Percutaneous Endoscopic Removal of Extruded Centering Pin in Lumbar Artificial Disc Causing Postoperative Radiculopathy: A Case Report

We present a case of postoperative radiculopathy caused by extrusion of centering pin marker in lumbar artificial disc treated by percutaneous endoscopic procedure. A 39-year-old man was presented with intermittent electric shock like left leg pain along S1 dermatome. He received lumbar total disc replacement (TDR) on L5-S1 for his degenerative disc disease (DDD) six years before the revisit to the clinic. X-ray and CT revealed extruded pin from the core of the implant compressing the thecal sac and left S1 root. The position and mobility of the implant were seen intact in follow-up X-rays. The marker pin was removed by percutaneous endoscopic interlaminar technique. The patient’s preoperative leg pain was completely resolved after the procedure

Electrophysiological Characterization of Benzofuroindole- Induced Potentiation of Large-Conductance Ca 2ϩ -Activated K ϩ Channels

ABSTRACT Large-conductance Ca 2ϩ -activated K ϩ (BK Ca ) channels are widely distributed and play key roles in various cell functions. We previously reported the chemical synthesis of several benzofuroindole compounds that act as potent openers of BK Ca channels. In this study, we investigated the mechanism of channel potentiation by one of the compounds, 7-trifluoromethyl-10H-benzo [4,5]furo[3,2-b]indole-1-carboxylic acid (TBIC), using electrophysiological means. This chemical highly activated cloned BK Ca channels from extracellular side independent of ␤ subunits and regardless of the presence of intracellular Ca 2ϩ . The EC 50 and Hill coefficient for rat BK Ca channel ␣ subunit, rSlo, were estimated as 8.9 Ϯ 1.5 M and 0.9, respectively. TBIC shifted the conductance-voltage curve of rSlo channels to more hyperpolarized potentials without altering its voltage dependence. Single-channel recording revealed that TBIC increased the open probability of the channel in a dosedependent manner without any changes in single-channel conductance. Strong potentiation by TBIC was also observed for native BK Ca channels from rat hippocampus pyramidal neurons. Thus, TBIC and the related benzofuroindole compounds can be useful tools to unravel the mechanism of this novel allosteric activation of BK Ca channels

The orphan nuclear receptor SHP is a positive regulator of osteoblastic bone formation

The orphan nuclear receptor small heterodimer partner (SHP; NR0B2) interacts with a diverse array of transcription factors and regulates a variety of cellular events such as cell proliferation, differentiation, and metabolism. However, the role of SHP in bone formation has not yet been elucidated. SHP expression is significantly increased during osteoblast differentiation, and its expression is partially regulated by bone morphogenetic protein 2 (BMP-2), which plays an important role in bone formation. In our study, inhibition of SHP expression significantly repressed BMP-2-induced osteoblast differentiation and ectopic bone formation. In accordance with these in vitro and in vivo results, osteoblast differentiation in SHP −/− mice primary osteoblasts was significantly repressed, and the mice showed decreased bone mass resulting from decreased numbers of osteoblasts. Finally, SHP physically interacts and forms a complex with runt-related transcription factor 2 (Runx2) on the osteocalcin gene promoter, and overexpression of SHP increased Runx2 transactivity via competition with histone deacetylase 4 (HDAC4), an enzyme that inhibits DNA binding of Runx2 to its target genes. Taken together, these results indicate that SHP acts as a novel positive regulator of bone formation by augmenting osteoblast differentiation through regulation of the transcriptional activity of Runx2. © 2010 American Society for Bone and Mineral ResearchPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65055/1/90718_ftp.pd

Effect of intradialytic change in blood pressure and ultrafiltration volume on the variation in access flow measured by ultrasound dilution

AbstractBackgroundProspective access flow measurement is the preferred method for vascular access surveillance in hemodialysis (HD) patients. We studied the effect of intradialytic change in blood pressure and ultrafiltration volume on the variation in access flow measured by ultrasound dilution.MethodsAccess flow was measured 30minutes, 120minutes, and 240minutes after the start of HD by ultrasound dilution in 30 patients during 89 HD sessions and evaluated for variation.ResultsThe mean age of the 30 patients was 62±11 years: 19 were male. The accesses comprised 16 fistulae and 14 grafts. The mean access flow over all sessions decreased by 6.1% over time (1265±568mL/min after 30minutes, 1260±599mL/min after 120minutes, and 1197±576mL/min after 240minutes, P<0.01 by repeated measures ANOVA). In addition, a≥5% decrease in mean arterial pressure during HD significantly reduced access flow (P=0.014). However, no other variable (ultrafiltration volume, sex, age, presence of diabetes, type or location of access, body surface area, hemoglobin, serum albumin level) interacted significantly with the effect of time on access flow. Furthermore, mean arterial pressure did not correlate with ultrafiltration volume.ConclusionWe conclude that the variation in access flow during HD is relatively small. Decreased blood pressure is a risk factor for variation in access flow measured by ultrasound dilution. In most patients whose blood pressures are stable during HD, the access flow can be measured at any time during the HD treatment

Clinical and laboratory profiles of hospitalized children with acute respiratory virus infection

