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Study Design: A network meta-analysis. Objectives: Lumbar degenerative disc disease (LDDD) is an important issue in aging population, for which lumbar interbody fusion (LIF) is a feasible management in cases refractory to conservative therapy. There are various techniques available to perform LIF, including posterior (PLIF), transforaminal (TLIF), and anterior (ALIF) approaches. However, the comparative safety profile of these procedures remains controversial. Our study aimed to evaluate comparative adverse events of the LIF procedures in patients with LDDD. Methods: We searched 5 databases for relevant prospective cohort studies and randomized clinical trials. After quality assessments, we extracted neural, spinal, vascular, and wound events for conducting contrast-based network meta-analysis. Results were reported in risk ratio (RR), 95% confidence interval (CI), and surface under the cumulative ranking (SUCRA). Results: We identified 14 studies involving 921 participants with LDDD. Pooled result showed that open PLIF (OPLIF) leads to significantly higher overall adverse event rate than does open TLIF (OTLIF; RR = 3.43, 95% CI = 1.21-9.73). OTLIF confers the highest SUCRA in neural (78.7) and spinal (80.8) event rates. Minimally invasive TLIF has the highest SUCRA in vascular event (84.2), and minimally invasive PLIF has the highest SUCRA in wound event (88.1). No inconsistency or publication bias was detected in the results. Conclusions: Based on our results, perhaps OPLIF should be avoided in the management of LDDD due to the inferiority of overall complications. Specifically, TLIF seems to have the safest profile in terms of neural, spinal, and vascular events. Nevertheless, shared decision making is still mandatory when choosing the proper LIF procedure for patients with LDDD in clinical practice.

The purpose of the study was to investigate the trajectory and determinants of changes in health-related quality of life (HRQoL) in the first year after lumbar spine surgery. A total of 154 consecutive patients who underwent lumbar spine surgery were included in this prospective longitudinal observational study. All participants were asked to complete a battery of questionnaires (Taiwanese version of World Health Organization Quality of Life-BREF, Numerical Rating Scale for leg and back pain, Mandarin Chinese version of the Clinically Useful Depression Outcome Scale, and Chinese version of the Pittsburgh Sleep Quality Index). The Japanese Orthopedic Association score was evaluated by neurosurgeons. The measurement time points were 1 week before and on the first, sixth, and twelfth month after lumbar spinal surgery. A linear mix model was used for data analyses. The analyses revealed significant upward trends in HRQoL, particularly in physical health and social relationships during the study period. Patients who aged

Sleep disturbance is a common complaint after traumatic brain injury (TBI). The aim of this study was to examine the effects of a home-based warm footbath intervention on sleep in patients with TBI.This was a randomized controlled crossover study, and 23 adults with TBI were recruited and randomized to receive first a 30-minute, 41°C warm footbath and then a usual care, or vice versa, with each lasting 3 days and separated by a 3-day washout. Sleep efficiency, sleep onset latency (SOL), total sleep time, and wake after sleep onset (WASO) were assessed by actigraphy.We found that home-based warm footbath significantly had a reduced SOL (difference, -5.11 minutes) and a suppressed WASO (difference, -2.57 minutes) compared with those of usual care, but not in sleep efficiency and total sleep time. No adverse effect was reported.This study suggested that home-based warm footbath is practical and effective in relieving post-TBI sleep disturbances, particular in SOL and WASO. Nurses can use home-based warm footbath as an effective intervention for management of sleep disturbances after TBI.

