Microglial Calcium Waves During the Hyperacute Phase of Ischemic Stroke.

BACKGROUND AND PURPOSE: Ischemic injury triggers multiple pathological responses in the brain tissue, including spreading depolarizations across the cerebral cortex (cortical spreading depolarizations [CSD]). Microglia have been recently shown to play a significant role in the propagation of CSD. However, the intracellular responses of myeloid cells during ischemic stroke have not been investigated. METHODS: We have studied intracellular calcium activity in cortical microglia in the stroke model of the middle cerebral artery occlusion, using the murine Polr2a-based and Cre-dependent GCaMP5 and tdTomato reporter (PC::G5-tdT). High-speed 2-photon microscopy through cranial windows was employed to record signals from genetically encoded indicators of calcium. Inflammatory stimuli and pharmacological inhibition were used to modulate microglial calcium responses in the somatosensory cortex. RESULTS: In vivo imaging revealed periodical calcium activity in microglia during the hyperacute phase of ischemic stroke. This activity was more frequent during the first 6 hours after occlusion, but the amplitudes of calcium transients became larger at later time points. Consistent with CSD nature of these events, we reproducibly triggered comparable calcium transients with microinjections of potassium chloride (KCl) into adjacent cortical areas. Furthermore, lipopolysaccharide-induced peripheral inflammation, mimicking sterile inflammation during ischemic stroke, produced significantly greater microglial calcium transients during CSD. Finally, in vivo pharmacological analysis with CRAC (calcium release-activated channel) inhibitor CM-EX-137 demonstrated that CSD-associated microglial calcium transients after KCl microinjections are mediated at least in part by the CRAC mechanism. CONCLUSIONS: Our findings demonstrate that microglia participate in ischemic brain injury via previously undetected mechanisms, which may provide new avenues for therapeutic interventions.

Halo vest immobilization - an institutional review of safety in acute cervical spine injury from 2013 to 2017.

Objective: Halo vest immobilization (HVI) remains an important treatment option for occipital-cervical injuries. It provides the surgeon with a safe and effective medical treatment options for challenging patients. The aim of this study was to evaluate the safety of HVI in these patients.Methods: This retrospective study identified adult patients treated with Halo vests immobilization (HVI) for acute cervical spine injury at our metropolitan level 1 trauma center from 2013 to 2017. This heterogenous cohort included 67 consecutive patients with acute cervical spine injury secondary to trauma or iatrogenic injury following surgical intervention with a mean age of 52 and a mean injury severity score (ISS) of 18. Forty-six percent of patients were treated with HVI as an adjunct therapy to surgical fixation (both short- and long-term immobilization), 45% of patients were treated with HVI as a primary medical treatment, and 9% of patients were treated with HVI instead of failed conservative medical treatment, such as cervical braces. Results: Pneumonia during the initial hospital stay was the most common complication (25%), followed by the correction of loose pins (22%) and pin site infections (18%). Overall, 51% of patients experienced at least one of these complications. There were significant associations between low initial GCS scores and the development of pneumonia (p < 0.001), high ISS scores and the development of pneumonia (p < 0.01), and duration of HVI and the occurrence of loose pins (p < 0.05). Four patients initially treated with HVI as primary medical treatment was converted to surgical treatment due to an intolerance of HVI or non-healing injuries.Conclusions:The HVI is a safe and effective treatment modality in a subset of patients with complex cervical junction and subaxial cervical spine pathology.

Meeting the Canadian strength training recommendations: Implications for the cardiometabolic, psychological and musculoskeletal health of nurses.

