Usefulness of Source Images of Magnetic Resonance Myelograms and Partial Laminectomy for Interlaminar Endoscopic Lumbar Discectomy at L5-S1: A Technical Note and Preliminary Clinical Results.

ABSTRACT: The primary objective of this study was to assess the clinical and radiologic outcomes and introduce the technical notes from 10 patients who underwent interlaminar endoscopic lumbar discectomy (IELD) at L5-S1 using the source images of magnetic resonance (MR) myelograms and performing partial laminectomy. A biportal endoscopic system was used to perform partial laminectomy, followed by fragmentectomy and subtotal discectomy using a uniportal endoscopic system. The source images of MR myelograms were used to identify the anatomical relationship between the herniated disc material, L5 and S1 nerve roots, the thecal sac, and L5 lamina. Preoperative leg and back visual analog scale scores were greatly improved immediately and after 3 months and 6 months postoperatively. Fragmentectomy and subtotal discectomy became easier after performing a partial laminectomy in all IELD cases at L5-S1. The source images of MR myelograms and partial laminectomy is useful for IELD at L5-S1. LEVEL OF EVIDENCE: Level IV.

Oxidation of bisphenol A (BPA) and related compounds by the multifunctional catalytic globin dehaloperoxidase.

Dehaloperoxidase (DHP) from the marine polychaete Amphitrite ornata is a multifunctional enzyme that possesses peroxidase, peroxygenase, oxidase and oxygenase activities. Herein, we investigated the reactivity of DHP B with bisphenol A (BPA) and related compounds (bisphenol E, bisphenol F, tetrachlorobisphenol A, 2,2'-biphenol, 3,3'-biphenol, 4,4'-biphenol, and 3,3'-dibromo-4,4'-biphenol). As a previously unknown substrate for DHP B, BPA (as a representative substrate) is an endocrine disruptor widely used in polycarbonate and epoxy resins, thus resulting in human exposure. Reactivity studies with these substrates were investigated using high performance liquid chromatography (HPLC), and their corresponding oxidation products were determined by mass spectrometry (GC-MS/ LC-MS). BPA undergoes oxidation in the presence of DHP B and hydrogen peroxide yielding two cleavage products (4-isopropenylphenol and 4-(2-hydroxypropan-2-yl)phenol), and oligomers with varying degrees of oxidation. 18O-labeling studies confirmed that the O-atom incorporated into the products was derived exclusively from water, consistent with substrate oxidation via a peroxidase-based mechanism. The X-ray crystal structures of DHP bound with bisphenol E (1.48 Å), bisphenol F (1.75 Å), 2,2'-biphenol (1.90 Å) and 3,3'-biphenol (1.30 Å) showed substrate binding sites are in the distal pocket of the heme cofactor, similar to other previously studied DHP substrates. Stopped-flow UV-visible spectroscopy was utilized to investigate the mechanistic details and enzyme oxidation states during substrate turnover, and a reaction mechanism is proposed. The data presented here strongly suggest that DHP B can catalyze the oxidation of bisphenols and biphenols, thus providing evidence of how infaunal invertebrates can contribute to the biotransformation of these marine pollutants.

Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery: a clinical retrospective comparative study.

BACKGROUND: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. METHODS: Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients' sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. RESULTS: The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. CONCLUSIONS: Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

Developing a new chemosensor targeting zinc ion based on two types of quinoline platform.

A chemosensor DQ (2-(2-(quinolin-2-yl)hydrazinyl)-N-(quinolin-8-yl)acetamide), based on two quinoline moieties, has been synthesized. DQ could detect zinc ion through fluorescence turn-on in aqueous media. Limit of detection was calculated as 0.07 µM, far lower than the standard of WHO for zinc ion. The practicality of DQ was demonstrated via the successful results of reusability with EDTA, easy detection on the test strip, and precise quantification in real water samples. Additionally, sensor DQ could be applied to bioimaging of zinc ion in zebrafish. Sensing process of zinc ion by DQ was studied through fluorescence and UV-Vis spectroscopy, 1H NMR titration, and ESI-mass spectrometry.

