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Study Design Systematic review and Meta-analysis. Objective This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL), and surgical time between multi-level instrumented fusions with LIVs (lowest instrumented vertebra) in the cervical spine and those that extend into the thoracic spine. Summary of Background Data Several studies address the question of whether to extend a long-segment, posterior cervical fusions, performed for degenerative disease, into the upper thoracic spine. Recommendations for appropriate LIV continue to vary. Methods A comprehensive computerized literature search through multiple electronic databases without date limits up until April 3rd, 2020 using combinations of key search terms and sets of inclusion/exclusion criteria was performed. Results Our comprehensive literature search yielded 3852 studies. Of these, 8 articles consisting of 1162 patients were included in the meta-analysis. In 61.2% of the patients, the fusion did not cross the cervicothoracic junction (CTJ) (cervical LIV, CLV). In the remaining 38.8%, the fusion extended into the upper thoracic spine (thoracic LIV, TLV). Overall, mean patient age was 62.5 years (range: 58.8-66.1 years). Our direct analysis showed that odds of fusion were not statistically different between the CLV and TLV groups (OR: .648, 95% CI: .336-1.252, P = .197). Similarly, odds of reoperation (OR: 0.726, 95% CI: 0.493-1.068, P = .104) and complication rates were similar between the 2 groups (OR: 1.214, 95% CI: 0.0.750-1.965, P = .430). Standardized mean difference (SMD) for the blood loss (SMD: .728, 95% CI: 0.554-.901, P = .000) and operative (SMD: 0.653, 95% CI: .479-.826, P = .000) differed significantly between the 2 groups. The indirect analysis showed similar fusion (Effect Size (ES)TLV: .892, 95% CI: .840-.928 vs ESCLV:0.894, 95% CI:0.849-.926); reoperation rate (ESTLV:0.112, 95% CI: 0.075-.164 vs ESCLV: .125, 95% CI: .071-.211) and complication rates (ESTLV: .108, 95% CI: .074-.154 vs ESCLV:0.081, 95% CI: .040-.156). Conclusions Our meta-analysis showed that fusion, complication, and reoperation rates did not differ significantly between patients in whom multi-level posterior fusions ended in the cervical spine vs those of which was extended into the thoracic spine. The mean blood loss, operative time and length of stay were significantly lower in patients with CLV at C6 or C7, compared to their counterparts. These data suggest that, absent focal, C7-T1 pathology, extension of long, posterior cervical fusions into the thoracic spine may not be necessary.

In 2008, the American Cancer Society endorsed computed tomography colonography (CTC) to virtually visualize the large intestine and help diagnose atypical pathological features of the colon. Virtual navigation through the colon provides the physician an increased opportunity to locate abnormalities without the risks associated with traditional colonoscopy. This article discusses why patients undergo CTC, how the examination is performed, and how patients should prepare. Although CTC primarily is used for the detection of polyps and cancerous tumors, the examination can benefit any patient who requires a minimally invasive alternative to a traditional colonoscopy.

Human cytomegalovirus (HCMV) generates a significant clinical burden worldwide, particularly among the immune compromised. In approximately 30% of untreated HIV/AIDS patients without access or sufficient response to antiretroviral therapies, for example, HCMV causes a sight-threatening retinitis. To study the mechanisms of AIDS-related HCMV retinitis, our lab has for many years used a mouse model in which a mixture of mouse retroviruses induces murine AIDS after approximately 10 weeks, rendering otherwise resistant mice susceptible to opportunistic pathogens. This immunodeficiency combined with subretinal inoculation of murine cytomegalovirus yields a reproducible model of the human disease, facilitating the discovery of many clinically relevant virologic and immunologic mechanisms of retinal destruction which we summarize in this review.

STUDY DESIGN Cross-sectional analysis. OBJECTIVE This study aimed to evaluate the quality and accuracy of the content surrounding cervical radiculopathy available on the internet. SUMMARY OF BACKGROUND DATA Those experiencing cervical radiculopathy and their families are increasingly browsing the world wide web for medical information. As the information offered is likely to influence their health care choices, spine care providers must understand the quality and accuracy of that information. METHODS Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo and Bing) using the keyword "cervical radiculopathy". The searches were performed on June 28th, 2019. The top 50 sites from each search engines were reviewed. The websites were evaluated using quality, accuracy and usability markers. RESULTS 77 unique websites were analyzed. 54.5% were physician or medical group professional sites, 20.8% as non-physician, 10.4% as unidentified, 7.8% as academics and 6.5% were commercial. Accuracy ranged from less than 25% to more than 75% were recorded with a mean accuracy of 3.5 signifying 50-75% agreement. Overall, website categories had a significant effect on Journal of American Medical Association (JAMA) score, content quality, accuracy, total summary scores, distraction index, reading ease and grade level (p

