Effect of the administration route on the hemostatic efficacy of tranexamic acid in patients undergoing short-segment posterior lumbar interbody fusion: a systematic review and meta-analysis.

OBJECTIVE: Tranexamic acid (TXA) is an FDA-approved antifibrinolytic that is seeing increased popularity in spine surgery owing to its ability to reduce intraoperative blood loss (IOBL) and allogeneic transfusion requirements. The present study aimed to summarize the current literature on these formulations in the context of short-segment instrumented lumbar fusion including ≥ 1-level posterior lumbar interbody fusion (PLIF). METHODS: The PubMed, Cochrane, and Web of Science databases were queried for all full-text English studies evaluating the use of topical TXA (tTXA), systemic TXA (sTXA), or combined tTXA+sTXA in patients undergoing PLIF. The primary endpoints of interest were operative time, IOBL, and total blood loss (TBL); secondary endpoints included venous thromboembolic complication occurrence, and allogeneic and autologous transfusion requirements. Outcomes were compared using random effects. Comparisons were made between the following treatment groups: sTXA, tTXA, and sTXA+tTXA. Given that sTXA is arguably the standard of care in the literature (i.e., the most common route of administration that to this point has been studied the most), the authors compared sTXA versus tTXA and sTXA versus sTXA+tTXA. Study heterogeneity was assessed with the I2 test, and grouped analysis using the Hedge's g test was performed for measurement of effect size. RESULTS: Forty-five articles were identified, of which 17 met the criteria for inclusion with an aggregate of 1008 patients. TXA regimens included sTXA only, tTXA only, and various combinations of sTXA and tTXA. There were no significant differences in operative time, TBL, or postoperative drainage between the sTXA and tTXA groups or between the sTXA and sTXA+tTXA groups. CONCLUSIONS: The present meta-analysis suggested clinical equipoise between isolated sTXA, isolated tTXA, and combinatorial tTXA+sTXA formulations as hemostatic adjuvants/neoadjuvants in short-segment fusion including ≥ 1-level PLIF. Given the theoretically lower venous thromboembolism risk associated with tTXA, additional investigations using large cohorts comparing these two formulations within the posterior fusion population are merited. Although TXA has been shown to be effective, there are insufficient data to support topical or systemic administration as superior within the open PLIF population.

Physician marriage survey reveals sex and specialty differences in marital satisfaction factors.

Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. "Other" specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse's work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex's impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Patient-specific rods in adult spinal deformity: a systematic review.

PURPOSE: The purpose of this review was to evaluate the effectiveness of patient-specific rods for adult spinal deformity. METHODS: A systematic review of the literature was performed through an electronic search of the PubMed, Scopus, and Web of Science databases. Human studies between 2012 and 2023 were included. Sample size, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), operation time, blood loss, follow-up duration, and complications were recorded for each study when available. RESULTS: Seven studies with a total of 304 adult spinal deformity patients of various etiologies were included. All studies reported SVA, and PT; two studies did not report PI-LL. Four studies reported planned radiographic outcomes. Two found a significant association between preoperative plan and postoperative outcome in all three outcomes. One found a significant association for PI-LL alone. The fourth found no significant associations. SVA improved in six of seven studies, PI-LL improved in all five, and three of seven studies found improved postoperative PT. Significance of these results varied greatly by study. CONCLUSION: Preliminary evidence suggests potential benefits of PSRs in achieving optimal spino-pelvic parameters in ASD surgery. Nevertheless, conclusions regarding the superiority of PSRs over traditional rods must be judiciously drawn, given the heterogeneity of patients and study methodologies, potential confounding variables, and the absence of robust randomized controlled trials. Future investigations should concentrate on enhancing preoperative planning, standardizing surgical methodologies, isolating specific patient subgroups, and head-to-head comparisons with traditional rods to fully elucidate the impact of PSRs in ASD surgery.

Deep Brain Stimulation as an Emerging Therapy for Cognitive Decline in Alzheimer Disease: Systematic Review of Evidence and Current Targets.

