81; minor, 1 19 [0 97-1 47], p = 0 10; bidirectional, 1 25 [0 91-

81; minor, 1.19 [0.97-1.47], p = 0.10; bidirectional, 1.25 [0.91-1.72], p = 0.17). Among related stem cell recipients, ABO matching had no significant influence on OS, while the minor and bidirectional mismatched groups among unrelated stem cell recipients exhibited lower OS with marginal significance, especially in patients with acute leukemia, patients who received transplants after 1998, and patients who underwent transplants at Asian centers.\n\nOur meta-analysis demonstrates no adverse association between any ABO mismatching and survival. However, marginally lower OS found in recipients of minor or bidirectional mismatched grafts from unrelated donors suggested the need

for larger studies focusing on unrelated transplants.”
“Objective(s):

Cytochrome P-450 SRT1720 1A1 is an important enzyme in the first phase of the metabolism of some carcinogens such as polycyclic aromatic hydrocarbons (PAHs), as well as estrogen. The present study evaluates the existence of CYP1A1 polymorphism in a number of breast cancer samples.\n\nMaterials and Methods: One hundred breast cancer patients and the same number of healthy controls were analyzed for the A2455G polymorphism of cytochrome P-450 1A1 by the polymerase chain reaction-restriction fragment length polymorphism technique.\n\nResults: Frequency of heterozygote genotype (A/G) indicated significant increase in case group (17%) compared to control group (7%) (OR=2.7; 95% CI=1.07-6.89; P-value=0.03). The related result of (A/A) genotype showed significantly decreased risk of breast cancer (OR=0.34; P-value=0.01). Higher frequency of heterozygotes was mainly observed among premenopausal PF-562271 order breast cancer patients.\n\nConclusion: learn more Our results suggest that the CYP1A1 polymorphism may be useful

for predicting breast cancer risk in our study population.”
“We propose a stochastic individual-based model of graph-structured population, viewed as a simple model of clonal plants. The dynamics is modeled in continuous time and space, and focuses on the effects of the network structure of the plant on the growth strategy of ramets. This model is coupled with an explicit advection-diffusion dynamics for resources. After giving a simulation scheme of the model, the capacity of the model to reproduce specific features of clonal plants, such as their efficiency to forage resources and colonize an empty field by means of phalanx or guerrilla strategies, is numerically studied. Next, we propose a large population approximation of the model for phalanx-type populations, taking the form of an advection-diffusion partial differential equation for population densities, where the influence of the local graph structure of the plant takes the form of a nonlinear dependence in the gradient of resources. (C) 2012 Elsevier BM. All rights reserved.”
“Brown fat can reduce obesity through the dissipation of calories as heat. Control of thermogenic gene expression occurs via the induction of various coactivators, most notably PGC-1 alpha.

The results varied by cancer type and medication exposure There

The results varied by cancer type and medication exposure. There was no association between glycemic control and breast or colon cancer; however, prostate cancer risk was significantly higher with better glycemic control (hemoglobin A1c7.0%). Insulin use was associated LY2157299 mw with increased colon cancer

incidence in women, but not with colon cancer in men or breast or prostate cancer risk. Metformin exposure was associated with reduced breast and prostate cancer incidence, but had no association with colon cancer risk. Sulfonylurea exposure was not associated with risk of any type of cancer. The data reported here support hyperinsulinemia, rather than hyperglycemia, as a major diabetes-related factor associated with increased risk of breast

and colon cancer. In contrast, hyperglycemia appears to be protective in the case of prostate cancer. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.”
“Introduction: Several presentations of neurologic complications p38 MAPK pathway caused by JC virus (JCV) in human immunodeficiency virus (HIV)-infected patients have been described and need to be distinguished from the “”classic”" form of progressive multifocal leukoencephalopathy (PML). The objectives of this study were: 1) to describe the spectrum and frequency of presentations of JCV-associated central nervous system (CNS) diseases; 2) identify factors associated with in-hospital mortality of patients with JCV-associated CNS disease; and Citarinostat 3) to estimate the overall mortality of this population.

