A retrospective review of patients who underwent an anterior cervical fusion using recombinant human bone morphogenetic protein (rhBMP)-2 with an absorbable collagen sponge (INFUSE; Medtronic Sofamor ...Danek, Minneapolis, MN).
To ascertain the complication rate after the use of high-dose INFUSE in anterior cervical fusions.
The rhBMP-2 has been primarily investigated in lumbar spine fusions, where it has significantly enhanced the fusion rate and decreased the length of surgery, blood loss, and hospital stay.
We present 151 patients who underwent either an anterior cervical discectomy and fusion (n = 138) or anterior cervical vertebrectomy and fusion (n = 13) augmented with high-dose INFUSE between July 2003 and March 2004. The rhBMP-2 (up to 2.1 mg/level) was used in the anterior cervical discectomy and fusions.
A total of 35 (23.2%) patients had complications after the use of high-dose INFUSE in the cervical spine. There were 15 patients diagnosed with a hematoma, including 11 on postoperative day 4 or 5, of whom 8 were surgically evacuated. Thirteen individuals had either a prolonged hospital stay (> 48 hours) or hospital readmission because of swallowing/breathing difficulties or dramatic swelling without hematoma.
A significant rate of complications resulted after the use of a high dose of INFUSE in anterior cervical fusions. We hypothesize that in the cervical area, the putative inflammatory effect that contributes to the effectiveness of INFUSE in inducing fusion may spread to adjacent critical structures and lead to increased postoperative morbidity. A thorough investigation is warranted to determine the optimal dose of rhBMP-2 that will promote cervical fusion and minimize complications.
Background: Although hospital length of stay (LOS) following lumbar fusion has decreased for a variety of reasons, different institutions find their LOS over the benchmarks published by the national ...Agency for Healthcare Research and Quality (AHRQ). Over a 3-year period, this prospective study introduced utilization of multidisciplinary committee meetings between surgeons and other caretakers to decrease LOS following spinal fusion surgery without compromising the quality of care.
Methods: A multidisciplinary committee was established to assess factors and institute recommendations that influence hospital LOS following lumbar fusion compared to the national compared to the national AHRQ benchmark at baseline and at 1 and 2 years after adjusting our standard practice. We also analyzed re-admission rates at 7 and 30 days and determined the average variable direct cost.
Results: While the national AHRQ benchmark average LOS (ALOS) was statistically better for DRGs 459 and 460 for all three years except for DRG 459 in the baseline year compared to our ALOS, we observed improvement in the ALOS for both DRG 459 and 460 throughout the 3 years of the study. ALOS for DRG 460 was statistically different for 2011-2012 vs 2013-2014 (P < 0.001) and 2012-2013 vs 2013-2014 (P < 0.001). There was a statistically significant improvement in cost initially for 2012-2013 vs 2011-2012 (P < 0.001) and for 2013-2014 vs 2011-2012 (P = 0.001).
Conclusions: This study established an effective patient discharge plan, patient education, partnerships with rehabilitation facilities, and study review and discussion among physicians and staff. Further monitoring of factors that impact hospital LOS following lumbar fusion is warranted to curtail patient complications and organizational expenditures while providing superior medical care.
Motivated primarily by the large uncertainties in the thermonuclear rate of the 30P(p,γ)31S reaction that limit our understanding of classical novae, we carried out lifetime measurements of 31S ...excited states using the Doppler Shift Lifetimes (DSL2) facility at the TRIUMF Isotope Separator and Accelerator (ISAC-II) facility. The 31S excited states were populated by the 3He(32S,α)31S reaction. The deexcitation γ rays were detected by a clover-type high-purity germanium detector in coincidence with the α particles detected by a silicon detector telescope. We have applied modern Markov chain Monte Carlo-based Bayesian statistical techniques to perform lineshape analyses of Doppler-shift attenuation method γ-ray data for the first time. We have determined the lifetimes of the two lowest-lying 31S excited states. First experimental upper limits on the lifetimes of four higher-lying states have been obtained. The experimental results were compared to shell-model calculations using five universal sd-shell Hamiltonians. Evidence for γ rays originating from the astrophysically important Jπ=3/2+, 260-keV 30P(p,γ)31S resonance with an excitation energy of Ex=6390.2(7) keV in 31S has also been observed, although strong constraints on the lifetime will require better statistics.
