Lumbar Discomfort Research Articles

Assessing the Impact of Prolonged Sitting and Poor Posture on Lower Back Pain: A Photogrammetric and Machine Learning Approach

Prolonged static sitting at the workplace is considered one of the main risks for the development of musculoskeletal disorders (MSDs) and adverse health effects. Factors such as poor posture and extended sitting are perceived to be a reason for conditions such as lumbar discomfort and lower back pain (LBP), even though the scientific explanation of this relationship is still unclear and raises disputes in the scientific community. The current study focused on evaluating the relationship between LBP and prolonged sitting in poor posture using photogrammetric images, postural angle calculation, machine learning models, and questionnaire-based self-reports regarding the occurrence of LBP and similar symptoms among the participants. Machine learning models trained with this data are employed to recognize poor body postures. Two scenarios have been elaborated for modeling purposes: scenario 1, based on natural body posture tagged as correct and incorrect, and scenario 2, based on incorrect body postures, corrected additionally by the rehabilitator. The achieved accuracies of respectively 75.3% and 85% for both scenarios reveal the potential for future research in enhancing awareness and actively managing posture-related issues that elevate the likelihood of developing lower back pain symptoms.

Analysis of traditional Chinese medicine syndrome elements and clinical symptoms in prediabetes: A systematic review.

Prediabetes mellitus (PDM) and impaired glucose regulation precedes diabetes and serve as early warning signals. A 2018 Chinese epidemiological survey reported prediabetes at 25.5% prevalence and type 2 diabetes at 10.8%, respectively. Untreated carries one-third of the risk of diabetes progression. This study aimed to understand traditional Chinese medicine syndromes in PDM to guide clinical practice and diabetes prevention. We systematically searched the Chinese and English literature in PubMed, EMBASE, Sinomed, CNKI, VIP, Wanfang until March 31, 2023. We manually explored the Chinese prediabetes literature, trial registrations, and references, adhering to predefined criteria. The results were independently summarized by 2 researchers. Statistical analysis was performed using EXCEL, IBM SPSS 27.0, and IBM SPSS Modeler 18.0, with data mining techniques including association and cluster analysis. Analysis of 23 clinical trials (8943 patients) identified phlegm dampness syndrome as predominant, with qi deficiency, dampness, and phlegm as the principal pathogenic elements. Spleen syndrome elements dominated, with a priori correlation analysis favoring spleen dampness. The prevalent PDM clinical symptoms include amnesia, mental fatigue, limb fatigue, dizziness, and lumbar discomfort. Prediabetes is strongly associated with spleen dampness, highlighting its role. Common traditional Chinese medicine syndrome elements include qi deficiency, phlegm, and dampness. Clinical diagnosis and treatment should prioritize syndrome differentiation and emphasize spleen-focused approaches. Although limited research exists on prediabetes syndromes, further exploration of PDM and spleen dampness is crucial.

Effect of Prenatal Yoga On Back Pain and Sleep Quality in Pregnant Women: A Scoping Review

Throughout pregnancy, the expectant mother experiences physiological and psychological alterations. These modifications can significantly affect the mother's many pregnancy complications, including respiratory difficulties, lumbar discomfort, haemorrhoids, and sleep disruptions. Background: Lower back pain (LBP) is a musculoskeletal ailment that can negatively impact the overall well-being of pregnant women. Failure to promptly address the complaint might have detrimental effects on both the mother and the fetus. Objective: This scoping review seeks to examine the effects of prenatal yoga on the occurrence of back pain and the quality of sleep in pregnant women. Methods: This article conducted a scoping review using the PRISMA approach. Articles published in the last five years (2019-2023) were identified through various sources, including Google Scholar, PubMed, Journal SAGE, Scopus, Science Direct, and EBSCO. This search yielded ten relevant journals. Findings: Our examination revealed that engaging in prenatal yoga during pregnancy can help pregnant women reduce back pain and improve the quality of their sleep. Conclusion: prenatal yoga is a non-pharmacological therapeutic option for pregnant women to alleviate back discomfort and enhance sleep quality.

