An Insight into the Prospects and Drawbacks of Stem Cell Therapy for Spinal Cord Injuries: Ongoing Trials and Future Directions

Spinal cord injury (SCI) is a devastating neurological disorder that has a substantial detrimental impact on a person's quality of life. The estimated global incidence of SCI is 40 to 80 cases per million people and around 90% of cases are traumatic. Various etiologies can be recognized for SCI, and post-traumatic SCI represents the most common of these. Patients worldwide with SCI suffer from a persistent loss of motor and sensory function, which affects every aspect of their personal and social lives. Given the lack of effective treatments, many efforts have been made to seek a cure for this condition. In recent years, thanks to their ability to regenerate tissue and repair lost or damaged cells, much attention has been directed toward the use of stem cells (embryonic, induced pluripotent, mesenchymal, hematopoietic), aimed at restoring the functional integrity of the damaged spinal cord and improving a functional recovery including sensory and motor function. In this paper, we offer an overview of the benefits and drawbacks of stem cell therapy for SCI based on clinical evidence. This report also addresses the characteristics of various stem cell treatments, as well as the field's likely future. Each cell type targets specific pathological characteristics associated with SCI and demonstrates therapeutic effects via cell replacement, nutritional support, scaffolds, and immunomodulation pathways. SCI accompanied by complex pathological processes cannot be resolved by single treatment measures. Stem cells are associated with the adjustment of the expression of neurotrophic factors that help to achieve better nutrition to damaged tissue. Single-cell treatments have been shown in some studies to provide very minor benefits for SCI in multiple preclinical studies and a growing number of clinical trials. However, SCI damage is complex, and many studies are increasingly recognizing a combination approach such as physical therapy, electrical stimulation, or medication therapy to treatment.

Key supply chain strategies for the post-COVID-19 era: implications for resilience and sustainability

Purpose

The impacts of the novel coronavirus (COVID-19) outbreak continue to devastate supply chain operations. To attain a competitive advantage in the post-COVID-19 era, decision-makers should explore key supply chain strategies to move forward and ready their policies to be implemented when the crisis sufficiently subsides. This is a significant and practical decision-making issue for any supply chain; hence, the purpose of this study is to explore and analyse key supply chain strategies to ensure robustness and resilience in the post-COVID-19 era.

Design/methodology/approach

This study conducted an expert survey targeting practitioners and academics to explore key supply chain strategies as means of moving forward in the post-COVID-19 era. Further, the key strategies were quantitatively analysed by applying the best-worst method (BWM) to determine their priority importance in the context of the manufacturing sector.

Findings

The results revealed that supply chain resilience and sustainability practices could play a dominant role in this period. The findings of the study can assist supply chain decision-makers in their formulations of key strategies.

Originality/value

This is the first study to investigate key supply chain strategies for the post-COVID-19 era. This study will help practitioners paying attention to resilience and sustainability practices for managing the impacts of future large-scale disruptions.

Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Background:

Recurrent lumbar disc herniation (RLDH) is one of the major causes for failure of primary surgery. The optimal surgical treatment of RLDH remains controversial.

Aim:

Retrospectively, we evaluate 135 patients and compare the clinical outcomes between fusion and nonfusion treatment of RLDH.

Methods:

Records of 75 men and 35 women aged 28–60 years for conventional revision discectomy alone (nonfusion) and 15 men and 10 women aged 30–65 years for revision discectomy with transforaminal lumbar interbody fusion (TLIF) and transpedicular screw fixation (fusion) were reviewed. Demographics, surgical data, and complications were collected and pre- and postoperative assessment were done by the Visual Analogue Scale (VAS) scale and Japanese Orthopaedic Association (JOA) score. The results after surgery were assessed according to the recovery rate as excellent, good, fair, and poor.

Results:

The mean follow-up period was 28.8 and 24.6 months in Group A (nonfusion) and Group B (fusion group), respectively. The preoperative data between both the groups showed no statistically significant difference. The postoperative mean VAS and JAO scores, recovery rate, and satisfaction rate showed no statistically significant difference except postoperative low back pain and occasional radicular pain and neurological deficit in nonfusion group which was significantly higher than that of fusion group. In comparison to fusion group, nonfusion group required significantly less operative time, less intraoperative blood loss, less postoperative hospital stay, no blood transfusion, and less total cost of the procedure. Satisfaction rate was 80% and 88% in nonfusion and fusion groups, respectively.

Conclusions:

Both convention revision discectomy (nonfusion) and discectomy with instrumented fusion (TLIF) surgery are effective in patients with RLDH.