Material and methods: This was a retrospective study of HIV-infected patients admitted consecutively for JCV-associated CNS diseases in a referral teaching center in Sao Paulo, Brazil, from 2002

to 2007. All patients with laboratory confirmed JCV-associated CNS diseases were included using the following criteria: compatible clinical and radiological features associated with the presence of JCV DNA in the cerebrospinal fluid. JCV-associated CNS diseases were classified as follows: 1) classic PML; 2) inflammatory PML; and 3) JC virus granule cell neuronopathy (GCN).

Results: We included 47 cases. JCV-associated CNS diseases were classified as follows: 1) classic PML: 42 (89%); 2) inflammatory PML: three (6%); and 3) JC virus GCN: four (9%). Nosocomial pneumonia (p = 0.003), previous diagnosis of HIV infection (p = 0.03), and imaging showing cerebellar and/or brainstem involvement (p = 0.02) were associated with in-hospital mortality. Overall mortality during hospitalization was 34%.

Conclusions: Novel presentations of JCV-associated CNS diseases were observed in our setting; nosocomial pneumonia, previous diagnosis of HIV infection, and cerebellar and/or brainstem involvement were associated with in-hospital mortality; and overall mortality was high. (C) 2012 Elsevier Editora Ltda. All rights reserved.

(J Am Vet Med Assoc 2012;240:1494-1500)”
“Background: In rec

(J Am Vet Med Assoc 2012;240:1494-1500)”
“Background: In recent years there has been an increase in life-threatening infections caused by Acinetobacter baumannii with multiple antibiotic resistance, which has lead to the use of polymyxins, especially colistin, being reconsidered. The aim of this study was to investigate the colistin sensitivity of A. baumannii isolates with multiple antibiotic resistance via different methods, and to evaluate the disk diffusion method for colistin against multi-resistant Acinetobacter isolates, in comparison to the E-test and Phoenix system.

Methods: The study was carried out on 100 Selleck JNK-IN-8 strains of A. baumannii (colonization

or infection) isolated from the microbiological samples of different patients followed in the clinics and intensive care units of Uludag. University Medical School between the years 2004 and 2005. Strains were identified and characterized for their antibiotic sensitivity by Phoenix system (Becton Dickinson, Sparks, MD, USA).

Results: In all studied A. baumannii strains, susceptibility to colistin was determined to be 100% with the disk diffusion, E-test, and broth microdilution methods. Results

of the E-test and broth microdilution method, which are accepted as reference methods, were found to be 100% consistent with the results of the disk diffusion tests; no very major or major error was identified learn more upon comparison of the tests. The sensitivity and the positive predictive value

of the disk diffusion method were found to be 100%.

Conclusions: Colistin resistance in A. baumannii was not detected in our region, and disk diffusion method results are in accordance with those of E-test and broth microdilution methods. (C) 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.”
“Three different polyester polyols, with various oleic acid content, were used in the preparation of polyurethane (PUR) coatings. The polyols were designated as Alk28, Atk40, and Alk65, in which 28, 40, and 65 represent the percentage of oleic acid of the polyol formulations. These polyester polyols were reacted with aromatic diisocyanate 3-MA concentration [toluene diisocyanate (TDI)] to form PUR coatings. The acid value, hydroxyl value, molecular weight, and viscosity of the polyols have been determined. The reaction between the polyols and TDI was studied by Fourier Transform Infrared spectroscopy and X-ray diffraction (XRD). The effects of varying NCO/OH ratio and oleic acid content of polyols on physical and mechanical properties of PUR films were studied. XRD results indicate that the samples are amorphous. PURs, made with Alk28, have the best mechanical properties followed by Alk40 and Alk65. The mechanical properties of the samples have increased as the NCO/OH ratio was increased from 1.2 to 1.6. (C) 2009 Wiley Periodicals, Inc.

The ability to immobilize proteins to a solid surface and registe

The ability to immobilize proteins to a solid surface and register the specific address of each protein YM155 cell line has bridged major limitations for investigating the proteome in biological samples, namely, the wide dynamic range of protein concentrations and the perturbation of the physical and chemical properties of proteins by their modification. Recent advances introduced the use of functional mammalian cell extracts to assay PTMs under different cellular conditions. This assay offers a new approach for performing large-scale complex

biochemical analysis of protein modifications. Here, we review studies of PTM profiling using protein microarrays and discuss the limitations and potential applications of the system. We believe that the information generated from such proteomic studies may be of significant value in our elucidation of the molecular mechanisms that govern human physiology. (C) 2010 John Wiley &

