. If the type of inflammatory cells shows to be of major influence on the rate of recovery, new immunomodulating treatment strategies can be developed to decrease the duration and intensity of symptoms. Moreover, identifying a beneficial inflammatory response in the disc through a biomarker in blood could lead to early identification of patients whose herniations will resorb spontaneously versus those that require surgery. Trial registration prospectively enrolled at trialregister.nl, ID:NL8464.

Inflammatory mechanisms in atherosclerosis

2014 ◽  
Vol 34 (01) ◽  
pp. 63-71 ◽  
Author(s):  
D. Wolf ◽  
P. Stachon ◽  
C. Bode ◽  
A. Zirlik
Keyword(s):  
Treatment Strategies ◽  
Inflammatory Cells ◽  
Plaque Formation ◽  
Current Status ◽  
Therapeutic Implications ◽  
Effector Functions ◽  
Atherosclerotic Plaque Formation ◽  
Inflammatory Processes ◽  
Anti Inflammatory

SummaryThroughout the last two decades inflammation has been recognized as the central mechanism underlying atherogenesis. A multitude of basic science work demonstrates the pivotal role of inflammatory processes during every step of atherosclerotic plaque formation: From initiation via propagation to complication.This review describes some of the key mechanisms involved with a particular focus on the diverse group of inflammatory cells and their subsets that distinctly contribute to atherogenic and anti-atherogenic phenomena. Furthermore, we summarize the controlling action of a tight network of co-stimulatory molecules and cytokines orchestrating the inflammatory and anti-inflammatory effector functions. Finally, the current status of clinical trials evaluating anti-inflammatory/ immune-modulatory treatment strategies is summarized and an outlook for future therapeutic implications is provided.

scholarly journals Pharmacological Interventions for Pulmonary Involvement in Rheumatic Diseases

2021 ◽  
Vol 14 (3) ◽  
pp. 251 ◽  
Author(s):  
Eun Ha Kang ◽  
Yeong Wook Song
Keyword(s):  
Rheumatic Diseases ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Pulmonary Involvement ◽  
Current Treatment ◽  
Targeted Agents ◽  
Pharmacological Interventions ◽  
Inflammatory Processes ◽  
Pulmonary Arterial ◽  
Epidemiologic Features

Among the diverse forms of lung involvement, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are two important conditions in patients with rheumatic diseases that are associated with significant morbidity and mortality. The management of ILD and PAH is challenging because the current treatment often provides only limited patient survival benefits. Such challenges derive from their common pathogenic mechanisms, where not only the inflammatory processes of immune cells but also the fibrotic and proliferative processes of nonimmune cells play critical roles in disease progression, making immunosuppressive therapy less effective. Recently, updated treatment strategies adopting targeted agents have been introduced with promising results in clinical trials for ILD ad PAH. This review discusses the epidemiologic features of ILD and PAH among patients with rheumatic diseases (rheumatoid arthritis, myositis, and systemic sclerosis) and the state-of-the-art treatment options, focusing on targeted agents including biologics, antifibrotic agents, and vasodilatory drugs.

Correlates of depression and quality of life in patients with inflammatory arthritides

2011 ◽  
Vol 26 (S2) ◽  
pp. 383-383 ◽  
Author(s):  
R. Krishnadas ◽  
V. Mallon ◽  
I. Mcinnes ◽  
J. Cavanagh
Keyword(s):  
Quality Of Life ◽  
Emotional Intelligence ◽  
Pain Scale ◽  
Trait Emotional Intelligence ◽  
Tertiary Referral Centre ◽  
Co Morbidity ◽  
Inflammatory Processes ◽  
Trait Emotional Intelligence Questionnaire ◽  
Therapeutic Doses

