Restoration of HDAC1 Enzymatic Activity after Stroke Protects Neurons from Ischemia/Reperfusion Damage and Attenuates Behavioral Deficits in Rats.

A therapeutic approach for promoting neuroprotection and brain functional regeneration after strokes is still lacking. Histone deacetylase 1 (HDAC1), which belongs to the histone deacetylase family, is involved in the transcriptional repression of cell-cycle-modulated genes and DNA damage repair during neurodegeneration. Our previous data showed that the protein level and enzymatic activity of HDAC1 are deregulated in stroke pathogenesis. A novel compound named 5104434 exhibits efficacy to selectively activate HDAC1 enzymatic function in neurodegeneration, but its potential in stroke therapy is still unknown. In this study, we adopted an induced rat model with cerebral ischemia using the vessel dilator endothelin-1 to evaluate the potential of compound 5104434. Our results indicated compound 5104434 selectively restored HDAC1 enzymatic activity after oxygen and glucose deprivation, preserved neurite morphology, and protected neurons from ischemic damage in vitro. In addition, compound 5104434 attenuated the infarct volume, neuronal loss, apoptosis, DNA damage, and DNA breaks in cerebral ischemia rats. It further ameliorated the behavioral outcomes of neuromuscular response, balance, forepaw strength, and functional recovery. Collectively, our data support the efficacy of compound 5104434 in stroke therapy and contend that it can be considered for clinical trial evaluation.

Health risk assessment of groundwater arsenic pollution in southern Taiwan.

Residents of the Pingtung Plain, Taiwan, use groundwater for drinking. However, monitoring results showed that a considerable portion of groundwater has an As concentration higher than the safe drinking water regulation of 10 µg/L. Considering residents of the Pingtung Plain continue to use groundwater for drinking, this study attempted to evaluate the exposure and health risk from drinking groundwater. The health risk from drinking groundwater was evaluated based on the hazard quotient (HQ) and target risk (TR) established by the US Environmental Protection Agency. The results showed that the 95th percentile of HQ exceeded 1 and TR was above the safe value of threshold value of 10-6. To illustrate significant variability of the drinking water consumption rate and body weight of each individual, health risk assessments were also performed using a spectrum of daily water intake rate and body weight to reasonably and conservatively assess the exposure and health risk for the specific subgroups of population of the Pingtung Plain. The assessment results showed that 0.01-7.50 % of the population's HQ levels are higher than 1 and as much as 77.7-93.3 % of the population being in high cancer risk category and having a TR value >10-6. The TR estimation results implied that groundwater use for drinking purpose places people at risk of As exposure. The government must make great efforts to provide safe drinking water for residents of the Pingtung Plain.

Zonal management of multi-purposes groundwater utilization based on water quality and impact on the aquifer.

Groundwater is widely used for drinking, irrigation, and aquaculture in the Pingtung Plain, Southwestern Taiwan. The overexploitation and poor quality of groundwater in some areas of the Pingtung Plain pose great challenges for the safe use and sustainable management of groundwater resources. Thus, establishing an effective management plan for multi-purpose groundwater utilization in the Pingtung Plain is imperative. Considerations of the quality of the groundwater and potential impact on the aquifer of groundwater exploitation are paramount to multi-purpose groundwater utilization management. This study proposes a zonal management plan for the multi-purpose use of groundwater in the Pingtung Plain. The zonal management plan is developed by considering the spatial variability of the groundwater quality and the impact on the aquifer, which is defined as the ratio of the actual groundwater extraction rate to transmissivity. A geostatistical Kriging approach is used to spatially delineate the safe zones based on the water quality standards applied in the three groundwater utilization sectors. Suitable zones for the impact on the aquifer are then spatially determined. The evaluation results showing the safe water quality zones for the three types of utilization demands and suitable zones for the impact on aquifer are integrated to create a zonal management map for multi-purpose groundwater utilization which can help government administrators to establish a water resource management strategy for safe and sustainable use of groundwater to meet multi-purpose groundwater utilization requirements in the Pingtung Plain.

