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Fracture of allograft interbody spacer resulting in post-operative radiculopathy: A case report

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World Journal of Orthopedics 2019年第4期10卷 206-211页

作者： Andrews Kyle Andrea Rowland Jacob Stirton hossein elgafy Department of Orthopaedic Surgery University of Toledo College of Medicine and Life Sciences

BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion(TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods,instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision.CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion.CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence,the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.

关键词： Transforaminal lumbar interbody fusion Interbody fusion Allograft

Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy:A case report and review of the literature

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World Journal of Orthopedics 2017年第8期8卷 651-655页

作者： hossein elgafy Mustafa Khan Jacob Azurdia Nicholas Peters Department of Orthopedics University of Toledo Medical Center

A 67-year-old female patient developed an esophagocutaneous fistula 4 mo after C4 and C5 partial corpectomy. Plain radiograph and computed tomography(CT) scan of cervical spine showed inferior screws pullout with plate migration that caused the esophageal perforation. Management included removal of anterior hardware, revision C4-5 corpectomy, iliac crest strut autograft and halo orthosis immobilization. The fistula was treated using antibiotics and a 10-french gauge rubber tube for daily irrigation and Penrose drain. At 3 mo, the esophagocutaneous fistula healed and the patient resumed oral feeding. Six months follow-up CT scan showed sound fusion with graft incorporation. At two-year follow-up, patient denied any neck pain or dysphagia. This case report presents a successful outcome of a conservative open wound management without attempted repair. The importance of this case report is to highlight this treatment method that may be considered in such a rare complication particularly if surgical repair failed.

关键词： Wound management Esophagocutaneous fistula

Analysis of a ten step protocol to decrease postoperative spinal wound infections

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World Journal of Orthopedics 2018年第11期9卷 271-284页

作者： hossein elgafy Craig J Raberding Megan L Mooney Kyle A Andrews Joan M Duggan Department of Orthopedics and Infectious Diseases University of Toledo Medical Center

AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have alrea

关键词： Wound infections Spine Ten step protocol Surgical site infections

Hemorrhagic lumbar synovial facet cyst secondary to transforaminal epidural injection:A case report and review of the literature

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World Journal of Orthopedics 2016年第7期7卷 452-457页

作者： hossein elgafy Nicholas Peters Justin E Lea Robert M Wetzel Department of Orthopedic Surgery University of Toledo Medical Center

A 64-year-old-female presented with progressive left foot weakness, low back and radicular pain after a left sided S1 transforaminal epidural steroid injection(ESI). Magnetic resonance imaging revealed left side L5-S1 large extradural heterogeneous mass with layering areas suggesting different stages of hematoma formation. Past medical history was significant for peripheral vascular disease and transient ischemic attacks, for which she took aspirin and clopidogrel(antiplatelet agent). These medications were discontinued one week prior to ESI. Although synovial cysts associated with facet arthropathy are common, hemorrhagic cyst is not. To the best of the authors' knowledge, this is the first reported case of symptomatic hemorrhagic lumbar facet synovial cyst following ESI on a patient taking antiplatelet medications.

关键词： Lumbar synovial cyst Hemorrhage Antiplatelet therapy Epidural injection

Critical care of obese patients during and after spine surgery

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World Journal of Critical Care Medicine 2016年第1期5卷 83-88页

作者： hossein elgafy Ryan Hamilton Nicholas Peters Daniel Paull Ali Hassan Departments of Orthopedic University of Toledo Medical Center Departments of Anesthesia University of Toledo Medical Center

Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA articlepublished in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Postoperatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes.

关键词： Obesity Spine sugary Critical care

Vacuum Packaging Sensor Based on Time-Resolved Phosphorescence Spectroscopy

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Photonic Sensors 2024年第1期14卷 1-12页

作者： Esmaeil HEYDARI Fatemeh YARI hossein ZARE-BEHTASH Nanophotonic Sensors&Optofluidics Lab Faculty of PhysicsKharazmi UniversityTehran 15719-14911Iran

Intelligent food packaging with the multisensory analysis is promising as the next generation technology of food packaging.The oxygen content in food packaging is one of the crucial parameters affecting the food quality and shelf life.Caviar is among the most nutritious and costly food sources.Here,a photonic oxygen-sensing system,based on the time-resolved phosphorescence spectroscopy of a platinum complex,is developed for non-contact,non-intrusive,and real-time vacuum packaging quality control,and implemented for caviar packaging.The sensor is embedded in protective polyethylene layers and excited with a short-pulsed light emitting diode(LED)source.Integration of a blue pulsed light source,a fast and amplified silicon photodiode controlled by the Spartan-6 field programmable gate array(FPGA),and a long lifetime platinum complex results in a photonics-based oxygen sensor with a fast response and high sensitivity to the vacum packaging damage,which is suitable for caviar.It is revealed that applying the polyethylene layers protects the caviar from the platinum complex,leaching while not interfering with the sensor functionality.Characterizing the photonic system based on its sensitivity,repeatability,stability,and long-term operation demonstrates its capability for this application.

