Postoperative Spinal Epidural Hematoma: The Danger Caused by the Misuse of Thrombin-Containing Local Hemostatics

Study DesignRetrospective case-control study.PurposeTo examine the hypothesis that the misuse of thrombin-containing local hemostatics (TCLH) increases the risk of postoperative spinal epidural hematoma (POSEH).Overview of LiteratureMany studies have focused on hypocoagulability as a risk factor for POSEH. However, there are no prior reports on the increased risk of POSEH in hypercoagulable states.MethodsPosterior instrumented lumbar spine surgery cases over 2 consecutive years were divided into two groups: a study group (98 patients in whom TCLH was used) and a control group (176 patients in whom TCLH was not used). The excess TCLH matrix that was not associated with blood clot was not removed from the patients in the study group. The senior author decided whether to use TCLH or not. Suction drains were used in all patients. The demographics, coagulation-related factors, and intraoperative factors of the patients in the two groups were analyzed. The development of POSEH was compared between the two groups.ResultsThe two groups were homogenous in demographics (age and sex), coagulation-related factors (platelet count, prothrombin time, activated partial thromboplastin time, and platelet function analysis), and surgical factors (total blood loss, operation time, blood loss/10 minutes, number of fusion segments, posterolateral fusion/posterior lumbar interbody fusion, and virgin or revision surgery). POSEH developed more frequently in the patients in the study group than in those in the control group (14/98 patients, 14.3% vs. 3/176 patients, 1.7%, respectively; p=0.001; odds ratio, 17.1).ConclusionsTCLH causes blood clot not only at the edge of damaged vessels but also at the site of extravascular blood. Excess TCLH matrix not associated with blood clot at the epidural space can enhance POSEH development because early clotted hematomas do not drain through suction drains

Development of Web GIS-Based VFSMOD System with Three Modules for Effective Vegetative Filter Strip Design

In recent years, Non-Point Source Pollution has been rising as a significant environmental issue. The sediment-laden water problem is causing serious impacts on river ecosystems not only in South Korea but also in most countries. The vegetative filter strip (VFS) has been thought to be one of the most effective methods to reduce the transport of sediment to down-gradient area. However, the effective width of the VFS first needs to be determined before VFS installation in the field. To provide an easy-to-use interface with a scientific VFS modeling engine, the Web GIS-based VFSMOD system was developed in this study. The Web GIS-based VFSMOD uses the UH and VFSM executable programs from the VFSMOD-w model as core engines to simulate rainfall-runoff and sediment trapping. To provide soil information for a point of interest, the Google Map interface to the MapServer soil database system was developed using the Google Map API, Javascript, Perl/CGI, and Oracle DB programming. Three modules of the Web GIS-based VFSMOD system were developed for various VFS designs under single storm, multiple storm, and long-term period scenarios. These modules in the Web GIS-based VFSMOD system were applied to the study watershed in South Korea and these were proven as efficient tools for the VFS design for various purposes

Development of Web GIS-Based VFSMOD System with Three Modules for Effective Vegetative Filter Strip Design

In recent years, Non-Point Source Pollution has been rising as a significant environmental issue. The sediment-laden water problem is causing serious impacts on river ecosystems not only in South Korea but also in most countries. The vegetative filter strip (VFS) has been thought to be one of the most effective methods to reduce the transport of sediment to down-gradient area. However, the effective width of the VFS first needs to be determined before VFS installation in the field. To provide an easy-to-use interface with a scientific VFS modeling engine, the Web GIS-based VFSMOD system was developed in this study. The Web GIS-based VFSMOD uses the UH and VFSM executable programs from the VFSMOD-w model as core engines to simulate rainfall-runoff and sediment trapping. To provide soil information for a point of interest, the Google Map interface to the MapServer soil database system was developed using the Google Map API, Javascript, Perl/CGI, and Oracle DB programming. Three modules of the Web GIS-based VFSMOD system were developed for various VFS designs under single storm, multiple storm, and long-term period scenarios. These modules in the Web GIS-based VFSMOD system were applied to the study watershed in South Korea and these were proven as efficient tools for the VFS design for various purposes

