Disc degeneration: current surgical options.

Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

Oculopalatal tremor: current concepts and new observations.

PURPOSE OF REVIEW: Oculopalatal tremor (OPT) is an acquired disorder resulting from the interruption of a specific brainstem circuitry, the dentato-rubro-olivary pathway or Guillain-Mollaret triangle. The recent literature on OPT and olivary hypertrophy was reviewed with specific interest regarding causes, diagnostic procedures, physiopathology and therapies. RECENT FINDINGS: OPT is associated with inferior olivary hypertrophy, and recent findings have provided a better understanding of its intimate mechanisms. A dual-mechanism model, combining an oscillator (inferior olive) and a modulator/amplifier (cerebellum), best explains the development of OPT. Electrotonic coupling and specific Ca channels contribute to oscillations of inferior olivary nucleus neurons in OPT. Improvement of visual symptoms can be achieved with oral gabapentin or memantine. SUMMARY: Both the neuronal circuitry and the physiopathology of OPT are now better understood. This opens up an era of specific therapy for this rare cause of disabling oscillopsia.

Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head?

BACKGROUND: As the long-term survival of pancreatic head malignancies remains dismal, efforts have been made for a better patient selection and a tailored treatment. Tumour size could also be used for patient stratification. METHODS: One hundred and fourteen patients underwent a pancreaticoduodenectomy for pancreatic adenocarcinoma, peri-ampullary and biliary cancer stratified according to: ≤20 mm, 21-34 mm, 35-45 mm and >45 mm tumour size. RESULTS: Patients with tumour sizes of ≤20 mm had a N1 rate of 41% and a R1/2 rate of 7%. The median survival was 3.4 years. N1 and R1/2 rates increased to 84% and 31% for tumour sizes of 21-34 mm (P = 0.0002 for N, P = 0.02 for R). The median survival decreased to 1.6 years (P = 0.0003). A further increase in tumour size of 35-45 mm revealed a further increase of N1 and R1/2 rates of 93% (P < 0.0001) and 33%, respectively. The median survival was 1.2 years (P = 0.004). Tumour sizes >45 mm were related to a further decreased median survival of 1.1 years (P = 0.2), whereas N1 and R1/2 rates were 87% and 20%, respectively. DISCUSSION: Tumour size is an important feature of pancreatic head malignancies. A tumour diameter of 20 mm seems to be the cut-off above which an increased rate of incomplete resections and metastatic lymph nodes must be encountered and the median survival is reduced.

Determination and Evaluation of Alternate Methods for Managing and Controlling Highway-Related Dust, TR-449, 2002

Road dust is caused by wind entraining fine material from the roadway surface and the main source of Iowa road dust is attrition of carbonate rock used as aggregate. The mechanisms of dust suppression can be considered as two processes: increasing particle size of the surface fines by agglomeration and inhibiting degradation of the coarse material. Agglomeration may occur by capillary tension in the pore water, surfactants that increase bonding between clay particles, and cements that bind the mineral matter together. Hygroscopic dust suppressants such as calcium chloride have short durations of effectiveness because capillary tension is the primary agglomeration mechanism. Somewhat more permanent methods of agglomeration result from chemicals that cement smaller particles into a mat or larger particles. The cements include lignosulfonates, resins, and asphalt products. The duration of the cements depend on their solubility and the climate. The only dust palliative that decreases aggregate degradation is shredded shingles that act as cushions between aggregate particles. It is likely that synthetic polymers also provide some protection against coarse aggregate attrition. Calcium chloride and lignosulfonates are widely used in Iowa. Both palliatives have a useful duration of about 6 months. Calcium chloride is effective with surface soils of moderate fine content and plasticity whereas lignin works best with materials that have high fine content and high plasticity indices. Bentonite appears to be effective for up to two years and works well with surface materials having low fines and plasticity and works well with limestone aggregate. Selection of appropriate dust suppressants should be based on characterization of the road surface material. Estimation of dosage rates for potential palliatives can be based on data from this report, from technical reports, information from reliable vendors, or laboratory screening tests. The selection should include economic analysis of construction and maintenance costs. The effectiveness of the treatment should be evaluated by any of the field performance measuring techniques discussed in this report. Novel dust control agents that need research for potential application in Iowa include; acidulated soybean oil (soapstock), soybean oil, ground up asphalt shingles, and foamed asphalt. New laboratory evaluation protocols to screen additives for potential effectiveness and determine dosage are needed. A modification of ASTM D 560 to estimate the freeze-thaw and wet-dry durability of Portland cement stabilized soils would be a starting point for improved laboratory testing of dust palliatives.

Parenteral anticoagulants in heart disease: Current status and perspectives (Section II). Position Paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease.

Anticoagulants are a mainstay of cardiovascular therapy, and parenteral anticoagulants have widespread use in cardiology, especially in acute situations. Parenteral anticoagulants include unfractionated heparin, low-molecular-weight heparins, the synthetic pentasaccharides fondaparinux, idraparinux and idrabiotaparinux, and parenteral direct thrombin inhibitors. The several shortcomings of unfractionated heparin and of low-molecular-weight heparins have prompted the development of the other newer agents. Here we review the mechanisms of action, pharmacological properties and side effects of parenteral anticoagulants used in the management of coronary heart disease treated with or without percutaneous coronary interventions, cardioversion for atrial fibrillation, and prosthetic heart valves and valve repair. Using an evidence-based approach, we describe the results of completed clinical trials, highlight ongoing research with currently available agents, and recommend therapeutic options for specific heart diseases.

