Ability to discriminate between healthy and low back pain sufferers using ultrasound during maximum lumbar extension

Objective To analyze the ability to discriminate between healthy individuals and individuals with chronic nonspecific low back pain (CNLBP) by measuring the relation between patient-reported outcomes and objective clinical outcome measures of the erector spinae (ES) muscles using an ultrasound during maximal isometric lumbar extension. Design Cross-sectional study with screening and diagnostic tests with no blinded comparison. Setting University laboratory. Participants Healthy individuals (n=33) and individuals with CNLBP (n=33). Interventions Each subject performed an isometric lumbar extension. With the variables measured, a discriminate analysis was performed using a value ≥6 in the Roland and Morris disability questionnaire (RMDQ) as the grouping variable. Then, a logistic regression with the functional and architectural variables was performed. A new index was obtained from each subject value input in the discriminate multivariate analysis. Main Outcome Measures Morphologic muscle variables of the ES muscle were measured through ultrasound images. The reliability of the measures was calculated through intraclass correlation coefficients (ICCs). The relation between patient-reported outcomes and objective clinical outcome measures was analyzed using a discriminate function from standardized values of the variables and an analysis of the reliability of the ultrasound measurement. Results The reliability tests show an ICC value >.95 for morphologic and functional variables. The independent variables included in the analysis explained 42% (P=.003) of the dependent variable variance. Conclusions The relation between objective variables (electromyography, thickness, pennation angle) and a subjective variable (RMDQ ≥6) and the capacity of this relation to identify CNLBP within a group of healthy subjects is moderate. These results should be considered by clinicians when treating this type of patient in clinical practice.

Comparison of silicate-substituted calcium phosphate (Actifuse®) with rhBMP-2 (Infuse®) in posterolateral instrumented lumbar fusion

Study Design This was a randomised controlled trial in patients with degenerative disc disease (DDD) who underwent instrumented posterolateral lumbar fusion (PLF) surgery. Objective The aim of this study was to assess the efficacy of the bone grafting substitute, silicate-substituted calcium phosphate (SiCaP) compared with bone morphogenetic protein (rhBMP-2) and to evaluate clinical outcomes over a period of two years. Methods Patients undergoing PLF surgery for DDD at a single centre were recruited and randomised to one of two groups; SiCaP (n=9) or rhBMP-2 (n=10). One patient withdrew prior to randomisation and another from the rhBMP-2 group after randomisation. The radiological and clinical outcomes were examined and compared. Fusion was assessed at 12 months with computed tomography (CT) and plain radiographs. Clinical outcomes were evaluated by recording measures of pain, quality of life, disability and neurological status from six weeks to two years postoperatively. Results In the SiCaP and rhBMP-2 groups, fusion was observed in 9/9 and 8/9 patients respectively. Pain and disability scores were reduced and quality of life increased in both groups. Leg pain, disability and satisfaction scores were similar between the groups at each postoperative time point, however, back pain was less at six weeks and quality of life was higher at six months in the SiCaP group than the rhBMP-2 group. Conclusions SiCaP and rhBMP-2 were comparable in terms of achieving successful bone growth and fusion. Both groups similarly alleviated pain and improved quality of life, neurological, satisfaction and return to work outcomes following PLF surgery.

Suggestive linkage of 2p22-25 and 11q12-13 with low bone mineral density at the lumbar spine in the Irish population

Osteoporosis is a disease characterized by low bone mineral density (BMD) and poor bone quality. Peak bone density is achieved by the third decade of life, after which bone is maintained by a balanced cycle of bone resorption and synthesis. Age-related bone loss occurs as the bone resorption phase outweighs the bone synthesis phase of bone metabolism. Heritability accounts for up to 90% of the variability in BMD. Chromosomal loci including 1p36, 2p22-25, 11q12-13, parathyroid hormone receptor type 1 (PTHR1), interleukin-6 (IL-6), interleukin 1 alpha (IL-1α) and type II collagen A1/vitamin D receptor (COL11A1/VDR) have been linked or shown suggestive linkage with BMD in other populations. To determine whether these loci predispose to low BMD in the Irish population, we investigated 24 microsatellite markers at 7 chromosomal loci by linkage studies in 175 Irish families of probands with primary low BMD (T-score ≤ -1.5). Nonparametric analysis was performed using the maximum likelihood variance estimation and traditional Haseman-Elston tests on the Mapmaker/Sibs program. Suggestive evidence of linkage was observed with lumbar spine BMD at 2p22-25 (maximum LOD score 2.76) and 11q12-13 (MLS 2.55). One region, 1p36, approached suggestive linkage with femoral neck BMD (MLS 2.17). In addition, seven markers achieved LOD scores > 1.0, D2S149, D11S1313, D11S987, D11S1314 including those encompassing the PTHR1 (D3S3559, D3S1289) for lumbar spine BMD and D2S149 for femoral neck BMD. Our data suggest that genes within a these chromosomal regions are contributing to a predisposition to low BMD in the Irish population.

