Risk factors for spinal epidural hematoma after spinal surgery

STUDY DESIGN

A case-control retrospective analysis comparing patients who developed a postoperative spinal epidural hematoma with patients who did not develop this complication.

OBJECTIVES

To identify risk factors for the development of an epidural hematoma following spinal surgery.

SUMMARY OF BACKGROUND DATA

Neurologic deterioration following spinal surgery is a rare but devastating complication. Epidural hematomas should be suspected in the patient who demonstrates a new postoperative neurologic deficit. The risk factors that predispose a patient to a postoperative spinal epidural hematoma have not been identified.

METHODS

Patients who underwent spinal surgery at a single institution over a 10-year period were retrospectively reviewed. Twelve patients who demonstrated neurologic deterioration after surgery and required surgical decompression because of an epidural hematoma were identified. All cases involved lumber laminectomies. A total of 404 consecutive patients that underwent lumbar decompression and did not develop an epidural hematoma formed the control group. Factors postulated to increase the risk of postoperative spinal epidural hematoma were compared between the two groups using logistic regression.

RESULTS

Multilevel procedures (P = 0.037) and the presence of a preoperative coagulopathy (P < 0.001) were significant risk factors. Age, body mass index, perioperative durotomies, and postoperative drains were not statistically significant risk factors.

CONCLUSIONS

Patients who require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk for developing a postoperative epidural hematoma.

Analysis of models for determining intestinal wall permeabilities

In determining intestinal wall permeabilities, several mass transport models may be applied to analyze the results from external perfusion experiments. The appropriateness of any given model depends on the applicability of the model assumptions to the experimental system. This report compares several mass transport models with respect to their assumptions and applicability to a particular experimental design. The models are shown to differ in their assumptions regarding convection and diffusion in the perfusing fluid. However, since the wall permeability is an unknown parameter in each model and is estimated from the data, all of the models fit the mass transfer results reasonably well, despite fundamentally different assumptions. However, the determined permeabilities differ. Residence time distribution analysis of the experimental system is more sensitive to the model assumptions. It is shown that, in a particular experimental system, laminar flow in a cylindrical tube is the most appropriate model. The model also has the advantage of implicitly accounting for the convection-diffusion problem in the perfusing fluid. Hence, the diffusion layer thickness is not estimated from the data. With the hydrodynamics defined, the relative permeabilities resulting from the application of the several models to the data can be interpreted. The wall permeability determined in the suggested manner provides an estimate of the limiting assistance under perfect mixing conditions.

Anti-inflammatory activities of triterpenoid saponins from Polygala japonica

Bioassay-guided investigation was performed to identify the active constituents from a methanol extract of Polygala japonica, a folk medicinal plant widely used in China to treat inflammatory diseases. The n-BuOH and EtOAc fractions of the P. japonica methanol extract, which show significant anti-inflammatory activity in in vivo test, were further subjected to column chromatography to afford six triterpene glycosides, marked here as saponins 1-6. All compounds were evaluated for their anti-inflammatory activity in the carageenan-induced mouse paw edema test, and saponins 1, 4 and 5 showed significantly anti-inflammatory effects on both phases of carageenan-induced acute paw edema in mice. Saponin 5 was also found to significantly inhibit the production of inflammatory mediators - nitric oxide (NO) in LPS-stimulated RAW264.7 macrophages, with no obvious effects on macrophage viability.

Extracellular DNA traps released by acute promyelocytic leukemia cells through autophagy

Acute promyelocytic leukemia (APL) cells exhibit disrupted regulation of cell death and differentiation, and therefore the fate of these leukemic cells is unclear. Here, we provide the first evidence that a small percentage of APL cells undergo a novel cell death pathway by releasing extracellular DNA traps (ETs) in untreated patients. Both APL and NB4 cells stimulated with APL serum had nuclear budding of vesicles filled with chromatin that leaked to the extracellular space when nuclear and cell membranes ruptured. Using immunofluorescence, we found that NB4 cells undergoing ETosis extruded lattice-like structures with a DNA-histone backbone. During all-trans retinoic acid (ATRA)-induced cell differentiation, a subset of NB4 cells underwent ETosis at days 1 and 3 of treatment. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were significantly elevated at 3 days, and combined treatment with TNF-α and IL-6 stimulated NB4 cells to release ETs. Furthermore, inhibition of autophagy by pharmacological inhibitors or by small interfering RNA against Atg7 attenuated LC3 autophagy formation and significantly decreased ET generation. Our results identify a previously unrecognized mechanism for death in promyelocytes and suggest that ATRA may accelerate ET release through increased cytokines and autophagosome formation. Targeting this cellular death pathway in addition to conventional chemotherapy may provide new therapeutic modalities for APL.

