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Purpose: Gene expression analysis of the endometrium has been shown to be a useful approach for identifying the molecular signatures and pathways involved in recurrent implantation failure (RIF). Nevertheless, individual studies have limitations in terms of study design, methodology and analysis to detect minor changes in expression levels or identify novel gene signatures associated with RIF. Method: To overcome this, we conducted an in silico meta-analysis of nine studies, the systematic collection and integration of gene expression data, utilizing rigorous selection criteria and statistical techniques to ensure the robustness of our findings. Results: Our meta-analysis successfully unveiled a meta-signature of 49 genes closely associated with RIF. Of these genes, 38 were upregulated and 11 downregulated in RIF patients' endometrium and believed to participate in key processes like cell differentiation, communication, and adhesion. GADD45A, IGF2, and LIF, known for their roles in implantation, were identified, along with lesser-studied genes like OPRK1, PSIP1, SMCHD1, and SOD2 related to female infertility. Many of these genes are involved in MAPK and PI3K-Akt pathways, indicating their role in inflammation. We also investigated to look for key miRNAs regulating these 49 dysregulated mRNAs as potential diagnostic biomarkers. Along with this, we went to associate protein–protein interactions of 49 genes, and we could recognize one cluster consisting of 11 genes (consisted of 22 nodes and 11 edges) with the highest score (p = 0.001). Finally, we validated some of the genes by qRT-PCR in our samples. Conclusion: In summary, the meta-signature genes hold promise for improving RIF patient identification and facilitating the development of personalized treatment strategies, illuminating the multifaceted nature of this complex condition. [ABSTRACT FROM AUTHOR]

Purpose of Review: Diabetes and metabolic syndrome are highly prevalent in patients undergoing spine surgery. This review aims to capture both the findings of recently published literature investigating the effects of diabetes and metabolic syndrome on spine surgery outcomes and the current best practices in patient management. Recent Findings: Diabetes and metabolic syndrome both contribute to worse outcomes in patients undergoing spine surgery. Although patients with diabetes are at greater risk of complications, those with uncontrolled diabetes experience increased healthcare costs and greater odds of postoperative complications. Furthermore, metabolic syndrome is repeatedly shown to have an adverse effect on spine surgery outcomes, including healthcare costs and medical complications. Summary: Spine surgeons should coordinate care with primary care physicians to optimize the preoperative profile of patients with comorbidities like diabetes and metabolic syndrome to minimize operative risk. With the shift to value-based care, understanding the patient factors that lead to complications is becoming increasingly important. Future studies should build upon the current literature and design preoperative interventions for at-risk patients. Additionally, further research is needed to analyze the modulatory effects of the social determinants of health in patients with diabetes and metabolic syndrome. [ABSTRACT FROM AUTHOR]

Purpose of Review: Vitamin D is an essential micronutrient for human bone health and maintenance. Patients undergoing orthopaedic surgery with hypovitaminosis D may be at greater risk for worsened clinical outcomes. This narrative review aims to compile the current literature studying the effects of low preoperative vitamin D on spine surgery outcomes, creating a resource that clinicians can use to inform their practice. Recent Findings: Vitamin D deficiency predisposes to worse outcomes following spine surgery. Vitamin D supplementation may be beneficial in reducing the risk for adverse postoperative events; however, the literature is inconclusive regarding its efficacy in improving bone density and fracture risk. Summary: Spine clinicians should be aware of the increased risk for poor outcomes in patients with preoperative vitamin D deficiency. Future investigations are needed to better evaluate the benefits of preoperative vitamin D screening and supplementation on improving surgical outcomes in spine patients. These studies must also consider the effects on perioperative healthcare costs. [ABSTRACT FROM AUTHOR]