Prognostic Factors of Neurological Complications in Spinal Surgeries

Study Design Retrospective study. Purpose To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. Overview of Literature There have been few reports on the prognosis of NCs according to the causes and treatment methods. Methods The subjects were 65 patients who had NCs for 19 years (1995–2013) after posterior thoracolumbar surgeries in Seoul Sacred Heart General Hospital. The degree of neurological injury was assessed using numeric scales as follows: G1, increased leg pain or sensory loss; G2, hemiparesis; G3, paraparesis; G4, cauda equine syndrome; and G5, complete paraplegia. The relative degree of neurological recovery was evaluated using four numeric scales as follows: Gr1, complete recovery; Gr2, almost complete recovery with residual sensory loss or numbness; Gr3, partial recovery with apparent neurological deficit; and Gr4, no recovery. The prognostic factors were investigated in terms of demographic and surgical variables that were available in a retrospective review. Results The causes were as follows: epidural hematoma (EH), 25 patients (38.5%); insufficient decompression and fusion, 14 patients (21.5%); mechanical injury, 11 patients (16.9%); insufficient discectomy, four patients (6.2%); and unknown, 11 patients (23.1%). The grade of neurological injury was as follows: G1, 11 patients (16.9%); G2, 34 patients (52.3%); G3, 15 patients (23.1%); G4, three patients (4.6%); and G5, two patients (3.1%). Thirteen patients received conservative treatment, and 52 underwent revision surgeries. Neurological recovery was as follows: Gr1, 21 patients (32.3%); Gr2, 17 patients (26.2%); Gr3, 20 patients (30.8%); and Gr4, seven patients (10.8%). The prognosis depended on the causes (p =0.041). The subgroup analysis of the revision group revealed a significant correlation between the degree of neurological recovery and the timing of revision, irrespective of causes (r =0.413, p =0.002). Conclusions The prognosis of NC depended on the causes. EH was the best and unknown was the worst prognostic factor. Revision should be performed as soon as possible for a better prognosis

Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results

PURPOSE: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. MATERIALS AND METHODS: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. RESULTS: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). CONCLUSION: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.ope

Spontaneous breaking of mirror symmetry beyond critical doping in Pb-Bi2212

Identifying ordered phases and their underlying symmetries is the first and most important step toward understanding the mechanism of high-temperature superconductivity; critical behaviors of ordered phases are expected to be correlated with superconductivity. Efforts to find such ordered phases have been focused on symmetry breaking in the pseudogap region while the Fermi liquid-like metal region beyond the so-called critical doping $p_{c}$ has been regarded as a trivial disordered state. Here, we used rotational anisotropy second harmonic generation and uncovered a broken mirror symmetry in the Fermi liquid-like phase in (Bi,Pb)$_{2}$Sr$_{2}$CaCu$_{2}$O$_{8+\delta}$ with $p = 0.205 > p_{c}$. By tracking the temperature evolution of the symmetry-breaking response, we verify an order parameter-like behavior with the onset temperature $T_{up}$ at which the strange metal to Fermi liquid-like-metal crossover takes place. Complementary angle-resolved photoemission study showed that the quasiparticle coherence between $\mathrm{CuO_{2}}$ bilayers is enhanced in proportion to the symmetry-breaking response as a function of temperature, indicating that the change in metallicity and symmetry breaking are linked. These observations contradict the conventional quantum disordered scenario for over-critical-doped cuprates and provide new insight into the nature of the quantum critical point in cuprates.Comment: 8 pages, 4 figure

Loss of Autophagy Diminishes Pancreatic β Cell Mass and Function with Resultant Hyperglycemia

SummaryAutophagy is a cellular degradation-recycling system for aggregated proteins and damaged organelles. Although dysregulated autophagy is implicated in various diseases including neurodegeneration, its role in pancreatic β cells and glucose homeostasis has not been described. We produced mice with β cell-specific deletion of Atg7 (autophagy-related 7). Atg7 mutant mice showed impaired glucose tolerance and decreased serum insulin level. β cell mass and pancreatic insulin content were reduced because of increased apoptosis and decreased proliferation of β cells. Physiological studies showed reduced basal and glucose-stimulated insulin secretion and impaired glucose-induced cytosolic Ca2+ transients in autophagy-deficient β cells. Morphologic analysis revealed accumulation of ubiquitinated protein aggregates colocalized with p62, which was accompanied by mitochondrial swelling, endoplasmic reticulum distension, and vacuolar changes in β cells. These results suggest that autophagy is necessary to maintain structure, mass and function of pancreatic β cells, and its impairment causes insulin deficiency and hyperglycemia because of abnormal turnover and function of cellular organelles