Citations

Abstract Introduction Lumbar spinal stenosis affects more than 200,000 adults in the United States, resulting in approximately 38,000 operations among the Medicare population and greater than $1.5 billion in hospital bills alone. Fortunately, Minimally Invasive Lumbar Decompression (MILD) and the Superion Indirect Decompression System have shown lasting benefit and cost savings compared to more aggressive surgical options. Objective Our primary objective was to retrospectively determine the rate of lumbar decompression surgery following the MILD and Superion procedures. Materials and Methods This was a pooled retrospective review of LSS patients who received MILD and/or Superion procedures between January 2011 and July 2019. Adult patients with CPT codes for MILD and Superion procedures were identified. Patients were included if they had a follow‐up visit at least 2 years from the procedure date, preprocedural MRI results, and surgical notes. Results A total of 199 patients were included in the final analysis, of which 57 patients (28.6%) underwent MILD procedure only, 124 patients (62.3%) underwent Superion only, and 18 patients (9.0%) underwent an MILD procedure initially followed by a Superion procedure. Two patients had an MILD procedure performed twice at the same level at separate encounters. A total of four patients in the entire cohort (2.0%; MILD 5.3%, Superion 0.8%) underwent subsequent lumbar spine surgery when followed for at least 2 years. It is notable that some of these patients may not have been surgical candidates and this may have skewed the results. Conclusions Patients undergoing minimally invasive decompression treatment of lumbar spinal stenosis have low rates of subsequent open surgery which potentially results in cost savings and a reduction in severe adverse events. The reason for low surgical rate may reflect improvement in their symptoms, a preference to avoid surgery, or being deemed not a surgical candidate.

Abstract Cellular senescence, which is a major cause of tissue dysfunction with aging and multiple other conditions, is known to be triggered by p16 Ink4a or p21 Cip1 , but the relative contributions of each pathway toward inducing senescence are unclear. Here, we directly addressed this issue by first developing and validating a p21 ‐ ATTAC mouse with the p21 Cip1 promoter driving a “suicide” transgene encoding an inducible caspase‐8 which, upon induction, selectively kills p21 Cip1 ‐expressing senescent cells. Next, we used the p21 ‐ ATTAC mouse and the established p16 ‐ INK ‐ ATTAC mouse to directly compare the contributions of p21 Cip1 versus p16 Ink4a in driving cellular senescence in a condition where a tissue phenotype (bone loss and increased marrow adiposity) is clearly driven by cellular senescence—specifically, radiation‐induced osteoporosis. Using RNA in situ hybridization, we confirmed the reduction in radiation‐induced p21 Cip1 ‐ or p16 Ink4a ‐driven transcripts following senescent cell clearance in both models. However, only clearance of p21 Cip1 +, but not p16 Ink4a +, senescent cells prevented both radiation‐induced osteoporosis and increased marrow adiposity. Reduction in senescent cells with dysfunctional telomeres following clearance of p21 Cip1 +, but not p16 Ink4a +, senescent cells also reduced several of the radiation‐induced pro‐inflammatory senescence‐associated secretory phenotype factors. Thus, by directly comparing senescent cell clearance using two parallel genetic models, we demonstrate that radiation‐induced osteoporosis is driven predominantly by p21 Cip1 ‐ rather than p16 Ink4a ‐mediated cellular senescence. Further, this approach can be used to dissect the contributions of these pathways in other senescence‐associated conditions, including aging across tissues.

AbstractImmune checkpoint inhibitors (ICIs), as a novel class of anticancer therapy, can be more efficacious and less toxic than chemotherapy, but their clinical success is confined to certain tumor types. Elucidating their targets, mechanisms and scope of action, and potential synergism with chemotherapy and/or targeted therapies are critical to widen their clinical indications. Treatment response to an ICI targeting programmed death‐1 (anti‐PD‐1) is sought to be understood here by conducting a preplanned correlative analysis of a phase II clinical trial in patients with small bowel adenocarcinoma (SBA). The cytolytic capacity of circulating immune cells in cancer patients using a novel ex vivo cytotoxicity assay is evaluated, and the utility of circulating biomarkers is investigated to predict and monitor the treatment effect of anti‐PD‐1. Baseline expression of Bim and NKG7 and upregulation of CX3CR1 in circulating T cells are associated with the clinical benefit of anti‐PD‐1 in patients with SBA. Overall, these findings suggest that the frequency and cytolytic capacity of circulating, effector immune cells may differentiate clinical response to ICIs, providing a strong rationale to support immune monitoring using patient peripheral blood.

