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2.
Nat Commun ; 12(1): 3199, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045463

RESUMO

In patients with metastatic cancer, spatial heterogeneity of somatic alterations may lead to incomplete assessment of a cancer's mutational profile when analyzing a single tumor biopsy. In this study, we perform sequencing of cell-free DNA (cfDNA) and distinct metastatic tissue samples from ten rapid autopsy cases with pre-treated metastatic cancer. We show that levels of heterogeneity in genetic biomarkers vary between patients but that gene expression signatures representative of the tumor microenvironment are more consistent. Across nine patients with plasma samples available, we are able to detect 62/62 truncal and 47/121 non-truncal point mutations in cfDNA. We observe that mutation clonality in cfDNA is correlated with the number of metastatic lesions in which the mutation is detected and use this result to derive a clonality threshold to classify truncal and non-truncal driver alterations with reasonable specificity. In contrast, mutation truncality is more often incorrectly assigned when studying single tissue samples. Our results demonstrate the utility of a single cfDNA sample relative to that of single tissue samples when treating patients with metastatic cancer.


Assuntos
Autopsia/métodos , DNA Tumoral Circulante/genética , Análise Mutacional de DNA/métodos , Neoplasias/diagnóstico , Microambiente Tumoral/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Quimiorradioterapia Adjuvante , Estudos de Coortes , Variações do Número de Cópias de DNA , Feminino , Heterogeneidade Genética , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias/sangue , Neoplasias/patologia , Neoplasias/terapia , Mutação Puntual , RNA-Seq , Valores de Referência , Sensibilidade e Especificidade , Análise Espacial , Fatores de Tempo , Sequenciamento Completo do Exoma
4.
Sci Rep ; 10(1): 11602, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665582

RESUMO

Atomically thin polycrystalline transition-metal dichalcogenides (TMDs) are relevant to both fundamental science investigation and applications. TMD thin-films present uniquely difficult challenges to effective nanoscale crystalline characterization. Here we present a method to quickly characterize the nanocrystalline grain structure and texture of monolayer WS2 films using scanning nanobeam electron diffraction coupled with multivariate statistical analysis of the resulting data. Our analysis pipeline is highly generalizable and is a useful alternative to the time consuming, complex, and system-dependent methodology traditionally used to analyze spatially resolved electron diffraction measurements.

5.
Phys Rev Lett ; 123(7): 076801, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31491121

RESUMO

Structural defects in 2D materials offer an effective way to engineer new material functionalities beyond conventional doping. We report on the direct experimental correlation of the atomic and electronic structure of a sulfur vacancy in monolayer WS_{2} by a combination of CO-tip noncontact atomic force microscopy and scanning tunneling microscopy. Sulfur vacancies, which are absent in as-grown samples, were deliberately created by annealing in vacuum. Two energetically narrow unoccupied defect states followed by vibronic sidebands provide a unique fingerprint of this defect. Direct imaging of the defect orbitals, together with ab initio GW calculations, reveal that the large splitting of 252±4 meV between these defect states is induced by spin-orbit coupling.

