Sunday, January 13, 2019

Allergic contact dermatitis from topical ophthalmic medications

Allergic contact dermatitis from topical ophthalmic medications: keep an eye on it!
Liesbeth Gilissen  Lana Dedecker  Toon Hulshagen  An Goossens
First published: 10 January 2019 https://doi.org/10.1111/cod.13209
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13209.
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Abstract
Background
Allergic contact dermatitis (ACD) from topical ophthalmic medications is often overlooked.

Objectives
To study the demographic characteristics, lesion locations, and associated medical conditions of the patients with ACD from ophthalmic drugs, and to identify the most common allergenic culprits, as well as trends in frequencies over the years.

Methods
From January 1990 until December 2016, 16 065 patients were investigated in our clinic; all patients with a positive patch‐test reaction to eye medication or its ingredient(s) having caused ACD were studied. For each allergen identified, the number of positive test results compared with the total number of those in the total population, as well as trends across three periods, namely 1990‐1998, 1999‐2007, and 2008‐2016 were studied.

Results
118 patients (0.7%) presented with positive patch‐test results to ingredients of, and/or topical ophthalmic medications. Aminoglycoside antibiotics, followed by corticosteroids, as pharmacologically active ingredients, as well as wool alcohols, thiomersal and benzalkonium chloride, as excipients were the most frequent culprits. Particularly chloramphenicol showed a decreasing trend in positive reactions over time, whereas reactions tobramycin were increasing.

Conclusion
ACD from eye medication is mainly due to active principles, but other excipient ingredients, beside the products "as is", should be tested as well.
https://onlinelibrary.wiley.com/doi/10.1111/cod.13209

The combination of lanolin alcohol and Amerchol L101 is effective in patch testing for diagnosing lanolin contact allergy

Diagnosing lanolin contact allergy with lanolin alcohol and Amerchol L101
Jannet Knijp  Derk P. Bruynzeel  Thomas Rustemeyer
First published: 09 January 2019 https://doi.org/10.1111/cod.13210
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cod.13210.
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Summary
Background
The prevalence of lanolin contact allergy in dermatitis patients varies from 1.2% to 6.9%. Different lanolin derivatives are used in patch testing.

Objectives
To determine which combination of lanolin derivatives is most effective in patch testing for diagnosing lanolin contact allergy.

Methods
A retrospective analysis of patients patch tested between 2016 and 2017 was performed. Patients were eligible if tested with lanolin alcohol 30% pet., Amerchol L101 50% pet. and a supplementary series containing other lanolin derivatives. Lanolin alcohol and Amerchol L101 were tested in duplicate.

Results
Out of 594 patients, 28.6% (95% confidence interval [CI]: 25.1%‐32.3%) had a positive patch test reaction to at least one lanolin derivative. Reactions were common to lanolin alcohol (14.7%, 95% CI: 11.3%‐18.2%) and Amerchol L101 (15.0%, 95% CI: 11.5%‐18.5%) in the routinely tested series. Reactions to other test preparations were significantly less frequent (P < 0.05). The addition of Amerchol L101 to lanolin alcohol significantly increased the number of positive cases (odds ratio 1.79, P < 0.001).

Conclusions
The combination of lanolin alcohol and Amerchol L101 is effective in patch testing for diagnosing lanolin contact allergy. Routinely testing with other lanolin derivatives may not be worthwhile as it detects only few additional patients.
https://onlinelibrary.wiley.com/doi/10.1111/cod.13210

Impaired antimicrobial response and mucosal protection induced by ibuprofen


Impaired antimicrobial response and mucosal protection induced by ibuprofen in the immature human intestine
Emanuela Ferretti, Eric Tremblay, Marie-Pierre Thibault, Sepideh Fallah, David Grynspan, Karolina M. Burghardt, Marcos Bettolli, Corentin Babakissa, Emile Levy & Jean-François Beaulieu 
Pediatric Researchvolume 84, pages813–820 (2018) | Download Citation

Abstract
Background
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (INDO) and ibuprofen (IBU) has been shown to be an effective therapy for the closure of patent ductus arteriosus (PDA). However, this treatment has been associated with an increased risk of developing enteropathies in neonates. Whether the use of IBU is safer than INDO for the immature intestine remains to be elucidated.

Methods
The direct impact of IBU on the human immature intestinal transcriptome was investigated using serum-free organ culture. Differentially expressed genes were analyzed with Ingenuity Pathway Analysis software and compared with those previously reported with INDO. Validation of differentially expressed genes was confirmed by qPCR.

Results
We identified several biological processes that were significantly modulated by IBU at similar levels to what had previously been observed with INDO, while the expression of genes involved in "antimicrobial response" and "mucus production" was significantly decreased exclusively by IBU in the immature intestine.

Conclusions
Our findings indicate that IBU has a harmful influence on the immature intestine. In addition to exerting many of the INDO observed deleterious effects, IBU alters pathways regulating microbial colonization and intestinal epithelial defense.
https://www.nature.com/articles/s41390-018-0201-y

Pediatric sinonasal rhabdomyosarcoma (RMS)


Clinicopathologic traits and prognostic factors associated with pediatric sinonasal rhabdomyosarcoma
Sana H. Siddiqui BA  Emaad Siddiqui BS  Rich D. Bavier BA  Nirali M. Patel BA  Suat Kiliç MD Soly Baredes MD, FACS  Wayne D. Hsueh MD  Jean Anderson Eloy MD, FACS, FARS
First published: 10 January 2019 https://doi.org/10.1002/alr.22267
Potential conflict of interest: None provided.
Presented orally at the 64th Annual Meeting of the American Rhinologic Society, Atlanta, GA, October 5‐6, 2018.
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Abstract
Background
Pediatric sinonasal rhabdomyosarcoma (RMS) is an aggressive and rare malignancy. This is the first multi‐institutional study on the prognostic factors associated with outcomes in this population.

Methods
The National Cancer Database was queried for the period from 2004 to 2013 for all cases of malignant sinonasal RMS in the pediatric population. The impact of patients' demographics, tumor characteristics, and Intergroup Rhabdomyosarcoma Study Group (IRSG) staging on survival was assessed using chi‐square test, Fisher's exact test, Kaplan‐Meier test, and Cox regression analyses.

Results
A total of 157 cases of pediatric sinonasal RMS were identified. Mean age at diagnosis was 9.38 years and male patients comprised 48.4% of the cohort. The nasal cavity (31.8%) and maxillary sinus (30.6%) were the most common primary sites. Alveolar was the most common histology (49.7%), followed by embryonal type (32.5%). The majority of patients received solely chemoradiation (52.9%), followed by surgery with adjuvant chemoradiation (30.6%). Five‐year overall survival (OS) was 55.2% (±4.5%). Metastatic disease was associated with a poorer 5‐year OS rate (24.4% vs 61.5%; p = 0.010). Maxillary sinus site was associated with an improved survival (71.8% vs 47.6%; p = 0.009). On multivariate analysis, chemoradiation with or without surgery was an additional prognostic factor. Although IRSG clinical stages did not correlate with survival, high‐risk patients in the IRSG clinical risk groups were associated with poorer survival on multivariate analysis (hazard ratio [HR], 2.005; 95% confidence interval, 1.007‐3.993; p = 0.048).

