Postoperative pain following posterior iliac crest bone graft harvesting in spine surgery: a prospective,randomized trial

Background Context

Postoperative pain at the site of bone graft harvest for posterior spine fusion is reported to occur in 6%–39% of cases. However, the area around the posterior, superior iliac spine is a frequent site of referred pain for many structures. Therefore, many postoperative spine patients may have pain in the vicinity of the posterior iliac crest that may not in fact be caused by bone graft harvesting. The literature may then overestimate the true incidence of postoperative iliac crest pain.

Plant-based research among the International Cooperative Biodiversity Groups

The International Cooperative Biodiversity Groups (ICBG), administered by the Fogarty International Center, was created in 1992. By 2007, the program had completed three cycles of funding. In the last cycle (2003-2008), seven ICBGs were operating in biodiversity hotspots around the world with support from nine Institutes and Centers of the National Institutes of Health and from the National Science Foundation and the US Department of Agriculture. Accomplishments over the history of the program include discovery of numerous bioactive compounds, training of thousands of young scientists in the US and abroad, and the creation and enhancement of biodiversity protected areas around the world. Over the history of the ICBG program plant-based research has been a significant component of many projects. Over 10,000 species of tropical, temperate and arid lands plants from 350 plant families have been analyzed. While some of the research has been guided by ethnobotanical science, particularly science oriented toward botanical medicines, much has been focused around diversity-oriented collections, and some have used ecological principles to identify active compounds. While marine and microbial organisms have grown in importance among the natural products research community, plants will continue to play important roles for the foreseeable future.     

Recombinant human bone morphogenetic protein-2 versus iliac crest bone graft in anterior cervical discectomy and fusion: Dysphagia and dysphonia rates in the early postoperative period with review of the literature

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is a growth factor utilized to stimulate bone development in several clinical scenarios. Although the U.S. Food and Drug Administration approved this therapeutic modality for only two applications, it is frequently used off-label in anterior cervical discectomy and fusion (ACDF) procedures as an alternative to iliac crest bone graft (ICBG), the prior standard of care. This usage has been a source of controversy in the medical community due to evidence of increased rates of postoperative edema and dysphagia. This retrospective cohort study investigates two groups of 200 patients having undergone ACDF, one using rhBMP-2 and the other using ICBG, to evaluate the incidence of complications in the early postoperative period. A significant reduction in average length of stay was found in the rhBMP-2 cohort (1.40 days) compared to the ICBG cohort (1.85 days) as well as a significantly increased rate of dysphagia (25.5% in rhBMP-2 vs. 15% in ICBG; p = 0.01). An increased rate of dysphonia was observed among patients undergoing revision surgery (25.0%) compared to primary surgery (1.6%), but stratification by number of levels, gender, and smoking status yielded no differences in complication rates. Our evaluation of two large cohorts along with review of the literature on the topic sheds light on potential benefits and risks of rhBMP-2 in ACDF procedures. Further investigation is warranted to determine if clinical gains outweigh the potential harms of rhBMP-2 use in this setting.     

Antiprotozoal Activity Against Plasmodium falciparum. and Trypanosoma cruzi. of Xanthones Isolated from Chrysochlamys tenuis.

Abstract

One new prenylated xanthone, 1,5-dihydroxy-3-methoxy-4-isoprenylxanthone (1), along with four previously known prenylated xanthones, ananixanthone (2), 1,3,7-trihydroxy-2,4-diisoprenylaxnthone (3), 8-desoxygartanin (4), and toxyloxanthone A (5), have been isolated from Chrysochlamys tenuis. (Hammel) (Clusiaceae). Compound 1 showed moderate activity (31 ± 9 µM) against a chloroquine-resistant strain of Plasmodium falciparum., and compounds 3 and 5 showed the highest antimalarial potency, IC₅₀ = 20 ± 2 and 16 ± 4 µM, respectively. Evaluated against Trypanosoma cruzi., compound 1 presented negligible activity, but compounds 2, 3, and 4 showed mild antitrypanosomal activity with IC₅₀ values of 23 ± 4, 21 ± 5, and 24 ± 3 µM, respectively. All structures were elucidated by NMR spectroscopy in combination with UV, IR, and MS spectral data.