6.
ACS Nano ; 13(9): 10520-10534, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31393700

RESUMO

Control of impurity concentrations in semiconducting materials is essential to device technology. Because of their intrinsic confinement, the properties of two-dimensional semiconductors such as transition metal dichalcogenides (TMDs) are more sensitive to defects than traditional bulk materials. The technological adoption of TMDs is dependent on the mitigation of deleterious defects and guided incorporation of functional foreign atoms. The first step toward impurity control is the identification of defects and assessment of their electronic properties. Here, we present a comprehensive study of point defects in monolayer tungsten disulfide (WS2) grown by chemical vapor deposition using scanning tunneling microscopy/spectroscopy, CO-tip noncontact atomic force microscopy, Kelvin probe force spectroscopy, density functional theory, and tight-binding calculations. We observe four different substitutional defects: chromium (CrW) and molybdenum (MoW) at a tungsten site, oxygen at sulfur sites in both top and bottom layers (OS top/bottom), and two negatively charged defects (CD type I and CD type II). Their electronic fingerprints unambiguously corroborate the defect assignment and reveal the presence or absence of in-gap defect states. CrW forms three deep unoccupied defect states, two of which arise from spin-orbit splitting. The formation of such localized trap states for CrW differs from the MoW case and can be explained by their different d shell energetics and local strain, which we directly measured. Utilizing a tight-binding model the electronic spectra of the isolectronic substitutions OS and CrW are mimicked in the limit of a zero hopping term and infinite on-site energy at a S and W site, respectively. The abundant CDs are negatively charged, which leads to a significant band bending around the defect and a local increase of the contact potential difference. In addition, CD-rich domains larger than 100 nm are observed, causing a work function increase of 1.1 V. While most defects are electronically isolated, we also observed hybrid states formed between CrW dimers. The important role of charge localization, spin-orbit coupling, and strain for the formation of deep defect states observed at substitutional defects in WS2 as reported here will guide future efforts of targeted defect engineering and doping of TMDs.

7.
Sci Rep ; 9(1): 2768, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808883

RESUMO

Materials for nanophotonic devices ideally combine ease of deposition, very high refractive index, and facile pattern formation through lithographic templating and/or etching. In this work, we present a scalable method for producing high refractive index WS2 layers by chemical conversion of WO3 synthesized via atomic layer deposition (ALD). These conformal nanocrystalline thin films demonstrate a surprisingly high index of refraction (n > 3.9), and structural fidelity compatible with lithographically defined features down to ~10 nm. Although this process yields highly polycrystalline films, the optical constants are in agreement with those reported for single crystal bulk WS2. Subsequently, we demonstrate three photonic structures - first, a two-dimensional hole array made possible by patterning and etching an ALD WO3 thin film before conversion, second, an analogue of the 2D hole array first patterned into fused silica before conformal coating and conversion, and third, a three-dimensional inverse opal photonic crystal made by conformal coating of a self-assembled polystyrene bead template. These results can be trivially extended to other transition metal dichalcogenides, thus opening new opportunities for photonic devices based on high refractive index materials.

8.
ACS Nano ; 13(2): 1284-1291, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30645100

RESUMO

Two-dimensional materials with engineered composition and structure will provide designer materials beyond conventional semiconductors. However, the potentials of defect engineering remain largely untapped, because it hinges on a precise understanding of electronic structure and excitonic properties, which are not yet predictable by theory alone. Here, we utilize correlative, nanoscale photoemission spectroscopy to visualize how local introduction of defects modifies electronic and excitonic properties of two-dimensional materials at the nanoscale. As a model system, we study chemical vapor deposition grown monolayer WS2, a prototypical, direct gap, two-dimensional semiconductor. By cross-correlating nanoscale angle-resolved photoemission spectroscopy, core level spectroscopy, and photoluminescence, we unravel how local variations in defect density influence electronic structure, lateral band alignment, and excitonic phenomena in synthetic WS2 monolayers.

