Intraosseous Radiofrequency Ablation of the Basivertebral Nerve in Chronic Low Back Pain: A Meta-Analysis

Purpose: To review the literature on the value of basivertebral nerve abla-tion in the treatment of chronic low back pain. Materials and Method: A systematic review and meta-analysis of the English literature to March 2020 was undertaken. The inclusion criteria were patients with discogenic back pain of more than 3 months duration with modic type 1 or 2 change and suc-cessful disc block or discogram. Primary outcomes were VAS pain, ODI, EQ-5D and SF36 improvement. Secondary outcomes were complications. Results: 6 studies were included, all funded by the same company, but oth-erwise of low bias. All studies showed significant improvement in all scores over the first 3 months with evidence these would be maintained over the longer term. There was one reported compression fracture, but otherwise no significant adverse events. Conclusion: This study supports the conclusion that radiofrequency ablation of the basivertebral nerve is a safe and effective treatment for discogenic chronic low back pain.

Challenges with Disaster Mortality Data and Measuring Progress Towards the Implementation of the Sendai Framework

Disasters exact a heavy toll globally.However,the degree to which we can accurately quantify their impact,in particular mortality,remains challenging.It is critical to ensure that disaster data reliably reflects the scale,type,and distribution of disaster impacts given the role of data in:(1)risk assessments;(2)developing disaster risk management programs;(3)determining the resources for response to emergencies;(4)the types of action undertaken in planning for prevention and preparedness;and(5)identifying research gaps.The Sendai Framework for Disaster Risk Reduction 2015–2030 s seven global disaster-impact reduction targets represent the first international attempt to systematically measure the effectiveness of disaster-impact reduction as a means of better informing policy with evidence.Target A of the Sendai Framework aims to‘‘substantially reduce global disaster mortality by 2030,aiming to lower the average per 100,000 global mortality rate in the decade 2020–2030 compared to the period 2005–2015.’’This article provides an overview of the complexities associated with defining,reporting,and interpreting disaster mortality data used for gauging success in meeting Target A,acknowledging different challenges for different types of hazard events and subsequent disasters.It concludes with suggestions of how to address these challenges to inform the public health utility of monitoring through the Sendai Framework.

Reduced striatal volumes in Parkinson’s disease:a magnetic resonance imaging study

Background:The presence and extent of structural changes in the brain as a consequence of Parkinson’s disease(PD)is still poorly understood.Methods:High-resolution 3-tesla T1-weighted structural magnetic resonance images in sixty-five PD and 27 age-matched healthy control participants were examined.Putamen,caudate,and intracranial volumes were manually traced in the axial plane of 3D reconstructed images.Striatal nuclei volumes were normalized to intracranial volume for statistical comparison.Disease status was assessed using the Unified Parkinson’s Disease Rating Scale and Hoehn and Yahr scale.Cognitive status was assessed using global status tests and detailed neuropsychological testing.Results:Both caudate and putamen volumes were smaller in PD brains compared to controls after adjusting for age and gender.Caudate volumes were reduced by 11%(p=0.001)and putamen volumes by 8.1%(p=0.025).PD striatal volumes were not found to be significantly correlated with cognitive or motor decline.Conclusion:Small,but significant reductions in the volume of both the caudate and putamen occur in PD brains.These reductions are independent of the effects of age and gender,however the relation of these reductions to the functional loss of dopamine,which is characteristic of PD,remains unclear.

Comparison of cognitive and UHDRS measures in monitoring disease progression in Huntington’s disease: a 12-month longitudinal study

Progressive cognitive decline is a feature of Huntington’s disease(HD),an inherited neurodegenerative movement disorder.Comprehensive neuropsychological testing is the‘gold standard’to establish cognitive status but is often impractical in time-constrained clinics.The study evaluated the utility of brief cognitive tests(MMSE and MoCA),UHDRS measures and a comprehensive neuropsychological tests battery in monitoring short-term disease progression in HD.Twenty-two manifest HD patients and 22 matched controls were assessed at baseline and 12-month.A linear mixed-effect model showed that although the HD group had minimal change in overall global cognition after 12 months,they did show a significant decline relative to the control group.The controls exhibited a practice effect in most of the cognitive domain scores over time.Cognitive decline at 12-month in HD was found in the executive function domain but the effect of this on global cognitive score was masked by the improvement in their language domain score.The varying practice effects by cognitive domain with repeated testing indicates the importance of comparing HD patients to control group in research trials and that cognitive progression over 12 months in HD should not be judged by changes in global cognitive score.The three brief cognitive tests effectively described cognition of HD patients on cross-sectional analysis.The UHDRS cognitive component,which focuses on testing executive function and had low variance over time,is a more reliable brief substitute for comprehensive neuropsychological testing than MMSE and MoCA in monitoring cognitive changes in HD patients after 12 months.