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The global demand for high-quality animal protein faces challenges, prompting a surge in interest in plant-based meat analogues (PBMA). PBMA have emerged as a promising solution, although they encounter technological obstacles. This review discusses the technological challenges faced by PBMA from the viewpoint of plant proteins, emphasizing textural, flavor, color, and nutritional aspects. Texturally, PBMA confront issues, such as deficient fibrous structure, chewiness, and juiciness. Addressing meat flavor and mitigating beany flavor in plant protein are imperative. Furthermore, achieving a distinctive red or pink meat color remains a challenge. Plant proteins exhibit a lower content of essential amino acids. Future research directions encompass (1) shaping myofibril fibrous structures through innovative processing; (2) effectively eliminating the beany flavor; (3) developing biotechnological methodologies for leghemoglobin and plant-derived pigments; (4) optimizing amino acid composition to augment the nutritional profiles. These advancements are crucial for utilization of plant proteins in development of high-quality PBMA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc., Methods: This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery., Results: A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months., Conclusion: In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

Lipid oxidation is a major cause of quality deterioration that decreases the shelf-life of muscle-based foods (red meat, poultry, and fish), in which heme proteins, particularly hemoglobin and myoglobin, are the primary pro-oxidants. Due to increasing consumer concerns over synthetic chemicals, extensive research has been carried out on natural antioxidants, especially plant polyphenols. The conventional opinion suggests that polyphenols inhibit lipid oxidation of muscle foods primarily owing to their strong hydrogen-donating and transition metal-chelating activities. Recent developments in analytical techniques (e.g., protein crystallography, nuclear magnetic resonance spectroscopy, fluorescence anisotropy, and molecular docking simulation) allow deeper understanding of the molecular interaction of polyphenols with heme proteins, phospholipid membrane, reactive oxygen species, and reactive carbonyl species; hence, novel hypotheses regarding their antioxidant mechanisms have been formulated. In this review, we summarize five direct and three indirect pathways by which polyphenols inhibit heme protein-mediated lipid oxidation in muscle foods. We also discuss the relation between chemical structures and functions of polyphenols as antioxidants.

Studies on the atmospheric pressure cold plasma (ACP) exposure of meat and meat products mainly determine microbial inactivation, lipid oxidation, and meat color. Some studies include sensory evaluation, but only a few determine the changes in volatile composition due to ACP treatment. The results of sensory evaluation are inconclusive and range from "improvement" to "off-odor". This could be due to differences in the food matrix, especially in processed foods, or different experimental settings, including inadvertent effects such as sample heating. The few studies analyzing volatile composition report changes in alcohols, esters, aldehydes, and other compounds, but not necessarily changes that are novel for meat and meat products. Most studies do not actually measure the formation of reactive species, although this is needed to determine the exact reactions taking place in the meat during ACP treatment. This is a prerequisite for an adjustment of the plasma conditions to achieve antimicrobial effects without compromising sensory quality. Likewise, such knowledge is necessary to clarify if ACP-exposed meat and products thereof require regulatory approval.

Lipid oxidation is the primary non-microbial reason for quality deterioration of meat and meat products. Lipid oxidation can be prevented or delayed by antioxidants. In this study, 15 sage ( Salvia spp. Labiatae) extracts (five genotypes, three harvest times) were tested for their ability to reduce lipid oxidation (peroxide value (PV) and thiobarbituric acid reactive substances (TBARS)) in ground, uncured, cooked porcine and bovine meat (60%/40% mixture) during 14 days of refrigerated storage. Additionally, total phenolic content was determined, and the antioxidant capacity of the extracts was measured as radical scavenging activity (2,2-diphenyl-1-picrylhydrazyl assay), reducing power, and superoxide anion scavenging activity. All 15 sage extracts were able to reduce lipid oxidation, though showing expected differences depending on genotype and harvest time. The extracts of S. officinalis accession from Foggia, Italy performed better than the other genotypes when looking at the entire storage period and considering both PV and TBARS. Of the applied methods for determining antioxidant capacity, superoxide anion scavenging activity proved to be the best determinant of the ability of sage to reduce lipid oxidation in the meat sample.

Sugar, as an essential component of beverages, not only provides sweetness in beverages but also plays a significant role in their flavor, texture, and preservation. In recent years, global sugar consumption has continued to increase, causing a variety of health concerns. Currently, there is growing awareness of the adverse effects of high-sugar consumption. Since beverages are the primary source of daily sugar intake, sugar reduction in beverages is imperative. In this work, the necessity of sugar reduction in beverages was first introduced. Furthermore, four primary sugar reduction strategies (direct sugar reduction, multi-sensory integration, sweeteners, and sweetness enhancers) employed in the beverage industry were systematically summarized. Each sugar reduction strategy was critically compared, while the current research progresses as well as challenges were discussed. The application of sweeteners is the most effective and widely used strategy for sugar reduction in spite of flavor and health concerns of sweeteners. Meanwhile, multi-sensory integration is also a promising strategy for sugar reduction. In addition, different evaluation methods (chemical, cell-based and sensory methods) for sweetness were overviewed. Given the current challenges of sugar reduction, the prospects of sugar reduction in beverages were also discussed. The present work can provide the current progress for sugar reduction in the beverage industry., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Assuring the safety of muscle foods and seafood is based on prerequisites and specific measures targeted against defined hazards. This concept is augmented by 'interventions', which are chemical or physical treatments, not genuinely part of the production process, but rather implemented in the framework of a safety assurance system. The present paper focuses on 'Cold Atmospheric pressure Plasma' (CAP) as an emerging non-thermal intervention for microbial decontamination. Over the past decade, a vast number of studies have explored the antimicrobial potential of different CAP systems against a plethora of different foodborne microorganisms. This contribution aims at providing a comprehensive reference and appraisal of the latest literature in the area, with a specific focus on the use of CAP for the treatment of fresh meat, fish and associated products to inactivate microbial pathogens and extend shelf life. Aspects such as changes to organoleptic and nutritional value alongside other matrix effects are considered, so as to provide the reader with a clear insight into the advantages and disadvantages of CAP-based decontamination strategies.

