Endoscopic Lateral Lumbar Interbody Fusion: Technical Note and Case Series.

BACKGROUND: Our objective is to describe a minimally invasive endoscopic surgical technique for performing lateral lumbar interbody fusion (LLIF). LLIF is a common approach to lumbar fusion in cases of degenerative lumbar disease; however, complications associated with psoas and lumbar plexus injury sometimes arise. The endoscopic modification presented here diminishes the requirement for sustained muscle retraction, minimizing complication risk while allowing for adequate decompression in select cases. METHODS: Endoscopic LLIF (ELLIF) was performed in 3 patients from 2019 to 2021. Surgeries were performed in the lateral position under general anesthesia with neurophysiological monitoring. Discectomy, endplate preparation, and harvesting of iliac crest bone were performed through a working channel endoscope. The introduction of an interbody cage (Joimax EndoLIF) was performed over a nitinol blunt-tip wire (Joimax). No expandable blade retractors were required. RESULTS: At 2-year follow-up of these 3 patients, the mean visual analog scale (VAS) score for leg pain improved from 9.3 to 1.7, and the mean Oswestry Disability Index (ODI) score improved from 40 to 8.3. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. Patients spent an average of 36 hours in the hospital postoperatively and returned to normal daily activities after an average of 48 days. CONCLUSIONS: A minimally invasive modification to the LLIF procedure is presented that offers several potential advantages due to the application of endoscopic techniques: reduced muscle retraction, smaller incision, and the opportunity to perform both indirect decompression and endoscopically visualized discectomy in the same fusion procedure. CLINICAL RELEVANCE: The proposed endoscopic lateral lumbar interbody fusion and decompression is a minimally invasive technique that may provide patients with minimal complications, quick recovery, and good functional recovery.

Salud mental y bienestar psicológico: variaciones durante la pandemia de COVID 19 en estudiantes de una facultad universitaria chilena

Antecedentes: Existe un aumento sostenido de la prevalencia de trastornos mentales en estudiantes universitarios, situación agudizada por la pandemia por COVID-19. Objetivo: Caracterizar la sintomatología de salud mental y el bienestar psicológico en un grupo de universitarios chilenos y explorar cambios en su situación durante el año académico en pandemia. Metodología: Diseño longitudinal, con dos mediciones utilizando un conjunto de instrumentos validados incluidos en un sistema de seguimiento del bienestar psicológico estudiantil (SIS-BP) disponible en una plataforma en línea. La muestra, de 1176 estudiantes, no probabilística, fue obtenida por participación voluntaria. Resultados: Se encontraron diferencias entre las administraciones, mostrando que, junto con producirse deterioro de la salud mental y el bienestar psicológico, también se desarrollan procesos de fortalecimiento de capacidades. Conclusión: Se destaca la importancia de acciones institucionales oportunas para sostener la trayectoria estudiantil frente al impacto de situaciones de emergencia en la salud mental de esta población.

Background: There is a sustained increase in the prevalence of mental disorders in college students, a situation exacerbated in 2020 by the COVID-19 pandemic. Objectives. To characterize the symptoms of mental health and psychological well-being in Chilean college students and to explore changes in the situation of students throughout the academic year during the pandemic. Methodology: A longitudinal survey design was used, with two measurements using a set of validated instruments included in a student psychological well-being monitoring system (SIS-BP), available on an online platform. The non-probabilistic sample of 1176 students were obtained by voluntary participation. Results: Differences were found between the administrations, showing that, along with the deterioration of mental health and psychological well-being, capacity building processes are also developed. Conclusion: The importance of timely institutional actions to sustain the trajectory of its students in the face of the impact of emergency situations on the mental health of this population is highlighted.

The effect of combining different sampling tools on the performance of electromagnetic navigational bronchoscopy for the evaluation of peripheral lung lesions and factors associated with its diagnostic yield.

