A matched-control study on the impact of depressive disorders following lumbar fusion for adult spinal deformity: an analysis of a nationwide administrative database.

PURPOSE: In recent years, depression rates have been on the rise, resulting in soaring mental health issues globally. There is paucity of literature about the impact of depression on lumbar fusion for adult spine deformity. The purpose of this study is to investigate whether patients with depressive disorders undergoing lumbar deformity fusion have higher rates of (1) in-hospital length of stay; (2) ninety-day medical and surgical complications; and (3) medical reimbursement. METHODS: A retrospective study was performed using a nationwide administrative claims database from January 2007 to December 2015 for patients undergoing lumbar fusion for spine deformity. Study participants with depressive disorders were selected and matched to controls by adjusting for sex, age, and comorbidities. In total, the query yielded 3706 patients, with 1286 who were experiencing symptoms of depressive disorders, and 2420 who served as the control cohort. RESULTS: The study revealed that patients with depressive disorders had significantly higher in-hospital length of stay (6.0 days vs. 5.0 days, p < 0.0001) compared to controls. Study group patients also had higher incidence and odds of ninety-day medical and surgical complications (10.2% vs. 5.0%; OR, 2.50; 95% CI, 2.16-2.89; p < .0001). Moreover, patients with depressive disorders had significantly higher episode of care reimbursement ($54,539.2 vs. $51,645.2, p < 0.0001). CONCLUSION: This study illustrated that even after controlling for factors such as sex, age, and comorbidities, patients with depressive disorders had higher rates of in-hospital length of stay, medical and surgical complications, and total reimbursement.

Comparison of baseline demographics and risk factors for aseptic loosening following primary total elbow arthroplasty.

BACKGROUND: Aseptic loosening is a feared complication following total elbow arthroplasty (TEA); however, literature regarding factors that may contribute to this complication is limited. The aims of this investigation were to: (1) compare baseline demographics of patients who developed aseptic loosening following primary TEA; and (2) identify patient-specific risk factors for the development of loosening. METHODS: Retrospective analysis using a nationwide claims database was performed to identify patients who underwent primary TEA and developed aseptic loosening within 2 years (study n = 307, control n = 10,741). Multivariate regression analysis generated odds ratio (OR), 95% confidence interval (95% CI), and p-value of risk factors. p < 0.05 was considered statistically significant. RESULTS: Patients who developed aseptic loosening had significant differences in numerous demographics, including age (p = 0.0001), sex (p = 0.0251), and various comorbid conditions such as obesity (15.96% vs. 8.36%, p < 0.0001). Furthermore, the risk factors most associated with aseptic loosening were obesity (OR 1.65, 95% CI 1.18-2.28, p = 0.002), male sex (OR 1.51, 95% CI 1.13-2.00, p = 0.004), and concomitant opioid use disorder (OR 1.58, 95% CI 1.14-2.15, p = 0.004). DISCUSSION: This study is the first to identify demographics and patient-related risk factors associated with aseptic loosening following primary TEA. This evidence could be applied to the clinical setting in order to educate at-risk patients of this potential complication as well as inform their post-operative clinical management. LEVEL OF EVIDENCE: Level III: Prognostic.

Conformation of the nuclear pore in living cells is modulated by transport state.

While the static structure of the nuclear pore complex (NPC) continues to be refined with cryo-EM and x-ray crystallography, in vivo conformational changes of the NPC remain under-explored. We developed sensors that report on the orientation of NPC components by rigidly conjugating mEGFP to different NPC proteins. Our studies show conformational changes to select domains of nucleoporins (Nups) within the inner ring (Nup54, Nup58, Nup62) when transport through the NPC is perturbed and no conformational changes to Nups elsewhere in the NPC. Our results suggest that select components of the NPC are flexible and undergo conformational changes upon engaging with cargo.

A Rapid and Facile Pipeline for Generating Genomic Point Mutants in C. elegans Using CRISPR/Cas9 Ribonucleoproteins.

The clustered regularly interspersed palindromic repeats (CRISPR)-CRISPR-associated protein 9 (Cas9) prokaryotic adaptive immune defense system has been co-opted as a powerful tool for precise eukaryotic genome engineering. Here, we present a rapid and simple method using chimeric single guide RNAs (sgRNA) and CRISPR-Cas9 Ribonucleoproteins (RNPs) for the efficient and precise generation of genomic point mutations in C. elegans. We describe a pipeline for sgRNA target selection, homology-directed repair (HDR) template design, CRISPR-Cas9-RNP complexing and delivery, and a genotyping strategy that enables the robust and rapid identification of correctly edited animals. Our approach not only permits the facile generation and identification of desired genomic point mutant animals, but also facilitates the detection of other complex indel alleles in approximately 4 - 5 days with high efficiency and a reduced screening workload.

Highly Efficient, Rapid and Co-CRISPR-Independent Genome Editing in Caenorhabditis elegans.

We describe a rapid and highly efficient method to generate point mutations in Caenorhabditis elegans using direct injection of CRISPR-Cas9 ribonucleoproteins. This versatile method does not require sensitized genetic backgrounds or co-CRISPR selection-based methods, and represents a single strategy that can be used for creating genomic point mutations, regardless of location. As proof of principle, we show that knock-in mutants more faithfully report variant-associated phenotypes as compared to transgenic overexpression. Data for nine knock-in mutants across five genes are presented that demonstrate high editing efficiencies (60%), a reduced screening workload (24 F1 progeny), and a rapid timescale (4-5 d). This optimized method simplifies genome engineering and is readily adaptable to other model systems.