Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS® measurements of 38 acetabula

AbstractBackgroundAbnormalities in acetabular orientation can promote the development of hip osteoarthritis, femoro-acetabular impingement, or even acetabular cup malposition. The objective of the present study was to determine whether pedicle substraction osteotomy (PSO) to correct sagittal spinal imbalance affected acetabular orientation.HypothesisPSO performed to correct sagittal spinal imbalance affects acetabular orientation by changing the pelvic parameters.Materials and methodsThis was a descriptive study in which two observers measured the acetabular parameters on both sides in 19 patients (38 acetabula) before and after PSO for post-operative flat-back syndrome. Mean time from PSO to post-operative measurements was 19months. Measurements were taken twice at a 2-week interval, on standing images obtained using the EOS® imaging system and sterEOS® software to obtain 3D reconstructions of synchronised 2D images. Acetabular anteversion and inclination were measured relative to the vertical plane. Mean pre-PSO and post-PSO values were compared using the paired t-test, and P values lower than 0.05 were considered significant. To assess inter-observer and intra-observer reproducibility, we computed the intra-class correlation coefficients (ICCs).ResultsThe measurements showed significant acetabular retroversion after PSO, of 7.6° on the right and 6.5° on the left (P<0.001). Acetabular inclination diminished significantly, by 4.5° on the right and 2.5° on the left (P<0.01). Inclination of the anterior pelvic plane decreased by 8.4° (P<0.01). Pelvic incidence was unchanged, whereas sacral slope increased by 10.5° (P<0.001) and pelvic tilt decreased by 10.9° (P<0.001). The ICC was 0.98 for both inter-observer and intra-observer reproducibility.ConclusionChanging the sagittal spinal alignment modifies both the pelvic and the acetabular parameters. PSO significantly increases sacral slope, thus inducing anterior pelvic tilt with significant acetabular retroversion. The measurements obtained using sterEOS® showed good inter-observer and intra-observer reproducibility. To our knowledge, this is the first study of changes in acetabular version after PSO

A new classification system for degenerative spondylolisthesis of the lumbar spine

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.PURPOSE: There is no consensus for a comprehensive analysis of degenerative spondylolisthesis of the lumbar spine (DSLS). A new classification system for DSLS based on sagittal alignment was proposed. Its clinical relevance was explored. METHODS: Health-related quality-of-life scales (HRQOLs) and clinical parameters were collected: SF-12, ODI, and low back and leg pain visual analog scales (BP-VAS, LP-VAS). Radiographic analysis included Meyerding grading and sagittal parameters: segmental lordosis (SL), L1-S1 lumbar lordosis (LL), T1-T12 thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Patients were classified according to three main types-1A: preserved LL and SL; 1B: preserved LL and reduced SL (≤5°); 2A: PI-LL ≥10° without pelvic compensation (PT < 25°); 2B: PI-LL ≥10° with pelvic compensation (PT ≥ 25°); type 3: global sagittal malalignment (SVA ≥40 mm). RESULTS: 166 patients (119 F: 47 M) suffering from DSLS were included. Mean age was 67.1 ± 11 years. DSLS demographics were, respectively: type 1A: 73 patients, type 1B: 3, type 2A: 8, type 2B: 22, and type 3: 60. Meyerding grading was: grade 1 (n = 124); grade 2 (n = 24). Affected levels were: L4-L5 (n = 121), L3-L4 (n = 34), L2-L3 (n = 6), and L5-S1 (n = 5). Mean sagittal parameter values were: PI: 59.3° ± 11.9°; PT: 24.3° ± 7.6°; SVA: 29.1 ± 42.2 mm; SL: 18.2° ± 8.1°. DSLS types were correlated with age, ODI and SF-12 PCS (ρ = 0.34, p < 0.05; ρ = 0.33, p < 0.05; ρ = -0.20, and p = 0.01, respectively). CONCLUSION: This classification was consistent with age and HRQOLs and could be a preoperative assessment tool. Its therapeutic impact has yet to be validated. LEVEL OF EVIDENCE: 4.No funds were received in support of this work. No benefits in any forms have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript

Higher education reform and the landscape diversity of higher education institutions in the Kyrgyz Republic, 1991–2015

Following its independence from the Soviet Union in 1991, Kyrgyzstan experienced processes of change across all areas of social, political and economic life. Higher education reform has been central to this agenda, and between 1991 and today the Soviet-era system of state-funded and Communist Party controlled higher education institutions (HEIs) in Kyrgyzstan has been transformed into an expansive, diverse, unequal, semi-privatized and marketized higher education (HE) landscape. Mindful of arguments that the marketization of higher education does not necessarily generate institutional diversification, that government regulation does not necessarily lead to homogenization among institutions, and that universities’ own institutional strategies and responses to environmental changes shape processes of structural reform in complex ways, this paper assesses the specific character of these changes to the higher education landscape in post-Soviet Kyrgyzstan. After briefly describing the structure and financing of higher education in the Kirgiz Soviet Socialist Republic from 1917–1991, we consider some key factors which have shaped patterns of the differentiation and diversification of HE in the post-Soviet period. These include the historical legacies of Soviet HE infrastructures, new legal and political frameworks for HE governance and finance, changes to regulations for the licensing of institutions and academic credentials, the introduction of new multinational policy agendas for higher education in the Central Asian region, changes in the relationship between higher education and labor, the introduction of a national university admissions examination, and the adoption of certain principles of the European Bologna Process. The picture of HE reform that emerges from this analysis is one in which concurrent processes of diversification and homogenization are not driven wholly by either state regulation or forces of market competition, but mediated by universities’ strategic negotiations of these forces in the context of historical institutional formations in Kyrgyzstan