The volatile composition and odor of meat and meat products is based on the precursors present in the raw meat. These are influenced by various pre-slaughter factors (species, breed, sex, age, feed, muscle type). Furthermore, post-mortem conditions (chiller aging, cooking conditions, curing, fermentation, etc.) determine the development of meat volatile organic compounds (VOCs). In this review, the main reactions leading to the development of meat VOCs such as the Maillard reaction; Strecker degradation; lipid oxidation; and thiamine, carbohydrate, and nucleotide degradation are described. The important pre-slaughter factors and post-mortem conditions influencing meat VOCs are discussed. Finally, the pros, cons, and future perspectives of the most commonly used sample preparation techniques (solid-phase microextraction, stir bar sorptive extraction, dynamic headspace extraction) and analytical methods (gas chromatography mass spectrometry and olfactometry, as well as electronic noses) for the analysis of meat VOCs are discussed, and the continued importance of sensorial analysis is pinpointed.

Reducing salt intake, as one of the most cost-effective approaches, is congruent with improved population health. Grass carp skin collagen was subjected to enzymatic hydrolysis and ultrafiltration, followed by glucosamine-induced Maillard reaction to prepare Maillard-reacted peptides. Their color, free amino acid and peptide size distribution were analyzed, while UV and fluorescence spectroscopy were utilized to characterize the progress of Maillard reaction. The salt taste-enhancing effect of Maillard-reacted peptides was investigated via sensory analysis and electronic tongue. LC-MS/MS was employed to analyze the glycation sites of Maillard-reacted peptides. The results indicated that the degree of Maillard reaction was relatively low, and thermal degradation and crosslinking simultaneously occurred. Maillard-reacted peptides exhibited a significant salt taste-enhancing effect, which may be attributed to the glucosamine-induced glycation confirmed by LC-MS/MS analysis. The current study provides a theoretical basis for preparation of salt taste-enhancing peptides and their future application to reduce salt content of formulated foods., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Plant-based meat analogues (PBMA) are promising foods to address the global imbalance between the supply and demand for meat products caused by the increasing environmental pressures and growing human population. Given that the flavor of PBMA plays a crucial role in consumer acceptance, imparting meat-like flavor is of great significance. As a natural approach to generate meat-like flavor, the Maillard reaction involving food-derived peptides could contribute to the required flavor compounds, which has promising applications in PBMA formulations. In this review, the precursors of meat-like flavor are summarized followed by a discussion of the reactions and mechanisms responsible for generation of the flavor compounds. The preparation and analysis techniques for food-derived Maillard reacted peptides (MRPs) as well as their taste and aroma properties are discussed. In addition, the MRPs as meat flavor precursors and their potential application in the formulation of PBMA are also discussed. The present review provides a fundamental scientific information useful for the production and application of MRPs as meat flavor precursors in PBMA., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Bovine (meat and heart) and porcine (hemoglobin and plasma) raw materials were hydrolyzed by Protease A (both endo- and exopeptidase activity), with or without glucosamine added during the enzyme inactivation step. Hydrolysates were characterized via peptide analysis (yield, UV- and fluorescence scanning spectroscopy, and peptide size distribution via size exclusion chromatography), sensory evaluation, and volatile compound analysis via gas chromatography mass-spectrometry (GC-MS) to determine if glucosamine-induced Maillard reaction improved taste and flavor. Porcine hemoglobin produced the most flavor-neutral hydrolysate, and could expectedly have the broadest application in food products. Both bovine meat and -heart hydrolysates were high in umami, and thereby good candidates for savory applications. Porcine plasma hydrolysate was high in liver flavor and would be suitable for addition to certain meat products where liver flavor is desirable. All hydrolysates had low perceived bitterness. Glucosamine-induced Maillard reaction had just a minor influence on the sensory profile via an increased perception of sweet taste ( p = 0.038), umami taste ( p = 0.042), and yolk flavor ( p = 0.038) in the hydrolysates, irrespective of raw material. Glucosamine addition had a statistically significant effect on 13 of 69 volatiles detected in the hydrolysates, but the effect was minor and raw material-specific.