Current knowledge on the Ralstonia solanacearum type III secretion system

R. solanacearum was ranked in a recent survey the second most important bacterial plant pathogen, following the widely used research model Pseudomonas syringae (Mansfield et al., 2012). The main reason is that bacterial wilt caused by R. solanacearum is the world"s most devastating bacterial plant disease (http://faostat.fao.org), threatening food safety in tropical and subtropical agriculture, especially in China, Bangladesh, Bolivia and Uganda (Martin and French, 1985). This is due to the unusually wide host range of the bacterium, its high persistence and because resistant crop varieties are unavailable. In addition, R. solanacearum has been established as a model bacterium for plant pathology thanks to pioneering molecular and genomic studies (Boucher et al., 1985; Cunnac et al., 2004b; Mukaihara et al., 2010; Occhialini et al., 2005; Salanoubat et al., 2002). As for many bacterial pathogens, the main virulence determinant in R. solanacearum is the type III secretion system (T3SS) (Boucher et al., 1994), which injects a number of effector proteins into plant cells causing disease in hosts or an hypersensitive response in resistant plants. In this article we discuss the current state in the study of the R. solanacearum T3SS, stressing the latest findings and future perspectives.

Evaluation of Racial Differences in Seat Belt and Child Restraint Use: A Review of Current Literature, 2004

This report presents the results of a literature review conducted to evaluate differences in seat belt use by race. A literature review was conducted to evaluate overall seat belt use, racial differences in seat belt use, overall child restraint use, racial differences in child restraint use, and information about seat belt and child restraint use specific to Iowa. A number of national studies and regional studies were found and are presented. Mixed results were found as to whether racial differences exist in both seat belt use and child restraint use. However, in the course of the literature review, several items that are of interest to safety in Iowa have emerged, although little data specific to Iowa was encountered. First, national seat belt use appears to be lower among African-Americans than for Caucasians or Hispanics. Second, national crash rates among Hispanics appear to be higher than those for Caucasians, particularly when population and lower vehicle miles traveled (VMT) are considered. One issue that should be considered throughout this literature review is that the Hispanic population may be higher than reported due to large numbers of undocumented persons who do not appear in population estimates, driver’s license, or other databases.

Laboratory Investigation of Bridge Strip Seal Joint Termination Details, SPR RB08-014, 2016

Bridge expansion joints, if not properly designed, constructed, and maintained, often lead to the deterioration of critical substructure elements. Strip seal expansion joints consisting of a steel extrusion and neoprene gland are one type of expansion joint and are commonly used by the Iowa Department of Transportation (DOT). Strip seal expansion joints are susceptible to tears and pull outs that allow water, chlorides, and debris to infiltrate the joint, and subsequently the bearings below. One area of the strip seal that is particularly problematic is where it terminates at the interface between the deck and the barrier rail. The Iowa DOT has noted that the initial construction quality of the current strip seal termination detail is not satisfactory, nor ideal, and a need exists for re-evaluation and possibly re-design of this detail. Desirable qualities of a strip seal termination detail provide a seal that is simple and fast to construct, facilitate quick gland removal and installation, and provide a reliable, durable barrier to prevent chloride-contaminated water from reaching the substructure. To meet the objectives of this research project, several strip seal termination details were evaluated in the laboratory. Alternate termination details may not only function better than the current Iowa DOT standard, but are also less complicated to construct, facilitating better quality control. However, uncertainties still exist regarding the long-term effects of using straight-through details, with or without the dogleg, that could not be answered in the laboratory in the short time frame of the research project.

Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices.

Autopsy-negative sudden cardiac deaths (SCD) seen in forensic practice are most often thought to be the result of sudden arrhythmic death syndrome. Postmortem genetic analysis is recommended in such cases, but is currently performed in only a few academic centers. In order to determine actual current practice, an on-line questionnaire was sent by e-mail to members of various forensic medical associations. The questions addressed routine procedures employed in cases of sudden cardiac death (autopsy ordering, macroscopic and microscopic cardiac examination, conduction tissue examination, immunohistochemistry and electron microscopy, biochemical markers, sampling and storage of material for genetic analyses, toxicological analyses, and molecular autopsy). Some questions concerned the legal and ethical aspects of genetic analyses in postmortem examinations, as well as any existing multidisciplinary collaborations in SCD cases. There were 97 respondents, mostly from European countries. Genetic testing in cases of sudden cardiac death is rarely practiced in routine forensic investigation. Approximately 60% of respondents reported not having the means to perform genetic postmortem testing and 40% do not collect adequate material to perform these investigations at a later date, despite working at university hospitals. The survey demonstrated that many of the problems involved in the adequate investigation of SCD cases are often financial in origin, due to the fact that activities in forensic medicine are often paid by and dependent on the judicial authorities. Problems also exist concerning the contact with family members and/or the family doctor, as well as the often-nonexistent collaboration with others clinicians with special expertise beneficial in the investigation of SCD cases, such as cardiologists and geneticists. This study highlights the importance in establishing guidelines for molecular autopsies in forensic medicine.

Current management of true aneurysm of the dorsalis pedis artery.

We describe two cases of true dorsalis pedis artery aneurysms in men referred for pulsatile mass of the dorsal part of the foot. Both aneurysms were resected and grafted with interposition of a short segment of saphenous vein. Histological analysis showed true aneurysm associated with atherosclerosis. To our knowledge, only 12 cases of true dorsalis pedis artery aneurysm have been reported previously. On the basis of our experience and after reviewing the literature, the management of this uncommon pathology was discussed.