A Comparative Study to Analyze the Effect of Lumbar Stabilization and Conventional Back Extension Exercises on Mechanical Pain in Patients with Chronic Low Back Pain in Greater Noida

Lumbar discomfort is a major problem due to its harmful effects on health and high frequency in the general population. Depending on where and how long the pain lasts, there are three general categorizations for Lumbar discomfort: acute less than 6 weeks, sub-acute 6 to 12 weeks, and chronic more than 12 weeks. Several theories concerning the cause of nonspecific LBP feature poor posture, low body mass, hamstring flexibility, psychological discomfort, diminished trunk extensor endurance, and faulty muscular control of trunk. Pain in the lower back is a challenging illness which can result from injuries pertaining to the muscles and ligaments providing support vertebral column or from overuse or strain. One common treatment method for Lumbar discomfort is exercise therapy. This includes diverse forms of therapies including muscular strengthening, several forms of flexibility and stretching, and cardiovascular exercise for overall physical fitness. Normally, the stabilization system's job is to give the spine enough stability to meet the demands of changing circumstances immediately due to the posture changes with static and dynamic loads. As Per traditional understanding, spinal stabilization primarily relies on spinal biomechanics, the intervertebral disc, spinal ligaments, and osseous components. The stabilization and mobility of the lumbar spine can be facilitated by any muscle that exits the lumbar region. However, according to certain research, the lumbar multifidus and transverses abdominis muscles are very crucial for the stability of the lumbar segment. There is preliminary data indicating that those with long-term Lumbar discomfort do not properly recruit their core muscles and display core weakness13. Standard Exercise for back extension and exercises for lumbar stability both are used to treat low back discomfort. Thus, an effort is undertaken to compare and investigate the benefits of traditional back extension exercises and lumbar stabilization activities in patients with chronic Lumbar discomfort.

A rare clinical observation of ureteral IgG4-related disease in urological practice: A case report

IgG4-related disease (IgG4-RD) is a systemic immune-dependent pathology marked by infiltration of lymphocytes and plasma cells expressing IgG4 in affected tissues, leading to phlebitis and fibrosclerosis. In urological practice, diagnosing IgG4-RD of the ureter, which may resemble a malignant tumor, presents challenges. We present a unique case: a 64-year-old patient (Patient P.) experienced left lumbar discomfort and a 4 kg weight loss over 2 months. A computed tomography scan revealed a 111 mm tumor obstructing the left ureter, causing hydronephrosis and regional lymphadenopathy. Suspecting ureteral urothelial cancer, the patient underwent a left nephroureterectomy with lymphadenectomy. Microscopic analysis revealed fibrosis and inflammation infiltration (lymphocytes, plasma cells, and eosinophils) in the ureter wall, with no evidence of tumor growth. Immunohistochemistry confirmed IgG4-positive plasma cells. Serum IgG4 rose to 149 mg/dL. Morphological findings led to a diagnosis of IgG4-RD of the ureter. Clinically, it is crucial to recognize IgG4-RD in ureteral neoplasms for early detection, to prevent unnecessary surgical intervention.

Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures

BackgroundThe ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP).ObjectiveThe research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes.MethodsA comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05).ConclusionIn juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.

Spinal posture assessment and low back pain.

Postural assessment can help doctors and therapists identify risk factors for low back pain and determine appropriate follow-up treatment. Postural alignment is not perfectly symmetrical, and small asymmetries can instead represent norms and criteria for postural evaluation. It is necessary to comprehensively observe patients' posture in all directions and analyze the factors related to posture evaluation. The results of reliability show that in general intra-rater reliability is higher than inter-rater reliability, and inclinometers are being more reliable than other instrumentations. Some common postural problems can cause lumbar discomfort, and prolonged poor posture is a potential risk factor for lumbar spine injuries. On the basis of previous studies on posture evaluation, a unified standardized method for posture evaluation must be established in future research.

