Symmetry-breaking motility of penetrable objects in active fluids.

We investigate how a symmetric penetrable object immersed in an active fluid becomes motile due to a negative drag acting in the direction of its velocity. While similar phenomena have been reported only for active fluids that possess polar or nematic order, we demonstrate that such motility can occur even in active fluids without any preexisting order. The emergence of object motility is characterized by both continuous and discontinuous transitions associated with the symmetry-breaking bifurcation of the object's steady-state velocity. Furthermore, we also discuss the relevance of the transitions to the nonmonotonic particle-size dependence of the object's diffusion coefficient.

Salivary pepsin as an independent predictor of treatment response for laryngopharyngeal reflux: prospective cohort study with multivariate analysis.

To analyze the predictive value of salivary pepsin for treatment outcomes in laryngopharyngeal reflux (LPR) using multivariate analysis that includes various associated factors. This prospective cohort study was conducted between August 2020 and August 2022. Patients with LPR who had symptoms lasting more than 1 month and a reflux symptom index (RSI) of 14 or higher were enrolled. The participants received a 2-month regimen of proton pump inhibitors (PPIs) treatment and lifestyle modification. Salivary pepsin was checked using fasting saliva before treatment. Salivary pepsin was detected more frequently in the good treatment response group (61.1%), compared to 14.3% in the poor response group. Similarly, patients with higher compliance to lifestyle modifications (> 90%) had a higher chance of a good response (91.7%) compared to those with lower compliance, who had a 53.8% chance of a good response. Other clinical factors have no significant association with treatment response. In multivariate analysis, both pretreatment salivary pepsin and higher compliance with lifestyle modification were found to be independent factors for treatment response (OR 14.457, CI 1.075 ~ 194.37 for both). This study found that positive salivary pepsin and strict lifestyle modification are independent predictors of treatment outcomes in LPR.

Primary Bilateral Tuberculous Otitis Media After Kidney Transplantation: A Case Report.

We report a case of primary bilateral tuberculous otitis media in a patient who underwent kidney transplantation. This case presents unusual clinical features and histopathology from those of classical tuberculous otitis media. A 75-year-old woman presented at the clinic with purulent ear discharge and hearing loss in both ears. She had undergone kidney transplantation 6 years prior and had been taking immunosuppressant medications. Otoscopic examination and imaging studies suggested acute otitis media, which was irresponsive to antibiotics. The patient underwent surgery to eradicate the disease, and histopathologic examination revealed multifocal granulomas with Langhans giant cells without caseous changes. Ziehl-Neelsen staining and polymerase chain reaction confirmed the diagnosis of tuberculous otitis media. While tuberculous otitis media is a very rare manifestation of extrapulmonary tuberculosis, this case is more noteworthy in that it occurred as a primary infection rather than as a reactivation of a prior infection. In addition, it did not show the classical triad of clinical manifestations, which occurred bilaterally, and its histopathology was different from those of classical tuberculous otitis media. This case presents a new clinical variation in tuberculous otitis media.

Objective Tinnitus of Nasopharyngeal Origin.

We report a rare case of objective tinnitus induced by nasopharyngeal muscle constriction. A 49-year-old female patient presented at the clinic with unintentional sounds coming from the nasal cavity while talking or swallowing, which were similar to the lip-smacking sound. Physical examination revealed a hypertrophic posterior nasopharyngeal wall and torus tubarius at rest. With voluntary effort, the posterior pharyngeal wall protruded prominently and collided with the torus tubarius on either side, generating a sound when they were separated. Botox injection was recommended but the patient refused. The diagnosis and treatment of objective tinnitus are well established, but in some cases, it may occur under unexpected conditions. We report a novel type of objective tinnitus. A thorough physical examination for tinnitus could reveal the cause.

Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review.

BACKGROUND: An abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported. CASE PRESENTATION: A 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved. CONCLUSION: We report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.

Effect of Lumbar Spinal Stenosis on Treatment of Osteoporosis: Comparison of Three Oral Bisphosphonate Therapies.