The majority of the previous literature investigating injuries in surfing have focused on acute or traumatic injuries. This systematic review appears to be the first to investigate the literature reporting on chronic and gradual-onset injuries and conditions in surfing populations. A search strategy was implemented on five databases in June 2020 to locate peer-reviewed epidemiological studies on musculoskeletal injuries or non-musculoskeletal conditions in surfing. A modified AXIS Critical Appraisal Tool was used to appraise all included texts. Extracted data included key information relevant to the epidemiology of the injuries and conditions. Twenty journal articles were included with the majority rated as good quality and a substantial agreement between raters (k = 0.724). Spine/back (29.3%), shoulder (22.9%), and head/face/neck (17.5%) were the most frequently reported locations of musculoskeletal injury, whilst the most common mechanism of injury was paddling (37.1%). Exostosis was the most frequently described injury or condition in surfing populations, with the most common grade of severity reported as mild obstruction. The key findings of injury type, location, severity, and mechanism can be used to develop relevant injury management and prevention programs for the surfing population, with an emphasis on chronic or gradual-onset spine/back and shoulder injuries, paddling technique, and education on the development and management of exostosis.

Patients and their families are increasingly turning to the internet for medical information. Most of these patients believe the information to be accurate and reliable. However, the quality and accuracy of that information on the internet is variable and unregulated. Accurate and applicable information may align patients’ expectations and improve satisfaction and overall outcomes. This study aimed to evaluate the quality and accuracy of scoliosis-related information available on the internet. Cross-sectional analysis. Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo and Bing) using the keyword “scoliosis”. The top 30 sites from each search engine were reviewed. Each website was categorized as per its authorship and sourcing. Each site was then evaluated for accuracy, readability and with quality-assurance markers such as Health on the Net code (HONcode), DISCERN, Journal of American Medical Association (JAMA) systems. The accuracy of the website was assessed by two fellowship-trained spine specialists. Website accuracy was rated on a scale of 1–4 based on the level of agreement with the information presented. Websites with greater than 75% agreement were rated 4. Finally, the sites were evaluated with a validated website distraction index and assessed for mobile friendliness. 42 unique websites were analyzed. 31% of the sites were categorized as academic (13 academic, 9 healthcare system, 12 health news outlets and 8 unspecified) and had the highest rate of physician authorship (54%). Accuracy ranged from less than 25% to more than 75% were recorded with a mean accuracy of 3 signifying 50–75% agreement. Academic sites had the highest scoliosis specific accuracy score (P

Hoki (Macruronus novaezelandiae) roes were used to produce a salted fermented (jeotgal-like) roe product at 4 °C and 25 °C. The impact of the fermentation temperature on the microbiological status, proximate analysis, acidity, colour, fatty acid profile and cholesterol content were determined over a 4-week fermentation period. Total bacterial count and total LAB (expressed as log CFU) increased with fermentation time (p 0.001). Fermentation temperature did not affect the proximate analysis, but fermentation time increased both the ash content and decreased the protein and moisture contents in the roe (p 0.001, for all). Products produced at 25 °C had a lighter colour (p 0.001) compared to products produced at 4 °C. Fermentation did not affect the roe fatty acid profile, but cholesterol content in the roe was reduced (p 0.001) at both fermentation temperatures. Results suggest that fermentation can be a feasible approach to reduce cholesterol levels in fish roe.

The paper presented considers soft skills in the hospitality sector and explores how managers in four hotels in Glasgow, Scotland enact recruitment and selection processes. Empirically, the analysis is based on a rich cross case comparison including interviews, observations, attendance at training events and analysis of hotels’ recruitment and selection policies. Conceptually, the analysis draws on the work of Pierre Bourdieu and Andrew Sayer, portraying an understanding of social class as a social, economic, and cultural category and people’s agency as shaped by their habitus and lay normativity. Crucially, the paper reveals the pivotal role individual managers play in enabling and constraining opportunities for employment in the enactment of hotel recruitment policy and engagement with job applicants and new recruits. Overall, the analysis suggests that, despite many deterministic analyses of class, an organization’s recruitment, learning and development strategies, plus management’s commitment to make a difference, can positively impact on those who might otherwise be part of a neglected pool of labour.

