Three-Dimensional Hounsfield Units Measurement of Pedicle Screw Trajectory for Predicating Screw Loosening in Lumbar Fusion Surgery.

Purpose: Dual-energy X-ray absorptiometry (DXA) is commonly used for evaluation of bone mineral density before spinal surgery, but frequently leads to overestimation in degenerative spinal diseases due to osteoproliferation factors. We introduce a novel method to compare the predictive ability of Hounsfield Units (HU) and DXA methods to predict screw loosening after lumbar interbody fusion surgery in degenerative spinal diseases by measuring HU of pedicle screw trajectory on computed tomography (CT) images preoperatively. Patients and Methods: This retrospective study was conducted on patients who underwent posterior lumbar fusion surgery for degenerative diseases. CT HUs measurement was performed using medical imaging software, including the cancellous region on cross-sections of the vertebral body and three-dimensional pedicle screw trajectory. Receiver operating characteristic (ROC) curve analyses were performed for the risk of pedicle screw loosening in association with the Hounsfield scale and preoperative BMD, and the area under the curve (AUC) and the cutoff values were calculated. Results: A total of 90 patients were enrolled and were divided into loosening (n = 33, 36.7%) and non-loosening groups (n = 57, 63.3%). No significant differences in age, gender, length of fixation and preoperative BMD were found between both groups. The loosening group showed lower CT HU values in the vertebral body and screw trajectory than the non-loosening group. Screw trajectory HU (ST-HU) exhibited a higher AUC value than vertebral body HU (B-HU). The cutoff values of B-HU and ST-HU were 160 and 110 HUs, respectively. Conclusion: Three-dimensional pedicle screw trajectory HU values yields a stronger predictive value than vertebral body HU values and BMD and may provide more guidance for surgery. The risk of screw loosening is significantly increased at ST-HU <110 or B-HU <160 at L5 segment.

Screening for anti-lipase properties of 37 traditional Chinese medicinal herbs.

BACKGROUND: To find new, crude anti-obesity drugs from natural sources through the inhibition of adsorption of dietary lipids, in vitro porcine pancreatic lipase (PPL; triacylglycerol lipase, EC 3.1.1.3) inhibitory tests were carried out on selected plants with weight-reducing or related potential, used in Chinese traditional medicine. METHODS: The methanolic extracts of 37 traditional Chinese herbal medicines of different families were assayed for their in vitro activity against PPL by using spectrophotometry with 2,4-dinitrophenyl butyrate as a synthetic substrate. Coexistent phytochemicals, or those present in high levels, in the 3 most promising Chinese herbs were tested for their anti-lipase activity. RESULTS: Extracts from 2 herbs, Prunella vulgaris L. (Labiatae) and Rheum palmatum L. (Polygonaceae), at a concentration of 200 mg/mL, significantly inhibited PPL-by 74.7% and 53.8%, respectively. Quercetin exhibited better activity (27.4%) than all the other phytochemicals at a final concentration of 25 mg/mL in the assay system, followed by luteolin, with an activity of 17.3%. CONCLUSION: The results support the view that herbs represent a rich source of anti-lipase compounds. The screening of the methanolic extracts of 37 Chinese medicinal plants in vitro led to the identification of several extracts with potential activity against PPL, in particular, P. vulgaris and R. palmatum. We also found that several monomeric chemicals in these herbs exhibited good or moderate activity against PPL. To the best of our knowledge, these traditional Chinese herbal medicines or phytochemicals have not been previously screened for their lipase inhibitory activity.