Delayed neurovascular inflammation after mild traumatic brain injury in rats.

INTRODUCTION: Experimental traumatic brain injury (TBI) elicits acute local inflammatory responses, including up-regulation of adhesion molecules and neutrophils in the injured brain. However, in clinical experiences there were at least three types of TBI, which included mild, moderate and severe types, and there would be different neuroinflammatory responses. This study investigated the inflammatory responses after mild TBI in rats. METHODS: Adult male Sprague-Dawley rats (n = 40) were group-housed and injured using an impact method. Motor function was assessed 1-4 days after the injury by using a grip test (Grip strength meter; Singa). Blood samples collected from the rats before the injury and after the injury and the Intercellular adhesion molecule-1 (ICAM-1) level were measured. RESULTS: The ICAM-1 expression from pre-injury to post-injury showed a significantly greater gradual elevation in the rats in the mild-injury group than in the moderate-injury group. The neurological function evaluated with grip test showed no deterioration of neurological function in the mild-injury group but gradual deterioration in the moderate-injury group. CONCLUSION: These findings showed a delayed inflammatory reaction in the mild-injury group without progressive deterioration of neurological function. Therefore, in the moderate-injury group, no progression phase was observed.

Probabilistic health risk assessment for ingestion of seafood farmed in arsenic contaminated groundwater in Taiwan.

Seafood farmed in arsenic (As)-contaminated areas is a major exposure pathway for the ingestion of inorganic As by individuals in the southwestern part of Taiwan. This study presents a probabilistic risk assessment using limited data for inorganic As intake through the consumption of the seafood by local residents in these areas. The As content and the consumption rate are both treated as probability distributions, taking into account the variability of the amount in the seafood and individual consumption habits. The Monte Carlo simulation technique is utilized to conduct an assessment of exposure due to the daily intake of inorganic As from As-contaminated seafood. Exposure is evaluated according to the provisional tolerable weekly intake (PTWI) established by the FAO/WHO and the target risk based on the US Environmental Protection Agency guidelines. The assessment results show that inorganic As intake from five types of fish (excluding mullet) and shellfish fall below the PTWI threshold values for the 95th percentiles, but exceed the target cancer risk of 10(-6). The predicted 95th percentile for inorganic As intake and lifetime cancer risks obtained in the study are both markedly higher than those obtained in previous studies in which the consumption rate of seafood considered is a deterministic value. This study demonstrates the importance of the individual variability of seafood consumption when evaluating a high exposure sub-group of the population who eat higher amounts of fish and shellfish than the average Taiwanese.

Quantitative Analysis of Brain Swelling Resolution With Regard to Cranioplasty After Decompressive Craniectomy.

OBJECTIVE: Adequate brain swelling resolution prior to cranioplasty (CP) is an important yet loosely defined issue. Despite efforts to balance timely CP and patient safety, heterogeneous study methodologies have led to conflicting results. This study aims to standardize this issue through quantifying degree of brain swelling resolution using a proposed Visual CP Scale. METHODS: The proposed Visual CP Scale is validated through a 2-pronged approach. The first prong involves a national survey in Taiwan, where neurosurgeons were surveyed to determine what constitutes a patient's readiness for CP. The second prong involves a large retrospective cohort, where the correlations between timing, degree of brain swelling resolution, and post-CP complication rates, are evaluated. RESULTS: In the national Taiwan CP Survey, 124 out of 772 neurosurgeons (17.2%) completed the survey. Respondents who chose higher grades on the Visual CP Scale preferred later CP timings. In the retrospective data, 378 out of 770 (49.1%) patients had pre-CP brain images, allowing for the utilization of the Visual CP Scale. A Visual CP Scale score of greater than or equal to 4 was associated with fewer complications after CP. CONCLUSIONS: The timing of CP should be determined by the degree of brain swelling resolution, not vice versa. The proposed Visual CP Scale offers an objective method for assessing brain swelling resolution, making it an adjuvant tool for clinical decision-making and future research related to CP.

