Inhibition of Maternal-to-Fetal Transfer of IgG Antibodies by FcRn Blockade in a Mouse Model of Arthrogryposis Multiplex Congenita

ObjectiveTo determine whether blocking the neonatal Fc receptor (FcRn) during gestation with an anti-FcRn monoclonal antibody (mAb) reduces transfer of pathogenic maternal antibodies in utero and decreases the likelihood of maternal antibody-mediated neonatal disease in the offspring.MethodsUsing a previously established maternal-to-fetal transfer mouse model of arthrogryposis multiplex congenita (AMC), we assessed the effect of 4470, an anti-FcRn mAb, on the transfer of total human immunoglobulin G (IgG) and specific acetylcholine receptor (AChR)-antibodies from mother to fetus, as well as its effect on the prevention of neurodevelopmental abnormalities in the offspring.ResultsOffspring of pregnant dams treated with 4470 during gestation showed a substantial reduction in total human IgG and AChR antibody levels compared with those treated with the isotype mAb control. Treatment with 4470 was also associated with a significant reduction in AMC-IgG–induced deformities (limb or spinal curve malformations) when compared with mAb control–exposed embryos and a nonsignificant increase in the percentage of fetuses showing spontaneous movements. 4470 exposure during pregnancy was not associated with changes in general parameters of maternal well-being or fetal development; indeed, male neonates showed faster weight gain and shorter time to reach developmental milestones.ConclusionsFcRn blockade is a promising therapeutic strategy to prevent the occurrence of AMC and other human maternal autoantibody-related diseases in the offspring.

Reliability of cervical vertebral maturation compared to hand-wrist for skeletal maturation assessment in growing subjects: A systematic review

BACKGROUND: Radiographic methods to assess skeletal maturity (SM) have a key role in adolescent idiopathic scoliosis (AIS) management, allowing to predict risk of spinal curve progression. Cervical vertebral maturation (CVM) has been recently introduced as an alternative tool to assess skeletal maturity; however, its clinical role is still debated. OBJECTIVE: This systematic review aimed to investigate the reliability of CVM in the SM assessment of growing subjects, comparing it to hand wrist maturation (HVM). METHODS: PubMed, Scopus, and Web of Science databases were systematically searched from inception until 31st December 2020 to identify observational studies presenting: growing subjects as participants; CVM methods as intervention; HVM methods as comparator; reliability for SM assessment as outcome. A 10-item quality tool has been used to assess study quality. RESULTS: Out of 205 papers, 12 papers were included in the data synthesis. We classified 10 studies (83.3%) as medium-quality studies and 2 studies (16.7%) as high-quality studies. Eight studies reported a significant correlation between CVM Baccetti and different HWM methods. CONCLUSION: Taken together, these findings suggested that CVM might be considered as reliable SM assessment method compared to HWM in growing subjects. However, further studies are warranted to confirm these findings.

CONCEPT OF TEXT NECK SYNDROME AND ITS MANAGEMENT THROUGH AYURVEDA

Text neck syndrome is an emerging disease of today’s world. The term ‘text neck’ is used to describe a re-petitive stress injury or an overuse syndrome due to forward head flexion and bent down looking at handheld devices like mobile phone, tablet or other wireless electronic devices for prolonged period of time. Our young generation is at high risk of developing this disease because they spend their most of the times by hunching over the mobile phones. It is manifested by neck pain, neck stiffness, reduced mobility of neck and headache. If it is left untreated then it may lead to flattening of the spinal curve, onset of early arthritis, spinal misalignment, disc compression, disc herniation, nerve damage and muscle damage etc. It can be correlated with Manyastambha due to similarity in their symptoms. Manyastambha is characterized by neck pain, neck stiffness and restricted movements of neck. One should follow proper preventive measures to avoid Text neck syndrome, as we know ‘Prevention is better than cure’. In this article Ayurve-dic management of this disease has been discussed in detail. It includes Nidana parivarjana, Abhyanga, Ruksha Swedana, Nasya Karma, Greeva basti and Shamana aushadhis etc. along with these some Yoga-asanas have also been mentioned that are beneficial to combat this disease.

