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Sample records for herniated nucleus pulposus

  1. Hydrated nucleus pulposus herniation in seven dogs.

    PubMed

    Manunta, M L; Evangelisti, M A; Bergknut, N; Grinwis, G C M; Ballocco, I; Meij, B P

    2015-03-01

    The clinical signs, magnetic resonance imaging (MRI) findings, treatment and follow-up in seven dogs with hydrated nucleus pulposus extrusion (HNPE) are reported. All dogs had tetraparesis or tetraplegia. T2-weighted MRI revealed extradural hyperintense homogeneous material compressing the cervical spinal cord. After conservative treatment (five dogs) or surgical decompression (two dogs), all dogs returned to ambulatory function within 1 month. Follow-up MRI in conservatively treated dogs revealed complete disappearance of the extruded material. Histopathological examination of surgical specimens confirmed that the retrieved material was extruded nucleus pulposus with evidence of early degeneration. PMID:25599897

  2. Nucleus pulposus cells derived IGF-1 and MCP-1 enhance osteoclastogenesis and vertebrae disruption in lumbar disc herniation

    PubMed Central

    Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie

    2014-01-01

    Study design: Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. Objective: To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Summary and background data: Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients’ life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Methods: Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Results: Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Conclusion: Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated

  3. Minimally invasive removal of a recurrent lumbar herniated nucleus pulposus by the small incised microendoscopic discectomy interlaminar approach.

    PubMed

    Koga, S; Sairyo, K; Shibuya, I; Kanamori, Y; Kosugi, T; Matsumoto, H; Kitagawa, Y; Sumita, T; Dezawa, A

    2012-02-01

    In this report, we introduce two cases of recurrent herniated nucleus pulposus (HNP) at L5-S1 that were successfully removed using the small incised microendoscopic discectomy (sMED) technique, proposed by Dezawa and Sairyo in 2011. sMED was performed via the interlaminar approach with a percutaneous endoscope. The patients had previously underdone microendoscopic discectomy for HNP. For the recurrent HNP, the sMED interlaminar approach was selected because the HNP occurred at the level of L5-S1; the percutaneous endoscopic transforaminal approach was not possible for anatomical reasons. To perform sMED via the interlaminar approach, we employed new, specially made devices to enable us to use this technique. In conclusion, sMED is the most minimally invasive approach available for HNP, and its limitations have been gradually eliminated with the introduction specially made devices. In the near future, percutaneous endoscopic surgery could be the gold standard for minimally invasive disc surgery. PMID:22776341

  4. The Factors Associated With the Successful Outcomes of Percutaneous Disc Decompression in Patients With Lumbar Herniated Nucleus Pulposus

    PubMed Central

    Lee, Sang Heon; Kim, Nack Hwan; Park, Hyeun Jun; Yoo, Hyun-Joon; Jo, Soo Yung

    2015-01-01

    Objective To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP). Methods We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD. Results The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (ΔVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (ΔODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012). Conclusion PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP. PMID:26605171

  5. Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report.

    PubMed

    Yamashita, Kazuta; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Abe, Mitsunobu; Morimoto, Masatoshi; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    Percutaneous endoscopic discectomy (PED) is a minimally invasive spinal technique and has several advantages compared with open surgery. We describe repeat PED surgery for recurrent herniated nucleus pulposus (HNP). The patient was a 33-year-old handball high level player. Previously, he underwent transforaminal PED under local anesthesia for intracanalicular HNP at L4-5 level about 2 years ago. He could return to his original competitive level. Two years later, he felt low back and right leg pain again when he was playing handball. Magnetic resonance imaging revealed the recurrence of HNP at the same level. We conducted transforaminal PED again using the exact same route as the previous surgery. Although there was a little adhesion around the L5 nerve root, we could easily identify and remove the herniated mass using endoscopic forceps. Immediately after the surgery, the low back and leg pain disappeared. Repeat PED surgery for recurrence of lumbar disc herniation is effective especially for athletes because of the benefits of PED, including surgery under local anesthesia, preservation of normal posterior structures, less postoperative pain, early discharge, and faster return to sports. PMID:27040069

  6. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus.

    PubMed

    Jeon, Kyoungkyu; Kim, Taeyoung; Lee, Sang-Ho

    2016-05-01

    [Purpose] The purpose of this study was to provide the data for constructing an integrated exercise program to help restore muscle strength and stability through extension strength exercise in adult females with lumbar disc herniation. [Subjects and Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization was performed by 26 females older than 20 with lumbar disc herniation findings. [Results] Significant differences were found in lumbar extension muscle strength at every angle of lumbar flexion after participation in the 8-week stabilization exercise program; but there was no significant difference in the weight distribution index. [Conclusion] An integrated exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the trunk can help to maintain muscle strength and balance. In addition, improvement in extension strength is expected to be helpful in daily life by securing the range of joint motion and improving the strength and stability. PMID:27313342

  7. Effects of muscle extension strength exercise on trunk muscle strength and stability of patients with lumbar herniated nucleus pulposus

    PubMed Central

    Jeon, Kyoungkyu; Kim, Taeyoung; Lee, Sang-Ho

    2016-01-01

    [Purpose] The purpose of this study was to provide the data for constructing an integrated exercise program to help restore muscle strength and stability through extension strength exercise in adult females with lumbar disc herniation. [Subjects and Methods] An 8-week exercise program for lumbar muscle extension strength and stabilization was performed by 26 females older than 20 with lumbar disc herniation findings. [Results] Significant differences were found in lumbar extension muscle strength at every angle of lumbar flexion after participation in the 8-week stabilization exercise program; but there was no significant difference in the weight distribution index. [Conclusion] An integrated exercise program aiming to strengthen lumbar spine muscles, reduce pain and stabilize the trunk can help to maintain muscle strength and balance. In addition, improvement in extension strength is expected to be helpful in daily life by securing the range of joint motion and improving the strength and stability. PMID:27313342

  8. Herniated disk

    MedlinePlus

    ... the disk. This may place pressure on nearby nerves or the spinal cord. ... Lumbar radiculopathy; Cervical radiculopathy; Herniated intervertebral disk; Prolapsed intervertebral disk; Slipped disk; Ruptured disk; Herniated nucleus pulposus

  9. A combinatorial relative mass value evaluation of endogenous bioactive proteins in three-dimensional cultured nucleus pulposus cells of herniated intervertebral discs: identification of potential target proteins for gene therapeutic approaches.

    PubMed

    Mern, Demissew S; Fontana, Johann; Beierfuß, Anja; Thomé, Claudius; Hegewald, Aldemar A

    2013-01-01

    Painful degenerative disc diseases have been targeted by different biological treatment approaches. Nucleus pulposus (NP) cells play a central role in intervertebral disc (IVD) maintenance by orchestrating catabolic, anabolic and inflammatory factors that affect the extracellular matrix. IVD degeneration is associated with imbalances of these factors, resulting in a catabolic inflammatory metabolism. Therefore, accurate knowledge about their quantity and quality with regard to matrix synthesis is vital for a rational gene therapeutic approach. NP cells were isolated from 63 patients operated due to lumbar disc herniation (mean age 56 / range 29 - 84 years). Then, three-dimensional culture with low-glucose was completed in a collagen type I scaffold for four weeks. Subsequently cell proliferation evaluation was performed using 3-(4, 5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide and intracellular concentration of 28 endogenously expressed anabolic, catabolic, inflammatory factors and relevant matrix proteins was determined by enzyme-linked immunosorbent assay. Specimen-related grades of degeneration were confirmed by preoperative magnetic resonance imaging. Independent from gender, age and grade of degeneration proliferation rates remained similar in all groups of NP cells. Progressive grades of degeneration, however, showed a significant influence on accumulation of selective groups of factors such as disintegrin and metalloproteinase with thrombospondin motifs 4 and 5, matrix metalloproteinase 3, metalloproteinase inhibitor 1 and 2, interleukin-1β and interleukin-1 receptor. Along with these changes, the key NP matrix proteins aggrecan and collagen II decreased significantly. The concentration of anabolic factors bone morphogenetic proteins 2, 4, 6 and 7, insulin-like growth factor 1, transforming growth factor beta 1 and 3, however, remained below the minimal detectable quantities. These findings indicate that progressive degenerative changes in NP may

  10. A Combinatorial Relative Mass Value Evaluation of Endogenous Bioactive Proteins in Three-Dimensional Cultured Nucleus Pulposus Cells of Herniated Intervertebral Discs: Identification of Potential Target Proteins for Gene Therapeutic Approaches

    PubMed Central

    Mern, Demissew S.; Fontana, Johann; Beierfuß, Anja; Thomé, Claudius; Hegewald, Aldemar A.

    2013-01-01

    Painful degenerative disc diseases have been targeted by different biological treatment approaches. Nucleus pulposus (NP) cells play a central role in intervertebral disc (IVD) maintenance by orchestrating catabolic, anabolic and inflammatory factors that affect the extracellular matrix. IVD degeneration is associated with imbalances of these factors, resulting in a catabolic inflammatory metabolism. Therefore, accurate knowledge about their quantity and quality with regard to matrix synthesis is vital for a rational gene therapeutic approach. NP cells were isolated from 63 patients operated due to lumbar disc herniation (mean age 56 / range 29 - 84 years). Then, three-dimensional culture with low-glucose was completed in a collagen type I scaffold for four weeks. Subsequently cell proliferation evaluation was performed using 3-(4, 5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide and intracellular concentration of 28 endogenously expressed anabolic, catabolic, inflammatory factors and relevant matrix proteins was determined by enzyme-linked immunosorbent assay. Specimen-related grades of degeneration were confirmed by preoperative magnetic resonance imaging. Independent from gender, age and grade of degeneration proliferation rates remained similar in all groups of NP cells. Progressive grades of degeneration, however, showed a significant influence on accumulation of selective groups of factors such as disintegrin and metalloproteinase with thrombospondin motifs 4 and 5, matrix metalloproteinase 3, metalloproteinase inhibitor 1 and 2, interleukin-1β and interleukin-1 receptor. Along with these changes, the key NP matrix proteins aggrecan and collagen II decreased significantly. The concentration of anabolic factors bone morphogenetic proteins 2, 4, 6 and 7, insulin-like growth factor 1, transforming growth factor beta 1 and 3, however, remained below the minimal detectable quantities. These findings indicate that progressive degenerative changes in NP may

  11. p38 mitogen-activated protein kinase inhibition modulates nucleus pulposus cell apoptosis in spontaneous resorption of herniated intervertebral discs: An experimental study in rats.

    PubMed

    Zhu, Yu; Liu, Jin-Tao; Yang, Li-Yan; Du, Wen-Pei; Li, Xiao-Chun; Qian, Xiang; Yu, Peng-Fei; Liu, Jian-Wen; Jiang, Hong

    2016-05-01

    The present study was performed to investigate the role of p38 mitogen‑activated protein kinase (MAPK) in the resorption of herniated intervertebral discs in 30 rats. In the non‑contained and p38 MAPK inhibition (p38i) groups, two coccygeal intervertebral discs (IVDs) were removed and wounded prior to relocation into the subcutaneous space of the skin of the back. In the contained group, the cartilage endplates maintained their integrity. Furthermore, SB203580 was injected intraperitoneally into the p38i group, whereas saline was injected into the other two groups. In the non‑contained group, the weight of the relocated IVDs decreased to a greater extent over time when compared with the contained and p38i groups. Phosphorylated p38, tumor necrosis factor‑α, and interleukin‑1β were observed to exhibit higher expression levels in the non‑contained group compared with the contained and p38i groups, at weeks 1 and 4 post‑surgery. The expression level of caspase‑3 and the densities of apoptotic disc cells were significantly higher in the non‑contained group compared with the contained and p38i groups at 4 weeks post‑surgery. In conclusion, p38 MAPK induces apoptosis in IVDs, while also accelerating the resorption of the relocated IVDs. Thus, p38 MAPK may be important in spontaneous resorption of IVDs. PMID:27035219

  12. Protective effect of cannabidiol on hydrogen peroxide‑induced apoptosis, inflammation and oxidative stress in nucleus pulposus cells.

    PubMed

    Chen, Jie; Hou, Chen; Chen, Xin; Wang, Dong; Yang, Pinglin; He, Xijing; Zhou, Jinsong; Li, Haopeng

    2016-09-01

    Cannabidiol, a major component of marijuana, protects nerves, and exerts antispasmodic, anti-inflammatory and anti‑anxiety effects. In the current study, the protective effect of cannabidiol was observed to prevent hydrogen peroxide (H2O2)‑induced apoptosis, inflammation and oxidative stress in nucleus pulposus cells. Nucleus pulposus cells were isolated from rats and cultured in vitro, and H2O2 was used to construct the nucleus pulposus cell model. Cell viability of the nucleus pulposus cells was assessed using a 3‑(4,5-dimethylthiazol-2-yl)-2,5‑diphenyltetrazolium bromide assay. The ratio of apoptotic cells, and caspase‑3 or cyclooxygenase‑2 (COX‑2) mRNA expression was analyzed by annexin V‑fluorescein isothiocyanate/propidium‑iodide staining and reverse transcription‑quantitative polymerase chain reaction, respectively. The quantities of interleukin (IL)‑1β and interleukin‑6 were measured using a series of assay kits. B-cell lymphoma 2 (Bcl‑2) and inducible nitric oxide synthase (iNOS) protein expression levels were analyzed using western blotting. The present study identified that cannabidiol enhanced cell viability and reduced apoptosis in H2O2‑treated nucleus pulposus cells in vitro using a lumbar disc herniation (LDH) model. In addition, cannabidiol reduced caspase‑3 gene expression and augmented the Bcl‑2 protein expression levels in the nucleus pulposus cells following H2O2 exposure. Pre‑treatment with cannabidiol suppressed the promotion of COX‑2, iNOS, IL‑1β and IL‑6 expression in the nucleus pulposus cells following H2O2 exposure. Taken together, these results suggest that cannabidiol potentially exerts its protective effect on LDH via the suppression of anti‑apoptosis, anti‑inflammation and anti‑oxidative activities in nucleus pulposus cells. PMID:27430346

  13. Numerical analysis of the influence of nucleus pulposus removal on the biomechanical behavior of a lumbar motion segment.

    PubMed

    Huang, Juying; Yan, Huagang; Jian, Fengzeng; Wang, Xingwen; Li, Haiyun

    2015-01-01

    Nucleus replacement was deemed to have therapeutic potential for patients with intervertebral disc herniation. However, whether a patient would benefit from nucleus replacement is technically unclear. This study aimed to investigate the influence of nucleus pulposus (NP) removal on the biomechanical behavior of a lumbar motion segment and to further explore a computational method of biomechanical characteristics of NP removal, which can evaluate the mechanical stability of pulposus replacement. We, respectively, reconstructed three types of models for a mildly herniated disc and three types of models for a severely herniated disc based on a L4-L5 segment finite element model with computed tomography image data from a healthy adult. First, the NP was removed from the herniated disc models, and the biomechanical behavior of NP removal was simulated. Second, the NP cavities were filled with an experimental material (Poisson's ratio = 0.3; elastic modulus = 3 MPa), and the biomechanical behavior of pulposus replacement was simulated. The simulations were carried out under the five loadings of axial compression, flexion, lateral bending, extension, and axial rotation. The changes of the four biomechanical characteristics, i.e. the rotation degree, the maximum stress in the annulus fibrosus (AF), joint facet contact forces, and the maximum disc deformation, were computed for all models. Experimental results showed that the rotation range, the maximum AF stress, and joint facet contact forces increased, and the maximum disc deformation decreased after NP removal, while they changed in the opposite way after the nucleus cavities were filled with the experimental material. PMID:24893132

  14. Development of injectable hydrogels for nucleus pulposus replacement

    NASA Astrophysics Data System (ADS)

    Thomas, Jonathan D.

    Intervertebral disc degeneration has been reported as the underlying cause for 75% of cases of lower back pain and is marked by dehydration of the nucleus pulposus within the intervertebral disc. There have been many implant designs to replace the nucleus pulposus. Some researchers have proposed the replacement of the nucleus pulposus with hydrogel materials. The insertion of devices made from these materials further compromises the annulus of the disc. An ideal nucleus replacement could be injected into the disc space and form a solid in vivo. However, injectable replacements using curing elastomers and thermoplastic materials are not ideal because of the potentially harmful exothermic heat evolved from their reactions and the toxicity of the reactants used. We propose a hydrogel system that can be injected as a liquid at 25°C and solidified to yield a hydrogel within the intervertebral disc at 37°C. In aqueous solutions, these polymers have Lower Critical Solution Temperatures (LCST) between 25-37°C, making them unique candidate materials for this application. Poly(N-isopropylacrylamide) (PNIPAAm) is the most widely studied LCST polymer due to its drastic transition near body temperature. However, by itself, pure PNIPAAm forms a hydrogel that has low water content and can readily undergo plastic deformation. To increase the water content and impart elasticity to PNIPAAm hydrogels, grafted and branched hydrogel systems were created that incorporated the thermogelling PNIPAAm and hydrophilic poly(ethylene glycol) (PEG). In this research, the effects of polymer composition and monomer to initiator ratio, which controls polymer MW, on the in vitro swelling properties (mass, chemical, and compressive mechanical stability) of hydrogels formed from aqueous solutions of these polymers were evaluated. Immersion studies were also conducted in solutions to simulate the osmotic environment of the nucleus pulposus. The effects of repeated compression and unloading cycles

  15. A photopolymerized composite hydrogel and surgical implanting tool for a nucleus pulposus replacement.

    PubMed

    Schmocker, Andreas; Khoushabi, Azadeh; Frauchiger, Daniela A; Gantenbein, Benjamin; Schizas, Constantin; Moser, Christophe; Bourban, Pierre-Etienne; Pioletti, Dominique P

    2016-05-01

    Nucleus pulposus replacements have been subjected to highly controversial discussions over the last 40 years. Their use has not yet resulted in a positive outcome to treat herniated disc or degenerated disc disease. The main reason is that not a single implant or tissue replacement was able to withstand the loads within an intervertebral disc. Here, we report on the development of a photo-polymerizable poly(ethylene glycol)dimethacrylate nano-fibrillated cellulose composite hydrogel which was tuned according to native tissue properties. Using a customized minimally-invasive medical device to inject and photopolymerize the hydrogel insitu, samples were implanted through an incision of 1 mm into an intervertebral disc of a bovine organ model to evaluate their long-term performance. When implanted into the bovine disc model, the composite hydrogel implant was able to significantly re-establish disc height after surgery (p < 0.0025). The height was maintained after 0.5 million loading cycles (p < 0.025). The mechanical resistance of the novel composite hydrogel material combined with the minimally invasive implantation procedure into a bovine disc resulted in a promising functional orthopedic implant for the replacement of the nucleus pulposus. PMID:26976264

  16. Differential regulation of matrix degrading enzymes in a TNFalpha-induced model of nucleus pulposus tissue degeneration.

    PubMed

    Séguin, Cheryle A; Bojarski, Marla; Pilliar, Robert M; Roughley, Peter J; Kandel, Rita A

    2006-09-01

    Intervertebral disc degeneration occurs commonly and is linked to persistent back pain and the development of disc herniation. The mechanisms responsible for tissue catabolism have not yet been fully elucidated. Previously we characterized an in vitro model of TNFalpha-induced nucleus pulposus degeneration, which demonstrates decreased expression of matrix macromolecules, increased expression of matrix degrading enzymes, and the activation of aggrecanase-mediated proteoglycan degradation [Seguin, C.A., Pilliar, R.M., Roughley, P.J., and Kandel, R.A. 2005. Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue. Spine 30: 1940-1948]. This study explores the intracellular pathways activated during TNFalpha-induced matrix degradation. We demonstrate that in nucleus pulposus cells, the p38 and JNK pathways regulate induction of MMP-1 and -3; p38, JNK, and NF-kappaB regulate the induction of MMP-13; and ERK regulates the up-regulation of MT1-MMP mRNA in response to TNFalpha. Induction of ADAMTS-4 and -5 mRNA occurred downstream of NF-kappaB activation. Depletion of tissue proteoglycans was mediated by ERK and NF-kappaB-dependent "aggrecanase" activity, suggesting MT1-MMP and ADAMTS-4 and -5 as effectors of TNFalpha-induced tissue catabolism. PMID:16934445

  17. Reduced tonicity stimulates an inflammatory response in nucleus pulposus tissue that can be limited by a COX-2-specific inhibitor.

    PubMed

    van Dijk, Bart; Potier, Esther; van DIjk, Maarten; Langelaan, Marloes; Papen-Botterhuis, Nicole; Ito, Keita

    2015-11-01

    In intervertebral disc herniation with nucleus pulposus (NP) extrusion, the elicited inflammatory response is considered a key pain mechanism. However, inflammatory cytokines are reported in extruded herniated tissue, even before monocyte infiltration, suggesting that the tissue itself initiates the inflammation. Since herniated tissue swells, we investigated whether this simple mechanobiological stimulus alone could provoke an inflammatory response that could cause pain. Furthermore, we investigated whether sustained-release cyclooxygenase-2 (COX2) inhibitor would be beneficial in such conditions. Healthy bovine NP explants were allowed to swell freely or confined. The swelling explants were treated with Celecoxib, applied either as a bolus or in sustained-release. Swelling explants produced elevated levels of interleukin-6 (IL-6) and prostaglandin E2 (PGE2 ) for 28 days, while confined explants did not. Both a high concentration bolus and 10 times lower concentration in sustained release completely inhibited PGE2 production, but did not affect IL-6 production. Swelling of NP tissue, without the inflammatory system response, can trigger cytokine production and Celecoxib, even in bolus form, may be useful for pain control in extruded disc herniation. PMID:25991050

  18. PHARMACOLOGIC TREATMENT OF HYPERALGESIA EXPERIMENTALLY INDUCED BY NUCLEUS PULPOSUS

    PubMed Central

    de Souza Grava, André Luiz; Ferrari, Luiz Fernando; Parada, Carlos Amílcar; Defino, Helton Luiz Aparecido

    2015-01-01

    Objective: To evaluate the effect of anti-inflammatory drugs (dexamethasone, indomethacin, atenolol and indomethacin plus atenolol) and analgesic drugs (morphine) on hyperalgesia experimentally induced by the nucleus pulposus (NP) in contact with the L5 dorsal root ganglion (DRG). Methods: Thirty male Wistar rats of weights ranging from 220 to 250 g were used in the study. Hyperalgesia was induced by means of a fragment of NP removed from the sacrococcygeal region that was placed in contact with the L5 dorsal root ganglion. The 30 animals were divided into experimental groups according to the drug used. The drugs were administered for two weeks after the surgical procedure to induce hyperalgesia. Mechanical and thermal hyperalgesia was evaluated using the paw pressure test, von Frey electronic test and Hargreaves test, over a seven-week period. Results: The greatest reduction of hyperalgesia was observed in the group of animals treated with morphine, followed by dexamethasone, indomethacin and atenolol. Reductions in hyperalgesia were observed after drug administration ceased, except for the group of animals treated with morphine, in which there was an increase in hyperalgesia after discontinuation of the treatment. Conclusion: Hyperalgesia induced by NP contact with the DRG can be reduced through administration of anti-inflammatory and analgesic drugs, but a greater reduction was observed with the administration of dexamethasone. PMID:27026966

  19. Rheological characterization of the nucleus pulposus and dense collagen scaffolds intended for functional replacement.

    PubMed

    Bron, J L; Koenderink, G H; Everts, V; Smit, T H

    2009-05-01

    Lumbar discectomy is an effective therapy for neurological decompression in patients suffering from sciatica due to a herniated nucleus pulposus (NP). However, high numbers of patients suffering from persisting postoperative low back pain have resulted in many strategies targeting the regeneration of the NP. For successful regeneration, the stiffness of scaffolds is increasingly recognized as a potent mechanical cue for the differentiation and biosynthetic response of (stem) cells. The aim of the current study is to characterize the viscoelastic properties of the NP and to develop dense collagen scaffolds with similar properties. The scaffolds consisted of highly dense (0.5%-12%) type I collagen matrices, prepared by plastic compression. The complex modulus of the NP was 22 kPa (at 10 rad s(-1)), which should agree with a scaffold with a collagen concentration of 23%. The loss tangent, indicative of energy dissipation, is higher for the NP (0.28) than for the scaffolds (0.12) and was not dependent of the collagen density. Gamma sterilization of the scaffolds increased the shear moduli but also resulted in more brittle behavior and a reduced swelling capacity. In conclusion, by tuning the collagen density, we can approach the stiffness of the NP. Therefore, dense collagen is a promising candidate for tissue engineering of the NP that deserves further study, such as the addition of other proteins. PMID:18991343

  20. In vitro measurement of nucleus pulposus swelling pressure: A new technique for studies of spinal adaptation to gravity

    NASA Technical Reports Server (NTRS)

    Hargens, A. R.; Glover, M. G.; Mahmood, M. M.; Gott, S.; Garfin, S. R.; Ballard, R.; Murthy, G.; Brown, M. D.

    1992-01-01

    Swelling of the intervertebral disc nucleus pulposus is altered by posture and gravity. We have designed and tested a new osmometer for in vitro determination of nucleus pulposus swelling pressure. The functional principle of the osmometer involves compressing a sample of nucleus pulposus with nitrogen gas until saline pressure gradients across a 0.45 microns Millipore filter are eliminated. Swelling pressure of both pooled dog and pooled pig lumbar disc nucleus pulposus were measured on the new osmometer and compared to swelling pressures determined using the equilibrium dialysis technique. The osmometer measured swelling pressures comparable to those obtained by the dialysis technique. This osmometer provides a rapid, direct, and accurate measurement of swelling pressure of the nucleus pulposus.

  1. Inflammation Induces Irreversible Biophysical Changes in Isolated Nucleus Pulposus Cells

    PubMed Central

    Maidhof, Robert; Jacobsen, Timothy; Papatheodorou, Angelos; Chahine, Nadeen O.

    2014-01-01

    Intervertebral disc degeneration is accompanied by elevated levels of inflammatory cytokines that have been implicated in disease etiology and matrix degradation. While the effects of inflammatory stimulation on disc cell metabolism have been well-studied, their effects on cell biophysical properties have not been investigated. The hypothesis of this study is that inflammatory stimulation alters the biomechanical properties of isolated disc cells and volume responses to step osmotic loading. Cells from the nucleus pulposus (NP) of bovine discs were isolated and treated with either lipopolysaccharide (LPS), an inflammatory ligand, or with the recombinant cytokine TNF-α for 24 hours. We measured cellular volume regulation responses to osmotic loading either immediately after stimulation or after a 1 week recovery period from the inflammatory stimuli. Cells from each group were tested under step osmotic loading and the transient volume-response was captured via time-lapse microscopy. Volume-responses were analyzed using mixture theory framework to investigate two biomechanical properties of the cell, the intracellular water content and the hydraulic permeability. Intracellular water content did not vary between treatment groups, but hydraulic permeability increased significantly with inflammatory treatment. In the 1 week recovery group, hydraulic permeability remained elevated relative to the untreated recovery control. Cell radius was also significantly increased both after 24 hours of treatment and after 1 week recovery. A significant linear correlation was observed between hydraulic permeability and cell radius in untreated cells at 24 hours and at 1-week recovery, though not in the inflammatory stimulated groups at either time point. This loss of correlation between cell size and hydraulic permeability suggests that regulation of volume change is disrupted irreversibly due to inflammatory stimulation. Inflammatory treated cells exhibited altered F

  2. In situ label-free cell viability assessment of nucleus pulposus tissue.

    PubMed

    Dittmar, Roman; van Dijk, Bart G M; van Zandvoort, Marc A M J; Ito, Keita

    2014-04-01

    Regenerative medicine approaches aiming at treating degenerating intervertebral discs, a major cause of back pain, are increasingly tested in ex-vivo disc explant models mimicking in-vivo conditions. For assessing the efficacy of regenerative therapies, cell viability is commonly measured requiring specific labels to stain cells. Here, we demonstrate and evaluate how cellular auto-fluorescence can be utilized to non-invasively assess viability in disc tissue in-situ using label-free two-photon microscopy. Live and dead bovine disc cells (0% and 100% cell viability) from the nucleus pulposus were seeded into collagen gels and auto-fluorescence was characterized. Subsequently, nucleus pulposus explants were cultured for 6 days in media with different glucose supplementation (0, 0.25, 0.5, and 1 g/L) to induce different degrees of cell death. Then, samples were split and viability was assessed using label-free two-photon microscopy and conventional staining. Results show that live and dead nucleus pulposus cells systematically emit auto-fluorescent light with distinct characteristics. Cell viability values obtained with label-free microscopy did not significantly differ from those acquired with staining. In summary, monitoring auto-fluorescence facilitates accurate cell viability assessment in nucleus tissue requiring no additional dyes. Thus, this technique may be suitable for pre-clinical testing of regenerative therapies in nucleus pulposus cultures. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:545-550, 2014. PMID:24391094

  3. The effect of nucleus pulposus crosslinking and glycosaminoglycan degradation on disc mechanical function.

    PubMed

    Yerramalli, C S; Chou, A I; Miller, G J; Nicoll, S B; Chin, K R; Elliott, D M

    2007-01-01

    Altered mechanical loading, secondary to biochemical changes in the nucleus pulposus, is a potential mechanism in disc degeneration. An understanding of the role of this altered mechanical loading is only possible by separating the mechanical and biological effects of early nucleus pulposus changes. The objective of this study was to quantify the mechanical effect of decreased glycosaminoglycans (GAG) and increased crosslinking in the nucleus pulposus using in vitro rat lumbar discs. Following initial mechanical testing the discs were injected according to the four treatment groups: PBS control, chondroitinase-ABC (ChABC) for GAG degradation, genipin (Gen) for crosslinking, or a combination of chondroitinase and genipin (ChABC+Gen). After treatment the discs were again mechanically tested, followed by histology or biochemistry. Neutral zone mechanical properties were changed by approximately 20% for PBS, ChABC, and ChABC+Gen treatments (significant only for PBS in a paired comparison). These trends were reversed with genipin crosslinking alone. With ChABC treatment the effective compressive modulus increased and the GAG content decreased; with the combination of ChABC+Gen the mechanics and GAG content were unchanged. Degradation of nucleus pulposus GAG alters disc axial mechanics, potentially contributing to the degenerative cascade. Crosslinking is unlikely to contribute to degeneration, but may be a potential avenue of treatment. PMID:16715318

  4. Effect of vertebroplasty filler materials on viability and gene expression of human nucleus pulposus cells.

    PubMed

    Lazáry, Aron; Speer, Gábor; Varga, Péter Pál; Balla, Bernadett; Bácsi, Krisztián; Kósa, János P; Nagy, Zsolt; Takács, István; Lakatos, Péter

    2008-05-01

    Consequences of intradiscal cement leakage--often occurring after vertebral cement augmentation for the treatment of vertebral compression fractures--are still unknown. In this study, we have investigated the influences of vertebroplasty filler materials (polymethylmethacrylate-, calcium phosphate- and calcium sulfate-based bone cement) on isolated nucleus pulposus cells. Cell viability of cultured human nucleus pulposus cells were measured after treatment with vertebroplasty filler materials. Gene expression profile of selected genes was determined with quantitative real-time PCR. The widely used polymethylmethacrylate and calcium phosphate cement significantly decreased cell number in a dose- and time-dependent manner while calcium sulfate cement affected cell viability less. Expression of genes involved in matrix metabolism of nucleus pulposus--aggrecan, collagens, small proteoglycans--as well as important transcription factors have also significantly changed due to treatment (e.g., 2.5-fold decrease in aggrecan expression was determined in cultures due to polymethylmethacrylate treatment). Our results suggest that vertebroplasty filler materials--depending on the type of applied material--can accelerate the degeneration of nucleus pulposus cells resulting in a less flexible disc in case of intradiscal cement leakage. This process may increase the risk of a subsequent new vertebral fracture, the main complication of vertebral augmentation. PMID:18176942

  5. MiR-27a Regulates Apoptosis in Nucleus Pulposus Cells by Targeting PI3K

    PubMed Central

    Chen, Huajiang; Yuan, Wen; Wang, Jianxi; Tang, Xianye

    2013-01-01

    The precise role of apoptosis in the pathogenesis of intervertebral disc degeneration (IDD) remains to be elucidated. We analyzed degenerative nucleus pulposus (NP) cells and found that the expression of miR-27a was increased. The overexpression of miR-27a was further verified using real-time RT-PCR. Bioinformatics target prediction identified phosphoinositide-3 kinases (PI3K) as putative targets of miR-27a. Furthermore, miR-27a inhibited PI3K expression by directly targeting their 3’-UTRs, and this inhibition was abolished by mutation of the miR-27a binding sites. Various cellular processes including cell growth, proliferation, migration and adhesion are regulated by activation of the PI3K/AKT signaling pathway, and nucleus pulposus cells are known to strongly express the phosphorylated survival protein AKT. Our results identify PI3K as a novel target of miR-27a. Upregulation of miR-27a thus targets PI3K, initiating apoptosis of nucleus pulposus cells. This present study revealed that downregulated miR-27a might develop a novel intervention for IDD treatment through the prevention of apoptosis in Nucleus pulposus Cells. PMID:24086481

  6. MiR-27a regulates apoptosis in nucleus pulposus cells by targeting PI3K.

    PubMed

    Liu, Gang; Cao, Peng; Chen, Huajiang; Yuan, Wen; Wang, Jianxi; Tang, Xianye

    2013-01-01

    The precise role of apoptosis in the pathogenesis of intervertebral disc degeneration (IDD) remains to be elucidated. We analyzed degenerative nucleus pulposus (NP) cells and found that the expression of miR-27a was increased. The overexpression of miR-27a was further verified using real-time RT-PCR. Bioinformatics target prediction identified phosphoinositide-3 kinases (PI3K) as putative targets of miR-27a. Furthermore, miR-27a inhibited PI3K expression by directly targeting their 3'-UTRs, and this inhibition was abolished by mutation of the miR-27a binding sites. Various cellular processes including cell growth, proliferation, migration and adhesion are regulated by activation of the PI3K/AKT signaling pathway, and nucleus pulposus cells are known to strongly express the phosphorylated survival protein AKT. Our results identify PI3K as a novel target of miR-27a. Upregulation of miR-27a thus targets PI3K, initiating apoptosis of nucleus pulposus cells. This present study revealed that downregulated miR-27a might develop a novel intervention for IDD treatment through the prevention of apoptosis in Nucleus pulposus Cells. PMID:24086481

  7. miR-21 promotes human nucleus pulposus cell proliferation through PTEN/AKT signaling.

    PubMed

    Liu, Hongzhe; Huang, Xiangwang; Liu, Xiangyang; Xiao, Sheng; Zhang, Yi; Xiang, Tiecheng; Shen, Xiongjie; Wang, Guoping; Sheng, Bin

    2014-01-01

    The precise role of nucleus pulposus cell proliferation in the pathogenesis of intervertebral disc degeneration remains to be elucidated. Recent findings have revealed that microRNAs, a class of small noncoding RNAs, may regulate cell proliferation in many pathological conditions. Here, we showed that miR-21 was significantly upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues that were isolated from patients with idiopathic scoliosis and that miR-10b levels were associated with disc degeneration grade. Moreover, bioinformatics target prediction identified PTEN as a putative target of miR-21. miR-21 inhibited PTEN expression by directly targeting the 3'UTR, and this inhibition was abolished through miR-21 binding site mutations. miR-21 overexpression stimulated cell proliferation and AKT signaling pathway activation, which led to cyclin D1 translation. Additionally, the increase in proliferation and cyclin D1 expression induced by miR-21 overexpression was almost completely blocked by Ly294002, an AKT inhibitor. Taken together, aberrant miR-21 upregulation in intervertebral disc degeneration could target PTEN, which would contribute to abnormal nucleus pulposus cell proliferation through derepressing the Akt pathway. Our study also underscores the potential of miR-21 and the PTEN/Akt pathway as novel therapeutic targets in intervertebral disc degeneration. PMID:24603539

  8. miR-21 Promotes Human Nucleus Pulposus Cell Proliferation through PTEN/AKT Signaling

    PubMed Central

    Liu, Hongzhe; Huang, Xiangwang; Liu, Xiangyang; Xiao, Sheng; Zhang, Yi; Xiang, Tiecheng; Shen, Xiongjie; Wang, Guoping; Sheng, Bin

    2014-01-01

    The precise role of nucleus pulposus cell proliferation in the pathogenesis of intervertebral disc degeneration remains to be elucidated. Recent findings have revealed that microRNAs, a class of small noncoding RNAs, may regulate cell proliferation in many pathological conditions. Here, we showed that miR-21 was significantly upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues that were isolated from patients with idiopathic scoliosis and that miR-10b levels were associated with disc degeneration grade. Moreover, bioinformatics target prediction identified PTEN as a putative target of miR-21. miR-21 inhibited PTEN expression by directly targeting the 3′UTR, and this inhibition was abolished through miR-21 binding site mutations. miR-21 overexpression stimulated cell proliferation and AKT signaling pathway activation, which led to cyclin D1 translation. Additionally, the increase in proliferation and cyclin D1 expression induced by miR-21 overexpression was almost completely blocked by Ly294002, an AKT inhibitor. Taken together, aberrant miR-21 upregulation in intervertebral disc degeneration could target PTEN, which would contribute to abnormal nucleus pulposus cell proliferation through derepressing the Akt pathway. Our study also underscores the potential of miR-21 and the PTEN/Akt pathway as novel therapeutic targets in intervertebral disc degeneration. PMID:24603539

  9. EVALUATION OF HYPERALGESIA AND HISTOLOGICAL CHANGES OF DORSAL ROOT GANGLION INDUCED BY NUCLEUS PULPOSUS

    PubMed Central

    Grava, André Luiz de Souza; Ferrari, Luiz Fernando; Parada, Carlos Amílcar; Defino, Helton Luiz Aparecido

    2015-01-01

    To evaluate the hyperalgesia and histological abnormalities induced by contact between the dorsal root ganglion and the nucleus pulposus. Methods: Twenty Wistar rats were used, divided into two experimental groups. In one of the groups, a fragment of autologous nucleus pulposus was removed from the sacrococcygeal region and deposited on the L5 dorsal root ganglia. In the other group (control), a fragment of adipose tissue was deposited on the L5 dorsal root ganglia. Mechanical and thermal hyperalgesia was evaluated on the third day and the first, third, fifth and seventh weeks after the operation. A L5 dorsal root ganglion was removed in the first, third, fifth and seventh weeks after the operation for histological study using HE staining and histochemical study using specific labeling for iNOS. Results: Higher intensity of mechanical and thermal hyperalgesia was observed in the group of animals in which the nucleus pulposus was placed in contact with the dorsal root ganglion. In this group, the histological study showed abnormalities of the dorsal root ganglion tissue, characterized by an inflammatory process and axonal degeneration. The histopathological abnormalities of the dorsal root ganglion tissue presented increasing intensity with increasing length of observation, and there was a correlation with maintenance of the hyperalgesia observed in the behavioral assessment. Immunohistochemistry using specific labeling for iNOS in the group of animals in which the nucleus pulposus was placed in contact with the dorsal root ganglion showed higher expression of this enzyme in the nuclei of the inflammatory cells (glial cells) surrounding the neurons. Conclusion: Contact between the nucleus pulposus and the dorsal root ganglion induced mechanical and thermal hyperalgesia and caused histological abnormalities in the dorsal root ganglion components. These abnormalities were characterized by an inflammatory and degenerative process in the structures of the dorsal root

  10. Comparison of two methods for RNA extraction from the nucleus pulposus of intervertebral discs.

    PubMed

    Gan, M F; Yang, H L; Qian, J L; Wu, C S; Yuan, C X; Li, X F; Zou, J

    2016-01-01

    RNA extraction from the nucleus pulposus of intervertebral discs has been extensively used in orthopedic studies. We compared two methods for extracting RNA from the nucleus pulposus: liquid nitrogen grinding and enzyme digestion. The RNA was detected by agarose gel electrophoresis, and the purity was evaluated by absorbance ratio using a spectrophotometer. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) expression was assayed by reverse transcription-polymerase chain reaction (RT-PCR). Thirty human lumbar intervertebral discs were used in this study. The liquid nitrogen-grinding method was used for RNA extraction from 15 samples, and the mean RNA concentration was 491.04 ± 44.16 ng/mL. The enzyme digestion method was used on 15 samples, and the mean RNA concentration was 898.42 ± 38.64 ng/mL. The statistical analysis revealed that there was a significant difference in concentration between the different methods. Apparent 28S, 18S, and 5S bands were detectable in RNA extracted using the enzyme digestion method, whereas no 28S or 18S bands were detected in RNA extracted using the liquid nitrogen-grinding method. The GAPDH band was visible, and no non-specific band was detected in the RT-PCR assay by the enzyme digestion method. Therefore, the enzyme digestion method is an efficient and easy method for RNA extraction from the nucleus pulposus of intervertebral discs for further intervertebral disc degeneration-related studies. PMID:27323116

  11. Hydrodynamic stimulation and long term cultivation of nucleus pulposus cells: a new bioreactor system to induce extracellular matrix synthesis by nucleus pulposus cells dependent on intermittent hydrostatic pressure.

    PubMed

    Gokorsch, S; Nehring, D; Grottke, C; Czermak, P

    2004-11-01

    A novel bioreactor system was constructed to induce extracellular matrix (ECM) synthesis by intervertebral disc (ID) cells due to intermittent hydrostatic pressure. The developed system is completely sterilizable and reusable. It is viable for cultivation, immobilization, and stimulation of various other cell types and tissues especially for cartilage. The custom made lid allows long-run cultivation through semi-continuous operation. Manual interferences and therefore the risk of contamination are reduced. Sampling, medium changing and addition of supplements are easily performed from the connected conditioning vessel, which could be placed in an incubator. For the present investigations nucleus pulposus cells from pigs were taken and immobilized in agarose to obtain three-dimensional cell matrix constructs which were subjected to intermittent hydrostatic pressure. Afterwards the construct was biochemically examined. The proven constituents of ECM were found to be released in dependence of the magnitude and profile of the applied pressure. PMID:15636054

  12. Percutaneous Disc Decompression with Nucleoplasty–Volumetry of the Nucleus Pulposus Using Ultrahigh-Field MRI

    PubMed Central

    Kasch, Richard; Mensel, Birger; Schmidt, Florian; Drescher, Wolf; Pfuhl, Ralf; Ruetten, Sebastian; Merk, Harry R.; Kayser, Ralph

    2012-01-01

    Purpose To evaluate changes in nucleus pulposus volume as a potential parameter for the effects of disc decompression. Methods Fifty-two discs (T8 to L1) were extracted from 26 pigs and separated into thoracic (T8 to T11) and thoracolumbar discs (T12 to L1). The discs were imaged using 7.1 Tesla ultrahigh-field magnetic resonance imaging (MRI) with acquisition of axial T2-weighted turbo spin-echo sequences for determination of baseline and postinterventional nucleus pulposus volumes. Volumes were calculated using OsiriX® (http://www.osirix-viewer.com). After randomization, one group was treated with nucleoplasty, while the placebo group was treated with an identical procedure but without coblation current. The readers analyzing the MR images were blinded to the kind of procedure performed. Baseline and postinterventional volumes were compared between the nucleoplasty and placebo group. Results Average preinterventional nucleus volume was 0.799 (SD: 0.212) ml. Postinterventional volume reduction in the nucleoplasty group was significant at 0.052 (SD: 0.035) ml or 6.30% (p<0.0001) (thoracic discs) and 0.082 (SD: 0.042) ml or 7.25% (p = 0.0078) (thoracolumbar discs). Nucleoplasty achieved volume reductions of 0.114 (SD: 0.054) ml or 14.72% (thoracic) and 0.093 (SD: 0.081) ml or 11.61% (thoracolumbar) compared with the placebo group. Conclusions Nucleoplasty significantly reduces thoracic and thoracolumbar nucleus pulposus volumes in porcine discs. PMID:22848512

  13. Mechanical compression and nucleus pulposus application on dorsal root Ganglia differentially modify evoked neuronal activity in the thalamus.

    PubMed

    Nilsson, Elin; Brisby, Helena; Rask, Katarina; Hammar, Ingela

    2013-06-01

    A combination of mechanical compression caused by a protruding disc and leakage of nucleus pulposus (NP) from the disc core is presumed to contribute to intervertebral disc hernia-related pain. Experimental models of disc hernia including both components have resulted in changes in neuronal activity at the level of the dorsal root ganglion (DRG) and spinal cord, but changes within the brain have been less well studied. However, acute application of NP to a DRG without mechanical compression rapidly increases neuronal activity in the thalamus, a major brain relay nucleus processing information from sensory pathways including ascending nociceptive tracts. The combination of mechanical compression and NP might therefore result in further increases in central neuronal activity. Using an experimental disc herniation rat model including both mechanical compression and NP the present study aimed to investigate changes in neuronal activity in the contralateral thalamic ventral posterior lateral nucleus in vivo. Measurements were obtained while electrically stimulating the ipsilateral sciatic nerve at Aδ fiber intensities. The L4 DRG was subjected to light mechanical compression and NP exposure, and acute changes in evoked thalamic responses were recorded for up to 40 min. In order to compare effects in naïve animals with effects following a longer period of NP exposure, animals that were either disc-punctured or sham-operated 24 h previously were also included. In all animals, light mechanical compression of the DRG depressed the number of evoked neuronal responses. Prior NP exposure resulted in less potent changes following mechanical compression (80% of baseline) than that observed in naïve animals (50%). During the subsequent NP application, the number of evoked responses compared to baseline increased in pre-exposed animals (to 87%) as well as in naïve animals (72%) in which the removal of the mechanical compression resulted in a further increase (106%). The

  14. miR-155 Inhibits Nucleus Pulposus Cells' Degeneration through Targeting ERK 1/2

    PubMed Central

    Dai, Libing; Yao, Yicun; Qin, Shengnan; Xie, Han; Wang, Wen

    2016-01-01

    We first investigated the difference in microRNA expression between normal NP cells and degenerative NP cells using gene chip. We have found that the expression of ERK1/2 was decreased with overexpression of miR-155 in normal nucleus pulposus cell. Expression of ERK1/2 was increased with inhibition of miR-155. Overexpression or inhibition of miR-155 had no effects on the expression level of mRNA ERK1/2 in nucleus pulposus cell, which showed that miR-155 affected the expression of pERK1/2 after transcription of ERK1/2 mRNA indicating that ERK1/2 was a new target protein regulated by miR-155. In the degeneration of intervertebral disc, inhibited miR-155 decreased the expressions of extracellular main matrix collagen II and glycosaminoglycan and increased expression of ERK1/2. Taken together, our data suggested that miR-155 was the identified miRNA which regulated NP cells degenerated through directly targeting ERK1/2.

  15. Injectable oxidized hyaluronic acid/adipic acid dihydrazide hydrogel for nucleus pulposus regeneration.

    PubMed

    Su, Wen-Yu; Chen, Yu-Chun; Lin, Feng-Huei

    2010-08-01

    Injectable hydrogel allows irregular surgical defects to be completely filled, lessens the risk of implant migration, and minimizes surgical defects due to the solution-gel state transformation. Here, we first propose a method for preparing oxidized hyaluronic acid/adipic acid dihydrazide (oxi-HA/ADH) injectable hydrogel by chemical cross-linking under physiological conditions. Fourier transform infrared spectrometry and trinitrobenzene sulfonate assay were used to confirm the oxidation of hyaluronic acid. Rheological properties were measured to evaluate the working ability of the hydrogel for further clinical application. The oxi-HA/ADH in situ forming hydrogel can transform from liquid form into a gel-like matrix within 3-8 min, depending on the operational temperature. Furthermore, hydrogel degradation and cell assessment is also a concern for clinical application. Injectable oxi-HA/ADH8 hydrogel can maintain its gel-like state for at least 5 weeks with a degradation percentage of 40%. Importantly, oxi-HA/ADH8 hydrogel can assist in nucleus pulposus cell synthesis of type II collagen and aggrecan mRNA gene expression according to the results of real-time PCR analysis, and shows good biocompatibility based on cell viability and cytotoxicity assays. Based on the results of the current study, oxi-HA/ADH hydrogel may possess several advantages for future application in nucleus pulposus regeneration. PMID:20193782

  16. Three-Dimensional Microgel Platform for the Production of Cell Factories Tailored for the Nucleus Pulposus.

    PubMed

    Fontana, Gianluca; Srivastava, Akshay; Thomas, Dilip; Lalor, Pierce; Dockery, Peter; Pandit, Abhay

    2015-07-15

    Intradiscal injection of growth factors or cells has been shown to attenuate symptoms of intervertebral disc degeneration. However, different approaches are needed to overcome limitations such as short-term efficacy and leakage of the injected solutions. The current study aims at creating a platform for the realization of functional cell factories by using in parallel cell delivery and gene therapy approaches. Superfect, a transfecting agent, was used as nonviral gene vector because of its ability to form complexes with plasmid DNA (polyplexes). Polyplexes were loaded into collagen hollow microsphere reservoirs, and their ability to transfect cells was ascertained in vitro. Adipose-derived stem cells were then embedded in three-dimensional (3D) microgels composed of type II collagen/hyaluronan, which mimics the environmental cues typical of the healthy nucleus pulposus. These were functionalized with polyplex-loaded collagen hollow spheres and the secretion of the target protein was assessed quantitatively. Delivery of polyplexes from a reservoir system lowered their toxicity significantly while maintaining high levels of transfection in a monolayer culture. In 3D microgels, lower levels of transfection were observed, however; increasing levels of luciferase were secreted from the microgels over 7 days of culture. These results indicate that 3D microgels, functionalized with polyplex-loaded reservoirs offer a reliable platform for the production of cell factories that are able to manufacture targeted therapeutic proteins for regenerative therapies that have applications in nucleus pulposus repair. PMID:25290910

  17. An In Vivo Model of Reduced Nucleus Pulposus Glycosaminoglycan Content in the Rat Lumbar Intervertebral Disc

    PubMed Central

    Boxberger, John I.; Auerbach, Joshua D.; Sen, Sounok; Elliott, Dawn M.

    2009-01-01

    Study Design An in vivo model resembling early stage disc degeneration in the rat lumbar spine. Objective Simulate the reduced glycosaminoglycan content and altered mechanics observed in intervertebral disc degeneration using a controlled injection of chondroitinase ABC (ChABC). Summary of Background Data Nucleus glycosaminoglycan reduction occurs early during disc degeneration; however, mechanisms through which degeneration progresses from this state are unknown. Animal models simulating this condition are essential for understanding disease progression and for development of therapies aimed at early intervention. Methods ChABC was injected into the nucleus pulposus, and discs were evaluated via micro-CT, mechanical testing, biochemical assays, and histology 4 and 12 weeks after injection. Results At 4 weeks, reductions in nucleus glycosaminoglycan level by 43%, average height by 12%, neutral zone modulus by 40%, and increases in range of motion by 40%, and creep strain by 25% were found. Neutral zone modulus and range of motion were correlated with nucleus glycosaminoglycan. At 12 weeks, recovery of some mechanical function was detected as range of motion and creep returned to control levels; however, this was not attributed to glycosaminoglycan restoration, because mechanics were no longer correlated with glycosaminoglycan. Conclusion An in vivo model simulating physiologic levels of glycosaminoglycan loss was created to aid in understanding the relationships between altered biochemistry, altered mechanics, and altered cellular function in degeneration. PMID:18197098

  18. Decreased swelling pressure of rat nucleus pulposus associated with simulated weightlessness

    NASA Technical Reports Server (NTRS)

    Hargens, Alan R.; Mahmood, Mubashar

    1989-01-01

    Data are presented on the effects of actual and simulated weightlessness on the swelling pressure of nucleus pulposus in rats exposed to 12.5 days of flight aboard Cosmos 1887 or to seven days of tail suspension, respectively. The flight-exposed rats were adapted to normal gravity for over 50 hrs prior to sacrifice and tissue harvesting. In the experiments with flight-exposed rats, swelling pressures were 690, 675, and 622 mm Hg for flight rats, synchronous controls, and vivarium controls, respectively. In experiments with simulated weightlessness, swelling pressures were 295, 610, and 527 mm Hg for tail-suspended rats, cage controls, and vivarium controls, respectively, suggesting that fluid moves into the disc during seven days of simulated weightlessness.

  19. Biomechanical Conditioning Enhanced Matrix Synthesis in Nucleus Pulposus Cells Cultured in Agarose Constructs with TGFβ

    PubMed Central

    Tilwani, Reshma K.; Bader, Dan L.; Chowdhury, Tina T.

    2012-01-01

    Biomechanical signals play an important role in normal disc metabolism and pathology. For instance, nucleus pulposus (NP) cells will regulate metabolic activities and maintain a balance between the anabolic and catabolic cascades. The former involves factors such as transforming growth factor-β (TGFβ) and mechanical stimuli, both of which are known to regulate matrix production through autocrine and paracrine mechanisms. The present study examined the combined effect of TGFβ and mechanical loading on anabolic activities in NP cells cultured in agarose constructs. Stimulation with TGFβ and dynamic compression reduced nitrite release and increased matrix synthesis and gene expression of aggrecan and collagen type II. The findings from this work has the potential for developing regenerative treatment strategies which could either slow down or stop the degenerative process and/or promote healing mechanisms in the intervertebral disc. PMID:24956513

  20. Chondroprotective supplementation promotes the mechanical properties of injectable scaffold for human nucleus pulposus tissue engineering.

    PubMed

    Foss, Berit L; Maxwell, Thomas W; Deng, Ying

    2014-01-01

    A result of intervertebral disc (IVD) degeneration, the nucleus pulposus (NP) is no longer able to withstand applied load leading to pain and disability. The objective of this study is to fabricate a tissue-engineered injectable scaffold with chondroprotective supplementation in vitro to improve the mechanical properties of a degenerative NP. Tissue-engineered scaffolds were fabricated using different concentrations of alginate and calcium chloride and mechanically evaluated. Fabrication conditions were based on structural and mechanical resemblance to the native NP. Chondroprotective supplementation, glucosamine (GCSN) and chondroitin sulfate (CS), were added to scaffolds at concentrations of 0:0µg/mL (0:0-S), 125:100µg/mL (125:100-S), 250:200µg/mL (250:200-S), and 500:400µg/mL (500:400-S), GCSN and CS, respectively. Scaffolds were used to fabricate tissue-engineered constructs through encapsulation of human nucleus pulposus cells (HNPCs). The tissue-engineered constructs were collected at days 1, 14, and 28 for biochemical and biomechanical evaluations. Confocal microscopy showed HNPC viability and rounded morphology over the 28 day period. MTT analysis resulted in significant increases in cell proliferation for each group. Collagen type II ELISA quantification and compressive aggregate moduli (HA) showed increasing trends for both 250:200-S and the 500:400-S groups on Day 28 with significantly greater HA compared to 0:0-S group. Glycosaminoglycan and water content decreased for all groups. Results indicate the increased mechanical properties of the 250:200-S and the 500:400-S was due to production of a functional matrix. This study demonstrated potential for a chondroprotective supplemented injectable scaffold to restore biomechanical function of a degenerative disc through the production of a mechanically functional matrix. PMID:24055794

  1. Photo-crosslinked Alginate Hydrogels Support Enhanced Matrix Accumulation by Nucleus Pulposus Cells In Vivo

    PubMed Central

    Chou, Alice I.; Akintoye, Sunday O.; Nicoll, Steven B.

    2009-01-01

    Objective Intervertebral disc (IVD) degeneration is a major health concern in the United States. Replacement of the nucleus pulposus (NP) with injectable biomaterials represents a potential treatment strategy for IVD degeneration. The objective of this study was to characterize the extracellular matrix assembly and functional properties of NP cell-encapsulated, photo-crosslinked alginate hydrogels in comparison to ionically crosslinked alginate constructs. Methods Methacrylated alginate was synthesized by esterification of hydroxyl groups with methacrylic anhydride. Bovine nucleus pulposus cells were encapsulated in alginate hydrogels by ionic crosslinking using CaCl2 or through photo-crosslinking upon exposure to long-wave UV light in the presence of a photoinitiator. The hydrogels were evaluated in vitro by gross and histological analysis and in vivo using a murine subcutaneous pouch model. In vivo samples were analyzed for gene expression, extracellular matrix localization and accumulation, and equilibrium mechanical properties. Results Ionically crosslinked hydrogels exhibited inferior proteoglycan accumulation in vitro and were unable to maintain structural integrity in vivo. In further studies, photo-crosslinked alginate hydrogels were implanted for up to 8 weeks to examine NP tissue formation. Photo-crosslinked hydrogels displayed temporal increases in gene expression and assembly of type II collagen and proteoglycans. Additionally, hydrogels remained intact over the duration of the study and the equilibrium Young’s modulus increased from 1.24 ± 0.09 kPa to 4.31 ± 1.39 kPa, indicating the formation of functional matrix with properties comparable to those of the native NP. Conclusions These findings support the use of photo-crosslinked alginate hydrogels as biomaterial scaffolds for NP replacement. PMID:19427928

  2. MicroRNA-10b promotes nucleus pulposus cell proliferation through RhoC-Akt pathway by targeting HOXD10 in intervetebral disc degeneration.

    PubMed

    Yu, Xin; Li, Zheng; Shen, Jianxiong; Wu, William K K; Liang, Jinqian; Weng, Xisheng; Qiu, Guixing

    2013-01-01

    Aberrant proliferation of nucleus pulposus cell is implicated in the pathogenesis of intervertebral disc degeneration. Recent findings revealed that microRNAs, a class of small noncoding RNAs, could regulate cell proliferation in many pathological conditions. Here, we showed that miR-10b was dramatically upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues isolated from patients with idiopathic scoliosis. Moreover, miR-10b levels were associated with disc degeneration grade and downregulation of HOXD10. In cultured nucleus pulposus cells, miR-10b overexpression stimulated cell proliferation with concomitant translational inhibition of HOXD10 whereas restored expression of HOXD10 reversed the mitogenic effect of miR-10b. MiR-10b-mediated downregulation of HOXD10 led to increased RhoC expression and Akt phosphorylation. Either knockdown of RhoC or inhibition of Akt abolished the effect of miR-10b on nucleus pulposus cell proliferation. Taken together, aberrant miR-10b upregulation in intervertebral disc degeneration could contribute to abnormal nucleus pulposus cell proliferation through derepressing the RhoC-Akt pathway by targeting HOXD10. Our study also underscores the potential of miR-10b and the RhoC-Akt pathway as novel therapeutic targets in intervertebral disc degeneration. PMID:24376640

  3. MicroRNA-10b Promotes Nucleus Pulposus Cell Proliferation through RhoC-Akt Pathway by Targeting HOXD10 in Intervetebral Disc Degeneration

    PubMed Central

    Shen, Jianxiong; Wu, William K. K.; Liang, Jinqian; Weng, Xisheng; Qiu, Guixing

    2013-01-01

    Aberrant proliferation of nucleus pulposus cell is implicated in the pathogenesis of intervertebral disc degeneration. Recent findings revealed that microRNAs, a class of small noncoding RNAs, could regulate cell proliferation in many pathological conditions. Here, we showed that miR-10b was dramatically upregulated in degenerative nucleus pulposus tissues when compared with nucleus pulposus tissues isolated from patients with idiopathic scoliosis. Moreover, miR-10b levels were associated with disc degeneration grade and downregulation of HOXD10. In cultured nucleus pulposus cells, miR-10b overexpression stimulated cell proliferation with concomitant translational inhibition of HOXD10 whereas restored expression of HOXD10 reversed the mitogenic effect of miR-10b. MiR-10b-mediated downregulation of HOXD10 led to increased RhoC expression and Akt phosphorylation. Either knockdown of RhoC or inhibition of Akt abolished the effect of miR-10b on nucleus pulposus cell proliferation. Taken together, aberrant miR-10b upregulation in intervertebral disc degeneration could contribute to abnormal nucleus pulposus cell proliferation through derepressing the RhoC-Akt pathway by targeting HOXD10. Our study also underscores the potential of miR-10b and the RhoC-Akt pathway as novel therapeutic targets in intervertebral disc degeneration. PMID:24376640

  4. [Diagnostics and therapy of spinal disc herniation].

    PubMed

    Zimmer, A; Reith, W

    2014-11-01

    Degenerative processes in a movement segment of the vertebral column, which can potentially give rise to herniation of elements of the nucleus pulposus, are complex and of variable clinical and radiological dimensions; however the mere assumption that degenerative changes precede disc herniation remains a matter of debate. By definition, spinal disc herniation (SDH) refers to components of the gelatinous nucleus pulposus protruding beyond the dorsal level of the vertebral body margin through tears in the annulus fibrosus. Clinical presentation may include pain, paresis and sensory disturbances. Magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of SDH. In the majority of patients a conservative approach with physical therapy exercises and adequate analgesic and antiphlogistic medical treatment results in a substantial improvement of symptoms. PMID:25398570

  5. 3D-Printed ABS and PLA Scaffolds for Cartilage and Nucleus Pulposus Tissue Regeneration

    PubMed Central

    Rosenzweig, Derek H.; Carelli, Eric; Steffen, Thomas; Jarzem, Peter; Haglund, Lisbet

    2015-01-01

    Painful degeneration of soft tissues accounts for high socioeconomic costs. Tissue engineering aims to provide biomimetics recapitulating native tissues. Biocompatible thermoplastics for 3D printing can generate high-resolution structures resembling tissue extracellular matrix. Large-pore 3D-printed acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA) scaffolds were compared for cell ingrowth, viability, and tissue generation. Primary articular chondrocytes and nucleus pulposus (NP) cells were cultured on ABS and PLA scaffolds for three weeks. Both cell types proliferated well, showed high viability, and produced ample amounts of proteoglycan and collagen type II on both scaffolds. NP generated more matrix than chondrocytes; however, no difference was observed between scaffold types. Mechanical testing revealed sustained scaffold stability. This study demonstrates that chondrocytes and NP cells can proliferate on both ABS and PLA scaffolds printed with a simplistic, inexpensive desktop 3D printer. Moreover, NP cells produced more proteoglycan than chondrocytes, irrespective of thermoplastic type, indicating that cells maintain individual phenotype over the three-week culture period. Future scaffold designs covering larger pore sizes and better mimicking native tissue structure combined with more flexible or resorbable materials may provide implantable constructs with the proper structure, function, and cellularity necessary for potential cartilage and disc tissue repair in vivo. PMID:26151846

  6. A Well-Controlled Nucleus Pulposus Tissue Culture System with Injection Port for Evaluating Regenerative Therapies.

    PubMed

    Arkesteijn, Irene T M; Mouser, Vivian H M; Mwale, Fackson; van Dijk, Bart G M; Ito, Keita

    2016-05-01

    In vitro evaluation of nucleus pulposus (NP) tissue regeneration would be useful, but current systems for NP culture are not ideal for injections. The aim of this study was to develop a long-term culture system for NP tissue that allows injections of regenerative agents. Bovine caudal NPs were harvested and placed in the newly designed culture system. After equilibration of the tissue to 0.3 MPa the volume was fixed and the tissue was cultured for 28 days. The cell viability and extracellular matrix composition remained unchanged during the culture period and gene expression profiles were similar to those obtained in earlier studies. Furthermore, to test the responsiveness of bovine caudal NPs in the system, samples were cultured for 4 days and injected twice (day 1 and 3) with (1) PBS, (2) Link-N, for regeneration, and (3) TNF-α, for degeneration. It was shown that TNF-α increased COX2 gene expression, whereas no effect of Link-N was detected. In conclusion, the newly designed system allows long-term culture of NP tissue, wherein tissue reactions to injected stimulants can be observed. PMID:26294008

  7. Injectable hydrogel provides growth-permissive environment for human nucleus pulposus cells.

    PubMed

    Priyadarshani, Priyanka; Li, Yongchao; Yang, ShangYou; Yao, Li

    2016-02-01

    Degeneration of intervertebral discs (IVDs) results in an overall alteration of the biomechanics of the spinal column and becomes a major cause of low back pain. In this study, an injectable hydrogel composite is fabricated and characterized as a potential scaffold for the treatment of degenerated IVDs. Crosslinking of type II collagen-hyaluronic acid (HA) hydrogel with 1-ethyl-3(3-dimethyl aminopropyl) carbodiimide (EDC) increases the gel stability against collagenase digestion and reduces water uptake in comparison with non-crosslinked gel. Cell viability assay exhibits the proliferation of human nucleus pulposus (HNP) cells in hydrogels. The cells in non-crosslinked gel and the gel crosslinked with a low concentration of EDC (0.1 mM) show superior cell viability and morphology compared with cells in gels crosslinked with higher concentration of EDC. Quantitative PCR assay demonstrates the gene expression of extracellular matrix (ECM) by cells cultured in the gels. The expression of ECM genes by HNP cells in the gels demonstrated the phenotypic change of the cells. This study suggests that the type II collagen-HA hydrogel and crosslinked hydrogel (0.1 mM EDC) are permissive matrix for the growth of HNP cells and can be potentially applied in NP repair. PMID:26422588

  8. 3D-Printed ABS and PLA Scaffolds for Cartilage and Nucleus Pulposus Tissue Regeneration.