OBJECTIVE: With no cure for Alzheimer disease (AD), current efforts involve therapeutics that prevent further cognitive impairment. Deep brain stimulation (DBS) has been studied for its potential to mitigate AD symptoms. This systematic review investigates the efficacy of current and previous targets for their ability to slow cognitive decline in treating AD. METHODS: A systematic review of the literature was performed through a search of the PubMed, Scopus, and Web of Science databases. Human studies between 1994 and 2023 were included. Sample size, cognitive outcomes, and complications were recorded for each study. RESULTS: Fourteen human studies were included: 7 studies with 6 distinct cohorts (n = 56) targeted the fornix, 6 studies with 3 distinct cohorts (n = 17) targeted the nucleus basalis of Meynert (NBM), and 1 study (n = 3) investigated DBS of the ventral striatum (VS). The Alzheimer's Disease Assessment Scale-Cognitive Subscale, Mini-Mental State Examination, and Clinical Dementia Rating Scale Sum of Boxes were used as the primary outcomes. In 5 of 6 cohorts where DBS targeted the fornix, cognitive decline was slowed based on the Alzheimer's Disease Assessment Scale-Cognitive Subscale or Mini-Mental State Examination scores. In 2 of 3 NBM cohorts, a similar reduction was reported. When DBS targeted the VS, the patients' Clinical Dementia Rating Scale Sum of Boxes scores indicated a slowed decline. CONCLUSIONS: This review summarizes current evidence and addresses variability in study designs regarding the therapeutic benefit of DBS of the fornix, NBM, and VS. Because of varying study parameters, varying outcome measures, varying study durations, and limited cohort sizes, definitive conclusions regarding the utility of DBS for AD cannot be made. Further investigation is needed to determine the safety and efficacy of DBS for AD.

Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: "(laparoscopic OR endoscopic) AND (anterior AND lumbar)." Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio's "metafor" package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

A globally fragmented and mobile lithosphere on Venus.

Venus has been thought to possess a globally continuous lithosphere, in contrast to the mosaic of mobile tectonic plates that characterizes Earth. However, the Venus surface has been extensively deformed, and convection of the underlying mantle, possibly acting in concert with a low-strength lower crust, has been suggested as a source of some surface horizontal strains. The extent of surface mobility on Venus driven by mantle convection, however, and the style and scale of its tectonic expression have been unclear. We report a globally distributed set of crustal blocks in the Venus lowlands that show evidence for having rotated and/or moved laterally relative to one another, akin to jostling pack ice. At least some of this deformation on Venus postdates the emplacement of the locally youngest plains materials. Lithospheric stresses calculated from interior viscous flow models consistent with long-wavelength gravity and topography are sufficient to drive brittle failure in the upper Venus crust in all areas where these blocks are present, confirming that interior convective motion can provide a mechanism for driving deformation at the surface. The limited but widespread lithospheric mobility of Venus, in marked contrast to the tectonic styles indicative of a static lithosphere on Mercury, the Moon, and Mars, may offer parallels to interior-surface coupling on the early Earth, when global heat flux was substantially higher, and the lithosphere generally thinner, than today.

Geodetic evidence that Mercury has a solid inner core.

Geodetic analysis of radio tracking measurements of the MESSENGER spacecraft while in orbit about Mercury has yielded new estimates for the planet's gravity field, tidal Love number, and pole coordinates. The derived right ascension (α = 281.0082° ± 0.0009°; all uncertainties are 3 standard deviations) and declination (δ =61.4164° ± 0.0003°) of the spin pole place Mercury in the Cassini state. Confirmation of the equilibrium state with an estimated mean (whole-planet) obliquity ϵ of 1.968 ± 0.027 arcmin enables the confident determination of the planet's normalized polar moment of inertia (0.333 ± 0.005), which indicates a high degree of internal differentiation. Internal structure models generated by a Markov-Chain Monte Carlo process and consistent with the geodetic constraints possess a solid inner core with a radius (r ic ) between 0.3 and 0.7 that of the outer core (r oc ).

Intense energetic electron flux enhancements in Mercury's magnetosphere: An integrated view with high-resolution observations from MESSENGER.

The MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) mission to Mercury has provided a wealth of new data about energetic particle phenomena. With observations from MESSENGER's Energetic Particle Spectrometer, as well as data arising from energetic electrons recorded by the X-Ray Spectrometer and Gamma-Ray and Neutron Spectrometer (GRNS) instruments, recent work greatly extends our record of the acceleration, transport, and loss of energetic electrons at Mercury. The combined data sets include measurements from a few keV up to several hundred keV in electron kinetic energy and have permitted relatively good spatial and temporal resolution for many events. We focus here on the detailed nature of energetic electron bursts measured by the GRNS system, and we place these events in the context of solar wind and magnetospheric forcing at Mercury. Our examination of data at high temporal resolution (10 ms) during the period March 2013 through October 2014 supports strongly the view that energetic electrons are accelerated in the near-tail region of Mercury's magnetosphere and are subsequently "injected" onto closed magnetic field lines on the planetary nightside. The electrons populate the plasma sheet and drift rapidly eastward toward the dawn and prenoon sectors, at times executing multiple complete drifts around the planet to form "quasi-trapped" populations.

Gravity field of the Orientale basin from the Gravity Recovery and Interior Laboratory Mission.

The Orientale basin is the youngest and best-preserved major impact structure on the Moon. We used the Gravity Recovery and Interior Laboratory (GRAIL) spacecraft to investigate the gravitational field of Orientale at 3- to 5-kilometer (km) horizontal resolution. A volume of at least (3.4 ± 0.2) × 106 km3 of crustal material was removed and redistributed during basin formation. There is no preserved evidence of the transient crater that would reveal the basin's maximum volume, but its diameter may now be inferred to be between 320 and 460 km. The gravity field resolves distinctive structures of Orientale's three rings and suggests the presence of faults associated with the outer two that penetrate to the mantle. The crustal structure of Orientale provides constraints on the formation of multiring basins.

Imaging Mercury's Polar Deposits during MESSENGER's Low-altitude Campaign.

Images obtained during MESSENGER's low-altitude campaign in the final year of the mission provide the highest-spatial-resolution views of Mercury's polar deposits. Images for distinct areas of permanent shadow within 35 north polar craters were successfully captured during the campaign. All of these regions of permanent shadow were found to have low-reflectance surfaces with well-defined boundaries. Additionally, brightness variations across the deposits correlate with variations in the biannual maximum surface temperature across the permanently shadowed regions, supporting the conclusion that multiple volatile organic compounds are contained in Mercury's polar deposits, in addition to water ice. A recent large impact event or ongoing bombardment by micrometeoroids could deliver water as well as many volatile organic compounds to Mercury. Either scenario is consistent with the distinctive reflectance properties and well-defined boundaries of Mercury's polar deposits and the presence of volatiles in all available cold traps.

Comparison of areas in shadow from imaging and altimetry in the north polar region of Mercury and implications for polar ice deposits.

Earth-based radar observations and results from the MESSENGER mission have provided strong evidence that permanently shadowed regions near Mercury's poles host deposits of water ice. MESSENGER's complete orbital image and topographic datasets enable Mercury's surface to be observed and modeled under an extensive range of illumination conditions. The shadowed regions of Mercury's north polar region from 65°N to 90°N were mapped by analyzing Mercury Dual Imaging System (MDIS) images and by modeling illumination with Mercury Laser Altimeter (MLA) topographic data. The two independent methods produced strong agreement in identifying shadowed areas. All large radar-bright deposits, those hosted within impact craters ≥6 km in diameter, collocate with regions of shadow identified by both methods. However, only ∼46% of the persistently shadowed areas determined from images and ∼43% of the permanently shadowed areas derived from altimetry host radar-bright materials. Some sizable regions of shadow that do not host radar-bright deposits experience thermal conditions similar to those that do. The shadowed craters that lack radar-bright materials show a relation with longitude that is not related to the thermal environment, suggesting that the Earth-based radar observations of these locations may have been limited by viewing geometry, but it is also possible that water ice in these locations is insulated by anomalously thick lag deposits or that these shadowed regions do not host water ice.