Bacillus anthracis edema factor substrate specificity: evidence for new modes of action

Since the isolation of Bacillus anthracis exotoxins in the 1960s, the detrimental activity of edema factor (EF) was considered as adenylyl cyclase activity only. Yet the catalytic site of EF was recently shown to accomplish cyclization of cytidine 5'-triphosphate, uridine 5'-triphosphate and inosine 5'-triphosphate, in addition to adenosine 5'-triphosphate. This review discusses the broad EF substrate specificity and possible implications of intracellular accumulation of cyclic cytidine 3':5'-monophosphate, cyclic uridine 3':5'-monophosphate and cyclic inosine 3':5'-monophosphate on cellular functions vital for host defense. In particular, cAMP-independent mechanisms of action of EF on host cell signaling via protein kinase A, protein kinase G, phosphodiesterases and CNG channels are discussed

Sur la p-dimension des corps

Let A be an excellent integral henselian local noetherian ring, k its residue field of characteristic p>0 and K its fraction field. Using an algebraization technique introduced by the first named author, and the one-dimension case already proved by Kazuya KATO, we prove the following formula: cd_p(K) = dim(A) + p-rank(k), if k is separably closed and K of characteristic zero. A similar statement is valid without those assumptions on k and K

Open Problems on Central Simple Algebras

We provide a survey of past research and a list of open problems regarding central simple algebras and the Brauer group over a field, intended both for experts and for beginners.Comment: v2 has some small revisions to the text. Some items are re-numbered, compared to v

ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of the laboratory-based science, clinical trials and qualitative research that were presented during the 2022 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, mobile/electronic health (m-health/e-health), clinical respiratory physiology, exercise and functional imaging

Environmental movements in space-time: the Czech and Slovak republics from Stalinism to post-socialism

To demonstrate the role of space and time in social movements, the paper analyses the evolution and context of the environmental movement in the Czech and Slovak republics from 1948 to 1998. It shows that the movement's identity was formed under socialism and that political opportunity and resource availability changed markedly over time, as did its organisational and spatial structure. The movement played a significant part in the collapse of the socialist regime, but in the 1990s was marginalised in the interests of building a market economy and an independent Slovakia. Nevertheless a diverse and flexible range of groups existed by the late 1990s. The successive space-times allow analysis of the multiple and changing variables that influence the geography of social movements

Agenesia e lipoma de corpo caloso: relato de caso

The agenesis and lipoma of the corpus callosum is a very rare association. We report the case of a 18-years old woman with rare epileptic seizures since the age of 6 years, normal neurological examination, as well as normal electroencephalogram. The brain computed tomography scanning and the magnetic resonance showed the lipoma and the agenesis of the corpus callosum.A agenesia e lipoma do corpo caloso é uma associação muito rara. Relatamos o caso de uma paciente de 18 anos com raras crises epilépticas desde os 6 anos de idade, exame neurológico normal, assim como eletrencefalograma normal. A tomografia computadorizada de crânio e a ressonância magnética mostraram o lipoma e a agenesia de corpo caloso.Escola Paulista de MedicinaUNIFESP, EPMSciEL

Solitary osteochondroma of the twelfth rib with intraspinal extension and cord compression in a middle-aged patient

<p>Abstract</p> <p>Background</p> <p>Osteochondroma is a disease of growing bone and thus typically presents in younger patients. It has rarely been described in middle-aged and elderly patients. Data on the occurrence of osteochondroma show that the reported incidence of costal osteochondroma is very low. Moreover, costal osteochondroma arising at the costovertebral junction with neural foraminal extension and spinal cord compression is extremely rare.</p> <p>Case presentation</p> <p>This study reports the case of a 58-year-old patient with a solitary osteochondroma of the 12th rib with intraspinal extension and spinal cord compression. The clinical history, plain radiographs, computed tomography (CT), magnetic resonance imaging, and pathologic findings of the reported patient have been reviewed. The relevant medical literature has also been reviewed. The patient was treated with surgery for complete tumour excision to avoid tumour recurrence. After surgery, the patient's symptoms improved. An additional CT scan obtained at 1 year after surgery did not show any evidence of recurrence.</p> <p>Conclusions</p> <p>This patient is the oldest patient reported to have this rare form of costal osteochondroma. The age of the patient and the erosion of the adjacent bones raised clinical suspicion of malignancy; therefore, surgical management involved complete tumour excision with thoracolumbar fixation and fusion.</p