Two distinct mechanisms of Plexin A function in Drosophila optic lobe lamination and morphogenesis.

Visual circuit development is characterized by subdivision of neuropils into layers that house distinct sets of synaptic connections. We find that, in the Drosophila medulla, this layered organization depends on the axon guidance regulator Plexin A. In Plexin A null mutants, synaptic layers of the medulla neuropil and arborizations of individual neurons are wider and less distinct than in controls. Analysis of semaphorin function indicates that Semaphorin 1a, acting in a subset of medulla neurons, is the primary partner for Plexin A in medulla lamination. Removal of the cytoplasmic domain of endogenous Plexin A has little effect on the formation of medulla layers; however, both null and cytoplasmic domain deletion mutations of Plexin A result in an altered overall shape of the medulla neuropil. These data suggest that Plexin A acts as a receptor to mediate morphogenesis of the medulla neuropil, and as a ligand for Semaphorin 1a to subdivide it into layers. Its two independent functions illustrate how a few guidance molecules can organize complex brain structures by each playing multiple roles.

COVID-19 Vaccination and Reproductive Health: a Comprehensive Review for Healthcare Providers.

With all the current misinformation on social media platforms about the COVID-19 vaccine and its potential effects on fertility, it is essential for healthcare providers to have evidenced-based research to educate their patients, especially those who are trying to conceive, of the risks to mothers and fetuses of being unvaccinated. It is well known that COVID-19 infection puts pregnant women at higher risk of complications, including ICU admission, placentitis, stillbirth, and death. In February of 2021, the American College of Obstetricians and Gynecologists (ACOG), the American Society for Reproductive Medicine (ASRM), and the Society for Maternal-Fetal Medicine (SMFM) released a statement denying any link between COVID vaccination and infertility. ASRM later confirmed and stated that "everyone, including pregnant women and those seeking to become pregnant, should get a COVID-19 vaccine". In this review, we aim to provide a compilation of data that denies any link between vaccination and infertility for healthcare providers to be able to educate their patients based on evidence-based medicine. We also reviewed the effect of COVID-19 virus and vaccination on various parameters and processes that are essential to obtaining a successful pregnancy.

Two distinct mechanisms of Plexin A function in Drosophila optic lobe lamination and morphogenesis.

Visual circuit development is characterized by subdivision of neuropils into layers that house distinct sets of synaptic connections. We find that in the Drosophila medulla, this layered organization depends on the axon guidance regulator Plexin A. In plexin A null mutants, synaptic layers of the medulla neuropil and arborizations of individual neurons are wider and less distinct than in controls. Analysis of Semaphorin function indicates that Semaphorin 1a, provided by cells that include Tm5 neurons, is the primary partner for Plexin A in medulla lamination. Removal of the cytoplasmic domain of endogenous Plexin A does not disrupt the formation of medulla layers; however, both null and cytoplasmic domain deletion mutations of plexin A result in an altered overall shape of the medulla neuropil. These data suggest that Plexin A acts as a receptor to mediate morphogenesis of the medulla neuropil, and as a ligand for Semaphorin 1a to subdivide it into layers. Its two independent functions illustrate how a few guidance molecules can organize complex brain structures by each playing multiple roles. Summary statement: The axon guidance molecule Plexin A has two functions in Drosophila medulla development; morphogenesis of the neuropil requires its cytoplasmic domain, but establishing synaptic layers through Semaphorin 1a does not.

Differences in Perioperative Management of Patients Undergoing Complex Spine Surgery: A Global Perspective.