BACKGROUND: We assessed the performance of Electromagnetic navigational bronchoscopy (ENB) as a standalone diagnostic technique and the performance of different sampling tools used during the procedure. METHODS: We recruited 160 consecutive patients who underwent ENB for peripheral lung lesions (PLL) at a tertiary care centre. The diagnostic performance of ENB and sampling tools was assessed using a logistic regression model and a ROC-curve in which the dependent variable was diagnostic success. A multivariate model was built to predict diagnostic success before performing ENB to select the best candidates for the procedure. RESULTS: Most patients with PLLs in the study were male (65%), with a mean age of 67.9 years. The yield was 66% when the most common techniques were used together as suction catheter + transbronchial biopsy forceps (TBBx) + bronchoalveolar lavage + bronchial washing (p < 0.001) and increased to 69% when transbronchial needle aspiration (TBNA) and cytology brush were added (p < 0.001). Adding diagnostic techniques such as TBBx and TBNA resulted in an increase in diagnostic performance, with a statistically significant trend (p = 0.002). The logistic model area-under the ROC-curve for diagnostic success during ENB was 0.83 (95% CI:0.75-0.90; p < 0.001), and a logit value ≥ 0.12 was associated with ≥ 50% probability of diagnostic success. CONCLUSIONS: ENB, as a stand-alone diagnostic tool for the evaluation of PLLs when performed by experienced operators using a multi-modality technique, has a good diagnostic yield. The probability of having a diagnostic ENB could be assessed using the proposed model.

Effects of COVID-19 pandemic on the management of pulmonary hypertension.

The coronavirus of 2019 (COVID-19) disrupted delivery of healthcare. Patients with pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), require significant resources for both diagnosis and management and are at high risk for decompensation due to disruption in their care. A survey consisting of 47 questions related to the care of patients with PH was designed by the American College of Chest Physicians 2020-2021 Pulmonary Vascular Disease (PVD) NetWork Steering Committee and sent to all members of the PVD NetWork, as well as the multiple other professional networks for PH. Participation was voluntary and anonymous. Responses were collected from November 2020 through February 2021. Ninety-five providers responded to this survey. The majority (93%) believe that care of PH patients has been affected by the pandemic. Sixty-seven percent observed decreased referrals for PH evaluation. Prior to the pandemic, only 15% used telemedicine for management of PH patients compared to 84% during the pandemic. Telemedicine was used most for follow up of selected low-risk patients (49%). While 22% respondents were completely willing to prescribe new PAH therapy via telemedicine, 11% respondents were completely unwilling. Comfort levels differed based on type of medication being prescribed. Over 90% of providers experienced disruptions in obtaining testing and 31% experienced disruptions in renewal or approval of medications. Overall, providers perceived that the COVID-19 pandemic caused significant disruption of care for PH patients. Telemedicine utilization increased but was used mostly in low-risk patients. Some providers had a decreased level of comfort prescribing PAH therapy via telemedicine encounters.

Overview of intraoperative neuromonitoring.

Intraoperative neuromonitoring (IONM) is used widely to reduce neurologic adverse postoperative outcomes. A variety of techniques are used. Initial techniques were used as far back as the 1930s, and the variety of methods expanded greatly since the 1980s. Many methods monitor baseline findings over time. Other methods test for neurologic function to identify nerves or eloquent cortex. Physicians trained in neurophysiology are key for interpretation of findings, supervision of staff, and making medical recommendations to the surgeon or anesthesiologist. Some neurophysiologists provide the services personally, and in other circumstances well-trained technologist staff help with the techniques. Much IONM is provided by the neurophysiology physician in the operating room, whereas in other cases, the physician may be on-line in real time from a remote site. When monitoring identifies changes, the IONM team must give a clear, timely, and compelling message to the surgeon and anesthesiologist.

