Methods: Twenty-four consecutive patients who underwent anterior debridement and spinal fusion with an autologous strut bone graft for infectious spondylodiscitis with osseous defects were reviewed retrospectively. Eleven patients underwent the minimal retroperitoneal approach (Group M), and 13 underwent the conventional open approach (Group C). Peri- and postoperative clinical outcomes, that is, estimated blood loss (EBL), operative time (OT), creatine kinase (CK) level, visual analog scale (VAS), and rates of bone union and additional posterior instrumentation, were evaluated, and the differences between both groups were assessed statistically.
Results: Mean EBL, serum CK on the 1st postoperative day, and VAS on the 14th postoperative day were 202.1 mL, 390.9 IU/L, and 9.5 mm in Group M and 648.3 mL, 925.5 IU/L, and 22.3 mm in Group C, respectively, with statistically significant differences between the groups. There were no statistically significant intergroup differences in OT and rates of bone union and additional posterior instrumentation.
Conclusions: Anterior debridement and spinal fusion using the minimal retroperitoneal approach is a useful and safe surgical technique. Although a preponderance of the minimal approach regarding early bone union is not validated, this technique has the advantages of conventional open surgery, but reduces blood loss, muscle injury, and pain postoperatively.
METHODS: A single-blinded placebo-controlled trial of surgical intervention triggered when CM amplitude dropped by at least 30% of a prior maximum amplitude during cochlear implantation. Intraoperative electrocochleography was recorded in 60 adults implanted with Cochlear Ltd's Thin Straight Electrode, half randomly assigned to a control group and half to an interventional group. The surgical intervention was to withdraw the electrode in ½-mm steps to recover CM amplitude. The primary outcome was hearing preservation 3 months following implantation, with secondary outcomes of speech-in-noise reception thresholds by group or CM outcome, and depth of implantation.
RESULTS: Sixty patients were recruited; neither pre-operative audiometry nor speech reception thresholds were significantly different between groups. Post-operatively, hearing preservation was significantly better in the interventional group. This was the case in absolute difference (median of 30 dB for control, 20 dB for interventional, χ² = 6.2, p = .013), as well as for relative difference (medians of 66% for the control, 31% for the interventional, χ² = 5.9, p = .015). Speech-in-noise reception thresholds were significantly better in patients with no CM drop at any point during insertion compared with patients with a CM drop; however, those with successfully recovered CMs after an initial drop were not significantly different (median gain required for speech reception score of 50% above noise of 6.9 dB for no drop, 8.6 for recovered CM, and 9.8 for CM drop, χ² = 6.8, p = .032). Angular insertion depth was not significantly different between control and interventional groups.
CONCLUSIONS: This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation.
METHODOLOGY: Proteomics was used to compare protein extracts of skim milk from Saanen, Jamnapari, and Toggenburg. Cow's milk was used as a control. IgE-immunoblotting and mass spectrometry were used to compare and identify proteins that cross-reacted with serum IgE from CMPA patients (n = 10).
RESULTS: The analysis of IgE-reactive proteins revealed that the protein spots identified with high confidence were proteins homologous to common cow's milk allergens such as α-S1-casein (αS1-CN), β-casein (β-CN), κ-casein (κ-CN), and beta-lactoglobulin (β-LG). Jamnapari's milk proteins were found to cross-react with four major milk allergens: α-S1-CN, β-CN, κ-CN, and β-LG. Saanen goat's milk proteins, on the other hand, cross-reacted with two major milk allergens, α-S1-CN and β-LG, whereas Toggenburg goat's milk proteins only react with one of the major milk allergens, κ-CN.
CONCLUSION: These findings may help in the development of hypoallergenic goat milk through cross-breeding strategies of goat breeds with lower allergenic milk protein contents.