Quantitative Ultrasound of Phalanx in Primary and Secondary Osteoporosis: Mini-review and Practical Experience

Objective: Dual x-ray absorptiometry (DXA) is gold standard of bone densitometry, but quantitative ultrasound (QUS) of bone is less expensive and portable. This study was designed to assess its usefulness in secondary osteoporosis diagnosis. Materials and Methods: There were 200 secondary osteoporosis cases (rheumatoid arthritis, hemodialysis, kidney transplant patients, and levothyroxine users) and of those, their phalanx QUS results were compared with normal controls. Also, the QUS and DXA results were compared to find any correlation of these methods for diagnosing osteoporosis. Results: There was not significantly different results compared with normal controls, except for those of hemodialysis patients ( P = .00). Also, the comparison of QUS with DXA results showed no significant correlation except in hemodialysis patients, in both spinal and femoral regions ( P = .023 and .21, respectively), as well as the levothyroxine group’s spinal region ( P = .005). Conclusion: These results suggest that QUS of phalanx may be useful in screening secondary osteoporosis but for establishment of diagnosis, DXA measurements are still needed.

Clinical characteristics and neurophysiology features of amyotrophic lateral sclerosis patients at Sanglah Hospital Denpasar

Background. Amyotrophic lateral sclerosis (ALS) is a one of motor neurons disease. The Incidents in Europe are 2.6 per 100,000 people per year and in the United States, more than 5,600 are diagnosed each year. The death was reportedly 2 per 100,000 people per year. In Sanglah Hospital there are no study that described the characteristics clinical and neurophysiology of ALS at Sanglah Hospital. Objective. To find the characteristics of ALS based on clinical and neurophysiology of ALS at Sanglah Hospital in terms of demography, clinical, Nerve Conduction Studies (NCS) and Electromyography (EMG). Methods. Retrospective descriptive study using medical records of patients in neurology polyclinic at Sanglah Hospital from January until December, 2018. Results. From 14 ALS patients with average age of 47 years old, men and women same amount, high school 71.4%, unemployed 50 %, and married 92.8%. Symptoms first appeared with an average age of 42 years with complaints of lower limb weakness 64.3%. The diagnosis of ALS with the symptom UMN and LMN on bulbar and 2 spinal region 71.4%, and symptom with the UMN and LMN on 3 spinal region 28.6%. Results of motor and sensory NCS were normal, type axonal and mixed neuropathy. Characteristics of EMG were PSW +4, fibrillation +4, MUAP: high amplitude (giant potential), widened duration, polyphasic phase, incomplete IP recruitment in all patients (100%) although in different muscles of the examined patient. Conclusions. Characteristics from 14 patients ALS in 2018 at Sanglah Hospital indicate that patients have a good prognosis.

Sacroiliac Joint Variation in Patients With Ossification of the Posterior Longitudinal Ligament

Study Design: Retrospective Cohort Study. Objectives: Ossification of the posterior longitudinal ligament (OPLL) reveals heterotopic ossification in the spinal ligament. OPLL also tends to ossify ligaments and entheses throughout the body. However, hallmarks of sacroiliac (SI) joint ossification and its variation in OPLL have not been clarified. Here, we investigated the morphological changes in SI joints in individuals with and without OPLL. Methods: We included 240 age- and sex-matched patients (OPLL+, 120; OPLL−, 120) in the study. SI joint variations were classified into 4 types: Type 1, normal or small peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophyte formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. Type 4 was further divided into 3 subgroups as previously described. Interactions between the ossified spinal region in OPLL and morphological changes in the SI joint were evaluated. Results: SI joint ankylosis occurs more frequently in patients with OPLL (51.7%) than in those without (non-OPLL) (33.3%). The SI joint vacuum phenomenon (49.2%) was the main finding in non-OPLL. SI joint ankylosis in OPLL was characterized by anterior bridging and intra-articular fusion. OPLL patients with multilevel ossification tend to develop degeneration and ankylosis of the SI joints. Conclusions: OPLL conferred a high risk of SI joint ossification compared with non-OPLL, and patients with extensive ossification had a higher rate of SI joint ankylosis. Understanding SI joint variation could help elucidate OPLL etiology and clarify the phenotypic differences in the SI joint between OPLL and other spinal disorders.

