Chronic low back pain due to disc degeneration represents a major social and economic burden worldwide. The current standard of care is limited to symptomatic relief and no current approved therapy promotes disc regeneration. Bone marrow-derived mesenchymal stem cells (MSCs) are easily accessible and well characterized. These MSCs are multipotent and exhibit great tissue regenerative potential including bone, cartilage, and fibrous tissue regeneration. The use of this cell-based biologic for treating protruding disc herniation and/or intervertebral disc degeneration is a promising therapeutic strategy, due to their known regenerative, immuno-modulatory and anti-inflammatory properties.

Background: Current treatment options for stable non-union fractures represent major clinical challenges, and are a major health issue.Fracture treatment can take many forms, usually requiring bone grafting and/or revisions of the fracture with open reduction and internal fixation (ORIF).Conservative care options such as bone morphogenic proteins and bone stimulators are also available.The purpose of this study was to determine if culture expanded, autologous MSC's injected into non-union fractures under c-Arm fluoroscopy could represent an alternative treatment modality in recalcitrant fracture non-unions.This paper reports on the findings of 6 patients with fracture non-union treated with autologous MSC's. Patients and methods:We evaluated 6 consecutive patients with chronic fracture non-unions.Patients consisted of 4 women and 2 men with treatment intervention at an average of 8.75 months post-fracture (range 4-18 months, one patient fracture not included in calculation was >100 mo.).All treated patients received autologous, culture expanded, mesenchymal stem cells injected percutaneously via fluoroscopic guidance into the site of the fracture non-union.Fracture union was evaluated with the use of follow up high-resolution x-ray and/or CT imaging.Phenotype of the culture-expanded MSCs was evaluated and quantified by flow cytometry of surface antigens. Conclusion:The results of this study support the hypothesis that autologous MSC's delivered via percutaneous re-implantation may be an alternative modality for the non-operative treatment of recalcitrant non-union fractures.

UNLABELLED ABSTRUCT: Mesenchymal stem cells (MSCs) hold great promise as therapeutic agents in regenerative medicine. Numerous animal studies have documented the multipotency of MSCs, showing their capabilities for differentiating into orthopedic tissues such as muscle, bone, cartilage, and tendon. However, the complication rate for autologous MSC therapy is only now beginning to be reported. METHODS Between 2005 and 2009, two groups of patients were treated for various orthopedic conditions with culture-expanded, autologous, bone marrow-derived MSCs (group 1: n=45; group 2: n=182). Cells were cultured in monolayer culture flasks using an autologous platelet lysate technique and re-injected into peripheral joints (n=213) or into intervertebral discs (n=13) with use of c-arm fluoroscopy. While both groups had prospective surveillance for complications, Group 1 additionally underwent 3.0T MRI tracking of the re-implant sites. RESULTS Mean follow-up from the time of the re-implant procedure was 10.6 +/- 7.3 months. Serial MRI's at 3 months, 6 months, 1 year and 2 years failed to demonstrate any tumor formation at the re-implant sites. Formal disease surveillance for adverse events based on HHS criteria documented 7 cases of probable procedure-related complications (thought to be associated with the re-implant procedure itself) and three cases of possible stem cell complications, all of which were either self-limited or were remedied with simple therapeutic measures. One patient was diagnosed with cancer; however, this was almost certainly unrelated to the MSC therapy. CONCLUSIONS Using both high field MRI tracking and general surveillance in 227 patients, no neoplastic complications were detected at any stem cell re-implantation site. These findings are consistent with other reports that also show no evidence of malignant transformation in vivo, following implantation of MSCs that were expanded in vitro for limited periods.

BACKGROUND AND OBJECTIVES:In a pilot study, we previously demonstrated a higher average skin to lumbar epidural space distance (STLESD) in our obstetric population compared with the published literature. Furthermore, we demonstrated differences in STLESD based on ethnicity. The aim of this study was to perform a comprehensive analysis of the STLESD in our patient population by expanding the number of patients and ethnic groups included. METHODS:Data from 3,305 patients were obtained from our electronic database from September 2003 through November 2005. Self-declared ethnicity included 1,177 Caucasians (36%), 1,162 African Americans (35%), 760 Hispanics (23%), 135 Asians (4%), and 71 Indian/Pakistani/Bangladeshi/Sri Lankans (2%). The influences of body mass index (BMI), ethnicity, and their interaction on the STLESD were tested with a multiple linear regression model. RESULTS:The mean +/- SD STLESD differed among the ethnic groups ranging from 4.8 +/- 0.9 cm in Asian patients to 6.3 +/- 1.6 cm in African American parturients. When all ethnic groups were compared, BMI had a significant influence on STLESD (P < .0001), but so did ethnicity (P = .0004). The Hispanic group demonstrated STLESDs that were significantly lower than the African American and Caucasian groups at high BMI (P < .0001). In a subanalysis performed without the Hispanic group, the influence of BMI on STLESD was found to be similar for each group. In this subanalysis, the African American group had STLESDs that were deeper compared with the other 3 ethnic groups (P < .0001), regardless of BMI. CONCLUSIONS:In this study we found that the STLESD was deeper than what was previously reported in the literature. Furthermore, ethnicity, in addition to BMI, influenced the STLESD.

