Pain Management by Ayurveda in Lumbar Spondylosis– A Case Study and Selective Review of Literature

Introduction: In Ayurveda, Snehana is an important method of treatment for diseases of the spine. As per Ayurveda, fatty substances are having properties opposite to that of Vata Dosha which is the root of many diseases. Therefore, Sneha (fatty substances) have an important position in Ayurvedic treatment. Fatty substances are of 4 types of Ghrita (Ghee), Taila (oil), Vasa (muscle fat), and Majja (bone marrow fat). Among these types, the literature is available about Ghrita (ghee), Taila (oil), and Majja (bone marrow fat) only, but Vasa (muscle fat) is not currently practiced. We got a case study, in which cod liver oil capsules were used as a representative of Vasa Sneha. A male of 35 suffering from lumbar spondylosis approached for moderate to severe low back pain. We successfully used cod liver oil capsules as representative of Vasa Sneha in this case. Study Design: A single case study and selective review of the literature. Place and Duration of Study: Panchakarma OPD, Yashwant Ayurvedic medical college, PGTRC, Kodoli, 416114, Dist. – Kolhapur, Maharashtra, India. Presentation of Case: This is a single case study in which a male of 35 years was suffering from chronic low back pain (CLBP) due to lumbar spondylosis The patient had chronic low back pain which was aggravated for 3 months. We prescribed him Ayurvedic medicines and cod liver oil capsules orally. The patient was followed for 16 months. Results: The outcome measure was assessed by the Oswestry low back pain disability questionnaire. The low back pain score was measured in different positions. The before treatment value was 36 (median ẋ = 3.5) and the score was 72, and after treatment value was 2 (median ẋ = 0) and the score was 4. The Mann Whitney U test was performed. The p was 0.00009 (<0.05). Conclusion: It is concluded that cod liver oil can be successfully used as a representative of vasa Sneha, and it is very effective in relieving chronic low back pain in lumbar spondylosis along with other ayurvedic preparations.

miR-6315 Attenuates Methotrexate Treatment-Induced Decreased Osteogenesis and Increased Adipogenesis Potentially through Modulating TGF-β/Smad2 Signalling

Methotrexate (MTX) treatment for childhood malignancies has shown decreased osteogenesis and increased adipogenesis in bone marrow stromal cells (BMSCs), leading to bone loss and bone marrow adiposity, for which the molecular mechanisms are not fully understood. Currently, microRNAs (miRNAs) are emerging as vital mediators involved in bone/bone marrow fat homeostasis and our previous studies have demonstrated that miR-6315 was upregulated in bones of MTX-treated rats, which might be associated with bone/fat imbalance by directly targeting Smad2. However, the underlying mechanisms by which miR-6315 regulates osteogenic and adipogenic differentiation require more investigations. Herein, we further explored and elucidated the regulatory roles of miR-6315 in osteogenesis and adipogenesis using in vitro cell models. We found that miR-6315 promotes osteogenic differentiation and it alleviates MTX-induced increased adipogenesis. Furthermore, our results suggest that the involvement of miR-6315 in osteogenesis/adipogenesis regulation might be partially through modulating the TGF-β/Smad2 signalling pathway. Our findings indicated that miR-6315 may be important in regulating osteogenesis and adipogenesis and might be a therapeutic target for preventing/attenuating MTX treatment-associated bone loss and marrow adiposity.

Radiomics Nomogram Based on Spectral CT Imaging to Diagnose Osteoporosis

Background: Osteoporosis is associated with a decrease of bone mineralized component as well as a increase of bone marrow fat. At present, there are few studies using radiomics nomogram based fat-water material decomposition (MD) images of spectral CT as an evaluation method of osteoporosis. This study aims to establish and validate a radiomics nomogram based the fat-water imaging of spectral CT in diagnosing osteoporosis.Methods: 95 patients who underwent spectral CT included T11-L2 and dual x-ray absorptiometry (DXA) were collected. The patients were divided into two groups according to T-score, normal bone mineral density (BMD) (T≥-1) and abnormally low BMD (T<-1). Radiomic features were selected from fat-water imaging of the spectral CT. Radscore was calculated by summing the selected features weighted by their coefficients. A nomogram combining the radiomics signature and significant clinical variables was built. The ROC curve was performed to evaluate the performance of the model. Finally, we used decision curve analysis (DCA) to evaluate the clinical usefulness of the model.Results: Five radiomic features based on fat-water imaging of spectral CT were constructed to distinguish abnormally low BMD from normal BMD, and its differential performance was high with an area under the curve (AUC) of 0.95 (95% CI, 0.89-1.00) in the training cohort and 0.97 (95% CI, 0.91-1.00) in the test cohort. The radiomics nomogram showed excellent differential ability with AUC of 0.96 (95%CI, 0.91-1.00) in the training cohort and 0.98 (95%CI, 0.93-1.00) in the test cohort, which performed better than the radiomics model and clinics model only. The DCA showed that the radiomics nomogram had a higher benefit in differentiating abnormally low BMD from normal BMD than the clinical model alone.Conclusion: The radiomics nomogram incorporated radiomics features and clinical factor based the fat-water imaging of spectral CT may serve as an efficient tool to identify abnormally low BMD from normal BMD well.

