A proposed set of metrics for standardized outcome reporting in the management of low back pain.

Background And Purpose: Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes.

[Feedback control of depth of anesthesia during propofol administration. Bispectral index as the controlled variable].

Background: The objective of this study was to evaluate the performance of a new system for closed-loop control of propofol administration using the bispectral index (BIS) under total intravenous anesthesia in the index values of middle-to-deep depth of anaesthesia.

Methods: In this study 20 adult patients anesthetized with propofol and remifentanil were investigated. The propofol infusion was carried out using a fuzzy-PD+I controller with a target BIS value of 40.

Runx2 and bone morphogenic protein 2 regulate the expression of an alternative Lef1 transcript during osteoblast maturation.

Lymphoid Enhancer Binding Factor (Lef) 1 is a transcriptional effector of the Wnt/Lrp5/beta-catenin signaling cascade, which regulates osteoblast differentiation, bone density, and skeletal strength. In this study, we describe the expression and function of an alternative Lef1 isoform in osseous cells. Lef1DeltaN is a naturally occurring isoform driven by a promoter (p2) within the intron between exons 3 and 4 of Lef1.

Treatment of an intracranial germinoma spinal metastasis.

A 20-year-old male with a solitary intradural extramedullary spinal metastasis from a pineal germinoma presented with progressive spinal cord compression. This was initially treated with radiotherapy and the patient showed rapid clinical improvement with complete resolution of his neurological symptoms and signs. Subsequent systemic chemotherapy resulted in complete radiological resolution of the lesion.

Spinal dysraphism and the Currarino triad.

A female born with a lumbosacral lipomyelomeningocele, an associated foot-shaped appendage attached to her sacrum, sacral dysgenesis, anal atresia, a recto-vaginal fistula and duplication of the right ureter is reported. We consider this case represents a pygomelus associated with a lipomyelomeningocele and an incomplete expression of Currarino's triad.

Collagen 11a1 is indirectly activated by lymphocyte enhancer-binding factor 1 (Lef1) and negatively regulates osteoblast maturation.

Alpha 1 (XI) collagen (Col11a1) is essential for normal skeletal development. Mutations in Col11a1 cause Marshall and Stickler syndromes, both of which are characterized by craniofacial abnormalities, nearsightedness and hearing deficiencies. Despite its link to human diseases, few studies have described factors that control Col11a1 transcription.

Cell cycle related modulations in Runx2 protein levels are independent of lymphocyte enhancer-binding factor 1 (Lef1) in proliferating osteoblasts.

Runt-related transcription factor Runx2 regulates osteogenic phenotype commitment and attenuates osteoblast growth. Runx2 levels are cell cycle regulated and maximal in the G1 phase of proliferating osteoblasts and during quiescence. The Wnt/Lrp5-Frizzled/beta-catenin/Lef-Tcf signaling cascade also controls progression along the osteogenic lineage with a net anabolic effect that promotes bone formation.

The benefits of using Guyton's model in a hypotensive control system.

In order to improve the intraoperative applications, this paper presents the advantages of using Guyton's model in hypotensive control system development. In this system, the mean arterial pressure is decreased and maintained at a low level during anaesthesia by controlling sodium nitroprusside infusion rate. The key of the study is to develop a physiological model of cardiovascular dynamics to present the mean arterial pressure response to sodium nitroprusside, which was considered as a linear model in most of known blood pressure control systems.

Ergonomic design interventions--a case study involving portable ladders.

Portable ladders are one of the most ancient tools conceived by man. They remain ubiquitous and indispensable even today. It is interesting to note that there is little difference between the makeshift portable ladders used throughout history and some still used today.

Lymphocyte enhancer-binding factor 1 (Lef1) inhibits terminal differentiation of osteoblasts.

Lef1 is a transcriptional regulator of the Wnt/beta-catenin signaling cascade. Wnts directly augment bone formation and osteoblast differentiation from mesenchymal stem cells by receptor-mediated pathways involving Lrp5 and Frizzled. We previously reported that Lef1 represses Runx2-dependent activation of the late osteoblast differentiation gene, osteocalcin.

Stereotactic atlantoaxial transarticular screw fixation.

Atlantoaxial stabilisation can be performed using a variety of surgical techniques. Developments in spinal instrumentation and stereotactic technology have been incorporated into these procedures. We have recently adopted frameless stereotaxy to assist in such operations.

