Spontaneous intracranial hypotension following epidural anesthesia: a case report

We report a case of refractory spontaneous intracranial hypotension (SIH) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post-dural puncture headache (PDPH). A 56-year-old man received a successful appendectomy under epidural anesthesia performed at a T11-T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a PDPH was diagnosed. However, the patient did not respond well to conservative treatment. Three months later, the first epidural blood patch was performed at the L3-L4 level, however, the patient still had an orthostatic headache. Five days later, spine magnetic resonance imaging showed multiple meningeal diverticulum in the cervicothoracic junction, and computerized tomography myelography demonstrated a C5-C6 spinal dural tear suggesting cerebrospinal fluid leaks. Finally, the patient was diagnosed as SIH and received a second epidural blood patch at the T2-T3 level and responded with improvements in symptomatology. The patient was then discharged, and at a 2-year follow-up, he had fully recovered except for some remaining neck stiffness. This case illustrates that SIH was misdiagnosed as PDPH because of the common clinical symptoms and potentially confounding events (epidural/spinal anesthesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. For a successful treatment of SIH, a timely epidural blood patch should be considered as soon as the diagnosis is established.

Enhancing immune responses of EV71 VP1 DNA vaccine by co-inoculating plasmid IL-12 or GM-CSF expressing vector in mice

Enterovirus 71 (EV71) is a major causative viral agent for large outbreaks of hand, foot, and mouth disease in children and infants, yet there is no vaccine or effective antiviral treatment for severe EV71 infection. The immunogenicity of EV71 VP1 DNA vaccine and the immunoregulatory activity of interleukin-12 (IL-12) or granulocyte-monocyte colony stimulating factor (GM-CSF) were investigated. DNA vaccine plasmids, pcDNA-VP1, pcDNA-IL-12 and pcDNA-GM-CSF were constructed and inoculated into BALB/c mice with or without pcDNA-IL-12 or pcDNA-GM-CSF by intramuscular injection. Cellular and humoral immune responses were assessed by indirect ELISA, lymphocyte proliferation assays, cytokine release assay and FACS. The VP1 DNA vaccine had good immunogenicity and can induce specific humoral and cellular immunity in BALB/c mice, while IL-2 or GM-CSF plays an immunoadjuvant role and enhances specific immune responses. This study provides a frame of reference for the design of DNA vaccines against EV71.

IgE and FcεRI are highly expressed on innate cells in psoriasis

BACKGROUND

Although elevated serum IgE levels have been reported in psoriasis, the role of IgE in psoriasis still needs to be clarified.

OBJECTIVES

To analyse serum total IgE levels in addition to the presence and distribution of IgE and FcεRI in psoriatic lesions, and to investigate alteration of IgE and FcεRI after successful systemic treatment.

METHODS

Total serum IgE levels were determined using enzyme-linked immunosorbent assay. The expression and localization of IgE and FcεRI was investigated using immunohistochemistry and double immunofluorescence.

RESULTS

Elevated total serum IgE levels were found in 39% of patients with psoriasis. The levels of total serum IgE were significantly higher in male patients compared with female patients. Furthermore, total serum IgE levels decreased after successful systemic treatment. A positive correlation between IgE+ and FcεRI+ cells and a significant increase of these cells was found in psoriatic lesions when compared with normal skin. Interestingly, IgE+ and FcεRI+ cells decreased significantly after successful therapy with ustekinumab. IgE and FcεRI were coexpressed on mast cells, epidermal Langerhans cells, dermal dendritic cells, macrophages and a small number of neutrophils.

CONCLUSIONS

IgE might participate in the development of psoriasis by activating FcεRI-bearing cells.

Preoperative serum α-fetoprotein and prognosis after hepatectomy for hepatocellular carcinoma

Background

While the majority of studies report that a raised serum α-fetoprotein (AFP) level before operation is associated with a high risk of recurrence and death in patients who undergo hepatectomy for hepatocellular carcinoma (HCC), results are conflicting. The aim of this study was to assess the prognostic value of AFP.

Methods

Serum AFP levels were measured in patients with hepatitis-associated HCC who underwent hepatectomy between 1995 and 2012. Kaplan–Meier and multivariable analyses were performed to identify risk factors for overall and disease-free survival. Univariable and multivariable Cox proportional hazards regression was used to evaluate the predictive value of AFP. Receiver operating characteristic (ROC) curves were generated to identify the AFP level that had the highest accuracy in discriminating between survivors and non-survivors.

