Demographic Analysis of Lumbar Pedicle Diameters in a Diverse Population

Joseph Albano,Jonathon Lentz,Robert Stockton,Vincent DePalma,Michael Markowitz,Maximillian Ganz,Gus Katsigiorgis,Kanwarpaul Grewal 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Retrospective chart review. Purpose: We sought to determine the differences in pedicle diameter (PD) in the lumbar spine between various races: ‘Asian,’ ‘Black,’ ‘White,’ and ‘Other.’ These data could aid in perioperative planning during instrumented spinal fusion. Overview of Literature: Recent literature underscores the importance of understanding diverse pedicle isthmus morphology to perform successful transpedicular procedures. These studies suggest that more detailed and reliable measurements of pedicles should be undertaken. However, none of the current literature comprehensively compares average PDs between diverse racial populations with a standardized study design. Methods: Coronal cuts of 5,060 lumbar spine pedicles were inspected to obtain their transverse outer cortical PD as measured through the isthmus at L1–L5. Data were collected and categorized on the basis of patient-reported race. We examined average PD and PD range at each level for each race. To determine the significance, we used a mixed analysis of variance and a post hoc analysis. Results: The Asian cohort consistently had a significantly smaller PD at L1–L5 than Blacks or Whites (p<0.001), as did the ‘Other’ group compared with Blacks (p<0.001) and Whites (p=0.032). At L1–L2, the ‘Other’ group showed the least variability in PD. At L3–L5, the Asian population showed the smallest range, and the Black population had the largest variability in PD except at L5. There was a significant difference in PD between the various races. Conclusions: The Asian population consistently has significantly smaller pedicles in the lumbar spine than the Black or White populations. This information could prove useful for surgical planning. We suggest using preoperative computed tomography for pedicle screw templating as a safe method for pedicle screw instrumentation with the highest pullout strength given the wide range of PD in the Black population and the variability of PD between races.

CHANDRA OBSERVATIONS OF THE AKARI NEP DEEP FIELD

T. Miyaji,M. Krumpe,H. Brunner,T. Ishigaki,H. Hanami,A. Markowitz,T. Takagi,T. Goto,M. A. Malkan,H. Matsuhara,C. Pearson,Y. Ueda,T. Wada 한국천문학회 2017 天文學論叢 Vol.32 No.1

The AKARI NEP Deep Field Survey is an international multiwavelength survey over 0.4 deg$^2$ of the sky. This is the deepest survey made by the InfraRed Camera (IRC) of the infrared astronomical satellite AKARI with 9 filters continuously covering the 2-25 μm range, including three filters in the Spitzer gap between the IRAC and MIPS coverages. This enabled us to make sensitive MIR detection of AGN candidates at z ~ 1, based on hot dust emission in the AGN torus. It is also efficient in detecting highly obscured Compton-thick AGN population. In this article, we report the first results of X-ray observations on this field. The field was covered by 15 overlapping Chandra ACIS-I observations with a total exposure of ~ 300 ks, detecting $\approx 450$ X-ray sources. We utilize rest-frame stacking analysis of the MIR AGN candidates that are not detected individually. Our preliminary analysis shows a marginal detection of the rest-frame stacked Fe K$\alpha$ line from our strong Compton-thick candidates.

Weekend Admission Increases Risk of Readmissions Following Elective Cervical Spinal Fusion