Relationship between vertebral endplate degeneration (Modic changes, Schmorl nodes, endplate irregularities) and Bone Mineral Density

ObjectiveThe end plate plays an important role in maintaining the structural integrity, balancing biomechanical and supplying nutrition, how dose it changes with the reduced bone mineral density (BMD) remains unknown. The objective of this study is to investigate the relationship between lumbar end plate degeneration and normal BMD, osteopenia and osteoporosis. MethodsA retrospective analysis of 362 patients equal or over 55 years old who underwent both lumbar MRI and dual-energy x-ray absorptiometry(DXA) examinations due to lumbar discomfort or a healthy physical examination. Two Radiologists reported the Modic changes, Schmorl node, and end plate irregularities of 11 end plates from L1 to S1. Data were separated by sex, and then the summed results were grouped in age matching. ResultsIn women, with the decrease of hip BMD, the positive rate and severity of Modic changes and the severity of end plate irregularities showed an increasing trend; Among men, the number of Modic changes and end plate irregularities increased in osteoporosis subjects and osteopenia subjects compared with normal BMD subjects. While the positive rate of Schmorl nodes incremental trend was not obvious in female and male subjects. ConclusionsOsteoporosis in the elderly will aggravate the degeneration of the lumbar end plate Modic changes and end plate irregularities.

Application and thinking of minimally invasive transforaminal lumbar interbody fusion in degenerative lumbar diseases.

BackgroundThis study sought to investigate the clinical efficacy and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases.MethodsThe clinical data of 55 patients with lumbar degenerative diseases treated at our hospital from January 2018 to January 2020 were analyzed retrospectively. Of the 55 patients, 35 who underwent MIS-TLIF were included in the MIS-TLIF group, and 20 who underwent posterior lumbar interbody fusion (PLIF) were included in the PLIF group. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, operation time, incision length, intraoperative bleeding, postoperative drainage, postoperative landing time, postoperative hospital stay, postoperative interbody fusion rate, and complications were compared between the two groups.ResultsThe patients in both groups were followed-up for at least 1.5 years (range, 18–30 months; with an average of 27.5±2.6 months). There was no significant difference in the operation time, incision length, intraoperative bleeding, VAS score for low back and leg pain, ODI score, interbody fusion rate, hospitalization expenses, and complication rate between the two groups (P>0.05). One patient had nail failure in the MIS-TLIF group, 1 patient in each group had nerve root irritation, and 1 patient in each group had superficial incision infection and local suture dehiscence. The postoperative drainage volume, postoperative landing time, and postoperative hospital stay of the MIS-TLIF group were less than those of the PLIF group (P<0.05).ConclusionsCompared to PLIF, the use of MIS-TLIF in the treatment of lumbar degenerative diseases has a number of advantages, including more complete intraoperative hemostasis, less postoperative drainage, earlier landing, and faster discharge, and also significantly improves postoperative lumbar discomfort.

Necessity of repeated renal arteriography in the treatment of severe hemorrhage after percutaneous nephrolithotomy

In order to discuss the necessity of repeated renal arteriography in the treatment of severe bleeding after percutaneous nephrolithotomy, this study retrospectively analyzed the clinical data of patients with severe bleeding after percutaneous nephrolithotomy in the Department of Urology Surgery of the First Hospital of China Medical University from August 2010 to July 2020, summarily analyzing treatments, outcomes and follow-up results of 27 patients who were treated by renal arteriography more than twice. Of these 27 patients who underwent repeated renal arteriography, 23 of them were treated by two times, 4 by three times, all of whom were diagnosed as renal vascular injury. And 15 of them were diagnosed as pseudoaneurysm, 4 of them renal arteriovenous fistula, and 8 of them pseudoaneurysm combined with renal arteriovenous fistula. After clear diagnosis, all these patients were performed with renal artery embolization, after which the symptoms of hematuria and lumbar discomfort were relieved or disappeared immediately. These patients were followed up from 6 months to 5 years, without corresponding symptoms recurring and with the renal function equivalent to that before embolization. The results showed that repeated renal arteriography was of great significance in the treatment of patients with severe bleeding after percutaneous nephrolithotomy, helping to clarify the cause of bleeding and giving appropriate and timely treatment.