Purpose of Review: Social determinants of health (SDH) are factors that affect patient health outcomes outside the hospital. SDH are "conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." Current literature has shown SDH affecting patient reported outcomes in various specialties; however, there is a dearth in research relating spine surgery with SDH. The aim of this review article is to identify connections between SDH and post-operative outcomes in spine surgery. These are important, yet understudied predictors that can impact health outcomes and affect health equity. Recent Findings: Few studies have shown associations between SDH pillars (environment, race, healthcare, economic, and education) and spine surgery outcomes. The most notable relationships demonstrate increased disability, return to work time, and pain with lower income, education, environmental locations, healthcare status and/or provider. Despite these findings, there remains a significant lack of understanding between SDH and spine surgery. Summary: Our manuscript reviews the available literature comparing SDH with various spine conditions and surgeries. We organized our findings into the following narrative themes: 1) education, 2) geography, 3) race, 4) healthcare access, and 5) economics. [ABSTRACT FROM AUTHOR]

Purpose of Review: Hypothyroidism is a common medical comorbidity and has been linked to adverse surgical outcomes. However, its effect on spine surgery outcomes is less clear. The aim of this review is to compile current literature to serve as a guide for spine surgeons when treating patients with hypothyroidism. Recent Findings: In both the cervical and lumbar spine, patients with hypothyroidism are at increased risk of postoperative medical complications. Consequently, patients with hypothyroidism experience increased healthcare costs and readmission rates. However, there are some contradictory findings with some studies suggesting that hypothyroidism may have a protective effect in patients undergoing lumbar fusion, specifically against postoperative myocardial infraction and decreased inpatient mortality. Summary: When examining spine surgery outcomes, there are mixed results when considering the effect of hypothyroidism. Some studies have shown increased medical complications, hardware failure, and increased expenditure; however, other recent findings suggest possible protective effects. Future studies are needed to help create concrete guidelines for treating patients with hypothyroidism. [ABSTRACT FROM AUTHOR]

Purposes: The present study was aimed to formulate dual-release reconstitutable oral suspension (DRROS) of cefpodoxime proxetil (CPDP) for pediatric patients using the Quality by Design (QbD) approach. Methods: CPDP pellets were prepared using the extrusion–spheronization technique. Sustained-release pellets (SRPs) of CPDP were prepared using HPMCK100M, Eudragit RSPO, and KollidonSR as release retardant, whereas immediate-release pellets (IRPs) were designed and evaluated using a varying concentration of super disintegrating agents. Qualitative risk analysis was performed to screen and identify the significant factors using the failure mode effect analysis (FMEA) model. 32 factorial designs were used to optimize the SRP formulation. The pellets were assessed for pellet size, pellet shape, flow properties, percent yield, percentage friability, and drug loading. DRROS formulations were prepared and evaluated for rheological and sedimentation behavior. Results: The result of optimizing the batch of IRPs displays the lowest disintegration time, shortest wetting time, and highest % water absorption, and appropriate pellet size, and presented around 99% drug release at 2 h. Aftereffects of SRPs presented that amount of Eudragit RSPO and HPMC K100M had a huge impact on t90 (h), t50 (h), Q2 (%), and Q10 (%), found to be critical factors in the FMEA model. Factorial batch B6 of SRPs showed 98.6% drug release at 12 h and f2 (86.36%) and f1 (2.72%). SEM showed that the P10 batch of IRP and SRP F6 batches were spherical with a smooth surface and carefully chosen to formulate DRROS. In vivo plasma anticipated the concentration–time profile from optimizing in vitro SRP data. DRROS demonstrated no critical contrast in % CPR on the first day and the following 15 days which shows the good stability of DRROS. Conclusion: The finding showed that DRROS of CPDP was successfully formulated for pediatric patients. [ABSTRACT FROM AUTHOR]

Purpose of Review: Cannabis is among the most used illicit substances globally, with medical applications, increased legalization, and shifting social attitudes leading to increased use in recent years. Cannabinoids are a group of psychoactive substances found within the cannabis plant, with the most common being Δ9-tetrahydrocannabinol and cannabidiol. Due to the high prevalence of use, it is increasingly important to evaluate the effects of cannabis and cannabinoids on spine patients, in both operative and nonoperative settings. Recent Findings: Cannabis and cannabinoids may be effective in treating patients with chronic conditions such as back pain and spinal cord injuries. Longitudinal effects and implications on surgical outcomes and complications are poorly understood. High-quality, outcomes-focused research can inform approaches for clinicians to approach cannabis and cannabinoid use. Studies to elucidate the standardization of cannabis regimens can help develop guidelines for potential therapeutic applications. Cannabis and cannabinoids may be useful alternatives or additions for many spine patients, but future research is needed for recommendations to be determined. Summary: Our manuscript reviews the available literature regarding cannabis use and various spinal conditions, organizing our findings into the following narrative themes: (1) the management of chronic lower back pain, (2) perioperative outcomes, (3) cannabis use in general orthopaedic procedures, and (4) spinal cord injuries. [ABSTRACT FROM AUTHOR]