Renee Ren,Calista Dominy,Brian Bueno,Sara Pasik,Jonathan Markowitz,Brandon Yeshoua,Brian Cho,Varun Arvind,Aly A. Valliani,Jun Kim,Samuel Cho 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Objective: The “weekend effect” occurs when patients cared for during weekends versus weekdays experience worse outcomes. But reasons for this effect are unclear, especially amongst patients undergoing elective cervical spinal fusion (ECSF). Our aim was to analyze whether index weekend admission affects 30- and 90-day readmission rates post-ECSF. Methods: All ECSF patients > 18 years were retrospectively identified from the 2016–2018 Healthcare Cost and Utilization Project Nationwide Readmissions Database (NRD), using unique patient linkage codes and International Classification of Diseases, Tenth Revision codes. Patient demographics, comorbidities, and outcomes were analyzed. Univariate logistic regression analyzed primary outcomes of 30- and 90-day readmission rates in weekday or weekend groups. Multivariate regression determined the impact of complications on readmission rates. Results: Compared to the weekday group (n = 125,590), the weekend group (n = 1,026) held a higher percentage of Medicare/Medicaid insurance, incurred higher costs, had longer length of stay, and fewer routine home discharge (all p < 0.001). There was no difference in comorbidity burden between weekend versus weekday admissions, as measured by the Elixhauser Comorbidity Index (p = 0.527). Weekend admissions had higher 30-day (4.30% vs. 7.60%, p < 0.001) and 90-day (7.80% vs. 16.10%, p < 0.001) readmission rates, even after adjusting for sex, age, insurance status, and comorbidities. All-cause complication rates were higher for weekend admissions (8.62% vs. 12.7%, p < 0.001), specifically deep vein thrombosis, infection, neurological conditions, and pulmonary embolism. Conclusion: Index weekend admission increases 30- and 90-day readmission rates after ECSF. In patients undergoing ECSF on weekends, postoperative care for patients at risk for specific complications will allow for improved outcomes and health care utilization.

Establishment and Characterization of Animal Model for Human Colon Cancer Metastasis with HCT 116 Cells

Ki Beom Bae,Ryan Fecteau,Gretchen Larusch,Lydia J. Beard,Stephen Fink,Sanford (Sandy) Markowitz 대한종양외과학회 2014 대한임상종양학회 학술대회지 Vol.2014 No.3

소아 안면열상 환자의 치료에 있어서 유용한 봉합술

김준형,권순범,어수락,조상헌,Kim, Jun-Hyung,Kwon, Soon-Beom,Eo, Su-Rak,Cho, Sang-Hun,Markowitz, Bernard L. 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: Lacerations requiring formal wound closure compose a significant number of all childhood injuries presenting to the emergency department. The problem with conventional suture technique are that suture removal is quite cumbersome, especially in children. Unwanted soft tissue damage can result in the process of suture removal, which calls for sedation, stressful for both medical personnel and child. The purpose of this study is to introduce the convenient suture technique for pediatric facial lacerations. Methods: Children under the age of four, presenting to the emergency department with facial lacerations were enrolled in the study. From March 2008 to June 2009, 63 patients (41 males and 22 females) with an average age of 1.4 years were treated with our convenient suture technique using utilized a loop suspended above a double, flat tie. Clean, tension free wounds were treated with our technique, wounds with significant skin defect and concomitant fractures were excluded. Results: The Patients were followed-up in 1, 3 and 5 days postoperatively. On the third hospital visit, suture removal was done by simply cutting the loop suspended above the wound margin and gently pulling the thread with forceps. There were no significant differences in the rates of infection and dehiscence compared with conventional suture technique. Conclusion: The use of our technique was to be simple with similar operative time compared with conventional suture technique. Removal of suture materials were easy without unwanted injuries to the surrounding tissue which resulted in less discomfort for the patient and greater parental satisfaction, minimized the complications. It can be considered as a viable alternative in the repair of pediatric facial lacerations.

The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion

Akiro H. Duey,Christopher Gonzalez,Eric A. Geng,Pierce J. Ferriter Jr,Ashley M. Rosenberg,Ula N. Isleem,Bashar Zaidat,Paul M. Al-Attar,Jonathan S. Markowitz,Jun S. Kim,Samuel K. Cho 대한척추신경외과학회 2022 Neurospine Vol.19 No.4