Results

Some 376 patients with hepatitis B virus (HBV)-associated HCC were included in the study. The overall survival rate was 58·8 per cent in patients with an AFP level of 400 ng/ml or less compared with 40·4 per cent for those with a level exceeding 400 ng/ml (P = 0·001). AFP concentration above 400 ng/ml was an independent risk factor for shorter disease-free and overall survival after surgery. ROC analysis indicated that the optimal cut-off values for AFP varied for different subtypes of HCC. The sensitivity and specificity were lower with areas under the ROC curve of less than 0·600. An AFP level greater than 400 ng/ml was not sensitive enough to predict the prognosis in patients with an HCC diameter smaller than 3 cm.

Conclusion

A serum AFP level above 400 ng/ml predicts poor overall and recurrence-free survival after hepatectomy in patients with HBV-associated HCC. AFP is not a strong prognostic marker given its poor discriminatory power, with low sensitivity and specificity.

Observation of the Singly Cabibbo-Suppressed Decay D^{+}→ωπ^{+} and Evidence for D^{0}→ωπ^{0}

Based on 2.93  fb^{-1} e^{+}e^{-} collision data taken at center-of-mass energy of 3.773 GeV by the BESIII detector, we report searches for the singly Cabibbo-suppressed decays D^{+}→ωπ^{+} and D^{0}→ωπ^{0}. A double tag technique is used to measure the absolute branching fractions B(D^{+}→ωπ^{+})=(2.79±0.57±0.16)×10^{-4} and B(D^{0}→ωπ^{0})=(1.17±0.34±0.07)×10^{-4}, with statistical significances of 5.5σ and 4.1σ, where the first and second uncertainties are statistical and systematic, respectively.

Measurements of Absolute Hadronic Branching Fractions of the Λ_{c}^{+} Baryon

We report the first measurement of absolute hadronic branching fractions of Λ_{c}^{+} baryon at the Λ_{c}^{+}Λ[over ¯]_{c}^{-} production threshold, in the 30 years since the Λ_{c}^{+} discovery. In total, 12 Cabibbo-favored Λ_{c}^{+} hadronic decay modes are analyzed with a double-tag technique, based on a sample of 567  pb^{-1} of e^{+}e^{-} collisions at sqrt[s]=4.599  GeV recorded with the BESIII detector. A global least-squares fitter is utilized to improve the measured precision. Among the measurements for twelve Λ_{c}^{+} decay modes, the branching fraction for Λ_{c}^{+}→pK^{-}π^{+} is determined to be (5.84±0.27±0.23)%, where the first uncertainty is statistical and the second is systematic. In addition, the measurements of the branching fractions of the other 11 Cabibbo-favored hadronic decay modes are significantly improved.

Advancement of highly charged ion beam production by superconducting ECR ion source SECRAL (invited)

At Institute of Modern Physics (IMP), Chinese Academy of Sciences (CAS), the superconducting Electron Cyclotron Resonance (ECR) ion source SECRAL (Superconducting ECR ion source with Advanced design in Lanzhou) has been put into operation for about 10 years now. It has been the main working horse to deliver intense highly charged heavy ion beams for the accelerators. Since its first plasma at 18 GHz, R&D work towards more intense highly charged ion beam production as well as the beam quality investigation has never been stopped. When SECRAL was upgraded to its typical operation frequency 24 GHz, it had already showed its promising capacity of very intense highly charged ion beam production. And it has also provided the strong experimental support for the so called scaling laws of microwave frequency effect. However, compared to the microwave power heating efficiency at 18 GHz, 24 GHz microwave heating does not show the ω(2) scale at the same power level, which indicates that microwave power coupling at gyrotron frequency needs better understanding. In this paper, after a review of the operation status of SECRAL with regard to the beam availability and stability, the recent study of the extracted ion beam transverse coupling issues will be discussed, and the test results of the both TE01 and HE11 modes will be presented. A general comparison of the performance working with the two injection modes will be given, and a preliminary analysis will be introduced. The latest results of the production of very intense highly charged ion beams, such as 1.42 emA Ar(12+), 0.92 emA Xe(27+), and so on, will be presented.