    PubMed

    Rosenzweig, Derek H; Carelli, Eric; Steffen, Thomas; Jarzem, Peter; Haglund, Lisbet

    2015-01-01

    Painful degeneration of soft tissues accounts for high socioeconomic costs. Tissue engineering aims to provide biomimetics recapitulating native tissues. Biocompatible thermoplastics for 3D printing can generate high-resolution structures resembling tissue extracellular matrix. Large-pore 3D-printed acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA) scaffolds were compared for cell ingrowth, viability, and tissue generation. Primary articular chondrocytes and nucleus pulposus (NP) cells were cultured on ABS and PLA scaffolds for three weeks. Both cell types proliferated well, showed high viability, and produced ample amounts of proteoglycan and collagen type II on both scaffolds. NP generated more matrix than chondrocytes; however, no difference was observed between scaffold types. Mechanical testing revealed sustained scaffold stability. This study demonstrates that chondrocytes and NP cells can proliferate on both ABS and PLA scaffolds printed with a simplistic, inexpensive desktop 3D printer. Moreover, NP cells produced more proteoglycan than chondrocytes, irrespective of thermoplastic type, indicating that cells maintain individual phenotype over the three-week culture period. Future scaffold designs covering larger pore sizes and better mimicking native tissue structure combined with more flexible or resorbable materials may provide implantable constructs with the proper structure, function, and cellularity necessary for potential cartilage and disc tissue repair in vivo. PMID:26151846

  9. Systematic study of cell isolation from bovine nucleus pulposus: Improving cell yield and experiment reliability.

    PubMed

    Lee, Juliana T Y; Cheung, Kenneth M C; Leung, Victor Y L

    2015-12-01

    Differences in matrix compositions in human nucleus pulposus (NP) clinical samples demand different cell isolation protocols for optimal results but there is no clear guide about this to date. Sub-optimal protocols may result in low cell yield, limited reliability of results or even failure of experiments. Cell yield, viability and attachment of cells isolated from bovine NP tissue with different protocols were estimated by cell counting, Trypan blue staining and cell culturing respectively. RNA was extracted from isolated cells and quantified by Nanodrop spectrometry and RT-qPCR. Higher collagenase concentration, longer digestion duration and pronase pre-treatment increased the cell yield. Cell viability remained high (<5% dead cells) even after 0.2% collagenase treatment for overnight. NP cells remained to have high ACAN, COL2A1, CDH2, KRT18, and KRT19 expression compared to muscle cells for different cell isolation conditions tested. Digestion by collagenase alone without the use of pronase could isolate cells from human degenerated NP tissue but clusters of cells were observed. We suggest the use of the disappearance of tissue as an indirect measure of cells released. This study provides a guide for researchers to decide the parameters involved in NP cell isolation for optimal outcome. PMID:26036782

  10. Characterization and mechanical performance study of silk/PVA cryogels: towards nucleus pulposus tissue engineering.

    PubMed

    Neo, Puay Yong; Shi, Pujiang; Goh, James Cho-Hong; Toh, Siew Lok

    2014-12-01

    Poly (vinyl) alcohol (PVA) cryogels are reported in the literature for application in nucleus pulposus (NP) replacement strategies. However, these studies are mainly limited to acellular approaches-in part due to the high hydrophilicity of PVA gels that renders cellular adhesion difficult. Silk is a versatile biomaterial with excellent biocompatibility. We hypothesize that the incorporation of silk with PVA will (i) improve the cell-hosting abilities of PVA cryogels and (ii) allow better tailoring of physical properties of the composite cryogels for an NP tissue engineering purpose. 5% (wt/vol) PVA is blended with 5% silk fibroin (wt/vol) to investigate the effect of silk : PVA ratios on the cryogels' physical properties. Results show that the addition of silk results in composite cryogels that are able to swell to more than 10 times its original dry weight and rehydrate to at least 70% of its original wet weight. Adding at least 20% silk significantly improves surface hydrophobicity and is correlated with an improvement in cell-hosting abilities. Cell-seeded cryogels also display an increment in compressive modulus and hoop stress values. In all, adding silk to PVA creates cryogels that can be potentially used as NP replacements. PMID:25329452

  11. Polyurethane scaffold with in situ swelling capacity for nucleus pulposus replacement.

    PubMed

    Li, Zhen; Lang, Gernot; Chen, Xu; Sacks, Hagit; Mantzur, Carmit; Tropp, Udi; Mader, Kerstin T; Smallwood, Thomas C; Sammon, Chris; Richards, R Geoff; Alini, Mauro; Grad, Sibylle

    2016-04-01

    Nucleus pulposus (NP) replacement offers a minimally invasive alternative to spinal fusion or total disc replacement for the treatment of intervertebral disc (IVD) degeneration. This study aimed to develop a cytocompatible NP replacement material, which is feasible for non-invasive delivery and tunable design, and allows immediate mechanical restoration of the IVD. A bi-phasic polyurethane scaffold was fabricated consisting of a core material with rapid swelling property and a flexible electrospun envelope. The scaffold was assessed in a bovine whole IVD organ culture model under dynamic load for 14 days. Nucleotomy was achieved by incision through the endplate without damaging the annulus fibrosus. After implantation of the scaffold and in situ swelling, the dynamic compressive stiffness and disc height were restored immediately. The scaffold also showed favorable cytocompatibility for native disc cells. Implantation of the scaffold in a partially nucleotomized IVD down-regulated catabolic gene expression, increased proteoglycan and type II collagen intensity and decreased type I collagen intensity in remaining NP tissue, indicating potential to retard degeneration and preserve the IVD cell phenotype. The scaffold can be delivered in a minimally invasive manner, and the geometry of the scaffold post-hydration is tunable by adjusting the core material, which allows individualized design. PMID:26828684

  12. Pain Behavior Changes Following Disc Puncture Relate to Nucleus Pulposus Rather than to the Disc Injury Per Se: An Experimental Study in Rats

    PubMed Central

    Nilsson, Elin; Nakamae, Toshio; Olmarker, Kjell

    2011-01-01

    It has previously been demonstrated that disc puncture in the rat induced changes in grooming and wet dog shakes, two behavioral changes that may be linked to discomfort and neuropathic pain. In this study the aim was to separate the effects of disc injury and the epidural presence of nucleus pulposus. Following anesthesia, the L4-5 disc was exposed using a dorsal approach. Ten rats received a superficial disc injury without nucleus pulposus leakage and ten rats received nucleus pulposus from a donor rat without disc injury. In ten animals the L4-5 disc was punctured using a ventral approach, with 10 corresponding controls. Spontaneous behavior was assessed after surgery. The data was matched to historical control of dorsal sham surgery and disc puncture. The study showed that the effects of nucleus pulposus were more pronounced than the effects induced by the disc injury. Ventral disc puncture did not induce any behavioral changes different from sham exposure. In conclusion, the data from the study indicate that behavioral changes induced by disc puncture are more likely to relate to the epidural presence of nucleus pulposus than the disc injury per se. PMID:21566734

  13. Nucleus pulposus phenotypic markers to determine stem cell differentiation: fact or fiction?

    PubMed Central

    Thorpe, Abbey A.; Binch, Abbie L.A.; Creemers, Laura B.; Sammon, Christopher; Le Maitre, Christine L.

    2016-01-01

    Progress in mesenchymal stem cell (MSC) based therapies for nucleus pulposus (NP) regeneration are hampered by a lack of understanding and consensus of the normal NP cell phenotype. Despite the recent consensus paper on NP markers, there is still a need to further validate proposed markers. This study aimed to determine whether an NP phenotypic profile could be identified within a large population of mature NP samples. qRT-PCR was conducted to assess mRNA expression of 13 genes within human non-degenerate articular chondrocytes (AC) (n=10) and NP cells extracted from patients across a spectrum of histological degeneration grades (n=71). qRT-PCR results were used to select NP marker candidates for protein expression analysis. Differential expression at mRNA between AC and non-degenerate NP cells was only observed for Paired Box Protein 1 (PAX1) and Forkhead box F1 (FOXF1). In contrast no other previously suggested markers displayed differential expression between non-degenerate NP and AC at mRNA level. PAX1 and FOXF1 protein expression was significantly higher in the NP compared to annulus fibrosus (AF), cartilaginous endplate (CEP) and AC. In contrast Laminin-5 (LAM-332), Keratin-19 (KRT-19) and Hypoxia Inducible Factor 1 alpha (HIF1α) showed no differential expression in NP cells compared with AC cells. A marker which exclusively differentiates NP cells from AF and AC cells remains to be identified, raising the question: is the NP a heterogeneous population of cells? Or does the natural biological variation during IVD development, degeneration state and even the life cycle of cells make finding one definitive marker impossible? PMID:26735178

  14. Expression of soluble Fas and soluble FasL in human nucleus pulposus cells.

    PubMed

    Sun, Zhen; Wan, Zhong-Yuan; Liu, Zhi-Heng; Guo, Yun-Shan; Yin, Jun-Bin; Duan, Chun-Guang; Gao, Yang; Li, Tao; Wang, Hai-Qiang; Luo, Zhuo-Jing

    2013-01-01

    The study aimed for addressing the expression of soluble Fas (sFas) and soluble Fas Ligand (sFasL) in human nucleus pulposus (NP) and its attendant relationship with disc degeneration. Human NP samples were collected from patients with disc degeneration and cadavers as degenerate and normal groups, respectively. Subsequently, NP cells were cultured in monolayer. ELISA was performed to identify the expression levels of sFas and sFasL in the supernatant of NP cell cultures in vitro. Quantitative real-time PCR was used to detect the expression of sFas and sFasL in human NP cells in mRNA solution. The study comprised 12 degenerate and 8 normal cadaveric NP samples. The concentration value of sFas in the supernatant was significantly higher from degenerate NP than that from normal NP at each time point. In contrast, sFasL was significantly lower at each time point. Moreover, the expression of sFas and sFasL reached the peak at various early stages of cell cultures and decreased thereafter. Furthermore, the mRNA level of Fas in degenerate NP cells was significantly higher than that in normal cells; whereas FasL showed an opposite pattern. The study is the first addressing the expression of sFas and sFasL in human NP cell cultures. Moreover, the expression of sFas and sFasL varies with culture time in vitro with different levels in degenerate and normal settings. These findings indicate that sFas and sFasL might play a role in intervertebral disc degeneration. PMID:23923075

  15. N-Cadherin-Mediated Signaling Regulates Cell Phenotype for Nucleus Pulposus Cells of the Intervertebral Disc

    PubMed Central

    Hwang, Priscilla Y.; Jing, Liufang; Michael, Keith W.; Richardson, William J.; Chen, Jun; Setton, Lori A.

    2015-01-01

    Juvenile nucleus pulposus (NP) cells of the intervertebral disc (IVD) are large, vacuolated cells that form cell clusters with strong cell–cell interactions. With maturation and aging, NP cells lose their ability to form these cell clusters, with aging-associated changes in NP cell phenotype, morphology, and proteoglycan synthesis that may contribute to IVD degeneration. Therefore, it is important to understand the mechanisms governing juvenile NP cell cluster behavior towards the goal of revealing factors that can promote juvenile, healthy NP cell phenotypes. N-cadherin has been identified as a cell–cell adhesion marker that is present in juvenile NP cells, but disappears with age. The goal of this study was to reveal the importance of N-cadherin in regulating cell–cell interactions in juvenile NP cell cluster formation and test for a regulatory role in maintaining a juvenile NP phenotype in vitro. Juvenile porcine IVD cells, of notochordal origin, were promoted to form cell clusters in vitro, and analyzed for preservation of the juvenile NP phenotype. Additionally, cadherin-blocking experiments were performed to prevent cluster formation in order to study the importance of cluster formation in NP cell signaling. Findings reveal N-cadherin-mediated cell–cell contacts promote cell clustering behavior and regulate NP cell matrix production and preservation of NP-specific markers. Inhibition of N-cadherin-mediated contacts resulted in loss of all features of the juvenile NP cell. These results establish a regulatory role for N-cadherin in juvenile NP cells, and suggest that preservation of the N-cadherin mediated cell–cell contact is important for preserving juvenile NP cell phenotype and morphology. PMID:25848407

  16. Decreased Zn(2+) Influx Underlies the Protective Role of Hypoxia in Rat Nucleus Pulposus Cells.

    PubMed

    Yin, Xiao-Fan; Jiang, Li-Bo; Ma, Yi-Qun; Xu, Jun; Gu, Hui-Jie; Wu, Xu-Hua; Li, Xi-Lei; Dong, Jian

    2015-11-01

    Zn(2+) is an essential component of metalloproteinases, and is required for their activity in cartilage; however, the effect of Zn(2+) on nucleus pulposus (NP) cells has not been widely investigated. The aim of this paper was to investigate the effect of intracellular Zn(2+) concentration ([Zn(2+)]i) in hypoxia-induced regulation of metalloproteinases (MMPs) and extracellular matrix (ECM) production in NP cells. NP cells from Sprague-Dawley (SD) rats were cultured as monolayers or in alginate beads. [Zn(2+)]i was assayed by FluoZin-3 AM staining. Alcian Blue staining, immunochemistry, 1,9-dimethylmethylene blue (DMMB) assay, and real-time PCR were used to assay collagen II, proteoglycan, and COL2A1, MMP-13, and ADAMTS-5 mRNA expression. ZIP8, a main Zn(2+) transporter in chondrocytes, was assayed by immunochemistry and in Western blotting. Interleukin (IL)-1β- and ZnCl2-induced increases of [Zn(2+)]i were significantly inhibited by hypoxia. Hypoxia did not reverse a decline of ECM expression caused by IL-1β and ZnCl2 in monolayer cultures, but did significantly attenuate the decreases of proteoglycan, glycosaminoglycan (GAG), and COL2A1 mRNA expression following IL-1β and ZnCl2 treatment in alginate bead cultures. However, ZnCl2 inhibited the protective effect of hypoxia. Both an intracellular Zn(2+) chelator and hypoxia prevented the increase in MMP-13 mRNA expression. IL-1β and ZnCl2 treatment increased ZIP8 expression in NP cells, and hypoxia inhibited ZIP8 expression. In conclusion, decrease of Zn(2+) influx mediates the protective role of hypoxia on ECM and MMP-13 expression. Consequently, changes in intracellular Zn(2+) concentration maybe involved in intervertebral disc degeneration. PMID:25910898

  17. Development of a bovine decellularized extracellular matrix-biomaterial for nucleus pulposus regeneration.

    PubMed

    Illien-Jünger, Svenja; Sedaghatpour, Dillon D; Laudier, Damien M; Hecht, Andrew C; Qureshi, Sheeraz A; Iatridis, James C

    2016-05-01

    Painful intervertebral disc (IVD) degeneration is a common cause for spinal surgery. There is a clinical need to develop injectable biomaterials capable of promoting IVD regeneration, yet many available biomaterials do not mimic the native extracellular matrix (ECM) or promote matrix production. This study aimed to develop a decellularized injectable bovine ECM material that maintains structural and compositional features of native tissue and promotes nucleus pulposus (NP) cell (NPC) and mesenchymal stem cell (MSC) adaption. Injectable decellularized ECM constructs were created using 3 NP tissue decellularization methods (con.A: sodium deoxycholate, con.B: sodium deoxycholate & sodium dodecyl sulfate, con.C: sodium deoxycholate, sodium dodecyl sulfate & TritonX-100) and evaluated for protein, microstructure, and for cell adaptation in 21 day human NPC and MSC culture experiments. Con.A was most efficient at DNA depletion, preserved best collagen microstructure and content, and maintained the highest glycosaminoglycan (GAG) content. NPCs in decellularized constructs of con.A&B demonstrated newly synthesized GAG production, which was apparent from "halos" of GAG staining surrounding seeded NPCs. Con.A also promoted MSC adaption with high cell viability and ECM production. The injectable decellularized NP biomaterial that used sodium deoxycholate without additional decellularization steps maintained native NP tissue structure and composition closest to natural ECM and promoted cellular adaptation of NP cells and MSCs. This natural decellularized biomaterial warrants further investigation for its potential as an injectable cell seeded supplement to augment NP replacement biomaterials and deliver NPCs or MSCs. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:876-888, 2016. PMID:26509556

  18. 3D segmentation of annulus fibrosus and nucleus pulposus from T2-weighted magnetic resonance images

    NASA Astrophysics Data System (ADS)

    Castro-Mateos, Isaac; Pozo, Jose M.; Eltes, Peter E.; Del Rio, Luis; Lazary, Aron; Frangi, Alejandro F.

    2014-12-01

    Computational medicine aims at employing personalised computational models in diagnosis and treatment planning. The use of such models to help physicians in finding the best treatment for low back pain (LBP) is becoming popular. One of the challenges of creating such models is to derive patient-specific anatomical and tissue models of the lumbar intervertebral discs (IVDs), as a prior step. This article presents a segmentation scheme that obtains accurate results irrespective of the degree of IVD degeneration, including pathological discs with protrusion or herniation. The segmentation algorithm, employing a novel feature selector, iteratively deforms an initial shape, which is projected into a statistical shape model space at first and then, into a B-Spline space to improve accuracy. The method was tested on a MR dataset of 59 patients suffering from LBP. The images follow a standard T2-weighted protocol in coronal and sagittal acquisitions. These two image volumes were fused in order to overcome large inter-slice spacing. The agreement between expert-delineated structures, used here as gold-standard, and our automatic segmentation was evaluated using Dice Similarity Index and surface-to-surface distances, obtaining a mean error of 0.68 mm in the annulus segmentation and 1.88 mm in the nucleus, which are the best results with respect to the image resolution in the current literature.

  19. The chemical morphology of age-related changes in human intervertebral disc glycosaminoglycans from cervical, thoracic and lumbar nucleus pulposus and annulus fibrosus.

    PubMed Central

    Scott, J E; Bosworth, T R; Cribb, A M; Taylor, J R

    1994-01-01

    Hyaluronan (HA), chondroitin and keratan sulphates (CS, KS), collagen and dry weights were measured in the annulus fibrosus and nucleus pulposus of human cervical, thoracic and lumbar intervertebral discs aged 36-79 y. Alcian blue-critical electrolyte concentration (CEC) staining of sections extended the results. The collagen, total polyanion, HA, CS and KS contents of the nucleus pulposus and annulus fibrosus were plotted for all 3 regions against age. Regional differences and age-related trends were found. For regional differences, the collagen content of the nucleus pulposus was highest in cervical discs and lowest in lumbar discs. In contrast, the total polyanion content of the nucleus pulposus was highest in lumbar discs and lowest in cervical discs. These differences were seen in fetal and adult discs. With respect to age-related trends, the collagen content of the annulus fibrosus was higher in adults and children than in neonates and infants. The collagen content of the nucleus pulposus increased with age in thoracic and lumbar discs, but it was consistently high in cervical discs. There was generally a downward trend of total polyanion and CS with increase in age. This was quite consistent for the annulus fibrosus in all regions and there were dramatic decreases in the lumbar nucleus pulposus in all adults compared with infants and children. These trends were least evident in the cervical nucleus pulposus where infant values were low. CS changes correlated with water content. HA and KS increased in all discs with increasing maturity. Oversulphated KS, absent from fetal discs, reached mature levels by 10 y. Many of the changes occurred before maturity. Glycosaminoglycan (GAG) levels correlated with increasing compressive loads. Higher collagen levels in the cervical nucleus pulposus correlated with greater ranges of torsional and shearing strains in cervical discs. High GAG levels in cervical annulus fibrosus probably facilitate lamellar movements during

  20. Inflammatory Kinetics and Efficacy of Anti-inflammatory Treatments on Human Nucleus Pulposus Cells

    PubMed Central

    Walter, Benjamin A; Purmessur, Devina; Likhitpanichkul, Morakot; Weinberg, Alan; Cho, Samuel K.; Qureshi, Sheeraz A.; Hecht, Andrew C.; Iatridis, James C.

    2015-01-01

    Study Design Human nucleus pulposus (NP) cell culture study investigating response to tumor necrosis factor-α (TNFα), effectiveness of clinically available anti-inflammatory drugs, and interactions between pro-inflammatory cytokines. Objective To characterize the kinetic response of pro-inflammatory cytokines released by human NP cells to TNFα stimulation and the effectiveness of multiple anti-inflammatories with 3 sub-studies: Timecourse, Same-time blocking, Delayed blocking. Summary of Background Data Chronic inflammation is a key component of painful intervertebral disc (IVD) degeneration. Improved efficacy of anti-inflammatories requires better understanding of how quickly NP cells produce pro-inflammatory cytokines and which pro-inflammatory mediators are most therapeutically advantageous to target. Methods Degenerated human NP cells (n=10) were cultured in alginate with or without TNFα (10ng/mL). Cells were incubated with one of four anti-inflammatories (anti-IL-6 receptor/atlizumab, IL-1 receptor anatagonist, anti-TNFα/infliximab and sodium pentosan polysulfate/PPS) in two blocking-studies designed to determine how intervention timing influences drug efficacy. Cell viability, protein and gene expression for IL-1β, IL-6 & IL-8 were assessed. Results Timecourse: TNFα substantially increased the amount of IL-6, IL-8 & IL-1β, with IL-1β and IL-8 reaching equilibrium within ~72 hours (IL-1β: 111±40pg/mL, IL-8: 8478±957pg/mL), and IL-6 not reaching steady state after 144 hours (1570±435 pg/mL). Anti-TNFα treatment was most effective at reducing the expression of all cytokines measured when added at the same time as TNFα stimulation. Similar trends were observed when drugs were added 72 hours after TNFα stimulation, however, no anti-inflammatories significantly reduced cytokine levels compared to TNF control. Conclusion IL-1β, IL-6 and IL-8 were expressed at different rates and magnitudes suggesting different roles for these cytokines in disease

  1. Regenerative and Immunogenic Characteristics of Cultured Nucleus Pulposus Cells from Human Cervical Intervertebral Discs

    PubMed Central

    Stich, Stefan; Stolk, Meaghan; Girod, Pierre Pascal; Thomé, Claudius; Sittinger, Michael; Ringe, Jochen; Seifert, Martina; Hegewald, Aldemar Andres

    2015-01-01

    Cell-based regenerative approaches have been suggested as primary or adjuvant procedures for the treatment of degenerated intervertebral disc (IVD) diseases. Our aim was to evaluate the regenerative and immunogenic properties of mildly and severely degenerated cervical nucleus pulposus (NP) cells with regard to cell isolation, proliferation and differentiation, as well as to cell surface markers and co-cultures with autologous or allogeneic peripheral blood mononuclear cells (PBMC) including changes in their immunogenic properties after 3-dimensional (3D)-culture. Tissue from the NP compartment of 10 patients with mild or severe grades of IVD degeneration was collected. Cells were isolated, expanded with and without basic fibroblast growth factor and cultured in 3D fibrin/poly (lactic-co-glycolic) acid transplants for 21 days. Real-time reverse-transcription polymerase chain reaction (RT-PCR) showed the expression of characteristic NP markers ACAN, COL1A1 and COL2A1 in 2D- and 3D-culture with degeneration- and culture-dependent differences. In a 5,6-carboxyfluorescein diacetate N-succinimidyl ester-based proliferation assay, NP cells in monolayer, regardless of their grade of degeneration, did not provoke a significant proliferation response in T cells, natural killer (NK) cells or B cells, not only with donor PBMC, but also with allogeneic PBMC. In conjunction with low inflammatory cytokine expression, analyzed by Cytometric Bead Array and fluorescence-activated cell sorting (FACS), a low immunogenicity can be assumed, facilitating possible therapeutic approaches. In 3D-culture, however, we found elevated immune cell proliferation levels, and there was a general trend to higher responses for NP cells from severely degenerated IVD tissue. This emphasizes the importance of considering the specific immunological alterations when including biomaterials in a therapeutic concept. The overall expression of Fas receptor, found on cultured NP cells, could have

  2. Effect of High Glucose on Stress-Induced Senescence of Nucleus Pulposus Cells of Adult Rats

    PubMed Central

    Kong, Jae-Gwan; Lee, Donghwan; Park, Eun-Young

    2015-01-01

    Study Design In vitro cell culture model. Purpose We investigated the effect of diabetes mellitus (DM) on senescence of adult nucleus pulposus (NP) cells. Overview of Literature DM is a major public health issue worldwide, especially adult-onset (type 2) DM. DM is also thought to be an important etiological factor in disc degeneration. Hyperglycemia is considered to be a major causative factor in the development of DM-associated diseases through senescence. However, little is known about the effects of DM on senescence in adult NP cells. Methods Adult NP cells were isolated from 24-week-old rats, cultured, and placed in either 10% fetal bovine serum (FBS, normal control) and 10% FBS plus two different high glucose concentrations (0.1 M or 0.2 M; experimental conditions) for 1 or 3 days. We identified and quantified the occurrence of senescence in adult rat NP cells using senescence-associated-beta-galactosidase (SA-β-Gal) staining. We also investigated the expression of proteins related to the replicative senescence (p53-p21-pRB) and stress-induced premature senescence (p16-pRB) pathways. Results The mean SA-β-Gal-positive percentage was increased in adult rat NP cells treated with high glucose in a dose- and time-dependent manner. Both high glucose levels increased the expression of p16 and pRB proteins in adult rat NP cells. However, the levels of p53 and p21 proteins were decreased in adult rat NP cells treated with both high glucose concentrations. Conclusions The current study demonstrated that high glucose accelerated stress-induced senescence in adult rat NP cells in a dose- and time-dependent manner. Accelerated stress-induced senescence in adult NP cells could be an emerging risk factor for intervertebral disc degeneration in older patients with DM. These results suggest that strict blood glucose control is important in prevent or delaying intervertebral disc degeneration in older patients with DM. PMID:25901224

  3. The three-dimensional architecture of the notochordal nucleus pulposus: novel observations on cell structures in the canine intervertebral disc

    PubMed Central

    Hunter, Christopher J; Matyas, John R; Duncan, Neil A

    2003-01-01

    Cells from the nucleus pulposus of young (< 2 years) and old (> 5 years) non-chondrodystrophoid dogs were studied using routine histology, confocal laser scanning microscopy and transmission electron microscopy. The architecture of cell structures – from the tissue scale down to subcellular scale – was reported. Clusters of notochordal cells were observed in young nuclei pulposi, ranging from 10 to 426 cells each. These clusters resisted mechanical disruption and showed evidence of cell–cell signalling via gap junctions. Cells (30–40 µm in diameter) within the clusters had a physaliferous appearance, containing numerous large inclusions which ranged from 1 to 20 µm in diameter. The inclusions were surrounded by a dense actin cortex but were not contained by a lipid bilayer. The contents of the inclusions were determined not to be predominantly carbohydrate or neutral lipid as assessed by histochemical staining, but the exact composition of the contents remained uncertain. There were striking differences in the cell architecture of young vs. old nuclei pulposi, with a loss of both cell clusters and physaliferous cells during ageing. These observations demonstrate unique cell structures, which may influence our understanding of the differences between notochordal and chondrocytic cells in the nucleus pulposus. Such differences could have substantial impact upon how we think about development, degeneration and repair of the intervertebral disc. PMID:12713268

  4. Regeneration of nucleus pulposus tissue in an ovine intervertebral disc degeneration model by cell-free resorbable polymer scaffolds.

    PubMed

    Woiciechowsky, Christian; Abbushi, Alexander; Zenclussen, Maria L; Casalis, Pablo; Krüger, Jan Philipp; Freymann, Undine; Endres, Michaela; Kaps, Christian

    2014-10-01

    Degeneration of intervertebral discs (IVDs) occurs frequently and is often associated with lower back pain. Recent treatment options are limited and treat the symptoms rather than regenerate the degenerated disc. Cell-free, freeze-dried resorbable polyglycolic acid (PGA)-hyaluronan implants were used in an ovine IVD degeneration model. The nucleus pulposus of the IVD was partially removed, endoscopically. PGA-hyaluronan implants were immersed in autologous sheep serum and implanted into the disc defect. Animals with nucleotomy only served as controls. The T2-weighted/fat suppression sequence signal intensity index of the operated discs, as assessed by magnetic resonance imaging (MRI), showed that implantation of the PGA-hyaluronan implant improved (p = 0.0066) the MRI signal compared to controls at 6 months after surgery. Histological analysis by haematoxylin and eosin and safranin O staining showed the ingrowth of cells with typical chondrocytic morphology, even cell distribution, and extracellular matrix rich in proteoglycan. Histomorphometric analyses confirmed that the implantation of the PGA-hyaluronan scaffolds improved (p = 0.027) the formation of regenerated tissue after nucleotomy. Disc heights remained stable in discs with nucleotomy only as well as after implantation of the implant. In conclusion, implantation of cell-free polymer-based implants after nucleotomy induces nucleus pulposus tissue regeneration and improves disc water content in the ovine model. PMID:22865642

  5. PKCε signalling activates ERK1/2, and regulates aggrecan, ADAMTS5, and miR377 gene expression in human nucleus pulposus cells.

    PubMed

    Tsirimonaki, Emmanouella; Fedonidis, Constantinos; Pneumaticos, Spiros G; Tragas, Adamantios A; Michalopoulos, Ioannis; Mangoura, Dimitra

    2013-01-01

    The protein kinase C (PKC) signaling, a major regulator of chondrocytic differentiation, has been also implicated in pathological extracellular matrix remodeling, and here we investigate the mechanism of PKCε-dependent regulation of the chondrocytic phenotype in human nucleus pulposus (NP) cells derived from herniated disks. NP cells from each donor were successfully propagated for 25+ culture passages, with remarkable tolerance to repeated freeze-and-thaw cycles throughout long-term culturing. More specifically, after an initial downregulation of COL2A1, a stable chondrocytic phenotype was attested by the levels of mRNA expression for aggrecan, biglycan, fibromodulin, and lumican, while higher expression of SOX-trio and Patched-1 witnessed further differentiation potential. NP cells in culture also exhibited a stable molecular profile of PKC isoforms: throughout patient samples and passages, mRNAs for PKC α, δ, ε, ζ, η, ι, and µ were steadily detected, whereas β, γ, and θ were not. Focusing on the signalling of PKCε, an isoform that may confer protection against degeneration, we found that activation with the PKCε-specific activator small peptide ψεRACK led sequentially to a prolonged activation of ERK1/2, increased abundance of the early gene products ATF, CREB1, and Fos with concurrent silencing of transcription for Ki67, and increases in mRNA expression for aggrecan. More importantly, ψεRACK induced upregulation of hsa-miR-377 expression, coupled to decreases in ADAMTS5 and cleaved aggrecan. Therefore, PKCε activation in late passage NP cells may represent a molecular basis for aggrecan availability, as part of an PKCε/ERK/CREB/AP-1-dependent transcriptional program that includes upregulation of both chondrogenic genes and microRNAs. Moreover, this pathway should be considered as a target for understanding the molecular mechanism of IVD degeneration and for therapeutic restoration of degenerated disks. PMID:24312401

  6. PKCε Signalling Activates ERK1/2, and Regulates Aggrecan, ADAMTS5, and miR377 Gene Expression in Human Nucleus Pulposus Cells

    PubMed Central

    Pneumaticos, Spiros G.; Tragas, Adamantios A.; Michalopoulos, Ioannis; Mangoura, Dimitra

    2013-01-01

    The protein kinase C (PKC) signaling, a major regulator of chondrocytic differentiation, has been also implicated in pathological extracellular matrix remodeling, and here we investigate the mechanism of PKCε-dependent regulation of the chondrocytic phenotype in human nucleus pulposus (NP) cells derived from herniated disks. NP cells from each donor were successfully propagated for 25+ culture passages, with remarkable tolerance to repeated freeze-and-thaw cycles throughout long-term culturing. More specifically, after an initial downregulation of COL2A1, a stable chondrocytic phenotype was attested by the levels of mRNA expression for aggrecan, biglycan, fibromodulin, and lumican, while higher expression of SOX-trio and Patched-1 witnessed further differentiation potential. NP cells in culture also exhibited a stable molecular profile of PKC isoforms: throughout patient samples and passages, mRNAs for PKC α, δ, ε, ζ, η, ι, and µ were steadily detected, whereas β, γ, and θ were not. Focusing on the signalling of PKCε, an isoform that may confer protection against degeneration, we found that activation with the PKCε-specific activator small peptide ψεRACK led sequentially to a prolonged activation of ERK1/2, increased abundance of the early gene products ATF, CREB1, and Fos with concurrent silencing of transcription for Ki67, and increases in mRNA expression for aggrecan. More importantly, ψεRACK induced upregulation of hsa-miR-377 expression, coupled to decreases in ADAMTS5 and cleaved aggrecan. Therefore, PKCε activation in late passage NP cells may represent a molecular basis for aggrecan availability, as part of an PKCε/ERK/CREB/AP-1-dependent transcriptional program that includes upregulation of both chondrogenic genes and microRNAs. Moreover, this pathway should be considered as a target for understanding the molecular mechanism of IVD degeneration and for therapeutic restoration of degenerated disks. PMID:24312401

  7. Differential expression of extracellular-signal-regulated kinase 5 (ERK5) in normal and degenerated human nucleus pulposus tissues and cells

    SciTech Connect

    Liang, Weiguo; Fang, Dejian; Ye, Dongping; Zou, Longqiang; Shen, Yan; Dai, Libing; Xu, Jiake

    2014-07-11

    Highlights: • ERK5 involved in NP cells. • ERK5 involved in NP tissue. • It was important modulator. - Abstract: Extracellular-signal-regulated kinase 5 (ERK5) is a member of the mitogen-activated protein kinase (MAPK) family and regulates a wide variety of cellular processes such as proliferation, differentiation, necrosis, apoptosis and degeneration. However, the expression of ERK5 and its role in degenerated human nucleus pulposus (NP) is hitherto unknown. In this study, we observed the differential expression of ERK5 in normal and degenerated human nucleus pulposus tissues by using immunohistochemical staining and Western blot. Treatment of NP cells with Pro-inflammatory cytokine, TNF-α decreased ERK5 gene expression as well as NP marker gene expression; including the type II collagen and aggrecan. Suppression of ERK5 gene expression in NP cells by ERK5 siRNA resulted in decreased gene expression of type II collagen and aggrecan. Furthermore, inhibition of ERK5 activation by BIX02188 (5 μM) decreased the gene expression of type II collagen and aggrecan in NP cells. Our results document the expression of ERK5 in degenerated nucleus pulposus tissues, and suggest a potential involvement of ERK5 in human degenerated nucleus pulposus.

  8. A prospective comparison of computed tomography and myelography in the diagnosis of herniated lumbar disks

    SciTech Connect

    Haughton, V.M.; Eldevik, O.P.; Magnaes, B.; Amundsen, P.

    1982-01-01

    Although CT effectively demonstrates normal and herniated intervetebral disks, the value of CT in low back pain has not been adequately evaluated. We compared CT prospectively with myelography in 107 patients referred to Ulleval Hospital Department of Radiology for myelography. Fifty-two patients subsequently had spinal explorations, one patient twice during the stud and two patients at two levels. Forty-six CT and 44 myelographic diagnoses agreed perfectly wth the operative diagnosis at that level. In 30 disk herniations, there were 29 true-positive CT diagnoses and 38 true-positive myelographic diagnoses. False-negative diagnoses of herniated nucleus pulposus were made twice on myelography and once on CT. In 24 other spinal operations, there were eight false-positive CT and nine false-positive myelographic diagnoses of herniated nucleus pulposus. CT demonstrates lumbar disk disease as effectively as myelography.

  9. Understanding nucleus pulposus cell phenotype: A prerequisite for stem cell based therapies to treat intervertebral disc degeneration

    PubMed Central

    Choi, Hyowon; Johnson, Zariel I.; Risbud, Makarand V.

    2015-01-01

    Intervertebral disc (IVD) degeneration and associated low back pain (LBP) remains a major burden to our society without a significant improvement in treatment strategies or patient’s quality of life. While the recent cell-transplantation studies for treatment of degenerative disc disease showed promising results, to better gauge the success and functional outcomes of these therapies, it is crucial to understand if transplanted cells give rise to healthy nucleus pulposus (NP) tissue. NP cell phenotype is unique and is defined by expression of a characteristic set of markers that reflect their specialized physiology and function. This review summarizes phenotypic markers that mirror unique physiology and function of NP cells and their progenitors and should be considered to measure outcomes of cell-based therapies to treat disc degeneration. PMID:25584906

  10. [Progress on the cause and mechanism of a separation of clinical symptoms and signs and imaging features in lumbar disk herniation].

    PubMed

    Hu, Xing-xin; Liu, Li-min

    2015-10-01

    A few of patients with lumbar disk herniation having a separation of clinical symptoms and signs and imaging features, can be found in clinic, but the traditional theory of direct mechanical compression of nerve roots by herniated nucleus pulposus can't be used to explain this abnormal protrusion of lumbar intervertebral disc. The clinical symptoms and signs of the atypical lumbar disk herniation are affected by multiple factors. The indirect mechanical compression and distraction effect of spinal nerve roots may play an important role in the occurrence of the separation, and the appearance of abnormal clinical symptoms and signs is closely related to the migration of herniated nucleus pulposus tissue, transmission of injury information in the nervous system, and the complex interactions among the nucleus pulposus, dural sac and nerve roots. Moreover,the changes of microcirculation and inflammation secondary to the herniated nucleus pulposus tissue, the hyperosteogeny in the corresponding segment of the lumbar vertebrae and the posture changes all results in a diversity of symptoms and signs in patients with lumbar intervertebral disc herniation. Besides, there exist congenital variation of lumbosacral nerve roots and vertebral bodies in some patients, and the misdiagnosis or missed diagnosis of imaging finding may occur in some cases. However, the appearance of a separation of clinical symptoms and signs and imaging examination in patients may be caused by a variety of reasons in clinic. The exact mechanism involved in the interaction among nucleus pulposus tissue, dural sac and nerve root, secondary changes of pathophysiology and biomechanics around the nucleus pulposus, the determination of lesioned responsible segments, and how to overcome the limitations of imaging all need the further researches. PMID:26727796

  11. Osthole, a herbal compound, alleviates nucleus pulposus-evoked nociceptive responses through the suppression of overexpression of acid-sensing ion channel 3 (ASIC3) in rat dorsal root ganglion

    PubMed Central

    He, Qiu-Lan; Chen, Yuling; Qin, Jian; Mo, Sui-Lin; Wei, Ming; Zhang, Jin-Jun; Li, Mei-Na; Zou, Xue-Nong; Zhou, Shu-Feng; Chen, Xiao-Wu; Sun, Lai-Bao

    2012-01-01

    Summary Background Osthole (Ost), a natural coumarin derivative, has been shown to inhibit many pro-inflammatory mediators and block voltage-gated Na+ channels. During inflammation, acidosis is an important pain inducer which activates nociceptors by gating depolarizing cationic channels, such as acid-sensing ion channel 3 (ASIC3). The aim of this study was to examine the effects of Ost on nucleus pulposus-evoked nociceptive responses and ASIC3 over-expression in the rat dorsal root ganglion, and to investigate the possible mechanism. Material/Methods Radicular pain was generated with application of nucleus pulposus (NP) to nerve root. Mechanical allodynia was evaluated using von Frey filaments with logarithmically incremental rigidity to calculate the 50% probability thresholds for mechanical paw withdrawal. ASIC3 protein expression in dorsal root ganglions (DRGs) was assessed with Western blot and immunohistochemistry. Membrane potential (MP) shift of DRG neurons induced by ASIC3-sensitive acid (pH6.5) was determined by DiBAC4 (3) fluorescence intensity (F.I.). Results The NP-evoked mechanical hyperalgesia model showed allodynia for 3 weeks, and ASIC3 expression was up-regulated in DRG neurons, reaching peak on Day 7. Epidural administration of Ost induced a remarkable and prolonged antinociceptive effect, accompanied by an inhibition of over-expressed ASIC3 protein and of abnormal shift of MP. Amiloride (Ami), an antagonist of ASIC3, strengthened the antinociceptive effect of Ost. Conclusions Up-regulation of ASIC3 expression may be associated with NP-evoked mechanical hyperalgesia. A single epidural injection of Ost decreased ASIC3 expression in DGR neurons and the pain in the NP-evoked mechanical hyperalgesia model. Osthole may be of great benefit for preventing chronic pain status often seen in lumbar disc herniation (LDH). PMID:22648244

  12. Construction of a tissue engineered intervertebral disc with high biological activity using an allogeneic intervertebral disc supplemented with transfected nucleus pulposus cells expressing exogenous dopamine beta-hydroxylase.

    PubMed

    Bai, M; Wang, Y H; Yin, H P; Li, S W

    2015-01-01

    This study addressed the in vitro construction and biological activity of tissue engineered intervertebral discs with exogenous human dopamine beta-hydroxylase (DBH) nucleus pulposus cells. pSNAV2.0-DBH expression plasmids were utilized to enhance the survival rates of intervertebral disc tissue cells. Various concentrations of transfected nucleus pulposus cells were injected into the discs, and DBH mRNA expression was determined using polymerase chain reaction amplification. Polysaccharide content and total collagen protein content in the engineered disc nucleus pulposus tissue were determined. The visible fluorescence intensities of the 1 x 10(5) and 1 x 10(6) groups vs the 1 x 10(4) group were significantly increased (P < 0.05); no significant difference was observed between the 1 x 10(5) and 1 x 10(6) groups (P > 0.05) at 7 days after injection. DBH mRNA expression could be detected in the all but the EGFP control group at 14 days culture. No significant difference was observed in the protein content between the 1 x 10(4) and the control groups at various times, while the protein content was significantly higher in the 1 x 10(5) vs the control and the 1 x 10(4) groups at 7-, 14-, and 21-day cultures. These results demonstrate that a tissue engineered intervertebral disc with high biological activity can be constructed by utilizing allogeneic intervertebral discs stored in liquid nitrogen and a 1 x 10(5) transfected nucleus pulposus cell complex with in vitro culture for 14 days. This model can be used in animal experiments to study the biological activity of the engineered discs. PMID:26400296

  13. Nucleus pulposus cells expressing hBMP7 can prevent the degeneration of allogenic IVD in a canine transplantation model.

    PubMed

    Chaofeng, Wang; Chao, Zhang; Deli, Wang; Jianhong, Wu; Yan, Zhang; Cheng, Xu; Hongkui, Xin; Qing, He; Dike, Ruan

    2013-09-01

    We have previously explored the possibilities of allogenic intervertebral disc (IVD) curing disc degeneration disease in clinical practice. The results showed that the motion and stability of the spinal unit was preserved after transplantation of allogenic IVD in human beings at 5-year follow-up. However, mild degeneration was observed in the allogenic transplanted IVD cases. In this study, we construct the biological tissue engineering IVD by injecting the nucleus pulposus cells (NPCs) expressing human bone morphogenetic protein 7 (hBMP7) into cryopreserved IVD, and transplant the biological tissue engineering IVD into a beagle dog to investigate whether NPCs expressing hBMP7 could prevent the degeneration of the transplanted allogenic IVDs. At 24 weeks after transplantation, MRI scan showed that IVD allografts injected NPCs expressing hBMP7 have a slighter signs of degeneration than IVD allografts with NPCs or without NPCs. The range of motion of left-right rotation in the group without NPCs was bigger than that of two cells injection group. PKH-26-labeled cells were identified at IVD allograft. The study demonstrated that NPCs expressing hBMP7 could survive at least 24 weeks and prevent the degeneration of the transplanted IVD. This solution might have a potential role in preventing the IVD allograft degeneration in long time follow-up. PMID:23580474

  14. Composite hydrogel of chitosan-poly(hydroxybutyrate-co-valerate) with chondroitin sulfate nanoparticles for nucleus pulposus tissue engineering.

    PubMed

    Nair, Manitha B; Baranwal, Gaurav; Vijayan, Prajuna; Keyan, Kripa S; Jayakumar, R

    2015-12-01

    Intervertebral disc degeneration, occurring mainly in nucleus pulposus (NP), is a leading cause of low back pain. In seeking to mitigate this condition, investigators in the field of NP tissue engineering have increasingly studied the use of hydrogels. However, these hydrogels should possess appropriate mechanical strength and swelling pressure, and concurrently support the proliferation of chondrocyte-like cells. The objective of this study was to develop and validate a composite hydrogel for NP tissue engineering, made of chitosan-poly(hydroxybutyrate-co-valerate) (CP) with chondroitin sulfate (CS) nanoparticles, without using a cross linker. The water uptake ability, as well as the viscoelastic properties of this composite hydrogel, was similar to native tissue, as reflected in the complex shear modulus and stress relaxation values. The hydrogel could withstand varying stress corresponding to daily activities like lying down (0.01 MPa), sitting (0.5 MPa) and standing (1.0 MPa) under dynamic conditions. The hydrogels were stable in PBS for 2 weeks and its stiffness, elastic and viscous modulus did not alter significantly during this period. Both CP and CP-CS hydrogels could assist the viability and adhesion of adipose derived rat mesenchymal stem cells (ADMSCs). The viability and chondrogenic differentiation of MSCs was significantly enhanced in presence of CS nanoparticles. Thus, CS nanoparticles-incorporated chitosan-PHBV hydrogels offer great potential for NP tissue engineering. PMID:26363270

  15. N-cadherin is Key to Expression of the Nucleus Pulposus Cell Phenotype under Selective Substrate Culture Conditions

    PubMed Central

    Hwang, Priscilla Y; Jing, Liufang; Chen, Jun; Lim, Foon-Lian; Tang, Ruhang; Choi, Hyowon; Cheung, Kenneth M; Risbud, Makarand V; Gersbach, Charles A; Guilak, Farshid; Leung, Victor Y; Setton, Lori A

    2016-01-01

    Nucleus pulposus (NP) cells of the intervertebral disc are essential for synthesizing extracellular matrix that contributes to disc health and mechanical function. NP cells have a unique morphology and molecular expression pattern derived from their notochordal origin, and reside in N-cadherin (CDH2) positive cell clusters in vivo. With disc degeneration, NP cells undergo morphologic and phenotypic changes including loss of CDH2 expression and ability to form cell clusters. Here, we investigate the role of CDH2 positive cell clusters in preserving healthy, biosynthetically active NP cells. Using a laminin-functionalized hydrogel system designed to mimic features of the native NP microenvironment, we demonstrate NP cell phenotype and morphology is preserved only when NP cells form CDH2 positive cell clusters. Knockdown (CRISPRi) or blocking CDH2 expression in vitro and in vivo results in loss of a healthy NP cell. Findings also reveal that degenerate human NP cells that are CDH2 negative can be promoted to re-express CDH2 and healthy, juvenile NP matrix synthesis patterns by promoting cell clustering for controlled microenvironment conditions. This work also identifies CDH2 interactions with β-catenin-regulated signaling as one mechanism by which CDH2-mediated cell interactions can control NP cell phenotype and biosynthesis towards maintenance of healthy intervertebral disc tissues. PMID:27292569

  16. In situ forming hydrogels composed of oxidized high molecular weight hyaluronic acid and gelatin for nucleus pulposus regeneration.

    PubMed

    Chen, Yu-Chun; Su, Wen-Yu; Yang, Shu-Hua; Gefen, Amit; Lin, Feng-Huei

    2013-02-01

    Encapsulation of nucleus pulposus (NP) cells within in situ forming hydrogels is a novel biological treatment for early stage intervertebral disc degeneration. The procedure aims to prolong the life of the degenerating discs and to regenerate damaged tissue. In this study we developed an injectable oxidized hyaluronic acid-gelatin-adipic acid dihydrazide (oxi-HAG-ADH) hydrogel. High molecular weight (1900 kDa) hyaluronic acid was crosslinked with various concentrations of gelatin to synthesize the hydrogels and their viscoelastic properties were analyzed. Interactions between the hydrogels, NP cells, and the extracellular matrix (ECM) were also evaluated, as were the effects of the hydrogels on NP cell gene expression. The hydrogels possess several clinical advantages, including sterilizability, low viscosity for injection, and ease of use. The viscoelastic properties of the hydrogels were similar to native tissue, as reflected in the complex shear modulus (∼11-14 kPa for hydrogels, 11.3 kPa for native NP). Cultured NP cells not only attached to the hydrogels but also survived, proliferated, and maintained their round morphology. Importantly, we found that hydrogels increased NP cell expression of several crucial ECM-related genes, such as COL2A1, AGN, SOX-9, and HIF-1A. PMID:23041783

  17. Mesenchymal stem cells regulate mechanical properties of human degenerated nucleus pulposus cells through SDF-1/CXCR4/AKT axis.

    PubMed

    Liu, Ming-Han; Bian, Bai-Shi-Jiao; Cui, Xiang; Liu, Lan-Tao; Liu, Huan; Huang, Bo; Cui, You-Hong; Bian, Xiu-Wu; Zhou, Yue

    2016-08-01

    Transplantation of mesenchymal stem cells (MSCs) into the degenerated intervertebral disc (IVD) has shown promise for decelerating or arresting IVD degeneration. Cellular mechanical properties play crucial roles in regulating cell-matrix interactions, potentially reflecting specific changes that occur based on cellular phenotype and behavior. However, the effect of co-culturing of MSCs with nucleus pulposus cells (NPCs) on the mechanical properties of NPCs remains unknown. In our study, we demonstrated that co-culture of degenerated NPCs with MSCs resulted in significantly decreased mechanical moduli (elastic modulus, relaxed modulus, and instantaneous modulus) and increased biological activity (proliferation and expression of matrix genes) in degenerated NPCs, but not normal NPCs. SDF-1, CXCR4 ligand, was highly expressed in MSCs when co-cultured with degenerated NPCs. Inhibition of SDF-1 using CXCR4 antagonist AMD3100 or knocking-down CXCR4 in degenerated NPCs abolished the MSCs-induced decrease in the mechanical moduli and increased biological activity of degenerated NPCs, suggesting a crucial role for SDF-1/CXCR4 signaling. AKT and FAK inhibition attenuated the MSCs- or SDF-1-induced decrease in the mechanical moduli of degenerated NPCs. In conclusion, it was demonstrated in vitro that MSCs regulate the mechanical properties of degenerated NPCs through SDF-1/CXCR4/AKT signaling. These findings highlight a possible mechanical mechanism for MSCs-induced modulation with degenerated NPCs, which may be applicable to MSCs-based therapy for disc degeneration. PMID:27163878

  18. N-cadherin is Key to Expression of the Nucleus Pulposus Cell Phenotype under Selective Substrate Culture Conditions.

    PubMed

    Hwang, Priscilla Y; Jing, Liufang; Chen, Jun; Lim, Foon-Lian; Tang, Ruhang; Choi, Hyowon; Cheung, Kenneth M; Risbud, Makarand V; Gersbach, Charles A; Guilak, Farshid; Leung, Victor Y; Setton, Lori A

    2016-01-01

    Nucleus pulposus (NP) cells of the intervertebral disc are essential for synthesizing extracellular matrix that contributes to disc health and mechanical function. NP cells have a unique morphology and molecular expression pattern derived from their notochordal origin, and reside in N-cadherin (CDH2) positive cell clusters in vivo. With disc degeneration, NP cells undergo morphologic and phenotypic changes including loss of CDH2 expression and ability to form cell clusters. Here, we investigate the role of CDH2 positive cell clusters in preserving healthy, biosynthetically active NP cells. Using a laminin-functionalized hydrogel system designed to mimic features of the native NP microenvironment, we demonstrate NP cell phenotype and morphology is preserved only when NP cells form CDH2 positive cell clusters. Knockdown (CRISPRi) or blocking CDH2 expression in vitro and in vivo results in loss of a healthy NP cell. Findings also reveal that degenerate human NP cells that are CDH2 negative can be promoted to re-express CDH2 and healthy, juvenile NP matrix synthesis patterns by promoting cell clustering for controlled microenvironment conditions. This work also identifies CDH2 interactions with β-catenin-regulated signaling as one mechanism by which CDH2-mediated cell interactions can control NP cell phenotype and biosynthesis towards maintenance of healthy intervertebral disc tissues. PMID:27292569

  19. Thymosin Beta-4 Recombinant Adeno-associated Virus Enhances Human Nucleus Pulposus Cell Proliferation and Reduces Cell Apoptosis and Senescence

    PubMed Central

    Wang, Yuan-Yi; Zhu, Qing-San; Wang, Yi-Wei; Yin, Ruo-Feng

    2015-01-01

    Background: Thymosin beta-4 (TB-4) is considered key roles in tissue development, maintenance and pathological processes. The study aimed to prove TB-4 positive biological function on nucleus pulposus (NP) cell apoptosis and slowing the process of cell aging while increasing the cell proliferation. Methods: TB-4 recombinant adeno-associated virus (AAV) was constructed and induced to human NP cells. Cell of same group were cultured without gene modification as controlled group. Proliferation capacity and cell apoptosis were observed during 6 passages of the cells. Morphology and expression of the TB-4 gene were documented as parameter of cell activity during cell passage. Results: NP cells with TB-4 transfection has normal TB-4 expression and exocytosis. NP cells with TB-4 transfection performed significantly higher cell activity than that at the control group in each generation. TB-4 recombinant AAV-transfected human NP cells also show slower cell aging, lower cell apoptosis and higher cell proliferation than control group. Conclusions: TB-4 can prevent NP cell apoptosis, slow NP cell aging and promote NP cell proliferation. AAV transfection technique was able to highly and stably express TB-4 in human NP cells, which may provide a new pathway for innovation in the treatment of intervertebral disc degenerative diseases. PMID:26021512

  20. Survivin is expressed in degenerated nucleus pulposus cells and is involved in proliferation and the prevention of apoptosis in vitro

    PubMed Central

    LIN, YAZHOU; YUE, BIN; XIANG, HONGFEI; LIU, YONG; MA, XUEXIAO; CHEN, BOHUA

    2016-01-01

    Survivin is a unique inhibitor of apoptosis, which is frequently present within degenerated human nucleus pulposus (NP) cells. Survivin has been extensively investigated using proliferation and apoptosis assays in tumor cells; however, studies conducted on survivin in degenerative NP cells remain limited to date. The aim of the present study was to investigate survivin expression and its effects on the proliferation and apoptosis of degenerated NP cells in vitro. The expression levels of survivin in the NP cells of patients (>45 years) with lumbar disc degenerative disease and the NP cells of patients (<25 years) with lumbar vertebra fracture were assessed by reverse transcription-quantitative polymerase chain reaction. The effects on in vitro proliferation and apoptosis were investigated through transfection with a specific small interfering (si)RNA. The results of the present study demonstrated that survivin was expressed in the degenerated NP cells, but was undetectable in normal NP cells at the mRNA level. Survivin suppression following transfection with a specific survivin-siRNA reduced the proliferation rate of NP cells and enhanced sensitization to pro-apoptotic stimuli. Therefore, survivin was shown to be expressed and exhibit an important role in the proliferation and prevention of apoptosis of degenerated NP cells. Studies on survivin in NP cells may aid in increasing the understanding of the complex processes underlying NP cell degeneration, and could provide fundamental information for gene therapy to inhibit this degeneration in vitro. PMID:26648308

  1. FIH-1-Mint3 Axis Does Not Control HIF-1α Transcriptional Activity in Nucleus Pulposus Cells*

    PubMed Central

    Hirose, Yuichiro; Johnson, Zariel I.; Schoepflin, Zachary R.; Markova, Dessislava Z.; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M.; Risbud, Makarand V.

    2014-01-01

    The objective of this study was to determine the role of FIH-1 in regulating HIF-1 activity in the nucleus pulposus (NP) cells and the control of this regulation by binding and sequestration of FIH-1 by Mint3. FIH-1 and Mint3 were both expressed in the NP and were shown to strongly co-localize within the cell nucleus. Although both mRNA and protein expression of FIH-1 decreased in hypoxia, only Mint3 protein levels were hypoxia-sensitive. Overexpression of FIH-1 was able to reduce HIF-1 function, as seen by changes in activities of hypoxia response element-luciferase reporter and HIF-1α-C-TAD and HIF-2α-TAD. Moreover, co-transfection of either full-length Mint3 or the N terminus of Mint3 abrogated FIH-1-dependent reduction in HIF-1 activity under both normoxia and hypoxia. Nuclear levels of FIH-1 and Mint3 decreased in hypoxia, and the use of specific nuclear import and export inhibitors clearly showed that cellular compartmentalization of overexpressed FIH-1 was critical for its regulation of HIF-1 activity in NP cells. Interestingly, microarray results after stable silencing of FIH-1 showed no significant changes in transcripts of classical HIF-1 target genes. However, expression of several other transcripts, including those of the Notch pathway, changed in FIH-1-silenced cells. Moreover, co-transfection of Notch-ICD could restore suppression of HIF-1-TAD activity by exogenous FIH-1. Taken together, these results suggest that, possibly due to low endogenous levels and/or preferential association with substrates such as Notch, FIH-1 activity does not represent a major mechanism by which NP cells control HIF-1-dependent transcription, a testament to their adaptation to a unique hypoxic niche. PMID:24867948

  2. Alkaptonuria and lumbar disc herniation. Report of three cases.

    PubMed

    Farzannia, Akbar; Shokouhi, Ghaffar; Hadidchi, Shahram

    2003-01-01

    Alkaptonuria is a rare metabolic disease caused by deficiency of homogentisic acid oxidase and characterized by bluish-black discoloration of cartilages and skin (ochronosis). The authors report the cases of three patients with lumbar disc herniation who underwent discectomy and in whom the nucleus pulposus was discovered to be black. Alkaptonuria was diagnosed after discectomy. Discal herniation requiring surgery is unusual in alkaptonuria, with only a few reports. The symptoms in the three patients disappeared after surgery and no symptoms were demonstrated on follow-up examination. PMID:12546396

  3. SDF-1/CXCR4 axis induces apoptosis of human degenerative nucleus pulposus cells via the NF-κB pathway

    PubMed Central

    LIU, ZONGCHAO; MA, CHUAN; SHEN, JIELIANG; WANG, DAWU; HAO, JIE; HU, ZHENMING

    2016-01-01

    Intervertebral disc degeneration (IVDD) is a major cause of lower back pain, and increased cell apoptosis is a key characteristic of IVDD. The present study aimed to investigate the effects and mechanism of the stromal cell-derived factor-1 (SDF-1)/C-X-C motif chemokine receptor 4 (CXCR4) axis on apoptosis in human degenerative nucleus pulposus cells (NPCs). The expression levels of SDF-1 and CXCR4 in human intervertebral discs (IVD) were determined using immunohistochemistry and western blot analysis. Apoptosis of primary cultured NPCs was quantified by Annexin V/propidium iodide staining following stimulation with SDF-1 and knockdown of CXCR4 using small interfering RNA (siRNA). The association with the nuclear factor-κB (NF-κB) signaling pathway was investigated using CXCR4-siRNA and NF-κB inhibitor, pyrrolidine dithiocarbamate (PDTC), treatment. The results demonstrated that SDF-1 and its receptor, CXCR4, were upregulated in degenerative IVD samples compared with normal samples. Stimulation with SDF-1 increased the level of apoptosis in cultured NPCs, and conversely, the apoptosis level was suppressed post-transfection with CXCR4 siRNA compared with SDF-1 stimulation alone. Furthermore, SDF-1 treatment increased the level of phosphorylated NF-κB subunit P65, which was downregulated following CXCR4 siRNA and PDTC treatment. In addition, CXCR4 siRNA and PDTC inhibited the nuclear translocation of P65, which was induced by SDF-1. Taken together, SDF-1-mediated apoptosis was suppressed by NF-κB inhibition using PDTC. In conclusion, the SDF-1/CXCR4 axis promoted cell apoptosis in human degenerative NPCs via the NF-κB pathway, thus suggesting that SDF-1/CXCR signaling may be a therapeutic target for the treatment of degenerative IVD diseases. PMID:27220474

  4. Injectable hydrogels with high fixed charge density and swelling pressure for nucleus pulposus repair: biomimetic glycosaminoglycan analogues.

    PubMed

    Sivan, S S; Roberts, S; Urban, J P G; Menage, J; Bramhill, J; Campbell, D; Franklin, V J; Lydon, F; Merkher, Y; Maroudas, A; Tighe, B J

    2014-03-01

    The load-bearing biomechanical role of the intervertebral disc is governed by the composition and organization of its major macromolecular components, collagen and aggrecan. The major function of aggrecan is to maintain tissue hydration, and hence disc height, under the high loads imposed by muscle activity and body weight. Key to this role is the high negative fixed charge of its glycosaminoglycan side chains, which impart a high osmotic pressure to the tissue, thus regulating and maintaining tissue hydration and hence disc height under load. In degenerate discs, aggrecan degrades and is lost from the disc, particularly centrally from the nucleus pulposus. This loss of fixed charge results in reduced hydration and loss of disc height; such changes are closely associated with low back pain. The present authors developed biomimetic glycosaminoglycan analogues based on sulphonate-containing polymers. These biomimetics are deliverable via injection into the disc where they polymerize in situ, forming a non-degradable, nuclear "implant" aimed at restoring disc height to degenerate discs, thereby relieving back pain. In vitro, these glycosaminoglycan analogues possess appropriate fixed charge density, hydration and osmotic responsiveness, thereby displaying the capacity to restore disc height and function. Preliminary biomechanical tests using a degenerate explant model showed that the implant adapts to the space into which it is injected and restores stiffness. These hydrogels mimic the role taken by glycosaminoglycans in vivo and, unlike other hydrogels, provide an intrinsic swelling pressure, which can maintain disc hydration and height under the high and variable compressive loads encountered in vivo. PMID:24270091

  5. Phenotypic Stability, Matrix Elaboration, and Functional Maturation of Nucleus Pulposus Cells Encapsulated in Photocrosslinkable Hyaluronic Acid Hydrogels

    PubMed Central

    Kim, Dong Hwa; Martin, John T.; Elliott, Dawn M.; Smith, Lachlan J.; Mauck, Robert L.

    2014-01-01

    Degradation of the nucleus pulposus (NP) is an early hallmark of intervertebral disc degeneration. The capacity for endogenous regeneration in the NP is limited due to the low cellularity and poor nutrient supply of this avascular tissue. Towards restoring the NP, a number of biomaterials have been explored for cell delivery. These materials must support the NP cell phenotype while promoting the elaboration of an NP-like extracellular matrix in the shortest possible time. Our previous work with chondrocytes and mesenchymal stem cells demonstrated that hydrogels based on hyaluronic acid (HA) are effective at promoting matrix production and the development of functional material properties. However, this material has not been evaluated in the context of NP cells. Therefore, to test this material for NP regeneration, bovine NP cells were encapsulated in 1% w/vol HA hydrogels at either a low seeding density (20 × 106 cells/ml) or a high seeding density (60 × 106 cells/ml), and constructs were cultured over an 8 week period. These engineered NP cell-laden HA hydrogels showed functional matrix accumulation, with increasing matrix content and mechanical properties with time in culture at both seeding densities. Furthermore, encapsulated cells showed NP-specific gene expression profiles that were significantly higher than expanded NP cells prior to encapsulation, suggesting a restoration of phenotype. Interestingly, these levels were higher at the lower seeding density compared to the higher seeding density. These findings support the use of HA-based hydrogels for NP tissue engineering and cellular therapies directed at restoration or replacement of the endogenous NP. PMID:25448344

  6. SDF‑1/CXCR4 axis induces apoptosis of human degenerative nucleus pulposus cells via the NF‑κB pathway.

    PubMed

    Liu, Zongchao; Ma, Chuan; Shen, Jieliang; Wang, Dawu; Hao, Jie; Hu, Zhenming

    2016-07-01

    Intervertebral disc degeneration (IVDD) is a major cause of lower back pain, and increased cell apoptosis is a key characteristic of IVDD. The present study aimed to investigate the effects and mechanism of the stromal cell‑derived factor‑1 (SDF‑1)/C‑X‑C motif chemokine receptor 4 (CXCR4) axis on apoptosis in human degenerative nucleus pulposus cells (NPCs). The expression levels of SDF‑1 and CXCR4 in human intervertebral discs (IVD) were determined using immunohistochemistry and western blot analysis. Apoptosis of primary cultured NPCs was quantified by Annexin V/propidium iodide staining following stimulation with SDF‑1 and knockdown of CXCR4 using small interfering RNA (siRNA). The association with the nuclear factor‑κB (NF‑κB) signaling pathway was investigated using CXCR4‑siRNA and NF‑κB inhibitor, pyrrolidine dithiocarbamate (PDTC), treatment. The results demonstrated that SDF‑1 and its receptor, CXCR4, were upregulated in degenerative IVD samples compared with normal samples. Stimulation with SDF‑1 increased the level of apoptosis in cultured NPCs, and conversely, the apoptosis level was suppressed post‑transfection with CXCR4 siRNA compared with SDF‑1 stimulation alone. Furthermore, SDF‑1 treatment increased the level of phosphorylated NF‑κB subunit P65, which was downregulated following CXCR4 siRNA and PDTC treatment. In addition, CXCR4 siRNA and PDTC inhibited the nuclear translocation of P65, which was induced by SDF‑1. Taken together, SDF‑1‑mediated apoptosis was suppressed by NF‑κB inhibition using PDTC. In conclusion, the SDF‑1/CXCR4 axis promoted cell apoptosis in human degenerative NPCs via the NF‑κB pathway, thus suggesting that SDF‑1/CXCR signaling may be a therapeutic target for the treatment of degenerative IVD diseases. PMID:27220474

  7. Biological characteristics of adult degenerative nucleus pulposus cells in a three-dimensional microcarrier stirring culture system.

    PubMed

    Ning, Bin; Liu, Haifei; Gong, Weiming; Jiang, Jianhao; Hu, Yougu; Yang, Shang-You

    2013-06-01

    A major problem in reconstructing degenerative intervertebral discs is to obtain sufficient nucleus pulposus (NP) seeding cells with normal physiologic functions. The current study adopted a three-dimensional microcarrier culture system for massive cell expansion and evaluated the biological characteristics and physiological functions of the propagated adult degenerative NP cells. Isolated adult NP cells were cultured in either microcarrier stirring culturing system or traditional monolayer cultivation. The growth characteristics, proliferation, extracellular matrix secretion, and apoptosis potential were examined to evaluate the different features of the two cultivation methods. Compared to the monolayer cultivation system, the adhesion time of NP cells in the three-dimensional microcarrier culture system appeared longer with relatively transient stable growth period. MTT and (3)H-TdR assays suggested significantly elevated proliferation and higher thymidine incorporation rates in cells from microcarrier system compare to cells in the monolayer system at the exponential growth phase (p < 0.05). Western blot data complimented the immunostaining results that the NP cells in the microcarrier system expressed significantly more protein levels of both type collagens at the exponential growth phase than that in the monolayer system (p < 0.05). Further, significantly more (35)S labeled proteoglycan incorporation was noticed in the cells on the microcarriers at both the stable growth and the exponential growth phases (p < 0.05 and p < 0.01). In conclusion, the three-dimensional microcarrier stirring culture system provides a means of fast and massive propagation of NP seeding cells which maintain their normal physiological characteristics and functions. PMID:23335154

  8. FoxC2 Enhances BMP7-Mediated Anabolism in Nucleus Pulposus Cells of the Intervertebral Disc

    PubMed Central

    Wang, Zheng; Fu, Changfeng; Chen, Yong; Xu, Feng; Wang, Zhenyu; Qu, Zhigang; Liu, Yi

    2016-01-01

    Bone-morphogenetic protein-7 (BMP-7) is a growth factor that plays a major role in mediating anabolism and anti-catabolism of the intervertebral disc matrix and cell homeostasis. In osteoblasts, Forkhead box protein C2 (FoxC2) is a downstream target of BMPs and promotes cell proliferation and differentiation. However, the role FoxC2 may play in degenerative human intervertebral disc tissue and the relationship between FoxC2 and BMP-7 in nucleus pulposus (NP) cells remain to be elucidated. This study aims to investigate the presence and signaling mechanisms of FoxC2 in degenerative human intervertebral disc tissue and NP cells. Western blot and real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) analyses were used to measure FoxC2 expression in the NP tissue and cells. Transfections were carried out to measure the effect of FoxC2 on BMP-7-mediated extracellular matrix upregulation. Adenoviral knock-down of Smad1 was performed to investigate the mechanism of BMP-7-induced FoxC2 expression. In degenerative NP tissue, FoxC2 was markedly upregulated and positively correlated with increased disc degeneration. Induction of NP cell proliferation was confirmed by using cell counting kit-8 assay, immunocytochemistry and real-time qRT-PCR for Ki67. FoxC2 led to decreased noggin expression and increased Smad1/5/8 phosphorylation. During combined treatment with BMP-7, FoxC2 greatly potentiated anabolism through synergistic mechanisms on ECM formation. Combination therapy using BMP-7 and FoxC2 may be beneficial to the treatment of intervertebral disc degeneration. PMID:26824865

  9. Herniated lumbar disc

    PubMed Central

    2011-01-01

    Introduction Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 37 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdiscectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction. PMID:21711958

  10. 17β-estradiol protects against apoptosis induced by interleukin-1β in rat nucleus pulposus cells by down-regulating MMP-3 and MMP-13.

