bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clg2p interacts with Clf and ClUrase to regulate appressorium formation, pathogenicity and conidial morphology in Curvularia lunata
Authors: Liu Tong , Wang Yuying , Ma Bingchen , Hou Jumei , Jin Yazhong , Zhang Youli , Ke Xiwang , Tai Lianmei , Zuo Yuhu , Dey Kishore 
Published: April 2016

AbstractRas is a small GTPase that regulates numerous processes in the cellular development and morphogenesis of many organisms. In this study, we identified and functionally characterized the Clg2p gene of Curvularia lunata, which is homologous with the Ras protein. The Clg2p deletion mutant (ΔClg2p) had altered appressorium formation and conidial morphology and produced fewer, smaller lesions compared with the wild-type strain. When a dominant Clg2p allele was introduced into the mutant, all of these defective phenotypes were completely restored. To further understand the regulation of Clg2p in appressorium formation and conidial morphology, and its role in pathogenicity, seven Clg2p-interacting proteins were screened using a yeast two-hybrid assay. Two of these proteins, Clf, a homologue of Mst11, which corresponds to MAP kinase kinase kinase in Magnaporthe oryzae, and urate oxidase (designated ClUrase) were functionally characterized. Clg2p specifically interacted with Clf through its RA domain to regulate appressorium formation and pathogenicity, whereas the Clg2p-ClUrase interaction regulated conidial morphology without affecting fungal pathogenicity. This report is the first to elucidate the regulatory mechanism of the key Ras protein Clg2p in C. lunata.
Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review
Authors: Gabel Brandon C. , Schnell Eric C. , Dettori Joseph R. , Jeyamohan Shiveindra , Oskouian Rod 
Published: April 2016

Study Design Systematic review. Objective To determine the frequency of pulmonary effusion, pneumothorax, and hemothorax in adult patients undergoing thoracic corpectomy or osteotomy for any condition and to determine if these frequencies vary by surgical approach (i.e., anterior, posterior, or lateral). Methods Electronic databases and reference lists of key articles were searched through September 21, 2015, to identify studies specifically evaluating the frequency of pulmonary effusion, pneumothorax, and hemothorax in patients undergoing thoracic spine surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met inclusion criteria. The frequency across studies of pulmonary effusion ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to 50%. There was no clear pattern of pulmonary complications with respect to surgical approach. Conclusions There is insufficient data to determine the risk of pulmonary complications following anterior, posterior, or lateral approaches to the thoracic spine. Methods for assessing pulmonary complications were not well reported, and data is sparse.
Structural and Functional Repair of the Annulus Fibrosus
Authors: Iatridis James C. 
Published: April 2016

Degenerated intervertebral discs (IVDs) are commonly implicated in low back pain and herniation is a direct cause of pain and disability. There are few minimally invasive treatments to treat and repair painful IVD degeneration including annulus fibrosus (AF) defects. Painful IVD injuries and degeneration are associated with structural disruption, chronic inflammation, and neurovascular ingrowth deep into the IVD and all of these conditions must be addressed to enhance function and inhibit painful conditions. Design goals for functional AF repair involve the restoration IVD height and motion segment biomechanics to intact conditions, sealing of defects in the AF, no (or minimal) risk of herniation under high physiological load conditions, and the ability to promote healing. Evaluation methods for AF repair strategies should progress from rapid screening studies to more advanced and rigorous evaluations in situ and eventually in vivo. Multiple hydrogel repair strategies are described including sealants and cell carriers. Fibrin crosslinked with geniplin (FibGen) shows promise for AF repair with good performance biomechanically and in organ culture. Disclosures: None
Biologic Targets for Mitigating Age-Associated Intervertebral Disc Degeneration
Authors: Vo Nam 
Published: April 2016

