Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study.

OBJECTIVE: Biportal endoscopic spinal surgery (BESS) is recommended as a safer and less destructive option for lumbar disc herniations. However, limited data exist on clinical outcomes for extraforaminal lumbar disc herniation (ELDH) surgery. This retrospective study presents our preliminary experience with transforaminal unilateral BESS for ELDH. METHODS: Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with ELDH by magnetic resonance imaging, and treated with transforaminal unilateral BESS in 2021-2023 in 2 institutions in Taiwan were eligible for inclusion. Those with lumbar spondylolisthesis grade 2 or more with segmental instability, history of drug abuse or psychiatric diseases, or with a follow-up duration <1 year were excluded. Primary outcomes included visual analog scale for pain, assessed at 1 week, 1 month, 6 months, and 1 year using generalized estimating equations analysis; success and satisfaction of BESS graded by the Macnab criteria; and perioperative complications. Secondary outcomes were operative time and hospital length of stay. RESULTS: Seventeen patients were included in the analysis, with a mean age of 65.8 years; 11 (64.7%) were males and 15 (88.2%) had no prior lumbar spine surgery. mean operative time was 107.9 minutes, and length of stay was 3.5 days. Graded by Macnab criteria, 16 (94.1%) of patients had good to excellent outcomes. Only 1 patient experienced complications. No recurrence/reoperation was observed. Generalized estimating equations analysis showed that postoperative visual analog scale scores decreased significantly at 1 week (adjusted Beta [aBeta] = -5.47, standard error: 0.29, P < 0.001), 1 month (aBeta = -5.82), 6 months (aBeta = -5.88), and 1 year (aBeta = -6.29). CONCLUSIONS: Transforaminal unilateral BESS is an alternative and feasible method for treating ELDH, producing good surgical outcomes with few complications and sustaining pain improvement. Future studies with larger patient numbers and comparisons between BESS and other minimally invasive techniques for ELDH are warranted.

Evaluating the contact anatomy and contact bone volume of spinal screws using a novel drilled surface image.

Intraoperative navigation systems have been widely applied in spinal fusion surgery to improve the implantation accuracy of spinal screws using orthogonal tomographic and surface-rendering imaging. However, these images contain limited anatomical information and no information on bone volume contact by the implanted screw, which has been proven to affect the stability of implanted screws. This study proposed a novel drilled surface imaging technique that displays anatomical integration properties to calculate the contact bone volume (CBV) of the screws implanted along an implantation trajectory. A cylinder was used to represent the area traversed by the screws, which was manually rotated and translated to a predetermined implantation trajectory according to a vertebra model obtained using computed tomography (CT) image volumes. The drilled surface image was reconstructed by interpolating the CT numbers at the predefined sampling points on the cylinder surface. The anatomical integration property and CBV of the screw implanted along the transpedicular trajectory (TT) and cortical bone trajectory (CBT) were evaluated and compared. The drilled surface image fully revealed the contact anatomical structure of the screw under the trajectories, improving the understanding of the anatomical integration of the screw and surrounding tissues. On average, the CBV of the CBT was 30% greater than that of the TT. The proposed drilled surface image may be applied in preoperative planning and integrated into intraoperative navigation systems to evaluate the anatomical integration and degree of bone contact of the screw implanted along a trajectory.

HPLC/ESI-MS and NMR Analysis of Chemical Constitutes in Bioactive Extract from the Root Nodule of Vaccinium emarginatum.

Vaccinium emarginatum Hayata is a medicinal plant that has been historically used in ethnopharmacy to treat diseases in Taiwan. The objective of this study is to evaluate the anti-cancer and anti-bacterial constitutes from the root nodule extract of V. emarginatum. The chemical composition of V. emarginatum fractions was analyzed by high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS) and the chemical constitutes were isolated and structurally identified by nuclear magnetic resonance (NMR) spectroscopy. Bioassay-guided chromatography showed that the ethyl acetate (EA) fraction was bioactive on the hepatocellular carcinoma (HepG2). By LC-ESI-MS/MS analysis, twenty peaks of EA fraction were partially identified and the phytochemical investigation of the fractions led to the isolation and identification of protocatuchuic acid (1), epicatechin (2), catechin (3), procyanidin B3 (4), procyanidin A1 (5), hyperin (6), isoquercetin (7), quercetin (8), lupeol (9), beta-amyrin (10), and alpha-amyrin (11). Both procyanidin B3 and A1 exhibited anti-proliferative activity against HepG2 and gastric adenocarcinoma (AGS) cells at IC50 values between 38.4 and 41.1 µM and 79.4 and 83.8 µM, respectively. In addition, isoquercetin displayed the strongest anti-proliferative activity against the HepG2, lung carcinoma (A549), and AGS cell at 18.7, 24.6 and 68.5 µM, respectively. Among the triterpenoids, only lupeol showed the inhibitory activity against all tested tumor cell lines at IC50 values between 72.9 and 146.8 µM. Furthermore, procyanidins B3, A1 and isoquercetin displayed moderate anti-bacterial activity against Staphylococcus aureus. In conclusion, this study provides background information on the exploitation of V. emarginatum as a potential natural anti-cancer and anti-bacterial agent in pharmaceutical research.