Viral contamination of edible bivalves is a major food safety issue. We studied the virucidal effect of a cold atmospheric plasma (CAP) source on two virologically different surrogate viruses [a double-stranded DNA virus (Equid alphaherpesvirus 1, EHV-1), and a single-stranded RNA virus (Bovine coronavirus, BCoV)] suspended in Dulbecco's Modified Eagle's Medium (DMEM). A 15 min exposure effectuated a statistically significant immediate reduction in intact BCoV viruses by 2.8 (ozone-dominated plasma, "low power") or 2.3 log cycles (nitrate-dominated, "high power") of the initial viral load. The immediate effect of CAP on EHV-1 was less pronounced, with "low power" CAP yielding a 1.4 and "high power" a 1.0 log reduction. We observed a decline in glucose contents in DMEM, which was most probably caused by a Maillard reaction with the amino acids in DMEM. With respect to the application of the virucidal CAP treatment in oyster production, we investigated whether salt water could be sanitized. CAP treatment entailed a significant decline in pH, below the limits acceptable for holding oysters. In oyster slurry (a surrogate for live oysters), CAP exposure resulted in an increase in total nitrogen, and, to a lower extent, in nitrate and nitrite; this was most probably caused by absorption of nitrate from the plasma gas cloud. We could not observe a change in colour, indicative for binding of NO x to haemocyanin, although this would be a reasonable assumption. Further studies are necessary to explore in which form this additional nitrogen is deposited in oyster flesh.

Objective: Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants., Methods: This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts., Results: The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation., Conclusion: Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates., Competing Interests: Conflict of Interest: The authors have no financial conflicts of interest., (Copyright © 2021 Korean Neurotraumatology Society.)

Effectiveness of commercial natural antioxidants from rosemary and green tea were investigated in deli-style meat products via headspace hexanal by solid-phase microextraction gas chromatography and sensory oxidation flavor by a trained panel at weeks 1, 7, and 13 of refrigerated storage. A water/oil-soluble rosemary extract at 400 mg/kg proved the most effective antioxidant in cured deli turkey (CDT). In chicken fillet (CF), a water-soluble rosemary extract at 400 mg/kg was most efficient, especially in combination with phosphate. In pulled pork (PP), none of the antioxidants were as efficient as phosphate, though all three tested antioxidants were moderately effective in PP without phosphate. Nitrite was such an efficient antioxidant on its own in CDT that hexanal levels were so low that it was not possible to build correlation models between headspace hexanal and sensory oxidation flavor throughout the storage period. Phosphate also proved very efficient on its own in both CF and PP. It was possible to build good correlation models throughout storage for both CF and PP. Hence, hexanal was found to satisfactorily predict development of oxidation flavor in different types of uncured deli meat products both with and without added phosphate.

High-pressure processing (HPP) has been the most adopted nonthermal processing technology in the food industry with a current ever-growing implementation, and meat products represent about a quarter of the HPP foods. The intensive research conducted in the last decades has described the molecular impacts of HPP on microorganisms and endogenous meat components such as structural proteins, enzyme activities, myoglobin and meat color chemistry, and lipids, resulting in the characterization of the mechanisms responsible for most of the texture, color, and oxidative changes observed when meat is submitted to HPP. These molecular mechanisms with major effect on the safety and quality of muscle foods are comprehensively reviewed. The understanding of the high pressure-induced molecular impacts has permitted a directed use of the HPP technology, and nowadays, HPP is applied as a cold pasteurization method to inactive vegetative spoilage and pathogenic microorganisms in ready-to-eat cold cuts and to extend shelf life, allowing the reduction of food waste and the gain of market boundaries in a globalized economy. Yet, other applications of HPP have been explored in detail, namely, its use for meat tenderization and for structure formation in the manufacturing of processed meats, though these two practices have scarcely been taken up by industry. This review condenses the most pertinent-related knowledge that can unlock the utilization of these two mainstream transformation processes of meat and facilitate the development of healthier clean label processed meats and a rapid method for achieving sous vide tenderness. Finally, scientific and technological challenges still to be overcome are discussed in order to leverage the development of innovative applications using HPP technology for the future meat industry., (© 2020 Institute of Food Technologists®.)

Purpose: This study aimed to investigate the biomechanical effects of a newly developed interspinous process device (IPD), called TAU. This device was compared with another IPD (SPIRE) and the pedicle screw fixation (PSF) technique at the surgical and adjacent levels of the lumbar spine., Materials and Methods: A three-dimensional finite element model analysis of the L1-S1 segments was performed to assess the biomechanical effects of the proposed IPD combined with an interbody cage. Three surgical models-two IPD models (TAU and SPIRE) and one PSF model-were developed. The biomechanical effects, such as range of motion (ROM), intradiscal pressure (IDP), disc stress, and facet loads during extension were analyzed at surgical (L3-L4) and adjacent levels (L2-L3 and L4-L5). The study analyzed biomechanical parameters assuming that the implants were perfectly fused with the lumbar spine., Results: The TAU model resulted in a 45%, 49%, 65%, and 51% decrease in the ROM at the surgical level in flexion, extension, lateral bending, and axial rotation, respectively, when compared to the intact model. Compared to the SPIRE model, TAU demonstrated advantages in stabilizing the surgical level, in all directions. In addition, the TAU model increased IDP at the L2-L3 and L4-L5 levels by 118.0% and 78.5% in flexion, 92.6% and 65.5% in extension, 84.4% and 82.3% in lateral bending, and 125.8% and 218.8% in axial rotation, respectively. Further, the TAU model exhibited less compensation at adjacent levels than the PSF model in terms of ROM, IDP, disc stress, and facet loads, which may lower the incidence of the adjacent segment disease (ASD)., Conclusion: The TAU model demonstrated more stabilization at the surgical level than SPIRE but less stabilization than the PSF model. Further, the TAU model demonstrated less compensation at adjacent levels than the PSF model, which may lower the incidence of ASD in the long term. The TAU device can be used as an alternative system for treating degenerative lumbar disease while maintaining the physiological properties of the lumbar spine and minimizing the degeneration of adjacent segments., Competing Interests: The authors declare no competing financial and personal relationships with other people or organizations. Also, the authors declare no competing relationships with GS medical Co., Ltd. with any other relevant declarations relating to employment, consultancy, patents, products in development, or marketed products, etc. This does not alter our a dherence to PLOS ONE policies on sharing data and materials.

