Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors.

OBJECTIVE: Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history. METHODS: A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded. RESULTS: Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors. CONCLUSIONS: This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources. LEVEL OF EVIDENCE: Level III.

Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery.

PURPOSE: In 2018, Best Practice Guidelines (BPGs) were published for preventing wrong-level surgery in pediatric spinal deformity, but successful implementation has not been established. The purpose of this study was to evaluate BPG compliance 5 years after publication. We hypothesized higher compliance among BPG authors and among surgeons with more experience, higher caseload, and awareness of the BPGs. METHODS: We queried North American and European surgeons, authors and nonauthors, and members of pediatric spinal study groups on adherence to BPGs using an anonymous survey consisting of 18 Likert scale questions. Respondents provided years in practice, yearly caseload, and guideline awareness. Mean compliance scores (MCS) were developed by correlating Likert responses with MCS scores ("None of the time" = no compliance = MCS 0, "Sometimes" = weak to moderate = MCS 1, "Most of the time" = high = MCS 2, and "All the time" = perfect = MCS 3). RESULTS: Of the 134 respondents, 81.5% reported high or perfect compliance. Average MCS for all guidelines was 2.4 ± 0.4. North American and European surgeons showed no compliance differences (2.4 vs. 2.3, p = 0.07). Authors and nonauthors showed significantly different compliance scores (2.8 vs 2.4, p < 0.001), as did surgeons with and without knowledge of the BPGs (2.5 vs 2.2, p < 0.001). BPG awareness and compliance showed a moderate positive correlation (r = 0.48, p < 0.001), with non-significant associations between compliance and both years in practice (r = 0.41, p = 0.64) and yearly caseload (r = 0.02, p = 0.87). CONCLUSION: Surgeons reported high or perfect compliance 81.5% of the time with BPGs for preventing wrong-level surgery. Authorship and BPG awareness showed increased compliance. Location, study group membership, years in practice, and yearly caseload did not affect compliance. LEVEL OF EVIDENCE: Level V-expert opinion.

Evaluating compliance with the 2013 best practice guidelines for preventing surgical site infection in high-risk pediatric spine surgery.

PURPOSE: Best Practice Guidelines (BPGs) were published one decade ago to decrease surgical site infection (SSI) in pediatric spinal deformity. Successful implementation has not been established. This study evaluated surgeon compliance with items on the BPG. We hypothesized that BPG authors and surgeons with more experience, higher caseload, and awareness of the BPG would have higher compliance. METHODS: We queried North American and European surgeons, authors and non-authors, and members of various spine study groups on adherence to BPGs using an anonymous survey. Mean compliance scores (MCSs) were developed by correlating Likert responses with MCSs ("None of the time" = no compliance = MCS 0, "Sometimes" = weak to moderate = MCS 1, "Most of the time" = high = MCS 2, "All the time" = perfect = MCS 3). RESULTS: Of the 142 respondents, 73.7% reported high or perfect compliance. Average compliance scores for all guidelines was 2.2 ± 0.4. There were significantly different compliance scores between North American and European surgeons (2.3 vs 1.8, p < 0.001), authors and non-authors (2.5 vs. 2.2, p = 0.023), and surgeons with and without knowledge of the BPGs (2.3 vs. 1.8, p < 0.001). There was a weak correlation between BPG awareness and compliance (r = 0.34, p < 0.001) and no correlation between years in practice (r = 0.0, p = 0.37) or yearly caseload (r = 0.2, p = 0.78) with compliance. CONCLUSIONS: Compliance among our cohort of surgeons surveyed was high. North American surgeons, authors of the BPGs and those aware of the guidelines had increased compliance. Participation in a spine study group, years in practice, and yearly caseload were not associated with compliance. LEVEL OF EVIDENCE: Level V-expert opinion.

Thoracic pediculectomy for acute spinal cord decompression in high-risk spinal deformity correction: illustrative case.