Purpose of Review: In recent years, machine learning techniques have been increasingly utilized across medicine, impacting the practice and delivery of healthcare. The data-driven nature of orthopaedic surgery presents many targets for improvement through the use of artificial intelligence, which is reflected in the increasing number of publications in the medical literature. However, the unique methodologies utilized in AI studies can present a barrier to its widespread acceptance and use in orthopaedics. The purpose of our review is to provide a tool that can be used by practitioners to better understand and ultimately leverage AI studies. Recent Findings: The increasing interest in machine learning across medicine is reflected in a greater utilization of AI in recent medical literature. The process of designing machine learning studies includes study design, model choice, data collection/handling, model development, training, testing, and interpretation. Recent studies leveraging ML in orthopaedics provide useful examples for future research endeavors. Summary: This manuscript intends to create a guide discussing the use of machine learning and artificial intelligence in orthopaedic surgery research. Our review outlines the process of creating a machine learning algorithm and discusses the different model types, utilizing examples from recent orthopaedic literature to illustrate the techniques involved. [ABSTRACT FROM AUTHOR]

p-Nitroaniline (PNAN) and nitrobenzene (NB) being important raw materials and intermediates for the production of a wide range of chemical products have the potential of constituting water pollutants. Hence, the development of the means of removing these chemicals from water would go a long way to safeguard the health of the environment. The goal of this research was to transform bagasse fly ash (BFA), solid waste from the sugar industry into porous zeolitic adsorbents MgFZBFA and MgMZBFA and examine them for their adsorptive removal of PNAN and NB from aqueous solutions. The syntheses of the sorbents involve alkali fusion technique and microwave hydrothermal treatment for the desired properties. Advanced characterization techniques such as FTIR (Fourier transform infrared spectroscopy), XRF (X-ray fluorescence spectroscopy), XRD (X-ray diffraction spectroscopy), SEM (scanning electron microscopy), Brunauer–Emmett–Teller (BET)/Barrett–Joyner–Halenda (BJH) Method, and TGA (thermogravimetric analysis) were used for the characterization and evaluation of the sorbents' properties. The adsorptive removal of PNAN and NB from aqueous solutions by MgFZBFA and MgMZBFA were investigated. Various parameters such as pH, adsorbent dosage, initial sorbate concentration were optimized during the adsorption experiment to achieve best performance. Adsorption isotherm, kinetics and dynamics were studied. It was found that Langmuir adsorption isotherm model better represents the adsorption processes and that the processes follow pseudo-second-order kinetics. More so, the sorption processes were most possibly completed by both surface sorption (liquid-film diffusion) and intra-particle diffusion. The maximum sorption capacities observed with MgFZBFA for PNAN and NB are 30.86 mg g−1 and 19.92 mg g−1, while with MgMZBFA the values are 12.72 mg g−1 and 10.20 mg g−1, respectively. The performances of MgFZBFA and MgMZBFA for the sorption of PNAN and NB were compared with some adsorbents previously studied for the same purpose, and results show that the adsorbents in the present study exhibit better performances. The application as materials of cheap source for the removal of PNAN and NB from contaminated water could be considered. [ABSTRACT FROM AUTHOR]