BACKGROUND: The aim of this survey was to understand institutional spine surgery practices and their concordance with published best practices/recommendations. METHODS: Using a global internet-based survey examining perioperative spine surgery practice, reported institutional spine pathway elements (n=139) were compared with the level of evidence published in guideline recommendations. The concordance of clinical practice with guidelines was categorized as poor (≤20%), fair (21%-40%), moderate (41%-60%), good (61%-80%), or very good (81%-100%). RESULTS: Seventy-two of 409 (17.6%) institutional contacts started the survey, of which 31 (7.6%) completed the survey. Six (19.4%) of the completed surveys were from respondents in low/middle-income countries, and 25 (80.6%) were from respondents in high-income countries. Forty-one incomplete surveys were not included in the final analysis, as most were less than 40% complete. Five of 139 (3.6%) reported elements had very good concordance for the entire cohort; hospitals with spine surgery pathways reported 18 elements with very good concordance, whereas institutions without spine surgery pathways reported only 1 element with very good concordance. Reported spine pathways included between 7 and 47 separate pathway elements. There were 87 unique elements in the reviewed pathways. Only 3 of 87 (3.4%) elements with high-quality evidence demonstrated very good practice concordance. CONCLUSIONS: This global survey-based study identified practice variation and low adoption rates of high-quality evidence in the care of patients undergoing complex spine surgery.

Association Between MitoScore, BMI, and Body Fat Percentage as a Predictive Marker for the Outcome of In-Vitro Fertilization (IVF).

Background Infertility is defined as the inability to establish a pregnancy within 12 months of regular and unprotected sexual intercourse. In response to these problems, assisted reproductive techniques (ARTs) have made profound impacts on the therapeutic management of infertility. However, in-vitro fertilization (IVF) success rates are confounded by several internal and external factors. A relatively new approach to embryo assessment is known as MitoScore (Igenomix, Miami, USA). As a result, we sough to evaluate whether MitoScore can help in predicting in IVF outcomes, and to assess the relationship between MitoScore, BMI, and body fat percentage in determining the success of ARTs. Methods Using retrospective cohort, a study population consisting of 166 women aged 26-43 who were undergoing ART with pre-implantation genetic testing for aneuploidy (PGT-A) was assessed to determine if MitoScore, BMI, and body fat percentage impacted IVF outcomes. Results MitoScore, BMI, and body fat percentage were significantly lower in pregnant women as compared to non-pregnant women. Furthermore, MitoScore was correlated with subclasses of IVF outcomes (delivery, biochemical pregnancy, and spontaneous abortion) and was found to be positively correlated with BMI in patients with biochemical pregnancies. Conclusion Our findings suggest that MitoScore, BMI, and body fat percentage could act as critical parameters in determining the success of ART. However, the association between MitoScore, BMI, and body fat percentage does not appear to be a significant confounding factor to determine pregnancy outcome at this stage. Still, many factors need to be considered to establish the correlation reliably.

[Seroprevalence of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) in a sample of patients diagnosed with Alcohol User Disorder in Albacete (Spain).] / Seroprevalencia del virus de la hepatitis B, del virus de la hepatitis C y del virus de la inmunodeficiencia humana en una muestra de pacientes diagnosticados de trastorno por consumo de alcohol en Albacete.

OBJECTIVE: Studies report a higher prevalence of HCV, HBV and HIV in the population with Alcohol Use Disorder. Our objective is to determine the seroprevalence for hepatitis B and C and the human immunodeficiency virus (HIV) in patients with alcohol use disorder, as well as to determine if there is a correct serological screening of these. METHODS: Retrospective study of 204 patients with Alcohol Use Disorder followed up in the Addictive Behaviors Unit from Albacete. They started treatment from 2013-2014 onwards, the last patient was recruited in December of 2017. RESULTS: Our sample has 160 men (78.4%) and 44 women (21.6%). The median age is 46.2 years. 161 patients (78.9%) had HIV serology and it was negative in all. 146 patients (71.6%) had negative hepatitis B serology and 12 (5.9%) were vaccinated. 36 patients (17.6%) had no hepatitis B serology performed. In 10 patients, hepatitis B serology was positive (4.9%; 95% CI 1.9-7.9%). 159 patients (77.9%) had negative hepatitis C serology, and 37 patients had not performed it (18.1%). 8 patients had positive serology (prevalence of 3.9%; 95% CI 1.2-6.6%). Excluding patients who did not have serology, seroprevalence was 5.9% (95% CI 2.3-9.6%) and 4.8% (95% CI 1.5-8.1%) respectively. Failure to perform serologies was associated with older age and less weekly Standard Drink Units (SDUs) consumption. CONCLUSIONS: The seroprevalence of HBV and HCV in patients with alcohol use disorder is high. It should be ensured that 100% of patients with alcohol use disorder undergo HCV, HIV, HBV serology, reducing the loss of diagnostic opportunities.