BACKGROUND: Neurological complications are higher in patients with severe spinal deformities (Cobb angle >100°). The authors highlight a known technique for thoracic concave apical pedicle resection that is useful for spinal cord decompression in patients with high-risk spinal deformities in the setting of intraoperative neuromonitoring (IONM) changes. OBSERVATIONS: A 14-year-old female with progressive idiopathic scoliosis presented for evaluation of her clinical deformity. Scoliosis radiographs showed a double major curve pattern comprising a 107° right main thoracic curve and a compensatory 88° left thoracolumbar curve. She underwent 2 weeks of halo-gravity traction that reduced her major thoracic curve to 72°. During thoracic posterior column osteotomies, the authors were alerted to decreases in IONM signals that were not responsive to increases in mean arterial pressure, traction weight reduction, and convex compression maneuvers. The dural surface was tightly draped over the two thoracic apical pedicles of T7 and T8, so emergent pediculectomies were performed at both levels for spinal cord decompression. IONM signals gradually improved and eventually became even better than baseline. The patient woke up without any neurological deficits. LESSONS: Pediculectomy of the concave apical pedicle(s) should be considered for spinal cord decompression if there are IONM changes during high-risk spinal deformity surgery.

Gynecologic Conditions in a Cohort with Inflammatory Bowel Disease: A Descriptive Analysis.

OBJECTIVE: Past studies have demonstrated that women with inflammatory bowel disease (IBD) have a higher risk of gynecological conditions than do women without it. We aimed to characterize the gynecological histories of Hispanic Women living in Puerto Rico with IBD. METHODS: We identified women, aged 21 to 55 years, with a confirmed IBD diagnosis and receiving follow-up care from the University of Puerto Rico IBD clinics from 2017 through 2020. A questionnaire was administered to acquire sociodemographics, family history, past medical history, IBD diagnosis, and gynecologic aspects. RESULTS: One hundred eighty-six women were recruited. Fifty-three (28%) patients had ulcerative colitis, while 133 (72%) had Crohn's disease. Fifty-six percent of all the participants had a chronic illness in addition to than their IBD. Seventy-four out of 186 patients reported having had at least 1 late period within the last 12 months. Fifty-three (28%) described their period patterns as irregular. Thirty-nine (21%) of the patients reported having been vaccinated against human papillomavirus (HPV), and 8 (4%) had been infected by it. Nine out of 186 (5%) patients reported suffering from infertility. CONCLUSION: The results showed that our Hispanic patients (living in Puerto Rico) had a prevalence of irregular menstrual cycles that was similar to that observed in other populations. On the other hand, the presence of HPV, infertility, and cervical cancer were lower and the frequency of Papanicolaou smears performed higher than what has been seen in the continental United States, suggesting that this topic should be investigated in future studies.

Integrated tire wear buildup and rainfall-runoff model to simulate tire wear particles in stormwater.

This paper presents an approach to integrate tire wear buildup and rainfall-runoff models to simulate tire wear buildup on road surfaces and its subsequent transport in stormwater runoff events. To do so, a buildup model is presented based on vehicle kilometers traveled, vehicle type, vehicle speed, and road roughness within a watershed. This buildup model was integrated into an EPA SWMM model that simulated the runoff of tire wear particles in twelve watersheds in the San Francisco, CA bay area. Results demonstrate that tire wear particle buildup within the watersheds ranged between 0.4 and 0.51 (kg/km2) per hour. Applied to the SWMM model, total event mean tire wear concentrations ranged between 0.5 and 67 µg/L. These concentrations were linearly correlated to depth-integrated samples collected at the outlet of each of the watersheds (R2 = 0.66). The proposed modeling approach can ultimately be applied to create solutions to an emerging stormwater contaminant.

Inefficient Induction of Neutralizing Antibodies against SARS-CoV-2 Variants in Patients with Inflammatory Bowel Disease on Anti-Tumor Necrosis Factor Therapy after Receiving a Third mRNA Vaccine Dose.

Management of inflammatory bowel disease (IBD) often relies on biological and immunomodulatory agents for remission through immunosuppression, raising concerns regarding the SARS-CoV-2 vaccine's effectiveness. The emergent variants have hindered the vaccine neutralization capacity, and whether the third vaccine dose can neutralize SARS-CoV-2 variants in this population remains unknown. This study aims to evaluate the humoral response of SARS-CoV-2 variants in patients with IBD 60 days after the third vaccine dose [BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna)]. Fifty-six subjects with IBD and 12 healthy subjects were recruited. Ninety percent of patients with IBD (49/56) received biologics and/or immunomodulatory therapy. Twenty-four subjects with IBD did not develop effective neutralizing capability against the Omicron variant. Seventy percent (17/24) of those subjects received anti-tumor necrosis factor therapy [10 = adalimumab, 7 = infliximab], two of which had a history of COVID-19 infection, and one subject did not develop immune neutralization against three other variants: Gamma, Epsilon, and Kappa. All subjects in the control group developed detectable antibodies and effective neutralization against all seven SARS-CoV-2 variants. Our study shows that patients with IBD might not be protected against SARS-CoV-2 variants, and more extensive studies are needed to evaluate optimal immunity.