Lunar impact basins revealed by Gravity Recovery and Interior Laboratory measurements.

Observations from the Gravity Recovery and Interior Laboratory (GRAIL) mission indicate a marked change in the gravitational signature of lunar impact structures at the morphological transition, with increasing diameter, from complex craters to peak-ring basins. At crater diameters larger than ~200 km, a central positive Bouguer anomaly is seen within the innermost peak ring, and an annular negative Bouguer anomaly extends outward from this ring to the outer topographic rim crest. These observations demonstrate that basin-forming impacts remove crustal materials from within the peak ring and thicken the crust between the peak ring and the outer rim crest. A correlation between the diameter of the central Bouguer gravity high and the outer topographic ring diameter for well-preserved basins enables the identification and characterization of basins for which topographic signatures have been obscured by superposed cratering and volcanism. The GRAIL inventory of lunar basins improves upon earlier lists that differed in their totals by more than a factor of 2. The size-frequency distributions of basins on the nearside and farside hemispheres of the Moon differ substantially; the nearside hosts more basins larger than 350 km in diameter, whereas the farside has more smaller basins. Hemispherical differences in target properties, including temperature and porosity, are likely to have contributed to these different distributions. Better understanding of the factors that control basin size will help to constrain models of the original impactor population.

Planetary science. Low-altitude magnetic field measurements by MESSENGER reveal Mercury's ancient crustal field.

Magnetized rocks can record the history of the magnetic field of a planet, a key constraint for understanding its evolution. From orbital vector magnetic field measurements of Mercury taken by the MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) spacecraft at altitudes below 150 kilometers, we have detected remanent magnetization in Mercury's crust. We infer a lower bound on the average age of magnetization of 3.7 to 3.9 billion years. Our findings indicate that a global magnetic field driven by dynamo processes in the fluid outer core operated early in Mercury's history. Ancient field strengths that range from those similar to Mercury's present dipole field to Earth-like values are consistent with the magnetic field observations and with the low iron content of Mercury's crust inferred from MESSENGER elemental composition data.

The 4 June 2011 neutron event at Mercury: A defense of the solar origin hypothesis.

We address claim that neutrons from a 4 June 2011 event at Mercury are nonsolarThe claim is based on an erroneous assumption about instrument singles countsThe best interpretation of the neutron event is that the neutrons have a solar origin.

Modular model for Mercury's magnetospheric magnetic field confined within the average observed magnetopause.

Accurate knowledge of Mercury's magnetospheric magnetic field is required to understand the sources of the planet's internal field. We present the first model of Mercury's magnetospheric magnetic field confined within a magnetopause shape derived from Magnetometer observations by the MErcury Surface, Space ENvironment, GEochemistry, and Ranging spacecraft. The field of internal origin is approximated by a dipole of magnitude 190 nT RM3, where RM is Mercury's radius, offset northward by 479 km along the spin axis. External field sources include currents flowing on the magnetopause boundary and in the cross-tail current sheet. The cross-tail current is described by a disk-shaped current near the planet and a sheet current at larger (≳ 5 RM ) antisunward distances. The tail currents are constrained by minimizing the root-mean-square (RMS) residual between the model and the magnetic field observed within the magnetosphere. The magnetopause current contributions are derived by shielding the field of each module external to the magnetopause by minimizing the RMS normal component of the magnetic field at the magnetopause. The new model yields improvements over the previously developed paraboloid model in regions that are close to the magnetopause and the nightside magnetic equatorial plane. Magnetic field residuals remain that are distributed systematically over large areas and vary monotonically with magnetic activity. Further advances in empirical descriptions of Mercury's magnetospheric external field will need to account for the dependence of the tail and magnetopause currents on magnetic activity and additional sources within the magnetosphere associated with Birkeland currents and plasma distributions near the dayside magnetopause.

Structure and evolution of the lunar Procellarum region as revealed by GRAIL gravity data.