Usos de Facebook y actividades académicas de estudiantes universitarios chilenos / Uses of Facebook and academic activities of university students / Usos do Facebook e atividades acadêmicas de estudantes universitários

La relevancia y la utilización cada vez más creciente de la plataforma social Facebook como una inminente herramienta educacional ha abierto alternativas para nuevos escenarios, en este contexto la investigación tuvo por objetivo explorar los usos de Facebook de estudiantes universitarios en su interacción con actividades académicas. Se utilizó una metodología de enfoque cualitativo. Respecto al procedimiento de recolección, se realizó triangulación de información a través de entrevistas en profundidad y grupos de discusión, en donde participaron estudiantes universitarios de 18 a 20 años de edad. Para el análisis de datos se usó el modelo adaptado de Hiles y Cermak, utilizando la perspectiva de contenidos categóricos. Los resultados indican que los estudiantes utilizan Facebook para seleccionar y direccionar el flujo de información, crear espacios de trabajo y cooperación, intercambiar recursos educativos y estar permanentemente actualizados. Además, los resultados muestran la valoración de los estudiantes y la influencia docente para el uso de esta plataforma. En cuanto a las conclusiones y discusiones, se resalta la proyección de abarcar nuevos escenarios de aprendizaje y estrategias vanguardistas que coexistan y nutran a la educación tradicional. Asimismo, se subraya el rol estudiantil protagonista en los usos y una valoración importante respecto de las múltiples ventajas que se perciben. Por último, se destaca la importancia de incorporar formalmente herramientas online para la satisfacción de necesidades y demandas permanentes en el ámbito educativo universitario.

The relevant and increasing use of Facebook social media as a prospect educational tool has put forward new choices for new settings. On this context, the present study objective is to explore how university students use Facebook in their academic activities interaction. The qualitative approach methodology was used. Concerning the data collection procedure, the information was triangulated by means of deep interviews and focus groups with the participation of 18 to 20 year-old university students. The Hiles and Cermark adapted model was used for the data analysis, by using the perspective of contents and categories. Results show that students use Facebook to select and direct the information flow, create rooms for cooperative work, exchange learning resources and to be permantently updated. Also, they show the value students give and the influence teachers have on using this social platform. Regarding conclusions, it is worthy to outstand the projection to reach new settings for avant-gard learning strategies to contribute and coexist with traditional education. Simultaneously, it is outstanding the students leading role in the use and value on the multiple benefits they perceive from this social platform. Lastly, it must be highlighted the importance of including online tools to meet the permanent needs and requirements on the university education area.

A relevância e o uso crescente da plataforma social Facebook como ferramenta educacional eminente, abre alternativas para novos cenários, neste contexto a pesquisa teve como objetivo explorar os uso do Facebook por estudantes universitários em sua interação com atividades acadêmicas. Foi utilizada uma metodologia de abordagem qualitativa. Quanto ao procedimento de coleta, as informações foram trianguladas por meio de entrevistas em profundidade e grupos de discussão, dos quais participaram universitários entre 18 e 20 anos. Para análise dos dados, foi utilizado o modelo adaptado de Hiles e Cermak, utilizando a perspectiva de conteúdo categórico. Os resultados indicam que os alunos utilizam o Facebook para selecionar e direcionar o fluxo de informações, criar espaços de trabalho e cooperação, trocar recursos educacionais e atualizar-se permanentemente. Além disso, os resultados mostram a avaliação dos alunos e a influência do ensino para o uso desta plataforma. Quanto às conclusões e discussões, destaca-se a projeção de abranger novos cenários de aprendizagem e estratégias de vanguarda que convivem e nutrir a educação tradicional. Da mesma forma, destaca-se o protagonismo dos alunos na utilização e uma importante avaliação das múltiplas vantagens que se percebem. Por fim, destaca-se a importância da incorporação formal de ferramentas online para atender as necessidades e demandas permanentes no campo educacional universitário.

Utilization of risk assessment tools in management of PAH: A PAH provider survey.