    PubMed

    Yang, Si-Dong; Yang, Da-Long; Sun, Ya-Peng; Wang, Bao-Lin; Ma, Lei; Feng, Shi-Qing; Ding, Wen-Yuan

    2015-03-01

    In our previous study, 17β-estradiol was proved to protect rat annulus fibrosus cells against apoptosis induced by interleukin-1β (IL-1β). However, whether 17β-estradiol has protective effect on rat nucleus pulposus cells remains unclear. The purpose of this study was to further explore the effects of 17β-estradiol on rat nucleus pulposus cells based on IL-1β-induced apoptosis. TUNEL assay and Annexin V/PI double staining were used to detect apoptosis and revealed that IL-1β induced notable apoptosis, which was reversed by 17β-estradiol. Meanwhile, cell viability and binding ability were decreased by IL-1β, but activated caspase-3 was increased. However, all of the detected effects of IL-1β were eliminated by 17β-estradiol. Furthermore, real-time quantitative RT-PCR was used to further find that IL-1β downregulated expression level of type II collagen, aggrecan, tissue inhibitor of matrix metalloproteinase (TIMP)-1, while upregulated matrix metalloproteinase (MMP)-3, MMP-13 and Bcl-2, which was further confirmed by western blot. Finally, 17β-estradiol was proved to abolish the above negative effects of IL-1β. In summary, this work presented that IL-1β maybe induced apoptosis of rat nucleus pulposus cells, which was resisted by 17β-estradiol by down-regulating MMP-3 and MMP-13 via a mitochondrial pathway. This research provides a novel insight into the anti-apoptotic effect of 17β-estradiol on IL-1β-induced cytotoxicity, and may potentially lead to a better understanding of the clinical effects of 17β-estradiol, especially in terms of intervertebral disc degeneration. PMID:25576195

  11. Low-intensity pulsed ultrasound stimulates cell proliferation, proteoglycan synthesis and expression of growth factor-related genes in human nucleus pulposus cell line.

    PubMed

    Kobayashi, Y; Sakai, D; Iwashina, T; Iwabuchi, S; Mochida, J

    2009-01-01

    Low-intensity pulsed ultrasound (LIPUS) stimulation has been shown to effect differentiation and activation of human chondrocytes. A study involving stimulation of rabbit disc cells with LIPUS revealed upregulation of cell proliferation and proteoglycan (PG) synthesis. However, the effect of LIPUS on human nucleus pulposus cells has not been investigated. In the present study, therefore, we investigated whether LIPUS stimulation of a human nucleus pulposus cell line (HNPSV-1) exerted a positive effect on cellular activity. HNPSV-1 cells were encapsulated in 1.2% sodium alginate solution at 1x10(5) cells/ml and cultured at 10 beads/well in 6-well plates. The cells were stimulated for 20 min each day using a LIPUS generator, and the effects of LIPUS were evaluated by measuring DNA and PG synthesis. Furthermore, mRNA expression was analyzed by cDNA microarray using total RNA extracted from the cultured cells. Our study revealed no significant difference in cell proliferation between the control and the ultrasound treated groups. However, PG production was significantly upregulated in HNPSV cells stimulated at intensities of 15, 30, 60, and 120 mW/cm(2) compared with the control. The results of cDNA array showed that LIPUS significantly stimulated the gene expression of growth factors and their receptors (BMP2, FGF7, TGFbetaR1 EGFRF1, VEGF). These findings suggest that LIPUS stimulation upregulates PG production in human nucleus pulposus cells by the enhancement of several matrix-related genes including growth factor-related genes. Safe and non-invasive stimulation using LIPUS may be a useful treatment for delaying the progression of disc degeneration. PMID:19598131

  12. Expression of Prolyl Hydroxylases (PHDs) Is Selectively Controlled by HIF-1 and HIF-2 Proteins in Nucleus Pulposus Cells of the Intervertebral Disc

    PubMed Central

    Fujita, Nobuyuki; Markova, Dessislava; Anderson, D. Greg; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M.; Risbud, Makarand V.

    2012-01-01

    Adaptive response to hypoxia in nucleus pulposus cells of the intervertebral disc is regulated by the hypoxia-inducible factors, HIF-1α and HIF-2α. Moreover, oxygen-dependent turnover of HIF-1α in these cells is controlled by the prolyl-4-hydroxylase domain (PHD) family of proteins. Whether HIF homologues control expression of PHDs and whether PHDs control hypoxia-inducible factor (HIF) turnover and/or activity under hypoxia is not known. Here, we show that in nucleus pulposus cells, hypoxia robustly induces PHD3 expression and, to a lesser extent, of PHD2 and PHD1. Reporter analysis shows that the hypoxic induction of the PHD2 promoter is HIF-1α dependent, whereas PHD3 promoter/enhancer activity is dependent on both HIF-1α and HIF-2α. Lentiviral delivery of HIF-1α, ShHIF-1α, and ShHIF-1β confirmed these observations. Noteworthy, HIF-1α maintains basal expression of PHD1 in hypoxia at the posttranscriptional level. Finally, loss of function studies using lentiviral transduction of ShPHDs clearly shows that even at 1% O2, PHD2 selectively degrades HIF-1α. In contrast, in hypoxia, PHD3 enhances HIF-1α transcriptional activity without affecting protein levels. To correlate these observations with disc disease, a condition characterized by tissue vascularization, we analyzed human tissues. Increased PHD1 mRNA expression but decreased PHD2 and PHD3 expression is observed in degenerate tissues. Interestingly, the hypoxic responsiveness of all the PHDs is maintained in isolated nucleus pulposus cells regardless of the disease state. We propose that PHD2 and PHD3 can be used as a biomarker of tissue oxygenation in the disc and that, as such, it may have important clinical implications. PMID:22451659

  13. Molecular immunotherapy might shed a light on the treatment strategies for disc degeneration and herniation.

    PubMed

    Sun, Zhen; Liu, Zhi-Heng; Chen, Yu-fei; Zhang, Yong-zhao; Wan, Zhong-yuan; Zhang, Wei-lin; Che, Lu; Liu, Xu; Wang, Hai-Qiang; Luo, Zhuo-Jing

    2013-09-01

    Despite surgical discectomy is one of the most effective treatments for intervertebral disc degeneration and lumbar disc herniation, a number of patients still complain of reserved low back pain, sciatica and numbness post-operatively with decreased life quality. Sciatica in patients with disc herniation is not only due to mechanical compression from herniated nucleus pulposus, but chemical and immunity agents. The intervertebral disc is composed of annulus fibrosus in the wedge and gelatinous nucleus pulposus in the centre with cartilage endplate sandwiched. Similar to other immune privilege organs, human intervertebral disc is one of the biggest avascular structures with FasL expression. Moreover, FasL-Fas and TRAIL death pathways might play roles in the machinery of immune privilege of the disc. We found that down-regulated miR-155 promotes Fas-mediated apoptosis in disc degeneration. Furthermore, once exposed to human immune system, nucleus pulposus can activate multiple specific and non-specific immune responses with cellular and fluid immune cells and molecules involved. Taken together, we hypothesize that a combined molecular immunotherapy with local and systemic immunity regulators might shed a novel light on the treatment strategies for disc degeneration and herniation. PMID:23849654

  14. [Cervical disc herniation].

    PubMed

    Schnake, K J; Hoffmann, C-H; Kandziora, F

    2012-12-01

    The cervical disc herniation is characterized by prolapsed nucleus pulposus material through the annulus into the spinal canal. The local mechanical or chemical irritation of neural structures typically leads to symptoms of radiculopathy, cervicocephalgia or myelopathy. Pronounced sensorimotor deficits or intractable pain constitute surgical treatment. In all other cases conservative treatment is indicated, including pain medication, active and passive physiotherapy, and local injections, respectively. Anterior cervical discectomy and interbody fusion (ACDF) is still the surgical treatment of choice. Predominantly, cages with or without plates are in use to obtain solid fusion. The implantation of a total disc replacement is a viable alternative, if no contraindications exist. Other surgical techniques may be performed in proper selected cases. The overall clinical and radiological results of both surgical and conservative treatment are good. PMID:23296562

  15. Effect of microRNA-21 on the proliferation of human degenerated nucleus pulposus by targeting programmed cell death 4

    PubMed Central

    Chen, B.; Huang, S.G.; Ju, L.; Li, M.; Nie, F.F.; Zhang, Y.; Zhang, Y.H.; Chen, X.; Gao, F.

    2016-01-01

    This study aims to explore the effect of microRNA-21 (miR-21) on the proliferation of human degenerated nucleus pulposus (NP) by targeting programmed cell death 4 (PDCD4) tumor suppressor. NP tissues were collected from 20 intervertebral disc degeneration (IDD) patients, and from 5 patients with traumatic spine fracture. MiR-21 expressions were tested. NP cells from IDD patients were collected and divided into blank control group, negative control group (transfected with miR-21 negative sequences), miR-21 inhibitor group (transfected with miR-21 inhibitors), miR-21 mimics group (transfected with miR-21 mimics) and PDCD4 siRNA group (transfected with PDCD4 siRNAs). Cell growth was estimated by Cell Counting Kit-8; PDCD4, MMP-2,MMP-9 mRNA expressions were evaluated by qRT-PCR; PDCD4, c-Jun and p-c-Jun expressions were tested using western blot. In IDD patients, the expressions of miR-21 and PDCD4 mRNA were respectively elevated and decreased (both P<0.05). The miR-21 expressions were positively correlated with Pfirrmann grades, but negatively correlated with PDCD4 mRNA (both P<0.001). In miR-21 inhibitor group, cell growth, MMP-2 and MMP-9 mRNA expressions, and p-c-Jun protein expressions were significantly lower, while PDCD4 mRNA and protein expressions were higher than the other groups (all P<0.05). These expressions in the PDCD4 siRNA and miR-21 mimics groups was inverted compared to that in the miR-21 inhibitor group (all P<0.05). MiR-21 could promote the proliferation of human degenerated NP cells by targeting PDCD4, increasing phosphorylation of c-Jun protein, and activating AP-1-dependent transcription of MMPs, indicating that miR-21 may be a crucial biomarker in the pathogenesis of IDD. PMID:27240294

  16. Dynamic Compression Effects on Immature Nucleus Pulposus: a Study Using a Novel Intelligent and Mechanically Active Bioreactor

    PubMed Central

    Li, Pei; Gan, Yibo; Wang, Haoming; Zhang, Chengmin; Wang, Liyuan; Xu, Yuan; Song, Lei; Li, Songtao; Li, Sukai; Ou, Yangbin; Zhou, Qiang

    2016-01-01

    Background: Previous cell culture and animal in vivo studies indicate the obvious effects of mechanical compression on disc cell biology. However, the effects of dynamic compression magnitude, frequency and duration on the immature nucleus pulposus (NP) from an organ-cultured disc are not well understood. Objective: To investigate the effects of a relatively wide range of compressive magnitudes, frequencies and durations on cell apoptosis and matrix composition within the immature NP using an intelligent and mechanically active bioreactor. Methods: Discs from the immature porcine were cultured in a mechanically active bioreactor for 7 days. The discs in various compressive magnitude groups (0.1, 0.2, 0.4, 0.8 and 1.3 MPa at a frequency of 1.0 Hz for 2 hours), frequency groups (0.1, 0.5, 1.0, 3.0 and 5.0 Hz at a magnitude of 0.4 MPa for 2 hours) and duration groups (1, 2, 4 and 8 hours at a magnitude of 0.4 MPa and frequency of 1.0 Hz) experienced dynamic compression once per day. Discs cultured without compression were used as controls. Immature NP samples were analyzed using the TUNEL assay, histological staining, glycosaminoglycan (GAG) content measurement, real-time PCR and collagen II immunohistochemical staining. Results: In the 1.3 MPa, 5.0 Hz and 8 hour groups, the immature NP showed a significantly increase in apoptotic cells, a catabolic gene expression profile with down-regulated matrix molecules and up-regulated matrix degradation enzymes, and decreased GAG content and collagen II deposition. In the other compressive magnitude, frequency and duration groups, the immature NP showed a healthier status regarding NP cell apoptosis, gene expression profile and matrix production. Conclusion: Cell apoptosis and matrix composition within the immature NP were compressive magnitude-, frequency- and duration-dependent. The relatively high compressive magnitude or frequency and long compressive duration are not helpful for maintaining the healthy status of an

  17. Effect of microRNA-21 on the proliferation of human degenerated nucleus pulposus by targeting programmed cell death 4.

    PubMed

    Chen, B; Huang, S G; Ju, L; Li, M; Nie, F F; Zhang, Y; Zhang, Y H; Chen, X; Gao, F

    2016-05-24

    This study aims to explore the effect of microRNA-21 (miR-21) on the proliferation of human degenerated nucleus pulposus (NP) by targeting programmed cell death 4 (PDCD4) tumor suppressor. NP tissues were collected from 20 intervertebral disc degeneration (IDD) patients, and from 5 patients with traumatic spine fracture. MiR-21 expressions were tested. NP cells from IDD patients were collected and divided into blank control group, negative control group (transfected with miR-21 negative sequences), miR-21 inhibitor group (transfected with miR-21 inhibitors), miR-21 mimics group (transfected with miR-21 mimics) and PDCD4 siRNA group (transfected with PDCD4 siRNAs). Cell growth was estimated by Cell Counting Kit-8; PDCD4, MMP-2,MMP-9 mRNA expressions were evaluated by qRT-PCR; PDCD4, c-Jun and p-c-Jun expressions were tested using western blot. In IDD patients, the expressions of miR-21 and PDCD4 mRNA were respectively elevated and decreased (both P<0.05). The miR-21 expressions were positively correlated with Pfirrmann grades, but negatively correlated with PDCD4 mRNA (both P<0.001). In miR-21 inhibitor group, cell growth, MMP-2 and MMP-9 mRNA expressions, and p-c-Jun protein expressions were significantly lower, while PDCD4 mRNA and protein expressions were higher than the other groups (all P<0.05). These expressions in the PDCD4 siRNA and miR-21 mimics groups was inverted compared to that in the miR-21 inhibitor group (all P<0.05). MiR-21 could promote the proliferation of human degenerated NP cells by targeting PDCD4, increasing phosphorylation of c-Jun protein, and activating AP-1-dependent transcription of MMPs, indicating that miR-21 may be a crucial biomarker in the pathogenesis of IDD. PMID:27240294

  18. Notochordal conditioned media from tissue increases proteoglycan accumulation and promotes a healthy nucleus pulposus phenotype in human mesenchymal stem cells

    PubMed Central

    2011-01-01

    Introduction Notochordal cells (NCs) are influential in development of the intervertebral disc (IVD) and species that retain NCs do not degenerate. IVD repair using bone marrow derived mesenchymal stem cells (MSCs) is an attractive approach and the harsh microenvironment of the IVD suggests pre-differentiation is a necessary first step. The goal of this study was to use soluble factors from NCs in alginate and NCs in their native tissue to differentiate human MSCs to a young nucleus pulposus (NP) phenotype. Methods Human MSCs (cultured under micromass conditions for 21 days in hypoxia) were differentiated with conditioned medium derived from porcine notochordal cells in native tissue (NCT) or in alginate beads (NCA), and compared with chondrogenic (TGFβ-3) or basal medium. A PCR array of 42 genes was utilized to screen a large number of genes known to be associated with the healthy NP phenotype and pellet cultures were also evaluated for glycosaminoglycan content, histology and viability. Proteomic analysis was used to assess candidate soluble factors in NCA and NCT. Results Notochordal cell conditioned media had diverse effects on MSC phenotype. NCT resulted in the highest levels of glycosaminoglycan (GAG), as well as up-regulation of SOX9 and Collagen II gene expression. NCA demonstrated effects that were catabolic yet also anti-fibrotic and minimally hypertrophic with down-regulation of Collagens I and III and low levels of Collagen X, respectively. Micromass culture and hypoxic conditions were sufficient to promote chondrogenesis demonstrating that both basal and chondrogenic media produced similar phenotypes. Candidate matricellular proteins, clusterin and tenascin were identified by proteomics in the NCA group. Conclusions NCs secreted important soluble factors capable of differentiating MSCs to a NP phenotype synthesizing high levels of proteoglycan while also resisting collagen fiber expression and hypertrophy, yet results were sensitive to the conditions

  19. Expression of acid-sensing ion channels in nucleus pulposus cells of the human intervertebral disk is regulated by non-steroid anti-inflammatory drugs.

    PubMed

    Sun, Xue; Jin, Jun; Zhang, Ji-Gang; Qi, Lin; Braun, Frank Karl; Zhang, Xing-Ding; Xu, Feng

    2014-09-01

    Non-steroid anti-inflammatory drugs (NSAIDs) are generally used in the treatment of inflammation and pain through cyclooxygenase (COX) inhibition. Mounting evidence has indicated additional COX-independent targets for NSAIDs including acid-sensing ion channels (ASICs) 1a and 3. However, detailed function and mechanism of ASICs still remain largely elusive. In this study, the impact of NSAIDs on ASICs in nucleus pulposus cells of the human intervertebral disk was investigated. Nucleus pulposus cells were isolated and cultured from protruded disk tissues of 40 patients. It was shown that ASIC1a and ASIC3 were expressed and functional in these cells by analyzing proton-gated currents after ASIC inhibition. We further investigated the neuroprotective capacity of ibuprofen (a COX inhibitor), psalmotoxin-1 (PcTX1, a tarantula toxin specific for homomeric ASIC1a), and amiloride (a classic inhibitor of the epithelial sodium channel ENaC/DEG family to which ASICs belong). PcTX1-containing venom has been shown to be comparable with amiloride in its neuroprotective features in rodent models of ischemia. Taken together, our data showed that amiloride, PcTX1, and ibuprofen decreased ASIC protein expression and thereby exerted protective effects from ASIC inhibition-mediated cell damage. PMID:25079679

  20. Expression of acid-sensing ion channels in nucleus pulposus cells of the human intervertebral disk is regulated by non-steroid anti-inflammatory drugs

    PubMed Central

    Sun, Xue; Jin, Jun; Zhang, Ji-Gang; Qi, Lin; Braun, Frank Karl; Zhang, Xing-Ding; Xu, Feng

    2014-01-01

    Non-steroid anti-inflammatory drugs (NSAIDs) are generally used in the treatment of inflammation and pain through cyclooxygenase (COX) inhibition. Mounting evidence has indicated additional COX-independent targets for NSAIDs including acid-sensing ion channels (ASICs) 1a and 3. However, detailed function and mechanism of ASICs still remain largely elusive. In this study, the impact of NSAIDs on ASICs in nucleus pulposus cells of the human intervertebral disk was investigated. Nucleus pulposus cells were isolated and cultured from protruded disk tissues of 40 patients. It was shown that ASIC1a and ASIC3 were expressed and functional in these cells by analyzing proton-gated currents after ASIC inhibition. We further investigated the neuroprotective capacity of ibuprofen (a COX inhibitor), psalmotoxin-1 (PcTX1, a tarantula toxin specific for homomeric ASIC1a), and amiloride (a classic inhibitor of the epithelial sodium channel ENaC/DEG family to which ASICs belong). PcTX1-containing venom has been shown to be comparable with amiloride in its neuroprotective features in rodent models of ischemia. Taken together, our data showed that amiloride, PcTX1, and ibuprofen decreased ASIC protein expression and thereby exerted protective effects from ASIC inhibition-mediated cell damage. PMID:25079679

  1. Relationship between Initial Telomere Length, Initial Telomerase Activity, Age, and Replicative Capacity of Nucleus Pulposus Chondrocytes in Human Intervertebral Discs: What Is a Predictor of Replicative Potential?

    PubMed Central

    Lee, Jun-Seok; Jeong, Seo-Won; Cho, Sung-Wook; Juhn, Joon-Pyo; Kim, Ki-Won

    2015-01-01

    There is evidence that telomere length (TL), telomerase activity (TA), and age are related to the replicative potential of human nucleus pulposus chondrocytes (NPCs). However, it has not yet been established if any of these factors can serve as predictors of the replicative potential of NPCs. To establish predictors of the replicative potential of NPCs, we evaluated potential relationships between replicative capacity of NPCs, initial TL (telomere length at the first passage), initial TA (telomerase activity at the first passage), and age. Nucleus pulposus specimens were obtained from 14 patients of various ages undergoing discectomy. NPCs were serially cultivated until the end of their replicative lifespans. Relationships among cumulative population doubling level (PDL), initial TL, initial TA, and age were analyzed. Initial TA was negatively correlated with age (r = -0.674, P = 0.008). However, no correlation between initial TL and age was observed. Cumulative PDL was also negatively correlated with age (r = -0.585, P = 0.028). Although the cumulative PDL appeared to increase with initial TL or initial TA, this trend was not statistically significant. In conclusion, age is the sole predictor of the replicative potential of human NPCs, and replicative potential decreases with age. Initial TL and initial TA are not predictors of replicative potential, and can serve only as reference values. PMID:26633809

  2. Target radiofrequency combined with collagenase chemonucleolysis in the treatment of lumbar intervertebral disc herniation

    PubMed Central

    Zhang, Daying; Zhang, Yong; Wang, Zhijian; Zhang, Xuexue; Sheng, Mulan

    2015-01-01

    Both target radiofrequency thermocoagulation and collagenase chemonucleolysis are effective micro-invasive therapy means for lumbar intervertebral disc herniation. In order to analyze the clinical effects of target radiofrequency thermocoagulation combined with collagenase chemonucleolysis on lumbar intervertebral disc herniation, the contents of hydroxyproline and glycosaminoglycan were measured and the histological changes of nucleus pulposus was detected in the vitro experiments. Radiofrequency thermocoagulation reduced the hydrolyzation of herniated nucleus pulposus caused by collagenase, as well as the content of hydroxyproline and glycosaminoglycan. Furthermore, 236 patients with lumbar intervertebral disc herniation were treated by target radiofrequency thermocoagulation combined with collagenase chemonucleolysis. The efficiency was evaluated according to Macnab criteria, and the index of lumbar disc herniation (IDH) was compared pre-operation with 3 months post-operation. The post-operative good rate was 66.5% (157/236) at 2 weeks post-operation, and 88.1% (208/236) at 3 months post-operation. In the post-operative follow-up exam, 86.8% of the re-examined cases demonstrated smaller or ablated protrusion, with reduced IDH values from pre-operation, which was statistically significant. No serious complications were detected intra-operatively and post-operatively. In conclusion, target radiofrequency combined with collagenase chemonucleolysis was an effective and safe method for treatment of lumbar intervertebral disc herniation. PMID:25785026

  3. Treatment of Lumbar Intervertebral Disc Herniation Using C-Arm Fluoroscopy Guided Target Percutaneous Laser Disc Decompression

    PubMed Central

    Zhao, Xu-Li; Xu, Yong-Guang; Zhao, Xue-Jun; Song, Wen-Ge; Zheng, Hong

    2012-01-01

    Abstract Objective: To evaluate the safety and therapeutic efficacy of target percutaneous laser disc decompression (T-PLDD) for the treatment of lumbar disc herniation. Background data: PLDD using the Nd:YAG laser has been regarded as an effective alternative treatment for disc herniation. However, all the previous studies were concentrated on vaporizing the nucleus pulposus in the intervertebral space. We hypothesize that insertion of the needle into the extruded part of the nucleus pulposus will decrease its volume and provide superior clinical effects compared to therapies that decrease the volume of the intradiscal nucleus pulposus. Materials and methods: A total of 25 patients suffering from posterolateral extruded but nonsequestered lumbar intervertebral disc herniation were treated with T-PLDD. After treatment, the patients were followed up and the therapeutic effect was assessed at 1, 3, 6, and 12 months using the modified MacNab criteria. Results: The success rate was 80.0% (18 of 25), 88.0% (22 of 25), 92.0% (23 of 25), and 92.0% (23 of 25) at 1, 3, 6, and 12 months respectively. No serious complications occurred in any of the patients. Furthermore, we did not observe any neurological sequelae. Conclusions: T-PLDD can significantly decrease pain and improve function of patients who have extruded but nonsequestered lumbar intervertebral disc herniation. PMID:22150064

  4. Tonicity enhancer binding protein (TonEBP) and hypoxia-inducible factor (HIF) coordinate heat shock protein 70 (Hsp70) expression in hypoxic nucleus pulposus cells: role of Hsp70 in HIF-1α degradation.

    PubMed

    Gogate, Shilpa S; Fujita, Nobuyuki; Skubutyte, Renata; Shapiro, Irving M; Risbud, Makarand V

    2012-05-01

    The objective of our study was to examine the regulation of hypoxic expression of heat shock protein 70 (Hsp70) in nucleus pulposus cells and to determine if Hsp70 promoted hypoxia-inducible factor (HIF)-1α degradation. Rat nucleus pulposus cells were maintained in culture in either 21% or 1% oxygen. To determine the regulation of Hsp70 expression by tonicity enhancer binding protein (TonEBP) and HIF-1/2, loss-of-function and gain-of-function experiments and mutational analysis of the Hsp70 promoter were performed. Hypoxia increased Hsp70 expression in nucleus pulposus cells. Noteworthy, hypoxia increased TonEBP transactivation and mutation of TonE motifs blocked hypoxic induction of the Hsp70 promoter. In contrast, mutation of hypoxia response element (HRE) motifs coupled with loss-of-function experiments suggested that HIF-1 and HIF-2 suppressed Hsp70 promoter activity and transcription. Interestingly, HIF-α interferes with TonEBP function and suppresses the inductive effect of TonEBP on the Hsp70 promoter. In terms of Hsp70 function, when treated with Hsp70 transcriptional inhibitor, KNK437, there was an increase in HIF-1α protein stability and transcriptional activity. Likewise, when Hsp70 was overexpressed, the stability of HIF-1α and its transcriptional activity decreased. Hsp70 interacted with HIF-1α under hypoxic conditions and evidenced increased binding when treated with MG132, a proteasomal inhibitor. These results suggest that Hsp70 may promote HIF-1α degradation through the proteasomal pathway in nucleus pulposus cells. In hypoxic and hyperosmolar nucleus pulposus cells, Hsp70, TonEBP, and HIFs form a regulatory loop. We propose that the positive regulation by TonEBP and negative regulation of Hsp70 by HIF-1 and HIF-2 may serve to maintain Hsp70 levels in these cells, whereas Hsp70 may function in controlling HIF-1α homeostasis. PMID:22322648

  5. Brain herniation

    MedlinePlus

    ... herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain ... Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most ...

  6. Treatment of lumbar disc herniation by percutaneous laser disc decompression (PLDD) and modified PLDD

    NASA Astrophysics Data System (ADS)

    Chi, Xiao fei; Li, Hong zhi; Wu, Ru zhou; Sui, Yun xian

    2005-07-01

    Objective: To study the micro-invasive operative method and to compare the effect of treatment of PLDD and modified PLDD for Lumbar Disc Herniation. Method: Vaporized part of the nucleus pulposus in single or multiple point after acupuncture into lumbar disc, to reach the purpose of the decompression of the lumbar disc. Result: Among the 19 cases of the regular PLDD group, the excellent and good rate was 63.2%, and among the 40 cases of the modified PLDD group, the excellent and good rate was 82.5%. Conclusion: The modified PLDD has good effect on the treatment for lumbar disc herniation.

  7. The natural history of lumbar disc herniation and radiculopathy.

    PubMed

    Benoist, Michel

    2002-03-01

    The majority of patients suffering from a radiculopathy caused by a herniated nucleus pulposus (HNP) heal spontaneously without surgery or chemonucleolysis. The clinical course of the radiculopathy varies as well as the efficacy of conservative treatment. In some patients the symptoms decline after a week or two; in others the pain may continue for many months or years. Despite an abundant literature there is still a controversy concerning the treatment of radiculopathies related to ruptured lumbar intervertebral discs. Obviously knowledge of the natural history of discal herniation, and of the mechanisms leading to the changes of the extruded discal tissue, would be of great help in planning the therapeutic procedure. The purpose of this article is to review the reliable data concerning the clinical and pathomorphological evolution and the biological mechanisms associated with the morphologic changes of discal herniation. PMID:12027305

  8. Thoracolumbar intradural disc herniation in eight dogs: clinical, low-field magnetic resonance imaging, and computed tomographic myelography findings.

    PubMed

    Tamura, Shinji; Doi, Shoko; Tamura, Yumiko; Takahashi, Kuniaki; Enomoto, Hirokazu; Ozawa, Tsuyoshi; Uchida, Kazuyuki

    2015-01-01

    Intradural disc herniation is a rarely reported cause of neurologic deficits in dogs and few published studies have described comparative imaging characteristics. The purpose of this retrospective cross sectional study was to describe clinical and imaging findings in a group of dogs with confirmed thoracolumbar intradural disc herniation. Included dogs were referred to one of four clinics, had acute mono/paraparesis or paraplegia, had low field magnetic resonance imaging (MRI) and/or computed tomographic myelography, and were diagnosed with thoracolumbar intradural disc herniation during surgery. Eight dogs met inclusion criteria. The prevalence of thoracolumbar intradural disc herniation amongst the total population of dogs that developed a thoracolumbar intervertebral disc herniation and that were treated with a surgical procedure was 0.5%. Five dogs were examined using low-field MRI. Lesions that were suspected to be intervertebral disc herniations were observed; however, there were no specific findings indicating that the nucleus pulposus had penetrated into the subarachnoid space or into the spinal cord parenchyma. Thus, the dogs were misdiagnosed as having a conventional intervertebral disc herniation. An intradural extramedullary disc herniation (three cases) or intramedullary disc herniation (two cases) was confirmed during surgery. By using computed tomographic myelography (CTM) for the remaining three dogs, an intradural extramedullary mass surrounded by an accumulation of contrast medium was observed and confirmed during surgery. Findings from this small sample of eight dogs indicated that CTM may be more sensitive for diagnosing canine thoracolumbar intradural disc herniation than low-field MRI. PMID:25263808

  9. Effects of age, replicative lifespan and growth rate of human nucleus pulposus cells on selecting age range for cell-based biological therapies for degenerative disc diseases.

    PubMed

    Lee, J S; Lee, S M; Jeong, S W; Sung, Y G; Lee, J H; Kim, K W

    2016-07-01

    Autologous disc cell implantation, growth factors and gene therapy appear to be promising therapies for disc regeneration. Unfortunately, the replicative lifespan and growth kinetics of human nucleus pulposus (NP) cells related to host age are unclear. We investigated the potential relations among age, replicative lifespan and growth rate of NP cells, and determined the age range that is suitable for cell-based biological therapies for degenerative disc diseases. We used NP tissues classified by decade into five age groups: 30s, 40s, 50s, 60s and 70s. The mean cumulative population doubling level (PDL) and population doubling rate (PDR) of NP cells were assessed by decade. We also investigated correlations between cumulative PDL and age, and between PDR and age. The mean cumulative PDL and PDR decreased significantly in patients in their 60s. The mean cumulative PDL and PDR in the younger groups (30s, 40s and 50s) were significantly higher than those in the older groups (60s and 70s). There also were significant negative correlations between cumulative PDL and age, and between PDR and age. We found that the replicative lifespan and growth rate of human NP cells decreased with age. The replicative potential of NP cells decreased significantly in patients 60 years old and older. Young individuals less than 60 years old may be suitable candidates for NP cell-based biological therapies for treating degenerative disc diseases. PMID:27149303

  10. High Glucose-Induced Oxidative Stress Mediates Apoptosis and Extracellular Matrix Metabolic Imbalances Possibly via p38 MAPK Activation in Rat Nucleus Pulposus Cells

    PubMed Central

    Cheng, Xiaofei; Ni, Bin; Zhang, Feng; Hu, Ying

    2016-01-01

    Objectives. To investigate whether high glucose-induced oxidative stress is implicated in apoptosis of rat nucleus pulposus cells (NPCs) and abnormal expression of critical genes involved in the metabolic balance of extracellular matrix (ECM). Methods. NPCs were cultured with various concentrations of glucose to detect cell viability and apoptosis. Cells cultured with high glucose (25 mM) were untreated or pretreated with N-acetylcysteine or a p38 MAPK inhibitor SB 202190. Reactive oxygen species (ROS) production was evaluated. Activation of p38 MAPK was measured by Western blot. The expression of ECM metabolism-related genes, including type II collagen, aggrecan, SRY-related high-mobility-group box 9 (Sox-9), matrix metalloproteinase 3 (MMP-3), and tissue inhibitor of metalloproteinase 1 (TIMP-1), was analyzed by semiquantitative RT-PCR. Results. High glucose reduced viability of NPCs and induced apoptosis. High glucose resulted in increased ROS generation and p38 MAPK activation. In addition, it negatively regulated the expression of type II collagen, aggrecan, Sox-9, and TIMP-1 and positively regulated MMP-3 expression. These results were changed by pretreatment with N-acetylcysteine or SB 202190. Conclusions. High glucose might promote apoptosis of NPCs, trigger ECM catabolic pathways, and inhibit its anabolic activities, possibly through a p38 MAPK-dependent oxidative stress mechanism.

  11. Three-dimensional scaffold of type II collagen promote the differentiation of adipose-derived stem cells into a nucleus pulposus-like phenotype.

    PubMed

    Zhou, Xiaopeng; Tao, Yiqing; Wang, Jingkai; Liu, Dongyu; Liang, Chengzhen; Li, Hao; Chen, Qixin

    2016-07-01

    Type II collagen is reported to have the capability of guiding adipose-derived stem cells (ADSCs) to differentiate towards a nucleus pulposus (NP)-like phenotype. So this study aimed to establish a three-dimensional (3D) collagen scaffold using N,N-(3-dimethylaminopropyl)-N'-ethyl carbodiimide and N-hydroxysuccinimide (EDAC/NHS) to increase the efficiency of ADSC differentiation into NP-like cells. Physical properties, such as porosity, biodegradation, and microstructure, and biological characteristics such as cytotoxicity, cell proliferation, and expression of relevant genes and proteins were measured to evaluate the efficacy of different scaffolds. Collagen scaffolds cross-linked with EDAC/NHS exhibited higher biological stability, better spatial structure, and higher gene and protein expression of functional markers such as aggrecan, SOX9 and COL2 than those of other groups. Based on the results, freeze-dried type II collagen cross-linked with EDAC/NHS formed the best 3D scaffold, for inducing ADSC proliferation and differentiation toward a NP-like phenotype. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1687-1693, 2016. PMID:26940048

  12. Collagen-low molecular weight hyaluronic acid semi-interpenetrating network loaded with gelatin microspheres for cell and growth factor delivery for nucleus pulposus regeneration.

    PubMed

    Tsaryk, Roman; Gloria, Antonio; Russo, Teresa; Anspach, Laura; De Santis, Roberto; Ghanaati, Shahram; Unger, Ronald E; Ambrosio, Luigi; Kirkpatrick, C James

    2015-07-01

    Intervertebral disc (IVD) degeneration is one of the main causes of low back pain. Current surgical treatments are complex and generally do not fully restore spine mobility. Development of injectable extracellular matrix-based hydrogels offers an opportunity for minimally invasive treatment of IVD degeneration. Here we analyze a specific formulation of collagen-low molecular weight hyaluronic acid (LMW HA) semi-interpenetrating network (semi-IPN) loaded with gelatin microspheres as a potential material for tissue engineering of the inner part of the IVD, the nucleus pulposus (NP). The material displayed a gel-like behavior, it was easily injectable as demonstrated by suitable tests and did not induce cytotoxicity or inflammation. Importantly, it supported the growth and chondrogenic differentiation potential of mesenchymal stem cells (MSC) and nasal chondrocytes (NC) in vitro and in vivo. These properties of the hydrogel were successfully combined with TGF-β3 delivery by gelatin microspheres, which promoted the chondrogenic phenotype. Altogether, collagen-LMW HA loaded with gelatin microspheres represents a good candidate material for NP tissue engineering as it combines important rheological, functional and biological features. PMID:25861947

  13. Levofloxacin increases the effect of serum deprivation on anoikis of rat nucleus pulposus cells via Bax/Bcl-2/caspase-3 pathway.

    PubMed

    Yang, Si-Dong; Bai, Zhi-Long; Zhang, Feng; Ma, Lei; Yang, Da-Long; Ding, Wen-Yuan

    2014-12-01

    Levofloxacin, a fluoroquinolone, is a widely-used and effective antibiotic. However, various adverse side effects are associated with levofloxacin. The purpose of this study was to further explore the effects of levofloxacin on rat nucleus pulposus cells (NPCs). Inverted phase-contrast microscopy, flow cytometry and caspase-3 activity assays were used and revealed that serum deprivation induced apoptosis, which was markedly increased by levofloxacin in a dose-dependent manner. Simultaneously, levofloxacin decreased cell binding to type II collagen (COL2). Thus, levofloxacin-induced apoptosis exhibits characteristics of anoikis, the process by which cell death is triggered by separation from the extracellular matrix, which contains COL2. Furthermore, real-time quantitative RT-PCR was used to further confirm that levofloxacin downregulates COL2 expression in a dose-dependent manner. At last, western blot was used to find that levofloxacin increased the ratio of Bax/Bcl-2 and active caspase-3 in a dose-dependent manner. Levofloxacin therefore increases the effects of serum deprivation on anoikis by downregulating COL2 in rat NPCs in vitro via Bax/Bcl-2/caspase-3 pathway. This research provides a novel insight into the mechanisms of levofloxacin-induced toxicity and may potentially lead to a better understanding of the clinical effects of levofloxacin, especially in terms of intervertebral disc degeneration. PMID:25224805

  14. Characterization of injectable hydrogels based on poly(N-isopropylacrylamide)-g-chondroitin sulfate with adhesive properties for nucleus pulposus tissue engineering.

    PubMed

    Wiltsey, Craig; Kubinski, Pamela; Christiani, Thomas; Toomer, Katelynn; Sheehan, Joseph; Branda, Amanda; Kadlowec, Jennifer; Iftode, Cristina; Vernengo, Jennifer

    2013-04-01

    The goal of this work is to develop an injectable nucleus pulposus (NP) tissue engineering scaffold with the ability to form an adhesive interface with surrounding disc tissue. A family of in situ forming hydrogels based on poly(N-isopropylacrylamide)-graft-chondroitin sulfate (PNIPAAm-g-CS) were evaluated for their mechanical properties, bioadhesive strength, and cytocompatibility. It was shown experimentally and computationally with the Neo-hookean hyperelastic model that increasing the crosslink density and decreasing the CS concentration increased mechanical properties at 37 °C, generating several hydrogel formulations with unconfined compressive modulus values similar to what has been reported for the native NP. The adhesive tensile strength of PNIPAAm increased significantly with CS incorporation (p < 0.05), ranging from 0.4 to 1 kPa. Live/Dead and XTT assay results indicate that the copolymer is not cytotoxic to human embryonic kidney (HEK) 293 cells. Taken together, these data indicate the potential of PNIPAAm-g-CS to function as a scaffold for NP regeneration. PMID:23371764

  15. Development and initial characterization of a chemically stabilized elastin-glycosaminoglycan-collagen composite shape-memory hydrogel for nucleus pulposus regeneration.

    PubMed

    Mercuri, Jeremy; Addington, Caroline; Pascal, Richard; Gill, Sanjitpal; Simionescu, Dan

    2014-12-01

    Nucleus pulposus (NP) is a resilient and hydrophilic tissue which plays a significant role in the biomechanical function of the intervertebral disc (IVD). Destruction of the NP extracellular matrix (ECM) is observed during the early stages of IVD degeneration. Herein, we describe the development and initial characterization of a novel biomaterial which attempts to recreate the resilient and hydrophilic nature of the NP via the construction of a chemically stabilized elastin-glycosaminoglycan-collagen (EGC) composite hydrogel. Results demonstrated that a resilient, hydrophilic hydrogel which displays a unique "shape-memory" sponge characteristic could be formed from a blend of soluble elastin aggregates, chondroitin-6-sulfate, hyaluronic acid and collagen following freeze-drying, stabilization with a carbodiimide and penta-galloyl glucose-based fixative, and subsequent partial degradation with glycosaminoglycan degrading enzymes. The resultant material exhibited the ability to restore its original dimensions and water content following multi-cycle mechanical compression and illustrated resistance to accelerated enzymatic degradation. Preliminary in vitro studies utilizing human adipose derived stem cells (hADSCs) demonstrated that the material was cytocompatible and supported differentiation towards an NP cell-like phenotype. In vivo biocompatibility studies illustrated host cell infiltration and evidence of active remodeling following 4 weeks of implantation. Feasibility studies demonstrated that the EGC hydrogel could be delivered via minimally invasive methods. PMID:24497431

  16. Differential expression of p38 MAPK α, β, γ, δ isoforms in nucleus pulposus modulates macrophage polarization in intervertebral disc degeneration

    PubMed Central

    Yang, Chen; Cao, Peng; Gao, Yang; Wu, Ming; Lin, Yun; Tian, Ye; Yuan, Wen

    2016-01-01

    P38MAPK mediates cytokine induced inflammation in nucleus pulposus (NP) cells and involves in multiple cellular processes which are related to intervertebral disc degeneration (IDD). The aim of this study was to investigate the expression, activation and function of p38 MAPK isoforms (α,β, γ and δ) in degenerative NP and the effect of p38 activation in NP cells on macrophage polarization. P38 α, β and δ isoforms are preferential expressed, whereas the p38γ isoform is absent in human NP tissue. LV-sh-p38α, sh-p38β transfection in NP cells significantly decreased the ADAMTS-4,-5, MMP-13,CCL3 expression and restored collagen-II and aggrecan expression upon IL-1β stimulation. As compared with p38α and p38β, p38δ exhibited an opposite effect on ADAMTS-4,-5, MMP-13 and aggrecan expression in NP cells. Furthermore, the production of GM-CSF and IFNγ which were trigged by p38α or p38β in NP cells induced macrophage polarization into M1 phenotype. Our finding indicates that p38 MAPK α, β and δ isoform are predominantly expressed and activated in IDD. P38 positive NP cells modulate macrophage polarization through the production of GM-CSF and IFNγ. Hence, Our study suggests that selectively targeting p38 isoforms could ameliorate the inflammation in IDD and regard IDD progression. PMID:26911458

  17. TGF-β1 antagonizes TNF-α induced up-regulation of matrix metalloproteinase 3 in nucleus pulposus cells: role of the ERK1/2 pathway.

    PubMed

    Yang, Hao; Gao, Fei; Li, Xiang; Wang, Jianru; Liu, Hui; Zheng, Zhaomin

    2015-11-01

    Tumor necrosis factor-α (TNF-α) has been shown to have a catabolic effect on intervertebral disc degeneration (IVDD), including increasing MMP3 expression and subsequent extracellular matrix (ECM) degradation. In contrast, transforming growth factor-β1 (TGF-β1) has an anabolic effect on nucleus pulposus (NP) cells. However, the anti-catabolic effect of TGF-β1 under inflammatory condition is unknown. The aim of this study was to demonstrate whether TGF-β1 can reverse TNF-α-induced MMP3 increase in NP cells and to further investigate the underlying mechanisms. The transcriptional activity, gene expression, and protein levels of MMP3 were measured by luciferase reporter assay, qRT-PCR and western blot, respectively. TNF-α increased MMP3 expression in rat NP cells time and dose dependently. TGF-β1 could abolish TNF-α-mediated up-regulation of collagen I and MMP3 expression, and down-regulate aggrecan and collagen II expression. The ERK1/2 signaling pathway was activated after exposure to TGF-β1. Treatment with ERK1/2 inhibitors (PD98059 and U0126) abolished the antagonistic effect of TGF-β1 on TNF-α mediated catabolic responses. These findings provide novel evidence supporting the anti-catabolic role of TGF-β1 in IVDD, which is important for the potential clinical application of TGF-β1 in disc degenerative disorders. PMID:26075533

  18. SOX9 directly Regulates CTGF/CCN2 Transcription in Growth Plate Chondrocytes and in Nucleus Pulposus Cells of Intervertebral Disc.

    PubMed

    Oh, Chun-do; Yasuda, Hideyo; Zhao, Weiwei; Henry, Stephen P; Zhang, Zhaoping; Xue, Ming; de Crombrugghe, Benoit; Chen, Di

    2016-01-01

    Several lines of evidence indicate that connective tissue growth factor (CTGF/CCN2) stimulates chondrocyte proliferation and maturation. Given the fact that SOX9 is essential for several steps of the chondrocyte differentiation pathway, we asked whether Ctgf (Ccn2) is the direct target gene of SOX9. We found that Ctgf mRNA was down-regulated in primary sternal chondrocytes from Sox9(flox/flox) mice infected with Ad-CMV-Cre. We performed ChIP-on-chip assay using anti-SOX9 antibody, covering the Ctgf gene from 15 kb upstream of its 5'-end to 10 kb downstream of its 3'-end to determine SOX9 interaction site. One high-affinity interaction site was identified in the Ctgf proximal promoter by ChIP-on-chip assay. An important SOX9 regulatory element was found to be located in -70/-64 region of the Ctgf promoter. We found the same site for SOX9 binding to the Ctgf promoter in nucleus pulposus (NP) cells. The loss of Sox9 in growth plate chondrocytes in knee joint and in NP cells in intervertebral disc led to the decrease in CTGF expression. We suggest that Ctgf is the direct target gene of SOX9 in chondrocytes and NP cells. Our study establishes a strong link between two regulatory molecules that have a major role in cartilaginous tissues. PMID:27436052

  19. SIRT1 expression is refractory to hypoxia and inflammatory cytokines in nucleus pulposus cells: Novel regulation by HIF-1α and NF-κB signaling.

    PubMed

    Wang, Xiaofei; Li, Hongjian; Xu, Kang; Zhu, Haipeng; Peng, Yan; Liang, Anjing; Li, Chunhai; Huang, Dongsheng; Ye, Wei

    2016-06-01

    Hypoxia and a marked increase in inflammatory cytokines are common hallmarks of intervertebral disc degeneration; these events disrupt the normal balance between extracellular matrix (ECM) degradation and synthesis in degenerative intervertebral discs. SIRT1, one of the NAD+-dependent class III histone deacetylases, controls cellular processes and is regulated by hypoxia and inflammatory cytokines in a cell-type-dependent manner. SIRT1 protects degenerative human nucleus pulposus cells against apoptosis. However, the role of SIRT1 in inflammation in intervertebral discs is still unclear. The current study showed that in rat NP cells, as in other cells, SIRT1 suppressed the induction of the mRNA expression of proteases that degrade ECM induced by TNF-α. Moreover, real-time PCR, transfection, and loss- and gain-of-function experiments revealed that SIRT1 mRNA and protein expression were refractory to hypoxia and HIF-1α. Additionally, SIRT1 mRNA and protein expression and the activity of the SIRT1 promoter were not affected by inflammatory cytokines but were sustained by NF-κB signaling in the presence or absence of TNF-α. In summary, the present study suggested that SIRT1 is not affected by hypoxia and inflammatory cytokines in rat intervertebral discs. Moreover, not HIF-1α but NF-κB signaling is critical for the maintenance of SIRT1 expression in NP cells under physiologic and pathophysiologic conditions. PMID:27061137

  20. FasL Expression on Human Nucleus Pulposus Cells Contributes to the Immune Privilege of Intervertebral Disc by Interacting with Immunocytes

    PubMed Central

    Liu, Zhi-Heng; Sun, Zhen; Wang, Hai-Qiang; Ge, Jun; Jiang, Ting-Shuai; Chen, Yu-Fei; Ma, Ying; Wang, Chen; Hu, Sheng; Samartzis, Dino; Luo, Zhuo-Jing

    2013-01-01

    The mechanisms of immune privilege in human nucleus pulposus (NP) remain unclear. Accumulating evidence indicates that Fas ligand (FasL) might play an important role in the immune privilege of the disc. We aimed for addressing the role of FasL expression in human intervertebral disc degeneration (IDD) and immune privilege in terms of the interaction between NP cells and immunocytes via the FasL-Fas machinery. We collected NP specimens from 20 patients with IDD as degenerative group and 8 normal cadaveric donors as control. FasL expression was detected by qRT-PCR, western blotting and flow cytometry (FCM). We also collected macrophages and CD8+ T cells from the peripheral blood of patients with IDD for co-cultures with NP cells. And macrophages and CD8+ T cells were harvested for apoptosis analysis by FCM after 2 days of co-cultures. We found that FasL expression in mRNA, protein and cellular resolutions demonstrated a significant decrease in degenerative group compared with normal control (p<0.05). FCM analysis found that human NP cells with increased FasL expression resulted in significantly increased apoptosis ratio of macrophages and CD8+ T cells. Our study demonstrated that FasL expression tends to decrease in degenerated discs and FasL plays an important role in human disc immune privilege, which might provide a novel target for the treatment strategies for IDD. PMID:23801893

  1. SOX9 directly Regulates CTGF/CCN2 Transcription in Growth Plate Chondrocytes and in Nucleus Pulposus Cells of Intervertebral Disc

    PubMed Central

    Oh, Chun-do; Yasuda, Hideyo; Zhao, Weiwei; Henry, Stephen P.; Zhang, Zhaoping; Xue, Ming; de Crombrugghe, Benoit; Chen, Di

    2016-01-01

    Several lines of evidence indicate that connective tissue growth factor (CTGF/CCN2) stimulates chondrocyte proliferation and maturation. Given the fact that SOX9 is essential for several steps of the chondrocyte differentiation pathway, we asked whether Ctgf (Ccn2) is the direct target gene of SOX9. We found that Ctgf mRNA was down-regulated in primary sternal chondrocytes from Sox9flox/flox mice infected with Ad-CMV-Cre. We performed ChIP-on-chip assay using anti-SOX9 antibody, covering the Ctgf gene from 15 kb upstream of its 5′-end to 10 kb downstream of its 3′-end to determine SOX9 interaction site. One high-affinity interaction site was identified in the Ctgf proximal promoter by ChIP-on-chip assay. An important SOX9 regulatory element was found to be located in −70/−64 region of the Ctgf promoter. We found the same site for SOX9 binding to the Ctgf promoter in nucleus pulposus (NP) cells. The loss of Sox9 in growth plate chondrocytes in knee joint and in NP cells in intervertebral disc led to the decrease in CTGF expression. We suggest that Ctgf is the direct target gene of SOX9 in chondrocytes and NP cells. Our study establishes a strong link between two regulatory molecules that have a major role in cartilaginous tissues. PMID:27436052

  2. TGF-β1 and GDF5 Act Synergistically to Drive the Differentiation of Human Adipose Stromal Cells toward Nucleus Pulposus-like Cells.

    PubMed

    Colombier, Pauline; Clouet, Johann; Boyer, Cécile; Ruel, Maëva; Bonin, Gaëlle; Lesoeur, Julie; Moreau, Anne; Fellah, Borhane-Hakim; Weiss, Pierre; Lescaudron, Laurent; Camus, Anne; Guicheux, Jérôme

    2016-03-01

    Degenerative disc disease (DDD) primarily affects the central part of the intervertebral disc namely the nucleus pulposus (NP). DDD explains about 40% of low back pain and is characterized by massive cellular alterations that ultimately result in the disappearance of resident NP cells. Thus, repopulating the NP with regenerative cells is a promising therapeutic approach and remains a great challenge. The objectives of this study were to evaluate the potential of growth factor-driven protocols to commit human adipose stromal cells (hASCs) toward NP-like cell phenotype and the involvement of Smad proteins in this differentiation process. Here, we demonstrate that the transforming growth factor-β1 and the growth differentiation factor 5 synergistically drive the nucleopulpogenic differentiation process. The commitment of the hASCs was robust and highly specific as attested by the expression of NP-related genes characteristic of young healthy human NP cells. In addition, the engineered NP-like cells secreted an abundant aggrecan and type II collagen rich extracellular matrix comparable with that of native NP. Furthermore, we demonstrate that these in vitro engineered cells survived, maintained their specialized phenotype and secretory activity after in vivo transplantation in nude mice subcutis. Finally, we provide evidence suggesting that the Smad 2/3 pathway mainly governed the acquisition of the NP cell molecular identity while the Smad1/5/8 pathway controlled the NP cell morphology. This study offers valuable insights for the development of biologically-inspired treatments for DDD by generating adapted and exhaustively characterized autologous regenerative cells. Stem Cells 2016;34:653-667. PMID:26661057

  3. Xylosyltransferase-1 Expression Is Refractory to Inhibition by the Inflammatory Cytokines Tumor Necrosis Factor α and IL-1β in Nucleus Pulposus Cells

    PubMed Central

    Ye, Wei; Zhou, Jie; Markova, Dessislava Z.; Tian, Ye; Li, Jun; Anderson, D. Greg; Shapiro, Irving M.; Risbud, Makarand V.

    2016-01-01

    We investigated whether expression of xylosyltransferase-1 (XT-1), a key enzyme in glycosaminoglycan biosynthesis, is responsive to disk degeneration and to inhibition by the inflammatory cytokines tumor necrosis factor α and IL-1β in nucleus pulposus (NP) cells. Analysis of human NP tissues showed that XT-1 expression is unaffected by degeneration severity; XT-1 and Jun, Fos, and Sp1 mRNA were positively correlated. Cytokines failed to inhibit XT-1 promoter activity and expression. However, cytokines decreased activity of XT-1 promoters containing deletion and mutation of the –730/–723 bp AP-1 motif, prompting us to investigate the role of AP-1 and Sp1/Sp3 in the regulation of XT-1 in healthy NP cells. Overexpression and suppression of AP-1 modulated XT-1 promoter activity. Likewise, treatment with the Sp1 inhibitors WP631 and mithramycin A or cotransfection with the plasmid DN-Sp1 decreased XT-1 promoter activity. Inhibitors of AP-1 and Sp1 and stable knockdown of Sp1 and Sp3 resulted in decreased XT-1 expression in NP cells. Genomic chromatin immunoprecipitation analysis showed AP-1 binding to motifs located at –730/–723 bp and –684/–677 bp and Sp1 binding to –227/–217 bp and –124/–114 bp in XT-1 promoter. These results suggest that XT-1 expression is refractory to the disease process and to inhibition by inflammatory cytokines and that signaling through AP-1, Sp1, and Sp3 is important in the maintenance of XT-1 levels in NP cells. PMID:25476526

  4. Serum-free, chemically defined medium with TGF-beta(3) enhances functional properties of nucleus pulposus cell-laden carboxymethylcellulose hydrogel constructs.

    PubMed

    Reza, Anna T; Nicoll, Steven B

    2010-02-01

    Degeneration of the nucleus pulposus (NP) has been implicated as a major cause of low back pain. Tissue engineering strategies may provide a viable NP replacement therapy; however, culture conditions must be optimized to promote functional tissue development. In this study, a standard serum-containing medium formulation was compared to a chemically defined, serum-free medium to determine the effect on matrix elaboration and functional properties of NP cell-laden carboxymethylcellulose (CMC) hydrogels. Additionally, both media were further supplemented with transforming growth factor-beta 3 (TGF-beta(3)). Glycosaminoglycan (GAG) content increased in both TGF-beta(3)-treated groups and was highest for treated, serum-free constructs (9.46 +/- 1.51 microg GAG/mg wet weight), while there were no quantifiable GAGs in untreated serum-containing samples. Histology revealed uniform, interterritorial staining for chondroitin sulfate proteoglycan throughout the treated, serum-free constructs. Type II collagen content was greater in both serum-free groups and highest in treated, serum-free constructs. The equilibrium Young's modulus was highest in serum-free samples supplemented with TGF-beta(3) (18.54 +/- 1.92 kPa), and the equilibrium weight swelling ratio of these constructs approached that of the native NP tissue (22.19 +/- 0.46 vs. 19.94 +/- 3.09, respectively). Taken together, these results demonstrate enhanced functional matrix development by NP cells when cultured in CMC hydrogels maintained in serum-free, TGF-beta(3) supplemented medium, indicating the importance of medium formulation in NP construct development. PMID:19777586

  5. Plumbagin exerts protective effects in nucleus pulposus cells by attenuating hydrogen peroxide-induced oxidative stress, inflammation and apoptosis through NF-κB and Nrf-2.

    PubMed

    Chu, Hui; Yu, Hang; Ren, Ding; Zhu, Kejun; Huang, Hong

    2016-06-01

    Plumbagin, one of the constituents responsible for the various biological activities of Plumbago zeylanica has been demonstrated to possess antioxidant activity, which may inhibit lipid peroxidation in a dose- and time-dependent manner. In the present study, we aimed to examine the protective effects of plumbagin as well as the underlying mechansim through which plumbagin attenuates hydrogen peroxide (H2O2)-induced oxidative stress in nucleus pulposus cells (NPCs). For this purpose, the NPCs were incubated with fresh medium containing H2O2 (200 µM) at 37˚C in a humidified 5% CO2 atmosphere for 6 h, and cultured with various concentrations of plumbagin (0, 0.5, 1, 2, 5, 10 and 20 µM). Treatment with plumbagin significantly increased the viability of the H2O2-exposed NPCs in a dose‑dependent manner. Moreover, plumbagin significantly reduced the generation of reactive oxygen species, lipid peroxidation, as well as the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 in the H2O2‑exposed NPCs. Glutathione (GSH) content, as well as the activity of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxdiase (GSH-Px) were increased. We found that the administration of plumbagin significantly inhibited the activity of caspase-9 and -3, and downregulated NF-κB expression and upregulated Nrf-2 expression in the H2O2-exposed NPCs. Taken together, these findings suggest that plumbagin exerts neuroprotective effects in NPCs by attenuating H2O2‑induced oxidative stress, inflammation and apoptosis through mediating the expression of NF-κB and Nrf-2. PMID:27082014

  6. Autophagy attenuates the catabolic effect during inflammatory conditions in nucleus pulposus cells, as sustained by NF-κB and JNK inhibition

    PubMed Central

    XU, KANG; CHEN, WEIJIAN; WANG, XIAOFEI; PENG, YAN; LIANG, ANJING; HUANG, DONGSHENG; LI, CHUNHAI; YE, WEI

    2015-01-01

    Proteoglycan degradation contributing to the pathogenesis of intervertebral disc (IVD) degeneration is induced by inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β). Cell autophagy exists in degenerative diseases, including osteoarthritis and inter-vertebral disc degeneration. However, the autophagy induced by TNF-α and IL-1β and the corresponding molecular mechanism appear to be cell-type dependent. The effect and mechanism of autophagy regulated by TNF-α and IL-1β in IVDs remains unclear. Additionally, the impact of autophagy on the catabolic effect in inflammatory conditions also remains elusive. In the present study, autophagy activator and inhibitor were used to demonstrate the impact of autophagy on the catabolic effect induced by TNF-α. A critical role of autophagy was identified in rat nucleus pulposus (NP) cells: Inhibition of autophagy suppresses, while activation of autophagy enhances, the catabolic effect of cytokines. Subsequently, the autophagy-related gene expression in rat NP cells following TNF-α and IL-1β treatment was observed using immunofluorescence, quantitative polymerase chain reaction and western blot analysis; however, no association was present. In addition, nuclear factor κB (NF-κB), c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinases and p38 mitogen-activated protein kinase inhibitors and TNF-α were used to determine the molecular mechanism of autophagy during the inflammatory conditions, and only the NF-κB and JNK inhibitor were found to enhance the autophagy of rat NP cells. Finally, IKKβ knockdown was used to further confirm the effect of the NF-κB signal on human NP cells autophagy, and the data showed that IKKβ knockdown upregulated the autophagy of NP cells during inflammatory conditions. PMID:26165348

  7. Inflammatory Cytokines Associated with Degenerative Disc Disease Control Aggrecanase-1 (ADAMTS-4) Expression in Nucleus Pulposus Cells through MAPK and NF-κB

    PubMed Central

    Tian, Ye; Yuan, Wen; Fujita, Nobuyuki; Wang, Jianru; Wang, Hua; Shapiro, Irving M.; Risbud, Makarand V.

    2014-01-01

    We investigated TNF-α and IL-1β regulation of ADAMTS-4 expression in nucleus pulposus (NP) cells and its role in aggrecan degradation. Real-time quantitative RT-PCR, Western blotting, and transient transfections with rat NP cells and lentiviral silencing with human NP cells were performed to determine the roles of MAPK and NF-κB in cytokine-mediated ADAMTS-4 expression and function. ADAMTS4 expression and promoter activity increased in NP cells after TNF-α and IL-1β treatment. Treatment of cells with MAPK and NF-κB inhibitors abolished the inductive effect of the cytokines on ADAMTS4 mRNA and protein expression. Although ERK1, p38α, p38β2, and p38γ were involved in induction, ERK2 and p38δ played no role in TNF-α–dependent promoter activity. The inductive effect of p65 on ADAMTS4 promoter was confirmed through gain and loss-of-function studies. Cotransfection of p50 completely blocked p65-mediated induction. Lentiviral transduction with shRNA plasmids shp65, shp52, shIKK-α, and shIKK-β significantly decreased TNF-α–dependent increase in ADAMTS-4 and -5 levels and aggrecan degradation. Silencing of either ADAMTS-4 or -5 resulted in reduction in TNF-α–dependent aggrecan degradation in NP cells. By controlling activation of MAPK and NF-κB signaling, TNF-α and IL-1β modulate expression of ADAMTS-4 in NP cells. To our knowledge, this is the first study to show nonredundant contribution of both ADAMTS-4 and ADAMTS-5 to aggrecan degradation in human NP cells in vitro. PMID:23602832

  8. Prolyl-4-hydroxylase Domain Protein 2 Controls NF-κB/p65 Transactivation and Enhances the Catabolic Effects of Inflammatory Cytokines on Cells of the Nucleus Pulposus*

    PubMed Central

    Li, Jun; Yuan, Wen; Jiang, Shuai; Ye, Wei; Yang, Hao; Shapiro, Irving M.; Risbud, Makarand V.

    2015-01-01

    Prolyl-4-hydroxylase (PHD) proteins are key in sensing tissue hypoxia. In nucleus pulposus (NP) cells, our previous work demonstrated that PHD isoforms have a differential contribution in controlling hypoxia-inducible factor (HIF)-α degradation and activity. Recently we have shown that a regulatory relationship exists between PHD3 and inflammatory cytokines in NP cells. With respect to PHD2, the most abundant PHD isoform in NP cells, very little is known concerning its function and regulation under inflammatory conditions that characterize intervertebral disc degeneration. Here, we show that PHD2 is a potent regulator of the catabolic activities of TNF-α; silencing of PHD2 significantly decreased TNF-α-induced expression of catabolic markers including SDC4, MMP-3, MMP-13, and ADAMTS5, as well as several inflammatory cytokines and chemokines, while partially restoring aggrecan and collagen II expression. Use of NF-κB reporters with ShPHD2, SiHIF-1α, as well as p65−/−, PHD2−/−, and PHD3−/− cells, shows that PHD2 serves as a co-activator of NF-κB/p65 signaling in HIF-1-independent fashion. Immunoprecipitation of endogenous and exogenously expressed tagged proteins, as well as fluorescence microscopy, indicates that following TNF-α treatment, PHD2 interacts and co-localizes with p65. Conversely, loss of function experiments using lentivirally delivered Sh-p65, Sh-IKKβ, and NF-κB inhibitor confirmed that cytokine-dependent PHD2 expression in NP cells requires NF-κB signaling. These findings clearly demonstrate that PHD2 forms a regulatory circuit with TNF-α via NF-κB and thereby plays an important role in enhancing activity of this cytokine. We propose that during disc degeneration PHD2 may offer a therapeutic target to mitigate the deleterious actions of TNF-α, a key proinflammatory cytokine. PMID:25635047

  9. Gene therapy for nucleus pulposus regeneration by heme oxygenase-1 plasmid DNA carried by mixed polyplex micelles with thermo-responsive heterogeneous coronas.

    PubMed

    Feng, Ganjun; Chen, Hongying; Li, Junjie; Huang, Qiang; Gupte, Melanie J; Liu, Hao; Song, Yueming; Ge, Zhishen

    2015-06-01

    Safe and high-efficiency gene therapy for nucleus pulposus (NP) regeneration was urgently desired to treat disc degeneration-associated diseases. In this work, an efficient nonviral cationic block copolymer gene delivery system was used to deliver therapeutic plasmid DNA (pDNA), which was prepared via complexation between the mixed cationic block copolymers, poly(ethylene glycol)-block-poly{N-[N-(2-aminoethyl)-2-aminoehtyl]aspartamide} [PEG-b-PAsp(DET)] and poly(N-isopropylacrylamide)-block-PAsp(DET) [PNIPAM-b-PAsp(DET)], and pDNA at 25 °C. The mixed polyplex micelles (MPMs) containing heterogeneous coronas with hydrophobic and hydrophilic microdomains coexisting could be obtained upon heating from 25 to 37 °C, which showed high tolerability against nuclease and strong resistance towards protein adsorption. The gene transfection efficiency of MPMs in NP cells was significantly higher than that of regular polyplex micelles prepared from sole block copolymer of PEG-b-PAsp(DET) (SPMs) in in vitro and in vivo evaluation due to the synergistic effect of improved colloidal stability and low cytotoxicity. High expression of heme oxygenase-1 (HO-1) in NP cells transfected by MPMs loading HO-1 pDNA significantly decreased the expression activity of matrix metalloproteinases 3 (MMP-3) and cyclo-oxygenase-2 (COX-2) induced by interleukin-1β (IL-1β), and simultaneously increased the NP phenotype-associated genes such as aggrecan, type II collagen, and SOX-9. Moreover, the therapeutic effects of MPMs loading pDNA were tested to treat disc degeneration induced by stab injury. The results demonstrated that administration of HO-1 pDNA carried by MPMs in rat tail discs apparently reduced inflammatory responses induced by need stab and increased glycosaminoglycan (GAG) content, finally achieving better therapeutic efficacy as compared with SPMs. Consequently, MPMs loading HO-1 pDNA were demonstrated to be potential as a safe and high-efficiency nonviral gene delivery system

  10. Transforming growth factor-beta 3 stimulates cartilage matrix elaboration by human marrow-derived stromal cells encapsulated in photocrosslinked carboxymethylcellulose hydrogels: potential for nucleus pulposus replacement.

    PubMed

    Gupta, Michelle S; Cooper, Elana S; Nicoll, Steven B

    2011-12-01

    Degeneration of the nucleus pulposus (NP) has been implicated as a major cause of low back pain. Tissue engineering strategies using marrow-derived stromal cells (MSCs) have been used to develop cartilaginous tissue constructs, which may serve as viable NP replacements. Supplementation with growth factors, such as transforming growth factor-beta 3 (TGF-β3), has been shown to enhance the differentiation of MSCs and promote functional tissue development of such constructs. A potential candidate material that may be useful as a scaffold for NP tissue engineering is carboxymethylcellulose (CMC), a biocompatible, cost-effective derivative of cellulose. Photocrosslinked CMC hydrogels have been shown to support NP cell viability and promote phenotypic matrix deposition capable of maintaining mechanical properties when cultured in serum-free, chemically defined medium (CDM) supplemented with TGF-β3. However, MSCs have not been characterized using this hydrogel system. In this study, human MSCs (hMSCs) were encapsulated in photocrosslinked CMC hydrogels and cultured in CDM with and without TGF-β3 to determine the effect of the growth factor on the differentiation of hMSCs toward an NP-like phenotype. Constructs were evaluated for matrix elaboration and functional properties consistent with native NP tissue. CDM supplemented with TGF-β3 resulted in significantly higher glycosaminoglycan content (762.69±220.79 ng/mg wet weight) and type II collagen (COL II) content (6.25±1.64 ng/mg wet weight) at day 21 compared with untreated samples. Immunohistochemical analyses revealed uniform, pericellular, and interterritorial staining for chondroitin sulfate proteoglycan and COL II in growth factor-supplemented constructs compared with faint, strictly pericellular staining in untreated constructs at 21 days. Consistent with matrix deposition, mechanical properties of hydrogels treated with TGF-β3 increased over time and exhibited the highest peak stress in stress-relaxation (

  11. Injection of AAV2-BMP2 and AAV2-TIMP1 into the nucleus pulposus slows the course of intervertebral disc degeneration in an in vivo rabbit model

    PubMed Central

    Leckie, Steven K.; Bechara, Bernard P.; Hartman, Robert A.; Sowa, Gwendolyn A.; Woods, Barrett I.; Coelho, Joao P.; Witt, William T.; Dong, Qing D.; Bowman, Brent W.; Bell, Kevin M.; Vo, Nam V.; Wang, Bing; Kang, James D.

