bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative displacement of hydroxyapatite spacers implanted during double-door laminoplasty
Authors: Kaito Takashi , Hosono Noboru , Makino Takahiro , Kaneko Noriyoshi , Namekata Masato , Fuji Takeshi 
Published: September 2009

Object
Double-door laminoplasty using hydroxyapatite (HA) spacers has been widely performed for compressive cervical myelopathy and has provided good neurological outcome. Although HA spacers are used for preventing reclosure of the opened laminae, they are often displaced or dislocated from their original position. The authors investigated the incidence and patterns of postoperative HA spacer displacement to determine the reasons for this unfavorable event.

Methods
Eighty-six patients with compressive myelopathy underwent double-door laminoplasty in which a total of 278 HA spacers were used. The displacement of HA spacers and opened laminae were assessed using postoperative lateral radiographs and CT scans.

Results
Postoperative dorsal migration > 2 mm was found in 116 (42%) of 278 implanted HA spacers. In addition, 33 (38%) of 86 HA spacers rotated > 10° and 29 (34%) of the 86 opened laminae tilted > 10°. Moreover, deformation of the newly formed spinal canal was observed in 51 (59%) of 86 cases, and bone fusion between the HA spacer and spinous process was achieved in only 15 (8.7%) of 172 cases. Neurological worsening and neck pain, however, were not associated with displacement of HA spacers or deformation of the spinal canal.

Conclusions
In double-door laminoplasty, postoperative displacement of the HA spacer with deformation of the enlarged spinal canal occurred frequently. Hydroxyapatite spacers tend to become displaced after surgery. Placing the HA spacer at the base of the spinous process close to the dura mater may prevent postoperative displacement.
Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy
Authors: Ahn Yong , Kim Jin Uk , Lee Byung Hoi , Lee Sang-Ho , Park Jong Dae , Hong Dong Hyun , Lee June Ho 
Published: September 2009

Object
The purpose of this study was to demonstrate the clinical characteristics of postoperative retroperitoneal hematoma (RPH) following transforaminal percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent the complication of unintended hemorrhage.

Methods
The medical records of 412 consecutive patients treated with transforaminal PELD between January 2005 and May 2007 were reviewed. A total of 4 patients (0.97%) experienced symptomatic postoperative RPH. The clinical outcomes were evaluated using the visual analog scale and the Oswestry Disability Index.

Results
The common symptom in all patients with a hematoma was inguinal pain. The mean hematoma volume was 527.9 ml (range 53.3–1274.1 ml). Two patients with massive diffuse-type RPHs compressing the intraabdominal structures required open hematoma evacuation performed by general surgeons, and the other 2 patients with small, localized RPHs of < 100 ml were treated conservatively. The mean follow-up period was 21.3 months (range 13–29 months). The mean visual analog scale score for radicular leg pain improved from 7.6 to 1.8 and that for back pain improved from 4.3 to 2. The mean Oswestry Disability Index improved from 58.8 to 9.1%. The preoperative symptoms improved after the second treatment without significant neurological sequelae in all patients.

Conclusions
Although transforaminal PELD is a minimally invasive and safe procedure, the possibility of RPH should be kept in mind. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially in the patient with underlying medical problems or previous operative scarring. A high index of suspicion and early detection is also important to avoid the progression of the hematoma.
Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States
Authors: Kumar Krishna , Bishop Sharon 
Published: September 2009

Object
Many institutions with spinal cord stimulation (SCS) programs fail to realize that besides the initial implantation cost, budgetary allocation must be made to address annual maintenance costs as well as complications as they arise. Complications remain the major contributing factor to the overall expense of SCS. The authors present a formula that, when applied, provides a realistic representation of the actual costs necessary to implant and maintain SCS systems in Canada and the US.

Methods
The authors performed a retrospective analysis of 197 cases involving SCS (161 implanted and 36 failed trial stimulations) between 1995 and 2006. The cost of patient workup, initial implantation, annual maintenance, and resources necessary to resolve complications were assessed for each case and a unit cost applied. The total cost allocated for each case was determined by summing across healthcare resource headings. Using the same parameters, the unit cost was calculated in both Canadian (CAD) and US dollars (USD) at 2007 prices.