9.
J Clin Oncol ; 36(18): 1805-1812, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-29688832

RESUMO

Purpose The breakthrough therapy program was established in 2012 to expedite the development and review of new medicines. We evaluated the times to approval, efficacy, and safety of breakthrough-designated versus non-breakthrough-designated cancer drugs approved by the US Food and Drug Administration (FDA). Methods We studied all new cancer drugs approved by the FDA between January 2012 and December 2017. Regulatory and therapeutic characteristics (time to FDA approval, pivotal trial efficacy end point, novelty of mechanism of action) were compared between breakthrough-designated and non-breakthrough-designated cancer drugs. Random-effects meta-regression was used to assess the association between breakthrough therapy designation and hazard ratios for progression-free survival (PFS), response rates (RRs) for solid tumors, serious adverse events, and deaths not attributed to disease progression. Results Between 2012 and 2017, the FDA approved 58 new cancer drugs, 25 (43%) of which received breakthrough therapy designation. The median time to first FDA approval was 5.2 years for breakthrough-designated drugs versus 7.1 years for non-breakthrough-designated drugs (difference, 1.9 years; P = .01). There were no statistically significant differences between breakthrough-designated and non-breakthrough-designated drugs in median PFS gains (8.6 v 4.0 months; P = .11), hazard ratios for PFS (0.43 v 0.51; P = .28), or RRs for solid tumors (37% v 39%; P = .74). Breakthrough therapy-designated drugs were not more likely to act via a novel mechanism of action (36% v 39%; P = 1.00). Rates of deaths (6% v 4%; P = .99) and serious adverse events (38% v 36%; P = 0.93) were also similar in breakthrough-designated and non-breakthrough-designated drugs. Conclusion Breakthrough-designated cancer drugs were associated with faster times to approval, but there was no evidence that these drugs provide improvements in safety or novelty; nor was there a statistically significant efficacy advantage when compared with non-breakthrough-designated drugs.


Assuntos
Antineoplásicos/administração & dosagem , Aprovação de Drogas/métodos , Neoplasias/tratamento farmacológico , Antineoplásicos/efeitos adversos , Estudos de Coortes , Drogas em Investigação/administração & dosagem , Drogas em Investigação/efeitos adversos , Humanos , Intervalo Livre de Progressão , Análise de Regressão , Estados Unidos , United States Food and Drug Administration
10.
Tissue Eng Part A ; 24(7-8): 559-568, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28726588

RESUMO

We developed methods for conditionally reprogramming (CR) primary human bronchial epithelial cells (HBECs) to extend their functional lifespan and permit their differentiation into both upper and lower airway lung epithelium. We also developed a bioreactor to support vascular perfusion and rhythmic breathing of decellularized mouse lungs reconstituted with CR HBECs isolated from patients with and without cystic fibrosis (CF). While conditionally reprogrammed cells only differentiate into an upper airway epithelium after 35 days at the air-liquid interface, in reconstituted lungs these cells differentiate into upper airway bronchial epithelium and lower airway alveolar structures after 12 days. Rapid scale-up and the ability to obtain clonal derivatives of primary patient-derived HBECs without the need for genetic manipulation may permit rapid reconstitution of the lung epithelium; facilitating the study of lung disease in tissue-engineered models.


Assuntos
Brônquios/citologia , Células Epiteliais/citologia , Pulmão/citologia , Animais , Diferenciação Celular/fisiologia , Células Cultivadas , Fibrose Cística/metabolismo , Células Epiteliais/metabolismo , Camundongos , Engenharia Tecidual
11.
Health Serv Res ; 53(4): 2118-2132, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28748564

RESUMO

OBJECTIVE: To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer. DATA SOURCES/STUDY SETTING/STUDY DESIGN: 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims. DATA COLLECTION/EXTRACTION METHODS: We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death. PRINCIPAL FINDINGS: Over the year of diagnosis, mean spending was $35,849, $26,295, $55,597, and $63,063 for breast, prostate, lung, and colorectal cancer, respectively. Over the year of death, spending was similar across different cancer types and stage at diagnosis. CONCLUSIONS: Characterization of Medicare spending according to clinically meaningful categories may assist development of oncology alternative payment models and cost-effectiveness models.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias Colorretais/mortalidade , Gastos em Saúde/estatística & dados numéricos , Neoplasias Pulmonares/mortalidade , Medicare/economia , Neoplasias da Próstata/mortalidade , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias Colorretais/epidemiologia , Planos de Pagamento por Serviço Prestado , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias da Próstata/epidemiologia , Programa de SEER/estatística & dados numéricos , Estados Unidos/epidemiologia
12.
Sci Rep ; 7(1): 4643, 2017 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-28680143

RESUMO

Due to its high refractive index and low absorption coefficient, gallium phosphide is an ideal material for photonic structures targeted at the visible wavelengths. However, these properties are only realized with high quality epitaxial growth, which limits substrate choice and thus possible photonic applications. In this work, we report the fabrication of single crystal gallium phosphide thin films on transparent glass substrates via transfer bonding. GaP thin films on Si (001) and (112) grown by MOCVD are bonded to glass, and then the growth substrate is removed with a XeF2 vapor etch. The resulting GaP films have surface roughnesses below 1 nm RMS and exhibit room temperature band edge photoluminescence. Magnesium doping yielded p-type films with a carrier density of 1.6 × 1017 cm-3 that exhibited mobilities as high as 16 cm2V-1s-1. Due to their unique optical properties, these films hold much promise for use in advanced optical devices.