Sons, Inc. WIREs Syst Biol Med 2011 3 347-356 DOI: 10.1002/wsbm.120″
“Thymosin beta-10 (T beta 10) is a member of beta-thymosins (T beta s), a family of low molecular mass peptides, which play essential roles in many cellular functions, including apoptosis, cell proliferation, cell migration, and endocytosis. The report that the T beta 10 gene is expressed selleck at high levels in embryonic human brain as well in human kidney induced us to study T beta 10 reactivity in the preterm kidney in order to verify, at tissue level, the expression of this peptide during renal embryogenesis. To this end, we analyzed, using immunocytochemistry, the expression of T beta 10 in samples of human kidney obtained, at autopsy, from 8 fetuses, 12 preterm infants, ranging from 25 to 36 weeks of gestation and 3 at term newborns. T beta 10 immunoreactivity was detected in 20 out of 22 kidneys examined, and was mainly localized in proximal and distal tubular structures, in the cytoplasm and occasionally in the nuclei of ductal cells. In 11 cases, we

also detected a focal and mild reactivity for the peptide in glomeruli. In 13 kidneys, we also observed immunostaining ABT-263 research buy for T beta 10 inside the “”comma-shaped bodies”" and the “”S-shaped bodies”" during active glomerulogenesis. Our data show, for the first time, the expression of T beta 10 in the human kidney during the initial phases of its physiological development, mainly restricted in the proximal and the distal tubuli. Further studies are needed in order to better characterize the role of T beta 10 in kidney embryogenesis.”
“This study was conducted to compare recovery times from rocuronium-induced muscle relaxation after reversal with three different doses of sugammadex with succinylcholine during electroconvulsive therapy (ECT).

(C) 2008 Elsevier Ltd All rights reserved “
“Aim The aim of

(C) 2008 Elsevier Ltd. All rights reserved.”
“Aim The aim of this study was to investigate the effect of bilateral ovariectomy (OVX), 17-beta estradiol (E2), and progesterone (P4) on the histology and estrogen receptor (ER) expression of the bladder using a female partial bladder outlet obstruction (pBOO) rat model. Material and Methods A total of 60 female Sprague-Dawley rats were evenly assigned into six groups of 10 each. Group A served as the control. Groups B-F underwent induced pBOO. Groups C-F underwent

OVX. Groups D-F were given E2 (0.1mg/kg/day), Group E was given P4 (1mg/kg/day), and Group F was given P4 and dehydroepiandrosterone (DHEA) (300g/kg/day) by an Alzet pump. Four weeks later, serum E2 and P4 levels were evaluated. Each rat was anesthetized check details and the urinary bladder was

removed for weighing and histological study. Results Expression of ER- was not significantly different between the control group and the other study groups. pBOO was shown to increase both bladder weight and detrusor muscle thickness. OVX had an additive effect to BOO on increased blood vessel density in the bladder. E2 was shown to increase selleck compound library blood vessel density, while P4 supplementation decreased blood vessel density. DHEA did not cause any significant effects on blood vessel density. Conclusion Hormone therapy did not change the expression of ER in bladder outlet obstruction. Estradiol stimulated the increased angiogenesis of the bladder detrusor but P4 decreased the angiogenesis of the bladder detrusor. DHEA had no effect on the bladder detrusor.”
“St. John’s wort (Hypericum perforatum) is widely used in traditional medical system as a laxative agent against gastrointestinal hypo-motility disorders, such as constipation. The present research was find more carried out to rationalize its therapeutic potential in constipation. St. John’s wort aqueous extract (Sw.Aq), which tested positive for presence of

flavonoids, saponins and tannins caused concentration-dependent (1.0-10 mg/mL) contractile effect in the isolated rabbit jejunum preparations. Pretreatment of tissues with atropine (0.1 mu M) abolished the stimulatory effect of Sw.Aq, suggesting that the spasmogenic effect of St. John’s wort is mediated possibly through muscarinic receptor activation. In the in-vivo studies, Sw.Aq exhibited laxative effect, reflected by increase in number of mice feces. These results indicate that Sw.Aq causes gut stimulation, via cholinergic mechanism and thus provides pharmacological basis for its medicinal use in gut hypo-motility disease, constipation.”
“Aim Lymph node metastasis is one of the predictive factors associated with poor prognosis of epithelial ovarian cancer.