Double photoionization of C(60) and C(70) in the valence region

Photoion yields from gaseous fullerenes, C(60) and C(70), for production of singly and doubly charged ions are measured by mass spectrometry combined with tunable synchrotron radiation at hnu=25-150 eV. Since the signal of triply or highly charged ions is very weak, the total photoionization yield curve can be estimated from the sum of the yields of the singly and doubly charged ions. A distinct feature appears in the resultant curve of C(60) which is absent in the calculated total photoabsorption cross section previously reported. This difference is attributed to C(60) (2+) ions chiefly produced by spectator Auger ionization of the shape resonance states followed by tunneling of the trapped electron or by cascade Auger ionization. Ratios between the yields of doubly and singly charged ions for C(60) and C(70) are larger than unity at hnu>50 eV. These ratios are quite different from those reported in the experiments using electron impact ionization.

Hierarchical Construction of Higher-Order Exceptional Points

The realization of higher-order exceptional points (HOEPs) can lead to orders of magnitude enhancement in light-matter interactions beyond the current fundamental limits. Unfortunately, implementing HOEPs in the existing schemes is a rather difficult task, due to the complexity and sensitivity to fabrication imperfections. Here we introduce a hierarchical approach for engineering photonic structures having HOEPs that are easier to build and more resilient to experimental uncertainties. We demonstrate our technique by an example that involves parity-time symmetric optical microring resonators with chiral coupling among the internal optical modes of each resonator. Interestingly, we find that the uniform coupling profile is not required to achieve HOEPs in this system-a feature that implies the emergence of HOEPs from disorder and provides resilience against some fabrication errors. Our results are confirmed by using full-wave simulations based on Maxwell's equation in realistic optical material systems.

Lot Consistency as an Equivalence Problem

One requirement for licensure of a vaccine in the United States is demonstration by the manufacturer of consistently produced lots of vaccine. Demonstration of consistency of manufacturing can be viewed as a multigroup equivalence problem. The standard statistical procedures for evaluating equivalence assume normally distributed data and define equivalence margins with respect to group means. As an alternative approach, we define a measure of the similarity among group distributions and their nonparametric estimators. Through computer simulations we explore the statistical properties of an equivalence test based on this estimator and compare them to the standard methods. Preliminary work suggests that a test of similarity can be useful in demonstrating equivalence when distributions are not normal or when there are differences in scale or shape. It appears to detect departures from equivalence that are not reflected by differences among group means.

Teaching safety: evaluation of a children's village in Maryland

OBJECTIVES

The purpose of this study was to evaluate Children's Village, a life safety education facility for children.

SETTING

The study took place in Washington County, Maryland, a rural county.

METHODS

Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program.

RESULTS

Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive.

CONCLUSIONS

Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs.

A method for the temperature calibration of an infrared camera using water as a radiative source

Presented here is an effective low-cost method for the temperature calibration of infrared cameras, for applications in the 0-100 degrees C range. The calibration of image gray level intensity to temperature is achieved by imaging an upwelling flow of water, the temperature of which is measured with a thermistor probe. The upwelling flow is created by a diffuser located below the water surface of a constant temperature water bath. The thermistor probe is kept immediately below the surface, and the distance from the diffuser outlet to the surface is adjusted so that the deformation of the water surface on account of the flow is small, yet the difference between the surface temperature seen by the camera and the bulk temperature measured by the thermistor is also small. The benefit of this method compared to typical calibration procedures is that, without sacrificing the quality of the calibration, relatively expensive commercial blackbodies are replaced by water as the radiative source (epsilon approximately 0.98 for the wavelengths considered here). A heat transfer analysis is provided, which improves the accuracy of the calibration method and also provides the user with guidance to further increases in accuracy of the method.

