Patterns of Lumbar Disc Degeneration: Magnetic Resonance Imaging Analysis in Symptomatic Subjects

Study Design: Cross-sectional study. Purpose: To evaluate lumbar disc degeneration (LDD) on magnetic resonance imaging (MRI) in symptomatic subjects to accumulate baseline data on the pattern of degeneration. Overview of Literature: LDD plays an important role in the diagnosis and treatment of low-back pain in patients. Few studies have focused on the pattern of LDD to understand how the lumbar spine ages. Methods: This study included 1,095 patients (mean age, 44.29 years; range, 16–85 years) who underwent upright lumbar MRI. LDD was graded into five categories (I–V). Positive LDD was defined as grade III or greater. The prevalence and pattern of LDD were ana-lyzed, and the correlations between age and total grade of LDD were evaluated. Results: The average number of LDD levels and the total grade of LDD increased with age. LDD moved cephalad with age. The rate of LDD increased rapidly during the decade before the prevalence of LDD and became \u3e 50%. In the single-level LDD group, the levels L5–S1 were the most common levels (60.3%). In the two-level group, L4–L5 and L5–S1 were the most common levels (53.5%). In the three-level group, L3–L4, L4–L5, and L5–S1 were the most common levels (55.7%). In the multilevel LDD group, contiguous multilevel disc degeneration (CMDD) was more common than the skipped level disc degeneration (SLDD). The levels L4–L5 were the most com-mon levels in the CMDD group, and L5–S1 were the most common levels among SLDD. Conclusions: LDD was found to correlate with age, and the specific patterns and rates of LDD depended on lumbar disc level and age. These LDD pattern data can be used before spinal procedures to predict the probability of natural LDD progression with age

The Effects of the Thai Traditional Medicine of Abdominal Massage on Defecation in Post Lumbar Laminectomy Patients

Objective: This prospective study examined the defecation enhancement effects in post-lumbar laminectomy patients who received Thai traditional medicine of abdominal massage (TTMAM) in combination with standard nursing care, compared with patients receiving only standard nursing care. Methods: This prospective, randomized, controlled trial was conducted at Siriraj Hospital between 2011 and 2015. Eighty-eight patients with spinal stenosis scheduled for lumbar laminectomy with or without fusion were enrolled. The patients were randomly assigned to two groups: the first group underwent standard nursing care combined with TTMAM (the TTMAM group), and the second group underwent standard nursing care (the non-TTMAM group). The clinical outcomes regarding the first defecation within 3 days after surgery, abdominal distension, and patient satisfaction with defecation care were evaluated. Results: When comparing the first defecation within 3 days after surgery, no significant differences were found in the number of patients between the two groups. The number of the patients who had their first defecation within 3 days after surgery was higher in the TTMAM group (46.5%) than the non-TTMAM group (27.3%). There was significantly less abdominal distension on the third day after surgery in the TTMAM group than in the non-TTMAM group. Moreover, the mean score of patient satisfaction of the TTMAM group was higher than that of the non-TTMAM group. Conclusion: Thai traditional medicine of abdominal massage tends to help defecation in post-lumbar laminectomy patients as it relieves abdominal distension and increases satisfaction with defecation care. Therefore, the use of TTMAM with other bowel care methods could provide additional benefit for lumbar laminectomy patients

The Effects of the Thai Traditional Medicine of Abdominal Massage on Defecation in Post Lumbar Laminectomy Patients

Objective: This prospective study examined the defecation enhancement effects in post-lumbar laminectomy patients who received Thai traditional medicine of abdominal massage (TTMAM) in combination with standard nursing care, compared with patients receiving only standard nursing care. Methods: This prospective, randomized, controlled trial was conducted at Siriraj Hospital between 2011 and 2015. Eighty-eight patients with spinal stenosis scheduled for lumbar laminectomy with or without fusion were enrolled. The patients were randomly assigned to two groups: the first group underwent standard nursing care combined with TTMAM (the TTMAM group), and the second group underwent standard nursing care (the non-TTMAM group). The clinical outcomes regarding the first defecation within 3 days after surgery, abdominal distension, and patient satisfaction with defecation care were evaluated. Results: When comparing the first defecation within 3 days after surgery, no significant differences were found in the number of patients between the two groups. The number of the patients who had their first defecation within 3 days after surgery was higher in the TTMAM group (46.5%) than the non-TTMAM group (27.3%). There was significantly less abdominal distension on the third day after surgery in the TTMAM group than in the non-TTMAM group. Moreover, the mean score of patient satisfaction of the TTMAM group was higher than that of the non-TTMAM group. Conclusion: Thai traditional medicine of abdominal massage tends to help defecation in post-lumbar laminectomy patients as it relieves abdominal distension and increases satisfaction with defecation care. Therefore, the use of TTMAM with other bowel care methods could provide additional benefit for lumbar laminectomy patients

