Miracle-dz/UniFAR-FTUs huggingface dataset:
Normal Functional Range of Motion of the Lumbar Spine During 15 Activities of Daily Living

Study Design Prospective clinical study. Objective The purpose of this investigation was to quantify normal lumbar range of motion (ROM) and compare these results with those used to perform 15 simulated activities of daily living (ADLs) in asymptomatic subjects. Summary of Background Data Previous studies reporting the ROM of the lumbar spine during ADLs have been limited, only focusing on 4 ADLs. The purpose of this investigation was to quantify the extent of normal lumbar ROM and determine how much motion is necessary to perform 15 simulated ADLs. Methods A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the lumbar spine. The accuracy and reliability of the devices were confirmed by comparing the ROM values acquired from dynamic flexion/extension and lateral bending radiographs with those provided by the device that was activated while the radiographs were obtained. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on consecutive days. These tools were employed in a clinical laboratory setting to evaluate the full active ROM of the lumbar spines (ie, flexion/extension, lateral bending, and axial rotation) of 60 asymptomatic subjects (30 women and 30 men; age 20 to 75 y) and to assess the functional ROM required to complete 15 simulated ADLs. Results When compared with radiographic measurements, the electrogoniometer was found to be accurate within 2.3±2.6 degrees (mean±SD). The intraobserver reliabilities for assessing full and functional ROM were both excellent (intraclass correlation coefficient of 0.96 and 0.88, respectively). The absolute ROM and percentage of full active lumbar spinal ROM used during the 15 ADLs was 3 to 49 degrees and 4% to 59% (median: 9 degrees/11%) for flexion/extension, 2 to 11 degrees and 6% to 31% (6 degrees/17%) for lateral bending, and 2 to 7 degrees and 6% to 20% (5 degrees/13%) for rotation. Picking up an object from the ground, either using a bending or squatting technique, required the most ROM of all the ADLs. Squatting required a significantly less amount of sagittal motion compared with bending at the waist (42 vs. 48 degrees, P=0.003). No difference was seen in both lateral and rotation motion between these 2 techniques (11 vs. 11 degrees and 6 vs. 6 degrees, respectively). Both ascending and descending stairs required equivalent amounts of total motion in all 3 motion planes. As a whole, personal hygiene ADLs (hand washing, washing hair, shaving, and make-up application) required a similar amount of motion compared with the 3 locomotive ADLs (walking, up and down stairs). Conclusions By quantifying the amounts of lumbar motion required to execute a series of simulated ADLs, this study indicates that most individuals use a relatively small percentage of their full active ROM when performing such activities. These findings provide baseline data that may allow clinicians to accurately assess preoperative impairment and postsurgical outcomes.
Pulmonary Function After Thoracoplasty in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Study Design Retrospective case series review. Objective To compare two similar groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T); attention was focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis. Summary of Background Data Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion have been found to have a deleterious effect on pulmonary function for as long as five years postoperatively after surgical treatment of adolescent idiopathic scoliosis. Methods A group of 40 consecutive adolescent patients, surgically treated between 1998 and 2001 by posterior spinal fusion and thoracoplasty, was compared with a similar cohort of 40 adolescents treated in the same period by posterior segmental fusion alone. Pedicle screw instrumentation alone and a minimum five-year follow-up were requested as inclusion criteria. Both a radiographic analysis and a chart review was performed, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire and the Lenke classification system. A radiographic Rib Hump (RH) assessment was also performed. Results The entire series was reviewed at an average clinical follow-up of 8.3 years. There were no statistically significant differences between the two groups in terms of gender, age (PSF+T: 16.3 y vs. PSF: 15.2 y), Lenke curve type classification and preoperative Cobb's main thoracic (MT) curve magnitude (PSF+T: 66° vs. PSF: 63°), whereas both final MT percent correction (PSF+T: 53.03% vs. PSF: 51.35%; P<0.03), RH absolute correction (PSF+T: −2.1 cm vs. PSF: −1.05; P<0.01) and RH overall percent correction (PSF+T: 55.4% vs. PSF: 35.4%; P<0.0001) were greater in the thoracoplasty group. No statistical differences were observed between the two groups in PFTs both pre-operatively and at last follow-up. Nevertheless, comparing preoperative to final PFT'S within each group, only in the PSF group both forced vital capacity and forced expiratory volume in one second showed a statistically significant improvement at final evaluation. At last follow-up visit, the SRS-30 scores did not show any statistical difference between the two groups (total score PSF+T: 4.1 vs. PSF: 4.3). Conclusions Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in AIS patients treated by posterior spinal fusion alone using pedicle screws instrumentation, as already highlighted by previous reports. A trend towards better coronal plane correction and rib hump improvement was seen, although not clearly reported in a self-assessment disease-specific questionnaire.
Reliability of the Balanced Inventory for Spinal Disorders, a Questionnaire for Evaluation of Outcomes in Patients With Various Spinal Disorders