2,3,5,4'-Tetrahydroxystilbene-2-O-β-d-glucoside (THSG) is an active compound extracted from Polygonum multiflorum Thunb. This herb and radix Polygoni Multiflori preparata have been used to treat arteriosclerosis, hyperlipidemia, hypercholesterolemia, and diabetes for thousands of years. This study aimed to investigate the protective effects of THSG in an Adriamycin (AD)-induced focal segmental glomerulosclerosis (FSGS) mouse model and the underlying mechanisms in an in vitro system. Mice were treated with THSG (2.5 and 10 mg/kg, oral gavage) for 24 consecutive days. On the third day, mice were intravenously given a single dose of AD (10 mg/kg). At the end of the experiment, plasma and kidney samples were harvested to evaluate the therapeutic effects of THSG. The potential mechanisms of THSG in protecting against AD-induced cytotoxicity were examined using a real-time polymerase chain reaction, immunoblots, lactate dehydrogenase assay, and a cellular oxidized-thiol detection system in a mouse mesangial cell line. In this study, THSG showed concentration-dependent protective effects in ameliorating the progression of AD-induced FSGS. THSG suppressed albuminuria and hypercholesterolemia and reduced the status of lipid peroxidation in urine, plasma, and kidney tissue samples. Furthermore, THSG protected against podocyte damage, reduced renal fibrotic gene expressions, and alleviated the severity of glomerulosclerosis. Treatment of mouse mesangial cells with THSG induced nuclear factor erythroid-derived 2-like 2 (Nrf2) nuclear translocation, increased heme oxygenase-1 and NAD(P)H:quinone oxidoreductase (NQO)-1 gene expressions, and reduced cellular thiol oxidation and resistance to AD-induced cytotoxicity. Silencing Nrf2 and its repressor protein, Kelch-like ECH-associated protein 1 (Keap1), abolished these protective effects of THSG. In conclusion, THSG can play a protective role in ameliorating the progression of FSGS in a mouse model through activation of the Nrf2-Keap1 antioxidant pathway. Although a well-designed therapeutic study is needed, THSG may be applied to manage chronic kidney disease.

Supplemental Material, Appendix for Safety of Lumbar Interbody Fusion Procedures for Degenerative Disc Disease: A Systematic Review With Network Meta-Analysis of Prospective Studies by Kuan-Yu Chi, Shih-Hao Cheng, Yu-Kai Kuo, En-Yuan Lin and Yi-No Kang in Global Spine Journal

Purpose This study compared the radiologic and clinical outcomes of kyphoplasty with intravertebral reduction device (IRD) and vertebroplasty (VP) in treating osteoporotic vertebral compression fractures (OVCFs). Materials and Methods We enrolled 75 patients with OVCFs who were aged >60 years and treated them through VP or kyphoplasty with IRD. The radiologic outcomes, namely the anterior and middle body heights (ABH and MBH, respectively) and kyphotic angle (KA), were measured preoperatively and at postoperative 1 week, 3 months, 6 months, and 1 year. The refracture was identified on the basis of a decrease in ABH, MBH, or KA compared with those at postoperative 1 week. Visual analog scale (VAS) for pain and complications were recorded. The incidence of adjacent and nonadjacent fractures was also recorded. Results We treated 36 patients with kyphoplasty with IRD (IRD group) and 39 through VP (VP group). The patient characteristics were comparable in both groups. The KA and its restoration were more favorable after IRD than after VP. Although ABHs were not different in either group, their restoration was more efficient after IRD than after VP. MBHs, their restoration, and their refracture rates were better after IRD than after VP. VAS pain scores and complication rates were not different between the groups. The incidences of adjacent or nonadjacent fractures were not different between the 2 groups. Conclusion Our findings reveal significantly more efficient height restoration and kyphosis correction and fewer refractures in the IRD group. IRD may not increase the risk of adjacent or nonadjacent fractures.