Transport and Retention of High Concentrated Nano-Fe/Cu Particles Through Highly Flow-Rated Packed Sand Column

The design of an efficient field-scale remediation based on the use of nanoscale zero valent iron (NZVI) requires an accurate assessment of the mobility of such particles in saturated porous media, both during injection in the subsurface (short-term mobility) and later (long-term mobility). In this study, the mobility of highly concentrated dispersions of bimetallic Fe/Cu nanoparticles (d50= 70±5 nm) in sand-packed columns (0.5 m length and 0.025 m inner diameter) was studied. In particular, the influence of flow rate (V = 5×10-4, 1×10-3, 2×10-3 m/s) and injected particle concentrations (2, 5, 8, 12 g/l) was addressed. Breakthrough curves and water pressure drop along the column, averaged effective porosity and final distribution of retained particles along the column were measured. Experimental results evidenced a good mobility of the Fe/Cu particles, with significant breakthrough in all explored experimental conditions of flow rate and C0, without requiring the addition of any stabilizing agent. Clogging phenomenon of the column and also the pore pressure variation during injection period are strongly affected by injected concentration. Clogging due to deposition of particles following a ripening dynamics was observed in particular for C0= 8 and 12 g/l. The experimental data were 23 modeled using the E-MNM1D software. The study has implications for field injection of bimetallic nanoparticles, suggesting that particular care is to be devoted when selecting injection concentration, to avoid porous medium clogging and control the radius of influenc

Radiographic evaluation of single-level infective lumbar spondylodiscitis following conservative compared to surgical treatment: A retrospective cohort study

Study design: Retrospective cohort study. Purpose: Spondylodiscitis is the most common infectious disease of the spine which can be treated either conservative or surgery. Nowadays, there are only a few studies on radiographic outcomes. The purpose of this study was to investigate the long-term radiographic outcomes of conservative treatment compared with surgical treatment in single-level infective spondylodiscitis patients. Methods: Patients diagnosed with single-level infective spondylodiscitis in lumbar vertebrae during July 2009 to September 2019 were eligible for inclusion. Radiographic evaluation comprising lumbar lordotic angle, segmental kyphotic angle, and foraminal height of was performed on lumbar lateral view before treatment and at the 1-year follow-up. Results: A total of 116 patients (mean age; 60 years; 53 males) were included. Except for length of hospital stay, which was significantly longer in the surgical group, there were no significant differences for any of the other demographic or clinical characteristics between groups. All pre-treatment radiographic parameters in the surgical group were worse than in the conservative group. At the 1-year follow-up, conservative treatment patients demonstrated significantly worse segmental kyphosis (p ​< ​0.01), In contrast, surgical treatment was shown to improve the segmental kyphotic angle. Concerning the surgical approach, the combined surgical approach resulted in a significantly improved segmental kyphotic angle at the 1-year follow-up (p ​= ​0.013); however, there was no significant change in the segmental kyphotic angle via the anterior or posterior approach (p ​= ​0.511 and p ​= ​0.475, respectively). Conclusion: In patients with single level infective lumbar spondylodiscitis, surgical treatment can significantly improve segmental kyphotic angle, and the result is more favorable than conservative treatment. The combined surgical approach was found to be superior to the anterior and posterior approaches for improving regional spinal alignment

Overexpression of Fusarium solani lipase in Pichia pastoris and its application in lipid degradation

Fusarium solani NAN103 lipase was successfully overexpressed in Pichia pastoris using inducible expression system and constitutive expression system under the control of alcohol oxidase 1 promoter (pAOX1) and glyceraldehyde-3-phosphate dehydrogenase promoter (pGAP), respectively. Lipase obtained using the constitutive promoter showed the highest activity of 18.8 U/mg in 3days of cultivation time. Optimal lipase activity was observed at pH 7.0 and 35 degrees C using p-nitrophenyl laurate as the substrate. Lipase activity was enhanced by Mn2+, Ba2+, Li+, Ca2+, Ni2+, CHAPS and Triton X-100 but was inhibited by Hg2+, Ag+ and SDS. The addition of 10% v/v of octanol, p-xylene, hexane and isopropanol increased lipase activity. Cultivation of lipase-expressing P. pastoris under pGAP in synthetic wastewater containing 1% w/v palm oil resulted in degradation of 87% of the oil within 72h. P. pastoris expressing F. solani lipase from constitutive expression system has the potential to be used as an alternative microorganism for lipid degradation

Midterm outcome after en bloc resection of C2 chordoma with transoral mandibular split and mesh cage reconstruction: a case report

Abstract Introduction Chordomas are rare, locally aggressive tumors that often occur in the axial spine, especially in the sacrum. The treatment of chordomas located in the upper cervical spine is challenging. En bloc resection is the preferred surgical option for total tumor removal. Case presentation We report the case of a C2 chordoma in a 47-year-old Thai woman. She was treated with a two-stage, anterior–posterior, C2 total spondylectomy with titanium mesh cage reconstruction and radiotherapy. The first stage involved posterior stabilization from the occiput to C5, a total laminectomy, and removal of the posterior rings of the bilateral foramen transversarium to preserve the bilateral vertebral arteries. The second stage comprised a transoral mandibular split with en bloc resection of C2, followed by titanium mesh cage reconstruction and kick-off anterior cervical plating. At the 5 year follow-up, no tumor recurrence was identified on magnetic resonance imaging. The patient had no neurological deficits but still had minor complications from the anterior transoral mandibular split. Conclusions Excellent midterm results were obtained using a transoral mandibular split with reconstruction and posterior spinal fusion from the occiput to the lower cervical spine coupled with adjuvant radiotherapy. We recommend this approach as the treatment of choice for chordoma in the upper cervical spine

An effectiveness and economic analyses of tricalcium phosphate combined with iliac bone graft versus RhBMP-2 in single-level XLIF surgery in Thailand

Abstract Study design Retrospective study. Objectives To perform effectiveness and economic analyses using data from a retrospective study of patients who underwent XLIF surgery using tricalcium phosphate combined with iliac bone graft (TCP + IBG) or BMP-2 in Thailand. Methods Data were collected from retrospective review of the medical charts and the spine registry of Siriraj Hospital, Bangkok, Thailand. The patients were divided into two groups (TCP + IBG group and BMP-2 group). Demographic, perioperative data, radiographic, clinical results, and quality of life related to health were collected and analyzed at 2-year follow-up. All economic data were collected during the perioperative period and presented as total charge, bone graft, implant/instrumentation, operative service, surgical supply, transfusion, medication, anesthesia, laboratory, and physical therapy. Results Twenty-five TCP + IBG and 30 BMP-2 patients with spondylolisthesis and spinal stenosis as primary diagnosis were included. There were no significant differences in all demographic parameters (gender, age, underlying disease, diagnosis, and level of spine) between these two groups. During the perioperative period, the TCP + IBG group had more mean blood loss and more postoperative complications compared to the BMP-2 group. At 2 years of follow-up, there were no significant differences between the radiographic and clinical outcomes of the TCP + IBG and BMP-2 groups. The fusion rate for TCP + IBG and BMP-2 at 2 years of follow-up was 80% and 96.7%, respectively, and no statistically significant differences were observed. All clinical outcomes (Utility, Oswestry Disability Index, and EuroQol Visual Analog Scale) at 2-year follow-up improved significantly compared to preoperative outcomes, but there were no significant differences between the TCP + IBG and BMP-2 groups, either at preoperatively or at 2-year follow-up. The total charge of TCP + IBG was statistically significantly lower than that of BMP-2. Furthermore, the charges of TCP + IBG and BMP-2 during the perioperative period in Thailand were up to three times less than those in the United States. Conclusions Using TCP + IBG as a standalone bone substitution for XLIF surgery with additional posterior instrumentation resulted in significantly lower direct medical charge compared to those using BMP-2 in the perioperative period. However, we could not detect a difference in the long-term radiographic and clinical outcomes of patients with TCP + IBG and BMP-2. These suggest that TCP + IBG may be a valuable alterative bone graft, especially in low- and middle-income countries