Complication rates following stand-alone lateral interbody fusion: a single institution series after 10 years of experience.

PURPOSE: This retrospective single institution study's goal was to analyze and report the complications from stand-alone lateral lumbar interbody fusions (LLIF). METHODS: This research was approved by the institutional review board (STUDY2021000113). We retrospectively reviewed the database of patients with adult degenerative spine deformity treated via LLIF at our institution between January 2016 and December 2020. RESULTS: Stand-alone LLIF was performed in 158 patients (145 XLIF, 13 OLIF; mean age 65 y.; 88 f., 70 m.). Mean surgical time was 85 min (± 24 min). Mean follow-up was 14 months (± 5 m). Surgical blood loss averaged 120 mL (± 187 mL) and the mean number of fused levels was 1.2 (± 0.4 levels). Overall complication rate was 19.6% (31 total; 23 approach-related, 8 secondary complications). CONCLUSION: Lateral interbody fusion appears to be a safe surgical intervention with relatively low complication- and revision rates.

COVID-19 Vaccine Related Cervical Radiculitis and Parsonage-Turner Syndrome: Case Report and Review of the Literature.

Parsonage-Turner Syndrome, or neuralgic amyotrophy, is an acute-onset upper limb and shoulder girdle palsy that can occur in a post-viral, post-surgical or idiopathic setting. There have also been some reported cases of the syndrome occurring following vaccinations. The pathophysiology of neuralgic amyotrophy is not completely understood and many of the commonly used diagnostic imaging modalities we use to try and diagnose this syndrome are inaccurate and misleading. We present the case of a 40-year-old gentleman who presented with acute onset burning pain and fasciculations in his right upper extremity following vaccination with the second dose of the Pfizer-BioNTech COVID-19 vaccine. His symptoms progressed to weakness in isolated muscle groups with electromyographic evidence of decreased nerve conduction. MRI of the cervical spine demonstrated multilevel central and foraminal stenosis, suggesting a diagnosis of cervical radiculopathy. The patient underwent a C4-5/C5-6 and C6-7 laminoforaminotomy and tolerated the procedure well. Post-operatively, the patient has experienced gradual symptom improvement with residual right triceps and pectoralis muscle weakness as well as paresthesias of the right elbow and forearm. Parsonage-Turner Syndrome is a brachial plexus palsy that can affect one or multiple branches of the brachial plexus. It causes acute-onset pain and weakness, and the diagnosis can be difficult to make with the commonly used diagnostic imaging methods. We reviewed other case reports about neuralgic amyotrophy following vaccinations as well as the current literature on more accurate diagnostic imaging modalities that may help our diagnosis and understanding of the pathophysiology of this condition.

Challenges in making the transition between pediatric and adult eating disorder programs: a qualitative study from the perspective of service providers.

There is scant research regarding the transition from pediatric to adult eating disorder programs. This study aims to increase understanding of the factors that impede or facilitate successful service transition for individuals with anorexia nervosa moving from pediatric to adult eating disorder programs. Participants included service providers representing pediatric and adult eating disorder programs, in addition to community treatment providers in a large city. The following themes were identified: a) readiness, not age, should determine service transition; and b) implementation of interventions for facilitating transition from pediatric to adult eating disorder programs including appropriate medical follow-up. These findings delineate various factors that may help facilitate or interrupt a seamless and coordinated transition from pediatric to adult eating disorder programs.

Navigating the transition from pediatric to adult eating disorder programs: perspectives of service providers.

OBJECTIVE: This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs. METHOD: Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted. RESULTS: Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs. DISCUSSION: These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.

The Role of Parenteral Dantrolene in the Contemporary Management of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

OBJECTIVE: Cerebral vasospasm remains a significant source of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage. Dantrolene has shown promise in several animal studies in the treatment of cerebral vasospasm. The present study seeks to critically review the evidence of its use in human subjects, aiming to 1) describe the forms and dosages used, 2) describe its safety profile, and 3) describe its effectiveness in treating cerebral vasospasm. METHODS: A systematic review of intra-arterial dantrolene use in cerebral vasospasm was performed. A total of 86 articles were identified across all databases, 6 of which were ultimately included in the present study. Primary outcomes included a description of the form and dosage of dantrolene prescribed, the incidence of adverse effects after dantrolene use, and its efficacy for the treatment of cerebral vasospasm. RESULTS: Study designs included 2 randomized controlled trials (33.3%), 2 case series (33.3%), and 2 case reports (33.3%). Both the intra-arterial and intravenous administration of dantrolene has been performed with varying dose regimens. Although there exists limited clinical information regarding side effects, a case of liver toxicity was reported. All existing studies reported benefit in vasospasm measured either by transcranial Doppler or digital subtraction angiography. The level of evidence was low, consisting largely of retrospective studies that had a high likelihood of bias. CONCLUSIONS: Dantrolene is a promising new therapeutic agent in the treatment of cerebral vasospasm. Although existing reports of its use are encouraging, high-quality prospective randomized trials are necessary for recommendations pertaining to dose, route, indications, and efficacy.

