Protecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration

Lumbar discectomy is an effective treatment for lumbar disc herniation (LDH). Although the majority of patients experience successful outcomes, a significant fraction will experience a recurrence of their back pain due to facet joint degeneration. Facet joint degeneration after discectomy may be the result of excessive nuclear removal, disc space narrowing, and annular injury. This study investigated whether implantation with the Barricaid annular closure device (ACD) during discectomy reduced the rate of facet degeneration. Inclusion criteria were primary lumbar disc herniation failing conservative treatment, Visual Analog Scale (VAS) Leg ≥ 40/100, Oswestry Disability Index (ODI) ≥ 40/100 and defects that were ≤60 mm² (Barricaid arm only), and patient age 18–75. CT interpretations were collected preoperatively and 12 months post-discectomy. Patients implanted with Barricaid had significantly reduced rates and grades of facet degeneration than patients without Barricaid. Reinforcing the annulus fibrosus with Barricaid during lumbar discectomy may slow the progression of facet joint degeneration.     

Quantifying continuous-flow dielectrophoretic trapping of cells and micro-particles on micro-electrode array

An interdigitated electrode array embedded within a micro-channel with forced flow is shown to enable dielectrophoretic (DEP) characterization of particles and/or cells based on measurements of their trapping percentage over a continuous frequency range. A simplified model of the trapping percentage, using spatial averaging of the convective and DEP force, linearly correlated it to the effective DEP force (in its positive mode). Thus, the Clausius–Mossotti factor was fitted to the experimental data, yielding effective electrical characteristics of the particles and/or cells. Also, the generated trapping percentage curve response over a continuous range of frequencies facilitates sorting and detection based on differences other than just the cross-over frequencies.     

Sunlight and ultraviolet radiation—pertinent retinal implications and current management

Unprotected and prolonged exposure to ultraviolet (UV) light from sunlight, lasers, and arc welding leads to outer retinal damage. The photoreceptors and retinal pigment epithelium located in the posterior pole are particularly susceptible to this radiation. Classically known as solar retinopathy, this disorder frequently affects young individuals who have clear lenses and a propensity toward observing solar eclipses. Various imaging techniques aid the clinician in diagnosis, even if patients cannot recall an exposure event. By far the most utilized technique is optical coherence tomography that, in tandem with fluorescein angiography, and fundus autofluorescence, is crucial in ruling out other conditions. Fortunately, the prognosis of acute UV retinopathy is favorable, as most cases fully recover; however, a significant percentage of patients suffer from chronic sequelae: reduced acuity and lifelong central/paracentral scotomas. Thus, education toward understanding UV exposure risks, coupled with either abstinence or proper eye protection, is critical in preventing macular damage. We outline the various etiologies responsible for UV-induced retinopathy, describe the limited treatments available, and provide recommendations to minimize the potential devastating ophthalmic consequences as our society increases its reliance on UV-emitting technology and further engages in solar eclipse viewing.     

Protein carboxymethylase activity in the rat superior cervical ganglion during development and after axonal injury

Cerebellar explants derived from neonatal mice were exposed to cytosine arabinoside, an inhibitor of DNA synthesis. Following such exposure, the cortical regions of the explants contained numerous closely packed large neurons with few intervening elements and without lamination. The surviving large cortical neurons included Golgi cells and Purkinje cells, the latter with persistent dendritic spines in the absence of granule cells. A marked increase in density of subcortical and intracortical neurites was evident in fiber stains. The neurites were identified as Purkinje cell axons and axon collaterals by fiber tracing. Myelin failed to form around the axonal elements. Both regular and phasic spontaneous discharges were recorded electrophysiologically. Trains of cortical stimuli elicited both excitatory and inhibitory responses in the absence of parallel fibers. Antidromic stimulation of Purkinje cell axon evoked inhibition of spontaneous cortical discharges. By contrast, antidromic activation of Purkinje cell axons in control cultures had no effect on spontaneous cortical discharges, or provoked a transient increase in discharge rate. These responses were interpreted as consistent with a cortical remodeling in granuloprival cerebellar cultures in which basket-stellate cell inhibition of Purkinje cells was preemted by Purkinje cell recurrent axon collateral inhibition.     

Alvimopan Accelerates Gastrointestinal Recovery After Radical Cystectomy: A Multicenter Randomized Placebo-Controlled Trial

Background

Radical cystectomy (RC) for bladder cancer is frequently associated with delayed gastrointestinal (GI) recovery that prolongs hospital length of stay (LOS).