Study Design An intrapatient reliability study of the previously validated 18-item questionnaire, the Balanced Inventory for Spinal disorders (BIS), in patients referred for planned spinal surgery. Statistical evaluation of the test-retest assessments was performed by a rank-based method that allows for separate analyses of the systematic and individual components of an observed disagreement. Objective To evaluate the intrapatient reliability and the art of disagreement, when present, in assessing the extent to which pain affects perceived physical health, social life, mental health, and quality of life according to the BIS. For comparative reasons corresponding items in Short-Form-36 (SF-36) and Oswestry Disability Index (ODI) were also evaluated. Summary of Background Data The questionnaires were filled in by 101 patients the evening before going to the clinic for planned spinal surgery and the following evening at the clinic. Results The percentage agreement in test-retest assessments of the items varied from 52% to 84%. The important items of pain, physical activities, social life, overall mental health, and quality of life showed high levels of reliability. An intrapatient disagreement of more than 1 category was seen in 4 items of mental health and in physical health, only. The observed individual variability and the significant systematic decrease on the second occasion could be explained by the fact that the patients were at the hospital on the retest occasion. The variation in percentage agreements found, and the different reasons for disagreement in items speak against that memory alone could have caused the retest assessments. Conclusion The comprehensive evaluation of test-retest reliability showed that the test-retest assessments on the BIS could be regarded as reliable, and the measures of reliability of the BIS items were on the same levels as for corresponding items of the SF-36 and the ODI questionnaires.
Manifestaciones hepatobiliares en la enfermedad inflamatoria intestinal

Es frecuente que en los pacientes con enfermedad inflamatoria intestinal (EII) se observen cambios analíticos o clínicos que indican la existencia de una enfermedad hepatobiliar. La frecuencia de estos hallazgos oscila entre el 11 y 49% en la colitis ulcerosa (CU) y entre el 15 y el 30% en la enfermedad de Crohn (EC) (1-4). En algunos casos, estas alteraciones se observan desde el primer momento en que se estudia a los enfermos, otras surgen en el curso de la enfermedad. Las causas que provocan estos cambios son, sin duda, múltiples. En unos casos son claras complicaciones de la EII, en otros, la causa de las lesiones es desconocida, al igual que es desconocida la etiología de esta última enfermedad, pero probablemente se relacionan con la EII por compartir mecanismos patogénicos comunes. Por último, hay casos en los que las alteraciones hepáticas se deben a reacciones adversas a algunos de los fármacos que habitualmente se emplean en el tratamiento de estos enfermos. Entre los primeros figura la enfermedad grasa del hígado no alcohólica, la colelitiasis y la amiloidosis. Al segundo grupo pertenecería la colangitis esclerosante primaria, la hepatitis autoinmune y los granulomas hepáticos. En el tercer grupo de alteraciones hepáticas podemos incluir los casos de hepatitis o colestasis farmacológicas, los cuados de hiperplasia nodular regenerativa del hígado, de enfermedad veno-oclusiva o de hipertensión portal no cirrótica que pueden surgir en el curso del tratamiento de la EII, o también las reactivaciones infecciosas, concretamente de infecciones latentes por el virus de la hepatitis B.
Effect of Spacer Diameter of the Dynesys Dynamic Stabilization System on the Biomechanics of the Lumbar Spine: A Finite Element Analysis