13.
J Foot Ankle Surg ; 56(4): 813-816, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28633783

RESUMO

The flexor hallucis longus tendon transfer is commonly used to restore function in chronic Achilles tendon ruptures and chronic Achilles tendinopathy. The tendon is often secured to the calcaneus either through a bone tunnel or by an interference screw. We hypothesized that tenodesis using the bone tunnel method would be mechanically superior to interference screw fixation for flexor hallucis longus transfers. Eight matched pairs of cadaveric specimens were assigned randomly to the bone tunnel or interference screw technique and were loaded to failure. Biomechanical analysis was performed to evaluate the ultimate strength, peak stress, Young's modulus, failure strain, and strain energy. Unpaired comparison, paired comparison, and linear regression analyses were used to determine statistical significance. A slight 22% ± 9% decrease in Young's modulus and a 52% ± 18% increase of strain energy were found in the interference screw group. However, no differences in ultimate strength, peak stress, or failure strain were seen between the 2 groups on paired comparison. Our findings suggest that interference screw fixation provides similar spontaneous biomechanical properties to the use of a bone tunnel for flexor hallucis longus transfer to the calcaneus. The interference screw is a practical option for fixation of the flexor hallucis longus tendon to the calcaneus and can be performed through a single incision approach.


Assuntos
Tendão do Calcâneo/cirurgia , Calcâneo/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tenodese/métodos , Tendão do Calcâneo/lesões , Tendão do Calcâneo/fisiopatologia , Adulto , Fenômenos Biomecânicos , Parafusos Ósseos , Cadáver , Doença Crônica , Humanos , Pessoa de Meia-Idade , Distribuição Aleatória , Ruptura , Traumatismos dos Tendões/fisiopatologia , Adulto Jovem
15.
Cochrane Database Syst Rev ; 2: CD011774, 2017 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-28211045

RESUMO

BACKGROUND: Walk-in clinics are growing in popularity around the world as a substitute for traditional medical care delivered in physician offices and emergency rooms, but their clinical efficacy is unclear. OBJECTIVES: To assess the quality of care and patient satisfaction of walk-in clinics compared to that of traditional physician offices and emergency rooms for people who present with basic medical complaints for either acute or chronic issues. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers on 22 March 2016 together with reference checking, citation searching, and contact with study authors to identify additional studies. We applied no restrictions on language, publication type, or publication year. SELECTION CRITERIA: Study design: randomized trials, non-randomized trials, and controlled before-after studies. POPULATION: standalone physical clinics not requiring advance appointments or registration, that provided basic medical care without expectation of follow-up. Comparisons: traditional primary care practices or emergency rooms. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. MAIN RESULTS: The literature search identified 6587 citations, of which we considered 65 to be potentially relevant. We reviewed the abstracts of all 65 potentially relevant studies and retrieved the full texts of 12 articles thought to fit our study criteria. However, following independent author assessment of the full texts, we excluded all 12 articles. AUTHORS' CONCLUSIONS: Controlled trial evidence about the mortality, morbidity, quality of care, and patient satisfaction of walk-in clinics is currently not available.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Doença Crônica/terapia , Serviço Hospitalar de Emergência/normas , Consultórios Médicos/normas , Qualidade da Assistência à Saúde , Gerenciamento Clínico , Humanos
16.
Kidney Int ; 91(2): 324-337, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27914707