Objective

To assess the efficacy of alvimopan to accelerate GI recovery after RC.

Design, setting, and participants

We conducted a randomized double-blind placebo-controlled trial in patients undergoing RC and receiving postoperative intravenous patient-controlled opioid analgesics.

Intervention

Oral alvimopan 12 mg (maximum: 15 inpatient doses) versus placebo.

Outcome measurements and statistical analysis

The two-component primary end point was time to upper (first tolerance of solid food) and lower (first bowel movement) GI recovery (GI-2). Time to discharge order written, postoperative LOS, postoperative ileus (POI)-related morbidity, opioid consumption, and adverse events (AEs) were evaluated. An independent adjudication of cardiovascular AEs was performed.

Results and limitations

Patients were randomized to alvimopan (n = 143) or placebo (n = 137); 277 patients were included in the modified intention-to-treat population. The alvimopan cohort experienced quicker GI-2 recovery (5.5 vs 6.8 d; hazard ratio: 1.8; p < 0.0001), shorter mean LOS (7.4 vs 10.1 d; p = 0.0051), and fewer episodes of POI-related morbidity (8.4% vs 29.1%; p < 0.001). The incidence of opioid consumption and AEs or serious AEs (SAEs) was comparable except for POI, which was lower in the alvimopan group (AEs: 7% vs 26%; SAEs: 5% vs 20%, respectively). Cardiovascular AEs occurred in 8.4% (alvimopan) and 15.3% (placebo) of patients (p = 0.09). Generalizability may be limited due to the exclusion of epidural analgesia and the inclusion of mostly high-volume centers utilizing open laparotomy.

Conclusions

Alvimopan is a useful addition to a standardized care pathway in patients undergoing RC by accelerating GI recovery and shortening LOS, with a safety profile similar to placebo.

Patient summary

This study examined the effects of alvimopan on bowel recovery in patients undergoing radical cystectomy for bladder cancer. Patients receiving alvimopan experienced quicker bowel recovery and had a shorter hospital stay compared with those who received placebo, with comparable safety.

Trial registration

ClinicalTrials.gov identifier NCT00708201     

Childhood Cancer and the Risk of ESKD

BackgroundIncreasing cancer incidence among children alongside improved treatments has resulted in a growing number of pediatric cancer survivors. Despite childhood cancer survivors’ exposure to various factors that compromise kidney function, few studies have investigated the association between childhood cancer and future kidney disease.MethodsTo assess the risk of ESKD among childhood cancer survivors, we conducted a nationwide, population-based, retrospective cohort study that encompassed all Israeli adolescents evaluated for mandatory military service from 1967 to 1997. After obtaining detailed histories, we divided the cohort into three groups: participants without a history of tumors, those with a history of a benign tumor (nonmalignant tumor with functional impairment), and those with a history of malignancy (excluding kidney cancer). This database was linked to the Israeli ESKD registry to identify incident ESKD cases. We used Cox proportional hazards models to estimate the hazard ratio (HR) of ESKD.ResultsOf the 1,468,600 participants in the cohort, 1,444,345 had no history of tumors, 23,282 had a history of a benign tumor, and 973 had a history of malignancy. During a mean follow-up of 30.3 years, 2416 (0.2%) participants without a history of tumors developed ESKD. Although a history of benign tumors was not associated with an increased ESKD risk, participants with a history of malignancy exhibited a substantially elevated risk for ESKD compared with participants lacking a history of tumors, after controlling for age, sex, enrollment period, and paternal origin (adjusted HR, 3.2; 95% confidence interval, 1.3 to 7.7).ConclusionsChildhood cancer is associated with an increased risk for ESKD, suggesting the need for tighter and longer nephrological follow-up.     

Beta-aminopropionitrile treatment can accelerate recovery of mice after spinal cord injury.

Modulations of the extracellular matrix and scar formation following central nervous system (CNS) injuries are considered prohibitive for axon regeneration, thus restricting functional recovery. Recent findings indicating that lysyl oxidase, an extracellular matrix-forming enzyme, appears in a time-dependent manner at brain injury sites have suggested that inhibition of this enzyme may be conducive for regeneration and functional recovery. Here, we report that after unilateral spinal cord transection in adult mice, daily treatment (for 20 days) with the lysyl oxidase inhibitor beta-aminopropionitrile (100 mg/kg intraperitoneal) resulted in accelerated and more complete functional recovery. The mode of functional recovery, however, indicates that axonal regeneration of long descending tracts did not occur.