Study Design: A finite element analysis to simulate the behavior of lumbar spines implanted with a posterior dynamic neutralization system, Dynesys, under displacement-controlled loading. Objective: To investigate whether Dynesys spacers with different diameters would alter the distribution of range of motion, disk stress, and facet contact force at the Dynesys bridging level and the cranial adjacent level. Summary of Background Data: The Dynesys system is designed to preserve intersegmental motion and reduce loading at adjacent levels, but clinical reports do not support these claims. This system has been shown to be almost as stiff as rigid fixation, which acts to hinder intersegmental motion. Few studies have investigated methods of reducing this stiffness. Methods: In the finite element study, a previously validated lumbar spine model was used. Five Dynesys constructs with different spacer diameters (0.8, 0.9, 1.0, 1.1, and 1.2 times the original standard size) were implanted into the spine model and bore 4 displacement-controlled loading cases: flexion, extension, torsion, and lateral bending. Resultant range of motions (ROMs), disk stress, and facet contact forces at the bridged level and the cranial adjacent level were compared with the results of a spine model without Dynesys implantation. Results: The results of ROMs, disk stress, and facet contact forces at the bridged levels were all less than those in the intact spine, except for contact forces at the left facet under lateral bending, facet contact forces at the right facet under torsion, and disk stress under torsion. The results of ROMs, disk stress, and facet contact forces at the cranial adjacent levels were all higher than those in the intact spine. Conclusions: The results of the present study show that changing the diameter of the spacers will alter the stiffness of the Dynesys construct. Dynesys constructs with larger diameters behave stiffer under flexion but behave softer under extension, torsion, and lateral bending. Changing the diameter of the Dynesys spacers does not significantly influence the load distribution at adjacent levels.
Biomechanics of Posterior Dynamic Fusion Systems in the Lumbar Spine: Implications for Stabilization With Improved Arthrodesis

Study Design:A comparative biomechanical human cadaveric spine study of a dynamic fusion rod and a traditional titanium rod. Objective:The purpose of this study was to measure and compare the biomechanical metrics associated with a dynamic fusion device, Isobar TTL Evolution, and a rigid rod. Summary of Background Data:Dynamic fusion rods may enhance arthrodesis compared with a rigid rod. Wolff’s law implies that bone remodeling and growth may be enhanced through anterior column loading (AL). This is important for dynamic fusion rods because their purpose is to increase AL. Methods:Six fresh-frozen lumbar cadaveric specimens were used. Each untreated specimen (Intact) underwent biomechanical testing. Next, each specimen had a unilateral transforaminal lumbar interbody fusion performed at L3–L4 using a cage with an integrated load cell. Pedicle screws were also placed at this time. Subsequently, the Isobar was implanted and tested, and finally, a rigid rod replaced the Isobar in the same pedicle screw arrangement. Results:In terms of range of motion, the Isobar performed comparably to the rigid rod and there was no statistical difference found between Isobar and rigid rod. There was a significant difference between the intact and rigid rod and also between intact and Isobar conditions in flexion extension. For interpedicular displacement, there was a significant increase in flexion extension (P=0.017) for the Isobar compared with the rigid rod. Isobar showed increased AL under axial compression compared with the rigid rod (P=0.024). Conclusions:Isobar provided comparable stabilization to a rigid rod when using range of motion as the metric, however, AL was increased because of the greater interpedicular displacement of dynamic rod compared with a rigid rod. By increasing interpedicular displacement and AL, it potentially brings clinical benefit to procedures relying on arthrodesis.
Education as a factor in mortality decline: an examination of Nigerian data