RESUMO

The kidney controls systemic calcium and phosphate levels and disturbances of its control mechanisms can lead to a variety of diseases. The insulin-sensitizing adipokine adiponectin is renoprotective and accelerates functional recovery following renal injury. However, unlike other adipokines, adiponectin is reduced in obesity. High adiponectin levels are also correlated with bone loss, suggestive of an additional action in mineral metabolism. Using knockout, wild-type, and adiponectin-overexpressing transgenic mice, we sought to identify the mechanistic basis for adiponectin's ability to regulate calcium and phosphate balance at the level of the kidney. Adiponectin knockout mice exhibited lower serum calcium, lower urinary calcium excretion, and markedly lower serum fibroblast growth factor 23 (FGF23) levels, although circulating klotho concentrations were significantly higher than in wild-type littermates. The transgenic mice exhibited lower bone mass and strength, particularly compared to adiponectin knockout mice. The transgenic mice were hyper-responsive to a 2% phosphate-enriched diet, exhibiting 2-fold higher serum FGF23 and concomitantly higher fractional phosphate excretion. These mice also excreted more calcium with calcium-enriched diet and had less renal klotho protein expression. In contrast, the knockout mice exhibited a smaller increase in FGF23 and maintained elevated klotho levels on both mineral challenges. Kidney-specific adiponectin expression in doxycycline-inducible adiponectin mice and adiponectin addition in vitro confirmed adiponectin's ability to reduce tubular epithelial cell klotho secretion. Thus, adiponectin alters calcium and phosphate balance and renal mineral excretion, in part, through klotho. This work highlights the profound effects of adipose tissue on renal function and has identified a new mechanism by which adiponectin may regulate bone mass.


Assuntos
Adiponectina/metabolismo , Cálcio na Dieta/metabolismo , Glucuronidase/sangue , Rim/metabolismo , Fosfatos/metabolismo , Fósforo na Dieta/metabolismo , Eliminação Renal , Adiponectina/deficiência , Adiponectina/genética , Animais , Fenômenos Biomecânicos , Cálcio na Dieta/sangue , Cálcio na Dieta/urina , Colágeno/metabolismo , Cães , Fêmur/metabolismo , Fatores de Crescimento de Fibroblastos/sangue , Fibrose , Genótipo , Glucuronidase/genética , Homeostase , Hormônios/sangue , Rim/patologia , Túbulos Renais/metabolismo , Células Madin Darby de Rim Canino , Masculino , Camundongos Knockout , Osteogênese , Fenótipo , Fosfatos/sangue , Fosfatos/urina , Fósforo na Dieta/sangue , Fósforo na Dieta/urina , Coluna Vertebral/metabolismo , Transfecção
17.
J Hosp Med ; 11(9): 658-61, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27596543

RESUMO

Accountable care organizations (ACOs) have shown promise in reducing healthcare spending growth, but have proven to be financially unsustainable for many healthcare organizations. Even ACOs with shared savings have experienced overall losses because the shared savings bonuses have not covered the costs of delivering population health. As physicians and former ACO leaders, we believe in the concept of accountable care, but ACOs need to evolve if they are to have a viable future. We propose the novel possibility of allowing ACOs to bill fee-for-service for their population health interventions, a concept we call population health billing. Journal of Hospital Medicine 2016;11:658-661. © 2016 Society of Hospital Medicine.


Assuntos
Organizações de Assistência Responsáveis/economia , Atenção à Saúde/métodos , Planos de Pagamento por Serviço Prestado , Atenção à Saúde/economia , Humanos , Medicare/economia , Patient Protection and Affordable Care Act , Estados Unidos
18.
Connect Tissue Res ; 55(3): 205-16, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24559385