Pulmonary arterial hypertension (PAH) is a chronically progressive fatal disease. A goal-oriented approach to achieve low risk status has been associated with improved survival. A variety of risk stratification tools are available, but use is low. We conducted a survey to assess potential reasons for under-utilization. We conducted a survey-based study of global PAH disease specialists with a goal of assessing risk assessment utilization and identifying modifiable barriers to use. The survey was designed by the American College of Chest Physicians' Pulmonary Vascular Diseases (PVD) NetWork. Respondents were global members of the PVD NetWork and Pulmonary Hypertension Association. Survey invitations were sent electronically to all members. Participation was anonymous and no provider or patient level data was collected. Participants from four countries responded with the majority (84%) being from the United States. Our survey found suboptimal use of any risk stratification tool with 71/112 (63%) reporting use. A total of 85% of the respondents had more than 5 years of experience in managing PAH. REVEAL 2.0 and European Society of Cardiology/European Respiratory Society risk tools were the most commonly used. A total of 44 (65%) surveyed felt that use of risk tools led to change in PAH therapies. Only 6 (9%) felt they prompted additional testing or changed the frequency of follow-up. A total of 5 (7%) reported they prompted goals of care/palliative care discussions and 2 (3%) that they triggered lung transplant referral. The vast majority indicated that incorporation of risk tools into electronic medical records (EMR) would improve utilization. PAH risk assessment tools remain under-utilized. Most respondents were experienced PAH clinicians. More than one-third were not routinely using risk tools. Most felt that risk tools led to PAH therapy changes but few reported impacts on other aspects of care. The most commonly identified barriers to use were time constraints and lack of integration with EMR.

Generating Subjective Theories After a Disaster: The Role of Personality / Generando Teorías Subjetivas Después del Desastre: El Rol de la Personalidad

Abstract The role of people's beliefs in their perception of disasters has been scarcely studied. This study, we analyzed how people who experienced an earthquake and a subsequent tsunami employ subjective theories (ST) to explain their traumatic experience. This study aimed to interpret the explanations developed by a group of people about the earthquake and tsunami that took place in Chile in 2015. Thirteen episodic interviews were conducted as part of a qualitative case study. The participants' theories were grouped into four categories: the impact of personality on one's reaction to hardships; the existence of a link between personality and coping styles; the limited influence of personality on one's way of coping with difficulties; and changes in personality after experiencing hardships. These findings are discussed analyzing whether the participants' explanations could foster personal growth and psychological well-being after the catastrophe.

Resumen El rol de las creencias en la experiencia del desastre ha sido poco investigado. En este estudio se analizó cómo personas que experimentaron un terremoto y posterior tsunami, utilizan teorías subjetivas (TS) para explicar la experiencia traumática. El propósito de este estudio fue interpretar las explicaciones que algunas personas elaboraron respecto al terremoto y tsunami vivido en la zona norte de Chile el año 2015. Se realizaron trece entrevistas episódicas, en el marco de un estudio de caso con metodología cualitativa. Como hallazgos interesantes de las teorías surgen cuatro categorías: implicancias de la personalidad en la reacción ante dificultades; existencia de relación entre personalidad y estilo de afrontamiento; poca importancia de la personalidad al momento de afrontar dificultades, y cambio en la personalidad luego de experimentar una dificultad. Estos hallazgos se discuten analizando si estas explicaciones podrían favorecer -o no- el crecimiento y bienestar psicológico posterior a la catástrofe.

Gut Microbiota-Metabolome Changes in Children With Diarrhea by Diarrheagenic E. coli.