AIM: To examine the proportion of nurses meeting the strength training recommendation and its associated cardiometabolic, psychological and musculoskeletal benefits. BACKGROUND: Strength training targets poor physical and mental health often reported by nurses; however, it is unknown whether nurses are meeting the strength training guidelines. METHODS: Nurses from 14 hospitals completed a 7-day physical activity log. Nurses were considered meeting the recommendation if they reported ≥2 strength training sessions per week. Cardiometabolic, psychological and musculoskeletal health, and levels of motivation were compared between nurses meeting and not meeting the guidelines. RESULTS: Of the 307 nurses (94% female; age: 43 ± 12 years), 29 (9.4%) met the strength training recommendation. These nurses had lower body mass index (24.1 ± 2.6 vs. 27.3 ± 5.5 kg/m2 , p = .007) and waist circumference (73.8 ± 8.3 vs. 81.1 ± 11.7 cm, p = .017); and higher vigour-activity (18.0 ± 5.8 vs. 15.6 ± 6.5 points, p = .046) and self-determined motivation (relative autonomic index: 54.9 ± 20.3 vs. 45.0 ± 23.8 points, p = .042) scores than nurses not meeting the recommendation. CONCLUSION: While the proportion of nurses meeting the strength training recommendation was small (<10%), they had lower body mass and waist circumference, and higher vigour-activity. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to increase the strength training engagement may improve the cardiometabolic health and increase vigour among nurses.

Device-measured physical activity, sedentary behaviour and cardiometabolic health and fitness across occupational groups: a systematic review and meta-analysis.

BACKGROUND: With approximately 8 hours of one's waking day spent at work, occupational tasks and environments are important influencers on an individual's physical activity (PA) and sedentary behaviours. Little research has compared device-measured physical activity, sedentary behaviour and cardiometabolic outcomes between occupational groups. OBJECTIVE: To compare device-measured movement (sedentary time [ST], light intensity physical activity [LPA], moderate-to-vigorous intensity physical activity [MVPA], and steps) across occupations. The secondary objective was to examine whether cardiometabolic and fitness outcomes differed by occupation. METHODS: Five bibliographic databases were searched to identify all studies which included working age, employed adults from high-income countries, and reported on device-measured movement within occupations. Risk of bias within and across studies was assessed. Results were synthesized using meta-analyses and narrative syntheses. RESULTS: The review includes 132 unique studies with data from 15,619 participants. Working adults spent ~ 60% of their working and waking time engaged in sedentary behaviour; a very small proportion (~ 4%) of the day included MVPA. On average, workers accumulated 8124 steps/day. Office and call center workers' steps/day were among the lowest, while those of postal delivery workers were highest. Office workers had the greatest ST and the lowest time in LPA both at work and during wakeful time. However, office workers had the greatest minutes sent in MVPA during wakeful hours. Laborers had the lowest ST and spent a significantly greater proportion of their work time in LPA and MVPA. Healthcare and protective services workers had higher levels of LPA at work compared to other occupations. Workers in driving-based occupations tended to have a higher body mass index and blood pressure. CONCLUSION: This review identifies that occupational and wakeful time PA and ST differed between occupations. Future studies are needed to assess whether patterns differ by age and sex, describe leisure-time movement and movement patterns, and the relationship with cardiometabolic health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017070448 .

KATP channel deficiency in mouse FDB causes an impairment of energy metabolism during fatigue.

The skeletal muscle ATP-sensitive K+ (KATP) channel is crucial in preventing fiber damage and contractile dysfunction, possibly by preventing damaging ATP depletion. The objective of this study was to investigate changes in energy metabolism during fatigue in wild-type and inwardly rectifying K+ channel (Kir6.2)-deficient (Kir6.2-/-) flexor digitorum brevis (FDB), a muscle that lacks functional KATP channels. Fatigue was elicited with one tetanic contraction every second. Decreases in ATP and total adenylate levels were significantly greater in wild-type than Kir6.2-/- FDB during the last 2 min of the fatigue period. Glycogen depletion was greater in Kir6.2-/- FDB for the first 60 s, but not by the end of the fatigue period, while there was no difference in glucose uptake. The total amount of glucosyl units entering glycolysis was the same in wild-type and Kir6.2-/- FDB. During the first 60 s, Kir6.2-/- FDB generated less lactate and more CO2; in the last 120 s, Kir6.2-/- FDB stopped generating CO2 and produced more lactate. The ATP generated during fatigue from phosphocreatine, glycolysis (lactate), and oxidative phosphorylation (CO2) was 3.3-fold greater in Kir6.2-/- than wild-type FDB. Because ATP and total adenylate were significantly less in Kir6.2-/- FDB, it is suggested that Kir6.2-/- FDB has a greater energy deficit, despite a greater ATP production, which is further supported by greater glucose uptake and lactate and CO2 production in Kir6.2-/- FDB during the recovery period. It is thus concluded that a lack of functional KATP channels results in an impairment of energy metabolism.