High intensity high charge state ion beam production with an evaporative cooling magnet ECRIS

LECR4 (Lanzhou ECR ion source No. 4) is a room temperature electron cyclotron resonance ion source, designed to produce high current, high charge state ion beams for the SSC-LINAC injector (a new injector for sector separated cyclotron) at the Institute of Modern Physics. LECR4 also serves as a PoP machine for the application of evaporative cooling technology in accelerator field. To achieve those goals, LECR4 ECR ion source has been optimized for the operation at 18 GHz. During 2014, LECR4 ion source was commissioned at 18 GHz microwave of 1.6 kW. To further study the influence of injection stage to the production of medium and high charge state ion beams, in March 2015, the injection stage with pumping system was installed, and some optimum results were produced, such as 560 eμA of O(7+), 620 eμA of Ar(11+), 430 eμA of Ar(12+), 430 eμA of Xe(20+), and so on. The comparison will be discussed in the paper.

Measurement of Azimuthal Asymmetries in Inclusive Charged Dipion Production in e^{+}e^{-} Annihilations at sqrt[s]=3.65 GeV

We present a measurement of the azimuthal asymmetries of two charged pions in the inclusive process e^{+}e^{-}→ππX, based on a data set of 62  pb^{-1} at the center-of-mass energy of 3.65 GeV collected with the BESIII detector. These asymmetries can be attributed to the Collins fragmentation function. We observe a nonzero asymmetry, which increases with increasing pion momentum. As our energy scale is close to that of the existing semi-inclusive deep inelastic scattering experimental data, the measured asymmetries are important inputs for the global analysis of extracting the quark transversity distribution inside the nucleon and are valuable to explore the energy evolution of the spin-dependent fragmentation function.

MAVEN observations of the response of Mars to an interplanetary coronal mass ejection

Coupling between the lower and upper atmosphere, combined with loss of gas from the upper atmosphere to space, likely contributed to the thin, cold, dry atmosphere of modern Mars. To help understand ongoing ion loss to space, the Mars Atmosphere and Volatile Evolution (MAVEN) spacecraft made comprehensive measurements of the Mars upper atmosphere, ionosphere, and interactions with the Sun and solar wind during an interplanetary coronal mass ejection impact in March 2015. Responses include changes in the bow shock and magnetosheath, formation of widespread diffuse aurora, and enhancement of pick-up ions. Observations and models both show an enhancement in escape rate of ions to space during the event. Ion loss during solar events early in Mars history may have been a major contributor to the long-term evolution of the Mars atmosphere.

Early MAVEN Deep Dip campaign reveals thermosphere and ionosphere variability

The Mars Atmosphere and Volatile Evolution (MAVEN) mission, during the second of its Deep Dip campaigns, made comprehensive measurements of martian thermosphere and ionosphere composition, structure, and variability at altitudes down to ~130 kilometers in the subsolar region. This altitude range contains the diffusively separated upper atmosphere just above the well-mixed atmosphere, the layer of peak extreme ultraviolet heating and primary reservoir for atmospheric escape. In situ measurements of the upper atmosphere reveal previously unmeasured populations of neutral and charged particles, the homopause altitude at approximately 130 kilometers, and an unexpected level of variability both on an orbit-to-orbit basis and within individual orbits. These observations help constrain volatile escape processes controlled by thermosphere and ionosphere structure and variability.

Obesity and iron deficiency: a quantitative meta-analysis

Hypoferraemia (i.e. iron deficiency) was initially reported among obese individuals several decades ago; however, whether obesity and iron deficiency are correlated remains unclear. Here, we evaluated the putative association between obesity and iron deficiency by assessing the concentration of haematological iron markers and the risks associated with iron deficiency in both obese (including overweight) subjects and non-overweight participants. We performed a systematic search in the databases PubMed and Embase for relevant research articles published through December 2014. A total of 26 cross-sectional and case-control studies were analysed, comprising 13,393 overweight/obese individuals and 26,621 non-overweight participants. Weighted or standardized mean differences of blood iron markers and odds ratio (OR) of iron deficiency were compared between the overweight/obese participants and the non-overweight participants using a random-effects model. Compared with the non-overweight participants, the overweight/obese participants had lower serum iron concentrations (weighted mean difference [WMD]: -8.37 μg dL(-1) ; 95% confidence interval [CI]: -11.38 to -5.36 μg dL(-1) ) and lower transferrin saturation percentages (WMD: 2.34%, 95% CI: -3.29% to -1.40%). Consistent with this finding, the overweight/obese participants had a significantly increased risk of iron deficiency (OR: 1.31; 95% CI: 1.01-1.68). Moreover, subgroup analyses revealed that the method used to diagnose iron deficiency can have a critical effect on the results of the association test; specifically, we found a significant correlation between iron deficiency and obesity in studies without a ferritin-based diagnosis, but not in studies that used a ferritin-based diagnosis. Based upon these findings, we concluded that obesity is significantly associated with iron deficiency, and we recommend early monitoring and treatment of iron deficiency in overweight and obese individuals. Future longitudinal studies will help to test whether causal relationship exists between obesity and iron deficiency.