Tonsillectomy is one of the most common surgical procedures carried out in ENT since ancient time, is associated with several morbidities in which the pain and bleeding being the commonest and can cause considerable delay in starting oral intake and discharge from the hospital. Different methods have been used to reduce posttonsillectomy pain including use of opioids, sucralfate and local anaesthetics. Local anaesthetics in the form of pre-incisional or post-incisional peritonsillar infiltration and also topical post-incisional spray or packing are some of the most effective methods for post-tonsillectomy pain management. In our hospital, a study was carried out for preincisional peritonsillar infiltration of 0.5% bupivacaine in tonsillectomy patients for post operative pain relief. Written informed valid consent was taken, all routine investigations were done. Pre anaesthetic check up was done and bupivacaine test dose was given, none of the patients showed allergic reactions. Our study showed that this is effective method of controlling post operative pain. Patients receiving bupivacaine showed lower pain scores 6 h post operatively. The mean pain scores for Bupivacaine group were 2.85, 5.52 and 7.04 versus 5.04, 7.04 and 7.61 in saline group at 2, 4, and 6 h post operatively (t value significant). Pre incisional peritonsillar infiltration of 0.5% bupivacaine significantly reduces postoperative pain till 6 h, thereby reducing the need of analgesics intraoperatively and post operatively. Oral intake was also earlier without any adverse effects in our study. [ABSTRACT FROM AUTHOR]

Purpose of Review: The field of spine surgery remains a unique target in the transition to value-based care. While spine surgery has benefited from new medical technologies, including minimally invasive surgery (MIS), these technologies may be a key driver in rising US healthcare costs. As such, MIS needs to clear an economic value threshold through a rigorous evaluation of the outcomes they provide and costs they incur. In this article, we review recent MIS surgery literature from the perspective of economic value. Recent Findings: Many studies report modest all-in cost savings and direct procedural cost equivalence for minimally invasive approaches relative to open surgeries. In terms of quality, studies found lower blood loss, length of stay, and infectious complications with MIS surgery but evidence on QALYs was mixed. Summary: In the past 5 years, there has been increasing research interest in defining economic value in MIS surgery. However, a significant amount of heterogeneity in research quality and methodology persists. Therefore, MIS surgery has the potential to be of high economic value, though this is not yet definitive. Future research should continue to focus on high-quality cost-effectiveness studies with clear methodologies to further elucidate economic value in MIS surgery. [ABSTRACT FROM AUTHOR]

Purpose: To determine if adolescent athletics increases the risk of structural abnormalities in the lumbar spine.Methods: A retrospective review of patients (ages 10-18) between 2004 and 2012 was performed. Pediatric patients with symptomatic low back pain, a lumbar spine MRI, and reported weekly athletic activity were included. Patients were stratified to an "athlete" and "non-athlete" group. Lumbar magnetic resonance and plain radiographic imaging was randomized, blinded, and evaluated by two authors for a Pfirrmann grade, herniated disc, and/or pars fracture.Results: A total of 114 patients met the inclusion criteria and were stratified into 66 athletes and 48 non-athletes. Athletes were more likely to have abnormal findings compared to non-athletes (67 vs. 40 %, respectively, p = 0.01). Specifically, the prevalence of a spondylolysis with or without a slip was higher in athletes vs. non-athletes (32 vs. 2 %, respectively, p = 0.0003); however, there was no difference in the average Pfirrmann grade (1.19 vs. 1.14, p = 0.41), percentage of patients with at least one degenerative disc (39 vs. 31 %, p = 0.41), or disc herniation (27 vs. 33 %, p = 0.43). Body mass index, smoking history, and pelvic incidence (51.5° vs. 48.7°, respectively, p = 0.41) were similar between the groups.Conclusion: Adolescents with low back pain have a higher-than-expected prevalence of structural pathology regardless of athletic activity. Independent of pelvic incidence, adolescent athletes with low back pain had a higher prevalence of spondylolysis compared to adolescent non-athletes with back pain, but there was no difference in associated disc degenerative changes or herniation. [ABSTRACT FROM AUTHOR]

