Comparison of percutaneous transpedicular stabilization of the spine 3D navigation-supported and robot-assisted.

Die transpedikuläre Stabilisierung nimmt innerhalb der Wirbelsäulenchirurgie einen wichtigen Stellenwert ein, da sie bei verschiedensten Diagnosen und in fast allen Bereichen der Wirbelsäule eingesetzt werden kann. Aufgrund der Relevanz dieser Operationsmethode existieren viele Hilfssysteme, die mit bildgestützter Navigation oder Roboter-assistierter Technik die Operation erleichtern sollen. Wichtigster Punkt ist hierbei die Präzision der intrapedikulären Lage der eingebrachten Schrauben, da Schraubenfehllagen zu Verletzungen vaskulärer und neuraler Strukturen mit konsekutiven neurologischen Defiziten führen können. Ziel dieser Arbeit ist der Vergleich eines 3D-Navigations-gestützten und eines Roboter-assistierten transpedikulären Stabilisierungsverfahrens hinsichtlich der postoperativen Ergebnisse. Besonderes Augenmerk liegt hierbei auf der Gesamtstrahlenbelastung, der Operationsdauer sowie der Beurteilung der intrapedikulären Schraubenlage. Hierfür wurden 60 Patienten, die von April 2014 bis Februar 2018 in der Neurochirurgischen Klinik der München Klinik Bogenhausen operiert worden waren, anhand des verwendeten Operationsverfahrens in zwei Gruppen unterteilt. Die Auswertung der Ergebnisse zeigte keinen statistisch signifikanten Unterschied in der applizierten Strahlendosis/Patient (Mittelwertunterschied 0,86, p = 0,59). Jedoch konnte ein signifikanter Zusammenhang zwischen der gewählten Operationsmethode und der damit erzielten Präzision der intrapedikulären Schraubenlage aufgezeigt werden. Das Roboter-assistierte Verfahren zeigte sich hierbei deutlich überlegen (p < 0,01). Hinsichtlich der Operationsdauer war bei Verwendung des Roboter-gestützten Verfahrens eine Lernkurve erkennbar, das bildgestützte-Navigationssystem zeichnete sich allerdings durch kürzere Operationszeiten aus. Hinsichtlich der Rechtfertigung des klinischen Einsatzes von Robotik in der Wirbelsäulenchirurgie müssen noch weitere klinische Vergleichsarbeiten erfolgen.Transpedicular stabilization plays an important role in spinal surgery, as it can be used in a wide variety of diagnoses and in almost all areas of the spine. Due to the relevance of this surgical method, there are many auxiliary systems that can be used with image-supported navigation or robot-assisted technology to facilitate the operation. The most important point here is the precision of the intrapedicular position of the inserted screws, since screw failures can lead to injuries of vascular and neural structures with consecutive neurological deficits. The aim of this work is to compare a 3D navigation-assisted and a robot-assisted transpedicular stabilization procedure with regard to postoperative results. Particular attention is paid to the total radiation exposure, the duration of the operation and the evaluation of the intrapedicular screw position. For this purpose, 60 patients who had undergone surgery from April 2014 to February 2018 at the Neurosurgical Clinic of the München Klinik Bogenhausen were divided into two groups according to the surgical procedure used. The evaluation of the results showed no statistically significant difference in the applied radiation dose/patient (mean difference 0.86, p = 0.59). However, a significant correlation between the chosen surgical method and the precision of the intrapedicular screw position could be demonstrated. The robot-assisted method was clearly superior (p < 0.01). With regard to the duration of the operation, a learning curve was recognizable when using the robot-assisted procedure, but the image-assisted navigation system was characterized by shorter operation times. With regard to the justification of the clinical use of robotics in spinal surgery, further clinical comparison work still has to be carried out.

