Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology

<p>Abstract</p> <p>Background</p> <p>Treatment of unstable thoracolumbar fractures is controversial regarding short or long segment pedicle screw fixation. Although long level fixation is better, it can decrease one motion segment distally, thus increasing load to lower discs.</p> <p>Methods</p> <p>We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.</p> <p>Results</p> <p>Average follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.</p> <p>Conclusion</p> <p>Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.</p

Platelet-activating Factor–mediated NF-κB Dependency of a Late Anaphylactic Reaction

Anaphylaxis is a life-threatening systemic allergic reaction with the potential for a recurrent or biphasic pattern. Despite an incidence of biphasic reaction between 5 and 20%, the molecular mechanism for the reaction is unknown. Using a murine model of penicillin V–induced systemic anaphylaxis, we show an autoregulatory cascade of biphasic anaphylactic reactions. Induction of anaphylaxis caused a rapid increase in circulating platelet-activating factor (PAF) levels. In turn, the elevated PAF contributes to the early phase of anaphylaxis as well as the subsequent activation of the nuclear factor (NF)-κB, a crucial transcription factor regulating the expression of many proinflammatory cytokines and immunoregulatory molecules. The induction of NF-κB activity is accompanied by TNF-α production, which, in turn, promotes late phase PAF synthesis. This secondary wave of PAF production leads eventually to the late phase of anaphylactic reactions. Mast cells do not appear to be required for development of the late phase anaphylaxis. Together, this work reveals the first mechanistic basis for biphasic anaphylactic reactions and provides possible therapeutic strategies for human anaphylaxis

Ubiquitous-Severance Hospital Project: Implementation and Results

OBJECTIVES: The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. METHODS: Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. RESULTS: The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. CONCLUSIONS: YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identifiedope

KNOW-Ped CKD (KoreaN cohort study for outcomes in patients with pediatric CKD): Design and methods

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Background The global prevalence of chronic kidney disease (CKD) is increasing. In children, CKD exhibits unique etiologies and can have serious impacts on childrens growth and development. Therefore, an aggressive approach to preventing the progression of CKD and its complications is imperative. To improve the understanding and management of Asian pediatric patients with CKD, we designed and launched KNOW-Ped CKD (KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease), a nationwide, prospective, and observational cohort study of pediatric CKD with funding from the Korean government. Methods/design From seven major centers, 450 patients <20 years of age with CKD stages I to V are recruited for the comprehensive assessment of clinical findings, structured follow-up, and bio-specimen collection. The primary endpoints include CKD progression, defined as a decline of estimated glomerular filtration rate by 50 %, and a requirement for renal replacement therapy or death. The secondary outcomes include the development of left ventricular hypertrophy or hypertension, impairment of growth, neuropsychological status, behavioral status, kidney growth, and quality of life. Discussion With this study, we expect to obtain more information on pediatric CKD, which can be translated to better management for the patients. Trial registration NCT02165878(ClinicalTrials.gov), submitted on June 11, 2014

Regulation of mouse steroidogenesis by WHISTLE and JMJD1C through histone methylation balance

The dynamic exchange of histone lysine methylation status by histone methyltransferases and demethylases has been previously implicated as an important factor in chromatin structure and transcriptional regulation. Using immunoaffinity TAP analysis, we purified the WHISTLE-interacting protein complexes, which include the heat shock protein HSP90α and the jumonji C-domain harboring the histone demethylase JMJD1C. In this study, we demonstrate that JMJD1C specifically demethylates histone H3K9 mono- and di-methylation, and mediates transcriptional activation. We also provide evidence suggesting that both WHISTLE and JMJD1C performs functions in the development of mouse testes by regulating the expression of the steroidogenesis marker, p450c17, via SF-1-mediated transcription. Furthermore, we demonstrate that WHISTLE is recruited to the p450c17 promoter via SF-1 and represses the transcription of prepubertal stages of steroidogenesis, after which JMJD1C replaces WHISTLE and activates the expression of target genes via SF-1-mediated interactions. Our results demonstrate that the histone methylation balance mediated by HMTase WHISTLE and demethylase JMJD1C perform a transcriptional regulatory function in mouse testis development

Very Late Stent Thrombosis in a Drug-Eluting Stent due to Interruption of Anti-Platelet Agents in Patients With Acute Myocardial Infarction and Thrombocytosis

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy

Growth dynamics of solid electrolyte interphase layer on SnO2 nanotubes realized by graphene liquid cell electron microscopy

Formation of stable solid electrolyte interphase (SEI) layer is critical to outstanding performance of energy storage devices, because it acts as a passive layer that allows facile transport of ions but forbids electron transport between the electrolyte and electrode. Although much study has been devoted to investigate the morphology and structure of SEI layer using a myriad of analytical devices on past decades, the direct observation of SEI layer on a real time scale has remained as a formidable challenge. In addition, it has been difficult to observe both the decomposition of electrolytes and formation process of stable SEI layer at nanometer scale. Here we utilize in situ transmission electron microscopy (TEM) using graphene liquid cell (GLC) to realize the observation of stable SEI layer formation in a sequential time scale. Upon e- beam irradiation, Li salts in the electrolytes react with reduced electrolytes and form gel-like agglomerates, which are deposited on the surface of the active material as a passivation layer and later stabilized to become more uniform in overall thickness. Additionally, growth dynamics of stable SEI layer were suggested, where the deposition of decomposed electrolytes eventually result in relatively uniform SEI layer. This paper demonstrates that it is possible to observe not only the formation of non-crystalline SEI layer but also the movement of decomposed electrolytes onto the surface of active materials which account for broader understanding of SEI layer, and has the potential to detect important interfacial phenomena in electrochemical devices that were overlooked so far. © 2016 Elsevier Ltd.114171sciescopu

Same Pattern of Circadian Variation According to the Season in the Timing of Ischemic Stroke Onset: Preliminary Report

Background and Objective Stroke occurrence shows a chronobiological variation, which is considered to be related with waking in the morning. We hypothesized that its seasonal difference would also exist because individual life activity including sleep-wake pattern can be influenced by interseasonal variability. The objective of this study was to investigate the seasonal difference of circadian variation in the timing of onset in patients with acute ischemic stroke. Methods We studied 1486 patients with acute ischemic stroke. Stroke onset time was defined as the earliest time the patient or a witness noted definite neurological symptoms. The patients with clear onset stroke were enrolled. Frequency of onset was analyzed for four 6-hour and twelve 2-hour intervals from 0 to 24 hour per day. Results The clear onset time was known in 968 patients (65.1%). Mean age of the patients was 67.63 ± 12.65 years and 589 patients (60.9%) were male. Stroke occurred in spring (26.5%), summer (27.2%), fall (24.1%), and winter (22.3%). In all cases, ischemic stroke showed a significant circadian variation in time of onset (p < 0.001). High peak period was between 6:01 AM to 12:00 PM (37%) with the same pattern in each season. Conclusions Seasonal difference was not significant despite circadian variation in time of onset of ischemic stroke. Thus, exogenous factors such as environmental factors and life styles may have less influence on inter-seasonal variability of circadian rhythms, which are related with chronobiological factors of stroke onset in this regional population