A case report of Japanese encephalitis in Paracelis, Mountain Province, the Philippines.

On 12 September 2022, a 10-year-old female in Paracelis municipality, Mountain Province, the Philippines, without travel history outside the municipality, experienced acute onset of fever and a change in mental status with disorientation, an altered level of consciousness and new onset of seizures. She was hospitalized at the district hospital from 1 to 3 October 2022, before being transferred to the regional hospital. As diphtheria was originally suspected, the investigation team reviewed records and reports and interviewed key informants to gather additional information and organize case finding and contact tracing. The patient's condition was laboratory-confirmed for Japanese encephalitis virus infection. An environmental survey was carried out at the patient's residence to check for the presence of vectors and contributing factors. Exemplifying inadequate vaccination coverage for Japanese encephalitis virus in Mountain Province, the patient had not been vaccinated against the disease. It is recommended that vaccination campaigns be immediately implemented in the affected area and the surveillance system be strengthened for early detection and prompt response to the emergence of cases and outbreaks. Overall, the investigation highlighted the importance of strong surveillance and response systems for early detection and control of diseases, such as Japanese encephalitis virus. It also underscores the need for comprehensive vaccination programmes to prevent outbreaks and protect vulnerable populations.

Descriptive analysis of a SARS-CoV-2 outbreak among health-care workers in a regional hospital in the Philippines.

Objective: On 25 July 2022, trainees from the Field Epidemiology Training Programme in Northern Luzon, Philippines were sent to conduct an epidemiological investigation of six confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among staff of a regional hospital in Mountain Province. The investigation had three objectives: to profile the cases, identify the source and mode of transmission, and recommend prevention and control measures. Methods: Descriptive epidemiology was used to investigate the outbreak, with the standard case definition issued by the Philippine Department of Health. Results: A total of 167 hospital personnel and interns tested positive for SARS-CoV-2 infection between 6 July and 31 August 2022, with a peak in the number of cases on 20 July. Among the cases, 57 (34%) had a history of travel, with 41 (25%) having travelled to Boracay island to attend team-building activities. Most cases were asymptomatic, and the most affected group was those aged 30-34 years. The highest number of cases occurred among nurses. It was discovered that the team-building activities on Boracay did not strictly adhere to safety protocols. Discussion: This outbreak suggests that transmission of SARS-CoV-2 among health-care workers can occur through contact with other staff members outside of the hospital setting and highlights the importance of strict adherence to safety protocols to prevent the spread of SARS-CoV-2.

Creating "boots on the ground": addressing the shortage of field epidemiologists in the Philippines through intermediate-level training programmes.

Problem: As of 2022, only 49 graduates of the Philippines' Field Epidemiology Training Programme (FETP) were employed by the Philippine Government, emphasizing the urgent need to increase the number of practicing field epidemiologists to better equip the country for public health emergencies. Context: The FETP-Intermediate Course (IC) curriculum is based mainly on the module of the United States Centers for Disease Control and Prevention that was incorporated into the Philippine context. It consists of five 1-2-week lecture series that provide participants with the knowledge and tools necessary to conduct job-relevant field projects. Individual projects are the centrepiece of the FETP-IC, requiring trainees to investigate outbreaks, design and develop protocols, conduct field data collection, manage data, analyse data, interpret data, write reports and deliver oral presentations. Action: To address the shortage of practicing field epidemiologists in the Philippines, a subnational initiative in Northern Luzon was implemented. Outcome: Within 3 years, the two FETP-IC subnational training programmes have produced 42 applied epidemiologists who will strengthen epidemiology and surveillance in their respective localities. As of February 2023, 92 studies have been conducted, including 39 outbreak investigations, 37 data quality analysis/process improvement projects, 10 epidemiological studies and six surveillance evaluations. Discussion: By training and deploying skilled epidemiologists to local health offices and hospitals, the programme is helping to improve the capacity of the health system to respond to public health threats and protect the health of the population. The programme's emphasis on practical training and real-world experience is an effective way to build a strong and sustainable epidemiological workforce.

C-N linked donor type porphyrin derivatives: unrevealed hole-transporting materials for efficient hybrid perovskite solar cells.

