Tag: nevin manimala

Spine J. 2024 Mar 20:S1529-9430(24)00110-4. doi: 10.1016/j.spinee.2024.03.005. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disk space by passing through a retroperitoneal corridor either pre- or trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach. However, there is a paucity of evidence on the prevalence of surgical complications following lateral fusion surgery in patients with a history of abdominal surgery.

PURPOSE: The primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical.

STUDY DESIGN: Retrospective study PATIENT SAMPLE: Patients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study.

OUTCOME MEASURES: The primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration.

METHODS: The electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria).

RESULTS: Of 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02-2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20-1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p > 0.05).

CONCLUSION: Though retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.

PMID:38518920 | DOI:10.1016/j.spinee.2024.03.005

Environ Res. 2024 Mar 20:118653. doi: 10.1016/j.envres.2024.118653. Online ahead of print.

ABSTRACT

BACKGROUND: In China, the effects of heavy metals and metalloids (HMMs) on liver health are not consistently documented, despite their prevalent environmental presence.

OBJECTIVE: Our research assessed the association between HMMs and liver function biomarkers in a comprehensive sample of Chinese adults.

METHODS: We analyzed data from 9445 participants in the China National Human Biomonitoring survey. Blood and urine were evaluated for HMM concentrations, and liver health was gauged using serum albumin (ALB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) metrics. Various statistical methods were employed to understand the relationship between 11 HMMs and liver function, adjusting for multiple factors. We also explored interactions with alcohol intake, gender, and age.

RESULTS: Among HMMs, selenium in blood [weighted geometric mean (GM) = 95.56 μg/L] and molybdenum in urine (GM = 46.44 μg/L) showed the highest concentrations, while lead in blood (GM = 21.92 μg/L) and arsenic in urine (GM = 19.80 μg/L) had the highest levels among risk HMMs. Manganese and thallium consistently indicated potential risk factor to liver in both sample types, while selenium displayed potential liver protection. Blood HMM mixtures were negatively associated with ALB (β = -0.614, 95% CI: -0.809, -0.418) and positively with AST (β = 0.701, 95% CI: 0.290, 1.111). No significant associations were found in urine HMM mixtures. Manganese, tin, nickel, and selenium were notable in blood mixture associations, with selenium and cobalt being significant in urine. The relationship of certain HMMs varied based on alcohol consumption.

CONCLUSION: This research highlights the complex relationship between HMM exposure and liver health in Chinese adults, particularly emphasizing metals like manganese, thallium, and selenium. The results suggest a need for public health attention to low dose HMM exposure and underscore the potential benefits of selenium for liver health. Further studies are essential to establish causality.

PMID:38518907 | DOI:10.1016/j.envres.2024.118653

Environ Res. 2024 Mar 20:118735. doi: 10.1016/j.envres.2024.118735. Online ahead of print.

ABSTRACT

Inert construction and demolition waste from Hong Kong (HK public fills) has been used for marine trial reclamation in the Guanghai Bay (GHWT) of the Chinese Mainland. However, an environmental assessment of HK public fills is necessary due to higher radioactivity in HK soils than typical global levels. Here, radiation dose rate, gamma radionuclides and gross beta of HK public fills were analyzed. The origin information was explored using natural primordial radionuclides as fingerprints. Our data show that radiation dose rate of HK public fills before disposal was 0.14-0.54 (0.33 ± 0.03) μSv/h (n = 16,722 data with 2787 ships) in 2014, which is less than the GHWT background. Monthly detection of ²³⁸U, ²²⁶Ra, ²¹⁰Pb, ²³²Th, ²²⁸Th, ⁴⁰K, and gross beta in HK public fills was conducted on three random ships. Their specific activities were <6.27-155.5, 58.7-98.7, <7.83-238.2,97.9-168.6, 87.1-136.0, 463.1-1,018, and 1047-1658 Bq/kg_DW, respectively. These results suggest that the radioactivity levels of HK public fills are essentially the same as the GHWT background. The study assessed potential risks using various indices icluding Ra_eq (Radium equivalent activity), H_ex (External radiation hazard index), H_in (Internal radiation hazard index), I_γ (Gamma index), AUI (Activity utilization index), AUI (Activity utilization index), E (Annual effective dose), AGDE (Annual gonadal dose equivalent), RLI (Representative level index), D_in (Indoor air absorbed dose rate), D_out (Outdoor air absorbed dose rate), and ELCR (Excess lifetime cancer risk). The study suggests that HK public fills should be used for the trial reclamation rather than building-house materials. This provides valuable insights for the resource utilization and minimizing environmental pollution of HK public fills. The aim is to offer fundamental technical assistance for future waste resource utilization, ecological protection, and restoration in the Guangdong-Hong Kong-Macao Greater Bay Area.

