A follow-up study evaluating postural control, lumbar movement perception, and paraspinal muscle reflexes in disc herniation-related chronic low back pain (LBP) before and after discectomy.
To assess ...the effect of discectomy on postural control, lumbar perception, and reflex activation of paraspinal muscles during sudden upper limb loading.
Impaired muscle function, postural control, and lumbar proprioception have been observed in LBP. However, they have not been studied in sciatica patients after surgery.
The study included 20 patients selected for an operation for chronic LBP caused by disc herniation and 15 controls without chronic LBP. The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface electromyography. The ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The postural control was measured with a vertical force platform. Pain, disability, and depression scores were recorded.
Patients had poorer lumbar perception (P = 0.012) and postural control (P < 0.05) than did healthy controls. The postural control remained unchanged, but lumbar perception (P = 0.054) and the lumbar feed-forward control (P = 0.043) improved after the surgery.
The results demonstrate impaired lumbar proprioception and postural control in sciatica patients. During short-term follow-up after operative treatment, postural control does not seem to change, but impaired lumbar proprioception and feed-forward control of paraspinal muscles seem to recover.
The integration of circular economy-based life cycle management (LCM) into product design and optimisation is essential for the transformation towards a circular economy (CE). However, companies ...often lack the expertise to adapt life-cycle design (LCD) thinking in their business operations and are in need of respective capacity building. To close this apparent gap is the aim of the project e-CirP (Embedding Circular Economy into Product Design and Optimization) where LUT University, Fraunhofer, Technical University of Denmark, University of Padova, Delft University of Technology, University of Helsinki and Metso Outotec have worked together to develop a program that allows Master students across Europe to learn how to integrate CE and Life Cycle Thinking principles into product design by analysing real industrial cases. In the project, modern pedagogical approaches have been applied. A modular training package covering general circular economy aspects, as well as detailed value chain perspectives, has been created. Next to the content-related aspects, a great focus was also on the support of so-called soft-skills development, e.g. through international student cooperation on case studies. The paper presents the perspective of participating students as well as the cooperating companies that supplied the industry cases to allow an overview of opportunities and challenges.
We report a series of 84 consecutive patients (41 women) with 92 distal anterior cerebral artery aneurysms (DACAA). All aneurysms were saccular. Four different locations of DACAAs were found: ...proximal, 5 aneurysms; frontobasal, 8; genu corporis callosi, 72; and distal, 7. Sixty-five patients presented with subarachnoid hemorrhage (SAH), the rest were incidental findings in patients with multiple aneurysms. Forty-five patients had single DACAAs. Multiple aneurysms (a total of 117) were found in 39 patients (46.4%), and DACAAs were responsible for SAH in 20 patients. Of the 65 patients with SAH, 54 underwent mainly early direct surgery, and 46 (85%) of these had good outcomes 1 year after surgery. Three patients remained severely disabled, and five patients (9%) died. All of the poor surgical results were obtained in patients with severe preoperative deficits. Exact measurements of DACAA sizes and necks were smaller than those of cerebral aneurysms in other locations. Aside from localization, microsurgery of these aneurysms presented no special difficulties, as compared with surgery of aneurysms in other locations.
A comparative study of lumbar paraspinal muscle reflexes during sudden upper limb loading in healthy control subjects and patients with sciatica.
To assess reflex activation of paraspinal muscles ...during sudden upper limb loading.
Sudden upper limb loading and upper limb voluntary movements cause reflex activation of trunk muscles. A short latency response of approximately 50 msec of lumbar muscles has been observed before, but the reflexes have not been studied in patients with sciatica.
The paraspinal muscle responses for upper limb loading during unexpected and expected conditions were measured by surface EMG from 20 patients selected for an operation as a result of disc herniation-related chronic low back pain and 15 back-healthy controls. Pain, disability, and depression scores were recorded.
Short latency response of paraspinal muscles for unexpected upper limb loading was similar in healthy controls and patients with sciatica in supported standing. During normal standing anticipation shortened the lumbar reflex latency in healthy controls but not among the patients.