PurposeDespite the availability of molecular methods, identification of the causative virus in children with acute respiratory infections (ARIs) has proven difficult as the same viruses are often detected in asymptomatic children.MethodsMultiplex reverse transcription polymerase chain reaction assays were performed to detect 15 common respiratory viruses in children under 15 years of age who were hospitalized with ARI between January 2013 and December 2015. Viral epidemiology and clinical profiles of single virus infections were evaluated.ResultsOf 3,505 patients, viruses were identified in 2,424 (69.1%), with the assay revealing a single virus in 1,747 cases (49.8%). While major pathogens in single virus-positive cases differed according to age, human rhinovirus (hRV) was common in patients of all ages. Respiratory syncytial virus (RSV), influenza virus (IF), and human metapneumovirus (hMPV) were found to be seasonal pathogens, appearing from fall through winter and spring, whereas hRV and adenovirus (AdV) were detected in every season. Patients with ARIs caused by RSV and hRV were frequently afebrile and more commonly had wheezing compared with patients with other viral ARIs. Neutrophil-dominant inflammation was observed in ARIs caused by IF, AdV, and hRV, whereas lymphocyte-dominant inflammation was observed with RSV A, parainfluenza virus, and hMPV. Monocytosis was common with RSV and AdV, whereas eosinophilia was observed with hRV.ConclusionIn combination with viral identification, recognition of virus-specific clinical and laboratory patterns will expand our understanding of the epidemiology of viral ARIs and help us to establish more efficient therapeutic and preventive strategies

Renal transplantation in a patient with Bartter syndrome and glomerulosclerosis

Bartter syndrome (BS) is a clinically and genetically heterogeneous inherited renal tube disorder characterized by renal salt wasting, hypokalemic metabolic alkalosis and normotensive hyperreninemic hyperaldosteronism. There have been several case reports of BS complicated by focal segmental glomerulosclerosis (FSGS). Here, we have reported the case of a BS patient who developed FSGS and subsequent end-stage renal disease (ESRD) and provided a brief literature review. The patient presented with classic BS at 3 months of age and developed proteinuria at 7 years. Renal biopsy performed at 11 years of age revealed a FSGS perihilar variant. Hemodialysis was initiated at 11 years of age, and kidney transplantation was performed at 16 years of age. The post-transplantation course has been uneventful for more than 3 years with complete disappearance of BS without the recurrence of FSGS. Genetic study revealed a homozygous p.Trp(TGG)610Stop(TGA) mutation in the CLCNKB gene. In summary, BS may be complicated by secondary FSGS due to the adaptive response to chronic salt-losing nephropathy, and FSGS may progress to ESRD in some patients. Renal transplantation in patients with BS and ESRD results in complete remission of BS

Reappraisal of Plasmapheresis as a Supportive Measure in a Patient with Hepatic Failure after Major Hepatectomy

Major resection of cirrhotic livers can result in hepatic failure, but no supportive treatment has been found to be generally effective. We successfully treated a 63-year-old woman with post-hepatectomy liver failure with plasmapheresis. Following right hepatectomy, the initial postoperative recovery of liver function was favorable, except for ascites. One month later, however, the amount of drained ascites increased up to 2 l/day. In addition, serum cholesterol concentration gradually decreased to around 30 mg/dl, and serum total bilirubin rose to 11.1 mg/dl. Plasmapheresis was performed, and after just 2 sessions, serum cholesterol level was rapidly corrected and prothrombin time was restored. After 3 sessions of plasmapheresis, the usual rebound rise of serum bilirubin disappeared, and the amount of ascites drained also decreased slowly. The patient underwent a total of 5 sessions of plasmapheresis over 2 weeks, after which liver function improved slowly, and she was finally discharged 72 days after liver resection. Mild ascites requiring diuretic therapy persisted over 3 months. She is doing well to date 10 months after liver resection without tumor recurrence or hepatic decompensation. This limited experience suggests that plasmapheresis can be a useful liver support for post-hepatectomy liver failure

A Hybrid Approach of Data-driven and Physics-based Methods for Estimation and Prediction of Fatigue Crack Growth

Lamb-wave-based nondestructive testing and evaluation (NDT/E) methods have drawn much attention due to their potential to inspect plate-like structures in a variety of industrial applications. To estimate and/or predict fatigue crack growth, many research efforts have been made to develop data-driven or physics-based methods. Data-driven methods show high predictive capability without the need for physical domain knowledge; however, fewer data can lead to overfitting in the results. On the other hand, physics-based methods can provide reliable results without the need for measured data; however, small amounts of physical information can worsen their predictive capability. In real applications, both the measurable data and the physical information of systems may be considerably limited; it is thus challenging to estimate and/or predict the crack length using either the data-driven or physics-based method alone. To make use of the advantages and minimize the disadvantages of each method, the work outlined in this paper aims to develop a hybrid approach that combines the data-driven and the physics-based methods for estimation and prediction of fatigue crack growth with and without Lamb wave signals. First, with Lamb wave signals, a data-driven method based on signal processing and the random forest model can be used estimate crack lengths. Second, in the absence of Lamb wave signals, a physics-based method based on an ensemble prognostics approach and Walker’s equation can be used to predict crack lengths with the help of the previously estimated crack lengths. To demonstrate the validity of the proposed approach, a case study is presented using datasets provided in the 2019 PHM Conference Data Challenge by the PHM Society. The case study confirms that the proposed method shows high accuracy; the RMSEs for specimens T7 and T8 are calculated as 0.2021 and 0.551, respectively. A penalty score is calculated as 7.63; this result led to a 2nd place finish in the Data Challenge. To the best of the authors’ knowledge, this is the first attempt to propose a hybrid approach for estimation and prediction of fatigue crack growth