Jerry L. Pettis Memorial VA Medical Center

The Coronary Artery Risk Development in Young Adults (CADIA) study of young overweight adults, black and white, demonstrated that dietary patterns characterised by increased dairy consumption had an inverse association with insulin resistance in their study population. The inclusion of low or non-fat dairy products, which provide additional calcium in the diet, may promote increased weight loss and improve insulin resistance. Therefore, supplementing dairy products to obese subjects on a caloric-restricted diet may be a useful strategy to enhance weight loss and improve insulin resistance. The study assesses dairy Calcium supplementation and its effects on body Fat, plasma leptin and glucose levels in obese postmenopausal women. This prospective randomised study of 3 months, parallel trial on the effect of non-fat / low-fat dairy calcium combined with energy restriction in overweight/obese postmenopausal women. The study therefore tested the short-term effects of supplementing 56 overweight or obese (body mass index [BMI] >26 kg/m2) post menopausal women on a caloric-restricted diet (1,400 kilocalories [kcal]) with two levels of dairy as yoghurt on body composition, blood insulin, leptin and glucose concentration. The group consuming four supplemented dairy servings (DS-4) was provided ~1400 mg Ca/day, and the group consuming two supplemented dairy servings (DS-2) were provided ~800 mg Ca/day. Over the 3-months daily energy intake averaged 51% carbohydrate, 20.7% of protein and 27.6% of fat for both groups. At 3 months, the DS-4 group demonstrated decreased weight (87.7 to 86.2 kg, P=0.001), BMI (33.5 to 32.8 kg/m2, P < 0.001), total fat (36.1 to 34.7 kg, P<0.001), and trunk fat (18.3 to 17.6 kg, P < 0.001). There were non-significant decreases in plasma glucose (74.7 to 71.1 mg/dl, P=0.494), leptin (32.5 to 31.3 µg/L, P=0.231) and insulin. For the DS-2 group, there was decreased weight (86.4 to 84.4 kg, p<0.02), BMI (32.5 to 31.8 kg/m2, P=0.002), total fat (37.3 to 35.4 kg, P=0.003), trunk fat (17.1 to 16.5 kg, P = 0.27) and plasma leptin (27.8 to 25.2 µg/L, P=0.114). The DS-2 group demonstrated a surprising and significant increase in the fasting blood glucose, with a marginally significant increase in insulin resistance as measured by HOMA at 3 months. We observed a significant treatment effect between the DS-2 and DS-4 groups for: % energy from fat (P=0.025), % energy from protein (P=0.047) and leptin (P=0.044). The study report that in a population of obese/overweight postmenopausal women supplementing their diet with dairy which provided a total estimated calcium intake of ~1400 mg/day (i.e. DS-4) was successful in the reduction of trunk fat and plasma glucose, while dairy calcium and caloric restriction decreased weight, BMI, total body fat, and insulin and leptin during the intervention. In contrast, the supplemented group ingesting 800 mg/d of dairy calcium (i.e. DS-2) in combination with caloric restriction provided significant increases in plasma glucose and insulin resistance. Our study demonstrated the expected weight loss with caloric restriction, but a paradoxical increase in blood glucose levels with dairy supplementation provided to maintain baseline calcium intake. Increasing dairy supplementation abrogated this small increase in fasting blood glucose and insulin resistance. The benefits of dairy calcium supplementation may be dependent on both the dose and the context of overall caloric intake.

Introduction Cervical central canal (CCC) stenosis is associated with low CCC area. Traditional methods involve manual measurements, which could potentially be replaced by artificial intelligent (AI). This study evaluates the predictive value of shape approximations, specifically elliptical, triangular, and rectangular as well as second-order approximations (SOA), in estimating the CCC area using anteroposterior diameter (APD) and interpedicular distance (IPD) in patients with CCC stenosis. Research Question How accurately can shape approximations, including SOA, predict the CCC area in patients with stenosis? Material and Methods This retrospective cohort study analyzed cervical spine imaging data from 334 patients. Central canal measurements, including APD, IPD, and CCC area, were obtained from CT scans. The APD and IPD values were applied to pre-existing approximation equations to estimate the CCC area. These approximated areas were compared to manual measurements, with statistical analyses such as mean differences, percent error, and paired sample t-tests used to assess the accuracy of the approximations. Results Out of 334 patients, 118 met the inclusion criteria, with 239 stenotic levels assessed. The ellipse approximation showed mean differences from -2.95 mm² at C5-6 to -36.03 mm² at C3-4. It demonstrated no significant difference from manual measurements at C4-5, C5-6, and C6-7. SOAs outperformed single-shape approximations, with mean differences ranging from -0.46 mm² at C6-7 to -16.26 mm² at C2-3, and showed no significant difference at C3-4, C4-5, C5-6, and C6-7. Discussion and Conclusion Elliptical and SOA methods effectively predict CCC area in stenosis, demonstrating potential for integration into AI-based diagnostic systems.

