Vertebral artery injuries in cervical spine surgery

Background contextVertebral artery injuries (VAIs) are rare but serious complications of cervical spine surgery, with the potential to cause catastrophic bleeding, permanent neurologic impairment, and even death. The present literature regarding incidence of this complication largely comprises a single surgeon or small multicenter case series.PurposeWe sought to gather a large sample of high-volume surgeons to adequately characterize the incidence and risk factors for VAI, management strategies used, and patient outcomes after VAI.Study designThe study was constructed as a cross-sectional study comprising all cervical spine patients operated on by the members of the international Cervical Spine Research Society (CSRS).Patient sampleAll patients who have undergone cervical spine surgery by a current member of CSRS as of the spring of 2012.Outcome measuresFor each surgeon surveyed, we collected self-reported measures to include the number of cervical cases performed in the surgeon's career, the number of VAIs encountered, the stage of the case during which the injury occurred, the management strategies used, and the overall patient outcome after injury.MethodsAn anonymous 10-question web-based survey was distributed to the members of the CSRS. Statistical analysis was performed using Student t tests for numerical outcomes and chi-squared analysis for categorical variables.ResultsOne hundred forty-one CSRS members (of 195 total, 72%) responded to the survey, accounting for a total of 163,324 cervical spine surgeries performed. The overall incidence of VAI was 0.07% (111/163,324). Posterior instrumentation of the upper cervical spine (32.4%), anterior corpectomy (23.4%), and posterior exposure of the cervical spine (11.7%) were the most common stages of the case to result in an injury to the vertebral artery. Discectomy (9%) and anterior exposure of the spine (7.2%) were also common time points for an arterial injury. One-fifth (22/111) of all VAI involved an anomalous course of the vertebral artery. The most common management of VAI was by direct tamponade. The outcomes of VAIs included no permanent sequelae in 90% of patients, permanent neurologic sequelae in 5.5%, and death in 4.5%. Surgeons at academic and private centers had nearly identical rates of VAIs. However, surgeons who had performed 300 or fewer cervical spine surgeries in their career had a VAI incidence of 0.33% compared with 0.06% in those with greater than 300 lifetime cases (p=.028).ConclusionsThe overall incidence of VAI during cervical spine surgery reported from this survey was 0.07%. Less experienced surgeons had a higher rate of VAI compared with their more experienced peers. The results of VAI are highly variable, resulting in no permanent harm most of the time; however, permanent neurologic injury or death occur in 10% of cases.     

Low temperature fabrication of Fe2O3 nanorod film coated with ultra-thin g-C3N4 for a direct z-scheme exerting photocatalytic activities

We engineered high aspect ratio Fe₂O₃ nanorods (with an aspect ratio of 17 : 1) coated with g-C₃N₄ using a sequential solvothermal method at very low temperature followed by a thermal evaporation method. Here, the high aspect ratio Fe₂O₃ nanorods were directly grown onto the FTO substrate under relatively low pressure conditions. The g-C₃N₄ was coated onto a uniform Fe₂O₃ nanorod film as the heterostructure, exhibiting rational band conduction and a valence band that engaged in surface photoredox reactions by a direct z-scheme mechanism. The heterostructures, particularly 0.75g-C₃N₄@Fe₂O₃ nanorods, exhibited outstanding photocatalytic activities compared to those of bare Fe₂O₃ nanorods. In terms of 4-nitrophenol degradation, 0.75g-C₃N₄@Fe₂O₃ nanorods degraded all of the organic pollutant within 6 h under visible irradiation at a kinetic constant of 12.71 × 10⁻³ min⁻¹, about 15-fold more rapidly than bare Fe₂O₃. Further, the hydrogen evolution rate was 37.06 μmol h⁻¹ g⁻¹, 39-fold higher than that of bare Fe₂O₃. We suggest that electron and hole pairs are efficiently separated in g-C₃N₄@Fe₂O₃ nanorods, thus accelerating surface photoreaction via a direct z-scheme under visible illumination.

The engineered high aspect ratio of Fe₂O₃ nanorods coated with g-C₃N₄ demonstrates z-scheme mechanism, showing the best performance in 4-nitrophenol photodegradation and H₂ evolution.     

The effect of PPIs Alone,PPIs plus cytoprotective agent,and H2RA plus cytoprotective agent on ulcer healing after endoscopic submucosal dissection: A prospective randomized controlled trial

Background and Study AimsEndoscopic submucosal dissection (ESD) is the most effective treatment for early gastric cancer or gastric adenoma. However, ESD results in iatrogenic ulcers and postoperative bleeding from ulcers. This study aimed to evaluate the effect of using a proton pump inhibitor (PPI) alone, a PPI + rebamipide combination therapy, and an H2 receptor antagonist (H2RA) + rebamipide combination therapy on ulcer healing after ESD.Patients and MethodsA total of 204 patients who underwent ESD from April 2014 to July 2017 at Dong-A University Hospital were randomly assigned to the following groups: PPI-alone group, PPI + rebamipide combination therapy group, and H2RA + rebamipide combination therapy group. However, only 156 patients were studied since we excluded those who were lost to follow-up or had diseases other than early gastric cancer or gastric adenoma. Twenty-eight days after ESD, we evaluated the ulcer residual ratio, S stage rates, ulcer bleeding ratio, and gastric pH.ResultsThis study included 156 patients (PPI-alone group: 52 patients; PPI + rebamipide group: 52 patients; H2RA + rebamipide group: 52 patients). The ulcer residual ratios were 24.3 ± 14.2%, 17.0 ± 12.1%, and 21.0 ± 13.8% in the PPI alone, PPI + rebamipide, and H2RA + rebamipide groups, respectively (P = 0.048).ConclusionsPPI + rebamipide was more effective in reducing the ulcer residual ratio after ESD. There was no statistical difference in ulcer stage and delayed bleeding after ESD among the groups. These findings showed that PPI + rebamipide had limited benefits after ESD.     

