Transforaminal lumbar interbody fusion with placement of steerable banana cage: A single-center retrospective analysis of radiographic parameters of success.

INTRODUCTION: The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. METHODS: This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. RESULTS: 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). CONCLUSIONS: TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. IMPLICATIONS FOR PRACTICE: As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection.

The effectiveness of semantic feature analysis: an evidence-based systematic review.

OBJECTIVES: This review examines the effectiveness of semantic feature analysis as an intervention to improve naming abilities for persons with aphasia. METHOD: A systematic search of the literature identified 11 studies that met the pre-determined inclusion criteria. Two independent raters evaluated each study for methodological quality and assigned appropriate levels of evidence using the Single Case Experimental Design scale. To determine clinical effectiveness, effect sizes using Cohen's d were calculated if sufficient data were available. Alternatively, percent of non-overlapping data was calculated. RESULTS: Results indicated that methodologically sound research has been conducted to determine the effectiveness of semantic feature analysis for persons with aphasia using single subject research designs. When using Cohen's d, the majority of participants showed a small effect size. However, when percent of non-overlapping data was calculated, a large treatment effect was present for the majority of participants. CONCLUSIONS: Semantic feature analysis was an effective intervention for improving confrontational naming for the majority of participants included in the current review. Further research is warranted to examine generalization effects.

Environmental equity and pesticide exposure.

Although people of color and low-income groups bear a disproportionate share of the health risks from exposure to pesticides, research attention has been meager, and data on acute and chronic health effects related to their toxic exposures are generally lacking. Increased resources are needed both to study this issue and to mitigate problems already identified. People of color should be a major research focus, with priority on long-term effects, particularly cancer, neurodevelopmental and neurobehavioral effects, long-term neurological dysfunction, and reproductive outcome. Suitable populations at high risk that have not been studied include noncertified pesticide applicators and seasonal and migrant farm workers, including children.

Pesticide residues in food crops analyzed by the California Department of Food and Agriculture in 1989.

California spends more than $40 million each year for the nation's most comprehensive program to regulate pesticide use: Pesticides are evaluated before they can be used. Businesses that sell or apply pesticides are licensed. Pesticide specialists enforce restrictions on pesticide use. Water, air, and soil are monitored for pesticide levels. And, as a final check in this integrated network of program, domestic and imported produce is sampled and tested for traces of pesticide residue. Annually, approximately 1% of the samples violate established standards. Because the standards include a safety margin, illegal residues rarely present a health risk, according to leading scientific experts, including the World Health Organization.

Illness, injuries, and deaths from pesticide exposures in California 1949-1988.

Data on human acute illness/injury and death associated with pesticide exposure in California for the 40-yr period, beginning with 1949, were reviewed. Even though California has better data of this type than most government jurisdictions in the world, there are some shortcomings. In the early part of this period, nonoccupational data were scant because poison information centers were just being developed. Also in the early period, many occupational exposures were not recorded in state statistics although a good system to allow for such reporting was in place. California data currently available still do not take into account (i) persons who are exposed and become ill, but do not visit a physician or call a poison center, and (ii) most occupational exposures of the self-employed, U.S. military employees, U.S. government employees, maritime workers, and interstate railroad workers. In 1987, 268,092,595 kg of pesticides were sold and estimated as used in the state. Although the amount of pesticides used annually in California is estimated to have increased 4-fold in this 40-yr period, it is believed that the actual number of pesticide-related occupational illnesses/yr increased very little. Cholinesterase inhibitors and methyl bromide were most often involved in the more serious occupational systemic poisonings throughout the time period. Well-educated and trained farmers and other pesticide handlers as well as a strict regulatory system have contributed to keeping the number and the extent of pesticide exposure in check, considering the widespread use of pesticides, some of which are quite toxic and potentially hazardous if misused. In 1987, there were 1,507 cases of occupational illness identified, with 744 of these demonstrating systemic toxic symptoms. In 1987, approximately 17,000 human pesticide exposure incidents, almost all of which were nonoccupational, were handled by poison control centers. It is estimated that about 30 to 60% developed signs or symptoms. Occupational deaths for the past 10 yr have averaged about 1/yr. Suicides by use of pesticides are estimated at 15/yr, and nonsuicides, nonoccupational deaths are estimated at 5/yr. This paper does not address chronic effects such as cancer induction, developmental effects, or reproductive effects that may be suspected as being the result of pesticide exposure. Data presented in this report may be useful in estimating the number of poisonings that may occur in other geographic settings. Numerous variables that must be considered in making such estimates are discussed.

Biological monitoring of dichloropropene: air concentrations, urinary metabolite, and renal enzyme excretion.

Fifteen applicators of dichloropropene (DCP) were studied for personal air exposure to DCP, excretion of the metabolite of DCP (3CNAC), and excretion of the renal tubular enzyme, N-acetyl glucosaminidase (NAG). Each was studied for four 6-8 h consecutive intervals following baseline determinations of 3CNAC and NAG excretion. In accord with pilot data, 24-h urinary excretion of 3CNAC (mg) correlated well with exposure product for DCP (min exposed.mg/m3), r = 0.854, p less than .001. A more precise correlation of the air exposure product with urinary excretion of 3CNAC was discerned by using the morning urine after the previous day of exposure (micrograms/mg of creatinine), r = 0.914, p less than .001. Four workers had clinically elevated activity of NAG (greater than 4 mU/mg creatinine) in any of their urine collections after baseline. Nine workers showed greater than 25% increases in NAG excretion when compared to baseline. Dichloropropene air exposure products of greater than 700 mg.min/m3 or excretion of greater than 1.5 mg 3CNAC/d distinguished abnormally high daily excretion of NAG. These data demonstrate a firm positive relationship between air exposure and internal exposure, and a possible subclinical nephrotoxic effect in DCP workers.

Selected incidents of illnesses and injuries related to exposure to pesticides reported by physicians in California in 1986.

California collects data on most occupational and many non-occupational illnesses and injuries related to pesticide exposure. Most of the occupational incidents are investigated by local agencies. A thorough investigation is conducted on all pesticide-related cases that meet "priority" guidelines: death; hospitalization of 1 or more persons for more than 24 hours with treatment; or 5 or more people with symptoms seeking medical care as a result of the same incident. This report summarizes the priority cases determined to be related to pesticide exposure during 1986. Of the 67 described incidents, involving 583 people ill, 26 (38%) were related to exposure to pesticides applied indoors (residences, offices), either by commercial pest control companies, employees or homeowners. Nearly 200 people (33%) became ill and more than 200 people were evacuated as a result of these types of applications. Most of these incidents were a result of careless application techniques and not following label instructions. Four other incidents, with 33 people ill, were the result of spills in retail stores. In all 4 cases, store employees tried to clean the spill without wearing protective clothing. Two other cases involved exposure via a pesticide being put in a food container. Nineteen of these type of incidents involved a pesticide product containing an organophosphate; most often chlorpyrifos (8 incidents), diazinon (3 incidents), and malathion (5 incidents). There were also 10 cases that resulted from suicide; eight different pesticides were involved. Five incidents involving agricultural workers, as well as 4 incidents involving non-agricultural workers, were primarily the result of allowing pesticides to drift from the target field.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary of illnesses and injuries reported in California by physicians in 1986 as potentially related to pesticides.

As a result of legislation in the early 1970's, physicians are required to report all cases of illness or injury which may have been a result of exposure to pesticides. The California Department of Food and Agriculture receives these reports through a variety of reporting mechanisms and compiles them into an annual data base. In 1986, 2099 illness/injury reports were received by the Worker Health and Safety Branch of the California Department of Food and Agriculture. After investigation by the County Agricultural Commissioners' staff, 1065 (51%) were determined to be confirmed cases of occupational illness/injury related to pesticide exposure. In addition, there were also 146 (7%) cases of non-occupational pesticide-related illness/injury, 424 (20%) cases determined to be unrelated to pesticide exposure, and 464 (22%) cases for which there was insufficient information to determine a cause and effect relationship. The number of confirmed cases of pesticide-related illness/injury decreased by nearly 30% from the corresponding 1985 figures. This apparent decrease is an artifact of the classification scheme employed for 1986. The change is primarily a result of a reduction in the number of field worker cases determined to be confirmed pesticide-related exposures. In previous years most investigations of pesticide application history for grape vineyard worker dermatitis cases were confined to a history from the last field worked prior to visiting a physician. This method assumes no latency period between exposure and onset of symptoms and/or that the worker immediately visited a physician at the onset of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring the urine of pesticide applicators in California for residues of chlordimeform and its metabolites 1982-1985.

Chlordimeform (Cdf) is readily absorbed through the skin of pesticide applicators. It also enters the body when breathed into the lungs. Cdf can be found in the urine of workers who handle or are involved in applying pesticide products which contain the chemical, even when they are wearing special protective clothing and respirators. Because of the adverse health effects seen in heavily exposed workers and the cancerous tumors seen in mice, special precautions are necessary when handling products containing Cdf to reduce the risk of adverse health effects. Because Cdf is known to enter the body very easily, with serious injury potential, workers handling pesticide products containing Cdf in California are required to have medical supervision including a blood test at the beginning and end of each application season and monthly testing of urine for possible cellular change and pesticide residues during the time Cdf exposure takes place. This program is designed to keep worker exposure as low as possible.

Biological monitoring of agricultural workers exposed to pesticides: I. Cholinesterase activity determinations.

An estimated 4 to 5 million persons work in agriculture; within this sector, mixers, loaders, applicators, and other workers who directly handle agricultural chemicals are at highest risk for pesticide-related illnesses. Among field workers, seasonal workers engaged in certain cultivation and harvesting operations are also at risk of exposure to pesticide residues. Biological screening for agricultural workers is limited at present to pesticide mixers, loaders, and applicators, and consists almost exclusively of measurements of cholinesterase activity to estimate inhibition by organophosphate and carbamate compounds. We review here the measurement and interpretation of cholinesterase activity in occupationally exposed populations and the correlation between cholinesterase activity and symptoms of acute and chronic illness among agricultural workers. The only state to mandate medical surveillance for agricultural workers is California: criteria for surveillance, baseline cholinesterase determination, periodicity of testing, and criteria for removal from and return to work are described, and alternative approaches for screening and clinical evaluations are discussed.

Biological monitoring of agricultural workers exposed to pesticides: II. Monitoring of intact pesticides and their metabolites.

Analytical methods have been developed for the detection of a variety of compounds that are found intact or as metabolites in biological samples from workers exposed to pesticides. Such tests are used primarily in research settings to describe patterns of absorption, metabolism, and excretion, to derive exposure limits for occupational exposure, to evaluate the adequacy of these limits and of work practices in field settings, and to confirm the etiology of poisonings for medicolegal purposes. We review here methods used in studies of occupational pesticide exposure, with particular attention to validation in terms of dose-response relationships, to technical complexity and cost, to the requirements for analytical quality control, and to the utility of these methods for field research purposes. Biological monitoring for intact pesticides or metabolites in agricultural workers is limited to a few chemicals, notably, pentachlorophenol, methyl bromide, and chlordimeform. These programs and their use in regulation and enforcement are described.

Poisoning of animals in the Los Angeles area with pesticides during 1977.

During 1977, there were 289 pesticide exposure incidents involving animals that were handled by the Thomas J. Fleming Memorial Poison Information Center in Los Angeles. Almost all of this service was provided to veterinarians and most of the incidents involved dogs. Cases handled by this center are considered typical for small animal practices in urban areas of California. Ingestion was the major route of exposure. As recently as 10 years ago, arsenic, strychnine, and phosphorus were major causes of such poisonings. During 1977, the n-methylcarbamates (27%), anticoagulants (19%), and organo-phosphates (15%) were the major pesticides involved in exposure incidents. Lesser percentages of cases attributed to a specific chemical included: Vacor (5%), metaldehyde (4%), chlorinated hydrocarbons (4%), and arsenicals (4%). A variety of other pesticides, classified as miscellaneous, were also involved in poisonings to a lesser extent.