(1) Background: Lumbar spinal stenosis (LSS) causes uncomfortable neuropathic symptoms, which can negatively affect osteoporosis. The aim of this study was to investigate the effect of LSS on bone mineral density (BMD) in patients treated with one of three oral bisphosphonates (ibandronate, alendronate and risedronate) for initially diagnosed osteoporosis. (2) Methods: We included 346 patients treated with oral bisphosphonates for three years. We compared annual BMD T-scores and BMD increases between the two groups according to symptomatic LSS. The therapeutic efficacies of the three oral bisphosphonates in each group were also evaluated. (3) Results: Annual and total increases in BMD were significantly greater in group I (osteoporosis) compared to group II (osteoporosis + LSS). The total increase in BMD for three years was significantly greater in the ibandronate and alendronate subgroups than that in the risedronate subgroup (0.49 vs. 0.45 vs. 0.25, p < 0.001). Ibandronate showed a significantly greater increase in BMD than that of risedronate in group II (0.36 vs. 0.13, p = 0.018). (4) Conclusions: Symptomatic LSS may interfere with the increase in BMD. Ibandronate and alendronate were more effective in treating osteoporosis than risedronate. In particular, ibandronate was more effective than risedronate in patients with both osteoporosis and LSS.

Prognostic Significance of the Post-Treatment Neutrophil-to-Lymphocyte Ratio in Pharyngeal Cancers Treated with Concurrent Chemoradiotherapy.

BACKGROUND: Even though the pre-treatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are well-established prognosticators in various cancers including head and neck cancers, there have been relatively few studies on the clinical significance of the post-treatment values. This study aimed to investigate the changes in NLR and PLR after concurrent chemoradiotherapy (CCRT) and to evaluate their prognostic significance in pharyngeal cancers. METHODS: This study was retrospectively conducted on 461 consecutive patients with primary pharyngeal cancer who had received definitive CCRT. Blood test results before and after CCRT were obtained, and the pre- and post-treatment NLR and PLR were calculated. Patient prognosis was evaluated based on overall survival (OS) and relapse-free survival (RFS). RESULTS: After CCRT, the NLR increased from 2.01 (interquartile range (IQR), 1.53-2.62) to 2.69 (IQR, 1.93-3.81), and the PLR increased from 118.84 (IQR, 92.61-151.63) to 193.19 (IQR, 146.28-262.46). Along with high pre-treatment NLR and high pre-treatment PLR, high post-treatment NLR was also significantly associated with worse OS and RFS (p = 0.013 and p = 0.026). In addition, patients with a high ΔNLR (i.e., the difference between pre- and post-treatment NLRs) had significantly worse OS and RFS (p = 0.013 and p = 0.026). However, only a high pre-treatment NLR (hazard ratio (HR), 2.19; 95% confidence interval (CI), 1.17-4.08; p = 0.014), age (HR, 2.16; 95% CI, 1.14-4.08; p = 0.018), and stage IV (HR, 2.11; 95% CI, 1.15-3.89; p = 0.017) were independent prognostic factors for OS in the multivariate analysis. CONCLUSIONS: In patients with pharyngeal cancers, following CCRT, the NLR and PLR increased significantly from pre-treatment values. Like the pre-treatment NLR and PLR, a high post-treatment NLR and a significant increase in NLR were also associated with poor prognosis. Further prospective studies are required to prove the independent significance of the post-treatment NLR and PLR.

Lumbar Interbody Fusion and Osteobiologics for Lumbar Fusion.

Lumbar interbody fusion (LIF) is an excellent treatment option for a number of lumbar diseases. LIF can be performed through posterior, transforaminal, anterior, and lateral or oblique approaches. Each technique has its own pearls and pitfalls. Through LIF, segmental stabilization, neural decompression, and deformity correction can be achieved. Minimally invasive surgery has recently gained popularity and each LIF procedure can be performed using minimally invasive techniques to reduce surgery-related complications and improve early postoperative recovery. Despite advances in surgical technology, surgery-related complications after LIF, such as pseudoarthrosis, have not yet been overcome. Although autogenous iliac crest bone graft is the gold standard for spinal fusion, other bone substitutes are available to enhance fusion rate and reduce complications associated with bone harvest. This article reviews the surgical procedures and characteristics of each LIF and the osteobiologics utilized in LIF based on the available evidence.

Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy: Two case reports.