25Siβ+-decay spectroscopy Sun, L. J.; Friedman, M.; Budner, T. ...
Physical review. C,
01/2021, Volume:
103, Issue:
1
Journal Article
Peer reviewed
Open access
Background: β-decay spectroscopy provides valuable information on exotic nuclei and a stringent test for nuclear theories beyond the stability line. Purpose: To search for new β-delayed protons and γ ...rays of 25Si to investigate the properties of 25Al excited states. Method: 25Si β decays were measured by using the Gaseous Detector with Germanium Tagging system at the National Superconducting Cyclotron Laboratory. The protons and γ rays emitted in the decay were detected simultaneously. Here, a Monte Carlo method was used to model the Doppler broadening of 24Mg γ-ray lines caused by nuclear recoil from proton emission. Shell-model calculations using two newly developed universal sd-shell Hamiltonians were performed. Results: The most precise 25Si half-life to date has been determined. A new proton branch at 724(4) keV and new proton-γ-ray coincidences have been identified. Three 24Mg γ-ray lines and eight 25Al γ-ray lines are observed for the first time in 25Si decay. The first measurement of the 25Si β-delayed γ-ray intensities through the 25Al unbound states is reported. All the bound states of 25Al are observed to be populated in the β decay of 25Si. Several inconsistencies between the previous measurements have been resolved, and new information on the 25Al level scheme is provided. An enhanced decay scheme has been constructed and compared to the mirror decay of 25Na and the shell-model calculations. Conclusions: The measured excitation energies, γ-ray and proton branchings, log $ft$ values, and Gamow-Teller transition strengths for the states of 25Al populated in the β decay of 25Si are in good agreement with the shell model calculations, offering gratifyingly consistent insights into the fine nuclear structure of 25Al.
Here, the thermonuclear 30P(p, γ)31S reaction rate is critical for modeling the final elemental and isotopic abundances of ONe nova nucleosynthesis, which affect the calibration of proposed nova ...thermometers and the identification of presolar nova grains, respectively. Unfortunately, the rate of this reaction is essentially unconstrained experimentally, because the strengths of key 31S proton capture resonance states are not known, largely due to uncertainties in their spins and parities. Using the β decay of 31Cl, we have observed the β-delayed γ decay of a 31S state at Ex = 6390.2(7) keV, with a 30P(p, γ)31S resonance energy of Er = 259.3(8) keV, in the middle of the 30P(p, γ)31S Gamow window for peak nova temperatures. This state exhibits isospin mixing with the nearby isobaric analog state at Ex = 6279.0(6) keV, giving it an unambiguous spin and parity of 3/2+ and making it an important l = 0 resonance for proton capture on 30P.
Certain astrophysical environments such as thermonuclear outbursts on accreting neutron stars (Type-I X-ray bursts) are hot enough to allow for breakout from the Hot CNO hydrogen burning cycles to ...the rapid proton capture (rp) process. An important breakout reaction sequence is 15O(α,γ)19Ne(p,γ)20Na and the 19Ne(p,γ)20Na reaction rate is expected to be dominated by a single resonance at 457 keV above the proton threshold in 20Na. The resonance strength and, hence, reaction rate depends strongly on whether this 20Na state at an excitation energy of 2647 keV has spin and parity of 1+ or 3+. Previous 20Mg (Jπ = 0+)β+ decay experiments have relied almost entirely on searches for β-delayed proton emission from this resonance in 20Na to limit the log ft value and, hence, Jπ. However there is a non-negligible γ-ray branch expected that must also be limited experimentally to determine the log ft value and constrain . We have measured the β-delayed γ decay of 20Mg to complement previous β-delayed proton decay work and provide the first complete limit based on all energetically allowed decay channels through the 2647 keV state. Our limit confirms that a 1+ assignment for this state is highly unlikely.
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