Treatment of a Patient with Ossification of Ligamentum Flavum of Cervical Spine and Literature Review

<i>Background</i>: The ossification of ligamentum flavum occurs frequently in the thoracic vertebra, and the incidence of ossification of cervical ligamentum flavum is relatively low. It is easy to cause misdiagnosis and mistreatment due to lack of understanding in clinical practice. <i>Object</i>: To understand the diagnosis and treatment of cervical ossification of ligamentum flavum through the treatment of one case. <i>Material</i>: A 65-year-old female patient was hospitalized due to "lumbar discomfort with numbness of both lower limbs for 1 year, and aggravation with numbness and weakness of both upper limbs for the last 3 months". Physical examination showed cervical flexion, extension and lateral flexion activities were limited, post extension limitations were obvious, limb muscle strength was grade 4, right knee tendon reflex was active, and bilateral Hoffman sign and right Babinski sign were positive. Cervical JOA score was 8 points. Magnetic resonance imaging of cervical spine showed that there were pressure objects protruding to the spinal canal between C3/4, C5/6, and C6/7 laminae. Sagittal MRI showed segmental or focal nodular space occupying and protruding into the spinal canal from the rear of the spinal canal. Cross sectional MRI showed nodular or "M" shaped occupying space. T1 weighted image was equal signal, and T2 weighted image showed low signal shadow, suggesting high-density ossification and severe spinal cord compression. The effective sagittal diameter was less than 8mm. <i>Method</i>: Hemilaminectomy was performed for a single segmental OLF of C3/4, and a total laminectomy was performed for bilateral and multi-segmental OLF of C5/6, 6/7. According to the range of intraoperative decompression, C5 and 6 posterior lateral mass screws and C7 pedicle screws were fixed. <i>Result</i>: After the operation, the patient indicated that his upper limbs were relaxed, the umbilical horizontal band disappeared, and the muscle strength of his limbs was stronger than that before the operation. She could move freely on the ground, and her holding was more flexible and powerful than before. The postoperative JOA score was 12 points. The postoperative pathological result was fibrous connective tissue and ossification. The follow-up JOA score was increased to 15 points 8 months after operation, and the improvement rate was 78%. The patient could completely take care of herself, and the treatment was satisfactory. <i>Conclusion</i>: Surgical resection of cervical olf and canal decompression is an effective method for the treatment of Cervical OLF and can achieve good clinical results.

Analysis the features of familial benign paroxysmal positional vertigo

Objective:The family heredity of BPPV disease was preliminarily discussed in order to guide the clinical practice, prevent early and shorten the course of BPPV disease in the future. Method:Familial BPPV patients were enquired and registered in detail, including gender, age at first onset, occupation, inducing factors, symptoms, diagnosis, sleep status and clinical manifestations. Analysis of the clinical data. Result:Nine patients with idiopathic BPPV from four families had no definite pathogenic factors, accounting for 0.4% of the patients with idiopathic BPPV, including 3 males and 6 females; the age of first onset ranged from 31 to 66 years old. the course of disease ranged from 2 days to 8 years; the duration of nystagmus ranged from seconds to 1 minute. The main clinical symptoms were dizziness and visual rotation related to position transformation. Family 1, 3 and 4 patients had a history of fatigue. Family 2 patients had a predisposing factor of forced lateral decubitus due to lumbar discomfort. All patients had nystagmus lasting less than 1 minute and were single-tube involvement, all patients were canalithiasis. Different patients in the same family have different pathogenic locations. Conclusion:Familial BPPV is urgent to attract the attention of clinicians and the public. Early clinical test for suspected familial BPPV can play a role in early prevention and shorten the process of disease, so as to improve the life quality of patients.