Qualitative Evaluation of Educational Content on Lateral Spine Surgery YouTube™ Demonstrations.

OBJECTIVE:  This study assessed the quality of educational content for lateral spine fusion procedures on YouTube™. METHODS:  YouTube™ was searched using the following keywords and phrases: "Lateral lumbar interbody fusion," "lateral lumbar spine surgery," "Oblique lateral interbody fusion (OLIF)," "Extreme lateral interbody fusion (XLIF)," and "Lateral lumbar interbody fusion (LLIF)." An expert panel of three senior-level spine surgeons [rater one to three (R1-R3)] rated videos on 13 qualitative evaluation parameters via a modified Delphi approach. RESULTS:  Thirty-eight videos were included for evaluation. Interrater reliability analysis indicated a moderate agreement between R1 and R2 (κ=0.50; standard error, SE = 0.05), R1 and R3 (κ = 0.60, SE = 0.04), and a substantial agreement between R2 and R3 (κ = 0.65, SE = 0.04). Unanimously positive assessments of the quality of the intraoperative presentation varied between 42% and 63% of the rated videos. However, perioperative quality features were unanimously rated positively less than 21% of the videos. CONCLUSION:  With regard to the surgical approach and execution of lateral lumbar fusions, YouTube™ videos can be seen as a valuable addition to academic education. The main problem, however, is the lack of control mechanisms that check the quality of the content offered before it is consumed by patients, students, and doctors in training.

The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systemic review and meta-analysis. OBJECTIVE: To review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion. METHODS: A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception to December 31, 2020, was conducted. Cohort studies directly comparing smokers with nonsmokers that provided the number of nonunions and fused segments were included. Following data extraction, the risk of bias was assessed using the Quality in Prognosis Studies Tool, and the strength of evidence for nonunion was evaluated using the GRADE working group criteria. All data analysis was performed in Review Manager 5, and a random effects model was used. RESULTS: Twenty studies assessing 3009 participants, which included 1117 (37%) smokers, met inclusion criteria. Pooled analysis found that smoking was associated with increased risk of nonunion compared to not smoking ≥1 year following spine surgery (RR 1.91, 95% CI 1.56 to 2.35). Smoking was significantly associated with increased nonunion in those receiving either allograft (RR 1.39, 95% CI 1.12 to 1.73) or autograft (RR 2.04, 95% CI 1.54 to 2.72). Both multilevel and single level fusions carried increased risk of nonunion in smokers (RR 2.30, 95% CI 1.64 to 3.23; RR 1.79, 95% CI 1.12 to 2.86, respectively). CONCLUSION: Smoking status carried a global risk of nonunion for spinal fusion procedures regardless of follow-up time, location, number of segments fused, or grafting material. Further comparative studies with robust methodology are necessary to establish treatment guidelines tailored to smokers.

Hemodynamic and oxygen-metabolic responses of the awake mouse brain to hypercapnia revealed by multi-parametric photoacoustic microscopy.

A widely used cerebrovascular stimulus and common pathophysiologic condition, hypercapnia is of great interest in brain research. However, it remains controversial how hypercapnia affects brain hemodynamics and energy metabolism. By using multi-parametric photoacoustic microscopy, the multifaceted responses of the awake mouse brain to different levels of hypercapnia are investigated. Our results show significant and vessel type-dependent increases of the vessel diameter and blood flow in response to the hypercapnic challenges, along with a decrease in oxygen extraction fraction due to elevated venous blood oxygenation. Interestingly, the increased blood flow and decreased oxygen extraction are not commensurate with each other, which leads to reduced cerebral oxygen metabolism. Further, time-lapse imaging over 2-hour chronic hypercapnic challenges reveals that the structural, functional, and metabolic changes induced by severe hypercapnia (10% CO2) are not only more pronounced but more enduring than those induced by mild hypercapnia (5% CO2), indicating that the extent of brain's compensatory response to chronic hypercapnia is inversely related to the severity of the challenge. Offering quantitative, dynamic, and CO2 level-dependent insights into the hemodynamic and metabolic responses of the brain to hypercapnia, these findings might provide useful guidance to the application of hypercapnia in brain research.

Investigating the Convergent Mechanisms between Major Depressive Disorder and Parkinson's Disease.

