Biomechanical Analysis of an Interspinous Process Fixation Device with In Situ Shortening Capabilities: Does Spinous Process Compression Improve Segmental Stability?

OBJECTIVE: The objective of this study was to characterize the biomechanical implications of spinous process compression, via in situ shortening of a next-generation interspinous process fixation (ISPF) device, in the context of segmental fusion. METHODS: Seven lumbar cadaveric spines (L1-L4) were tested. Specimens were first tested in an intact state, followed by iterative instrumentation at L2-3 and subsequent testing. The order followed was 1) stand-alone ISPF (neutral height); 2) stand-alone ISPF (shortened in situ from neutral height; shortened); 3) lateral lumbar interbody fusion (LLIF) + ISPF (neutral); 4) LLIF + ISPF (shortened); 5) LLIF + unilateral pedicle screw fixation; 6) LLIF + bilateral pedicle screw fixation. A 7.5-Nm moment was applied in flexion/extension, lateral bending, and axial rotation via a kinematic test frame. Segmental range of motion (ROM) and lordosis were measured for all constructs. Comparative analysis was performed. RESULTS: Statistically significant flexion/extension ROM reductions: all constructs versus intact condition (P \u3c 0.01); LLIF + ISPF (neutral and shortened) versus stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + USPF versus ISPF (neutral) (P = 0.049); bilateral pedicle screw fixation (BPSF) versus stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + BPSF versus LLIF + unilateral pedicle screw fixation (UPSF) (P \u3c 0.01). Significant lateral bending ROM reductions: LLIF + ISPF (neutral and shortened) versus intact condition and stand-alone ISPF (neutral) (P \u3c 0.01); LLIF + UPSF versus intact condition and stand-alone ISPF (neutral and shortened) (P \u3c 0.01); LLIF + BPSF versus intact condition and all constructs (P \u3c 0.01). Significant axial rotation ROM reductions: LLIF + ISPF (shortened) and LLIF + UPSF versus intact condition and stand-alone ISPF (neutral) (P ≤ 0.01); LLIF + BPSF versus intact condition and all constructs (P ≤ 0.04). CONCLUSIONS: In situ shortening of an adjustable ISPF device may support increased segmental stabilization compared with static ISPF

A Biomechanical Evaluation of a Next-Generation Integrated and Modular ACDF Device Possessing Full-Plate, Half-Plate, and No-Profile Fixation Iterations.

Study Design: In vitro biomechanical study. Objectives: The objective of this in vitro biomechanical range-of-motion (ROM) study was to evaluate spinal segmental stability following fixation with a novel anterior cervical discectomy and fusion (ACDF) device ( novel device ) that possesses integrated and modular no-profile, half-plate, and full-plate fixation capabilities. Methods: Human cadaveric (n = 18, C3-T1) specimens were divided into 3 groups (n = 6/group). Each group would receive one novel device iteration. Specimen terminal ends were potted. Each specimen was first tested in an intact state, followed by anterior discectomy (C5/C6) and iterative instrumentation. Testing order: (1) novel device (group 1, no-profile; group 2, half-plate; group 3, full-plate); (2) novel device (all groups) with lateral mass screws (LMS); (3) traditional ACDF plate + cage; (4) traditional ACDF plate + cage + LMS. A 2 N·m moment was applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) via a kinematic testing machine. Segmental ROM was tracked and normalized to intact conditions. Comparative statistical analyses were performed. Results: Key findings: (1) the novel half- and full-plate constructs provided comparable reduction in FE and LB ROM to that of traditional plated ACDF ( Conclusions: The novel ACDF device may be a versatile alternative to traditional no-profile and independent plating techniques, as it provides comparable ROM reduction in all principle motion directions, across all device iterations

Prospectus, August 21, 2013

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Isometric Exercise Training and Arterial Hypertension: An Updated Review