Background: Diarrheagenic Escherichia coli (DEC) strains are a main cause of diarrhea worldwide in children under 5 years old. DEC virulence is strongly regulated by environmental conditions and metabolites produced by the gut microbiota in the intestinal tract. In this study, we evaluated changes in gut microbiota-metabolome in children with or without diarrhea produced by DEC pathotypes. Goal: To determine gut microbiota composition and metabolome in stool samples obtained from healthy children and children with diarrhea positive for DEC pathotypes. Methods: We analyzed a total of 16 age-paired stool samples: 8 diarrheal samples positive for one DEC pathotype and 8 stool samples from healthy children. To identify the microbiota composition, we sequenced the V3-V4 region of the 16S rRNA and determined operational phylogenetic units (OPU). OPU were then used to predict metabolic pathways using the PICRUSt2 software. The presence of metabolites in stool samples was determined by LC-MS. A correlation analysis was performed with the main genera from each group and main metabolites. Bacteria associated with variance of main metabolites were identified using the MIMOSA2 software. Results: DEC and healthy groups showed a statistically different microbiota composition. A decrease in Firmicutes together with an increase in Bacteroidetes and Proteobacteria was found in the DEC group compared to the healthy group. Metabolic pathway predictions based on microbiota diversity showed that pathways involved in histidine and L-ornithine metabolism were significantly different between groups. A total of 88 metabolites detected by LC-MS were included in the metabolome analysis. We found higher levels of histamine and lower levels of ornithine in DEC samples than in the healthy group. Histamine and L-ornithine were associated with a specific microbiota species and the corresponding metabolic pathways. Conclusion: Stool samples from healthy children and children positive for DEC displayed a differential metabolome and microbiota composition. A strong correlation between a gut microbiota species and certain metabolites, such as histamine and L-ornithine, was found in the DEC group. This information might be useful to identify mechanisms and signaling molecules involved in the crosstalk between microbiota and DEC pathotypes.

Collective Self-Esteem and School Segregation in Chilean Secondary Students.

Chile has established hybrid policies for the administrative distribution of its educational establishments, leading to significant gaps in educational results and school conditions between public, mixed, and private schools. As a result, there are high levels of segregation, and social and economic vulnerability that put public schools at a disadvantage, affecting their image and causing a constant decrease in enrollment. An abbreviated version of Luhtanen and Crocker's (1992) collective self-esteem scale was adapted and validated for the Chilean educational context because of its usefulness in studying processes of social segregation and cultural coherence, seeking to identify student perception about the appreciation of school actions in the context of belonging and identification with schools, in order to compare between groups according to types of establishment and assess the effects of school conditions on the perception of students. A representative sample of Chilean secondary students between 9th and 12th grades participated (n = 3635, 52.8% women, average age 15.9 years, SD = 1.1). Descriptive analyses, comparison of means between groups, confirmatory factorial analyses, and multi-group analyses were conducted to test the adjustment and invariance of the unifactorial structure of a reduced version of four items. The results indicated that the scale satisfactorily complies with the proposed adjustment indexes, presents total invariance by gender and partial invariance by administrative dependence, and allows establishing statistically significant differences in the collective self-esteem, indicating a higher score for students in the private system, and a lower score for those in the public system. These results show the negative effects of high school segregation on students' collective self-esteem, affecting the appreciation of personal, collective, and institutional activities and the sense of belonging. Although previous research has explored some of the effects of school segregation, the present study focuses on collective self-esteem, which is closely related to identity and belonging, and allows for further innovative research on school segregation. The scale is useful as an instrument for researching social conditions of student well-being, in regards to educational management.

Correction to: Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary.

The article Is the new ASNM intraoperative neuromonitoring supervision "guideline" a trustworthy guideline? A commentary, written by Stanley A. Skinner, Elif Ilgaz Aydinlar, Lawrence F. Borges, Bob S. Carter, Bradford L. Currier, Vedran Deletis, Charles Dong, John Paul Dormans, Gea Drost, Isabel Fernandez­Conejero, E. Matthew Hoffman, Robert N. Holdefer, Paulo Andre Teixeira Kimaid, Antoun Koht, Karl F. Kothbauer, David B. MacDonald, John J. McAuliffe III, David E. Morledge, Susan H. Morris, Jonathan Norton, Klaus Novak, Kyung Seok Park, Joseph H. Perra, Julian Prell, David M. Rippe, Francesco Sala, Daniel M. Schwartz, Martín J. Segura, Kathleen Seidel, Christoph Seubert, Mirela V. Simon, Francisco Soto, Jeffrey A. Strommen, Andrea Szelenyi, Armando Tello, Sedat Ulkatan, Javier Urriza and Marshall Wilkinson, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 05 January 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 30 January 2019 to © The Author(s) 2019 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The original article has been corrected.