Expression profile of insulin-like growth factor system genes in muscle tissues during the postnatal development growth stage in ducks

Insulin-like growth factors (IGFs) are regulators that modulate the proliferation and differentiation of muscle tissues. We quantified the messenger RNA (mRNA) expression of IGF-I, IGF-II, and type I and II IGF receptors (IGF-IR and IGF-IIR) in muscle tissues including the breast, leg, and myocardium during an early postnatal development growth stage (post-hatching weeks 1-8) in ducks. The results showed a significant age-related change in mRNA in these muscle tissues. In breast muscle, the developmental expression of IGF-I and IGF-II was highest during week 1 but decreased quickly and maintained a relatively lower level. Leg muscle had the highest mRNA expression of IGF-I and IGF-II genes at week 3. In myocardial tissues, the expression level of IGF-IR and IGF-IIR genes exhibited a "rise-decline" developmental trend. The expression patterns of IGF-I/IGF-IR and IGF-II/IGF-IIR were different between weeks 4 and 6. The same expression pattern was observed for IGF-I and IGF-IR; however, it was different from that observed for IGF-II and IGF-IIR. Our results showed a negative correlation between IGF-II mRNA expression and leg muscle weight at week 4 (P < 0.05). A negative correlation was also found between IGF-II mRNA expression and breast muscle weight (P < 0.01), and a positive correlation was found between IGF-IR expression and breast muscle weight. At week 6, a positive correlation was found between IGF-IR expression and breast muscle weight. However, at week 8, a negative correlation was found between IGF-IR expression and breast muscle weight. The results showed that the expression of IGF mRNA in duck tissues exhibits a specific developmental trend and an age-related pattern, suggesting that the regulation mechanism of these 4 genes in proliferation and differentiation of muscle tissues differed.

A method for removing surfactants from an air/water interface

The study of heat, mass, and momentum transport across an air/water interface is an aspect of fluid mechanics where the presence of surfactant monolayers can play a significant role. Experimental studies of air/water transport typically require a method for cleaning the air/water interface so that it is free from any contaminating surfactant monolayer. This may be for the sake of running an experiment under clean surface conditions, or to clean the surface prior to deposition of a known surfactant. Herein a method is described for maintaining a clean air/water interface during conditions of finite air flow over the water surface. The unique aspect of this method is its ability to maintain clean surfaces while experiments are conducted.

Identification and Automated Delineation of Radioresistant Biological Tumor Volume in Nasopharyngeal Carcinoma Based on Magnetic Resonance Imaging Radiomics

PURPOSE/OBJECTIVE(S)

Widespread use of intensity modulated radiotherapy (IMRT) has improved the tumor control rate of nasopharyngeal carcinoma (NPC). However, nearly 20% of the patients with local-advanced NPC would relapse after precise irradiation and 80% of the recurrent lesions occur within the high dose field, suggesting that there are radiation-resistant cancer cell subsets within the tumor. In this context, identification and contouring of radiation resistance region of NPC for dose escalation at primary IMRT could be advantageous. In this work, we proposed a two-step radiomics workflow to predict local relapse and the recurrent region of NPC before primary IMRT.

MATERIALS/METHODS

In this single-center, retrospective study, pre-treatment magnetic resonance (MR) sequences of T1-weighted imaging (T1-w) and contrast-enhanced T1-weighted imaging (CET1-w) were collected from 800 patients of newly diagnosed and non-metastatic NPC between April 2009 and December 2015. The primary gross tumor volume (GTVp) of all patients and the actual recurrent lesion (GTVr) of patients who suffered from local recurrence were manually contoured for further analysis. A two-step complete radiomics workflow was designed to predict tumor recurrence and segment the region. First, least absolute shrinkage and selection operator (LASSO) was utilized for radiomics features selection of GTVp and support vector machine (SVM) was adopted to predict the recurrence. If the model predicts a recurrence, then the workflow utilizes an improved 3D U-Net to segment the recurrent region. Area under receiver operating characteristic curve (ROC-AUC) was used to evaluate the performance of tumor recurrence prediction, and Dice similarity coefficient (DSC) was used to assess the consistence between the actual and predicted GTVr.

