Cervical disc arthroplasty (CDA) has emerged as an alternative surgical option to anterior cervical discectomy and fusion (ACDF) for cervical disc pathology, with recent trials demonstrating ...non-inferiority of CDA to ACDF. While short-term trends regarding utilization rates, revision procedures and complications have been explored, longer-term outcomes, specifically involving re-operation rates and type of reoperation are lacking. Therefore, we used the New York Statewide Planning and Research Cooperative Systems (SPARCS) database to characterize subsequent cervical spine surgery in patients undergoing primary elective CDA and ACDF.
Characterize subsequent cervical spine surgery in patients undergoing primary elective CDA and ACDF.
Retrospective state database study.
Patients who underwent elective inpatient CDA and ACDF in New York State.
We analyzed the SPARCS inpatient database from 2005 to 2013 to identify patients who underwent elective inpatient CDA and ACDF procedures. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to extract the index procedures (CDA: 84.61, 84.62; ACDF: 81.02) and to identify patient demographics and cervical re-operation procedures. Patients were longitudinally followed until September 2015, corresponding to a minimum of two year follow-up, to determine the incidence of subsequent cervical spine reoperation, which included another primary CDA or ACDF, revision CDA or ACDF, and posterior cervical fusion. Logistic regression analysis was used to determine the odds of subsequent cervical spine reoperation.
Between January 2005 and September 2013, 731 patients underwent an inpatient CDA and 45,204 underwent an inpatient ACDF. Patients undergoing CDA were more likely to be younger (43.6 vs. 50.7, p<.0001), to have fewer comorbidities (p<.001), and to have a cervical diagnosis of disc displacement (68.4% vs. 46.5%, p<.001). Subsequent cervical spine reoperation rates did not differ at one (OR=1.06, 95%CI=0.60–1.89, p=.840) or two years (OR=1.35, 95%CI=0.95–1.94, p=.099) postoperatively. When analyzing subsequent cervical reoperations, CDA patients were 29 times more likely to return to the operating room to receive a primary ACDF procedure compared to ACDF patients returning to undergo a primary CDA procedure (OR=29.13, 95%CI: 19.52–43.48, p<.001). Patients undergoing CDA had a decreased odds of undergoing another CDA primary procedure at adjacent cervical levels compared to ACDF patients undergoing another primary cervical ACDF procedure (OR:0.17, 95%CI:0.07–0.46, p<.001). Patients undergoing CDA had a decreased odds of undergoing revision CDA compared to ACDF patients undergoing revision ACDF (OR:0.41, 95%CI:0.17–0.98, p=.045). The most common reason for subsequent cervical re-operation after CDA or ACDF was cervical disc displacement (CDA: 28.6%, ACDF: 21.4%).
Compared to patients undergoing ACDF, patients undergoing CDA are more likely to be younger, to have fewer comorbidities and to have a primary diagnosis of cervical disc displacement. While there is no significant difference in subsequent cervical spine re-operation rates between ACDF and CDA, surgeons performing revision procedures at the same cervical level or performing primary procedures at adjacent cervical levels are more likely to utilize ACDF rather than CDA. Further investigation in outpatient primary and revision cervical spine cases is needed to assess these findings.
This abstract does not discuss or include any applicable devices or drugs.
In the United States, the federal government and several state governments are formulating or implementing policies aimed at reducing greenhouse gases emissions. In April 2009, the State of ...California adopted the Low-Carbon Fuel Standard (LCFS), a groundbreaking policy for reducing greenhouse gas emissions in the transportation sector. This paper reviews the major elements of a LCFS, focusing on California's implementation, and discusses the key open issues of a LCFS. This paper also summarizes the major elements of the cap-and-trade and carbon tax concepts, the two principal alternative approaches to regulating greenhouse gases emissions. Analytical issues associated with the LCFS are highlighted, including land-use change effects associated with certain biofuels. If electricity becomes a significant transportation fuel, a number of regulatory issues will need to be addressed. Beyond California, the LCFS approach appears to be favored by several other US states and the European Union. A Hydrogen-Success scenario example illustrates the key features of a national LCFS following California's model.