Conclusion
To date, this is the largest study on pediatric sinonasal RMS. IRSG clinical risk groups may be useful in stratifying high‐risk patients with poor prognosis.
https://onlinelibrary.wiley.com/doi/10.1002/alr.22267

Formation of papillary mucosa folds and enhancement of epithelial barrier in odontogenic sinusitis


Formation of papillary mucosa folds and enhancement of epithelial barrier in odontogenic sinusitis
Yuan Zhang MD, PhD  Feng Lan MD, PhD  Ying Li BS  Chengshuo Wang MD, PhD  Luo Zhang MD, PhD
First published: 08 January 2019 https://doi.org/10.1002/alr.22277
Funding sources for the study: National Key R&D Program of China (2016YFC20160905200); the National Natural Science Foundation of China (81570895, 81420108009, 81400444, 81470678, and 81630023); Changjiang Scholars and Innovative Research Team (IRT13082); Special Fund of Capital Health Development (2011‐1017‐06, 2011‐1017‐02); Special Fund of Sanitation Elite Reconstruction of Beijing (2009‐2‐007); Beijing Health Bureau Program for High Level Talents (2011‐3‐043); Beijing Municipal Administration of Hospitals' Mission Plan (SML20150203); Capital Citizenry Health Program (z161100000116062).
Potential conflict of interest: None provided.
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Abstract
Background
Odontogenic sinusitis (OS) presents more satisfactory therapeutic effect after endoscopic surgery compared with chronic rhinosinusitis (CRS) of other origin. The aim of the present study was to investigate the clinical characteristics, morphological features, and epithelial barrier function of sinus mucosa of OS and discuss the possible relationship with good prognosis.

Methods
A total of 25 subjects with OS, 7 CRS without nasal polyps (CRSsNP), 10 CRS with nasal polyps (CRSwNP), and 9 control subjects were recruited. The biopsy specimens were stained with hematoxylin and eosin for general observation of cytomorphologic features. Epithelial tight junctions (TJs) protein claudin‐4 expression was determined to evaluate the epithelial barrier integrity by using immunofluorescence and Image‐Pro Plus software analysis. The representative cytokine profiles regarding T helper 1 (Th1) (interferon [IFN]‐γ), Th2 (interleukin [IL]‐5), and Th17 (IL‐17) were examined by reverse transcription–polymerase chain reaction (RT‐PCR).

Results
Extensively small papillary protrusions could be seen in the maxillary sinus mucosa of OS patients under nasal endoscopy, similar to the morphological behavior, which also presented as papillary folds in the surface of the epithelium. The epithelium in OS kept an increased claudin‐4 expression compared with that seen in CRSsNP, CRSwNP, and control subjects. The inflammatory pattern analysis demonstrated that OS belonged to the lymphocyte and plasma cell‐dominant cellular phenotypes, whereas IL‐17 was dominant compared with IFN‐γ as well as IL‐5.

Conclusion
The odontogenic infections might induce the formation of papillary mucosa folds and enhance the epithelial TJ barrier function. OS exhibited as lymphocyte and plasma cell–dominant cellular phenotypes and Th17 cytokine profiles.
https://onlinelibrary.wiley.com/doi/10.1002/alr.22277

Broncho‐Vaxom(R) (OM‐85 BV) soluble components stimulate sinonasal innate immunity


Broncho‐Vaxom® (OM‐85 BV) soluble components stimulate sinonasal innate immunity
Vasiliki Triantafillou BS  Alan D. Workman MD  Neil N. Patel BA, BS  Ivy W. Maina BA Charles C. L. Tong MD  Edward C. Kuan MD, MBA  David W. Kennedy MD  … See all authors
First published: 07 January 2019 https://doi.org/10.1002/alr.22276
Funding sources for the study: National Institutes of Health (National Institute on Deafness and Other Communication Disorders [NIDCD] R01DC013588 to N.A.C.); Veterans Affairs Merit Review (CX001617 to N.A.C.).
Potential conflict of interest: None provided.
Presented orally at the ARS Meeting at the annual Combined Otolaryngology Spring Meetings (COSM) on April 18‐22, 2018, National Harbor, MD.
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Abstract
Background
Broncho‐Vaxom® (OM‐85 BV) is an extract of infectious respiratory bacteria that is used as an immunostimulant outside of the United States for the prevention and treatment of bronchitis and rhinosinusitis. Prior studies have shown that use of OM‐85 BV is associated with reduction in frequency of respiratory infection and decreased duration of antibiotic usage. However, the effects of OM‐85 BV on respiratory mucosal innate immunity are unknown.

Methods
Human sinonasal epithelial cells were grown at an air‐liquid interface (ALI). Ciliary beat frequency (CBF) and nitric oxide (NO) production in response to stimulation with OM‐85 BV was measured in vitro. Pharmacologic inhibitors of bitter taste receptor (T2R) signaling were used to determine if this pathway was taste‐receptor–mediated.

Results
Apical application of OM‐85 BV resulted in an NO‐mediated increase in CBF (p < 0.05) and increased NO production (p < 0.0001) when compared to saline‐stimulated control cultures. ALI pretreatment with taste receptor pathway inhibitors blocked OM‐85 BV–induced increases in NO.

Conclusion
OM‐85 BV has ciliostimulatory and immunogenic properties that may be partially responsible for its observed efficacy as a respiratory therapeutic. These responses were NO‐dependent and consistent with T2R activation. Further work is necessary to elucidate specific component‐receptor signaling relationships.
https://onlinelibrary.wiley.com/doi/10.1002/alr.22276

Terminal Hydridozinc Cation

Chem. Commun., 2019, Accepted Manuscript
DOI: 10.1039/C8CC09839E, Communication
Raju Chambenahalli, Alex P Andrews, Florian Ritter, Jun Okuda, Ajay Venugopal
A thermally stable terminal hydridozinc cation has been isolated. The nucleophilicity of the hydride ligand is demonstrated by inserting carbon dioxide, carbodiimide and benzophenone across the Zn-H bond in a...
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Psychologists “Affirm Without Doubt” the Evidence for Imminent Climate Catastrophe

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Guest essay by Eric Worrall According to Psychology Today contributors Sara Gorman, Ph.D., MPH, and Jack M. Gorman, MD, psychologists are united in their determination to help climate "deniers" face the need for urgent climate action to prevent imminent human extinction, though they are uncertain about how to deliver group therapy to millions of people…

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Pssst. Trump is Winning the China Trade Dispute

Car sales in China, the world's largest car market, plummeted by 19 per cent in December.AFP Getty file photo

Keep it under your hat, but Trump is getting the best of China in the trade confrontation.  Lawrence Solomon explains in a Financial Times article Remember Trump's supposedly 'lose-lose' trade war? He's winning. China's losing. Excerpts in italics with my bolds.

The tariffs clearly hurt China's economy more than America's

Not that long ago, China's economy was seen as a juggernaut that would soon overtake America's to become the world's largest. "Made in China 2025," the Chinese government's blueprint to take over manufacturing, was seen as an existential threat to U.S. technological leadership. Speculation had the Chinese yuan replacing the United States dollar as the world's reserve currency.

US-China-trade-war.jpgWhat a difference a trade war makes. No one marvels at the Chinese economy today.

Car sales in China, the world's largest car market, plummeted by 19 per cent in December, capping a six-per-cent decline in sales for the 2018 year, the industry's first fall in 20 years. Goldman Sachs predicts the decline will steepen to seven per cent in 2019. More broadly, China's private and public manufacturing sectors both contracted in December.  China's mainland stock markets, which declined 25 per cent in 2018, aren't doing well either. Neither is growth in consumer spending, which is at a 15-year low. The government is backpedalling on its targets for "Made in China 2025," and its other high-profile initiatives — the much-ballyhooed Asian Infrastructure Investment Bank and the Belt and Road Initiative — are falling short.

maxresdefault.jpgIn fact, the entire Chinese economy may not only be falling short, it may never have performed as well as claimed. Many believe that China's official economic growth rate, a fabulous 6.5 per cent, is more a fable. A World Bank estimate for 2016 put China's economic growth at 1.1 per cent, with other estimates showing low or even negative growth. Also worrying is the potentially catastrophic hidden debt that fuelled China's growth — as much as US$6 trillion by China's local governments alone, according to S&P Global Ratings, which called it "a debt iceberg with titanic credit risks."

Many authorities point to the trade war to explain in part these poor metrics, typically adding that trade wars are always lose-lose. Yet while China clearly seems a loser, the same can't be said for the U.S., whose economy is on fire.

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In contrast to the 15- and 20-year lows logged by China's economic indicators, the U.S. is racking up 20-, 30-, 40- and 50-year highs.