We developed an integrated chip for real-time amplification and detection of nucleic acid using pH-sensing complementary metal-oxide semiconductor (CMOS) technology. Here we show an amplification-coupled detection method for directly measuring released hydrogen ions during nucleotide incorporation rather than relying on indirect measurements such as fluorescent dyes. This is a label-free, non-optical, real-time method for detecting and quantifying target sequences by monitoring pH signatures of native amplification chemistries. The chip has ion-sensitive field effect transistor (ISFET) sensors, temperature sensors, resistive heating, signal processing and control circuitry all integrated to create a full system-on-chip platform. We evaluated the platform using two amplification strategies: PCR and isothermal amplification. Using this platform, we genotyped and discriminated unique single-nucleotide polymorphism (SNP) variants of the cytochrome P450 family from crude human saliva. We anticipate this semiconductor technology will enable the creation of devices for cost-effective, portable and scalable real-time nucleic acid analysis. [ABSTRACT FROM AUTHOR]

Purpose: The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma. Methods: Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors. Results: Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often ( n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries. Conclusions: A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries. [ABSTRACT FROM AUTHOR]

Purpose: The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma.Methods: Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors.Results: Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often (n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries.Conclusions: A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries. [ABSTRACT FROM AUTHOR]

Introduction: Anterior cervical decompression and fusion is a well-established procedure for treatment of degenerative disc disease and cervical trauma including flexion-distraction injuries. Low-profile interbody devices incorporating fixation have been introduced to avoid potential issues associated with dissection and traditional instrumentation. While these devices have been assessed in traditional models, they have not been evaluated in the setting of traumatic spine injury. This study investigated the ability of these devices to stabilize the subaxial cervical spine in the presence of flexion-distraction injuries of increasing severity. Methods: Thirteen human cadaveric subaxial cervical spines (C3-C7) were tested at C5-C6 in flexion-extension, lateral bending and axial rotation in the load-control mode under ±1.5 Nm moments. Six spines were tested with locked screw configuration and seven with variable angle screw configuration. After testing the range of motion (ROM) with implanted device, progressive posterior destabilization was performed in 3 stages at C5-C6. Results: The anchored spacer device with locked screw configuration significantly reduced C5-C6 flexion-extension (FE) motion from 14.8 ± 4.2 to 3.9 ± 1.8°, lateral bending (LB) from 10.3 ± 2.0 to 1.6 ± 0.8, and axial rotation (AR) from 11.0 ± 2.4 to 2.5 ± 0.8 compared with intact under ( p < 0.01). The anchored spacer device with variable angle screw configuration also significantly reduced C5-C6 FE motion from 10.7 ± 1.7 to 5.5 ± 2.5°, LB from 8.3 ± 1.4 to 2.7 ± 1.0, and AR from 8.8 ± 2.7 to 4.6 ± 1.3 compared with intact ( p < 0.01). The ROM of the C5-C6 segment with locked screw configuration and grade-3 F-D injury was significantly reduced from intact, with residual motions of 5.1 ± 2.1 in FE, 2.0 ± 1.1 in LB, and 3.3 ± 1.4 in AR. Conversely, the ROM of the C5-C6 segment with variable-angle screw configuration and grade-3 F-D injury was not significantly reduced from intact, with residual motions of 8.7 ± 4.5 in FE, 5.0 ± 1.6 in LB, and 9.5 ± 4.6 in AR. Conclusions: The locked screw spacer showed significantly reduced motion compared with the intact spine even in the setting of progressive flexion-distraction injury. The variable angle screw spacer did not sufficiently stabilize flexion-distraction injuries. The resulting motion for both constructs was higher than that reported in previous studies using traditional plating. Locked screw spacers may be utilized with additional external immobilization while variable angle screw spacers should not be used in patients with flexion-distraction injuries. [ABSTRACT FROM AUTHOR]

Specimens of the anterior lens capsule with an attached monolayer of lens epithelial cells (LECs) were obtained from patients ( n = 52) undergoing cataract surgery. Specimens were divided into three groups based on the type of cataract: nuclear cataract, cortical cataract and posterior subcapsular cataract (PSC). Clear lenses ( n = 11) obtained from donor eyes were used as controls. Expression was studied by immunofluorescence, real-time PCR and Western blot. Statistical analysis was done using the student's t-test. Immunofluorescence results showed punctate localization of Cx43 at the cell boundaries in controls, nuclear cataract and PSC groups. In the cortical cataract group, cytoplasmic pools of Cx43 without any localization at the cell boundaries were observed. Real-time PCR results showed significant up-regulation of Cx43 in nuclear and cortical cataract groups. Western blot results revealed significant increase in protein levels of Cx43 and significant decrease of ZO-1 in all three cataract groups. Protein levels of alpha-catenin were decreased significantly in nuclear and cortical cataract group. There was no significant change in expression of beta-catenin in the cataractous groups. Our findings suggest that ZO-1 and alpha-catenin are important for gap junctions containing Cx43 in the LECs. Alterations in cell junction proteins may play a role during formation of different types of cataract. [ABSTRACT FROM AUTHOR]