A new series of Zn(II) and Cu(II)-based porphyrin complexes 5a and 5b doubly functionalised with carbazole units were developed to be used as hole-transporting materials (HTMs) in perovskite solar cells (PSCs). These complexes were obtained via a nucleophilic substitution reaction mediated by PhI(OAc)2/NaAuCl4·2H2O, or using C-N transition metal-assisted coupling. The hole extraction capability of 5a and 5b was assessed using cyclic voltammetry; this study confirmed the better alignment of the Zn(II) complex 5a with the perovskite valence band level, compared to the Cu(II) complex 5b. The optimised geometry and molecular orbitals of both complexes also corroborate the higher potential of 5a as a HTM. Photoluminescence characterisation showed that the presence of 5a and 5b as HTMs on the perovskite surface resulted in the quenching of the emission, matching the hole transfer phenomenon. The photovoltaic performance was evaluated and compared with those of reference cells made with the standard HTM spiro-OMeTAD. The optimised 5-based devices showed improvements in all photovoltaic characteristics; their open circuit voltage (Voc) reached close to 1 V and short-circuit current density (Jsc) values were 13.79 and 9.14 mA cm-2 for 5a and 5b, respectively, disclosing the effect of the metallic centre. A maximum power conversion efficiency (PCE) of 10.01% was attained for 5a, which is 65% of the PCE generated by using the spiro-OMeTAD reference. This study demonstrates that C-N linked donor-type porphyrin derivatives are promising novel HTMs for developing efficient and reproducible PSCs.

School outbreak of hand, foot and mouth disease in Balungao, Pangasinan Province, Philippines, October 2022.

Objective: On 24 September 2022, the Regional Public Health Unit in Ilocos received a report of a cluster of suspected hand, foot and mouth disease (HFMD) in one school in Balungao, Pangasinan Province, the Philippines. On 4 October 2022, the public health unit sent a team from the Field Epidemiology Training Program - Intermediate Course to conduct an outbreak investigation. Methods: Active case-finding was conducted at the school. A suspected case was defined as any student or staff member with mouth ulcers and papulovesicular or maculopapular rash on the palms, fingers, soles of the feet or buttocks occurring from 1 September to 5 October 2022. We interviewed school officials about possible sources of infection and students' activities. We collected oropharyngeal swab samples for testing. Findings were used for descriptive analysis. Results: Nine suspected cases of HFMD were detected, with the highest number of cases (6, 67%) occurring in children in grade 1. The majority of cases (7, 78%) were 6 years old, and five cases (56%) were male. Seven (78%) of the cases had been exposed to a confirmed case of HFMD, as reported by their parents or guardians and teachers. Six cases (67%) were positive for coxsackievirus A16 and two (22%) for enterovirus. Discussion: The causative agents of this outbreak were coxsackievirus A16 and other enteroviruses. Direct contact with a confirmed case was the source of transmission, with a lack of physical distancing in classrooms likely contributing to transmission. We recommended that the local government implement measures to control the outbreak.

Paper-based laser-induced graphene for sustainable and flexible microsupercapacitor applications.

Laser-induced graphene (LIG) is as a promising material for flexible microsupercapacitors (MSCs) due to its simple and cost-effective processing. However, LIG-MSC research and production has been centered on non-sustainable polymeric substrates, such as polyimide. In this work, it is presented a cost-effective, reproducible, and robust approach for the preparation of LIG structures via a one-step laser direct writing on chromatography paper. The developed strategy relies on soaking the paper in a 0.1 M sodium tetraborate solution (borax) prior to the laser processing. Borax acts as a fire-retardant agent, thus allowing the laser processing of sensitive substrates that other way would be easily destroyed under the high-energy beam. LIG on paper exhibiting low sheet resistance (30 Ω sq-1) and improved electrode/electrolyte interface was obtained by the proposed method. When used as microsupercapacitor electrodes, this laser-induced graphene resulted in specific capacitances of 4.6 mF cm-2 (0.015 mA cm-2). Furthermore, the devices exhibit excellent cycling stability (> 10,000 cycles at 0.5 mA cm-2) and good mechanical properties. By connecting the devices in series and parallel, it was also possible to control the voltage and energy delivered by the system. Thus, paper-based LIG-MSC can be used as energy storage devices for flexible, low-cost, and portable electronics. Additionally, due to their flexible design and architecture, they can be easily adapted to other circuits and applications with different power requirements.