Investigations into the Toxicology of Spirolides, a Group of Marine Phycotoxins

Spirolides are marine phycotoxins produced by the dinoflagellates Alexandrium ostenfeldii and A. peruvianum. Here we report that 13-desmethyl spirolide C shows little cytotoxicity when incubated with various cultured mammalian cell lines. When administered to mice by intraperitoneal (ip) injection, however, this substance was highly toxic, with an LD50 value of 6.9 µg/kg body weight (BW), showing that such in vitro cytotoxicity tests are not appropriate for predicting the in vivo toxicity of this toxin. Four other spirolides, A, B, C, and 20-methyl spirolide G, were also toxic to mice by ip injection, with LD50 values of 37, 99, 8.0 and 8.0 µg/kg BW respectively. However, the acute toxicities of these compounds were lower by at least an order of magnitude when administration by gavage and their toxic effects were further diminished when administered with food. These results have implications for future studies of the toxicology of these marine toxins and the risk assessment of human exposure

Fetal Liver Bisphenol A Concentrations and Biotransformation Gene Expression Reveal Variable Exposure and Altered Capacity for Metabolism in Humans

Widespread exposure to the endocrine active compound, bisphenol A (BPA), is well documented in humans. A growing body of literature suggests adverse health outcomes associated with varying ranges of exposure to BPA. In the current study, we measured the internal dose of free BPA and conjugated BPA and evaluated gene expression of biotransformation enzymes specific for BPA metabolism in 50 first‐ and second‐trimester human fetal liver samples. Both free BPA and conjugated BPA concentrations varied widely, with free BPA exhibiting three times higher concentrations than conjugated BPA concentrations. As compared to gender‐matched adult liver controls, UDP‐glucuronyltransferase, sulfotransferase, and steroid sulfatase genes exhibited reduced expression whereas β‐glucuronidase mRNA expression remained unchanged in the fetal tissues. This study provides evidence that there is considerable exposure to BPA during human pregnancy and that the capacity for BPA metabolism is altered in the human fetal liver. © 2012 Wiley Periodicals, Inc. J BiochemMol Toxicol 27:116‐123, 2013; View this article online at wileyonlinelibrary.com . DOI 10.1002/jbt.21459Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96672/1/jbt21459.pd

Quality of Life 10 Years after Sleeve Gastrectomy: A Multicenter Study

Objective: Sleeve gastrectomy (SG) has recently become the most commonly applied bariatric procedure worldwide. Substantial regaining of weight or severe reflux might compromise quality of life (QOL) after SG in the long-term follow-up. Long-term data on patients’ QOL is limited, even though the persistent improvement in QOL is one of the aims of bariatric surgery. The objective of this study was to present patients’ QOL 10 years after SG. Methods: Of 65 SG patients with a follow-up of ≥10 years after SG who were asked to fill out the Bariatric Quality of Life Index (BQL) and Short Form 36 (SF36) questionnaires, 48 (74%) completed them. This multicenter study was performed in a university hospital setting in Austria. Results: The BQL score revealed nonsignificant differences between the patients with &#x3e; 50% or &#x3c; 50% excess weight loss (EWL). It did show significant differences between patients with and without any symptoms of reflux. Patients with &#x3c; 50% EWL scored significantly lower in 3/8 categories of SF36. Patients suffering from reflux had significantly lower scores in all categories. Conclusions: EWL and symptomatic reflux impair patients’ long-term QOL after SG

Natural flavonoids as potential multifunctional agents in prevention of diabetic cataract

Cataract is one of the earliest secondary complications of diabetes mellitus. The lens is a closed system with limited capability to repair or regenerate itself. Current evidence supports the view that cataractogenesis is a multifactorial process. Mechanisms related to glucose toxicity, namely oxidative stress, processes of non-enzymatic glycation and enhanced polyol pathway significantly contribute to the development of eye lens opacity under conditions of diabetes. There is an urgent need for inexpensive, non-surgical approaches to the treatment of cataract. Recently, considerable attention has been devoted to the search for phytochemical therapeutics. Several pharmacological actions of natural flavonoids may operate in the prevention of cataract since flavonoids are capable of affecting multiple mechanisms or etiological factors responsible for the development of diabetic cataract. In the present paper, natural flavonoids are reviewed as potential agents that could reduce the risk of cataract formation via affecting multiple pathways pertinent to eye lens opacification. In addition, the bioavailability of flavonoids for the lens is considered