The contributions of cartilage endplate composition and vertebral bone marrow fat to intervertebral disc degeneration in patients with chronic low back pain

Purpose: The composition of the subchondral bone marrow and cartilage endplate (CEP) could affect intervertebral disc health by influencing vertebral perfusion and nutrient diffusion. However, the relative contributions of these factors to disc degeneration in patients with chronic low back pain (cLBP) have not been quantified. The goal of this study was to use compositional biomarkers derived from quantitative MRI to establish how CEP composition (surrogate for permeability) and vertebral bone marrow fat fraction (BMFF, surrogate for perfusion) relate to disc degeneration. Methods: MRI data from 60 patients with cLBP were included in this prospective observational study (28 female, 32 male; age = 40.0 ± 11.9 years, 19–65 [mean ± SD, min–max]). Ultra-short echo-time MRI was used to calculate CEP T2* relaxation times (reflecting biochemical composition), water-fat MRI was used to calculate vertebral BMFF, and T1ρ MRI was used to calculate T1ρ relaxation times in the nucleus pulposus (NP T1ρ, reflecting proteoglycan content and degenerative grade). Univariate linear regression was used to assess the independent effects of CEP T2* and vertebral BMFF on NP T1ρ. Mixed effects multivariable linear regression accounting for age, sex, and BMI was used to assess the combined relationship between variables. Results: CEP T2* and vertebral BMFF were independently associated with NP T1ρ (p = 0.003 and 0.0001, respectively). After adjusting for age, sex, and BMI, NP T1ρ remained significantly associated with CEP T2* (p = 0.0001) but not vertebral BMFF (p = 0.43). Conclusion: Poor CEP composition may play a significant role in disc degeneration severity and can affect disc health both with and without deficits in vertebral perfusion.

miR-542-3p Attenuates Bone Loss and Marrow Adiposity Following Methotrexate Treatment by Targeting sFRP-1 and Smurf2

Intensive methotrexate (MTX) treatment for childhood malignancies decreases osteogenesis but increases adipogenesis from the bone marrow stromal cells (BMSCs), resulting in bone loss and bone marrow adiposity. However, the underlying mechanisms are unclear. While microRNAs (miRNAs) have emerged as bone homeostasis regulators and miR-542-3p was recently shown to regulate osteogenesis in a bone loss context, the role of miR-542-3p in regulating osteogenesis and adipogenesis balance is not clear. Herein, in a rat MTX treatment-induced bone loss model, miR-542-3p was found significantly downregulated during the period of bone loss and marrow adiposity. Following target prediction, network construction, and functional annotation/ enrichment analyses, luciferase assays confirmed sFRP-1 and Smurf2 as the direct targets of miR-542-3p. miRNA-542-3p overexpression suppressed sFRP-1 and Smurf2 expression post-transcriptionally. Using in vitro models, miR-542-3p treatment stimulated osteogenesis but attenuated adipogenesis following MTX treatment. Subsequent signalling analyses revealed that miR-542-3p influences Wnt/β-catenin and TGF-β signalling pathways in osteoblastic cells. Our findings suggest that MTX treatment-induced bone loss and marrow adiposity could be molecularly linked to miR-542-3p pathways. Our results also indicate that miR-542-3p might be a therapeutic target for preserving bone and attenuating marrow fat formation during/after MTX chemotherapy.

I Can Get Fat Where? The Other Types of Fat

This chapter considers the more obscure non-white types of adipose tissue present in the human body. The first and better-known type discussed is brown fat, which contributes to the regulation of body temperature as it burns (excess) calories to generate heat. The second section explores the biology of bone marrow fat, whose enigmatic behaviour in the context of starvation and obesity does little to help define its role. After considering the relationship between bone marrow adipose tissue, bone strength, and overall metabolic health, this chapter concludes by briefly reviewing other, lesser-known types of (white) fat (e.g., epicardial fat) and their potential contribution to human biology.