The results provide evidence for impaired feed-forward control of lumbar muscles in patients with sciatica.
Aneurysm of the internal carotid-posterior communicating artery (ICA-PCoA) is the most frequent cause of sudden unilateral oculomotor palsy. Timely surgery for the aneurysm is the most important ...factor for third nerve recovery.
We scrutinized the world literature with nearly one thousand cases of isolated unilateral oculomotor palsy caused by intracranial aneurysms and treated with surgery. Only those reports (one-third of all) in which the time interval between onset of oculomotor palsy and surgery could be determined were included. We treated 1314 patients with cerebral aneurysms (183 = 14% with ICA-PCoA aneurysms) from our catchment area in Eastern Finland during years 1977-1992. Twenty-eight patients having oculomotor palsy caused by ICA-PCoA aneurysm had surgery as soon as the diagnosis was made.
Eight of 9 patients operated within three days (0-3) and 4 of 6 patients operated on within 4 to 6 days the onset of oculomotor palsy had complete recovery of their third nerve function, in contrast to only 4 of 13 patients operated on later. Especially those operated on more than four weeks later had a dismal outcome: only 1 of 6 had complete recovery.
We recommend immediate admission and acute or early surgery for aneurysm-induced third nerve palsy, preferably within 3 days, to avoid functionally and cosmetically invalidizing disability.
A patient with cervicocranial fibromuscular dysplasia (FMD) presented with subarachnoid hemorrhage. A ruptured dissecting distal vertebral artery aneurysm required clip ligation of the parent artery; ...a contralateral dissecting proximal vertebral aneurysm was occluded with detachable coils. Progressive dissecting, extracranial aneurysms of the internal carotid artery were treated with self-expanding stents. Subsequent angiography and intravascular sonography revealed patent stents, a smooth luminal surface, and total occlusion of the aneurysm. Clinical outcome was excellent.
This study investigated the outcome of medial facetectomy in reoperations after a previous discectomy. In a consecutive series of 98 patients with varying combinations of disc herniation, lateral ...stenosis, and scar, a good or moderate outcome was reached in 57% of the patients. Scar as an operative finding was a significant factor for poor outcome, especially in patients with preoperative symptoms for >1 year.
Lumbosacral tissue defects are usually closed with local flaps. Sometimes in large high-situated defects free microvascular flaps are used. However, finding a suitable recipient vessel for ...microvascular anastomosis in this region is difficult. In large soft-tissue defects high in the lumbar area, closure with a free flap using the iliac artery and vein as recipient vessels channelled from the pelvic cavity to the back through a drill canal in a bone presents an alternative option where other vessels are damaged by radiotherapy or infection. This has been used successfully in two cases.
Livestock grazing is an important management tool of agri-environment schemes initiated within the European Union to maintain and restore biodiversity of grassland birds. However, grazing can affect ...bird populations negatively by depressing reproduction through nest trampling and increasing nest predation. These effects are, however, considered low when using recommended stocking rates. By simulating wader nests, we experimentally quantify and examine the causes of variation in trampling rates on managed Baltic coastal meadows. Secondly, we examine whether livestock presence increases nest predation of one management target, the critically endangered southern dunlin (
Calidris alpina schinzii
). Trampling rates of experimental nests were high. Only 21% of nests would have survived a three week incubating period early in the grazing season. Trampling rates were most severe at the onset of grazing and decreased with time. Thus, timing of grazing plays a crucial role in determining breeding success on managed meadows. Predation rates of dunlin nests were moderate and did not depend on livestock presence suggesting that incubating dunlin are not disturbed by cattle. While grazing is vital in habitat restoration and in conserving grassland biodiversity, our results suggest that grazing may also threaten the viability of populations if negative effects are underestimated. Therefore, management plans, especially for endangered species, should not only rely on general recommendations on stocking rates but instead planners need to evaluate the significance of negative effects in terms of local conditions (timing of breeding and grazing, space use of cattle and birds, measured trampling rates) and adjust grazing practises accordingly.
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