Background: Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA)., Methods: We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery., Results: The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34-15.73; p = 0.015)., Conclusion: We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

Objective: In the present study, we compared the clinical and radiographic outcomes of an interspinous process fixation device (IFD) with those of extended pedicle screw fixation (PSF) for symptomatic adjacent segment disease (ASD) after lumbar fusion., Methods: The data from 109 patients with ASD treated with IFD (n = 48) or extended PSF (n = 61) from January 2009 to January 2016 were reviewed retrospectively. The clinical outcomes were measured using a visual analog scale (VAS) and the Oswestry disability index. The radiographic outcomes included the fusion rate, incidence of cage subsidence, and additional radiographic ASD., Results: The mean incision length, operative time, blood loss, and length of hospital stay were significantly lower in the IFD group (P < 0.001). Postoperative back and leg pain were relieved in both groups (P < 0.001). The mean preoperative VAS scores were 8.3 ± 1.3 and 8.5 ± 1.1 in the IFD and PSF groups and had improved to 2.8 ± 1.1 and 2.7 ± 1.2 after 36 months, respectively (P < 0.001). At 36 months postoperatively, 10 of the 56 patients (17.9%) in the PSF group had developed additional radiographic ASD compared with 2 of 44 patients (4.5%) in the IFD group., Conclusion: Our results have demonstrated that in the treatment of symptomatic ASD, comparable clinical and radiologic outcomes can be achieved using IFD, which has a shorter skin incision, shorter operative time, less intraoperative blood loss, and shorter hospital stay than the extended PSF technique. Although not statistically significant, the IFD resulted in a lower ASD incidence compare with the PSF technique. Thus, IFD might be an alternative surgical method for symptomatic ASD after lumbar spine fusion., (Copyright © 2020. Published by Elsevier Inc.)

Objective: Rheumatoid arthritis (RA) is known to involve the cervical spine up to 86%. It often causes cervical instability like atlantoaxial subluxation (AAS), subaxial subluxation, and vertical subluxation (VS). In order to find the relation between RA and cord compression, we will evaluate the characteristics and risk factors of basilar invagination (BI) and cervicomedullary junction (CMJ) compression., Methods: From January 2007 to May 2015, 12667 patients administrated to Hanyang University Medical Center. Four thousand three hundred eighty-six patients took cervical X-ray and 250 patients took cervical computed tomography or magnetic resonance imaging. Radiologic parameters, medication records were obtained from 242 patients. Multivariate logistic regression analysis was performed with correlation of CMJ compression, basin-dental interval (BDI), basin-posterior axial line interval (BAI), pannus formation, BI, and AAS., Results: In the point of CMJ compression, atlantodental interval (ADI), posterior-atlantodental interval, BAI, AAS, and BI are relatively highly correlated. Patients with BI have 82 times strong possibility of radiologic confirmed CMJ compression, while AAS has 6-fold and pannus formation has the 3-fold possibility. Compared to the low incidence of BI, AAS and pannus formation have more proportion in CMJ compression. Furthermore, wrist joint erosion was correlated with VS and AAS., Conclusion: BI has a very strong possibility of CMJ compression, while AAS and pannus formation have a high proportion in CMJ compression. Hence bilateral wrist joint erosion can be used as an indicator for the timing of screening test for cervical involvement. We suggest the early recommendation of cervical spine examination for the diagnosis of cervical involvement in order to prevent morbidity and mortality.

Objective: To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence., Methods: Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients., Results: The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4-5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05)., Conclusion: Patients with high BMI or severe disc degeneration should be informed of HLD revision.

