Posterior Cervical Spine Crisscross Fixation: Biomechanical Evaluation

Background Biomechanical/anatomic limitations may limit the successful implantation, maintenance, and risk acceptance of posterior cervical plate/rod fixation for one stage decompression-fusion. A method of posterior fixation (crisscross) that resolves biomechanical deficiencies of previous facet wiring techniques and not reliant upon screw implantation has been devised. The biomechanical performance of the new method of facet fixation was compared to the traditional lateral mass plate/screw fixation method. Methods Thirteen human cadaver spine segments (C2-T1) were tested under flexion-compression loading and four were evaluated additionally under pure-moment load. Preparations were evaluated in a sequence of surgical alterations with intact, laminectomy, lateral mass plate/screw fixation, and crisscross facet fixation using forces, displacements and kinematics. Findings Combined loading demonstrated significantly lower bending stiffness (p \u3c 0.05) between laminectomy compared to crisscross and lateral mass plate/screw preparations. Crisscross fixation showed a comparative tendency for increased stiffness. The increased overall motion induced by laminectomy was resolved by both fixation techniques, with crisscross fixation demonstrating a comparatively more uniform change in segmental motions. Interpretation The crisscross technique of facet fixation offers immediate mechanical stability with resolution of increased flexural rotations induced by multi-level laminectomy. Many of the anatomic limitations and potentially deleterious variables that may be associated with multi-level screw fixation are not associated with facet wire passage, and the subsequent fixation using a pattern of wire connection crossing each facet joint exhibits a comparatively more uniform load distribution. Crisscross wire fixation is a valuable addition to the surgical armamentarium for extensive posterior cervical single-stage decompression-fixation

Towards a More Robust Lower Neck Compressive Injury Tolerance - An Approach Combining Multiple Test Methodologies

Objective.The compressive tolerance of the cervical spine has traditionally been reported in terms of axial force at failure. Previous studies suggest that axial compressive force at failure is particularly sensitive to the alignment of the cervical vertebra and the end conditions of the test methodology used. The present study was designed to develop a methodology to combine the data of previous experiments into a diverse dataset utilizing multiple test methods to allow for the evaluation of the robustness of current and proposed eccentricity based injury criteria. Methods. Data was combined from two studies composed of dynamic experiments including whole cervical spine and head kinematics that utilized different test methodologies with known end conditions, spinal posture, injury outcomes and measured kinetics at the base of the neck. Loads were transformed to the center of the C7-T1 intervertebral disc and the eccentricity of the sagittal plane resultant force relative to the center of the disc was calculated. The correlation between sagittal plane resultant force and eccentricity at failure was evaluated and compared to the correlation between axial force and sagittal plane moment and axial force alone. Results. Accounting for the eccentricity of the failure loads decreased the scatter in the failure data when compared to the linear combination of axial force and sagittal plane moment and axial force alone. A correlation between axial load and sagittal plane flexion moment at failure (R2 = 0.44) was identified. The sagittal plane extension moment at failure did not have an identified correlation with the compressive failure load for the tests evaluated in this data set (R2 = 0.001). The coefficients of determination for the linear combinations of sagittal plane resultant force with anterior and posterior eccentricity are 0.56 and 0.29 respectively. These correlations are an improvement compared to the combination of axial force and sagittal plane moment. Conclusions. Results using the outlined approach indicate that the combination of lower neck sagittal plane resultant force and the anterior-posterior eccentricity at which the load is applied generally correlate with the type of cervical damage identified. These results show promise at better defining the tolerance for compressive cervical fractures in male Post Mortem Human Subjects (PMHS) than axial force alone. The current analysis requires expansion to include more tolerance data so the robustness of the approach across various applied loading vectors and cervical postures can be evaluated

Molecular epidemiology of Giardia duodenalis and Cryptosporidium spp on swine farms in Ontario, Canada