Transonic Properties of Accretion Disk Around Compact Objects

An accretion flow is necessarily transonic around a black hole.However, around a neutron star it may or may not be transonic, depending on the inner disk boundary conditions influenced by the neutron star. I will discuss various transonic behavior of the disk fluid in general relativistic (or pseudo general relativistic) framework. I will address that there are four types of sonic/critical point. possible to form in an accretion disk. It will be shown that how the fluid properties including location of sonic point's vary with angular momentum of the compact object which controls the overall disk dynamics and outflows.

2.5-dimensional solution of the advective accretion disk:a self-similar approach

We provide a 2.5-dimensional solution to a complete set of viscous hydrodynamical equations describing accretion- induced outflows and plausible jets around black holes/compact objects. We prescribe a self-consistent advective disk-outflow coupling model, which explicitly includes the information of vertical flux. Inter-connecting dynamics of an inflow-outflow system essentially upholds the conservation laws. We provide a set of analytical family of solutions through a self-similar approach. The flow parameters of the disk-outflow system depend strongly on the viscosity parameter α and the cooling factor.

Time dependent rotational flow of a viscous fluid over an infinite porous disk with a magnetic field

Both the semi-similar and self-similar flows due to a viscous fluid rotating with time dependent angular velocity over a porous disk of large radius at rest with or without a magnetic field are investigated. For the self-similar case the resulting equations for the suction and no mass transfer cases are solved numerically by quasilinearization method whereas for the semi-similar case and injection in the self-similar case an implicit finite difference method with Newton's linearization is employed. For rapid deceleration of fluid and for moderate suction in the case of self-similar flow there exists a layer of fluid, close to the disk surface where the sense of rotation is opposite to that of the fluid rotating far away. The velocity profiles in the absence of magnetic field are found to be oscillatory except for suction. For the accelerating freestream, (semi-similar flow) the effect of time is to reduce the amplitude of the oscillations of the velocity components. On the other hand the effect of time for the oscillating case is just the opposite.

Cavitation erosion characteristics of poly(methyl methacrylate) in a rotating disk device

Experimental results pertaining to the initiation, dynamics and mechanism of cavitation erosion on poly(methyl methacrylate) specimens tested in a rotating disk device are described in detail. Erosion normally starts at the location nearest to the center of rotation (CR). As the exposure time to cavitation increases, additional erosion areas or sites appear away from the CR and secondary erosion (induced by eroded pits) spreads upstream and merges with the main pit. The microcracks increase in density towards the end of the incubation period and transform into macrocracks in most cases. A study of light optical photographs and scanning electron micrographs of the eroded area shows that material particles are removed from the network of cracks because of crack joining and pits indicate particle debris. Optical degradation (loss of transmittance) is observed to be greater on the back of the specimen than on the front.

The harmonic torsional oscillations of a thin disk submerged in a fluid with a surfactant surface layer

A formulation in terms of a Fredholm integral equation of the first kind is given for the axisymmetric problem of a disk oscillating harmonically in a viscous fluid whose surface is contaminated with a surfactant film. The equation of the first kind is converted to a pair of coupled integral equations of the second kind, which are solved numerically. The resistive torque on the disk is evaluated and surface velocity profiles are computed for varying values of the ratio of the coefficient of surface shear viscosity to the coefficient of viscosity of the substrate fluid, and the depth of the disk below the surface.