Novel MRI technique for the quantification of biochemical deterioration in steroid-induce osteonecrosis of femoral head: a prospective diagnostic trial

To explore the novel magnetic resonance imaging techniques, IVIM-DWI and IDEAL-IQ in detecting bone marrow fat and microcirculation in steroid-induced osteonecrosis of the femoral head (SIONFH). In this prospective study, 49 patients (80 hips) with SIONFH taking glucocorticoids and 24 healthy volunteers (48 hips) were recruited and assessed by T1WI, T2WI/fs, IDEAL-IQ and IVIM-DWI. The affected hips, contralateral asymptomatic hips and normal hips, as well as normal, penumbra and necrotic areas in the affected hips, were classified and evaluated. Imaging results were compared with histologic bone sections obtained from SIONFH patients undergoing surgery. The fat fraction (FF) and perfusion fraction (f) differences between groups were analyzed using analysis of variance, the LSD t-test, Pearson correlation analysis and ROC curve analysis. Our results demonstrate that IDEAL-IQ (FF) and IVIM-DWI (f) enable the classification of SIONFH at different ARCO stages. The FF was positively associated with the progression of the disease (r = 0.72), in contrast to f (r = −0.17). The FF and f were significantly different among the necrotic, penumbra and normal areas, and they were negatively correlated with each other (r = −0.37). The diagnostic sensitivity and specificity of IDEAL-IQ were 96.9% and 86.7%, and those of IVIM-DWI were 72.34% and 58.33%, respectively. The FF in contralateral asymptomatic hips was significantly higher than in normal hips, but no difference was found for f. IDEAL-IQ, and not IVIM-DWI, was identified to successfully detect bone marrow fat, which is beneficial to the diagnosis of the severity of SIONFH.

The Osteocyte as a Signaling Cell

Osteocytes, former osteoblasts encapsulated by mineralized bone matrix, are far from being passive and metabolically inactive bone cells. Instead, osteocytes are multifunctional and dynamic cells capable of integrating hormonal and mechanical signals and transmitting them to effector cells in bone as well as in distant tissues. Osteocytes are a significant source of molecules that regulate bone homeostasis by integrating mechanical cues and hormonal signals that coordinate the differentiation and function of osteoclasts and osteoblasts. Osteocyte function is altered in rare and common bone diseases, suggesting that osteocyte dysfunction is directly involved in the pathophysiology of disorders affecting the skeleton. Advances in osteocyte biology initiated the development of novel therapeutics interfering with osteocyte secreted molecules. Moreover, osteocytes are targets and key distributors of biological signals mediating the beneficial effects of various bone therapeutics used in the clinic. Herein, we review the most recent discoveries in osteocyte biology demonstrating that osteocytes regulate bone homeostasis and bone marrow fat via paracrine signaling, influence body composition and energy metabolism via endocrine signaling, and contribute to the damaging effects of diabetes mellitus and hematological and metastatic cancers in the skeleton.

Evaluating indices of nutritional condition for caribou (Rangifer tarandus): which are the most valuable and why?

Body composition studies are critical for evaluating the accuracy of nutritional condition indices for predicting body components. We evaluated >40 indices of nutritional condition for caribou (Rangifer tarandus (Linnaeus, 1758)) using 29 female caribou captured from three populations in Alaska (USA) that ranged in condition from 2.3% to 11.2% ingesta-free body fat (IFBF) and 6 captive female caribou that ranged in condition from 8.1% to 26.0% IFBF. Estimates of body fat, protein, and gross energy were regressed against each index of nutritional condition. Generally, indices with linear or slightly curvilinear relations to body fat and those based on multiple fat depots were the most accurate in predicting nutritional condition and the most useful over the full range of nutritional condition. A scaledLIVINDEX (a combination of subcutaneous fat thickness and a condition score), CONINDEX (a combination of kidney fat and marrow fat), and a subset of the Kistner score (pericardium and kidneys only) had the strongest relationship with body fat (r2 > 0.86) and were useful over the entire range of nutritional condition. If used properly and with adequate training, indices of nutritional condition can be a critical tool for understanding the severity and seasonality of nutritional limitations in wild caribou populations.