Factors influencing discharge against medical advice (DAMA) in traumatic brain injury patients requiring decompressive surgery: a comprehensive analysis.

raumatic brain injury (TBI) is a significant global health concern, particularly affecting young individuals, and is a leading cause of mortality and morbidity worldwide. Despite improvements in treatment infrastructure, many TBI patients choose discharge against medical advice (DAMA), often declining necessary surgical interventions. We aimed to investigate the factors that can be associated with DAMA in TBI patients that were recommended to have surgical treatment. This study was conducted at single tertiary university center (2008-2018), by retrospectively reviewing 1510 TBI patients whom visited the emergency room. We analyzed 219 TBI surgical candidates, including 50 declining surgery (refused group) and the others whom agreed and underwent decompressive surgery. Retrospective analysis covered demographic characteristics, medical history, insurance types, laboratory results, CT scan findings, and GCS scores. Statistical analyses identified factors influencing DAMA. Among surgical candidates, 169 underwent surgery, while 50 declined. Age (60.8 ± 17.5 vs. 70.5 ± 13.8 years; p < 0.001), use of anticoagulating medication (p = 0.015), and initial GCS scores (9.0 ± 4.3 vs. 5.3 ± 3.2; p < 0.001) appeared to be associated with refusal of decompressive surgery. Based on our analysis, factors influencing DAMA for decompressive surgery included age, anticoagulant use, and initial GCS scores. Contrary to general expectations and some previous studies, our analysis revealed that the patients' medical conditions had a larger impact than socioeconomic status under the Korean insurance system, which fully covers treatment for TBI. This finding provides new insights into the factors affecting DAMA and could be valuable for future administrative plans involving national insurance.

Tadpole growth rates and gut bacterial community: Dominance of developmental stages over temperature variations.

Tadpoles present an intriguing model system for studying the regulation and selection of gut microbiota. They offer a unique perspective to enhance our understanding of host-microbiota interactions, given their capacity to alter the dynamics of the gut microbial community by interacting with multiple environmental factors within a complex life cycle. In this study, we comprehensively investigated variations in growth rate and gut bacterial community in relation to temperature differences during the complex process of amphibian metamorphosis. Higher temperatures prompted tadpoles to metamorphose more rapidly than at lower temperatures, but the impact on size and weight was minimal. Differences in temperature were not associated with gut bacterial diversity, but they did affect certain aspects of beta diversity and bacterial composition. However, the developmental stage invoked greater heterogeneity than temperature in gut bacterial diversity, composition, and functional groups. These findings suggest that inherent biological systems exert stronger control over an organism's homeostasis and variation than the external environment. Although results may vary based on the magnitude or type of environmental factors, metamorphosis in tadpoles greatly influences their biology, potentially dominating microbial interactions.

Gut bacterial diversity in Vespa velutina and implications for potential adaptation in South Korea.

BACKGROUND: Invasive species such as the yellow-legged hornet (Vespa velutina), along with four other Vespa species - Vespa analis, Vespa crabro, Vespa ducalis, and Vespa mandarinia - pose significant threats to the environment, economy, and human health. This study focuses on understanding the key factors contributing to the successful invasion of these species, particularly V. velutina, in South Korea. The analysis encompasses the gut bacterial communities and stable isotopes of carbon and nitrogen of the queen hornets, aiming to identify variances in gut microbial composition and food resource utilization. RESULTS: The gut bacterial communities in the five Vespa species were primarily composed of Proteobacteria, with Firmicutes and Bacteroidetes present. Vespa velutina and V. mandarinia had higher Firmicutes abundance at the phylum level, possibly indicating an increased capacity for dietary fiber breakdown and short-chain fatty acid production, providing them with a competitive edge. No significant differences in nitrogen and carbon stable isotope values were found among the five Vespa species, suggesting that they fed on similar food sources. However, V. velutina had a higher number of unique gut bacterial operational taxonomic units (OTUs), implying adaptation through the acquisition of a distinct gut bacterial set. Significant correlations were found between the observed index and the Shannon index, and between δ15 N and the observed index, suggesting that the food source diversity may influence the gut bacterial community diversity. CONCLUSION: Our study offered valuable insights regarding the adaptation of V. velutina to its new environment in South Korea. The potential role of gut microbiota in the success of invasive species was elucidated. This information is crucial for the management of invasive species, targeted control methods, and implementing preventive regulations. Further studies with larger sample sizes and comprehensive sampling are required to gain a complete understanding of the gut microbiota of Vespa species and their adaptation to new environments. © 2023 Society of Chemical Industry.