Detoxification of ochratoxin A and zearalenone by Pleurotus ostreatus during in vitro gastrointestinal digestion.

Powdered Pleurotusostreatus (PO) was tested for the detoxification of ochratoxin A (OTA) and zearalenone (ZEN) through in vitro gastrointestinal digestion in the absence and presence of ground feed and cornmeal. Ochratoxin α was detected in the chromatograms after OTA elimination, suggesting the presence of an OTA-hydrolytic enzyme in the PO, whereas ZEN was adsorbed by PO. OTA was totally eliminated at pH 5 and 7, while ZEN was better adsorbed at pH 3. In simulated gastrointestinal conditions conducted without feed matrices, PO eliminated OTA by 85% and ZEN by 23% at the end of the intestinal phase. When digestions were conducted with ground feed and cornmeal, PO eliminated OTA by 13 and 34%, and ZEN by 20 and 2%, respectively. PO demonstrated great potential for OTA detoxification, but the feed matrices adsorbed the mycotoxins, reducing their bioaccessibility considerably in the oral and gastric phases and negatively influencing PO detoxification capacity.

Oxidative stress and neuroinflammation in a rat model of co-morbid obesity and psychogenic stress.

BACKGROUND: There is growing recognition for a reciprocal, bidirectional link between anxiety disorders and obesity. Although the mechanisms linking obesity and anxiety remain speculative, this bidirectionality suggests shared pathophysiological processes. Neuroinflammation and oxidative damage are implicated in both pathological anxiety and obesity. This study investigates the relative contribution of comorbid diet-induced obesity and stress-induced anxiety to neuroinflammation and oxidative stress. METHODS: Thirty-six (36) male Lewis rats were divided into four groups based on diet type and stress exposure: 1) control diet unexposed (CDU) and 2) exposed (CDE), 3) Western-like high-saturated fat diet unexposed (WDU) and 4) exposed (WDE). Neurobehavioral tests were performed to assess anxiety-like behaviors. The catalytic concentrations of glutathione peroxidase and reductase were measured from plasma samples, and neuroinflammatory/oxidative stress biomarkers were measured from brain samples using Western blot. Correlations between behavioral phenotypes and biomarkers were assessed with Pearson's correlation procedures. RESULTS: We found that WDE rats exhibited markedly increased levels of glial fibrillary acidic protein (185 %), catalase protein (215 %), and glutathione reductase (GSHR) enzymatic activity (418 %) relative to CDU rats. Interestingly, the brain protein levels of glutathione peroxidase (GPx) and catalase were positively associated with body weight and behavioral indices of anxiety. CONCLUSIONS: Together, our results support a role for neuroinflammation and oxidative stress in heightened emotional reactivity to obesogenic environments and psychogenic stress. Uncovering adaptive responses to obesogenic environments characterized by high access to high-saturated fat/high-sugar diets and toxic stress has the potential to strongly impact how we treat psychiatric disorders in at-risk populations.

Asociación de invaginación y malrotación intestinal con el Síndrome de Waugh / Association of invagination and intestinal malrotation with Waugh's síndrome

El síndrome de Waugh es una patología del neonato caracterizado por la asociación de una malrotación intestinal a una intususcepción. Existen pocos casos documentados en la literatura, lo que conlleva una baja incidencia. Presentamos el caso de un neonato femenino de 4 meses de edad quien fue llevada a tratamiento quirúrgico con oclusión intestinal y evolución posoperatoria favorable. El objetivo del trabajo es presentar el caso de un síndrome de Waugh en un lactante en cuyo cuadro se debe mantener una alta sospecha diagnostica, apoyándose con la toma de estudios de imagen complementarios ante un cuadro de dolor abdominal en pacientes lactantes cuya resolución diagnostica siempre resulta un reto para el médico. Si bien estas acciones podrán en un futuro reflejar un aumento en la incidencia de este síndrome, también es posible que el manejo de dicho síndrome se optimice. Paciente femenina de 4 meses de edad la cual fue sometida a tres intentos de desinvaginación hidrostática antes de pasar a laparotomía exploradora para corrección definitiva de su patología. La asociación de invaginación con mal rotación intestinal actualmente es subdiagnósticada, debido a la tendencia conservadora actual. Es importante realizar más estudios de imagen antes de iniciar con cualquier estrategia terapéutica, para no retrasar el manejo quirúrgico definitivo que este requiere. De esta manera se podrá ganar en la calidad de los pronósticos de los pacientes(AU)