Observation of a Neutral Structure near the DD[over ¯]^{*} Mass Threshold in e^{+}e^{-}→(DD[over ¯]^{*})^{0}π^{0} at sqrt[s]=4.226 and 4.257 GeV

A neutral structure in the DD[over ¯]^{*} system around the DD[over ¯]^{*} mass threshold is observed with a statistical significance greater than 10σ in the processes e^{+}e^{-}→D^{+}D^{*-}π^{0}+c.c. and e^{+}e^{-}→D^{0}D[over ¯]^{*0}π^{0}+c.c. at sqrt[s]=4.226 and 4.257 GeV in the BESIII experiment. The structure is denoted as Z_{c}(3885)^{0}. Assuming the presence of a resonance, its pole mass and width are determined to be [3885.7_{-5.7}^{+4.3}(stat)±8.4(syst)]  MeV/c^{2} and [35_{-12}^{+11}(stat)±15(syst)]  MeV, respectively. The Born cross sections are measured to be σ[e^{+}e^{-}→Z_{c}(3885)^{0}π^{0},Z_{c}(3885)^{0}→DD[over ¯]^{*}]=[77±13(stat)±17(syst)]  pb at 4.226 GeV and [47±9(stat)±10(syst)]  pb at 4.257 GeV. The ratio of decay rates B[Z_{c}(3885)^{0}→D^{+}D^{*-}+c.c.]/B[Z_{c}(3885)^{0}→D^{0}D[over ¯]^{*0}+c.c.] is determined to be 0.96±0.18(stat)±0.12(syst), consistent with no isospin violation in the process, Z_{c}(3885)^{0}→DD[over ¯]^{*}.

Measurement of the Absolute Branching Fraction for Λ_{c}^{+}→Λe^{+}ν_{e}

We report the first measurement of the absolute branching fraction for Λ_{c}^{+}→Λe^{+}ν_{e}. This measurement is based on 567  pb^{-1} of e^{+}e^{-} annihilation data produced at sqrt[s]=4.599  GeV, which is just above the Λ_{c}^{+}Λ[over ¯]_{c}^{-} threshold. The data were collected with the BESIII detector at the BEPCII storage rings. The branching fraction is determined to be B(Λ_{c}^{+}→Λe^{+}ν_{e})=[3.63±0.38(stat)±0.20(syst)]%, representing a significant improvement in precision over the current indirect determination. As the branching fraction for Λ_{c}^{+}→Λe^{+}ν_{e} is the benchmark for those of other Λ_{c}^{+} semileptonic channels, our result provides a unique test of different theoretical models, which is the most stringent to date.

c-MYC responds to glucose deprivation in a cell-type-dependent manner

Metabolic reprogramming supports cancer cells’ demands for rapid proliferation and growth. Previous work shows that oncogenes, such as MYC, hypoxia-inducible factor 1 (HIF1), have a central role in driving metabolic reprogramming. A lot of metabolic enzymes, which are deregulated in most cancer cells, are the targets of these oncogenes. However, whether metabolic change affects these oncogenes is still unclear. Here we show that glucose deprivation (GD) affects c-MYC protein levels in a cell-type-dependent manner regardless of P53 mutation status. GD dephosphorylates and then decreases c-MYC protein stability through PI3K signaling pathway in HeLa cells, but not in MDA-MB-231 cells. Role of c-MYC in sensitivity of GD also varies with cell types. c-MYC-mediated glutamine metabolism partially improves the sensitivity of GD in MDA-MB-231 cells. Our results reveal that the heterogeneity of cancer cells in response to metabolic stress should be considered in metabolic therapy for cancer.