Wages are up, especially for those traditionally worse off, while unemployment rates for blacks, Hispanics and women are at lows not seen in decades. The U.S. economy has added 4.8 million jobs since Donald Trump was elected president, with U.S. manufacturers last year adding 284,000 jobs, the most in more than 20 years. Americans are ditching food stamps and disability payments for well-paying jobs. "Put it together, and this is the best time for the American labor market in at least 18 years and maybe closer to 50," The New York Times noted in November.

So much for the claims of the U.S. Chamber of Commerce, which warned that Trump's tariff policy on imported products "endangers the jobs of millions of workers"; of the Tax Foundation, which predicted that Trump's tariffs would decrease Americans' wages; of Bank of England Governor Mark Carney, who stated the trade war with China would reduce U.S. GDP; and of the Heritage Foundation, which called Trump's tariffs "ineffective and dangerous".

While China's demise and America's rise can't all or even mostly be attributed to Trump's tariffs, the tariffs clearly hurt China's economy more than America's. For one thing, the "tax" that tariffs represent has mostly been paid by China. According to a recent policy brief from EconPol Europe, a network of researchers in the European Union, U.S. companies and consumers will pay only 4.5 per cent of the 25-per-cent tariffs on US$250 billion of Chinese goods, with the other 20.5 per cent falling on Chinese producers. The EconPol report found that the Trump administration selected easily replaced products, forcing China's exporters to cut selling prices to keep buyers. "Through its strategic choice of Chinese products, the U.S. government was not only able to minimize the negative effects on U.S. consumers and firms, but also to create substantial net welfare gains in the U.S.," the authors determined, adding that the tariffs will accomplish Trump's goals of lowering the trade deficit with China.

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More importantly, the tariffs have spurred investment confidence in the U.S., not only in steel and aluminum, where dozens of plants are either being built or reopened, but in the broader economy, too. A UBS Wealth Management Americas survey found that 71 per cent of American business owners support additional tariffs on imports from China, with only one-third believing tariffs would hurt them. A Bloomberg Businessweek article in October bore out the view that tariffs hitting steel and aluminum imports would be beneficial: "Employment in metal-using industries has risen since the tariffs went into effect last spring, (more than) the increase for overall manufacturing."

The American public likes tariffs, too: According to a Mellman Group and Public Opinion Strategies poll in October, nearly 60 per cent of likely voters deem it important for Trump and Congress to "place trade restrictions on countries that violate trade agreements." When the tariffs apply to China, the public doubtless also likes them for non-economic factors — to rein in one of the world's worst human rights offenders and America's chief military threat.

Contrary to the conventional wisdom, this trade war is anything but lose-lose. This one is a big win for the U.S.

• Lawrence Solomon is a policy analyst with Toronto-based Probe International.

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Covalent functionalization of reduced graphene oxide aerogels with polyaniline for high performance supercapacitors

Chem. Commun., 2019, Accepted Manuscript
DOI: 10.1039/C8CC07744D, Communication
Ruijun Li, Yue Yang, Datong Wu, Kelin Li, Yong Qin, Yongxin Tao, Yong Kong
Covalent functionalization of reduced graphene oxide aerogels (RGOA), which had undergone diazotization and amidation, was achieved via grafting polyaniline (PANI) onto the surface of RGOA. Diazotization and amidation could introduce...
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H.R. Beer Report Part 2

The final part of the H.R. Beer Report Continue reading

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What are the Implications for Climate of Recent North Magnetic Pole Activity?

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Guest Opinion: Dr. Tim Ball The headline says, Scientists warn Earth's magnetic North Pole has begun moving 'erratically' at speeds so fast they are having to issue an emergency update to maps used by electronic navigation systems It is another story that implies a normal event is abnormal. The magnetic pole is always moving, and…

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Greenland Near-Surface Land Air Temperature Data from Berkeley Earth Present Some Surprises

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I enjoy surprises in data, especially when they might make alarmists unhappy. Willis Eschenbach's post Greenland Is Way Cool at WattsUpWithThat prompted me to take a look at the Berkeley Earth edition of the Greenland TAVG temperature data. See Figure 1, which presents the graph of the annual Berkeley Earth TAVG temperature (not anomaly) data…

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Watch: Morano on Canadian TV: ‘Medieval clerics’ of green movement impose ‘sin tax’ on meat

http://bit.ly/2TN62US On Friday's episode of The Ezra Levant Show, I was joined by Marc Morano of ClimateDepot.com to talk about some breaking "global warming" stories including a green MP in the UK calling on Parliament to impose a tax on meat to cut greenhouse gas emissions and reduce climate change. The idea of going after meat consumption in the name of the planet has [...]

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EPA Whistle-blower Dr. Alan Carlin: ‘Urgent Need for a Formal Reevaluation of Climate Alarmist Scam Science’ – CO2 has no significant effect on temperatures’

The Urgent Need for a Formal Reevaluation of Climate Alarmist Scam Science Alan Carlin | January 11, 2019 I have been interested in whether climate alarmism is based on valid science for almost a decade, and have long held that it is not (see here and here). In the last few years the literature has blossomed with more [...]

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MMT: Magical Money Theory

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Pardon me for mixing up acronyms.  Somehow the increasing mention of MMT (Modern Monetary Theory) made me think of the classic Beatles trip album.  Perhaps that association was triggered by today's suddenly fashionable socialists relying on MMT to pay for their "everything free for everybody" political visions.  (Maybe one the Ms could stand for 'mushrooms".)

A primer on what MMT is and is not, here is an article by Karl Smith (descendant of Adam?) in National Review The Uses and Abuses of Modern Monetary Theory.  Excerpts in italics with my bolds.

MMT advocates overlook its flaws.

Newly elected representative Alexandria Ocasio-Cortez (D., N.Y.) argued on Monday that Modern Monetary Theory (MMT) ought to be a part of the conversation when it comes to funding major social-policy initiatives, such as her proposed Green New Deal. Stephanie Kelton, former economic advisor to Bernie Sanders, has likewise insisted that MMT should replace our current thinking about government finance. Yet what is MMT? And is it really as revolutionary as its proponents claim?

At its heart, MMT is a way of describing the federal budget and the Federal Reserve as if they were unified under a single executive authority. In describing the system so, the dangers of federal deficit spending are no longer that it crowds out private investment and slows economic growth, but that it leads potentially to excess inflation.

Yet Modern Monetary Theorists then invariably argue that inflation is not, and indeed could not be, a major problem for the United States. Many hard-core adherents go so far as to propose a job-guarantee program paid for by the federal government, which, they argue, will virtually eliminate both unemployment and the possibility of runaway inflation.

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The tenets of MMT should be familiar to an older generation of fiscal conservatives. Before the 1980s, central banks such as the Federal Reserve were controlled far more directly by their governments. As a result, they could — and often did — bail out profligate governments by simply printing more money to cover the government's debt.

This led to massive currency devaluation, runaway inflation, or both. In the early 1980s, however, central banks in the developed world were granted independence in the hopes that doing so would stop the spiraling inflation of the late 1960s and 1970s.

In the U.S., Fed chairman Paul Volcker was spectacularly successful at this. So were, to varying degrees, most central banks in the developed world. Some holdouts existed, notably in Southern Europe — a situation that would come back to haunt them decades later.

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But MMT waves away the significance of these developments, instead focusing attention on several technical facts. First, when the federal government wants to spend money, it does so by having the Treasury issue checks. These checks are processed by the Federal Reserve Bank of New York (FRBNY). Second, the FRBNY does this literally by marking up the value of digital reserves in an account belonging to the check recipients' bank and marking down the account of the Treasury by an equal amount.

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These two operations are, in theory, separate. There is no technical reason why the FRBNY has to mark down the Treasury account. It only does so because laws require the federal government to meet all of its obligations. Such laws, argue Modern Monetary Theorists, cannot bind Congress, which after all has the power to alter them.