The Gut Bacterial Community of Chlaenius pallipes (Coleoptera: Carabidae) Associates with Their Habitat and Morphology.

We investigated whether the gut bacterial community of Chlaenius pallipes could represent the health conditions of individuals or populations based on where these beetles inhabit. Considering the ecological traits of the species, the gut bacterial communities of carabid populations inhabiting stable or unstable habitats were compared. Food resource quality (δ15N) and morphological shape, especially body and wing size, may be significant factors that directly or indirectly affect the gut bacterial community of carabid beetles. Firmicutes (51.7%) and Proteobacteria (36.3%) were the predominant phyla in the gut bacterial community of C. pallipes. A significant difference in the gut bacterial community structure was observed between organisms inhabiting unstable and stable habitats in this study. Wing size, as estimated by centroid size, was correlated with differences in the gut bacterial community composition of the species. Even if a factor is not strong enough to determine the survival of carabid beetles, the composition of the gut bacterial community can change. We found that although each individual has a large variation in the gut bacterial community composition, the gut bacterial community can be used to evaluate the condition of each habitat through consistent investigation. Habitat assessment based on changes in the number of carabid beetle species and their composition requires relatively long-term research; however, the gut bacterial community of carabid beetles can help identify short-term environmental changes.

Elucidating the effect of mechanical stretch stress on the mechanism of ligamentum flavum hypertrophy: Development of a novel in vitro multi-torsional stretch loading device.

OBJECTIVE: We developed a novel multi-torsional mechanical stretch stress loading device for ligamentum flavum cells and evaluated its influence on the development of ligamentum flavum hypertrophy, a common cause of lumbar spinal canal stenosis. MATERIALS AND METHODS: Stretch strength of the device was optimized by applying 5% and 15% MSS loads for 24, 48, and 72 h. A cytotoxicity assay of human ligamentum flavum cells was performed and the results were compared to control (0% stress). Inflammatory markers (interleukin [IL]-6, IL-8), vascular endothelial growth factor [VEGF], and extracellular matrix (ECM)-regulating cytokines (matrix metalloproteinase [MMP]-1, MMP-3 and MMP-9, and tissue inhibitor of metalloproteinase [TIMP]-1 and TIMP-2) were quantified via enzyme-linked immunosorbent assay. RESULTS: Using our multi-torsional mechanical stretch stress loading device, 5% stress for 24 hour was optimal for ligamentum flavum cells. Under this condition, the IL-6 and IL-8 levels, VEGF level, and MMP-1, MMP-3, and TIMP-2 were significantly increased, compared to the control. CONCLUSION: Using the novel multi-torsional mechanical stretch stress loading device we confirmed that, mechanical stress enhances the production of inflammatory cytokines and angiogenic factors, and altered the expression of ECM-regulating enzymes, possibly triggering ligamentum flavum hypertrophy.

Genetic and morphological variation of Vespa velutina nigrithorax which is an invasive species in a mountainous area.

The yellow-legged hornet (Vespa velutina nigrithorax) is an invasive species in South Korea with negative economic, ecological, and public health impacts. We investigated genetic and morphological variation in the species populations on Mt. Jiri, the tallest mountain in South Korea. We hypothesized that a high-altitude would be negatively correlated with the genetic diversity of the hornet population, and hornet wing morphology would change with an increase in altitude. Our results showed that the genetic diversity of yellow-legged hornets did not decrease as altitude increased. Regardless of the altitude, the inbreeding coefficient was high at the newly colonized sites. A single genetic population occurred in the mountainous areas examined and gradually expanded its range. Wing morphology, especially shape, did not change with an increase in altitude or decrease in temperature. Although snow cover and cool temperatures at high altitudes could limit nest-building activities, they did not prevent the extension of the range of the species. Therefore, the yellow-legged hornet cannot be controlled naturally by climate or topography; combined approaches, including chemical control, nest removal, and bait-trapping techniques should be implemented.