Hypertension is recognised as a leading attributable risk factor for cardiovascular disease and premature mortality. Global initiatives towards the prevention and treatment of arterial hypertension are centred around non-pharmacological lifestyle modification. Exercise recommendations differ between professional and scientific organisations, but are generally unanimous on the primary role of traditional aerobic and dynamic resistance exercise. In recent years, isometric exercise training (IET) has emerged as an effective novel exercise intervention with consistent evidence of reductions in blood pressure (BP) superior to that reported from traditional guideline-recommended exercise modes. Despite a wealth of emerging new data and endorsement by select governing bodies, IET remains underutilised and is not widely prescribed in clinical practice. This expert-informed review critically examines the role of IET as a potential adjuvant tool in the future clinical management of BP. We explore the efficacy, prescription protocols, evidence quality and certainty, acute cardiovascular stimulus, and physiological mechanisms underpinning its anti-hypertensive effects. We end the review with take-home suggestions regarding the direction of future IET research

Presence of genes for type III secretion system 2 in Vibrio mimicus strains

<p>Abstract</p> <p>Background</p> <p>Vibrios, which include more than 100 species, are ubiquitous in marine and estuarine environments, and several of them e.g. <it>Vibrio cholerae</it>, <it>V. parahaemolyticus</it>, <it>V. vulnificus </it>and <it>V. mimicus</it>, are pathogens for humans. Pathogenic <it>V. parahaemolyticus </it>strains possess two sets of genes for type III secretion system (T3SS), T3SS1 and T3SS2. The latter are critical for virulence of the organism and be classified into two distinct phylogroups, T3SS2α and T3SS2β, which are reportedly also found in pathogenic <it>V. cholerae </it>non-O1/non-O139 serogroup strains. However, whether T3SS2-related genes are present in other <it>Vibrio </it>species remains unclear.</p> <p>Results</p> <p>We therefore examined the distribution of the genes for T3SS2 in vibrios other than <it>V. parahaemolyticus </it>by using a PCR assay targeting both T3SS2α and T3SS2β genes. Among the 32 <it>Vibrio </it>species tested in our study, several T3SS2-related genes were detected in three species, <it>V. cholerae</it>, <it>V. mimicus </it>and <it>V. hollisae</it>, and most of the essential genes for type III secretion were present in T3SS2-positive <it>V. cholerae </it>and <it>V. mimicus </it>strains. Moreover, both <it>V. mimicus </it>strains possessing T3SS2α and T3SS2β were identified. The gene organization of the T3SS2 gene clusters in <it>V. mimicus </it>strains was fundamentally similar to that of <it>V. parahaemolyticus </it>and <it>V. cholerae </it>in both T3SS2α- and T3SS2β-possessing strains.</p> <p>Conclusions</p> <p>This study is the first reported evidence of the presence of T3SS2 gene clusters in <it>V. mimicus </it>strains. This finding thus provides a new insight into the pathogenicity of the <it>V. mimicus </it>species.</p

Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services

Genome-Wide Profiling of MicroRNAs in Adipose Mesenchymal Stem Cell Differentiation and Mouse Models of Obesity

In recent years, there has been accumulating evidence that microRNAs are key regulator molecules of gene expression. The cellular processes that are regulated by microRNAs include e.g. cell proliferation, programmed cell death and cell differentiation. Adipocyte differentiation is a highly regulated cellular process for which several important regulating factors have been discovered, but still not all are known to fully understand the underlying mechanisms. In the present study, we analyzed the expression of 597 microRNAs during the differentiation of mouse mesenchymal stem cells into terminally differentiated adipocytes by real-time RT-PCR. In total, 66 miRNAs were differentially expressed in mesenchymal stem cell-derived adipocytes compared to the undifferentiated progenitor cells. To further study the regulation of these 66 miRNAs in white adipose tissue in vivo and their dependence on PPARγ activity, mouse models of genetically or diet induced obesity as well as a mouse line expressing a dominant negative PPARγ mutant were employed