Depression is a major co-morbidity in patients with inflammatory arthritides. In addition to the inflammatory processes, factors like pain, quality of life and trait emotional intelligence or the awareness on one's emotion and the ability to regulate these effectively may be associated with the presence of depression in this population.AimsThe aims of the present study were to determine the rates of depression in patients with psoriatic (PsA) and rheumatoid arthritis (RA) attending a tertiary referral centre, and to investigate possible factors that are associated with depression in this population.MethodsInterim data pertaining to depression (HADS), pain (British Pain Society Pain scale), quality of life (EuroQoL), physical function (HAQ-DI), inflammation (CRP) and emotional intelligence (Trait Emotional Intelligence Questionnaire - TEIQue-SF) were analysed from data from 100 patients (50 PsA and 50 RA).ResultsUpto 30% of patients with PsA and RA were found to be depressed. Similarly, upto 25% of patients with PsA and RA fulfilled the criteria for caseness on the HADS A subscale.None of these patients were on therapeutic doses of an antidepressant. There was significant correlation between depression scores and scores on quality of life, disability and emotional intelligence. Together, they explained almost 50% of the variance in depression scores.ConclusionThe prevalence of depression is high in people with inflammatory arthritides. Disability, Quality of life and trait emotional intelligence seems to be important factors associated with inflammation and presence of depression in this population.

Disentangling ‘sciatica’ to understand and characterise somatosensory profiles and potential pain mechanisms

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Brigitte Tampin ◽  
Christopher Lind ◽  
Angela Jacques ◽  
Helen Slater
Keyword(s):  
Mechanical Vibration ◽  
Radicular Pain ◽  
Leg Pain ◽  
Heat Sensitivity ◽  
Loss Of Function ◽  
Pain Mechanisms ◽  
Vibration Detection ◽  
Lumbar Radicular Pain ◽  
Pain Experiences ◽  
Pain Descriptors

Abstract Objectives The study aimed to investigate if patients with lumbar radicular pain only and those with combined lumbar radicular pain + radiculopathy differ in their somatosensory profiles and pain experiences. Methods Quantitative sensory testing (QST) was performed in 26 patients (mean age 47 ± 10 years, 10 females) with unilateral leg pain in the L5 or S1 distribution in their main pain area (MPA) and contralateral mirror side, in the relevant foot dermatome on the symptomatic side and in the hand dorsum. Pain experience was captured on the painDETECT. Results Eight patients presented with lumbar radicular pain only and 18 patients with combined radicular pain + radiculopathy. Patients with radicular pain only demonstrated widespread loss of function (mechanical detection) bilaterally in the MPA (p<0.003) and hand (p=0.002), increased heat sensitivity in both legs (p<0.019) and cold/heat sensitivity in the hand (p<0.024). QST measurements in the dermatome did not differ compared to HCs and patients with radiculopathy. Patients with lumbar radiculopathy were characterised by a localised loss of function in the symptomatic leg in the MPA (warm, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p<0.031) and dermatome (mechanical, vibration detection p<0.001), consistent with a nerve root lesion. Pain descriptors did not differ between the two groups with the exception of numbness (p<0.001). Patients with radicular pain did not report symptoms of numbness, while 78% of patients with radiculopathy did. Conclusions Distinct differences in somatosensory profiles and pain experiences were demonstrated for each patient group, suggesting differing underlying pain mechanisms.

Immunohistochemical Study of Presence of T Cells, B Cells, and Macrophages in Periradicular Lesions of Primary Teeth

2008 ◽  
Vol 32 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Michele Bolan ◽  
Daniele de Almeida Lima ◽  
Cláudia Pinto Figueiredo ◽  
Gabriella Di Giunta ◽  
Maria José de Carvalho Rocha
Keyword(s):  
T Cells ◽  
Immune System ◽  
B Cells ◽  
Primary Teeth ◽  
Microscopic Analysis ◽  
Inflammatory Cells ◽  
Periapical Lesions ◽  
Inflammatory Processes ◽  
Local Inflammatory Reaction

BACKGROUND: The periapical lesion is the result of a local inflammatory reaction caused by bacteria and its products present on the root canal. The interaction between inflammatory cells and bacteria elicit both specific and non-specific immune responses. OBJETIVE: Due to the lack of studies evaluating the role of the immune system in periapical lesions of primary teeth and considering the potentially systemic effects that these infections can cause in children, especially because of the immaturity of their immune system, we sought to evaluate the presence of T cells, B cells and macrophages on periradicular lesions in primary teeth. STUDY DESIGN: 14 periradicular lesions were analyzed. The immunohistochemistry technique was performed using CD45RO, CD20, CD68 monoclonal antibodies aiming to identify T cells, B cells and macrophages, respectively. Cells were quantified by microscopic analysis of histological sections. RESULTS: Mean percentage of positive cells CD45RO was 11.76; CD20 was 5.25; CD68 was 10.92. Our results showed that T and B cells and macrophages comprise the majority of the inflammatory infiltrate. CONCLUSION: We concluded that both humoral and cell mediated immune reactions take place in periradicular lesions of primary teeth. The immune system plays an important role on the periradicular inflammatory processes in primary teeth.