Coupling of plasmonic nanoparticles on a semiconductor substrate via a modified discrete dipole approximation method.

Understanding the plasmonic coupling between a set of metallic nanoparticles (NPs) in a 2D array, and how a substrate affects such coupling, is fundamental for the development of optimized optoelectronic structures. Here, a simple semi-analytical procedure based on discrete dipole approximation (DDA) is reported to simulate the far-field and near-field properties of arrays of NPs, considering the coupling between particles, and the effect of the presence of a semiconductor substrate based on the image dipole approach. The method is validated for Ag NP dimers and single Ag NPs on a gallium nitride (GaN) substrate, a semiconductor widely used in optical devices, by comparison with the results obtained by the finite element method (FEM), indicating a good agreement in the weak coupling regime. Next, the method is applied to square and random arrays of Ag NPs on a GaN substrate. The increase in the surface density of NPs on a GaN substrate mainly results in a redshift of the dipolar resonance frequency and an increase in the near-field enhancement. This model, based on a single dipole approach, grants very low computational times, representing an advantage to predict the optical properties of large NP arrays on a semiconductor substrate for different applications.

Effects of a plant-derived biostimulant application on quality and functional traits of greenhouse cherry tomato cultivars.

A greenhouse experiment was conducted to study the effects of the application of a plant-derived biostimulant (Bioup® TF) on fruit quality and composition of two clusters (cluster II and cluster VI) of the cherry tomato cultivars 'Eletta', 'Kaucana', and 'Top Stellina'. The biostimulant application promoted fruit yield by 12% (up to 1.3 kg m-2 in 'Kaucana') and increased the concentrations of important functional constituents like phytoene, γ-tocopherol and ß-tocopherol by up to 16, 25, and 23%, respectively. Fruits from late-ripe cluster VI showed higher fruit weights, D-fructose, and total sugar contents than those from early-ripe cluster II (by 15, 7 and 5%, respectively), but reduced concentrations of acyclic carotenoids (phytoene and lycopene) and tocochromanols (mainly γ-tocopherol, -44%). 'Top Stellina' showed the highest responsiveness to the biostimulant, as particularly (all-E)-ß-carotene, phytofluene, and γ-tocopherol concentrations increased, indicating a genotype-dependent effect of the treatment. However, fruits of all treated genotypes showed a contextual decrease in D-fructose and total sugars in response to the biostimulant (on average by 7 and 10%, respectively), indicating a metabolic load burdening the accumulation of lipophilic antioxidants in cherry tomatoes at the expense of their taste-related C pool.

Microvascularization and Expression of Fibroblast Growth Factor and Vascular Endothelial Growth Factor and Their Receptors in the Mare Oviduct.

The oviduct presents the ideal conditions for fertilization and early embryonic development. In this study, (i) vascularization pattern; (ii) microvascular density; (iii) transcripts of angiogenic factors (FGF1, FGF2, VEGF) and their receptors-FGFR1, FGFR2, KDR, respectively, and (iv) the relative protein abundance of those receptors were assessed in cyclic mares' oviducts. The oviductal artery, arterioles and their ramifications, viewed by means of vascular injection-corrosion, differed in the infundibulum, ampulla and isthmus. The isthmus, immunostained with CD31, presented the largest vascular area and the highest number of vascular structures in the follicular phase. Transcripts (qPCR) and relative protein abundance (Western blot) of angiogenic factors fibroblast growth factor 1 (FGF1) and 2 (FGF2) and vascular endothelial growth factor (VEGF), and their respective receptors (FGFR1, FGFR2, VEGFR2 = KDR), were present in all oviduct portions throughout the estrous cycle. Upregulation of the transcripts of angiogenic receptors FGF1 and FGFR1 in the ampulla and isthmus and of FGF2 and KDR in the isthmus were noted. Furthermore, in the isthmus, the relative protein abundance of FGFR1 and KDR was the highest. This study shows that the equine oviduct presents differences in microvascular density in its three portions. The angiogenic factors VEGF, FGF1, FGF2 and their respective receptors are expressed in all studied regions of the mare oviduct, in agreement with microvascular patterns.

Desmoid fibromatosis following surgical resection of spinal meningioma.