Muscle uncoupling protein 3 overexpression mimics endurance training and reduces circulating biomarkers of incomplete ß-oxidation.

Exercise substantially improves metabolic health, making the elicited mechanisms important targets for novel therapeutic strategies. Uncoupling protein 3 (UCP3) is a mitochondrial inner membrane protein highly selectively expressed in skeletal muscle. Here we report that moderate UCP3 overexpression (roughly 3-fold) in muscles of UCP3 transgenic (UCP3 Tg) mice acts as an exercise mimetic in many ways. UCP3 overexpression increased spontaneous activity (∼40%) and energy expenditure (∼5-10%) and decreased oxidative stress (∼15-20%), similar to exercise training in wild-type (WT) mice. The increase in complete fatty acid oxidation (FAO; ∼30% for WT and ∼70% for UCP3 Tg) and energy expenditure (∼8% for WT and 15% for UCP3 Tg) in response to endurance training was higher in UCP3 Tg than in WT mice, showing an additive effect of UCP3 and endurance training on these two parameters. Moreover, increases in circulating short-chain acylcarnitines in response to acute exercise in untrained WT mice were absent with training or in UCP3 Tg mice. UCP3 overexpression had the same effect as training in decreasing long-chain acylcarnitines. Outcomes coincided with a reduction in muscle carnitine acetyltransferase activity that catalyzes the formation of acylcarnitines. Overall, results are consistent with the conclusions that circulating acylcarnitines could be used as a marker of incomplete muscle FAO and that UCP3 is a potential target for the treatment of prevalent metabolic diseases in which muscle FAO is affected.

Congenital disorders of glycosylation: new defects and still counting.

Almost 50 inborn errors of metabolism have been described due to congenital defects in N-linked glycosylation. These phenotypically diverse disorders typically present as clinical syndromes, affecting multiple systems including the central nervous system, muscle function, transport, regulation, immunity, endocrine system, and coagulation. An increasing number of disorders have been discovered using novel techniques that combine glycobiology with next-generation sequencing or use tandem mass spectrometry in combination with molecular gene-hunting techniques. The number of "classic" congenital disorders of glycosylation (CDGs) due to N-linked glycosylation defects is still rising. Eight novel CDGs affecting N-linked glycans were discovered in 2013 alone. Newly discovered genes teach us about the significance of glycosylation in cell-cell interaction, signaling, organ development, cell survival, and mosaicism, in addition to the consequences of abnormal glycosylation for muscle function. We have learned how important glycosylation is in posttranslational modification and how glycosylation defects can imitate recognizable, previously described phenotypes. In many CDG subtypes, patients unexpectedly presented with long-term survival, whereas some others presented with nonsyndromic intellectual disability. In this review, recently discovered N-linked CDGs are described, with a focus on clinical presentations and therapeutic ideas. A diagnostic approach in unsolved N-linked CDG cases with abnormal transferrin screening results is also suggested.

Outcomes After Minimally Invasive Sacroiliac Joint Fusion: A Scoping Review.

BACKGROUND: Sacroiliac joint (SIJ) dysfunction is a significant contributor to lower back pain. Although open surgical treatment for persistent pain has long been the standard, it is associated with significant surgical morbidity, high complication rates, and variable patient satisfaction. Minimally invasive SIJ fusion (MISJF) is a promising and effective approach. This scoping review was carried out to map the available evidence on outcomes after MISJF. METHODS: This review was conducted in accordance with the PRISMA guidelines. Inclusion criteria were all full-text articles reporting on functional, clinical, and quality-of-life outcomes after MISJF. Exclusion criteria consisted of studies including patients with traumatic sacroiliac injuries or congenital spinal abnormalities, and procedures involving multiple spinal fusions or an open approach to SIJ fusion. RESULTS: A total of 1305 studies were identified across 6 databases. After duplicate removal and further screening, 33 independent studies were included in our review. Regarding pain management, 21 studies reported visual analog scale scores, and all showed significant (>50%) reductions in pain at multiple time points postoperatively. Six studies reported on quality-of-life outcomes and showed significant increases, especially compared with nonsurgical treatment. CONCLUSIONS: This study highlights the existing literature regarding outcomes after MISJF. MISJF provides favorable responses in quality-of-life metrics, pain scores, and overall postoperative outcomes in select patients. Although outcomes have been widely studied, more studies, especially prospectively designed and those without industry influence, should be performed to elucidate the optimal management of patients with intractable SIJ pain.