Diagnosis and treatment of noncommunicating extradural spinal thoracolumbar arachnoid cyst

Background:

Noncommunicating extradural spinal arachnoid cysts are extremely rare. They are believed to arise from congenital defects in the dura mater and become enlarged as a consequence of increased cerebro-spinal fluid (CSF) pressure within the subarachnoid space. Most retain a communicating pedicle through which the extradural cyst maintains connection with the subarachnoid space, and only rarely does this communication become sealed. The optimal treatment consists of complete surgical removal of the cyst with ligation of the communicating pedicle.

Case Description:

A 29-year-old male presented with a progressive spastic paraparesis of 6 months’ duration. The MRI showed a circumscribed intradural extramedullary cystic lesion located from D11-L2. Notably, peroperatively, the cyst appeared to be entirely extradural, without a communicating intradural pedicle. Further, no CSF leak was observed even after Valsalva maneuvers. Following surgical extirpation of the cyst, the patient sustained an uneventful recovery within 1 postoperative month.

Conclusion:

Noncommunicating extradural arachnoid cysts are extremely rare causes of spinal cord compression and should be fully excised.

Conservative versus operative management of postoperative lumbar discitis

Background:

Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis.

Aim:

The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy.

Methods:

We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis.

Results:

VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t-test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up.

Conclusions:

Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.

Investigation of the challenges of implementing social sustainability initiatives: a case study of the apparel industry

Purpose

Introducing social sustainability initiatives in the apparel industry is a complex and challenging process. This study aims to investigate the challenges facing Bangladesh apparel supplier organisations in implementing factory safety initiatives.

Design/methodology/approach

This study identifies challenges of implementing social sustainability initiatives of the apparel industry based on a literature review and case-study interviews with senior-level management of apparel supplier organisations.

Findings

The analysis shows significant challenges facing apparel supplier organisations in implementing social sustainability initiatives relate to resource and institutional issues. These challenges are resource management and strategy, cost and financial concerns, as well as cultural, regulation and monitoring issues.

Practical implications

The identified challenges may be useful for policymakers and managers of apparel buyer and supplier organisations to recognise critical issues involved in social initiative implementation and to help improve social sustainability practices of the apparel industry.

Social implications

By addressing the identified issues, stakeholders in the apparel industry can work to ensure improved social sustainability practices in apparel manufacturing factories.

Originality/value

The study contributes to the research on social sustainability practices of the apparel industry by identifying and addressing challenges faced by apparel supplier organisations in implementing social sustainability initiatives in apparel manufacturing factories.

Exploring the critical determinants of environmentally oriented public procurement using the DEMATEL method

This study explores the critical determinants of environmentally oriented public procurement in Singapore, and investigates the causal relationships among the determinants that influence this procurement. Using the extant literature and basing our examination on natural-resource-based theory, we develop a conceptual framework for the implementation of environmentally oriented public procurement using three high-level dimensions and ten determinants. Sixteen interviews were conducted with 16 senior executives working in various ministries and statutory boards in Singapore who are closely involved in the public-procurement process. The decision-making trial and evaluation laboratory (DEMATEL) method, which is a multicriteria decision-making tool, is employed to analyse the interview data and information. The results of the analysis reveal that the two most critical determinants for environmentally oriented public procurement in Singapore are energy-efficiency strategy and environmental standards. These two determinants were also found to be the primary drivers of the implementation of environmentally oriented public procurement in Singapore. Through further analysis using the level of influence, a cognition map is developed to illustrate the relationships among the ten determinants. Understanding the dynamic nature of public procurement through these causal relationships is essential for the formulation of environmentally oriented public procurement implementation strategies.

Single-stage posterior instrumentation for progressive tubercular thoracic and thoracolumbar kyphosis

PURPOSE

To review the outcome of single-stage posterior instrumentation for progressive tubercular thoracic and thoracolumbar kyphosis in 45 patients.

METHODS

Records of 16 men and 29 women aged 20 to 59 (mean, 34.1) years who underwent single-stage posterior instrumentation for active thoracic (n=27) or thoracolumbar (n=18) tuberculosis by a single surgeon and were followed up for a minimum of 5 years were reviewed. Neurological status was evaluated using the Frankel grading system. Pain was assessed using the visual analogue score (VAS). Disability status was assessed using the Oswestry Disability Index (ODI). Outcome was graded according to the Kim and Lee criteria. Kyphosis at presentation, preoperation (after one month of conservative therapy), immediate postoperation, and 5-year follow-up was measured on radiographs to determine the kyphosis progression, correction of deformity, postoperative loss of correction, and residual deformity.