Case Report: A Variant Non-ketotic Hyperglycinemia With GLRX5 Mutations: Manifestation of Deficiency of Activities of the Respiratory Chain Enzymes

Objective: Variant non-ketotic hyperglycinaemia (NKH) is a rare disorder characterized by variable clinical, biochemical, and imaging features. The variant form of NKH is rare and characterized by variable clinical, biochemical and imaging features.Subjects: Herein, we report a girl with variant NKH with two mutations in glutaredoxin 5 (GLRX5), which has been described in only three patients.Results: The clinical and biochemical phenotypes of the patient are also described. She suffered from developmental regression associated with spasticity, developmental delay, anemia and optic atrophy. The mitochondrial leukoencephalopathy was used to designate these disorders. An increased T2 signal from the medulla oblongata to the C6 spinal region was also observed on spinal cord MRI. Tandem mass analysis of a dried blood sample revealed elevated levels of glycine. The patient has two compound heterozygous mutations (c.151_153 del AAG and c.196C>T) in the GLRX5 gene. The c.196C>T mutation led to a stop codon (p.Q66Ter). Activities of mitochondrial respiratory chain (MRC) complexes II+III in the patient's fibroblasts were abnormal.Conclusions: We present the case of a girl with variant NKH who manifested spasticity and bilateral cavitating leukoencephalopathy. The patient had a deficiency of a respiratory chain enzyme, and this is the first report. Genetic testing is important for physicians to evaluate suspected variant NKH patients and to provide proper genetic counseling.

The efficiency of using protein hydro-lyzate to stimulate the reproductive function of minks and improve the commercial properties of animal skins

From the point of view of solving the problem of feed supply in fur farming, the use of biologically active additives that normalize the protein balance is of great interest. The hydrolyzate obtained by the technology developed by us from the waste of fur farming is a highly digestible protein, is characterized by a high content of amine nitrogen, and contains all non-replaceable amino acids. The introduction of hydrolyzate from sable muscle tissue into the main diet of minks allowed to reduce by 1.3 times the number of missing female minks, to increase the yield of mink puppies per main female, increase the viability of the offspring. The efficiency of feeding the protein hydrolyzate in the diet of caged minks was assessed by the commercial properties of the skins. The most important indicators are the thickness of the skin and the ratio of its layers, on which the duration of processing of raw materials during production operations and indicators of the physical and mechanical properties of the skins depend. Analysis of the obtained measurements made it possible to conclude that feeding with protein hydrolyzate led to an increase in the thickness of the skin of various topographic areas of mink skins. The maximum value of the epidermis thickness was observed on the rump part, the minimum - on the spinal region, while the maximum number of guard hairs was noted on the spinal part, the minimum - on the lateral part of the mink skins. Thus, the results obtained indicate the effectiveness of using a protein hydrolyzate to stimulate the reproductive function of minks and improve the commercial properties of animal skins.

Multilevel Pedicle Subtraction Osteotomy for Correction of Severe Rigid Adult Spinal Deformities: A Case Series, Indications, Considerations, and Literature Review

BACKGROUND Rigid and ankylosed thoracolumbar spinal deformities require three-column osteotomy (3CO) to achieve adequate correction. For severe and multiregional deformities, multilevel 3CO is required but its use and outcomes are rarely reported. OBJECTIVE To describe the use of multilevel pedicle subtraction osteotomy (PSO) in adult spinal deformity (ASD) patients with severe, rigid, and ankylosed multiregional deformity. METHODS Retrospective review of 5 ASD patients who underwent multilevel PSO for the correction of severe fixed deformity and review the literature regarding the use of multilevel PSO. RESULTS Five patients presented with spinal imbalance secondary to regional and multiregional spinal deformities involving the thoracolumbar spine. All patients underwent a single-stage two-level noncontiguous PSO, and 2 of the patients underwent a staged third PSO to treat deformity involving a separate spinal region. Significant radiographic correction was achieved with normalization of spinal alignment and parameters. Two-level PSO was able to provide greater than 80 degrees of sagittal plane correction in both the lumbar and thoracic spine. Two patients experienced new postoperative weakness which recovered to preoperative baseline at 3 to 6 mo follow-up. At most recent follow-up, 4 of the 5 patients gained significant pain relief and had improved functionality. CONCLUSION Noncontiguous multilevel PSO is a formidable surgical technique. Additional risk (compared to single-level 3CO) comes in the form of greater blood loss and higher risk for postoperative weakness. Nonetheless, multilevel PSO is feasible and effective for correcting severe multiplanar and multiregional ASD, and patients gain significant benefits in increased functionality and pain relief.