    2016-01-01

    BACKGROUND CONTEXT Intervertebral disc degeneration (IDD) is a common cause of back pain. Patients who fail conservative management may face the morbidity of surgery. Alternative treatment modalities could have a significant impact on disease progression and patients’ quality of life. PURPOSE To determine if the injection of a virus vector carrying a therapeutic gene directly into the nucleus pulposus improves the course of IDD. STUDY DESIGN Prospective randomized controlled animal study. METHODS Thirty-four skeletally mature New Zealand white rabbits were used. In the treatment group, L2–L3, L3–L4, and L4–L5 discs were punctured in accordance with a previously validated rabbit annulotomy model for IDD and then subsequently treated with adeno-associated virus serotype 2 (AAV2) vector carrying genes for either bone morphogenetic protein 2 (BMP2) or tissue inhibitor of metalloproteinase 1 (TIMP1). A nonoperative control group, nonpunctured sham surgical group, and punctured control group were also evaluated. Serial magnetic resonance imaging (MRI) studies at 0, 6, and 12 weeks were obtained, and a validated MRI analysis program was used to quantify degeneration. The rabbits were sacrificed at 12 weeks, and L4–L5 discs were analyzed histologically. Viscoelastic properties of the L3–L4 discs were analyzed using uniaxial load normalized displacement testing. Creep curves were mathematically modeled according to a previously validated two-phase exponential model. Serum samples obtained at 0, 6, and 12 weeks were assayed for biochemical evidence of degeneration. RESULTS The punctured group demonstrated MRI and histologic evidence of degeneration as expected. The treatment groups demonstrated less MRI and histologic evidence of degeneration than the punctured group. The serum biochemical marker C-telopeptide of collagen type II increased rapidly in the punctured group, but the treated groups returned to control values by 12 weeks. The treatment groups

  12. Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings

    NASA Astrophysics Data System (ADS)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

  13. Injection of human umbilical tissue–derived cells into the nucleus pulposus alters the course of intervertebral disc degeneration in vivo

    PubMed Central

    Leckie, Steven K.; Sowa, Gwendolyn A.; Bechara, Bernard P.; Hartman, Robert A.; Coelho, Joao Paulo; Witt, William T.; Dong, Qing D.; Bowman, Brent W.; Bell, Kevin M.; Vo, Nam V.; Kramer, Brian C.; Kang, James D.

    2016-01-01

    Background context Patients often present to spine clinic with evidence of intervertebral disc degeneration (IDD). If conservative management fails, a safe and effective injection directly into the disc might be preferable to the risks and morbidity of surgery. Purpose To determine whether injecting human umbilical tissue–derived cells (hUTC) into the nucleus pulposus (NP) might improve the course of IDD. Design Prospective, randomized, blinded placebo–controlled in vivo study. Patient sample Skeletally mature New Zealand white rabbits. Outcome measures Degree of IDD based on magnetic resonance imaging (MRI), biomechanics, and histology. Methods Thirty skeletally mature New Zealand white rabbits were used in a previously validated rabbit annulotomy model for IDD. Discs L2–L3, L3–L4, and L4–L5 were surgically exposed and punctured to induce degeneration and then 3 weeks later the same discs were injected with hUTC with or without a hydrogel carrier. Serial MRIs obtained at 0, 3, 6, and 12 weeks were analyzed for evidence of degeneration qualitatively and quantitatively via NP area and MRI Index. The rabbits were sacrificed at 12 weeks and discs L4–L5 were analyzed histologically. The L3–L4 discs were fixed to a robotic arm and subjected to uniaxial compression, and viscoelastic displacement curves were generated. Results Qualitatively, the MRIs demonstrated no evidence of degeneration in the control group over the course of 12 weeks. The punctured group yielded MRIs with the evidence of disc height loss and darkening, suggestive of degeneration. The three treatment groups (cells alone, carrier alone, or cells+carrier) generated MRIs with less qualitative evidence of degeneration than the punctured group. MRI Index and area for the cell and the cell+carrier groups were significantly distinct from the punctured group at 12 weeks. The carrier group generated MRI data that fell between control and punctured values but failed to reach a statistically

  14. Tumor Necrosis Factor-α– and Interleukin-1β–Dependent Matrix Metalloproteinase-3 Expression in Nucleus Pulposus Cells Requires Cooperative Signaling via Syndecan 4 and Mitogen-Activated Protein Kinase–NF-κB Axis

    PubMed Central

    Wang, Xin; Wang, Hua; Yang, Hao; Li, Jun; Cai, Qiqing; Shapiro, Irving M.; Risbud, Makarand V.

    2015-01-01

    Matrix metalloproteinase-3 (MMP-3) plays an important role in intervertebral disc degeneration, a ubiquitous condition closely linked to low back pain and disability. Elevated expression of syndecan 4, a cell surface heparan sulfate proteoglycan, actively controls disc matrix catabolism. However, the relationship between MMP-3 expression and syndecan 4 in the context of inflammatory disc disease has not been clearly defined. We investigated the mechanisms by which cytokines control MMP-3 expression in rat and human nucleus pulposus cells. Cytokine treatment increased MMP-3 expression and promoter activity. Stable silencing of syndecan 4 blocked cytokine-mediated MMP-3 expression; more important, syndecan 4 did not mediate its effects through NF-κB or mitogen-activated protein kinase (MAPK) pathways. However, treatment with MAPK and NF-κB inhibitors resulted in partial blocking of the inductive effect of cytokines on MMP-3 expression. Loss-of-function studies confirmed that NF-κB, p38α/β2/γ/δ, and extracellular signal–regulated kinase (ERK) 2, but not ERK1, contributed to cytokine-dependent induction of MMP3 promoter activity. Similarly, inhibitor treatments, lentiviral short hairpin-p65, and short hairpin-IκB kinase β significantly decreased cytokine-dependent up-regulation in MMP-3 expression. Finally, we show that transforming growth factor-β can block the up-regulation of MMP-3 induced by tumor necrosis factor (TNF)-α by counteracting the NF-κB pathway and syndecan 4 expression. Taken together, our results suggest that cooperative signaling through syndecan 4 and the TNF receptor 1–MAPK–NF-κB axis is required for TNF-α–dependent expression of MMP-3 in nucleus pulposus cells. Controlling these pathways may slow the progression of intervertebral disc degeneration and matrix catabolism. PMID:25063530

  15. Herniated disks unchanged over time: Size reduced after oxygen-ozone therapy.

    PubMed

    Bonetti, Matteo; Zambello, Alessio; Leonardi, Marco; Princiotta, Ciro

    2016-08-01

    The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the utility of oxygen-ozone therapy in the treatment of disk herniation, resulting in disk shrinkage. This retrospective study evaluates the outcomes of a series of patients with a history of herniated disks neuroradiologically unchanged in size for over two years, treated with oxygen-ozone therapy at our center over the last 15 years. We treated 96 patients, 84 (87.5%) presenting low back pain complicated or not by chronic sciatica. No drug therapy had yielded significant benefits. A number of specialists had been consulted in two or more years resulting in several neuroradiological scans prior to the decision to undertake oxygen-ozone therapy. Our study documents how ozone therapy for slipped disks "unchanged over time" solved the problem, with disk disruption or a significant reduction in the size of the prolapsed disk material extruded into the spinal canal. PMID:27066816

  16. Therapeutic effects of Chinese osteopathy in patients with lumbar disc herniation.

    PubMed

    Zhang, Wei; Guo, Wei; Zhao, Ping; Zhou, Wei; Wei, Jie; Li, Xi-De; Liu, Liang

    2013-01-01

    A clinical study was conducted in 72 lumbar disc herniation (LDH) patients and 40 asymptomatic subjects to evaluate the efficacy of Feng's spinal manipulation (FSM). FSM was performed twice a week for less than 20 days. Changes in the symmetrical index of spinal column (SISC) and quantified symptom index (QSI) before and after FSM in both groups were collected. The QSI consisted of the visual analogue scale (VAS), score of the Japanese Orthopedic Association, and straight leg raising test, for measurement of pain perception, dysfunction of lower limb extension or flexion, and symptomatic relief. A correlation analysis was conducted to compare the difference in protruded nucleus pulposus size using computerized projection grating profilometry, SISC, and QSI before and after the therapy. The results showed that the SISC and QSI significantly decreased after treatment in the LDH group (p < 0.01). The SISC before and after treatment was closely correlated with the improvement of QSI, although there was no change in protruded nucleus pulposus following the therapy. Among the five components in SISC, the LR was found to be an ideal indicator for evaluation of the real circumstances in LDH patients. Our data suggested that FSM achieved satisfactory therapeutic effects in relieving the symptom of LDH while no effects were observed in asymptomatic subjects. PMID:24117063

  17. Prolyl hydroxylase 3 (PHD3) modulates catabolic effects of tumor necrosis factor-α (TNF-α) on cells of the nucleus pulposus through co-activation of nuclear factor κB (NF-κB)/p65 signaling.

    PubMed

    Fujita, Nobuyuki; Gogate, Shilpa S; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M; Risbud, Makarand V

    2012-11-16

    Recent studies suggest a differential role of prolyl hydroxylase (PHD) isoforms in controlling hypoxia-inducible factor (HIF)-α degradation and activity in nucleus pulposus (NP) cells. However, the regulation and function of PHDs under inflammatory conditions that characterize disc disease are not yet known. Here, we show that in NP cells, TNF-α and IL-1β induce PHD3 expression through NF-κB. Lentiviral delivery of Sh-p65 and Sh-IKKβ confirms that cytokine-mediated PHD3 expression is NF-κB-dependent. It is noteworthy that although both cytokines induce HIF activity, mechanistic studies using Sh-HIF-1α and PHD3 promoter/enhancer constructs harboring well characterized hypoxia response element (HRE) show lack of HIF involvement in cytokine-mediated PHD3 expression. Loss-of-function studies clearly indicate that PHD3 serves as a co-activator of NF-κB signaling activity in NP cells; PHD3 interacts with, and co-localizes with, p65. We observed that when PHD3 is silenced, there is a significant decrease in TNF-α-induced expression of catabolic markers that include ADAMTS5, syndecan4, MMP13, and COX2, and at the same time, there is restoration of aggrecan and collagen type II expression. It is noteworthy that hydroxylase function of PHDs is not required for mediating cytokine-dependent gene expression. These findings show that by enhancing the activity of inflammatory cytokines, PHD3 may serve a critical role in degenerative disc disease. PMID:22948157

  18. Prolyl Hydroxylase 3 (PHD3) Modulates Catabolic Effects of Tumor Necrosis Factor-α (TNF-α) on Cells of the Nucleus Pulposus through Co-activation of Nuclear Factor κB (NF-κB)/p65 Signaling*

    PubMed Central

    Fujita, Nobuyuki; Gogate, Shilpa S.; Chiba, Kazuhiro; Toyama, Yoshiaki; Shapiro, Irving M.; Risbud, Makarand V.

    2012-01-01

    Recent studies suggest a differential role of prolyl hydroxylase (PHD) isoforms in controlling hypoxia-inducible factor (HIF)-α degradation and activity in nucleus pulposus (NP) cells. However, the regulation and function of PHDs under inflammatory conditions that characterize disc disease are not yet known. Here, we show that in NP cells, TNF-α and IL-1β induce PHD3 expression through NF-κB. Lentiviral delivery of Sh-p65 and Sh-IKKβ confirms that cytokine-mediated PHD3 expression is NF-κB-dependent. It is noteworthy that although both cytokines induce HIF activity, mechanistic studies using Sh-HIF-1α and PHD3 promoter/enhancer constructs harboring well characterized hypoxia response element (HRE) show lack of HIF involvement in cytokine-mediated PHD3 expression. Loss-of-function studies clearly indicate that PHD3 serves as a co-activator of NF-κB signaling activity in NP cells; PHD3 interacts with, and co-localizes with, p65. We observed that when PHD3 is silenced, there is a significant decrease in TNF-α-induced expression of catabolic markers that include ADAMTS5, syndecan4, MMP13, and COX2, and at the same time, there is restoration of aggrecan and collagen type II expression. It is noteworthy that hydroxylase function of PHDs is not required for mediating cytokine-dependent gene expression. These findings show that by enhancing the activity of inflammatory cytokines, PHD3 may serve a critical role in degenerative disc disease. PMID:22948157

  19. An injectable nucleus replacement as an adjunct to microdiscectomy: 2 year follow-up in a pilot clinical study

    PubMed Central

    Schwarzenbach, Othmar

    2009-01-01

    Literature indicates that loss of disc tissue from herniation and/or surgery can accelerate degeneration of the disc. The associated loss of disc height may correspond with recurrent back and/or leg pain. A novel hydrogel has been developed to replace lost nucleus pulposus and potentially restore normal disc biomechanics following herniation and surgery. A single-center, non-randomized, prospective feasibility study was undertaken to investigate the use of NuCore® Injectable Nucleus hydrogel (Spine Wave, Inc., Shelton, CT, USA) as a replacement for nuclear tissue lost to herniation and microdiscectomy. Fourteen patients were enrolled at the authors’ hospital as the initial site in a worldwide multicenter pilot study. Subjects who were entered into the study suffered from radicular pain due to single-level herniated nucleus pulposus and were non-respondent to conservative therapy. Following a standard microdiscectomy procedure, the hydrogel material was injected into the nuclear void to replace what tissue had been lost to the herniation and surgery. Leg and back pain, function and disability scores were monitored pre- and post-operatively through 2 years. Neurologic and physical evaluations, blood and serum analyses, and radiographic evaluations of disc height and implant stability were also performed. Results showed significant improvement for leg and back pain, as well as function scores. No complications or device related adverse events were observed. MR controls confirmed stable position of the implants with no reherniations. Radiographic measurements indicated better maintenance of disc height compared to literature data on microdiscectomy alone. The NuCore® material appears to protect the disc from early collapse following microdiscectomy; and therefore, may have the potential to slow the degenerative cascade of the spinal segment over time. PMID:19688352

  20. Periodic mechanical stress induces the extracellular matrix expression and migration of rat nucleus pulposus cells by upregulating the expression of intergrin α1 and phosphorylation of downstream phospholipase Cγ1.

    PubMed

    Gao, Gongming; He, Jin; Nong, Luming; Xie, Hua; Huang, Yongjing; Xu, Nanwei; Zhou, Dong

    2016-09-01

    Intervertebral disk degeneration (IDD) is a major cause of low back pain and an important socioeconomic burden. Degradation of the extracellular matrix (ECM) of nucleus pulposus (NP) cells in the interverterbal disk is important for IDD. Stress of a suitable frequency and amplitude promotes the synthesis of the ECM of NP cells, however, the associated mechanisms remain to be fully elucidated The present study aimed to investigate the effect of integrin α1 on the migration and ECM synthesis of NP cells under soft periodic mechanical stress. Rat NP cells were isolated and plated onto slides, and were then treated with or without the use of a periodic mechanical stress system. The expression levels of integrin α1, α5 and αv, ECM collagen 2A1 (Col2A1) and aggrecan, and the phosphorylation of phospholipase C‑γ1 (PLCγ1) were measured using reverse transcription‑quantitative polymerase chain reaction and western blot analyses. Cell migration was assayed using a scratch experiment. The results showed that exposure to periodic mechanical stress significantly induced the mRNA expression levels of Col2A1 and aggrecan, cell migration, mRNA expression of integrin α1 and phosphorylation of PLC‑γ1 of the NP, compared with the control (P<0.05). Inhibition of the PLCγ1 protein by U73122 significantly decreased the ECM expression under periodic mechanical stress (P<0.05). Small interfering RNA‑mediated integrin α1 gene knockdown suppressed the mRNA expression levels of Col2A1 and aggrecan, and suppressed the migration and phosphorylation of PLCγ1 of the NP cells under periodic mechanical stress, compared with the control (P<0.05). In conclusion, periodic mechanical stress induced ECM expression and the migration of NP cells via upregulating the expression of integrin α1 and the phosphorylation of downstream PLCγ1. These findings provide novel information to aid the understanding of the pathogenesis and development of IDD. PMID:27484337

  1. Leptin modulates the expression of catabolic genes in rat nucleus pulposus cells through the mitogen-activated protein kinase and Janus kinase 2/signal transducer and activator of transcription 3 pathways

    PubMed Central

    MIAO, DAOYI; ZHANG, LINGZHOU

    2015-01-01

    Obesity has been demonstrated to be involved in the progress of intervertebral disc degeneration (IDD). However, the associated mechanisms remain to be elucidated. The purpose the present study was to examine the effect of leptin on the expression of degeneration-associated genes in rat nucleus pulposus (NP) cells, and determine the possible mechanism. Normal NP cells, obtained from Sprague Dawley rats, were identified using immunocytochemistry for the expression of collagen II and CA125, and treated with leptin and/or interleukin (IL)-β. Subsequently, the mRNA expression levels of matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, ADAMTS-5, aggrecan and COL2A1 were detected by reverse transcription-quantitative polymerase chain reaction (RT-q-PCR). Alcian staining and immunocytochemistry were used to examine the expression levels of proteoglycan and collagen II. The pathway activation was investigated using western blotting, and inhibitors of the pathways were used to reveal the effect of these pathways on the NP cells. The results of the RT-qPCR demonstrated that leptin alone upregulated the mRNA expression levels of MMP-1, MMP-13, ADAMTS-4, ADAMTS-5 and COL2A1. Synergy of leptin and IL-β was found in the increased expression levels of MMP-1, MMP-3 and ADAMTS-5. The leptin-treated NP cells exhibited decreased expression of collagen II. The mitrogen-activated protein kinase (MAPK) pathway (c-Jun-N-terminal kinase, phosphorylated extracellular signal-regulated kinase and p38), phosphatidylinositol 3-kinase (PI3K)/Akt pathway and Janus kinase (JAK)2/signal transducer and activator of transcription 3 pathway were all activated by leptin, however, inhibitors of all the pathways, with the exception of the PI3K/Akt pathway, reversed the expression levels of MMP-1 and MMP-13. These results suggested that leptin promoted catabolic metabolism in the rat NP cells via the MAPK and JAK2/STAT3

  2. Leptin modulates the expression of catabolic genes in rat nucleus pulposus cells through the mitogen-activated protein kinase and Janus kinase 2/signal transducer and activator of transcription 3 pathways.

    PubMed

    Miao, Daoyi; Zhang, Lingzhou

    2015-08-01

    Obesity has been demonstrated to be involved in the progress of intervertebral disc degeneration (IDD). However, the associated mechanisms remain to be elucidated. The purpose the present study was to examine the effect of leptin on the expression of degeneration-associated genes in rat nucleus pulposus (NP) cells, and determine the possible mechanism. Normal NP cells, obtained from Sprague Dawley rats, were identified using immunocytochemistry for the expression of collagen II and CA125, and treated with leptin and/or interleukin (IL)-β. Subsequently, the mRNA expression levels of matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, ADAMTS-5, aggrecan and COL2A1 were detected by reverse transcription-quantitative polymerase chain reaction (RT-q-PCR). Alcian staining and immunocytochemistry were used to examine the expression levels of proteoglycan and collagen II. The pathway activation was investigated using western blotting, and inhibitors of the pathways were used to reveal the effect of these pathways on the NP cells. The results of the RT-qPCR demonstrated that leptin alone upregulated the mRNA expression levels of MMP-1, MMP-13, ADAMTS-4, ADAMTS-5 and COL2A1. Synergy of leptin and IL-β was found in the increased expression levels of MMP-1, MMP-3 and ADAMTS-5. The leptin-treated NP cells exhibited decreased expression of collagen II. The mitrogen-activated protein kinase (MAPK) pathway (c-Jun-N-terminal kinase, phosphorylated extracellular signal-regulated kinase and p38), phosphatidylinositol 3-kinase (PI3K)/Akt pathway and Janus kinase (JAK)2/signal transducer and activator of transcription 3 pathway were all activated by leptin, however, inhibitors of all the pathways, with the exception of the PI3K/Akt pathway, reversed the expression levels of MMP-1 and MMP-13. These results suggested that leptin promoted catabolic metabolism in the rat NP cells via the MAPK and JAK2/STAT3

  3. Periodic mechanical stress induces the extracellular matrix expression and migration of rat nucleus pulposus cells by upregulating the expression of intergrin α1 and phosphorylation of downstream phospholipase Cγ1

    PubMed Central

    Gao, Gongming; He, Jin; Nong, Luming; Xie, Hua; Huang, Yongjing; Xu, Nanwei; Zhou, Dong

    2016-01-01

    Intervertebral disk degeneration (IDD) is a major cause of low back pain and an important socioeconomic burden. Degradation of the extracellular matrix (ECM) of nucleus pulposus (NP) cells in the interverterbal disk is important for IDD. Stress of a suitable frequency and amplitude promotes the synthesis of the ECM of NP cells, however, the associated mechanisms remain to be fully elucidated The present study aimed to investigate the effect of integrin α1 on the migration and ECM synthesis of NP cells under soft periodic mechanical stress. Rat NP cells were isolated and plated onto slides, and were then treated with or without the use of a periodic mechanical stress system. The expression levels of integrin α1, α5 and αv, ECM collagen 2A1 (Col2A1) and aggrecan, and the phosphorylation of phospholipase C-γ1 (PLCγ1) were measured using reverse transcription-quantitative polymerase chain reaction and western blot analyses. Cell migration was assayed using a scratch experiment. The results showed that exposure to periodic mechanical stress significantly induced the mRNA expression levels of Col2A1 and aggrecan, cell migration, mRNA expression of integrin α1 and phosphorylation of PLC-γ1 of the NP, compared with the control (P<0.05). Inhibition of the PLCγ1 protein by U73122 significantly decreased the ECM expression under periodic mechanical stress (P<0.05). Small interfering RNA-mediated integrin α1 gene knockdown suppressed the mRNA expression levels of Col2A1 and aggrecan, and suppressed the migration and phosphorylation of PLCγ1 of the NP cells under periodic mechanical stress, compared with the control (P<0.05). In conclusion, periodic mechanical stress induced ECM expression and the migration of NP cells via upregulating the expression of integrin α1 and the phosphorylation of downstream PLCγ1. These findings provide novel information to aid the understanding of the pathogenesis and development of IDD. PMID:27484337

  4. [Spontaneous resolution of a lumbar disc herniation].

    PubMed

    Gelabert-González, M; Serramito-García, R; Aran-Echabe, E; García-Allut, A

    2007-04-01

    Lumbar disc herniation is a common cause of lower leg radiculopathy and the most effective methods of treatment remain in question. Both surgical and nonsurgical treatments may provide a successful outcome in appropriately selected patients. The spontaneous resolution of herniated lumbar discs is a well-established phenomenon. The authors present a case of spontaneous regression of a herniated lumbar nucleus pulpous in a patient with radiculopathy. PMID:17497061

  5. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint.

    PubMed

    Du, Hong-Gen; Liao, Sheng-Hui; Jiang, Zhong; Huang, Huan-Ming; Ning, Xi-Tao; Jiang, Neng-Yi; Pei, Jian-Wei; Huang, Qin; Wei, Hui

    2016-05-01

    This study investigates the effect of a new Chinese massage technique named "press-extension" on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1-S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique. PMID:27275119

  6. Can clinical and radiological findings predict surgery for lumbar disc herniation? A systematic literature review

    PubMed Central

    White, Andrew P.; Harrop, James; Dettori, Joseph R.

    2012-01-01

    Study design: Systematic review. Objective or clinical question: What clinical and radiological findings in patients with lumbar-herniated nucleus pulposus can serve as predictors of surgical intervention? Methods: Articles published between January 1975 and August 2011 were systematically reviewed using Pubmed, Cochrane, National Guideline Clearinghouse Databases, and bibliographies of key articles. Each article was subject to quality rating and was analyzed by two independent reviewers. Results: From 123 citations, 21 underwent full-text review. Four studies met inclusion criteria. Only baseline disability as measured by the Roland Disability Index (RDI) or the Oswestry Disability Index (ODI) was consistently associated with a greater likelihood of having discectomy surgery across multiple studies. With the current literature, we were not able to find an association between surgery and several characteristics including smoking status, body mass index, neurological deficit, positive straight leg testing, and level of herniation. Conclusions: From the limited data available, it appears that individual radiographic and clinical features are not able to predict the likelihood of surgical intervention. Higher baseline disability measurements (Oswestry and Roland) did correlate, however, with surgical treatment. PMID:23236305

  7. A history of lumbar disc herniation from Hippocrates to the 1990s.

    PubMed

    Truumees, Eeric

    2015-06-01

    In ancient times, a supernatural understanding of the syndrome of lumbar radiculopathy often involved demonic forces vexing the individual with often crippling pain. The ancient Greeks and Egyptians began to take a more naturalistic view and, critically, suspected a relationship between lumbar spinal pathology and leg symptoms. Relatively little then changed for those with sciatica until the classic works by Cotugno and Kocher arrived in the late 18th century. Early lumbar canal explorations were performed in the late 1800s and early 1900s by MacEwen, Horsley, Krause, Taylor, Dandy, and Cushing, among others. In these cases, when compressive pathologies were found and removed, the lesions typically were (mis-)identified as enchondromas or osteochondritis dissecans. To better understand the history, learn more about the first treatments of lumbar disc herniation, and evaluate the impact of the early influences on modern spine practice, searches of PubMed and Embase were performed using the search terms discectomy, medical history, lumbar spine surgery, herniated disc, herniated nucleus pulposus, sciatica, and lumbar radiculopathy. Additional sources were identified from the reference lists of the reviewed papers. Many older and ancient sources including De Ischiade Nervosa are available in English translations and were used. When full texts were not available, English abstracts were used. The first true, intentional discectomy surgery was performed by Mixter and Barr in 1932. Early on, a transdural approach was favored. In 1938, Love described the intralaminar, extradural approach. His technique, although modified with improved lighting, magnification, and retractors, remains a staple approach to disc herniations today. Other modalities such as chymopapain have been investigated. Some remain a part of the therapeutic armamentarium, whereas others have disappeared. By the 1970s, CT scanning after myelography markedly improved the clinical evaluation of patients with

  8. The clinical study of percutaneous disc decompression of treating herniation of cervical disc with Nd:YAG laser

    NASA Astrophysics Data System (ADS)

    Zhang, Dianxue; Cheng, Hefu; Wang, Jindong

    2005-07-01

    Objective: The possibility of PLDD (percutaneous laser disc decompression) and an ideal non-operative method which is long everlasting effect for PLDD was investigated. Methods: 159 patients of Cervical Disc Herniation with PLDD were studied. All the herniated discs were irradiated with 10­15J/S Nd:YAG laser quantum through optical-fiber under the supervision of C-arm X-ray. Results: All the patients were followed and reexamined CT or MRI after one to six months of PLDD. The result of cured (67.92%), excellent (24.53%), moderation (5.66%), non-effect (1.88%) was got. The excellent rate was 88.24%. The effective rate was 97.65%. Non-effective rate was 2.35%. Conclusion: When irradiated with Nd:YAG laser, the nucleus pulposus was vapouring, charring and coagulating. The volume and inner-pressure of the disc decreased. So the symptoms and signs improved. The main value of this methods were micro-damage, non-operation, no bleeding, no bone injury, good therapy effect, quick recovery, lesser pain, safety and excellent long everlasting effect. It is an ideal non-operative method of treating PLDD.

  9. Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disc Herniation

    NASA Technical Reports Server (NTRS)

    Feiveson, A.; Mendez, C.; Somers, J.

    2015-01-01

    A previous study reported that the instantaneous risk of developing a Herniated Nucleus Pulposus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNPs occurred well into astronauts' careers or in somecases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. In addition, when an HNP occurs after spaceflight, is it related to previous spaceflight exposure? The purpose of this study was to investigate whether multiple missions, sex, age, vehicle landing dynamics, and flight duration affect the risk of developing an HNP usinga competing risks model. The outcome of the study will inform the Human System Risk Board assessment of back pain, inform the risk of injury due to dynamic loads, and update the previous dataset, which contained events up to December 31, 2006.

  10. The Effect of GCSB-5 a New Herbal Medicine on Changes in Pain Behavior and Neuroglial Activation in a Rat Model of Lumbar Disc Herniation

    PubMed Central

    Cho, Hee Kyung; Kim, So-Yeon; Choi, Mi Jung; Baek, Seung Ok; Kwak, Sang Gyu

    2016-01-01

    Objective Lumbar disc herniation can induce sciatica by mechanical compression and/or chemical irritation. The aim of this study was to compare the effects of GCSB-5 (Shinbaro®) and NSAIDs on pain-related behavior and on the expressions of microglia, astrocytes, CGRP, TRPV1, IL-6, and CX3CL1 in a rat model of lumbar disc herniation. Methods 112 male Sprague-Dawley rats underwent implantation of nucleus pulposus to a dorsal root ganglion (DRG). Rats were divided into five groups as follows; a saline group (the vehicle control group) (n=27), a 10 mg/kg aceclofenac group (the aceclofenac group) (n=22), and 100, 300 or 600 mg/kg GCSB-5 groups (the GCSB-5 100, 300, or 600 groups) (n=21 for each group). Rats were tested for mechanical allodynia at 3 days after surgery and at 1 day, 3 days, 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, 49 days, and 56 days after treatment commencement. Immunohistochemical staining of microglia (Iba1), astrocytes (GFAP), CGRP, and TRPV1, and PCR for IL-6 and CX3CL1 were performed on spinal dorsal horns and DRGs at 56 days after medication commencement. Results After 56 days of GCSB-5 300 administration, mechanical withdrawal thresholds were significantly increased (p<0.05), and immunohisto-chemical expressions of Iba1, GFAP, CGRP, and TRPV1 were reduced than other groups, but this difference was not statistically significant. Conclusion These results indicate GCSB-5 reduces mechanical allodynia and downregulates neuroglial activity and the expressions of CGRP and TRPV1 in the spinal segments of a rat model of lumbar disc herniation. PMID:26962414

  11. Cytokine expression in the epidural space: a model of non-compressive disc herniation-induced inflammation

    PubMed Central

    Cuellar, Jason M.; Borges, Paula M.; Cuéllar, Vanessa Gabrovsky; Yoo, Andrew; Scuderi, Gaetano J.; Yeomans, David C.

    2012-01-01

    Study Design Animal study Objective Development of an animal model for the study of biochemical changes that occur in the epidural space after intervertebral disc herniation. Summary of Background Data Although strong evidence for an inflammatory component exists, the biochemical processes underlying pain following disc herniation remain unknown. Methods Epidural lavage was performed in 48 rats after L5 dorsal root ganglion (DRG) exposure at baseline and 3, 6, or 24 hours after placement of autologous nucleus pulposus (NP) (N = 15), saline (N = 15), or NP + an interferon-gamma antibody (anti-IFNγ; N = 18) directly onto the DRG. Multiplex assays quantifying interleukin (IL-)-1-α, IL-1β, IL-2, IL-4, IL-6, IL-10, TNFα, IFNγ and GM-CSF were performed. NP (N = 7) was also analyzed for these cytokines by placing NP into saline and measuring the relative concentration. Results Cytokines measured low at baseline (0–100pg/ml) in all groups. Compared to saline, NP application caused IL-6 elevation, peaking at T=3hr, that was prevented by anti-IFNγ. NP induced elevation of TNFα, peaking at T=24hr and was prevented by anti-IFNγ. IFNγ was elevated after NP at T=3hr and T=24hr. IL-1α was similar after saline versus NP. The concentrations of IL-1β and IL-10 were elevated at T=3hr, 6hr and 24hr in all groups without between-groups difference. The level of IL-4 peaked at T=3hr in the NP group and was different than saline and NP +anti-IFNγ groups but the time effect was insignificant. There was no change for GM-CSF. The concentration of cytokines measured in normal NP was < 2pg/ml for all cytokines except TNFα. Conclusion In this model of acute non-compressive disc herniation, NP caused the elevation of epidural IL-6, TNFα and IFNγ; all attenuated by IFNγ blockade. IL-1β and IL-10 were both significantly elevated by saline alone and their response was not prevented by IFNγ blockade. This model may prove useful for the study of the biochemical processes by which

  12. Herniated Lumbar Disc

    MedlinePlus

    ... 50. A herniated lumbar disc may also cause back pain, although back pain alone (without leg pain) can have many causes ... 90% success); surgery is less effective in relieving back pain. Nonsurgical treatment Your doctor may prescribe nonsurgical treatments ...

  13. Herniated disk repair (image)

    MedlinePlus

    ... one of the most common causes of lower back pain. The mainstay of treatment for herniated disks is an initial period of rest with pain and anti-inflammatory medications followed by physical therapy. If pain and symptoms persist, surgery to remove ...

  14. LUMBAR DISC HERNIATION

    PubMed Central

    Vialle, Luis Roberto; Vialle, Emiliano Neves; Suárez Henao, Juan Esteban; Giraldo, Gustavo

    2015-01-01

    Lumbar disc herniation is the most common diagnosis among the degenerative abnormalities of the lumbar spine (affecting 2 to 3% of the population), and is the principal cause of spinal surgery among the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (four to six weeks). The initial treatment should be conservative, managed through medication and physiotherapy, sometimes associated with percutaneous nerve root block. Surgical treatment is indicated if pain control is unsuccessful, if there is a motor deficit greater than grade 3, if there is radicular pain associated with foraminal stenosis, or if cauda equina syndrome is present. The latter represents a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces the risk of recurrence over the long term. PMID:27019834

  15. Asymptomatic Transhiatal Pancreatic Herniation after Oesophagectomy

    PubMed Central

    Pal, Sujoy; Dash, Nihar Ranjan; Madhusudhan, KS; Srivastava, Deep Narayan

    2014-01-01

    Transhiatal herniation of abdominal organs after oesophageal resection and reconstruction is rare and sparsely described in the literature. The commonest organ to herniate is the colon. Pancreatic herniation has been reported twice before. We report a case of postoesophagectomy transhiatal pancreatic herniation in an asymptomatic patient. PMID:25478403

  16. Upper lumbar disk herniations.

    PubMed

    Cedoz, M E; Larbre, J P; Lequin, C; Fischer, G; Llorca, G

    1996-06-01

    Specific features of upper lumbar disk herniations are reviewed based on data from the literature and from a retrospective study of 24 cases treated surgically between 1982 and 1994 (seven at L1-L2 and 17 at L2-L3). Clinical manifestations are polymorphic, misleading (abdominogenital pain suggestive of a visceral or psychogenic condition, meralgia paresthetica, isolated sciatica; femoral neuralgia is uncommon) and sometimes severe (five cases of cauda equina syndrome in our study group). The diagnostic usefulness of imaging studies (radiography, myelography, computed tomography, magnetic resonance imaging) and results of surgery are discussed. The risk of misdiagnosis and the encouraging results of surgery are emphasized. PMID:8817752

  17. Sensitization of P2X3 receptors by cystathionine β-synthetase mediates persistent pain hypersensitivity in a rat model of lumbar disc herniation.

    PubMed

    Wang, Qianliang; Zhu, Hongyan; Zou, Kang; Yuan, Bo; Zhou, You-Lang; Jiang, Xinghong; Yan, Jun; Xu, Guang-Yin

    2015-01-01

    Lumbar disc herniation (LDH) is a major cause of discogenic low back pain and sciatica, but the underlying mechanisms remain largely unknown. Hydrogen sulfide (H2S) is becoming recognized for its involvement in a wide variety of processes including inflammation and nociception. The present study was designed to investigate the roles of the H2S signaling pathway in the regulation of expression and function of purinergic receptors (P2XRs) in dorsal root ganglion (DRG) neurons from rats with LDH. LDH was induced by implantation of autologous nucleus pulposus (NP), harvested from rat tail, in lumbar 5 and 6 spinal nerve roots. Implantation of autologous NP induced persistent pain hypersensitivity, which was partially reversed by an intrathecal injection of A317491, a potent inhibitor of P2X3Rs and P2X2/3Rs. The NP induced persistent pain hypersensitivity was associated with the increased expression of P2X3Rs, but not P2X1Rs and P2X2Rs, receptors in L5-6 DRGs. NP implantation also produced a 2-fold increase in ATP-induced intracellular calcium signals in DRG neurons when compared to those of controls (P < 0.05). Interestingly, NP implantation significantly enhanced expression of the endogenous hydrogen sulfide producing enzyme, cystathionine-β-synthetase (CBS). Systematic administration of O-(Carboxymethyl) hydroxylamine hemihydrochloride (AOAA), an inhibitor of CBS, suppressed the upregulation of P2X3R expression and the potentiation of ATP-induced intracellular calcium signals in DRG neurons (P < 0.05). Intrathecal injection of AOAA markedly attenuated NP induced- persistent pain hypersensitivity. Our results suggest that sensitization of P2X3Rs, which is likely mediated by CBS-H2S signaling in primary sensory neurons, contributes to discogenic pain. Targeting CBS/H2S-P2X3R signaling may represent a potential treatment for neuropathic pain caused by LDH. PMID:25885215

  18. Herniated Disk in the Lower Back

    MedlinePlus

    ... lives. A high percentage of people will have low back and leg pain caused by a herniated disk. Although a herniated ... pressure against the outer ring may cause lower back pain. If the disk is very worn or injured, ...

  19. Acute cardiac herniation following pneumonectomy.

    PubMed

    Tschersich, H U; Skorapa, V; Fleming, W H

    1976-09-01

    Pneumonectomy with partial pericardiectomy may result in herniation of the heart through the pericardial defect, leading to cardiovascular collapse and death. Awareness of this grave potential complication and familarity with its clinical and roentgenographic features should permit prompt diagnosis and facilitate lifesaving repeat thoracotomy. PMID:948585

  20. Chronic herniation of the hindbrain

    PubMed Central

    Williams, Bernard

    1981-01-01

    Herniation of the hindbrain occurs when the lowest parts of the cerebellum and sometimes part of the medulla are moved downwards through the foramen magnum, a pressure difference acting across the foramen magnum moulding the tissues into a plug. It is suggested that the clinical course in both adults and babies with spina bifida may be explained by the hindbrain hernia acting as a valve. The term 'Chiari Type I deformity' is commonly used for an abnormality in which the tonsils and lowermost parts of the cerebellar hemispheres are prolapsed through a normal foramen magnum. Acute herniation may occur as a result of space-occupying lesions. Chronic herniation may be morphologically identical although it tends to be more severe. Sometimes it will produce few symptoms which often may be delayed so that the original causative lesion may not be apparent. Causes include bone softening, tumour, or previous meningitis. Birth injury is probably the commonest cause of the deformity, which presents clinically in adults. In infants with severe forms of spina bifida a hindbrain herniation is present. This abnormality may be called 'Chiari Type II deformity' or Arnold—Chiari deformity and is an intra-uterine abnormality in which the fourth ventricle and medulla are grotesquely herniated before they are properly developed and the foramen magnum is enlarged. The commonest clinical presentation of Chiari Type I deformity is syringomyelia, which is usually not diagnosed until adult life. Other presentations include syringobulbia, headache, oscillopsia, attacks of giddiness, lower cranial nerve palsies, and ataxia. Particularly characteristic are cough headache and cough syncope. Syringomyelia and syringobulbia in particular may be irreversible by the time they are diagnosed. Nevertheless, surgical decompression may be successful in relieving symptoms of headache, cough syncope, and long-tract compression; most cases of syringomyelia show some improvement and in others progression

  1. Lipoxin A4 attenuates radicular pain possibly by inhibiting spinal ERK, JNK and NF-κB/p65 and cytokine signals, but not p38, in a rat model of non-compressive lumbar disc herniation.

    PubMed

    Miao, G-S; Liu, Z-H; Wei, S-X; Luo, J-G; Fu, Z-J; Sun, T

    2015-08-01

    Inflammatory response induced by protrused nucleus pulposus (NP) has been shown to play a crucial role in the process of radicular pain. Lipoxins represent a unique class of lipid mediators that have anti-inflammatory and pro-resolving action. The present study was undertaken to investigate if intrathecal lipoxin A4 (LXA4) could alleviate mechanical allodynia in the rat models of application of NP to the L5 dorsal root ganglion (DRG). Non-compressive models of application of NP to L5 DRG were established and intrathecal catheterization for drug administration was performed in rats. Daily intrathecal injection of vehicle or LXA4 (10ng or 100ng) was performed for three successive days post-operation. Mechanical thresholds were tested and the ipsilateral lumbar (L4-L6) segment of spinal dorsal horns were removed for the determination of tumor necrosis factor-α (TNF-α), IL-1β, transforming growth factor-β1 (TGF-β1) and IL-10 expression and NF-κB/p65, extracellular signal-regulated kinase (ERK), C-Jun N-terminal kinase (JNK) and P38 expression. Application of NP to DRG in rats induced mechanical allodynia, increased the expression of pro-inflammatory factors (TNF-α and IL-1β), NF-κB/p65, the phosphorylated-ERK (p-ERK), -JNK (p-JNK) and -P38 (p-p38) and decreased the expression of anti-inflammatory cytokines (TGF-β1 and IL-10) in the ipsilateral lumbar (L4-L6) segment of spinal dorsal horns. Intrathecal injection of LXA4 alleviated the development of neuropathic pain, inhibited the upregulation of pro-inflammatory cytokines (TNF-α and IL-1β), upregulated the expression of anti-inflammatory cytokines (TGF-β1 and IL-10) and attenuated the activation of NF-κB/p65, p-ERK, p-JNK, but not p-p38, in a dose-dependent manner. In this study, we have demonstrated that LXA4 potently alleviate radicular pain in a rat model of non-compressive lumbar disc herniation. The anti-inflammatory and pro-resolution properties of LXA4 have shown a great promise for the management

  2. Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disk Herniation

    NASA Technical Reports Server (NTRS)

    Feiveson, A. H.; Mendez, C. M.; Somers, J. T.

    2014-01-01

    BACKGROUND: A previous study [1] reported that the instantaneous risk of developing a Herniated Nucleus Pulposus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNP's occurred well into astronauts' careers or in some cases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. The purpose of this study was to support the Human System Risk Board assessment of back pain, evaluate the risk of injury due to dynamic loads, and update the previous dataset which contained events up to December 31, 2006. METHODS: Data was queried from the electronic medical record and provided by the Lifetime Surveillance of Astronaut Health. The data included all 330 United States astronauts from 1959 through February 2014. Cases were confirmed by Magnetic Resonance Imaging, Computerized Tomography, Myelography, operative findings, or through clinical confirmation with a neurologist or neurosurgeon. In this analysis, astronauts who had an HNP at selection into the corps or had an HNP diagnosis prior to their first flight were excluded. The statistical challenges in using the available data to separate effects of spaceflight from those associated with general astronaut training and lifestyle on propensity to develop HNPs are many. The primary outcome is reported date of first HNP (if any), which at best is only an approximation to the actual time of occurrence. To properly analyze this data with a survival analysis model, one must also know the "exposure" time - i.e. how long each astronaut has been at risk for developing an HNP. If an HNP is reported soon after a mission, is it mission caused or general? If the former, exposure time

  3. Intradural herniation of lumbar intervertebral discs.

    PubMed

    Hodge, C J; Binet, E F; Kieffer, S A

    1978-12-01

    A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression. PMID:741242

  4. Lumbar Epidural Varix Mimicking Disc Herniation

    PubMed Central

    Bursalı, Adem; Guvenal, Ahmet Burak; Yaman, Onur

    2016-01-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  5. Lumbar Epidural Varix Mimicking Disc Herniation.

    PubMed

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method. PMID:27446525

  6. Microdiscectomy for a Paracentral Lumbar Herniated Disk.

    PubMed

    Millhouse, Paul W; Schroeder, Gregory D; Kurd, Mark F; Kepler, Christopher K; Vaccaro, Alexander R; Savage, Jason W

    2016-02-01

    Lumbar disk herniations occur frequently and are often associated with leg pain, weakness, and paresthesias. Fortunately, the natural outcomes of radiculopathy due to a disk herniation are generally favorable, and the vast majority of patients improve with nonoperative care. Surgical intervention is reserved for patients who have significant pain that is refractory to at least 6 weeks of conservative care, patients who have a severe or progressive motor deficit, or patients who have any symptoms of bowel or bladder dysfunction. This paper reviews the preoperative and postoperative considerations, as well as the surgical technique, for a microdiscectomy for a lumbar intervertebral disk herniation. PMID:26710186

  7. [Lumbar disc herniation and andrological diseases].

    PubMed

    Jin, Bao-fang

    2015-10-01

    Lumbar disc herniation is a common male disease. In the past, More academic attention was directed to its relationship with lumbago and leg pain than to its association with andrological diseases. Studies show that central lumber intervertebral disc herniation may cause cauda equina injury and result in premature ejaculation, erectile dysfunction, chronic pelvic pain syndrome, priapism, and emission. This article presents an overview on the correlation between central lumbar intervertebral disc herniation and andrological diseases, focusing on the aspects of etiology, pathology, and clinical progress, hoping to invite more attention from andrological and osteological clinicians. PMID:26665671

  8. Incidence of trocar site herniation following robotic gynecologic surgery

    PubMed Central

    Clark, Leslie H.; Soliman, Pamela T.; Odetto, Diego; Munsell, Mark F.; Schmeler, Kathleen M.; Fleming, Nicole; Westin, Shannon N.; Nick, Alpa M.; Ramirez, Pedro T.

    2014-01-01

    Objective Trocar site herniation is a recognized complication of minimally invasive surgery, but published data on trocar site herniation after robotic surgery are scarce. We sought to determine the incidence of trocar site herniation in women undergoing robotic surgery for gynecologic disease. Methods A retrospective review of robotic surgeries performed from January 1, 2006, through December 31, 2012, was conducted. Postoperative trocar site herniations were identified, along with time to presentation, location of herniation, and management. Patients were excluded if surgery was converted to laparotomy or traditional laparoscopy. The Wilcoxon rank-sum test was used to compare patients with and without herniation with respect to continuous variables, and Fisher's exact test was used to compare these 2 groups with respect to categorical variables. Results The study included 500 patients, 3 of whom experienced herniation at a single trocar site. The patients with and without herniation did not differ with respect to age, body mass index, smoking status, medical comorbidities, operating time, or estimated blood loss. All 3 herniations occurred at 12-mm trocar sites. Two herniations occurred at assistant port sites, and 1 occurred at the umbilical camera port site. The median time to herniation was 21 days (range, 8-38 days). One patient required immediate surgical intervention; the other 2 patients had conservative management. Conclusions Trocar site herniation is a rare complication following robotic surgery. The most important risk factor for trocar site herniation appears to be larger trocar size, as all herniations occurred at 12-mm port sites. PMID:23988416

  9. Traumatic herniation of the buccal fat pad.

    PubMed

    Iehara, Tomoko; Tomoyasu, Chihiro; Nakajima, Hisakazu; Osamura, Toshio; Hosoi, Hajime

    2016-07-01

    Traumatic herniation of the buccal fat pad is a rare traumatic disease. Treatment consists of either excision or replacement. We herein report the first case in which a traumatic herniation of the buccal fat pad healed naturally. It was necessary to differentiate the disease from lipoblastoma. A 17-month-old boy was admitted to a clinic with an intraoral tumor that had suddenly increased in size. The tumor was diagnosed as herniation of the buccal fat pad on pathology of a biopsy specimen. In the present case, the escaped buccal fat body returned naturally and engrafted without dysfunction or facial defects. Given that young children may easily fall down with various objects in their mouth, care is required to prevent traumatic accidents. Traumatic herniation of the buccal fat pad should be considered in the differentiation of tumors of the oral cavity in young children. PMID:26892590

  10. [Intradural lumbar disk herniation (ILDH). Case report and literature review].

    PubMed

    Bayassi, S

    1998-01-01

    In this report, the author presents a rare case of a 59 year-old man with ILDH. It was the only case of ILDH among 960 patients surgically treated, during the period 1989-1996. Clinically the patient demonstrated an acute cauda equina syndrome. The diagnosis was established by radiculograms, which showed a total block at the L3-L4 level. There was a 3 days time interval between the diagnosed syndrome itself and the operation. At surgery the L3-L4 level was intact, whereas dense adhesions were found between the L4-L5 disc and the dura. Root retraction to expose the nucleus pulposus mass was impossible. A laminectomy of the L4 was undertaken. An incision was made in the dura and arachnoid, revealing an extruded discal mass, lying between the roots of the cauda equina. It was carefully removed. The state of the patient at follow-up 1 year after surgery was unsatisfactory. The patient has moderate flaccid paraparesis, bladder dysfunction improved. The prognosis appeared to be linked to the preoperative duration of symptoms. PMID:10463243

  11. Treatment of Lumbar Disc Herniations by Interventional Fluoroscopy-Guided Endoscopy

    PubMed Central

    Reul, Juergen

    2014-01-01

    Summary The neurointerventional transforaminal endoscopic approach to sequestered disk herniation is a minimally invasive alternative to established microsurgical techniques. In addition to those techniques approaching the nucleus like APLD, the transforaminal approach allows the removal of dislocated sequesters in the epidural space. The main steps of the procedure are fluoroscopy-guided, so a good experience with fluoroscopy based interventional techniques is helpful, but the technique has a significant learning curve. If familiar with the different steps, it allows nearly every lumbar disk herniation to be treated with a very short hospital stay and short rehabilitation time. The paper describes in detail the steps of the procedure, the difficulties and advantages and gives a short review of the relevant literature. PMID:25363256

  12. Clinical and Radiological Characteristics of Lumbosacral Lateral Disc Herniation in Comparison With Those of Medial Disc Herniation

    PubMed Central

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Abstract Lateral disc herniation (foraminal and extra foraminal) has clinical characteristics that are different from those of medial disc herniation (central and subarticular), including older age, more frequent radicular pain, and neurologic deficits. This is supposedly because lateral disc herniation mechanically irritates or compresses the exiting nerve root or dorsal root ganglion inside of a narrow canal more directly than medial disc herniation. The purpose of this study was to investigate clinical and radiological characteristics of lateral disc herniation in comparison with medial disc herniation. The 352 subjects diagnosed with localized lumbosacral disc herniation and followed up for at least 12 months after completion of treatment were included and divided into medial and lateral disc herniation groups, according to the anatomical location of the herniated disc in axial plain of magnetic resonance image. Clinical and radiological data were obtained and compared between the two groups. The lateral group included 74 (21%) patients and the medial group included 278 (79%). Mean age of the lateral group was significantly higher than that in the medial group. The lateral group showed a significantly larger proportion of patients with radiating leg pain and multiple levels of disc herniations than the medial group. No significant differences were found in terms of gender, duration of pain, pretreatment numeric rating scale, severity of disc herniation (protrusion and extrusion), and presence of weakness in leg muscles. The proportion of patients who underwent surgery was not significantly different between the 2 groups. However, the proportion of patients who accomplished successful pain reduction after treatment was significantly smaller in the lateral than in the medial group. In conclusion, patients with lateral disc herniation were older and had larger proportion of radiating leg pain than those with medial disc herniation. Lateral disc herniation was more

  13. Clinical and Radiological Characteristics of Lumbosacral Lateral Disc Herniation in Comparison With Those of Medial Disc Herniation.

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-02-01

    Lateral disc herniation (foraminal and extra foraminal) has clinical characteristics that are different from those of medial disc herniation (central and subarticular), including older age, more frequent radicular pain, and neurologic deficits. This is supposedly because lateral disc herniation mechanically irritates or compresses the exiting nerve root or dorsal root ganglion inside of a narrow canal more directly than medial disc herniation. The purpose of this study was to investigate clinical and radiological characteristics of lateral disc herniation in comparison with medial disc herniation. The 352 subjects diagnosed with localized lumbosacral disc herniation and followed up for at least 12 months after completion of treatment were included and divided into medial and lateral disc herniation groups, according to the anatomical location of the herniated disc in axial plain of magnetic resonance image. Clinical and radiological data were obtained and compared between the two groups. The lateral group included 74 (21%) patients and the medial group included 278 (79%). Mean age of the lateral group was significantly higher than that in the medial group. The lateral group showed a significantly larger proportion of patients with radiating leg pain and multiple levels of disc herniations than the medial group. No significant differences were found in terms of gender, duration of pain, pretreatment numeric rating scale, severity of disc herniation (protrusion and extrusion), and presence of weakness in leg muscles. The proportion of patients who underwent surgery was not significantly different between the 2 groups. However, the proportion of patients who accomplished successful pain reduction after treatment was significantly smaller in the lateral than in the medial group. In conclusion, patients with lateral disc herniation were older and had larger proportion of radiating leg pain than those with medial disc herniation. Lateral disc herniation was more

  14. [Mucocele caused by postraumatic orbitary herniation].

    PubMed

    Virós Porcuna, David; Gras Cabrerizo, Juan Ramón; Montserrat Gili, Joan Ramon; Piñeiro Agüín, Zenaida

    2009-01-01

    Sinusal mucoceles are expansive lesions related to ostium sinus obstruction and treatment is surgical. We present a case of frontal mucocele secondary to ostium drainage obstruction due to herniated orbital content. This entailed difficulties for intranasal surgical resolution so a combined approach was used. The different surgical options for treating such cases are discussed. PMID:19268133

  15. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

    PubMed Central

    Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  16. Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting.

    PubMed

    Michael, Alex P; Espinosa, Jose

    2016-01-01

    Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option. PMID:27446619

  17. An unexpectedly progressed lumbar herniated disk.

    PubMed

    Lipton, James A; McLeod, Geoffrey A

    2013-12-01

    The authors describe a case of a 26-year-old female military veteran who presented with low back pain that she attributed to a recent foot injury. The patient reported a history of lumbar pain while in the military that had been treated successfully with high-velocity, low-amplitude osteopathic manipulative treatment. The patient's current pain was improved with osteopathic manipulative treatment and gait correction. Several weeks after her initial presentation, the patient reported that she had had a herniated disk diagnosed 2 years earlier by means of magnetic resonance imaging. Updated magnetic resonance imaging was performed, the results of which revealed a large herniated disk that had caused severe stenosis. The patient was immediately referred to a neurosurgeon for consultation and subsequently underwent surgical treatment. PMID:24285036

  18. ILEAL HERNIATION THROUGH THE FORAMEN OF WINSLOW: OVEREATING AS A RISK FACTOR FOR INTERNAL HERNIATION.

    PubMed

    Kirigin, Lora Stanka; Nikolić, Marko; Kruljac, Ivan; Marjan, Domagoj; Penavić, Ivan; Ljubicić, Neven; Budimir, Ivan; Vrkljan, Milan

    2016-03-01

    Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention. PMID:27333733

  19. Lumbar disk herniation surgery: outcome and predictors.

    PubMed

    Sedighi, Mahsa; Haghnegahdar, Ali

    2014-12-01

    Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated

  20. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

    PubMed Central

    Kadono, Yoshinori; Yuguchi, Takamichi; Ohnishi, Yu-ichiro; Iwatsuki, Koichi; Yoshimine, Toshiki

    2015-01-01

    Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression. PMID:25861499

  1. Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report.

    PubMed

    Samuel, Nardin; Goldstein, Christina L; Santaguida, Carlo; Fehlings, Michael G

    2015-09-01

    Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits. PMID:26023901

  2. Risk Factors for Recurrent Lumbar Disc Herniation

    PubMed Central

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  3. Development of an in situ controllable polymerization tool and process for hydrogel used to replace nucleus pulposus

    NASA Astrophysics Data System (ADS)

    Schmocker, Andreas M.; Khoushabi, Azadeh; Bourban, Pierre-Etienne; Schizas, Constantin; Pioletti, Dominique P.; Moser, Christophe

    2015-06-01

    Currently implants or tissue replacements are inserted either as a whole implant or by injecting a liquid which polymerizes to form a solid implant at the appropriate location. This is either highly invasive or not controllable. We developed a tool to perform such surgeries in a minimally invasive and controllable way. It combines photopolymerization and fluorescence spectroscopy in a surgical apparatus. However, to successfully replace tissue such as cartilage or an intervertebral disc, photopolymerizable materials do not only need to be photoactive. They should also be able to withstand the environmental loading conditions after implantation. Therefore we developed a set of in situ and in vitro tests adapted to the evaluation of photopolymerized tissue replacements and implants. In particular in this article, we report on a method, which combines photopolymerization and photorheology to track the current state of polymer during photopolymerization.

  4. Prostaglandin E2 and Prostaglandin F2α Differentially Modulate Matrix Metabolism of Human Nucleus Pulposus Cells

    PubMed Central

    Vo, Nam V.; Sowa, Gwendolyn A.; Kang, James D.; Seidel, Christopher; Studer, Rebecca K.

    2016-01-01

    Prostaglandin (PG) actions on disc metabolism are unclear even though certain PGs are highly expressed by disc cells under inflammatory conditions and nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to block PG production to treat back pain. Hence this study aimed to (1) quantify gene expression of arachidonic acid cascade components responsible for PG synthesis and (2) examine the effects of key PGs on disc matrix homeostasis. Microarray analysis revealed that inflammatory stress increases expression of synthases and receptors for prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α), resulting in elevated PGE2 and PGF2α production in conditioned media of disc cells. PGE2 diminished disc cell proteoglycan synthesis, in a dose-dependent manner. Semiquantitative RT-PCR revealed differential effects of PGE2 and PGF2α on disc cell expression of key matrix structural genes, aggrecan, versican, collagens type I and II. PGE2 and PGF2α also decreased message for the anabolic factor, IGF-1. PGE2 decreased mRNA expression for the anti-catabolic factor TIMP-1 while PGF2α increased mRNAs for catabolic factors MMP-1 and MMP-3. Thus, PGE2 and PGF2α may have an overall negative impact on disc matrix homeostasis, and the use of NSAIDs may impact disc metabolism as well as treat back pain. PMID:20839316

  5. [Physiotherapeutic management of patients after surgical treatment of nucleus pulposus prolapse in the lumbar section of the spine].

    PubMed

    Kotela, Paweł; Kotela, Ireneusz

    2010-01-01

    The conservative treatment of patients with low back pain syndrome frequently provides an insufficient form of patients' mobilization, which therefore requires more invasive and more complex treatment techniques. Surgical treatment, which is the ultimate form of medical interference, is supported by rehabilitation techniques ensuring advantageous and relatively prompt effect. PMID:20684352

  6. Functional Self-Assembled Peptide Nanofibers for Bone Marrow Mesenchymal Stem Cell Encapsulation and Regeneration in Nucleus Pulposus.

    PubMed

    Wu, Yaohong; Jia, Zhiwei; Liu, Longgang; Zhao, Yachao; Li, Hao; Wang, Chaofeng; Tao, Hui; Tang, Yong; He, Qing; Ruan, Dike

    2016-06-01

    Low back pain (LBP) is mainly caused by intervertebral disc degeneration (IDD). Recent studies have demonstrated that the transplantation of mesenchymal stem cells (MSCs) can regenerate regions that have undergone degeneration, and the regenerative effect can be enhanced by using a hydrogel carrier. This article describes an injectable functional hydrogel system manufactured by combining RADA16-I and RADA-KPSS (RADA-KPSS was manufactured by conjugating a bioactive motif derived from BMP-7 [KPSS] onto the C terminal of RADA16-I) at a volume ratio of 1:1. This hydrogel system can enhance the proliferation, differentiation, and chemotactic migration of BMSCs. In addition, the encapsulation of BMSCs with this system maintains cell viability for a long period after transplantation into an ex vivo cultured disc model. In conclusion, KPSS-conjugated RADKPS is an ideal encapsulation system for BMSCs in intervertebral disc (IVD) regeneration. PMID:27153338

  7. Degenerative Grade Affects the Responses of Human Nucleus Pulposus Cells to Link-N, CTGF, and TGFβ3

    PubMed Central

    Abbott, Rosalyn D.; Purmessur, Devina; Monsey, Robert D.; Brigstock, David R.; Laudier, Damien M.; Iatridis, James C.

    2012-01-01

    Study Design Cells isolated from moderately and severely degenerated human intervertebral discs (IVDs) cultured in an alginate scaffold. Objective To compare the regenerative potential of moderately vs. severely degenerated cells using three pro-anabolic stimulants. Summary of Background Data Injection of soluble cell signaling factors has potential to slow the progression of IVD degeneration. While degenerative grade is thought to be an important factor in targeting therapeutic interventions it remains unknown whether cells in severely degenerated IVDs have impaired metabolic functions compared to lesser degenerative levels or if they are primarily influenced by the altered microenvironment. Methods NP cells were cultured in alginate for 21 days and treated with three different pro-anabolic stimulants: a growth factor/anti-inflammatory combination of TGFβ3+Dex, or matricellular proteins CTGF or Link-N. They were assayed for metabolic activity, DNA content, glycosaminoglycan (GAG), and qRT-PCR gene profiling. Results Moderately degenerated cells responded to stimulation with increased proliferation, decreased IL-1β, MMP9 and COL1A1 expression, and upregulated HAS1 as compared to severely degenerated cells. TGFβR1 (ALK5) receptors were expressed at greater levels in moderately than severely degenerated cells. TGFβ3+Dex had a notable stimulatory effect on moderately degenerated NP cells with increased anabolic gene expression, and decreased COL1A1 and ADAMTS5 gene expression. Link-N and CTGF had similar responses in all assays, and both treatments up-regulated IL-1β expression and had a more catabolic response than TGFβ3+Dex, particularly in the more severely degenerated group. All groups, including different degenerative grades, produced similar amounts of GAG. Conclusion Pro-anabolic stimulants alone had limited capacity to overcome the catabolic and pro-inflammatory cytokine expression of severely degenerated NP cells and likely require additional anti-inflammatory treatments. Moderately degenerated NP cells had greater TGFβ receptor 1 expression and better responded to anabolic stimulation. PMID:22907063

  8. Percutaneous diskectomy for lumbar disk herniation. A preliminary report.

    PubMed

    Sakou, T; Masuda, A

    1993-01-01

    Percutaneous diskectomy is a new method for reducing lumbar disk herniation. This procedure is simple, safe, and only semiinvasive since it causes no direct damage to the dura or nerve roots. This technique employs a nucleotome (blunt-tipped, suction-cutting probe) with a rotating electric shaver (3 mm in diameter) that was specially developed for this procedure. It was applied to 117 patients with lumbar disk herniation whose sciatica had not been relieved by conservative treatments. The results of the technique were considered effective in 94 patients (80.3%). The improvements were even more marked in patients with protrusion or prolapse type herniation. Reviewed with postoperative examinations using magnetic resonance imaging (MRI), excision of the herniated disk, resulting in decompression of the nerve root, may be correlated with the relief of symptoms. PMID:8425341

  9. Migratory intradural disk herniation and a strategy for intraoperative localization.

    PubMed

    Daffner, Scott D; Sedney, Cara L; Rosen, Charles L

    2015-02-01

    Study Design Case report. Objective Describe a case of intradural disk herniation and a method for intraoperative localization. Methods Intradural disk herniations are uncommon but well described. The diagnosis of these lesions is often difficult, and sometimes they may be diagnosed only through an intradural exploration after an expected disk fragment cannot be located. We report the case of an intradural disk herniation with an additional diagnostic difficulty-a migrated intradural disk. Results We present the first intraoperative imaging evidence of disk migration and propose a strategy to locate intradural disk fragments prior to durotomy. Conclusion Intradural disk herniations should be suspected when intraoperative findings are not congruent with imaging findings. An intraoperative myelogram may be helpful. PMID:25648315

  10. Assessing the Effect of Spaceflight on the Propensity for Astronauts to Develop Disk Herniation

    NASA Technical Reports Server (NTRS)

    Feiveson, Alan H.; Mendez, C. M.; Somers, J. T.

    2015-01-01

    A previous study [1] reported the instantaneous risk of developing a Herniated Nucleus Pulosus (HNP) was higher in astronauts who had flown at least one mission, as compared with those in the corps who had not yet flown. However, the study only analyzed time to HNP after the first mission (if any) and did not account for the possible effects of multiple missions. While many HNP's occurred well into astronauts' careers or in some cases years after retirement, the higher incidence of HNPs relatively soon after completion of space missions appears to indicate that spaceflight may lead to an increased risk of HNP. The purpose of this study was to support the Human System Risk Boards assessment of back pain, assess the risk of injury due to dynamic loads, and update the dataset analyzed which contained data through December 31, 2006.

  11. Inguinal herniation with hydrometra/mucometra in a poodle bitch.

    PubMed

    Sontas, B Hasan; Toydemir, F T Seval; Erdogan, Ozge; Sennazli, Gülbin; Ekici, Hayri

    2013-09-01

    A 5-year-old, sexually intact poodle bitch was presented with a 2-year history of inguinal mass. A tentative diagnosis of hydrometra/mucometra with inguinal herniation was made and ovariohysterectomy with hernia repair was performed. Both fluid-filled uterine horns, both broad ligaments, and the uterine body were observed to be herniated through the inguinal ring. On histopathology, marked edema and diffuse hemorrhage were diagnosed in the uterus. PMID:24155486

  12. Inguinal herniation with hydrometra/mucometra in a poodle bitch

    PubMed Central

    Sontas, B. Hasan; Toydemir, F.T. Seval; Erdogan, Özge; Şennazli, Gülbin; Ekici, Hayri

    2013-01-01

    A 5-year-old, sexually intact poodle bitch was presented with a 2-year history of inguinal mass. A tentative diagnosis of hydrometra/mucometra with inguinal herniation was made and ovariohysterectomy with hernia repair was performed. Both fluid-filled uterine horns, both broad ligaments, and the uterine body were observed to be herniated through the inguinal ring. On histopathology, marked edema and diffuse hemorrhage were diagnosed in the uterus. PMID:24155486

  13. Emergency Neurological Life Support: Intracranial Hypertension and Herniation

    PubMed Central

    Shoykhet, Michael; Cadena, Rhonda

    2016-01-01

    Sustained intracranial hypertension and acute brain herniation are “brain codes,” signifying catastrophic neurological events that require immediate recognition and treatment to prevent irreversible injury and death. As in cardiac arrest, a brain code mandates the organized implementation of a stepwise management algorithm. The goal of this emergency neurological life support protocol is to implement an evidence-based, standardized approach to the evaluation and management of patients with intracranial hypertension and/or herniation. PMID:26438459

  14. Sacral Perineural Cyst Accompanying Disc Herniation

    PubMed Central

    Ju, Chang Il; Shin, Ho; Kim, Hyeun Sung

    2009-01-01

    Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain. PMID:19352483

  15. Sacral perineural cyst accompanying disc herniation.

    PubMed

    Ju, Chang Il; Shin, Ho; Kim, Seok Won; Kim, Hyeun Sung

    2009-03-01

    Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain. PMID:19352483

  16. [Cervical disc herniation--diagnosis and treatment].

