Applications of SPECT/CT in the Evaluation of Spinal Pathology: A Review.

BACKGROUND: Accurate identification of pain generators in the context of low back and spine-related pain is crucial for effective treatment. This review aims to evaluate the potential usefulness of single photon emission computed tomography with computed tomography (SPECT/CT) as an imaging modality in guiding clinical decision-making. METHODS: A broad scoping literature review was conducted to identify relevant studies evaluating the use of SPECT/CT in patients with spine-related pain. Studies were reviewed for their methodology and results. RESULTS: SPECT/CT appears to have advantages over traditional modalities, such as magnetic resonance imaging and CT, in certain clinical scenarios. It may offer additional information to clinicians and improve the specificity of diagnosis. However, further studies are needed to fully assess its diagnostic accuracy and clinical utility. CONCLUSIONS: SPECT/CT is a promising imaging modality in the evaluation of low back pain, particularly in cases where magnetic resonance imaging and CT are inconclusive or equivocal. However, the current level of evidence is limited, and additional research is needed to determine its overall clinical relevance. CLINICAL RELEVANCE: SPECT/CT may have a significant impact on clinical decision-making, particularly in cases in which traditional imaging modalities fail to provide a clear diagnosis. Its ability to improve specificity could lead to more targeted and effective treatment for patients with spinal pathology.

Is Subjective Cognitive Decline Associated with Behavioral Health Outcomes Among Mothers?

OBJECTIVES: Studies suggests that pregnancy can alter the maternal neurological function of the brain (i.e., result in cognitive decline) in a way that remains prevalent well into middle and older adulthood. However, little research has explored these changes and how they might affect behavioral health outcomes, such as substance use and depression. METHODS: We merged data from the 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys, with a final analytic sample of 1330 female participants (649 participants were mothers). Chi-square tests or t-tests were used to examine differences in demographic and health characteristics of the sample by subjective cognitive decline (SCD) status. To test the study hypotheses, three generalized linear mixed models were estimated with a logit link. RESULTS: SCD was not associated with alcohol misuse among mothers (aOR = 0.27, p = 0.23). Mothers with SCD were more likely to smoke (aOR = 3.33, p = 0.01) and experience mental distress (aOR = 6.59, p < 0.001) than those without SCD. CONCLUSION: Interventions aimed at supporting mothers should consider how existing mental health and tobacco cessation programs can be adapted to better serve this population and should aim to identify those that may have early signs of early signs of neurodegenerative conditions.

Nursing Care for Metastatic Bone Cancer: Trends for the Future.

To effectively treat patients and minimize viral exposure, oncology nurses and radiology departments during COVID-19 had to re-examine the ability to offer palliative radiation treatments to people with metastatic bone cancer. Decreasing potential exposure to the virus resulted in extra measures to keep patients and personnel safe. Limiting radiotherapy treatments, social distancing, and limiting caregivers were a few of the ways that oncology patients were impacted by the pandemic. Hypofractionated radiation therapy (HFRT), or the delivery of fewer higher-dose treatments, was a method of providing care but also limiting exposure to infection for immunocompromised patients as well as healthcare staff. As oncology radiation centers measure the impact of patient care during the pandemic, a trend toward HFRT may occur in treating the painful symptoms of bone cancer. In anticipation that HFRT may be increasingly used in patient treatment plans, oncology nurses should consider patient perspectives and outcomes from the pandemic to further determine how to manage future trends in giving personalized care, and supportive care.

Metastatic mesenchymal chondrosarcoma of the spine managed with nonsurgical treatment: A case report and review of the literature.

In this report, we present a rare case of a 17-year-old male patient with metastatic mesenchymal chondrosarcoma (MCS) managed with nonsurgical treatment who subsequently demonstrated a favorable response to concurrent chemotherapy and radiation therapy, followed with pazopanib target therapy. Further study regarding nonoperative care for metastatic MCS of spine is warranted.

Lung Cancer Screening Using Low-Dose Computed Tomography.

Lung and bronchus cancers account for almost 13% of new cancer cases and are responsible for approximately 23% of cancer deaths in the United States. Lung cancer has a poor prognosis, primarily because of advanced disease stage at initial diagnosis. An estimated 80% to 90% of lung cancer deaths are caused by smoking tobacco, and although smoking rates have decreased in recent decades, millions of people are eligible for lung cancer screening each year because they smoke. Screening high-risk populations for lung cancer using low-dose computed tomography has resulted in increased lung cancer survival rates because diagnosis is possible at an earlier disease stage.