The objective of this study was to investigate the impact of endo- and exo-peptidase treatment on certain structural characteristics of peptides and volatile compounds of porcine hemoglobin and whole blood hydrolysates. Porcine hemoglobin and whole blood were hydrolyzed by endo- and exo-peptidases. The presence of exopeptidases reduced the bitterness and altered the volatile profiles of protein hydrolysates. Exopeptidase treatment can release terminal amino acids from peptides, which in turn may contribute to formation of volatile compounds by Maillard reactions. In contrast, endopeptidases conferred a slightly bitter taste and different volatile profiles. For hemoglobin hydrolysates, principal component analysis revealed that proteases were categorized into three groups based on endo- or exo-peptidase activity. Whole blood is a more complex raw material, yet the proteases were still categorized in a similar fashion. This work contributes to understanding structural characteristics responsible for taste and volatile profiles of protein hydrolysates., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Traumatic brain injury (TBI) is a major cause of death and disability. This study evaluated a possible relationship between serum factors at admission and the outcome of TBI. We propose a statistically validated scale for patients with TBI that combines serum factors and the Glasgow Coma Scale (GCS)., Methods: Between May 2011 and July 2016, 219 patients underwent decompressive craniectomy for TBI. We assessed laboratory data on admission, and correlations with GSC and Glasgow Outcome Scale were investigated. The modified GCS was developed from a multivariable logistic regression model, which was validated with the backward stepwise method., Results: Of 219 patients with TBI enrolled in our study, 175 were men (79.9%) and 44 were women (20.1%) with a mean age of 49.1 ± 11.5 years. Initial serum values of hemoglobin, platelets, prothrombin time, and lactate dehydrogenase were associated with in-hospital mortality. The factor score was derived by adding the following points: hemoglobin (≥13.0 g/dL = 0, <13.0 g/dL = 1), platelets (≥150 × 10 3 /mm 3  = 0, <150 × 10 3 /mm 3  = 1), prothrombin time (<13.2 seconds = 0, ≥13.2 seconds = 1), and lactate dehydrogenase (<271 U/L = 0, ≥271 U/L = 1). The modified GCS score (GCS score [range, 6-15] - FS [range, 0-4]) was calculated., Conclusions: The modified GCS score using serum factors extended the information provided about patient outcomes to be comparable to more complex methods. The modified GCS score may be useful to predict in-hospital mortality in patients with TBI., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Percutaneous vertebroplasty (VP) and medial branch block (MBB) are used to treat osteoporotic vertebral compression fractures (VCF). We compared the clinical outcomes, radiologic changes, and economic results of MBB with those of VP in treating osteoporotic VCFs., Methods: A total of 164 patients with 1-level osteoporotic VCF were reviewed retrospectively. The clinical outcomes were measured with a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). To compare economic costs between groups, total hospital costs at the last follow-up day were calculated., Results: The patients were divided into 2 groups: 72 patients in the conservative group treated by MBB (MBB group) and 92 patients in the group who underwent VP (VP group). The VAS and ODI scores improved significantly within postoperative week 1 in the VP group compared with the MBB group. However, the VAS and ODI scores did not differ between the groups after 1 postoperative year. After 2 years of follow-up, 14 new fractures occurred in the VP group and 3 in the MBB group. The improvement in compression ratio was statistically greater in the VP group than in the MBB group. However, after 2 years the radiologic changes between groups did not differ statistically. After the final follow-up visits, the hospital costs were significantly lower in the MBB group., Conclusions: After 2 years of follow-up, VP and MBB both had similar efficacy in terms of pain relief and radiologic changes. MBB was more cost effective than VP. Thus, MBB alone can be a possible alternative to VP in patients with 1-level osteoporotic VCFs., (Copyright © 2018. Published by Elsevier Inc.)

High pressure (HP) treatment often results in discoloration of beef, lamb, pork, and poultry. The degree of color changes depends on the physical and chemical state of the meat, especially myoglobin, and the atmospheric conditions during and after pressurization. A decreased redness is attributed to a large degree to the oxidation of the bright red oxymyoglobin or the purplish deoxymyoglobin into the brownish metmyoglobin, as well as to the denaturation of myoglobin. Surely, the high myoglobin content makes beef more exposed to this discoloration compared to the white chicken meat. In addition, HP treatment causes denaturation of myofibrillar proteins followed by aggregation, consequently, changing the surface reflectance and increasing lightness. Other intrinsic and extrinsic factors may affect the pressure-induced color changes positively or negatively. In this review, the pressure-induced color changes in meat are discussed in relation to modification of the myoglobin molecule, changes in the meat microstructure, and the impact of the presence of different chemical compounds and physical conditions during processing.

This study aimed to evaluate the effect of brain atrophy on the functional outcome of patients with moderate-volume basal ganglia hemorrhage. Of 1003 patients with spontaneous intracerebral hemorrhage, 124 with moderate-volume basal ganglia hemorrhage (hematoma volume of 20-50 mL) were enrolled. The intercaudate distance (ICD) and sylvian fissure ratio (SFR) were used as linear brain atrophy parameters. The patients were divided into groups with favorable and unfavorable outcomes, according to the Glasgow Outcome Scale score, 90 days after symptom onset. Demographic and radiographic features, including the ICD and SFR, were compared between the two groups. Among the 124 patients, 74 (59.7%) exhibited a favorable outcome. The ICD and SFR values were significantly greater for the favorable group than for the unfavorable group. Multivariate analysis indicated that young age, high Glasgow Coma Scale score at admission, small hematoma volume, and increased ICD (odds ratio [OR], 1.207; 95% confidence interval [CI], 1.004-1.451) and SFR (OR, 1.046; 95% CI, 1.007-1.086, per 0.001) values had a beneficial effect on functional outcome. In conclusion, brain atrophy exhibits protective effects in patients with moderate-volume basal ganglia hemorrhage, and is an important factor for predicting functional outcome.