Open Lumbar Microdiscectomy and Posterolateral Endoscopic Lumbar Discectomy for Antero- and Retrospondylolisthesis.

BACKGROUND: Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. OBJECTIVES: We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. STUDY DESIGN: This study used a retrospective design. SETTING: Research was conducted in a hospital and outpatient surgical center. METHODS: This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data. RESULTS: Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD. LIMITATIONS: The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection. CONCLUSIONS: In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011. KEY WORDS: Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.

A Novel Thiophene-Based Fluorescent Chemosensor for the Detection of Zn2+ and CN-: Imaging Applications in Live Cells and Zebrafish.

A novel fluorescent turn-on chemosensor DHADC ((E)-3-((4-(diethylamino)-2-hydroxybenzylidene)amino)-2,3-dihydrothiophene-2-carboxamide) has been developed and used to detect Zn2+ and CN-. Compound DHADC displayed a notable fluorescence increase with Zn2+. The limit of detection (2.55 ± 0.05 µM) for zinc ion was far below the standard (76 µM) of the WHO (World Health Organization). In particular, compound DHADC could be applied to determine Zn2+ in real samples, and to image Zn2+ in both HeLa cells and zebrafish. Additionally, DHADC could detect CN- through a fluorescence enhancement with little inhibition with the existence of other types of anions. The detection processes of compound DHADC for Zn2+ and CN- were demonstrated with various analytical methods like Job plots, 1H NMR titrations, and ESI-Mass analyses.

Highly Sensitive Dansyl-Based Chemosensor for Detection of Cu2+ in Aqueous Solution and Zebrafish.

A new dansyl-based chemosensor (2-(4-((5-(dimethylamino)naphthalen-1-yl)sulfonyl)piperazin-1-yl)-N-(quinolin-8-yl)acetamide) (DC) for detecting Cu2+ was synthesized and characterized. DC showed great selectivity to Cu2+ by a fluorescent "on-off" detection method. Job plot, ESI-mass spectroscopy, and 1H NMR titration suggested a 1 to 1 binding mode between DC and Cu2+. The detection limit was determined to be 43 nM, which is greatly below the WHO guidelines. In addition, DC can be applied to real samples and zebrafish imaging. The fluorescence quenching mechanism was proposed as the enhancement of intramolecular charge transfer with calculations.

Fluorescent determination of zinc by a quinoline-based chemosensor in aqueous media and zebrafish.

A quinoline-based fluorescence sensor QDTD was developed for Zn2+. QDTD can detect Zn2+ by fluorescence turn-on. Detecting limit (0.27 µM) of QDTD for Zn2+ was far below WHO standard (76.0 µM). For the practical application, compound QDTD could be used to determine Zn2+ in real samples and applied to the test kit. More importantly, QDTD was expertly applied for Zn2+ imaging in HeLa cells and zebrafish with good membrane-permeability. Detection mechanism of Zn2+ ion by compound QDTD was suggested through the analytical tools like 1H NMR titration, ESI-MS, Job plot, fluorescent and UV-vis titration, and theoretical calculations, and through the synthesis and applications of a model compound AAQA.

An Imidazo[1,5-α]Pyridine-Based Fluorometric Chemodosimeter for the Highly Selective Detection of Hypochlorite in Aqueous Media.

A new fluorometric chemodosimeter 2-amino-3-(((E)-3-(1-phenylimidazo[1,5-α]pyridin-3-yl)benzylidene)amino)maleonitrile (BPI-MAL) has been designed and synthesized for sensing hypochlorite. BPI-MAL showed a selective turn-on fluorescence for ClO- through hypochlorite-promoted de-diaminomaleonitrile reaction. It also could detect ClO- in the presence of various competitive anions including reactive oxygen species. Interestingly, sensor BPI-MAL was successfully applied as a fluorescent test kit for ClO- determination. The sensing property and mechanism of BPI-MAL toward ClO- were studied by fluorescence and UV-vis spectroscopy, NMR titration and DFT calculations.