MMT advocates argue that Congress should ask the Treasury to sell Treasury bonds to cover any of its outstanding obligations. This is not, however, because they think it is necessary to fulfill the government's obligations, but because doing so would help stabilize the macroeconomy.

All well and good. But at some point, won't the debt become so large that merely paying interest on it will require issuing additional debt? Won't this process feed on itself until all the borrowing capacity in the economy is soaked up?

No, MMT advocates reply, because the government can simply stop issuing debt — meeting its obligations instead by having the Federal Reserve simply create money on its behalf.

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Indeed, this is what distressed governments have traditionally done when their liabilities add up — and the result has typically been hyperinflation. Modern Monetary Theorists argue that this need not be the case. Their exact reasoning differs.

At times, they argue that hyperinflation only occurs in countries that borrow from abroad in debt denominated in a foreign government's currency. I don't know enough about every single instance of hyperinflation to verify this claim, but it is true that the worst incidences of hyperinflation are typically associated with borrowing from abroad.

When a country prints money in an attempt to fund the government, the international exchange value of its currency collapses. If the country owes debt denominated in a foreign currency, that debt becomes more difficult to pay down as its own currency falls. Then the country has to print even more money to meet its debt payments, which of course causes the exchange value of its currency to fall further, creating a vicious circle that ends in hyperinflation.

Modern Monetary Theorists argue that this can't happen to the United States because all of our debt is in the form of Treasury bonds that are denominated in dollars. If the international exchange value of the dollar falls, that does not change the value of our debt.

It does, however, mean that foreigners will be repaid in a currency that will be worth much less to them. Foreign bondholders are not stupid; they would regard this as a type of unofficial default. After experiencing this type of default through currency devaluation, they would be much less willing to buy Treasury bonds or indeed any type of American security again. This is precisely the situation that Italy, Spain, and Greece found themselves in during the 1980s.

Both countries had regularly devalued their currency as a way to get out from underneath foreign debts and were increasingly locked out of international markets. The euro was created, at least in part, in an effort to solve this. It could ultimately be printed only with the authority of the European Central Bank, meaning that neither Italy, Spain, Greece, nor any other member country could avert a debt crisis by devaluing its currency. Instead, they would have to raise taxes to meet their obligations.

That brings us to the second argument MMT advocates invoke when arguing that we should not worry about excessive debt leading to inflation: If inflation becomes a problem, the federal government can simply raise taxes, slowing down the economy which, in turn, will cool inflation.

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But there are two problems with this approach. First, it is political suicide. At a time when consumers are facing ever-rising prices, it would seem cruel beyond measure to slap them with a tax increase. Very few governments would have the nerve to do this. If anything, history shows us that governments will instead resort to spending money on subsidies to ease the burden of rapidly rising prices.

Second, committing to this approach would risk an economic calamity. In 1973, OPEC placed an embargo on the United States that resulted in the price of oil quadrupling overnight. The sharply rising price of oil led both to a slowing economy and an increase in inflation — a dangerous mix.

A slowing economy lowers tax revenues, making it more difficult for the government to meet its debt payments. Suppose, at a time when the economy was slowing but inflation was rising, the U.S. government had firmly committed itself to MMT principles and refused to waver. In that case, it would not be able to resort to money printing because inflation was rising. Instead, it would be obligated to raise taxes both to meet its debt payments and to slow the rate of inflation.

Sharp increases in taxes during a recession, however, can be self-defeating. This is exactly the situation that Greece, and to a lesser extent Italy and Spain, found themselves in during the Great Recession. The crises lowered revenue, which worsened their budget deficits.

As a result, the government was forced to raise taxes and lower spending during the recession. This caused the economy to contract further, which caused tax revenue to fall so much that the budget deficit actually rose. In the case of Greece, this self-defeating cycle of higher taxes and lower revenues caused the government to ultimately default on its debts anyway. That, of course, worsened the economic crisis the country was already facing.

In the face of such a calamity, no sovereign government would or perhaps even should refrain from devaluing its currency and inflating away at least some of its debts. For that reason, governments have designed institutions to avoid falling into this trap.

In the United States, that means both making the Federal Reserve independent and not subject to the direct authority of the Treasury, and requiring the Treasury to meet all of its obligations with cash raised from tax revenues or Treasury-bond sales. In effect, we've outlawed the methods of Modern Monetary Theory — and with good reason.

KARL SMITH — Karl Smith is a senior fellow at the Niskanen Center. He was previously Assistant Professor of Economics and Government at the University of North Carolina (UNC) School of Government.

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Study: Hurricanes: ‘It’s Better Than We Thought’ – ‘Simply no increase’ in global hurricane activity

http://bit.ly/2FpSrQb Full study here: Hurricanes: It's Better Than We Thought "Simply no increase" in hurricane activity around the world London 13 January:   A new paper from the Global Warming Policy Foundation (GWPF) reveals that there has been no increase in global hurricane activity, despite frequent claims that global warming is making hurricanes more of a problem. As the [...]

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Democrats Failing to Control Alexandria Ocasio-Cortez’s Green Revolution

Pelosi-Ocasio-Cortez-300x144.jpg

Guest essay by Eric Worrall Democrats are reportedly desperate to rein in Alexandria Ocasio-Cortez's wild attacks on the Democrat establishment, such as her fury at being denied her new green deal, but at the same time they are terrified of upsetting her. Exasperated Democrats try to rein in Ocasio-Cortez The effort is part carrot, part…

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Warmer Than Thought? GWPF Science Editor Sceptical About New Ocean-Warming Paper

By Paul Homewood

 

 

It's worse than we thought!

 

 image

A new report published in the US journal Science, led by the Chinese Academy of Sciences, suggests the world's oceans are warming 40 percent faster than what a UN panel predicted five years ago. Although data collection is more accurate than in the past, some experts advise against jumping to hasty conclusions.

About 93 percent of excess heat trapped around the Earth by greenhouse gases that come from the burning of fossil fuels accumulates in the world's oceans.

The UN Intergovernmental Panel on Climate Change (IPCC) says ocean warming has led to rising sea levels and contributes to increases in rainfall intensity, more violent storms and the destruction of coral reefs.

t is also a threat to biodiversity and one of the earth's major food supplies.

"Ocean heating is a very important indicator of climate change, and we have robust evidence that it is warming more rapidly than we thought," said co-author Zeke Hausfather, a graduate student in the Energy and Resources Group at the University of California, Berkeley.

Their report relied on four studies, published between 2014 and 2017 whose conclusions are based on measurements recorded by a fleet of some 4,000 floating robot monitors called Argo.

The robtos drift throughout the world's oceans, every few days diving to a depth of 2,000 meters and measuring the ocean's temperature, pH, salinity and other information.

Voir l'image sur Twitter

Argo "has provided consistent and widespread data on ocean heat content since the mid-2000s," the report said.

The new analysis shows warming in the oceans is on pace with measurements of rising air temperature.

And if nothing is done to reduce greenhouse gases, "models predict that the temperature of the top 2,000 meters of the world's oceans will rise 0.78 degrees Celsius by the end of the century," it said.

http://en.rfi.fr/environment/20190111-global-warming-are-our-oceans-heating-faster-we-thought

There are, however, a number of issues which rather undermine Hausfather's hype.

For a start, ocean heat content (OHC) is not rising faster than before, simply faster than scientists guessed a few years ago. There is a big difference between the two.

 

GWPF's David Whitehouse also puts a dampener on the matter:

"I think you've got to be very careful when splicing together two sets of data from two sets of instruments and trying to compare them", he told RFI, referring to the fact that the study in question pulled together measurements from before the Argo system was up and running.

"The past is full of people trying to do this and have had to be re-evaluated years later because we found out something else about the measurements made in the past and the measurements made today."

"They can make a case that the oceans are warming this way, provided you accept that they understand what's going on and I wouldn't say that we understand completely about the past instruments."

"The most sensible thing to do would be to stick to the data since 2006 which is quite good enough to give us a baseline with a coherent data set."