Characterizing hydrochemical properties of springs in Taiwan based on their geological origins.

This study was performed to characterize hydrochemical properties of springs based on their geological origins in Taiwan. Stepwise discriminant analysis (DA) was used to establish a linear classification model of springs using hydrochemical parameters. Two hydrochemical datasets-ion concentrations and relative proportions of equivalents per liter of major ions-were included to perform prediction of the geological origins of springs. Analyzed results reveal that DA using relative proportions of equivalents per liter of major ions yields a 95.6% right assignation, which is superior to DA using ion concentrations. This result indicates that relative proportions of equivalents of major hydrochemical parameters in spring water are more highly associated with the geological origins than ion concentrations do. Low percentages of Na(+) equivalents are common properties of springs emerging from acid-sulfate and neutral-sulfate igneous rock. Springs emerging from metamorphic rock show low percentages of Cl( - ) equivalents and high percentages of HCO[Formula: see text] equivalents, and springs emerging from sedimentary rock exhibit high Cl( - )/SO(2-)(4) ratios.

Radiotherapy After Endoscopic Biopsy in an Adult with Pineocytoma, the Rare Brain Tumor in an Adult: A Case Report and Literature Review.

Tumors in the pineal region usually present with acute hydrocephalus. Histologic diagnosis is most important, as it greatly influences treatment, because over 17 tumor types occur in this area. Biopsies of these lesions play an important role in further management. Pineocytomas are benign and rare tumors that typically exhibit a slow progression. However, the appropriate treatment for pineocytoma varies. Surgical excision was considered for good long-term outcomes; however, this may not always be possible. Radiotherapy also appears to be effective in patients with residual pineocytomas. We report a case of pineocytoma with hemorrhagic transformation and complicated hydrocephalus. The patient refused to undergo aggressive tumor excision. Thus, the patient only underwent endoscopic biopsy and external ventricular drain (EVD) implantation, but the outcome was acceptable. In addition, we reviewed the current management strategies for pineocytomas in the literature.

Comprehensive assessment of the impact of land use and hydrogeological properties on the groundwater quality in Taiwan using factor and cluster analyses.

This study aims at making a comprehensive assessment of the impact of land use and the hydrogeological properties on groundwater quality. First, factor analysis (FA) is applied to reveal the main pollutant sources and hydrogeological processes controlling the groundwater quality. FA identifies the four most important factors. Factor 1 (seawater salinization) is characterized by a medium loading of land use type of aquaculture. It is recognized that the high scores for factor 1 in coastal areas are due to over-pumping from aquafarms. Focused land use management is required to prevent saline-water intrusion in coastal aquifers. Factor 3 (nitrate pollution) shows high correlations with the land use type of fruit farming and the gravel thickness in unsaturated layers. High scores for factor 3 are also found in the proximal area of the Chuoshui River Alluvial Fan and the northeastern mountain area in the Pingtung Plain. Fruit farmers should be educated to reduce the application of fertilizers and promote the organic fruit farming. The impacts of land use and the hydrogeological properties on both Factor 2 (arsenic enrichment) and Factor 4 (reductive dissolution of Fe2+ and Mn2+) are negligible. Second, cluster analysis (CA) is performed on computed scores of the four main factors to separates 123 monitoring wells into cluster 1 (low polluted zone), cluster 2 (nitrate polluted zone) and cluster 3 (hybrid polluted zone). The results obtained from CA provide practical applications such as reduce agrichemical use in the areas of cluster 2 and enforce intensive monitoring in the prioritizing areas of cluster 3. This study successively uses the FA and CA to extract the meaningful information present by geographical visualization of scores for 4 main factors and 3 distinct clusters zones. The results are essential for formulating sound groundwater resource and land use management policies to ensure groundwater sustainability.

Gamma Knife Radiosurgery as a Salvage Treatment for Nasopharyngeal Carcinoma with Skull Base and Intracranial Invasion (T4b).