Microglia and Post-Subarachnoid Hemorrhage Vasospasm: Review of Emerging Mechanisms and Treatment Modalities.

Vasospasm is a potentially severe complication of subarachnoid hemorrhage. It can be attributed to neuroinflammation and the robust recruitment of microglia. Emerging evidence has linked this sustained inflammation to the development of delayed cerebral ischemia following subarachnoid hemorrhage. In this focused review, we provide an overview of the historical understanding of vasospasm. We then delve into the role of neuroinflammation and the activation of microglia. These activated microglia releases a host of inflammatory cytokines contributing to an influx of peripheral macrophages. This thereby opens a new and innovative treatment strategy to prevent vasospasm. Pre-clinical work has been promising, and the transition to clinical trials is warranted. Finally, some of the key mechanistic targets are outlined with emphasis on translation. This review will serve as a catalyst for researchers and clinicians alike in the quest to improve treatment options for vasospasm.

Pharmaceutical Management for Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage can have deleterious consequences. Vasospasm, delayed cerebral ischemia, and re-hemorrhage can all cause delayed sequelae. Furthermore, severe headaches are common and require careful modulation of pain medications. Limited treatment options currently exist and are becoming more complex with the rising use of oral anticoagulants needing reversal. In this review, we highlight the current treatment options currently employed and address avenues of future discovery based on emerging preclinical data. Furthermore, we dive into the best treatment approach for managing headaches following subarachnoid hemorrhage. The review is designed to serve as a catalyst for further prospective investigation into this important topic.

Innovation-Oriented Medical School Curricula: Review of the Literature.

Innovation and entrepreneurship (I&E) programs in medical education have become available as medical schools recognize the need to train forward-thinking physicians. There is considerable diversity in the design and implementation of these curricula, which represents a challenge and possibly serves as a deterrent for the development of additional I&E programs. A comprehensive search of medical school I&E programs and review of all Association of American Medical Colleges member websites (n = 171) were conducted. This review sought to (1) identify all American and Canadian allopathic medical schools with I&E curricula, (2) evaluate their structure/integration in the context of medical education, (3) outline core learning themes, and (4) describe the evaluative metrics. Information was collected through published or publicly available websites and through a questionnaire sent to identified I&E program leaders. Twenty-eight I&E-oriented medical education programs were identified from 26 schools; all of the programs integrated faculty leadership with backgrounds in medicine, engineering, and/or business/entrepreneurship. Of the programs, 57% (16/28) had been launched within the past four years and 75% (21/28) based program enrollment on a selective application process. Nearly all (27/28) incorporated lecture series and/or hands-on modules as a teaching technique. The most prevalent metric was completion of a capstone project (22/28; 79%). At least 15.2% (26/171) of American and Canadian allopathic medical schools include the option for students to participate in an I&E curriculum-based program. This review can be used to help medical school faculty with developing I&E curricula.

Fatigue preconditioning increases fatigue resistance in mouse flexor digitorum brevis muscles with non-functioning K(ATP) channels.