RESUMO

The topographical variations of the zonal properties of canine articular cartilage over the medial tibia were evaluated as the function of external loading by microscopic magnetic resonance imaging (µMRI). T2 and T1 relaxation maps and GAG (glycosaminoglycan) images from a total of 70 specimens were obtained with and without the mechanical loading at 17.6 µm depth resolution. In addition, mechanical modulus and water content were measured from the tissue. For the bulk without loading, the means of T2 at magic angle (43.6 ± 8.1 ms), absolute thickness (907.6 ± 187.9 µm) and water content (63.3 ± 9.3%) on the meniscus-covered area were significantly lower than the means of T2 at magic angle (51.1 ± 8.5 ms), absolute thickness (1251.6 ± 218.4 µm) and water content (73.2 ± 5.6%) on the meniscus-uncovered area. However GAG (86.0 ± 15.3 mg/ml) on the covered area was significantly higher than GAG (70.0 ± 8.8 mg/ml) on the uncovered area. Complex relationships were found in the tissue properties as the function of external loading. The tissue parameters in the superficial zone changed more profoundly than the same properties in the radial zone. The tissue parameters in the meniscus-covered areas changed differently when comparing with the same parameters in the uncovered areas. This project confirms that the load-induced changes in the molecular distribution and structure of cartilage are both depth-dependent and topographically distributed. Such detailed knowledge of the tibial layer could improve the early detection of the subtle softening of the cartilage that will eventually lead to the clinical diseases such as osteoarthritis.


Assuntos
Cartilagem Articular/patologia , Cartilagem/patologia , Imageamento por Ressonância Magnética , Tíbia/patologia , Animais , Cães , Humanos , Articulações/patologia , Masculino , Osteoartrite/patologia
19.
Adv Mater ; 25(29): 4018-22, 2013 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-23754531

RESUMO

A transparent, flexible contact is developed using Ni nanoparticles and Ag nanowires and demonstrated on free-standing, polymer embedded, Si microwire solar cells. Contact yields of over 99% and a series resistance of 14 Ω cm² are demonstrated.


Assuntos
Fontes de Energia Elétrica , Compostos Inorgânicos/química , Membranas Artificiais , Nanopartículas Metálicas/química , Nanopartículas Metálicas/ultraestrutura , Metais/química , Energia Solar , Módulo de Elasticidade , Desenho de Equipamento , Análise de Falha de Equipamento , Compostos Inorgânicos/efeitos da radiação , Teste de Materiais , Metais/efeitos da radiação , Tamanho da Partícula
20.
Global Spine J ; 3(4): 231-6, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24436874

RESUMO

Study Design Single-center, retrospective study. Objective Suboptimal concentrations of vitamin D have been linked to hip and knee osteoarthritis in large, population-based cohort studies. We sought to examine the association of vitamin D levels with intervertebral disk disease. Methods From January 2010 through May 2011, 91 consecutive, eligible adult spine surgery patients who had undergone cervical magnetic resonance imaging (MRI) and preoperative serum 25-hydroxyvitamin D (s25D) measurement were retrospectively included. MRI was read for C2-T1 disk herniation and degeneration (grades I to V). Logistic regressions were performed. Results Compared with the 384 disks of nondeficient patients, 162 disks of vitamin D-deficient (< 20 ng/mL) patients were more frequently herniated (40% versus 27%, p = 0.004); deficiency was not predictive of individual disk grade (unadjusted odds ratio [uOR] = 0.98, p = 0.817). On regression analysis, deficiency was associated with increased number of herniations per patient (uOR = 2.17, 95% confidence interval [CI] = 1.22 to 3.87, p = 0.009; adjusted odds ratio [aOR] = 2.12, 95% CI = 1.11 to 4.03, p = 0.023). When disks were analyzed individually, and levels (e.g., C5 to C6), additionally controlled for, deficiency correlated with greater likelihood of herniation per disk (uOR = 1.81, 95% CI = 1.22 to 2.66, p = 0.003; aOR = 2.06, 95% CI = 1.25 to 3.41, p = 0.005). Conclusion Among adults undergoing spine surgery at our institution, vitamin D deficiency was associated with cervical disk herniation. Considering the current epidemics of vitamin D insufficiency and neck pain, further investigation is warranted, as these data were retrospectively collected and subject to sampling bias.

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