The debate between those who see economic development and those who regard advances in medical technology as bearing major responsibility for mortality decline usually gives little attention to different stages of social change when economic or medical conditions are fixed. However Nigerian statistics analyzed here show that very different levels of child survivorship result from different levels of maternal education in an otherwise similar socioeconomic context and when there is equal access to the use of medical facilities. Indeed maternal education in Nigeria appears to be the single most powerful determinant of the level of child mortality. The statistics come from 2 surveys undertaken in 1973: one of 6606 women in Ibadan city and the other of 1499 women in a large area of southwest Nigeria. Proportions of children surviving are compounded into an index of child mortality to increase the frequencies in individual cells and standardize maternal age when child survivorship is correlated with a range of factors and 2 component indices are also constructed to detect change over time. It is concluded that womens education in societies like that of the Yoruba in Nigeria can produce profound changes in family structure and relationships which in turn may influence both mortality and fertility levels. Education may well play a major role in the demographic transition and this role may help to explain the close timing of mortality and fertility transitions. (Authors)
The Effect of Dietary Fiber on Glucose and Hormone Responses to a Mixed Meal in Normal Subjects and in Diabetic Subjects With and Without Autonomie Neuropathy

We investigated the effects of fiber on responses of blood glucose, serum insulin, gastric inhibitory polypeptide (GIP), and immunoreactive pancreatic glucagon (IRG) to ingestion of a mixed meal with and without added fiber (5 g guar and 5 g pectin) in 12 normal, healthy subjects and in 12 age-, sex-, and weight-matched non-insulin-dependent, maturity-onset diabetic subjects (NIDDM). Fiber markedly enhanced glucose tolerance in the normal subjects without a change in insulin or GIP but with a significant reduction in glucagon responses. Fiber also markedly improved glucose tolerance in the NIDDMs without changing insulin or GIP but with a significant reduction in the glucagon responses. The NIDDMs were divided into two groups of six subjects, with and without autonomic neuropathy (AN). In NIDDMs without AN, glucose tolerance was improved by fiber without a change in insulin, IRG, or GIP. In diabetic subjects with AN, glucose tolerance was not improved, although glucagon levels were lowered and insulin and GIP responses were unchanged. It appears, therefore, that fiber improves glucose tolerance by altering factors other than insulin. It seems also that autonomie nervous supply to the gastrointestinal tract is important in mediating the effect.
Spontaneous intracranial hypotension caused by cervical CSF fistulae mimicking subarachnoid haemorrhage – a case report

Abstract We describe an unusual and rarely documented site of SIH supported by clear radiological evidence: a case of spontaneous cerebrospinal fluid (CSF) fistulae involving the C7 and C8 nerve root sheaths, presenting with sudden onset headache and requiring surgical intervention to seal the leaks. Investigations confirmed the leaks and the typical MRI findings of meningeal enhancement, which were resolved after surgery.
Musculotendinous Injuries About the Athletically Active Middle-Aged Knee

As the number of athletically active middle-aged individuals grows, these patients may present with injuries previously found in younger athletes or injuries unique to their age group. Physiologic age-related changes to the musculutendinous unit may predispose to more frequent injury, altered healing responses, and potential delay in recovery. This article reviews these changes and common musculotendinous injuries around the knee of the middle-aged athlete. With a better understanding of these processes, the physician should be able to make timely, accurate diagnoses with appropriate and cost-effective treatment and rehabilitative recommendations.
Simultaneous determination of three dipeptides (JBP485, Gly-Sar and JBP923) in the cell lysates by liquid chromatography-tandem mass spectrometry: application to identify the function of the PEPT1 transfected cell.

A simple and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of JBP485, Gly-Sar and JBP923 in the cell lysates using methanol as a deproteinization solvent was developed and validated. Detection was performed by turbo ionspray ionization in multiple reaction monitoring mode using the transitions of m/z 147.1 → m/z 90.1 for Gly-Sar, m/z 201.1 → m/z 86.1 for JBP485, m/z 219.1 → m/z 86.1 for JBP923 and m/z 152.0 → m/z 110.0 for paracetamol (internal standard). The analytes were separated on a Hypersil ODS C18 HPLC column using isocratic elution mode with a mobile phase containing 0.1% formic acid in water-methanol (97:3, v/v) at a flow rate of 0.2 mL/min. The calibration curves were demonstrated to be linear over the concentration range of 5.00-5000 nm with coefficient of 0.9968 for Gly-Sar, 0.9975 for JBP485 and 0.9952 for JBP923. The intra- and inter-day precisions were <10.2% for each quality contro; level, and the accuracy was within ±5.6% for each analyte. The matrix effect, the extraction recovery and stabilities of LC-MS/MS analysis were also investigated. This validated method was successfully applied to the simultaneous determination of JBP485, Gly-Sar and JBP923 in the cell lysates for identification of stably transfected HeLa cells with human PEPT1.
The Biomechanical Properties of Pedicle Screw Fixation Combined With Trajectory Bone Cement Augmentation in Osteoporotic Vertebrae