The objective of this study was to determine how an initial fatigue bout (FAT1 at 37°C) affects free myoplasmic Ca(2+) concentration and force ([Ca(2+)](i)/force) during a subsequent fatigue bout (FAT2) in mouse flexor digitorum brevis (FDB). During FAT1, both tetanic [Ca(2+)](i)/force decreased; however, they decreased to significantly lower levels when FAT1 was carried out in the presence of glibenclamide, a sarcolemmal K(ATP) (sK(ATP)) channel blocker. Glibenclamide also elicited greater increases in unstimulated [Ca(2+)](i)/force, which occurred when fibres failed to fully relax between contractions during FAT1. Finally, glibenclamide impaired force recovery after FAT1. The decreases in tetanic [Ca(2+)](i)/force and increases in unstimulated [Ca(2+)](i)/force were slower during FAT2 elicited 60 min after FAT1. Under control conditions, the effects were small with very few significant differences. In the presence of glibenclamide, on the other hand, the differences between FAT1 and FAT2 were very large. Unexpectedly, the differences in unstimulated and tetanic [Ca(2+)](i)/force between control and glibenclamide conditions observed during FAT1 were no longer observed during FAT2. The lack of differences was not related to a failure of glibenclamide to block K(ATP) channels during FAT2 because the effects of FAT1 on FAT2 were also observed using Kir6.2(-/-) mouse FDB, which lack sK(ATP) channel activity. The differences in [Ca(2+)](i)/force between FAT1 and FAT2 could be observed with FAT1 duration of just 30 s and a FAT1-FAT2 interval of at least 30 min. A modulation of factors involved in ischaemic pre-conditioning, i.e. A1-adenosine receptors, sK(ATP) and mitochondrial K(ATP) (mK(ATP)) channels, PKC and reactive oxygen species, during FAT1 had no effect on FAT2 fatigue kinetics. It is concluded that a preceding fatigue bout triggers an acute physiological process that prevents the contractile dysfunction induced by non-functioning K(ATP) channels.

Urinary dysfunction in acute brain injury: A narrative review.

The frontal lobe urinary control center is an important regulator of urinary function. Neurologic injury often causes damage or temporary dysfunction of this center and other related urinary control pathways. Little has been reported about this topic in the literature although a majority of neurologic injury patients suffer from some type of urinary dysfunction. In this review, we highlight what is known about urinary dysfunction based on injury type (traumatic brain injury, hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage, subdural hematoma, and epilepsy). We discuss both clinical and pre-clinical data and pinpoint areas warranting further investigation. In the final section, we provide proposed practice suggestions for managing these patients clinically with the intended goal for refinement in these approaches following further clinical trials.

Spontaneous Cerebral Spinal Fluid Rhinorrhea with Meningocele Secondary to Congenital Foramen Rotundum Defect: A Case Report and Review of Literature.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a rare occurrence. We present a case of spontaneous CSF rhinorrhea in a 57-year-old patient secondary to a sphenoid osseous defect involving the foramen rotundum and maxillary nerve with an associated arachnoid cyst and meningocele compressing the maxillary nerve. The location of the defect made correction amenable to an open skull-based approach. To the best of our knowledge, this is the first reported case of a spontaneous meningocele herniating into the sphenoid osseous defect through the medial aspect of the foramen rotundum. Early detection of these defects, open or endoscopic approaches and definitive treatment by closing the defect can result in excellent outcomes.

Combined Posterior-Anterior Interbody Fusion in the Management of Traumatic Lumbosacral Dissociation: A Case Report and Review of Literature.

Traumatic lumbosacral dissociation is a unique, but well-documented, phenomenon that generally stems from high-energy impact injuries to the lower lumbar spine. Patients typically present with complicated and multisystem injuries with wide-ranging neurological deficits below the level of trauma. This presents stark challenges regarding the diagnosis, management, and surgical correction technique utilized. In this study, we present the case of a 21-year-old, morbidly obese, male patient that presented after a traumatic motor vehicle accident with L5-S1 lumbosacroiliac dissociation, cauda equina syndrome, and left lower extremity monoplegia. The degree of disruption warranted a 360° approach, we opted for an anterior lumbar interbody fusion followed by a posterior, lumbar interbody, short segment fusion. We review the case and relevant literature of similar lumbosacral dissociation studies with their management options and outcomes. Due to the rare nature of these devastating injuries, there remains wide variability in their management, with a combination of open anterior and posterior approaches resulting in variable long-term outcomes. The management of these rare injuries will require appropriate consideration of the patient's unique etiology, coexisting injuries, and radiological imaging in deciding surgical stabilization techniques.

Using the 6-min Walk Test to Monitor Peak Oxygen Uptake Response to Cardiac Rehabilitation in Patients With Heart Failure.