Study design: Retrospective case series. Objective: To analyze the causes of conversion to open for the surgical treatment of lumbar disc herniation with use of full endoscopic (FE) technique, and prophylaxis of conversion to open also proposed. Method: 50 patients with lumbar disc herniation underwent discectomy using unilateral portal FE interlaminar approach collected from August 2008 to August 2010. All FE operations were performed under general anesthesia and endotracheal intubation. According to the level incision of the ligament flavum, the starting point of nerve root at the dura under endoscopic view was classified as: Type I (starting point of the nerve root was higher than the incision) and Type II (the starting point of nerve root was lower than the incision). The causes and effective prophylactic measurements for cases of conversion to open were analyzed. Results: There were 47 cases classified as Type I for a rate of 94 %, and Type II in 3 cases for a rate of 6 %. Five cases were converted to open surgery, and the conversion rate was 10 %. There were three males and two females with a mean age of 36.2 (29-44) years, the average duration of symptoms was 58.4 (35-105) days. The level was L5-S1 in four cases and L4-5 in one, lateral extrusion in three cases, paracentral extrusion in one, and sequestration in one. Leg pain resolved in three cases and improved in two after open surgery. Of five cases of conversion to open, misplacement of the working portal occurred in one case (Type I). Difficult dissection of nerve root and hemostasis resulting in open conversion occurred in one case (Type II); this patient sustained a dural injury. The nerve root could not be exposed in three cases (Type II), the FE changed to open finally. During the open procedure with Type II, we found that the location of origin of the nerve root was caudal to the inferior laminar edge. Therefore, partial removal of bony structures along lateral recess was necessary in order to visualize the nerve root. Conclusion: Misplacement of working portal during the exposure of the ligament flavum and difficulty in indentifying anatomy are potential causes for conversion to open in the initial adoption of FE technique. However, uncommon conditions such as variation of the nerve root origin can also result in conversion to open in experienced hands. Endoscopic experience, proper patient selection and specific radiographic examination are needed to obtain optimal outcomes using a full endoscopic technique for microdiscectomies. [ABSTRACT FROM AUTHOR]

An experimental in vitro biomechanical study was conducted on human cadaveric spines to evaluate the motion segment (C4–C5) and global subaxial cervical spine motion after placement of a cervical arthroplasty device (Altia TDI™,Amedica, Salt Lake City, UT) as compared to both the intact spine and a single-level fusion. Six specimens (C2–C7) were tested in flexion/extension, lateral bending, and axial rotation under a ± 1.5 Nm moment with a 100 N axial follower load. Following the intact spine was tested; the cervical arthroplasty device was implanted at C4–C5 and tested. Then, a fusion using lateral mass fixation and an anterior plate was simulated and tested. Stiffness and range of motion (ROM) data were calculated. The ROM of the C4–C5 motion segment with the arthroplasty device was similar to that of the intact spine in flexion/extension and slightly less in lateral bending and rotation, while the fusion construct allowed significantly less motion in all directions. The fusion construct caused broader effects of increasing motion in the remaining segments of the subaxial cervical spine, whereas the TDI did not alter the adjacent and remote motion segments. The fusion construct was also far stiffer in all motion planes than the intact motion segment and the TDI, while the artificial disc treated level was slightly stiffer than the intact segment. The Altia TDI allows for a magnitude of motion similar to that of the intact spine at the treated and adjacent levels in the in vitro setting. [ABSTRACT FROM AUTHOR]