Preliminary Evaluation of Standing Full-Length Plain Radiographs Utility in an Adult Degenerative Spine Practice.

INTRODUCTION: The role of weight-bearing full-length standing radiographs (FLSRs) of the spine in the preoperative workup of adult degenerative disease of the lumbar spine is a subject of increasing research. This investigation aims to determine whether FLSR influences preoperative planning decisions. METHODS: In this prospective study, eight spine surgeons reviewed two 30-patient case series. The first set (set A) contained a patient history, physical examination data, and preoperative images. The second set (set B) contained all information in set A in addition to preoperative FLSR AP and lateral radiographs. Within 2 weeks of evaluating set A, reviewers assessed set B. Case sets were randomized. After reviewing each set, reviewers gave surgical plans and whether they believed an FLSR was important in planning. Decisions were evaluated by subspecialty, years of practice, and postfellowship years. A McNemar test assessed differences between set viewings. A chi-square test assessed differences of preoperative decision changes between different specialties and levels of experience. A Poisson regression assessed characteristics associated with changing preoperative plans. We analyzed patients by the number of unique reviewer procedures, surgical levels, and associated pathology. RESULTS: After viewing an FLSR, 44.7% of reviewers changed procedure. Reviewer opinion of FLSR importance differed between sets (27.1% versus 35.7%, P = 0.047). Among all reviewers, FLSR presentation was associated with aligning the number of proposed procedures in 15 patients. Scoliosis and sacral dysplasia were associated with negative deltas. FLSR viewing reduced the span of operational levels considered. Along the most divided patients, those with a high magnitude (≥6 choices) of initial procedures had more negative deltas than did those with a high number (≥5 choices) of surgical level choices. CONCLUSION: FLSR remains a critical aspect of presurgical planning. Even when reviewers initially believed patients would not benefit from FLSR, we observed changes in preoperative planning after FLSR viewing.

A chemisorbed interfacial layer for seeding atomic layer deposition on graphite.

The integration of graphene, and more broadly two-dimensional materials, into devices and hybrid materials often requires the deposition of thin films on their usually inert surface. As a result, strategies for the introduction of surface reactive sites have been developed but currently pose a dilemma between robustness and preservation of the graphene properties. A method is reported here for covalently modifying graphitic surfaces, introducing functional groups that act as reactive sites for the growth of high quality dielectric layers. Aryl diazonium species containing tri-methoxy groups are covalently bonded (grafted) to highly oriented pyrolytic graphite (HOPG) and graphene, acting as seeding species for atomic layer deposition (ALD) of Al2O3, a high-κ dielectric material. A smooth and uniform dielectric film growth is confirmed by scanning electron microscopy (SEM), atomic force microscopy (AFM) and electrical measurements. Raman spectroscopy showed that the aryl groups gradually detach from the graphitic surface during the Al2O3 ALD process at 150 °C, with the surface reverting back to the original sp2-hybridized state and without damaging the dielectric layer. Thus, the grafted aryl groups can act as a sacrificial seeding layer after healing the defects of the graphitic surface with annealing treatment.

Detection and Stabilization of a Previously Unknown Two-Dimensional (Pseudo)polymorph using Lateral Nanoconfinement.

We report on the detection and stabilization of a previously unknown two-dimensional (2D) pseudopolymorph of an alkoxy isophthalic acid using lateral nanoconfinement. The self-assembled molecular networks formed by the isophthalic acid derivative were studied at the interface between covalently modified graphite and an organic solvent. When self-assembled on graphite with moderate surface coverage of covalently bound aryl groups, a previously unknown metastable pseudopolymorph was detected. This pseudopolymorph, which was presumably "trapped" in between the surface bound aryl groups, underwent a time-dependent phase transition to the stable polymorph typically observed on pristine graphite. The stabilization of the pseudopolymorph was then achieved by using an alternative nanoconfinement strategy, where the domains of the pseudopolymorph could be formed and stabilized by restricting the self-assembly in nanometer-sized shallow compartments produced by STM-based nanolithography carried out on a graphite surface with a high density of covalently bound aryl groups. These experimental results are supported by molecular mechanics and molecular dynamics simulations, which not only provide important insight into the relative stabilities of the different structures, but also shed light onto the mechanism of the formation and stabilization of the pseudopolymorph under nanoscopic lateral confinement.