Role of MK2 signaling pathway in the chronic compression of cervical spinal cord

OBJECTIVE

In this study, chronic compression of cervical spinal cord was introduced into twy/twy mice and the role of MK2 signaling pathway was investigated in this disease.

METHODS

twy/twy mice aged 6-24 weeks were used and the inflammatory response in the cervical spinal cord was observed. The Institute of Cancer Research (ICR) mice were used as controls. MK2 inhibitor (PF-3644022, 30 mg/kg) was administered intragastrically to twy/twy mice. The motor behavior was firstly observed in these three groups by Catwalk gait analysis. And the cervical spinal cord between C2 and C3 of vertebral segments was analyzed by MRI and Western blot assay.

RESULTS

The stride length of paws and interlimb coordination reduced in twy/twy mice. However, at 4 weeks after PF-3644022 treatment, a marked improvement was observed in the motor function. The expressions of inflammation related factors (such as IL-1β, NF-κB, TNF-α, MK2 and p-MK2) and apoptosis related proteins (such as cleaved caspase-8 and bax/bcl-2) in the spinal cord of twy/twy mice significantly increased as compared to controls, but 4-week treatment with PF-3644022 markedly reduced the expressions of these factors and apoptotic proteins in the cervical spinal cord.

CONCLUSION

MK2 signaling pathway is involved in the chronic compression induced inflammation of the cervical spinal cord. Thus, to inhibit the MK2 pathway may used to improve the outcome and prevent the deterioration of neurological dysfunction.

Observation of a Neutral Charmoniumlike State Z_{c}(4025)^{0} in e^{+}e^{-}→(D^{*}D[over ¯]^{*})^{0}π^{0}

We report a study of the process e^{+}e^{-}→(D^{*}D[over ¯]^{*})^{0}π^{0} using e^{+}e^{-} collision data samples with integrated luminosities of 1092 pb^{-1} at sqrt[s]=4.23 GeV and 826 pb^{-1} at sqrt[s]=4.26 GeV collected with the BESIII detector at the BEPCII storage ring. We observe a new neutral structure near the (D^{*}D[over ¯]^{*})^{0} mass threshold in the π^{0} recoil mass spectrum, which we denote as Z_{c}(4025)^{0}. Assuming a Breit-Wigner line shape, its pole mass and pole width are determined to be (4025.5_{-4.7}^{+2.0}±3.1) MeV/c^{2} and (23.0±6.0±1.0) MeV, respectively. The Born cross sections of e^{+}e^{-}→Z_{c}(4025)^{0}π^{0}→(D^{*}D[over ¯]^{*})^{0}π^{0} are measured to be (61.6±8.2±9.0) pb at sqrt[s]=4.23 GeV and (43.4±8.0±5.4) pb at sqrt[s]=4.26 GeV. The first uncertainties are statistical and the second are systematic.

Inhibition of Drp1 by Mdivi-1 attenuates cerebral ischemic injury via inhibition of the mitochondria-dependent apoptotic pathway after cardiac arrest

Mitochondrial fission is predominantly controlled by the activity of dynamin-related protein1 (Drp1), which has been reported to be involved in mitochondria apoptosis pathways. However, the role of Drp1 in a rat model of cardiac arrest remains unknown. In this study, we found that activation of Drp1 in the mitochondria was increased after cardiac arrest and inhibition of Drp1 by 1.2 mg/kg of mitochondrial division inhibitor-1 (Mdivi-1) administration after the restoration of spontaneous circulation (ROSC) significantly protected against cerebral ischemic injury, shown by the increased 72-h survival rate and improved neurological function. Moreover, the increase of the vital neuron and the reduction of cytochrome c (CytC) release, apoptosis-inducing factor (AIF) translocation and caspase-3 activation in the brain indicate that this protection might result from the suppression of neuron apoptosis. Altogether, these results indicated that Drp1 is activated after cardiac arrest and the inhibition of Drp1 is protective against cerebral ischemic injury in a rat of cardiac arrest model via inhibition of the mitochondrial apoptosis pathway.