A single-molecule method for sequencing DNA that does not require fluorescent labelling could reduce costs and increase sequencing speeds. An exonuclease enzyme might be used to cleave individual nucleotide molecules from the DNA, and when coupled to an appropriate detection system, these nucleotides could be identified in the correct order. Here, we show that a protein nanopore with a covalently attached adapter molecule can continuously identify unlabelled nucleoside 5'-monophosphate molecules with accuracies averaging 99.8%. Methylated cytosine can also be distinguished from the four standard DNA bases: guanine, adenine, thymine and cytosine. The operating conditions are compatible with the exonuclease, and the kinetic data show that the nucleotides have a high probability of translocation through the nanopore and, therefore, of not being registered twice. This highly accurate tool is suitable for integration into a system for sequencing nucleic acids and for analysing epigenetic modifications. [ABSTRACT FROM AUTHOR]

Background: Despite numerous attempts at classifying thoracolumbar spinal injuries, there remains no consensus on a single unifying algorithm of management. The ideal system should provide diagnostic and prognostic information, exhibit adequate reliability and validity and be easily applicable to clinical practice. The purpose of this study is to assess the reliability and validity of two novel classification systems for thoracolumbar fractures - the Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) - and also to discuss potential efforts towards research in the future. Matereials and Methods: Seventy-one patients with thoracolumbar fractures were prospectively assessed by surgeons with different levels of training and experience (attending orthopedic surgeon, attending neurosurgeon, spine fellows, senior level and junior level residents) at a single institution. Plain radiographs, CT and MRI imaging were used to classify these injuries using the TLISS system. Seven months later, 25 consecutive injuries were prospectively assessed with the TLISS and TLICS systems. Unweighted Cohen's kappa coefficients and Spearman's correlation values were calculated to assess inter-observer reliability and validity at each point in time. Results: For both the TLISS and TLICS algorithms, the inter-rater kappa statistics for all of the subgroups demonstrated moderate-to-substantial reliability (0.45-0.74), although there were no significant differences among the shared subgroups. The kappa score of the TLISS system was greater than that of the TLICS system for injury mechanism/ morphology. Correlation values were also greater across all subgroups (P≤0.01). Statistically significant improvements in TLISS inter-observer reliability were observed across all TLISS fields (P <0.05). The TLISS and TLICS schemes both demonstrated excellent validity. Conclusion: The TLISS and TLICS scales both exhibited substantial reliability and validity. However, the TLISS system displayed greater inter-observer correlation than did the TLICS and demonstrated significant improvements in reliability over time. [ABSTRACT FROM AUTHOR]

The potentially revolutionary effect that bone morphogenic proteins (BMPs) could have on orthopaedic surgery has fueled an exhaustive research effort that continues today. Upwards of 1.5 million bone-grafting operations take place in the US annually, with the anterior and posterior iliac crest being the most common donor site for autologous bone graft. Harvesting autologous bone graft, however, is not benign. It is postulated that a synthetic bone graft containing BMPs would possess the characteristics of autologous bone that allow new bone formation: osteogenesis, osteoinduction, and osteoconduction, without the negative repercussions related to bone harvesting. As a result of the ensuing research following their discovery some 40 years ago by Marshall Urist, the basic science behind BMPs has been largely uncovered. New information on BMPs now comes from clinical trials regarding their utility and efficacy in surgical applications. To date, BMPs have been studied in skeletal bone surgery throughout the body, and have been found to be particularly useful in surgical applications such as spinal arthrodesis. Osteogenic protein-1 (OP-1), or recombinant human BMP-7, is one subtype of BMPs that has shown particular potential in clinical trials. Pre-clinical and clinical studies have, thus far, garnered OP-1 a Humanitarian Device Exemption approval for spinal applications in the US. As clinical trials with larger patient numbers and longer clinical follow-up are completed, the usefulness of OP-1 as a bone graft substitute will be better elucidated. [ABSTRACT FROM AUTHOR]

We present a case of Papillary Thyroid Carcinoma (PTC) in a 4- year- old boy. The very young age of the patient and unusual presentation with respiratory distress prompted us to report this case. [ABSTRACT FROM AUTHOR]