Repetitive Treatment with Diluted Bee Venom Attenuates the Induction of Below-Level Neuropathic Pain Behaviors in a Rat Spinal Cord Injury Model

The administration of diluted bee venom (DBV) into an acupuncture point has been utilized traditionally in Eastern medicine to treat chronic pain. We demonstrated previously that DBV has a potent anti-nociceptive efficacy in several rodent pain models. The present study was designed to examine the potential anti-nociceptive effect of repetitive DBV treatment in the development of below-level neuropathic pain in spinal cord injury (SCI) rats. DBV was applied into the Joksamli acupoint during the induction and maintenance phase following thoracic 13 (T13) spinal hemisection. We examined the effect of repetitive DBV stimulation on SCI-induced bilateral pain behaviors, glia expression and motor function recovery. Repetitive DBV stimulation during the induction period, but not the maintenance, suppressed pain behavior in the ipsilateral hind paw. Moreover, SCI-induced increase in spinal glia expression was also suppressed by repetitive DBV treatment in the ipsilateral dorsal spinal cord. Finally, DBV injection facilitated motor function recovery as indicated by the Basso–Beattie–Bresnahan rating score. These results indicate that the repetitive application of DBV during the induction phase not only decreased neuropathic pain behavior and glia expression, but also enhanced locomotor functional recovery after SCI. This study suggests that DBV acupuncture can be a potential clinical therapy for SCI management.     

Pro-Apoptotic Activity of 4-Isopropyl-2-(1-Phenylethyl) Aniline Isolated from Cordyceps bassiana

Cordyceps species including Cordyceps bassiana are a notable anti-cancer dietary supplement. Previously, we identified several compounds with anti-cancer activity from the butanol fraction (Cb-BF) of Cordyceps bassiana. To expand the structural value of Cb-BF-derived anti-cancer drugs, we employed various chemical moieties to produce a novel Cb-BF-derived chemical derivative, KTH-13-amine-monophenyl [4-isopropyl-2-(1-phenylethyl) aniline (KTH-13-AMP)], which we tested for anti-cancer activity. KTH-13-AMP suppressed the proliferation of MDA-MB-231, HeLa, and C6 glioma cells. KTH-13-AMP also dose-dependently induced morphological changes in C6 glioma cells and time-dependently increased the level of early apoptotic cells stained with annexin V-FITC. Furthermore, the levels of the active full-length forms of caspase-3 and caspase-9 were increased. In contrast, the levels of total forms of caspases-3, caspase-8, caspase-9, and Bcl-2 were decreased in KTH-13-AMP treated-cells. We also confirmed that the phosphorylation of STAT3, Src, and PI3K/p85, which is linked to cell survival, was diminished by treatment with KTH-13-AMP. Therefore, these results strongly suggest that this compound can be used to guide the development of an anti-cancer drug or serve as a lead compound in forming another strong anti-proliferative agent.     

Nitrogen-doped micro-nano carbon spheres with multi-scale pore structure obtained from interpenetrating polymer networks for electrochemical capacitors

A chemical process was developed to prepare N-doped micro-nano carbon spheres with multi-scale pore structures via carbonization of N-PF/PMMA interpenetrating polymer networks, which contain melamine resin as the nitrogen source, PF as the carbon source, and polymethylmethacrylate (PMMA) as the pore-former. The N-content of N-doped micro-nano carbon spheres was controlled by adjusting the mass ratio of melamine and phenol before polymerization. The N-doped micro-nano carbon spheres as electrode materials possess appropriate pore size distribution, higher specific surface area (559 m² g⁻¹) and consistently dispersed nitrogen atoms with adjustable doping content. These distinct characteristics endow the prospective electrode materials with excellent performance in electrochemical capacitors. In particular, N-CS-IPN-4 exhibits the highest specific capacitance of 364 F g⁻¹ at 0.5 A g⁻¹ in 6 M KOH aqueous electrolyte in a three-electrode system. It also possesses superior rate capability (57.7% retention at current densities ranging from 0.5 to 50 A g⁻¹) and excellent cycling performance at 2 A g⁻¹ (100% retention after 10 000 cycles). All these results confirm that the N-doped micro-nano carbon spheres are promising electrochemical capacitor materials, which possesses the advantages of simple preparation procedure, multi-scale pore structures, higher specific surface areas, easy adjustment of N-content and excellent electrochemical properties.

The N-doped micro-nano carbon spheres with multi-scale pore structures was prepared via carbonization of N-PF/PMMA interpenetrating polymer networks, which contain melamine resin as nitrogen source, PF as carbon source, and PMMA as pore-former.