PMID:38518905 | DOI:10.1016/j.envres.2024.118735

Food Chem Toxicol. 2024 Mar 20:114583. doi: 10.1016/j.fct.2024.114583. Online ahead of print.

ABSTRACT

Any functional change in cigarette filter design warrants a rigorous assessment to ensure comparability to existing filter functionality. This study compares the functionality of a standard CA filter with a novel cellulose-based alternative using a combination of emissions, in silico approaches, pre-clinical assessments and behavioural studies. We assess the challenges faced with a significant filtration change, the substantiation of this change and the limitations of such assessments. We explore cigarette emission chemical profiles; assess the potential toxicological impacts (in vitro and statistical modelling) of the differing chemical profiles of cigarette smoke aerosol resulting from the respective filter types; and, finally investigate the behavioural aspects associated with use of the novel filter as compared to the traditional one. The aim of the study was to establish a weight of evidence assessment framework for the comprehensive evaluation of a novel cigarette filter design as part of robust stewardship approach. The data show comparability to a standard CA filter across all assessments and highlight potential areas of investigation for future novel filter product iterations. The approach demonstrates the applicability of a comprehensive step-wise assessment framework to identify any potential increased toxicant emissions and exposures associated with using the novel filter.

PMID:38518883 | DOI:10.1016/j.fct.2024.114583

J Neurosurg Spine. 2024 Mar 22:1-9. doi: 10.3171/2024.1.SPINE23744. Online ahead of print.

ABSTRACT

OBJECTIVE: This retrospective study was designed to evaluate the incidence and predisposing factors of heterotopic ossification (HO) after cervical disc arthroplasty (CDA) with a specific implant at 1 and 2 levels, and to investigate the biomechanical effects related to HO. The study goal was to identify ways to reduce the likelihood of HO formation after surgery.

METHODS: The study included patients who underwent only 1- or 2-level CDA with the Baguera C disc between November 2014 and December 2021 at a single medical center. All patients were operated on by the same neurosurgeon. The surgical indication included 1-level or 2-level disc herniation between C3 and C7 with radiculopathy, myelopathy, or both, with minimal spondylosis. The various factors were assessed by evaluating plain radiographs and cervical CT scans. The presence of HO was evaluated at different intervals postsurgery, and HO severity was graded using the McAfee classification.

RESULTS: Of 107 patients who underwent CDA, 47 (43.9%) had HO at 63 of 171 levels (36.8%). Most cases with HO were grade 1, and no grade 4 was observed. Statistically significant risk factors for HO were the length of endplate coverage ratio and inferior anterior residual exposed endplate (AREE); sex, age, implant height and width, shell angle, and pre- and postoperative functional spinal unit (FSU) angle were not significant. More AREE and greater kyphotic postoperative FSU angle in the flexion position were significant factors differentiating HO grades 0 and 1 from grades 2 and 3. Furthermore, the non-HO group showed a trend of higher range of motion at any postoperative time compared to the HO group, especially at 1 month after surgery.

CONCLUSIONS: The HO incidence after CDA was correlated with the residual length of endplate coverage and inferior AREE. Additionally, the AREE and kyphotic postoperative FSU angle in the flexion position were associated with HO grade progression. Patients with HO also showed a trend of lower range of motion at 1 month after surgery. Using an adequately sized implant and encouraging neck motion may help prevent HO development and progression.

