Cervical spine surgery for tandem spinal stenosis: The impact on low back pain

Objective Tandem spinal stenosis (TSS) can present similarly to cervical myelopathy, but often has a worse prognosis. Few studies have investigated outcomes and compared treatment approaches for patients with TSS. We sought to determine the impact of cervical spine surgery on cervical and lumbar spine symptoms in patients with symptomatic tandem spinal stenosis. Patients Methods 84 patients with TSS were identified over 5 years. 48 underwent cervical spine surgery alone, 20 underwent both cervical and lumbar spine surgery, and 16 received conservative treatment alone (conservative cohort). Quality of life (QOL) measures included the Visual Analogue Scale (VAS) for arm, neck, and back pain, and EuroQOL-5 Dimensions (EQ-5D). QOL data were acquired at baseline (pre-operative) and 1 year postoperatively via an institutional prospectively collected database. Results Both surgical cohorts showed significant (p < 0.01) pre- to postoperative improvement for VAS neck and arm scores at 1-year post-op and significantly (p < 0.01) greater improvements than the conservative cohort. In addition, the cohort undergoing cervical spine surgery alone experienced significant improvement in the EQ-5D score whereas those undergoing both cervical and lumbar spine surgery did not. Conclusions Cervical spine surgery with or without follow-up lumbar spine surgery significantly improves neck pain in patients with TSS. In contrast, cervical spine surgery in these patients does not improve lumbar symptoms. Lumbar surgery also did not improve low back pain or quality of life. Future prospective studies are necessary to examine the impact of lumbar decompression alone on cervical spine symptoms in patients with TSS

Quality of life changes after lumbar decompression in patients with tandem spinal stenosis

Objective Tandem spinal stenosis (TSS) is a degenerative spinal condition characterized by spinal canal narrowing at 2 or more distinct spinal levels. It is an aging-related condition that is likely to increase as the population ages, but which remains poorly described in the literature. Here we sought to determine the impact of primary lumbar decompression on quality-of-life (QOL) outcomes in patients with symptomatic TSS. Patients and methods We retrospectively reviewed 803 patients with clinical and radiographic evidence of TSS treated between 2008 and 2014 with a minimum 2-year follow-up. The records of patients with clinical and radiographic evidence of concurrent cervical and lumbar stenosis were reviewed. Prospectively gathered QOL data, including the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), EuroQOL-5 Dimensions (EQ-5D), and Visual Analogue Scale (VAS) for low back pain, were assessed at the 6-month, 1-year, and 2-year follow-ups. Results Of 803 identified patients (mean age 66.2 years; 46.9% male), 19.6% underwent lumbar decompression only, 14.1% underwent cervical + lumbar decompression, and 66.4% underwent conservative management only. Baseline VAS scores were similar across all groups, but patients undergoing conservative management had better baseline QOL scores on all other measures. Both surgical cohorts experienced significant improvements in the VAS, PDQ, and EQ-5D at all time points; patients in the cervical + lumbar cohort also had significant improvement in the PHQ-9. Conservatively managed patients showed no significant improvement in QOL scores at any follow-up interval. Conclusion Lumbar decompression with or without cervical decompression improves low back pain and QOL outcomes in patients with TSS. The decision to prioritize lumbar decompression is therefore unlikely to adversely affect long-term quality-of-life improvements

Antimicrobial Resistance Markers of Class 1 and Class 2 Integron-bearing Escherichia coli from Irrigation Water and Sediments

Municipal and agricultural pollution affects the Rio Grande, a river that separates the United States from Mexico. Three hundred and twenty-two Escherichia coli isolates were examined for multiple antibiotic resistance phenotypes and the prevalence of class 1 and class 2 integron sequences. Thirty-two (10%) of the isolates were resistant to multiple antibiotics. Four (13%) of these isolates contained class 1–specific integron sequences; one isolate contained class 2 integron–specific sequences. Sequencing showed that the class 1 integron–bearing strain contained two distinct gene cassettes, sat-1 and aadA. Although three of the four class 1 integron–bearing strains harbored the aadA sequence, none of the strains was phenotypically resistant to streptomycin. These results suggest that integron-bearing E. coli strains can be present in contaminated irrigation canals and that these isolates may not express these resistance markers