Objectives Lumbar interbody fusion (LIF) is a treatment option for patients with degenerative disc disease (DDD). However, the effects of the most common LIF procedures—posterior LIF, transforaminal LIF, and anterior LIF—for the treatment of patients with DDD remain controversial. This study evaluated the pain and function caused by the LIF procedures for the treatment of patients with DDD. Methods Cochrane library, EMBASE, Ovid Medline, and PubMed were searched from inception to July 17, 2018. We only included prospective studies comparing the LIF procedures for treating patients with DDD. Pain score, Oswestry disability index (ODI) score, and operative time were analyzed in a contrast-based consistency model. Results are reported in weighted mean difference (WMD) and 95% confidence interval (CI). Results This study included eight prospective studies that recruited 503 patients for the LIF procedures. Minimally invasive posterior LIF resulted in lower pain scores than open transforaminal LIF (WMD: −1.45, 95% CI: −2.27 to −0.63) and open posterior LIF (WMD: −0.61, 95% CI: −1.10 to −0.12). It also resulted in a lower ODI score than open transforaminal LIF (WMD: −15.34, 95% CI: −21.76 to −8.91), anterior LIF (WMD: −15.64, 95% CI: −26.37 to −4.91), minimally invasive transforaminal LIF (WMD: −11.63, 95% CI: −16.86 to −6.40), and open posterior LIF (WMD: −10.93, 95% CI: −16.07 to −5.79). Small study effects were not detected in any consistency models. Conclusions Although minimally invasive posterior LIF has longer operative time than anterior LIF, it is associated with lower pain and ODI scores. Therefore, minimally invasive posterior LIF may be a superior LIF procedure for patients with DDD.

To translate the Mental Fatigue Scale into a Chinese version (CMFS), to develop a more valid and precise CMFS by using an item response theory-based model, and to examine the reliability and validity of the CMFS.One hundred and fifty adults having traumatic brain injury for at least 6 months were included. Each participant completed a battery of questionnaires (i.e. the Chinese version of the Chalder Fatigue Scale [ChCFS], Chinese version of the Clinically Useful Depression Outcome Scale [CUDOS-Chinese], and CMFS). Two-parameter graded response models were used to evaluate the location and discrimination performance of the CMFS. The reliability and validity of the CMFS were also evaluated.One item investigating 'increased sleep at night' (item 14) was removed because it had a low discrimination value (0.86) and provided less information. The internal consistency and test-retest reliability of the 13-item CMFS were high (0.92 and 0.96, respectively). The CMFS score was positively correlated with the ChCFS and the CUDOS-Chinese scores (r = 0.77 and 0.80, respectively).The CMFS provides reliable and valid information on mental fatigue for future research and clinical practice involving patients with traumatic brain injury.

This study was intended to determine whether the use of hypnotics is associated with dementia in traumatic-brain-injury (TBI) patients. Data retrieved from the Longitudinal Health Insurance Database 2000. TBI patients who received a diagnosis of insomnia at 2 or more independent examinations after the index date of TBI were included. The comparison cohort consisted of randomly selected TBI patients who were matched to insomnia cohort patients based on sex and age. The 2 cohorts of TBI patients were subsequently divided into the following 4 study groups: hypnotics users with insomnia (TBI-IH, N=599), insomniacs who did not use hypnotics (TBI-I, N=931), hypnotics users without insomnia (TBI-H, N=199), and people without insomnia who did not use hypnotics (TBI-C, N=4271). Cox proportional-hazards regression models were used to determine the difference in dementia-free survival among the 4 study groups, after adjusting for the propensity score. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of the TBI-IH and TBI-H groups showed that they had a higher risk of dementia (aHRs: 1.86 and 3.98; 95% CIs: 1.15-3.00 and 2.44-6.47, respectively), compared with that of the TBI-C group. However, the risk of dementia in the TBI-I group was not significantly different from that of the TBI-C group (aHR: 1.36; 95% CI: 0.85-2.19). This study suggests that the use of hypnotics is associated with an increased risk of dementia in TBI patients with or without insomnia, whereas insomnia alone is not.