BACKGROUND: Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus, percutaneous endoscopic lumbar discectomy (PELD) has been developed. The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach. We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization. CASE SUMMARY: In case 1, a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital. Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area. Under suspicion of vascular injury, arteriography was performed. Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified. Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery. In case 2, a 75-year-old woman was transferred to our emergency department with low blood pressure, right flank pain, and drowsy mental status after PELD at a local hospital. When the patient arrived at the emergency room, the blood pressure decreased from 107/55 mmHg to 72/47 mmHg. Low blood pressure persisted. Under suspicion of vessel injury, arteriography was performed, and the right 4th lumbar segmental artery rupture was confirmed. Emergency transarterial embolization was performed for bleeding of segmental artery. CONCLUSION: We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.

Delayed Recovery in Idiopathic Sudden Sensorineural Hearing Loss.

Sudden hearing loss is an easily encountered disease in clinics, but its prognosis has not been completely elucidated. In the present study, we investigated the long-term prognosis of sudden hearing loss with 130 patients who were diagnosed based on strict criteria and provided uniform treatment. The patients with incomplete recovery were reevaluated after 2 months without receiving additional treatment. Hearing levels at different time points were compared. Moreover, the associated factors affecting the degree of hearing improvement over time were evaluated using stepwise multiple linear regression. After treatment, 73 out of the 130 (56.1%) patients attained incomplete recovery and were reevaluated after 2 months. Seventeen out of the seventy-three (23.3%) patients showed a grade promotion, fifty-four (74%) were constant, and two (2.7%) were aggravated. The mean interaural hearing differences (IHDs) showed significant improvement. Old age, poor initial IHD, and poor recovery grade were significantly associated with a profitable delayed hearing gain. Poorer hearing level at the time of onset might be a sign for slower recovery rather than a poorer prognostic factor. The treatment outcome of idiopathic sudden sensorineural hearing loss (ISSNHL) should be evaluated at least 2 months after treatment completion, and counseling is required due to the need for long-term follow-up in patients with ISSNHL.

Unstable Bony Chance Fracture Successfully Treated With Teriparatide in Patient With Ankylosed Spine: A Case Report and Review of the Literature.

Background: Ankylosed spines with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis (DISH) are prone to fractures due to osteoporosis and fracture instability from long lever arm. In such cases, surgical management is the main treatment option. Case presentation: We report a first case of successful treatment of unstable bony Chance fracture at thoracolumbar junction in DISH patient using teriparatide and review previous literature on ankylosed spine fractures treated with teriparatide. An 82-year-old male patient presented with back pain after falling from a 3 m height 3 months ago. Imaging studies showed L1 unstable flexion-distraction injury (bony Chance fracture) and intravertebral vacuum cleft in ankylosed spine due to DISH. Conservative treatment, teriparatide and orthosis, was determined as the most appropriate approach because the patient declined surgery and presented with tolerable mechanical back pain without any neurologic deficits. Solid bony union was successfully achieved without any complications after 1-year treatment. Conclusion: Although surgical management is strongly recommended for unstable fracture in ankylosed spine, non-surgical treatment including teriparatide and orthosis might be safer and effective options in bony Chance fracture without neurologic deficits and intractable mechanical pain.

Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review.

BACKGROUND: Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. CASE PRESENTATION: An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. CONLCUSIONS: If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell's Disease With Neurologic Deficits-A Retrospective Case Series.

PURPOSE: Various surgical methods have been reported for Kummell's disease with neurologic deficits. The aim of this study was to introduce long-segmental posterior fusion (LPF) combined with vertebroplasty (VP) and wiring as an alternative surgical technique. MATERIAL AND METHODS: We retrospectively analyzed 10 patients undergoing posterior decompression and LPF combined with VP and wiring for Kummell's disease with neurologic deficits from January 2011 to December 2014. The radiologic outcomes included the local kyphotic angle (LKA) and segmental kyphotic angle (SKA). Clinical outcomes, including the visual analog scale (VAS), the Oswestry Disability Index (ODI) and the Frankel grade were assessed. Surgery-related complications were also evaluated. RESULTS: The mean age of the included patients was 77 ± 8 years with a mean follow-up period of 31.4 ± 4.9 months and a mean bone mineral density of -3.5 ± 0.7 (T-score). The mean operation time was 220 ± 32.3 minutes with a mean blood loss of 555 ± 125.7 mL. The preoperative LKA and SKA were significantly corrected postoperatively (37.9 ± 8.7° vs. 15.3 ± 5.3°, p = 0.005 for LKA; 21.3 ± 5.1° vs. 7.6 ± 2.8°, p = 0.005 for SKA) without a loss of correction at the last follow-up. The VAS and ODI were also significantly improved (7.7 ± 1.1 vs. 3.0 ± 1.6, p = 0.007 for VAS; 90.3 ± 8.9 vs. 49.6 ± 22.7, p = 0.007 for ODI). The Frankel grade of all patients was improved by at least 1 or 2 grades at the last follow-up. Surgery-related complications such as intraoperative cement leakage and implant loosening during the follow-up were not observed. CONCLUSIONS: LPF combined with VP and wiring might be an effective surgical option for Kummell's disease with neurologic deficits, especially for the elderly patients with morbidities. LEVEL OF EVIDENCE: level IV.