Major depressive disorder (MDD) affects more than cognition, having a temporal relationship with neuroinflammatory pathways of Parkinson's disease (PD). Although this association is supported by epidemiological and clinical studies, the underlying mechanisms are unclear. Microglia and astrocytes play crucial roles in the pathophysiology of both MDD and PD. In PD, these cells can be activated by misfolded forms of the protein α-synuclein to release cytokines that can interact with multiple different physiological processes to produce depressive symptoms, including monoamine transport and availability, the hypothalamus-pituitary axis, and neurogenesis. In MDD, glial cell activation can be induced by peripheral inflammatory agents that cross the blood-brain barrier and/or c-Fos signalling from neurons. The resulting neuroinflammation can cause neurodegeneration due to oxidative stress and glutamate excitotoxicity, contributing to PD pathology. Astrocytes are another major link due to their recognized role in the glymphatic clearance mechanism. Research suggesting that MDD causes astrocytic destruction or structural atrophy highlights the possibility that accumulation of α-synuclein in the brain is facilitated as the brain cannot adequately clear the protein aggregates. This review examines research into the overlapping pathophysiology of MDD and PD with particular focus on the roles of glial cells and neuroinflammation.

Longitudinal cortex-wide monitoring of cerebral hemodynamics and oxygen metabolism in awake mice using multi-parametric photoacoustic microscopy.

Multi-parametric photoacoustic microscopy (PAM) has emerged as a promising new technique for high-resolution quantification of hemodynamics and oxygen metabolism in the mouse brain. In this work, we have extended the scope of multi-parametric PAM to longitudinal, cortex-wide, awake-brain imaging with the use of a long-lifetime (24 weeks), wide-field (5 × 7 mm2), light-weight (2 g), dual-transparency (i.e., light and ultrasound) cranial window. Cerebrovascular responses to the window installation were examined in vivo, showing a complete recovery in 18 days. In the 22-week monitoring after the recovery, no dura thickening, skull regrowth, or changes in cerebrovascular structure and function were observed. The promise of this technique was demonstrated by monitoring vascular and metabolic responses of the awake mouse brain to ischemic stroke throughout the acute, subacute, and chronic stages. Side-by-side comparison of the responses in the ipsilateral (injury) and contralateral (control) cortices shows that despite an early recovery of cerebral blood flow and an increase in microvessel density, a long-lasting deficit in cerebral oxygen metabolism was observed throughout the chronic stage in the injured cortex, part of which proceeded to infarction. This longitudinal, functional-metabolic imaging technique opens new opportunities to study the chronic progression and therapeutic responses of neurovascular diseases.

Importance of Arg-599 of ß-galactosidase (Escherichia coli) as an anchor for the open conformations of Phe-601 and the active-site loop.

Structural and kinetic data show that Arg-599 of ß-galactosidase plays an important role in anchoring the "open" conformations of both Phe-601 and an active-site loop (residues 794-803). When alanine was substituted for Arg-599, the conformations of Phe-601 and the loop shifted towards the "closed" positions because interactions with the guanidinium side chain were lost. Also, Phe-601, the loop, and Na+, which is ligated by the backbone carbonyl of Phe-601, lost structural order, as indicated by large B-factors. IPTG, a substrate analog, restored the conformations of Phe-601 and the loop of R599A-ß-galactosidase to the open state found with IPTG-complexed native enzyme and partially reinstated order. ᴅ-Galactonolactone, a transition state analog, restored the closed conformations of R599A-ß-galactosidase to those found with ᴅ-galactonolactone-complexed native enzyme and completely re-established the order. Substrates and substrate analogs bound R599A-ß-galactosidase with less affinity because the closed conformation does not allow substrate binding and extra energy is required for Phe-601 and the loop to open. In contrast, transition state analog binding, which occurs best when the loop is closed, was several-fold better. The higher energy level of the enzyme•substrate complex and the lower energy level of the first transition state means that less activation energy is needed to form the first transition state and thus the rate of the first catalytic step (k2) increased substantially. The rate of the second catalytic step (k3) decreased, likely because the covalent form is more stabilized than the second transition state when Phe-601 and the loop are closed. The importance of the guanidinium group of Arg-599 was confirmed by restoration of conformation, order, and activity by guanidinium ions.

Force relaxation between latex and non-latex orthodontic elastics in simulated saliva solution.

UNLABELLED: The aim of this study was to compare the force relaxation between traditional latex elastics to different brands of non-latex elastics in a simulated saliva solution. The force relaxation of 6.35 mm (0.25 inch), 99 g (3.5 oz), non-colored latex elastics from Ormco Corp. and non-latex elastics from Phoenix Orthodontics, ClassOne Orthodontics, and Glenroe was tested. The elastics were stretched to 40 mm (1.57 inch) and the force produced by the elastics was then measured using a Mini 44 Instron machine. RESULTS: The latex elastics had an initial relaxation of 15 percent after 1 hour of incubation and maintained their reduced force after 24 hours of incubation. Non-latex elastics lost approximately 20 percent of their force after the first hour and continued to lose force after up to 24 hours of incubation resulting in as much as 48 percent force relaxation. CONCLUSION: Latex elastics should be used whenever possible; however, when non-latex elastics are warranted, the clinician should take into account their greater initial forces, significant force relaxation, and variability among brands.