Spinal shrinkage, sagittal alignment and back discomfort changes in manufacturing company workers during a working day

Prolonged standing and lifting heavy loads are risk factors for the appearance of low back pain in work. The aim of this study was to observe changes in the height, spinal sagittal alignment, and the lumbar and dorsal discomfort perception in assembly line workers. Cross-sectional study, 40 assembly line workers (6 females). Height, sitting height, grades of thoracic kyphosis and lumbar lordosis and perceived spine discomfort, before and after the working day, were determined. Thoracic and lumbar sagittal alignment was compared between discomfort developers and no developers. There was a significant decrease in the height and sitting height of the workers at the end of the day. Thoracic and lumbar curvature increased significantly, as did the perceived lumbar discomfort. Workers on the assembly line, in a prolonged standing work, suffer an increase in lumbar discomfort, and changes in height and thoracic and lumbar curvatures. Practitioner summary: Spinal shrinkage, sagittal alignment and back discomfort (upper and lower back), were analysed in assembly line workers in prolonged standing during a workday. Assembly line workers suffer a decrease in height, an increase in their thoracic and lumbar curvature, and in lumbar discomfort throughout their workday.

Experience of diagnosis and treatment for renal multiple malignant tumors

Objective To investigate the diagnosis and treatment of ipsilateral multiple renal malignant tumors. Methods 4 patients with multiple renal malignant tumors were retrospectively reviewed from May 2013 to November 2017. All cases were males, with average age of 64 years old (ranging 54-82 years old). Two cases were found that tumor located in right side. The duration of disease ranged from 7 days to 6 months, with an average of 2 months. One case was found the tumor due to the complaining of lumbar discomfort, and other 3 cases were found by physical examination. The number of tumors was 2 in 1 case, and 3 in 3 cases. The sonographic features of the tumors were iso-echoic nodules. CT showed irregular soft tissue shadow, partially prominent outside the kidney, and heterogeneous enhanced after enhancement.3 cases were undergone laparoscopic radical nephrectomy and 1 case which was solitary kidney, was undergone laparoscopic partial nephrectomy. Results All operations were performed successfully. 3 cases were undergone laparoscopic radical nephrectomy, which the operative time was 189-271 min (average, 230 min), and blood loss was 50-100 ml (mean 83 ml). Postoperative hospitalization time was 5-14 days, average 9.7 days. 1 case occurred intestinal obstruction after surgery, which was improved after treatment. 1 case was found the close distance of 3 tumors during the laparoscopic surgery. In order to short the ischemic duration, open surgery conversion was performed in this case. The total operation time was 207min. The ischemic time was 15min and blood loss was 50 ml. The postoperative hospital stay was 6 days. Pathological reported that 3 cases were clear cell carcinoma, another 1 case was clear cell carcinoma with papillary carcinoma. All patients were followed up for 2-55 months (mean 38 months). No recurrence sign was recorded in all cases. Conclusion Ipsilateral multiple renal malignant tumors are rare, laparoscopic radical nephrectomy is effectie. Meanwhile, partial nephrectomy can also be chosen in some optimal cases. Key words: Kidney; Multiple; Malignant tumor; Treatment

NIRS-based experimental evaluation of driver back fatigue during long-term driving

ABSTRACTMost research on the relationship between driver fatigue, driving comfort, stability and other factors related to driving has consisted subjective assessments via surveys. Bio-signal measurements allow more objective evaluations but the measurement processes and types are very complicated, and measurement signals are sensitive to noise. To address this issue, this paper attempts to quantify driver fatigue by measuring and analyzing hemodynamic responses with near-infrared spectroscopy. The oxygen concentration changes in the erector spinae muscle were measured for the same subjects when driving a vehicle on a highway for a long time, in one of two driving postures: posture A based on the seat status of the average male body type in South Korea (a 107.7° torso angle, 109.1° chair back angle and 561.0 mm seat x-axis position posture) and Posture B with the chair back angle adjusted by −10° from posture A and the seat moved 4 cm back. A survey was carried out on the degree of lumbar discomfort. The analysis of the degree of relative fatigue, based on driver posture utilizing a mathematical model for the physiological system of lower-back fatigue, showed that posture B is relatively uncomfortable compared to posture A by approximately 41%. The results of analyzing the degree of relative discomfort with regard to driver posture using a mathematical model allow the verification that interpreting the relative degree of discomfort based on the changes in the oxygen concentration at a particular time is possible, and the experimental results show the usefulness of the proposed method.