Results
The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136–18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381–28,495) for Medicare and $21,390 (range $573–54,547) for BCBS (both USD). Using these calculations a formula was derived as follows: the annual maintenance cost (a) was added to the average annual cost per complication per patient implanted (b); the sum was then divided by the implantation cost (c); and the result was multiplied by 100 to obtain a percentage (a + b ÷ c × 100). To make this budgetary cap universally applicable, the results from the application of the formula were averaged, resulting in an 18% premium.

Conclusions
For budgeting purposes the institution should first calculate the initial implantation costs that then can be “grossed up” by 18% per annum. This amount of 18% should be in addition to the implantation costs for the individual institution for new patients, as well as for each actively managed patient. This resulting amount will cover the costs associated with annual maintenance and complications for every actively managed patient. As the initial cost of implantation in any country reflects their current economics, the formula provided will be applicable to all implanters and policy makers alike.
Developing consistently reproducible intervertebral disc degeneration at rat caudal spine by using needle puncture
Authors: Zhang Huina , La Marca Frank , Hollister Scott J. , Goldstein Steven A. , Lin Chia-Ying 
Published: September 2009

Object
The goal in this study was to develop a convenient, less-invasive animal model to monitor progression of intervertebral disc (IVD) degeneration for future testing of new treatments for disc degeneration.

Methods
Level 5/6 and 7/8 IVDs of rat caudal spine were stabbed laterally with 18- or 21-gauge hypodermic needles to a depth of 5 mm from the subcutaneous surface with the aid of fluoroscopy. In vivo MR imaging studies were performed at 4, 8, and 12 weeks postsurgery to monitor progression of IVD degeneration. Histological analysis including H & E and safranin O staining, and immunohistochemical studies of collagen type II and bone morphogenetic protein receptor type II (BMPRII) were assessed at 12 weeks postsurgery.

Results
The 18- and 21-gauge needle–stabbed discs illustrated decreases in both the T2 density and MR imaging index starting at 4 weeks, with no evidence of spontaneous recovery by 12 weeks. Histological staining demonstrated a decreased nucleus pulposus (NP) area, and the NP–anulus fibrosus border became unclear during the progression of disc degeneration. Similar patterns of degenerative signs were also shown in both safranin O– and collagen type II–stained sections. The BMPRII immunohistochemical analysis of stabbed discs demonstrated an increase in BMPRII expression in the remaining NP cells and became stronger in anulus fibrosus with the severity of disc degeneration.

Conclusions
After introducing an 18- or 21-gauge needle into the NP area of discs in the rat tail, the stabbed disc showed signs of degeneration in terms of MR imaging and histological outcome measurements. Changes in BMPRII expression in this animal model provide an insight for the effectiveness of delivering BMPs into the region responsible for chondrogenesis for disc repair. This convenient, less-invasive, reproducible, and cost-effective model may be a useful choice for testing novel treatments for disc degeneration.
Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery
Authors: Ratliff John K. , Lebude Bryan , Albert Todd , Anene-Maidoh Tony , Anderson Greg , Dagostino Phillip , Maltenfort Mitchel , Hilibrand Alan , Sharan Ashwini , Vaccaro Alexander R. 
Published: September 2009

Object
Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.

Methods
The authors surveyed a cohort of practicing spine surgeons via email and a web-based survey. Surgeons were presented with various complication scenarios and were asked to grade the presence or absence of a complication as well as complication severity, with responses limited to “major complication” and “minor complication/adverse event.” The authors administered a similar assessment, modified for lay persons, to patients in a spinal surgery clinic.