Growing old is the greatest risk factor for the development of intervertebral disc degeneration (IDD), an underlying condition of many debilitating spine-related disorders including chronic back pain. Understanding the biology of intervertebral disc aging to develop effective interventions to minimize the adverse effects of aging on disc health is imperative, given the rapid global growth of the aging population. Recent research studies have begun to shed light on the basic biological process of disc aging. Accumulation of DNA damage was recently demonstrated as a key molecular driver of aging of the intervertebral discs. This talk summarizes the major findings that shed lights on the molecular mechanisms of how disc DNA damage is induced and the consequences of accumulated DNA damage on disc cell phenotype and extracellular matrix homeostasis. In particular, cellular senescence emerges as a central mediator of age-related disc degenerative changes which originated from DNA damage. The molecular processes of how DNA damage induces disc cellular senescence leading to perturbation of disc matrix homeostasis and matrix proteglycan loss through the NF-kB signaling are discussed in details. Key molecular steps involved in generation of DNA damage, formation of senescence, and activation of NF-kB signaling in disc cells will be highlighted as novel therapeutic targets along with the emerging candidate therapeutics that may mitigate age-associated IDD. Disclosures: None
The Experience of Eggshell Technique during Kyphoplasty to Prevent Cement Leakage in Treatment of Osteoporotic Vertebral Fracture
Authors: Lo Haoju 
Published: April 2016

Introduction Osteoporosis is the big problem in the aging human. Among these osteoporotic related fractures, vertebral compression commonly is the main one. Pain and disability pose major problems in these patients. To restore the vertebral height for driving physical stiffness, and loading bearing toward normal limited and control the pain, kyphoplasty with variable filling materials (PMMA, CPC etc.) have been used for the treatment. For decreasing the rate of PMMA leakage in various wall injuries in vertebral compression fracture, we performed kyphoplasty with modified eggshell technique in different characteristics of vertebral wall. Material and Methods Twenty-four symptomatic vertebral fractures were enrolled. Visual Analogue Scale, the Oswestry Disability Index and Vertebral Wall Injury Score were assessed. The vertebral height loss and changes of kyphotic angle were also recorded by plain X-ray. Three-dimensional CT will be arranged for evaluating the condition of deficiency vertebral wall and central body collapse if need. After creating cavity by percutaneous bipedicular balloon device, PMMA was injected into weak wall site according the pre-operative evaluation or intra-operative finding. The balloon was once again introduced into the created cavity and inflated to achieve the PMMA shield (regional egg-shell method). Then the PMMA or other materials as CPC materials will be continuously to be fill into the left space. Outcome, fill materials leakage condition, X-ray and CT were reviewed postoperatively. Results Symptomatic cement extravasation related complications or leakage on X-ray were not observed in follow up. Only one adjacent compression fracture was happened in one month. Improvement in vertebral height and the mean kyphotic angle was also noted. The mean VAS and ODI decreased significantly from pre-operation to post-operation ( p < 0.05). The Vertebral Wall Injury Score reviews also told us the eggshell technique is fit for multiple conditions of wall injury Conclusion It's always concerned for the leakage of PMMA during spine surgery. There are many options of new implant for decreasing the rate of leakage. Greene introduces the eggshell technique in 2007, they used the eggshell idea to cover the possible leakage site. They had only 7 patients and those possible cortical defects were noted over superior endplate or lateral wall in their paper. According to our experiences in kyphoplasty with this regional eggshell technique in our 24 patients with various wall injuries. The technique is a safe and significantly functional works for decreasing the leakage of PMMA in various wall injury conditions with experienced surgery operator.
Characterization of Distribution of Segmental Changes in Cervical Alignment after Lumbar Pedicle Subtraction Osteotomy
Authors: Ailon Tamir , Scheer Justin , Shaffrey Christopher , Lafage Virginie , Protopsaltis Themistocles , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction Adult spinal deformity (ASD) patients with positive sagittal malalignment develop compensatory cervical hyperlordosis to maintain horizontal gaze, which spontaneous improves following lumbar PSO. We sought to characterize the segmental distribution and characteristics of these reciprocal changes in a similar patient group. Material and Methods Change in cervical radiographic measures from baseline to 6 weeks postop in 27 patients who underwent lumbar pedicle subtraction osteotomy (PSO) for correction of sagittal malalignment was assessed. Parameters included: C2–7 sagittal vertical axis (C2–7 SVA), C2-S1 SVA, C7-S1 SVA, pelvic incidence-lumbar lordosis mismatch (PI-LL) pelvic tilt (PT) and T1 and T9 spino-pelvic inclination (SPI). The cobb method was used for: occiput (C0)-C2, C2-T1, C2-C7. Harrison method for: Segmental angles between C2-T1. Vertebral body slopes were measured at the occiput (C0S), axis (C2S), T1 (T1S) and S1 (SS). Results All thoracolumbar parameters significantly improved to below established alignment thresholds: C2-S1 SVA (146/47mm), C7-S1 SVA (119/17mm), PI-LL (34.9/1.3 deg), PT (30.2/19.7 deg) ( p < 0.001). C2–7 SVA did not significantly change. Mean cervical lordosis (C2–7) decreased (19.9–14.1, p = 0.05, range 27.4, -40.9). Majority of the reciprocal decrease in C2–7 occurred at C3–4 (59.1%) and C4–5 (27.2%, Figure) with little at C5/6 (13.6%) and none at C6/7. Mean lordosis increased 1 deg at C2/3. There was an additional 1.3 deg decrease at C7-T1, accounting for 16.5% of the total decrease in C2-T1 angle (−6.9 deg). The C0-C2 angle increased 1.6 degrees. C2S and SS increased 5.8 and 10.3 deg, respectively ( p < 0.005) whereas C0S and T1S did not change significantly. Conclusion Following successful correction of positive sagittal malalignment, reciprocal changes in cervical alignment ensue. The majority of relaxation in hyper-lordosis occurs at C3–4 and C4–5. The angle between the occiput and C2 increased slightly to maintain head balance in response to decreased subaxial lordosis.
Effect of Topical versus Parentral Tranexamic Acid on Blood Loss in Spinal Deformity Surgery. A Prospective Randomized Controlled Trial
Authors: El-Sharkawi Mohammad , Sayed Sherif , Gad Wael , El-Meshtawy Mohamed 
Published: April 2016