Anterior Lumbar Interbody Fusion for Degenerative Discogenic Low Back Pain: Evaluation of L4-S1 Fusion

The treatment of degenerative discogenic pain is controversial, and anterior lumbar fusion for the treatment of degenerative discogenic low back pain has also been a controversial topic for over a generation.The aim of this systematic review was to evaluate the outcome of different anterior lumbar fusion levels for degenerative discogenic low back pain.In this study, we performed a clinical outcome subgroup analysis. The outcomes of 84 consecutive patients who underwent anterior lumbar interbody fusion from 2004 to 2009 were reviewed. The operative time, intraoperative blood loss, hospital stay, Oswestry Disability Index (ODI), visual analog scale (VAS) results, and complication rate were recorded separately.Medical indications were degenerative disc disease (73.8%), postdiscectomy disc disease (16.1%), and disc herniation (9.5%). Patients with severe spondylolysis or disc degeneration, with more than 3 or multilevel lesions, were excluded.The mean operative time was 124.5 ± 10.9 min (range 51-248 min), the mean intraoperative blood loss was 242.1 ± 27.7 mL (range 50-2700 mL), the mean hospital stay was 3.9 ± 1.1 days (range 3-6 days), the mean preoperative VAS score was 7.5 ± 1.4, and the mean preoperative ODI score was 60.0 ± 5.7. At the 1-year follow-up, the mean postoperative VAS score was 3.3 ± 1.3 and the mean postoperative ODI score was 13.6 ± 3.4 (P < 0.05). L4-L5 disc fusion led to better clinical results than 2-level L4-L5/L5-S1 disc fusion. Additionally, the 2-level fusion of L4-L5/L5-S1 had better clinical results than the L5-S1 disc fusion at both the 1 and 2-year postoperative follow-ups regarding the VAS score and the ODI score. The rate of complications was more frequent in the 2-level L4-L5/L5-S1 group (27.3%) (group C) than in the L4-L5 group (9.1%) (group A) and the L5-S1 group (12.5%) (group B). There was no difference between the L4-L5 group (9.1%) and the L5-S1 group (12.5%). A venous tear occurred during surgery and was successfully repaired in 6 of the 84 patients. Also, out of the 84 patients, 6 were found with pseudarthrosis during the follow-up, and these patients underwent a spinal fusion with instrumentation, with a posterior approach after a mean of 1 year. The complications secondary to the surgical approach were persistent abdominal pain (1/84, 1.2%) and wound dehiscence (1/84, 1.2%).Anterior lumbar interbody fusion for L4-L5 had better clinical results than the 2-segmental L4-L5/L5-S1 disc fusion, and the 2-segmental L4-L5/L5-S1 disc fusion had better clinical results than the L5-S1 disc fusion. Also, the 2-segmental L4-L5/L5-S1 disc fusion had a higher complication rate (27.3%), but there was no difference between the L4-L5 group (9.1%) and the L5-S1 group (12.5%).

Intravertebral clefts in osteoporotic compression fractures of the spine: incidence, characteristics, and therapeutic efficacy

OBJECTIVE

To determine the pathogenesis and characteristics and to assess the long-term effectiveness of polymethylmethacry late (PMMA) vertebroplasty treatment in patients with intravertebral cleft (IVC) in osteoporotic compression fractures.

METHODS

A retrospective analysis of radiological and clinical parameters was performed on 388 patients who underwent percutaneous vertebroplasty or kyphoplasty to treat osteoporotic compression fractures from January 2010 to October 2012. IVC sign was observed in the MRI of 47 patients. Postoperative follow-ups were conducted for at least 2 years after surgery.

RESULTS

IVC incidence was associated with older age and lower bone mineral density. Other baseline measurements, such as preoperative visual analogue scale and Oswestry Disability Index (ODI), showed no significant difference between IVC and non-IVC fracture patients. Vertebral height and kyphotic angle were corrected after percutaneous vertebroplasty or kyphoplasty with no significant difference in outcome between the two procedures. Restored vertebral height collapsed and the kyphotic angle became aggravated during the 2 years following surgery in patients with IVC. Similarly, initial improvements in visual analogue scale and ODI decreased over time. Non-IVC patients' had a slight recurrence of compression and kyphosis that began to normalize after 1 year. Visual analogue scale and ODI at 2 years' post-surgery was also significantly lower in non-IVC than IVC patients.

CONCLUSION

Polymethylmethacrylate vertebroplasty treatment of osteoporotic compression fractures is initially effective for patients with signs of IVC, but compression and kyphosis gradually reoccur. Therefore, we strongly recommend strict observation and follow-up after vertebroplasty.