    PubMed

    Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

    2015-10-28

    A cervical disc herniation (CDH) is a frequently encountered pathology in primary care medicine. It may give rise to a compression of a nerve root (a radiculopathy, with or without sensory-motor deficit) or of the spinal cord (myelopathy). The majority of CDHs can be supported by means of a conservative treatment. When a radiculopathy is found and a clinico-radiological correlation is present, a moderate neurological deficit appears suddenly, or if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during 6 to 8 months, surgery is then recommended. A symptomatic cervical myelopathy is, by itself, an indication for a surgical treatment. PMID:26672182

  17. [Lumbar disc herniation--diagnosis and treatment].

    PubMed

    Corniola, M-V; Tessitore, E; Schaller, K; Gautschi, O P

    2014-12-10

    A lumbar disc herniation (LDH) is a condition frequently encountered in primary care medicine. It may give rise to a compression of one or more nerve roots, which can lead to a nerve root irritation, a so-called radiculopathy, with or without a sensorimotor deficit. The majority of LDHs can be supported by means of a conservative treatment consisting of physical therapy, ergotherapy, analgetics, anti-inflammatory therapy or corticosteroids, which may be eventually administered by infiltrations. If a clinico-radiological correlation is present and moderate neurological deficit appears suddenly, if it is progressive under conservative treatment or if pain is poorly controlled by well-conducted conservative treatment performed during four to six months, surgery is then recommended. PMID:25632633

  18. Thalamic Pain Misdiagnosed as Cervical Disc Herniation

    PubMed Central

    Lim, Tae Ha; Choi, Soo Il; Yoo, Jee In; Choi, Young Soon; Lim, Young Su; Sang, Bo Hyun; Bang, Yun Sic

    2016-01-01

    Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease. PMID:27103967

  19. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

    PubMed Central

    O'Connell, Grace D.; Leach, J. Kent; Klineberg, Eric O.

    2015-01-01

    Abstract The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine. PMID:26634189

  20. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    SciTech Connect

    Kelekis, Alexis D. Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-10-15

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  1. Treatment of a symptomatic forearm muscle herniation with a mesh graft.

    PubMed

    Sanders, Brett S; Bruce, Jeremy; Robertson, Jason

    2011-03-01

    Symptomatic muscle herniations are an unusual cause of upper extremity pain in the athlete that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion. This article describes a successful repair of a 21-year-old rock climber's ventral forearm herniation with polypropylene mesh. PMID:23016006

  2. Relationship between physical work load and lumbar disc herniation.

    PubMed

    Ahsan, M K; Matin, T; Ali, M I; Ali, M Y; Awwal, M A; Sakeb, N

    2013-07-01

    Lumbar disc herniation (LDH) is a disabling problem. This retrospective case control study was done to evaluate the possible relevance of physical work load with Lumbar Disc Herniation. We have performed this study in the Spinal Surgery Unit of Department of Orthopaedic Surgery at BSMMU, Dhaka from July 2007 to June 2010 where 200 cases with Lumbar Disc Herniation and 200 control subjects matched by age, gender and area of residence were taken and analyzed. Chi-square test was computed for sex, area of residence, type of physical work and effort at work, whereas Odds ratio was computed for physical work load, stress at work and daily working period. The highest odds ratio (OR) was with the physical work load (OR: 03.48, CI: 01.84-06.59), hard work (OR: 03.14, CI: 01.74-05.65) and working period of >8 hours (OR: 01.34, CI: 0.75-02.38). Odds ratio for heavy load carrying at work was 03.48 and less job satisfaction or stress at work was 02.45. There was a statistically significant positive association between cumulative exposure of physical work load and lumbar disc herniation indicating an increased occurrence of herniation in heavy physical work load and occupation requiring harder efforts. PMID:23982545

  3. Herniation of the cervical disk in plastic surgeons.

    PubMed

    Tzeng, Yuan-Sheng; Chen, Shyi-Gen; Chen, Tim-Mo

    2012-12-01

    Herniations of the cervical disk in plastic surgeons are far more common in practice than the paucity of reported cases would indicate. A likely explanation may be the peculiar, nonergonomic positions that plastic surgeons must hold during surgery while wearing a headlight and loupes. From January 2003 to December 2006, at Tri-Service General Hospital, Taiwan, 4 plastic surgeons experienced herniations of the cervical disk. Magnetic resonance imaging study indicated there was disk herniation or bulging with spinal cord impingement. Two plastic surgeons received cervical diskectomy, corpectomy with strut reconstruction using titanium cages. These 2 surgeons were symptom-free 2 years after their operations. The other 2 plastic surgeons were under conservative physical therapy with persistent symptoms. The clinical evidence indicated that cervical disk herniation is an occupational hazard in plastic surgeons. To prevent prolonged hyperflexion and twisting of the neck, we proposed wearing a cervical brace during surgery for the plastic surgeons at Tri-Service-General Hospital since January 2008. No more plastic surgeons have experienced herniation of the cervical disk since then. The results indicated that wearing a cervical brace may be an effective measure to protect plastic surgeons from cervical disk disease. PMID:23154341

  4. Concomitance of fibromyalgia syndrome and cervical disc herniation.

    PubMed

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-03-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2-3, 16.6% C5-6, 16.6% C6-7, 33.3% C4-5, C5-6 (two levels in two patients) and 16.6% C4-5, C5-6, C7-1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  5. Results of hemivertebrectomy and fusion for symptomatic thoracic disc herniation.

    PubMed

    Debnath, U K; McConnell, J R; Sengupta, D K; Mehdian, S M H; Webb, J K

    2003-06-01

    We retrospectively analysed ten consecutive patients (age range 32-77 years) treated surgically from 1994 to 1999 for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. Clinically, eight patients had varying grades of back pain and eight patients had paraparesis. Radiography showed calcification in 50% of the herniated discs. Two patients had two-level thoracic disc herniation. Hemivertebrectomy followed by discectomy and fusion was carried out in all patients. Instrumentation with cages was performed in eight patients and bone grafting alone in two patients. The average follow-up was 24 months (range 13-36 months). Six patients had an excellent or good outcome, three had a fair outcome and one had a poor outcome. One patient had atelectasis, which recovered within 2 days of surgery. Another patient had developed complete paraplegia, detected at surgery by SSEPs, and underwent resurgery following magnetic resonance (MR) scan with complete corpectomy and instrumented fusion. At 2 years, she had a functional recovery. The patient with poor outcome had undergone a previous discectomy at T9/10. He developed severe back pain and generalised hyper-reflexia following corpectomy and fusion for disc herniation at T10/11. We advocate anterior transthoracic discectomy following partial corpectomy for symptomatic thoracic disc herniation between the 6th and 12th thoracic discs. This procedure offers improved access to the thoracic disc for an instrumented fusion, which is likely to decrease the risk of iatrogenic injury to the spinal cord. PMID:12800003

  6. [Spinal and extra-spinal tumors mimicking discal herniation].

    PubMed

    Tamir, E; Mirovsky, Y; Robinson, D; Halperin, N

    1999-12-15

    Low back pain radiating to a limb is usually caused by lumbar disc herniation. Tumors of the spinal cord or near the sciatic or femoral plexus can cause neural compression and clinical signs similar to those of disc herniation. Such tumors are usually misdiagnosed as discal herniation and appropriate treatment is delayed. We present 4 men who had tumors causing low back pain radiating to the leg: a 70-year-old with metastatic squamous cell carcinoma of the lung, a 20-year-old with aneurysmal bone cyst of the vertebral column, a 52-year-old with retroperitoneal sarcoma and a 32-year-old who also had retroperitoneal sarcoma. Diagnosis and treatment were delayed because the clinical symptoms were ascribed to lumbar disc herniation. The latter 2 patients had CT-scans showing lumbar disc herniation, but similar findings are common among asymptomatic individuals. The differential diagnosis of low back pain radiating to the leg should include tumor when there is a history of cancer, pain not relieved by conservative treatment nor by lying down, pain is increased at night, pain accompanied by weight loss, and when physical examination demonstrates injury to more than 1 nerve root. In these circumstances work-up should include EMG, radioisotope scan and CT of the pelvis. PMID:10959387

  7. Concomitance of fibromyalgia syndrome and cervical disc herniation

    PubMed Central

    Güler, Mustafa; Aydın, Teoman; Akgöl, Erdal; Taşpınar, Özgür

    2015-01-01

    [Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population. PMID:25931731

  8. High energy nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Wosiek, B.

    1986-01-01

    Experimental results on high energy nucleus-nucleus interactions are presented. The data are discussed within the framework of standard super-position models and from the point-of-view of the possible formation of new states of matter in heavy ion collisions.

  9. Syndrome of transtentorial herniation: is vertical displacement necessary?

    PubMed Central

    Ropper, A H

    1993-01-01

    MRI from a comatose patient with a massive acute subdural haematoma showed most of the features of transtentorial herniation described in the classic pathology literature. In addition to encroachment on the perimesencephalic cisterns, infarction in the anterior and posterior cerebral artery territories, ischaemic change in the lower diencephalon, and ventricular enlargement were visualised. Despite the clinical syndrome and these secondary changes due to compression, there was only approximately 2 mm of downward displacement of the upper brainstem compared with 13 mm horizontal displacement. Although tissue shifts adjacent to the tentorial aperture cause brainstem and vascular compression, these changes may occur with minimal downward herniation. Images PMID:8350117

  10. [Relationship between lumbosacral multifidus muscle and lumbar disc herniation].

    PubMed

    Chen, Wei-ye; Wang, Kuan; Yuan, Wei-an; Zhan, Hong-sheng

    2016-06-01

    As a common disease in clinical, the treatment of lumbar disc herniation (LDH) focused on local intervertebral disc, such as surgery and other interventional therapy treatment, but postoperative complications and recurrence rate has been a difficult problem in the field of profession. With the development of spine biomechanics and anatomy, researches on lumbar herniation also increased. Researchers discovered that the incidence and prognosis of LDH were inseparable with local muscle and soft tissue. As the deep paraspinal muscles, multifidus muscle plays an important role to make lumbar stability. Its abnormal function could reduce the stable of lumbar spine, and the chronic lumbar disease could also lead to multifidus muscle atrophy. PMID:27534095

  11. Percutaneous laser disk decompression under CT and fluoroscopic guidance: indications, technique, and clinical experience.

    PubMed

    Gangi, A; Dietemann, J L; Ide, C; Brunner, P; Klinkert, A; Warter, J M

    1996-01-01

    The aim of percutaneous laser disk decompression (PLDD) is to vaporize a small portion of the nucleus pulposus of an intervertebral disk, thereby reducing the volume and pressure of a diseased disk. This minimally invasive technique can be performed in patients who need surgical intervention for disk herniation with leg pain. PLDD is usually performed under fluoroscopic guidance with or without diskoscopy. However, it can also be performed under dual computed tomographic (CT) and fluoroscopic guidance as an outpatient procedure. CT and fluoroscopic guidance increases the safety and accuracy of PLDD, with high precision of instrument guidance, direct visualization of nucleus pulposus vaporization, and reduced risk of complications. Of 119 patients with lumbar disk herniation treated with PLDD under CT and fluoroscopic guidance, 91 (76.5%) had a good or fair response. PLDD performed with CT and fluoroscopic guidance appears to be a safe and effective treatment for herniated intervertebral disks. PMID:10946692

  12. Rudimentary horn pregnancy with herniation into the main uterine cavity.

    PubMed

    Fitzmaurice, Laura E; Ehsanipoor, Robert M; Porto, Manuel

    2010-03-01

    We report a case of a rudimentary horn pregnancy with herniation of a fetal arm and umbilical cord into the main uterine cavity that presented as an incidental finding on a routine second-trimester ultrasound scan. We also review the literature that guides the diagnosis and management of these rare complicated pregnancies. PMID:20207232

  13. Tension pneumocephalus causing brain herniation after endoscopic sinus surgery.

    PubMed

    Çelikoğlu, Erhan; Hazneci, Jülide; Ramazanoğlu, Ali Fatih

    2016-01-01

    Endoscopic sinus surgery (ESS) may rarely be complicated by intracranial complications; the most common of them is a cerebrospinal fluid fistula. Pneumocephalus as a complication of ESS is quite rare. Here, we presented a unique case of tension pneumocephalus causing brain herniation as a complication of ESS, to whom emergent craniotomy was performed. PMID:27366266

  14. Tension pneumocephalus causing brain herniation after endoscopic sinus surgery

    PubMed Central

    Çelikoğlu, Erhan; Hazneci, Jülide; Ramazanoğlu, Ali Fatih

    2016-01-01

    Endoscopic sinus surgery (ESS) may rarely be complicated by intracranial complications; the most common of them is a cerebrospinal fluid fistula. Pneumocephalus as a complication of ESS is quite rare. Here, we presented a unique case of tension pneumocephalus causing brain herniation as a complication of ESS, to whom emergent craniotomy was performed. PMID:27366266

  15. Surgical discectomy for lumbar disc herniation: surgical techniques.

    PubMed

    Blamoutier, A

    2013-02-01

    Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root compression induced by the herniation. Initially, the approach was a unilateral posterior 5-cm incision: the multifidus was detached from the vertebra, giving access through an interlaminar space in case of posterolateral herniation; an alternative paraspinal approach was used for extraforaminal herniation. Over the past 30 years, many technical improvements have decreased operative trauma by reducing incision size, thereby reducing postoperative pain and hospital stay and time off work, while improving clinical outcome. Magnification and illumination systems by microscope and endoscope have been introduced to enable minimally invasive techniques. Several comparative studies have analyzed the clinical results of these various techniques. Although the methodology of most of these studies is debatable, all approaches seem to provide clinical outcomes of similar quality. At all events, minimally invasive techniques reduce hospital stay. While technical proficiency is essential, the final result depends on strict compliance with a prerequisite for surgical indication: close correlation between clinical symptoms and radiological findings. It is essential to discuss the risk/benefit ratio and explain the pros and cons of the recommended technique to the patient. PMID:23352565

  16. Nucleus-nucleus scattering at high energies

    NASA Technical Reports Server (NTRS)

    Franco, V.; Varma, G. K.

    1977-01-01

    Nucleus-nucleus scattering is treated in the Glauber approximation. The usual optical limit result, generally thought to improve as the number of nucleons in the colliding nuclei increases, is found to be the first term of a series which diverges for large nuclei. Corrections to the optical limit are obtained which provide a means of performing realistic calculations for collisions involving light nuclei. Total cross section predictions agree well with recent measurements.

  17. Automatic diagnosis of lumbar disc herniation with shape and appearance features from MRI

    NASA Astrophysics Data System (ADS)

    Alomari, Raja'S.; Corso, Jason J.; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    Intervertebral disc herniation is a major reason for lower back pain (LBP), which is the second most common neurological ailment in the United States. Automation of herniated disc diagnosis reduces the large burden on radiologists who have to diagnose hundreds of cases each day using clinical MRI. We present a method for automatic diagnosis of lumbar disc herniation using appearance and shape features. We jointly use the intensity signal for modeling the appearance of herniated disc and the active shape model for modeling the shape of herniated disc. We utilize a Gibbs distribution for classification of discs using appearance and shape features. We use 33 clinical MRI cases of the lumbar area for training and testing both appearance and shape models. We achieve over 91% accuracy in detection of herniation in a cross-validation experiment with specificity of 91% and sensitivity of 94%.

  18. Intervertebral disk (image)

    MedlinePlus

    ... are filled with a gelatinous substance, called the nucleus pulposus, which provides cushioning to the spinal column. ... fibrosus is a fibrocartilaginous ring that surrounds the nucleus pulposus, which keeps the nucleus pulposus in tact ...

  19. Brain Herniations into the Dural Venous Sinuses or Calvarium: MRI of a Recently Recognized Entity

    PubMed Central

    Battal, Bilal; Castillo, Mauricio

    2014-01-01

    Summary Brain herniations into dural venous sinuses (DVS) are rare findings recently described and their etiology and clinical significance are controversial. We describe five patients with brain herniations into the DVS or calvarium identified on MRI, and discuss their imaging findings, possible causes, and relationship to the patient's symptoms. All patients were examined with MRI including high resolution pre- and post-contrast T1- and T2-weighted sequences. With respect to brain herniations we documented their locations, signal intensities in different sequences, and size. We then reviewed clinical records in an attempt to establish if any symptoms were related to the presence of these herniations. Three males and two females were examined (age range, 11-68 years). Three patients had unilateral temporal lobe herniations into transverse sinuses, one had a cerebellar herniation into the skull, and one had bilateral temporal lobe herniations into the transverse sinuses as well as a cerebellar herniation into the sigmoid sinus. In all, the herniated brain and surrounding cerebrospinal fluid (CSF) had normal signal intensity on all MRI sequences. When correlated with clinical symptoms, brain herniations were thought to be incidental and asymptomatic in three patients and two patients had histories of headaches. Brain herniations with surrounding CSF into the DVS/skull should be considered potential sources of filling defects in the DVS. We believe that they are probably incidental findings that may be more common than previously recognized and should be not confused with the more common arachnoid granulations, clots, or tumors. Two patients had headaches, but their relation to the presence of herniated brain was uncertain. PMID:24571834

  20. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level.

    PubMed

    Hakan, Tayfun; Gürcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome. PMID:27429818

  1. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

    PubMed Central

    Gürcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome. PMID:27429818

  2. The Use of Dynamic Ultrasonography for the Confirmation of Lower Leg Muscle Herniation

    PubMed Central

    Rho, Nark Kyoung; Kim, Won Serk; Kim, Yeon Jin; Yoo, Kwang Ho; Kim, Myeung Nam

    2008-01-01

    The term muscle herniation represents focal muscular protrusions through an acquired or congenital fascial defect. The anterior tibialis muscle is the most common site of herniation. Dynamic ultrasonography has become an important tool in dermatology for diagnosing suspected muscle herniation because it is a non-invasive, highly accurate, readily available and cost-effective imaging technique. We present here the case of a 21-year-old male Korean soldier who underwent dynamic ultrasonography to confirm the diagnosis of anterior tibialis muscle herniation. PMID:27303189

  3. Delayed tentorial herniation after crainoplasty with polymethylmethacrylate: a rare complication.

    PubMed

    Yamahata, Hitoshi; Tokimura, Hiroshi; Kuratsu, Jun-ichi; Sakamoto, Akihisa; Matsuyama, Nozomu; Awa, Ryuji; Arita, Kazunori

    2011-12-01

    We report the case of a 49-year-old man who underwent a craniectomy for severe head trauma and subsequent cranioplasty with polymethylmethacrylate. He was discharged with moderate right-hand weakness. Five years after the cranioplasty he experienced double vision and slight right hemiparesis. Magnetic resonance imaging (MRI) revealed signs of tentorial herniation but no specific space-occupying lesions. The hand-moulded polymethylmethacrylate bone flap was found to be uneven and protrusions on the inner surface of the bone graft slightly compressed the brain below. His symptoms improved dramatically after a second cranioplasty using a ceramic implant. Although some complications including infection and cosmetic problems have been reported, tentorial herniation during late follow-up as a specific complication of cranioplasty has not been documented previously. We attribute his neurological improvement to the release of compression from the initial graft and to the consequent restoration of cerebrospinal fluid dynamics. PMID:21211986

  4. Herniation of a Pulmonary Emphysematous Bulla to Contralateral Hemithorax

    PubMed Central

    Shameem, Mohammad; Baneen, Ummul; Khan, Nafees Ahmad; Siddiqui, Mohammed Azfar

    2011-01-01

    Herniation of an emphysematous bulla is extremely rare. A 55-year-old male patient presented with complains of shortness of breath and cough for the last 10 years which had exacerbated in the last two days. The patient was a diagnosed case of chronic obstructive pulmonary disease. Chest x-ray showed bilateral hyperinflated lung fields along with loss of lung markings in left upper lobe and a thin white line in right upper lobe suggestive of wall of bulla. High resolution computed tomography of the chest revealed anterior herniation of a pulmonary bulla from left to right side across midline. Patient was put on antibiotics, hydrocortisone and aminophylline by intravenous route and nebulization of steroid and bronchodilator. However, the patient expired after 5 days following admission. PMID:25191377

  5. [Minimally invasive surgery in treatment of lumbar intervertebral disc herniation].

    PubMed

    Rotim, Krešimir; Sajko, Tomislav; Borić, Marta; Subašić, Ante

    2015-01-01

    Surgical treatment of lumbar intervertebral disc herniation is one of the most common neurosurgical procedures. Besides conventional surgical techniques, in the last more than 30 years, different methods with minimal damage to neuromuscular spine structures are being developed and introduced, all having the purpose of reducing postoperative back pain. The advantages of the minimally invasive spine surgery include: possibility of performing procedures under local anaesthesia, reduced hospital stay, limited blood loss with consecutively reduced fibrous tissue development. Patients are capable of return to work and everyday activities early after surgery. From the economical point of view, this kind of treatment is considered to be a cost-effective intervention. Three methods that are being used for treatment of lumbar intervertebral disc herniation are: percutaneous laser disc decompression (PLDD), microdiscectomy using tubular retractor system and selective endoscopic discectomy (SED). Conducted prospective studies have shown that minimally invasive methods are adequate alternative to classic surgical procedures. PMID:26065287

  6. Cervical lung lobe herniation in dogs identified by fluoroscopy.

    PubMed

    Nafe, Laura A; Robertson, Ian D; Hawkins, Eleanor C

    2013-10-01

    This study aimed to determine the frequency of cervical lung lobe herniation (CLLH) in dogs evaluated fluoroscopically and to identify associated characteristics. Reports of diagnostic procedures and patient summaries from 2008 to 2010 were reviewed retrospectively. Signalment, body weight, duration of cough, presence of heart murmur and airway collapse, and radiographic findings were compared between dogs with and without CLLH. Of the 121 dogs that were examined, CLLH occurred in 85 (70%). The extra-thoracic trachea kinked during herniation in 33 (39%) dogs with CLLH. Collapse of the intra-thoracic trachea (assessed fluoroscopically or bronchoscopically) and collapse of major bronchi (assessed fluoroscopically) were strongly associated with CLLH. Although redundant dorsal tracheal membrane on radiographs was associated with CLLH, extra-thoracic tracheal collapse, assessed fluoroscopically or bronchoscopically, was not. No other associations were found. Cervical lung lobe herniation was present in most dogs evaluated during cough and was associated with intra-thoracic large airway collapse, but not duration of cough. PMID:24155415

  7. Paradoxical Herniation in the Postcraniectomy Syndrome: Report and Literature Update

    PubMed Central

    Ramos-Zúñiga, Rodrigo; Mares-Pais, Roberto; Gutiérrez-Avila, Oscar; Saldaña-Koppel, Daniel A.

    2016-01-01

    Introduction The decompressive craniectomy is a surgical strategy widely used with specific criteria to control the refractory intracranial pressure (ICP). However, it is important to warn about the presence of a postcraniectomy syndrome and analyze the risk-benefit on a long term. Case Report A 72-year-old male patient diagnosed with a subarachnoid hemorrhage secondary to the rupture of an anterior circulation aneurysm that develops vasospasm, secondary ischemia, and edema with signs of herniation that required a decompressive craniectomy on a first step. Afterwards, the aneurysm was approached and he consequently developed hydrocephaly. A ventriculoperitoneal shunt is installed, contralateral to the craniectomy, and progressive sinking of the skin flap, there is neurological deterioration and paradoxical herniation. Its association with the clinical deterioration by bronchoaspiration did not allow the cranioplasty to resolve the ICP decompensation. Conclusions The paradoxical herniation as part of the postcraniectomy syndrome is an increasingly common condition identified in adult patients with cortical atrophy, and who have also been treated with ventricular shunt systems. Timely cranioplasty represents the ideal therapeutic plan once the compromise from the mass effect has resolved to avoid complications derived from the decompressive craniectomy per se. PMID:26929899

  8. Cervical lung lobe herniation in dogs identified by fluoroscopy

    PubMed Central

    Nafe, Laura A.; Robertson, Ian D.; Hawkins, Eleanor C.

    2013-01-01

    This study aimed to determine the frequency of cervical lung lobe herniation (CLLH) in dogs evaluated fluoroscopically and to identify associated characteristics. Reports of diagnostic procedures and patient summaries from 2008 to 2010 were reviewed retrospectively. Signalment, body weight, duration of cough, presence of heart murmur and airway collapse, and radiographic findings were compared between dogs with and without CLLH. Of the 121 dogs that were examined, CLLH occurred in 85 (70%). The extra-thoracic trachea kinked during herniation in 33 (39%) dogs with CLLH. Collapse of the intra-thoracic trachea (assessed fluoroscopically or bronchoscopically) and collapse of major bronchi (assessed fluoroscopically) were strongly associated with CLLH. Although redundant dorsal tracheal membrane on radiographs was associated with CLLH, extra-thoracic tracheal collapse, assessed fluoroscopically or bronchoscopically, was not. No other associations were found. Cervical lung lobe herniation was present in most dogs evaluated during cough and was associated with intra-thoracic large airway collapse, but not duration of cough. PMID:24155415

  9. Indigo Carmine for the Selective Endoscopic Intervertebral Nuclectomy

    PubMed Central

    Kim, Inn-Se; Shin, Sang-Wook; Kim, Tae-Kyun; Kim, Jeung-Il

    2005-01-01

    This study was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc. PMID:16100472

  10. Massive inguinoscrotal herniation of the bladder with ureter: incidental demonstration on bone scan.

    PubMed

    Ilgan, Seyfettin; Ozguven, Mehmet; Emer, Mustafa O; Karacalioglu, Alper O

    2007-08-01

    Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy. PMID:17705019

  11. Incarcerated Trocar Site Herniation of the Small Bowel following Laparoscopic Myomectomy

    PubMed Central

    Zomer, Monica Tessmann; de Azevedo, Rafael Menezes

    2013-01-01

    Small bowel herniation through the fascial defect created by the entry of trocars is one of the major complications of the laparoscopic surgery. In this paper, we describe a 42-year-old woman developing an incarcerated trocar site herniation of the small bowel following laparoscopic myomectomy and treated by laparoscopic approach. PMID:23956895

  12. Chronic tonsillar herniation: an attempt at classifying chronic hernitations at the foramen magnum.

    PubMed

    Friede, R L; Roessmann, U

    1976-03-30

    A system is presented for the classification of chronic herniations of the cerebellar tonsils in the absence of space-occupying intracranial lesions, based on a survey of the literature and 13 own cases. The Arnold-Chiari malformation in adults typically involves herniation of the cerebellar tonsils instead of herniation of the vermis as is typical when it occurs in infancy. Identification of chronic tonsillar herniation with the Arnold-Chiari malformation in adults was thought to require at least one other sign of the Arnold-Chiari complex, e.g. a medullary deformity. Cases for which chronic herniation and sclerosis of the cerebellar tonsils present as the only nervous lesion are classified as "chronic tonsillar herniation". Such cases may manifest with neurological symptoms during adult life, or they may be found incidentally at autopsy. Attention is drawn to the occurrence of chronic tonsillar herniation in 7 infants and children where it apparently represents a cause of sudden unexpected death. The overlap between chronic tonsillar herniation and the Arnold-Chiari malformation of adults is discussed in regard to the frequence of associated osseous anomalies, hydrocephalus and syringomyelia. PMID:1266580

  13. Remote cerebellar hemorrhage as an early and potentially lethal complication of a discal lumbar herniation surgery.

    PubMed

    Royon, V; Rabehenoina, C; Tourrel, F; Compère, V; Dureuil, B

    2014-01-01

    Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery. PMID:24439492

  14. The Nucleus Introduced

    PubMed Central

    Pederson, Thoru

    2011-01-01

    Now is an opportune moment to address the confluence of cell biological form and function that is the nucleus. Its arrival is especially timely because the recognition that the nucleus is extremely dynamic has now been solidly established as a paradigm shift over the past two decades, and also because we now see on the horizon numerous ways in which organization itself, including gene location and possibly self-organizing bodies, underlies nuclear functions. PMID:20660024

  15. Anterior Herniation of Partially Calcified and Degenerated Cervical Disc Causing Dysphagia.

    PubMed

    Ozdol, Cagatay; Turk, Cezmi Cagri; Yildirim, Ali Erdem; Dalgic, Ali

    2015-08-01

    We report a rare case of anterior cervical disc herniation associated with dysphagia. A 32-year-old man presented with complaints of dysphagia and concomitant pain in the right arm resistant to conservative therapy. On physical examination with respect to the muscle strength, the right shoulder abduction and flexion of the forearm were 3/5. Lateral X-ray revealed calcified osteophytes at the anterior C4-5 level. Magnetic resonance imaging showed soft disc herniation involving the right C6 root at the C5-6 level and anterior herniation of the C4-5 cervical disc. Anterior discectomies for C4-5 and C5-6 levels stabilized and ameliorated the dysphagia and pain. Cervical disc herniation usually presents with radicular findings. However, dysphagia may be an uncommon presentation. Anterior cervical disc herniation should be considered in a patient presenting with dysphagia. PMID:26240723

  16. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation

    PubMed Central

    Li, Jian; Zhang, Zai-Heng

    2008-01-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ≥11° or horizontal displacement (HD) ≥3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no

  17. Spontaneous regression of cervical disc herniation: a case report.

    PubMed

    Han, Seong Rok; Choi, Chan Young

    2014-12-01

    Spontaneous regression of cervical disc herniation is a rare, and such reports are few. A 39 year-old woman complained of severe neck pain associated with tingling and numbness of right upper extremity. The MRI of the cervical spine revealed a posterior disc extrusion at the C4-C5 level in the right para-central location. The patient was treated with conservative management without any surgical treatment. The patient's symptoms were significant improvement. After two years later, we performed follow-up cervical MRI that revealed significant spontaneous regression of the C4-C5 intervertebral disc extrusion. PMID:25620984

  18. A rare case of femoral herniation of female internal genitalia

    PubMed Central

    Ambedkar, Vivek; Singh, Abhilash; Bain, Jayanta; Singh, Lal Mani

    2015-01-01

    We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery. PMID:26283851

  19. Multiple Intradural Disc Herniations Masquerading as Intradural Extramedullary Tumors: A Case Report and Review of the Literature

    PubMed Central

    Park, Young-Seop; Hyun, Seung-Jae; Jahng, Tae-Ahn

    2016-01-01

    Intradural disc herniation is a very rare condition, and multiple intradural disc herniations have not been reported to date. The latter may be confused with intradural extramedullary (IDEM) spinal tumors. Here, we report a case of multiple intradural disc herniations masquerading as multiple IDEM tumors and review the relevant literature. We retrospectively reviewed the patient's medical chart, reviewed the intraoperative microscopic findings, and reviewed of PubMed articles on intradural disc herniation. The masses considered to be IDEM tumors were confirmed to be multiple intradural disc herniations. A nonenhancing mass was found to have migrated along the intra-arachnoid space. Two enhancing masses could not migrate because of adhesion and showed peripheral neovascularization. We report an extremely rare case of multiple intradural lumbar disc herniations showing diverse enhancing patterns and masquerading as multiple IDEM tumors. In case of multiple enhancing IDEM masses suspected preoperatively, surgeons should consider the possibility of intradural disc herniation. PMID:27123028

  20. Kaon-nucleus scattering

    NASA Technical Reports Server (NTRS)

    Hong, Byungsik; Maung, Khin Maung; Wilson, John W.; Buck, Warren W.

    1989-01-01

    The derivations of the Lippmann-Schwinger equation and Watson multiple scattering are given. A simple optical potential is found to be the first term of that series. The number density distribution models of the nucleus, harmonic well, and Woods-Saxon are used without t-matrix taken from the scattering experiments. The parameterized two-body inputs, which are kaon-nucleon total cross sections, elastic slope parameters, and the ratio of the real to the imaginary part of the forward elastic scattering amplitude, are presented. The eikonal approximation was chosen as our solution method to estimate the total and absorptive cross sections for the kaon-nucleus scattering.

  1. Convergence of the nucleus-nucleus Glauber multiple scattering series

    SciTech Connect

    Usmani, A.A.; Ahmad, I. )

    1991-05-01

    The Glauber {ital S}-matrix operator for nucleus-nucleus scattering is expressed as a finite series of matrix elements involving Bell's polynomials. Analyzing {alpha}{sup 4}He elastic-scattering data at the incident momentum of 4.32 GeV/{ital c}, we infer that our expansion is appreciably converging. Further, by applying closure over target and projectile states and neglecting a certain class of terms involving intermediate excitations, we arrive at a recurrence relation for nucleus-nucleus multiple scattering series terms, which invites further study as it seems to provide a simple method for calculating the nucleus-nucleus elastic-scattering cross section.

  2. Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

    PubMed Central

    Hawasli, Ammar H.; Ray, Wilson Z.; Wright, Neill M.

    2014-01-01

    Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair. PMID:24871148

  3. Disappearing large calcified thoracic disc herniation in a patient with thalassaemia.

    PubMed

    Ahmad, Faiz U; Schallert, Erica; Bregy, Amade; Post, Judith D; Vanni, Steven

    2016-01-01

    Regression of herniated disc fragments with subsequent improvement in clinical symptoms has been reported in the lumbar and cervical spine. Such regressions in the thoracic spine are extremely rare. We report a case of a 38-year-old patient with thalassaemia who had regression of a large calcified herniated thoracic disc causing cord compression, with subsequent herniation of a second calcified disc at a different level and discuss the possible aetiopathogenesis. This is the first such case reported in the thalassaemia population. PMID:26823353

  4. Adolescent lumbar disc herniation in a Tae Kwon Do martial artist: a case report

    PubMed Central

    Kazemi, Mohsen

    1999-01-01

    Lumbar disc herniations are rare in children. The etiology and clinical picture may be different in children than in adults. Conservative management is the treatment of choice. Tae Kwon Do is a Korean martial art which is notorious for its high fast kicks. Tae Kwon Do will be an official Olympic sport in the year 2000. Low back pain is occasionally reported by Tae Kwon Do athletes but there are no reported cases in the literature on disc herniation in a Tae Kwon Do athlete. A case report is presented to illustrate clinical presentation, diagnosis, radiological assessment and conservative management of lumbar disc herniation in children. ImagesFigure 1Figure 2

  5. Considerations for surgical treatment of patients with upper lumbar disc herniations.

    PubMed

    Ido, K; Shimizu, K; Tada, H; Matsuda, Y; Shikata, J; Nakamura, T

    1998-02-01

    Nine patients treated by surgery for upper lumbar disc herniations were reviewed. Of nine patients with upper lumbar disc herniations at the L1-L2 or L2-L3 level, five were treated by anterior procedures, whereas four underwent posterior procedures. Four of the five patients on whom anterior procedures were performed underwent additional spinal instrumentation using the Kaneda device and Z-plate system. Clinical symptoms improved in all nine patients. Confirmation of the type and level of disc herniation and increased thoracolumbar kyphosis must be taken into consideration when the optimal surgical procedure and spinal instrumentation method are selected. PMID:9493774

  6. Spontaneous Regression of Lumbar Disc Herniation After Weight Loss: Case Report.

    PubMed

    Tokmak, Mehmet; Altiok, Inci Baltepe; Guven, Mustafa; Aras, Adem Bozkurt; Cosar, Murat

    2015-01-01

    Diagnosis, treatment, and surgery for lumbar disc herniations have existed for over a century. However, during the last three decades, there have been many new developments in imaging techniques, surgical procedures, physical medicine, and rehabilitation. In light of this, the most effective and appropriate treatment is controversial. Spontaneous regression of sequestrated, extruded, or protruded disc herniation has often been reported in the literature, although it is still a rare phenomenon. After a thorough review of the literature, we did not find any case report about this phenomenon after weight loss. In this report, though, we present a recent case about spontaneous regression of extruded disc herniation following weight loss. PMID:26242347

  7. Nucleus Course in Japanese.

    ERIC Educational Resources Information Center

    Akiyama, Nobuo; Flamm, Carol S.

    The "Nucleus Course in Japanese," based on the Institute of Modern Languages'"Situational Reinforcement" approach, is designed for 80 to 100 hours of instruction. Each lesson has several sections--Response drills, Appropriate Response Sequence, and Reading. Most of the lessons also include optional sections with Sentences for Repetition or a…

  8. Cell nucleus in context

    SciTech Connect

    Lelievre, Sophie A.; Bissell, Mina J.; Pujuguet, Philippe

    1999-11-11

    The molecular pathways that participate in regulation of gene expression are being progressively unraveled. Extracellular signals, including the binding of extracellular matrix and soluble molecules to cell membrane receptors, activate specific signal transducers that convey information inside the cell and can alter gene products. Some of these transducers when translocated to the cell nucleus may bind to transcription complexes and thereby modify the transcriptional activity of specific genes. However, the basic molecules involved in the regulation of gene expression are found in many different cell and tissue types; thus the mechanisms underlying tissue-specific gene expression are still obscure. In this review, we focus on the study of signals that are conveyed to the nucleus. We propose that the way in which extracellular signals are integrated may account for tissue-specific gene expression. We argue that the integration of signals depends on the structural organization of cells ( i.e., extracellular matrix, cell membrane, cytoskeleton, nucleus) which a particular cell type within a tissue. Putting the nuclei in context allows us to envision gene expression as being regulated not only by the communication between the extracellular environment and the nucleus, but also by the influence of organized assemblies of cells on extracellular-nuclear communications.

  9. Sensitivity analysis of permeability parameters of bovine nucleus pulposus obtained through inverse fitting of the nonlinear biphasic equation: effect of sampling strategy.

    PubMed

    Riches, Philip E

    2012-01-01

    Permeability controls the fluid flow into and out of soft tissue, and plays an important role in maintaining the health status of such tissue. Accurate determination of the parameters that define permeability is important for the interpretation of models that incorporate such processes. This paper describes the determination of strain-dependent permeability parameters from the nonlinear biphasic equation from experimental data of different sampling frequencies using the Nelder-Mead simplex method. The ability of this method to determine the global optimum was assessed by constructing the whole manifold arising from possible parameter combinations. Many parameter combinations yielded similar fits with the Nelder-Mead algorithm able to identify the global maximum within the resolution of the manifold. Furthermore, the sampling strategy affected the optimum values of the permeability parameters. Therefore, permeability parameter estimations arising from inverse methods should be utilised with the knowledge that they come with large confidence intervals. PMID:21749275

  10. Thermally triggered injectable hydrogel, which induces mesenchymal stem cell differentiation to nucleus pulposus cells: Potential for regeneration of the intervertebral disc.

    PubMed

    Thorpe, A A; Boyes, V L; Sammon, C; Le Maitre, C L

    2016-05-01

    There is an urgent need for new therapeutic options for low back pain, which target degeneration of the intervertebral disc (IVD). Here, we investigated a pNIPAM hydrogel system, which is liquid at 39°C ex vivo, where following injection into the IVD, body temperature triggers gelation. The combined effects of hypoxia (5% O2) and the structural environment of the hydrogel delivery system on the differentiation of human mesenchymal stem cells (hMSCs), towards an NP cell phenotype was investigated. hMSCs were incorporated into the liquid hydrogel, the mixture solidified and cultured for up to 6weeks under 21% O2 or 5% O2 where viability was maintained. Immunohistochemistry revealed significant increases in NP matrix components: aggrecan; collagen type II and chondroitin sulphate after culture for 1week in 5% O2, accompanied by increased matrix staining for proteoglycans and collagen, observed histologically. NP markers HIF1α, PAX1 and FOXF1 were also significantly increased where hMSC were incorporated into hydrogels with accelerated expression observed when cultured in 5% O2. hMSCs cultured under hypoxic conditions, which mimic the native disc microenvironment, accelerate differentiation of hMSCs within the hydrogel system, towards the NP phenotype without the need for chondrogenic inducing medium or additional growth factors, thus simplifying the treatment strategy for the repair of IVD degeneration. PMID:26996377

  11. Cervical cord injury after massage.

    PubMed

    Lee, Tzu-Han; Chiu, Jan-Wei; Chan, Rai-Chi

    2011-10-01

    We present the case of a 47-yr-old gentleman with cervical cord injury after he received massage in the neck area. Magnetic resonance imaging of the cervical spine showed a herniation of the nucleus pulposus and compressive myelopathy. The patient required surgical intervention and rehabilitation. Despite 6 mos of rehabilitation, residual hand dysfunction and minor ambulation problems persisted. Although massage has many benefits, this case reminds us that there is potential danger in performing neck massage. PMID:21862908

  12. Onset of deconfinement in nucleus-nucleus collisions

    SciTech Connect

    Gazdzicki, M.; Gorenstein, M. I.; Seyboth, P.

    2012-05-15

    The energy dependence of hadron production in relativistic nucleus-nucleus collisions reveals anomalies-the kink, horn, and step. They were predicted as signals of the deconfinement phase transition and observed by the NA49 Collaboration in central PbPb collisions at the CERN SPS. This indicates the onset of the deconfinement in nucleus-nucleus collisions at about 30 A GeV.

  13. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation

    PubMed Central

    Weinstein, James N.; Lurie, Jon D.; Tosteson, Tor D.; Skinner, Jonathan S.; Hanscom, Brett; Tosteson, Anna N. A.; Herkowitz, Harry; Fischgrund, Jeffrey; Cammisa, Frank P.; Albert, Todd; Deyo, Richard A.

    2008-01-01

    Context For patients with lumbar disk herniation, the Spine Patient Outcomes Research Trial (SPORT) randomized trial intent-to-treat analysis showed small but not statistically significant differences in favor of diskectomy compared with usual care. However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care. Objective To compare the treatment effects of diskectomy and usual care. Design, Setting, and Patients Prospective observational cohort of surgical candidates with imaging-confirmed lumbar intervertebral disk herniation who were treated at 13 spine clinics in 11 US states and who met the SPORT eligibility criteria but declined randomization between March 2000 and March 2003. Interventions Standard open diskectomy vs usual nonoperative care. Main Outcome Measures Changes from baseline in the Medical Outcomes Study Short-Form Health Survey (SF-36) bodily pain and physical function scales and the modified Oswestry Disability Index (American Academy of Orthopaedic Surgeons/MODEMS version). Results Of the 743 patients enrolled in the observational cohort, 528 patients received surgery and 191 received usual nonoperative care. At 3 months, patients who chose surgery had greater improvement in the primary outcome measures of bodily pain (mean change: surgery, 40.9 vs nonoperative care, 26.0; treatment effect, 14.8; 95% confidence interval, 10.8-18.9), physical function (mean change: surgery, 40.7 vs nonoperative care, 25.3; treatment effect, 15.4; 95% CI, 11.6-19.2), and Oswestry Disability Index (mean change: surgery, −36.1 vs nonoperative care, −20.9; treatment effect, −15.2; 95% CI, −18.5. to −11.8). These differences narrowed somewhat at 2 years: bodily pain (mean change: surgery, 42.6 vs nonoperative care, 32.4; treatment effect, 10.2; 95% CI, 5.9-14.5), physical function (mean change: surgery, 43.9 vs nonoperavtive care 31.9; treatment

  14. Proton Nucleus Elastic Scattering Data.

    Energy Science and Technology Software Center (ESTSC)

    1993-08-18

    Version 00 The Proton Nucleus Elastic Scattering Data file PNESD contains the numerical data and the related bibliography for the differential elastic cross sections, polarization and integral nonelastic cross sections for elastic proton-nucleus scattering.

  15. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma.

    PubMed

    Wani, Adil S; Kalamkar, Prachi; Alhassan, Sulaiman; Farrell, Michael J

    2015-12-01

    Lung herniation has been defined as a protrusion of lung tissue through its bounding structure. We present a case of spontaneous intercostal lung herniation following bouts of cough, which was complicated by multiple rib fractures, in which we had to adopt a non-surgical approach due to the clinical circumstance. Its understanding in the field of internal medicine is important as appropriate therapeutic judgment, and long-term follow-up is essential for full recovery. PMID:26719812

  16. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma

    PubMed Central

    Wani, Adil S.; Kalamkar, Prachi; Alhassan, Sulaiman; Farrell, Michael J.

    2015-01-01

    Lung herniation has been defined as a protrusion of lung tissue through its bounding structure. We present a case of spontaneous intercostal lung herniation following bouts of cough, which was complicated by multiple rib fractures, in which we had to adopt a non-surgical approach due to the clinical circumstance. Its understanding in the field of internal medicine is important as appropriate therapeutic judgment, and long-term follow-up is essential for full recovery. PMID:26719812

  17. Minimally invasive pars approach for foraminal disc herniation.

    PubMed

    Hitchon, Patrick W; Awe, Olatilewa O; Close, Liesl; Sukkarieh, Hamdi G

    2015-07-01

    We present a retrospective cohort study on the outcome of patients with foraminal disc herniations (FDH) treated with partial pars resections using minimally invasive surgery (MIS) through a tube. FDH present a challenge due to the more lateral trajectory needed for their excision and thereby more muscle dissection and possibly facet resection. Forty patients, 19 women and 21 men with a mean age ± standard deviation of 58 ± 12 years, underwent MIS for FDH. Data on length of hospital stay, body mass index and outcomes were collected prospectively and reviewed retrospectively. Average length of stay following surgery was 1 ± 1 days. There was one wound infection and four unsatisfactory results. Using the Macnab score, good to excellent results were achieved in 89% of the patients. Based on these results, MIS surgery with partial pars resection is an attractive option in the treatment of FDH with low morbidity and short hospital stays. PMID:25882259

  18. [Cauda equina syndrome due to giant disc herniation].

    PubMed

    Barriga, A; Villas, C

    2002-01-01

    In cases of acute or progressive development in a few hours of bilateral sciatica, severe foot and occasional quadriceps weakness and/or retention or incontinence of urine with perineal hypalgesia or anesthesia, acute compression of the cauda equina should be suspected, which is usually due to a lumbar disc herniation. Cauda equina syndrome requires emergency spinal surgery. To identify and confirm this syndrome by MR, Ismanoatory. Early surgical decompression must be achieved. Decompression within 24-48 hours significantly improves the neurological and urological outcome. We present the case of a patient who had previously been treated for low back pain who developed a cauda equina syndrome a few days later. PMID:12685115

  19. [Paradoxical transtentorial herniation, extreme trephined syndrome sign: A case report].

    PubMed

    Narro-Donate, Jose Maria; Huete-Allut, Antonio; Escribano-Mesa, Jose A; Rodríguez-Martínez, Virginia; Contreras-Jiménez, Ascensión; Masegosa-González, Jose

    2015-01-01

    The current increasing use of decompressive craniectomy carries the implicit appearance of complications due to alterations in both intracranial pressure and in the hydrostatic-hemodynamic equilibrium. Paradoxical transtentorial herniation represents a rare manifestation, included in "trephine syndrome", extremely critical but with relatively simple treatment. We present the case of a 56-year-old woman with no interesting medical history, who, after an olfactory groove meningioma surgery, presented a haemorrhage located in the surgical area with an important oedema. The patient required a second emergency surgery without any chance of conserving the cranial vault. During the post-operational period, great neurological deterioration in orthostatic position was noticed, which resolved spontaneously in decubitus. This deficit was resolved with bone replacement afterwards. We discuss possible predisposing factors and aetiologies of this pathology. PMID:25455761

  20. Tonsillar Herniation After Lumbar Puncture in Idiopathic Intracranial Hypertension.

    PubMed

    Borire, Adeniyi A; Hughes, Andrew R; Lueck, Christian J

    2015-09-01

    A 30-year-old woman with coexisting renal tubular acidosis and idiopathic intracranial hypertension (IIH), treated with acetazolamide, experienced coning (cerebellar tonsillar herniation) after a lumbar puncture (LP). Brain magnetic resonance imaging at initial diagnosis of IIH showed minor tonsillar descent and computed tomographic venography revealed hypoplasia of the left transverse sinus. The patient previously had three uneventful LPs, all of which showed high opening pressures and normal cerebrospinal fluid composition. In retrospect, it was noted that her serum bicarbonate had fallen to 9 mmol/L (normal: 22-28 mm/L) 1 week before the LP. We hypothesize that the combination of cerebral edema (due to worsening metabolic acidosis), poor venous drainage, and preexisting minor tonsillar descent contributed to her post-LP coning. PMID:25786203

  1. Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

    PubMed Central

    Jung, Je-Tea; Lee, Sang-Jin; Kim, Young-Sang; Jang, Han-Jin; Yoo, Bang

    2016-01-01

    The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH. PMID:27583117

  2. Intradural lumbar disc herniations: report of three cases.

    PubMed

    Prestar, F J; Schattke, H H

    1995-09-01

    Intradural lumbar disc herniation is a rare pathological entity. Three new cases among a series of 5000 lumbar spine operations are added to the about 60 previous case reports in the literature. None of our patients had undergone lumbar spine surgery before. In one patient the location of the free disc fragment was medial within the dural sac; in two patients the free disc fragment had penetrated the dural sac from the axilla of the nerve root. Pathogenesis is discussed (congenital adhesions of the dura mater to the posterior longitudinal ligament at the lower lumbar spine; weakness of the dura mater ventrally and at the axilla of the nerve root). By multiplanar MRI, the free disc hernia within the dural sac may be shown preoperatively. PMID:8542333

  3. Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations.

    PubMed

    Choi, Dae-Jung; Jung, Je-Tea; Lee, Sang-Jin; Kim, Young-Sang; Jang, Han-Jin; Yoo, Bang

    2016-09-01

    The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH. PMID:27583117

  4. [The lumbar disc herniation - management, clinical aspects and current recommendations].

    PubMed

    Stienen, M N; Cadosch, D; Hildebrandt, G; Gautschi, O P

    2011-11-30

    Lumbar disc herniation has a high prevalence and strong social-medical impact. Patients suffer from lower back pain that radiates from the spine. Loss of sensation or paresis adds to the clinical picture. The diagnosis should be confirmed by imaging in patients considered for surgery. High remission rates initially warrant conservative treatment (adequate analgesia and physiotherapy) in many patients. If this treatment does not lead to significant alleviation within 5-8 weeks, surgery should be performed to reduce the risk of chronic nerve affection. Posterior interlaminar fenestration is the intervention primarily conducted for this diagnosis. A relapse in the same region occurs in up to 10% of patients after months through years, which sometimes necessitates a reoperation if symptoms are pertinent. PMID:22124958

  5. Repeated microendoscopic discectomy for recurrent lumbar disk herniation

    PubMed Central

    Hou, Tianyong; Zhou, Qiang; Dai, Fei; Luo, Fei; He, Qingyi; Zhang, Jinsong; Xu, Jianzhong

    2015-01-01

    OBJECTIVES: To explore the microendoscopic discectomy technique and inclusion criteria for the treatment of recurrent lumbar disc herniation and to supply feasible criteria and technical notes to avoid complications and to increase the therapeutic effect. METHODS: A consecutive series of 25 patients who underwent posterior microendoscopic discectomy for recurrent lumbar disc herniation were included. The inclusion criteria were as follows: no severe pain in the lumbar region, no lumbar instability observed by flexion-extension radiography and no intervertebral discitis or endplate damage observed by magnetic resonance imaging. All patients were diagnosed by clinical manifestations and imaging examinations. RESULTS: Follow-up visits were carried out in all cases. Complications, such as nerve injuries, were not observed. The follow-up outcomes were graded using the MacNab criteria. A grade of excellent was given to 12 patients, good to 12 patients and fair to 1 patient. A grade of excellent or good occurred in 96% of cases. One patient relapsed 3 months after surgery and then underwent lumbar interbody fusion and inner fixation. The numerical rating scale of preoperative leg pain was 7.4± 1.5, whereas it decreased to 2.1±0.8 at 7 days after surgery. The preoperative Oswestry disability index of lumbar function was 57.5±10.0, whereas it was 26.0±8.5 at 7 days after surgery. CONCLUSION: In these cases, microendoscopic discectomy was able to achieve satisfactory clinical results. Furthermore, it has advantages over other methods because of its smaller incision, reduced bleeding and more efficient recovery. PMID:25789521

  6. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher.

    PubMed

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-Ichi; Watanabe, Kazuyuki; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

    2016-06-01

    Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  7. Transdural approach for calcified central disc herniations of the upper lumbar spine. Technical note.

    PubMed

    Choi, Jeong-Wook; Lee, Jung-Kil; Moon, Kyung-Sub; Hur, Hyuk; Kim, Yeon-Seong; Kim, Soo-Han

    2007-09-01

    Disc herniations of the upper lumbar spine (L1-2 and L2-3) have a frequency of 1 to 2% of all disc herniations. During posterior discectomy after laminectomy, significant manipulation of the exiting nerve root is unavoidable because of the narrow lamina and the difficulty in mobilizing the nerve root. The authors adopted a transdural approach in patients with calcified central disc herniation at the L1-2 level to reduce the risk of nerve root injury. Four patients suffering from radiating pain together with back pain were treated using the transdural approach. Preoperative neuroimaging studies revealed severe central disc herniation with calcification at the L1-2 level. After laminectomy or laminotomy, the incised dura mater was tacked, and the cauda equina rootlets were gently retracted. An intentional durotomy was performed over its maximal bulging of the ventral dura. After meticulous dissection of dense adhesions between the disc herniation and the dural sac, adequate decompression with removal of calcified disc fragments and osteophytes was accomplished. Clinical symptoms improved in all patients. Postoperative permanent cerebrospinal fluid leakage and pseudomeningocele were not observed, and no patient had a progressive lumbar deformity at an average follow-up of 53 months. Transient mild motor weakness and sensory change were observed in two patients postoperatively; however, these symptoms resolved completely within 1 week. The posterior transdural approach offers an alternative in central calcified upper lumbar disc herniation when root retraction is dangerous. PMID:17877277

  8. Diagnosis, treatment, and complications of adult lumbar disk herniation: evidence-based data for the healthcare professional.

    PubMed

    Klineberg, Eric; Ching, Alexander; Mundis, Greg; Burton, Douglas; Bess, Shay

    2015-01-01

    Lumbar disk herniation is a commonly seen disorder that requires care by spinal surgeons and healthcare professionals. Although there has been substantial research on the diagnosis, treatment, complications, and outcomes of lumbar disk herniation, patient management varies. A review and evaluation of the literature (with special regard for high-quality randomized studies) and familiarity with best practices guidelines for the evaluation, management, and treatment of adult lumbar disk herniation will enhance the optimal delivery of health care to affected patients. PMID:25745924

  9. Plasma disc decompression for contained cervical disc herniation: a randomized, controlled trial

    PubMed Central

    Nardi, Pier Vittorio

    2009-01-01

    Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF-36 health survey, collected at 6 weeks, 3 months, 6 months, and 1 year. The PDD group had significantly lower VAS pain scores at all follow-up time points (PDD vs. CC: 6 weeks, −46.87 ± 2.71 vs. −15.26 ± 1.97; 3 months, −53.16 ± 2.74 vs. −30.45 ± 2.59; 6 months, −56.22 ± 2.63 vs. −40.26 ± 2.56; 1 year, −65.73 ± 2.24 vs. −36.45 ± 2.86; GEE, P < 0.0001). PDD patients also had significant NDI score improvement over baseline when compared to CC patients at the 6 weeks (PDD vs. CC: −9.15 ± 1.06 vs. −4.61 ± 0.53, P < 0.0001) and 1 year (PDD vs. CC: −16.70 ± 0.29 vs. −12.40 ± 1.26, P = 0.005) follow-ups. PDD patients showed statistically significant improvement over baseline in SF-36 physical component summary scores when compared to CC patients at 6 weeks and 1 year (PDD vs. CC: 8.86 + 8.04 vs. 4.24 ± 3.79, P = 0.0004; 17.64 ± 10.37 vs. 10.50 ± 10.6, P = 0.0003, respectively). In patients who had neck/arm pain due to a contained cervical disc herniation, PDD was associated with significantly better clinical outcomes than a CC regimen. At 1 year, CC patients appeared to suffer a “relapse, showing signs of decline in most measurements, whereas PDD

  10. Analytic optical potentials for nucleon-nucleus nucleus-nucleus collisions involving light and medium nuclei

    NASA Technical Reports Server (NTRS)

    Bidasaria, H. B.; Townsend, L. W.

    1982-01-01

    Utilizing an optical model potential approximation to the exact nucleus-nucleus multiple-scattering series, optical potentials for nucleon-nucleus and nucleus-nucleus collisions are analytically derived. These expressions are applicable to light and medium cosmic ray nuclei as their single-particle density distributions are analytically determined, without approximation, from their actual harmonic well charge density distributions. Pauli correlation effects are included through the use of a simple Gaussian function to replace the usual expression obtained in the infinite nuclear matter approximation.

  11. Nucleus from string theory

    NASA Astrophysics Data System (ADS)

    Hashimoto, Koji; Morita, Takeshi

    2011-08-01

    In generic holographic QCD, we find that baryons are bound to form a nucleus, and that its radius obeys the empirically-known mass-number (A) dependence r∝A1/3 for large A. Our result is robust, since we use only a generic property of D-brane actions in string theory. We also show that nucleons are bound completely in a finite volume. Furthermore, employing a concrete holographic model (derived by Hashimoto, Iizuka, and Yi, describing a multibaryon system in the Sakai-Sugimoto model), the nuclear radius is evaluated as O(1)×A1/3[fm], which is consistent with experiments.

  12. Neutrino-nucleus interactions

    SciTech Connect

    Gallagher, H.; Garvey, G.; Zeller, G.P.; /Fermilab

    2011-01-01

    The study of neutrino oscillations has necessitated a new generation of neutrino experiments that are exploring neutrino-nuclear scattering processes. We focus in particular on charged-current quasi-elastic scattering, a particularly important channel that has been extensively investigated both in the bubble-chamber era and by current experiments. Recent results have led to theoretical reexamination of this process. We review the standard picture of quasi-elastic scattering as developed in electron scattering, review and discuss experimental results, and discuss additional nuclear effects such as exchange currents and short-range correlations that may play a significant role in neutrino-nucleus scattering.

  13. Higgs-Boson Production in Nucleus-Nucleus Collisions

    NASA Technical Reports Server (NTRS)

    Norbury, John W.

    1992-01-01

    Cross section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two photon fusion. The calculations are performed in position space using Baur's method for folding together the Weizsacker-Williams virtual-photon spectra of the two colliding nuclei. It is found that two photon fusion in nucleus-nucleus collisions is a plausible way of finding intermediate-mass Higgs bosons at the Superconducting Super Collider or the CERN Large Hadron Collider.

  14. Higgs-boson production in nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Norbury, J. W.; Townsend, L. W. (Principal Investigator)

    1990-01-01

    Cross-section calculations are presented for the production of intermediate-mass Higgs bosons produced in ultrarelativistic nucleus-nucleus collisions via two-photon fusion. The calculations are performed in position space using Baur's method for folding together the Weizsacker-Williams virtual-photon spectra of the two colliding nuclei. It is found that two-photon fusion in nucleus-nucleus collisions is a plausible way of finding intermediate-mass Higgs bosons at the Superconducting Super Collider or the CERN Large Hadron Collider.

  15. Networking the nucleus

    PubMed Central

    Rajapakse, Indika; Scalzo, David; Tapscott, Stephen J; Kosak, Steven T; Groudine, Mark

    2010-01-01

    The nuclei of differentiating cells exhibit several fundamental principles of self-organization. They are composed of many dynamical units connected physically and functionally to each other—a complex network—and the different parts of the system are mutually adapted and produce a characteristic end state. A unique cell-specific signature emerges over time from complex interactions among constituent elements that delineate coordinate gene expression and chromosome topology. Each element itself consists of many interacting components, all dynamical in nature. Self-organizing systems can be simplified while retaining complex information using approaches that examine the relationship between elements, such as spatial relationships and transcriptional information. These relationships can be represented using well-defined networks. We hypothesize that during the process of differentiation, networks within the cell nucleus rewire according to simple rules, from which a higher level of order emerges. Studying the interaction within and among networks provides a useful framework for investigating the complex organization and dynamic function of the nucleus. PMID:20664641

  16. Treatment of Recurrent Disc Herniation: A Systematic Review

    PubMed Central

    Ugiliweneza, Beatrice; Al-Khouja, Lutfi; Yang, Dongyan; Johnson, Patrick; Kim, Terrence; Boakye, Maxwell

    2016-01-01

    Intervertebral disc herniation is one of the most common causes of back and extremity pain. The most commonly used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) after a successful first discectomy. Currently, there aren’t any guidelines to assist surgeons in determining which approach is most appropriate to treat rDH. A recent survey showed significant heterogeneity among surgeons regarding treatment options for rDH. It remains unclear which methods lead to better outcomes, as there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if one intervention provides better outcomes than the other; more specifically, whether outcome differences exist between discectomy alone and discectomy with fusion. We applied the PICOS (participants, intervention, comparison, outcome, study design) format to develop this systematic review through PubMed. Twenty-seven papers from 1978-2014 met our inclusion criteria and were included in the analysis. Nine papers reported outcomes after discectomy and seven of them showed good or excellent outcomes (70.60%-89%). Ten papers reported on minimally invasive discectomy. The percent change in visual analog scale (VAS) ranged from -50.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported good or excellent outcomes (81% to 90.2%). Three studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one study, we found the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Six studies evaluated the transforaminal lumbar interbody fusion. All reported improvement in pain. Four used VAS, and we found the percent change to be -54% to -86.5%. The other two used the Japanese Orthopedic Association (JOA) score, and we found the percent change to be 68.3% to 93.3%. We

  17. Treatment of Recurrent Disc Herniation: A Systematic Review.

    PubMed

    Drazin, Doniel; Ugiliweneza, Beatrice; Al-Khouja, Lutfi; Yang, Dongyan; Johnson, Patrick; Kim, Terrence; Boakye, Maxwell

    2016-01-01

    Intervertebral disc herniation is one of the most common causes of back and extremity pain. The most commonly used surgical treatment is lumbar discectomy. About 0.5-25% go on to develop recurrent disc herniation (rDH) after a successful first discectomy. Currently, there aren't any guidelines to assist surgeons in determining which approach is most appropriate to treat rDH. A recent survey showed significant heterogeneity among surgeons regarding treatment options for rDH. It remains unclear which methods lead to better outcomes, as there are no comparative studies with a sufficient level of evidence. In this study, we aimed to perform a systematic review to compare treatment options for rDH and determine if one intervention provides better outcomes than the other; more specifically, whether outcome differences exist between discectomy alone and discectomy with fusion. We applied the PICOS (participants, intervention, comparison, outcome, study design) format to develop this systematic review through PubMed. Twenty-seven papers from 1978-2014 met our inclusion criteria and were included in the analysis. Nine papers reported outcomes after discectomy and seven of them showed good or excellent outcomes (70.60%-89%). Ten papers reported on minimally invasive discectomy. The percent change in visual analog scale (VAS) ranged from -50.77% to -86.57%, indicating an overall pain reduction. Four studies out of the ten reported good or excellent outcomes (81% to 90.2%). Three studies looked at posterolateral fusion. Three studies analyzed posterior lumbar interbody fusion. For one study, we found the VAS percentage change to be -46.02%. All reported good to excellent outcomes. Six studies evaluated the transforaminal lumbar interbody fusion. All reported improvement in pain. Four used VAS, and we found the percent change to be -54% to -86.5%. The other two used the Japanese Orthopedic Association (JOA) score, and we found the percent change to be 68.3% to 93.3%. We did

  18. Statistical shape model reconstruction with sparse anomalous deformations: Application to intervertebral disc herniation.

    PubMed

    Neubert, Aleš; Fripp, Jurgen; Engstrom, Craig; Schwarz, Daniel; Weber, Marc-André; Crozier, Stuart

    2015-12-01

    Many medical image processing techniques rely on accurate shape modeling of anatomical features. The presence of shape abnormalities challenges traditional processing algorithms based on strong morphological priors. In this work, a sparse shape reconstruction from a statistical shape model is presented. It combines the advantages of traditional statistical shape models (defining a 'normal' shape space) and previously presented sparse shape composition (providing localized descriptors of anomalies). The algorithm was incorporated into our image segmentation and classification software. Evaluation was performed on simulated and clinical MRI data from 22 sciatica patients with intervertebral disc herniation, containing 35 herniated and 97 normal discs. Moderate to high correlation (R=0.73) was achieved between simulated and detected herniations. The sparse reconstruction provided novel quantitative features describing the herniation morphology and MRI signal appearance in three dimensions (3D). The proposed descriptors of local disc morphology resulted to the 3D segmentation accuracy of 1.07±1.00mm (mean absolute vertex-to-vertex mesh distance over the posterior disc region), and improved the intervertebral disc classification from 0.888 to 0.931 (area under receiver operating curve). The results show that the sparse shape reconstruction may improve computer-aided diagnosis of pathological conditions presenting local morphological alterations, as seen in intervertebral disc herniation. PMID:26060085

  19. Thoracic Disk Herniation, a not Infrequent Cause of Chronic Abdominal Pain

    PubMed Central

    Lara, F.J. Pérez; Berges, A. Ferrer; Quesada, J. Quintero; Ramiro, J.A. Moreno; Toledo, R. Bustamante; Muñoz, H. Oliva

    2012-01-01

    This study assesses the proportion of patients presenting with nonvisceral chronic abdominal pain who have thoracic disk herniation as a possible cause. We designed a descriptive transversal study of patients attending our offices between February 2009 and October 2010, with a complaint of chronic abdominal pain of suspected abdominal wall source (positive Carnett sign). Nuclear magnetic resonance (NMR) of the spinal column was performed on all patients. When the NMR showed thoracic disk herniation the patients were treated according to their etiology. We also evaluated the symptoms in patients with thoracic disk herniation and their response to the applied treatment. Twenty-seven patients with chronic abdominal pain were evaluated. The NMR results in 18 of these 27 patients (66.66%) showed evidence of disk herniation. We report on the results of these 18 patients, emphasizing that the symptoms are florid and varied. Many patients had been previously diagnosed with irritable bowel syndrome. Thoracic disk herniation may account for chronic abdominal pain in many patients who remain undiagnosed or are diagnosed with irritable bowel syndrome. Thus, this possibility needs to be taken into account to achieve a correct diagnosis and a suitable mode of treatment. PMID:23101998

  20. Discography-induced acute lumbar disc herniation: a report of five cases.

    PubMed

    Poynton, Ashley R; Hinman, Adrian; Lutz, Gregory; Farmer, James C

    2005-04-01

    The reported complication rate of provocative lumbar discography is low, ranging from 0-2.5%. We report five cases of acute lumbar disc herniation precipitated by discography, a previously unreported complication. The cases reported comprise of four men and one woman with ages ranging from 23-45 years. All developed an acute exacerbation of radicular leg pain following multilevel provocative lumbar discography. One patient developed an acute foot drop. Comparison of lumbar MRI scans before and after discography demonstrated either a new herniated disc fragment or an increase in size of a preexisting herniation in all cases. On review of each discogram study and pre-discogram MRI an annular tear or small disc herniation was noted in all cases. In each case the patients' symptoms failed to resolve necessitating surgical intervention in all cases. In conclusion, annular deficiency is an obvious predisposing factor to discogram related disc herniation. New onset or a persistent exacerbation of radicular symptoms following provocative discography merits further investigation. PMID:15800440

  1. Electric quadrupole excitations in relativistic nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Norbury, John W.

    1989-01-01

    Calculations are presented for electric quadrupole excitations in relativistic nucleus-nucleus collisions. The theoretical results are compared to an extensive data set and it is found that electric quadrupole effects provide substantial corrections to cross sections, especially for heavier nuclei.

  2. Meson multiplicity versus energy in relativistic nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Atwater, T. W.; Freier, P. S.

    1986-01-01

    A systematic study of meson multiplicity as a function of energy at energies up to 100 GeV/u in nucleus-nucleus collisions has been made, using cosmic-ray data in nuclear emulsion. The data are consistent with simple nucleon-nucleon superposition models. Multiplicity per interacting nucleon in AA collisions does not appear to differ significantly from pp collisions.