Animals-127 guinea pigs

Procedures-Records of urinary

Animals-127 guinea pigs.

Procedures-Records of urinary calculi that had been submitted to the University of California Stone Laboratory from 1985 through 2003 were reviewed. In addition, DNA Damage inhibitor submissions of urinary calculi for evaluation by the laboratory were prospectively solicited from 2004 through 2007 Prospectively obtained calculi were accompanied by a urine sample for urinalysis and bacteriologic culture

and a completed questionnaire. All calculi were analyzed by use of polarized light microscopy and infrared spectroscopy. A subset of calculi was examined by means of x-ray diffractometry (XRD).

Results-83% (43/52) of calculi from the laboratory database and 93% (70/75) of calculi that were prospectively solicited were composed of 100% calcium carbonate. Analysis via XRD confirmed that 5 of 6 calculi from a subset that had the greatest gross morphologic variation were composed of 100% calcite. Although many guinea pigs had received antimicrobials before bacteriologic cultures

of urine were performed, Corynebacterium renale was isolated from 5 urine samples.

Conclusions and Clinical Relevance-Contrary to findings of other studies, urinary calculi analyzed for the present study were most commonly composed of 100% calcium carbonate, and infrared spectroscopy or Z-IETD-FMK ic50 XRD was necessary to differentiate this mineral from others. Treatments, including diet and husbandry practices, should be developed to help prevent development of calcium carbonate calculi in guinea pigs. (J Am Vet Med Assoc 2009;234:214-220)”
“Many plants have recently been considered as potential sunscreen resources because of their capacity to absorb the solar ultraviolet EPZ004777 mouse radiation. The objective of this work was to evaluate the sunscreen

activity of ten Zona da Mata Mineira plants extracts by in vitro test using ultraviolet spectrophotometry. From the studied species, three (Lantana aff. fucata Lindl, Solidago microglossa DC and Stachytarpheta gesnerioides Cham.) showed sun protection factor (SPF) higher than 2, which is the minimum value required by the Brazilian legislation to label a product as containing a SPF. These results suggest that it can be possible to utilize these species to manufacture a new natural sunscreen or associate them with synthetic UV-filters.”
“Polymorphisms in GSTM1 and GSTT1 may be associated with asthma risk, yet several studies and meta-analyses have reported inconclusive results. Therefore, an updated meta-analysis was conducted. Literature searches were performed using the Pubmed, Embase and Web of Science databases until October 2012. Variant null’ genotype was compared with wild-type present’ in the pooled data. All statistical analyses were performed using STATA 11.0. A total of 26 case-control studies were suitable for inclusion in the meta-analysis. In the overall population, a significant association was found for both the GSTM1 (odds ratio (OR)=1.452; 95% confidence interval (CI): 1.192-1.770) and GSTT1 polymorphism (OR=1.


“We have fabricated suspensions exhibiting the giant elect


“We have fabricated suspensions exhibiting the giant electrorheological

(GER) effect comprising nanoparticles-multiwall carbon nanotubes (MCNTs) composite particles dispersed in silicone oil. This type of GER fluids display dramatically enhanced antisedimentation characteristic without sacrificing the yield stress. The nanoparticles-nanotubes composites were fabricated by modifying the coprecipitation method with MCNTs and urea-coated see more barium titanyl-oxylate (BTRU) nanoparticles as the components. The composite solid particles are denoted MCNT-BTRU. In the best cases, stabilized suspensions with MCNT-BTRU particles dispersed in silicone oil have been maintained for several months without any appreciable sedimentation being observed. Both the sedimentary and rheological properties of the MCNT-BTRU suspension were systematically studied and compared with their BTRU counterparts. Yield stress as high as 194 selleck kinase inhibitor kPa was obtained in the MCNT-BTRU suspensions. The MCNT-BTRU based

GER fluids, with their antisedimentation characteristic, may have broad engineering applications. (C) 2010 American Institute of Physics. [doi:10.1063/1.3407503]“
“Background: alpha-Linolenic acid (ALA; 18: 3n-3) has been associated inconsistently with an increased risk of prostate cancer. Additional studies have become available since the publication of 2 previous meta-analyses.

