Multiple Levels of Lumbar Spondylolysis - A Case Report -

We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery

Autozygome-guided exome sequencing in retinal dystrophy patients reveals pathogenetic mutations and novel candidate disease genes

Retinal dystrophy (RD) is a heterogeneous group of hereditary diseases caused by loss of photoreceptor function and contributes significantly to the etiology of blindness globally but especially in the industrialized world. The extreme locus and allelic heterogeneity of these disorders poses a major diagnostic challenge and often impedes the ability to provide a molecular diagnosis that can inform counseling and gene-specific treatment strategies. In a large cohort of nearly 150 RD families, we used genomic approaches in the form of autozygome-guided mutation analysis and exome sequencing to identify the likely causative genetic lesion in the majority of cases. Additionally, our study revealed six novel candidate disease genes (C21orf2, EMC1, KIAA1549, GPR125, ACBD5, and DTHD1), two of which (ACBD5 and DTHD1) were observed in the context of syndromic forms of RD that are described for the first time

抗腫瘍性トロポロン誘導体の創製と作用機序に関する研究

We image the lithospheric and upper asthenospheric structure of western continental Yemen with 24 broadband stations to evaluate the role of the Afar plume on the evolution of the continental margin and its extent eastward along the Gulf of Aden. We use teleseismic tomography to compute relative P wave velocity variations in south-western Yemen down to 300 km depth. Published receiver function analysis suggest a dramatic and localized thinning of the crust in the vicinity of the Red Sea and the Gulf of Aden, consistent with the velocity structure that we retrieve in our model. The mantle part of the model is dominated by the presence of a low-velocity anomaly in which we infer partial melting just below thick Oligocene flood basalts and recent off-axis volcanic events (from 15 Ma to present). This low-velocity anomaly could correspond to an abnormally hot mantle and could be responsible for dynamic topography and recent magmatism in western Yemen. Our new P wave velocity model beneath western Yemen suggests the young rift flank volcanoes beneath margins and on the flanks of the Red Sea rift are caused by focused small-scale diapiric upwelling from a broad region of hot mantle beneath the area. Our work shows that relatively hot mantle, along with partial melting of the mantle, can persist beneath rifted margins after breakup has occurred

Tectonic events, continental intraplate volcanism, and mantle plume activity in northern Arabia: constraints form geochemistry and Ar-Ar dating of Syrian lavas

New (40)Ar/(39)Ar ages combined with chemical and Sr, Nd, and Pb isotope data for volcanic rocks from Syria along with published data of Syrian and Arabian lavas constrain the spatiotemporal evolution of volcanism, melting regime, and magmatic sources contributing to the volcanic activity in northern Arabia. Several volcanic phases occurred in different parts of Syria in the last 20 Ma that partly correlate with different tectonic events like displacements along the Dead Sea Fault system or slab break-off beneath the Bitlis suture zone, although the large volume of magmas and their composition suggest that hot mantle material caused volcanism. Low Ce/Pb (<20), Nb/Th (<10), and Sr, Nd, and Pb isotope variations of Syrian lavas indicate the role of crustal contamination in magma genesis, and contamination of magmas with up to 30% of continental crustal material can explain their (87)Sr/(86)Sr. Fractionation-corrected major element compositions and REE ratios of uncontaminated lavas suggest a pressure-controlled melting regime in western Arabia that varies from shallow and high-degree melt formation in the south to increasingly deeper regions and lower extents of the beginning melting process northward. Temperature estimates of calculated primary, crustally uncontaminated Arabian lavas indicate their formation at elevated mantle temperatures (T(excess) similar to 100-200 degrees C) being characteristic for their generation in a plume mantle region. The Sr, Nd, and Pb isotope systematic of crustally uncontaminated Syrian lavas reveal a sublithospheric and a mantle plume source involvement in their formation, whereas a (hydrous) lithospheric origin of lavas can be excluded on the basis of negative correlations between Ba/La and K/La. The characteristically high (206)Pb/(204)Pb (similar to 19.5) of the mantle plume source can be explained by material entrainment associated with the Afar mantle plume. The Syrian volcanic rocks are generally younger than lavas from the southern Afro-Arabian region, indicating a northward progression of the commencing volcanism since the arrival of the Afar mantle plume beneath Ethiopia/Djibouti some 30 Ma ago. The distribution of crustally uncontaminated high (206)Pb/(204)Pb lavas in Arabia indicates a spatial influence of the Afar plume of similar to 2600 km in northward direction with an estimated flow velocity of plume material on the order of 22 cm/a

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Derivation of minimum steel ratio: based on service applied stresses

Reinforced concrete beams undergo several design stages starting with the immediate application of loading and till the ultimate failure of the beam. In many practical applications, the beam is designed to function in the service stage during which steel plays a major role in the determination of the location of the Neutral axis. The ACI code implements several provisions on the minimum steel ratio in order to encourage ductile behaviour of the beam and to prevent against the unfavourable scenario of a sudden failure. The ACI 318-08 provisions encompass a derived expression to calculate the minimum amount of flexural reinforcement that is independent of concrete strength. This paper suggests an expansion to the formula by deriving the minimum steel ratio based on the modulus of rupture and the applied service stresses. The special case for a cracking bending moment is extrapolated from the suggested formula and the result is compared to different minimum steel area formulas