(1) To describe the use of multi-rod constructs (MRCs) in adult spinal deformity (ASD) surgery, (2) to report rod fractures occurring at MRC sites, and (3) to evaluate risk factors for rod fractures.
...A single-center, retrospective cohort study was conducted of patients undergoing ASD surgery with these inclusion criteria: minimum 2-year follow-up, MRCs used, ≥ 10-level fusion, and fused to sacrum/pelvis. The primary outcome was rod fracture. Univariate/multivariate logistic regression was performed controlling for age, kickstand rod usage, number of rods across the lumbosacral junction (LSJ), and the amount of coronal/sagittal Cobb correction.
Among 57 patients undergoing ASD surgery with MRCs, mean age was 60 ± 11 years. With respect to MRCs, 32 (56%) patients had 3 rods, 18 (32%) had 4, and 7 (12%) had 5. Rods crossing the LSJ were most often three (63%), followed by four (25%) and five (5%) rods. Nine (16%) patients experienced rod fractures with eight (89%) patients having no more than three rods crossing the LSJ. A coronal correction > 30 mm was more often seen in patients with rod fracture (p = 0.030), while an SVA correction > 50 mm was not significantly different (p = 0.608). Multivariate logistic regression revealed that the amount of coronal correction was significantly associated with rod fracture (OR 1.03, 95% CI 1.01-1.07, p = 0.044), as was achieving a coronal correction > 30 mm (OR 7.72, 95% CI 1.17-51.10, p = 0.034), with no association between the amount of sagittal correction obtained and rod fracture.
This study found that greater coronal correction was associated with an increased odds of rod fracture. We suggest adding at least four rods across the LSJ cephalad to the interbody fusions to avoid rod fractures in these high demand areas.
III.
Primary open-angle glaucoma is the most common optic neuropathy and an important cause of irreversible blindness worldwide. The optic nerve head or optic disc is divided in two parts: a central cup ...(without nerve fibers) surrounded by the neuroretinal rim (containing axons of the retinal ganglion cells). The International Glaucoma Genetics Consortium conducted a meta-analysis of genome-wide association studies consisting of 17,248 individuals of European ancestry and 6,841 individuals of Asian ancestry. The outcomes of the genome-wide association studies were disc area and cup area. These specific measurements describe optic nerve morphology in another way than the vertical cup-disc ratio, which is a clinically used measurement, and may shed light on new glaucoma mechanisms. We identified 10 new loci associated with disc area (CDC42BPA, F5, DIRC3, RARB, ABI3BP, DCAF4L2, ELP4, TMTC2, NR2F2, and HORMAD2) and another 10 new loci associated with cup area (DHRS3, TRIB2, EFEMP1, FLNB, FAM101, DDHD1, ASB7, KPNB1, BCAS3, and TRIOBP). The new genes participate in a number of pathways and future work is likely to identify more functions related to the pathogenesis of glaucoma.
Recent efforts to improve medical education include adopting a new framework based on 6 broad competencies defined by the Accreditation Council for Graduate Medical Education. In this article, the ...Alliance for Academic Internal Medicine Education Redesign Task Force II examines the advantages and challenges of a competency-based educational framework for medical residents. Efforts to refine specific competencies by developing detailed milestones are described, and examples of training program initiatives using a competency-based approach are presented. Meeting the challenges of a competency-based framework and supporting these educational innovations require a robust faculty development program. Challenges to competency-based education include teaching and evaluating the competencies related to practice-based learning and improvement and systems-based practice, as well as implementing a flexible time frame to achieve competencies. However, the Alliance for Academic Internal Medicine Education Redesign Task Force II does not favor reducing internal medicine training to less than 36 months as part of competency-based education. Rather, the 36-month time frame should allow for remediation to address deficiencies in achieving competencies and for diverse enrichment experiences in such areas as quality of care and practice improvement for residents who have demonstrated skills in all required competencies.
LIV Selection in AdIS patients fused short of the sacrum is still debatable. Multiple radiographic methods have been devised to determine LIV, however, there is no universal standard. The TV rule for ...LIV determination has previously been described as providing acceptable LIV positioning on long-term follow-up in Adolescent Idiopathic Scoliosis (AIS) Lenke type-1 and -2 curves. We investigated whether the TV could be employed for guiding LIV selection in AdIS patients fused short of sacrum (LIV = L4 and above).