Transformation of Follicular Lymphoma to a High Grade B-Cell Lymphoma with MYC and BCL2 Translocations and Overlapping Features of Burkitt Lymphoma and Acute Lymphoblastic Leukemia

Most commonly, histologic transformation (HT) from follicular lymphoma (FL) manifests as a diffuse large B cell lymphoma, not otherwise specified (DLBCL, NOS). Less frequently, HT may result in a high-grade B cell lymphoma with MYC and BCL2 and/or BCL6 gene rearrangements, also known as "double-hit" or "triple-hit" lymphomas. In the 2016 revision of the WHO classification of lymphoid neoplasms, the category B-cell lymphoma, unclassifiable was eliminated due to its vague criteria and limiting diagnostic benefit. Instead, the WHO introduced the high-grade B-cell lymphoma (HGBL) category, characterized by MYC and BCL2 and/or BCL6 rearrangements. Cases that present as an intermediate phenotype of DLBCL and Burkitt lymphoma (BL) will fall within this HGBL category.Very rarely, HT results in both the intermediate DLBCL and BL phenotype, and exhibits lymphoblastic features, in which case the WHO recommends that this morphological appearance should be noted. In comparison to de-novo patients with DLBCL, NOS, those with MYC and BCL2 and/or BCL6 gene rearrangements have a worse prognosis.A 63-year-old female presented with left neck adenopathy. Lab assessment including complete blood count (CBC), complete metabolic panel (CMR), serum lactate dehydrogenase (LDH) and B-2 microglobulin were all normal. A whole body computerized tomography (CT) scan revealed diffuse adenopathy above and below the diaphragm. An excisional node biopsy showed grade 3A nodular FL. The Ki-67 labeling index was 40-50%. A bone marrow biopsy showed a small focus of para-trabecular CD20+ lymphoid aggregates.She received 6 cycles of bendamustine (90 mg/m2 days +1 and + 2) and rituximab (375 mg/m2 on day+2) with each cycle delivered every 4 weeks. A follow up CT scan at completion of therapy showed a partial response with resolution of axillary adenopathy and a dramatic shrinkage of the large retroperitoneal nodes.18 months later she had crampy abdominal pain in the absence of B symptoms. Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose integrated with CT (18F-FDG PET/CT) scan showed widespread adenopathy, diffuse splenic involvement and substantial marrow involvement. Biopsy of a 2.4 cm right axillary node (SUVmax of 16.1) showed involvement by grade 3A FL with a predominant nodular pattern of growth. A bone marrow biopsy once again showed only a small focus of FL.She received idelalisib (150 mg twice daily), and rituximab (375 mg/m2, monthly) beginning May, 2015. After 4 cycles, a repeat CT scan showed a complete radiographic response. Idelalisib was subsequently held while she received corticosteroids for immune-mediated colitis. A month later she restarted idelalisib with a 50% dose reduction. Two weeks later she returned to clinic complaining of bilateral hip and low lumbar discomfort but no B symptoms. A restaging 18F-FDG PET/CT in January of 2016 showed dramatic marrow uptake. A bone marrow aspirate showed sheets of tumor cells representing a spectrum from intermediate sized cells with lymphoblastic features to very large atypical cells with multiple nucleoli. Two distinct histologies were present; one remained consistent with the patient's known FL with a predominant nodular pattern and the other consistent with HT (The large atypical cells expressed PAX5, CD10, BCL2, and cMYC, and were negative for CD20, MPO, CD34, CD30, and BCL6). Focal areas showed faint, heterogeneous expression of terminal deoxynucleotidyl transferase (TdT) best seen on the clot section. Ki67 proliferation index was high (4+/4). FISH analysis showed two populations with MYC amplification and/or rearrangement, and no evidence of BCL6 rearrangement; a karyotype analysis showed a complex abnormal female karyotype with t (14; 18) and multiple structural and numerical abnormalities.She started dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) with concomitant prophylactic intrathecal methotrexate and cytarabine. She had but a short lived response before dying in hospice from progressive lymphoma.Whether idelalisib could provide a microenvironment for selection of more aggressive clones needs to be addressed. Our patient's clinical course is confounded by the incorporation of idelalisib while being further complicated by the complexity of HT and the mechanisms in which first-line chemotherapy regimens impact DHL. DisclosuresNo relevant conflicts of interest to declare.