Objective: The objective was to review the published data on the relation between ALA and prostate cancer.

Design: We conducted a systematic review to identify studies that included data on ALA and risk of prostate cancer. Data were pooled from studies that compared the highest

ALA quantile with the lowest ALA quantile, and risk estimates were combined by using a random-effects model.

Results: The relation between ALA and prostate cancer is inconsistent across A-1210477 datasheet studies. We pooled data from 8 case-control and 8 prospective studies. The summary estimate revealed that high ALA dietary intakes or tissue concentrations are weakly associated with prostate cancer risk (relative risk [RR]: 1.20; 95% CI: 1.01, 1.43). When examined by study type (ie, retrospective compared with prospective or dietary ALA compared with tissue concentration) or by decade of publication, only the 6 studies examining blood or tissue ALA concentrations revealed a statistically significant association. With the exception of these studies, there was significant heterogeneity and evidence of publication bias. After adjustment for publication bias, there was no association between ALA and prostate cancer (RR: 0.96; 95% CI: 0.79, 1.17).

Conclusions: Studies examining the relation between ALA and prostate cancer have produced inconsistent findings.

Among the 6 nonintubated patients, all were given steroid treatme

Among the 6 nonintubated patients, all were given steroid treatment with or without an immunosuppressant drug, and all survived. In our reported case, plasma exchange appeared to help resolve the pulmonary hemorrhage PARP signaling and crescentic glomerulonephritis that were associated with HSP.

Conclusions: For pediatric HSP patients with pulmonary hemorrhage but no respiratory failure, methylprednisolone pulse or nonpulse therapy could be the first-line therapy. In the presence of

respiratory failure, cyclophosphamide pulse therapy is suggested. Plasma exchange may be considered for treatment of pulmonary renal syndrome or refractory pulmonary hemorrhage. (C) 2011 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:305-312″
“Pituitary aspergillosis AC220 is a very rare disease, documented in only 12 cases. Although seen in both immunocompetent and immunocompromised patients, serious invasive sequelae, such as meningoencephalitis and death, have been noted in immunocompromised patients. Immunocompromised patients are susceptible and require complex multidisciplinary care to contain the spread of infection and maximize outcomes. This is the first case report, to our knowledge, of pituitary aspergillosis in the setting of an organ transplant. A 68-year-old woman presented with cephalgia, left temporal hemianopsia, and ptosis. Non-contrast

magnetic resonance imaging of the head revealed a sellar mass, which was believed to be a benign pituitary adenoma. She underwent trans-sphenoidal resection, and subsequent histopathologic examination

showed aspergillosis. Flavopiridol price She was subsequently started on voriconazole. On postoperative day 3, she developed a left anterior cerebral artery ischemic stroke, likely from Aspergillus angioinvasion and occlusion. Her mental status declined further and she died when care was withdrawn.”
“This study investigated the immunoadjuvant effects of three types of bacterial genomic DNA and CpG oligonucleotides (CpG ODN) on the avian influenza virus (AIV) subtype H5N1 inactivated oil emulsion vaccine under two immunization strategies. The genomic DNA extracted from Escherichia coli O(2), Staphylococcus aureus, Streptococcus faecalis FQ68, and synthetic CpG ODN were used as adjuvants, and their effects on the AIV oil emulsion vaccine were examined in chickens. The results indicated that when administered separately from the vaccine, adjuvants induced lower haemagglutination inhibition (HI) titres and serum IgG titres but resulted in higher concentrations of IFN-gamma and IL-10. In contrast, when combined with the oil emulsion vaccine prior to inoculation, CpG ODN induced higher HI, IgG titres and IFN-gamma concentration but resulted in lower IL-10 concentration.