RESULTS

Respectively for 27 and 18 patients with thoracic or thoracolumbar involvement, at 5 years the mean VAS score improved from 5.5 to 1.9 (p<0.001) and from 6.8 to 1.5 (p<0.001), whereas the mean ODI improved from 60.8 to 11.7 (p<0.001) and from 57.5 to 7.6 (p<0.001). The outcome was excellent in 17 and 11, good in 7 and 5, and fair in 3 and 2 patients, respectively. The mean kyphosis progression from presentation to preoperation was from 20.2º to 26.2º and from 10.3º to 14.1º, respectively, whereas the corresponding mean predicted kyphosis progression was from 15.5º to 48.1º and from 13.8º to 50.4º. The respective mean correction of deformity was -8.1º and -8.5º; the respective mean residual deformity was 4.1º and 6.8º; and the respective mean loss of correction at 5 years was 1.9 and 1.9. Two patients had a dural tear, and 3 patients had a transient root injury. Two diabetic patients had superficial wound infection. One patient had downward migration of one rod at 30 months but remained asymptomatic.

CONCLUSION

Single-stage posterior instrumentation combined with continued chemotherapy for a minimum 12 months is a viable option for early progressive thoracic and thoracolumbar tubercular kyphosis.

An investigation into critical service determinants of customer to business (C2B) type product returns in retail firms

Purpose

– In spite of regular occurrence of product returns, research into determinants of returns services in retail businesses is still limited. To fill the gap, the purpose of this paper is to investigate critical determinants of customer to business type product returns services in the retail industry.

Design/methodology/approach

– The authors develop a framework of product returns services that consists of three major service categories and 16 returns service determinants. The criticality of the determinants of product returns management are assessed employing the analytic hierarchy process (AHP) based multi-criteria decision-making approach. Under AHP set up the authors interview retail operations managers of major retail firms in Australia to identify critical determinants of product returns services.

Findings

– Results indicate that the most important returns services dimensions are the way in which returns services are handled through interaction, and the outcome of service delivery. The top five critical service determinants of product returns are related to: communication support service for customer, money back for any type of returns, customer support access, user-friendly interaction, and product replacement.

Originality/value

– The findings of the study can be considered by senior managers of retail firms as a reference guide for designing efficient and effective returns service systems and developing strategies for competitive advantage through product returns, namely, customer retention.

Priapism of the Newborn - A Case Report

Neonatal Priapism is a rare condition and its causes differ from that in childhood and adult. Management also is challenging as the ultimate goal is the preservation of normal erectile function. Most of the cases are idiopathic. A spontaneous detumescence occurs in majority of cases, so initially conservative non-surgical treatment is advocated. Here we report a case of a newborn presenting with priapism on the 1st day of life. Detumescence was achieved on the 8th day of life with conservative treatment.

Recruiting Project Managers: A Comparative Analysis of Competencies and Recruitment Signals from Job Advertisements

This research addresses the competencies organizations use through project manager job advertisements. We develop a list of project manager job competencies; break down the competency components into knowledge, skills, and abilities; and conduct a comparative analysis of the use of these competencies. We examine the online contents of project manager job advertisements in the public domain. Analysis shows that industry job advertisements emphasize “soft skills” and competencies in a manner different than that in the literature. Additionally, differences are found across countries and between industries. Implications from the findings highlight the incongruent dissemination of project manager competencies, regional and industrial demands, and the recruitment of project managers.

Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability

BACKGROUND

Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011.

MATERIALS AND METHODS

Review of the records of 102 operated cases of lumbar instability with minimum 1 year followup was done. A total of 52 cases (11 men and 41 women, mean age 46 years SD 05.88, range 40-59 years) underwent PLIF and 50 cases (14 men and 36 women, mean age 49 years SD 06.88, range 40-59 years) underwent TLIF. The surgical time, duration of hospital stay, intraoperative blood loss were compared. Self-evaluated low back pain and leg pain status (using Visual Analog Score), disability outcome (using Oswestry disability questionnaire) was analyzed. Radiological structural restoration (e.g., disc height, foraminal height, lordotic angle, and slip reduction), stability (using Posner criteria), fusion (using Hackenberg criteria), and overall functional outcome (using MacNab's criteria) were compared.

RESULTS

Pain, disability, neurology, and overall functional status were significantly improved in both groups but PLIF required more operative time and caused more blood loss. Postoperative hospital stay, structural restoration, stability, and fusion had no significant difference but neural complications were relatively more with PLIF.

CONCLUSIONS

Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.

Discectomy for primary and recurrent prolapse of lumbar intervertebral discs

PURPOSE

To reviewed 416 patients who underwent discectomy for primary or recurrent prolapse of lumbar intervertebral discs (PLID).