"If you just look at the Argo array itself, you cannot see this catastrophic, runaway ocean warming in just that data. So I know all scientists will say this, but I'd really like another 15 years of data in order to convince me."

https://www.thegwpf.com/warmer-than-thought-gwpf-science-editor-sceptical-about-new-ocean-warming-paper/

 

Amen to that! There are still huge uncertainties in the measurement of OHC, even with Argo buoys. Prior to 2006, we really don't have a clue. To splice the Argo data onto the prior numbers is not proper science.

But we can delve a little deeper. Willis Eschenbach wrote a very thoughtful piece on WUWT in 2014 about OHC, which is still highly relevant. It is worth reading in full here. With thanks to Willis, I will re-use some of his numbers and concepts here.

 

The first thing to note is that, up to 2014 at least, OHC has only risen in the southern extratropical ocean. The tropics and northern extratropical ocean have not warmed at all.

 

nclimate2872-f5_sm

http://www.argo.ucsd.edu/global_change_analysis.html

 

Any claim that OHC is rising as a result of GHGs surely has to explain this inconsistency.

 

Willis also raised the question of error margins. As Hausfather's own graph above shows, these are substantial. Indeed when margins of error are factored in, we have no way of knowing whether OHC has risen at all since 2006.

As the Argo website itself admits:

The global Argo dataset is not yet long enough to observe global change signals. Seasonal and interannual variability dominate the present 10-year globally-averaged time series. Sparse global sampling during 2004-2005 can lead to substantial differences in statistical analyses of ocean temperature and trend (or steric sea level and its trend, e.g. Leuliette and Miller, 2009). Analyses of decadal changes presently focus on comparison of Argo to sparse and sometimes inaccurate historical data.

http://www.argo.ucsd.edu/global_change_analysis.html#temp

 

To pretend that the data is accurate enough for the purposes claimed is ridiculous.

To put this concept into perspective, you may note that the Hausfather graph uses zettajoules on the y-axis. One zettajoule is a billion trillion joules, an impressive sounding number, but one that makes no sense at all to most people.

Voir l'image sur Twitter

 

Willis handily converted OHC into actual temperatures:

 

global change in ocean temperature argo

As Willis commented, a linear trend of 0.02C per decade is hardly scary. But more importantly, it simply is not possible to measure the heat content of the world's oceans to such an accurate degree.

Willis in another post, here, concluded that the claimed error margin of +/-0.003C had been badly underestimated.

 

Hausfather claims that recent observations "tend to agree quite well with climate model predictions". I suspect that was the real objective of the exercise all along.



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Geoscientists reconstruct ‘eye-opening’ 900-year Northeast climate record

Credit: planetsave.com


This supports the idea that temperature cycles in the region of 60 years are very likely a common feature of Earth's climate.

Deploying a new technique for the first time in the region, geoscientists at the University of Massachusetts Amherst have reconstructed the longest and highest-resolution climate record for the Northeastern United States, which reveals previously undetected past temperature cycles and extends the record 900 years into the past, well beyond the previous early date of 1850, reports Phys.org.

First author Daniel Miller, with Helen Habicht and Benjamin Keisling, conducted this study as part of their doctoral programs with advisors geosciences professors Raymond Bradley and Isla Castañeda.

As Miller explains, they used a relatively new quantitative method based on the presence of chemical compounds known as branched glycerol dialkyl glycerol tetra ethers (branched GDGTs) found in lakes, soils, rivers and peat bogs around the world. The compounds can provide an independent terrestrial paleo-thermometer that accurately assesses past temperature variability.

Miller says, "This is the first effort using these compounds to reconstruct temperature in the Northeast, and the first one at this resolution." He and colleagues were able to collect a total of 136 samples spanning the 900-year time span, many more than would be available with more traditional methods and from other locations that typically yield just one sample per 30-100 years.

In their results, Miller says, "We see essentially cooling throughout most of the record until the 1900s, which matches other paleo-records for North America. We see the Medieval Warm Period in the early part and the Little Ice Age in the 1800s."

An unexpected observation was 10, 50-to-60-year temperature cycles not seen before in records from Northeast U.S., he adds, "a new finding and surprising. We're trying to figure out what causes that. It may be caused by changes in the North Atlantic Oscillation or some other atmospheric patterns. We'll be looking further into it."

Continued here.

Related: Anthropogenic CO2 warming challenged by 60-year cycle



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Do Amazon turtles exposed to environmental concentrations of the antineoplastic drug cyclophosphamide present mutagenic damages? If so, would such damages be reversible?

Abstract

Antineoplastic drugs (AD) have been increasingly used, but the disposal of their wastes in the environment via hospital effluent and domestic sewage has emerged as an environmental issue. The current risks posed to these animals and effects of pollutants on the reptiles' population level remain unknown due to lack of studies on the topic. The aim of the present study was to evaluate the mutagenicity of neonate Podocnemis expansa exposed to environmental concentrations (EC) of cyclophosphamide (Cyc). The adopted doses were EC-I 0.2 μg/L and EC-II 0.5 μg/L Cyc. These doses correspond to 1/10 and ¼ of concentrations previously identified in hospital effluents. Turtles exposed to the CyC recorded larger total number of erythrocyte nuclear abnormalities than the ones in the control group after 48-h exposure. The total number of abnormalities for both groups (EC-I and EC-II) 96 h after the experiment had started was statistically similar to that of animals exposed to high Cyc concentration (positive control 5 × 104 μg/L). This outcome confirms the mutagenic potential of Cyc, even at low concentrations. On the other hand, when the animals were taken to a pollutant-free environment, their mutagenic damages disappeared after 240 h. After such period, their total of abnormalities matched the basal levels recorded for the control group. Therefore, our study is the first evidence of AD mutagenicity in reptiles, even at EC and short-term exposure, as well as of turtles' recovery capability after the exposure to Cyc.



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Sun As Main Driver: Japanese Scientist Cites 7 Major Examples How Real Climatic Data Contradict AGW Claims

By Kyoji Kimoto
kyoji@mirane.co.jp

1. Warmer period of the 1930s

In 1998 D. Dahl-Jensen et al. pointed out in the journal Science that the 1930s is 0.5°K warmer than the present time based on a bore-hole study of Greenland ice sheet.

The following data support D. Dahl-Jensen's findings, from Soon 2012.

Also heat waves were far worse across the USA in the 1930s:

More heat waves in the 1930s.

The strongest hurricane was the Labor Day hurricane, which hit in 1935. Hurricane Irma and Harvey had much higher central pressure at landfall. (U.S .National Hurricane Center):

Strongest hurricane occurred in the 1930s.

2. Arctic temperature and sea ice extent

Parts of the Arctic were warmer in the 1930s:

Source: Real Climate Science.

Arctic sea ice levels were just as low in the 1930s as they are today:

Read more here.

3. NASA & NOAA altered the data

The climatic data above can be understood with solar activity change (aa Index) and ocean oscillation (Pacific Decadal Oscillation Index), see the 2 charts that follow.

(Archibald)

The Pacific Decadal Oscillation (PDO) index was also in its warm phase during the 1930s:

PDO index was positive from1925 to1945. Data: Japan Meteorological Agency.

In summary, increasing solar activity with positive PDO index caused the warmer period of the 1930s. However, NASA and NOAA have made data tampering to stress recent warming.

Recent temperature data shows strong influence of ocean oscillation (El Nino) and no relation with CO2 increase as follows:

Source: Climate4you

4. MWP & LIA caused by changes in solar activity

Solar activity proxies show the MWP & the LIA in Japan and China as follows:

Chart above: Kitagawa, H. & Matsumoto, E., Geophysical Research Letters, Vol. 22, 2155-2158, 1995

 

Graphic above: Quansheng GE. et al., Advances in atmospheric sciences, Vol. 34, 941-951, 2017.

There are hundreds of other proxies worldwide that support solar activity as the main climate driver.

5. Sea level rise

Almost 25-years of meticulous data gathered by the Australian Bureau of Meteorology displays no discernible sea-level rise for Solomon Islands and Nauru. See the two graphs that follow:

Source: WUWT.

