Pedicle screw fixation in spinal disorders: A European view

Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near futur

X-ray sources and their optical counterparts in the globular cluster M 22

Using XMM-Newton EPIC imaging data, we have detected 50 low-luminosity X-ray sources in the field of view of M 22, where 5 +/- 3 of these sources are likely to be related to the cluster. Using differential optical photometry, we have identified probable counterparts to those sources belonging to the cluster. Using X-ray spectroscopic and timing studies, supported by the optical colours, we propose that the most central X-ray sources in the cluster are cataclysmic variables, millisecond pulsars, active binaries and a blue straggler. We also identify a cluster of galaxies behind this globular cluster.Comment: 11 pages, 7 figures, accepted for publication in A&

The Deuterium Abundance in the z=0.7 absorber towards QSO PG1718+4807

We report a further analysis of the ratio of deuterium to hydrogen (D/H) using HST spectra of the z=0.701 Lyman limit system towards the QSO PG1718+481. Initial analyses of this absorber found it gave a high D/H value, 1.8 - 3.1 \times 10^{-4} (Webb et al. 1998), inconsistent with several higher redshift measurements. It is thus important to critically examine this measurement. By analysing the velocity widths of the DI, HI and metal lines present in this system, Kirkman et al. (2001) report that the additional absorption in the blue wing of the lya line can not be DI, with a confidence level of 98%. Here we present a more detailed analysis, taking into account possible wavelength shifts between the three sets of HST spectra used in the analysis. We find that the constraints on this system are not as strong as those claimed by Kirkman et al. The discrepancy between the parameters of the blue wing absorption and the parameters expected for DI is marginally worse than 1 sigma. Tytler et al.(1999) commented on the first analysis of Webb et al.(1997,1998), reporting the presence of a contaminating lower redshift Lyman limit system, with log[N(HI)] = 16.7 at z=0.602, which biases the N(HI) estimate for the main system. Here we show that this absorber actually has log[N(HI)] < 14.6 and does not impact on the estimate of N(HI) in the system of interest at z = 0.701. The purpose of the present paper is to highlight important aspects of the analysis which were not explored in previous studies, and hence help refine the methods used in future analyses of D/H in quasar spectra.Comment: 11 pages, 9 figures. Accepted by MNRA

Remotely controlled mirror of variable geometry for small angle x-ray diffraction with synchrotron radiation

A total-reflecting mirror of 120-cm length was designed and built to focus synchrotron radiation emanating from the electron-positron storage ring at the Stanford Linear Accelerator Center (SPEAR). The reflecting surface is of unpolished float glass. The bending and tilt mechanism allows very fine control of the curvature and selectability of the critical angle for wavelengths ranging from 0.5 to 3.0 Å. Elliptical curvature is used to minimize aberrations. The mirror is placed asymmetrically onto the ellipse so as to achieve a tenfold demagnification of the source. The bending mechanism reduces nonelastic deformation (flow) and minimizes strains and stresses in the glass despite its length. Special design features assure stability of the focused image. The mirror reduces the intensity of shorter wavelength harmonics by a factor of approximately 100

Gain control from beyond the classical receptive field in primate primary visual cortex

Gain control is a salient feature of information processing throughout the visual system. Heeger (1991, 1992) described a mechanism that could underpin gain control in primary visual cortex (VI). According to this model, a neuron's response is normalized by dividing its output by the sum of a population of neurons, which are selective for orientations covering a broad range. Gain control in this scheme is manifested as a change in the semisaturation constant (contrast gain) of a VI neuron. Here we examine how flanking and annular gratings of the same or orthogonal orientation to that preferred by a neuron presented beyond the receptive field modulate gain in V1 neurons in anesthetized marmosets (Callithrix jacchus). To characterize how gain was modulated by surround stimuli, the Michaelis-Menten equation was fitted to response versus contrast functions obtained under each stimulus condition. The modulation of gain by surround stimuli was modelled best as a divisive reduction in response gain. Response gain varied with the orientation of surround stimuli, but was reduced most when the orientation of a large annular grating beyond the classical receptive field matched the preferred orientation of neurons. The strength of surround suppression did not vary significantly with retinal eccentricity or laminar distribution. In the mannoset, as in macaques (Angelucci et al., 2002a,b), gain control over the sort of distances reported here (up to 10 deg) may be mediated by feedback from extrastriate areas

Optical variability of the accretion disk around the intermediate mass black hole ESO 243-49 HLX-1 during the 2012 outburst

We present dedicated quasi-simultaneous X-ray (Swift) and optical (Very Large Telescope (VLT), V- and R-band) observations of the intermediate mass black hole candidate ESO 243-49 HLX-1 before and during the 2012 outburst. We show that the V-band magnitudes vary with time, thus proving that a portion of the observed emission originates in the accretion disk. Using the first quiescent optical observations of HLX-1, we show that the stellar population surrounding HLX-1 is fainter than V~25.1 and R~24.2. We show that the optical emission may increase before the X-ray emission consistent with the scenario proposed by Lasota et al. (2011) in which the regular outbursts could be related to the passage at periastron of a star circling the intermediate mass black hole in an eccentric orbit, which triggers mass transfer into a quasi-permanent accretion disk around the black hole. Further, if there is indeed a delay in the X-ray emission we estimate the mass-transfer delivery radius to be ~1e11 cm.Comment: 9 pages, 2 figures, accepted for publication in ApJ

Investigating slim disk solutions for HLX-1 in ESO 243-49

The hyper luminous X-ray source HLX-1 in the galaxy ESO 243-49, currently the best intermediate mass black hole candidate, displays spectral transitions similar to those observed in Galactic black hole binaries, but with a luminosity 100-1000 times higher. We investigated the X-ray properties of this unique source fitting multi-epoch data collected by Swift, XMM-Newton & Chandra with a disk model computing spectra for a wide range of sub- and super-Eddington accretion rates assuming a non-spinning black hole and a face-on disk (i = 0 deg). Under these assumptions we find that the black hole in HLX-1 is in the intermediate mass range (~2 x 10^4 M_odot) and the accretion flow is in the sub-Eddington regime. The disk radiation efficiency is eta = 0.11 +/-0.03. We also show that the source does follow the L_X ~ T^4 relation for our mass estimate. At the outburst peaks, the source radiates near the Eddington limit. The accretion rate then stays constant around 4 x 10^(-4) M_odot yr^(-1) for several days and then decreases exponentially. Such "plateaus" in the accretion rate could be evidence that enhanced mass transfer rate is the driving outburst mechanism in HLX-1. We also report on the new outburst observed in August 2011 by the Swift-X-ray Telescope. The time of this new outburst further strengthens the ~1 year recurrence timescale.Comment: 24 pages, 10 figures, accepted for publication in Ap