Oxidative stress is an important pathological mechanism in various liver diseases. Polygonum multiflorum Thunb. (PM) can be used for the treatment of diseases associated with aging, hyperlipidemia, and oxidative stress in traditional Chinese medicine. In this study, we examined the hepatoprotective effects of the ethanolic extract of PM (PME) in in vitro and in vivo models. The PME induced expression of antioxidant-response-element- (ARE-) related genes in HepG2 cells showed a dose-dependent manner. Pretreatment of HepG2 cell with PME suppressed H2O2- and acetaminophen- (APAP-) induced cellular reactive oxygen species (ROS) generation and cytotoxicity. In APAP-induced mouse liver injury, pretreatment with PME also showed ability to increase the survival rate and reduce the severity of liver injury. Treatment with PME attenuated bile duct ligation-induced extrahepatic cholestatic liver injury and further increased multidrug resistance protein 4 (MRP4) and reduced organic anion-transporting polypeptide (OATP) expression. Furthermore, increased nuclear translocation of the nuclear factor erythroid 2-related factor 2 (Nrf2) was observed after treatment with PME in both in vivo models. In conclusion, the current study showed the hepatoprotective activity of PME by regulating the redox state in liver injury through Nrf2 activation and controlling hepatic bile acid homeostasis in obstructive cholestasis, through bile acid transporter expression modulation.

// Kao-Hui Liu 1 , Shun-Tai Yang 2 , Yen-Kuang Lin 3 , Jia-Wei Lin 2 , Yi-Hsuan Lee 4 , Jia-Yi Wang 1,5 , Chaur-Jong Hu 6 , En-Yuan Lin 7 , Shu-Mei Chen 8 , Chee-Kin Then 9 and Shing-Chuan Shen 1 1 Taipei Medical University, College of Medicine, Graduate Institute of Medical Sciences, Taipei, Taiwan 2 Taipei Medical University-Shuang Ho Hospital, Department of Neurosurgery, Taipei, Taiwan 3 Taipei Medical University, Biostatistics Center, Taipei, Taiwan 4 National Yang-Ming University, Department and Institute of Physiology, Taipei, Taiwan 5 Taipei Medical University, College of Medicine, School of Medicine, Department of Physiology, Taipei, Taiwan 6 Taipei Medical University-Shuang Ho Hospital, School of Medicine, Department of Neurology, Taipei, Taiwan 7 Taipei Medical University Hospital, Department of Neurosurgery, Taipei, Taiwan 8 Taipei Medical University-Wan Fang Hospital, Department of Neurosurgery, Taipei, Taiwan 9 Taipei Medical University, College of Medicine, School of Medicine, Taipei, Taiwan Correspondence: Shing-Chuan Shen, email: // Keywords : glioblastoma, antidepressant, AMPA receptor, excitotoxicity Received : November 24, 2014 Accepted : December 26, 2014 Published : December 31, 2014 Abstract The efficacy of glioblastoma chemotherapy is not satisfactory; therefore, a new medication is expected to improve outcomes. As much evidence shows that antidepressants decrease cancer incidence and improve patients’ quality of life, we therefore attempted to explore the potential for fluoxetine to be used to treat GBM and its possible underlying mechanism. The expression level of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) was determined using immunohistochemical staining and PCR analysis. The mechanism of fluoxetine-induced apoptosis of gliomas was elucidated. Computer modeling and a binding assay were conducted to investigate the interaction of fluoxetine with the AMPAR. The therapeutic effect of fluoxetine was evaluated using an animal model. We found that fluoxetine directly bound to AMPAR, thus inducing transmembrane Ca 2+ influx. The rise in the intracellular calcium concentration ([Ca 2+ ] i ) causes mitochondrial Ca 2+ overload, thereby triggering apoptosis. AMPARs are excessively expressed in glioma tissues, suggesting that fluoxetine specifically executes glioma cells. Our in vivo study revealed that fluoxetine suppressed the growth of glioblastomas in brains of Nu/Nu mice, an effect similar to that produced by temozolomide. Our preclinical studies suggest fluoxetine, a commonly used antidepressant, might be selectively toxic to gliomas and could provide a new approach for managing this disease.