PURPOSE: We examined the agreement between peak oxygen uptake (V˙o2peak), estimated using prediction equations from the 6-min Walk Test (6MWT), and V˙o2peak measured using a cardiopulmonary exercise test (CPX) to estimate change in V˙o2peak in patients with heart failure (HF) enrolled in cardiac rehabilitation (CR). METHODS: This was secondary analysis of 54 (including 9 women) patients with HF who completed a clinical CR program. Four previously published equations using 6MWT distance were used to estimate V˙o2peak and were compared with a CPX at baseline, follow-up, and change using the standard and modified Bland-Altman method. Analyses were repeated for quartiles of cardiorespiratory fitness (CRF) based on measured V˙o2peak from the CPX. RESULTS: Bland-Altman plots revealed proportional bias between all prediction equations and the measured V˙o2peak. The difference between methods varied by the level of CRF, with overestimation of prediction equations at greater levels of CRF and underestimation at lower levels of CRF. This poor agreement remained when comparisons were made between the estimated and measured V˙o2peak values at quartiles of CRF, indicating prediction equations have limited ability to predict V˙o2peak at any level of CRF. CONCLUSION: Estimated V˙o2peak using 6MWT distance demonstrated poor agreement with measured V˙o2peak from a CPX. While distance ambulated on the 6MWT remains an important measure of physical performance in patients with HF, prediction equations using 6MWT distance are not appropriate to monitor changes in V˙o2peak following CR in patients with HF.

Does Surgical Intervention Help with Neurological Recovery in a Lumbar Spinal Gun Shot Wound? A Case Report and Literature Review.

The third leading cause of spinal injuries are gunshot wounds to the spine, accounting for 15.2% of all spinal cord injuries. Treatment for gunshot wound spinal cord injuries (GSWSCI) remains variable, with indications for surgery being controversial. There is no clear evidence or guidelines that can help spine surgeons decide and direct surgical intervention. With the paucity of available literature, we report an interesting case of a gunshot injury to the lumbar spine at L1-L2, discuss the presentation and outcome, and evaluate relevant literature. A 27-year-old incarcerated male patient presented with a conus cauda equina asymmetrical injury involving the lower extremities and required initial medical stabilization in the intensive care unit (ICU). He subsequently underwent delayed surgical treatment with decompression and fragment resection at L1-L2. The patient improved neurologically to the American Spinal Injury Association (ASIA) Classification D and eventually regained nearly all lower extremity neurological function. Despite considerable evidence favoring the conservative management of GSWSCI and the absence of guidelines or recommendations on surgical interventions, our case report demonstrates that surgical intervention in appropriately selected patients can yield good recovery of neurological function and improvement in the quality of life. The key remains careful patient selection, the appropriate location of the retained fragment, and the extent of neurological injury that occurred. We feel surgical decompression and fragment removal, along with debridement, can result in good neurological recovery and long-term outcomes.

Psychosocial and Cardiometabolic Health of Patients With Differing Body Mass Index Completing Cardiac Rehabilitation.

BACKGROUND: It remains unclear whether cardiac rehabilitation (CR) provides similar benefits to patients with varying levels of body mass index (BMI). We assessed the psychosocial and cardiometabolic health of patients with increased BMI who completed CR. METHODS: The records of 582 patients who completed a 3-month outpatient CR program were analyzed. On the basis of their BMI at baseline, patients were categorized as normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), or severely obese (≥ 35.0 kg/m2). Analysis of covariance was used to compare health-related quality of life (ie, Physical Component Summary [PCS] and Mental Component Summary scores), anxiety, depression, and cardiometabolic health indicators between BMI categories after CR. RESULTS: At baseline, patients with severe obesity, when compared with those with normal BMI, had lower PCS scores (39.7 ± 8.5 vs 44.4 ± 8.4, P < 0.001), elevated levels of anxiety (7.0 ± 3.7 vs 4.8 ± 3.2, P = 0.001) and depression (5.5 ± 4.4 vs 3.4 ± 3.7, P < 0.001), higher glycated hemoglobin A1C (6.5 ± 1.1 vs 5.6 ± 0.7%, P < 0.001) and triglycerides (1.6 ± 0.5 vs 1.1 ± 0.4 mmol/L, P < 0.001), and lower high-density lipoprotein cholesterol (1.1 ± 0.3 vs 1.2 ± 0.4 mmol/L, P = 0.006). After CR, notwithstanding a greater percent weight reduction in obesity (-3.5% ± 6.9% vs +1.1% ± 7.0%, P = 0.002) and severe obesity (-6.5% ± 6.9% vs +1.1% ± 7.0%, P < 0.001), smaller improvements in PCS scores were seen in the obese (4.1 ± 7.4 vs 6.9 ± 7.6, P = 0.011) and severely obese (4.1 ± 7.6 vs 6.9 ± 7.6, P = 0.039) when compared with those with normal BMI. CONCLUSIONS: Poorer psychosocial and cardiometabolic health at baseline coupled with smaller improvements in the PCS score suggest that patients with obesity and severe obesity will benefit from enhanced care in the CR setting.