Selective inhibitors of sodium glucose cotransporter-2 (SGLT2) are widely used for the treatment of type 2 diabetes and act primarily to lower blood glucose by preventing glucose reabsorption in the ...kidney. However, it is controversial whether these agents also act on the pancreatic islet, specifically the alpha cell, to increase glucagon secretion. To determine the effects of SGLT2 on human islets, we analyzed SGLT2 expression and hormone secretion by human islets treated with the SGLT2 inhibitor dapagliflozin (DAPA) in vitro and in vivo. Compared to the human kidney, SLC5A2 transcript expression was 1600-fold lower in human islets and SGLT2 protein was not detected. In vitro, DAPA treatment had no effect on glucagon or insulin secretion by human islets at either high or low glucose concentrations. In mice bearing transplanted human islets, 1 and 4 weeks of DAPA treatment did not alter fasting blood glucose, human insulin, and total glucagon levels. Upon glucose stimulation, DAPA treatment led to lower blood glucose levels and proportionally lower human insulin levels, irrespective of treatment duration. In contrast, after glucose stimulation, total glucagon was increased after 1 week of DAPA treatment but normalized after 4 weeks of treatment. Furthermore, the human islet grafts showed no effects of DAPA treatment on hormone content, endocrine cell proliferation or apoptosis, or amyloid deposition. These data indicate that DAPA does not directly affect the human pancreatic islet, but rather suggest an indirect effect where lower blood glucose leads to reduced insulin secretion and a transient increase in glucagon secretion. (Endocrinology 161: 1-12, 2020) Key Words: diabetes, islet, insulin, glucagon
Nuclear import of plasmid DNA in nondividing cells is a process essential to the success of numerous viral life cycles, gene therapy protocols, and gene expression experiments. Here, intact ...protein-free SV40 DNA was cytoplasmically injected into cells and its subcellular localization was followed by
in situhybridization. SV40 DNA localized to the nucleus consistent with a mechanism of transport through the nuclear pore complex (NPC): import was inhibited by the addition of the NPC-inhibitory agents wheat germ agglutinin and an anti-nucleoporin antibody as well as by energy depletion. DNA transport appeared to be a multistep process with the DNA accumulating at the nuclear periphery before its import. Most importantly, nuclear import was sequence specific: a region of SV40 DNA containing the origin of replication and the early and late promoters supported import, whereas bacterial sequences alone and other SV40-derived sequences did not. The majority of the imported DNA colocalized with the SC-35 splicing complex antigen, suggesting that the intranuclear DNA localizes to areas of transcription or message processing. This link to transcription was strengthened by the finding that inhibition of transcription blocked DNA import but not protein nuclear import. Taken together, these results support a model in which plasmid DNA nuclear import occurs by a mechanism similar to that used by nuclear localization signal-containing proteins but is also dependent on transcription.
Heavy metals are well known to be able to induce immunotoxicity, but comparative metal studies related to apoptosis have not been conducted. In the present study, the effects of arsenic, cadmium, ...gold, lead, manganese, and mercury on thymocytes from BALB/c mice were analyzed. Thymic cells were cultured for 3-24 h in vitro in the absence or presence of metal, and markers of apoptosis or cell death, including annexin V binding, DNA loss/oligonucleosomal fragmentation, 7-amino-actinomycin D uptake (loss of impermeance), changes of the mitochondrial membrane potential (JC-1 fluorescence), and Western analysis of cellular thiols, were assayed. Mercury (Hg) was the only metal shown to be consistently toxic with the dose and times utilized. Cadmium (Cd) was the only other metal tested that also produced some significant level of DNA loss; however, the induction of apoptosis by Cd was not as consistent as that observed with Hg. When Hg was added with 2-mercaptoethanol (2-ME), Hg produced greater toxicity. Endogenous DNA synthesis by thymocytes was immediately inhibited by Hg and Hg + 2-ME. The Hg + 2-ME-induced apoptosis appeared to be associated with altered levels of cellular thiols, in that glutathione (GSH) depletion was significant in comparison to the non-metal control and Hg alone. The increased Hg-induced toxicity in the presence of 2-ME likely was due to the ability of 2-ME to enhance (10- to 20-fold) the cellular uptake of Hg. Western analysis with biotin maleimide demonstrated that Hg + 2-ME and to a lesser extent the positive control dexamethasone eliminated many reactive thiols; the major thiol-reactive protein still reactive with the maleimide probe had an approximate Molecular Mass of 45 kD. Surprisingly, Hg alone enhanced the expression of this thiol-expressing protein, which by Mass Spectrometry (MS)/MS analysis was shown to be β-actin. Hg also produced the appearance of yet to be identified new proteins. Based on the results with Hg + 2-ME, it is suggested that numerous protein thiols participate in maintenance of cell survival and their loss is associated with apoptosis. The increased expression of new thiol-reactive proteins or thiol-reactive proteins with altered electrophoretic profiles needs to be further investigated. However, the enhanced toxicity attributed to Hg + 2-ME suggests that increased intracellular oxidative stress, observed as increased depletion of GSH, is responsible for the accelerated cell death.