scholarly journals Pharmacology and Adverse Events of Emergency-Use Authorized Medication in Moderate to Severe COVID-19

2021 ◽  
Vol 14 (10) ◽  
pp. 955
Author(s):  
Jen-Yu Hsu ◽  
Yan-Chiao Mao ◽  
Po-Yu Liu ◽  
Kuo-Lung Lai
Keyword(s):  
Adverse Events ◽  
Metabolic Pathways ◽  
Case Reports ◽  
Secondary Infection ◽  
Treatment Strategies ◽  
Serious Adverse Events ◽  
Small Molecule Drugs ◽  
Post Market ◽  
Inflammatory Processes ◽  
Effective Drugs

Some effective drugs have been approved or issued an Emergency Use Authorization for the treatment of COVID-19 in hospitalized patients, but post-market surveillance is warranted to monitor adverse events. We reviewed clinical trials and case reports in patients with moderate-to-severe COVID-19 infection who received remdesivir, baricitinib, tocilizumab, or sarilumab. The drug-specific pharmacokinetics, toxicity, and drug interactions are summarized in this study. Remdesivir and baricitinib are small-molecule drugs that are mainly metabolized by the kidneys, while tocilizumab and sarilumab are monoclonal antibody drugs with metabolic pathways that are currently not fully understood. The most common adverse events of these drugs are alterations in liver function, but serious adverse events have rarely been attributed to them. Only a few studies have reported that remdesivir might be cardiotoxic and that baricitinib might cause thromboembolism. Biological agents such as baricitinib, tocilizumab, and sarilumab could inhibit the pathway of inflammatory processes, leading to immune dysregulation, so the risk of secondary infection should be assessed before prescribing. Further recognition of the pathogenic mechanism and risk factors of adverse events is essential for optimizing treatment strategies.

scholarly journals Changes in Midbrain Pain Receptor Expression, Gait and Behavioral Sensitivity in a Rat Model of Radiculopathy

2012 ◽  
Vol 6 (1) ◽  
pp. 383-391 ◽  
Author(s):  
Priscilla Y Hwang ◽  
Kyle D Allen ◽  
Mohammed F Shamji ◽  
Liufang Jing ◽  
Brian A Mata ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Radicular Pain ◽  
Receptor Expression ◽  
Motor Deficits ◽  
Intervertebral Disc Herniation ◽  
Metabotropic Glutamate ◽  
Behavioral Sensitivity ◽  
Inflammatory Processes ◽  
Pain Receptors ◽  
The Right

Intervertebral disc herniation may contribute to inflammatory processes that associate with radicular pain and motor deficits. Molecular changes at the affected dorsal root ganglion (DRG), spinal cord, and even midbrain, have been documented in rat models of radiculopathy or nerve injury. The objective of this study was to evaluate gait and the expression of key pain receptors in the midbrain in a rodent model of radiculopathy. Radiculopathy was induced by harvesting tail nucleus pulposus (NP) and placing upon the right L5 DRG in rats (NP-treated, n=12). Tail NP was discarded in sham-operated animals (n=12). Mechanical allodynia, weight-bearing, and gait were evaluated in all animals over time. At 1 and 4 weeks after surgery, astrocyte and microglial activation was tested in DRG sections. Midbrain sections were similarly evaluated for immunoreactivity to serotonin (5HT2B), mu-opioid (µ-OR), and metabotropic glutamate (mGluR4 and 5) receptor antibodies. NP-treated animals placed less weight on the affected limb 1 week after surgery and experienced mechanical hypersensitivity over the duration of the study. Astroctye activation was observed at DRGs only at 4 weeks after surgery. Findings for pain receptors in the midbrain of NP-treated rats included an increased expression of 5HT2B at 1, but not 4 weeks; increased expression of µ-OR and mGluR5 at 1 and 4 weeks (periaqueductal gray region only); and no changes in expression of mGluR4 at any point in this study. These observations provide support for the hypothesis that the midbrain responds to DRG injury with a transient change in receptors regulating pain responses.