There is a growing market for the use of hydrolysates from animal side-streams for production of high-protein supplements. However, there can be issues with development of off-flavors, either due to the raw material in question or due to the hydrolysis process itself. This study examined the development of volatile compounds during hydrolysis of hemoglobin. Briefly, porcine hemoglobin was hydrolyzed by 0.5% papain for up to 5 h, and the development of volatile compounds was analyzed via gas chromatography-mass spectrometry. The results showed that there was significant development of a number of volatile compounds with time, e.g., certain Maillard reaction and lipid oxidation products, which are likely candidates for the aroma development during hydrolysis. Furthermore, it was shown that development of a number of the volatiles was due to the hydrolysis process, as these compounds were not found in a control without enzyme., Competing Interests: This project was partially funded by Danish Crown Ingredients, who participated in the design of the experiment and agreed to publish the results.

Study Design: Retrospective data analysis., Objective: To identify factors affecting the atlantodental interval, the Ranawat value, and subaxial translation after rheumatoid arthritis (RA) diagnosis. In addition, factors predictive for cervical spine instability (CSI) development after RA diagnosis were examined., Summary of Background Data: Development of CSI affects the prognosis and mortality of RA patients. Previous studies described that obesity is associated with reduced radiographic joint damage in RA patients. We hypothesized that body mass index (BMI) is also associated with radiographic cervical damage in RA patients., Methods: Cervical radiographs were taken at full flexion, neutral position, and full extension to measure the geometric length of the anterior atlantodental interval, the Ranawat value, and subaxial translation. These values were entered into multivariable linear regression analysis based on potential associated factors. Hazard ratios were calculated to identify independent factors predictive of CSI., Results: Of the patients diagnosed with RA between January 2005 and August 2015, 1611 who underwent at least one cervical radiograph were included. After adjusting for sex, age, BMI category, CSI, rheumatoid factor, and RA medication, multivariate analysis revealed that the risk of atlantoaxial subluxation in the underweight and normal BMI groups was about 1.6-fold (hazard ratio, 1.63; 95% CI, 1.10-2.43; P = 0.015) and 1.7-fold higher, respectively, than that in the obese group, and that the risk of vertical subluxation was about 2.5-fold (hazard ratio, 2.52; 95% CI, 1.32-4.83; P = 0.005) higher in the underweight group than in the obese group. We also found that the rheumatoid factor positivity was a predictive risk factor for CSI development., Conclusion: We identified risk factors predictive for CSI occurrence after RA diagnosis through cervical radiograph assessment. We found that BMI was an independent predictor for development of CSI. Further large-scale prospective studies are required to confirm these findings., Level of Evidence: 3.

Background: Rheumatoid arthritis (RA) is an autoimmune disease that often occurs in the atlantoaxial segment of the cervical spine and results in instability that can cause severe pain and neurologic symptoms. Thickening of soft tissue posterior to the odontoid process of the atlantoaxial segment is referred to as retro-odontoid soft tissue (ROST) thickness or pseudotumor. The mechanism of ROST thickness is still unknown., Methods: Among patients diagnosed with RA, those with cervical radiographs and magnetic resonance imaging records were selected for investigation of their clinical symptoms, laboratory findings, radiologic evaluation, and RA medication history., Results: A total of 199 patients were selected and divided into lower and upper median groups according to the ROST thickness value. In patients with RA, the median ROST thickness value was 2.3 mm (interquartile range, 1.4-3.4). The median value of the anterior atlanto-dens interval (ADI) was 2.4 mm, with a significant difference being observed between the lower and upper median ROST thickness groups (P = 0.001). Multivariable linear regression analysis revealed a correlation between Steinbrocker stage and the positivity of rheumatoid factor. For each unit increase in the Steinbrocker stage, the ROST thickness increased by 0.35 mm (β, -0.349; 95% confidence interval -0.643 to -0.055; P = 0.020). For every 1-mm increase in the ADI, ROST thickness decreased by 0.16 mm (β, -0.163; 95% confidence interval -0.264 to -0.062; P = 0.002)., Conclusions: This study showed a statistical correlation between ROST thickness and ADI related to biomechanical changes in the dynamic atlantoaxial segment, thereby suggesting the value of a prospective study., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines., Introduction: Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA., Methods: The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI., Results: A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, -0.029; 95% CI, -0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, -0.036; 95% CI, -0.061 to -0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group., Conclusions: Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.