BACKGROUND CONTEXT Several studies address the question of whether to extend a long-segment, posterior cervical fusions into the upper thoracic spine. Recommendations for appropriate caudal “end level” continue to vary. PURPOSE This systematic review seeks to compare fusion, reoperation and complication rates, estimated blood loss (EBL) and surgical time between multilevel instrumented fusions ending in the cervical spine and those that extend into the thoracic spine. STUDY DESIGN/SETTING Systematic review and Meta-analysis. OUTCOME MEASURES Fusion, reoperation and complication rates, EBL and surgical time. METHODS A comprehensive computerized literature search through multiple electronic databases without date limits up until April Week 3 2020 using combinations of key search terms and inclusion/exclusion criteria was performed. RESULTS Our comprehensive literature search yielded 3,852 studies. Of these, 8 articles consisting of 1,162 patients were included in the meta-analysis. In 61.2% of the patients the fusion did not cross the CTJ (the cervical end level CEL). In the remaining 38.8%, fusion extended into the upper thoracic spine (thoracic end level, TEL). Mean age of CEL group ranged from 57 to 67.8 years, and for TEL group, it was 55 to 65.3 years. Our direct analysis showed that odds of fusion were not statistically different between CEL and TEL groups (OR: 0.648, 95% CI: 0.336-1.252, p=0.197). Similarly, odds of reoperation (OR:0.726, 95% CI:0.493-1.068, p=0.104) and complication rates were similar between the two groups (OR:1.299, 95% CI:0.536-3.149, p=0.563). Standardized mean difference (SMD) for the blood loss (SMD: 0.728, 95% CI:0.554-0.901, p=0.000) and operative (SMD:0.653, 95% CI: 0.479-0.826, p=0.000) differed significantly between the two groups. The indirect analysis showed similar fusion (Effect Size (ES)crossing: 0.892, 95% CI: 0.840-0.928 vs ES not crossing:0.894, 95% CI:0.849-0.926); reoperation rate (EScrossing:0.112, 95% CI:0.075-0.164 vs ES not crossing: 0.125, 95% CI: 0.071-0.211) and complication rates (EScrossing: 0.108, 95% CI: 0.074-0.154 vs ES not crossing:0.081, 95% CI: 0.040-0.156). CONCLUSIONS Our meta-analysis showed that fusion, complication and reoperation rates did not differ significantly between patients in whom multi-level posterior fusions ended in the cervical spine versus those of which was extended into the thoracic spine. The mean blood loss, operative time and length of stay were significantly lower in patients with caudal level as C7 or below, compared to their counterparts. These data suggest that, absent focal C7-T1 pathology, extension of long posterior cervical fusions into the thoracic spine may not be necessary. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Ninety-three participants with poorly controlled type 2 diabetes despite optimized drug therapy were randomised to receive intensive dietary advice or usual care for six months. Following dietary intervention a significant reduction in interleukin-18 levels was observed, with a ratio of change (95% CI) of 0.90 (0.82-0.99); p = 0.033. Changes in IL-18 correlated with changes in neopterin, r = 0.299 (p = 0.009). Clinical Trial registration ID #NCT00124553.

Objective: To investigate the impact of intensive lifestyle education on dietary practices, exercise and metabolic measurements in people with insulin-dependent diabetes mellitus (IDDM). Design: Sixty-one volunteer subjects with IDDM were randomised to intensive (Group 1) or standard (Group 2) education programmes for six months. During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice (phase 2). Current insulin regimens were modified to optimise glycaemic control before the start of the intervention phase. Nutrient intakes, weight, blood pressure, glycated haemoglobin (HbA), plasma lipids, lipoproteins and maximal oxygen consumption (VO max) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2. Setting: Department of Human Nutrition at the University of Otago. Results: Glycated haemoglobin decreased significantly in both groups between recruitment and randomisation, the improvement being sustained during the six months of the randomised trial and for group 1 during the six months of post trial observation. A further decrease was seen in Group 2 during the second six month period when they were given intensive advice. Comparable changes were seen with total and low density lipoprotein (LDL) cholesterol in Group 1 during the trial, but significant decreases were only seen in Group 2 in association with intensive intervention (phase 2). These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids, a reduction in intakes of total and saturated fat, and an improvement in maximum oxygen consumption. Conclusions: A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits sufficient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime. More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater beneficial changes than those observed here. Sponsorship: This study was supported by the Eli Lilly Research Grant (Eli Lilly and Company (New Zealand) Ltd), The Deans Research Grant (Otago Medical School, New Zealand) and The New Zealand Dietetic Association (Abbott Award).