Sex differences in psychosocial and cardiometabolic health among patients completing cardiac rehabilitation.

Current programs of cardiac rehabilitation (CR) typically provide a standardized approach to all patients. We examined whether CR would produce similar improvements in psychosocial and cardiometabolic health indicators in women compared with men. The records of patients who completed a 3-month outpatient CR program were examined. We compared health-related quality of life (i.e., Physical Component Summary (PCS) and Mental Component Summary (MCS) scores), anxiety, depression, and cardiometabolic health indicators between women and men completing CR. Of the 591 participants who completed CR, 155 (26.2%) were women and 436 (73.8%) were men. At baseline, women were older (64 ± 9 vs. 62 ± 9 years, p = 0.045), had lower PCS (39.5 ± 8.1 vs. 43.9 ± 7.8 points, p < 0.001), and MCS (46.6 ± 10.8 vs. 49.4 ± 9.8 points, p = 0.003) scores, experienced elevated levels of anxiety (6.4 ± 4.0 vs. 5.2 ± 4.0 points, p = 0.001) and depression (4.7 ± 3.5 vs. 3.6 ± 3.3 points, p = 0.001), and had higher low-density lipoprotein cholesterol (2.1 ± 0.9 vs. 1.7 ± 0.7 mmol/L, p < 0.001) and high-density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.1 ± 0.3 mmol/L, p < 0.001) concentrations when compared with men. Following CR, women showed smaller improvements in percent body mass (+1.1% ± 10.1% vs. -2.1% ± 9.7%, p = 0.002) and PCS scores (3.0 ± 8.1 vs. 6.3 ± 7.5 points, p < 0.001) when compared with men. Considering poorer psychosocial health at baseline and smaller improvements in health-related quality of life in women when compared with men, more specific CR strategies addressing the particular needs of women are required to improve their health status and reduce the risk of secondary cardiac events.

Reimbursement patterns for neurosurgery: Analysis of the NERVES survey results from 2011-2016.

OBJECTIVE: In response to rising national health expenditures, the Patient Protection and Affordable Care Act (ACA) was passed in 2010, with major provisions implemented in 2014. Due to increasing concerns about workload and compensation among neurosurgeons, we evaluated trends in neurosurgical reimbursement, productivity and compensation before and after the implementation of the major provisions of the ACA. PATIENTS AND METHODS: Results from Neurosurgery Executives' Resource Value and Education Society (NERVES) annual surveys were collected, representing data from 2011 to 2016. Responses from different practice settings across the six years were categorized into groups, and inverse variance-weighted averaging was performed within the frameworks of a one-way ANOVA model with year. Data from 2011 to 2013 and 2014-2016 were analyzed similarly for differences among practice setting and region. RESULTS: The NERVES survey response rates ranged from 20% to 36%. Median values for compensation decreased by 3.66%, 6.42%, and 10.34% within private, hospital, and academic practices respectively after 2014 although these trends did not reach statistical significance. Median work RVUs had a trend to decrease by 5.67%, 13.08%, and 19.44% within private, hospital, and academic practices respectively after 2014. Academic practices showed statistically significant decreases in annual total RVUs, total gross charges and collections. CONCLUSION: These data demonstrate neurosurgical reimbursement and productivity have trended down during a time that increases in productivity and reimbursement were predicted. This phenomenon is most notable in academic practices compared to private or hospital based practices. Prospective analyses of the impact of healthcare policy reform on neurosurgical productivity are urgently needed.