A 42-year-old female patient with a history of cervicothoracic junction meningioma World Health Organization grade I, resected in early 2011, was admitted to the hospital with intractable headache and lower extremity weakness. Magnetic resonance imaging (MRI) showed an epidural mass compressing the spinal cord at the prior surgical site, which was interpreted as recurrent meningioma. Following surgical resection, histopathological analysis revealed desmoid fibromatosis (desmoid tumor). In retrospect, dynamic contrast-enhanced magnetic resonance imaging performed prior to surgery should have allowed for prospective exclusion of meningioma as the recurrent mass and suggested an alternative diagnosis such as post-traumatic desmoid fibromatosis or the need for biopsy to confirm diagnosis.

Risk of recurrence in patients with papillary thyroid carcinoma and minimal extrathyroidal extension not treated with radioiodine.

PURPOSE: This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) and minimal extrathyroidal extension (mETE) who had low thyroglobulin (Tg) after total thyroidectomy, and therefore, did not receive radioactive iodine (RAI). METHODS: This was a prospective study including 182 patients with tumors ≤ 4 cm and mETE without aggressive histology or clinically apparent lymph node involvement (cN0pNx). After thyroidectomy, all patients had nonstimulated Tg ≤ 0.3 ng/ml, negative antithyroglobulin antibodies (TgAb), and neck ultrasonography (US) showing no anomalies. Because of these results, the patients were not submitted to RAI. RESULTS: The time of follow-up ranged from 24 to 132 months (median 72 months). One hundred and seventy-eight patients (97.8%) continued to have nonstimulated Tg ≤ 0.3 ng/ml and negative US. Four patients (2.2%) exhibited an increase in Tg and lymph node metastases (structural recurrence). After surgery, these patients obtained nonstimulated Tg < 1 ng/ml and no apparent tumor was detected by the imaging methods. CONCLUSION: The results suggest that patients with mETE and without other adverse features, who have low nonstimulated Tg and negative neck US after thyroidectomy, do not require ablation with RAI.

Conocimientos y actitudes de las gestantes sobre los principales signos y síntomas de alarma en el embarazo, Hospital Regional de Ica, enero 2017 / Knowledge and attitudes of the pregnant on the main signs and symptoms of alarm in pregnancy, Ica Regional Hospital, january 2017

Objetivo: Determinar los conocimientos y actitudes sobre los principales signos y síntomas de alarma durante el embarazo en las gestantes hospitalizadas en el Servicio de Obstetricia del Hospital Regional de Ica, enero 2017.Material y métodos: Se realizó un estudio de tipo prospectivo, descriptivo y de corte transversal. En 150 gestantes hospitalizadas en el Servicio de Obstetricia del Hospital Regional de Ica. Se empleó una encuesta como instrumento de recolección de datos. Resultados: Existe una asociación entre el nivel de conocimientos y las actitudes adoptadas por las gestantes (X2 =89.303; gl=4; p=0.000). El nivel de conocimiento es alto con un 70.7% y las actitudes son favorables con un 95.3%. El 70.7% tiene entre 20 a 34 años; el 61.3% son de estado civil conviviente, el 50% tienen grado superior y el 85.3% convive con su pareja, el 37.3% están gestando por primera vez, el 67.3% se encuentran en la segunda mitad del embarazo, el 86.7% conoce sobre los signos y síntomas de alarma, de estos el 96.7% refiere haber recibido la información por parte de un profesional de la salud. Los signos y síntomas de alarma más reconocidos por las gestantes fueron: el Sangrado vaginal, fiebre y pérdida de líquido amniótico. Conclusiones: Existe una correlación entre las variables de estudio, ya que a mayor nivel de conocimiento se muestra una mejor actitud frente a los signos y síntomas de alarma. (AU)

Objetive: To determine the knowledge and attitudes about the main signs and symptoms of alarm during pregnancy in pregnant women hospitalized at the Obstetrics Service of the Regional Hospital of Ica, January 2017. Materials and Methods: A prospective, descriptive and Of cross-section. In 150 pregnant women hospitalized in the Obstetrics Service of the Regional Hospital of Ica. A survey was used as an instrument of data collection. Results: There is an association between the level of knowledge and the attitudes adopted by pregnant women (X2 = 89.303; gl = 4; p = 0.000). The level of knowledge is high with 70.7% and attitudes are favorable with 95.3%. 70.7% are between 20 and 34 years old; 61.3% are married, 50% have a higher degree and 85.3% live with their partner, 37.3% are pregnant for the first time, 67.3% are in the second half of pregnancy, 86.7% are aware of The signs and symptoms of alarm, of these 96.7% refer to having received the information from a health professional. The signs and symptoms of alarm most recognized by pregnant women were: Vaginal bleeding, fever and loss of amniotic fluid.Conclusions: There is a correlation between the study variables, since a higher level of knowledge shows a better attitude towards the signs and symptoms of alarm. (AU)