BACKGROUND:Baker's cysts are commonly encountered in pain management practices.OBJECTIVE:To ascertain if sclerotherapy treatment of a Baker's cyst could produce objectively verifiable MRI imaging changes.DESIGN:Case report.METHODS:A 52-year-old white male with a posterior horn of the medial meniscus tear and a large Baker's cyst who had failed conservative care and drainage was imaged before treatment with sclerosing. Three injections of 12.5% dextrose and anesthetic with sodium morrhuate were injected intraarticular into the right knee after drainage.RESULTS:The Baker's cyst resolved on both postoperative imaging after the completion of care as well as on physical examination.CONCLUSIONS:Prolotherapy in this case study seemed to be an effective treatment for Baker's cyst in this patient.

Successful problem solving and improvement require more than the discovery of a workable solution. At some point, the results need to become part of daily routines and locked in place so that these new practices do not revert to old, less productive habits. Using performance improvement steps to secure the change can ensure that process owners will not revisit the same set of issues in the future.

An extravasated IV catheter may have serious clinical consequences. These include the inability to circulate emergency medications, cause pain on injection, infection at the site, and tissue damage. Clinical signs such as swelling, redness, and pain with injection are valuable, but may not be helpful in the presence of obesity, edema, or in a tracheally intubated and sedated patient. Here we describe a case illustrating a novel approach in which we used an IV dye injection (indigo carmine) to detect a correctly placed and then an extravasated IV. The ability to see visible flow of IV dye intravascularly helped confirm the correct placement. The technique we describe is quick, safe, and inexpensive.

SUMMARY Intrathecal injection of ondansetron has the potential to reduce opioid‐related side‐effects. The aim of the present study was to determine whether this route of administration produces neuraxial injury. Adult, non‐pregnant female New Zealand white rabbits received a single bolus injection of a low (40 mg) or high (4.0 mg) dose of ondansetron into the intrathecal space between the 4th and 5th lumbar vertebrae. In some cases, ondansetron was coadministered with morphine (5 mg/kg). Control animals received a bolus injection of normal saline. Behavioural assessments were conducted at 1 and 24 h to determine overt changes in arousal and mobility, followed by histological evaluation of the excised spinal cord. Of 45 animals investigated, 10 rabbits exhibited modest behavioural evidence of spinal injury, the incidence of which was equally distributed between the treatment groups. Haematoxylin and eosin, along with HAM56, staining of cross‐sections of the cervical, thoracic and upper and lower lumbar areas revealed mild signs of inflammation. This, too, was equally distributed between the treatment groups, suggesting that any observed neuraxial injury was the result of needle trauma and not ondansetron neurotoxicity. Collectively, these negative findings support conducting further experiments to fully assess the clinical usefulness of intrathecal ondansetron administration.

Performance ImprovementVolume 45, Issue 4 p. 13-17 Article Measuring service industry performance: Some basic concepts John R. Schultz, John R. Schultz [email protected] John R. Schultz teaches and administers an advanced technical certificate program in quality management. He has an MS in Management, has done graduate study in adult education, and has undergraduate degrees in Industrial Management and Organizational Behavior.Search for more papers by this author John R. Schultz, John R. Schultz [email protected] John R. Schultz teaches and administers an advanced technical certificate program in quality management. He has an MS in Management, has done graduate study in adult education, and has undergraduate degrees in Industrial Management and Organizational Behavior.Search for more papers by this author First published: 17 August 2006 https://doi.org/10.1002/pfi.2006.4930450405Citations: 7 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References Brassard, M., Finn, L., Ginn, D., & Ritter, D. (2002). The six sigma memory jogger II. Salem, NH: Goal/QPC. Google Scholar Citing Literature Volume45, Issue4April 2006Pages 13-17 ReferencesRelatedInformation

This case report demonstrates the use of an automated voltage mapping algorithm to facilitate the rapid mapping of the low‐voltage zone and isolate the critical diastolic pathway of an intra‐atrial reentrant tachycardia circuit. Catheter ablation targeted to this pathway successfully terminated the arrhythmia.

BACKGROUND Conventional mapping of ventricular tachycardia (VT) after myocardial infarction is limited in patients with hemodynamically untolerated or noninducible VT.OBJECTIVES The purpose of this study was to develop a unique strategy using noncontact unipolar mapping to define infarct substrate and VT circuits.METHODS Dynamic substrate mapping (DSM) was performed in seven pigs with healed anterior myocardial infarction. This technique defined substrate as the intersection of low-voltage areas identified in sinus rhythm and during pacing around the infarct. Pacing was also performed within the substrate to determine exit sites.RESULTS Anteroapical transmural scar was identified in all animals. A mean of three pacing sites was used for substrate definition. The mean area (+/- SD) was 18.4 +/- 8.8 cm(2) by DSM and 15.4 +/- 6.9 cm(2) by pathology (P > .5). A mean of 4.5 sites was paced within substrate. Ten of 18 paced wavefronts exited substrate adjacent to the pacing area, seven exited at distant areas, and one had two exits. VT was induced in five animals (1.6 morphologies per animal). Except for one VT, circuit exit sites were identified at substrate borders on the endocardium. VT exit sites were at (n = 6) or near (it = 3) a pacing exit site. Electrogram voltages differed significantly between substrate, border, and nonsubstrate areas in infarcted animals and in comparison with control animals. No Substrate was identified in two control animals.CONCLUSION DSM is a reliable method for infarct substrate localization in this model. Pacing within substrate can predict VT exit sites and may prove useful for ablation of unmappable VT after myocardial infarction.