METHODS

Records of 296 men and 102 women aged 19 to 60 (mean, 39) years who underwent discectomy for a primary PLID, and 14 men and 4 women aged 28 to 50 (mean, 40) years who underwent revision discectomy for a recurrent ipsilateral (n=14) or contralateral (n=4) PLID at L4-5 (n=14), L5-S1 (n=3), or L3-4 (n=1) were reviewed. The pain-free interval, side and degree of herniation, operating time, length of hospital stay, and pre- and post-operative visual analogue score (VAS) for pain were recorded. Clinical outcomes were evaluated using the modified Macnab criteria and the Oswestry Disability Index.

RESULTS

Patients were followed up for one to 4 years. The mean operating time was significantly longer in revision discectomy (65 vs. 141 minutes, p<0.001, unpaired t-test). There was no significant difference between revision and primary discectomy in terms of length of hospital stay or clinical improvement rates. Age, gender, smoking, profession, level and extent of herniation, and pain-free interval did not affect clinical outcomes. In the 18 revision cases, the mean pain-free interval until recurrence was 31 (range, 1-42) months. At the one-year follow-up, results were excellent in 8, good in 6, fair in 3, and poor in one. Three of the patients had persistent pain despite taking analgesics. 14 of the patients had returned to their normal daily activities. Complications included foot drop (n=1), dural tear (n=3), and superficial wound infection (n=1).

CONCLUSION

Discectomy achieved satisfactory results for both primary and recurrent PLIDs.

Operational Performance Analysis of a Public Hospital Laboratory

Efficient utilization of scarce resources is an issue for any healthcare system. In developing countries, proper tools, techniques, and resources must be widely used in healthcare operational planning. Considering the necessity of effective resource planning, this study focuses on the rural healthcare system of Bangladesh and concentrates on the sub-district government hospital laboratory. The authors’ determine possible ways to improve operations of laboratory facilities. To analyze existing system efficiency, sample laboratory data is fed into a simulation model. This paper identifies several possible ways for future expansion and suggests using simulation for better planning and analysis.

Treatment of cervical disc prolapse by anterior cervical discectomy fusion and stabilization with plating

Different types of surgical techniques are used for effective treatment of cervical disc prolapse. Techniques with fusion without stabilization have some disadvantages like collapse of the graft, extrusion of graft, nonunion and recurrence of symptoms. We have carried out this prospective interventional study between March 2001 to November 2007 on 129 cases of cervical disc prolapse treated with anterior cervical discectomy, fusion & stabilization with plating at IBN SINA Hospital, Dhanmondi, Dhaka, Al-Manar Hospital, Lalmatia and Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka. There were 106(82.17%) male and 23(17.82%) female patients. The commonest age group of the patients was 4th decade. The commonest level of disc prolapse was found in C5/6 level and in each case, diagnosis was made on the basis of clinical findings, plain X-ray and MRI of cervical spine. We performed anterior cervical discectomy, fusion and stabilization with plating in all cases. A per-operative marking film was taken in each case to identify proper level. Per-operative undue hemorrhage from donor site occurred in 1 case, 27 patients complained of dysphagia temporarily, 64 patients complained of donor site pain significantly which was relieved within 3-6 months of follow-up period. Donor site infection was found in 1 patient. The post operative follow-up period was 3 months to 6 years. The functional out come obtained excellent in 71.43%, good in 19.64%, fair in 8.93%, poor in 2.32% in this series.

Sexually transmitted infections prevalence rates in slum communities of Dhaka, Bangladesh

The study objective was to estimate the prevalence of selected sexually transmitted infections (STIs) and associated factors among Dhaka slum dwellers. Blood and urine specimens were collected from 1534 men and women. Participants in this cross-sectional study responded to a questionnaire, providing socioeconomic data, symptomatology and treatment-seeking behaviour. Specimens were tested for syphilis, hepatitis B (HBsAg), Neisseria gonorrhoeae, Chlamydia trachomatis, and HIV. Serologic evidence of syphilis infection was found in 6.0% of respondents, HBsAg in 3.8%. Prevalence rates of gonorrhoea and chlamydia were 1.7% and <1%, respectively. No HIV infections were found. Men were more than twice as likely as women to be infected with syphilis or HBsAg carriers. Behaviours facilitating STI transmission were common among men. Syphilis infection is prevalent enough to warrant the initiation of screening programmes in this population. The prevalence rate of hepatitis B carriage suggests that this population would benefit from universal vaccination against hepatitis B.