“Quality Evaluation of Manipulated and Industrialized Simv


“Quality Evaluation of Manipulated and Industrialized Simvastatin Formulations. Chronic drug treatments with simvastatin may be expensive to patients, favoring the use of manipulated pharmaceutical forms as an alternative, thus, quality must be ensured. Thus,

the study addressed the quality of the reference (R), generics (G1 and G2) and similars (S1 and S2) industrialized tablets, and four pharmacy click here manipulated capsules (M1-4) of simvastatin by evaluating the average weight, dissolution profile, content of active substance and uniformity of dosage unity. All parameters tested were in accordance with the Pharmacopeias for all dosage forms, except for the uniformity of dosage unity of M4, which presented less than 75% of the expected simvastatin content with relative standard deviation of 10.30 % for three samples. Furthermore, the amount of released sinvastatin was 63.74% within 30 minutes, which is below the recommendation of the American Pharmacopeia. Thus, it was shown the importance to ensure the quality of commercially available medicines avoiding therapeutic inefficacy.”
“Here, we describe a fast, easy-to-use, and sensitive NU7026 concentration method to profile in-depth structural micro-heterogeneity, including intricate N-glycosylation profiles, of monoclonal antibodies at the native intact protein level by means of mass spectrometry using a recently introduced

modified Orbitrap Exactive Plus mass spectrometer. We demonstrate the versatility selleck of our method

to probe structural micro-heterogeneity by describing the analysis of three types of molecules: (1) a non-covalently bound IgG4 hinge deleted full-antibody in equilibrium with its half-antibody, (2) IgG4 mutants exhibiting highly complex glycosylation profiles, and (3) antibody-drug conjugates. Using the modified instrument, we obtain baseline separation and accurate mass determination of all different proteoforms that may be induced, for example, by glycosylation, drug loading and partial peptide backbone-truncation. We show that our method can handle highly complex glycosylation profiles, identifying more than 20 different glycoforms per monoclonal antibody preparation and more than 30 proteoforms on a single highly purified antibody. In analyzing antibody-drug conjugates, our method also easily identifies and quantifies more than 15 structurally different proteoforms that may result from the collective differences in drug loading and glycosylation. The method presented here will aid in the comprehensive analytical and functional characterization of protein micro-heterogeneity, which is crucial for successful development and manufacturing of therapeutic antibodies”
“P75 nerve growth factor receptor (p75 NGF-R) is a low-affinity receptor expressed on the surface of neural crest-derived cells and in a variety of neural tumors. Strong p75 NGF-R expression has been found in spindle cell melanoma (SCM).

Furthermore it was possible to prioritize crops in terms of the s

Furthermore it was possible to prioritize crops in terms of the specific pesticide applied to the crop (by expressing the WHP as a ratio of the total amount of pesticide applied to the crop to the total use of all pesticides applied in the country). This allows for an improved spatial assessment of the use of priority pesticides. The methodology applied here provides a first level of basic, important information that can be used to develop monitoring programmes, identify priority areas for management interventions Nirogacestat concentration and to investigate optimal mitigation strategies. (C) 2013 Elsevier Ltd. All

rights reserved,”
“This case series’ purpose is to review a referral center’s experience with complications from mesh kits. A chart review of 12 patients who presented with complications associated with transvaginal mesh kit procedures was performed. All patients underwent complete surgical removal of the mesh to treat mesh exposure, pain, or vaginal bleeding/discharge

followed by an anterior or posterior repair. The mean follow-up time after surgery was 3.4 months. Eight of 12 patients had mesh that had formed a fibrotic band. Six of 12 patients had complete resolution of pain. Of the nine patients with mesh exposure, all required significant resection of the vaginal wall. No further mesh exposure occurred. The use of transvaginal mesh kits may cause previously undescribed complications such as pelvic/vaginal pain or large extrusions requiring EPZ004777 complete PI3K inhibitor removal. Removal of all mesh except the arms may cure or significantly improve these problems.”
“Brain metastases represent a common and devastating complication of cancer. With advances in surgery, radiology, and medical and radiation oncology, the number of treatment options have greatly increased. In addition, the prognosis for patients can vary widely depending on factors such as the number of lesions, extent of extracranial disease, age, and functional status. Recently,

the possible impairment of whole brain radiation therapy on neurocognitive function has been a subject of concern and debate. Thus, the use of whole brain radiation therapy in conjunction with other treatment modalities should be optimized to ensure the best outcomes with regard to tumor control and functional status. As a result, patient management has become controversial, with strong opinions often dictating “”optimal”" therapy. This review of the management of brain metastases focuses on whole brain radiation therapy, surgery, stereotactic radiosurgery, radiation sensitizers, and clinical trials.”
“Background: For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion:following arthrodesis procedures, or persistent symptoms.