Artificial Intelligence in Diagnostic Imaging and Radiation Therapy.

Artificial intelligence (AI) is a rapidly growing profession that shows continued promise for diagnostic imaging in various disciplines, including dermatology and pathology. The benefits of AI, however, extend beyond the imaging department as radiation oncology departments begin to automate labor-intensive treatment planning processes. Given the increase in interest and research concerning AI, radiologic technologists must become familiar with AI terminology, current and potential applications, challenges, and patient perspectives.

Visualization of the Cervicothoracic Junction With EOS Imaging Is Superior to Conventional Lateral Cervical Radiographs.

STUDY DESIGN: Single-center retrospective review. OBJECTIVES: The cervicothoracic junction (CTJ) is typically difficult to visualize using traditional radiographs. Whole-body stereoradiography (EOS) allows for imaging of the entire axial skeleton in a weightbearing position without parallax error and with lower radiation doses. In this study we sought to compare the visibility of the vertebra of the CTJ on lateral EOS images to that of conventional cervical lateral radiographs. METHODS: Two fellowship-trained spine surgeons evaluated the images of 50 patients who had both lateral cervical radiographs and EOS images acquired within a 12-month period. The number of visible cortices of the vertebral bodies of C6-T2 were scored 0-4. Patient body mass index and the presence of spondylolisthesis >2 mm at each level was recorded. The incidence of insufficient visibility to detect spondylolisthesis at each level was also calculated for both modalities. RESULTS: On average, there were more visible cortices with EOS versus XR at T1 and T2, whereas visible cortices were equal at C6 and C7. Patient body mass index was inversely correlated with cortical visibility on XR at T2 and on EOS at T1 and T2. There was a significant difference in the incidence of insufficient visibility to detect spondylolisthesis on EOS versus XR at C7-T1 and T1-2, but not at C6-7. CONCLUSIONS: EOS imaging is superior at imaging the vertebra of the CTJ. EOS imaging deserves further consideration as a diagnostic tool in the evaluation of patients with cervical deformity given its ability to produce high-quality images of the CTJ with less radiation exposure.

Promoting Interdisciplinary Communication as a Vital Function of Effective Teamwork to Positively Impact Patient Outcomes, Satisfaction, and Employee Engagement.

INTRODUCTION: Failure to effectively communicate between disciplines negatively impacts patient care, and therefore, outcomes and satisfaction. The integration ofspecific communication skill sets between disciplines is not commonly a part oftraditional curriculum across health care programs. CASE AND OUTCOMES: Patient scenario where inter-disciplinary communication is the focus, not the specific patient situation. DISCUSSION: Radiology students in clinical rotation were able to identify instances of failed inter-disciplinary communication within the clinical setting and, using Kolb's Experiential Learning Theory techniques discussed and practiced in didactic training, were able to identify communication techniques to use in similar circumstances. CONCLUSION: Fostering the development of inter-disciplinary communication strategiesin the educational setting provides the foundation for continued use at the bedside. Identifying barriers to effective communication, discussing the ramifications of communication failures, examining solutions provided in evidence-based practice and learning how to apply these solutions to a variety of clinical settings can positively impact patient outcomes, and therefore, satisfaction, as well as enhance employee engagement.

Mentoring in Radiologic Science.

Mentoring occurs every day in the workplace, as experienced employees (mentors) help guide inexperienced ones (protégés) toward a common goal. Both the mentor and protégé possess hallmark characteristics that contribute to a successful mentorship. The typology of mentoring includes formal versus informal, as well as group, one-on-one, peer, remote, and invisible mentors. The benefits of these mentorships can impact students, inexperienced employees, health care institutions, education institutions, patient care, and the mentors themselves. Finally, there are recommendations for fostering mentoring for educators and managers.

Porous Self-Assembled Molecular Networks as Templates for Chiral-Position-Controlled Chemical Functionalization of Graphitic Surfaces.