Basal Serum Calcitonin, After Calcium Stimulation, and in the Needle Washout of Patients with Thyroid Nodules and Mild or Moderate Basal Hypercalcitoninemia.

This prospective study evaluated the concentrations of basal serum calcitonin (Ctn), Ctn after stimulation with calcium, and Ctn in the needle washout (FNA-Ctn) as predictors of sporadic medullary thyroid carcinoma (MTC) in patients with thyroid nodules and basal Ctn between 10 and 100 pg/ml. Forty-one patients were included in the study. MTC was diagnosed in only 6 patients (14.6%). None of the patients with basal Ctn≤24.6 pg/ml (n=26) or stimulated Ctn≤186.5 pg/ml (n=21) had MTC. All patients without MTC had basal Ctn<47 pg/ml and stimulated Ctn<655.2 pg/ml. Among patients with basal Ctn between 24.6 and 47 pg/ml (n=12), 3 (25%) had MTC. Among patients with stimulated Ctn between 186.5 and 655.2 pg/ml (n=18), 4 (22.2%) had MTC. FNA-Ctn distinguished nodules that were MTC (n=6) from those that were not (n=60), without overlapping results. In the calcium stimulation test, 19 patients (46.3%) reported some adverse effect, but none of them was severe or required specific treatment. Our results highlight that in patients without a history suspicious for MTC, mild or moderate basal hypercalcitoninemia should not establish the diagnosis of this tumor. Depending on the concentration found, basal Ctn should be sufficient to define patient management. In doubtful cases, FNA-Ctn seems to be the best diagnostic test. Calcium stimulation testing was safe, but more studies are needed to determine the Ctn cutoff after stimulation with calcium.

Synthesis and structural characterization of homochiral 2D coordination polymers of zinc and copper with conformationally flexible ditopic imidazolium-based dicarboxylate ligands.

Different novel coordination polymers containing zinc, 1-4, and copper, 5-8, metals, connected via chiral imidazolium-based dicarboxylate ligands, [LR]-, were isolated by reaction between zinc acetate or copper acetate and enantiomerically pure HLR compounds. They were characterised and structurally identified by X-ray diffraction methods (single crystal and powder). These compounds are two-dimensional homochiral coordination polymers, [M(LR)2]n, in which the metal ions are coordinated by the two carboxylate groups of [LR]- anions in a general bridging monodentate µ2-κ1-O1,κ1-O3 fashion that afforded tetrahedral metal coordination environments for zinc, 1-4, and square planar for copper, 5-8, complexes. In all the compounds the 3D supramolecular architecture is constructed by non-covalent interactions between the hydrophobic parts (R groups) of the homochiral 2D coordination polymers and, in some cases, by weak C-HO non-classical hydrogen bonds that provided, in general, a dense crystal packing. DFT calculations on the [LR]- anions confirmed their conformational flexibility as ditopic linkers and this fact makes possible the formation of different coordination polymers for four-coordinated metal centers. Preliminary studies on the Zn-catalyzed synthesis of chiral α-aminophosphonates were carried out and, unfortunately, no enantioselectivity was observed in these reactions.

Bone Morphogenic Protein Is a Viable Adjunct for Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). PURPOSE: To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. OVERVIEW OF LITERATURE: BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up. METHODS: From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted. RESULTS: The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively. CONCLUSIONS: The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up.

Screening for Hyperparathyroidism by Measurement of Calcium in Patients Undergoing Thyroid Surgery: A Prospective Study.