Introduction Massive hemorrhage and massive blood transfusion are not uncommon in spinal deformity surgery. There are many factors which may affect the perioperative blood loss. Multiple studies showed the beneficial effects of parentral tranexamic acid (TXA) in decreasing intraoperative blood loss but there is a lack of knowledge about the effect of topical use of tranexamic acid. The aim of this study is to evaluate the effect of using tranexamic acid topically versus parentrally on the amount of intra operative blood loss. Material and Methods Between 2011 and 2014, eighty three patients (49 females/34 males, mean age 17 ± 4 ys, body weight 49 ± 6 kg) underwent correction (in the form of multiple Ponte osteotomies, PSO, PVCR) and posterior spinal fusion for spinal deformity (57 AIS, 14 congenital scoliosis, 12 syndromic). These patients were randomized into one of three groups. In group 1 ( n = 31 patients), TXA was used topically. TXA was sprayed directly in the wound and sponges soaked with it were used. In group 2 ( n = 29 patients), intravenous TXA was used intra-operatively. In group 3 ( n = 23 patients), TXA acid was used neither topically nor systemically. Intraoperative blood loss and the number of blood units transfused were recorded for all patients. The three groups were comparable in the mean age, body weight, operative time, type of deformity, type of osteotomy, number of fused segments, number of screws used. Results The mean operative time was (240 minute ± 50). The mean blood loss in group 1 was 1353 ± 273 cc, 1271 ±279 cc in group 2, and 1430 ± 311 cc in group 3. The mean number of blood units transfused in group 1 was 2.65 ± 0.587, 2.3 ± 0.571 in group 2, and 3.4 ± 0.5 in group 3. There were no significant differences in intraoperative blood loss and number of units of transfused blood between the first and second groups while there was a significant difference between them and the control group. One patient developed DVT in the intravenous TXA group. Conclusion Topical TXA is as effective as intravenous TXA and may be used safely to decrease the need for blood transfusion and intraoperative blood loss.
Surgical Site Infection in Spinal Operations a Tertiary Centre Review of 4557 Consecutive Procedures over 5 Years
Authors: Fawi Hassan , Ahmed Mohamed , Sousa Jose , Lewis Megan , Ahuja Sashin 
Published: April 2016