A multifunctional selective "turn-on" fluorescent chemosensor for detection of Group IIIA ions Al3+, Ga3+ and In3.

A versatile chemosensor 1 (E)-2-(((8-hydroxy-2,3,6,7-tetrahydro-1H,5H-pyrido[3,2,1-ij]quinolin-9-yl)methylene)amino)-1H-benzo[de]isoquinoline-1,3(2H)-dione, based on naphthalimide and julolidine moieties, was developed for highly distinguishable and selective recognition of Group IIIA metal ions (Al3+, Ga3+ and In3+). Sensor 1 exhibited significant 'off-on' fluorescence responses at 488 nm in the presence of Al3+ and at 570 nm in the presence of Ga3+ and In3+. The same emission of Ga3+ and In3+ could be distinguished through different color changes (from colorless to yellow for Ga3+ and no color change for In3+). Binding constants of 1 for Ga3+ and In3+ are the highest reported to date for an organic chemosensor. A 2 : 1 binding mode between 1 with Al3+, Ga3+ and In3+ is proposed based on electrospray ionization mass spectrometry, Job plot analysis, and theoretical calculations.

A Multi-Responsive Naphthalimide-Based "Turn-on" Fluorescent Chemosensor for Sensitive Detection of Trivalent Cations Ga3+, Al3+ and Cr3.

A new multifunctional chemosensor 1, (E)-2-(((2-hydroxynaphthalen-1-yl)methylene)amino)-1H-benzo[de]isoquinoline-1,3(2H)-dione, based on naphtalimide and naphthaldehyde was developed, which showed the fluorescence responses to trivalent metal ions (Ga3+, Al3+ and Cr3+). Sensor 1 detected and differentiated selectively trivalent metal ions Ga3+, Al3+ and Cr3+ by fluorescence enhancement at different emissions. The association constant of Ga3+-2∙1 complex is the highest one among those of the organic chemosensors reported, to date. The sensing mechanisms for Ga3+, Al3+ and Cr3+ were explained by UV-vis titrations, Job plots, ESI-mass analyses and theoretical calculations.

Salvage Anterior Lumbar Interbody Fusion for Pseudoarthrosis After Posterior or Transforaminal Lumbar Interbody Fusion: A Review of 10 Patients.

BACKGROUND: After interbody cage implantation for posterior or transforaminal lumbar interbody fusion (PLIF or TLIF) spinal fusion surgery, pseudoarthrosis can develop. However, there are several shortcomings of the posterior approach if the interbody cage requires removal. Therefore, an anterior approach may be useful. METHODS: We reviewed salvage anterior lumbar interbody fusion (ALIF) for pseudoarthrosis after PLIF or TLIF performed from December 2006 to December 2016. A total of 10 patients met inclusion criteria for the study. All preoperative and postoperative clinical and radiologic parameters were recorded. RESULTS: Salvage ALIF resulted in improvements in clinical and radiologic outcomes in all cases. In 9 cases, the previously inserted cage was successfully removed. In 1 case, only 1 of the 2 previously inserted cages could be removed, as the previously inserted cage exhibited a high subsidence and remained in a diagonal position in the vertebral body. No serious complications occurred in all cases. Bone fusion was successful in all cases. CONCLUSIONS: ALIF is useful for salvage surgery to treat failed PLIF or TLIF. The advantages of salvage ALIF include improvements in clinical and radiologic outcomes and a low complication rate after surgery. To successfully remove a previously inserted cage, the vascular window of the anterior index level and the degree of subsidence of the cage should be well characterized through preoperative radiologic imaging.

Use of a Zero-Profile Device for Contiguous 2-Level Anterior Cervical Diskectomy and Fusion: Comparison with Cage with Plate Construct.