Effect of lumbar spinal stenosis on bone mineral density in osteoporosis patients treated with ibandronate.

BACKGROUND: Lumbar spinal stenosis (LSS) can cause various neurological symptoms and reduce the daily activity of patients. Many studies have shown that free physical activities and exercise can improve bone mineral density (BMD) in patients with osteoporosis. However, the effect of LSS on BMD has not been reported. The purpose of this study was to investigate the effects of LSS on BMD in patients treated with ibandronate for newly diagnosed osteoporosis. METHODS: Group 1 included 83 patients treated for osteoporosis alone, and group 2 included 76 patients treated for both osteoporosis and symptomatic LSS. We confirmed four BMD values presented as T-score at initial, and 1-, 2-, and 3-year follow-ups. Mean BMD and annual changes of BMD for three years were compared between the two groups. Correlations between initial BMD and total change of BMD, and related factors for continuous BMD improvement for three years were also evaluated. RESULTS: Mean annual BMDs were significantly higher in group 1 compared than in group 2 (-3.39 vs. -3.58 at 1-year; -3.27 vs. -3.49 at 2-year; -3.13 vs. -3.45 at 3-year; all p < 0.05). Annual change of BMD at 1-year follow-up (0.32 vs. 0.21, p = 0.036) and total change of BMD for three years (0.57 vs. 0.35, p = 0.002) were significantly higher in group 1. Group 1 had a strong negative correlation (r = -0.511, P = 0.000) between initial BMD and total change of BMD, whereas group 2 showed a weak negative correlation (r = -0.247, p = 0.032). In multivariate analysis, symptomatic LSS was the only independent risk factor for continuous BMD improvement (Odds ratio = 0.316, p = 0.001). CONCLUSIONS: Symptomatic LSS may interfere with BMD improvement in the treatment of osteoporosis with ibandronate. Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS.

Binder-free and high-loading sulfurized polyacrylonitrile cathode for lithium/sulfur batteries.

Sulfurized polyacrylonitrile (SPAN) is a promising active material for Li/S batteries owing to its high sulfur utilization and long-term cyclability. However, because SPAN electrodes are synthesized using powder, they require large amounts of electrolyte, conducting agents, and binder, which reduces the practical energy density. Herein, to improve the practical energy density, we fabricated bulk-type SPAN disk cathodes from pressed sulfur and polyacrylonitrile powders using a simple heating process. The SPAN disks could be used directly as cathode materials because their π-π structures provide molecular-level electrical connectivity. In addition, the electrodes had interconnected pores, which improved the mobility of Li+ ions by allowing homogeneous adsorption of the electrolyte. The specific capacity of the optimal electrode was very high (517 mA h gelectrode -1). Furthermore, considering the weights of the anode, separator, cathode, and electrolyte, the Li/S cell exhibited a high practical energy density of 250 W h kg-1. The areal capacity was also high (8.5 mA h cm-2) owing to the high SPAN loading of 16.37 mg cm-2. After the introduction of 10 wt% multi-walled carbon nanotubes as a conducting agent, the SPAN disk electrode exhibited excellent cyclability while maintaining a high energy density. This strategy offers a potential candidate for Li/S batteries with high practical energy densities.

Cervical foraminal stenosis causing unilateral diaphragmatic paralysis without neurologic manifestation: A case report and review of the literature.