This study screened for asymptomatic primary hyperparathyroidism (PHPT) by measuring calcium (Ca) before thyroid surgery. The study was prospective. A total of 676 patients without a suspicion of PHPT were studied. PHPT was defined as elevated Ca (in 2 measurements) in the presence of PTH>25 pg/ml and in the absence of hypocalciuria. PHPT was diagnosed in 5 patients (0.74%), all of them women. One of the 5 patients with PHPT had no indication for parathyroidectomy (PTx) according to current guidelines. Parathyroid adenoma was easily identified during perioperative assessment of thyroid surgery in 3 patients. In the other 2 patients (0.3%), localization of the adenoma required specific exploration, which was only performed because of the preoperative diagnosis of PHPT. Normalization of Ca and PTH was achieved in all 5 patients. In conclusion, in patients without a clinical or ultrasonographic suspicion of PHPT, approximately 300 individuals should be screened before thyroid surgery to avoid one reoperation (PTx) due to PHPT, which does not seem to be cost-effective.

Usefulness of Serum Calcitonin in Patients Without a Suspicious History of Medullary Thyroid Carcinoma and with Thyroid Nodules Without an Indication for Fine-Needle Aspiration or with Benign Cytology.

This study evaluated the usefulness of serum calcitonin (Ctn) in subjects without a suspicious history of medullary thyroid carcinoma (MTC) and with nodular thyroid disease without an indication for fine-needle aspiration (FNA) or with benign cytology. This was a prospective study that evaluated 421 patients with nodular disease without an indication for FNA and 602 patients with benign cytology. Patients with basal Ctn>10 pg/ml were submitted to calcium stimulation testing. Patients with stimulated Ctn>100 pg/ml were submitted to total thyroidectomy. Basal Ctn was<10 pg/ml in 1001 patients (97.8%). Among patients with basal Ctn>10 pg/ml, 16/22 exhibited stimulated Ctn>100 pg/ml. Two of these 16 patients had MTC. The 2 patients with MTC had undetectable basal Ctn 6 months after surgery. Using a cut-off of 30 pg/ml in women and 60 pg/ml in men for basal Ctn, the 2 cases of MTC of our series would have been identified and there would have been no false-positive case. It should be noted that 14/16 patients with stimulated Ctn>100 pg/ml were false-positive cases. Although uncommon, even subjects without a suspicious history and with nodular thyroid disease without an indication for FNA or with benign cytology can have MTC. The measurement of Ctn permits the diagnosis of these cases. Our results favor the hypothesis that basal Ctn could be superior to stimulated Ctn.

Bone Morphogenic Protein Is a Viable Adjunct for Fusion in Minimally Invasive Transforaminal Lumbar Interbody Fusion

STUDY DESIGN: Comparison of prospectively collected data of patients undergoing minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) with and without recombinant human bone morphogenic protein 2 (BMP). PURPOSE: To compare the clinical, radiological outcome and complications of patients undergoing MIS-TLIF with and without BMP. OVERVIEW OF LITERATURE: BMP is an effective fusion enhancer with potential complications. Direct comparison of MIS-TLIF with and without BMP is limited to retrospective studies with short follow-up. METHODS: From June 2005 to February 2011, consecutive cases of MIS-TLIF performed by a single surgeon were included. North American Spine Society (NASS) score, Oswestry disability index (ODI), Short Form-36 (SF-36), and visual analogue score (VAS) were assessed preoperatively and at 6 and 24 months postoperatively. Fusion rates and complications were noted. RESULTS: The 252 cases comprised 104 non-BMP and 148 BMP cases. The BMP group was significantly older (mean age, 60.2 vs. 53.9; p<0.01). Preoperative scores were similar. Immediate postoperative morphine usage was significantly lower in the BMP group (12.4 mg vs. 20.1 mg, p<0.01). At 6 months, the BMP group had lower VAS back and leg pain scores (p<0.01). At 2 years, the BMP group had better leg pain scores (p<0.01), ODI (15.4 vs. 20.3, p=0.04) and NASS scores (8.8 vs. 15.8, p<0.01). Both groups showed significant clinical improvement compared to their preoperative levels. The BMP group attained a significantly higher rate of fusion at 6 months follow-up (88.4% vs. 76.8%, p=0.016) with no difference at 2 years. The non-BMP and BMP group had 12 (11.5%) and 9 (6.1%) complications and 5 (4.8%) and 2 (1.4%) reoperations, respectively. CONCLUSIONS: The use of BMP to augment fusion in MIS-TLIF is an acceptable alternative that has potential benefits of less pain in early and intermediate postoperative follow-up.