Background: Many surgical procedures have been introduced to manage atlantoaxial instability caused by rheumatoid arthritis (RA) to prevent complications and improve fusion rate. We report the surgical outcome between transarticular screw fixation (TAF) and C1 lateral mass-C2 pedicle screw fixation (C1LM-C2P) in patients with atlantoaxial instability from RA., Methods: Between 2002 and 2012, 58 patients were enrolled in the study. According to surgical procedures, patients were divided into 2 groups: group I who received TAF (n = 33) and group II who received C1LM-C2P (n = 25). Bony fusion was assessed by radiologic comparison immediately after the operation and 1 year postoperatively. In addition, complications and clinical and functional outcomes were evaluated., Results: Overall, bone fusion was achieved in 32 patients in group I (97%). In group II, the fusion rate was evaluated in 100% of patients. Complications (regardless of neurologic deterioration) were cable loosening and screw malposition in group I and violation into the vertebral canal and spinal canal in group II. There was no statistical significance in fusion rate, clinical outcomes, or complications. The 12-month atlantodental interval after operation for the C1LM-C2P group was significantly lower than that for the TAF group after adjusting for all variables., Conclusions: Two surgical techniques showed a good fusion rate by rigid fixation in the immediate postoperative period and fewer surgery-related complications in patients with RA. Because surgical complications are more likely during the learning curve (as with other surgical techniques), surgeons should carefully evaluate patients before surgery by radiologic and neurologic examinations., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment., Methods: We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level., Results: The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was 13.6±7.0 years. The risk factors for surgically treated AAS development were the serum CRP level ( p =0.005) and radiographic hand joint erosion ( p =0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion ( p <0.001) and young age at RA diagnosis ( p =0.04)., Conclusion: The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.

Objective: Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA., Methods: The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome., Results: Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability., Conclusion: Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

Objective: We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs., Methods: From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done., Results: Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery., Conclusion: In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.

Background: Atlantoaxial fusion is a surgical technique that is performed for the treatment of atlantoaxial instability. The standard surgical procedure is fixation of the atlantoaxial complex via a C1 lateral mass and C2 pedicle screw with posterior wiring. Bone grafting material may still be biomechanically suboptimal, such as autologous bone obtained from osteoporotic patients, and may result in collapse and loosening of posterior wiring., Methods: Fourteen patients with C1 lateral mass and C2 pedicle fixation as a result of atlantoaxial instability were included in this study. All patients were treated by a single surgeon using a titanium mesh cage with demineralized bone matrix packing. Patient clinical history, imaging data, and medical records were reviewed. To evaluate bony fusion, measurement of the atlantodental interval and computed tomography were performed in the preoperative period, immediate postoperative period, and at 1, 3, 6, and 12 months postoperatively. The Wilcoxon signed-rank test was used to compare differences in the radiologic evaluation at 1 and 12 months postoperatively., Results: Bone fusion was achieved in all patients (100%). Of the 14 patients, 11 had rheumatoid arthritis and 3 had trauma. The mean atlantodental interval of patients with rheumatoid arthritis was 1.85 mm in the immediate postoperative period, 1.96 mm at 1 month postoperatively, 1.98 mm at 3 months postoperatively, 1.96 mm at 6 months, and 1.93 mm at 12 months. Hardware failure and other complications were not observed., Conclusions: The titanium mesh cage has several advantages compared with bone autografts, including reduced donor-site morbidity, immediate rigid fixation, and successful bone fusion., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model., Methods: Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections., Results: At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group., Conclusion: The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.

Copeptin, the C-terminal part of provasopressin, has emerged as a novel prognostic marker after hemorrhagic or ischemic stroke. The aim of this study was to quantitatively assess the prognostic significance of plasma copeptin level on functional outcome and mortality in patients with acute stroke using a meta-analysis of the available evidence. Thirteen relevant studies from 2,746 patients were finally included in our study. An elevated plasma copeptin level was associated with an increased risk of unfavorable outcome and mortality after stroke (OR 1.77; 95% CI, 1.44-2.19 and OR 3.90; 95% CI 3.07-4.95, respectively). The result of the pooled measure on standardized mean difference (SMD) was that plasma copeptin levels were found to be significantly higher in patients who died compared to survivors (SMD 1.70; 95% CI, 1.36-2.03). A stratified analysis by study region showed significant differences in SMD of copeptin, and the heterogeneity among studies was significantly decreased. However, the positive association of copeptin with poor prognosis after stroke was consistent in each stratified analysis. The present meta-analysis suggests that early measurement of plasma copeptin could provide better prognostic information about functional outcome and mortality in patients with acute stroke.

Objective: Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods., Methods: Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months., Results: Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups., Conclusion: Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

Objective: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI., Methods: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared., Results: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI., Conclusion: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.

Objective: Chronic subdural hematoma (CSDH) is common in elderly patients. So, with an increasing number of elderly people in the general population, there is a need to investigate risk factors which increase recurrence rate. In this study, factors affecting the postoperative recurrence are investigated based on the reoperative CSDH cases., Methods: Total of ninety-seven patients was enrolled in this study who had have operation for CSDH. In all patients, one burr hole trephination and drainage was the method of choice for the initial treatment of CSDH. We retrospectively evaluated several factors which affect to recurrence of CSDH., Results: Retrospective analysis was performed in 97 patients. Sixteen patients experienced reoperation within 3 months (16/97, 16.5%) for recurrence of CSDH. And, when hematoma was divided by internal architecture, heterogeneous density group seems to be have close relationship with recurrence more significantly than homogeneous density group (p=0.002). Hypertension, diabetes mellitus, early removal of drainage tube, bilaterality of hematoma also have significant relationship with recurrence., Conclusion: Recurrence rate of CSDH treated with one burr hole drainage is related with some various factors. There was statistically significant difference between recurred group and non-recurred group. Not only demographic factors but also internal architecture on preoperative brain computed tomography is a significant predicting factor of recurrence in CSDH patients who underwent a surgery. In this study, heterogeneous type hematoma have significantly related with recurrence of CSDH. We should give attention to these predicting factors for more effective care.