  3. Scaling phenomenon in relativistic nucleus-nucleus collisions

    SciTech Connect

    Wong, C. Y.; Blankenbecler, R.

    1980-01-01

    New scaling variables for proton and pion production in relativistic nucleus-nucleus collisions are introduced which are the generalizations of the Feynmann scaling variable. They allow a simple description of the cross sections at forward and backward angles. 2 figures.

  4. Momentum loss in proton-nucleus and nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Khan, Ferdous; Townsend, Lawrence W.

    1993-01-01

    An optical model description, based on multiple scattering theory, of longitudinal momentum loss in proton-nucleus and nucleus-nucleus collisions is presented. The crucial role of the imaginary component of the nucleon-nucleon transition matrix in accounting for longitudinal momentum transfer is demonstrated. Results obtained with this model are compared with Intranuclear Cascade (INC) calculations, as well as with predictions from Vlasov-Uehling-Uhlenbeck (VUU) and quantum molecular dynamics (QMD) simulations. Comparisons are also made with experimental data where available. These indicate that the present model is adequate to account for longitudinal momentum transfer in both proton-nucleus and nucleus-nucleus collisions over a wide range of energies.

  5. The Galactic Nucleus

    NASA Astrophysics Data System (ADS)

    Melia, Fulvio

    Exciting new broadband observations of the galactic nucleus have placed the heart of the Milky Way under intense scrutiny in recent years. This has been due in part to the growing interest from theorists motivated to study the physics of black hole accretion, magnetized gas dynamics, and unusual star formation. The center of our Galaxy is now known to harbor the most compelling supermassive black hole candidate, weighing in at 3-4 million solar masses. Its nearby environment is comprised of a molecular dusty ring, clusters of evolved and young stars, diffuse hot gas, ionized gas streamers, and several supernova remnants. This chapter will focus on the physical makeup of this dynamic region and the feasibility of actually imaging the black hole's shadow in the coming decade with mm interferometry.

  6. Intra-radicuar Disc Herniation mimicking a Nerve Root Tumor

    PubMed Central

    Pillai, Suresh Sivadasan

    2012-01-01

    Introduction: Intra-radicular disc herniations are rare disorders with only few cases reported in literature. In most of these cases there is evidence of some part of the disc in adjacent area. We present a case of completely intra-radicular disc which was misdiagnosed as nerve root tumor as there was no evidence of disc prolapse at the time of diagnosis. Case Presentation: 51 year old male presented with history of severe back pain radiating to right lower limb since 11/2 month. MRI showed hypointense lesion completely inside the S1 root and a provisional diagnosis of nerve root tumor was done. At surgery, fluffy material was removed from the lesion which was histopathologically confirmed as intervertebral disc. Post operatively all symptoms of patient was relieved except dysesthesia in sole which lasted for a year post surgery. At 5 year follow up patient has no symptoms. Conclusion: A diagnosis of intra-radicular disc should be considered in differential of nerve root tumor. Surgical excision of intra-radicular disc gives good clinical and functional results.

  7. Minimally invasive redo discectomy for recurrent lumbar disc herniations.

    PubMed

    Kogias, Evangelos; Franco Jimenez, Pamela; Klingler, Jan-Helge; Hubbe, Ulrich

    2015-09-01

    The purpose of this systematic review is to investigate which minimally invasive techniques have been used for discectomy in recurrent lumbar disc herniation (LDH), to present the success and complication rates and to evaluate the advantages and limitations of each technique. Discectomy for recurrent LDH is accompanied by a higher morbidity rate compared with primary LDH. Because of the limited operating field, the majority of surgeons have been discouraged from utilising a minimally invasive approach for revision surgery. Minimally invasive techniques have gained ground in the treatment of primary LDH and an increasing number of patients are expressing interest in such techniques for the treatment of recurrent LDH. Microendoscopic discectomy (MED), endoscopic transforaminal and interlaminar discectomy (ETD and EID) have been used for treatment of recurrent LDH. The reported success rate is 60-95%. Full endoscopic techniques, especially ETD, showed favourable results concerning dural tear rates but have a demanding learning curve. The limitations of ETD include dislocated disc fragments or concomitant lateral recess stenosis, and MED is more effective in these instances. All three techniques have a low delayed instability rate. MED, ETD and EID are safe and efficient treatment options for surgical management of recurrent LDH with good success and low complication rates. At the same time, they offer the advantages of minimally invasive access. PMID:26122379

  8. Unloaded Treadmill Training Therapy for Lumbar Disc Herniation Injury

    PubMed Central

    Simpson, Steve; Bettis, Brad; Herbertson, James

    1996-01-01

    The low back region is an area that is very susceptible to injury in athletes. Running is an activity that can be significantly affected by chronic overuse stress. The athlete presented in this case report suffered a herniation of the disc between L-4 and L-5 while training for and racing in a national championship marathon. The athlete was placed on a treatment program of heat, electrical muscle stimulation, and strength and flexibility exercises. The athlete also continued to train by unloaded treadmill training therapy. Unloaded treadmill training therapy produced an effect that reduced stress on injured joints and tissue. This enabled the athlete to maintain fitness while running pain-free on this specialized equipment. The athlete trained twice a week for 16 weeks and training runs ranged from 3 miles to a half-marathon (13.1 miles). Unloaded amounts decreased from 20 to 3 pounds. Training times improved at all distances and were maintained following resumption of normal training. ImagesFig 1.Fig 2.Fig 3. PMID:16558374

  9. Intestinal Rotation and Physiological Umbilical Herniation During the Embryonic Period.

    PubMed

    Ueda, Yui; Yamada, Shigehito; Uwabe, Chigako; Kose, Katsumi; Takakuwa, Tetsuya

    2016-02-01

    Drastic changes occur during the formation of the intestinal loop (IL), including elongation, physiological umbilical herniation (PUH), and midgut rotation. Fifty-four sets of magnetic resonance images of embryos between Carnegie stage (CS) 14 and CS 23 were used to reconstruct embryonic digestive tract in three dimensions in the Amira program. Elongation, PUH, and rotation were quantified in relation to the proximal part of the superior mesenteric artery (SMA), designated as the origin. Up to CS 16, IL rotation was initially observed as a slight deviation of the duodenum and colorectum from the median plane. The PUH was noticeable after CS 17. At CS 18, the IL showed a hairpin-like structure, with the SMA running parallel to the straight part and the cecum located to the left. After CS 19, the IL began to form a complex structure as a result of the rapid growth of the small intestinal portion. By CS 20, the IL starting point had moved from the right cranial region to an area caudal to the origin, though elongation of the duodenum was not conspicuous-this was a change of almost 180° in position. The end of the IL remained in roughly the same place, to the left of and caudal to the origin. Notably, the IL rotated around the origin only during earlier stages and gradually moved away, running transversely after CS 19. The movements of the IL may be explained as the result of differential growth, suggesting that IL rotation is passive. PMID:26599074

  10. Outcomes of conservative treatment for ruptured lumbar disc herniation.

    PubMed

    Yu, Peng-Fei; Jiang, Fang-Da; Liu, Jin-Tao; Jiang, Hong

    2013-12-01

    The authors set up a prospective study of the effect of conservative treatment on a ruptured lumbar disc herniation in 89 patients, between June 2008 and June 2010. Seventy-two patients (81%) improved, while the other 17 (19%) needed surgery. The JOA score (best possible result: 29) was found to be significantly improved in the 72 patients of the conservative group, at 1 month, 3 months, 6 months, 1 year and 2 years (t-test: p < 0.001). At final follow-up, after 2 years, 84.7% of the patients in the conservative group had a good or excellent result. However, if the 17 surgical cases were included, this proportion dropped to 68.5%. The volume of the protrusion decreased significantly in the 72 patients of the conservative group: from 1422.52 +/- 539.10 mm3 to 102735 +/- 585.51 mm3 (paired t-test: p < 0.001). There was a definite correlation, in the conservative group, between the final resorption rate on the one hand and the percentage of combined excellent and good results on the other hand (72 cases; Spearman rank correlation coefficient: r 0.01 = 0.470, p < 0.001). PMID:24563981

  11. [Abdominal wall closure by incisional hernia and herniation after laparostoma].

    PubMed

    Mischinger, H-J; Kornprat, P; Werkgartner, G; El Shabrawi, A; Spendel, S

    2010-03-01

    As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair. PMID:20145901

  12. Mucosa-associated lymphoid tissue lymphoma masquerading as herniated orbital fat.

    PubMed

    Hwang, Cindy S; Diaz-Marchan, Pedro; Marx, Douglas P

    2014-01-01

    Lymphomas are the most common primary orbital malignancies in adults. The authors present a 62-year-old Hispanic woman with a 2-year history of slowly enlarging bilateral lower eyelid masses that the patient described as "bags." On palpation, firm, mobile, nontender masses with associated tear trough deformities were noted. Biopsy of the left lower eyelid mass was consistent with a mucosa-associated lymphoid tissue lymphoma. Herniated orbital fat is an extremely common finding in the aging population and is often associated with a prominent tear trough. The patient with orbital lymphoma appeared to have herniated orbital fat with associated tear trough deformities. Lymphoma resembling herniated orbital fat is uncommon but should be considered in all patients with prominence in the periorbital region. PMID:24614565

  13. Gangrenous small bowel obstruction secondary to congenital internal herniation: a case report.

    PubMed

    Tan, Y L; Alhagi, Muthu V

    2012-02-01

    Congenital internal herniation is a rare condition presenting as recurrent abdominal pain or acute intestinal obstruction. In cases in which bowel incarceration or strangulation develop, rapid progression to bowel ischemia, necrosis or perforation is inevitable. Mortality in such cases has been reported to be as high as 50%. Despite advances in imaging modalities, arriving at a pre-operative diagnosis of a congenital internal herniation remains a challenge. We report such a case where imaging was unsuccessful in determining the cause of intestinal obstruction in a 3 year old child. Congenital internal herniation may result in disastrous consequences if not addressed in a timely fashion due to its rarity. Hence a high index of clinical suspicion is needed to avoid missing this diagnosis in a child presenting with recurrent abdominal pain or acute intestinal obstruction. PMID:22582563

  14. Prognostic factors for return to work after low-back disc herniation surgery.

    PubMed

    Seyedmehdi, Mohammad; Attarchi, Mirsaeed; Ghaffari, Mostafa; Mohammadi, Saber; Darnahal, Maryam; Sadeghi, Zargham

    2015-03-01

    Return to work (RTW) is an important outcome following disc herniation surgery. The present study aimed at determining factors that may affect early RTW after disc herniation surgery. Data were collected from 603 patients who underwent disc herniation surgery in an educational hospital via phone interviews during a 4-year period (2005-2009). Delayed RTW and failed RTW were associated with female gender, lower educational levels, longer hospitalization periods, greater BMI, biological age exceeding 40 years, employment in manual labor, lack of encouragement by the physician to RTW, being in pain at the time of the phone interview, having negative expectations about the outcome of surgery preoperatively, and low job satisfaction (P < .05). Psychological and occupational factors have direct effects on RTW. Important factors include positive expectations about the outcome of surgery, encouragement by the physician to RTW, job characteristics, and job satisfaction. RTW can be accelerated by appropriate strategies and team work. PMID:23293315

  15. Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

    PubMed Central

    İbrahimoğlu, Muhammet

    2015-01-01

    Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed. PMID:25883664

  16. Five and Ten Year Follow-up on Intradiscal Ozone Injection for Disc Herniation

    PubMed Central

    Buric, Josip; Rigobello, Luca; Hooper, David

    2014-01-01

    Background Disc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited. Methods One hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months. Results MRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced. Conclusions/Level of Evidence We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed. Clinical Relevance Intradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable. PMID

  17. Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach

    PubMed Central

    Lee, Jun Gue; Kim, Hyeun Sung; Ju, Chang Il

    2016-01-01

    Objective The anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation. Methods We retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications. Results Of 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus. Conclusion For patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope. PMID:27437013

  18. Antiproton-nucleus interaction

    NASA Astrophysics Data System (ADS)

    Cugnon, J.; Vandermeulen, J.

    The antiproton-nucleus physics is reviewed. On the experimental side, the recent results obtained at the LEAR, BNL and KEK facilities are analyzed. A brief summary of the main pp and pn experimental data is also given. The antiproton-nucleus interaction can lead to elasic, inelastic and charge exchange scattering and to annihilation. The latter is very dominant. The scattering cross-sections are usually analyzed in terms of complex potential models. The relationship between potentials, charge conjugation and Dirac phenomenology is discussed. Much emphasis is put on the dynamics of the antiproton annihilation on nuclei. The energy transfer, pion absorption and target response are analyzed within the intranuclear cascade model. Special interest is devoted to strangeness production, hypernucleus formation and possible annihilation on two nucleons. Signatures for this new process are searched in experimental data. Finally, the highly debated question of quark-gluon formation is analyzed. Cet article constitue une revue de la physique antiproton-noyau. Du point de vue expérimental, cette revue porte particulièrement sur les récents résultats obtenus à LEAR, BNL et KEK. On y a aussi inclus une mise à jour des faits expérimentaux principaux pour pp et pn. L'interaction antiproton-noyau conduit à la diffusion élastique, inélastique et d'xA9change de charge et à des processus d'annihilation. Habituellement, les expériences de diffusion sont analysées en termes de potentiels complexes. La relation entre ces potentiels, la conjugaison de charge et la phénoménologie de Dirac est discutée. On s'est particulièrement intéressé à la dynamique de l'annihilation d'antiprotons sur des noyaux. Le transfert d'énergie, l'absorption de pions et la réponse de la cible sont analysés dans le cadre du modèle de cascade intranucléaire. Certains autres points sont discutés plus en détail: la production d'étrangeté, la formation d'hypernoyaux et l'annihilation sur

  19. Brown-Sequard syndrome produced by calcified herniated cervical disc and posterior vertebral osteophyte: Case report.

    PubMed

    Guan, Dawei; Wang, Guanjun; Clare, Morgan; Kuang, Zhengda

    2015-12-01

    Brown-Sequard syndrome (BSS) produced by cervical disc disorders has rarely been seen clinically and only 50 cases have been reported in English literatures. However, most of which have resulted from acute disc herniation. Here, we report a case of BSS produced by calcified herniated C4-C5 disc and posterior vertebral osteophyte, in which decompression through anterior approach was performed. This case revealed the potential of cervical spondylopathy leading to BSS in a chronic manner. Once the diagnosis is established, it is advisable to perform decompression as early as possible. PMID:27047233

  20. Progressive Brown-Séquard syndrome: A rare manifestation of cervical disc herniation.

    PubMed

    Porto, Guilherme B F; Tan, Lee A; Kasliwal, Manish K; Traynelis, Vincent C

    2016-07-01

    Brown-Séquard syndrome (BSS) is a rare syndrome and is often described in association with spinal cord injury resulting from hemisection of the spinal cord. BSS due to cervical disc herniation is rare with often delayed diagnosis. The importance of early recognition with imaging cannot be over-emphasized, as the prognosis is better when compared to traumatic and vascular etiologies of BSS. We report a rare case of BBS in an 86-year-old man secondary to cervical disc herniation who had dramatic improvement after surgical intervention. This case highlights the unusual presentation from a very common spinal pathology along with a review of the pertinent literature. PMID:26921137

  1. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature.

    PubMed

    Yang, Xiaohui; Zhang, Qin; Hao, Xiaoning; Guo, Xinghua; Wang, Liping

    2016-04-01

    Lumbar disc herniation (LDH) is a common disease that induces back pain and radicular pain. The most efficient method for the treatment of lumbar disc herniation is still controversial. Spontaneous regression of LDH has been recognized with the advancement of radiological diagnostic tools and can explain the reason of spontaneous relief of symptoms without treatment. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed. PMID:26907997

  2. Diagnosis of disc herniation based on classifiers and features generated from spine MR images

    NASA Astrophysics Data System (ADS)

    Koh, Jaehan; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    In recent years the demand for an automated method for diagnosis of disc abnormalities has grown as more patients suffer from lumbar disorders and radiologists have to treat more patients reliably in a limited amount of time. In this paper, we propose and compare several classifiers that diagnose disc herniation, one of the common problems of the lumbar spine, based on lumbar MR images. Experimental results on a limited data set of 68 clinical cases with 340 lumbar discs show that our classifiers can diagnose disc herniation with 97% accuracy.

  3. Mechanics of the Nucleus

    PubMed Central

    Lammerding, Jan

    2015-01-01

    The nucleus is the distinguishing feature of eukaryotic cells. Until recently, it was often considered simply as a unique compartment containing the genetic information of the cell and associated machinery, without much attention to its structure and mechanical properties. This article provides compelling examples that illustrate how specific nuclear structures are associated with important cellular functions, and how defects in nuclear mechanics can cause a multitude of human diseases. During differentiation, embryonic stem cells modify their nuclear envelope composition and chromatin structure, resulting in stiffer nuclei that reflect decreased transcriptional plasticity. In contrast, neutrophils have evolved characteristic lobulated nuclei that increase their physical plasticity, enabling passage through narrow tissue spaces in their response to inflammation. Research on diverse cell types further demonstrates how induced nuclear deformations during cellular compression or stretch can modulate cellular function. Pathological examples of disturbed nuclear mechanics include the many diseases caused by mutations in the nuclear envelope proteins lamin A/C and associated proteins, as well as cancer cells that are often characterized by abnormal nuclear morphology. In this article, we will focus on determining the functional relationship between nuclear mechanics and cellular (dys-)function, describing the molecular changes associated with physiological and pathological examples, the resulting defects in nuclear mechanics, and the effects on cellular function. New insights into the close relationship between nuclear mechanics and cellular organization and function will yield a better understanding of normal biology and will offer new clues into therapeutic approaches to the various diseases associated with defective nuclear mechanics. PMID:23737203

  4. Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival

    PubMed Central

    Chen, Weiqiang; Guo, Jingfang; Wu, Jin; Peng, Guoyi; Huang, Mindong; Cai, Chuwei; Yang, Yingming; Wang, Shousen

    2016-01-01

    Abstract Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed. This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH. The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage. The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage. PMID:26945365

  5. Two Neutron Removal in Relativistic Nucleus-Nucleus Reactions

    NASA Technical Reports Server (NTRS)

    Norbury, John W.

    1992-01-01

    Significant discrepancies between theory and experiment have previously been noted for double neutron removal via electromagnetic processes in relativistic nucleus-nucleus collisions. The present work examines the cause of these discrepancies and systematically investigates whether the problem might be due to electromagnetic theory, nuclear contributions, or an underestimate of experimental error. Using cross section systematics from other reactions it is found that the discrepancies can be resolved in a plausible manner.

  6. Unexpected doubly-magic nucleus.

    SciTech Connect

    Janssens, R. V. F.; Physics

    2009-01-01

    Nuclei with a 'magic' number of both protons and neutrons, dubbed doubly magic, are particularly stable. The oxygen isotope {sup 24}O has been found to be one such nucleus - yet it lies just at the limit of stability.

  7. Treatment of the degenerated intervertebral disc; closure, repair and regeneration of the annulus fibrosus.

    PubMed

    Sharifi, Shahriar; Bulstra, Sjoerd K; Grijpma, Dirk W; Kuijer, Roel

    2015-10-01

    Degeneration of the intervertebral disc (IVD) and disc herniation are two causes of low back pain. The aetiology of these disorders is unknown, but tissue weakening, which primarily occurs due to inherited genetic factors, ageing, nutritional compromise and loading history, is the basic factor causing disc degeneration. Symptomatic disc herniation mainly causes radicular pain. Current treatments of intervertebral disc degeneration and low back pain are based on alleviating the symptoms and comprise administration of painkillers or surgical methods such as spinal fusion. None of these methods is completely successful. Current research focuses on regeneration of the IVD and particularly on regeneration of the nucleus pulposus. Less attention has been directed to the repair or regeneration of the annulus fibrosus, although this is the key to successful nucleus pulposus, and therewith IVD, repair. This review focuses on the importance of restoring the function of the annulus fibrosus, as well as on the repair, replacement or regeneration of the annulus fibrosus in combination with restoration of the function of the nucleus pulposus, to treat low back pain. PMID:24616324

  8. Superficial siderosis due to dural defect with thoracic spinal cord herniation.

    PubMed

    Boncoraglio, Giorgio B; Ballabio, Elena; Erbetta, Alessandra; Prada, Francesco; Savoiardo, Mario; Parati, Eugenio A

    2012-01-15

    Superficial siderosis (SS) of the central nervous system is a rare disorder caused by chronic or recurrent hemorrhages into the subarachnoid space with hemosiderin and ferritin deposition, which leads to neuronal damage. The source of bleeding remains unknown in 50% of cases. Recently, attention has been focused on fluid-filled collection in the spinal canal, suggesting the presence of a dural defect which may be the bleeding point. We present a patient with SS and spinal extradural fluid collection due to midthoracic dural defect with spinal cord herniation. The reduction of the spinal cord herniation and the repair of the dural defect resulted in the disappearance of the fluid collection and cerebrospinal fluid abnormalities. The case here reported is, to our knowledge, the first case of spinal cord herniation presenting with SS and confirms the key role played by dural lacerations in the pathogenesis of both SS and spinal cord herniation. The search for dural lacerations should be one of the primary aims in patients with SS. PMID:21868040

  9. Lung herniation secondary to minimally invasive direct coronary artery bypass grafting.

    PubMed

    Deeik, R K; Memon, M A; Sugimoto, J T

    1998-06-01

    Lung herniation after thoracotomy is rare. We report a 66-year-old man who presented with this complication after undergoing attempted minimally invasive direct coronary artery bypass grafting. The defect was repaired with a composite of Marlex mesh and methyl methacrylate. PMID:9647101

  10. A technique for repair of traumatic parasternal lung herniation: case report.

    PubMed

    Cernilia, J; Lin, J; Ott, R; Scannell, G; Waxman, K

    1995-06-01

    A case of traumatic lung herniation through an area of costalsternal separation in a 36-year-old male is presented. Persistent pain and the threat of strangulated lung tissue prompted repair that was accomplished with an expanded polytetrafluoroethylene Gortex tissue patch. PMID:7602639

  11. Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation.

    PubMed

    Zeng, Zhenhua; Yan, Min; Dai, Yi; Qiu, Weidong; Deng, Shuo; Gu, Xinzhu

    2016-08-01

    Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n=84) or bipolar radiofrequency thermocoagulation (experimental group, n=84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60s each, 80°C for 90s, and 92°C for 100s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180days postoperatively. At 180days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, P<0.05). No severe complications were occurred in either group. Targeted ablation via bipolar radiofrequency thermocoagulation is efficient for lumbar disc herniation treatment, and should be further explored for broad clinical application. PMID:27234606

  12. Inflammatory Serum Protein Profiling of Patients with Lumbar Radicular Pain One Year after Disc Herniation.

    PubMed

    Moen, Aurora; Lind, Anne-Li; Thulin, Måns; Kamali-Moghaddam, Masood; Røe, Cecilie; Gjerstad, Johannes; Gordh, Torsten

    2016-01-01

    Earlier studies suggest that lumbar radicular pain following disc herniation may be associated with a local or systemic inflammatory process. In the present study, we investigated the serum inflammatory protein profile of such patients. All 45 patients were recruited from Oslo University Hospital, Ullevål, Norway, during the period 2007-2009. The new multiplex proximity extension assay (PEA) technology was used to analyze the levels of 92 proteins. Interestingly, the present data showed that patients with radicular pain 12 months after disc herniation may be different from other patients with regard to many measurable serum cytokines. Given a false discovery rate (FDR) of 0.10 and 0.05, we identified 41 and 13 proteins, respectively, which were significantly upregulated in the patients with severe pain one year after disc herniation. On the top of the list ranked by estimated increase we found C-X-C motif chemokine 5 (CXCM5; 217% increase), epidermal growth factor (EGF; 142% increase), and monocyte chemotactic protein 4 (MCP-4; 70% increase). Moreover, a clear overall difference in the serum cytokine profile between the chronic and the recovered patients was demonstrated. Thus, the present results may be important for future protein serum profiling of lumbar radicular pain patients with regard to prognosis and choice of treatment. We conclude that serum proteins may be measurable molecular markers of persistent pain after disc herniation. PMID:27293953

  13. [Thoracic and thoraco-lumbar discs herniations: diagnosis and therapeutic management].

    PubMed

    Diop, A A; De Soultrait, F; Dagain, A; Hoffman, J J; Pernot, P H

    2005-01-01

    Summary Management of symptomatic thoracic disc hemiations is difficult because of their polymorphic symptomatology and hardness to join the intervertebral thoracic disc surgically. The objective of this study was first to show the difficult diagnosis of these discal herniations and their posterior approach particularities; secondly, to analyse our results and compare them with those of the literature. This retrospective study analyses a four patients series operated between January 1997 and march 2003 using intraoperative somatosensory evoked potentials. All of them had before surgical management, a lumbar Xray or a MRI. The average postoperative follow-up was seven months. All patients were males with a mean age of 39.5 years old (extremes: 22-59). They had systematisation of their lumboradiculalgia, leading to an average delayed diagnosis of 10 months. The disc herniation was paramedian in three cases, median in one,. It was in T10-T11 in one case, in T11-T12 in two and in T12-L1 in one. All the patients were operated on with a posterior approach, recording the intraoperative somatosensory evoked potentials. Disc herniation was resected in three cases. Functional results were satisfactory (no pains for three patients) in the follow-up period of seven months. Every patient presenting with an atypical lumboradiculalgia must have a spine MRI to diagnose the symptomatic thoracic disc herniation. Surgery has good results if technical details are used respecting the threatened spinal cord. PMID:16295758

  14. Genotypic and Antimicrobial Characterisation of Propionibacterium acnes Isolates from Surgically Excised Lumbar Disc Herniations

    PubMed Central

    Rollason, Jess; Albert, Hanne B.; Barnard, Emma; Worthington, Tony; Hilton, Anthony C.; Vernallis, Ann; Patrick, Sheila; Elliott, Tom

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed. PMID:24066290

  15. Inflammatory Serum Protein Profiling of Patients with Lumbar Radicular Pain One Year after Disc Herniation

    PubMed Central

    Moen, Aurora; Lind, Anne-Li; Thulin, Måns; Kamali-Moghaddam, Masood; Røe, Cecilie; Gordh, Torsten

    2016-01-01

    Earlier studies suggest that lumbar radicular pain following disc herniation may be associated with a local or systemic inflammatory process. In the present study, we investigated the serum inflammatory protein profile of such patients. All 45 patients were recruited from Oslo University Hospital, Ullevål, Norway, during the period 2007–2009. The new multiplex proximity extension assay (PEA) technology was used to analyze the levels of 92 proteins. Interestingly, the present data showed that patients with radicular pain 12 months after disc herniation may be different from other patients with regard to many measurable serum cytokines. Given a false discovery rate (FDR) of 0.10 and 0.05, we identified 41 and 13 proteins, respectively, which were significantly upregulated in the patients with severe pain one year after disc herniation. On the top of the list ranked by estimated increase we found C-X-C motif chemokine 5 (CXCM5; 217% increase), epidermal growth factor (EGF; 142% increase), and monocyte chemotactic protein 4 (MCP-4; 70% increase). Moreover, a clear overall difference in the serum cytokine profile between the chronic and the recovered patients was demonstrated. Thus, the present results may be important for future protein serum profiling of lumbar radicular pain patients with regard to prognosis and choice of treatment. We conclude that serum proteins may be measurable molecular markers of persistent pain after disc herniation. PMID:27293953

  16. Far caudally migrated extraforaminal lumbosacral disc herniation treated by a microsurgical lateral extraforaminal transmuscular approach: case report.

    PubMed

    Tschugg, Anja; Tschugg, Sebastian; Hartmann, Sebastian; Rhomberg, Paul; Thomé, Claudius

    2016-03-01

    A 33-year-old man presented with moderate low-back pain and L-5 radiculopathy that progressed to severe paresis of L-5. On initial imaging, a corresponding spinal lesion was overlooked. Further CT and contrast-enhanced MRI demonstrated a presacral mass along the L-5 root far extraforaminally. A herniated disc was suspected, but with standard imaging a schwannoma could not be ruled out. The presacral L-5 root was explored via a microsurgical lateral extraforaminal transmuscular approach. To the best of the authors' knowledge, there have been no reports of sequestered extraforaminal lumbosacral disc herniations that herniated into the presacral region. PMID:26637061

  17. Economic value of treating lumbar disc herniation in Brazil.

    PubMed

    Falavigna, Asdrubal; Scheverin, Nicolas; Righesso, Orlando; Teles, Alisson R; Gullo, Maria Carolina; Cheng, Joseph S; Riew, K Daniel

    2016-04-01

    OBJECT Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system

  18. Early metabolic/cellular-level resuscitation following terminal brain stem herniation: implications for organ transplantation.

    PubMed

    Arbour, Richard B

    2013-01-01

    Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor's organs (liver, kidneys, heart, etc.) after death by neurological

  19. Sensitivity of cross sections for elastic nucleus-nucleus scattering to halo nucleus density distributions

    SciTech Connect

    Alkhazov, G. D.; Sarantsev, V. V.

    2012-12-15

    In order to clear up the sensitivity of the nucleus-nucleus scattering to the nuclear matter distributions in exotic halo nuclei, we have calculated differential cross sections for elastic scattering of the {sup 6}He and {sup 11}Li nuclei on several nuclear targets at the energy of 0.8 GeV/nucleon with different assumed nuclear density distributions in {sup 6}He and {sup 11}Li.

  20. Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Kim, Hong-Ki; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

    2016-01-01

    Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation. PMID:27114779

  1. Pathogenesis of the discal cysts communicating with an adjacent herniated disc. Histological and ultrastructual studies of two cases.

    PubMed

    Kobayashi, Shigeru; Takeno, Kenichi; Uchida, Kenzo; Yayama, Takafumi; Nakajima, Hideaki; Miyazaki, Tsuyoshi; Guerrero, Alexander; Baba, Hisatoshi

    2010-03-01

    Discal cyst of the lumbar spine is a very rare cause of back pain and sciatica. We report two cases of discal cysts communicating with an adjacent herniated disc. From CT and MRI findings, they were diagnosed as having a discal cyst in the epidural space, which compressed the nerve root. After an adequate surgical field was obtained with a microscope and a Casper retractor, the discal cyst could be excised and satisfactory decompression of the adjacent nerve root was obtained. From histological and electron microscopic study, the presence of residual herniated tissues was confirmed in the cyst wall. Macrophages played an important role in the absorption of herniated tissue and the formation of the discal cyst. Hemorrhage in the cyst wall will make the serous hemorrhagic fluid-filled cystic structure in the absorbed spaces of the prolapsed disc. In this study, we confirmed that the discal cyst could have developed from the absorption process of a disc herniation. PMID:20138794

  2. Double Nucleus in M83

    NASA Astrophysics Data System (ADS)

    Mast, Damián; Díaz, Rubén J.; Agüero, M. Paz

    2006-03-01

    M83 is one of the nearest galaxies with enhanced nuclear star formation, and it presents one of the best opportunities to study the kinematics and physical properties of a circumnuclear starburst. Our three-dimensional spectroscopy data in the R band confirm the presence of a secondary nucleus or mass concentration (previously suggested by Thatte and coworkers). We determine the position of this hidden nucleus, which would be more massive than the visible one and was not detected in the optical Hubble Space Telescope images due, probably, to the strong dust extinction. Using a Keplerian approximation, we estimated for the optical nucleus a mass of (5.0+/-0.8)×106 Msolar/sini (r<1.5"), and for the hidden nucleus, located 4''+/-1'' to the northwest (position angle of 271deg+/-15deg) of the optical nucleus, a mass of (1.00+/-0.08)×107 Msolar/sini (r<1.5"). The emission-line ratio map also unveils the presence of a second circumnuclear ring structure, previously discovered by IR imaging (Elmegreen and coworkers). The data allow us to resolve the behavior of the interstellar medium inside the circumnuclear ring and around the binary mass concentration.

  3. Apophyseal ring fracture associated with two levels extruded disc herniation: case report and review of the literature

    PubMed Central

    da Silva Alvarenga, José Alexandre Lopes; Ueta, Fernando Tadashi Salvioni; Curto, David Del; Ueta, Renato Hiroshi Salvioni; Martins, Delio Eulalio; Wajchenberg, Marcelo; Puertas, Eduardo Barros

    2014-01-01

    ABSTRACT Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment. PMID:25003931

  4. Nucleus management with irrigating vectis.

    PubMed

    Srinivasan, Aravind

    2009-01-01

    The main objective in modern cataract surgery is to achieve a better unaided visual acuity with rapid post-surgical recovery and minimal surgery-related complications. Early visual rehabilitation and better unaided vision can be achieved only by reducing the incision size. In manual small incision cataract surgery (MSICS), incision is between 5.5 to 7 mm. Once the nucleus is prolapsed into the anterior chamber, it can be extracted through the tunnel. Nucleus extraction with an irrigating vectis is a very simple technique, which combines mechanical and hydrostatic forces to express out the nucleus. This technique is time-tested with good results and more than 95% of nuclei in MSICS are extracted in this way offering all the merits of phacoemulsification with the added benefits of having wider applicability, better safety, shorter learning curve and lower cost. PMID:19075403

  5. Cometary nucleus and active regions

    NASA Technical Reports Server (NTRS)

    Whipple, F. L.

    1984-01-01

    On the basis of the icy conglomerate model of cometary nuclei, various observations demonstrate the spotted nature of many or most nuclei, i.e., regions of unusual activity, either high or low. Rotation periods, spin axes and even precession of the axes are determined. The observational evidence for variations in activity over the surfaces of cometary nuclei are listed and discussed. On June 11 the comet IRAS-ARAKI-ALCOCK approached the Earth to a distance of 0.031 AU, the nearest since C/Lexell, 1770 I, providing a unique opportunity for near-nucleus observations. Preliminary analysis of these images establishes the spin axis of the nucleus, with an oblioquity to the orbit plane of approximately 50 deg, and a lag angle of sublimation approximately 35 deg from the solar meridian on the nucleus. Asymmetries of the inner coma suggests a crazy-quilt distribution of ices with differing volatility over the surface of the nucleus. The observations of Comet P/Homes 1892 III, exhibiting two 8-10 magnitude bursts, are carefully analyzed. The grazing encounter produced, besides the first great burst, an active area on the nucleus, which was rotating retrograde with a period of 16.3hr and inclination nearly 180 deg. After the first burst the total magnitude fell less than two magnitudes from November 7 to November 30 (barely naked eye) while the nuclear region remained diffuse or complex, rarely if ever showing a stellar appearance. The fading was much more rapid after the second burst. The grazing encounter distributed a volume of large chunks in the neighborhood of the nucleus, maintaining activity for weeks.

  6. Formin' actin in the nucleus.

    PubMed

    Baarlink, Christian; Grosse, Robert

    2014-01-01

    Many if not most proteins can, under certain conditions, change cellular compartments, such as, for example, shuttling from the cytoplasm to the nucleus. Thus, many proteins may exert functions in various and very different subcellular locations, depending on the signaling context. A large amount of actin regulatory proteins has been detected in the mammalian cell nucleus, although their potential roles are much debated and are just beginning to emerge. Recently, members of the formin family of actin nucleators were also reported to dynamically localize to the nuclear environment. Here we discuss our findings that specific diaphanous-related formins can promote nuclear actin assembly in a signal-dependent manner. PMID:24637338

  7. Acridine: a versatile heterocyclic nucleus.

    PubMed

    Kumar, Ramesh; Kaur, Mandeep; Kumari, Meena

    2012-01-01

    Acridine is a heterocyclic nucleus. It plays an important role in various medicines. A number of therapeutic agents are based on acridine nucleus such as quinacrine (antimalarial), acriflavine and proflavine (antiseptics), ethacridine (abortifacient), amsacrine and nitracine (anticancer), and tacrine. Acridine is obtained from high boiling fraction of coal tar. It is also obtained in nature from plant and marine sources. Acridine undergoes a number of reactions such as nucleophilic addition, electrophilic substitution, oxidation, reduction, reductive alkylation and photoalkylation. The present review article summarizes the synthesis, reaction, literature review and pharmaceutical importance of acridine. PMID:22574501

  8. Functionalized active-nucleus complex sensor

    DOEpatents

    Pines, Alexander; Wemmer, David E.; Spence, Megan; Rubin, Seth

    2003-11-25

    A functionalized active-nucleus complex sensor that selectively associates with one or more target species, and a method for assaying and screening for one or a plurality of target species utilizing one or a plurality of functionalized active-nucleus complexes with at least two of the functionalized active-nucleus complexes having an attraction affinity to different corresponding target species. The functionalized active-nucleus complex has an active-nucleus and a targeting carrier. The method involves functionalizing an active-nucleus, for each functionalized active-nucleus complex, by incorporating the active-nucleus into a macromolucular or molecular complex that is capable of binding one of the target species and then bringing the macromolecular or molecular complexes into contact with the target species and detecting the occurrence of or change in a nuclear magnetic resonance signal from each of the active-nuclei in each of the functionalized active-nucleus complexes.

  9. An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. The Northeast Collaborative Group on Low Back Pain.

    PubMed

    Mundt, D J; Kelsey, J L; Golden, A L; Panjabi, M M; Pastides, H; Berg, A T; Sklar, J; Hosea, T

    1993-01-01

    The associations between participation in several specific sports, use of free weights, and use of weight lifting equipment and herniated lumbar or cervical intervertebral discs were examined in a case-control epidemiologic study. Specific sports considered were baseball or softball, golf, bowling, swimming, diving, jogging, aerobics, and racquet sports. Included in the final analysis were 287 patients with lumbar disc herniation and 63 patients with cervical disc herniation, each matched by sex, source of care, and decade of age to 1 control who was free of disc herniation and other conditions of the back or neck. Results indicated that most sports are not associated with an increased risk of herniation, and may be protective. Relative risk estimates for the association between individual sports and lumbar or cervical herniation were generally less than or close to 1.0. There was, however, a weak positive association between bowling and herniation at both the lumbar and cervical regions of the spine. Use of weight lifting equipment was not associated with herniated lumbar or cervical disc, but a possible association was indicated between use of free weights and risk of cervical herniation (relative risk, 1.87; 95% confidence interval, 0.74 to 4.74). PMID:8291639

  10. Perforation of the Pregnant Uterus during Laparoscopy for Suspected Internal Herniation after Gastric Bypass

    PubMed Central

    Harsem, N. K.; Røstad, S.; Mathisen, L. C.; Jacobsen, A. F.

    2014-01-01

    We report perforations of a pregnant uterus during laparoscopy for suspected internal herniation after gastric bypass at 24 weeks of gestation. Abdominal access and gas insufflation were achieved by the use of a 12 mm optic trocar. An additional 5 mm trocar was positioned. The perforations were handled by suturing following laparotomy and mobilisation of the high located uterus. The uterine fundus was located in the subcostal area. Internal herniation was not verified. A cesarean section was made 6 weeks later due to acute low abdominal pain. During delivery the uterus was found normal. At 5 months of age the child has developed normal and seems healthy. Optical trocars should be used with caution for abdominal access during laparoscopy in pregnancy. Open access should probably be preferred in most cases. Accidental perforations of the uterine cavity may be handled in selected cases with simple closure even following the use of large trocars under close postoperative surveillance throughout the pregnancy. PMID:25548693

  11. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

    PubMed Central

    Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-01-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

  12. Detection of Myofascial Herniation on Dynamic Sonography and Magnetic Resonance Imaging

    PubMed Central

    Khaladkar, Sanjay M.; Kondapavuluri, Sushen Kumar; Kamal, Anubhav; Kalra, Raghav; Kamal, Vigyat

    2016-01-01

    Muscle hernia is an uncommon cause of leg swelling. It can be detected in the early stages only if there is a high index of suspicion. It is common in lower extremity compared to the upper extremity. Tibialis anterior muscle in the leg is commonly involved. Dynamic sonography and magnetic resonance imaging (MRI) are the mainstay in their diagnosis, which demonstrate a facial defect with herniation of muscle fibers. We report a case of 23-year-old male patient who presented with a painless swelling in the anterolateral aspect of the left upper leg. Dynamic sonography done with high-resolution probe demonstrated a defect in fascia overlying tibialis anterior with herniation of outer muscle fibers which increased during dorsiflexion and reduced in the supine position at rest. MRI of the left leg confirmed the findings. PMID:26885428

  13. Gallbladder herniation into the lesser sac through the foramen of Winslow: report of a case.

    PubMed

    Numata, Koji; Kunishi, Yosuke; Kurakami, Yuichi; Tsuchida, Kazuhito; Yoshida, Tatsuya; Osaragi, Tomohiko; Yoneyama, Katsuya; Kasahara, Akio; Yamamoto, Yuuji; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka

    2013-10-01

    We report a case of gallbladder hernia into the lesser sac through the foramen of Winslow. The patient was a 90-year-old woman, admitted to hospital with obstructive jaundice. Computed tomography (CT) showed a left-deviated and remarkably enlarged gallbladder dragging the liver, and a dilated intrahepatic bile duct. The deviated gallbladder was thought to compress the common bile duct, causing the obstruction. Laparoscopic examination revealed gallbladder herniation into the lesser sac without a floating gallbladder; thus, we performed laparoscopic cholecystectomy. Herniation of the gallbladder is the rarest of all internal hernias and most reported cases have involved a floating gallbladder. The case we report here is therefore considered especially unusual. PMID:23338597

  14. Case Report: Frontalis sign for early bedside consideration of impending uncal herniation

    PubMed Central

    Munakomi, Sunil; Mohan Kumar, Bijoy

    2016-01-01

    It is prudent to have early diagnosis and timely management of uncal herniation for better management of neurosurgical patients. There are several clinical and radiological armamentariums that aid in early recognition of the condition. Through this case report, we try to highlight a simple bedside clinical sign that can be a valuable adjunct in early recognition of the impending uncal herniation especially in scenarios wherein it is difficult to assess the pupillary size and reactivity correctly. The improvement in the sign also confirms the resolution of the mass effect in the postoperative period. This is especially helpful for doctors working in the periphery or in resource restrained areas, for a timely referral of the patient to tertiary centre.

  15. Fournier's gangrene secondary to an acutely inflamed appendix herniating into the deep inguinal ring

    PubMed Central

    Sarmah, Piyush B.; Khan, Mashuk; Zilvetti, Miguel

    2015-01-01

    Fournier's gangrene (FG) requires prompt recognition and management. We report the case of a 68-year-old man who presented with extensive pain and purple discolouration from the right iliac fossa to perineum. Computed tomography demonstrated gas within the right hemiscrotum extending into the inguinal canal and right buttock, with a right pelvic fluid and air collection. At debridement necrotic fluid was arising from the superficial inguinal ring so laparotomy was performed, revealing a grossly inflamed appendix herniating into the inguinal canal; a right hemicolectomy was performed. Unfortunately, the patient went into cardiac arrest and passed away on the operating table. Histological analysis demonstrated acute-on-chronic inflammation involving the appendix. The condition where appendicitis is implicated in FG is usually due to retroperitoneal rupture and tracking into the perineal spaces. This is the first case reported of an inflamed appendix herniating into the inguinal canal and thus causing FG. PMID:25829533

  16. Urgent decisions and a tight spot: embolic infarction of a herniated cerebellar tonsil.

    PubMed

    Mc Donagh, Ruth; Bradley, David; Harbison, Joseph Augustine

    2016-01-01

    A previously well 30-year-old woman presented at 17:30 with a sudden onset of dizziness, ataxia and headache. She was initially investigated with a CT scan of the brain and lumbar puncture, which yielded no diagnosis. Subsequent MR scan revealed multiple posterior circulation infarcts, along with a previously undiagnosed Arnold-Chiari 2 malformation with an associated syrinx of her cervical and thoracic spine. The infarct involved one of the herniated cerebellar tonsils. Oedema of an infarct in the herniated tonsils caused compression of the medulla at the foramen magnum, with associated neurological symptoms including Lhermitte's phenomenon and headache on valsalva manoeuvre. Owing to these symptoms a surgical decompression was performed. The most likely aetiology of her stroke was determined to be a paradoxical embolus via patent foramen ovale. PMID:27489065

  17. Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation.

    PubMed

    Matsumoto, Tomiya; Toyoda, Hiromitsu; Terai, Hidetomi; Dohzono, Sho; Hori, Yusuke; Nakamura, Hiroaki

    2016-08-01

    Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH. PMID:27559461

  18. Patho-anatomy of Herniation of the Reticulum Through the Diaphragm in the Bovine

    PubMed Central

    Deshpande, K. S.; Krishnamurthy, D.; Nigam, J. M.; Sharma, D. N.

    1981-01-01

    Dissection of embalmed and untreated water buffalo carcasses (n=10) revealed that hernias had occurred at the musculotendinous junction of the diaphragm, ventral to the foramen venae cavae and slightly lateral to the median plane. The diameter of the hernial ring varied from 7 cm to 20 cm. Herniation was more common in the right thoracic cavity with the reticulum firmly adherent to the hernia ring. Adhesions between the herniated portion of the reticulum and pleura, lung, pericardium or thoracic wall were present, while in a few cases thick fibrous tracts concealing metallic bodies were found. In two cases, involvement of esophageal groove with malalignment of cardia and reticulo-omasal opening was observed. Displacement and compression of the heart was observed in four animals. ImagesFigure 1.Figure 2.Figure 3. PMID:7340924

  19. Discal cyst associated with myxoid change and apoptosis of herniated disc materials: a case report.

    PubMed

    Okada, Kyoji; Saito, Hajime; Nishida, Jun; Miyakoshi, Naohisa; Takahashi, Shu; Nagasawa, Hiroyuki; Suzuki, Norio; Chida, Shuichi

    2007-01-01

    Discal cyst is a lumbar intraspinal cyst communicating with intervertebral disc, and previously reported series described the wall of these cysts as consisting of dense fibrous connective tissue. We report a 29-year-old Japanese male with discal cyst showing unusual histological features. Clinical symptoms in the current case as well as imaging features including discography were similar to those previously reported.However, the wall of the cyst consisted of disc material with myxoid degeneration. In addition, apoptosis of chondrocytes was diffusely observed in the herniated disc material. The current case was considered a histological variant of discal cyst. Myxoid degeneration of herniated disc material with diffuse apoptotic change of chondrocytes was probably associated with the formation of discal cyst. PMID:17578806

  20. Higgs and Particle Production in Nucleus-Nucleus Collisions

    NASA Astrophysics Data System (ADS)

    Liu, Zhe

    We apply a diagrammatic approach to study Higgs boson, a color-neutral heavy particle, pro- duction in nucleus-nucleus collisions in the saturation framework without quantum evolution. We assume the strong coupling constant much smaller than one. Due to the heavy mass and colorless nature of Higgs particle, final state interactions are absent in our calculation. In order to treat the two nuclei dynamically symmetric, we use the Coulomb gauge which gives the appropriate light cone gauge for each nucleus. To further eliminate initial state interactions we choose specific prescriptions in the light cone propagators. We start the calculation from only two nucleons in each nucleus and then demonstrate how to generalize the calculation to higher orders diagrammatically. We simplify the diagrams by the Slavnov-Taylor-Ward identities. The resulting cross section is factorized into a product of two Weizsacker-Williams gluon distributions of the two nuclei when the transverse momentum of the produced scalar particle is around the saturation momentum. To our knowledge this is the first process where an exact analytic formula has been formed for a physical process, involving momenta on the order of the saturation momentum, in nucleus-nucleus collisions in the quasi-classical approximation. Since we have performed the calculation in an unconventional gauge choice, we further confirm our results in Feynman gauge where the Weizsacker-Williams gluon distribution is interpreted as a transverse momentum broadening of a hard gluons traversing a nuclear medium. The transverse momentum factorization manifests itself in light cone gauge but not so clearly in Feynman gauge. In saturation physics there are two different unintegrated gluon distributions usually encountered in the literature: the Weizsacker-Williams gluon distribution and the dipole gluon distribution. The first gluon distribution is constructed by solving classical Yang-Mills equation of motion in the Mc

  1. Transforaminal Lumbar Interbody Fusion for Management of Recurrent Lumbar Disc Herniation

    PubMed Central

    2016-01-01

    Study Design Retrospective study. Purpose To study the surgical outcome of transforaminal lumbar interbody fusion (TLIF) combined with trans-pedicular screws fixation for management of selected cases of recurrent lumbar disc herniation. Overview of Literature Recurrent lumbar disc herniation is a major cause of surgical failure, occurring in 5%–11% of cases. The optimal technique for treatment is controversial. Some authors believe that repeated simple discectomy is the treatment of choice, but approach-related complications can be considerable. Other surgeons prefer more removal of posterior elements (as lamina and facet joints) with posterior fusion. Methods The study included 15 patients who presented with symptomatic recurrent lumbar disc herniation who underwent reoperation through posterior trans-pedicular screws and TLIF in our department from April 2008 to May 2010, with a 24-month follow-up. Japanese Orthopedic Association Scale (JOA) was used for low back pain. The results of surgery were also evaluated with the MacNab classification. Results The mean JOA score showed significant improvement, increasing from 9.5 before surgery to 24.0 at the end of follow-up (p<0.001). Clinical outcome was excellent in 7 patients (46% of cases), good in 6 patients (40%) and fair in only 2 patients (14%). There was a significant difference (p<0.05) between patients presenting with recurrent disc at the ipsilateral side and those at the contralateral side. Conclusions In spite of the small number of patients and the short follow-up period, the good clinical and radiological outcome achieved in this study encourage the belief that TLIF is an effective option for the treatment of selected cases of recurrent lumbar disc herniation. PMID:26949458

  2. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation

    PubMed Central

    Radcliff, Kristen; Hilibrand, Alan; Lurie, Jon D.; Tosteson, Tor D.; Delasotta, Lawrence; Rihn, Jeffrey; Zhao, Wenyan; Vaccaro, Alexander; Albert, Todd J.; Weinstein, James N.

    2012-01-01

    Background: The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. Methods: One hundred and fifty-four patients included in the intervertebral disc herniation arm of the SPORT who had received an epidural steroid injection during the first three months of the study and no injection prior to the study (the ESI group) were compared with 453 patients who had not received an injection during the first three months of the study or prior to the study (the No-ESI group). Results: There was a significant difference in the preference for surgery between groups (19% in the ESI group compared with 56% in the No-ESI group, p < 0.001). There was no difference in primary or secondary outcome measures at four years between the groups. A higher percentage of patients changed from surgical to nonsurgical treatment in the ESI group (41% versus 12% in the No-ESI, p < 0.001). Conclusions: Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22739998

  3. Horner's syndrome secondary to intervertebral disc herniation at the level of T1–2

    PubMed Central

    Spacey, Kate; Dannawi, Zaher; Khazim, R; Dannawi, Z

    2014-01-01

    A 54-year-old Caucasian woman presented with a 6 week history of periscapular pain and a T1 radiculopathy associated with Horner's syndrome. MRI of her cervicothoracic spine revealed an intervertebral disc herniation at the level of T1–2. During investigation she experienced some improvement in her symptoms and a conservative approach was pursued. At 6 months her pain and radiculopathy had resolved, and there was mild residual ptosis. PMID:24903729

  4. Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report.

    PubMed

    Tamaki, Yasuaki; Sakai, Toshinori; Miyagi, Ryo; Nakagawa, Takefumi; Shimakawa, Tateaki; Sairyo, Koichi; Chikawa, Takashi

    2015-09-01

    A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD. PMID:26068274

  5. Surgery for lumbar disc herniation: Analysis of 500 consecutive patients treated in an interdisciplinary spine centre.

    PubMed

    Schmid, S L; Wechsler, C; Farshad, M; Antoniadis, A; Ulrich, N H; Min, K; Woernle, C M

    2016-05-01

    Surgical removal of a symptomatic herniated lumbar disc is performed either with or without the support of a microscope. Up to the time of writing, the literature has reported similar clinical outcomes for the two procedures. Five hundred consecutive patients, operated upon for primary single-level lumbar disc herniation in our University Spine Center between 2003-2011, with (n=275), or without (n=225), the aid of a microscope were included. Data were retrospectively analyzed, comparing the primary endpoint of clinical outcome and the secondary endpoints of complications, surgical time and length of hospitalization. Clinical outcomes and reoperation rates were comparable in both groups. Surgical time was significantly shorter with a mean time of 47minutes without use of the microscope compared to the mean time of 87minutes (p<0.001) with the use of the microscope. Mean length of hospitalization was shorter in those operated with the microscope (5.3days) compared to those without (6.1days, p=0.004). There was no difference in rates of complications. Microdiscectomy versus open sequestrectomy and discectomy for surgical treatment of lumbar disc herniation is associated with similar clinical outcomes and reoperation rates. Open sequestrectomy is associated with shorter operation times. Microdiscectomy is associated with shorter hospitalization stays. PMID:26778355

  6. Comparison of Discectomy versus Sequestrectomy in Lumbar Disc Herniation: A Meta-Analysis of Comparative Studies

    PubMed Central

    Ran, Jisheng; Hu, Yejun; Zheng, Zefeng; Zhu, Ting; Zheng, Huawei; Jing, Yibiao; Xu, Kan

    2015-01-01

    Background Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy) versus conservative removal of the offending disc fragment alone (sequestrectomy) provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis. Methods A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes. Results Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001), lower visual analogue scale (VAS) for low back pain (p<0.05), less post-operative analgesic usage (p<0.05) and better patients’ satisfaction (p<0.05). Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference. Conclusions According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures. PMID:25815514

  7. Outcome of nucleoplasty in patients with radicular pain due to lumbar intervertebral disc herniation

    PubMed Central

    Ogbonnaya, Sunny; Kaliaperumal, Chandrasekaran; Qassim, Abdulla; O’Sullivan, Michael

    2013-01-01

    Background: Nucleoplasty (percutaneous lumbar disc decompression) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation, against open microdiscectomy, which would be the mainstay treatment modality. The literature reports a favorable outcome in up to 77% of patients at 6 months. Aim: To evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain. Materials and Methods: The medical notes of 33 patients, admitted for nucleoplasty between June 2006 and September 2007, were reviewed retrospectively. All had radicular pain, and contained herniated disc as seen on magnetic resonance imaging (MRI) of lumbosacral spine. Patients were followed up at 1 and 3 months post-procedure. The outcome measures employed in this study were satisfaction with symptoms and self-reported improvement. Results: Thirty-three cases were examined (18 males and 15 females). Twenty-seven procedures were performed with no complications and six were abandoned due to anatomical reasons. There were 18 and 15 cases of disc herniation at L5/S1 and L4/5 levels, respectively. Four weeks following the procedure, 13 patients reported improvement in symptoms, and 14 remained symptomatically the same and subsequently had open microdiscectomy. Conclusion: Nucleoplasty has been shown to be a safe and minimal-access procedure. Less than half of our selected cohort of patients reported symptomatic improvement at 1-month follow-up. We no longer offer this procedure to our patients. Possible reasons are discussed. PMID:23633860

  8. Myelopathy Caused by Soft Cervical Disc Herniation : Surgical Results and Prognostic Factors

    PubMed Central

    Kim, Young-Jin; Yi, Hyeong-Joong; Kim, Young-Soo; Ko, Yong; Oh, Suck Jun

    2007-01-01

    Objective The purpose of this study was to investigate the surgical results and prognostic factors for patients with soft cervical disc herniation with myelopathy. Methods During the last 7 years, 26 patients with cervical discogenic myelopathy were undertaken anterior discectomy and fusion. Clinical and radiographic features were reviewed to evaluate the surgical results and prognostic factors. The clinical outcome was judged using two grading systems (Herkowitz's scale and Nurick's grade). Results Male were predominant (4:1), and C5-6 was the most frequently involved level. Gait disturbance, variable degree of spasticity, discomfort in chest and abdomen, hand numbness were the most obvious signs. Magnetic resonance(MR) images showed that central disc herniation was revealed in 16 cases, and accompanying cord signal changes in 4. Postoperatively, 23 patients showed favorable results (excellent, good and fair) according to Herkowitz's scale. Conclusion Anterior cervical discectomy and fusion effectively reduced myelopathic symptoms due to soft cervical disc herniation. The authors assured that the shorter duration of clinical attention, the lesser the degree of myelopathy and better outcome in discogenic myelopathy. PMID:19096586

  9. Internal Herniation Through Foramen of Winslow: A Diagnosis Not to Be Missed

    PubMed Central

    Leung, Edmund; Bramhall, Simon; Kumar, Prajeesh; Mourad, Moustafa; Ahmed, Amdad

    2016-01-01

    INTRODUCTION Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality. METHOD We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on “PubMed” as a search platform using the keywords “foramen of Winslow” and “hernia”. CASE SUMMARY A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient’s postoperative recovery was uneventful. CONCLUSION Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity. PMID:27330337

  10. Comparison of Two Methods of Epidural Steroid Injection in the Treatment of Recurrent Lumbar Disc Herniation

    PubMed Central

    Ebrahimi-Nejad, Ali; Shahsavarani, Shahram; Keikhosravi, Ehsan; Shahba, Mohsen; Ebrahimi, Farzaneh

    2014-01-01

    Study Design Prospective study. Purpose We compared the effects of two methods of epidural steroid injection in patients with recurrent disc herniation. Overview of Literature To our knowledge, there is no previous report of such a comparison in these patients. Methods The study was performed with 30 patients with relapsed lumbar disc herniation whose pain was not relieved by conservative remedies. The patients were divided into two groups, each of 15 patients, and entered the study for caudal or transforaminal injections. The degree of pain, ability to stand and walk, and the Prolo function score were evaluated in both groups before the injection and 2 months and 6 months after the injection. Results The degrees of pain reduction in the caudal injection group in the second and sixth months were 0.6 and 1.63, respectively, and in the transforaminal injection group were 1.33 and 1.56, respectively. The difference between the two methods was not statistically significant. Similarly, no other evaluated criterion showed a significant difference between the methods. Conclusions In the current study, the caudal and transforaminal steroid injection methods showed similar outcomes in the treatment of relapsed lumbar disc herniation. However, more detailed patient categorizing may help in finding possible subgroups with differences. PMID:25346818

  11. Against the Odds: Massive Lumbar Intradural Disk Herniation in the Elderly.

    PubMed

    Orakcioglu, Berk; Dao Trong, Huy Philip; Jungk, Christine; Unterberg, Andreas

    2015-10-01

    Study Design Case report. Objective Presentation of an unusual case of an elderly patient with massive intradural disk herniation at the L2-L3 level. Methods Clinical and imaging data are presented after obtaining informed consent from the patient. Results A 90-year-old man suffering from sudden-onset neurogenic bladder dysfunction and lower back pain but no further neurologic deficits initially presented with magnetic resonance imaging and laboratory values suggestive of an intraspinal infection. However, intraoperative inspection proved the unexpected finding of a large intradural lumbar disk herniation at the L2-L3 level. Conclusions Lumbar soft disk herniation to the intradural space is a rare event and has never been described in a patient over the age of 75. This case of a 90-year-old man with acute-onset bladder dysfunction underlines the necessity to consider this as a differential diagnosis in the case of a newly diagnosed intradural mass. PMID:26430608

  12. Dynamical nucleus-nucleus potential at short distances

    SciTech Connect

    Jiang Yongying; Wang Ning; Li Zhuxia; Scheid, Werner

    2010-04-15

    The dynamical nucleus-nucleus potentials for fusion reactions {sup 40}Ca+{sup 40}Ca, {sup 48}Ca+{sup 208}Pb, and {sup 126}Sn+{sup 130}Te are studied with the improved quantum molecular dynamics model together with the extended Thomas-Fermi approximation for the kinetic energies of nuclei. The obtained fusion barrier for {sup 40}Ca+{sup 40}Ca is in good agreement with the extracted fusion barrier from the measured fusion excitation function, and the depths of the fusion pockets are close to the results of time-dependent Hartree-Fock calculations. The energy dependence of the fusion barrier is also investigated. The fusion pocket becomes shallow for a heavy fusion system and almost disappears for heavy nearly symmetric systems, and the obtained potential at short distances is higher than the adiabatic potential.

  13. Azimuthal correlation and collective behavior in nucleus-nucleus collisions

    SciTech Connect

    Mali, P.; Mukhopadhyay, A. Sarkar, S.; Singh, G.

    2015-03-15

    Various flow effects of nuclear and hadronic origin are investigated in nucleus-nucleus collisions. Nuclear emulsion data collected from {sup 84}Kr + Ag/Br interaction at an incident energy of 1.52 GeV per nucleon and from {sup 28}Si + Ag/Br interaction at an incident energy of 14.5 GeV per nucleon are used in the investigation. The transverse momentum distribution and the flow angle analysis show that collective behavior, like a bounce-off effect of the projectile spectators and a sidesplash effect of the target spectators, are present in our event samples. From an azimuthal angle analysis of the data we also see a direct flow of the projectile fragments and of the produced charged particles. On the other hand, for both data samples the target fragments exhibit a reverse flow, while the projectile fragments exhibit an elliptic flow. Relevant flow parameters are measured.

  14. Analysis of relativistic nucleus-nucleus interactions in emulsion chambers

    NASA Technical Reports Server (NTRS)

    Mcguire, Stephen C.

    1987-01-01

    The development of a computer-assisted method is reported for the determination of the angular distribution data for secondary particles produced in relativistic nucleus-nucleus collisions in emulsions. The method is applied to emulsion detectors that were placed in a constant, uniform magnetic field and exposed to beams of 60 and 200 GeV/nucleon O-16 ions at the Super Proton Synchrotron (SPS) of the European Center for Nuclear Research (CERN). Linear regression analysis is used to determine the azimuthal and polar emission angles from measured track coordinate data. The software, written in BASIC, is designed to be machine independent, and adaptable to an automated system for acquiring the track coordinates. The fitting algorithm is deterministic, and takes into account the experimental uncertainty in the measured points. Further, a procedure for using the track data to estimate the linear momenta of the charged particles observed in the detectors is included.

  15. Single nucleon emission in relativistic nucleus-nucleus reactions

    NASA Technical Reports Server (NTRS)

    Norbury, John W.; Townsend, Lawrence W.

    1992-01-01

    Significant discrepancies between theory and experiment have previously been noted for nucleon emission via electromagnetic processes in relativistic nucleus-nucleus collisions. The present work investigates the hypothesis that these discrepancies have arisen due to uncertainties about how to deduce the experimental electromagnetic cross section from the total measured cross section. An optical-model calculation of single neutron removal is added to electromagnetic cross sections and compared to the total experimental cross sections. Good agreement is found thereby resolving some of the earlier noted discrepancies. A detailed comparison to the recent work of Benesh, Cook, and Vary is made for both the impact parameter and the nuclear cross section. Good agreement is obtained giving an independent confirmation of the parameterized formulas developed by those authors.

  16. Hummingbird Comet Nucleus Analysis Mission

    NASA Technical Reports Server (NTRS)

    Kojiro, Daniel; Carle, Glenn C.; Lasher, Larry E.

    2000-01-01

    Hummingbird is a highly focused scientific mission, proposed to NASA s Discovery Program, designed to address the highest priority questions in cometary science-that of the chemical composition of the cometary nucleus. After rendezvous with the comet, Hummingbird would first methodically image and map the comet, then collect and analyze dust, ice and gases from the cometary atmosphere to enrich characterization of the comet and support landing site selection. Then, like its namesake, Hummingbird would carefully descend to a pre-selected surface site obtaining a high-resolution image, gather a surface material sample, acquire surface temperature and then immediately return to orbit for detailed chemical and elemental analyses followed by a high resolution post-sampling image of the site. Hummingbird s analytical laboratory contains instrumentation for a comprehensive molecular and elemental analysis of the cometary nucleus as well as an innovative surface sample acquisition device.

  17. Paraspinal electromyographic abnormalities as a predictor of occult metastatic carcinoma.

    PubMed

    Watson, R; Waylonis, G W

    1975-05-01

    Profound membrane irritability localized primarily to the paraspinal muscles was the major electromyographic criterion proposed by LaBan and associates to predict the early presence and localization of spinal metastatic disease. A retrospective review was recently conducted to determine the accuracy of this interpretation and the effect of the electromyographic report on the attending physician's subsequent workup. In an analysis of 1800 electromyograms at Riverside Hospital, 91 cases were found which met the following criteria: (1) three or more paraspinal segments involved, (2) little or no membrane irritability in the anterior rami, and (3) no previous surgery on the paraspinal area. The proven discharge diagnoses were carcinoma in 24%, herniated nucleus pulposus in 28%, degenerative disc disease in 16%, diabetes mellitus in 9% and miscellaneous in 8%; in 15% no diagnosis could be made. We were unable to differentiate some cases of herniated nucleus pulposus from carcinoma using such criteria as profoundness of levels or number of spinal segments involved. There are partial explanations of why only paraspinal segments may be involved with profound changes in the diseases mentioned, but no explanation for the widespred involvement in localized disease such as a herniated disc. At our hospital it was interesting to note that internists infrequently order myelography or cerebrospinal fluid analysis while orthopedists, neurosurgeons and neurologists rarely order metastatic surveys. PMID:1137474

  18. Photoproduction of lepton pairs in proton-nucleus and nucleus-nucleus collisions at RHIC and LHC energies

    SciTech Connect

    Moreira, B. D.; Goncalves, V. P.; De Santana Amaral, J. T.

    2013-03-25

    In this contribution we study coherent interactions as a probe of the nonlinear effects in the Quantum Electrodynamics (QED). In particular, we study the multiphoton effects in the production of leptons pairs for proton-nucleus and nucleus-nucleus collisions for heavy nuclei. In the proton-nucleus we assume the ultrarelativistic proton as a source of photons and estimate the photoproduction of lepton pairs on nuclei at RHIC and LHC energies considering the multiphoton effects associated to multiple rescattering of the projectile photon on the proton of the nucleus. In nucleus - nucleus colllisions we consider the two nuclei as a source of photons. As each scattering contributes with a factor {alpha}Z to the cross section, this contribution must be taken into account for heavy nuclei. We consider the Coulomb corrections to calculate themultiple scatterings and estimate the total cross section for muon and tau pair production in proton-nucleus and nucleus-nucleus collisions at RHIC and LHC energies.

  19. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    PubMed

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved. PMID:27290969

  20. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

    PubMed Central

    Lee, Dong Yeob; Shim, Chan Shik; Ahn, Yong; Choi, Young-Geun; Kim, Ho Jin

    2009-01-01

    Objective The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation. PMID:20062565

  1. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature

    PubMed Central

    Nellensteijn, Jorm; Bartels, Ronald; Peul, Wilco; van Royen, Barend; van Tulder, Maurits

    2009-01-01

    The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for patients with symptomatic lumbar disc herniations have become increasingly popular. The literature has not yet been systematically reviewed. A comprehensive systematic literature search of the MEDLINE and EMBASE databases was performed up to May 2008. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality and outcomes were extracted by the two reviewers independently. One randomized controlled trial, 7 non-randomized controlled trials and 31 observational studies were identified. Studies were heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures and the methodological quality of these studies was poor. The eight trials did not find any statistically significant differences in leg pain reduction between the transforaminal endoscopic surgery group (89%) and the open microdiscectomy group (87%); overall improvement (84 vs. 78%), re-operation rate (6.8 vs. 4.7%) and complication rate (1.5 vs. 1%), respectively. In conclusion, current evidence on the effectiveness of transforaminal endoscopic surgery is poor and does not provide valid information to either support or refute using this type of surgery in patients with symptomatic lumbar disc herniations. High-quality randomized controlled trials with sufficiently large sample sizes are direly needed to evaluate if transforaminal endoscopic surgery is more effective than open microdiscectomy. PMID:19756781

  2. [Nerve root compression by gas containing lumbar disc herniation--case report].