Controlled covalent functionalization of graphitic surfaces with molecular scale precision is crucial for tailored modulation of the chemical and physical properties of carbon materials. We herein present that porous self-assembled molecular networks (SAMNs) act as nanometer scale template for the covalent electrochemical functionalization of graphite using an aryldiazonium salt. Hexagonally aligned achiral grafted species with lateral periodicity of 2.3, 2.7, and 3.0 nm were achieved utilizing SAMNs having different pore-to-pore distances. The unit cell vectors of the grafted pattern match those of the SAMN. After the covalent grafting, the template SAMNs can be removed by simple washing with a common organic solvent. We briefly discuss the mechanism of the observed pattern transfer. The unit cell vectors of the grafted pattern align along nonsymmetry axes of graphite, leading to mirror image grafted domains, in accordance with the domain-specific chirality of the template. In the case in which a homochiral building block is used for SAMN formation, one of the 2D mirror image grafted patterns is canceled. This is the first example of a nearly crystalline one-sided or supratopic covalent chemical functionalization. In addition, the positional control imposed by the SAMN renders the functionalized surface (homo)chiral reaching a novel level of control for the functionalization of carbon surfaces, including surface-supported graphene.

Interface Chemistry of Graphene/Cu Grafted By 3,4,5-Tri-Methoxyphenyl.

Chemical reaction with diazonium molecules has revealed to be a powerful method for the surface chemical modification of graphite, carbon nanotubes and recently also of graphene. Graphene electronic structure modification using diazonium molecules is strongly influenced by graphene growth and by the supporting materials. Here, carrying on a detailed study of core levels and valence band photoemission measurements, we are able to reconstruct the interface chemistry of trimethoxybenzenediazonium-based molecules electrochemically grafted on graphene on copper. The band energy alignment at the molecule-graphene interface has been traced revealing the energy position of the HOMO band with respect to the Fermi level.

Patient Perceptions of Physician Ownership in Spine Care.

STUDY DESIGN: This was a prospective study. OBJECTIVE: This study aims to determine the perspectives of patients seeking spine care in regard to physician ownership of surgical facilities and to understand the importance of disclosing financial conflicts. SUMMARY OF BACKGROUND DATA: There has been limited investigation regarding patient perceptions of the proprietary structure of surgical facilities. METHODS: Patients seeking treatment for spine pathology completed an 8-item survey. The questions assessed if patients acknowledged the owners of surgical facilities, if the patient thought knowledge of ownership is important, who they perceived as most qualified to own surgical facilities, preference of communication of ownership, and impact of facility ownership on care. RESULTS: A total of 200 patients completed the survey. When patients were asked whom they thought owned the hospital, most reported private hospital corporations followed by universities/medical schools and insurance companies. With regard to whom patients thought owned an ambulatory surgical center, most reported physicians, followed by private hospital corporations and individual investors. When asked how important it is to know the financial stakeholders of a surgical facility, 73.5% of patients stated "very important" or "somewhat important." Most patients reported they were not aware of who owned the facility. Regarding how facility owners should be communicated, 31.0% answered "written document," whereas 25.0% preferred verbal communication with the staff/surgeon. When asked how much impact the owner of a surgical facility has on their care, 38.0% of patients responded, "strong impact," followed by "moderate impact," (43.0%), and "little or no impact" (19.0%). Patients thought that physicians were the most qualified to own an ambulatory surgical center, followed by universities/medical schools and private hospital corporations. CONCLUSIONS: The pretreatment perception of patients referred to a spine clinic favored the opinion that physicians were the most qualified to own and manage surgical facilities. Therefore, physicians should be encouraged to share disclosures with patients as their ownership of surgical facilities is viewed favorably.

Comparing Allografts to Autografts for Maintenance of Cervical Sagittal Parameters and Clinical Outcomes Following Anterior Cervical Discectomy and Fusion With Anterior Cervical Plating.

OBJECTIVE: Current literature has not shown if using either allograft or autograft differentially affects postoperative cervical sagittal parameters. The goal of this study was to compare sagittal alignment and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) with allograft versus autograft. METHODS: A retrospective cohort analysis of patients who underwent single-level ACDF was conducted. Preoperative, immediate postoperative, and final follow-up radiographic assessments were conducted and included: change in C2-7 lordosis, T1 slope, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, and proximal and distal adjacent segment degeneration (ASD). Patient-reported outcomes were obtained using the Neck Disability Index and visual analogue scale scores for neck and arm. RESULTS: A total of 404 patients were assessed; 353 using allograft and 51 using autograft. No significant differences existed in demographics. Cervical lordosis improved in both groups without significant changes in SVA. Autograft group had a significantly greater amount of lordosis at the proximal segment on immediate postoperative radiographs and less overall cervical lordosis at final follow-up. Sagittal parameters were similar at each time point without significant changes between the 3-time points. No significant differences existed in radiographic ASD or reoperation rates. Fusion rates exceeded 96% in both groups. No significant differences existed between preoperative, postoperative, or change in patient-reported outcomes between the 2 groups. CONCLUSION: Sagittal alignment is maintained following ACDF when using either allograft or autograft. Radiographic evidence of ASD is present in both groups; however, this was not considered clinically significant, given low rates of pseudarthrosis or reoperation. No significant differences exist between groups in terms of patient-reported outcomes.