The effect of high pressure (HP) treatment (400 MPa, 10 min) of porcine longissimus dorsi was investigated using reflectance spectroscopy and by UV-vis and circular dichroism spectroscopy for the soluble protein fraction. The soluble protein content was expectedly lowered significantly by HP treatment, whereas the solid state fraction of the meat responded to HP by exhibition of characteristic spectral changes in the visible reflectance data with a temporal evolution over the course of 2 days. However, the soluble protein fraction did not exhibit the same altered spectral characteristics in the visible region as seen in the solid state following HP, and there were no indications of altered folding of the proteins that remain in solution., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Color stability of minced cured restructured ham was studied by considering the effects of high pressure (HP) (600 MPa, 13°C, 5 min), raw meat pH24 (low, normal, high), salt content (15, 30 g/kg), drying (20%, 50% weight loss), and residual oxygen level (0.02%-0.30%). Raw hams were selected by pH24 in Semimembranosus, mixed with additives, frozen, sliced, and dried by the Quick-Dry-Slice® (QDS) process followed by HP treatment or not (control). Packaging and storage simulated industrial packaging: modified atmosphere containing 80% N2, 20% CO2, and residual O2 in one of three intervals: <0.1%, 0.1%-0.2%, or 0.2%-0.3%, and retail storage conditions: chill storage, 12 h light, 12 h darkness. HP improved the stability of the redness of 20% QDS hams, while the stabilizing effect on 50% QDS hams was smaller, concluding that water has the dominating role. Raw meat pH24, salt content, and residual oxygen level had varying effects on the stability of the red color., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The color of pork longissimus dorsi high pressure (HP) treated at 200 to 800 MPa at 5 and 20 °C for 10 min was determined to a high degree by pressure level and to a lesser degree by temperature. Severe color changes appeared up to a threshold pressure at 400 MPa. HP treatment at 20 °C compared to 5 °C resulted in meat, which was less red and slightly lighter. Storage at 2 °C for 6 days had no effect on lightness due to no further protein denaturation, but meat HP treated above 300 MPa became significantly less red and more yellow within the first day of storage. Reflectance spectra showed that a short-lived ferrohemochrome myoglobin species was formed during HP treatment at 300 to 800, but transformed into a brown, ferric form of the pigment within the first day of storage. This explains the observed changes in the redness and yellowness after one day of storage., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw., Methods: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups., Results: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16±2.1 and 8.03±2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3±2.9 and 1.2±3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029)., Conclusion: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

Objective: Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods., Methods: During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph., Results: Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was 9.87° in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05)., Conclusion: Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.

Objective: Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea., Methods: We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed., Results: In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved)., Conclusion: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.

Color changes of minced cured restructured ham was studied considering the effects of high pressure (HP) treatment (600MPa, 13°C, 5min), raw meat pH(24) (low, normal, high), salt content (15, 30g/kg), and drying (20%, 50% weight loss). Raw hams were selected based on pH(24) in Semimembranosus, mixed with additives, frozen, sliced, and dried using the Quick-Dry-Slice® process. Meat color (CIE 1976 L*a*b*) and reflectance spectra were measured before and after HP treatment. HP significantly increased L*, decreased a*, and decreased b* for restructured ham dried to 20% weight loss, regardless of salt content and pH(24). L* and a* were best preserved in high pH/high salt restructured ham. HP had no effect on the color of restructured ham dried to 50% weight loss. HP had no effect on the shape of reflectance curves, indicating that the pigment responsible for minced cured restructured ham color did not change due to HP., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection., Methods: There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically., Results: Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection., Conclusion: The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.

Objective: This investigation was conducted to evaluate a new, safe entry point for the C2 pedicle screw, determined using the anatomical landmarks of the C2 lateral mass, the lamina, and the isthmus of the pars interarticularis., Methods: Fifteen patients underwent bilateral C1 lateral mass-C2 pedicle screw fixation, combined with posterior wiring. The C2 pedicle screw was inserted at the entry point determined using the following method : 4 mm lateral to and 4 mm inferior to the transitional point (from the superior end line of the lamina to the isthmus of the pars interarticularis). After a small hole was made with a high-speed drill, the taper was inserted with a 30 degree convergence in the cephalad direction. Other surgical procedures were performed according to Harm's description. Preoperatively, careful evaluation was performed with a cervical X-ray for C1-C2 alignment, magnetic resonance imaging for spinal cord and ligamentous structures, and a contrast-enhanced 3-dimensional computed tomogram (3-D CT) for bony anatomy and the course of the vertebral artery. A 3-D CT was checked postoperatively to evaluate screw placement., Results: Bone fusion was achieved in all 15 patients (100%) without screw violation into the spinal canal, vertebral artery injury, or hardware failure. Occipital neuralgia developed in one patient, but this subsided after a C2 ganglion block., Conclusion: C2 transpedicular screw fixation can be easily and safely performed using the entry point of the present study. However, careful preoperative radiographic evaluation, regardless of methods, is mandatory.