OBJETIVO: Estudios relatan mayor prevalencia de VHC, VHB y VIH en población con Trastorno de Consumo de Alcohol. El objetivo de nuestro estudio fue determinar la seroprevalencia para Virus de Hepatitis B (VHB), Virus de Hepatitis C (VHC) y el Virus de la Inmunodeficiencia Humana (VIH) en pacientes con trastorno por consumo de alcohol, así como determinar si existe un correcto cribaje serológico de éstos. METODOS: Estudio retrospectivo de 204 pacientes con trastorno por consumo de alcohol seguidos en la unidad de conductas adictivas de Albacete, que iniciaron tratamiento desde el año 2013-2014 en adelante, el último paciente fue reclutado en diciembre de 2017. RESULTADOS: Nuestra muestra tiene 160 hombres (78,4%) y 44 mujeres (21,6%). La mediana de edad es 46,2 años. 161 pacientes (78,9%) tenían serología de VIH y fue negativa en todos. 146 pacientes (71,6%) tenían serología negativa de hepatitis B y 12 (5,9%) estaban vacunados. 36 pacientes (17,6%) no tenían serología realizada de hepatitis B. En 10 pacientes la serología de hepatitis B fue positiva (4,9%; IC95% 1,9-7,9%). 159 pacientes (77,9%) tenían serología negativa de hepatitis C, y 37 pacientes no la tenían realizada (18,1%). 8 pacientes tenían serología positiva (prevalencia de 3,9%; IC95% 1,2-6,6%). Excluyendo a los pacientes que no tenían serología la seroprevalencia fue de 5,9% (IC95% 2,3-9,6%) y de 4.8% (IC95% de 1,5-8,1%) respectivamente. La no realización de serologías se asoció a mayor edad y un menor consumo de Unidades de Bebida Estándar (UBEs) por semana. CONCLUSIONES: La seroprevalencia de VHB y VHC en pacientes con trastorno por consumo de alcohol es alta. Debería asegurarse que el 100% de pacientes con trastorno de consumo de alcohol, se realicen serologías de VHC, VIH, VHB disminuyendo pérdida de oportunidades diagnósticas.

Seroprevalencia del virus dela hepatitis B, del virus de la hepatitis Cy del virus de la inmunodeficienciahumana en una muestra de pacientesdiagnosticados de trastorno porconsumo de alcohol en Albacete / Seroprevalence of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) in a sample of patients diagnosed with Alcohol User Disorder in Albacete (Spain)

FUNDAMENTOS: Estudios relatan mayor prevalencia de VHC, VHB y VIH en población con Trastorno de Consumo de Alcohol. Elobjetivo de nuestro estudio fue determinar la seroprevalencia para Virus de Hepatitis B (VHB), Virus de Hepatitis C (VHC) y el Virus dela Inmunodeficiencia Humana (VIH) en pacientes con trastorno por consumo de alcohol, así como determinar si existe un correctocribaje serológico de éstos.MÉTODOS : Estudio retrospectivo de 204 pacientes con trastorno por consumo de alcohol seguidos en la unidad de conductas adic-tivas de Albacete, que iniciaron tratamiento desde el año 2013-2014 en adelante, el último paciente fue reclutado en diciembre de 2017.RESULTADOS: Nuestra muestra tiene 160 hombres (78,4%) y 44 mujeres (21,6%). La mediana de edad es 46,2 años. 161 pacientes(78,9%) tenían serología de VIH y fue negativa en todos. 146 pacientes (71,6%) tenían serología negativa de hepatitis B y 12 (5,9%)estaban vacunados. 36 pacientes (17,6%) no tenían serología realizada de hepatitis B. En 10 pacientes la serología de hepatitis B fuepositiva (4,9%; IC95% 1,9-7,9%). 159 pacientes (77,9%) tenían serología negativa de hepatitis C, y 37 pacientes no la tenían realizada(18,1%). 8 pacientes tenían serología positiva (prevalencia de 3,9%; IC95% 1,2-6,6%). Excluyendo a los pacientes que no tenían serolo-gía la seroprevalencia fue de 5,9% (IC95% 2,3-9,6%) y de 4.8% (IC95% de 1,5-8,1%) respectivamente. La no realización de serologíasse asoció a mayor edad y un menor consumo de Unidades de Bebida Estándar (UBEs) por semana.CONCLUSIONES: La seroprevalencia de VHB y VHC en pacientes con trastorno por consumo de alcohol es alta. Debería asegurarseque el 100% de pacientes con trastorno de consumo de alcohol, se realicen serologías de VHC, VIH, VHB disminuyendo pérdida deoportunidades diagnósticas.(AU)

