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Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain. Currently, inflammation is associated with adverse symptoms related to the stimulation of nerve fibers that may lead to pain. However, inflammation has also been indicated as the main factor responsible for LDH regression. This apparent controversy places inflammation as a good prognostic indicator of spontaneous regression of LDH. This review addresses the molecular and cellular mechanisms involved in LDH regression, including matrix remodeling and neovascularization, in the scope of the clinical decision on conservative versus surgical intervention. Based on the evidence, a special focus on the inflammatory response in the LDH context is given, particularly in the monocyte/macrophage role. The phenomenon of spontaneous regression of LDH, extensively reported in the literature, is therefore analyzed here under the perspective of the modulatory role of inflammation.

Background Lumbar disc herniation is a prevalent condition that leads to pain, disability, and a reduction in quality of life. While conventional treatments are widely utilized, virtual reality-based exercise programs present a promising alternative. However, the effectiveness of these exercises in the rehabilitation of lumbar disc herniation remains unclear. The aim of this study was to evaluate the effects of virtual reality-based exercises on pain, daily activities, quality of life, and fall risk in individuals with lumbar disc herniation. Materials and methods This randomized controlled trial included 68 patients meeting the study criteria. Inclusion criteria: No other physical disabilities, no surgery in the last 6 months, no uncontrolled diseases, no vertigo, knee or joint issues, moderate/low balance impairment, and body mass ındex below 40. Exclusion criteria: Uncontrolled diseases, vertigo, knee/joint issues, cognitive impairments, pregnancy, inability to complete fall risk measurement, or attend follow-ups . Participants were divided into a virtual reality group ( n  = 34, Mean age ± Standard Deviation = 51.05 ± 13.39, 41.2% male, 58.8% female) and a control group ( n  = 34, Mean age ± Standard Deviation = 53.55 ± 12.25, 29.4% male, 70.6% female). The virtual reality group performed 28 sessions of virtual reality -based exercises, while the control group received routine hospital treatment. The study was conducted in a single hospital due to equipment limitations in the region. Data were collected using the Patient Information Form, Visual Analog Scale, Oswestry Disability Index, Short Form-36 Quality of Life Scale, and Fall Risk Device. Statistical analyses were performed using Statistical Package for the Social Sciences 20, including t-tests, chi-square tests, effect size analysis, and skewness/kurtosis assessments for homogeneity. Results The virtual reality group showed a significant reduction in pain (Visual Analog Scale: 3.38 ± 1.48, Cl: -2.49, -0.86, p  < 0.05) and disability (Oswestry Disability Index: 21.59 ± 6.00, Cl: -19.92, -7.38, p  < 0.05), along with significant improvements in all Short Form-36 Quality Of Life sub-dimensions ( p  < 0.05).Fall risk scores also decreased significantly in the virtual reality group (Cl: -26.57, -7.26, p  < 0.05). There were no significant baseline differences between the groups, confirming their comparability before the intervention. Conclusion Virtual reality -based exercises effectively reduced pain, improved daily activities and quality of life, and decreased fall risk in lumbar disc herniation patients, suggesting their potential as a complementary rehabilitation approach. Blinding was not applied due to the nature of the interventions, which may introduce a potential risk of bias. Trial registration This study was registered at ClinicalTrials.gov (Clinical trial number: NCT05463588; Registration date: 08/07/2022). The study was retrospectively registered.

From the Man Booker Prize-shortlisted author of Swimming Home, a single volume comprising her first two novels: Beautiful Mutants, long out of print, and Swallowing Geography, never before published in the United States.

Background Intervertebral disc degeneration is a common condition with few inexpensive and effective modes of treatment, but current investigations seek to clarify the underlying process and offer new treatment options. It will be important for physicians to understand the molecular basis for the pathology and how it translates to developing clinical treatments for disc degeneration. In this review, we sought to summarize for clinicians what is known about the molecular processes that causes disc degeneration. Results A healthy disc requires maintenance of a homeostatic environment, and when disrupted, a catabolic cascade of events occurs on a molecular level resulting in upregulation of proinflammatory cytokines, increased degradative enzymes, and a loss of matrix proteins. This promotes degenerative changes and occasional neurovascular ingrowth potentially contributing to the development of pain. Research demonstrates the molecular changes underlying the harmful effects of aging, smoking, and obesity seen clinically while demonstrating the variable influence of exercise. Finally, oral medications, supplements, biologic treatments, gene therapy, and stem cells hold great promise but require cautious application until their safety profiles are better outlined. Conclusions Intervertebral disc degeneration occurs where there is a loss of homeostatic balance with a predominantly catabolic metabolic profile. A basic understanding of the molecular changes occurring in the degenerating disc is important for practicing clinicians because it may help them to inform patients to alter lifestyle choices, identify beneficial or harmful supplements, or offer new biologic, genetic, or stem cell therapies.