Decompression with Lateral Pediculectomy and Circumferential Reconstruction for Unstable Thoracolumbar Burst Fractures: Surgical Techniques and Results in 18 Patients.

OBJECTIVE: To introduce our technique and results of retropleural/peritoneal lateral pediculectomy for the decompression of thoracolumbar fractures and reconstruction using an expandable titanium cage and circumferential fixation at a single stage. METHODS: Eighteen patients who had single unstable, burst thoracolumbar fracture were treated by this technique between January 2014 and December 2016 (T12: n = 9, L1: n = 7, L2: n = 2). They were reviewed retrospectively in terms of radiologic outcomes (computed tomography [CT] scan and radiograph), clinical outcomes, and complications. The results were compared with another cohort of thoracolumbar fractures treated by posterior-only surgery. RESULTS: There were no radiologic complications implying pseudoarthrosis or instrument failure on the postoperative 6-month CT scan. There was also no neurologic deterioration or infection during the same period. Two patients (11.1%) of iatrogenic injury and 1 patient of trauma-related injury of the dura were secured without any delayed complications. Three patients (16.7%) with transient weakness in left hip flexion immediately after operation were observed and recovered within 2 weeks in all cases. Six patients (33.3%) complained of dysesthesia and/or hypoesthesia on the incision site. CONCLUSIONS: In this study, we suggest lateral pediculectomy as a distinct anatomic landmark to access and remove bony fragments effectively and safely in unstable thoracolumbar burst fractures. This provides a more straightforward access to the burst fragment and helps the surgeon to make better intraoperative decompression strategies. Moreover, this circumferential instrumentation with anterior support and fusion revealed better restoration of the thoracolumbar spine alignment compared with posterior-only surgery, with acceptable complications rates.

Clinical and Radiological Comparison between Ipsilateral and Contralateral Side Canal Decompression Using an Unilateral Laminotomy Approach.

OBJECTIVE: To compare the clinical and radiological outcome of both sides using the unilateral approach. METHODS: Unilateral laminotomy was performed to achieve bilateral decompression. Thirty-nine patients who underwent this procedure were analyzed prospectively using the Oswestry Disability Index (ODI), the visual analog scale (VAS) pain score to evaluate symptoms in both legs, and the radiological morphometric index to calculate the anteriorposterior diameter and midcanal width. The incidence of complications from this approach was then evaluated. RESULTS: The mean follow-up time was 12.2 months. The mean ODI was 48.4 preoperatively and 14.2 postoperatively. The mean dural sac widening of the ipsilateral side (187.0%) was significantly larger (p<0.01) than that of the the contralateral side (145.6%). The VAS improvement ratio ([preoperative VAS score-postoperative VAS score]/[preoperative VAS score]×100) for the pain in each leg was 75.4%(ipsilateral side) and 73.7%(contralateral side). While the VAS improvement ratio for pain in each side was significantly reduced, the difference in the VAS ratio between sides was statistically insignificant (p=0.64). There were 2 cases (5.1%) of dural tearing during the procedure, 1 case (2.6%) of transient paresthesia of nerve roots, and 2 cases (5.1%) of transient paresthesia of the contralateral nerve root. The transient paresthesias of nerve roots never lasted more than 2 weeks. CONCLUSION: This technique allows for significant decompression of the contralateral canal and excellent clinical outcomes without troublesome complications. Although ipsilateral the dural sac widening was significantly larger than contralateral side, the difference in the clinical outcome between sides was statistically insignificant.

Double Stent Assist Coiling of Ruptured Large Saccular Aneurysm in Proximal Basilar Artery Fenestration.

Basilar artery fenestration is infrequent and even rarer in association with a large aneurysm. With proximity to brain stem and vital perforators, endovascular coiling can be considered first. If the large ruptured aneurysm with a wide neck originated from fenestra of the proximal basilar artery and the fenestration loop has branches of posterior circulation, therapeutic consideration should be thorough and fractionized. We report endovascular therapeutic details for a case of a ruptured large saccular aneurysm in proximal basilar artery fenestration.