It is usually difficult to achieve good outcomes with salvage treatment for recurrent nasopharyngeal carcinoma (NPC) because of its deep-seated location, surrounding critical structures, and patient history of high-dose irradiation. Gamma Knife radiosurgery (GKS) is a treatment option for malignancies with skull base and intracranial invasion. We conducted a retrospective, observational, single-center study including 15 patients with recurrent NPC (stage T4b) involving the skull base and intracranial invasion, who underwent GKS as a salvage treatment. Patients were enrolled over 12 years. Per a previous study, the TNM classification T4b was subclassified into T4b1 and T4b2, defined as the involvement of the skull base or cavernous sinus with an intracranial extension of <5 mm and >5 mm, respectively. The effect of prognostic factors, including age, sex, survival period, magnetic resonance imaging (MRI) presentation, presence of other distant metastases, tumor volume, marginal dose, maximal dose, and Karnofsky Performance Status (KPS), on outcomes was analyzed. The patients with T4b1 NPC (p = 0.041), small tumor volume (p = 0.012), higher KPS (p < 0.001), and no other metastasis (p = 0.007) had better outcomes after GKS treatment, suggesting that it is a viable treatment modality for NPC. We also suggest that detailed brain imaging studies may enable the early detection of intracranial invasion.

A Machine Learning Approach for Spatial Mapping of the Health Risk Associated with Arsenic-Contaminated Groundwater in Taiwan's Lanyang Plain.

Groundwater resources are abundant and widely used in Taiwan's Lanyang Plain. However, in some places the groundwater arsenic (As) concentrations far exceed the World Health Organization's standards for drinking water quality. Measurements of the As concentrations in groundwater show considerable spatial variability, which means that the associated risk to human health would also vary from region to region. This study aims to adapt a back-propagation neural network (BPNN) method to carry out more reliable spatial mapping of the As concentrations in the groundwater for comparison with the geostatistical ordinary kriging (OK) method results. Cross validation is performed to evaluate the prediction performance by dividing the As monitoring data into three sets. The cross-validation results show that the average determination coefficients (R2) for the As concentrations obtained with BPNN and OK are 0.55 and 0.49, whereas the average root mean square errors (RMSE) are 0.49 and 0.54, respectively. Given the better prediction performance of the BPNN, it is recommended as a more reliable tool for the spatial mapping of the groundwater As concentration. Subsequently, the As concentrations estimated obtained using the BPNN are applied to develop a spatial map illustrating the risk to human health associated with the ingestion of As-containing groundwater based on the noncarcinogenic hazard quotient (HQ) and carcinogenic target risk (TR) standards established by the U.S. Environmental Protection Agency. Such maps can be used to demarcate the areas where residents are at higher risk due to the ingestion of As-containing groundwater, and prioritize the areas where more intensive monitoring of groundwater quality is required. The spatial mapping of As concentrations from the BPNN was also used to demarcate the regions where the groundwater is suitable for farmland and fishponds based on the water quality standards for As for irrigation and aquaculture.

Optimal Cut-Off Points of Sagittal Spinopelvic Parameters as a Morphological Parameter to Predict Efficiency in Nerve Block and Pulsed Radiofrequency for Lumbar Facet Joint Pain: A Retrospective Study.

BACKGROUND: After proper patient selection, anatomically correct pulsed radiofrequency of the lumbar facet joints provide long-term pain relief in a routine clinical setting. In the study, we performed an analysis of clinical and radiological predictive factors and provide the scientific basis for this promising modality. METHODS: The study included 198 patients with lower back pain due to lumbar facet joint disease who underwent medial branch block and pulsed radiofrequency during the period 2015-2019. According to the improvement in pain score, the patients were divided into good and poor outcome groups. Clinical and radiological data were collected and analyzed. RESULTS: The multivariable analysis revealed the predictive factors, including lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and post lumbar fusion procedures. CONCLUSION: With the results of this study, we demonstrated that the improved outcome after the surgery was related to lumbar lordosis, lower lumbar lordosis, pelvic tilt, the number of facet joints, old compression fracture with/without vertebroplasty, and the lumbar fusion procedures. Old compression fractures and lumbar fusion would change the radiological factors and cause refractory lumbar facet joint pain.