Biofeedback Posture Training for Adolescents with Mild Scoliosis

Asymmetry in paraspinal myoelectric activities is a prominent risk factor for curve progression in adolescent idiopathic scoliosis. This study aimed to evaluate the effectiveness of a surface electromyography (sEMG) biofeedback posture training program for adolescents with mild scoliosis (Cobb’s angle < 30°), with the ultimate goal of controlling the curve progression. Seven female adolescents (age, 12–14 years) with mild scoliosis (Cobb’s angle < 30°) were recruited. The participants received 30 tailor-made sessions of sEMG biofeedback posture training at a rate of one to two sessions per week for approximately 6 months. The activities of the paraspinal muscles (the trapezius, latissimi dorsi, thoracic erector spinae, and lumbar erector spinae), as measured by sEMG during habitual sitting postures, and spinal deformity, as evaluated by ultrasound imaging, were compared before and after training to evaluate its effectiveness. The mean values of the root-mean-square sEMG ratio, an index of symmetry in paraspinal muscle activity between the concave and convex of the spinal curve, revealed significant asymmetry over the trapezius and lumbar erector spinae before the training. After the training, all seven adolescents achieved significantly more symmetrical muscle activity over these two muscle pairs. In two adolescents, the spinal curvature decreased by more than 5°, whereas the remaining adolescents showed a minimal curve progression with changes in the spinal curvature controlled under 5°. sEMG biofeedback posture training is effective in adolescents with mild scoliosis, and can be implemented as an early intervention to improve their posture and mitigate curve progression.

A Semi-Automatic Algorithm for Estimating Cobb Angle

Background: Scoliosis is the most common type of spinal deformity. A universal and standard method for evaluating scoliosis is Cobb angle measurement, but several studies have shown that there is intra- and inter- observer variation in measuring cobb angle manually.Objective: Develop a computer- assisted system to decrease operator-dependent errors in Cobb angle measurement.Methods: The spinal cord in the given x-ray image of the spine is highlighted using contract-stretching technique. The overall structural curvature of the spine is determined by a semi-automatic algorithm aided by the operator. Once the morphologic curve of the spine is determined, in the last step the cobb-angle is estimated by calculating the angle between two normal lines to the spinal curve at the inflection points of the curve.Results: Evaluation results of the developed algorithms using 14 radiographs of patients ( 4 - 40 years old) with cobb angle ranges from 34 - 82 degrees, revealed that the developed algorithm accurately estimated cobb angle. Statistical analysis showed that average angle values estimated using the developed method and that provided by experts are statistically equal. The correlation coefficient between the angle values estimated using the developed algorithm and those provided by the expert is 0.81.Conclusion: Compared with previous algorithms, the developed system is easy to use, less operator-dependent, accurate, and reliable. The obtained results are promising and show that the developed computer-based system could be used to quantify scoliosis by measuring Cobb angle.

FUNCTIONAL CAPACITY IN ADOLESCENT IDIOPATHIC SCOLIOSIS DURING THE POSTOPERATIVE PERIOD

ABSTRACT Introduction: Patients with Adolescent Idiopathic Scoliosis (AIS) show reduced exercise capacity during the Incremental Shuttle Walk Test (ISWT). However, we not know how patients behave in the late postoperative (LPO) period. Objective: The aim of this study was to evaluate the ISWT distance (ISWTD) and physiological responses during ISWT in AIS patients during the LPO period. Methods: We included 22 patients with AIS in the LPO period (SG) and 21 adolescents in the Control Group (CG). We assessed pulmonary function (FVC and FEV1). During ISWT, a gas analyzer was used to assess peak oxygen (VO2) and submaximal relations: Oxygen Uptake Efficiency Slope (OUES) and the breathing pattern (ΔVT/ΔlnVE). Results: Significantly lower values were observed in SG: VO2 (22 ± 5 vs. 27 ± 4), ISWTD (567 ± 94 vs.604 ± 86), FVC (2.70 ± 0.47 vs. 3.33 ± 0.52) and FEV1 (2.41 ± 0.46 vs. 2.84 ± 0.52). There were significant correlations between ISWTD and VO2/Kg (r = 0.80); between OUES and ΔVT/ΔlnVE (r = 0.65); and between the main thoracic curve with VO2/Kg (r= −0.61). Conclusion: AIS patients in the LPO period have significantly reduced exercise capacity associated with reduced lung function, residual spinal curve and cardiovascular deconditioning. Level of Evidence III; Prognostic Studies - Investigation of the effect of characteristic of a patient on the outcome of the disease.