PMID:38518295 | DOI:10.3171/2024.1.SPINE23744

J Neurosurg. 2024 Mar 22:1-9. doi: 10.3171/2024.1.JNS23730. Online ahead of print.

ABSTRACT

OBJECTIVE: Olfactory neuroblastoma (ONB) is a rare, malignant tumor of the sinonasal tract that arises from olfactory epithelium. Although surgery is the preferred first-line treatment, tumor involvement of adjacent structures may preclude the ability to achieve negative margins during initial resection. Herein, the authors examine the oncological outcomes of patients with positive margins after primary resection of ONB, with the aim of determining predictors of disease progression and patterns of recurrence.

METHODS: The authors performed an institutional review of 25 patients with positive-margin ONB after resection. Cox survival analyses were used to determine any statistically significant predictors of worse progression-free survival (PFS) and overall survival (OS).

RESULTS: A total of 93 patients who were diagnosed with ONB were identified, of whom 25 patients had positive margins following their primary resection. Eleven (44%) had a delayed finding of positive margins that were initially negative in the operating room but returned as positive on final pathology. Four patients had subtotal resection (STR), whereas the remaining patients underwent gross-total resection. Twenty-four patients received adjuvant radiotherapy (96%), and 15 additionally received adjuvant chemotherapy (60%). Fourteen patients (56%) experienced recurrence/progression at a median time of 35 months following resection (IQR 19-70 months). Local recurrence occurred in 10 patients (40%), regional in 9 (36%), and distant metastasis in 2 (8%). In Cox survival analyses, the 5-year PFS and OS were 55.1% and 79.2%, respectively. Kadish stage D was predictive of worse PFS in univariate (hazard ratio [HR] 15.67, 95% CI 3.38-72.61, p < 0.001) and multivariate (HR 15.46, 95% CI 1.45-164.91, p = 0.023) analyses. Hyams grade, adjuvant chemotherapy, and primary radiotherapy were not associated with PFS. Furthermore, Kadish stage D and STR were predictive of worse OS in univariate analysis (HR 12.64, 95% CI 2.03-78.86, p = 0.007; HR 7.31, 95% CI 1.45-36.84, p = 0.016; respectively). However, local and regional recurrence was not associated with worse OS.

CONCLUSIONS: Approximately half of patients with positive-margin ONB may experience disease recurrence. Patients with an advanced disease stage (Kadish D) may have a higher likelihood of developing recurrence/progression. Furthermore, patients with tumor burden following resection (STR and Kadish D) may have worse OS. However, in positive-margin ONB with no gross disease following initial resection, the presence of disease recurrence does not significantly alter survival when receiving salvage therapy.

PMID:38518294 | DOI:10.3171/2024.1.JNS23730

J Neurosurg. 2024 Mar 22:1-9. doi: 10.3171/2024.1.JNS231633. Online ahead of print.

ABSTRACT

OBJECTIVE: The influence of socioeconomic factors on racial disparities among patients with sporadic meningiomas is well established, yet other potential causative factors warrant further exploration. The authors of this study aimed to determine whether there is significant variation in the genomic profile of meningiomas among patients of different races and ethnicities and its correlation with clinical outcomes.

METHODS: The demographic, genomic, and clinical data of patients aged 18 years and older who had undergone surgery for sporadic meningioma between September 2008 and November 2021 were analyzed. Statistical analyses were performed to detect differences across all racial/ethnic groups, as were direct comparisons between Black and non-Black groups plus Hispanic and non-Hispanic groups.

RESULTS: This study included 460 patients with intracranial meningioma. Hispanic patients were significantly younger at surgery (53.9 vs 60.2 years, p = 0.0006) and more likely to show symptoms. Black patients had a higher incidence of anterior skull base tumors (OR 3.2, 95% CI 1.7-6.3, p = 0.0008) and somatic hedgehog mutations (OR 5.3, 95% CI 1.6-16.6, p = 0.003). Hispanics were less likely to exhibit the aggressive genomic characteristic of chromosome 1p deletion (OR 0.28, 95% CI 0.07-1.2, p = 0.06) and displayed higher rates of TRAF7 somatic driver mutations (OR 2.96 95% CI 1.1-7.8, p = 0.036). Black patients had higher rates of recurrence (OR 2.6, 95% CI 1.3-5.2, p = 0.009) and shorter progression-free survival (PFS; HR 2.9, 95% CI 1.6-5.4, p = 0.002) despite extents of resection (EORs) similar to those of non-Black patients (p = 0.745). No significant differences in overall survival were observed among groups.