    PubMed

    Yasuoka, Hiroki; Nemoto, Osamu; Kawaguchi, Masahisa; Naitou, Satoko; Yamamoto, Kouji; Ukegawa, You

    2009-06-01

    The radiographic appearance of gas collection in the intervertebral disc represents the so-called "vacuum phenomenon." Incidence of the vacuum phenomenon on plain radiographs is reported to be 1-20%, whereas gas-containing disc herniations are rarely observed. We present a case report involving a patient with L4/5 gas-containing disc herniation, which was demonstrated by CT and MRI scans and was also surgically documented. A 48-year-old man with no previous back trauma presented with a 14-day history of left leg pain. On neurologic examination, the straight leg raising test was positive at 60degrees. Leg muscle strength was weak on the extensor hallucis longus. Sensory disturbances and abnormalities in deep-tendon reflexes were not observed. Lumbar roentogenograms showed "vacuum phenomenon" at L2/3, L4/5 and the L5/S disc space. MRI indicated a herniated disc at L4/5 displacing the dural sac and a focal low intensity in the lesion. Administration of an epidural block relieved the patient's symptoms. Ten months later, the patient reported a gradual return of similar left leg pain. His symptoms did not respond to conservative management. Lumbar spine films indicated abnormalities identical to the original results. MRI showed an enlarged area of low intensity with compression of the left L5 nerve root. In addition to recurrent pain, discography with metrizamide injections confirmed the presence of intradiscal gas and compression of the left L5 nerve root. During surgery, a gray-bluish air mass compressing the L5 nerve root was identified. Manipulation of the mass resulted in rupture and the release of gas. The displaced nerve root immediately relaxed to its normal position. Seven months after the operation, the patient remains free of pain. PMID:19526837

  3. Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Wargo, Bradley W.; Malla, Yogesh

    2012-01-01

    Study Design: A randomized, double-blind, active controlled trial. Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis. PMID:22859902

  4. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy

    PubMed Central

    Lovi, Alessio; Brayda-Bruno, Marco; Zagra, Antonino; Corriero, Andrea; Giudici, Fabrizio; Minoia, Leone

    2010-01-01

    Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 18–65 years affected by posterior lumbar disc herniation and symptoms lasting over 6 weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6 weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12- and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2 years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy. PMID:20127495

  5. Postfixed Brachial Plexus Radiculopathy Due to Thoracic Disc Herniation in a Collegiate Wrestler: A Case Report

    PubMed Central

    Kuzma, Scott A.; Doberstein, Scott T.; Rushlow, David R.

    2013-01-01

    Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1–T2 disc herniation. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Differential Diagnosis: Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. Treatment: The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1–T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Uniqueness: Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. Conclusions: The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1–T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for

  6. Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation

    PubMed Central

    Abrishamkar, Saeid; Kouchakzadeh, Masih; Mirhosseini, Ahmad; Tabesh, Homayoun; Rezvani, Majid; Moayednia, Amir; Ganjeifar, Babak; Mahabadi, Amir; Yousefi, Elham; Kooshki, Ali Mehrabi

    2015-01-01

    Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. Materials and Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Conclusion: Our results show that while

  7. Management of post-goniopuncture iris herniation: a two-step procedure.

    PubMed

    Martín-Moro, Julio González; Miguel, Yolanda Fernández

    2014-06-01

    A 38-year-old male presented to the emergency room suffering acute pain in his left eye. Two months before he had been submitted to uneventful non-penetrating deep sclerectomy and one month before to YAG-laser goniopuncture. Examination showed iris herniation into the trabeculo-descemet's window. Surgical reduction was carried out through a peripheral corneal incision, and a large air bubble was injected into the anterior chamber. Four days later a wide laser peripheral iridotomy was performed. This technique can transform a non-penetrating technique into a full-trabeculectomy, without reopening the superficial flap. PMID:23740144

  8. Surgical management of thoracic idiopathic spinal cord herniation. Technical case report and review.

    PubMed

    Payer, Michael; Zumsteg, Dominik; De Tribolet, Nicolas; Wetzel, Stephan

    2016-08-01

    Idiopathic spinal cord herniation (ISCH) is a rare spinal disease, in which chronic cerebrospinal fluid pulsations push the arachnoid and adjacent thoracic spinal cord region through an antero-lateral dural defect of congenital, post-traumatic, or inflammatory/erosive origin. Symptomatic patients commonly present around the 5th decade of life with slowly progressive myelopathy. Diagnosis relies on high-resolution magnetic resonance imaging. Stable mild cases may be observed, whereas in progressive symptomatic situations, surgical spinal cord reposition and dural defect repair with a dural patch is the preferred treatment. We present a case of ISCH at T5/6 and a review the literature. PMID:27221089

  9. Spontaneous intradural disc herniation with focal distension of the subarachnoid space in a dog

    PubMed Central

    Barnoon, Itai; Chai, Orit; Srugo, Itai; Peeri, Dana; Konstantin, Lilach; Brenner, Ori; Shamir, Merav H.

    2012-01-01

    Myelo-computed tomography of a paraparetic 14-year-old dog revealed subarachnoid distension with an intradural filling defect above the T13–L1 disc space. T12–L1 hemilaminectomy followed by durotomy allowed removal of a large piece of degenerated disc material that compressed the spinal parenchyma. Full return to function was achieved 10 days post-surgery. The distension was likely secondary to the intradural herniation, and is a rare and distinct finding. PMID:23633713

  10. Recurrent pseudoaneurysm of the left ventricle with subcutaneous herniation into the chest wall. A case report.

    PubMed Central

    Rao, M S; Vaijyanath, P; Taneja, K; Dubey, B; Manchanda, S C; Venugopal, P

    1998-01-01

    Pseudoaneurysm of the left ventricle is rare, and recurrence is extremely rare. We report the case of a 62-year-old man who presented at our hospital with a painless pulsatile swelling in the left breast. He had undergone coronary artery bypass grafting and left-ventricular aneurysmectomy 14 years earlier. On investigation, the swelling was diagnosed to be a pseudoaneurysm of the left ventricle with subcutaneous herniation. The extreme rarity of this condition prompted us to report the case. The investigative techniques and the surgical strategy are discussed. Images PMID:9885110

  11. Mesenteric Defect with Internal Herniation: A Rare Cause of Bowel Obstruction in Newborn.

    PubMed

    Adnen, Hakim; Aida, Borgi; Serra, Belhadj; Narjess, Ghali; Asma, Hamdi; Ammar, Khaldi; Khaled, Menif; Said, Jlidi; Nejla, Ben Jaballah

    2015-01-01

    Herniation through a congenital mesenteric defect is a rare cause of intestinal obstruction in the newborn. Early diagnosis and surgical treatment improves the prognosis. We present a case of a full-term infant who presented with respiratory distress at birth. Enteral feeding was not started because abdominal distension and delayed passage of meconium. Bowel obstruction was suspected. Radiological investigation did not provide a clear diagnosis. Surgical exploration revealed transmesenteric congenital hernia. After surgical repair, enteral feeding was tolerated and patient was discharged with an uneventful outcome. Diagnostic difficulties were discussed. PMID:25978102

  12. [Use of glucocorticoids in low back pain due to disc herniation with radicular involvement].

    PubMed

    Lazarou, Ilias; Genevay, Stéphane; Nendaz, Mathieu

    2011-10-19

    Although systemic glucocorticoids are frequently used for the treatment of radicular pain due to disc herniation, there are only few studies available. No trial has successfully demonstrated the superiority of systemic glucocorticoids compared to placebo. Therefore their use is not recommended. Spinal injection using radiographic guidance appears to provide some beneficial short-term effect on pain. It might be offered when pain treatments according to the WHO steps have failed. Because rare but serious adverse events have been reported, transforaminal periradicular injections should only be used after thorough analysis of risks and benefits with the patient. PMID:22073701

  13. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report.

    PubMed

    Tuna, Serpil; Özdemir, Tayfun; Öz, Hande Ece

    2016-03-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989

  14. Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report

    PubMed Central

    Özdemir, Tayfun; Öz, Hande Ece

    2016-01-01

    Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation. PMID:27134989

  15. Schmorl Nodes Can Cause Increased 68Ga DOTATATE Activity on PET/CT, Mimicking Metastasis in Patients With Neuroendocrine Malignancy.

    PubMed

    Papadakis, Georgios Z; Millo, Corina; Bagci, Ulas; Sadowski, Samira M; Stratakis, Constantine A

    2016-03-01

    Schmorl node (SN) is the herniation of the nucleus pulposus through the cartilaginous and bony endplate into the adjacent vertebral body. It is documented that SNs produce areas of moderately increased F-FDG uptake. We present a case of a patient with history of neuroendocrine tumor, who underwent Ga DOTATATE PET/CT for follow-up, showing increased focal vertebral uptake suggestive of bone metastasis. CT revealed typical findings of an SN. The presented case indicates that SNs should be considered when encountering focally increased skeletal uptake in Ga DOTATATE PET/CT studies, which can mimic metastasis in patients with history of neuroendocrine tumors. PMID:26562580

  16. Comet nucleus sample return mission

    NASA Technical Reports Server (NTRS)

    1983-01-01

    A comet nucleus sample return mission in terms of its relevant science objectives, candidate mission concepts, key design/technology requirements, and programmatic issues is discussed. The primary objective was to collect a sample of undisturbed comet material from beneath the surface of an active comet and to preserve its chemical and, if possible, its physical integrity and return it to Earth in a minimally altered state. The secondary objectives are to: (1) characterize the comet to a level consistent with a rendezvous mission; (2) monitor the comet dynamics through perihelion and aphelion with a long lived lander; and (3) determine the subsurface properties of the nucleus in an area local to the sampled core. A set of candidate comets is discussed. The hazards which the spacecraft would encounter in the vicinity of the comet are also discussed. The encounter strategy, the sampling hardware, the thermal control of the pristine comet material during the return to Earth, and the flight performance of various spacecraft systems and the cost estimates of such a mission are presented.

  17. Theoretical antideuteron-nucleus absorptive cross sections

    NASA Technical Reports Server (NTRS)

    Buck, W. W.; Norbury, J. W.; Townsend, L. W.; Wilson, J. W.

    1993-01-01

    Antideuteron-nucleus absorptive cross sections for intermediate to high energies are calculated using an ion-ion optical model. Good agreement with experiment (within 15 percent) is obtained in this same model for (bar p)-nucleus cross sections at laboratory energies up to 15 GeV. We describe a technique for estimating antinucleus-nucleus cross sections from NN data and suggest that further cosmic ray studies to search for antideuterons and other antinuclei be undertaken.

  18. Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy.

    PubMed

    Li, Xiaolong; Dou, Qingyu; Hu, Shuai; Liu, Jiaxiang; Kong, Qingquan; Zeng, Jiancheng; Song, Yueming

    2016-06-01

    To evaluate the feasibility and clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) for cauda equina syndrome (CES) caused by disc herniation. 16 patients with CES caused by LDH at the early and middle stages of Shi's classification were selected as the objects of study, who underwent PELD. Clinical outcomes were assessed using the Macnab criteria and the visual analogue scale (VAS). The VAS for leg pain and back pain significantly decreased from preoperative scores of 7.67 ± 1.23 and 7.52 ± 1.42, respectively, to postoperative scores of 1.71 ± 0.53 and 3.18 ± 0.72. Thirteen patients showed favorable results. Complications included one patient of motor weakness, and one patient developed an ipsilateral recurrent herniation who finally acquired satisfactory result after reoperation. Hence, PELD could be used as an alternative surgical method for the treatment of CES in properly selected cases and appropriate patient selection and a reasonable surgical approach will give rise to better outcomes. PMID:26292929

  19. Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation

    PubMed Central

    Balik, Mehmet Sabri; Kanat, Ayhan; Erkut, Adem; Ozdemir, Bulent; Batcik, Osman Ersagun

    2016-01-01

    Objective: Inequality in leg length may lead to to abnormal transmission of load across the endplates and degeneration lumbar spine and the disc space. There has been no study focusing on lumbar disc herniation (LDH) and leg length discrepancy. This subject was investigated in this study. Materials and Methods: Consecutive adult patients with leg length discrepancy and low back pain (LBP) admitted to our department were respectivelly studied. Results: A total number of 39 subjects (31 women and eight men) with leg length discrepancy and LBP and 43 (25 females and 18 males) patients with LBP as a control group were tested. Occurrence of disc herniation is statistically different between patients with hip dysplasia and control groups (P < 0.05). Conclusion: The results of this study showed a statistically significant association between leg length discrepancy and occurrence of LDH. The changes of spine anatomy with leg length discrepancy in hip dysplastic patients are of importance in understanding the nature of LDH. PMID:27217654

  20. Composite features for automatic diagnosis of intervertebral disc herniation from lumbar MRI.

    PubMed

    Ghosh, Subarna; Alomari, Raja' S; Chaudhary, Vipin; Dhillon, Gurmeet

    2011-01-01

    Lower back pain is widely prevalent in the world today, and the situation is aggravated due to a shortage of radiologists. Intervertebral disc disorders like desiccation, degeneration and herniation are some of the major causes of lower back pain. In this paper, we propose a robust computer-aided herniation diagnosis system for lumbar MRI by first extracting an approximate Region Of Interest (ROI) for each disc and then using a combination of viable features to produce a highly accurate classifier. We describe the extraction of raw, LBP (Local Binary Patterns), Gabor, GLCM (Gray-Level Co-occurrence Matrix), shape, and intensity features from lumbar SPIR T2-weighted MRI and also present a thorough performance comparison of individual and combined features. We perform 5-fold cross validation experiments on 35 cases and report a very high accuracy of 98.29% using a combination of features. Also, combining the desired features and reducing the dimensionality using LDA, we achieve a high sensitivity (true positive rate) of 98.11%. PMID:22255478

  1. Spontaneous Anterior Thoracic Spinal Cord Herniation through Dura Defect: A Case Report

    PubMed Central

    Jeong, Kyung-Ho; Lee, Hyun-Woo

    2016-01-01

    Thoracic spinal cord herniation is a rare disease cause of progressive myelopathy. Magnetic resonance image is a useful tool to diagnose preoperatively. Operation is a treatment of option. Sixty-six-year-old female visited Dong-A University Medical Center for progressive gait disturbance with falling tendency to right side. She had radiating pain and tingling sense on both leg. Sense of touch and temperature was decreased below T6 level. Both hip and knee motor power were grade IV. Magnetic resonance imaging scan showed anterior displacement of the spinal cord at T4-T5 vertebral level. Under the diagnosis of thoracic spinal cord herniation with dura defect, operation was performed for the patient with intraoperative neuromonitoring. Laminectomy at T4 and T5 level was done, and intradural exploration of the spinal cord revealed dura defect about 25mm×8mm in size. Spinal cord was released under microscope and dura defect was repaired with Lyoplant. The patient's symptom improved after the surgical procedure, but touch and temperature sense under T6 level had unchanged. PMID:27437019

  2. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.

    PubMed

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH.Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed.A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53-2.58), disc protrusion (OR 1.79, 95% CI 1.15-2.79), and diabetes (OR 1.19, 95% CI 1.06-1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly.Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  3. Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report

    PubMed Central

    Pak, Kevin I.; Hoffman, David C.; Herzog, Richard J.

    2010-01-01

    We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5–S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5–S1. After a failed left L5 transforaminal epidural steroid injection, the patient was brought back for a percutaneous intradiscal aspiration of the vacuum disc gas. This resulted in immediate relief for the patient. A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain. PMID:22294964

  4. [Morphological rationale for medial facetectomy during microsurgical removal of herniated lumbar disks].

    PubMed

    Kushniruk, P I; dreval', O N

    2006-01-01

    The study was undertaken to provide an anatomic and morphological rationale for the use of medial facetectomy in the microsurgical treatment of herniated lumbar disks and to assess the results of performed operations. Morphological studies were conducted on corpses, by comparing coronal and transverse sections of the lumbar spine. The concept "nervous root canal" was used during the study. The detected features of the anatomical and topographic structure of the nervous root canal permitted the substantiation of the necessity and volume of medial facetectomy at different levels. When an approach is applied into the discal area, the highest and least volume of bone resection at medial facetectomy is required at the levels of L3-L4 and L5-S1, respectively. The clinical study involved an analysis of the results of microsurgical treatment of 530 patients with herniated lumbar disks. The analysis of clinical findings revealed that medial facetectomy had been used during 382 (72%) operations. When the operations were performed at different levels, the usage of this technique differs: at the levels of L3-L4, L4-L5, and L5-S1 in 30 (100%), 206 (91%), and 145 (53%) cases, respectively. The data on the usage of medial facetectomy during operations correspond to the revealed specific features of the anatomic and topographic structure of the nervous root canal at each of the operated levels. PMID:16739929

  5. Gastrocnemius muscle herniation as a rare differential diagnosis of ankle sprain: case report and review of the literature

    PubMed Central

    2012-01-01

    Background Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described. Case presentation We present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch. Conclusions Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic) ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects. PMID:22417228

  6. Nonmedical methods to relieve low back pain caused by lumbar disc herniation: a descriptive study in northeastern Turkey.

    PubMed

    Cilingir, Dilek; Hintistan, Sevilay; Yigitbas, Cagla; Nural, Nesrin

    2014-06-01

    Low back pain due to the effects of lumbar disc herniation is a common complaint of patients who often subsequently seek help from medical professionals. It is also a significant health problem which is quite difficult to treat. This descriptive study was conducted to determine nonmedical methods used by patients with lumbar disc herniation to relieve low back pain; the patients' intensity of low back pain when they were admitted to the hospital was also explored. Ninety-two patients with lumbar disc herniation participated in this study, which was carried out at a university hospital in northeastern Turkey. Data were collected using a patient information form and the visual analog scale (VAS). When the patients were admitted to hospital, their mean VAS score was 6.56 ± 2.45. The study results showed that as a first choice nearly all of the patients (94.6%) with lumbar disc herniation preferred consulting with their physicians before to obtain relief for low back pain. However, in addition to seeing their physician, more than one-half of these patients (57.6%) also used nonmedical methods. The primary nonmedical methods were hot/cold compresses, wrapping various substances on the back, and herbal preparations. An increase in pain was noted by 17.0% of patients after using nonmedical methods. Findings indicated that more than two-thirds of patients experienced either no change or an increase in pain after using nonmedical methods to find relief. PMID:24882024

  7. Treatment of contained lumbar disc herniations using radiofrequency assisted micro-tubular decompression and nucleotomy: four year prospective study results

    PubMed Central

    2014-01-01

    Background Patients with radiculopathy caused by contained disc herniations are less likely to have good outcomes following discectomy surgery than patients with disc herniations that are not contained. The author presents his 4-year results from a prospective trial regarding the efficacy and safety of a tubular transforaminal radiofrequency-assisted manual decompression and annulus modulation of contained disc herniations in 58 patients. Methods Fifty-eight patients with lumbar radiculopathy due to a contained disc herniation were enrolled in a prospective clinical study. Visual analog scores (VAS) for back pain and leg pain, quality of life assessment, Macnab criteria, and SF-12 were collected from patients before treatment, at 2-years and 4-years post-treatment. Results At 4 years, results were obtained from 47 (81%) of patients. Compared to mean pre- treatment assessments, mean 4-year VAS for back pain improved from 8.6 to 2.3 points, and mean VAS for leg pain improved from 7.8 to 2.3. Eighty-three percent of respondents reported that they were “satisfied” or “very satisifed” with their quality of life at 4-years as per SF-12. At 4 years, recurrence was noted in 3 (6.4%) of respondents and no complications were reported. Conclusions The 2-year and 4-year study results are nearly identical, suggesting durable benefit out to 4 years. These results also suggest that in carefully selected patients with sustained contained disc herniations who have failed conservative treatments, manual decompression combined with radiofrequency-assisted decompression and annulus modulation are very likely to have good outcomes 4 years post-treatment. PMID:25694932

  8. Actomyosin contractility rotates the cell nucleus

    PubMed Central

    Kumar, Abhishek; Maitra, Ananyo; Sumit, Madhuresh; Ramaswamy, Sriram; Shivashankar, G. V.

    2014-01-01

    The cell nucleus functions amidst active cytoskeletal filaments, but its response to their contractile stresses is largely unexplored. We study the dynamics of the nuclei of single fibroblasts, with cell migration suppressed by plating onto micro-fabricated patterns. We find the nucleus undergoes noisy but coherent rotational motion. We account for this observation through a hydrodynamic approach, treating the nucleus as a highly viscous inclusion residing in a less viscous fluid of orientable filaments endowed with active stresses. Lowering actin contractility selectively by introducing blebbistatin at low concentrations drastically reduced the speed and coherence of the angular motion of the nucleus. Time-lapse imaging of actin revealed a correlated hydrodynamic flow around the nucleus, with profile and magnitude consistent with the results of our theoretical approach. Coherent intracellular flows and consequent nuclear rotation thus appear to be an intrinsic property of cells. PMID:24445418

  9. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy

    PubMed Central

    Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

    2016-01-01

    Abstract Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain. The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3. A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty. Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4–C5 and C5–C6 that caused severe spinal cord compression and surrounding edema. We performed C4–C5–C6

  10. The retrotrapezoid nucleus and breathing.

    PubMed

    Guyenet, Patrice G; Stornetta, Ruth L; Abbott, Stephen B G; Depuy, Seth D; Kanbar, Roy

    2012-01-01

    The retrotrapezoid nucleus (RTN) is located in the rostral medulla oblongata close to the ventral surface and consists of a bilateral cluster of glutamatergic neurons that are non-aminergic and express homeodomain transcription factor Phox2b throughout life. These neurons respond vigorously to increases in local pCO(2) via cell-autonomous and paracrine (glial) mechanisms and receive additional chemosensory information from the carotid bodies. RTN neurons exclusively innervate the regions of the brainstem that contain the respiratory pattern generator (RPG). Lesion or inhibition of RTN neurons largely attenuates the respiratory chemoreflex of adult rats whereas their activation increases respiratory rate, inspiratory amplitude and active expiration. Phox2b mutations that cause congenital central hypoventilation syndrome in humans prevent the development of RTN neurons in mice. Selective deletion of the RTN Phox2b-VGLUT2 neurons by genetic means in mice eliminates the respiratory chemoreflex in neonates.In short, RTN Phox2b-VGLUT2 neurons are a major nodal point of the CNS network that regulates pCO(2) via breathing and these cells are probable central chemoreceptors. PMID:23080151

  11. The multifunctional lateral geniculate nucleus.

    PubMed

    Weyand, Theodore G

    2016-02-01

    Providing the critical link between the retina and visual cortex, the well-studied lateral geniculate nucleus (LGN) has stood out as a structure in search of a function exceeding the mundane 'relay'. For many mammals, it is structurally impressive: Exquisite lamination, sophisticated microcircuits, and blending of multiple inputs suggest some fundamental transform. This impression is bolstered by the fact that numerically, the retina accounts for a small fraction of its input. Despite such promise, the extent to which an LGN neuron separates itself from its retinal brethren has proven difficult to appreciate. Here, I argue that whereas retinogeniculate coupling is strong, what occurs in the LGN is judicious pruning of a retinal drive by nonretinal inputs. These nonretinal inputs reshape a receptive field that under the right conditions departs significantly from its retinal drive, even if transiently. I first review design features of the LGN and follow with evidence for 10 putative functions. Only two of these tend to surface in textbooks: parsing retinal axons by eye and functional group and gating by state. Among the remaining putative functions, implementation of the principle of graceful degradation and temporal decorrelation are at least as interesting but much less promoted. The retina solves formidable problems imposed by physics to yield multiple efficient and sensitive representations of the world. The LGN applies context, increasing content, and gates several of these representations. Even if the basic concentric receptive field remains, information transmitted for each LGN spike relative to each retinal spike is measurably increased. PMID:26479339

  12. Music and the nucleus accumbens.

    PubMed

    Mavridis, Ioannis N

    2015-03-01

    Music is a universal feature of human societies over time, mainly because it allows expression and regulation of strong emotions, thus influencing moods and evoking pleasure. The nucleus accumbens (NA), the most important pleasure center of the human brain (dominates the reward system), is the 'king of neurosciences' and dopamine (DA) can be rightfully considered as its 'crown' due to the fundamental role that this neurotransmitter plays in the brain's reward system. Purpose of this article was to review the existing literature regarding the relation between music and the NA. Studies have shown that reward value for music can be coded by activity levels in the NA, whose functional connectivity with auditory and frontal areas increases as a function of increasing musical reward. Listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the NA. The functional connectivity between brain regions mediating reward, autonomic and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences. Musical stimuli can significantly increase extracellular DA levels in the NA. NA DA and serotonin were found significantly higher in animals exposed to music. Finally, passive listening to unfamiliar although liked music showed activations in the NA. PMID:25102783

  13. New Diagnostic Tool for Far Lateral Lumbar Disc Herniation : The Clinical Usefulness of 3-Tesla Magnetic Resonance Myelography Comparing with the Discography CT

    PubMed Central

    Kim, Duk-Gyu; Park, Jung-Soo

    2012-01-01

    Objective To prospectively assess the diagnostic and clinical value of a new technique (3-tesla magnetic resonance myelography, 3T MRM) as compared to computed tomographic discography (disco-CT) in patients with far lateral disc herniation. Methods We evaluated 3T MRM and disco-CT of 25 patients, whom we suspected of suffering from far lateral disc herniation. Using an assessment scale, 4 observers examined independently both 3T MRM and disco-CT images. We analyzed observer agreement and the accentuation of each image. Results We found complete matching, and observer agreement, between high resolution images of 3T MRM and disco-CT for diagnosing far lateral disc herniation. Conclusion We think noninvasive 3T MRM is an appropriate diagnostic tool for far lateral disc herniation as compared to disco-CT. PMID:23091667

  14. Nucleus accumbens stimulation in pathological obesity.

    PubMed

    Harat, Marek; Rudaś, Marcin; Zieliński, Piotr; Birska, Julita; Sokal, Paweł

    2016-01-01

    One of the potential treatment methods of obesity is deep brain stimulation (DBS) of nucleus accumbens. We describe the case of 19 years old woman with hypothalamic obesity. She weighted 151.4 kg before DBS and the non-surgical methods proved to be inefficient. She was treated with implantation of DBS electrode to nucleus accumbens bilaterally. Results were measured with body mass index and neuropsychological tests. Follow-up was 14 months. Fourteen months after surgery weight was 138 kg, BMI was 48.3. Neuropsychological test results were intact. The presented case supports the thesis of treatment of obesity with nucleus accumbens stimulation. PMID:27154450

  15. Dexamethasone in the management of symptoms due to herniated lumbar disc.

    PubMed Central

    Green, L N

    1975-01-01

    One hundred consecutive patients with radicular pain due to myelographically proven herniated lumbar intervertebral discs were treated with initially high but tapering doses of intramuscular dexamethasone for seven days. All patients had reflief of pain within 24-48 hours. Bed rest was eliminated as a significant factor in the improvement. Nine patients required surgery at the end of the hospital treatment period. Another 11 required surgery during the follow-up of 15 months. Review of work status and recurrent pain during the follow-up indicates that the non-surgically treated patients in this series fared better. It is concluded that nerve root inflammation is the immediate cause of radicular symptoms in case of ruptured lumbar disc and that treatment with dexamethasone gives prompt relief of pain and may avoid the need for surgery in most cases. Images PMID:1219086

  16. Amniotic Sac Herniation Through a Prior Cornual Scar in The Third Trimester

    PubMed Central

    Saad, Antonio F.; Costantine, Maged M.; Saade, George; Makhlouf, Michel

    2015-01-01

    Introduction Uterine rupture occurs in less than 0.1% of pregnancies. This complication can be detrimental to mother and fetus if not detected and managed in a timely manner. We report an unusual presentation of uterine scar rupture that was diagnosed on ultrasound in a completely stable patient with reassuring fetal status. Case Report A 24-year-old Gravida 5, Para 3 with history of cornual resection for ectopic pregnancy and two previous uterine ruptures presented at 30 weeks' gestation with worsening abdominal pain. Ultrasound identified herniation of the amniotic sac with fetal parts. The patient underwent cesarean delivery and cornual defect repair. Conclusion Close observation and early delivery remain vital to the patient's management. PMID:26495171

  17. Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations.

    PubMed

    Alexandre, A; Corò, L; Azuelos, A; Buric, J; Salgado, H; Murga, M; Marin, F; Giocoli, H

    2005-01-01

    For disc herniations the use of open surgical approaches is reduced since new percutaneous methods allowing shrinkage of the disc and improvement of the radicular function are gaining interest. Studies on the spontaneous disappearance of disc fragments have demonstrated autoimmune responses with a chronic inflammatory reaction. Also radicular pain has been shown to be mostly due to biochemical mechanisms. Researchers in different fields surprisingly noticed that a brief, calculated, oxidative stress by ozone administration may correct a persistent imbalance due to excessive, chronic oxidative injury. Oxygen-ozone gas injection in painful patients has a dramatic effect on clinical symptoms. On these bases the intradiscal injection of oxygen-ozone gas has been conceived. We report the treatment on a series of patients affected by cervical disc pathology, treated by intradiscal injection of oxygen-ozone gas mixture. The effects both on pain and on radicular dysfunction are impressive. The morphological effect of the treatment was also evaluated by pathological examination. PMID:15830973

  18. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome*

    PubMed Central

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries. PMID:26131874

  19. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome.

    PubMed

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-year old woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900 mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries. PMID:26131874

  20. Dorsal Extradural Lumbar Disc Herniation Causing Cauda Equina Syndrome : A Case Report and Review of Literature

    PubMed Central

    Lee, Sang-Ho; Arbatti, Nikhil J.

    2010-01-01

    A 73-year-old male presented with a rare dorsally sequestrated lumbar disc herniation manifesting as severe radiating pain in both leg, progressively worsening weakness in both lower extremities, and urinary incontinence, suggesting cauda equina syndrome. Magnetic resonance imaging suggested the sequestrated disc fragment located in the extradural space at the L4-L5 level had surrounded and compressed the dural sac from the lateral to dorsal sides. A bilateral decompressive laminectomy was performed under an operating microscope. A large extruded disc was found to have migrated from the ventral aspect, around the thecal sac, and into the dorsal aspect, which compressed the sac to the right. After removal of the disc fragment, his sciatica was relieved and the patient felt strength of lower extremity improved. PMID:20379476

  1. Subdural haemorrhage and severe coagulopathy resulting in transtentorial uncal herniation in a neonate undergoing therapeutic hypothermia

    PubMed Central

    Wang, Dianna; McMillan, Hugh; Bariciak, Erika

    2014-01-01

    Therapeutic hypothermia has been shown to be efficacious for improving long-term neurodevelopmental outcomes following perinatal asphyxia. Thus, cooling protocols have been adopted at most tertiary neonatal centres. We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischaemic encephalopathy following a difficult forceps delivery. She abruptly deteriorated, exhibiting signs of transtentorial uncal herniation and severe disseminated intravascular coagulopathy. CT of the head confirmed a life-threatening subdural haematoma and a concealed skull fracture. Hypothermia has been shown to impair haemostasis in vivo and thus may potentially exacerbate occult haemorrhages in a clinical setting. Newborns that require instrument-assisted delivery are a particularly high-risk group for occult head injuries and should undergo careful clinical assessment for fractures and intracranial haemorrhage prior to initiation of therapeutic hypothermia. PMID:25100805

  2. [Long-term results of surgical treatment of lumbar disk herniation in adults].

    PubMed

    Dudek, H; Michno, T; Łebkowski, W J; Kozłowski, A

    2001-01-01

    The authors present long-term results (10.2 years post-op) of surgical treatment of lumbar disc herniation in 1003 patients operated at the Department of Neurosurgery by the University of Medical Sciences in Białystok. The operated group comprised 33.1% women (mean age--55.6 years) and 68.7% men (mean age 57.3 years). Ten years post-op 15.9% women and 5.8% men kept the recommended diet, 14% women and 7.0% men continued muscle strengthening exercise. Ten years post-op excellent and good results were noted in respectively 42.4% and 46.5% women and 45.4% and 46.6% men. PMID:11761755

  3. Psoas Compartment Blockade in a Laterally Herniated Disc Compressing the Psoas Muscle -A Case Report-

    PubMed Central

    Kim, Hye Young; Park, Jin Woo; Moon, Jee Youn; Shin, Jae Hyuck; Park, Sang Hyun

    2012-01-01

    A psoas compartment block has been used to provide anesthesia for orthopedic surgical procedures and analgesia for post-operative pain. Currently, this block is advocated for relieving pain in the lower extremity and pelvic area resulting from various origins. We report a case of a 69-year-old male patient who had gait abnormality with posterior pelvic and hip pain, which were both aggravated by hip extension. From the magnetic resonance image, the patient was found to have a laterally herniated intervertebral disc at the L2/3 level, which compressed the right psoas muscle. This was thought to be the origin of the pain, so a psoas compartment block was performed using 0.25% chirocaine with triamcinolone 5mg, and the pain in both the pelvis and hip were relieved. PMID:22514781

  4. Co-existence of L5-S1 disc herniation and conus medullaris ependymoma

    PubMed Central

    Minoğlu, Mustafa; Akkol, İsmail; Özdemir, Nail; Yıldırım, Levent

    2014-01-01

    INTRODUCTION The lumbar disc herniations are seen very common than spinal ependymomas in the neurosurgery polyclinic routine. PRESENTATION OF CASE In our case, both pathologies were seen at the most frequently located levels compatible with the literature. Aim of this case report is, to remind once more that, different pathologies can be found at the same time in a single patient; differential diagnosis must be done very carefully. DISCUSSION The routine Computed Tomography (CT) imaging for low back pain can not show the conus medullaris pathology. Spinal tumors or other similar pathologies should be kept in mind for differential diagnosis. A good medical history and a good physical examination must be completed before the final diagnosis. CONCLUSION Viewing of spinal canal with Magnetic Resonance Imaging (MRI) will be useful for the patients who we intend to do disc surgery. PMID:25460457

  5. Preoperative retrolisthesis as a risk factor of postdecompression lumbar disc herniation.

    PubMed

    Takenaka, Shota; Tateishi, Kosuke; Hosono, Noboru; Mukai, Yoshihiro; Fuji, Takeshi

    2016-04-01

    OBJECT In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion. METHODS Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance. RESULTS Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension. CONCLUSIONS The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension. PMID:26654340

  6. Clinical effect of additional electroacupuncture on thoracolumbar intervertebral disc herniation in 80 paraplegic dogs.

    PubMed

    Han, Hyun-Jung; Yoon, Hun-Young; Kim, Joon-Young; Jang, Ha-Young; Lee, Bora; Choi, Seok Hwa; Jeong, Soon-Wuk

    2010-01-01

    The clinical efficacy of electroacupuncture and acupuncture in combination with medication for the treatment of thoracolumbar intervertebral disc herniation was investigated in paraplegic dogs with intact deep pain perception. To evaluate the additional effect of electroacupuncture, dogs treated with conventional medicines alone were compared to dogs treated with electroacupuncture and acupuncture and conventional medicine. Medical records of 80 dogs were reviewed for this investigation and classified into two groups undergoing different treatment methods: (1) treatment with conventional medicine alone (Group C, n = 37) and (2) treatment with conventional medicine combined with electroacupuncture and acupuncture (Group CE, n = 43). Prednisone was the conventional medicine and electroacupuncture was applied at GV07 and GV02-1 at 0.5-2.5 mV, mixed Hz of 2 and 15 Hz for 25-30 min. Acupuncture was performed locally at urinary bladder meridian points near the lesion, and bilaterally distantly at GB30, GB34, and ST36. Treatment efficacy was evaluated by post-operative neurologic function, ambulation, relapse, complication, and urinary function. Ambulation recovery was more prevalent in Group CE than Group C (p = 0.01) and recovery of ambulation and back pain relief time was shorter in Group CE compared to Group C (p = 0.011 and 0.001, respectively). Relapse rate was significantly lower in Group CE (p = 0.031). The results suggest that a combination of electroacupuncture and acupuncture with conventional medicine is more effective than conventional medicine alone in recovering ambulation, relieving back pain, and decreasing relapse. Electroacupuncture and acupuncture is thus a reasonable option for the treatment of intervertebral disc herniation in paraplegic dogs with intact deep pain perception. PMID:21061457

  7. Novel Clinical Scale for Evaluating Pre-Operative Risk of Cerebral Herniation from Traumatic Epidural Hematoma.

    PubMed

    Lin, Hong; Wang, Wen-Hao; Hu, Lian-Shui; Li, Jun; Luo, Fei; Lin, Jun-Ming; Huang, Wei; Zhang, Ming-Sheng; Zhang, Yuan; Hu, Kang; Zheng, Jian-Xian

    2016-06-01

    Secondary massive cerebral infarction (MCI) is the predominant prognostic factor for cerebral herniation from epidural hematoma (EDH) and determines the need for decompressive craniectomy. In this study, we tested the clinical feasibility and reliability of a novel pre-operative risk scoring system, the EDH-MCI scale, to guide surgical decision making. It is comprised of six risk factors, including hematoma location and volume, duration and extent of cerebral herniation, Glasgow Coma Scale score, and presence of preoperative shock, with a total score ranging from 0 to 18 points. Application of the EDH-MCI scale to guide surgical modalities for initial hematoma evacuation surgery for 65 patients (prospective cohort, 2012.02-2014.01) showed a significant improvement in the accuracy of the selected modality (95.38% vs. 77.95%; p = 0.002) relative to the results for an independent set of 126 patients (retrospective cohort, 2007.01-2012.01) for whom surgical modalities were decided empirically. Results suggested that simple hematoma evacuation craniotomy was sufficient for patients with low risk scores (≤9 points), whereas decompressive craniectomy in combination with duraplasty were necessary only for those with high risk scores (≥13 points). In patients with borderline risk scores (10-12 points), those having unstable vital signs, coexistence of severe secondary brainstem injury, and unresponsive dilated pupils after emergent burr hole hematoma drainage had a significantly increased incidence of post-traumatic MCI and necessity of radical surgical treatments. In conclusion, the novel pre-operative risk EDH-MCI evaluation scale has a satisfactory predictive and discriminative performance for patients who are at risk for the development of secondary MCI and therefore require decompressive craniectomy. PMID:25393339

  8. Assessing the Risk of Disc Heniation Related to Landing Impact Following Long-duration Spacecraft

    NASA Technical Reports Server (NTRS)

    Somers, J. T.; Newby, N..; Wells, J.

    2014-01-01

    Previous research has shown that crewmembers returning on the Space Shuttle have an increased incidence of herniated nucleus pulposus after spaceflight. This increased risk is thought to be related to disc volume expansion due to unloading and prolonged exposure to microgravity. Although there is an increased risk of disc herniation in Space Shuttle astronauts, it is unknown if dynamic landing loads further contribute to the risk of herniation. To determine if dynamic loads increase the risk of incidence, data from crewmembers (excluding cosmonauts) returning on the Soyuz spacecraft will be compared to Space Shuttle astronauts. These data will be obtained from the Lifetime Surveillance of Astronaut Health (LSAH) Project at NASA. Severity and incidence after spaceflight will be mined from the data, and statistical analyses will be used to determine if Soyuz crewmembers have a higher incidence of disc herniation than Space Shuttle crewmembers. The results are expected to show no difference between Space Shuttle and Soyuz crewmembers, indicating that higher dynamic loads on landing and long-duration spaceflight do not significantly increase the risk of disc herniation. If no difference is shown between the two crewmember populations, then disc volume expansion due to microgravity does not significantly increase the risk of injury due to dynamic loads for deconditioned crewmembers. Any risk associated with deconditioning would be primarily due to bone structure changes and resulting bone strength changes. This study is an important first step in determining whether the spinal disc plays a role in injury due to dynamic loads.

  9. Herniated Disk

    MedlinePlus

    Your backbone, or spine, is made up of 26 bones called vertebrae. In between them are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep them in place. As you age, ...

  10. Herniated disk

    MedlinePlus

    ... diet and exercise are very important for improving back pain. Physical therapy is important for nearly everyone with ... with treatment. But you may have long-term back pain even after treatment. It may take several months ...

  11. Brain herniation

    MedlinePlus

    Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 406. Stippler M. Trauma of ...

  12. Dynamic risk control by human nucleus accumbens.

    PubMed

    Nachev, Parashkev; Lopez-Sosa, Fernando; Gonzalez-Rosa, Javier Jesus; Galarza, Ana; Avecillas, Josue; Pineda-Pardo, Jose Angel; Lopez-Ibor, Juan José; Reneses, Blanca; Barcia, Juan Antonio; Strange, Bryan

    2015-12-01

    Real-world decisions about reward often involve a complex counterbalance of risk and value. Although the nucleus accumbens has been implicated in the underlying neural substrate, its criticality to human behaviour remains an open question, best addressed with interventional methodology that probes the behavioural consequences of focal neural modulation. Combining a psychometric index of risky decision-making with transient electrical modulation of the nucleus accumbens, here we reveal profound, highly dynamic alteration of the relation between probability of reward and choice during therapeutic deep brain stimulation in four patients with treatment-resistant psychiatric disease. Short-lived phasic electrical stimulation of the region of the nucleus accumbens dynamically altered risk behaviour, transiently shifting the psychometric function towards more risky decisions only for the duration of stimulation. A critical, on-line role of human nucleus accumbens in dynamic risk control is thereby established. PMID:26428667

  13. Testing string dynamics in lepton nucleus reactions

    SciTech Connect

    Gyulassy, M.; Pluemer, M.

    1989-10-01

    The sensitivity of nuclear attenuation of 10-100 GeV lepton nucleus ({ell}A) reactions to space-time aspects of hadronization is investigated within the context of the Lund string model. We consider two mechanisms for attenuation in a nucleus: final state cascading and string flip excitations. Implications for the evolution of the energy density in nuclear collisions are discussed. 16 refs., 10 figs.

  14. Volumes of cochlear nucleus regions in rodents.

    PubMed

    Godfrey, Donald A; Lee, Augustine C; Hamilton, Walter D; Benjamin, Louis C; Vishwanath, Shilpa; Simo, Hermann; Godfrey, Lynn M; Mustapha, Abdurrahman I A A; Heffner, Rickye S

    2016-09-01

    The cochlear nucleus receives all the coded information about sound from the cochlea and is the source of auditory information for the rest of the central auditory system. As such, it is a critical auditory nucleus. The sizes of the cochlear nucleus as a whole and its three major subdivisions - anteroventral cochlear nucleus (AVCN), posteroventral cochlear nucleus (PVCN), and dorsal cochlear nucleus (DCN) - have been measured in a large number of mammals, but measurements of its subregions at a more detailed level for a variety of species have not previously been made. Size measurements are reported here for the summed granular regions, DCN layers, AVCN, PVCN, and interstitial nucleus in 15 different rodent species, as well as a lagomorph, carnivore, and small primate. This further refinement of measurements is important because the granular regions and superficial layers of the DCN appear to have some different functions than the other cochlear nucleus regions. Except for DCN layers in the mountain beaver, all regions were clearly identifiable in all the animals studied. Relative regional size differences among most of the rodents, and even the 3 non-rodents, were not large and did not show a consistent relation to their wide range of lifestyles and hearing parameters. However, the mountain beaver, and to a lesser extent the pocket gopher, two rodents that live in tunnel systems, had relative sizes of summed granular regions and DCN molecular layer distinctly larger than those of the other mammals. Among all the mammals studied, there was a high correlation between the size per body weight of summed granular regions and that of the DCN molecular layer, consistent with other evidence for a close relationship between granule cells and superficial DCN neurons. PMID:27435005

  15. Commissural axons of the mouse cochlear nucleus.

    PubMed

    Brown, M Christian; Drottar, Marie; Benson, Thane E; Darrow, Keith

    2013-05-01

    The axons of commissural neurons that project from one cochlear nucleus to the other were studied after labeling with anterograde tracer. Injections were made into the dorsal subdivision of the cochlear nucleus in order to restrict labeling only to the group of commissural neurons that gave off collaterals to, or were located in, this subdivision. The number of labeled commissural axons in each injection was correlated with the number of labeled radiate multipolar neurons, suggesting radiate neurons as the predominant origin of the axons. The radiate commissural axons are thick and myelinated, and they exit the dorsal acoustic stria of the injected cochlear nucleus to cross the brainstem in the dorsal half, near the crossing position of the olivocochlear bundle. They enter the opposite cochlear nucleus via the dorsal and ventral acoustic stria and at its medial border. Reconstructions of single axons demonstrate that terminations are mostly in the core and typically within a single subdivision of the cochlear nucleus. Extents of termination range from narrow to broad along both the dorsoventral (i.e., tonotopic) and the rostrocaudal dimensions. In the electron microscope, labeled swellings form synapses that are symmetric (in that there is little postsynaptic density), a characteristic of inhibitory synapses. Our labeled axons do not appear to include excitatory commissural axons that end in edge regions of the nucleus. Radiate commissural axons could mediate the broadband inhibition observed in responses to contralateral sound, and they may balance input from the two ears with a quick time course. PMID:23124982

  16. Improved Cloud Condensation Nucleus Spectrometer

    NASA Technical Reports Server (NTRS)

    Leu, Ming-Taun

    2010-01-01

    An improved thermal-gradient cloud condensation nucleus spectrometer (CCNS) has been designed to provide several enhancements over prior thermal- gradient counters, including fast response and high-sensitivity detection covering a wide range of supersaturations. CCNSs are used in laboratory research on the relationships among aerosols, supersaturation of air, and the formation of clouds. The operational characteristics of prior counters are such that it takes long times to determine aerosol critical supersaturations. Hence, there is a need for a CCNS capable of rapid scanning through a wide range of supersaturations. The present improved CCNS satisfies this need. The improved thermal-gradient CCNS (see Figure 1) incorporates the following notable features: a) The main chamber is bounded on the top and bottom by parallel thick copper plates, which are joined by a thermally conductive vertical wall on one side and a thermally nonconductive wall on the opposite side. b) To establish a temperature gradient needed to establish a supersaturation gradient, water at two different regulated temperatures is pumped through tubes along the edges of the copper plates at the thermally-nonconductive-wall side. Figure 2 presents an example of temperature and supersaturation gradients for one combination of regulated temperatures at the thermally-nonconductive-wall edges of the copper plates. c) To enable measurement of the temperature gradient, ten thermocouples are cemented to the external surfaces of the copper plates (five on the top plate and five on the bottom plate), spaced at equal intervals along the width axis of the main chamber near the outlet end. d) Pieces of filter paper or cotton felt are cemented onto the interior surfaces of the copper plates and, prior to each experimental run, are saturated with water to establish a supersaturation field inside the main chamber. e) A flow of monodisperse aerosol and a dilution flow of humid air are introduced into the main

  17. Intravenous contrast-enhanced CT of the postoperative lumbar spine: improved identification of recurrent disk herniation, scar, arachnoiditis, and diskitis

    SciTech Connect

    Teplick, J.G.; Haskin, M.E.

    1984-10-01

    Unsuccessful relief of symptoms after back surgery is usually attributable to hypertrophic extradural scar or recurrent herniated disk. Their clinical and myelographic differentiation is difficult, yet important because reoperation is not always beneficial for scar removal. This article examines the usefulness of intravenous contrast-enhanced computed tomography for this problem. Forty-five postsurgical patients were studied; eight had subsequent surgery. In the four with hypertrophic scars, intravenous contrast enhancement of the scar allowed its recognition in each case; in the four with hypertrophic scars, intravenous contrast enhancement of the scar allowed its recognition in each case; in the four with recurrent disk herniation, nonenhancement of the extruded disk allowed its recognition in three. In the other 37 patients who were not reoperated, 33 were believed to have scar on the basis of contrast enhancement. The method seems promising for more accurate evaluation of failed back surgery, including the recognition of diskitis.

  18. A craniocervical injury-induced syringomyelia caused by central canal dilation secondary to acquired tonsillar herniation. Case report.

    PubMed

    Takamura, Y; Kawasaki, T; Takahashi, A; Nunomura, K; Tiba, K; Hasunuma, M; Itou, T

    2001-07-01

    The authors report on a 19-year-old man with an acquired tonsillar herniation caused by a craniocervical junction injury in which serial magnetic resonance (MR) images demonstrated patent and isolated segments of the central canal participating in the dilation and then formation of a cervical syrinx. The patient was involved in a motor vehicle accident; he developed tonsillar herniation as a complication of subarachnoid and epidural hemorrhage, predominantly observed around the cisterna magna and upper cervical canal. Repeated MR images obtained over an 11-month period indicated the for mation and acute enlargement of the syrinx. Ten months after the accident, the patient presented with sensory disturbance in both upper extremities and spasticity due to syringomyelia. He underwent craniocervical decompressive surgery and doraplasty, which reduced the size of syringomyelia. The authors postulate that the patent central canal may play a role in determining the location of a syrinx remote from a focus of cerebrospinal fluid obstruction. PMID:11453413

  19. Idiopathic spinal cord herniation of the cervical cord: unusual cause of proximal muscle weakness in upper limbs.

    PubMed

    Rajapakse, Dilina; Mapara, Leah; Maniharan, Sathiyaseelan

    2016-01-01

    Idiopathic spinal cord herniation (ISCH) is a recognised rare cause of progressive and potentially curable myelopathy. Around 170 cases have been described in the literature, all to be found between the T2 and T8 vertebrae. We report a case of ISCH in the cervical region. A 23-year-old man with no history of trauma presented with a 6-year history of bilateral mild resting hand tremor and left scapular pain radiating to the left arm for a duration of 8 months. Nerve conduction studies showed some denervation changes of the upper limbs and bulbar regions. MRI of the spine showed anterior midline herniation of the spinal cord at the level of C7 vertebra with an associated collection of cerebrospinal fluid in the extradural space in the cervical region. Owing to the non-progressive nature of symptoms, currently the patient is managed conservatively. PMID:27190115

  20. Meckel’s diverticulum mesentery along with its band forming a hernial sac: A rare case of internal herniation

    PubMed Central

    Pandove, Paras K.; Moudgil, Ashish; Pandove, Megha; Chandrashekhar; Sharda, Divya; Sharda, Vijay K.

    2015-01-01

    Introduction Meckel’s diverticulum is the most common congenital gastrointestinal anomaly. However, only 2% of cases are symptomatic. It can cause intestinal obstruction by various mechanisms as volvulus, adhesions, Littre’s hernia, intussusception. Case presentation An unusual case of internal herniation of small bowel loops into complete hernia sac formed by unusual mesentery of Meckel’s diverticulum which was present upto the adhesive band, extending from tip of the Meckel’s diverticulum to the adjacent mesentery of small intestine leading to small bowel obstruction (SBO). Diverticulectomy with resection of adjacent ileum with ileo-ileal anastomosis was done. Discussion Internal herniation by MD leading to SBO is an extremely rare complication. In literature, cases of internal hernia through mesentry of Meckel’s diverticulum, through mesodiverticular band, adhesion of inflamed end of MD to corresponding base of mesentry, fibrous cord extending upto umblical wall have been reported but in our case, patient had both adhesion band along with internal herniation into sac formed by unusual mesentry of the meckel’s diverticulum and the adhesion band. Preoperative diagnosis is often difficult with only 6–12% of cases diagnosed correctly. Surgical intervention is indicated for patients with intestinal obstruction or high risk of incarceration. Conclusion Meckel’s diverticulum causing internal hernia is rare event. It’s presentation due to herniation of bowel loops into sac formed by mesentery attached to diverticulum and the adhesion is rarest, with non specific signs and symptoms. Early diagnosis and prompt treatment prevent further complications. PMID:25790912

  1. Clinical and Magnetic Resonance Imaging Factors Which May Predict the Need for Surgery in Lumbar Disc Herniation

    PubMed Central

    Motiei-Langroudi, Rouzbeh; Sadeghian, Homa

    2014-01-01

    Study Design Case-control. Purpose Evaluate clinical and imaging factors which may predict the risk of failure of medical therapy in patients with lumbar disc herniation (LDH). Overview of Literature LDH is a common cause of low back pain and radicular leg pain, with a generally favorable natural course. At present, however, it is not possible to identify patients who may be candidates for surgery in an early stage of their disease by means of clinical signs or diagnostic imaging criteria. Methods We designed a study investigating patients with untreated low back pain to assess the predictive value of demographic, clinical or imaging findings in identifying patients who finally would meet the classic current criteria for surgery. Results Among 134 patients, 80.6% were successfully treated with conservative therapy and 19.4% finally underwent surgery. Sex, occupation, involved root level, presence of Modic changes, osteophytes or annular tears were not significantly different between the 2 groups, while cerebrospinal fluid block, Pfirrmann's grade, location of herniation with regard to the midline, and type of herniation were significantly different. Anteroposterior fragment size was significantly higher and intervertebral foramen height and thecal sac diameters were significantly lower in the surgical group. Conclusions Although it is strongly recommended to practice conservative management at first for patients with LDH symptoms, the results of this study shows that higher Pfirrmann's grade, more laterally located discs, extrusion and protrusion herniation types, and larger fragments could predict the risk of conservative treatment failure. This way, unnecessarily prolonged conservative management (beyond 4-8 weeks) may be precluded. PMID:25187861

  2. One stage laminoplasty and posterior herniotomy for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation

    PubMed Central

    Yue, Bin; Chen, Bohua; Ma, Xue-Xiao; Xi, Yong-Ming; Xiang, Hong-Fei; Hu, You-Gu; Zhang, Guoqing

    2015-01-01

    The aim of the study was to introduce a method of one stage laminoplasty and posterior herniotomy for myelopathy caused by cervical stenosis with cervical disc herniation and to evaluate the clinical efficacy of this surgery. From 1999 to 2008, 18 patients with myelopathy caused by cervical stenosis with cervical disc herniation who underwent this procedure were included. The average age was 63 years (range 48-74 years), and the average follow-up period was 46 months (range 3-108 months). Neurologic status was evaluated using the JOA scoring system. Neurological symptoms improvement was seen in all patients after surgery. The average JOA score was 14.22±1.86 by final follow-up, which was higher than preoperative values (P<0.01), and the average improvement in neurological function was 76.63%. Neurologic examination showed that excellent results had been obtained by 10 patients, good results by 8 patients, with no fair or poor results. 2 patients developed cerebrospinal fluid leakage after surgery and recovered during the follow-up period. One patient with cervical disc herniation developed postoperative C5 palsy on the axle side on the third day after surgery. She completely recovered by 1 month after surgery. No other patients experienced postoperative neurologic complications. Complete anterior and posterior decompression of the spinal cord was achieved after surgery. We concluded that one stage laminoplasty and posterior herniotomy is an effective, reliable, and safe procedure for the treatment of myelopathy caused by cervical stenosis with cervical disc herniation. PMID:26309625

  3. Cough-induced rib fracture and diaphragmatic rupture resulting in simultaneous abdominal visceral herniation into the left hemithorax and subcutaneously.

    PubMed

    Daniel, Romany; Naidu, Babu; Khalil-Marzouk, Joseph

    2008-10-01

    Violent coughing is associated with a multitude of complications including rib fractures and diaphragmatic rupture. In this report we present a case of a 70-year-old male with the rare combination of both complications resulting in herniation of bowel into the left hemithorax and subcutaneously between the separated ribs. Surgical repair was performed via a left thoracotomy, the hernia reduced and the diaphragmatic and chest wall defect repaired primarily with excellent patient recovery and relief of symptoms. PMID:18715797

  4. Lumbar extension exercises in conjunction with mechanical traction for the management of a patient with a lumbar herniated disc.

    PubMed

    Gagne, Allison R; Hasson, Scott M

    2010-05-01

    Low back pain resulting from lumbar disc herniation is a common reason for referral for physical therapy. There is no evidence to support the management of lumbar disc herniation and derangement using mechanical traction combined with lumbar extension exercises. Therefore, the purpose of this case report was to describe and discuss the use of mechanical traction in conjunction with lumbar extension exercises for a patient with a lumbar herniated disc. The patient was a 49-year-old male referred to physical therapy with a medical diagnosis of a lumbar herniated disc at L5-S1 with compression of the L5 nerve root confirmed by MRI. The patient's chief complaint was pain over the left lumbosacral and central lumbar region with radiating pain into the left buttock accompanied by numbness and tingling in the left lower leg and foot. The patient was seen for a total of 14 visits. The first 5 days (2 weeks) of therapy consisted of lumbar extension exercises. For the following nine visits (over a 3-week period), mechanical traction was added as an adjunct to the extension exercises. Outcome measures included the Oswestry Disability Questionnaire, Back Pain Function Scale (BPFS), and the Numeric Pain Rating Scale (NPRS). Results from initial evaluation to discharge (Oswestry: 36% to 0%; BPFS: 33/60 to 57/60; NPRS: 7/10 to 0/10) demonstrated that the patient no longer experienced low back pain and improved in terms of functional status and pain-related disability. The patient no longer complained of numbness and tingling in the left lower extremity and the goals for the patient had been attained. The data from this case report suggests lumbar extension exercises in conjunction with mechanical traction facilitated the patient's improvement in pain and return to prior level of function. PMID:20397860

  5. Describing a new syndrome in L5-S1 disc herniation: Sexual and sphincter dysfunction without pain and muscle weakness

    PubMed Central

    Akca, Nezih; Ozdemir, Bulent; Kanat, Ayhan; Batcik, Osman Ersagun; Yazar, Ugur; Zorba, Orhan Unal

    2014-01-01

    Context: Little seems to be known about the sexual dysfunction (SD) in lumbar intervertebral disc herniation. Aims: Investigation of sexual and sphincter dysfunction in patient with lumbar disc hernitions. Settings and Design: A retrospective analysis. Materials and Methods: Sexual and sphincter dysfunction in patients admitted with lumbar disc herniations between September 2012-March 2014. Statistical Analysis Used: Statistical analysis was performed using the Predictive Analytics SoftWare (PASW) Statistics 18.0 for Windows (Statistical Package for the Social Sciences, SPSS Inc., Chicago, Illinois). The statistical significance was set at P < 0.05. The Wilcoxon signed ranks test was used to evaluate the difference between patients. Results: Four patients with sexual and sphincter dysfunction were found, including two women and two men, aged between 20 and 52 years. All of them admitted without low back pain. In addition, on neurological examination, reflex and motor deficit were not found. However, almost all patients had perianal sensory deficit and sexual and sphincter dysfunction. Magnetic resonance imaging (MRI) of three patients displayed a large extruded disc fragment at L5-S1 level on the left side. In fourth patient, there were not prominent disc herniations. There was not statistically significant difference between pre-operative and post-operative sexual function, anal-urethral sphincter function, and perianal sensation score. A syndrome in L5-S1 disc herniation with sexual and sphincter dysfunction without pain and muscle weakness was noted. We think that it is crucial for neurosurgeons to early realise that paralysis of the sphincter and sexual dysfunction are possible in patients with lumbar L5-S1 disc disease. Conclusion: A syndrome with perianal sensory deficit, paralysis of the sphincter, and sexual dysfunction may occur in patients with lumbar L5-S1 disc disease. The improvement of perianal sensory deficit after surgery was counteracted by a trend

  6. Clinical diagnosis and surgical management of diaphragmatic retroperitoneal perirenal fat and kidney herniation in a pet rabbit.

    PubMed

    Wu, Ruey-Shyuan; Chu, Che-Chu; Wang, Hsien-Chi; Chen, Kuan-Sheng

    2016-06-15

    CASE DESCRIPTION A 6-year-old 2.08-kg (4.58-lb) neutered male Lionhead-mix pet rabbit (Oryctolagus cuniculus) was examined because of sneezing and increased respiratory effort. CLINICAL FINDINGS On the basis of the rabbit's radiographic findings, a diagnosis of diaphragmatic retroperitoneal perirenal fat and kidney herniation was made. Nine months later, physical examination revealed increased respiratory rate and effort and slightly decreased body weight. Thoracic radiography revealed decreased lung aeration and further craniomedial displacement of the right kidney, compared with the initial evaluation findings, suggesting progressive herniation of the retroperitoneal perirenal fat. TREATMENT AND OUTCOME During exploratory celiotomy, a tear in the right dorsal tendinous portion of the diaphragm was noted. The right kidney and perirenal fat were found to be displaced into the thorax. Diaphragmatic herniorrhaphy was performed after replacement of the right kidney and the perirenal fat in the retroperitoneal space. The rabbit recovered uneventfully from anesthesia and surgery. Clinical signs did not recur during the following 16 months. CLINICAL RELEVANCE For rabbits with increased respiratory effort, diaphragmatic retroperitoneal perirenal fat and kidney herniation should be included as a differential diagnosis. As illustrated by the case described in this report, appropriate surgical management can provide a successful outcome for affected pet rabbits. PMID:27270063

  7. Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

    PubMed

    Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

    2016-07-01

    We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary. PMID:27380604

  8. Feasibility and Efficacy of Percutaneous Lateral Lumbar Discectomy in the Treatment of Patients with Lumbar Disc Herniation: A Preliminary Experience

    PubMed Central

    Jiang, Wenjin; Sun, Bolin; Sheng, Qirui; Song, Xuepeng; Zheng, Yanbo; Wang, Ligang

    2015-01-01

    Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation. Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Association score. Results. The surgery was performed successfully in all patients (102 males and 81 females aged from 21 to 66 years) with a mean 16.6-month follow-up (range from 26 to 65 months). No postoperative complications, including intestinal and vascular complications, nerve injuries, and postoperative infections, were associated with PLLD. At one month after surgery, visual analog scale (3.12±1.44 versus 6.76±2.31, P<0.05) was significantly lower than the baseline and was sustained until 24 months after surgery (3.25 ± 1.78 versus 6.76±2.31, P<0.05). Besides that, Japanese Orthopaedic Association score (25.25±3.21 versus 11.78±2.38, P<0.05) was increased when compared to the baseline. Conclusions. PLLD was a promising, mini-invasive, and effective treatment for lumber disc herniation. PMID:25695066

  9. Spontaneous secretion of interleukin 1 receptor antagonist (IL-1ra) by cells isolated from herniated lumbar discal tissue after discectomy.

    PubMed

    Koch, H; Reinecke, J A; Meijer, H; Wehling, P

    1998-09-01

    In the study presented, cells of a herniated lumbar disc were cultivated in vitro and analysed for interleukin 1beta (IL-1beta) and interleukin 1 receptor antagonist (IL-1Ra) production. The objective of this study was the detection of IL-1beta and IL-1Ra secreted by herniated lumbar discal cells after discectomy. The involvement of cytokines in the degeneration of intervertebral discs and in the pathophysiology of radiculopathy is established. Antagonizing proteins, e.g. IL-1Ra are thought to have considerable therapeutic potential. In the present study, a 51-year-old male with massive sequestrated lumbar disc herniation at L5/S1 was treated by microsurgical discectomy. Discal cells were isolated, cultures and culture supernatants immunochemically analysed for IL-1beta and IL-1Ra secretion. Spontaneous secretion of IL-1Ra was found. IL-1beta was not detected. Our findings might contradict recent studies on the role of IL-1beta and IL-1Ra. A possible therapeutic role of exogenous IL-1Ra in disc degeneration needs further research. PMID:9770331

  10. Computer program for parameterization of nucleus-nucleus electromagnetic dissociation cross sections

    NASA Technical Reports Server (NTRS)

    Norbury, John W.; Townsend, Lawrence W.; Badavi, Forooz F.

    1988-01-01

    A computer subroutine parameterization of electromagnetic dissociation cross sections for nucleus-nucleus collisions is presented that is suitable for implementation in a heavy ion transport code. The only inputs required are the projectile kinetic energy and the projectile and target charge and mass numbers.

  11. A Model of Comet Nucleus Rotation

    NASA Astrophysics Data System (ADS)

    Keller, H. U.; Jorda, L.; Rickman, H.; Thomas, N.

    2000-10-01

    Modelling cometary rotation is of particular interest for the preparation of space missions to comets. For example, the mapping phase during the ROSETTA mission must be planned keeping in mind that, unlike most asteroids, the rotational state of most short-period comets might be complex (excited). The modelling of cometary nucleus rotation can also provide us with important parameters that are needed to interpret coma structures or to build time-dependent thermal models of the nucleus. We combine a general three-dimensional model for the nucleus shape, surface properties, and insolation with a simplified thermal model to calculate the local time-dependent activity and consequently the non-gravitational forces acting on the nucleus. The torque of this force is then used to numerically solve the forced Euler equations for a homogeneously outgassing irregularly-shaped cometary nucleus. We will discuss the results of our model for comets 46P/Wirtanen, the target of the ROSETTA mission, and 19P/Borrelly, the target of DEEP-SPACE 1 and derive some generalized inferences.

  12. Protein quality control in the nucleus.

    PubMed

    Jones, Ramon D; Gardner, Richard G

    2016-06-01

    The nucleus is the repository for the eukaryotic cell's genetic blueprint, which must be protected from harm to ensure survival. Multiple quality control (QC) pathways operate in the nucleus to maintain the integrity of the DNA, the fidelity of the DNA code during replication, its transcription into mRNA, and the functional structure of the proteins that are required for DNA maintenance, mRNA transcription, and other important nuclear processes. Although we understand a great deal about DNA and RNA QC mechanisms, we know far less about nuclear protein quality control (PQC) mechanisms despite that fact that many human diseases are causally linked to protein misfolding in the nucleus. In this review, we discuss what is known about nuclear PQC and we highlight new questions that have emerged from recent developments in nuclear PQC studies. PMID:27015023

  13. Interpretive monitoring in the caudate nucleus

    PubMed Central

    Yanike, Marianna; Ferrera, Vincent P

    2014-01-01

    In a dynamic environment an organism has to constantly adjust ongoing behavior to adapt to a given context. This process requires continuous monitoring of ongoing behavior to provide its meaningful interpretation. The caudate nucleus is known to have a role in behavioral monitoring, but the nature of these signals during dynamic behavior is still unclear. We recorded neuronal activity in the caudate nucleus in monkeys during categorization behavior that changed rapidly across contexts. We found that neuronal activity maintained representation of the identity and context of a recently categorized stimulus, as well as interpreted the behavioral meaningfulness of the maintained trace. The accuracy of this cognitive monitoring signal was highest for behavior for which subjects were prone to make errors. Thus, the caudate nucleus provides interpretive monitoring of ongoing behavior, which is necessary for contextually specific decisions to adapt to rapidly changing conditions. DOI: http://dx.doi.org/10.7554/eLife.03727.001 PMID:25415238

  14. Uncovering the Nucleus Candidate for NGC 253

    NASA Astrophysics Data System (ADS)

    Günthardt, G. I.; Agüero, M. P.; Camperi, J. A.; Díaz, R. J.; Gomez, P. L.; Bosch, G.; Schirmer, M.