Background The level of glycated albumin in circulation is an indicator of blood glucose control over the preceding 2 weeks. It is not known if the level of glycated albumin in circulation relates to an individual's postprandial blood glucose response. Methods Eighty-four euglycemic young adults (21.1 [3.9] years, BMI 23.9 [4.0] kg/m2) primarily of European descent underwent a fasted meal test of 50 g carbohydrate from white bread. Capillary blood was then sampled at regular intervals over 2 hours. Correlations were sought between glycated albumin, fasted and 2-hour post-load blood glucose measurements, incremental area under the blood glucose curve, glycemic range, body mass index (BMI), and C-reactive protein (CRP). Results When adjusted for age and sex, glycated albumin was inversely correlated with BMI (r=−.25, P=.027). No significant correlations existed for glycated albumin and postprandial markers of blood glucose control. BMI and CRP values correlate in this population (r=.30, P=.009). Conclusions Glycated albumin in circulation is not related to postprandial blood glucose response in young euglycemic adults. Glycated albumin is lower in euglycemic adults with higher BMI values. Contrary to research with older adults or those with impaired glucose control, glycated albumin did not correlate to CRP.

In fewer than 140 characters on Twitter, the National Heart, Lung, and Blood Institute’s The Heart Truth campaign helps to educate and empower women to take action against their number one killer: heart disease. Social support and strong social networks make important contributions to our health (Albrecht & Goldsmith, 2003). They provide emotional and practical resources, and they make us feel cared for, loved, esteemed, and valued. Consequently, social marketers have long relied on these networks as channels to raise awareness of public health issues, facilitate behavior change, and ultimately help people live healthier, safer lives (Hughes, 2010).

Although adults of Pacific ethnicity living in New Zealand have more than double the prevalence of diabetes and cardiovascular disease than the general population, little is known regarding the presence of risk factors for these disorders among young Pacific Islanders. The study aim was to examine relationships between body composition, glucose and lipid metabolism, and components of the metabolic syndrome (MS) in a community sample of Pacific Island (PI) teenagers living in Dunedin. Anthropometry, body composition (dual-energy x-ray absorptiometry), glucose and lipid metabolism, insulin resistance (homeostasis model assessment [HOMA2], McAuley index), and components of MS were assessed in 80 PI teenagers (aged 15-18 years). Results showed that 6 participants had full MS, 2 had high fasting blood glucose values (>7.0 mmol/L), 55 had high adiposity, and 21 had insulin resistance. Assessment of the components of MS by body mass index (BMI) status showed that obese participants (n = 29) had a high prevalence (86.2% had one or more component), whereas only 10.5% of those with healthy BMI status (n = 19) had any MS component. Elevated fat mass had substantial effects on fasting insulin values, HOMA2, and the McAuley index because in data adjusted for age, sex, and lean mass, a 10% greater fat mass was associated with a 4.7% increase in fasting insulin, a 5.3% rise in HOMA2, and a 2.3% decrease in the McAuley index. Our results suggest that the antecedents of cardiovascular disease and type 2 diabetes mellitus occur frequently in young Pacific Islanders having high adiposity. We conclude that community studies of PI adolescents should focus on assessing risk factors whenever BMI values are high.

Background and aims Some individuals respond to a greater extent than others to changes in dietary fat and cholesterol even when dietary intake is consistent. A prospective study has been undertaken in which two groups of individuals according to cholesteryl ester transfer protein (CETP) genotype were compared in terms of plasma lipid response to altering the nature of dietary fat in a free-living situation. Methods and results Following genotyping, 35 individuals with the CETP Taq1 B1B1 genotype were paired with age and sex-matched individuals with one or two CETP B2 alleles, to undertake a single crossover trial with a diet high in saturated fat and a diet high in polyunsaturated fat. There was no washout period between the two 4-week phases. Plasma lipoproteins were measured at the beginning and end of each phase. The difference (95% CI) in plasma LDL-cholesterol concentration at the end of the PUFA and SAFA diets was 0.95 (0.71, 1.19) mmol/l in the CETP B1B1 group and 0.80 (0.57, 1.04) mmol/l in the group with at least one CETP B2 allele. The dietary induced changes in the two genotype groups were not significantly different (p = 0.38) from each other. Comparable results were observed for plasma total cholesterol. The high PUFA and SAFA diets did not significantly alter plasma HDL concentration in either of the CETP genotype groups. Response was also similar according to apolipoprotein E genotype (E3E3 vs E4+) and lipoprotein lipase genotype (S447X). Conclusions The results of this study do not support previous studies in which CETP genotype predicted plasma LDL-cholesterol response to diet. CETP genotype does not significantly affect the change in plasma total and LDL-cholesterol concentrations that occur when altering the nature of dietary fat. These data suggest that the influence of genetic factors on total and LDL-cholesterol may be relatively small in comparison with the effect of dietary manipulation.