ABSTRACTJoint trauma induces a presynaptic reflex inhibition termed arthrogenic muscle inhibition (AMI) that prevents complete activation of muscles. Reduced motor unit (MU) output is a hypothesised mechanism for persistent strength deficits. The objective of this study was to determine MU characteristics of thigh musculature and determine how they change with anterior cruciate ligament (ACL) injury compared to healthy controls. A randomised protocol of knee flexion/extension isometric contractions (10–50% maximal voluntary isometric contraction) was performed for each leg with surface EMG 5‐pin array electrodes placed on the vastus medialis, vastus lateralis, semitendinosus and biceps femoris. Longitudinal assessments for average rate coding, recruitment thresholds and MU action potentials were acquired at 6‐month intervals. With exception of the vastus medialis, all thigh musculature of ACL‐injured demonstrated smaller MU action potential peak‐to‐peak amplitude. For average rate coding, ACL‐injured demonstrated lower coding rates than Controls for the quadriceps (p < .05) and higher rates than Controls for the hamstrings (p < .05). These MU characteristics were different from Controls after ACL reconstruction up to 12 months post‐surgery, yet maximal strength increased during this time frame. As thigh MU characteristics are known across phases of ACL rehabilitation, future studies can assess these patterns of motor control and their potential to determine risk of re‐injury. Further, future rehabilitation can target specific intervention programmes to restore motor control.Highlights Motor unit strategies of arthrogenic muscle inhibition are characterised for the first time via decomposed EMG. Motor unit deficits of thigh musculature persist throughout all phases of ACL rehabilitation, even after return‐to‐sport. After ACL injury, motor unit sizes at similar recruitment thresholds were smaller than those of healthy controls.

AbstractObjectiveMultiple Sclerosis (MS) is often accompanied by myelopathy, which may be associated with progressive worsening. A specific finding of MS‐associated myelopathy is McArdle sign, wherein neck flexion is associated with prominent increased limb weakness relative to that detected with neck extension. In this study, we characterized neuromotor control properties of finger extensors in association with the McArdle sign.MethodsA custom‐built device was utilized to monitor torque production of the wrist extensors with simultaneous recording of surface electromyography of the extensor digitorum. The electromyography was decomposed and analyzed via both linear and nominal regressions.ResultsLinear regressions demonstrated a strong difference between groups for MS from healthy controls and other myelopathies for motor unit action potential amplitude and average firing rate (p < 0.001). Further, linear regression demonstrated good correlations of neuromotor variables to mechanical torque output (0.24 ≤ R2 ≤ 0.76). Nominal regression distinguished MS from healthy controls with an AUC of 0.87, specificity of 0.97, and sensitivity of 0.64. Nominal regression of MS from other myelopathies demonstrated an AUC of 0.88, specificity of 0.85, and sensitivity of 0.79.InterpretationThese data demonstrate the neuromotor control factors that largely determine muscle force production change with the observation of McArdle sign; these neuromotor control factors can differentiate MS from both healthy controls and other myelopathy conditions.

PURPOSEThe study of rare diseases, such as multiple myeloma (MM), often experiences unique research hurdles that can delay or prevent lifesaving discoveries. HealthTree Cure Hub is a first-in-class software program designed to overcome these potential research hurdles.METHODSWe assessed whether HealthTree Cure Hub improved four commonly experienced research hurdles such as (1) small numbers of patient accrual to clinical trials and research studies, (2) shallow and isolated data sets, (3) high costs to answer research questions, and (4) lack of long-term follow-up patient data.RESULTSAs of June 2021, HealthTree Cure Hub, with its unique portal features, has attracted 9,225 patients with MM and diverse demographic backgrounds. While completing an online health profile, patients shared comprehensive data, as well as provided consent to contribute data from electronic medical records. Portal use answered research questions using patient-driven real-world data. This also cultivated relationships with patients and established communication channels that enabled continual patient contact to allow for long-term follow-up.CONCLUSIONThese results suggest that a patient-driven data capture tool such as HealthTree Cure Hub will help alleviate common research hurdles, which, in turn, will accelerate MM research, develop new hypotheses, and ultimately improve survival.