Double medial and lateral graft in myringoplasty. / Miringoplastia con injerto doble medial y lateral.

OBJECTIVES: A surgical technique for a double medial and lateral overlay autologous fascia graft myringoplasty is described in this paper along with its indications and results. MATERIAL AND METHOD: The presurgical and one year post surgery characteristics are analyzed for 100 cases with the double medial and lateral overlay autologous fascia graft technique. The anatomical and functional results are analyzed. RESULTS: The results are analyzed one year post surgery. The probabilities of obtaining a graft take using this methodology are 95%. The incidence of persistence of the perforations is 12.5% in children under 10 and 2.5% in children over ten years of age and adults. The complications are 4% of epithelial pearls with blunting of the neo-tympanum, 1% of retractions and 3% of epithelitis which is resolved with a topical medical treatment. The average residual air/bone gap is less than 20dB in 85% of the cases. Less than 10dB in 38%, and between 10 and 20dB in 47%. The causes for incomplete closure of the gap are analyzed; possibly related to fibrosis and sclerosis of the tympanic remnants and/or the ossicular chain. CONCLUSIONS: It is concluded that this methodology provides the best results in comparison with other methods we have used and have set aside for very specific situations related to the size and location of the perforation.

Efficacy of leptospiral commercial vaccines on the protection against an autochtonous strain recovered in Brazil

Abstract In swine and bovines, leptospirosis prevention and control is carried out via vaccination of susceptible animals using bacterins. However, the efficiency of leptospirosis vaccines has been questioned. This work aimed to investigate the potency of five leptospirosis vaccines sold commercially in Brazil, challenging the animals with one autochthonous strain of Leptospira, Canicola serovar, denoted LO4, isolated from swine. The standard protocol was followed, and renal carriers of Leptospira were identified among the surviving animals by culture and PCR. Of the five vaccines tested, only two proved effective. None of the surviving animals was positive by culture; however, one animal was positive by PCR. Three of the five vaccines sold commercially in Brazil for the immunization of swine or bovines failed the test of the efficacy to protect the vaccinated animals following challenge with an autochthonous Leptospira strain, Canicola serovar. The two vaccines provided protection against the renal carrier state in the surviving animals. The criteria used to produce leptospirosis bacterins sold commercially in Brazil must be reviewed. The industry should support researches on leptospiral vaccinology to improve the quality of the present vaccines and discover new immunogenic strains, because it is known that vaccination is one of the most important tools to increase the reproduction rates in livestock.

Computer tomographic imaging in 4 dogs with primary nasal canine transmissible venereal tumor and differing cellular phenotype.

Primary nasal canine transmissible venereal tumor (CTVT) without genital affection is uncommon. The aim of this report was to describe the primary nasal CTVT findings and CT staging in 4 dogs with different cytological phenotypes. Three male dogs and 1 bitch were evaluated for their chronic histories of sneezing, snoring, mucopurulent nasal discharge and nasal deformation. Cytological examination of nasal secretions suggested CTVT, confirmed by histopathological examination and LINE-1/c-myc. Males had the plasmacytoid phenotype of CTVT, and the bitch had the lymphocytoid phenotype. CTVT were staged based on the CT findings using modified Adams staging system. The bitch was classified as stage 1, 2 males were classified as stage 3 and 1 male as stage 4. All dogs had a complete tumoral remission after chemotherapy. Plasmacytoid phenotype was identified in cases with most important damage of the nasal cavity. However, the cytological type did not affect the response to chemotherapy.