6. El Nino linked to solar activity

A publication by Njau (2006) showed El Nino starts at the year of sunspot minimum or maximum, thus showing that solar activity has a major impact on oceanic oscillations, which in turn powerfully impact weather and climate.

7. Extreme weather and solar activity

Bucha (1988) showed decreased solar activity causes meandering of jet stream which produces extreme weather in broad area. Since 2006 decreased solar activity has been causing heat waves, wildfires and heavy rainfall and snowfall all over the world.

Bucha (1988)



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Ben Santer: We Need Understanding, Not Physical Walls, to Address Climate Change

wpid-imag0106-300x179.jpg?is-pending-loa

Guest essay by Eric Worrall h/t Dr. Willie Soon – University of East Anglia alumni Ben "Beat the cr*p out of him" Santer offering President Trump lessons on fostering international cooperation, shared humanity, mutual understanding and the need to focus on climate action rather than building physical walls. Ultima Thule, the Cold War and Trump's…

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Integrated pathways for meeting climate targets and ensuring access to safe water

From EurekAlert! Public Release: 11-Jan-2019 International Institute for Applied Systems Analysis IIASA researchers have led work to develop new pathways showing how the world can develop water and energy infrastructure consistent with both the Paris Agreement and the UN Sustainable Development Goal 6 (SDG6) – Ensure availability and sustainable management of water and sanitation for…

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Cervical spondylotic myelopathy


Natural history, prevalence, and pathophysiology of cervical spondylotic myelopathy Highly accessed article p. 5
Gomatam Raghavan Vijay Kumar, Dibyendu Kumar Ray, Rupant Kumar Das
DOI:10.4103/isj.isj_48_18  
This study is a narrative review performed to summarize the current knowledge about the epidemiology, natural history and pathogenesis of cervical spondylotic myelopathy (CSM). A comprehensive search was undertaken to look at all available articles between January 1, 1956 to May 1, 2018, on PubMed and the Cochrane Collaboration Library. The natural history of CSM is variable. The main determinants of the clinical course of CSM are the extent of neurological impairment, age, cervical instability, abnormalities of cord conduction, canal diameter, congenitally stenotic spinal canal and the extent of involvement and tract disruption on diffusion tensor imaging (DTI) imaging. There is little data on the true incidence and prevalence of CSM across the globe and none from India. The pathoanatomic basis of CSM is cord compression, either dynamic or static. The biological events that are thought to play a significant role in the development of CSM are ischemia, derangement of the blood-spinal cord barrier, chronic neuronal inflammation, and apoptosis. Emerging knowledge about the molecular biology holds promise for potential intervention, both for prevention and for cure, of this common and debilitating condition.

Degenerative cervical myeloradiculopathy

Clinical spectrum and importance of evaluation systems in degenerative cervical myeloradiculopathy p. 13
Ganesh Swaminathan, Vetrivel Muralidharan, Baylis Vivek Joseph
DOI:10.4103/isj.isj_61_18  
Degenerative cervical myelopathy includes facet joint arthropathy and/or intervertebral disc prolapse, as well as aberration (hypertrophy, calcification, or ossification) in the ligamentum flavum, and/or posterior longitudinal ligament. Cervical spondylotic myelopathy and ossification of posterior longitudinal ligament are two major conditions under this spectrum. Patients with degenerative changes of the cervical spine can present with wide spectrum of symptoms and signs ranging from axial neck pain, radiculopathy or myelopathy. A combination of history, physical examination, and provocative tests such as Spurling's sign, shoulder abduction test, neck distraction test, Valsalva maneuver, Elvey's upper limb tension/brachial plexus tension test increase the likelihood of diagnosis of cervical radiculopathy. Myelopathy can manifest in the early stage as subtle changes in the upper limb dexterity or mild walking difficulty and in late stage with severe spasticity and flexor spasms. Clinicians are increasingly using quantitative or semi-quantitative scales of neurological impairment. However, there is no gold standard evaluation systems that can reliably assess disease severity.

Cervical spondylotic myelopathy

Anterior surgical options for cervical spondylotic myelopathy p. 33
Andrei Fernandes Joaquim, John Alex Sielatycki, K Daniel Riew
DOI:10.4103/isj.isj_39_18  
Cervical spondylotic myelopathy (CSM) is one of the most common among causes of spinal cord dysfunction worldwide. In this article, we provide a broad narrative review of the options to treat CSM from an anterior approach to the cervical spine. Anterior procedures are effective and safe, especially for one or two level disease (although can be used up to 7-8 levels). This approach can be used in patients with lordotic, neutral, or kyphotic cervical spine alignment and provide excellent access for direct neural decompression. The most common adverse effects of anterior cervical operations are dysphagia and dysphonia, but fortunately, these are mild and transient in the majority of cases. Severe complications, such as vertebral arterial injury, spinal cord injury or airway compromise, are rare but must be taken into consideration, especially when additional risk factors are present (multilevel procedures, revision surgeries, older, and infirm patients). The primary anterior cervical procedures for treating CSM are anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), oblique cervical corpectomy, and cervical disc arthroplasty. A combination (hybrid) of ACDF and ACCF is also utilized as an option to allow for wide decompression, deformity correction, and provide more surface area of exposed, and bleeding cancellous bone. More recently, the senior author (KDR) has utilized a hemi-corpectomy and fusion hybrid technique which will be described in this text. Advantages and disadvantages of each of these options are discussed in detail, as well as the need for posterior instrumentation supplementation in selected patients; such as those with concomitant cervical deformity, poor bone quality, or those at risk for pseudarthrosis following multilevel arthrodeses. The management of patients with cervical spinal cord compression without myelopathy or with mild symptoms is also discussed.

Spondylotic cervical myelopathy

Posterior surgical options for spondylotic cervical myelopathy p. 42
Shankar Acharya, Nikhil Jain
DOI:10.4103/isj.isj_57_18  
Cervical spondylotic myelopathy (CSM) is a common presentation in the middle-aged to elderly population. The cause of myelopathy is multifactorial, and cervical spondylosis is the most common cause. This review looks into the treatment options, timing of the surgery, and the advantages and disadvantages of the various posterior approaches for multilevel spondylotic myelopathy. CSM is a disabling disorder that should be addressed in its early phases. There are limited surgical options available, and each procedure has its advantages and disadvantages. Since the neurological and functional outcomes are the same for all well-performed decompressions, the choice of surgical approach depends on various other factors. Posterior approaches are good for multilevel disease as they make the surgery simpler, shorter and with reduced complications in comparison to multilevel anterior surgeries.

Ossification of the posterior longitudinal ligament

: Etiology, prevalence, progression, and surgical strategies p. 52
Yoshiharu Kawaguchi
DOI:10.4103/isj.isj_41_18  
Ossification of the posterior longitudinal ligament (OPLL) is characterized by replacement of the ligamentous tissue by ectopic new bone formation. OPLL often causes narrowing of the spinal canal and has been recognized as a cause of cervical myelopathy and/or radiculopathy. Although a clear inheritance of OPLL has not been identified, there is a strong genetic background for OPLL. A recent genome-wide association study using all Japan cohort reported that there were 6 susceptible loci for OPLL. In addition, there were several studies to seek the biomarkers of OPLL. OPLL is frequently found in the cervical spine. However, 53.4% had OPLL not only in the cervical spine, but also in other spinal regions in patients with cervical OPLL. Further, 65.2% with cervical OPLL had ossification of the ligamentum flavum (OLF) especially at the levels of the thoracic and the lumbar spine. There is no effective conservative treatment. Surgical decompression is considered in patients with severe and/or progressive myelopathy. Early surgical decompression of the spinal cord is recommended in patients with apparent myelopathy. Operative methods are divided into two procedures, anterior decompressive surgery and posterior decompressive surgery. The choice of the surgical procedure is determined according to several factors, such as local pathology of OPLL and spinal alignment.