RESULTS

Of 800 NPC patients, 95 (11.9%) patients developed in-field local recurrence. For recurrence risk prediction, the SVM ensemble model (T1-w+CET1-w) was selected for further application with higher sensitivity. The average ROC-AUC, specificity, sensitivity of the SVM ensemble model in a 5-fold cross-validation and in the independent test set of 160 patients were 0.922, 0.922, 0.777 and 0.928, 0.915, 0.737, respectively. Moreover, for recurrent region segmentation, the multi-modality (T1-w+CET1-w) model was superior to the single-modality (T1-w or CET1-w) model. In an independent test set of 15 patients, the DSC, sensitivity and 95% Hausdorff Distance between actual and predicted GTVr was 0.549±0.176, 0.696±0.118 and 9.813±4.788 which was superior to 0.444±0.188, 0.497±0.218 and 12.047±5.361 of original 3D U-Net.

CONCLUSION

The proposed two-step radiomics workflow showed a good performance in predicting tumor recurrence of NPC. The predicted location of the recurrence lesion was all accurate, but there was still a certain difference between the volume of the automated delineated and actual GTVr, which needed to be further optimized to be used as biological tumor volume.

Polarity-extended liquid chromatography-triple quadrupole mass spectrometry for simultaneous hydrophilic and hydrophobic metabolite analysis

Although various metabolomic methods have been reported in recent years, simultaneous detection of hydrophilic and hydrophobic metabolites in a single analysis remains a technical challenge. In this study, based on the combination of hydrophilic interaction liquid chromatography (HILIC) and reversed phase liquid chromatography (RPLC), an online two-dimensional liquid chromatography/triple quadrupole mass spectrometry method (2D-LC/TQMS) was developed for the simultaneous analysis of hydrophilic and hydrophobic metabolites of various biological samples. The method can measure 417 biologically important metabolites (e.g., amino acids and peptides, pyrimidines, purines, monosaccharides, fatty acids and conjugates, organic dicarboxylic acids, and others) with logP values ranging from -10.3 to 21.9. The metabolites are involved in a variety of metabolic pathways (e.g., purine metabolism, pyrimidine metabolism, tyrosine metabolism, galactose metabolism, gluconeogenesis, and TCA cycle). The developed method has good intra- and inter-day reproducibility (RSD of retention time <2%, RSD of peak area <30%), good linearity (R2 > 0.9) and wide linear range (from 0.0025 μg/mL to 5 μg/mL). The applicability of the method was tested using different biological samples (i.e., plasma, serum, urine, fecal, seminal plasma and liver) and it was found that 208 (out of 417) identical metabolites were detected in all biological samples. Furthermore, the metabolomic method was applied to a case/control study of urinary of bladder cancer. Thirty differential metabolites were identified that were involved in carbohydrate and amino acid metabolism.

[Characteristics of tinnitus related to idiopathic suddensensorineural hearing loss in 272 patients]

Objective:To investigate the characteristics of sudden sensorineural hearing loss (SSHL) patients with tinnitus.Method:Two-hundred and seventy two SSHL patients with tinnitus underwent evalution through Tinnitus Handicap Inventory(THI) and Tinnitus Questionnaire(TQ).Demographic data and tinnitus characteristics were analyzed.Result:In 272 patients,41.6% of patients suffered from low frequency tinnitus,2.0% with medium frequency tinnitus,56.4% with high frequency tinnitus.There were 79% patients whose tinnitus were continous,while 21% were intermittent;From the view point of daily life compromising,37.4% were minor,44.8% were moderate,17.8% were serious.The most important factors that deteriorate tinnitus were bad sleep,noise,life pressure and tiredness.Conclusion:There were individual differences among patients with sudden deafness and tinnitus.Enough evaluation should be made to decrease the infection of tinnitus.