关键词： Caviar photoluminescence lifetime oxygen sensor platinum porphyrin complex vacuum packaging

Top 20 cited Spine Journal articles,1990-2009

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World Journal of Orthopedics 2014年第3期5卷 392-397页

作者： hossein K elgafy Jacob D Miller Sohaib Hashmi Steven Ericksen Department of Orthopaedic Surgery University of Toledo Medical CenterToledoOH 43614United States

AIM:To determine the most cited articles and most published authors in Spine Journal from 1990-2009.METHODS:Spine Journal,established in 1976,is affiliated with 12 spine societies and a leader in spine research articles.Citation analysis is a method to determine the impact of a journal and its articles on academia and clinical practice.Using the Institute for Scientific Information Web of Knowledge,we determined the most cited articles in Spine Journal between1990-2009.The characteristics and type of article were recorded.Next,we evaluated the most published authors during the same time period and calculated the number of citations for each author.The number of first authorships for each of these authors was also determined along with the number of citations for those articles.RESULTS:The top 20 cited articles range from 491 to267 total citations.The top 20 published authors had between 41 and 135 articles.Seventeen of the top 20articles were clinical studies.The range of citations per lead authorship ratio was 36 to 724 with one author having no lead authorships.Low back pain was the most common theme encountered in the top cited articles.The first-ranked article was not a spine-specific topic rather it was regarding general physical and men-tal health status survey update review.CONCLUSION:Spine Journal and its authors have a clear impact on the scientific community based on this review of the top articles and authors in the last 20years.

关键词： Citation analysis Back pain Spine Journal

An SDN-Based Algorithm for Caching,Routing,and Load Balancing in ICN

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China Communications 2024年第5期21卷 64-76页

作者： MohammadBagher Tavasoli hossein Saidi Ali Ghiasian Department of Electrical and Computer Engineering Isfahan University of TechnologyIsfahanIran Department of Technology and Engineering Shahrekord UniversityShahrekordIran

One of the challenges of Informationcentric Networking(ICN)is finding the optimal location for caching content and processing users’requests.In this paper,we address this challenge by leveraging Software-defined Networking(SDN)for efficient ICN management.To achieve this,we formulate the problem as a mixed-integer nonlinear programming(MINLP)model,incorporating caching,routing,and load balancing decisions.We explore two distinct scenarios to tackle the problem.Firstly,we solve the problem in an offline mode using the GAMS environment,assuming a stable network state to demonstrate the superior performance of the cacheenabled network compared to non-cache networks.Subsequently,we investigate the problem in an online mode where the network state dynamically changes over time.Given the computational complexity associated with MINLP,we propose the software-defined caching,routing,and load balancing(SDCRL)algorithm as an efficient and scalable solution.Our evaluation demonstrates that the SDCRL algorithm significantly reduces computational time while maintaining results that closely resemble those achieved by GAMS.

关键词： in-network caching information-centric network power efficiency routing software-defined networking

CRISPR,CAR-T,and NK:Current applications and future perspectives

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Genes & Diseases 2024年第4期11卷 246-257页

作者： Mohadeseh Khoshandam hossein Soltaninejad Amir Ali Hamidieh Saman hosseinkhani Department of Reproductive Biology Academic Center for EducationCultureand Research(ACECR)Qom branch***Iran National Institute of Genetic Engineering and Biotechnology(NIGEB) Tehran 14965/161Iran Department of stem cells technology and Tissue Regeneration Faculty of Interdisciplinary Science and TechnologiesTarbiat Modares UniversityTehran 15614Iran Pediatric Cell Therapy and Gene Therapy Research Center GeneCell&Tissue Research InstituteTehran University of Medical SciencesTehran ***Iran Department of Biochemistry Faculty of Biological SciencesTarbiat Modares UniversityTehran 15614Iran

Chimeric antigen receptor T(CAR-T)cell therapy represents a breakthrough in personalized cancer treatments.In this regard,synthetic receptors comprised of antigen recognition domains,signaling,and stimulatory domains are used to reprogram T-cells to target tum or cells and destroy them.Despite the success of this approach in refractory B-cell malignancies,the optimal potency of CAR T-cell therapy for many other cancers,particularly solid tumors,has not been validated.Natural killer cells are powerful cytotoxic lymphocytes specialized in recognizing and dispensing the tumor cells in coordination with other anti-tumor immunity cells.Based on these studies,many investigations are focused on the accurate designing of CAR T-cells with clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)system or other novel gene editing tools that can induce hereditary changes with or without the presence of a double-stranded break into the genome.These methodologies can be specifically focused on negative controllers of T-cells,induce modifications to a particular gene,and produce reproducible,safe,and powerful allogeneic CAR T-cells for on-demand cancer immunotherapy.The improvement of the CRISPR/Cas9 innovation offers an adaptable and proficient gene-editing capability in activating different pathways to help natural killer cells interact with novel CARs to particularly target tumor cells.Novel achievements and future challenges of combining next-generation CRISPR-Cas9 gene editing tools to optimize CAR T-cell and natural killer cell treatment for future clinical trials toward the foundation of modern cancer treatments have been assessed inthis review.

关键词： Cancer CAR T-cell CRISPR Gene editing Immunotherapy NK cell