Statin-induced immune-mediated necrotizing myopathy (IMNM) is a rare subtype of idiopathic inflammatory myopathy associated with statin exposure and characterized by positive anti-hydroxymethylglutaryl coenzyme A reductase antibodies. Here, we describe a case of a 66-year-old male who was admitted with the presumed diagnosis of rhabdomyolysis in the setting of chronic statin use but was later confirmed to have statin-induced IMNM after his symptoms were refractory to treatment. This case highlights the importance of having a high clinical suspicion for statin-induced IMNM when statin-associated muscle symptoms fail to resolve after the discontinuation of statins.

Extracellular vesicles (EVs), particularly exosomes (EXOs) of various skeletal and stem cells, were shown to delay osteoarthritis (OA) progression, and apoptotic bodies (ABs), another EV subtype, of osteoclasts showed osteoanabolic actions and were involved in the osteoclastic-regulation of local bone formation. Moreover, this study demonstrates that microvesicles (MVs) released by osteoclasts displayed potent pro-chondrogenic, pro-osteogenic, and anti-inflammatory activities. These activities were unique to osteoclastic MVs and were not shared by osteoclastic ABs and EXOs or MVs of other cell types. Because chronic synovial inflammation, progressive articular cartilage erosion, abnormal subchondral bone remodeling, and inability to regenerate articular cartilage are key etiologies of OA, we postulate that the foregoing activities of osteoclastic MVs could simultaneously target multiple etiologies of OA and could thereby be an effective therapy for OA. Accordingly, this study sought to assess the feasibility of an osteoclastic MV-based strategy for OA with a mouse tibial plateau injury model of OA. Briefly, tibial plateau injuries were created on the right knees of adult C57BL/6J mice, MVs were intraarticularly injected into the injured joints biweekly, and the OA progression was monitored histologically at five weeks post-injury. The MV treatment reduced the OA-induced losses of articular cartilage area and thickness, decreased irregularity in the articular cartilage surface, reduced loss of gliding/intermediate zone of articular cartilage, reduced osteophyte formation, suppressed synovial inflammation, and decreased the OARSI OA score. In summary, treatment with osteoclastic MVs delayed or reversed OA progression. Thus, this study supports the feasibility of an osteoclastic MV-based therapy for OA.

To establish normative anatomic measurements of lumbar segmental angulation (SA) and disk space height (DSH) in relation to neuroforaminal dimensions (NFDs), and to uncover the influence of patient demographic and anthropometric characteristics on SA, DSH, and NFDs. NFDs, SA, and anterior, middle, and posterior DSH were measured using computed tomography of 969 patients. NFDs were defined as sagittal anterior-to-posterior width, foraminal height, and area. Statistical analyses were performed to assess associations among SA, DSH, NFDs, and patient height, weight, body mass index, sex, and ethnicity. SA and DSH measurements increased moving caudally from L1 to S1. Foraminal width decreased moving caudally from L1 to S1. Foraminal height and area demonstrated unimodal distribution patterns with the largest values clustered at L2-L3 on the right side and L3-L4 on the left. Significant differences in SA, DSH, and NFD measurements were observed based on the disk level. Inconsistent, marginal NFD differences were observed based on laterality. Across all disk levels, only weak-to-moderate correlations were observed between SA and DSH in relation to NFDs. Patient height, weight, and body mass index were only weakly associated with SA, DSH, and NFDs. Based on patient sex, significant differences were observed for SA, DSH, and NFD measurements from L1 to S1, with males demonstrating consistently larger values compared with females. Based on patient race and ethnicity, significant differences in SA and NFD measurements were observed from L1 to S1. This study describes 48 450 normative measurements of L1-S1 SA, DSH, and NFDs. These measurements serve as representative models of normal anatomic dimensions necessary for several applications including surgical planning and diagnosis of foraminal stenosis. Normative values of SA and DSH are not moderately or strongly associated with NFDs. SA, DSH, and NFDs are influenced by sex and ethnicity, but are not strongly or moderately influenced by patient anthropometric factors.