Waugh's syndrome is a neonatal pathology characterized by the association of intestinal malrotation and intussusception. There is a low number of cases documented in literature, which implies low incidence. Here is a 4 months-old female neonate who was surgically treated because of intestinal occlusion, and her postoperative recovery was favorable. The objective was to present a Waugh's syndrome case in a newborn in which high diagnostic suspicion is important, supported by complementary imaging studies when we face abdominal pain in neonates whose diagnostic resolution is always a challenge to the physician. These actions may show an increase in the incidence of this syndrome in the future; it is also possible that the management of this disease be optimized. Hydrostatic disinvagination was performed three times in this patient before undergoing exploratory laparotomy for final correction of her pathology. The association of invagination and intestinal malrotation is poorly diagnosed at present, due to current conservative tendencies. However, it is important to perform more imaging studies before adopting any therapeutic strategy to avoid delays in the definitive surgical management of this disease(AU)

Schwannoma de retroperitoneo asociado a Neurofibromatosis tipo I / Retroperitoneal Schannoma associated to type I neurofibromatosis

Los Schwannomas son tumores de origen neural, corresponden al 1 por ciento de los tumores de retroperitoneo. En la mayoría de las ocasiones, son tumores de comportamiento benigno, encontrando que solo del 5 - 18 por ciento son malignos y aún menos frecuente es que sean de alto grado en su histología. Se trata de una paciente de 46 años de edad sin antecedentes crónico degenerativos. Con diagnóstico conocido de neurofibromatosis tipo I. Inició su padecimiento actual tres años previos a su ingreso en 2013, al presentar artralgia de rodilla derecha la cual se asocia a mialgias de forma ipsilateral. Se le solicitó como apoyo diagnostico una resonancia magnética de columna dorsal y lumbar, en la que se reporta una tumoración en la región del retroperitoneo de lado derecho con medidas de 10 x 17 cm con aparente origen espinal en L2 y L3. A pesar de ser masas de origen neural benignas la mayoría de las veces, no es infrecuente su malignización encontrando una cavidad con estructuras vecinas tomada por el tumor. En estos casos, es de vital importancia el manejo preoperatorio de manera multidisciplinaria tanto en la preparación preoperatoria, así como durante el procedimiento quirúrgico(AU)

Schwannomas are tumors of neural origin and account for 1 percent of retroperitoneal tumors. In many times, they are benign tumors and just 5 to 8 percent are malignant; high degree is even less frequent in its histology. This is a male patient aged 46 years with no history of chronic degenerative problems and diagnosis of type I neurofibromatosis. The disease appeared three years before his admission to hospital in 2013 because of right knee arthralgia associated to myalgias on the same side. Diagnostic support was requested in terms of performance of magnetic resonance of dorsal and lumbar spine; this test reported the presence of a tumor in the right side of the retroperitoneal region, it measured 10 x 17 cm with apparent spinal origin in L2 and L3. Although they are often masses of benign neural origin, their malignization is not rare. There was a cavity with adjoining structures affected by the tumor. In this type of cases, the preoperative management with multidisciplinary involvement both in the preoperative preparation and during the surgical procedure is of vital importance(AU)

Asociación de invaginación y malrotación intestinal con el Síndrome de Waugh / Association of invagination and intestinal malrotation with Waugh's síndrome

