Clinical survey: patterns of utilization of lumbar epidural steroid injections by a cohort of spinal surgeons.

Objective: There are few data on responses to conservative therapy in the management of lumbar degenerative diseases. To understand the use of epidural steroid injections (ESIs) by spine surgeons in the treatment of 2 distinct lumbar spinal conditions-herniated nucleus pulposus (HNP) and degenerative disk disease (DDD)-a survey of orthopedic and neurosurgical spine surgeons was conducted.

Design: Participants were surveyed via posting of a survey on a commercially maintained Web site.

Quality assessment of neoadjuvant therapy use in breast conservation: barriers to implementation.

Neoadjuvant systemic therapy (NST) for operable breast cancer can increase the options for conservative surgery in patients with breast cancer. We performed an analysis of a breast cancer outcomes database as a quality assessment of neoadjuvant therapy use in relation to breast conservative rate (BCR). Data were reviewed from a breast cancer database established to monitor outcomes of breast cancer surgery at a tertiary care breast cancer clinic.

Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery.

Object: Definitions of complications in spinal surgery are not clear. Therefore, the authors assessed a group of practicing spine surgeons and, through the surgeons' responses to an online and emailed survey, developed a simple definition of operative complications due to spinal surgery. To validate this assessment, the authors revised their survey to make it appropriate for a lay audience and repeated the assessment with a cohort of patients who underwent spine surgery.

Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons.

Objectives: To identify and quantify surgical outcomes as possible quality measures of initial breast cancer surgery and to assess variation among surgeons.

Design: Descriptive analysis of concurrently collected outcome measures.

Setting: University hospital with a designated breast cancer center.

Low-carbohydrate diet disrupts the association between insulin resistance and weight gain.

The cornerstone to treat metabolic syndrome and insulin resistance is dietary intervention. Both low-carbohydrate diet (LCD) and low-fat diet (LFD) have been reported to induce weight loss and improve these conditions. One of the factors associated with a subject's adherence to the diet is satiety.

Carbohydrate restriction (with or without additional dietary cholesterol provided by eggs) reduces insulin resistance and plasma leptin without modifying appetite hormones in adult men.

Carbohydrate-restricted diets (CRDs) have been shown to reduce body weight, whereas whole egg intake has been associated with increased satiety. The purpose of this study was to evaluate the effects of additional dietary cholesterol and protein provided by whole eggs while following a CRD on insulin resistance and appetite hormones. Using a randomized blind parallel design, subjects were allocated to an egg (640 mg/d additional dietary cholesterol) or placebo (0 mg/d additional dietary cholesterol) group for 12 weeks while following a CRD.

Eggs distinctly modulate plasma carotenoid and lipoprotein subclasses in adult men following a carbohydrate-restricted diet.

We previously reported that carbohydrate restriction (CR) (10-15% en) during a weight loss intervention lowered plasma triglycerides (TG) by 45% in male subjects (P<.001). However, those subjects with a higher intake of cholesterol provided by eggs (640 mg additional cholesterol, EGG group) had higher concentrations of high-density lipoprotein (HDL) cholesterol (P<.

Decomposition of dimethyl methylphosphonate on Pt, Au, and Au-Pt clusters supported on TiO2(110).

The decomposition of dimethyl methylphosphonate (DMMP) was studied by temperature programmed desorption (TPD), X-ray photoelectron spectroscopy (XPS), and Auger electron spectroscopy (AES) on TiO(2)-supported Pt, Au, and Au-Pt clusters as well as on TiO(2)(110) itself. In agreement with previous work, TPD experiments for DMMP on TiO(2)(110) showed that methyl and methane were the main gaseous products. Multiple DMMP adsorption-reaction cycles on TiO(2)(110) demonstrated that active sites for DMMP decomposition were blocked after a single cycle, but some activity for methyl production was sustained even after five cycles.

Trouble crossing the bridge: altered interhemispheric communication of emotional images in anxiety.

Worry is thought to involve a strategy of cognitive avoidance, in which internal verbalization acts to suppress threatening emotional imagery. This study tested the hypothesis that worry-prone individuals would exhibit patterns of between-hemisphere communication that reflect cognitive avoidance. Specifically, the hypothesis predicted slower transfer of threatening images from the left to the right hemisphere among worriers.

Perioperative complications of minimally invasive surgery (MIS): comparison of MIS and open interbody fusion techniques.

The risk of perioperative complications while adopting minimally invasive spine surgery techniques may slow the acceptance of this technology. We assess the perioperative complication rate with minimally invasive single- and two-level interbody fusions and compare this incidence with a contemporaneous cohort of open single- and two-level open interbody fusions, with all procedures completed by a single surgeon in a single practice group. We compiled all open and MIS interbody fusion cases completed during the study period.

Cervical extradural meningioma: case report and literature review.

Background: Extradural lesions are most commonly metastatic neoplasms. Extradural meningioma accounts for 2.7 to 10% of spinal neoplasms and most commonly is found in the thoracic spine.