OGLE-2018-BLG-0532Lb: Cold Neptune With Possible Jovian Sibling

We report the discovery of the planet OGLE-2018-BLG-0532Lb, with very obvious signatures in the light curve that lead to an estimate of the planet-host mass ratio $q=M_{\rm planet}/M_{\rm host}\simeq 1\times10^{-4}$. Although there are no obvious systematic residuals to this double-lens/single-source (2L1S) fit, we find that $\chi^2$ can be significantly improved by adding either a third lens (3L1S, $\Delta\chi^2=81$) or second source (2L2S, $\Delta\chi^2=65$) to the lens-source geometry. After thorough investigation, we conclude that we cannot decisively distinguish between these two scenarios and therefore focus on the robustly-detected planet. However, given the possible presence of a second planet, we investigate to what degree and with what probability such additional planets may affect seemingly single-planet light curves. Our best estimates for the properties of the lens star and the secure planet are: a host mass $M\sim 0.25\,M_\odot$, system distance $D_L\sim 1\,$kpc and planet mass $m_{p,1}= 8\,M_\oplus$ with projected separation $a_{1,\perp}=1.4\,$au. However, there is a relatively bright $I=18.6$ (and also relatively blue) star projected within $<50\,$mas of the lens, and if future high-resolution images show that this is coincident with the lens, then it is possible that it is the lens, in which case, the lens would be both more massive and more distant than the best-estimated values above.Comment: 48 pages, 9 figures, 7 table

A rotating white dwarf shows different compositions on its opposite faces

White dwarfs, the extremely dense remnants left behind by most stars after their death, are characterised by a mass comparable to that of the Sun compressed into the size of an Earth-like planet. In the resulting strong gravity, heavy elements sink toward the centre and the upper layer of the atmosphere contains only the lightest element present, usually hydrogen or helium. Several mechanisms compete with gravitational settling to change a white dwarf's surface composition as it cools, and the fraction of white dwarfs with helium atmospheres is known to increase by a factor ~2.5 below a temperature of about 30,000 K; therefore, some white dwarfs that appear to have hydrogen-dominated atmospheres above 30,000 K are bound to transition to be helium-dominated as they cool below it. Here we report observations of ZTF J203349.8+322901.1, a transitioning white dwarf with two faces: one side of its atmosphere is dominated by hydrogen and the other one by helium. This peculiar nature is likely caused by the presence of a small magnetic field, which creates an inhomogeneity in temperature, pressure or mixing strength over the surface. ZTF J203349.8+322901.1 might be the most extreme member of a class of magnetic, transitioning white dwarfs -- together with GD 323, a white dwarf that shows similar but much more subtle variations. This new class could help shed light on the physical mechanisms behind white dwarf spectral evolution.Comment: 45 pages, 11 figure

Optical follow-up of the neutron star-black hole mergers S200105ae and S200115j

LIGO and Virgo’s third observing run revealed the first neutron star–black hole (NSBH) merger candidates in gravitational waves. These events are predicted to synthesize r-process elements1,2 creating optical/near-infrared ‘kilonova’ emission. The joint gravitational wave and electromagnetic detection of an NSBH merger could be used to constrain the equation of state of dense nuclear matter3, and independently measure the local expansion rate of the Universe4. Here, we present the optical follow-up and analysis of two of the only three high-significance NSBH merger candidates detected to date, S200105ae and S200115j, with the Zwicky Transient Facility5. The Zwicky Transient Facility observed ~48% of S200105ae and ~22% of S200115j’s localization probabilities, with observations sensitive to kilonovae brighter than −17.5 mag fading at 0.5 mag d−1 in the g- and r-bands; extensive searches and systematic follow-up of candidates did not yield a viable counterpart. We present state-of-the-art kilonova models tailored to NSBH systems that place constraints on the ejecta properties of these NSBH mergers. We show that with observed depths of apparent magnitude ~22 mag, attainable in metre-class, wide-field-of-view survey instruments, strong constraints on ejecta mass are possible, with the potential to rule out low mass ratios, high black hole spins and large neutron star radii

Rhetoric and Relationship in Milton\u27s Paradise Lost

Archival abstract submitte