Objective: Subsidence following anterior cervical discectomy and fusion (ACDF) may lead to disruptions of cervical alignment and lordosis. The purpose of this study was to evaluate the effect of subsidence on segmental, regional, and global lordosis. Methods: This was a retrospective cohort study performed between 2016–2021 at a single institution. All measurements were performed using lateral cervical radiographs at the immediate postoperative period and at final follow-up greater than 6 months after surgery. Associations between subsidence and segmental lordosis, total fused lordosis, C2–7 lordosis, and cervical sagittal vertical alignment change were determined using Pearson correlation and multivariate logistic regression analyses. Results: One hundred thirty-one patients and 244 levels were included in the study. There were 41 one-level fusions, 67 two-level fusions, and 23 three-level fusions. The median follow-up time was 366 days (interquartile range, 239–566 days). Segmental subsidence was significantly negatively associated with segmental lordosis change in the Pearson (r = -0.154, p = 0.016) and multivariate analyses (beta = -3.78; 95% confidence interval, -7.15 to -0.42; p = 0.028) but no associations between segmental or total fused subsidence and any other measures of cervical alignment were observed. Conclusion: We found that subsidence is associated with segmental lordosis loss 6 months following ACDF. Surgeons should minimize subsidence to prevent long-term clinical symptoms associated with poor cervical alignment.

Colonic 15-PGDH levels are stable across distance and time and are not perturbed by aspirin intervention.

Fink, Stephen P,Yang, Dong-Hoon,Barnholtz-Sloan, Jill S,Ryu, Yeon-Mi,Mikkola, Debra,Potter, John D,Lampe, Johanna W,Markowitz, Sanford D,Myung, Seung-Jae Plenum Pub. Corp.] 2013 Digestive diseases and sciences Vol.58 No.9

<P>15-Hydroxprostaglandin dehydrogenase (15-PGDH) mediates a colon neoplasia suppressor pathway, acting through metabolic antagonism of cyclooxygenase-mediated colon carcinogenesis. To determine whether the colon tumor prevention activity of 15-PGDH acts as a constant or variable effect among individuals, we determined whether 15-PGDH levels remain stable over subsite and time in the human colon, determined the extent of differences in 15-PGDH levels between different individuals, and determined whether 15-PGDH modulation mediates any part of the anti-colon tumor effect of aspirin.</P>

Prostaglandin E₂ Activates YAP and a Positive-Signaling Loop to Promote Colon Regeneration After Colitis but Also Carcinogenesis in Mice

Kim, H.B.,Kim, M.,Park, Y.S.,Park, I.,Kim, T.,Yang, S.Y.,Cho, C.J.,Hwang, D.,Jung, J.H.,Markowitz, S.D.,Hwang, S.W.,Yang, S.K.,Lim, D.S.,Myung, S.J. Elsevier North Holland [etc.] 2017 Gastroenterology Vol.152 No.3

<P>BACKGROUND & AIMS: Prostaglandin E-2 (PGE(2)) is mediator of inflammation that regulates tissue regeneration, but its continual activation has been associated with carcinogenesis. Little is known about factors in the PGE(2) signaling pathway that contribute to tumor formation. We investigated whether yes-associated protein 1 (YAP1), a transcriptional co-activator in the Hippo signaling pathway, mediates PGE(2) function. METHODS: DLD-1 and SW480 colon cancer cell lines were transfected with vectors expressing transgenes or small hairpin RNAs and incubated with recombinant PGE(2), with or without pharmacologic inhibitors of signaling proteins, and analyzed by immunoblot, immunofluorescence, quantitative reverse-transcription polymerase chain reaction, transcriptional reporter, and proliferation assays. Dextran sodium sulfate (DSS) was given to induce colitis in C57/BL6 (control) mice, as well as in mice with disruption of the hydroxyprostaglandin dehydrogenase 15 gene (15-PGDH-knockout mice), Yap1 gene (YAP-knockout mice), and double-knockout mice. Some mice also were given indomethacin to block PGE(2) synthesis. 15-PGDH knockout mice were crossed with mice with intestine-specific disruption of the salvador family WW domain containing 1 gene (Sav1), which encodes an activator of Hippo signaling. We performed immunohistochemical analyses of colon biopsy samples from 26 patients with colitis-associated cancer and 51 age-and sex-matched patients with colorectal cancer (without colitis). RESULTS: Incubation of colon cancer cell lines with PGE(2) led to phosphorylation of cyclic adenosine monophosphate-responsive element binding protein 1 and increased levels of YAP1 messenger RNA, protein, and YAP1 transcriptional activity. This led to increased transcription of the prostaglandin-endoperoxide synthase 2 gene (PTGS(2) or cyclooxygenase 2) and prostaglandin E-receptor 4 gene (PTGER4 or EP4). Incubation with PGE(2) promoted proliferation of colon cancer cell lines, but not cells with knockdown of YAP1. Control mice developed colitis after administration of DSS, but injection of PGE(2) led to colon regeneration in these mice. However, YAP-knockout mice did not regenerate colon tissues and died soon after administration of DSS. 15-PGDH-knockout mice regenerated colon tissues more rapidly than control mice after withdrawal of DSS, and had faster recovery of body weight, colon length, and colitis histology scores. These effects were reversed by injection of indomethacin. SAV1-knockout or 15-PGDH-knockout mice did not develop spontaneous tumors after colitis induction, but SAV1/15-PGDH double-knockout mice developed polyps that eventually progressed to carcinoma in situ. Administration of indomethacin to these mice prevented spontaneous tumor formation. Levels of PGE(2) correlated with those of YAP levels in human sporadic colorectal tumors and colitis-associated tumors. CONCLUSIONS: PGE(2) signaling increases the expression and transcriptional activities of YAP1, leading to increased expression of cyclooxygenase 2 and EP4 to activate a positive signaling loop. This pathway promotes proliferation of colon cancer cell lines and colon tissue regeneration in mice with colitis. Constitutive activation of this pathway led to formation of polyps and colon tumors in mice.</P>