Incidence of Screw Loosening in Cortical Bone Trajectory Fixation Technique between Single- and Dual-Threaded Screws.

Purpose: This study aims to elucidate the radiological outcome after Cortical bone trajectory (CBT) screw fixation and whether dual-threaded (DT) screws should be used in the fusion surgery. Methods: 159 patients with degenerative lumbar disorder who had undergone midline lumbar inter-body fusion surgery by CBT screw-fixation technique (2014 to 2018). Patient subgroups were based on single-threaded (ST) or DT screw, fixation length, as well as whether fixation involved to sacrum level (S1). Serial dynamic plain films were reviewed and an appearance of a halo phenomenon between screw-bone interfaces was identified as a case of screw loosening. Results: 29 patients (39.7%) in ST group and 10 patients (11.6%) in DT group demonstrated a halo phenomenon (p < 0.0001 ****). After subgrouping with fixation length, the incidence rates of a halo phenomenon in each group were 11.1%:3% (ST-1L vs. DT-1L), 37%:13.8% (ST-2L vs. DT-2L), and 84.2%:23.5% (ST-3L vs. DT-3L). Among the 85 patients with a fixation involved in S1, 26 patients (52%) with single-threaded screw (STS group) and 8 patients (22.8%) with dual-threaded screw (DTS group) demonstrated a halo appearance (p = 0.0078 **). After subgrouping the fixation level, the incidence of a halo appearance in each group was 25%:0% (STS-1L vs. DTS-1L), 40.9%:26.3% (STS-2L vs. DTS-2L), and 87.5%: 30% (STS-3L vs. DTS-3L). Conclusion: Both fixation length and whether fixation involved to S1 contribute to the incidence of screw loosening, the data supports clinical evidence that DT screws had greater fixation strength with an increased fixative stability and lower incidence of screw loosening in CBT screw fixation compared with ST screws. Level of evidence: 2.

Exploring the relationships among professional quality of life, personal quality of life and resignation in the nursing profession.

AIM: To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation. DESIGN: Prospective cohort design. METHODS: The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation. RESULTS: Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation. CONCLUSION: Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice. IMPACT: The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

Combined posterior and anterior approaches for cervical intradural disc herniation: A case report.

Intradural disc herniation (IDH) is an extremely rare condition. The authors report the case of a 53-year-old female who had neck and right shoulder pain associated with right-sided hemiparesis and hyperesthesia. Magnetic resonance imaging (MRI) of the cervical spine (C-spine) revealed central mass-like lesions that caused the; compression of the right side of the spinal cord. The posterior surgical approach was used to remove two pieces of IDH. After surgery, the muscle strength in the right upper limb improved from Grade 0/5 to 4+/5 without surgery-related complications. Although there are some reports in literature on the radiologic features of cervical IDH (including the Halo sign, Y-sign, hawk-beak sign, and crumble disc sign), it can be difficult to diagnose radiologically. We present the clinical image of the case along with a review of the literature to remind surgeons to consider IDH as a differential diagnosis when patients are affected by anterior intradural lesions.

Level-based analysis of screw loosening with cortical bone trajectory screws in patients with lumbar degenerative disease.