Retrospective cohort. To report normative measurements of L1 to S1 lumbar neuroforamina on plain film radiography (PFR), computed tomography (CT), and magnetic resonance imaging (MRI), accounting for patients' sex and ethnicity. The quantitative criteria fothe diagnosis of neuroforaminal stenosis remains unknown. Acquiring a thorough understanding of normative foraminal dimensions is a key step in formulating objective parameters for neuroforaminal stenosis. We measured 988 images from 494 patients between 18 and 35 years old without spinal pathology who received PFR, CT, or MRI within 1 year of each other. Neuroforaminal measurements were defined as the height, area, and sagittal and axial widths. Statistical analyses were performed to assess relationships among PFR, CT, and MRI-derived neuroforaminal measurements, as well as the influence of patients' sex and ethnicity. 330 PFR, 377 CT, and 281 MRI were measured. Of these, 213 PFR and CT, 117 PFR and MRI, and 164 MRI and CT intrapatient images were compared. Statistically significant differences were observed among PFR, CT, and MRI measurements across all levels L1 to S1. PFR measurements were larger compared with those derived from CT and MRI. Weak-to-moderate correlations were observed between PFR and CT, PFR and MRI, and CT and MRI, with the magnitude of correlation decreasing caudally from L1 to S1. Variations in neuroforaminal anatomy were observed based on sex and ethnicity. This study reports 25,951 measurements of normal L1 to S1 neuroforaminal anatomy assessed by PFR, CT, and MRI. The values reported in this study may be used as normative reference measurements of the lumbar neuroforamina. PFR measurements of the neuroforamina are larger compared with those derived from CT and MRI across all levels from L1 to S1. There is a poor correlation between PFR, CT, and MRI when measuring the lumbar neuroforamina. Differences in neuroforaminal anatomy are evident based on patients' sex and ethnicity.

The kidneys, ribs, liver, spleen, and iliac crests can pose access-related issues to the disc space during both anterior-to-psoas (ATP) and transpsoas (TP) surgical approaches. The aim of this study was to identify and compare the presence and degree of obstruction caused by these structures for the ATP and TP approaches bilaterally from L1 to S1 using abdominal computed tomography. Presence of obstruction by a given structure was recorded if the structure was within ATP or TP borders. Degree of obstruction was calculated as the quotient of the structure measurement within the ATP or TP approach divided by the entire corridor length at the point of obstruction. The percentage of time the left kidney was present during the ATP vs TP approaches at L1 to L2 was 44% vs 89% (P < 0.001), at L2 to L3 was 26% vs 75% (P < 0.001), and at L3 to L4 was 5% vs 19% (P < 0.001). For the right kidney, these values were 37% vs 78% (P < 0.001), 43% vs 71% (P < 0.001), and 11% vs 18% (P < 0.001). The percentage of time the left rib was present during ATP vs TP approaches was 41% vs 81% (P < 0.001) at L1 to L2 and 11% vs 26% (P = 0.413) at L2 to L3. With respect to the liver, the ATP approach was obstructed 56%, 30%, and 9% of the time at the levels of L1 to L2, L2 to L3, and L3 to L4; the liver was not present in L1 to L4 TP approach. This study is the first to both characterize and compare nonneurological structures at risk during ATP and TP fusion approaches bilaterally from L1 to S1 using abdominal computed tomography. Findings suggest the ATP approach poses less structures at risk relative to the TP approach with respect to the kidneys, ribs, and iliac crests bilaterally. The TP approach offers advantages compared with ATP approach with respect to the liver and spleen. Findings from this study are clinically relevant for ATP and TP surgical approach planning.

The aim of this study was to identify the incidence and characteristics of malpractice lawsuits pertaining to laminectomy performed either as a stand-alone operation or concurrent with another procedure by querying the Westlaw Edge and VerdictSearch databases. Malpractice claims analysis is performed by several medical specialties to provide insight into patient values, methods to improve quality of care, and risk factors for litigation pertaining to specific procedures or treatments. Westlaw and VerdictSearch were queried using the keywords "laminectomy" and "spine." Claims were reviewed, with the inclusion criteria defined as a case filed between 2000 and 2022 that involved the plaintiff's basis of litigation resting on a claim of medical malpractice due to laminectomy. Additional collected data included the case date, verdict ruling, state or federal location of the filed claim, sustained injuries, and payment or settlement amount. After review of 4732 cases, 201 were identified as malpractice claims due to laminectomy. The most common reasons for litigation were delayed or denied treatment (n = 106), procedural errors (n = 38), inadequate management of postlaminectomy syndrome (n = 26), and incorrect procedural selection (n = 14). Regarding the verdict ruling, 47.3% (n = 95) of cases ruled in favor of the defendant, 9.0% (n = 18) resulted in a mixed ruling, 15.9% (n = 32) ruled in favor of the plaintiff, and 9.5% (n = 19) were resolved with an out-of-court settlement. An average payment of $4,530,277 resulted from the cases that ruled in favor of the plaintiff, while out-of-court settlements yielded an average payment of $1,193,146. This study suggests that there are several well-documented risk factors for malpractice claims attributed to laminectomy. The study findings suggest that prompt and accurate diagnosis, coordination of care, timely referral for surgical intervention, and understanding of the indications versus limitations of conservative therapy may help to mitigate the risk of litigation associated with laminectomy.

Introduction: Administration of Epidural Steroid Injection (ESI) increased approximately 99% from 2000 to 2014. Analysis of reasons for malpractice claims due to ESI may provide insight into methods to improve patient care. This study analyzed malpractice claims due to ESI using two well established legal databases