A Novel NGF Receptor Agonist B355252 Ameliorates Neuronal Loss and Inflammatory Responses in a Rat Model of Cerebral Ischemia.

INTRODUCTION: Cerebral ischemia is a leading cause of disability and death worldwide. However, an effective therapeutic approach for the condition remains undiscovered. The previously proposed growth factor-based therapy has been inefficient due to its inability to pass through the blood-brain barrier. B355252, a newly developed small molecule, exhibited a potential neuroprotective effect in vivo. However, its exact efficacy in cerebral ischemia remains unclear. METHODS: We adopt an endothelin-1 stereotaxic intracranial injection to induced cerebral ischemia in rat. We further conducted 2,3,5-triphenyltetrazolium chloride (TTC) staining, immunofluorescent staining, enzyme-linked immunosorbent assay (ELISA), and behavioral tests to evaluate the efficacy of B355252 in neuroprotection, anti-inflammation, and behavioral outcome improvements. RESULTS: We identified that B355252 could protect ischemic neurons from neuronal loss by attenuating DNA damage, reducing ROS production and the LDH level, and preventing neuronal apoptosis. Moreover, inflammatory responses in astrocytic and microglial gliosis, as well as IL-1ß and TNF-α levels, were ameliorated. Consequently, the behavioral outcomes of ischemic rats in neurologic responses and fore paw function recovery were improved. DISCUSSION: Overall, our study verified the in vivo therapeutic potential of B355252. The study findings further support its application in the development of a therapeutic approach for stroke.

HDAC1 deregulation promotes neuronal loss and deficit of motor function in stroke pathogenesis.

Stroke is a common cause of death worldwide and leads to disability and cognitive dysfunction. Ischemic stroke and hemorrhagic stroke are major categories of stroke, accounting for 68% and 32% of strokes, respectively. Each year, 15 million people experience stroke worldwide, and the stroke incidence is rising. Epigenetic modifications regulate gene transcription and play a major role in stroke. Accordingly, histone deacetylase 1 (HDAC1) participates in DNA damage repair and cell survival. However, the mechanisms underlying the role of HDAC1 in stroke pathogenesis are still controversial. Therefore, we investigated the role of HDAC1 in stroke by using a rat model of endothelin-1-induced brain ischemia. Our results revealed that HDAC1 was deregulated following stroke, and its expressional level and enzymatic activity were decreased. We also used MS-275 to inhibit HDAC1 function in rats exposed to ischemic insult. We found that HDAC1 inhibition promoted the infarct volume, neuronal loss, DNA damage, neuronal apoptosis after stroke, and levels of reactive oxygen species and inflammation cytokines. Additionally, HDAC1 inhibition deteriorated the behavioral outcomes of rats with ischemic insult. Overall, our findings demonstrate that HDAC1 participates in ischemic pathogenesis in the brain and possesses potential for use as a therapeutic target.

Simvastatin-Ezetimibe enhances growth factor expression and attenuates neuron loss in the hippocampus in a model of intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a common and severe neurological disorder associated with high morbidity and mortality rates. Despite extensive research into its pathology, there are no clinically approved neuroprotective treatments for ICH. Increasing evidence has revealed that inflammatory responses mediate the pathophysiological processes of brain injury following ICH. Experimental ICH was induced by direct infusion of 100 µL fresh (non-heparinized) autologous whole blood into the right basal ganglia of Sprague-Dawley rats at a constant rate (10 µL/min). The simvastatin group was administered simvastatin (15 mg/kg) and the combination therapy group was administered simvastatin (10 mg/kg) and ezetimibe (10 mg/kg). Magnetic resonance imaging (MRI), the forelimb use asymmetry test, the Morris water maze test, and two biomarkers were used to evaluate the effect of simvastatin and combination therapy. MRI imaging revealed that combination therapy resulted in significantly reduced perihematomal edema. Biomarker analyses revealed that both treatments led to significantly reduced endothelial inflammatory responses. The forelimb use asymmetry test revealed that both treatment groups had significantly improved neurological outcomes. The Morris water maze test revealed improved neurological function after combined therapy, which also led to less neuronal loss in the hippocampal CA1 region. In conclusion, simvastatin-ezetimibe combination therapy can improve neurological function, attenuate the endothelial inflammatory response and lead to less neuronal loss in the hippocampal CA1 region in a rat model of ICH.