Graphite and Graphene Fairy Circles: A Bottom-Up Approach for the Formation of Nanocorrals.

A convenient covalent functionalization approach and nanopatterning method of graphite and graphene is developed. In contrast to expectations, electrochemically activated dediazotization of a mixture of two aryl diazonium compounds in aqueous media leads to a spatially inhomogeneous functionalization of graphitic surfaces, creating covalently modified surfaces with quasi-uniform spaced islands of pristine graphite or graphene, coined nanocorrals. Cyclic voltammetry and chronoamperometry approaches are compared. The average diameter (45-130 nm) and surface density (20-125 corrals/µm2) of these nanocorrals are tunable. These chemically modified nanostructured graphitic (CMNG) surfaces are characterized by atomic force microscopy, scanning tunneling microscopy, Raman spectroscopy and microscopy, and X-ray photoelectron spectroscopy. Mechanisms leading to the formation of these CMNG surfaces are discussed. The potential of these surfaces to investigate supramolecular self-assembly and on-surface reactions under nanoconfinement conditions is demonstrated.

Traumatic Fracture of the Pediatric Cervical Spine: Etiology, Epidemiology, Concurrent Injuries, and an Analysis of Perioperative Outcomes Using the Kids' Inpatient Database.

BACKGROUND: The study aimed to characterize trends in incidence, etiology, fracture types, surgical procedures, complications, and concurrent injuries associated with traumatic pediatric cervical fracture using a nationwide database. METHODS: The Kids' Inpatient Database (KID) was queried. Trauma cases from 2003 to 2012 were identified, and cervical fracture patients were isolated. Demographics, etiologies, fracture levels, procedures, complications, and concurrent injuries were assessed. The t-tests elucidated significance for continuous variables, and χ2 for categoric values. Logistic regressions identified predictors of spinal cord injury (SCI), surgery, any complication, and mortality. Level of significance was P < .05. RESULTS: A total of 11 196 fracture patients were isolated (age, 16.63 years; male, 65.7%; white, 65.4%; adolescent, 55.4%). Incidence significantly increased since 2003 (2003 vs 2012, 2.39% vs 3.12%, respectively), as did Charlson Comorbidity Index (CCI; 2003 vs 2012, 0.2012 vs 0.4408, respectively). Most common etiology was motor vehicle accidents (50.5%). Infants and children frequently fractured at C2 (closed: 43.1%, 32.9%); adolescents and young adults frequently fractured at C7 (closed: 23.9%, 26.5%). Upper cervical SCI was less common (5.8%) than lower cervical SCI (10.9%). Lower cervical unspecified-SCI, anterior cord syndrome, and other specified SCIs significantly decreased since 2003. Complications were common (acute respiratory distress syndrome, 7.8%; anemia, 6.7%; shock, 3.0%; and mortality, 4.2%), with bowel complications, cauda equina, anemia, and shock rates significantly increasing since 2003. Concurrent injuries were common (15.2% ribs; 14.4% skull; 7.1% pelvis) and have significantly increased since 2003. Predictors of SCI included sports injury and CCI. Predictors of surgery included falls, sports injuries, CCI, length of stay, and SCI. CCI, SCIs, and concurrent injuries were predictors of any complication and mortality, all (P < .001). CONCLUSIONS: Since 2003, incidence, complications, concurrent injuries, and fusions have increased. CCI, SCI, falls, and sports injuries were significant predictors of surgical intervention. Decreased mortality and SCI rates may indicate improving emergency medical services and management guidelines. LEVEL OF EVIDENCE: III. CLINICAL RELEVANCE: Clinicians should be aware of increased case complexity in the onset of added perioperative complications and concurrent injuries. Cervical fractures resultant of sports injuries should be scrutinized for concurrent SCIs.