[Pharmacological study on the compatibility of cortex Cinnamomi with Halloysitum Rubrum]

The decoction of Cortex Cinnamomi (CC, 1 g/kg p.o.) and Halloysitum Rubrum (HR, 3 g/kg p.o.) or the combination of the two drugs (4 g/kg p.o., CC 1 g/kg, HR 3 g/kg) could antagonize the diarrhea caused by p.o. water ex tract of Radix et Rhizoma Rhei in mice; and inhibit the platelet aggregation induced by ADP in vitro. Meanwhile, the effect of the combination of the two drugs was not different from that of each single one. In addition, CC was able to inhibit the spontaneous movement of intestine in situ and showed an analgesic effect (hot-plate method) in mice; HR was ineffective in these aspects and did not reduce the effect of CC. CC(20 g/kg p.o., i.p. or i.v.) exhibited very strong toxicity in mice, while HR(60 g/kg p.o., i.p. or i.v.) was nontoxic. When the two drugs were used together, the toxicity was markedly reduced.

Extrication process of chlorogenic acid in Crofton weed and antibacterial mechanism of chlorogenic acid on Escherichia coli

Crofton weed is a perennial herb and a biological intruding species. The present study firstly used the orthogonal test to compare the differences in extraction of chlorogenic acid in leaves and stems of Crofton weed by using three kinds of solvents, namely water, ethanol and ethyl acetate. The best effect was found by using ethonolic extraction of chlorogenic acid in Crofton weed. Further, by choosing Escherichia coli as test object, in-vitro antibacterial test was conducted to study the antimicrobial activities of chlorogenic acid by testing a series of indexes before and after the interaction between chlorogenic acid and Escherichia coli, to clarify the antibacterial mechanism of chlorogenic acid on Escherichia coli. Finally, by comparing the antibacterial activities of isochlorogenic acid A on Escherichia coli, it was concluded that both chlorogenic acid and isochlorogenic acid A showed antibacterial activities against Escherichia coli, wherein chlorogenic acid had a better antibacterial effect on Escherichia coli than isochlorogenic acid A.

[Effects of yizhi pills on memory, superoxide dismutase and malondialdehyde of brain and immunity in mice]

Passive avoidance tests have shown that Yizhi Pills (YZ) markedly improve the memory of normal mice at a dose of 100 mg/kg after oral administration for fifteen days, and significantly reverse the scopolamine, NaNO2 and EtOH-induced disruptions of memory retention in mice at doses of 100, 200, 500 mg/kg after oral administration for five days. In aged mice induced by D-galactose, YZ also significantly improve the impaired memory, increase the activity of SOD and decrease the content of MDA in brain. All these effects were observed at doses of 200, 500 mg/kg after oral administration for forty-one days. YZ significantly promote blood carbon particle clearance, enhance hemolysin antibody in immunodepressed mice induced by cyclophosphamide, and increase earswelling in immunodepressed mice induced by prednisolonum.

Effect of ibudilast on ciliary activity of human paranasal sinus mucosa in vitro

The effect of ibudilast (CAS 50847-11-5, 3-isobutyryl-2-isopropylpyrazolo[1,5-a]pyridine, KC-404), an anti-asthmatic drug, on ciliary beat frequency (CBF) of human paranasal sinus mucosa was examined in vitro. Ciliary activation was observed after a 10-min exposure to 4.6 x 10(-6) mol/l ibudilast. Ibudilast dose-dependently increase CBF at the concentrations ranging from 4.6 x 10(-7) mol/l to 4.6 x 10(-5) mol/l. Propranolol inhibited ciliary activity induced by ibudilast; however, neither indometacin nor verapamil affected the activation of ibudilast on CBF. Platelet activating factor (PAF) and Leukotriene D4 (LTD4) are chemical mediators inducing mucosal dysfunction and damage. Ibudilast prevented ciliary inhibition induced by PAF and LTD4. These findings indicated that ibudilast activates CBF and inhibits the effect of PAF and LTD4 on ciliated cells, and consequently improves the pathogenesis of allergic disorders such as the inhibited mucociliary transport system and airway hyperresponsiveness.