Results
Complete responses were obtained from 229 surgeons; orthopedic surgeons comprised the majority of respondents (73%). The authors obtained completed surveys from 197 patients. Overall, there was consistent agreement between physicians and patients regarding the presence or absence of a complication in the majority of scenarios (8 [73%] of 11 scenarios with agreement that a complication was present). The overall kappa value, evaluating major versus minor complication, and presence or absence of a complication over the entire cohort, was fair (κ = 0.21). The authors found greater variation between the cohorts when evaluating complication severity. Patients were consistently more critical than physicians in the majority of scenarios in which a difference was evident. In 4 scenarios, patients were more likely than surgeons to deem the scenario a complication and to grade the complication as major versus minor (p < 0.01). In 3 additional scenarios, patients were more likely than physicians to grade a major complication as opposed to minor complication (p < 0.01). In only 1 scenario were patients less likely than physicians to report a complication (p < 0.001).

Conclusions
Comparing responses of spine surgeons and patients who underwent spinal surgery in assessing a group of common postoperative events, the authors found significant agreement on perception of presence of a complication in the majority of scenarios reviewed. However, patients were consistently more critical than surgeons when differences in reporting were found. The authors' data underscore the importance of reconciling differing opinions regarding complications through open discussions between physicians and patients to ensure accurate patient expectations of planned medical or surgical interventions.
Wildtiereinfluss auf die Waldverjüngung messen: mit Stammzahlen oder mit dem Verbissprozent? | Which measurement category for quantifying the impact of wild ungulates on forest regeneration: stem number or browsing percentage?
Authors: Odermatt Oswald 
Published: September 2009

In forest and game management there is frequently controversy about the right measurement category for quantifying the impact of wild ungulates on forest regeneration. This paper tries to describe under which circumstances it is appropriate to determine the browsing percentage and under which circumstances it is preferable to make an analysis of the stem number. The limitations of the two approaches are also described. To quantify the impact of ungulates over a large area, determining the browsing percentage (browsed trees in proportion to the totality of young trees) is the most appropriate, it allows the impact of browsing on the development of the stem number to be monitored. Undesirable developments can be detected early. If the stem number in a particular size category of a certain tree species begins to decrease, this is defined as a critical point.
To identify browsing damage however, the stem number should be analyzed. Such an analysis should only be performed in forest stands where regeneration is required. Absence of regeneration should not be treated as damage in cases where the silvicultural aim does not necessarily involve it.
Evaluation of Refraction in a Statistically Significant Sample: Changes According to Age and Strabismus
Authors: Chiesi Carlo , Chiesi Laura , Cavallini Gian Maria 
Published: September 2009

Purpose:
To assess possible refractive changes according to age and strabismus in a statistically significant cohort.

Methods:

A population-based sample of 12,534 subjects 0.5 to 20 years old, examined between 2004 and 2006, was tested. Each subject received a complete orthoptic examination, including spherocylindrical streak retinoscopy in cycloplegia. Patients were divided into those with orthophoria (7,784) and those with strabismus (4,750), and the latter group was further divided into those with esodeviation (3,026) and those with exodeviation (1,724). A statistical analysis of the spherical equivalent, astigmatism, and anisometropia was performed with an independent samples
t
test or one-way analysis of variance.

Results:

The percentage of patients with a mean spherical equivalent within ± 1 and ± 2 standard deviations was greater than 68% and 95%, respectively. The mean spherical equivalent of the total sample was 1.62 diopters (D) (± 2.88). The mean spherical equivalent was 1.10 ± 2.94 D in the orthophoria group, 3.22 ± 2.29 D in the esodeviation group, and 1.13 ± 2.50 D in the exodeviation group (one-way analysis of variance;
P
= .000). Age-related changes in the mean spherical equivalent showed a clear and steady myopic shift, reaching mean myopic refraction at 12 to 14 years in both the total sample and the orthophoria and exodeviation groups. It assumed a more constant trend, with no myopic swing, in the esodeviation group (
P
= .000). Mean astigmatism was less in patients with less than 1.00 D anisometropia (0.83 ± 0.92 D) than in those with 1.00 D or greater anisometropia (1.42 ± 1.18 D) (
t
test;
P
= .0001).

Conclusion:
Both the age-related trend in the spherical equivalent and the high hyperopic values of the distribution peak in patients with esodeviation confirm the importance of the hypermetropic refractive component. The statistically significantly higher incidence of astigmatism in patients with 1.00 D or greater ametropia highlights its incidence in amblyopia.

[J Pediatr Ophthalmol Strabismus 2009;46:266–272.]
Demographic Changes and Response to Laser Treatment in Threshold Retinopathy of Prematurity: 10-Year Experience
Authors: Kim Judy E. , Lee Alexander C. 
Published: September 2009

Purpose:
To evaluate the outcome of indirect diode laser treatment for threshold retinopathy of prematurity (ROP) and to report demographic changes observed over 10 years.

Methods:
Retrospective chart review and statistical analysis of 111 eyes of 61 infants treated for threshold ROP between 1991 and 2001 at a single academic institution.

Results:

Ninety-six of 111 (86%) eyes showed regression of neovascularization after laser treatment. Fourteen (13%) eyes had zone 1 disease and 97 (87%) eyes had zone 2 disease. Thirty-six percent of eyes with zone 1 disease progressed to stage 4 or 5 disease despite treatment, whereas 10% of the zone 2 eyes progressed. Based on multivariate logistic regression, zone and female gender were found to be predictive of progression, whereas birth weight was predictive of zone. Between 1991 and 2001, a significant trend toward lower mean gestational age at time of birth (Pearson correlation = −0.36,
P
= .005) and mean birth weight (Pearson correlation = −0.35,
P
= .0041) was found. However, progression rates to stage 4 and 5 disease following laser treatment were similar for infants born before and after 1997 (
P
= .0796).

Conclusion:
Regression of neovascularization was noted in 86% of eyes following laser treatment for threshold ROP. Zone was predictive of progression to stage 4 or 5 despite treatment. Premature infants being treated for threshold ROP tended to be born at an earlier gestational age and with lower birth weights over time, but progression rates to more severe stages did not increase following laser treatment, suggesting that optimal treatment can yield favorable ocular outcomes.
Pure Hemozoin Is Inflammatory In Vivo and Activates the NALP3 Inflammasome via Release of Uric Acid
Authors: Griffith Jason W. , Sun Tiffany , McIntosh Michael T. , Bucala Richard 
Published: September 2009

Abstract
The role of proinflammatory cytokine production in the pathogenesis of malaria is well established, but the identification of the parasite products that initiate inflammation is not complete. Hemozoin is a crystalline metabolite of hemoglobin digestion that is released during malaria infection. In the present study, we characterized the immunostimulatory activity of pure synthetic hemozoin (sHz) in vitro and in vivo. Stimulation of naive murine macrophages with sHz results in the MyD88-independent activation of NF-κB and ERK, as well as the release of the chemokine MCP-1; these responses are augmented by IFN-γ. In macrophages prestimulated with IFN-γ, sHz also results in a MyD88-dependent release of TNF-α. Endothelial cells, which encounter hemozoin after schizont rupture, respond to sHz by releasing IL-6 and the chemokines MCP-1 and IL-8. In vivo, the introduction of sHz into the peritoneal cavity produces an inflammatory response characterized by neutrophil recruitment and the production of MCP-1, KC, IL-6, IL-1α, and IL-1β. MCP-1 and KC are produced independently of MyD88, TLR2/4 and TLR9, and components of the inflammasome; however, neutrophil recruitment, the localized production of IL-1β, and the increase in circulating IL-6 require MyD88 signaling, the IL-1R pathway, and the inflammasome components ICE (IL-1β-converting enzyme), ASC (apoptosis-associated, speck-like protein containing CARD), and NALP3. Of note, inflammasome activation by sHz is reduced by allopurinol, which is an inhibitor of uric acid synthesis. These data suggest that uric acid is released during malaria infection and may serve to augment the initial host response to hemozoin via activation of the NALP3 inflammasome.
Genetic Evidence That the Differential Expression of the Ligand-Independent Isoform of CTLA-4 Is the Molecular Basis of the Idd5.1 Type 1 Diabetes Region in Nonobese Diabetic Mice
Authors: Araki Manabu , Chung Denise , Liu Sue , Rainbow Daniel B. , Chamberlain Giselle , Garner Valerie , Hunter Kara M. D. , Vijayakrishnan Lalitha , Peterson Laurence B. , Oukka Mohamed , Sharpe Arlene H. , Sobel Raymond , Kuchroo Vijay K. , Wicker Linda S. 
Published: September 2009

Abstract
Idd5.1 regulates T1D susceptibility in nonobese diabetic (NOD) mice and has two notable candidate genes, Ctla4 and Icos. Reduced expression of one of the four CTLA-4 isoforms, ligand-independent CTLA-4 (liCTLA-4), which inhibits in vitro T cell activation and cytokine production similarly to full-length CTLA-4 (flCTLA-4), has been hypothesized to increase type 1 diabetes (T1D) susceptibility. However, further support of this hypothesis is required since the Idd5.1 haplotypes of the diabetes-susceptible NOD and the resistant B10 strains differ throughout Ctla4 and Icos. Using haplotype analysis and the generation of novel Idd5.1-congenic strains that differ at the disease-associated Ctla4 exon 2 single-nucleotide polymorphism, we demonstrate that increased expression of liCTLA-4 correlates with reduced T1D susceptibility. To directly assess the ability of liCTLA-4 to modulate T1D, we generated liCTLA-4-transgenic NOD mice and compared their diabetes susceptibility to nontransgenic littermates. NOD liCTLA-4-transgenic mice were protected from T1D to the same extent as NOD.B10 Idd5.1-congenic mice, demonstrating that increased liCTLA-4 expression alone can account for disease protection. To further investigate the in vivo function of liCTLA-4, specifically whether liCTLA-4 can functionally replace flCTLA-4 in vivo, we expressed the liCTLA-4 transgene in CTLA-4−/− B6 mice. CTLA-4−/− mice expressing liCTLA-4 accumulated fewer activated effector/memory CD4+ T cells than CTLA-4−/− mice and the transgenic mice were partially rescued from the multiorgan inflammation and early lethality caused by the disruption of Ctla4. These results suggest that liCTLA-4 can partially replace some functions of flCTLA-4 in vivo and that this isoform evolved to reinforce the function of flCTLA-4.
Enhanced Th2 Cell Differentiation and Allergen-Induced Airway Inflammation in Zfp35-Deficient Mice
Authors: Kitajima Masayuki , Iwamura Chiaki , Miki-Hosokawa Takako , Shinoda Kenta , Endo Yusuke , Watanabe Yukiko , Shinnakasu Ryo , Hosokawa Hiroyuki , Hashimoto Kahoko , Motohashi Shinichiro , Koseki Haruhiko , Ohara Osamu , Yamashita Masakatsu , Nakayama Toshinori 
Published: September 2009

Abstract
Studies of human asthma and of animal models of allergic airway inflammation revealed a crucial role for Th2 cells in the pathogenesis of allergic asthma. Kruppel-type zinc finger proteins are the largest family of a regulatory transcription factor for cellular development and function. Zinc finger protein (Zfp) 35 is an 18-zinc finger motif-containing Kruppel-type zinc finger protein, while its function remains largely unknown. The aim of this study was to clarify the role of Zfp35 in the pathogenesis of Th2-dependent allergic inflammation, such as allergic asthma. We examined airway eosinophilic inflammation and hyperresponsiveness in two mouse models, which use our newly generated Zfp35-deficient (Zfp35−/−) mice and adoptive transfer of cells. In Zfp35−/− mice, Th2 cell differentiation, Th2 cytokine production, eosinophilic inflammation, and airway hyperresponsiveness were substantially enhanced. Furthermore, adoptive transfer of Ag-sensitized Zfp35−/− CD4 T cells into the asthmatic mice resulted in enhanced airway inflammation and airway hyperresponsiveness. These results indicate that Zfp35 controls Th2 cell differentiation, allergic airway inflammation, and airway hyperresponsiveness in a negative manner. Thus, Zfp35 may control Th2-dependent diseases, such as allergic asthma.