scholarly journals Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Jennifer Sucre ◽  
Lena Haist ◽  
Charlotte E. Bolton ◽  
Anne Hilgendorff
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Health Care Professionals ◽  
Treatment Strategies ◽  
Oxygen Toxicity ◽  
Growth Factor Signaling ◽  
Inflammatory Processes ◽  
Long Term Consequences ◽  
Neonatal Chronic Lung Disease

Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.

scholarly journals COVID-19 in the Healthy Patient Population

2020 ◽  
Vol 40 (11) ◽  
pp. 2764-2775
Author(s):  
Diana Maria Ronderos Botero ◽  
Alaa Mabrouk Salem Omar ◽  
Haozhe Keith Sun ◽  
Nikhitha Mantri ◽  
Ked Fortuzi ◽  
...  
Keyword(s):  
Patient Population ◽  
Cluster Model ◽  
Treatment Strategies ◽  
Inflammatory Cells ◽  
Age Group ◽  
Healthy Patient ◽  
Comorbid Conditions ◽  
Retrospective Study Design ◽  
Cluster 2

Objective: Coronavirus disease 2019 (COVID-19) can infect patients in any age group including those with no comorbid conditions. Understanding the demographic, clinical, and laboratory characteristics of these patients is important toward developing successful treatment strategies. Approach and Results: In a retrospective study design, consecutive patients without baseline comorbidities hospitalized with confirmed COVID-19 were included. Patients were subdivided into ≤55 and >55 years of age. Predictors of in-hospital mortality or mechanical ventilation were analyzed in this patient population, as well as subgroups. Stable parameters in overall and subgroup models were used to construct a cluster model for phenotyping of patients. Of 1207 COVID-19–positive patients, 157 met the study criteria (80≤55 and 77>55 years of age). Most reliable predictors of outcomes overall and in subgroups were age, initial and follow-up d -dimer, and LDH (lactate dehydrogenase) levels. Their predictive cutoff values were used to construct a cluster model that produced 3 main clusters. Cluster 1 was a low-risk cluster and was characterized by younger patients who had low thrombotic and inflammatory features. Cluster 2 was intermediate risk that also consisted of younger population that had moderate level of thrombosis, higher inflammatory cells, and inflammatory markers. Cluster 3 was a high-risk cluster that had the most aggressive thrombotic and inflammatory feature. Conclusions: In healthy patient population, COVID-19 remains significantly associated with morbidity and mortality. While age remains the most important predictor of in-hospital outcomes, thromboinflammatory interactions are also associated with worse clinical outcomes regardless of age in healthy patients.

scholarly journals Genetic and Epigenetic Aspects of Atopic Dermatitis

2020 ◽  
Vol 21 (18) ◽  
pp. 6484 ◽  
Author(s):  
Bogusław Nedoszytko ◽  
Edyta Reszka ◽  
Danuta Gutowska-Owsiak ◽  
Magdalena Trzeciak ◽  
Magdalena Lange ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Strategies ◽  
Structural Proteins ◽  
Epigenetic Changes ◽  
Epigenetic Alterations ◽  
Adaptive Immune ◽  
Genes Encoding ◽  
Inflammatory Processes ◽  
Non Coding Rnas

Atopic dermatitis is a heterogeneous disease, in which the pathogenesis is associated with mutations in genes encoding epidermal structural proteins, barrier enzymes, and their inhibitors; the role of genes regulating innate and adaptive immune responses and environmental factors inducing the disease is also noted. Recent studies point to the key role of epigenetic changes in the development of the disease. Epigenetic modifications are mainly mediated by DNA methylation, histone acetylation, and the action of specific non-coding RNAs. It has been documented that the profile of epigenetic changes in patients with atopic dermatitis (AD) differs from that observed in healthy people. This applies to the genes affecting the regulation of immune response and inflammatory processes, e.g., both affecting Th1 bias and promoting Th2 responses and the genes of innate immunity, as well as those encoding the structural proteins of the epidermis. Understanding of the epigenetic alterations is therefore pivotal to both create new molecular classifications of atopic dermatitis and to enable the development of personalized treatment strategies.

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