Mapping of Back Muscle Stiffness along Spine during Standing and Lying in Young Adults: A Pilot Study on Spinal Stiffness Quantification with Ultrasound Imaging

Muscle stiffness in the spinal region is essential for maintaining spinal function, and might be related to multiple spinal musculoskeletal disorders. However, information on the distribution of muscle stiffness along the spine in different postures in large subject samples has been lacking, which merits further investigation. This study introduced a new protocol of measuring bilateral back muscle stiffness along the thoracic and lumbar spine (at T3, T7, T11, L1 & L4 levels) with both ultrasound shear-wave elastography (SWE) and tissue ultrasound palpation system (TUPS) in the lying and standing postures of 64 healthy adults. Good inter-/intra-reliability existed in the SWE and TUPS back muscle stiffness measurements (ICC ≥ 0.731, p < 0.05). Back muscle stiffness at the L4 level was found to be the largest in the thoracic and lumbar regions (p < 0.05). The back muscle stiffness of males was significantly larger than that of females in both lying and standing postures (p < 0.03). SWE stiffness was found to be significantly larger in standing posture than lying among subjects (p < 0.001). It is reliable to apply SWE and TUPS to measure back muscle stiffness. The reported data on healthy young adults in this study may also serve as normative reference data for future studies on patients with scoliosis, low back pain, etc.

Experimental evaluation of precision and accuracy of RSA in the lumbar spine

Purpose Roentgen stereophotogrammetric analysis is a technique to make accurate assessments of the relative position and orientation of bone structures and implants in vivo. While the precision and accuracy of stereophotogrammetry for hip and knee arthroplasty is well documented, there is insufficient knowledge of the technique’s precision and, especially accuracy when applied to rotational movements in the spinal region. Methods The motion of one cadaver lumbar spine segment (L3/L4) was analyzed in flexion–extension, lateral bending and internal rotation. The specific aim of this study was to examine the precision and accuracy of stereophotogrammetry in a controlled in vitro setting, taking the surrounding soft tissue into account. The second objective of this study was to investigate the effect of different focal spot values of X-ray tubes. Results Overall, the precision of flexion–extension measurements was found to be better when using a 0.6 mm focal spot value rather than 1.2 mm (± 0.056° and ± 0.153°; respectively), and accuracy was also slightly better for the 0.6 mm focal spot value compared to 1.2 mm (− 0.137° and − 0.170°; respectively). The best values for precision and accuracy were obtained in lateral bending for both 0.6 mm and 1.2 mm focal spot values (precision: ± 0.019° and ± 0.015°, respectively; accuracy: − 0.041° and − 0.035°). Conclusion In summary, the results suggest stereophotogrammetry to be a highly precise method to analyze motion of the lumbar spine. Since precision and accuracy are better than 0.2° for both focal spot values, the choice between these is of minor clinical relevance.

Awareness About Spinal Anaesthesia Among Dental Students

Spinal anaesthesia is administered in the lumbar spinal region and utilized for surgeries, including the lower midsection, pelvis and lower extremities. Spinal anaesthesia is acted in the lumbar region, explicitly the mid to low lumbar levels to maintain a strategic distance from harm to the spinal cord and furthermore to forestall intrathecally-administered drugs from having any action in the upper cervical and thoracic areas. The aim of the study is to assess the awareness about spinal anaesthesia among dental students. This was a questionnaire based cross-sectional type of study comprising 100 dental college students in Chennai. A self-designed questionnaire contains ten questions based on the knowledge and awareness about spinal anaesthesia among dental college students. Questionnaires were circulated through an online website survey planet. The questions explored the awareness on spinal anaesthesia, indications, contraindications, mechanism of administration and side complications. After the responses were received from 100 participants, data was collected and analysed.18% are aware about spinal anaesthesia. 15% are aware of the mechanism of administration of spinal anaesthesia. 13% are aware of the indications of spinal anaesthesia. 11% are aware of the contraindications of spinal anaesthesia.9%.are aware of the complications of spinal anaesthesia. The awareness about spinal anaesthesia was less among dental students. Increased awareness and educational programs should be initiated to spread knowledge about applications of spinal anaesthesia.