BACKGROUND: Studies report a higher prevalence of HCV, HBV and HIV in the population with Alcohol Use Disorder. Our objectiveis to determine the seroprevalence for hepatitis B and C and the human immunodeficiency virus (HIV) in patients with alcohol usedisorder, as well as to determine if there is a correct serological screening of these.METHODS: Retrospective study of 204 patients with Alcohol Use Disorder followed up in the Addictive Behaviors Unit from Albacete.They started treatment from 2013-2014 onwards, the last patient was recruited in December of 2017.RESULTS: Our sample has 160 men (78.4%) and 44 women (21.6%). The median age is 46.2 years. 161 patients (78.9%) had HIV sero-logy and it was negative in all. 146 patients (71.6%) had negative hepatitis B serology and 12 (5.9%) were vaccinated. 36 patients (17.6%)had no hepatitis B serology performed. In 10 patients, hepatitis B serology was positive (4.9%; 95% CI 1.9-7.9%). 159 patients (77.9%)had negative hepatitis C serology, and 37 patients had not performed it (18.1%). 8 patients had positive serology (prevalence of 3.9%;95% CI 1.2-6.6%). Excluding patients who did not have serology, seroprevalence was 5.9% (95% CI 2.3-9.6%) and 4.8% (95% CI 1.5-8.1%)respectively. Failure to perform serologies was associated with older age and less weekly Standard Drink Units (SDUs) consumption.CONCLUSIONS: The seroprevalence of HBV and HCV in patients with alcohol use disorder is high. It should be ensured that 100%of patients with alcohol use disorder undergo HCV, HIV, HBV serology, reducing the loss of diagnostic opportunities.(AU)

Common Laboratory Parameters Are Useful for Screening for Alcohol Use Disorder: Designing a Predictive Model Using Machine Learning.

The diagnosis of alcohol use disorder (AUD) remains a difficult challenge, and some patients may not be adequately diagnosed. This study aims to identify an optimum combination of laboratory markers to detect alcohol consumption, using data science. An analytical observational study was conducted with 337 subjects (253 men and 83 women, with a mean age of 44 years (10.61 Standard Deviation (SD)). The first group included 204 participants being treated in the Addictive Behaviors Unit (ABU) from Albacete (Spain). They met the diagnostic criteria for AUD specified in the Diagnostic and Statistical Manual of mental disorders fifth edition (DSM-5). The second group included 133 blood donors (people with no risk of AUD), recruited by cross-section. All participants were also divided in two groups according to the WHO classification for risk of alcohol consumption in Spain, that is, males drinking more than 28 standard drink units (SDUs) or women drinking more than 17 SDUs. Medical history and laboratory markers were selected from our hospital's database. A correlation between alterations in laboratory markers and the amount of alcohol consumed was established. We then created three predicted models (with logistic regression, classification tree, and Bayesian network) to detect risk of alcohol consumption by using laboratory markers as predictive features. For the execution of the selection of variables and the creation and validation of predictive models, two tools were used: the scikit-learn library for Python, and the Weka application. The logistic regression model provided a maximum AUD prediction accuracy of 85.07%. Secondly, the classification tree provided a lower accuracy of 79.4%, but easier interpretation. Finally, the Naive Bayes network had an accuracy of 87.46%. The combination of several common biochemical markers and the use of data science can enhance detection of AUD, helping to prevent future medical complications derived from AUD.