    2015-11-01

    NGC 253 is the nearest spiral galaxy with a nuclear starburst that becomes the best candidate for studying the relationship between starburst and active galactic nucleus activity. However, this central region is veiled by large amounts of dust, and it has been so far unclear which is the true dynamical nucleus to the point that there is no strong evidence that the galaxy harbors a supermassive black hole co-evolving with the starburst as was supposed earlier. Near-infrared (NIR) spectroscopy, especially NIR emission line analysis, could be advantageous in shedding light on the true nucleus identity. Using Flamingos-2 at Gemini South we have taken deep K-band spectra along the major axis of the central structure and through the brightest infrared source. In this work, we present evidence showing that the brightest NIR and mid-infrared source in the central region, already known as radio source TH7 and so far considered just a large stellar supercluster, in fact presents various symptoms of a genuine galactic nucleus. Therefore, it should be considered a valid nucleus candidate. Mentioning some distinctive aspects, it is the most massive compact infrared object in the central region, located at 2.″0 of the symmetry center of the galactic bar, as measured in the K-band emission. Moreover, our data indicate that this object is surrounded by a large circumnuclear stellar disk and it is also located at the rotation center of the large molecular gas disk of NGC 253. Furthermore, a kinematic residual appears in the H2 rotation curve with a sinusoidal shape consistent with an outflow centered in the candidate nucleus position. The maximum outflow velocity is located about 14 pc from TH7, which is consistent with the radius of a shell detected around the nucleus candidate, observed at 18.3 μm (Qa) and 12.8 μm ([Ne ii]) with T-ReCS. Also, the Brγ emission line profile shows a pronounced blueshift and this emission line also has the highest equivalent width at this

  15. Sigma-nucleus potential in A=28.

    PubMed

    Noumi, H; Saha, P K; Abe, D; Ajimura, S; Aoki, K; Bhang, H C; Endo, T; Fujii, Y; Fukuda, T; Guo, H C; Imai, K; Hashimoto, O; Hotchi, H; Kim, E H; Kim, J H; Kishimoto, T; Krutenkova, A; Maeda, K; Nagae, T; Nakamura, M; Outa, H; Sekimoto, M; Saito, T; Sakaguchi, A; Sato, Y; Sawafta, R; Shimizu, Y; Takahashi, T; Tang, L; Tamura, H; Tanida, K; Watanabe, T; Xia, H H; Zhou, S H; Zhu, L H; Zhu, X F

    2002-08-12

    We have studied the (pi(-),K+) reaction on a silicon target to investigate the sigma-nucleus potential. The inclusive spectrum was measured at a beam momentum of 1.2 GeV/c with an energy resolution of 3.3 MeV (FWHM) by employing the superconducting kaon spectrometer system. The spectrum was compared with theoretical calculations within the framework of the distorted-wave impulse approximation, which demonstrates that a strongly repulsive sigma-nucleus potential with a nonzero size of the imaginary part reproduces the observed spectrum. PMID:12190516

  16. Nucleus model for periodic Comet Tempel 2

    NASA Technical Reports Server (NTRS)

    Sekanina, Zdenek

    1991-01-01

    Observational data obtained primarily during 1988 are analyzed and synthesized to develop a comprehensive physical model for the nucleus of Periodic Comet Tempel 2, one of the best studied members of Jupiter's family of short-period comets. It is confirmed that a previous investigation provided reliable information on the comet's spin-axis orientation, which implies and obliquity of 54 degrees of the orbit plane to the equatorial plane and which appears to have varied little - if at all - with time. This conclusion is critical for fitting a triaxial ellipsoid to approximate the figure of the nucleus.

  17. Facet tropism: possible role in the pathology of lumbar disc herniation in adolescents.

    PubMed

    Wang, Honggang; Zhou, Yue

    2016-07-01

    OBJECTIVE The role of facet tropism (FT) in lumbar disc herniation (LDH) is ambiguous. The present study aimed to investigate the association between FT and LDH in adolescents. METHODS This study included 65 adolescents with LDH with 1- or 2-level LDH, or both. Facet angles were measured with MRI. FT was defined as asymmetry of 10° between the left and right side. The same levels of 30 healthy persons who had no lumbar lesions were used as controls. Statistical analysis was performed using the chi-square test. RESULTS FT was identified in 16 of 39 patients with LDH in L4-5 and in 3 of 30 controls (p = 0.006, OR 6.261, 95% CI 1.619-24.217). It was also identified in 12 of 27 patients with LDH in L5-S1 and in 4 of 30 controls (p = 0.017, OR 5.200, 95% CI 1.420-19.039). One patient had LDH in both L4-5 and L5-S1. CONCLUSIONS FT is associated with LDH in both L4-5 and L5-S1 levels in adolescents. PMID:26942268

  18. Clinical Effect of Acupotomy Combined with Korean Medicine: A Case Series of a Herniated Intervertebral Disc.

    PubMed

    Kim, Hyun-ji; Jeon, Ju-hyun; Kim, Young-il

    2016-02-01

    The aim of this study is to evaluate the effect of acupotomy for treating patients with a herniated intervertebral disc (HIVD). This case series includes five HIVD patients who were treated at the Department of Acupuncture and Moxibustion, Daejeon University Dunsan Korean Hospital, Daejeon, Korea, from January 2015 to April 2015. Acupotomy was performed three times over a 2-week period, along with Korean medical treatment. The outcomes were evaluated by using a numeric rating scale (NRS), physical examination, the Oswestry Low Back Pain Disability Index (ODI), the Short-Form 36-Item Health Survey (SF-36), and the Surgical Safety Checklist. The NRS and physical examination results, as well as the ODI scores, were improved in all cases. No significant differences were noted on the SF-36. No patients had any adverse effects. This study, with its findings of encouraging responses in reducing low back pain and radiating pain and in recovering the kinetic state of soft tissue, supports the potential use of acupotomy for the treatment of patients suffering from HIVD. PMID:26896075

  19. A retrospective study of intervertebral disc herniation in dogs in Japan: 297 cases.

    PubMed

    Itoh, Hisanori; Hara, Yasushi; Yoshimi, Natsuko; Harada, Yasuji; Nezu, Yoshinori; Yogo, Takuya; Ochi, Hiroki; Hasegawa, Daisuke; Orima, Hiromitsu; Tagawa, Masahiro

    2008-07-01

    We investigated the epidemiological characteristics of intervertebral disc herniation (IVDH) in Japan in a large population using a retrospective study. The sample population was dogs (n=297) with IVDH in Japan. Medical records were reviewed for breed, sex, age, affected interspace and neurological severity. The dogs were comprised of 132 cases of cervical IVDH (C-IVDH) and 165 cases of thoracolumbar IVDH (TL-IVDH). In Japan, the Dachshund, Beagle and Shih Tzu tended to suffer from both C-IVDH and TL-IVDH. The Shiba Inu, a characteristic Japanese dog breed, suffered from both C-IVDH and TL-IVDH, although there was little data relating to the whole breed. Male dogs tended to suffer from C-IVDH and TL-IVDH at a rate almost twice that of females in Japan. Among the three predominant dog breeds, the Dachshund, Beagle and Shih Tzu, the Dachshund tended to suffer from both C-IVDH and TL-IVDH at an earlier age than the Beagle, and the Beagle tended to suffer from both C-IVDH and TL-IVDH earlier than the Shih Tzu. Among the three predominant breeds, the Shih Tzu, in particular, tended to suffer from both C-IVDH and TL-IVDH at multiple sites. Our data from Japan were in partial agreement with previous data from the U.S.A., and epidemiological characteristics of IVDH peculiar to Japan were also identified. PMID:18685242

  20. Risk factors for diskospondylitis in dogs after spinal decompression surgery for intervertebral disk herniation.

    PubMed

    Canal, Sara; Contiero, Barbara; Balducci, Federica; Calò, Pietro; Bernardini, Marco

    2016-06-15

    OBJECTIVE To determine the incidence of and risk factors for development of postoperative diskospondylitis (POD) in dogs that underwent spinal decompression surgery for intervertebral disk herniation (IVDH). DESIGN Retrospective single cohort study. ANIMALS 372 dogs that underwent spinal decompression surgery for IVDH between January 2007 and January 2011. PROCEDURES Medical records of dogs were retrospectively reviewed. Data regarding signalment, type and anatomic site of IVDH, severity of neurologic signs, type of surgery, duration of anesthesia, esophageal temperature during surgery, and use of corticosteroid drugs were analyzed for associations with POD. RESULTS POD developed in 8 of 372 (2.2%) dogs. Univariate analysis revealed that German Shepherd Dogs had 9.8 times the odds of POD, compared with the odds for other breeds. In addition, dogs > 8.8 years of age, weighing > 20 kg (44 lb), or having disk protrusions were at higher risk of developing POD than were other dogs. The only factor that retained a significant association with POD after controlling for other factors in multivariate analysis was body weight > 20 kg. CONCLUSIONS AND CLINICAL RELEVANCE Factors identified in this study may be useful for prediction of POD, an apparently uncommon outcome, in dogs undergoing spinal decompression surgery for IVDH. Dogs at higher risk than others, particularly those weighing > 20 kg, should be monitored carefully in the immediate postoperative period, and signs of worsening neurologic condition after initial improvement should be promptly investigated. PMID:27270060

  1. A review of current treatment for lumbar disc herniation in children and adolescents

    PubMed Central

    Liu, Zhongjun

    2009-01-01

    Lumbar disc herniation (LDH) is a common disorder among adults with degenerated lumbar intervertebral discs. However, its occurrence in childhood and adolescence is much less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults. This difference indicates that children and adolescents are far from being just little adults. Over the years, there have constantly been published studies concerning this entity where the findings suggested that pediatric LDH is, in many ways, different from that in adults. To date, the prevalence, the etiological and the diagnostic features of pediatric LDH have been fully described in the literature whereas the characteristics regarding to the treatment is yet to be reviewed in details. The aim of the present review is to provide a collective opinion on the treatment of pediatric LDH as well as its outcome. It reviewed the relevant information available in the literature and compared the results among and within various treatments. It was found that pediatric patients responded less favorably to conservative treatment as compared with adults. In addition, the outcome of surgery remained to be satisfactory for at least 10 years after the initial operation, even though it appeared to deteriorate slightly. To the best of our knowledge, this is the first literature review focusing on the treatment of pediatric LDH. PMID:19890666

  2. [Treatment of lumbar disk herniation with depot cortisone intrathecally and peridurally (author's transl)].

    PubMed

    Kneissel, H

    1976-09-10

    During an operation for lumbar disk herniation, 160 patients were injected - intrathecally and peridurally, against the affected nerve root - one ampoule of Volon A40. The postoperative course was compared to that stated in 160 patients who had been operated in the same way without this medication. The irritation of the spinal root effected by the disk prolapse and the manipulation during the operation was immediately influenced in a favourable manner by Volon A40. The patients had no more complaints from the first postoperative day on. Mobilization of the patient could be started about three to four days earlier. During recurrency operations, the root did not show any adhesions. Prevention of postoperative cicatrization around the root appears to be an essential condition for a permanent state without complaints. The percutaneous intrathecal and peridural application of Volon A40 has proved to be efficacious in cases of lumbar root irritation, which can neither be treated surgically nor be influenced by a physical therapy. PMID:134249

  3. Efficacy of Transforaminal Endoscopic Spine System (TESSYS) Technique in Treating Lumbar Disc Herniation.

    PubMed

    Pan, Zhimin; Ha, Yoon; Yi, Seong; Cao, Kai

    2016-01-01

    BACKGROUND To compare efficacy and safety of percutaneous transforaminal endoscopic spine system (TESSYS) and traditional fenestration discectomy (FD) in treatment of lumbar disc herniation (LDH). MATERIAL AND METHODS A total of 106 LDH patients were divided into TESSYS group (n=48) and FD group (n=58). Visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and modified MacNab criteria were used for efficacy evaluation. Post-operative responses were compared by enzyme-linked immunosorbent assay (ELISA) based on detection of serum IL-6, CRP, and CPK levels. RESULTS In the TESSYS group, compared with the FD group, we observed, shorter incision length, less blood loss, shorter hospital stay, lower hospitalization cost, shorter recovery time, lower complication rate (all P<0.001), and lower VAS scores of lumbago and skelalgia at 3 days and 1, 3, and 6 months postoperatively (all P<0.05). At 24 and 48 h postoperatively, CRP level was remarkably higher in the FD group compared to the TESSYS group (P<0.001). Further, comparison of IL-6 levels at 6, 12, 24, and 48 h postoperatively revealed significantly higher levels in the FD group than in the FESSYS group (all P<0.001). CONCLUSIONS TESSYS had clinical advantages over FD and entails less trauma and quicker postoperative recovery, suggesting that TESSYS is well tolerated by patients and is a better approach than FD in surgical treatment of LDH. PMID:26887645

  4. The outcome of lumbar disc herniation surgery is worse in old adults than in young adults.

    PubMed

    Strömqvist, Fredrik; Strömqvist, Björn; Jönsson, Bo; Karlsson, Magnus K

    2016-10-01

    Background and purpose - The outcome of surgical treatment of lumbar disc herniation (LDH) has been thoroughly evaluated in middle-aged patients, but less so in elderly patients. Patients and methods - With validated patient-reported outcome measures (PROMs) and using SweSpine (the national Swedish Spine Surgery Register), we analyzed the preoperative clinical status of LDH patients and the 1-year postoperative outcome of LDH surgery performed over the period 2000-2012. We included 1,250 elderly patients (≥ 65 years of age) and 12,840 young and middle-aged patients (aged 20-64). Results - Generally speaking, elderly patients were referred for LDH surgery with worse PROM scores than young and middle-aged patients, they improved less by surgery, they experienced more complications, they had inferior 1-year postoperative PROM scores, and they were less satisfied with the outcome (with all differences being statistically significant). Interpretation - Elderly patients appear to have a worse postoperative outcome after LDH surgery than young and middle-aged patients, they are referred to surgery with inferior clinical status, and they improve less after the surgery. PMID:27391663

  5. Efficacy of Transforaminal Endoscopic Spine System (TESSYS) Technique in Treating Lumbar Disc Herniation

    PubMed Central

    Pan, Zhimin; Ha, Yoon; Yi, Seong; Cao, Kai

    2016-01-01

    Background To compare efficacy and safety of percutaneous transforaminal endoscopic spine system (TESSYS) and traditional fenestration discectomy (FD) in treatment of lumbar disc herniation (LDH). Material/Methods A total of 106 LDH patients were divided into TESSYS group (n=48) and FD group (n=58). Visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and modified MacNab criteria were used for efficacy evaluation. Post-operative responses were compared by enzyme-linked immunosorbent assay (ELISA) based on detection of serum IL-6, CRP, and CPK levels. Results In the TESSYS group, compared with the FD group, we observed, shorter incision length, less blood loss, shorter hospital stay, lower hospitalization cost, shorter recovery time, lower complication rate (all P<0.001), and lower VAS scores of lumbago and skelalgia at 3 days and 1, 3, and 6 months postoperatively (all P<0.05). At 24 and 48 h postoperatively, CRP level was remarkably higher in the FD group compared to the TESSYS group (P<0.001). Further, comparison of IL-6 levels at 6, 12, 24, and 48 h postoperatively revealed significantly higher levels in the FD group than in the FESSYS group (all P<0.001). Conclusions TESSYS had clinical advantages over FD and entails less trauma and quicker postoperative recovery, suggesting that TESSYS is well tolerated by patients and is a better approach than FD in surgical treatment of LDH. PMID:26887645

  6. Outcome of surgical treatment of lumbar disc herniation in young individuals.

    PubMed

    Strömqvist, F; Strömqvist, B; Jönsson, B; Gerdhem, P; Karlsson, M K

    2015-12-01

    Lumbar disc herniation (LDH) is uncommon in youth and few cases are treated surgically. Very few outcome studies exist for LDH surgery in this age group. Our aim was to explore differences in gender in pre-operative level of disability and outcome of surgery for LDH in patients aged ≤ 20 years using prospectively collected data. From the national Swedish SweSpine register we identified 180 patients with one-year and 108 with two-year follow-up data ≤ 20 years of age, who between the years 2000 and 2010 had a primary operation for LDH. Both male and female patients reported pronounced impairment before the operation in all patient reported outcome measures, with female patients experiencing significantly greater back pain, having greater analgesic requirements and reporting significantly inferior scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects of Short Form-36 and Oswestry Disabilities Index, when compared with male patients. Surgery conferred a statistically significant improvement in all registered parameters, with few gender discrepancies. Quality of life at one year following surgery normalised in both males and females and only eight patients (4.5%) were dissatisfied with the outcome. Virtually all parameters were stable between the one- and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in both male and female patients aged 20 years or younger, who failed to recover after non-operative management. PMID:26637684

  7. Projections of the sensory trigeminal nucleus in a percomorph teleost, tilapia (Oreochromis niloticus).

    PubMed

    Xue, Hao-Gang; Yamamoto, Naoyuki; Yang, Chun-Ying; Kerem, Gulnisa; Yoshimoto, Masami; Sawai, Nobuhiko; Ito, Hironobu; Ozawa, Hitoshi

    2006-03-20

    The sensory trigeminal nucleus of teleosts is the rostralmost nucleus among the trigeminal sensory nuclear group in the rhombencephalon. The sensory trigeminal nucleus is known to receive the somatosensory afferents of the ophthalmic, maxillar, and mandibular nerves. However, the central connections of the sensory trigeminal nucleus remain unclear. Efferents of the sensory trigeminal nucleus were examined by means of tract-tracing methods, in a percomorph teleost, tilapia. After tracer injections to the sensory trigeminal nucleus, labeled terminals were seen bilaterally in the ventromedial thalamic nucleus, periventricular pretectal nucleus, medial part of preglomerular nucleus, stratum album centrale of the optic tectum, ventrolateral nucleus of the semicircular torus, lateral valvular nucleus, prethalamic nucleus, tegmentoterminal nucleus, and superior and inferior reticular formation, with preference for the contralateral side. Labeled terminals were also found bilaterally in the oculomotor nucleus, trochlear nucleus, trigeminal motor nucleus, facial motor nucleus, facial lobe, descending trigeminal nucleus, medial funicular nucleus, and contralateral sensory trigeminal nucleus and inferior olive. Labeled terminals in the oculomotor nucleus and trochlear nucleus showed similar densities on both sides of the brain. However, labelings in the trigeminal motor nucleus, facial motor nucleus, facial lobe, descending trigeminal nucleus, and medial funicular nucleus showed a clear ipsilateral dominance. Reciprocal tracer injection experiments to the ventromedial thalamic nucleus, optic tectum, and semicircular torus resulted in labeled cell bodies in the sensory trigeminal nucleus, with a few also in the descending trigeminal nucleus. PMID:16440296

  8. Nucleus-nucleus interactions between 20 and 65 GeV per nucleon

    NASA Technical Reports Server (NTRS)

    Burnett, T. H.; Derrickson, J. H.; Fountain, W. F.; Meegan, C. A.; Parnell, T. A.; Roberts, F. E.; Watts, J. W.; Oda, H.; Takahashi, Y.; Jones, W. V.

    1987-01-01

    A hybrid electronic-counter/emulsion-chamber instrument was exposed to high-energy cosmic rays on a balloon. The data on 105 nucleus-nucleus collisions in the energy range 20-65 GeV/nucleon and for incident nuclear charges Zp in the range of 22 to 28 are presented. Inclusive characteristics of particle production on different targets (plastic, emulsion, and lead) are shown and compared with models based on the superposition of nucleon-nucleus interactions. Features of a subset of the more central collisions with a plastic target and some characteristics of individual events with the highest multiplicity of produced particles are described.

  9. Compound nucleus studies withy reverse kinematics

    SciTech Connect

    Moretto, L.G.

    1985-06-01

    Reverse kinematics reactions are used to demonstrate the compound nucleus origin of intermediate mass particles at low energies and the extension of the same mechanism at higher energies. No evidence has appeared in our energy range for liquid-vapor equilibrium or cold fragmentation mechanisms. 11 refs., 12 figs.

  10. Coherent elastic neutrino-nucleus scattering

    NASA Astrophysics Data System (ADS)

    Scholberg, Kate

    2015-05-01

    I describe physics potential and experimental prospects for coherent elastic neutrino-nucleus scattering (CEvNS), a process which has not yet been observed. Germanium- based detectors represent a promising technology for CEvNS experiments. I focus primarily on stopped-pion neutrino sources.

  11. Transport model of nucleon-nucleus reaction

    NASA Technical Reports Server (NTRS)

    Wilson, J. W.; Townsend, L. W.; Cucinotta, F. A.

    1986-01-01

    A simplified model of nucleon-nucleus reaction is developed and some of its properties are examined. Comparisons with proton production measured for targets of Al-27, Ni-58, Zr-90, and Bi-209 show some hope for developing an accurate model for these complex reactions. It is suggested that binding effects are the next step required for further development.

  12. The Checkerboard Model of the Nucleus

    NASA Astrophysics Data System (ADS)

    Lach, Theodore

    2015-04-01

    The Checker Board Model (CBM) of the nucleus and the associated extended standard model predicts that nature has 5 generations of quarks not 3 and that Nucleus is 2 dimensional. The CBM theory began with an insight into the structure of the He nucleus around the year 1989. Details of how this theory evolved which took many years, and is found on my web site (http://checkerboard.dnsalias.net) or in the following references One independent check of this model is that the wavelength of the ``up'' quark orbiting inside the proton at 84.8123% the speed of light (around the ``dn'' quark in the center of the proton) turns out to be exactly one de Broglie wavelength something determined after the mass and speed of the up quark were determined by other means. This theory explains the mass of the proton and neutron and their magnetic moments and this along with the beautiful symmetric 2D structure of the He nucleus led to the evolution of this theory. When this theory was first presented at Argonne in 1996, it was the first time that anyone had predicted the quarks orbited inside the proton at relativistic speeds and it was met with skepticism.

  13. The Nucleus and the Simple Microscope.

    ERIC Educational Resources Information Center

    Ford, Brian J.

    1982-01-01

    The 150th anniversary of the naming of the nucleus by Robert Brown in 1831 was commemorated by re-creating some of his most important observations using two of his microscopes. Comments on Brown's career and the microtechnique employed during his time are provided. (Author/JN)

  14. Nucleon-nucleus interactions from JACEE

    NASA Technical Reports Server (NTRS)

    Burnett, T. H.; Dake, S.; Fuki, M.; Gregory, J. C.; Hayashi, T.; Holynski, R.; Iwai, J.; Jones, W. V.; Jurak, A.; Lord, J. J.

    1985-01-01

    Results on hadron-nucleus interactions from the Japanese-American Cooperation Emulsion Experiment experiment are presented. Angular distributions for charged particles, and angular and transverse momentum spectra for photons have been measured for a sample of events with sigma epsilon sub gamma. Results on central rapidity density and transverse energy flow are discussed.

  15. A Modified Approach of Percutaneous Endoscopic Lumbar Discectomy (PELD) for Far Lateral Disc Herniation at L5-S1 with Foot Drop.

    PubMed

    Chun, Eun Hee; Park, Hahck Soo

    2016-01-01

    Foraminal or extraforaminal Far Lateral Disc Herniations (FLDH) extending into or beyond the foraminal zone have been recognized as between 7-12% of all lumbosacral disc herniations. Conventional posterior laminectomy may not provide good access to a herniation that lies far lateral to the lateral margin of the pedicle. Use of the endoscopic technique through a percutaneous approach to treat such FLDH patients can decrease the surgical morbidity while achieving better outcomes. We made an effort to utilize the advantages of percutaneous endoscopic lumbar discectomy (PELD) and to determine the appropriate approach for FLDH at the level between the 5th Lumbar and first Sacral vertebrae(L5-S1). The authors present a case of an endoscopically resected lumbar extruded disc of the left extraforaminal zone with superior foraminal migration at the level of L5-S1, which had led to foot drop, while placing the endoscope in the anterior epidural space without facetectomy. PMID:26839673

  16. Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI

    PubMed Central

    Yi, Ji Sook; Han, Jong Kyu; Kim, Hyun-Joo

    2015-01-01

    Objective To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Materials and Methods Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. Results The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Conclusion Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI. PMID:26175589

  17. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546

    PubMed Central

    Arts, Mark P; Peul, Wilco C; Brand, Ronald; Koes, Bart W; Thomeer, Ralph TWM

    2006-01-01

    Background Open discectomy is the standard surgical procedure in the treatment of patients with long-lasting sciatica caused by lumbar disc herniation. Minimally invasive approaches such as microendoscopic discectomy have gained attention in recent years. Reduced tissue trauma allows early ambulation, short hospital stay and quick resumption of daily activities. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in patients with lumbar disc herniation. Methods/Design Patients (age 18–70 years) presenting with sciatica due to lumbar disc herniation lasting more than 6–8 weeks are included. Patients with disc herniation larger than 1/3 of the spinal canal diameter, or disc herniation less than 1/3 of the spinal canal diameter with concomitant lateral recess stenosis or sequestration, are eliglible for participation. Randomisation into microendoscopic discectomy or conventional unilateral transflaval discectomy will take place in the operating room after induction of anesthesia. The length of skin incision is equal in both groups. The primary outcome measure is the functional assessment of the patient, measured by the Roland Disability Questionnaire for Sciatica, at 8 weeks and 1 year after surgery. We will also evaluate several other outcome parameters, including perceived recovery, leg and back pain, incidence of re-operations, complications, serum creatine kinase, quality of life, medical consumption, absenteeism and costs. The study is a randomised prospective multi-institutional trial, in which two surgical techniques are compared in a parallel group design. Patients and research nurses are kept blinded of the allocated treatment during the follow-up period of 2 years. Discussion Currently, open discectomy is the golden standard in the surgical treatment of lumbar disc herniation. Whether

  18. Heavy-flavour dynamics in proton-proton and nucleus-nucleus collisions at LHC

    NASA Astrophysics Data System (ADS)

    Nardi, M.; Beraudo, A.; De Pace, A.; Monteno, M.; Prino, F.

    2016-01-01

    We present recent results for heavy-quark observables in nucleus-nucleus collisions at LHC energies, obtained by the POWLANG transport setup. The initial creation of c c ¯ and b b ¯ pairs is simulated with a perturbative QCD approach (POWHEG+PYTHIA) and validated through comparison to experimental data of proton-proton collisions. In the nucleus-nucleus case, the propagation of the heavy quarks in the plasma is studied with the relativistic Langevin equation, here solved using weak-coupling transport-coefficients. Successively, the heavy quarks hadronize in the medium. We compute the nuclear modification factor RAA and the elliptic flow v2 of the final D mesons, as well as D - h correlations, and compare our results to experimental data from the ALICE and CMS Collaborations.

  19. Average transverse momentum and energy density in high-energy nucleus-nucleus collisions

    NASA Technical Reports Server (NTRS)

    Burnett, T. H.; Dake, S.; Fuki, M.; Gregory, J. C.; Hayashi, T.; Holynski, R.; Iwai, J.; Jones, W. V.; Jurak, A.; Lord, J. J.

    1986-01-01

    Emulsion chambers were used to measure the transverse momenta of photons or pi(0) mesons produced in high-energy cosmic-ray nucleus-nucleus collisions. A group of events having large average transverse momenta has been found which apparently exceeds the expected limiting values. Analysis of the events at early interaction times, of the order of 1 fm/c, indicates that the observed transverse momentum increases with both rapidity density and energy density.

  20. Results on ultra-relativistic nucleus-nucleus interactions from balloon-borne emulsion chambers

    NASA Technical Reports Server (NTRS)

    Burnett, T. H.; Dake, S.; Derrickson, J. H.; Fountain, W.; Meegan, C. A.; Takahashi, Y.; Watts, J. W.; Fuki, M.; Gregory, J. C.; Hayashi, T.

    1985-01-01

    The results of balloon-borne emulsion-chamber measurements on high-energy cosmic-ray nuclei (Burnett et al., 1983) are summarized in tables and graphs and briefly characterized. Special consideration is given to seven nucleus-nucleus interaction events at energy in excess of 1 TeV/A with multiplicity greater than 400, and to Fe interactions (53 with CHO, 10 with emulsion, and 14 with Pb) at 20-60 GeV/A.

  1. Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

    2012-01-01

    Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

  2. Targeted CT-Guided Epidural Blood Patch for Treatment of Spontaneous Intracranial Hypotension Due to Calcified Intradural Thoracic Disc Herniation

    PubMed Central

    Agarwal, V.; Sreedher, G.; Rothfus, W.E.

    2013-01-01

    Summary Calcified thoracic intradural disc herniations have recently been reported as a cause of spontaneous intracranial hypotension (SIH). We report successful treatment of SIH with a targeted CT-guided epidural blood patch. A 57-year-old man presented to the emergency department with a two-week history of progressively debilitating headache. CT and MRI of the brain showed findings consistent with intracranial hypotension and MRI of the spine showed findings consistent with CSF leak. Subsequent CT myelogram of the thoracic spine confirmed the presence of CSF leak and calcified disc herniations at the T6-7, T7-8 and T8-9 levels indenting the ventral dura and spinal cord. The calcified disc herniation at T6-7 had an intradural component and was therefore the most likely site of the CSF leak. Under CT fluoroscopic guidance, a 20-gauge Tuohy needle was progressively advanced into the dorsal epidural space at T6-7. After confirmation of needle tip position, approximately 18cc of the patient's own blood was sterilely removed from an arm vein and slowly re-injected into the dorsal epidural space. With satisfactory achievement of clot formation, the procedure was terminated. The patient tolerated the procedure well. The next morning, his symptoms had completely resolved and he was neurologically intact. At five-week follow up, he was symptom-free. Targeted epidural blood patch at the site of presumed CSF leak can be carried out in a safe and effective manner using CT fluoroscopic guidance and can be an effective alternative to open surgical management in selected patients. PMID:23472734

  3. Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations

    PubMed Central

    Cristante, Alexandre Fogaça; Rocha, Ivan Diasda; Marcon, Raphael Martus; de Barros Filho, Tarcísio Eloy Pessoa

    2016-01-01

    OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes). Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138). The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups. PMID:27276397

  4. Mini-open transthoracic approach for resection of a calcified herniated thoracic disc and repair of the dural surface with fibrin glue: a case report.

    PubMed

    Yoshioka, Katsuhito; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Tsuchiya, Hiroyuki

    2015-08-01

    This study reports a case of severe anterior compression of the spinal cord by a calcified herniated thoracic disc at the T9/10 level in a 46-year-old woman. She underwent resection of the calcified herniated thoracic disc and the integrated dura, using a microscopically assisted mini-open transthoracic approach. The remaining dura mater was shaped and repaired by alternate overlapping without suture. The dural surface was reinforced with a combination of fibrin glue and a polyglycolic acid sheet. This novel procedure prevented postoperative cerebrospinal fluid leakage. The patient made an excellent recovery, without any complications. PMID:26321561

  5. Applicability of fluid-dynamical modeling of nucleus-nucleus collisions at relativistic energies

    NASA Astrophysics Data System (ADS)

    Hazineh, Dean; Auvinen, Jussi; Nahrgang, Marlene; Bass, Steffen

    2015-10-01

    At sufficiently high temperatures and densities, similar to the conditions found in the early universe, QCD matter forms a deconfined state called the quark gluon plasma (QGP). This state of matter can be created in collisions of ultra-relativistic heavy-ions, and RHIC data suggests that this QGP behaves similar to an ideal fluid. Viscous relativistic fluid dynamics therefore is one of the preferred theoretical tools to model the time-evolution and properties of the QGP. As the collision energy or the system size is decreased, the range of applicability of viscous fluid dynamics becomes smaller as the length scale of the interaction among the basic constituents is similar to the overall scale of the collision system itself. In order to investigate the validity of fluid-dynamical modeling of proton-nucleus and nucleus-nucleus collisions at LHC and RHIC, we conduct an analysis of the spatial and temporal evolution of the Knudsen number, i.e. the ratio of the microscopic mean free path to the macroscopic length scale of the system. We show results for large and small collision systems, as a function of the specific shear viscosity, and discuss the range of applicability of fluid-dynamical modeling in relativistic proton-nucleus and nucleus-nucleus collisions at different energies.

  6. Nucleus-nucleus total reaction cross sections, and the nuclear interaction radius

    SciTech Connect

    Abu-Ibrahim, Badawy

    2011-04-15

    We study the nucleus-nucleus total reaction cross sections for stable nuclei, in the energy region from 30A MeV to about 1A GeV, and find them to be in proportion to ({radical}({sigma}{sub pp}{sup tot}Z{sub 1}{sup 2/3}+{sigma}{sub pn}{sup tot}N{sub 1}{sup 2/3})+{radical}({sigma}{sub pp}{sup tot}Z{sub 2}{sup 2/3}+{sigma}{sub pn}{sup tot}N{sub 2}{sup 2/3})) {sup 2} in the mass range 8 to 100. Also, we find a parameter-free relation that enables us to predict a total reaction cross section for any nucleus-nucleus within 10% uncertainty at most, using the experimental value of the total reaction cross section of a given nucleus-nucleus. The power of the relation is demonstrated by several examples. The energy dependence of the nuclear interaction radius is deduced; it is found to be almost constant in the energy range from about 200A MeV to about 1A GeV; in this energy range and for nuclei with N=Z, R{sub I}(A)=(1.14{+-}0.02)A{sup 1/3} fm.

  7. CT and MR findings of bilateral submandibular gland aplasia associated with hypertrophied symmetrical sublingual glands herniated through mylohyoid defects

    PubMed Central

    Haktanır, A

    2012-01-01

    There are very limited reports of aplasia of bilateral submandibular glands associated with bilateral sublingual gland hypertrophy. We report the case of a 13-year-old girl with bilateral submandibular gland aplasia associated with symmetrical sublingual gland hypertrophy that herniated from bilateral mylohyoid defects and presented as bilateral masses on CT and MRI images. Prolapsed bilateral sublingual gland hypertrophy should be considered in patients with bilateral submandibular masses to avoid unnecessary biopsy or surgery. We suggest that radiological evaluation of these cases should be performed before any intervention. PMID:22184630

  8. Misunderstanding of foot drop in a patient with charcot-marie-tooth disease and lumbar disk herniation.

    PubMed

    Han, Youngmin; Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung

    2015-04-01

    We report the case of 57-year-old woman diagnosed with Charcot-Marie-Tooth (CMT) disease and lumbar disk herniation (LDH). She had left leg weakness and foot numbness, foot deformity (muscle atrophy, high arch, and clawed toes). The lumbar spine MRI showed LDH at L4-5. Additionally, electrophysiology results were consistent with chronic peripheral motor-sensory polyneuropathy (axonopathy). In genetic testing, 17p11.2-p12 duplication/deletions characteristic of CMT disease were observed. We confirmed the patient's diagnosis as CMT disease and used conservative treatment. PMID:25932299

  9. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation.

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Transforaminal (TF) approach is preferred by physician to interlaminar (IL) approach because it can deliver injectates directly around nerve root and dorsal root ganglion, which is regarded as main pain sources. Axial neck pain is originated from sinuvertebral nerve located in ventral epidural spaces, which has been described to be related to central or paramedian disc herniation. It is very questionable that TF injection is also more effective than IL injection in the patients with axial neck or interscapular pain. This study was to evaluate clinical efficacy of cervical epidural injection in patients with axial pain due to cervical disc herniation and to compare the clinical outcomes between TF and IL approaches. Fifty-six and 52 patients who underwent IL and TF epidural injections, respectively, for axial neck/interscapular pain due to central or paramedian cervical disc herniation were included. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) were compared between both groups at 2 and 8 weeks after treatment. Successful pain relief was defined if a 50% or more reduction of NRS score was achieved in comparison with pretreatment one. Successful functional improvement was defined if at least a 40% reduction of NDI was obtained. Overall, 79 (73.1%) and 57 (52.8%) among 108 patients showed successful pain relief at 2 and 8 weeks, respectively. Seventy-six (70.4%) and 52 (48.1%) had successful functional improvement at 2 and 8 weeks, respectively. The IL and TF groups showed no significant difference in proportion of successful results of NRS 2 weeks (73.2% vs 67.3%) and 8 weeks (48.2% vs 48.1%). Also, no significant difference was obtained in proportion of successful NDI between 2 groups at 2 weeks (75.0% vs 71.2%) and 8 weeks (53.6% vs 51.9%). Cervical epidural injection showed favorable results in 2 weeks and moderate results in 8 weeks in patients with axial pain due to cervical disc herniation. IL and TF showed no significant difference in clinical

  10. Collateral projections from the lateral parabrachial nucleus to the paraventricular thalamic nucleus and the central amygdaloid nucleus in the rat.

    PubMed

    Liang, Shao-Hua; Yin, Jun-Bin; Sun, Yi; Bai, Yang; Zhou, Kai-Xiang; Zhao, Wen-Jun; Wang, Wei; Dong, Yu-Lin; Li, Yun-Qing

    2016-08-26

    Combined the retrograde double tracing with immunofluorescence histochemical staining, we examined the neurons in the lateral parabrachial nucleus (LPB) sent collateral projections to the paraventricular thalamic nucleus (PVT) and central amygdaloid nucleus (CeA) and their roles in the nociceptive transmission in the rat. After the injection of Fluoro-gold (FG) into the PVT and tetramethylrhodamine-dextran (TMR) into the CeA, respectively, FG/TMR double-labeled neurons were observed in the LPB. The percentages of FG/TMR double-labeled neurons to the total number of FG- or TMR-labeled neurons were 6.18% and 9.09%, respectively. Almost all of the FG/TMR double-labeled neurons (95%) exhibited calcitonin gene-related peptide (CGRP) immunoreactivity. In the condition of neuropathic pain, 94% of these neurons showed FOS immunoreactivity. The present data indicates that some of CGRP-expressing neurons in the LPB may transmit nociceptive information toward the PVT and CeA by way of axon collaterals. PMID:27423318

  11. Recovery of stepping and coordination in dogs following acute thoracolumbar intervertebral disc herniations.

    PubMed

    Rousse, C A; Olby, N J; Williams, K; Harris, T L; Griffith, E H; Mariani, C L; Muñana, K R; Early, P J

    2016-07-01

    Prospective data on the recovery of coordination in dogs suffering acute thoracolumbar intervertebral disc herniations (TL-IVDH) are limited. The purpose of this study was to use treadmill based and open field scores (OFS) to quantify recovery of stepping ability and forelimb, hindlimb coordination in the 6 weeks following surgical decompression of dogs with TL-IVDH. Sixty-three dogs were grouped at presentation as grades 3 (non-ambulatory paraparetic), 4 (paraplegic) or 5 (paraplegic without pain sensation) and were evaluated 2, 4, and 6 weeks post-operatively. Stepping scores and Regularity Index (RI), a measure of coordination, were calculated from treadmill walking, and an OFS incorporating supported and unsupported walking was assigned. Outcomes for the three measures were compared between groups and correlation between scoring methods was assessed. Grade 3 and 4 dogs recovered ambulation by 2 weeks, reaching median stepping scores of 96 and 90% by 6 weeks, respectively. Recovery of coordination differed between groups 3 and 4 with median RI scores of 93.9% and 63%, respectively, by 6 weeks. Eight grade 5 dogs failed to recover independent ambulation by 6 weeks. Nine dogs recovered with scores that were significantly worse than the grade 3 and 4 dogs at 6 weeks for stepping score (P < 0.001) and RI (P < 0.001). OFS correlated closely with stepping and RI scores and each group was significantly different using this ordinal scale. In conclusion, recovery of coordination was incomplete in dogs that showed good recovery of stepping. The data generated could be used for clinical trial design. PMID:27240917

  12. A PHASED REHABILITATION PROTOCOL FOR ATHLETES WITH LUMBAR INTERVERTEBRAL DISC HERNIATION

    PubMed Central

    VanGelder, Leonard H.; Vaughn, Daniel W.

    2013-01-01

    Conservative non-surgical management of a herniated lumbar intervertebral disc (HLD) in athletes is a complex task due to the dramatic forces imparted on the spine during sport participation. The demands placed upon the athlete during rehabilitation and return to sport are unique not only from a sport specific perspective, but also regarding return to the sport strength and conditioning programs utilized for sport preparation. Many prescriptions fail to address postural and motor control faults specific to athletic development, which may prevent full return to sport after suffering a HLD or predispose the athlete to future exacerbations of a HLD. Strength exercises involving squatting, deadlifting, and Olympic power lifts are large components of the typical athlete's conditioning program, therefore some progressions are provided to address potential underlying problems in the athlete's technique that may have contributed to their HLD in the first place. The purpose of this clinical commentary is to propose a framework for rehabilitation that is built around the phases of healing of the disc. Phase I: Non-Rotational/Non-Flexion Phase (Acute Inflammatory Phase), Phase II: Counter rotation/Flexion Phase (Repair Phase), Phase III: Rotational Phase/Power development (Remodeling Phase), and Phase IV: Full return to sport. This clinical commentary provides a theoretical basis for these phases based on available literature as well as reviewing many popular current practice trends in the management of an HLD. The authors recognize the limits of any general exercise rehabilitation recommendation with regard to return to sport, as well as any general strength and conditioning program. It is vital that an individual assessment and prescription is made for every athlete which reviews and addresses movement in all planes of motion under all necessary extrinsic and intrinsic demands to that athlete. Level of Evidence: 5 PMID:24175134

  13. Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation

    PubMed Central

    Bae, Jung Sik; Kang, Kyung Hee; Park, Jeong Hyun; Lim, Jae Hyeon

    2016-01-01

    Objective We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. Methods A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Results Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0–79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). Conclusion This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes. PMID:26962420

  14. Prognostic Value of Impaired Preoperative Ankle Reflex in Surgical Outcome of Lumbar Disc Herniation

    PubMed Central

    Omidi-Kashani, Farzad; EG, Hasankhani; Zare, Atefe

    2016-01-01

    Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH. Methods: We retrospectively evaluated 181 patients (108 male and 73 female) who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.3±8.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=0.538 and P=0.709, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=0.012 and P=0.002, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P<0.001 in all three). Conclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction. PMID:26894219

  15. Paradoxical Herniation After Unilateral Decompressive Craniectomy Predicts Better Patient Survival: A Retrospective Analysis of 429 Cases.

    PubMed

    Chen, Weiqiang; Guo, Jingfang; Wu, Jin; Peng, Guoyi; Huang, Mindong; Cai, Chuwei; Yang, Yingming; Wang, Shousen

    2016-03-01

    Paradoxical herniation (PH) is a life-threatening emergency after decompressive craniectomy. In the current study, we examined patient survival in patients who developed PH after decompressive craniectomy versus those who did not. Risk factors for, and management of, PH were also analyzed. This retrospective analysis included 429 consecutive patients receiving decompressive craniectomy during a period from January 2007 to December 2012. Mortality rate and Glasgow Outcome Scale (GOS) were compared between those who developed PH (n = 13) versus those who did not (n = 416). A stepwise multivariate logistic regression analysis was carried out to examine the risk factors for PH. The overall mortality in the entire sample was 22.8%, with a median follow-up of 6 months. Oddly enough, all 13 patients who developed PH survived beyond 6 months. Glasgow Coma Scale did not differ between the 2 groups upon admission, but GOS was significantly higher in subjects who developed PH. Both the disease type and coma degree were comparable between the 13 PH patients and the remaining 416 patients. In all PH episodes, patients responded to emergency treatments that included intravenous hydration, cerebral spinal fluid drainage discontinuation, and Trendelenburg position. A regression analysis indicated the following independent risk factors for PH: external ventriculostomy, lumbar puncture, and continuous external lumbar drainage. The rate of PH is approximately 3% after decompressive craniectomy. The most intriguing findings of the current study were the 0% mortality in those who developed PH versus 23.6% mortality in those who did not develop PH and significant difference of GOS score at 6-month follow-up between the 2 groups, suggesting that PH after decompressive craniectomy should be managed aggressively. The risk factors for PH include external ventriculostomy, ventriculoperitoneal shunt, lumbar puncture, and continuous external lumbar drainage. PMID:26945365

  16. Surgical Treatment for Central Calcified Thoracic Disk Herniation: A Novel L-Shaped Osteotome.

    PubMed

    Zhuang, Qing-shan; Lun, Deng-xing; Xu, Zhao-wan; Dai, Wei-hua; Liu, Da-yong

    2015-09-01

    Few reports are available on the posterior transfacet approach for the treatment of central calcified thoracic disk herniation (TDH). The objective of this study was to assess outcomes and complications in a consecutive series of patients with TDH who underwent posterior transfacet decompression and diskectomy with segmental instrumentation and fusion. The data for 27 patients (16 males and 11 females) were retrospectively reviewed and analyzed, including clinical presentation, blood loss, operative time, pre- and postoperative complications, visual analog scale, Japanese Orthopedic Association (JOA) score, and Frankel grade. All patients underwent trans-facet decompression and segmental instrumentation with interbody fusion. Mean patient age at surgery was 55.2 years (range, 21-81 years). Average follow-up was 30±19 months (range, 12-50 months). All patients were successfully treated with posterior decompression and segmental instrumentation with interbody fusion. Average operative time was 124±58 minutes (range, 87-180 minutes). Mean blood loss was 439±225 mL (range, 300-1500 mL). Average pre- and postoperative JOA scores were 4.12±0.87 and 8.01±0.97 points, respectively. Overall JOA scores showed a significant postoperative improvement. Overall recovery rates were excellent in 12 patients, good in 6, fair in 5, and unchanged in 1. No patient was classified as worse. The results suggest that the posterior approach using a special L-shaped osteotome is feasible. No major complications occurred while achieving adequate decompression for central calcified TDH. PMID:26375537

  17. Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases

    PubMed Central

    Kim, Sung Chul; Cho, Ki Hong

    2012-01-01

    Objective This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Methods Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. Results This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. Conclusion PDCT is a safe and efficient treatment modality in a selective patient with HLD. PMID:22396836

  18. Is intervertebral disc pressure linked to herniation?: An in-vitro study using a porcine model.

    PubMed

    Noguchi, Mamiko; Gooyers, Chad E; Karakolis, Thomas; Noguchi, Kimihiro; Callaghan, Jack P

    2016-06-14

    Approximately 40% of low back pain cases have been attributed to internal disc disruption. This disruption mechanism may be linked to intradiscal pressure changes, since mechanical loading directly affects the pressure and the stresses that the inner annulus fibrosus experiences. The objective of this study was to characterize cycle-varying changes in four dependent measures (intradiscal pressure, flexion-extension moments, specimen height loss, and specimen rotation angle) using a cyclic flexion-extension (CFE) loading protocol known to induce internal disc disruption. A novel bore-screw pressure sensor system was used to instrument 14 porcine functional spinal units. The CFE loading protocol consisted of 3600 cycles of flexion-extension range of motion (average 18.30 (SD 3.76) degrees) at 1Hz with 1500N of compressive load. On average, intradiscal pressure and specimen height decreased by 47% and 62%, respectively, and peak moments increased by 102%. From 900 to 2100 cycles, all variables exhibited significant changes between successive time points, except for the specimen posture at maximum pressure, which demonstrated a significant shift towards flexion limit after 2700 cycles. There were no further changes in pressure range after 2100 cycles, whereas peak moments and height loss were significantly different from prior time points throughout the CFE protocol. Twelve of the 14 specimens showed partial herniation; however, injury type was not significantly correlated to any of the dependent measures. Although change in pressure was not predictive of damage type, the increase in pressure range seen during this protocol supports the premise that repetitive combined loading (i.e., radial compression, tension and shear) imposes damage to the inner annulus fibrosus, and its failure mechanism may be linked to fatigue. PMID:27157242

  19. Interleukin-21 Is Associated with the Pathogenesis of Lumbar Disc Herniation.

    PubMed

    Xue, Huawei; Yao, Yu; Wang, Xiaoying; Zhang, Feng; Jiang, Xingjie; Liu, Jinbao; Wang, Hua; Li, Yuqian; Wang, Xiaodong; Li, Hongbin; Zhang, Jianhua

    2015-10-01

    Inflammation is an important reaction underlying lumbar disc herniation (LDH). Th17 cells play a critical role in immune activation. Interleukin (IL)-21 controls the functional activity of effector T-helper cells and the differentiation of Th17 cells, and promotes B-cell differentiation. It plays important roles in chronic inflammation and autoimmune diseases. However, little is known about relationship between IL-21 and LDH. This study was aimed to determine the association between IL-21 levels and pain scores in LDH patients compared to healthy controls.We enrolled 34 LDH patients and 20 healthy controls in this study. The LDH patients underwent surgery. Pain intensity was recorded using visual analogue scale (VAS) scores preoperatively. Serum IL-21 and IL-17 levels in the peripheral blood were determined using enzyme-linked immunosorbent assay. Disc tissue was examined using western blot and quantitative reverse-transcription polymerase chain reaction to determine IL-21, IL-17, and cyclooxygenase (COX)-2 expression, and using immunohistochemistry to assess IL-21 expression.LDH patients exhibited significantly higher levels of serum IL-21 and IL-17 than healthy controls. Moreover, higher expression of IL-21, IL-17, and COX-2 was found in the protein and mRNA levels in disc tissues from LDH patients than in normal disc tissues. Different parameters like VAS pain scores, IL-17, and COX-2 were positively correlated with the IL-21 levels. Enhanced production of IL-21 in disc tissues of LDH patients was also confirmed using immunohistochemical analyses.We concluded that inflammation was responsible for the pain associated with LDH, and that increased IL-21 expression may be associated with the pathogenesis of LDH. PMID:26742440

  20. Characteristics of Lumbar Disc Herniation With Exacerbation of Presentation Due to Spinal Manipulative Therapy

    PubMed Central

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-01-01

    Abstract The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4–15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4–L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

  1. Characteristics of lumbar disc herniation with exacerbation of presentation due to spinal manipulative therapy.

    PubMed

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-03-01

    The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4-15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4-L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

  2. Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation.

    PubMed

    Talekar, Kiran; Poplawski, Michael; Hegde, Rahul; Cox, Mougnyan; Flanders, Adam

    2016-10-01

    We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy. PMID:27616315

  3. Dropped nucleus following phacoemulsification cataract surgery.

    PubMed

    Tajunisah, I; Reddy, S C

    2007-12-01

    Twenty two cases of dropped nucleus following 1,196 phacoemulsification procedures in cataract surgery were examined retrospectively to determine the incidence, predisposing factors and visual outcomes of this dreaded complication. All the cases underwent pars plana vitrectomy and the lens fragments were removed with phacofragmotome, vitrectomy cutter or delivered through limbus. The incidence of dropped nucleus was 1.84%. The predisposing factors were hard cataracts (13.6%), polar cataracts (9.1%), previously vitrectomized eyes (4.5%) and high myopia (4.5%). The final visual outcome was > or = 6/12 in 10 eyes (45.5%); complications were seen in 5 eyes (22.7%). The interval between initial surgery and vitrectomy, the method of fragment removal and the type of lens implanted, did not influence the final visual outcome. PMID:18705466

  4. Cell Nucleus-Targeting Zwitterionic Carbon Dots

    PubMed Central

    Jung, Yun Kyung; Shin, Eeseul; Kim, Byeong-Su

    2015-01-01

    An innovative nucleus-targeting zwitterionic carbon dot (CD) vehicle has been developed for anticancer drug delivery and optical monitoring. The zwitterionic functional groups of the CDs introduced by a simple one-step synthesis using β-alanine as a passivating and zwitterionic ligand allow cytoplasmic uptake and subsequent nuclear translocation of the CDs. Moreover, multicolor fluorescence improves the accuracy of the CDs as an optical code. The CD-based drug delivery system constructed by non-covalent grafting of doxorubicin, exhibits superior antitumor efficacy owing to enhanced nuclear delivery in vitro and tumor accumulation in vivo, resulting in highly effective tumor growth inhibition. Since the zwitterionic CDs are highly biocompatible and effectively translocated into the nucleus, it provides a compelling solution to a multifunctional nanoparticle for substantially enhanced nuclear uptake of drugs and optical monitoring of translocation. PMID:26689549

  5. Macromolecular transport in synapse to nucleus communication.

    PubMed

    Panayotis, Nicolas; Karpova, Anna; Kreutz, Michael R; Fainzilber, Mike

    2015-02-01

    Local signaling events at synapses or axon terminals must be communicated to the nucleus to elicit transcriptional responses. The lengths of neuronal processes pose a significant challenge for such intracellular communication. This challenge is met by mechanisms ranging from rapid signals encoded in calcium waves to slower macromolecular signaling complexes carried by molecular motors. Here we summarize recent findings on macromolecular signaling from the synapse to the nucleus, in comparison to those employed in injury signaling along axons. A number of common themes emerge, including combinatorial signal encoding by post-translational mechanisms such as differential phosphorylation and proteolysis, and conserved roles for importins in coordinating signaling complexes. Neurons may integrate ionic flux with motor-transported signals as a temporal code for synaptic plasticity signaling. PMID:25534890

  6. Core-nucleus distortation in hypernuclei

    SciTech Connect

    Bodmer, A.R.; Usmani, Q.N.

    1995-08-01

    We are completing a study of the effects of the spherical distortion of the {open_quotes}core{close_quotes} nucleus by the {Lambda} in a hypernucleus. The response of the core was determined by an appropriately chosen energy-density functional which depends, in particular, on the nuclear compressibility. The forcing action of the A is determined by the nuclear density dependence of the {Lambda} binding in nuclear matter which is obtained from our work on the {Lambda} single-particle energies. Because of the strongly repulsive {Lambda}NN forces, this {Lambda} binding {open_quotes}saturates{close_quotes} at a density close to the central density of nuclei, and results in a reduced core-nucleus distortion much less than would otherwise be obtained. The effects of the core distortion then turn out to be very small even for quite light hypernuclei. This result justifies the assumption that spherical core nuclei are effectively undistorted in a hypernucleus.

  7. Coherency in neutrino-nucleus elastic scattering

    NASA Astrophysics Data System (ADS)

    Kerman, S.; Sharma, V.; Deniz, M.; Wong, H. T.; Chen, J.-W.; Li, H. B.; Lin, S. T.; Liu, C.-P.; Yue, Q.; Texono Collaboration

    2016-06-01

    Neutrino-nucleus elastic scattering provides a unique laboratory to study the quantum mechanical coherency effects in electroweak interactions, towards which several experimental programs are being actively pursued. We report results of our quantitative studies on the transitions towards decoherency. A parameter (α ) is identified to describe the degree of coherency, and its variations with incoming neutrino energy, detector threshold, and target nucleus are studied. The ranges of α that can be probed with realistic neutrino experiments are derived, indicating complementarity between projects with different sources and targets. Uncertainties in nuclear physics and in α would constrain sensitivities in probing physics beyond the standard model. The maximum neutrino energies corresponding to α >0.95 are derived.

  8. Finite nucleus effects on relativistic energy corrections

    NASA Technical Reports Server (NTRS)

    Dyall, Kenneth G.; Faegri, Knut, Jr.

    1993-01-01

    The effect of using a finite nucleus model in quantum-chemical calculations is examined. Relativistic corrections from the first order Foldy-Wouthuysen terms are affected indirectly by the change in wavefunction, but also directly as a result of revised expressions for the Darwin and spin-orbit terms due to the change in nuclear potential. A calculation for the Rn atom indicates that the mass-velocity and Darwin corrections are much more sensitive to the finite nucleus than the non-relativistic total energy, but that the total contribution for these two terms is quite stable provided the revised form of the Darwin term is used. The spin-orbit interaction is not greatly affected by the choice of nuclear model.

  9. Neurofibromin is actively transported to the nucleus.

    PubMed

    Vandenbroucke, Ina; Van Oostveldt, Patrick; Coene, Elisabeth; De Paepe, Anne; Messiaen, Ludwine

    2004-02-27

    Mutations in the neurofibromatosis type 1 (NF1) tumor suppressor gene predispose individuals to a variety of benign and malignant tumors. Many tumor suppressors 'shuttle' between the nucleus and the cytoplasm, thus regulating their function. By expressing different NF1 constructs in COS-7 cells (encompassing exons 28-49 and fused to the green fluorescent protein), we identified a functional nuclear localization signal (NLS) in exon 43. Mutation of the NLS completely abolishes the nuclear entry of the NF1-derivative fusion protein. A highly expressed splice variant that lacks this NLS controls the localization and hence the function of neurofibromin. The localization of neurofibromin in the nucleus may provide novel clues to unknown functions for NF1. PMID:14988005

  10. Revisiting the supratrigeminal nucleus in the rat.

    PubMed

    Fujio, T; Sato, F; Tachibana, Y; Kato, T; Tomita, A; Higashiyama, K; Ono, T; Maeda, Y; Yoshida, A

    2016-06-01

    The supratrigeminal nucleus (Vsup), originally proposed as a premotoneuron pool in the trigeminal reflex arc, is a key structure of jaw movement control. Surprisingly, however, the location of the rat Vsup has not precisely been defined. In light of our previous cat studies, we made two hypotheses regarding the rat Vsup: (1) the Vsup is cytoarchitectonically distinguishable from its surrounding structures; (2) the Vsup receives central axon terminals of the trigeminal mesencephalic nucleus (Vmes) neurons which are primary afferents innervating muscle spindles of jaw-closing muscles and periodontal ligaments around the teeth. To test the first hypothesis, we examined the cytoarchitecture of the rat Vsup. The Vsup was identified as an area medially adjacent to the dorsomedial part of trigeminal principal sensory nucleus (Vp), and extended from the level just rostral to the caudal two-thirds of the trigeminal motor nucleus (Vmo) to the level approximately 150μm caudal to the Vmo. Our rat Vsup was much smaller and its location was considerably different in comparison to the Vsup reported previously. To evaluate the second hypothesis, we tested the distribution patterns of Vmes primary afferent terminals in the cytoarchitectonically identified Vsup. After transganglionic tracer applications to the masseter, deep temporal, and medial pterygoid nerves, a large number of axon terminals were observed in all parts of Vsup (especially in its medial part). After applications to the inferior alveolar, infraorbital, and lingual nerves, a small number of axon terminals were labeled in the caudolateral Vsup. The Vsup could also be identified electrophysiologically. After electrical stimulation of the masseter nerve, evoked potentials with slow negative component were isolated only in the Vsup. The present findings suggest that the rat Vsup can be cytoarchitectonically and electrophysiologically identified, receives somatotopic termination of the trigeminal primary afferents, and

  11. Physical Properties of Cometary Nucleus Candidates

    NASA Technical Reports Server (NTRS)

    Jewitt, David; Hillman, John (Technical Monitor)

    2003-01-01

    In this proposal we aim to study the physical properties of the Centaurs and the dead comets, these being the precursors to, and the remnants from, the active cometary nuclei. The nuclei themselves are very difficult to study, because of the contaminating effects of near-nucleus coma. Systematic investigation of the nuclei both before they enter the zone of strong sublimation and after they have depleted their near-surface volatiles should neatly bracket the properties of these objects, revealing evolutionary effects.

  12. Development of a Mobile Ice Nucleus Counter

    SciTech Connect

    Kok, Gregory; Kulkarni, Gourihar

    2014-07-10

    An ice nucleus counter has been constructed. The instrument uses built-in refrigeration systems for wall cooling. A cascade refrigeration system will allow the cold wall to operate as low as -70 deg C, and a single stage system can operate the warm wall at -45 deg C. A unique optical particle counter has been constructed using polarization detection of the scattered light. This allows differentiation of the particles exiting the chamber to determine if they are ice or liquid.

  13. The fast Ice Nucleus chamber FINCH

    NASA Astrophysics Data System (ADS)

    Bundke, U.; Nillius, B.; Jaenicke, R.; Wetter, T.; Klein, H.; Bingemer, H.

    2008-11-01

    We present first results of our new developed Ice Nucleus (IN) counter FINCH from the sixth Cloud and Aerosol Characterization Experiment (CLACE 6) campaign at Jungfraujoch station, 3571 m asl. Measurements were made at the total and the ICE CVI inlet. Laboratory measurements of ice onset temperatures by FINCH are compared to those of the static diffusion chamber FRIDGE (FRankfurt Ice Deposition Freezing Experiment). Within the errors of both new instruments the results compare well to published data.

  14. Parity violation in the compound nucleus

    SciTech Connect

    Mitchell, G. E.; Crawford, B. E.; Grossmann, C. A.; Lowie, L. Y.; Bowman, J. D.; Knudson, J.; Penttilae, S.; Seestrom, S. J.; Smith, D. A.; Yen, Yi-Fen; Yuan, V. W.; Delheij, P. P. J.; Haseyama, T.; Masaike, A.; Matsuda, Y.; Postma, H.; Roberson, N. R.; Sharapov, E. I.; Stephenson, S. L.

    1999-06-10

    Measurements have been performed on the helicity dependence of the neutron resonance cross section for many nuclei by our TRIPLE Collaboration. A large number of parity violations are observed. Generic enhancements amplify the signal for symmetry breaking and the stochastic properties of the compound nucleus permit the strength of the symmetry-breaking interaction to be determined without knowledge of the wave functions of individual states. A total of 15 nuclei have been analyzed with this statistical approach. The results are summarized.

  15. Comet nucleus impact probe feasibility study

    NASA Technical Reports Server (NTRS)

    Castro, A. J.

    1980-01-01

    A top level listing of the comet nucleus impact probe (CNIP) feasibility experiments requirements are presented. A conceptual configuration which shows that the feasibility of engineering the experiment is possible and describes the candidate hardware is discussed. The design studies required in order to design the operating experiment are outlined. An overview of a program plan used to estimate a rough order of magnitude cost for the CNIP experiment is given.

  16. Experimental studies on the effect of chymopapain on nerve root compression caused by intervertebral disk material.

    PubMed

    Krempen, J F; Minnig, D I; Smith, B S

    1975-01-01

    Chymopapain degrades the nucleus pulposus portion of the intervertebral disk of rabbits. The degradation is not grossly visible until 15 days post-injection. Depolymerization of the chondromucoprotein and decreases in the ability of a disk to imbibe fluid, is, in effect, a "chemical decompression" of the nucleur pulposus. The enzyme must come into direct contact with the chondromucoprotein complex of the disk material, and to a significant extent also must reach the area of disk material adjacent to the herniated annulus. Rapid depolymerization of the chondromucoprotein complex on a biomechanical level, and "decompression" of disk material on a biomechanical level can be correlated with relief of pain in all types of disk herniation in human beings. A primary biochemical change in the disk material would lead to a secondary decrease in inflammation if the change led to a "decompression" of the chondromucoprotein. Since the primary effect of chymopapain is on the chondromucoprotein of the disk, beneficial results would not be expected if nerve root compression is due to bony impingement or scar tissue following previous surgery. Chymopapain did not seem to possess any anti-inflammatory properties when bone was used as an irritant under a nerve root. However, this was technically difficult to evaluate and the possibility that chymopapain may also interfere with a chemical mediator of pain or interfere directly with an inflammatory reaction secondary to root compression can not be excluded. PMID:1126086

  17. Comet nucleus and asteroid sample return missions

    NASA Astrophysics Data System (ADS)

    1992-06-01

    Three Advanced Design Projects have been completed this academic year at Penn State. At the beginning of the fall semester the students were organized into eight groups and given their choice of either a comet nucleus or an asteroid sample return mission. Once a mission had been chosen, the students developed conceptual designs. These were evaluated at the end of the fall semester and combined into three separate mission plans, including a comet nucleus same return (CNSR), a single asteroid sample return (SASR), and a multiple asteroid sample return (MASR). To facilitate the work required for each mission, the class was reorganized in the spring semester by combining groups to form three mission teams. An integration team consisting of two members from each group was formed for each mission so that communication and information exchange would be easier among the groups. The types of projects designed by the students evolved from numerous discussions with Penn State faculty and mission planners at the Johnson Space Center Human/Robotic Spacecraft Office. Robotic sample return missions are widely considered valuable precursors to manned missions in that they can provide details about a site's environment and scientific value. For example, a sample return from an asteroid might reveal valuable resources that, once mined, could be utilized for propulsion. These missions are also more adaptable when considering the risk to humans visiting unknown and potentially dangerous locations, such as a comet nucleus.

  18. Comet nucleus and asteroid sample return missions

    NASA Technical Reports Server (NTRS)

    1992-01-01

    Three Advanced Design Projects have been completed this academic year at Penn State. At the beginning of the fall semester the students were organized into eight groups and given their choice of either a comet nucleus or an asteroid sample return mission. Once a mission had been chosen, the students developed conceptual designs. These were evaluated at the end of the fall semester and combined into three separate mission plans, including a comet nucleus same return (CNSR), a single asteroid sample return (SASR), and a multiple asteroid sample return (MASR). To facilitate the work required for each mission, the class was reorganized in the spring semester by combining groups to form three mission teams. An integration team consisting of two members from each group was formed for each mission so that communication and information exchange would be easier among the groups. The types of projects designed by the students evolved from numerous discussions with Penn State faculty and mission planners at the Johnson Space Center Human/Robotic Spacecraft Office. Robotic sample return missions are widely considered valuable precursors to manned missions in that they can provide details about a site's environment and scientific value. For example, a sample return from an asteroid might reveal valuable resources that, once mined, could be utilized for propulsion. These missions are also more adaptable when considering the risk to humans visiting unknown and potentially dangerous locations, such as a comet nucleus.

  19. Efficient nucleus detector in histopathology images.

    PubMed

    Vink, J P; Van Leeuwen, M B; Van Deurzen, C H M; De Haan, G

    2013-02-01

    In traditional cancer diagnosis, (histo)pathological images of biopsy samples are visually analysed by pathologists. However, this judgment is subjective and leads to variability among pathologists. Digital scanners may enable automated objective assessment, improved quality and reduced throughput time. Nucleus detection is seen as the corner stone for a range of applications in automated assessment of (histo)pathological images. In this paper, we propose an efficient nucleus detector designed with machine learning. We applied colour deconvolution to reconstruct each applied stain. Next, we constructed a large feature set and modified AdaBoost to create two detectors, focused on different characteristics in appearance of nuclei. The proposed modification of AdaBoost enables inclusion of the computational cost of each feature during selection, thus improving the computational efficiency of the resulting detectors. The outputs of the two detectors are merged by a globally optimal active contour algorithm to refine the border of the detected nuclei. With a detection rate of 95% (on average 58 incorrectly found objects per field-of-view) based on 51 field-of-view images of Her2 immunohistochemistry stained breast tissue and a complete analysis in 1 s per field-of-view, our nucleus detector shows good performance and could enable a range of applications in automated assessment of (histo)pathological images. PMID:23252774

  20. The nucleus basalis in Huntington's disease.

    PubMed

    Clark, A W; Parhad, I M; Folstein, S E; Whitehouse, P J; Hedreen, J C; Price, D L; Chase, G A

    1983-10-01

    The nucleus basalis of Meynert (nbM) provides most of the cholinergic input to the cerebral cortex. The loss of cortical choline acetyltransferase (CAT) activity in Alzheimer's disease (AD) and senile dementia of the Alzheimer's type (SDAT) appears to be related to a severe depopulation of the nbM in this dementia. In Huntington's disease (HD), by contrast, there is no loss of cortical CAT activity. The present quantitative study indicates that (1) there is no significant loss of neurons from the nbM in HD, and (2) that the previously described cytologic changes in the neurons of this nucleus in HD patients do not differ significantly from controls. These findings are consistent with the working hypothesis that the types of dementia associated with reductions of neocortical CAT activity are characterized by dysfunction or death of neurons in the nbM, but dementing disorders with normal neocortical CAT activity manifest no major abnormalities in this cholinergic nucleus of the basal forebrain. PMID:6225032