Does the addition of Clonidine to lumbar nerve root blocks improve outcome? A randomised, prospective, single-blinded controlled pilot study

Purpose To evaluate if adding clonidine to a standard nerve root block containing local anaesthetic and steroid improved the outcome of patients with severe lumbar nerve root pain secondary to MRI proven lumbar disc prolapse. Methods We undertook a single blind, prospective, randomised controlled trial evaluating 100 consecutive patients with nerve root pain secondary to lumbar disc prolapse undergoing trans-foraminal epidural steroid injection either with or without the addition of clonidine. 50 patients were allocated to each arm of the study. The primary outcome measure was the avoidance of a second procedure- repeat injection or micro-discectomy surgery. Secondary outcome measures were also studied: pain scores for leg and back pain using a visual analogue scale (VAS), the Roland Morris Disability Questionnaire (RMDQ) and the Measure Your Own Medical Outcome Profile (MYMOP). Follow up was carried out at 6 weeks, 6 months and 1 year. Results No serious complications occurred. Of the 50 patients who received the addition of clonidine, 56% were classified as successful injections, with no further intervention required, as opposed to 40% who received the standard injection. This difference did not reach statistical significance (p=0.109, chi-squared test). All secondary measures showed no statistically significant differences between the groups except curiously, the standard group who had been classified as successful had better leg pain relief than the clonidine group (p=0.026) at 1 year. Conclusions This pilot study has shown a 16% treatment effect with adding clonidine to lumbar nerve root blocks and that it is a safe injectate for this purpose.

Transonic Properties of Accretion Disk Around Compact Objects

An accretion flow is necessarily transonic around a black hole. However, around a neutron star it may or may not be transonic, depending on the inner disk boundary conditions influenced by the neutron star. I will discuss various transonic behavior of the disk fluid in general relativistic (or pseudo general relativistic) framework. I will address that there are four types of sonic/critical point. possible to form in an accretion disk. It will be shown that how the fluid properties including location of sonic point's vary with angular momentum of the compact object which controls the overall disk dynamics and outflows.

Disk-Outflow Coupling: Energetics Around Spinning BlacK Holes

The mechanism by which outflows and plausible jets are driven from black hole systems still remains observationally elusive. This notwithstanding, several observational evidences and deeper theoretical insights reveal that accretion and outflow/jet are strongly correlated. We model an advective disk-outflow coupled dynamics, incorporating explicitly the vertical flux. Inter-connecting dynamics of outflow andaccretion essentially upholds the conservation laws. We investigate the properties of the disk-outflow surface and its strong dependence on the rotation parameter of the black hole. The energetics of the disk outflow strongly depend on the mass, accretion rate, and spin of the black holes. The model clearly shows that the outflow power extracted from the disk increases strongly with the spin of the black hole, inferring that the power of the observed astrophysical jets has a proportional correspondence with the spin of the central object. In the case of blazars (BL Lacs and flat spectrum radio quasars, FSRQs), most of their emission are believed to be originated from their jets. It is observed that BL Lacs are relatively low luminous than FSRQs. The luminosity might be linked to the power of the jet, which in turn reflects that the nuclear regions of the BL Lac objects have a relatively low spinning black hole compared to that in the case of FSRQs. If extreme gravity is the source that powers strong outflows and jets, then the spin of the black hole, perhaps, might be the fundamental parameter to account for the observed astrophysical processes in an accretion powered system.

An unsteady flow due to eccentrically rotating porous disk and a fluid at infinity

An exact solution of the unsteady Navier-Stokes equations is obtained for the flow due to non-coaxial rotations of a porous disk, executing non-torsional oscillations in its own plane, and a fluid at infinity. It is shown that the infinite number of solutions existing for a flow confined between two disks reduce to a single unique solution in the case of a single disk. The adjustment of the unsteady flow near the rotating disk to the flow at infinity rotating about a different axis is explained.

Analysing local algorithms in location-aware quasi-unit-disk graphs

A local algorithm with local horizon r is a distributed algorithm that runs in r synchronous communication rounds; here r is a constant that does not depend on the size of the network. As a consequence, the output of a node in a local algorithm only depends on the input within r hops from the node. We give tight bounds on the local horizon for a class of local algorithms for combinatorial problems on unit-disk graphs (UDGs). Most of our bounds are due to a refined analysis of existing approaches, while others are obtained by suggesting new algorithms. The algorithms we consider are based on network decompositions guided by a rectangular tiling of the plane. The algorithms are applied to matching, independent set, graph colouring, vertex cover, and dominating set. We also study local algorithms on quasi-UDGs, which are a popular generalisation of UDGs, aimed at more realistic modelling of communication between the network nodes. Analysing the local algorithms on quasi-UDGs allows one to assume that the nodes know their coordinates only approximately, up to an additive error. Despite the localisation error, the quality of the solution to problems on quasi-UDGs remains the same as for the case of UDGs with perfect location awareness. We analyse the increase in the local horizon that comes along with moving from UDGs to quasi-UDGs.