HISTORY This is a case report of a 64-year-old white male with a 20 year history of unilateral hip pain that had become debilitating over the last several years. On intake, Harris hip score was rated as: Pain subscale = 10, Function subscale = 32, Deformity subscale = 4, Motions subscale = 4.775 with a total score of 50.8 out of 100. MRI of the affected hip showed severe degeneration with spurring, decrease in joint space, and several large subchondral cysts. The patient had been evaluated by an orthopedic surgeon and told he was a candidate for bipolar hip replacement. METHOD Two autologous nucleated cell collections were performed from bone marrow with subsequent isolation and transfers into the intra-articular hip using a hyaluronic acid and thrombin activated platelet rich plasma scaffold. Marrow samples were processed by centrifugation and lysis techniques to isolate nucleated cells. CONCLUSION This report describes partial by articular surface regeneration 8 weeks after intraarticular bone marrow transfer. Post-op 3.0T FGRE MRI showed neocortex formation when compared to immediate pre-op MRI and objective improvements were noted that coincided with subjective reports of improvement.

A stochastic simulation technique was used with ship wave observations, which form the largest world-wide data base of wave information. Twenty years of wave parameter (height, period, and direction) observations from the Comprehensive Ocean–Atmosphere Data Set (COADS) were used as the input data. Simulations were compared to four years of wave parameters from a National Data Buoy Center (NDBC) data buoy near Monterey Bay, CA. The comparisons are satisfactory with differences mainly caused by biases between ship observations and buoy data. The stochastic simulation technique is attractive because it is computationally efficient and few decisions are required for its application. The applied techniques can be employed with global COADS data to simulate wave conditions at many world-wide locations where measurements and hindcasts by computer models do not exist.

The Bryan-Cox model of general ocean circulation is adapted to the East China Sea to study the flow-through of the Kuroshio. The model domain lies between 22°N and 35°N and between 119°E and 135°E, with a horizontal grid size of 16° and a vertical resolution provided by 30 levels so placed as to represent adequately the rapid change in bottom topography over the upper continental slope that underlies the Kuroshio. The model is driven by a steady inflow and outflow consistent with the Sverdrup transport calculated from the annual mean windstress field over the entire North Pacific. Temperature and salinity at the model sea surface are relaxed to the climatological values on a 50-day time scale. There is no locally imposed windstress. The model is initialized with the inflow-and-outflow-forced streamfunction field and climatological fields of temperature and salinity. The outflow condition is subsequently updated to reflect the redistribution suggested by the adjusted interior during the first year of integration. The model is then run with a combination of relaxation and radiation conditions along open boundaries for a total of six years, nearly five years beyond the time when the basin averaged kinetic energy reaches a constant value. In the final quasi-steady state, the model exhibits many of the patterns evident in observations, including a sharpened Kuroshio front over the upper continental slope, the countercurrent at about 200 m northeast of Taiwan, and the separation of the Kuroshio at about 30°N. A budget calculation at the final state shows that about 5% of the net poleward heat transport carried by the Kuroshio across 24°N in the North Pacific is routed through the marginal seas. Similarly, a salt flux about 5% of the net poleward transport carried by the Kuroshio across 24°N is directed to the north into the Sea of Japan, making the East China Sea an important salt source for water mass formation at high latitudes in the North Pacific Ocean.

An experimental program was conducted to evaluate the relative accuracy of differential ignition and nitric acid solubilization methods for determining the amount of biomass in activated sludge to which powdered activated carbon was added. The results showed the nitric acid method gave better results over a wider range of carbon and biomass concentrations. The nitric acid method was then used in an additional study to determine the ratio of carbon to biomass solids in both the mixed liquor and effluent from a bench scale reactor. The results of this study indicated that there was little difference in the carbon to biomass ratios and supports the concept that solids residence times determined with total suspended solids can be used to control process operation.

An experimental program was conducted to evaluate the significance of enhanced biodegradation, bioregeneration, and metabolic end product (MEP) adsorption in a bench-scale biophysical reactor using phenol as the substrate. Radiotracer methods and a desorption-extraction procedure that measures the amount of adsorbed phenol were used to discriminate between the various mechanisms. The results showed the major benefit of PAC addition under steady-state conditions to be MEP adsorption. Furthermore, adsorption reversibility was established as the controlling mechanism for bioregeneration. Reversibly adsorbed phenol could be desorbed to regenerate the PAC, but irreversibly adsorbed MEP could not. PAC, therefore, acts as a storage reservoir during shock loads via an adsorption-desorption sequence.