Positive effects of thyroid replacement therapy on assisted reproductive technology outcomes in women with subclinical hypothyroidism with positive thyroid peroxidase autoantibodies.

Objective: To study the beneficial effects of thyroid replacement therapy (TRT) on pregnancy outcomes in patients with subclinical hypothyroidism (SCl hypoT) with respect to thyroid peroxidase (TPO) autoantibodies. Design: Retrospective study of 706 patients. Setting: Not applicable. Patients: The study evaluated 706 patients, who were divided into 3 cohorts: euthyroid patients, with pre-in vitro fertilization thyroid-stimulating hormone levels of <2.5 µIU/mL; patients with SCl hypoT, defined as thyroid-stimulating hormone levels of >2.5 µIU/mL and <4 µIU/mL, who were not treated; and patients with SCl hypoT who received TRT. The 3 cohorts were further subclassified into 2 groups, each based on TPO antibody levels. Interventions: The cohorts were compared for the effects of TRT on pregnancy outcomes. Main Outcome Measures: Identification of effects of TRT on assisted reproductive technology outcomes. Results: Patients with SCl hypoT had significantly fewer positive pregnancy outcomes than euthyroid patients. Importantly, low-dose TRT was found to be beneficial in improving IVF success and pregnancy outcomes in patients with SCl hypoT. The original cohort of patients, further classified into 2 subgroups on the basis of antithyroid (TPO) antibodies, showed that low-dose TRT was associated with improved pregnancy outcomes in women with SCl hypoT and TPO-positive antibodies. Conclusions: Our findings demonstrate that low-dose TRT may be beneficial in improving in vitro fertilization success and pregnancy outcomes in women with SCl hypoT and TPO-positive antibodies.

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care.

Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.

Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward.

PURPOSE OF REVIEW: This review illustrates the evolution and progress with standardization of fellowship education in neuroanesthesiology. It provides a structured discussion around the need for curricula and framework which individual training programs in neuroanesthesiology can use to meet defined educational standards thus meeting criteria for accreditation. RECENT FINDINGS: Neuroanesthesiology training has traditionally been heterogenous around the world but international efforts from the community of neuroanesthesiology have culminated in the development of an international council for perioperative training in neuroscience in anesthesiology(ICPNT). This serves not only as an accrediting body but also creates a platform through their neuroanesthesia program relations committee for collaboration and engagement between various training programs internationally, increasing the educational standards of the individual programs and collectively increasing the overall level of standards for neuroanesthesia training. Standardized curriculum and competency-based assessments and milestones would help with narrowing the focus to quality education in neuroanesthesiology. SUMMARY: Structured training around the three pillars of neuroanesthesiology with concomitant accreditation is expected to lead to higher education standards with better patient care. The SNACC created milestones for neuroanesthesiology training during residency and the ICPNT can now use this as a foundation for fellowship training. Having a council to accredit and standardize will likely become indispensable in creating a set path for training in neuroanesthesiology. Additionally, the flexibility built in due to the international nature would allow modified and variable pathways depending upon individual capabilities and interests. The path forward will include widespread adoption of standardization supporting the overarching goal of excellent patient outcomes around the world.

Impact of preoperative opioid use disorder on outcomes following lumbar-spine surgery.