Lhermitte-Duclos disease: A case report with radiologic-pathologic correlation.

Background: Lhermitte-Duclos disease (LDD) stems from the development of a rare benign lesion of uncertain pathogenesis that distorts the normal cerebellar laminar cytoarchitecture. We explored the lesion's appearance on conventional magnetic resonance imaging (MRI) combined with susceptibility-weighted imaging, diffusion-weighted imaging, perfusion imaging, or arterial spin labeling. Although many cases of LDD have been previously reported in the literature, the radiologic-pathologic correlation has been described in only a few of these cases. To the best of our knowledge, this is the first case report to provide detailed information about the radiologic-pathologic correlation of LDD. Case Report: A 48-year-old woman presented with left facial tics, occipital headache, and dizziness for 1 month. MRI revealed a left cerebellar lesion with hypointensity on T1-weighted images. On T2-weighted images, the mass was hyperintense with tigroid appearance due to alternating high and normal signal intensities. High signal intensity was noted on fluid-attenuated inversion recovery images. Magnetic resonance spectroscopy indicated decreased level of choline (Cho), N-acetyl aspartate, and myoinositol with elevated level of lactate on the affected side. The lesion showed a bright signal on diffusion-weighted images, whereas apparent diffusion coefficient mapping revealed no disturbance of diffusion. The pathology of the excised lesion was consistent with LDD. Conclusion: MRI with advanced techniques can provide not only preoperative diagnosis but also better pathologic correlation.

Spatial analysis of the risk to human health from exposure to arsenic contaminated groundwater: A kriging approach.

A long-term groundwater quality survey in northeastern Taiwan's Lanyang Plain has revealed obvious contamination of the groundwater in some areas, with measured As concentrations in excess of the acceptable level of 10µg/L. Efforts for assessing the health risk associated with the intake of As through the drinking of contaminated groundwater are a necessary part of the important work of health risk management. However, the standard approach to assessing risks to human health does not adequately account for spatial heterogeneity in the measured As concentrations. Thus, this study applies two different kriging approaches to carry out a spatial analysis of the health risk associated with ingesting As through the drinking of groundwater in the Lanyang Plain. It is found that the indicator kriging (IK) approach, with occurrence probability threshold values of 0.4, 0.5 and 0.6 yields correct classification percentages of 75%, 68% and 61%, respectively, of unacceptable HQ zones. An HQ map prepared with the ordinary kriging (OK) approach shows a correct classification of unacceptable HQ zones of 80%. Considering that the OK approach does not require subjective selection of an occurrence probability threshold value as is the case with the IK approach and can yield a higher percentage of correct classification for unacceptable HQ zones, it is recommended as a more direct and reliable method for spatial analysis of human health risk due to arsenic exposure through the drinking of groundwater. The results show that the geographical distribution of unacceptable HQ zones is concentrated in the eastern part of the study area, which includes the high-population density townships. In other words, 34% of the people had access to groundwater where the HQ was >1. The results of this type of spatial health risk assessment can provide a basis for improving the decision-making process for health risk management.

Spatial Analysis of Human Health Risk Due to Arsenic Exposure through Drinking Groundwater in Taiwan's Pingtung Plain.