Background Surgical Site Infection (SSI) is a potential inherent risk of any surgical intervention. SSI can pose significant consequences especially in spinal surgery. Previous research showed that there are seasonal variations in the incidence of SSI with numbers peaking in summer months. Objective To evaluate (1) incidence of Surgical Site Infection (SSI) for consecutive operations in a tertiary center, (2) the commonest pathogen, (3) The management in our unit and its long-term outcome, and (4) Effect of seasonal change on SSI. Methods Consecutive spinal operations ( N = 4557) between Jan 2007 – Jan 2012 were studied looking for SSI using the Centres for Disease Control National Health Safety Network criteria. All patients with SSI positive criteria were included in the study. Further evaluation was based on the study objectives. Results 4557 procedures were assessed, of which 30.5% were Decompressions, Variable Thoraco-Lumbar Fusions (inc. ALIf, TLIF, XLIF, Deg. Scoliois correction) 25.8%, Cervical operations 18.8%, Scoliosis operations 10.5%, Decompressions and Interspinious spacers 6.9%, and miscellaneous procedures were 7.5%. In total 8.5% of cases were revision surgeries. The incidence of SSI was 4.9% with 62.1% Male and 37.9% Females. Commonest organisms were Coagulase Negative Staph 31.7%, Staph Aureus 26.8%, Pseudomonas 7%, MRSA 4%, and polymicrobial 30.5%. The average time to detection of infection was 23 days (3–200). Of the positive SSI cases, 9.75% needed surgical debridement. 2.4% needed removal of metal work/Replacement. They all made uneventful long-term recovery. 54.9% of SSI had their operations in the summer months, while 45.1% were operated in the Autumn/Winter months. Conclusion Bearing in mind the low infection rate of deep surgical site infections we encountered: Most of the SSI cases were effectively treated in our unit by using antibiotics only; The close liaison with our microbiology unit was and remains of paramount importance; There is no clear difference found in our study between Summer/Spring and Autumn/Winter months in the rate of developing SSI.
Surgical Results of 135 Thoraco-Lumbar Fractures Treated with Open Posterior Multi-Level Segmental Fixation: A Single Center Experience
Authors: Wasserberg Jonathan , Veres Robert , Urbansky Milan 
Published: April 2016

Introduction Surgical treatment strategies for thoraco-lumbar spine fractures differ widely around the world. Choice of operative approach varies depending on many factors including fracture classification, presence of spinal cord injury and whether subluxation or dislocation is present. Combinations of anterior and posterior approaches vary depending on surgeon choice, available resources and fracture morphology. We reviewed our experience of thoraco-lumbar vertebral fractures treated at our institution from Jan 14 – May 2015 to determine if our policy of posterior multi- level segmental fixation produced acceptable restoration of spinal alignment and reduction of kyphosis. Materials and Methods A retrospective cohort review was performed using the hospital electronic medical records system (Cerner, USA). All surgical cases were identified from the operating theater records. Only fractures from T1 to L5 were included. Imaging was reviewed using the hospital PACS system and classified according to the AO thoraco -lumbar classification system. Spinal cord injury was classified according to the ASIA scale. Post-operative images were reviewed and levels of fixation recorded. Accuracy of screw placement was assessed. Neurological status at discharge was recorded. Results 135 cases of TL fracture underwent surgery via an open posterior approach. Screw placement was performed using C-arm fluoroscopy.Data on the extent of kyphosis reduction is presented. Post-operative results in cases of vertebral subluxation and dislocation are presented. Early surgical outcome in cases with spinal cord injury are presented. Due to the high level of loss to follow up in our region we were unable to carry out longitudinal outcome studies. Conclusion The majority of thoraco -lumbar fractures can be managed by posterior approaches alone with good surgical outcomes. Type C fractures and fractures with dural tears and nerve damage can be adequately dealt with via this approach. The majority of cases had pedicle screw fixation two levels above and one level below the affected level. This strategy allowed good reduction of deformity, especially for fractures at L1, where fixation only to T12 can be associated with late onset of adjacent segment degeneration.The inability to carry out longitudinal outcome measures is an acknowledged weakness of our study, but the short-term surgical results are comparable to those in the literature using other surgical strategies. This retrospective cohort review supports our continuing use of the posterior multi-level segmental approach for T-L fractures irrespective of fracture type.
Psychosocial Representations of the Illness before Lumbar Spine Surgery and Their Effects on Recovery
Authors: Pócza-Véger Petra , Csabai Márta , Barzó Pál 
Published: April 2016