OBJECTIVES: Opioid use disorder (OUD) has previously been shown to negatively impact postoperative outcomes. As the number of spine surgeries continues to rise annually, more patients with preexisting OUD will be seen in operating rooms. Our retrospective cohort study aims to expand on the independent association between preoperative OUD and outcomes following lumbar-spine surgery. PATIENTS AND METHODS: Using 2007-2014 data from the State Inpatient Databases (SID) for the states of California (2007-2011), Florida, New York, Maryland, and Kentucky, we identified patients ≥18 years of age undergoing lumbar-spine surgery. Our primary variable of interest was present-on-admission OUD. Outcomes of interest included a range of postoperative complications divided into those specific to spinal surgery and general surgical complications, length of stay (LOS), 30- and 90-day readmission rates, and total hospital charges. RESULTS: Of the 267,976 patients undergoing lumbar-spine surgery, 1902 patients were identified as having OUD. After adjusting for patient- and hospital-level confounders, we found that patients with OUD were more likely to experience complications related specifically to spine surgery (aOR = 1.51, 95%CI = 1.33-1.71) as well as general postoperative complications (aOR = 1.63, 95%CI = 1.36-1.96) compared to those without OUD. OUD was additionally associated with longer LOS (aIRR = 1.29, CI = 1.24-1.34) and higher total charges (aIRR = 1.14, CI = 1.11-1.18). Whereas no statistically significant difference was detected for 30-day-readmission rates, patients with OUD experienced higher rates of readmission within 90 days of discharge (aOR = 1.20, CI = 1.08-1.35). CONCLUSIONS: Our study strengthens the evidence that patients with OUD fare poorly after lumbar-spine surgery. More research is needed to determine whether reducing opioid use before surgery can mitigate the postoperative risks associated with OUD.

Intraoperative Simulation: Team Training for Resuscitation While Using Intraoperative Computed Tomography: 2-Dimensional Operative Video.

Spine surgeons increasingly use intraoperative computed tomography (iCT) to facilitate surgery. iCT has several advantages, including the ability to decrease radiation exposure, improve surgical accuracy, and decrease operative time.1-3 However, the large footprint of the equipment can impede fast patient access in the event of an emergency resuscitation. This challenge is compounded when the patient is prone with rigid head fixation. To achieve fast, high-quality resuscitation, a large team must overcome numerous challenges. Cohesive team functioning under these circumstances requires planning, practice, and refinement.4 As a result of our simulation sessions, we have made several changes to the setup of our iCT cases. The following equipment is now routinely used: extralong tubing between the anesthesia circuit and patient, portable vital monitor, additional intravenous access is obtained, and extension tubing is used with all lines. We have created educational diagrams to streamline 2 challenging processes: optimal bed placement (for supination) and removal of equipment from the operating room (OR) to accommodate an influx of emergency personnel and equipment. Since the implementation of this protocol, 1 prone posterior cervical patient had intraoperative cardiac arrest. The protocol was followed. Return of spontaneous circulation was achieved within 5 min. The patient was discharged from the hospital with no neurological sequelae. During debriefing, stakeholders uniformly credited the simulated practice with this positive outcome. Emergency planning is a multifaceted process that continually evolves. With a steady flux of personnel and equipment, ongoing practice is essential to ensure readiness. Here, we share the key elements of our twice-yearly simulation. This simulation was performed on a training mannequin. This study did not involve human subjects. Any depictions of care rendered to nonidentifiable patients were standard (nonexperimental).

Anesthesia for Carotid Endarterectomy, Angioplasty, and Stent.

Anesthetic management of carotid artery disease requiring carotid endarterectomy or carotid stenting is complex and varies widely, but relies on excellent communication between the anesthesia and surgical team throughout the procedure to ensure appropriate cerebral perfusion. With a systematic approach to vascular access and hemodynamic and neurologic monitoring, anesthesia can be applied to maximize cerebral perfusion while minimizing the risk of postoperative hemorrhage or hyperperfusion.

Scoliosis Correction with One Ventricle: A Multispecialty Approach.

BACKGROUND: Patients with single-ventricle congenital heart disease may present for scoliosis correction. These patients undergo a series of cardiac operations that create a novel circulation that has a significant impact on the management of their spinal surgery. CASE DESCRIPTION: A 21-year-old man with severe scoliosis presented for posterior T4-L3 spinal fusion. He was born with complex congenital heart disease that resulted in his having a single functioning ventricle. He underwent a series of operations culminating in a Fontan procedure to palliate his heart disease. Both the surgical procedure and the anesthetic plan were modified based on his abnormal physiology, which led to a successful correction with no complications. CONCLUSIONS: Patients who have undergone a Fontan procedure can successfully undergo a lengthy scoliosis correction, but it requires multidisciplinary planning.