Intramolecular addition of acyl radicals to alpha-substituted vinylogous carbonates: demonstrating the effect of ring size on acyclic stereocontrol

The level of stereocontrol obtained in the reduction of the free radical derived from the intramolecular addition of an acyl radical to an alpha-branched vinylogous carbonate is dependent upon the ring-size of the cyclic ether.

Clostridium difficile colitis associated with treatment of Helicobacter pylori infection

Helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. This is likely to result in an increase in complications such as antibiotic-associated diarrhea. However, there is no literature on the incidence of such diarrhea, particularly Clostridium difficile colitis, in patients treated for Helicobacter pylori infection. We report the case of a patient who developed Clostridium difficile colitis after treatment for Helicobacter pylori infection with metronidazole, amoxicillin, H2 blockers, and bismuth subsalicylate. This patient presented with severe diarrhea that responded to a course of metronidazole with rapid disappearance of symptoms. The incidence of Clostridium difficile colitis in patients treated for Helicobacter pylori infection has not been studied. This unique association, although not unexpected, has not yet been reported in the literature. The increasing number of patients being diagnosed and treated for this infection requires a heightened awareness on the part of physicians, to assure early diagnosis and treatment of this treatable, yet potentially dangerous, complication.

Psoriatic arthritis associated with dilated cardiomyopathy and Takayasu's arteritis

A 40-year-old Japanese man with psoriatic arthritis (PA) involving the spine, sacroiliac and peripheral joints presented with dyspnoea and ankle oedema. Blood pressure was 180/110 and 114/80 mmHg in the right and left upper arms, respectively. Examinations showed left ventricular dilatation and diffuse hypokinesis of the left ventricle, with no involvement of the coronary arteries. Aortography detected total occlusion of the left subclavian artery and stenosis of the origin at the right renal artery. Dilated cardiomyopathy and Takayasu's arteritis associated with PA was diagnosed. A few cases of PA have been reported in association with cardiovascular diseases, but the association of these three diseases has not been documented in the literature to date. Dermatologists need to be aware of cardiovascular manifestations in patients with PA, because cardiovascular diseases are not rare in other seronegative spondyloarthropathies.

Mutations of the INK4a locus in squamous cell carcinomas of human skin

The INK4a locus encodes two different, cell cycle-regulating proteins, p16INK4a and p19ARF. In this study, we screened mutations in all coding regions of the INK4a locus (exons 1 beta, 1 alpha, 2, and 3) in 21 squamous cell carcinomas (SCCs) of human skin by polymerase chain reaction-single strand conformation polymorphism analysis. Mutations were detected in 3 SCCs in exon 2, which is common to both p16INK4a and p19ARF. These included an in-frame deletion of 21 base pairs from codon 84 to 90, a frameshift mutation of CCC-->TC at codon 75, and a nonsense mutation of CGA-->TGA at codon 80 of the p16INK4a gene. These results suggest that inactivation of the INK4a locus has some relevance to the carcinogenesis in at least some of SCCs of human skin. This is the first demonstration of aberrations in the INK4a locus in SCCs of human skin.

Color analysis of nevus of Ota for evaluation of treatment with a Q-switched alexandrite laser

BACKGROUND/AIMS

The Q-switched alexandrite laser shows excellent results in treating nevi of Ota. This study sought to examine the utility of color monitoring of the lesion for quantifying the efficacy of laser treatment.

METHODS

Lesion images were obtained from 12 patients using a video microscope before and after a series of laser treatments. The RGB color data in a 50 mm(2) area of the images were converted into coordinates of three color systems and compared with clinical evaluation.

RESULTS

On three coordinates representing the brightness of skin color (the intensity, the L* and the melanin index), there were significant differences between data obtained before and after treatment (P<0.01), in accord with clinical impressions. Darker lesions tended to show more improvement. Coordinates based on chromaticity were less useful for evaluation of treatment.

CONCLUSIONS

Color analysis of nevi of Ota is useful for quantifying efficacy of laser treatment, especially when assessed in a small area of the lesion.

Squamous cell carcinoma associated with verruciform xanthoma of the penis

We report a case of squamous cell carcinoma of the penis that seemed to arise within a verruciform xanthoma of this organ. A lesion in the prepuce was initially diagnosed as a verruciform xanthoma histopathologically and was removed in part. Six years later, the patient exhibited a well-differentiated squamous cell carcinoma of the penis that contained many clusters of xanthoma cells in the stroma. Although the retrospective examination of biopsy specimens of the initial lesion in this patient showed the features mainly of verruciform xanthoma, significant architectural and cytological atypia was also present in the overlying epidermis. Thus, we must be careful not to overlook the presence of a squamous cell carcinoma arising within a benign reactive lesion such as a verruciform xanthoma.