Traumatic spondyloptosis of the thoracolumbar spine.

Object: Traumatic Grade V thoracolumbar spondylolisthesis, or traumatic spondyloptosis (severe translation injuries), are uncommon spinal injuries. To the best of the authors' knowledge, this article represents the first reported case series of these unique spinal lesions.

Methods: The authors undertook a retrospective review of a tertiary care regional spinal cord injury patient population treated over a 10-year period (1997-2007).

A 10-year analysis of venous thromboembolism on the surgical service: the effect of practice guidelines for prophylaxis.

Background: There is a national effort to decrease the incidence of venous thromboembolism (VTE) in surgical patients by encouraging compliance with established guidelines for prophylaxis. Reported compliance with these guidelines has been poor. The outcome of noncompliance in terms of morbidity and mortality in surgical patients is unknown.

Acute cervical fracture or congenital spinal deformity?

Background/objective: There are few reports of developmental or congenital cervical spinal deformities. Such cases may be mistaken for traumatically induced fractures, and additional treatment may ensue.

Methods: A retrospective analysis was performed to identify patients with congenital cervical spine deformities.

Whiplash: diagnosis, treatment, and associated injuries.

Study Design: Focused review of the current literature.

Objective: To identify and synthesize the most current data pertaining to the diagnosis and treatment of whiplash and whiplash-associated disorders (WAD), and to report on whiplash-related injuries.

Methods: A search of OVID Medline (1996-January 2007) and the Cochrane database of systematic reviews was performed using the keywords whiplash and WAD.

Eggs modulate the inflammatory response to carbohydrate restricted diets in overweight men.

Background: Carbohydrate restricted diets (CRD) consistently lower glucose and insulin levels and improve atherogenic dyslipidemia [decreasing triglycerides and increasing HDL cholesterol (HDL-C)]. We have previously shown that male subjects following a CRD experienced significant increases in HDL-C only if they were consuming a higher intake of cholesterol provided by eggs compared to those individuals who were taking lower concentrations of dietary cholesterol. Here, as a follow up of our previous study, we examined the effects of eggs (a source of both dietary cholesterol and lutein) on adiponectin, a marker of insulin sensitivity, and on inflammatory markers in the context of a CRD.

An alloantibody to a high-prevalence MNS antigen in a person with a GP.JL/Mk phenotype.

The low-prevalence MNS blood group antigenTSEN is located at the junction of glycophorin A (GPA) to glycophorin B (GPB) in several hybrid glycophorin molecules. Extremely rare people have RBCs with a double dose of the TSEN antigen and have made an antibody to a high-prevalence MNS antigen. We report the first patient who is heterozygous for GYP.

Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet.

Carbohydrate-restricted diets (CRD) significantly decrease body weight and independently improve plasma triglycerides (TG) and HDL cholesterol (HDL-C). Increasing intake of dietary cholesterol from eggs in the context of a low-fat diet maintains the LDL cholesterol (LDL-C)/HDL-C for both hyper- and hypo-responders to dietary cholesterol. In this study, 28 overweight/obese male subjects (BMI = 25-37 kg/m2) aged 40-70 y were recruited to evaluate the contribution of dietary cholesterol from eggs in a CRD.

Evaluation of neurologic deficit without apparent cause: the importance of a multidisciplinary approach.

Background/objective: A patient presenting with an acute neurologic deficit with no apparent etiology presents a diagnostic dilemma. A broad differential diagnosis must be entertained, considering both organic and psychiatric causes.

Methods: A case report and thorough literature review of acute paraplegia after a low-energy trauma without a discernible organic etiology.

Spinal injuries after falls from hunting tree stands.

Background Context: Spinal injuries are common sequelae of falls from hunting tree stands. Significant neurological injury is not uncommon and can result in significant morbidity as well as enormous expenditure of health care dollars. Recent literature on the subject is limited.

Mortality rates in geriatric patients with spinal cord injuries.

Object: The authors undertook this study to evaluate the incidence of spinal cord injury (SCI) in geriatric patients (> or = 70 years of age) and examine the impact of patient age, extent of neurological injury, and spinal level of injury on the mortality rate associated with traumatic SCI.

Methods: A prospectively maintained SCI database (3481 patients) at a single institution was retrospectively studied for the period from 1978 through 2005. Parameters analyzed included patient age, admission American Spinal Injury Association (ASIA) motor score, level of SCI, mechanism of injury, and mortality data.

Regional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeons.

Background: Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS), was recently described by Vaccaro.

Anxiety and error monitoring: increased error sensitivity or altered expectations?

This study tested the prediction that the error-related negativity (ERN), a physiological measure of error monitoring, would be enhanced in anxious individuals, particularly in conditions with threatening cues. Participants made gender judgments about faces whose expressions were either happy, angry, or neutral. Replicating prior studies, midline scalp negativities were greater following errors than following correct responses.