Background Although previous studies have illustrated improvements in surgical cohorts for patients with intervertebral disc herniation, there are limited data on predictors of long-term outcomes comparing surgical and nonsurgical outcomes. Questions/purposes We assessed outcomes of operative and nonoperative treatment for patients with intervertebral disc herniation and symptomatic radiculopathy at 8 years from the Spine Patient Outcomes Research Trial. We specifically examined subgroups to determine whether certain populations had a better long-term outcome with surgery or nonoperative treatment. Methods Patients with symptomatic lumbar radiculopathy for at least 6 weeks associated with nerve root irritation or neurologic deficit on examination and a confirmed disc herniation on cross-sectional imaging were enrolled at 13 different clinical sites. Patients consenting to participate in the randomized cohort were assigned to surgical or nonoperative treatment using variable permuted block randomization stratified by site. Those who declined randomization entered the observational cohort group based on treatment preference but were otherwise treated and followed identically to the randomized cohort. Of those in the randomized cohort, 309 of 501 (62%) provided 8-year data and in the observational group 469 of 743 (63%). Patients were treated with either surgical discectomy or usual nonoperative care. By 8 years, only 148 of 245 (60%) of those randomized to surgery had undergone surgery, whereas 122 of 256 (48%) of those randomized to nonoperative treatment had undergone surgery. The primary outcome measures were SF-36 bodily pain, SF-36 physical function, and Oswestry Disability Index collected at 6 weeks, 3 months, 6 months, 12 months, and then annually. Further analysis studied the following factors to determine if any were predictive of long-term outcomes: sex, herniation location, depression, smoking, work status, other joint problems, herniation level, herniation type, and duration of symptoms. Results The intent-to-treat analysis of the randomized cohort at 8 years showed no difference between surgical and nonoperative treatment for the primary outcome measures. Secondary outcome measures of sciatica bothersomeness, leg pain, satisfaction with symptoms, and self-rated improvement showed greater improvement in the group randomized to surgery despite high levels of crossover. The as-treated analysis of the combined randomized and observational cohorts, adjusted for potential confounders, showed advantages for surgery for all primary outcome measures; however, this has the potential for confounding from other unrecognized variables. Smokers and patients with depression or comorbid joint problems had worse functional outcomes overall (with surgery and nonoperative care) but similar surgical treatment effects. Patients with sequestered fragments, symptom duration greater than 6 months, those with higher levels of low back pain, or who were neither working nor disabled at baseline showed greater surgical treatment effects. Conclusions The intent-to-treat analysis, which is complicated by high rates of crossover, showed no difference over 8 years for primary outcomes of overall pain, physical function, and back-related disability but did show small advantages for secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement. Subgroup analyses identified those groups with sequestered fragments on MRI, higher levels of baseline back pain accompanying radiculopathy, a longer duration of symptoms, and those who were neither working nor disabled at baseline with a greater relative advantage from surgery at 8 years. Level of Evidence Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

PurposeThis study evaluates consumption displacement, the shift in consumption that occurs when consumers experience a change in the availability of goods, services and amenities to which they are accustomed as the result of an external event, and which is characterised by the points in space and time where consumption occurs and by the movements to, from, and between those points, that is occurring as a result of the effects of COVID-19 on the services sector in the Canterbury region of New Zealand.Design/methodology/approachBased on consumer spending data, the authors identify patterns of consumption displacement for the hospitality and retail sectors as defined by ANZSIC. We answer where, when, how, what and why consumption displacement happens.FindingsThe findings provide evidence of spatial and temporal displacement of consumption based on consumer spending patterns. Evidence of increased spending in some consumption categories confirms stockpiling behaviours. The hospitality sector experiences a sharp decline in consumer spending over lockdown.Originality/valueGiven the lack of studies analysing the impacts of crises and disasters on the services sector and consumption displacement, this study provides evidence of different forms of consumption displacement related to COVID-19.