Introduction Psychosocial representation of the illness means those personal and mental meanings and thoughts which the patient connects with his/her own condition. The examination of representation of the illness is very important to understand the behavior of the patients because these representations contain of the patients' beliefs about their illness or injury. These beliefs influence the cure, the duration of recovery and these beliefs affect the strategies, which the patients use to cope with the illness. In clinical environment, the nonverbal methods help the exploration of representations of the illness, since the physical status can hamper the verbal expression of burdens (for example: pain, suffering). In such cases, we can use the PRISM task (Pictorial Representation of Illness Self-Measure) to measure the burden of suffering. Methods and Materials: In our research, there have been 110 inpatients (52 men). We have examined the patients before lumbar surgery, using the following tests: Psychological Vulnerability Questionnaire, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale and PRISM-D (drawing version of PRISM task) and we followed how many days the patients stayed at the clinic after the operation. Using the PRISM-D, we are observing the patients drawing the in some spatial formations, which are the following: 1. Self-shield (the patient draws the important things around herself/himself), 2. Illness-shield (the patient draws the important things around the illness), 3. Protective line (the patient draws the important things in horizontal or/and vertical line), 4. Network (the important things and the illness are diffused in space of the current life), 5. Fusion (the important things and the illness intersect with the self or every circle intersect with each other), 6. Self-part (the illness is drawn in the self and the other important things are located far away from the self). Results We have found that those patients who have drawn their illness in their own Self ( Self-part), went home later than the other patients (Self-shield: p = 0,004, Fusion: p = 0,026, Illness-shield: p = 0,008, Protective line: p = 0,036, Network: p = 0,004). But those patients, who represented their illness in Self-shield spatial formation, went home earliest (mean: 4,14 days). Although, these patients were the most vulnerable in the whole population. Conclusion Our results suggest the illness modifies the self-identity because the information related to the pain becomes the most essential in the organization of the self. It could be problematic, if majority of the self-scheme consists of illness-scheme. We can see this in Self-part spatial formation, thus it is affirmable if the illness-scheme increase within the Self, the recovery will slow down. This is often the case with the patients having low back pain.
Posterior Vertebral Column Resection: A Salvage for Thoracolumbar Kyphosis after Failed Anterior Instrumented Fusion
Authors: Chen Fei , Dai Zhehao 
Published: April 2016

Introduction Anterior thoracolumbar spine surgery is typically indicated for restoration of structural stability and /or decompression of neural element secondary to trauma, tumor or infection. But postoperative complications especially kyphosis poses distinct challenges to the spinal surgeon. The aim of this study was to explore the effects of posterior vertebral column resection of thoracolumbar kyphosis after failed anterior instrumented fusion. Material and Methods A retrospective study was conducted of 10 patients of kyphotic deformity with previous failed anterior surgery in our department from October 2005 to December 2009. The indications for revision surgery included pain refractory to conservative treatment, progressive neurological deficit and kyphosis. Anterior removal of the implant and posterior vertebral column resection (PVCR) was performed. Mean operating time, average intraoperative blood loss, kyphosis angle, the visual analog scale (VAS), Oswestry disability index (ODI), bone fusion time and complications were used for clinical assessment in a minimum 18-month follow-up (18 – 60 months). Results The mean age was 38.7 years old (ranging from 24 to 56 years old) and the average kyphosis angle was 54.60 (ranging from 45 0 to 74 0). Mean operating time was 323.5 (range 245 minute to 420 minute) with average intraoperative blood loss of 1189 ml (range 850 ml to 1550 ml). After revision surgery, Kyphosis angle was 4.800 (range3- 70) immediately and 6.80 (range 5 to 90) at the 18 months follow-up and there was good bony fusion in every case. The average time of bony fusion was 6.8 months (range 5–9 months). All patients had satisfied spinal sagittal and coronal balance at the last follow-up. None of our patients experienced implant failure. The average preoperative VAS was 6.2, falling to 2.6 at the 18 months follow-up with significant improvement. None of the patients suffered any surgery-related neurological deterioration and one patient whose neurological status was Frankel Grade C improved to Grade D. The ODI changed form a mean value of 39.8 (rang 31–48) preoperatively to 24.5 (rang 15–29) at the final follow-up. The difference was statistically significant. Complications occurred in four patients (40%); these included three with tearing of the lung and one with a superficial wound infection. Conclusion Despite the technically demanding procedure, anterior removal of the implant and posterior vertebral column resection was a safe and effective revision surgery for patients with prior anterior fusion with rigid post-surgical deformities.