This work was supported by National Institutes of Health grant ES11135. The authors acknowledge use of the Immunology and Biological Mass Spectrometry Facilities of Wadsworth Center. We also especially appreciate the assistance of Kathy Lubowski, Joan Pedersen-Lane, and Renjie Song.
To determine the specificity of the Abbott Murex HIV antigen/antibody combination enzyme immunoassay (EIA) for the diagnosis of HIV infection in Tanzania. A cross-sectional survey of 7333 Tanzanian ...adolescents and young adults was carried out. Sera testing positive by the Murex assay were further evaluated using a battery of other EIA which detect either antibody to HIV-1 or p24 antigen, and by PCR using pol primers. Of the 674 sera testing positive by the Murex assay, only 53 (7.9%) were confirmed. The specificity of the Murex assay was 91.5%. Serological tests for HIV may perform differently in different populations. New diagnostic tests should not be introduced into populations in which they have not been evaluated.
Poorly controlled diabetes has been demonstrated to correlate with worse outcomes and higher complication rates following surgery. The use of hemoglobin A1c measurements (HbA1c) as a proxy for ...glycemic control and as a screening tool to identify high-risk patients who would benefit from preoperative optimization has been validated in the joint replacement literature. The role of HbA1c as a predictive risk factor following spine surgery has not yet been well defined. A recent nationwide database study compared well controlled diabetics to poorly controlled diabetics (as defined by diagnosis codes) and found increased length of stay, complication rates, and costs of care postoperatively. Another study correlated perioperative HbA1c levels with postoperative infection rates following single-level decompressive lumbar spine surgery.
The impact of HbA1C on postoperative complications following lumbar spinal fusion surgery has not yet been elucidated. Thus, we sought in this study to examine the relationship between perioperative glycemic control (as measured by HbA1c) and complications within 30 days following elective lumbar spinal fusion surgery.
This is a retrospective cohort study comparing characteristics between patients who had a complication following lumbar spinal fusion to those who did not.
We retrospectively analyzed the charts of 90 patients who underwent elective lumbar spinal fusion for complications within 30 days.
Our primary outcome measure was a complication within 30 days, which included: DVT, PE, acute kidney injury (AKI), delirium, sepsis, surgical site infection, UTI, MI, reoperation, pneumonia, or anemia requiring transfusion.
We retrospectively analyzed data on diabetic patients who underwent elective lumbar spinal fusions. Our study included single- as well as multilevel fusions performed either by anterior or posterior approach, as well as both instrumented and non-instrumented fusions. For each patient, an HbA1c level which had been drawn within one month of surgery was used for analysis. Our primary outcome measure was a complication within 30 days. Patient demographic and perioperative factors were compared using Pearson's chi-square test for categorical variables and an independent samples t-test for continuous variables. A receiver operating characteristic (ROC) curve was plotted to determine a threshold for HbA1c that was predictive of complications.
We retrospectively analyzed the charts of 90 patients who underwent elective lumbar spinal fusion for complications within 30 days. Twelve of the 90 patients had a complication, resulting in a complication rate of 13.3%. Analysis revealed no significant difference in demographic variables including age, BMI, ethnicity, and type of diabetic medication used (p > 0.05) among patients with and without complications. The group with complications had a significantly higher mean HbA1c levels (6.82 vs 7.58, p=0.033) than those without. The ROC analysis demonstrated that the HbA1c level most predictive of postoperative complications within 30 days was 6.65 (AUC=0.721; sensitivity=83.3%; specificity=51.3%; p=0.011).
Our data have demonstrated a significant relationship between perioperative HbA1c levels and the 30-day complication rate following elective spinal fusion surgery. This is consistent with prior literature which has demonstrated that poorly controlled diabetics have higher complication rates in spine surgery. Interestingly, our data determined a lower HbA1c cutoff value for predicting all complications within 30 days as compared to the previously described cutoff found to be predictive of deep infection in single level decompressions (6.65 vs 7.5). This may represent different levels of disease burden causing different complications, or may represent some other difference between the spinal fusion and single level decompression patient cohorts.
This abstract does not discuss or include any applicable devices or drugs.
Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We ...hypothesized that early arrest hemodynamics and end-tidal C o2 (ET co2 ) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients.
Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016-2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497).
Eighteen ICUs participated in ICU-RESUS.
There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation.
None.
Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ET co2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ET co2 less than 10 mm Hg and two (12%) had a maximum ET co2 less than 10 mm Hg during the initial 10 minutes of resuscitation.
We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ET co2 less than 10 mm Hg may survive with favorable neurologic outcome.
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