MICROFRACTURE OF HUMAN THORACOLUMBAR VERTEBRAL BODY UNDER FATIGUE LOADING

The purpose of this study was to investigate the relationship between lumbar vertebral microfracture and fatigue loading on young human spine under physiological cyclic compression loads. Thirty-three thoracolumbar vertebrae (T12 to L4) were obtained from 7 adult Chinese male cadavers. They were randomly divided into 5 groups. Cyclical compression was performed for 20,000 cycles with 2 Hz. Load magnitude was determined respectively as 10%, 20% and 30% of the ultimate compressive load. Four cylindrical sections were obtained from each vertebra and the cross-sectional slides were made. The histomorphometry was used to determine microfracture densitiy and distribution. No fracture was detected in the radiographs of groups III, IV and V after fatigue load. Microfracture density in the cyclic compression group increased from 0.46 #/mm2 in Group III to 0.66 #/mm2 (Group IV) and 0.94 #/mm2 (Group V) under different loading levels (). These results provide evidence for the existence of microfractures caused by fatigue loads that are undetectable by X-ray

EFFECTS OF REHABILITATION ON BACK MUSCLE CONTRACTION PATTERNS OF LOW BACK PAIN PATIENTS

The aims of this study were to conduct a comparative investigation of muscle function between low back pain (LBP) patients and normal subjects, as well as to explore whether intensive rehabilitation can change back muscle contraction synergy. 20 normal subjects and 20 patients with chronic LBP were asked to perform symmetrical and asymmetrical tasks. LBP patients were tested in the weeks immediately before and after 12-week LBP rehabilitation treatment. Tasks include “carrying” weights up and down with a 45° left rotation. Eight channel surface EMG electrodes were placed on the surface of paraspinal muscles. correlation between right and left corresponding muscles as well as between pre- and post-treatment were calculated. Lifting capacity for LBP patients were also measured before and after treatment. EMG profiles showed that the muscle activity strategies varied between normal subjects and LBP patients. The correlation coefficients for spinal muscles have shown very reproducible intra-subject muscle contraction synergies. Unbalanced EMG patterns found in LBP patients under symmetrical tasks were not affected by rehabilitation treatment

Search for vectorlike charge 2/3 T quarks in proton-proton collisions at root(s)=8 TeV

Peer reviewe

Service quality of travel agents in Turkey

Travel Agent, Satisfaction, Servqual, Service quality, Perception, Expectation, Factor analysis, Regression analysis,

Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation.

We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P < 5 × 10-9), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease