Serum Levels of Interleukin-8 and Tumor Necrosis Factor-alpha in Coal Workers' Pneumoconiosis: One-year Follow-up Study

Objectives: Various cytokines induced by inhalation of coal dust may mediate inflammation and lead to tissue damage or fibrosis, such as coal workers' pneumoconiosis (CWP).Methods: To investigate the relevance of serum cytokines in CWP, the levels of serum interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-α) as CWP biomarkers in 110 retired coal miners (22 controls and 88 CWP subjects) were related to cross sectional findings and 1-year progressive changes of the pneumoconiosis. Progressive changes of CWP were evaluated by paired comparison of chest radiographs. Analysis by a receiver operating characteristic (ROC) curve assessed the biomarker potential of each cytokine.Results: The mean serum IL-8 level was significantly higher in CWP compared to controls and IL-8 levels correlated with the degree of CWP. The median serum TNF-α level was significantly higher in subjects with progressive CWP compared to subjects without CWP progression. The area under the ROC curve for IL-8 (0.70) and TNF-α (0.72) for CWP identification and progression, respectively, indicated the biomarker potential of the two cytokines. Serum cutoff values of IL-8 and TNF-α were 11.63 pg/ml (sensitivity 69%; specificity 64%) and 4.52 pg/ml (sensitivity 67%; specificity 79%), respectively.Conclusion: The results suggest that high levels of serum IL-8 are associated with the presence of CWP and those of serum TNF-α are associated with the progression of CWP

Huge Retroperitoneal Hematoma Following Oblique Lumbar Interbody Fusion

A 64-year-old man who had lumbar spinal stenosis underwent oblique lumbar interbody fusion (OLIF) with cortical screw fixation at the L2-3, L3-4, and L4-5 levels. During the operation, there was no event of serious surgical bleeding. After the operation, he complained of severe flank pain and back pain. A computerized tomography (CT) scan identified a huge amount of retroperitoneal hematoma compressing peritoneum and the patient underwent exploration immediately. There was active arterial bleeding at the drain puncture site. The active arterial bleeding was controlled and the retroperitoneal hematoma was removed. The patient’s symptoms were recovered after the second operation. A huge amount of retroperitoneal hematoma after OLIF requiring reoperation is rare. Meticulous bleeding control and repeated inspection of the drain puncture site are critical prior to wound closure. In addition, for patients presenting with severe pain after the operation, rapid evaluation using CT and second operation is required as soon as possible

Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach for Removal of Dorsally Migrated Lumbar Disc Herniation: A case Report with Technical Note

Treatment of dorsally migrated lumbar disc described so far commonly in present literature is removal by open technique through hemi or complete laminectomy or by use of microsurgical technique or by partial use of endoscope without use of irrigation system. We present a case of dorsally migrated disc herniation treated safely with good outcome by Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach. A 60 years old man presented with subacute onset of back pain and right leg radiating pain with weakness of right great toe dorsiflexion and diagnosed as a case of dorsally migrated L4-5 disc herniation was treated with this technique. He had also subtle instability at that level.His pain resolved immediately after surgery. Weakness of right great toe also resolved gradually in 2 months. Postoperative X-ray showed no further instability. Postoperative MRI revealed complete removal of disc with resolution of cauda equina compression. No complication was noted related to this technique. This new technique ultimately preserves motion segment while simultaneously addressing symptomatic pathology of dorsally migrated HNP with added benefits of minimally invasive spine surgery

Knuckling Down on Predictive Factors for Early Relapse after Posterolateral Percutaneous Endoscopic Lumbar Discectomy

Objective Percutaneous endoscopic lumbar discectomy (PELD) has several advantages, but it is not used routinely due to early relapse and steep learning curve. We have studied the factors associated with early relapse in patients who underwent posterolateral PELD at or above the L4-5 level. Methods In this retrospective study, we have enrolled 200 cases and divided them into 4 groups (A, B, C, and D) with 50 patients in each group, that had undergone PELD by 2 different techniques (inside-out and outside-in with or without anti-adhesive agent) and operated by 2 different surgeons between May 2009 and November 2010. The factors studied were - Age, gender, disc (degeneration grade, location, level), associated adjacent level herniated nucleus pulposus (HNP), episode (first or recurrent), anti-adhesive agent, annulus preservation, approach, disc height and segmental dynamic motion (discrepancy in flexion and extension). Statistical analysis was done by Pearson’s chi-square test and p value (significance). The clinical results were evaluated by visual analogue scale (VAS). Results The mean age and mean follow-up period was comparable in all four groups. The overall recurrence rate was 9.5% (19/200). Average early relapse time was 3.26 months. Factors like Age of the patient, multilevel HNP and degeneration grade showed significant correlation with relapse rate. The change in VAS pre-operatively to post-operatively was significant across all groups (p<0.001). Conclusion Based on the results of this study, high grade disc degeneration, multilevel disc herniation, and early postoperative activity are significantly associated with early relapse after PELD

A Degenerative Intraspinal Cyst Mimicking a Nerve Root: A Case Report on an Intraoperative Challenge

Various intraspinal cysts have been described in the literature. Sometimes these cysts are difficult to recognize intraoperative and can place a surgeon in dilemma. We report a case of a degenerative intraspinal cyst with severe adhesion with dura, which was mimicking as a nerve root and posed a diagnostic dilemma during surgery. A Sixty-year-old man presented with insidious onset, gradually progressing lower back pain, right leg pain and neurological claudication of six months duration. The pain radiated to the right S1 dermatome. Right side straight leg raise test was positive at 45°. Sensations were diminished over the right L5 and S1 dermatomes. Motor function was normal. MRI showed a large cystic lesion at right L5-S1 level. The cyst appeared to compress the dural sac and traversing right S1 root at L5-S1 level. The lesion was isointense on T1-weighted image and hyperintense on T2-weighted image. While treating this condition using the uniportal full endoscopic technique the cyst appeared as nerve root. Meticulous dissection was required to separate the cyst from neural structures. Histology confirmed the diagnosis of a degenerative intraspinal cyst. The patient had significant improvement after surgery and at six months follow up he was completely asymptomatic. Various cysts can occur in the intraspinal canal, and careful attention should be paid to minimize the nerve injury in the presence of severe adhesions

Get Ready for 100 Years of Active Spine Life Using Percutaneous Endoscopic Spine Surgery (PESS)

Lumbar spinal stenosis is the most common indication for spinal surgery in patients older than 65 years. After the introduction of Kambin's safety triangle, percutaneous endoscopic spine surgery has started through transforaminal approach for discectomy and is now being extended to spinal stenosis through interlaminar approach, which is an important part of the degenerative spinal disease. With the increase in human longevity, the development of effective treatment for degenerative diseases is inevitable, and future percutaneous endoscopic spine surgery (PESS) will play a very important role in maintaining the health of this ‘super-aged’ population. Endoscopic techniques impart minimal approach related disruption of normal spinal anatomy and function while concomitantly increasing functional visualization and correction of degenerative stenosis. Advantages of full endoscopic spine surgeries are less soft tissue dissection, less blood loss, reduced hospital admission days, early functional recovery and enhancement in the quality of life. With proper training and advancement in equipment and technologies, percutaneous endoscopic spine surgery will be able to successfully treat the aging spine

Gut taste receptor type 1 member 3 is an intrinsic regulator of Western diet-induced intestinal inflammation

Background Long-term intake of a Western diet (WD), characterized by a high-fat content and sugary drinks, is hypothesized to contribute to the development of inflammatory bowel disease (IBD). Despite the identified clinical association, the molecular mechanisms by which dietary changes contribute to IBD development remain unknown. Therefore, we examined the influence of long-term intake of a WD on intestinal inflammation and the mechanisms by which WD intake affects IBD development. Methods Mice fed normal diet or WD for 10weeks, and bowel inflammation was evaluated through pathohistological and infiltrated inflammatory cell assessments. To understand the role of intestinal taste receptor type 1 member 3 (TAS1R3) in WD-induced intestinal inflammation, cultured enteroendocrine cells harboring TAS1R3, subjected to RNA interference or antagonist treatment, and Tas1r3-deficient mice were used. RNA-sequencing, flow cytometry, 16S metagenomic sequencing, and bioinformatics analyses were performed to examine the involved mechanisms. To demonstrate their clinical relevance, intestinal biopsies from patients with IBD and mice with dextran sulfate sodium-induced colitis were analyzed. Results Our study revealed for the first time that intestinal TAS1R3 is a critical mediator of WD-induced intestinal inflammation. WD-fed mice showed marked TAS1R3 overexpression with hallmarks of serious bowel inflammation. Conversely, mice lacking TAS1R3 failed to exhibit inflammatory responses to WD. Mechanistically, intestinal transcriptome analysis revealed that Tas1r3 deficiency suppressed mTOR signaling, significantly increasing the expression of PPARγ (a major mucosal defense enhancer) and upregulating the expression of PPARγ target-gene (tight junction protein and antimicrobial peptide). The gut microbiota of Tas1r3-deficient mice showed expansion of butyrate-producing Clostridia. Moreover, an increased expression of host PPARγ-signaling pathway proteins was positively correlated with butyrate-producing microbes, suggesting that intestinal TAS1R3 regulates the relationship between host metabolism and gut microflora in response to dietary factors. In cultured intestinal cells, regulation of the TAS1R3–mTOR–PPARγ axis was critical for triggering an inflammatory response via proinflammatory cytokine production and secretion. Abnormal regulation of the axis was observed in patients with IBD. Conclusions Our findings suggest that the TAS1R3–mTOR–PPARγ axis in the gut links Western diet consumption with intestinal inflammation and is a potential therapeutic target for IBD.This work was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (Grant NRF-2021R1A2C3010280), and the Korea Mouse Phenotyping Project through the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant NRF-2013M3A9D5072550). The funding sources had no role in the design of the study, in the collection, analysis, and interpretation of data, or in the writing of the manuscrip