Preoperative Low Back Pain Affects Postoperative Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery

Study Design A single-center retrospective study. Purpose To research the predictive factors associated with postoperative patient satisfaction 1 year after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), a minimally invasive procedure for lumbar degenerative disease. Overview of Literature There have been reports of numerous variables influencing patient satisfaction with lumbar surgery; however, there have been few investigations on MIS are limited. Methods This study included 229 patients (107 men and 122 women; mean age, 68.9 years) who received one or two levels of MIS-TLIF, and the patient’s age, gender, disease, paralysis, preoperative physical functions, duration of symptom(s), and surgery-associated factors (waiting for surgery, number of surgical levels, surgical time, and intraoperative blood loss) were studied. Radiographic characteristics and clinical outcomes such as Oswestry Disability Index (ODI) scores and Visual Analog Scale (VAS; 0–100) ODI scores for low back pain, leg pain, and numbness were studied. One year following surgery, patient satisfaction (defined as satisfaction for surgery and for present condition; 0–100) was assessed using VAS and its relationships with investigation factors were examined. Results The mean VAS scores of satisfaction for surgery and for present condition were 88.6 and 84.2, respectively. The results of multiple regression analysis showed that preoperative adverse factors of satisfaction for surgery were being elderly (β=−0.17, p=0.023), high preoperative low back pain VAS scores (β=−0.15, p=0.020), and postoperative adverse factors were high postoperative ODI scores (β=−0.43, p<0.001). In addition, the preoperative adverse factor of satisfaction for present condition was high preoperative low back pain VAS scores (β=−0.21, p=0.002), and postoperative adverse factors were high postoperative ODI scores (β=−0.45, p<0.001) and high postoperative low back pain VAS scores (β=−0.26, p=0.001). Conclusions According to this study, significant preoperative low back pain and high postoperative ODI score after surgery are linked to patient unhappiness

Mutations of the PAX6 Gene Detected in Patients with a Variety of Optic-Nerve Malformations

The PAX6 gene is involved in ocular morphogenesis and is expressed in the developing central nervous system and numerous ocular tissues during development. PAX6 mutations have been detected in various ocular anomalies, including aniridia, Peters anomaly, corneal dystrophy, congenital cataracts, and foveal hypoplasia. However, it has not been identified in patients with optic-nerve malformations. Here, we identified novel mutations in eight pedigrees with optic-nerve malformations, including coloboma, morning glory disc anomaly, optic-nerve hypoplasia/aplasia, and persistent hyperplastic primary vitreous. A functional assay demonstrated that each mutation decreased the transcriptional activation potential of PAX6 through the paired DNA-binding domain. PAX6 and PAX2 are each thought to downregulate the expression of the other. Four of the detected mutations affected PAX6-mediated transcriptional repression of the PAX2 promoter in a reporter assay. Because PAX2 gene mutations were detected in papillorenal syndrome, alternation of PAX2 function by PAX6 mutations may affect phenotypic manifestations of optic-nerve malformations

Influence of the Preoperative Duration of Symptoms on Patients’ Clinical Outcomes after Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spinal Diseases

Background and Objectives: The impact of the duration of symptoms (DOS) on postoperative clinical outcomes of patients with degenerative lumbar spinal diseases is important for determining the optimal timing of surgical intervention; however, the timing remains controversial. This prospective case–control study aimed to investigate the influence of the preoperative DOS on surgical outcomes in minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF). Materials and Methods: Patients who underwent single-level TLIF for lumbar degenerative diseases between 2017 and 2018 were reviewed. Only patients with full clinical data during the 1-year follow-up period were included. The patients were divided into two groups (DOS Results: A total of 163 patients were assessed: 60 in group S and 103 in group L. No differences in baseline characteristics and clinical outcomes were found. The ODI and VAS significantly improved from the baseline to each follow-up period (all p p = 0.019) and 6 months (p = 0.022). In addition, group S had significantly lower VAS scores for leg pain at 3 months (p = 0.027). In a comparison between both groups, only the patients with cauda equina symptoms showed that ODI and leg pain VAS scores at 3 months after surgery were significantly lower in group S (19.9 ± 9.1 vs. 14.1 ± 12.5; p = 0.037, 7.4 ± 13.9 vs. 14.7 ± 23.1; p = 0.032, respectively). However, the clinical outcomes were not significantly different between both groups 1 year after surgery. Patient satisfaction was also not significantly different between both groups. Conclusions: Patients with a shorter DOS tended to have a significantly slower recovery; however, clinical outcomes 1 year after surgery were good, regardless of the DOS

Serum miRNAs Predicting Sustained HBs Antigen Reduction 48 Weeks after Pegylated Interferon Therapy in HBe Antigen-Negative Patients

The therapeutic goal for hepatitis B virus (HBV) infection is HBs antigen (HBsAg) seroclearance, which is achieved through 48-week pegylated interferon (Peg-IFN) therapy. This study aimed to identify predictive biomarkers for sustained HBsAg reduction by analyzing serum microRNAs. Twenty-two consecutive chronic HBV infection patients negative for HBe antigen (HBeAg) with HBV-DNA levels &lt;5 log copies/mL, alanine aminotransferase (ALT) &lt;100 U/L, and compensated liver functions, were enrolled. The patients were subcutaneously injected with Peg-IFN&alpha;-2a weekly for 48 weeks (treatment period), followed by the 48-week observation period. HBsAg 1-log drop relative to baseline levels recorded at the end of the observation period was considered effective. Sera were obtained at weeks 0 and 24 during the treatment period analyzed for microRNAs. The microRNA (miRNA) antiviral activity was evaluated in vitro using Huh7/sodium taurocholate cotransporting polypeptide (NTCP) cells. As a result, six patients achieved the HBsAg 1-log drop after the observation periods. Comparison of serum microRNA levels demonstrated that high miR-6126 levels at week 24 predicted HBsAg 1-log drop. Furthermore, miR-6126 reduced HBsAg in culture medium supernatants and intracellular HBV-DNA quantities in Huh7/NTCP cells. In conclusion, high serum miR-6126 levels during Peg-IFN therapy predicted the HBsAg 1-log drop 48 weeks after the completion of therapy. In vitro assays revealed that miR-6126 was able to suppress HBsAg production and HBV replication