RATIONALE: Unilateral diaphragmatic paralysis due to cervical spondylosis has rarely been reported. We present the first case of unilateral diaphragmatic paralysis without radicular pain or motor weakness due to cervical foraminal stenosis and a review of the related literature. PATIENT CONCERNS: A 59-year-old man presented with dyspnea and fever. His chest radiograph revealed right hemidiaphragmatic paralysis. DIAGNOSES: The differential diagnosis of phrenic nerve palsy excluded mediastinal and neurodegenerative diseases. Imaging studies showed right foraminal stenosis caused by cervical spondylosis at C3-4 and C4-5. INTERVENTIONS: The patient underwent foraminotomy at C3-4 and C4-5 on the right side. The operative findings revealed a severe compression of the C4 root. OUTCOMES: At 3 months postoperatively, the unilateral diaphragmatic paralysis and dyspnea were recovered. LESSONS: Hemidiaphragmatic paralysis deserves careful evaluation for the presence of cervical spondylosis, even without concomitant neurologic manifestations.

Fabrication of Nickel Sulfide/Nitrogen-Doped Reduced Graphene Oxide Nanocomposite as Anode Material for Lithium-Ion Batteries and Its Electrochemical Performance.

In this study, NiS/graphene nanocomposites were synthesized by simple heat treatment method of three graphene materials (graphene oxide (GO), reduced graphene oxide (rGO) and nitrogen-doped graphene oxide (N-rGO)) and NiS precursor. The morphology and crystal structure of NiS/graphene nanocomposites were characterized using field emission scanning electron microscope (FE-SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy. Electrochemical properties were also investigated. NiS/graphene nanocomposites homogeneously wrapped by graphene materials have been successfully manufactured. Among the three nanocomposites, NiS/N-rGO nanocomposite exhibited the highest initial and retention capacity in discharge, respectively, of 1240 mAh/g and 467 mAh/g up to 100 cycles at 0.5 C.

Hydrothermal Synthesis and Electrochemical Behavior of the SnO2/rGO as Anode Materials for Lithium-Ion Batteries.

In this work, the hydrothermal method was employed to produce SnO2/rGO as anode material. Nanostructured SnO2 was prepared to enhance reversibility and to deal with the undesirable volume changes during cycling. The SnO2/rGO hybrid exhibits long cycle life in lithium-ion storage capacity and rate capability with an initial discharge capacity of 1327 mAh/g at 0.1 C rate. These results demonstrate that a fabricated SnO2/rGO matrix will be a possible way to obtain high rate performance.

Electrochemical Properties of Silicon-Polyacrylonitrile (PAN) Composite Anodes for Flexible Batteries.

Polyacrylonitrile (PAN)/Si composite fibers (electrodes) with flexibility were fabricated using an elec-trospinning method and then Si-embedded carbon (Si/C) fibers were prepared by carbonizing the composite fibers at 800, 900, and 1000°C. Si particles were distributed in the interior and exterior of entangled PAN fibers. After carbonization, the structure of electrodes was preserved but the diameter of fibers was decreased owing to the release of component elements constituting PAN such as nitrogen and oxygen. Crystalline Si particles existed in carbon fibers with both amorphous and crystalline phases. As carbonization temperature increased, the carbon content and the crys-tallinity of carbon increased. The electrode carbonized at 1000°C with the lowest charge transfer resistance exhibited the best electrochemical properties in terms of capacity, coulombic efficiency and cycle life.

Free-Standing NiS2 Electrode as High-Rate Anode Material for Sodium-Ion Batteries.

Owing to the speculated price hike and scarcity of lithium resources, sodium-ion batteries are attracting significant research interest these days. However, sodium-ion battery anodes do not deliver good electrochemical performance, particularly rate performance. Herein, we report the facile electrospinning synthesis of a free-standing nickel disulfide (NiS²) embedded on carbon nanofiber. This electrode did not require a conducting agent, current collector, and binder, and typically delivered high capacity and rate performance. The electrode delivered a high initial capacity of 603 mAh g-1 at the current density of 500 mA g-1. Moreover, the electrode delivered the capacity of 271 mAh g-1 at the high current density of 15 A g-1. The excellent rate performance and high coulombic efficiency of the electrode were attributed to its low charge transfer resistance and unique structure.