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Study Design: Systematic review and meta-analysis of comparative studies.Objective: To characterize the association of annular defect width after lumbar discectomy with the risk of symptom recurrence and reoperation.Summary Of Background Data: Large annular defect width after lumbar discectomy has been reported to increase risk of symptom recurrence. However, this association has not been evaluated in a systematic manner.Methods: A systematic literature search of MEDLINE and EMBASE was performed to identify comparative studies of large versus small annular defects following lumbar discectomy that reported symptom recurrence or reoperation rates. Main outcomes were reported with pooled odds ratios (OR) and 95% confidence intervals (CIs). Sensitivity analyses were performed to assess the robustness of the meta-analysis findings.Results: After screening 696 records, we included data from 7 comparative studies involving 1653 lumbar discectomy patients, of whom 499 (30%) had large annular defects and 1154 (70%) had small annular defects. Methodological quality of studies was good overall. The median follow-up period was 2.9 years. The risk of symptom recurrence (OR = 2.5, 95% CI = 1.3-4.5, P = 0.004) and reoperation (OR = 2.3, 95% CI = 1.5-3.7, P < 0.001) was higher in patients with large versus small annular defects. Publication bias was not evident. The associations between annular defect width and risk of symptom recurrence and reoperation remained statistically significant in all sensitivity analyses.Conclusion: Annular defect width after lumbar discectomy is an under-reported modifier of patient outcome. Risk for symptom recurrence and reoperation is higher in patients with large versus small annular defects following lumbar discectomy.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the research results of anterior cervical discectomy and fusion (ACDF) utilizing allograft and ACDF with autograft, ACDF with cage devices, and cervical disc arthroplasty to treat cervical disc disease. The study analyzes patient outcomes such as neck and arm pain, neck disability index (NDI), and physical component summary (PCS). The study found that the four treatment groups demonstrated similar improvements for the treatment of the said disease.

Background: Patients with large defects in the annulus fibrosus following lumbar discectomy have high rates of symptomatic reherniation. The Barricaid annular closure device provides durable occlusion of the annular defect and has been shown to significantly lower the risk of symptomatic reherniation in a large European randomized trial. However, the performance of the Barricaid device in a United States (US) population has not been previously reported., Design and Methods: This is a historically controlled post-market multicenter study to determine the safety and efficacy of the Barricaid device when used in addition to primary lumbar discectomy in a US population. A total of 75 patients with large annular defects will receive the Barricaid device following lumbar discectomy at up to 25 sites in the US and will return for clinical and imaging follow-up at 4 weeks, 3 months, and 1 year. Trial oversight will be provided by a data safety monitoring board and imaging studies will be read by an independent imaging core laboratory. Patients treated with the Barricaid device in a previous European randomized trial with comparable eligibility criteria, surgical procedures, and outcome measures will serve as historical controls. Main outcomes will include back pain severity, leg pain severity, Oswestry Disability Index, health utility on the EuroQol-5 Dimension questionnaire, complications, symptomatic reherniation, and reoperation. Propensity score adjustment using inverse probability of treatment weighting will be used to adjust for differences in baseline patient characteristics between the US trial participants and European historical controls., Ethics and Dissemination: This study was approved by a central institutional review board. The study results of this trial will be widely disseminated at conference proceedings and published in peer-reviewed journals. The outcomes of this study will have important clinical and economic implications for all stakeholders involved in treating patients with lumbar discectomy in the US., Study Registration: ClinicalTrials.gov (https://clinicaltrials.gov): NCT03986580., Level of Evidence: 3.

Purpose: Goji berry (Lycium barbarum L.) is purported to benefit vision because of its high antioxidant (especially zeaxanthin) content, although this effect has not been demonstrated in high-quality human studies. The purpose of this study was to evaluate the effects of daily supplementation with a proprietary milk-based formulation of goji berry, Lacto-Wolfberry (LWB), on macular characteristics and plasma zeaxanthin and antioxidant capacity levels in elderly subjects., Methods: This was a double-masked, randomized, placebo-controlled trial in healthy elderly subjects (range, 65 to 70 years) receiving 13.7 g/d of LWB (n = 75) or placebo (n = 75) for 90 days. Subjects underwent direct ophthalmic examination to assess pigmentation and soft drusen count in the macula and a blood draw to measure plasma zeaxanthin level and total antioxidant capacity., Results: The placebo group demonstrated hypopigmentation and soft drusen accumulation in the macula, whereas the LWB group remained stable. Both plasma zeaxanthin level and antioxidant capacity increased significantly in the LWB group, by 26% and 57%, respectively, but did not change in the placebo group. No product-related adverse events were reported in either group., Conclusions: Overall, daily dietary supplementation with goji berry for 90 days increases plasma zeaxanthin and antioxidant levels as well as protects from hypopigmentation and soft drusen accumulation in the macula of elderly subjects. However, the mechanism of action is unclear, given the lack of relationship between change in plasma zeaxanthin and change in macular characteristics.

Purpose: This study was conducted to identify predictors of training effect after 6 months of supervised exercise for cardiac rehabilitation patients., Methods: Data at baseline and after 6 months of supervised exercise from 60 patients with coronary artery disease were used for this study. All the patients exercised 3 days per week for 5 to 9 months. Attendance exceeded 70%. The training effect was independently evaluated by the change in rate-pressure product at a 5-metabolic equivalent (MET) workload (RPP5), and the change in estimated peak METs (METPK) during treadmill testing. Baseline variables were examined to identify predictors of change in RPP5 and METPK separately using multiple linear regression., Results: A reduction in RPP5 (-23 +/- 33 bpm x mm Hg x 10(2); P<.0001) and an increase in METPK (2.1 +/- 1.7 METs; P<.0001) were found after training. Baseline fitness was the best predictor of training effect. Inverse relations were found between baseline scores and change scores for RPP5 (r=-0.68; P<.001) and METpk (r=-0.39; P=.002). Beta-blocker status also was useful for predicting change in RPP5. No association was found between training effect and age, revascularization status, or exercise-induced ischemia., Conclusions: Training effect has limited predictability using baseline variables. No baseline patient characteristics other than high initial fitness were related to reduced training effect. Therefore, patients with clinical characteristics similar to those evaluated in this study can achieve a training effect successfully and are eligible for cardiac rehabilitation. The findings of this study support previous research related to this topic.