To examine the effect of mind-body interventions (MBIs) on sleep quality among cancer patients, the moderating effects of the intervention components, subject characteristics, and methodological features of the relationship between MBIs and sleep.Electronic databases, including PubMed, Cochrane Library, PsycINFO, and CINAHL, containing data with English-language restriction recorded up to September 15, 2013 were searched thoroughly using keywords related to various types of MBI and sleep.Of the 114 identified citations, 99 were ineligible. Fifteen studies that followed 1,405 patients with cancer met the inclusion criteria and were analyzed.The primary outcome was change in the sleep parameter. Other variables related to components of MBIs, subject characteristics, and methodological features of the studies were also extracted.The weighted mean effect size (ES) was -0.43 (95% confidence interval [CI], -0.24 to -0.62) and the long-term effect size (up to 3 months) was -0.29 (95% CI, -0.52 to -0.06). The sensitivity analysis revealed that MBIs had a significant effect on sleep (g = -0.33, P.001). The moderating effects of components of the intervention, methodological features, subject characteristics, and quality of the studies on the relationship between MBIs and sleep were not found (all P values.05).This meta-analysis confirms that the MBIs yielded a medium effect size on sleep quality and the effect was maintained for up to 3 months. The findings support the implementation of MBIs into the multimodal approach to managing sleep quality in patients with cancer.

We aimed to evaluate the response rate of migraines by using anti-calcitonin gene-related peptide (anti-CGRP) for patients with migraines. We searched three main medical databases up to 29 March 2019. No restriction on language and publication time were applied. Eligible trials included randomized clinical trials investigating a 50%, 75%, and 100% response rate of migraine patients after anti-CGRP intervention. The collected data were dichotomous, and risk ratios (RRs) with a 95% confidence interval (CI) were used to present the quantitative synthesis results. The systematic review identified 16 eligible randomized clinical trials (RCTs) with 9439 patients. Eight of the 16 trials with 2516 patients reported a 50% response rate, and the pooled results showed a significant benefit from anti-CGRP. However, the effects seem to gradually reduce from the first month (RR 1.99, 95% CI 1.59 to 2.49) to the third month (RR 1.48, 95% CI 1.26 to 1.75) of treatment. The magnitude of effect was influenced by the type of anti-CGRP, according to the test for differences between subgroups (I-square = 53%). The funnel plots and Egger’s tests did not show serious small study effects in the results. In conclusion, the current evidences confirmed that anti-CGRP treatment can reduce migraine pain in the short term (within three months), but the long-term effect should be investigated in the future. Moreover, its effects may be influenced by the type and dose of anti-CGRP. Therefore, future studies should make direct comparisons among anti-CGRP medications.

Ultraviolet B (UVB), with a wavelength of 280-320 nm, represents one of the most important environmental factors for skin disorders, including sunburn, hyperpigmentation, solar keratosis, solar elastosis and skin cancer. Therefore, protection against excessive UVA-induced damage is useful for prevention of sunburn and other human diseases. Baicalin, a major component of traditional Chinese medicine Scutellaria baicalensis, has been reported to possess antioxidant and cytostatic capacities. In this study, we examined whether baicalin is also capable of protecting human keratinocytes from UVB irradiation. The results showed that baicalin effectively scavenged reactive oxygen species (ROS) elevated within 4 h after UVB radiation and reversed the UVB-suppressed cell viability and UVB-induced apoptosis after 24 h. Our results demonstrated the utility of baicalin to complement the contributions of traditional Chinese medicine in UVB-induced damage to skin and suggested their potential application as pharmaceutical agents in long-term sun-shining injury prevention.

The purpose of this study was to compare the effect of PbtO2-guided therapy with traditional intracranial pressure- (ICP-) guided treatment on the management of cerebral variables, therapeutic interventions, survival rates, and neurological outcomes of moderate and severe traumatic brain injury (TBI) patients. From 2009 to 2010, TBI patients with a Glasgow coma scale 2-guided management (PbtO2> 20 mmHg), and 27 patients were treated with ICP-guided therapy (ICP < 20 mmHg and CPP > 60 mmHg) in the neurosurgical intensive care unit (NICU); demographic characteristics were similar across groups. The survival rate in the PbtO2-guided group was also significantly increased at 3 and 6 months after injury. Moreover, there was a significant correlation between the PbtO2signal and Glasgow outcome scale-extended in patients from 1 to 6 months after injury. This finding demonstrates that therapy directed by PbtO2monitoring is valuable for the treatment of patients with moderate and severe TBI and that increasing PaO2to 150 mmHg may be efficacious for preventing cerebral hypoxic events after brain trauma.