BACKGROUND: A new zero-profile, standalone device (Zero P) was recently developed and has shown a lower incidence rate of complications and competitive clinical outcomes compared with anterior cervical cage with plate construct (CP) in single and multilevel anterior cervical diskectomy and fusion (ACDF). However, there is still concern whether Zero P is appropriate for multilevel ACDF. In addition, there have been few reports of contiguous 2-level ACDF used in conjunction with Zero P. METHODS: We reviewed contiguous 2-level ACDF performed from December 2006 to February 2015. A total of 63 patients met inclusion criteria for the study (CP group = 32 cases; Zero P group = 31 cases). All preoperative and postoperative clinical and radiologic parameters were recorded. These parameters were compared between both groups. RESULTS: The postoperative change of Cobb S over time in the Zero P group was significantly different from that in the CP group. The maintenance of Cobb S in the Zero P group was better than that in the CP group (P < 0.05). The maintenance of anterior intervertebral disk height (IDH) at postoperative assessment for the Zero P group was significantly better than that in the CP group (P < 0.05). Within-group comparison of the postoperative change of anterior and posterior IDH over time revealed that the anterior IDH was significantly lower than the posterior IDH in the Zero P group (P < 0.05). CONCLUSION: For 2-level contiguous ACDF, the use of a zero-profile device has the capacity to show compatible outcomes in correction and maintenance of segmental angle if the anterior titanium alloy plate is properly positioned at the anterior vertebral line.

Salvage Percutaneous Vertebral Augmentation Using Polymethyl Methacrylate in Patients with Failed Interbody Fusion.

BACKGROUND: Percutaneous vertebral augmentation with cement is used as a salvage procedure for failed instrumentation. Few studies have reported the use of this procedure for failed anterior lumbar fusion in elderly patients with osteoporosis and other complicated diseases who have undergone a previous major operation. METHODS: Between January 2007 and December 2015, the clinical and radiographic results of 8 patients with osteoporosis who showed subsidence and migration of the implant after an initial operation were examined. After the development of implant failure, the patients underwent vertebral augmentation with polymethyl methacrylate. RESULTS: Mean patient age was 73.4 years (range, 67-78 years), and mean bone mineral density was -2.96 (range, -2.1 to -3.8). The mean radiologic follow-up period between augmentation and the last follow-up examination was 16 months (range, 3-38 months). Although the subjective clinical outcome was not satisfying to the patients, no loss of correction, fractures, or screw loosening occurred during the follow-up period. CONCLUSIONS: The injection of cement around the instrument might help to stabilize it by providing strength to the axis and preventing further loosening. This salvage procedure could be an alternative in the management of cases with failed interbody fusion.

An Upper and Middle Cervical Spine Posterior Arch Defect Leading to Myelopathy and a Thoracic Spine Posterior Arch Defect.

BACKGROUND: Abnormalities of the posterior arches of the upper and middle cervical spine that can cause myelopathy are rare, and no reports of such defects at the thoracic spinal level have been published. CASE DESCRIPTION: A 29-year-old male patient reported right arm weakness and pain for 1 year. Magnetic resonance imaging of the cervical spine showed spinal canal stenosis at the C3-4 and C4-5 levels, as well as a posterior arch defect at the C2, 3, and 4 levels that was compressing the spinal cord. Three-dimensional cervical computed tomography (CT) showed that the spinous process and a piece of lamina were fused at each of the posterior C2, 3, and 4 levels, producing a free-floating bony structure. Spina bifida occulta was observed at C1. Osseous formation had failed between the lateral mass and spinous process at the C2 and C3 levels bilaterally, and the C4 level unilaterally. Three-dimensional thoracolumbar CT showed blocked vertebrae and spinous process fusion at T11 and T12. Osseous formation had failed between the lamina and spinous process at the T11 level unilaterally, and the T12 level bilaterally. The free-floating bony structure was successfully removed surgically. CONCLUSIONS: A posterior arch defect of the upper and middle cervical spine leading to myelopathy combined with the same defect at the thoracic spine is a rare disease. If this congenital defect is detected at any spinal level, whole-spine CT can be helpful for accurately diagnosing the congenital anomaly.