The Procellarum region is a broad area on the nearside of the Moon that is characterized by low elevations, thin crust, and high surface concentrations of the heat-producing elements uranium, thorium, and potassium. The region has been interpreted as an ancient impact basin approximately 3,200 kilometres in diameter, although supporting evidence at the surface would have been largely obscured as a result of the great antiquity and poor preservation of any diagnostic features. Here we use data from the Gravity Recovery and Interior Laboratory (GRAIL) mission to examine the subsurface structure of Procellarum. The Bouguer gravity anomalies and gravity gradients reveal a pattern of narrow linear anomalies that border Procellarum and are interpreted to be the frozen remnants of lava-filled rifts and the underlying feeder dykes that served as the magma plumbing system for much of the nearside mare volcanism. The discontinuous surface structures that were earlier interpreted as remnants of an impact basin rim are shown in GRAIL data to be a part of this continuous set of border structures in a quasi-rectangular pattern with angular intersections, contrary to the expected circular or elliptical shape of an impact basin. The spatial pattern of magmatic-tectonic structures bounding Procellarum is consistent with their formation in response to thermal stresses produced by the differential cooling of the province relative to its surroundings, coupled with magmatic activity driven by the greater-than-average heat flux in the region.

Asymmetric distribution of lunar impact basins caused by variations in target properties.

Maps of crustal thickness derived from NASA's Gravity Recovery and Interior Laboratory (GRAIL) mission revealed more large impact basins on the nearside hemisphere of the Moon than on its farside. The enrichment in heat-producing elements and prolonged volcanic activity on the lunar nearside hemisphere indicate that the temperature of the nearside crust and upper mantle was hotter than that of the farside at the time of basin formation. Using the iSALE-2D hydrocode to model impact basin formation, we found that impacts on the hotter nearside would have formed basins with up to twice the diameter of similar impacts on the cooler farside hemisphere. The size distribution of lunar impact basins is thus not representative of the earliest inner solar system impact bombardment.

The origin of lunar mascon basins.

High-resolution gravity data from the Gravity Recovery and Interior Laboratory spacecraft have clarified the origin of lunar mass concentrations (mascons). Free-air gravity anomalies over lunar impact basins display bull's-eye patterns consisting of a central positive (mascon) anomaly, a surrounding negative collar, and a positive outer annulus. We show that this pattern results from impact basin excavation and collapse followed by isostatic adjustment and cooling and contraction of a voluminous melt pool. We used a hydrocode to simulate the impact and a self-consistent finite-element model to simulate the subsequent viscoelastic relaxation and cooling. The primary parameters controlling the modeled gravity signatures of mascon basins are the impactor energy, the lunar thermal gradient at the time of impact, the crustal thickness, and the extent of volcanic fill.

Thermal stability of volatiles in the north polar region of Mercury.

Thermal models for the north polar region of Mercury, calculated from topographic measurements made by the MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) spacecraft, show that the spatial distribution of regions of high radar backscatter is well matched by the predicted distribution of thermally stable water ice. MESSENGER measurements of near-infrared surface reflectance indicate bright surfaces in the coldest areas where water ice is predicted to be stable at the surface, and dark surfaces within and surrounding warmer areas where water ice is predicted to be stable only in the near subsurface. We propose that the dark surface layer is a sublimation lag deposit that may be rich in impact-derived organic material.

Evidence for water ice near Mercury's north pole from MESSENGER Neutron Spectrometer measurements.

Measurements by the Neutron Spectrometer on the MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) spacecraft show decreases in the flux of epithermal and fast neutrons from Mercury's north polar region that are consistent with the presence of water ice in permanently shadowed regions. The neutron data indicate that Mercury's radar-bright polar deposits contain, on average, a hydrogen-rich layer more than tens of centimeters thick beneath a surficial layer 10 to 30 cm thick that is less rich in hydrogen. Combined neutron and radar data are best matched if the buried layer consists of nearly pure water ice. The upper layer contains less than 25 weight % water-equivalent hydrogen. The total mass of water at Mercury's poles is inferred to be 2 × 10(16) to 10(18) grams and is consistent with delivery by comets or volatile-rich asteroids.