Background An occipital interhemispheric approach for the lesions in the middle part of the medial temporal region has been reported. However, this approach usually requires the excision of the tentorium to provide satisfactory exposure. In this case, we used this approach without the excision of the tentorium to remove the parahippocampal gyrus tumor, which was located superolateral to tentorial edge in the middle part of the medial temporal region. Case Description A 22-year-old man who had seizures for 3 years presented with a tumor in the right parahippocampal gyrus. The tumor was successfully removed by the occipital interhemispheric approach without the excision of the tentorium. The postoperative course was uneventful. Conclusions An occipital interhemispheric approach without the excision of tentorium is a feasible and safe approach for parahippocampal tumors superolateral to tentorial edge, even in a case where the tumor is deeply located in the middle part of medial temporal region.

An intracranial saccular aneurysm is not commonly diagnosed in a patient with head injury. We present a patient with a history of minor head trauma and a CT scan of the brain revealing minimal subarachnoid hemorrhage 17 days prior to admission, complaining of severe headache, dysarthria and focal right limb seizures 3 hours prior to admission. A traumatic aneurysm was suspected based on clinical history and radiological findings including hematoma in the falx region on a CT scan of the brain and an aneurysm of the pericallosal artery on magnetic resonance angiography and four-vessel cerebral angiography. However, at craniotomy, an intracranial non-traumatic saccular aneurysm at the bifurcation of the pericallosal artery was found. The patient recovered fully after successful clipping the aneurysm.

BackgroundTranspedicular cement augmentation has became a significant treatment for osteoporotic vertebral compression fractures with the evident effect of pain-relief. However, height restoration ...

Solitary metastastic pituitary stalk tumors account for approximately less than 1% of all pituitary gland tumors and present difficulties in clinical diagnosis because most of them are clinically silent and usually too small to cause radiological changes. With the advance of microsurgical techniques, keyhole surgery is indicated to obtain a specimen for pathological diagnosis and possible removal of the tumor. Here, we reported a patient who has a history of advanced breast cancer and who complained of poly-uria and polydypsia. Magnetic resonance images revealed a solitary tumor over the pituitary stalk. A right supraorbital craniotomy was performed and the pathological report confirmed the diagnosis of metastatic breast cancer. This is the first case report using keyhole surgery to confirm the pathology and improve the clinical symptoms. The relevant literature is also reviewed.

A 55-year-old female presented with a painful protruding mass in right parietal skull for 7 months. Interestingly, another smaller bony lesion, separated from the symptomatic one, was disclosed in right frontal skull on imaging study. The larger one was completely excised, first with a picture of an aggressive osteoblastoma in the pathology. The smaller one in the frontal skull was excised subsequently, presenting the same pathological picture as the larger one. No other foci of osteoblastomas were detected on the whole body bone scan. To our knowledge, this is the first case with double independent osteoblastomas occurring in frontal and parietal skull. Surgical strategy for these two bony lesions was discussed.

There are many reasons for hypotension in trauma patients. Life-threatening hemorrhage associated with maxillofacial trauma is considered rare. Here, we present a 25-year-old patient with maxillofacial trauma complicated by life-threatening hemorrhage after a traffic accident. At the emergency department, massive epistaxis was noted. Nasal packing and blood transfusion were performed, but vital signs of the patient were still unstable. Cerebral angiography revealed contrast extravasation from the left superficial temporal and internal maxillary arteries of the left external carotid artery. After transarterial embolization was performed, the hemorrhage immediately stopped. When common treatment such as nasal packing, correction of coagulopathy, reduction of fractures, and arterial ligation fails to control the hemorrhage, transarterial embolization can offer a safe alterative to surgical exploration.