An observation concerning the effect of the application of prone position maintenance device in patients after retinal detachment operation

Objective To observe the effect of the application of crescent-shaped face pillow and U-shaped cushion to help patients to maintain prone position after retinal detachment operation with silicone oil tamponade.Methods Eighty-eight consecutive patients with retinal detachment after silicone oil tamponade were recruited and separated into two groups randomly:the study group and the control group.Patients in the study group used the crescent-shaped face pillow and U-shaped cushion and while patients in the control group maintained prone position without medical protective device.The duration of position maintenance,physical discomforts,eye discomforts and postoperative diseases were analyzed.Results Compared with the control group,patients in the study group hold prone posture significantly longer,including the maximum postural maintain time and the mean postural maintain time,and slept time significantly longer (P ＜ 0.05).Patients in the study group also reported significantly less neck discomfort,chest tightness,lumbar discomfort,choking sensation,heavy sensation of the eye,and eye pain than the control group (P ＜ 0.05).Postoperative glaucoma was found less in the study group in comparison with the control group (P ＜ 0.05).Conclusion The crescent-shaped face pillow and U-shaped cushion are a good position maintenance device to help patients after retinal detachment operation with silicone oil tamponade to keep prone posture. Key words: Device,position maintenance; Pillow,face, crescent-shaped; Cushion, U-shaped; Position,prone, postoperation, retinal detachment' tamponade,silicone oil

Postoperative pseudomeningocele in a 40-year-old man

Postoperative pseudomeningocele is a relatively rare complication of spinal surgery. In addition to patient inconvenience and apprehension, it is also associated with other morbidities, such as headache, lumbar discomfort, and radiculopathy. The word ‘‘pseudo-’’ means that the lesion does not possess of a true meningeal layer lining the cyst wall, which is not a complete sac or cyst and communicates with the arachnoid space. Herein we present a patient who suffered pseudomeningocele formation after lumbar surgery, and was treated successfully with reoperation. This 40-year-old man had a L4–L5 laminectomy, pedicle screw fixation, and intervertebral bone graft fusion for low back pain on March 2004 at a local hospital. During the operation, a cerebrospinal fluid (CSF) leak had occurred. After 1.5 months without symptoms, he came to our hospital for recurrent legs pain and postural headache. On physical examination, there was a palpable fluctuating mass under the previous surgical scar. Magnetic resonance imaging (MRI) revealed an oval-like cystic collection lying posterior to L3–L5 vertebrae. The lesion was about 5 9 8 cm and isointense compared with the CSF signal on both T1and T2-weighted images (Fig. 1). A diagnosis of postoperative pseudomeningocele was highly suspected. Because of failure of conservation treatment, the wound was reopened on February 2005. The entire cyst was visualized and followed deep into the durotomy site. It was fluctuant and tense, and the walls were thin, shiny, and pinkish white. About 100 mL translucence fluid fluxed when incised it. A tiny communication between the dural sac and the pseudomeningocele was seen with the aid of a Valsalva maneuver. After freeing and returning all nerve roots into the intradural space, the defect was sealed. Subcutaneous fat was placed loosely over the site of the dural repair. Paraspinal muscles and overlying fascia were closed in two layers with sutures placed 3–4 mm apart. Drainage tube was not used routinely because we considered that it might lead to the persistence of communication between the intraand extradural spaces and serve as nidus for infection. Postoperatively, he had a good recovery. Postural headache and legs pain were resolved immediately. With a 4-year follow-up, he was still free of symptom. Postoperative pseudomeningocele is described as ‘‘ugly bulging wounds filled with fluid’’ lying dorsal to the thecal canal. It has been postulated occurring mostly by CSF fistula, and these two can be considered to be on a continuum. It may or may not be associated with an arachnoid tear, but a dural tear is necessary for one to form. In this case, it seemed likely, in the presence of a dural defect, that the intradural pressure of the CSF caused a constant outflow of CSF, which kept the tiny defect opening and prevented healing. On the other hand, as a consequence of paravertebral muscle atrophy after previous procedures, there was less soft tissue to tamponade the CSF leak. The resultant paravertebral dead space became filled with CSF and subsequently formed the pseudomeningocele cavity. Although persistent CSF leakage existed, it still took times (more than 1 month) to become large enough to cause the signs and symptoms. C. Liu H.-X. Cai S.-W. Fan (&) Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China e-mail: srrshspine@hotmail.com