CONCLUSIONS: Despite similar EORs, Black patients had worse clinical outcomes following meningioma resection, characterized by a higher prevalence of somatic hedgehog mutations, increased recurrence rates, and shorter PFS. Meanwhile, Hispanic patients had less aggressive meningiomas, a predisposition for TRAF7 mutations, and no difference in PFS. These findings could inform the care and treatment strategies for meningiomas, and they establish the foundation for future studies focusing on the genomic origins of these observed differences.

PMID:38518289 | DOI:10.3171/2024.1.JNS231633

Pol Merkur Lekarski. 2024;52(1):104-111. doi: 10.36740/Merkur202401116.

ABSTRACT

OBJECTIVE: Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction.

PATIENTS AND METHODS: Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm.

RESULTS: Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%.

CONCLUSION: Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.

PMID:38518241 | DOI:10.36740/Merkur202401116

Pol Merkur Lekarski. 2024;52(1):95-103. doi: 10.36740/Merkur202401115.

ABSTRACT

OBJECTIVE: Aim: The purpose of the research is to study trends in the dynamics of morbidity and mortality from arterial hypertension in the Republic of Kazakhstan for 2010-2019.

PATIENTS AND METHODS: Materials and Methods: Due to the interdisciplinary nature of the study, a set of methods was used: analytical, graph-analytical, statistical, sociological, clinical and economic analysis, organizational experiment.

RESULTS: Results: The survey of 318 hypertension patients highlighted a common profile: hypertensive men aged 45-59, smokers, alcohol drinkers, urban dwellers, married with children, industrially employed, physically active at their country house, and facing stress. Gender differences showed 74.4% of hypertensive women were over 50, while a fifth of men were under 45, with higher risk factors in men: smoking (1.87), alcohol (2.53), occupational hazards (2.76), and harsh climates (2.54).

CONCLUSION: Conclusions: The analysis findings reveal noteworthy trends within the hypertension patient population in Kazakhstan. Despite a decline in hypertension prevalence and initial occurrences, along with reduced relative hospitalization rates between 2010 and 2019, mortality linked to hypertension-related causes and the occurrence of heart attacks have remained relatively steady in recent times.

PMID:38518240 | DOI:10.36740/Merkur202401115

Pol Merkur Lekarski. 2024;52(1):79-86. doi: 10.36740/Merkur202401113.

ABSTRACT

OBJECTIVE: . Aim: To assess the effectiveness of monotherapy and complex treatment of patients with erectile dysfunction depending on its severity.

PATIENTS AND METHODS: Materials and Methods: Men with moderate and mild erectile dysfunction took part in the study, who, in turn, were divided into groups, depending on the treatment, with the evaluation of the results of the International Index of Erectile Function (MIEF-15), the state of cavernous hemodynamics and the function of the vascular endothelium before and after treatment.

RESULTS: Results: In patients with an average degree of severity, who received complex treatment including a course of low-energy shock wave therapy, against the background of taking sildenafil and L-arginine, the best results were obtained in the quality of erection and increased cavernous blood flow, which positively affected satisfaction with sexual intercourse and overall satisfaction. It has also been proven that the function of the endothelium was improved in patients receiving L-arginine, due to which there was a probable decrease in endothelin-1. A probable improvement of erectile function was obtained in the group of patients with a mild degree who received L-arginine, and there was no statistical difference from the indicators in the group who received sildenafil, which was confirmed by the data of dopplerography.

CONCLUSION: Conclusions: Patients with an average degree of erectile dysfunction require comprehensive treatment. The use of L-arginine can be an alternative to phosphodiesterase type 5 inhibitors in the treatment of mild erectile dysfunction.

PMID:38518238 | DOI:10.36740/Merkur202401113