Chronic arsenic (As) exposure continues to be a public health problem of major concern worldwide, affecting hundreds of millions of people. A long-term groundwater quality survey has revealed that 20% of the groundwater in southern Taiwan's Pingtung Plain is clearly contaminated with a measured As concentration in excess of the maximum level of 10 µg/L recommended by the World Health Organization. The situation is further complicated by the fact that more than half of the inhabitants in this area continue to use groundwater for drinking. Efforts to assess the health risk associated with the ingestion of As from the contaminated drinking water are required in order to determine the priorities for health risk management. The conventional approach to conducting a human health risk assessment may be insufficient for this purpose, so this study adopts a geostatistical Kriging method to perform a spatial analysis of the health risk associated with ingesting As through drinking groundwater in the Pingtung Plain. The health risk is assessed based on the hazard quotient (HQ) and target cancer risk (TR) established by the U.S. Environmental Protection Agency. The results show that most areas where the HQ exceeds 1 are in the southwestern part of the study area. In addition, the high-population density townships of Daliao, Linyuan, Donggang, Linbian, Jiadong, and Fangliao presently have exceedingly high TR values that are two orders of magnitude higher than the acceptable standard. Thus, the use of groundwater for drinking in these townships should be strictly avoided. A map that delineates areas with high TR values and high population densities is provided. The findings broaden the scope of the spatial analysis of human health risk and provide a basis for improving the decision-making process.

Groundwater Vulnerability Assessment of the Pingtung Plain in Southern Taiwan.

In the Pingtung Plain of southern Taiwan, elevated levels of NO3--N in groundwater have been reported. Therefore, efforts for assessing groundwater vulnerability are required as part of the critical steps to prevent and control groundwater pollution. This study makes a groundwater vulnerability assessment for the Pingtung Plain using an improved overlay and index-based DRASTIC model. The improvement of the DRASTIC model is achieved by reassigning the weighting coefficients of the factors in this model with the help of a discriminant analysis statistical method. The analytical results obtained from the improved DRASTIC model provide a reliable prediction for use in groundwater vulnerability assessment to nitrate pollution and can correctly identify the groundwater protection zones in the Pingtung Plain. Moreover, the results of the sensitivity analysis conducted for the seven parameters in the improved DRASTIC model demonstrate that the aquifer media (A) is the most sensitive factor when the nitrate-N concentration is below 2.5 mg/L. For the cases where the nitrate-N concentration is above 2.5 mg/L, the aquifer media (A) and net recharge (R) are the two most important factors.

Clinical outcome following DIAM implantation for symptomatic lumbar internal disk disruption: a 3-year retrospective analysis.

BACKGROUND/OBJECTIVE: Internal disk disruption (IDD), an early event of lumbar disk degeneration, is the most common cause of low back pain. Since increased intradiskal pressure (IDP) is associated with symptoms and progression of disk degeneration, unloading a painful disk with an interspinous process device (IPD) is a rational treatment option. The goal of this study was to evaluate the effectiveness of dynamic stabilization with an IPD in the treatment of symptomatic IDD of the lumbar spine. PATIENTS AND METHODS: Patients with symptomatic IDD were treated with implantation of an IPD, the device for intervertebral assisted motion (DIAM). Diagnosis of IDD was based on typical MRI finding of posterior annular high-intensity zone and positive provocative test on discography. IDP was analyzed intraoperatively. Axial back and leg pain was evaluated with visual analog scale, functional status with Oswestry Disability Index, and final clinical outcomes with Odom criteria. Data from 34 patients followed up for at least 3 years were collected. RESULTS: DIAM implantation significantly reduced IDP (n=11, P<0.0001). All 34 patients reported symptom relief. Thirty-one patients (91%) remained symptom free until the last followups. Three patients (9%) experienced recurrence of pain, of which the causes were unrelated to the IDD or surgery. Disk status at the DIAM-implanted segments remained stable. Segmental flexion/extension mobility was preserved in 27 of 30 patients with preoperative mobility. No proximal or distal adjacent segment degeneration was observed. The final clinical outcomes were excellent/good in 31 and fair/poor in three patients. CONCLUSION: For patients with symptomatic IDD, dynamic stabilization with DIAM provides pain relief and functional improvement. The implantation maintains disk status and prevents progression of disk degeneration, without compromising segmental flexion/extension mobility or causing adjacent segment degeneration.