Expanding scroll rings and negative tension turbulence in a model of excitable media.

Scroll waves in excitable media, described by the Barkley model, are studied. In the parameter region of weak excitability, negative tension of wave filaments is found. It leads to expansion of scroll rings and instability of wave filaments.

Wnt signaling in osteoblasts and bone diseases.

Recent revelations that the canonical Wnt signaling pathway promotes postnatal bone accrual are major advances in our understanding of skeletal biology and bring tremendous promise for new therapeutic treatments for osteoporosis and other diseases of altered bone mass. Wnts are soluble glycoproteins that engage receptor complexes composed of Lrp5/6 and Frizzled proteins. A subgroup of Wnts induces a cascade of intracellular events that stabilize beta-catenin, facilitating its transport to nuclei where it binds Lef1/Tcf transcription factors and alters gene expression to promote osteoblast expansion and function.

Histone deacetylase 3 interacts with runx2 to repress the osteocalcin promoter and regulate osteoblast differentiation.

The Runt domain transcription factor Runx2 (AML-3, and Cbfa1) is essential for osteoblast development, differentiation, and bone formation. Runx2 positively or negatively regulates osteoblast gene expression by interacting with a variety of transcription cofactor complexes. In this study, we identified a trichostatin A-sensitive autonomous repression domain in the amino terminus of Runx2.

Tumor promoter-induced MMP-13 gene expression in a model of initiated epidermis.

In mouse epidermis in vivo, the tumor promoter 12-O-tetradecanoylphorbol-13-acetate (TPA) increases gene expression of matrix metalloproteinase-13 (MMP-13), an enzyme implicated in carcinogenesis. Here we used a keratinocyte cell line (308) derived from initiated mouse skin to investigate TPA-induced MMP-13 gene expression. Use of a pharmacological inhibitor (U0126) demonstrated that extracellular signal regulated kinase (ERK) plays a major role in TPA-induced MMP-13 gene expression.

Lymphoid enhancer factor-1 and beta-catenin inhibit Runx2-dependent transcriptional activation of the osteocalcin promoter.

Functional control of the transcription factor Runx2 is crucial for normal bone formation. Runx2 is detectable throughout osteoblast development and maturation and temporally regulates several bone-specific genes. In this study, we identified a novel post-translational mechanism regulating Runx2-dependent activation of the osteocalcin promoter.

Runx2 (Cbfa1, AML-3) interacts with histone deacetylase 6 and represses the p21(CIP1/WAF1) promoter.

Runx2 (Cbfa1, AML-3) is multifunctional transcription factor that is essential for osteoblast development. Runx2 binds specific DNA sequences and interacts with transcriptional coactivators and corepressors to either activate or repress transcription of tissue-specific genes. In this study, the p21(CIP/WAF1) promoter was identified as a repressible target of Runx2.

Predicting injurious events.

This paper has attempted to quantify the size and the nature of the industrial personal damage problem, in terms of not only classifying that damage but also showing the predominant damaging energy types. We have shown the majority of the cost of work-related personal damage (in Australia) is from non-fatal permanent disability. It is not possible to make this statement as clearly for the United States.

Corticotroph pituitary carcinoma: case report and literature review.

Pituitary carcinomas, currently defined as primary adenohypophyseal neoplasms with evidence of either brain invasion or metastatic spread, are exceptionally rare. A case of corticotroph pituitary carcinoma is reported. A 17-year-old female first presented with an invasive and clinically non-functioning pituitary macroadenoma.

Arachnoiditis ossificans and syringomyelia: a unique case report.

A 62-year-old male presented with progressive quadriparesis. Magnetic resonance imaging of the spine revealed a spinal cord syrinx but failed to detect extensive arachnoiditis ossificans noted on insertion of a syringopleural shunt. A postoperative computed tomography scan clearly demonstrated the abnormality and its extent.

Internal carotid artery dissection: an animal model?

This paper describes an internal carotid artery (ICA) dissection model in a rabbit. An animal model for ICA dissection has not been described. New Zealand White rabbits were anaesthetized and surgical microdissection performed to expose the right internal carotid artery.

Orbitocranial penetration by a fern: case report.

Objective And Importance: Cranial and orbitocranial penetration by organic foreign material is not infrequent. It is important to identify whether penetration has occurred and to localize and remove the organic foreign material.

Clinical Presentation: We report a 15-month-old patient who suffered orbitocranial penetration with the stem of a fern.