The median labio-mandibulo-glossotomy approach to the upper cervical spine

: A personal series and tips and pearlsp. 92
K Venugopal Menon, Hood Al Saqri, Renjit Kumar, Maruti Kambali
DOI:10.4103/isj.isj_8_18  
Background: Wide exposure to the anterior part of the upper cervical spine is difficult due to anatomical constraints. The Labio-Mandibulo-Glossotomy (LMG) approach is considered a difficult approach with high morbidity. The objective of this study is to describe the authors experience with the approach and it's outcomes in six cases and offer tips and pearls to the surgical access. Methods: This is a retrospective review of a small series of six cases that were operated for upper cervical lesions by the LMG approach. Two had mandible fractures that needed fixation and in the others osteotomy of the mandible was performed. The patients were followed up for minimum two years or death (in malignancy). We specifically looked for cosmetic or functional problems related to osteotomy, glossotomy, and, hospital and ICU stay duration. Surgical access is described in detail. Results: The hospital stay was similar to other major spine trauma or tumour surgeries at our center (median 14 days) and mean ICU stay 2.8 days. There were no long-term issues related to the access. Several tips and tricks are offered to minimize intra and post-operative problems. Conclusions: The LMG approach, though apparently formidable, is quite a safe and simple procedure with few residual complications.

Spine

EDITORIALS 

Publish or perish Highly accessed articlep. 1
Anil K Jain, Manish Chadha
DOI:10.4103/isj.isj_74_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Symposium on cervical spondylo-myelopathyp. 4
T Ajoy Prasad Shetty, Ankur Nanda
DOI:10.4103/isj.isj_71_18  
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
SYMPOSIUM - CERVICAL SPONDYLOMYELOPATHYTop

Natural history, prevalence, and pathophysiology of cervical spondylotic myelopathy Highly accessed articlep. 5
Gomatam Raghavan Vijay Kumar, Dibyendu Kumar Ray, Rupant Kumar Das
DOI:10.4103/isj.isj_48_18  
This study is a narrative review performed to summarize the current knowledge about the epidemiology, natural history and pathogenesis of cervical spondylotic myelopathy (CSM). A comprehensive search was undertaken to look at all available articles between January 1, 1956 to May 1, 2018, on PubMed and the Cochrane Collaboration Library. The natural history of CSM is variable. The main determinants of the clinical course of CSM are the extent of neurological impairment, age, cervical instability, abnormalities of cord conduction, canal diameter, congenitally stenotic spinal canal and the extent of involvement and tract disruption on diffusion tensor imaging (DTI) imaging. There is little data on the true incidence and prevalence of CSM across the globe and none from India. The pathoanatomic basis of CSM is cord compression, either dynamic or static. The biological events that are thought to play a significant role in the development of CSM are ischemia, derangement of the blood-spinal cord barrier, chronic neuronal inflammation, and apoptosis. Emerging knowledge about the molecular biology holds promise for potential intervention, both for prevention and for cure, of this common and debilitating condition.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Clinical spectrum and importance of evaluation systems in degenerative cervical myeloradiculopathyp. 13
Ganesh Swaminathan, Vetrivel Muralidharan, Baylis Vivek Joseph
DOI:10.4103/isj.isj_61_18  
Degenerative cervical myelopathy includes facet joint arthropathy and/or intervertebral disc prolapse, as well as aberration (hypertrophy, calcification, or ossification) in the ligamentum flavum, and/or posterior longitudinal ligament. Cervical spondylotic myelopathy and ossification of posterior longitudinal ligament are two major conditions under this spectrum. Patients with degenerative changes of the cervical spine can present with wide spectrum of symptoms and signs ranging from axial neck pain, radiculopathy or myelopathy. A combination of history, physical examination, and provocative tests such as Spurling's sign, shoulder abduction test, neck distraction test, Valsalva maneuver, Elvey's upper limb tension/brachial plexus tension test increase the likelihood of diagnosis of cervical radiculopathy. Myelopathy can manifest in the early stage as subtle changes in the upper limb dexterity or mild walking difficulty and in late stage with severe spasticity and flexor spasms. Clinicians are increasingly using quantitative or semi-quantitative scales of neurological impairment. However, there is no gold standard evaluation systems that can reliably assess disease severity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Imaging in cervical myelopathyp. 20
Rajavelu Rajesh, Shanmuganathan Rajasekaran, Sri Vijayanand
DOI:10.4103/isj.isj_63_18  
This is a narrative review. The objective of this study is to provide an overview on the imaging modalities and their utilization in cervical myelopathy (CM). Using PubMed, studies published on the "imaging modalities in CM," "cervical spondylotic myelopathy (CSM) imaging," "computed tomography (CT) and magnetic resonance imaging (MRI) in CM," "imaging in ossified posterior longitudinal ligament (OPLL)," "dural ossification in OPLL," "diffusion tensor imaging (DTI) in CSM," and "dynamic MRI, functional MRI, and magnetic resonance spectroscopy (MRS) in CSM" were evaluated. The review addresses the evaluation of CM with various imaging modalities ranging from radiographs, CT, and MRI to advanced imaging techniques such as DTI and MRS. Each investigation contributes specific detail to the disease process in a different dimension. Specific parameters for CSM and OPLL, and their influence on outcome are discussed. Imaging in CM plays an important role in analyzing the cause of myelopathy, defining the level of the lesion, parameters to assess the time of intervention and to predict the outcome.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Anterior surgical options for cervical spondylotic myelopathyp. 33
Andrei Fernandes Joaquim, John Alex Sielatycki, K Daniel Riew
DOI:10.4103/isj.isj_39_18  
Cervical spondylotic myelopathy (CSM) is one of the most common among causes of spinal cord dysfunction worldwide. In this article, we provide a broad narrative review of the options to treat CSM from an anterior approach to the cervical spine. Anterior procedures are effective and safe, especially for one or two level disease (although can be used up to 7-8 levels). This approach can be used in patients with lordotic, neutral, or kyphotic cervical spine alignment and provide excellent access for direct neural decompression. The most common adverse effects of anterior cervical operations are dysphagia and dysphonia, but fortunately, these are mild and transient in the majority of cases. Severe complications, such as vertebral arterial injury, spinal cord injury or airway compromise, are rare but must be taken into consideration, especially when additional risk factors are present (multilevel procedures, revision surgeries, older, and infirm patients). The primary anterior cervical procedures for treating CSM are anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), oblique cervical corpectomy, and cervical disc arthroplasty. A combination (hybrid) of ACDF and ACCF is also utilized as an option to allow for wide decompression, deformity correction, and provide more surface area of exposed, and bleeding cancellous bone. More recently, the senior author (KDR) has utilized a hemi-corpectomy and fusion hybrid technique which will be described in this text. Advantages and disadvantages of each of these options are discussed in detail, as well as the need for posterior instrumentation supplementation in selected patients; such as those with concomitant cervical deformity, poor bone quality, or those at risk for pseudarthrosis following multilevel arthrodeses. The management of patients with cervical spinal cord compression without myelopathy or with mild symptoms is also discussed.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Posterior surgical options for spondylotic cervical myelopathyp. 42
Shankar Acharya, Nikhil Jain
DOI:10.4103/isj.isj_57_18  
Cervical spondylotic myelopathy (CSM) is a common presentation in the middle-aged to elderly population. The cause of myelopathy is multifactorial, and cervical spondylosis is the most common cause. This review looks into the treatment options, timing of the surgery, and the advantages and disadvantages of the various posterior approaches for multilevel spondylotic myelopathy. CSM is a disabling disorder that should be addressed in its early phases. There are limited surgical options available, and each procedure has its advantages and disadvantages. Since the neurological and functional outcomes are the same for all well-performed decompressions, the choice of surgical approach depends on various other factors. Posterior approaches are good for multilevel disease as they make the surgery simpler, shorter and with reduced complications in comparison to multilevel anterior surgeries.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ossification of the posterior longitudinal ligament: Etiology, prevalence, progression, and surgical strategiesp. 52
Yoshiharu Kawaguchi
DOI:10.4103/isj.isj_41_18  
Ossification of the posterior longitudinal ligament (OPLL) is characterized by replacement of the ligamentous tissue by ectopic new bone formation. OPLL often causes narrowing of the spinal canal and has been recognized as a cause of cervical myelopathy and/or radiculopathy. Although a clear inheritance of OPLL has not been identified, there is a strong genetic background for OPLL. A recent genome-wide association study using all Japan cohort reported that there were 6 susceptible loci for OPLL. In addition, there were several studies to seek the biomarkers of OPLL. OPLL is frequently found in the cervical spine. However, 53.4% had OPLL not only in the cervical spine, but also in other spinal regions in patients with cervical OPLL. Further, 65.2% with cervical OPLL had ossification of the ligamentum flavum (OLF) especially at the levels of the thoracic and the lumbar spine. There is no effective conservative treatment. Surgical decompression is considered in patients with severe and/or progressive myelopathy. Early surgical decompression of the spinal cord is recommended in patients with apparent myelopathy. Operative methods are divided into two procedures, anterior decompressive surgery and posterior decompressive surgery. The choice of the surgical procedure is determined according to several factors, such as local pathology of OPLL and spinal alignment.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Clinical predictors of complications and outcomes in degenerative cervical myeloradiculopathyp. 59
Jamie R F Wilson, Fan Jiang, Michael G Fehlings
DOI:10.4103/isj.isj_60_18  
Degenerative cervical myelopathy (DCM) is the leading cause of adult spinal cord dysfunction worldwide, and surgical decompression remains the mainstay treatment to arrest the progression of neurological deterioration. A number of clinical factors can predict and influence the outcomes of surgery, including patient demographics, baseline myelopathy severity, duration of symptoms, imaging characteristics, and types of surgical approach. Understanding the influence and relationship of these factors on surgical outcomes allows the treating clinician the ability to provide the patient with realistic expectations when discussing surgical intervention for DCM.
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The spine clinics – Cervical spondylotic myelopathy – Clinical scenariosp. 68
Ankur Nanda, KR Renjith, Abhinandan Mallepally, C S Vishnu Prasath, Ajoy P Shetty
DOI:10.4103/isj.isj_67_18  
This section of the symposium deals with different case scenarios related to cervical spondylotic myelopathy (CSM) which in our daily clinical practice not only act as diagnostic challenges but also test our decision-making abilities. These cases have been handled by different experts and hence help the readers in providing a wider perspective to the problem of cervical myelopathy and its management. This section ends with comments by the authors on key takeaway points from each case scenario, and some literature supported recommendations for the management of CSM.
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REVIEW ARTICLETop