Decoupled pelvis adjustment to induce lumbar motion: A technique that controls low back load in sitting

Static sitting in confined settings have been associated with low back pain in sedentary occupations such as office works and car driving. To prevent lumbar discomfort in prolonged static sitting, periodic motion of the lumbar spine is needed. Because the pelvis forms the basis for lumbar spine curvature, a passive motion technique was developed, which adjusts pelvis orientation independent from the trunk. This study uses a computer-aided simulator chair instrumented with a mechanism for decoupled pelvis adjustment and investigates the effects on low back load in eighteen healthy male individuals. Experiments involved measurement of body segments orientation, interface back pressure distribution and seat reaction forces during quasi-static actuated pelvis rotation in the sagittal and frontal plane. Joint forces and torques were estimated in the lumbosacral spine region. In sagittal pelvis adjustment, the pelvis rotated 19 ± 3 degrees and strong relations (r 2 > 0.8) were found with centre of back pressure in upward direction (cp z, r 2 = 0.90), lumbosacral shear force in forward direction (F ly, r 2 = 0.91), lumbosacral normal force in axial direction (F lz, r 2 = 0.80), lumbosacral torque around lateral direction (T lx, r 2 = 0.87) and interface pressure at the lower back (P lb, r 2 = 0.88). In frontal pelvis adjustment, the pelvis rotated 9 ± 1 degrees and strong relations were found with centre of back pressure in lateral direction (cp x, r 2 = 0.96), lumbosacral torque around forward direction (T ly, r 2 = 0.98) and lumbosacral torque around axial direction (T lz, r 2 = 0.95). These findings indicate that decoupled pelvis adjustment could be an applicable intervention to control low back load in prolonged static sitting. Relevance to industry Decoupled pelvis adjustment might be an applicable technique to induce periodic lumbar motion which potentially improves tolerance for prolonged static sitting.

Relationship between comfort and back posture and mobility in sitting-posture

The objective of this work is to analyze the causes of lumbar discomfort while sitting on a chair, by analyzing the relationship of lumbar curvature, pelvic inclination and their mobilities with discomfort. An experiment has been performed with healthy subjects, in which comfort, postural and mobility parameters have been measured. Their relationship has been analyzed with multivariate analysis. Factorial analysis has been used to represent all the correlated variables measured. Logistic regression and discriminant analyses have been used to classify discomfort/absence of discomfort. The results show that great changes of posture are a good indicator of discomfort, and that lordotic postures with forward leaned pelvis and low mobility are the principal causes of the increase of discomfort.