This study aimed to verify the relationship between the number of fusion level and the risk of screw loosening by using cortical bone trajectory (CBT) screws in patients with lumbar degenerative disease.We retrospectively reviewed the serial plain radiograph images of lumbar degenerative disease patients who had undergone posterior fixation and fusion surgery with CBT from 2014. All included patients should have been followed-up with computed tomography scan or plain radiograph for at least 6 months after operation. We individually evaluated the prevalence of screw loosening according to each vertebral level. We also determined whether the number of screw fixation affected the prevalence of screw loosening and whether S1 fixation increased the risk of screw loosening.The screw-loosening rates were high at the S1 level. Moreover, although fixation involved to S1, the loosening rates evidently increased (Fisher exact test, P = .002). The screw-loosening rate was 6.56% in 2 level fusion. However, it increased with the number of fusion levels (3 level: 25.00%, 4 level: 51.16%, and 5 level: 62.50%). To investigate if the number of fusion level affected the S1 screw loosening, we classified the cohort of patients into either involving S1 (S1+ group) or not (S1- group) according to different fusion levels (). The screw loosening between 2 group in 2 (5.56% vs 6.98%) and 3 fusion level (26.32% vs 22.73%) did not exhibit any significant difference. Interestingly, significantly high screw loosening was found in 4 fusion level (60.00% vs 15.38%), indicating that the higher fusion level (4 level) can directly increase the risk of S1 screw loosening.Our data confirmed that the screw-loosening rate increases rate when long segment CBT fixation involves to S1. Therefore, in case of long-segment fixation by using CBT screw, surgeons should be aware of the fusion level of S1.

Primary Intraosseous Hemangioma of the Orbital Roof: A Pitfall of Surgery.

A primary intraosseous hemangioma (IOH) of the orbital bone is extremely rare. The preferred method of treatment for IOH is total surgical excision with reconstruction. Herein, the authors describe a patient with an orbital roof IOH and the unexpected complications of ptosis and deteriorated exophthalmos. These findings showed that the total surgical excision and subsequent reconstruction provided adequate decompression and prevented further ocular complications from the orbital wall defect.

An acute bleeding metastatic spinal tumor from HCC causes an acute onset of cauda equina syndrome.

Hepatocellular carcinoma (HCC) is an aggressive tumor that frequently occurs in the setting of chronic liver disease and cirrhosis. Herein, we describe a case where a patient presented with acute onset cauda equina syndrome due to an intradural and extramedullary metastatic tumor bleeding from hepatocellular carcinoma (HCC). The patient had lower back pain that had radiated to the bilateral lower legs for 3 weeks. Then, the patient had experienced an acute onset of bilateral lower leg weakness as well as bladder-urinary dysfunction 2 days before going to the ER. The patient received a laminectomy from the L1 to L4 vertebra, removing the intradural spinal tumor and hematoma. To the best of our knowledge, this is the first reported case of HCC metastasized to the cauda equina with tumor bleeding causing cauda equina syndrome.

One-year Outcome of Bilateral Subthalamic Stimulation in Parkinson Disease: An Eastern Experience.

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely accepted as a treatment for advanced Parkinson disease (PD). However, published studies were conducted mainly in Western centers and recruited small numbers of patients. This study presents 1-year outcomes in Taiwanese patients with PD. METHODS: Sixty-two consecutive patients underwent STN-DBS surgery during a 7-year period. Their median drug-off Hoehn and Yahr stage was 3 and mean illness history was 8 years. Clinical outcomes were evaluated by the change in drug-off/DBS-on Unified Parkinson Disease Rating Scale (UPDRS) scores relative to presurgical drug-off baseline and change in daily levodopa-equivalent dose (LED). RESULTS: After 1 year of DBS therapy, patients showed significant improvements with a clinically high effect size in cardinal signs, particularly in tremor (63%). Posture instability was also improved, whereas speech dysfunction was hardly corrected. The LED need was significantly reduced, therefore preoperative drug-induced complications were prominently (51%) ameliorated after surgery and drug-induced dyskinesia was remarkably (63%) diminished. No serious adverse effects were encountered after surgery. Overall, motor functions declined by 15% within 1 year in drug-off state. CONCLUSIONS: Bilateral STN-DBS therapy provided effective and sustained benefits to Eastern patients with PD over a 1-year period.

The effectiveness of a health education intervention on self-care of traumatic wounds.

AIMS AND OBJECTIVES: To explore the effectiveness of wound care programme for emergency traumatic patient in Taiwan. BACKGROUND: Wound care is one of the most major issues for trauma patients at home. Wound infection has been alerted mostly on medical treatment. Little is known about how healthcare education impact patient care of traumatic wound after discharged from emergency department. DESIGN: A quasi-experimental design was used by using two groups post-test. METHODS: Random sampling was used to recruited participants, 89 participants in each group in emergency department at a medical centre in Taiwan. A 25-minute wound care programme was given to patients in the intervention group. A questionnaire was used to evaluate the effectiveness of the programme after 72 hours as patient followed up in out-patient department. The data of wound infection were collected from patient's medical record by followed 2 weeks after injured. RESULTS: After wound care programme, the knowledge, skills of wounds care, the satisfaction of health education in experimental group are better than the control group (p < 0·05). Wound infection rate in experimental group (9%) is lower than control group (20·2%), and statistically significant (p < 0·05). CONCLUSION: The wound care programme could increase the knowledge, skills of wound care of emergency patient and reduce the wound infection rate. RELEVANCE TO CLINICAL PRACTICE: Wound care requites technical knowledge; thus, practical demonstration of teaching and self-practice is more effectiveness for patients in learning their wound care. An appropriated health programme can improve the patients' wound care and care quality.

