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Objective: The objective of this study was to show that degenerative lumbar magnetic resonance imaging findings variably increase discography pain by level., Methods: Lumbar discography and magnetic resonance imaging of 736 patients were retrospectively reviewed. Univariate/multivariate logistic regressions calculated the odds ratio (OR) (95% confidence interval, P < 0.05)., Results: L3-4 multivariate regression OR for a degenerative disc is 9.9; for bulge, 10.9; for annular tear, 38.9; for herniation, 51.5; and for degenerative facet, 2.158. Endplate changes were not significant. L4-5 OR for a degenerative disc is 4.52; for bulge, 13.74, for tear, 19.13; for herniation, 28.65; for endplate edema, 3.47; and fatty change, 3.84. Degenerative facet ORs were not significant. L5-S1 OR for a degenerative disc is 6.86; for bulge, 5.65; for tear, 40.56; and for herniation, 77.98. Endplate changes and degenerative facet OR's were not significant., Conclusions: Advancing degeneration increases pain at L5-S1 followed by L3-4. Endplate signal is significant only at L4-5., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To test the hypothesis that a multicomponent workshop about wheelchairs, tailored for undergraduate medical students, is effective in improving medical students' wheelchair-related knowledge, skills, and attitudes., Design: A randomized controlled trial of 24 first- and second-year medical students randomly allocated into intervention and control groups was undertaken. The intervention group received a 4-hr workshop that included didactic, practical, community, and reflective elements. The educational objectives were validated by a focus group. The main outcome measures were a written knowledge test, a practical examination, the Scale of Attitudes Toward Disabled Persons, and students' perceptions., Results: The baseline characteristics of the groups were comparable. After the workshop, the mean scores on the written knowledge test and practical examination for the intervention group were higher than for the control group by 23.9% (95% confidence interval, 17.6%-30.3%; P < 0.0001) and 34.4% (95% confidence interval, 26.3%-42.5%; P < 0.0001), respectively. The difference (-1.6%) for the Scale of Attitudes Toward Disabled Persons scores was not significant (P = 0.93), but there may have been a ceiling effect (both groups' mean scores were >87%). The perceptions of the students who took the workshop were highly positive., Conclusions: A wheelchair workshop designed for medical students was practical, well received by students, and effective at improving students' knowledge and skills. Although students' attitudes were not measurably affected by the intervention, there was qualitative evidence of a positive effect.

Previous studies report S-adenosyl-L-methionine (SAMe) can exert hepatoprotective effects. At present, the role of SAMe in affecting the activation and/or proliferation of hepatic stellate cells (HSCs) during alcohol-induced fibrotic disease progression is poorly understood. In the human disease state, chronic ethanol intake increases hepatic exposure to LPS and magnifies the hepatic insult leading to fibrosis and cirrhosis. In this study, we developed a "2-hit" ethanol-LPS fibrotic liver rat model with which to investigate the effects of SAMe as a hepatic antifibrotic treatment. Male rats were maintained on liquid diets containing either ethanol or isocalorically matched controls for 8 weeks. Animals received ethanol alone (E), ethanol concomitant with twice weekly LPS injections (EL), or ethanol, LPS, and daily SAMe injections. When using this model, SAMe-treated animals demonstrated significantly decreased fibrosis, oxidative stress, steatosis, and improved liver function versus the EL group. In addition, the EL group showed increased HSC activation, an effect that was abrogated by the addition of SAMe. Analysis of the transforming growth factor-beta (TGF-beta) signaling pathways demonstrated increased hepatic TGF-beta and Smad3 messenger RNA expression in the E and EL groups, which was inhibited in the presence of SAMe. Conversely, SAMe led to increased Smad7 (an inhibitor of TGF-beta signaling) messenger RNA expression. These data demonstrate chronic ethanol feeding combined with LPS induces liver fibrosis, and the addition of SAMe significantly reduces hepatic injury and fibrosis through inhibition of oxidative stress and HSC activation.