RESUMEN El síndrome de Waugh es una patología del neonato caracterizado por la asociación de una malrotación intestinal a una intususcepción. Existen pocos casos documentados en la literatura, lo que conlleva una baja incidencia. Presentamos el caso de un neonato femenino de 4 meses de edad quien fue llevada a tratamiento quirúrgico con oclusión intestinal y evolución posoperatoria favorable. El objetivo del trabajo es presentar el caso de un síndrome de Waugh en un lactante en cuyo cuadro se debe mantener una alta sospecha diagnostica, apoyándose con la toma de estudios de imagen complementarios ante un cuadro de dolor abdominal en pacientes lactantes cuya resolución diagnostica siempre resulta un reto para el médico. Si bien estas acciones podrán en un futuro reflejar un aumento en la incidencia de este síndrome, también es posible que el manejo de dicho síndrome se optimice. Paciente femenina de 4 meses de edad la cual fue sometida a tres intentos de desinvaginación hidrostática antes de pasar a laparotomía exploradora para corrección definitiva de su patología. La asociación de invaginación con mal rotación intestinal actualmente es subdiagnósticada, debido a la tendencia conservadora actual. Es importante realizar más estudios de imagen antes de iniciar con cualquier estrategia terapéutica, para no retrasar el manejo quirúrgico definitivo que este requiere. De esta manera se podrá ganar en la calidad de los pronósticos de los pacientes(AU)

ABSTRACT Waugh's syndrome is a neonatal pathology characterized by the association of intestinal malrotation and intussusception. There is a low number of cases documented in literature, which implies low incidence. Here is a 4 months-old female neonate who was surgically treated because of intestinal occlusion, and her postoperative recovery was favorable. The objective was to present a Waugh's syndrome case in a newborn in which high diagnostic suspicion is important, supported by complementary imaging studies when we face abdominal pain in neonates whose diagnostic resolution is always a challenge to the physician. These actions may show an increase in the incidence of this syndrome in the future; it is also possible that the management of this disease be optimized. Hydrostatic disinvagination was performed three times in this patient before undergoing exploratory laparotomy for final correction of her pathology. The association of invagination and intestinal malrotation is poorly diagnosed at present, due to current conservative tendencies. However, it is important to perform more imaging studies before adopting any therapeutic strategy to avoid delays in the definitive surgical management of this disease(AU)

Schwannoma de retroperitoneo asociado a Neurofibromatosis tipo I / Retroperitoneal Schannoma associated to type I neurofibromatosis

RESUMEN Los Schwannomas son tumores de origen neural, corresponden al 1 por ciento de los tumores de retroperitoneo. En la mayoría de las ocasiones, son tumores de comportamiento benigno, encontrando que solo del 5 - 18 por ciento son malignos y aún menos frecuente es que sean de alto grado en su histología. Se trata de una paciente de 46 años de edad sin antecedentes crónico degenerativos. Con diagnóstico conocido de neurofibromatosis tipo I. Inició su padecimiento actual tres años previos a su ingreso en 2013, al presentar artralgia de rodilla derecha la cual se asocia a mialgias de forma ipsilateral. Se le solicitó como apoyo diagnostico una resonancia magnética de columna dorsal y lumbar, en la que se reporta una tumoración en la región del retroperitoneo de lado derecho con medidas de 10 x 17 cm con aparente origen espinal en L2 y L3. A pesar de ser masas de origen neural benignas la mayoría de las veces, no es infrecuente su malignización encontrando una cavidad con estructuras vecinas tomada por el tumor. En estos casos, es de vital importancia el manejo preoperatorio de manera multidisciplinaria tanto en la preparación preoperatoria, así como durante el procedimiento quirúrgico(AU)

ABSTRACT Schwannomas are tumors of neural origin and account for 1 percent of retroperitoneal tumors. In many times, they are benign tumors and just 5 to 8 percent are malignant; high degree is even less frequent in its histology. This is a male patient aged 46 years with no history of chronic degenerative problems and diagnosis of type I neurofibromatosis. The disease appeared three years before his admission to hospital in 2013 because of right knee arthralgia associated to myalgias on the same side. Diagnostic support was requested in terms of performance of magnetic resonance of dorsal and lumbar spine; this test reported the presence of a tumor in the right side of the retroperitoneal region, it measured 10 x 17 cm with apparent spinal origin in L2 and L3. Although they are often masses of benign neural origin, their malignization is not rare. There was a cavity with adjoining structures affected by the tumor. In this type of cases, the preoperative management with multidisciplinary involvement both in the preoperative preparation and during the surgical procedure is of vital importance(AU)