Disconnected subduroperitoneal shunt catheter induces silent bowel perforation: An unusual complication.

We report a case of silent bowel perforation by a fractured subduroperitoneal shunt after surgical shunt revision. A 93-year-old bedridden man experienced transanal prolapse of a shunt catheter after defecation. Upon arrival, the patient showed no fever or acute abdominal signs. Abdominal computed tomography (CT) showed an abandoned shunt catheter in the lower abdomen with rectum perforation. The disconnected catheter was successfully removed from the anus by digital rectal maneuver, and no peritonitis or other complication developed afterward. Such broken shunts no longer provide drainage function, and also pose a risk of migrating into the hollow viscera. Therefore, even in the absence of overt peritoneal signs, disconnected catheters should be removed by laparoscopic or minimal surgery to prevent possible development of this unusual complication. Instances of the rare complication are reviewed, and pathogenesis and treatment of the condition are discussed.

Preventing iatrogenic injury from inadvertent intracranial migration of a urinary foley catheter while controlling profuse epistaxis after severe craniofacial trauma.

The massive nasopharyngeal bleeding that may accompany complicated comminuted fractures of the craniofacial bones can be controlled by pressure tamponade using an inflatable urinary Foley catheter. However, inadvertent intracranial catheter penetration poses a serious risk in such situations. Management of a relevant case is described, and a simple preventive measure is suggested.

Three-dimensional reconstructed CT scanning for targeting hypertensive putaminal hemorrhage.

We developed an accurate frontal targeting method for hypertensive putaminal hemorrhage (HPH) using three-dimensional (3D) reconstructed CT scanning. Five consecutive unconscious patients with a significant volume of HPH were treated neuroendoscopically via frontal trephination. CT images were examined and reconstructed by an independent neuroradiologist for measuring the selected frontal entry point, depth of penetrating path, and surgical trajectory on the basis of the plane formed by the bilateral orbitomental lines delineated on the reconstructed 3D CT images. All patients regained consciousness post-operatively without complications. All had an accurate trajectory of penetrating path and the average percentage hematoma evacuation was 84%. Use of the 3D reconstructed CT imaging technique combined with neuroendoscopy may prove valuable as a minimally invasive and time-saving method of targeting HPH. Using this method, no further CT scanning is needed for subsequent surgical planning.

Microcalorimetric studies of the mechanism of interaction between designed peptides and hydrophobic adsorbents.

To understand the mechanism of interaction between peptides and peptides with hydrophobic ligands, the oligomers (GWG, GWWG, GWWWG) were designed and synthesized to study adsorption behavior with octyl sepharose and CM-octyl sepharose. By batch equilibrium binding analysis and dilution heat of peptide solution measurement, the binding isotherm and adsorption enthalpy were obtained and the binding thermodynamics parameters were calculated and analyzed. In the isotherm analysis, we reveled that the affinity of GWG for both adsorbents is stronger than that of GWWG and GWWWG. The results demonstrate that the cation-pi interaction between the peptides and the buffer molecules is significant for solutions of peptides with tryptophan residues, and the solvation is competitive with the hydrophobic interaction between the peptides and the hydrophobic ligands. From the dilution heat measurements, we observed an endothermic dilution heat for GWG and exothermic for GWWG and GWWWG. All these results indicate that the increased tryptophan chain length can promote the solvation behavior of the peptides by the peptide-buffer interaction in this buffer system. Comparing the types of ligands reveals that the binding affinities of each peptide for the two adsorbents are similar. However, the mechanism of adsorption for peptides with hydrophobic ligands might be quite different with respect to the binding enthalpy between peptides and adsorbents. The adsorption of the peptides on octyl sepharose is an entropy-driven process for all the peptides. In contrast, the adsorption of CM-octyl sepharose with GWG and GWWG is an enthalpy-driven process, whereas that with GWWWG is entropy-driven. These findings indicate that the amount of tryptophan controls the characteristics of the peptides and the interaction mechanism in the binding procedure. This study of the adsorption mechanism of the designed peptide could provide fundamental information for peptide purification and amino acid residue behavior in peptide drug design.