A subset of swine farms in Ontario, Canada have been monitored for Cryptosporidium and Giardia. Fecal samples were collected from different stages of production as well as from manure pits. G. duodenalis cysts and Cryptosporidium spp. oocysts were detected in the manure samples using immunofluorescence microscopy. A nested PCR and sequencing method was performed to determine the genotypes. A mixed multivariable method was used to compare the prevalence of Cryptosporidium and Giardia in samples from different sources

Metal Ion Dependence of the Asymmetric Transamination of Phenylpyruvic Acid by Pyridoxamine in the Presence of β-Cyclodextrin

Transamination reactions of phenylpyruvic acid and pyridoxamine in the presence of metal ions and B-cyclodextrin as a chiral auxiliary have been investigated in neutral aqueous solution. The rate and extent of the transamination, and the asymmetric induction observed in the reaction depend upon the nature of the metal ion. In particular, while Zn2+and C02+yield preferentially the aldimine complex of L-phenylalanine, Cu2\u27 yields preferentially the complex of D-phenylalanine and Ni2+only the racemic product. It is proposed that the ketimine complexes are bound to B-cyclodextrin through the phenyl group of the keto acid residue and that the stereoselectivity of the reaction is originated by some direct interaction of the hydroxyl groups of the cyclodextrin moiety and the metal ions. Although the extent of asymmetric induction is modest in these simple systems (10-20°/0 optical purities), the present results show that transition metal complexes can play a prominent role in determining the steric course of the asymmetric reaction

Occupant Dynamics in Rollover Crashes: Influence of Roof Deformation and Seat Belt Performance on Probable Spinal Column Injury

Motor vehicle crashes are the leading cause of death in the United States for people ages 3–33, and rollover crashes have a higher fatality rate than any other crash mode. At the request and under the sponsorship of Ford Motor Company, Autoliv conducted a series of dynamic rollover tests on Ford Explorer sport utility vehicles (SUV) during 1998 and 1999. Data from those tests were made available to the public and were analyzed in this study to investigate the magnitude of and the temporal relationship between roof deformation, lap–shoulder seat belt loads, and restrained anthropometric test dummy (ATD) neck loads

Retention of Supraspinal Delta-like Analgesia and Loss of Morphine Tolerance in δ Opioid Receptor Knockout Mice

AbstractGene targeting was used to delete exon 2 of mouse DOR-1, which encodes the δ opioid receptor. Essentially all 3H-[D-Pen2,D-Pen5]enkephalin (3H-DPDPE) and 3H-[D-Ala2,D-Glu4]deltorphin (3H-deltorphin-2) binding is absent from mutant mice, demonstrating that DOR-1 encodes both δ1 and δ2 receptor subtypes. Homozygous mutant mice display markedly reduced spinal δ analgesia, but peptide δ agonists retain supraspinal analgesic potency that is only partially antagonized by naltrindole. Retained DPDPE analgesia is also demonstrated upon formalin testing, while the nonpeptide δ agonist BW373U69 exhibits enhanced activity in DOR-1 mutant mice. Together, these findings suggest the existence of a second delta-like analgesic system. FinallyDOR-1 mutant mice do not develop analgesic tolerance to morphine, genetically demonstrating a central role for DOR-1 in this process

The Effects of Collective Bargaining Systems on the Productivity Function of Firms: An Analysis of Bargaining Structures and Processes and the Implications for Policy Making

In recent years, individual and company bargaining have increasingly supplanted sector and country collective bargaining leading to increasingly heterogeneous and perforated, i.e. hybrid, national collective bargaining systems. Little is known about the relative effects of these different systems. In this paper the authors derive and test a comprehensive categorization of collective bargaining systems and argue that different systems are associated with different production functions and therefore have different effects on labour productivity. The hypotheses are tested using representative workplace level data for all member states of the European Union. It is found that the performance of coordinated sector collective bargaining systems is higher than for all other forms of collective and individual bargaining. Policy implications of the results are discussed as these results challenge attempts to reform collective bargaining in Europe

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.Peer reviewe

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Background: Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method: A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions: The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting