High-fat high-sugar diet induces polycystic ovary syndrome in a rodent model.

Obesity has been linked with a host of metabolic and reproductive disorders including polycystic ovary syndrome (PCOS). While a clear association exists between obesity and PCOS, the exact nature of this relationship remains unexplained. The primary symptoms of PCOS include hyperandrogenism, anovulation, and polycystic ovaries. Most animal models utilize androgen treatments to induce PCOS. However, these models often fail to address the underlying causes of the disease and do not effectively reproduce key metabolic features such as hyperinsulinemia. Here, we present a novel rodent model of diet-induced obesity that recapitulates both the metabolic and reproductive phenotypes of human PCOS. Rats on a high-fat high-sugar (HFHS) diet not only demonstrated signs of metabolic impairment, but they also developed polycystic ovaries and experienced irregular estrous cycling. Though hyperandrogenism was not characteristic of HFHS animals as a group, elevated testosterone levels were predictive of high numbers of ovarian cysts. Alterations in steroidogenesis and folliculogenesis gene expression were also found via RNA sequencing of ovarian tissue. Importantly, the PCOS-like symptoms induced in these rats may share a similar etiology to PCOS in humans. Therefore, this model offers a unique opportunity to study PCOS at its genesis rather than following the development of disease symptoms.

Incidence and Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Fusion.

STUDY DESIGN: This was a prospective cohort study (observational-retrospective chart review). OBJECTIVE: The objective of this study was to determine clinical rates and correlations of postoperative urinary retention (POUR) in elective spine decompression and fusion procedures. SUMMARY OF BACKGROUND DATA: POUR is a common postoperative complication that often has a major adverse impact on a patient's recovery from elective lumbar spine surgery. The etiology of POUR in most cases is unknown. Patients undergoing lumbar spine surgery are considered to be at increased risk for POUR due to prone positioning during surgery and intraoperative cauda equina nerve root manipulation. Current studies reporting on POUR after elective spine surgery provide limited insight regarding risk factors and effective prevention strategies for this at-risk population. The purpose of this study is to identify risk factors for POUR after elective lumbar spine surgery and strategies for reducing its incidence. MATERIALS AND METHODS: Two hundred consecutive patients aged 50 years or older undergoing combined lumbar decompression and fusion procedures over a 5-month period at a single institution were prospectively observed. Demographic and clinical data were prospectively recorded, including: medical history, surgical data, medications administered, complications, and postoperative hospital course. Factors correlating with POUR through a univariate analysis with P≤0.20 were considered for multivariate analysis. RESULTS: POUR occurred in 19 of 200 patients. Those with POUR were more likely to be male (20% vs. 4%, odds ratio=6.2). Administration of scopolamine (P=0.02), neostigmine (P=0.01), and the total number of levels operated on (P=0.02) were found to be independent risk factors for the development of POUR. Length of surgery, surgical level, the performance of an interbody fusion did not have a bearing on the development of POUR (P>0.05). DISCUSSION: We describe a single institution's experience of POUR incidence in 200 consecutive patients aged 50 years or older undergoing single or multilevel lumbar spine fusion procedures by 1 of 4 surgeons. Specific demographic and clinical risk factors were identified and a codified classification for POUR in a surgical population is presented.The results of this study will help clinicians appropriately counsel patients undergoing elective lumbar fusion about the potential development of POUR. The perioperative administration of scopolamine and neostigmine should be cautiously considered in men over 50 years of age due to the increased POUR risk. CONCLUSIONS: Perioperative scopolamine and neostigmine administration in men over 50 should be avoided when possible to minimize the risk of POUR. LEVEL OF EVIDENCE: Level III.

Extradural arachnoid cyst with bony erosion: a rare case report.

The authors present the case of an otherwise healthy 38-year-old female with an atypical extradural arachnoid cyst with multi-level involvement in the lumbar spine leading to left quadriceps weakness and dysesthesia. Upon presentation, a lumbar spine MRI with contrast and plain radiographs revealed extensive L4 bony erosion. An MR angiogram and cervical spine MRI with contrast were then obtained in order to rule out any aortic root or cervical spine pathology. With no other apparent clinically relevant pathology revealed by these additional tests, an L3-5 posterior decompression and fusion procedure was performed. Her preoperative symptoms were successfully resolved following the procedure, with no resultant surgical complications. The cyst is atypical not only due to its size and location, but also due of the significant bony erosion of the left L4 pedicle and vertebral body. To the authors' knowledge, this is the first reported case of an extradural arachnoid cyst in the lumbar spine with bony erosion of the pedicle and vertebral body. In cases such as this, a CT myelogram may be useful in planning the operative approach through visualization of the exact communication between cyst and dura. This approach may also aid in diagnosing and identifying atypical cyst presentations such as the one presented here.