To compare two low fat diets one rich in walnuts on parameters of lipid metabolism in a group of hyperlipidaemic subjects.A randomised cross over study.Department of Human Nutrition, University of Otago, Dunedin, New ZealandTwenty one men with mean (s.d.) levels of total and LDL cholesterol of 6.58 (0.60) and 4.63 (0.58) respectively.For two periods of four weeks subjects were asked to consume two low fat diets (fat 30% total energy), one containing, on average, 78 g/d walnuts. Walnuts obtained through Lincoln University and the Walnut Growers Group (South Canterbury).Participants reported a higher total fat intake on the walnut diet (38% compared with 30% on the low fat diet P0.01) The most consistent change in fatty acid profile of triacylglycerol, phospholipid and cholesterol ester on the walnut diet was a significant (P0.01) increase in linoleic acid. Triacylglycerol linolenate also increased significantly (P0.01). Total and LDL cholesterol were lower on both experimental diets than at baseline, 0.25 mmol/l and 0.36 mmol/l respectively on the walnut diet and 0.13 mmol/l and 0.20 mmol/l respectively on the low fat diet. High density lipoprotein cholesterol was higher on both the walnut and low fat diets when compared to baseline (0.15 mmol/l and 0.12 mmol/l, respectively). When comparing the walnut and low fat diets only apo B was significantly lower (P0.05) on the walnut diet.Despite an unintended increase in the total fat intake on the walnut diet, fatty acid profile of the major lipid fractions showed changes which might be expected to reduce risk of cardiovascular disease. The reduction of apolipoprotein B suggests a reduction in lipoprotein mediated risk, the relatively low myristic acid content of both diets perhaps explaining the absence of more extensive differences in lipoprotein levels on the two diets.

Objective: To examine the effect on lipid and lipoprotein concentrations when butter or an unsaturated margarine is used for cooking or spreading in a reduced fat diet. Design: Randomised crossover study with two intervention periods of six weeks9 duration separated by a five week washout. Setting: Community setting in New Zealand. Subjects: 49 volunteers with polygenic hypercholesterolaemia and baseline total cholesterol concentration in the range 5.5-7.9 mmol/l. Main outcome measures: Concentrations of total and low density lipoprotein, Lp(a) lipoprotein, high density lipoprotein, apolipoprotein B 100, and apolipoprotein AI. Results: Concentrations of low density lipoprotein cholesterol and apolipoprotein B were about 10% lower with margarine than with butter. Lp(a) lipoprotein and high density lipoprotein cholesterol concentrations were similar with the two diets. Conclusion: Despite concerns about adverse effects on lipoproteins of trans fatty acids in margarines, the use of unsaturated margarine rather than butter by hypercholesterolaemic people is associated with a lipoprotein profile that would be expected to reduce cardiovascular risk. Key messages Key messages These findings suggest that the relatively small amounts of trans fatty acids that are typically present in unsaturated margarine have no adverse effects on lipid and lipoprotein concentrations The effects of unsaturated margarine on oxidation of low density lipoproteins are still to be examined Nevertheless, unsaturated margarine seems to be an appropriate substitute for saturated fat in diets recommended to people with hyperlipidaemia

To investigate the effects of meal frequency on plasma lipid and carbohydrate metabolism, 19 healthy normocholesterolemic free-living men and women consumed their usual diet as three or nine meals per day in random order for 2 wk each. There was no significant difference in macronutrient intake. Compared with the three-meal/d diet, nine meals per day reduced fasting plasma total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol by 6.5% (P < 0.005), 8.1% (P < 0.005), and 4.1% (P < 0.05), respectively. Body weight, fasting triglycerides, apolipoproteins A-I and B, and the LDL-HDL cholesterol ratios were not different for the two diets, as were 24-h urinary C peptide-creatinine ratios and insulin-glucose response to a glucose load. The insulin-glucose curve measured over 3 h in the evening after the evening meal was flatter for the nine meals, but the areas under the curves were not significantly different. Increasing meal frequency while maintaining a constant nutrient intake produces a small but significant decrease in LDL cholesterol in normolipidemic free-living subjects.