Cell-based treatment strategies for intervertebral disc degeneration: An overview on potentials and shortcomingsp. 81
Prasanthi Sampara, Rajkiran Reddy Banala, Satish Kumar Vemurit, AV Gurava Reddy, G P V Subbaiah
DOI:10.4103/isj.isj_21_17  
The intervertebral discs (IVDs) are the cushioning pads of fibrocartilage, which are immeasurably vital for the uprightness of vertebral column and for its function. IVD provides flexibility, tensile strength to the spine, and also cope up with varied types of biomechanical stresses. IVD degeneration (IVDD) is one of the musculoskeletal disorders mostly seen in older population, and it is the foremost cause of low back pain and consequences of IVDD are disc herniation, spinal stenosis, and degenerative lumbar scoliosis. Yet the therapeutic options are restricted and the treatments given remain unsatisfactory putting more economical burden on world's population. IVDD is considered as a multifactorial disorder, due to the involvement of factors such as genetic inheritance, alterations in cellular composition, and anabolic and catabolic reactions, which could initiate degenerative process in the IVD. However, our conception on IVD genesis and the etiopathology of IVDD have given us an opportunity for exploring and formulate appropriate therapies to tackle IVDD. The cell therapy gives scope for sustained matrix synthesis, controlled inflammation, and prevention of osteophyte formation in IVD. The present review focuses on the existing issues related to current therapeutic approaches and about latest evidence on cell therapy-based regeneration of IVD and maintaining the microenvironment of cellular matrix which holds a promise for future therapeutic applications.
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ORIGINAL ARTICLESTop

The median labio-mandibulo-glossotomy approach to the upper cervical spine: A personal series and tips and pearlsp. 92
K Venugopal Menon, Hood Al Saqri, Renjit Kumar, Maruti Kambali
DOI:10.4103/isj.isj_8_18  
Background: Wide exposure to the anterior part of the upper cervical spine is difficult due to anatomical constraints. The Labio-Mandibulo-Glossotomy (LMG) approach is considered a difficult approach with high morbidity. The objective of this study is to describe the authors experience with the approach and it's outcomes in six cases and offer tips and pearls to the surgical access. Methods: This is a retrospective review of a small series of six cases that were operated for upper cervical lesions by the LMG approach. Two had mandible fractures that needed fixation and in the others osteotomy of the mandible was performed. The patients were followed up for minimum two years or death (in malignancy). We specifically looked for cosmetic or functional problems related to osteotomy, glossotomy, and, hospital and ICU stay duration. Surgical access is described in detail. Results: The hospital stay was similar to other major spine trauma or tumour surgeries at our center (median 14 days) and mean ICU stay 2.8 days. There were no long-term issues related to the access. Several tips and tricks are offered to minimize intra and post-operative problems. Conclusions: The LMG approach, though apparently formidable, is quite a safe and simple procedure with few residual complications.
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CASE REPORTSTop

A novel surgical technique for hydatid cyst involving cervicothoracic anterior epidural spacep. 99
Bharat R Dave, Degulmadi Devanand, Ganesh Deshmukh
DOI:10.4103/isj.isj_17_18  
Spinal hydatid cyst comprises <1% of the total cases of hydatid disease. There is very little literature on the involvement of anterior epidural space by hydatid cyst and its management. This report presents a unique presentation of spinal hydatidosis in cervicothoracic anterior epidural space and a novel technique in surgical management.
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Sacral chordoma with degenerative spondylolisthesis and upper lumbar disc herniationp. 102
Shakti A Goel, Hitesh N Modi, Yatin J Desai, Bhavin Patel
DOI:10.4103/isj.isj_24_17  
Sacral chordoma is a rare condition requiring multidisciplinary approach for management. Here, we report a 72-year-old male patient who was diagnosed with sacral chordoma with L2–L3 disc herniation and L5–S1 degenerative spondylolisthesis and L1 body fracture. The patient was first managed by discectomy L2–L3 with D12–L3 decompression and fixation. Sacral chordoma excision was done 10 months later. The chordoma was excised by anterior laparoscopic resection and mobilization of tissues from the tumor followed by posterior sacrectomy with L5–S1 decompression and extension of fixation in a single stage. Proline mesh was used to support the colon posteriorly. This was further complicated by proximal junction fracture due to fall which was further managed by proximal extension of the rod-screw construct. The patient became symptom free without any radiotherapy or chemotherapy and is able to walk independently, two years following the primary surgery without recurrence of tumor.
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Lumbar disc herniation in ochronosisp. 108
Subbiah Jayakumar, Sathish Devadoss, Annamalai Devadoss
DOI:10.4103/isj.isj_40_18  
Alkaptonuria is a rare metabolic, autosomal recessive disorder caused by the deficiency of homogentisic acid oxidase and it is characterized by bluish-black discoloration of cartilages, skin (Ochronosis), degenerative changes in the articular, extra-articular cartilages, intervertebral disc, other tissues causing pain in the joints and spinal column. Although intervertebral disc degeneration is common in these patients, those presenting with symptoms severe enough to warrant surgery are rare. Only a few patients have been treated surgically. We present a case of alkaptonuria presenting with radiculopathy and lumbar disc herniation. The case presented demonstrates that although lumbar disc herniation is rare in alkaptonuria, it should be sought in such patients and surgical treatment yields good functional outcome.
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