Inhibition of 15-Hydroxyprostaglandin Dehydrogenase by <i>Helicobacter pylori</i> in Human Gastric Carcinogenesis

Ryu, Yeon-Mi,Myung, Seung-Jae,Park, Young Soo,Yang, Dong-Hoon,Song, Ho June,Jeong, Jin-Yong,Lee, Sun Mi,Song, Miyeoun,Kim, Do Hoon,Lee, Hyo-Jeong,Park, Soo-Kyung,Fink, Stephen P.,Markowitz, Sandy D.,J American Association for Cancer Research 2013 Cancer prevention research Vol.6 No.4

<P><I>Helicobacter pylori</I> (<I>H. pylori</I>) infection induces a chronic inflammatory response, which promotes gastric carcinogenesis. 15-Hydroxyprostaglandin dehydrogenase (15-PGDH) plays a key role as a tumor suppressor in gastrointestinal cancers. The aim of this study was to elucidate the role of 15-PGDH in gastric carcinogenesis associated with <I>H. pylori</I>. 15-PGDH expression in gastric biopsies from <I>H. pylori</I>–infected (<I>n</I> = 25) and noninfected (<I>n</I> = 15) subjects was analyzed by quantitative real-time PCR, Western blot analysis, and immunohistochemistry. 15-PGDH DNA methylation was evaluated by methylation-specific PCR and pyrosequencing. The expression of 15-PGDH, Snail, extracellular signal–regulated kinase (ERK)1/2, TLR4, and MyD88 in response to <I>H. pylori</I> infection was assessed by immunoblot analysis. Compared with negative specimens, <I>H. pylori</I>–positive specimens had 2-fold lower 15-PGDH mRNA levels and significantly less 15-PGDH protein. In four <I>H. pylori–</I>infected subjects with longitudinal follow-up, the suppression of 15-PGDH expression was reversed by <I>H. pylori</I> eradication therapy. In parallel with suppressing 15-PGDH expression, <I>H. pylori</I> infection activated expression of TLR4 and MyD88 expression, increased levels of phospho-ERK1/2, and increased expression of EGF receptor (EGFR)-Snail. Inhibition of Snail and MyD88 reversed suppression of 15-PGDH expression, and siMyD88 reduced phosphorylated ERK1/2. Similarly, treatment with an ERK1/2 and EGFR inhibitor also restored 15-PGDH expression. <I>H. pylori</I> appeared to promote gastric carcinogenesis by suppressing15-PGDH. This process is mediated by the TLR4/MyD88 pathway via ERK1/2 or EGFR-Snail transcriptional regulation. 15-PGDH may be a useful marker and a potential therapeutic target in <I>H. pylori</I>–induced gastric carcinogenesis. <I>Cancer Prev Res; 6(4); 349–59. ©2013 AACR.</I></P>