Hemangiopericytoma is a rare vascular tumor, of which 5% to 10% occur in the pediatric population. Although usually benign in infants, local recurrence, metastasis, and deaths have been reported. Clonal chromosomal rearrangements have been described, most involving the long arm of chromosome 12. We report a case of a 6-month-old boy with an hemangiopericytoma of the left forearm initially incorrectly diagnosed as hemangioma. He was treated successfully with chemotherapy alone using vincristine, doxorubicin, actinomycin-D, and cyclophosphamide. Although cytogenetic analysis was not performed on his biopsy, it was later discovered that a prenatal karyotype had shown 46,XY,inv(12)(q15q24.1).

Objective: To test the hypotheses that increased rolling resistance (RR) reduces rear-wheel displacement and perceived difficulty during the takeoff and balance phases of stationary wheelchair wheelies., Design: We carried out within-subject comparisons of 20 participants as they each performed, in random order, two 30-sec stationary wheelies in three RR settings (tile, 5-cm-thick foam, and 12.5-cm-high blocks in front of and behind the rear wheels). The main outcome measures were rear-wheel displacement (in centimeters for the takeoff phase and centimeters per second for the balance phase) from a spring-loaded potentiometer and Likert scales of perceived difficulty., Results: For rear-wheel displacement, all six of the pairwise comparisons (three terrains x two phases (takeoff and balance)) showed a significant statistical difference (P < 0.002). In each of the six pairwise comparisons, displacement was less for the higher of the two RR conditions. For perceived difficulty, during the balance phase, participants perceived tile to be significantly more difficult than either foam (P = 0.0067) or blocks (P = 0.0002). The other pairwise comparisons were not statistically significant., Conclusion: In conditions of increased RR, rear-wheel displacement and perceived difficulty are reduced during stationary wheelchair wheelies. These findings have implications for teaching wheelchair users to perform wheelies, a foundation of many advanced wheelchair skills.

The lumbar spine magnetic resonance (MR) studies in 246 consecutive patients who suffered from persistent back and leg pain were evaluated for the degree of degenerative disc disease and the presence of disc bulging, prolapse, or herniation. No patient had a history of previous back surgery. In those patients, degenerative disc changes increased with age until the fifth decade of life, after which a relatively similar proportion of patients had degenerative disc disease. Significant dehydration and degeneration occurred in less than 5% of the upper two disc spaces while L4/5 and L5/S1 had marked changes in greater than 20%. Prolapse and herniation progressively increased with each lower interspace, where at L5/S1 it was present in nearly one-third of the patients. Although a few patients had disc prolapse or herniation with a nondegenerated disc, there was a relationship between the presence of disc degeneration and prolapse or herniation.

The relation between personality characteristics and the psychological functioning of headache patients has long been a topic of interest. Early investigations focused on clinical and anecdotal reports while recent research has moved toward a more objective evaluation of headache groups by using the MMPI. However, the findings from diverse studies have not been integrated, nor has a rationale for the use of these data in the clinical management of headache been formally presented. The focus of this review is to present a concise, integrated analysis of previous group MMPI headache studies and apply these findings to differential diagnosis, prediction of treatment outcome, and client-treatment matching. Five selected clinical case studies indicating various degrees of psychopathology in migraine headache patients are presented to highlight treatment issues in support of an idiographic utilization of the MMPI for the clinical treatment of headache patients.

Migraine, muscle-contraction headache patients, and non-headache controls were physiologically assessed during self-selected 'stressful' and 'relaxing' imagery in headache and non-headache states. Musculoskeletal (frontalis, bilateral temporalis), vascular (heart rate, bilateral temporal artery pulse volume), and autonomic (skin conductance response) measures failed to differentiate the groups on resting response levels--in both headache and non-headache states. 'Stressful' imagery elicited greater reactivity than 'relaxing' imagery in all three response systems, regardless of headache type. However, a group by condition interaction eventuated only for the electromyographic measures, indicating that the muscle-contraction patients were significantly more reactive during stressful imagery than migrainers and controls.