Study Design:The biomechanics of pedicle screw fixation combined with trajectory cement augmentation with various filling volumes were measured by pull-out, periodic antibending, and compression fatigue tests. Objective:To investigate the biomechanical properties of the pedicle screw fixation combined with trajectory bone cement (polymethylmethacrylate) augmentation in osteoporotic vertebrae and to explore the optimum filling volume of the bone cement. Summary of Background Data:Pedicle screw fixation is considered to be the most effective posterior fixation method. The decrease of the bone mineral density apparently increases the fixation failure risk caused by screw loosening and displacement. Trajectory bone cement augmentation has been confirmed to be an effective method to increase the bone intensity and could markedly increase the stability of the fixation interface. Methods:Sixteen elderly cadaveric 1–5 lumbar vertebral specimens were diagnosed with osteoporosis. The left and right vertebral pedicles were alternatively randomized for treatment in all groups, with the contralateral pedicles as control. The study groups included: group A (pedicle screw fixation with full trajectory bone cement augmentation), group B (75% filling), group C (50% filling), and group D (25% filling). Finally, the bone cement leakage and dispersion were assessed and the mechanical testing was conducted. Results:The bone cement was well dispersed around the pedicle screw. The augmented bone intensity, pull-out strength, periodic loading times, and compression fatigue performance were markedly higher than those of the control groups. With the increase in trajectory bone cement, the leakage was also increased (P<0.05). The pull-out strength of the pedicle screw was increased with an increase in bone mineral density and trajectory bone cement. It peaked at 75% filling, with the largest power consumption. Conclusions:The optimal filling volume of the bone cement was 75% of the trajectory volume (about 1.03 mL). The use of excessive bone cement did not increase the fixation intensity but increased the risk of leakage.
Presence of inflammatory proteins S100A8 and S100A9 in a giant intracranial aneurysm after flow diverter treatment

Abstract We demonstrate the presence of S100A8 and S100A9 proteins in the wall and thrombosed lumen of an enlarged intracranial aneurysm after flow diverter treatment. These proteins have shown to play an important role in vascular inflammation and may serve as a biomarker and potential therapeutic target for intracranial aneurysms.
Development and validation of a reversed-phase HPLC method for CYP1A2 phenotyping by use of a caffeine metabolite ratio in saliva.

CYP1A2 is important for metabolizing various clinically used drugs. Phenotyping of CYP1A2 may prove helpful for drug individualization therapy. Several HPLC methods have been developed for quantification of caffeine metabolites in plasma and urine. Aim of the present study was to develop a valid and simple HPLC method for evaluating CYP1A2 activity during exposure in xenobiotics by the use of human saliva. Caffeine and paraxanthine were isolated from saliva by liquid-liquid extraction (chlorophorm/isopropanol 85/15v/v). Extracts were analyzed by reversed-phase HPLC on a C18 column with mobile phase 0.1% acetic acid/methanol/acetonitrile (80/20/2 v/v) and detected at 273nm. Caffeine and paraxanthine elution times were <13min with no interferences from impurities or caffeine metabolites. Detector response was linear (0.10-8.00µg/ml, R(2) >0.99), recovery was >93% and bias <4.47%. Intra- and inter-day precision was <5.14% (n=6). The limit of quantitation was 0.10µg/ml and the limit of detection was 0.018±0. 002µg/mL for paraxanthine and 0.032±0. 002µg/ml for caffeine. Paraxanthine/caffeine ratio of 34 healthy volunteers was significantly higher in smokers (p<0.001). Saliva paraxanthine/caffeine ratios and urine metabolite ratios were highly correlated (r=0.85, p<0.001). The method can be used for the monitoring of CYP1A2 activity in clinical practice and in studies relevant to exposure to environmental and pharmacological xenobiotics.