The TV has been demonstrated as a reliable way to select the LIV in AIS. Here we sought to determine whether the TV rule is a reliable method for LIV selection in AdIS patients fused short of the sacrum.
Single center/surgeon retrospective study.
Radiographic review of 52 patients with AdIS treated between July 2015 and December 2019.
CSVL-LIV distance determined on standing AP radiographs.
AdIS patients treated by senior author between 2015 and 2019, with LIV L4 or above, and a minimum of 1-year radiographic follow-up (range: 1- 3 years) were included. The TV was determined on preoperative standing AP radiographs as the most cephalad lumbar vertebra “touched” by the center sacral vertical line (CSVL) and then compared to the LIV. Postoperative LIV position was evaluated in relation to the CSVL and the offset (CSVL-LIV distance) compared among patients fused cephalad-, caudad- and to the TV.
Fifty-two AdIS patients with ≥ 1 year of follow-up were available for review. Of these, 18 (35%) had fusion to the TV, 21 (40%) cephalad to the TV, and 13 (25%) caudad to the TV. Patients fused cephalad of the TV (TV≤-1) had larger CSVL-LIV distance (1.71±0.54 cm) on follow-up compared to those who had fusion to the TV (0.92±0.58cm) p=0.05. Patients who had fusion caudad to the TV (TV≥+1) had a shorter CSVL-LIV distance (0.7±0.58cm) compared to those fused to the TV, but this was not statistically significant.
Fusion to, or caudad to, the TV in AdIS results in significantly lower CSVL-LIV translation on radiographic follow-up compared to fusion cephalad to the TV. However, fusion caudad to the TV incurs fewer distal mobile segments, but with no significant benefit in decreasing CSVL-LIV translation, and thus fusion to the TV appears to be the best option in AdIS patients fused short of the sacrum.
This abstract does not discuss or include any applicable devices or drugs.
We have tested the feasibility of real-time localized blood flow measurements, obtained with interstitial (IS) Doppler optical coherence tomography (DOCT), to predict photodynamic therapy ...(PDT)-induced tumor necrosis deep within solid Dunning rat prostate tumors. IS-DOCT was used to quantify the PDT-induced microvascular shutdown rate in s.c. Dunning prostate tumors (n=28). Photofrin (12.5 mg/kg) was administered 20 to 24 hours before tumor irradiation, with 635 nm surface irradiance of 8 to 133 mWcm(-2) for 25 minutes. High frequency ultrasound and calipers were used to measure the thickness of the skin covering the tumor and the location of the echogenic IS probe within it. A two-layer Monte Carlo model was used to calculate subsurface fluence rates within the IS-DOCT region of interest (ROI). Treatment efficacy was estimated by percent tumor necrosis within the ROI, as quantified by H&E staining, and correlated to the measured microvascular shutdown rate during PDT treatment. IS-DOCT measured significant PDT-induced vascular shutdown within the ROI in all tumors. A strong relationship (R2=0.723) exists between the percent tumor necrosis at 24 hours posttreatment and the vascular shutdown rate: slower shutdown corresponded to higher treatment efficacy, i.e., more necrosis. Controls (needle+light, no drug, n=3) showed minimal microvascular changes or necrosis (4%+/-1%). This study has correlated a biological end point with a direct and localized measurement of PDT-induced microvascular changes, suggesting a potential clinical role of on-line, real-time microvascular monitoring for optimizing treatment efficacy in individual patients.
We present Galaxy Evolution Explorer (GALEX) images of the prototypical edge-on starburst galaxies M82 and NGC253. Our initial analysis is restricted to the complex of ultraviolet (UV) filaments in ...the starburst-driven outflows in the galaxy halos. The UV luminosities in the halo are too high to be provided by shock-heated or photoionized gas except perhaps in the brightest filaments in M82, suggesting that most of the UV light is the stellar continuum of the starburst scattered into our line of sight by dust in the outflow. This interpretation agrees with previous results from optical imaging polarimetry in M82. The morphology of the UV filaments in both galaxies shows a high degree of spatial correlation with H-alpha and X-ray emission. This indicates that these outflows contain cold gas and dust, some of which may be vented into the intergalactic medium (IGM). UV light is seen in the ``H-alpha cap\'\' 11 kpc North of M82. If this cap is a result of the wind fluid running into a pre-existing gas cloud, the gas cloud contains dust and is not primordial in nature but was probably stripped from M82 or M81. If starburst winds efficiently expel dust into the IGM, this could have significant consequences for the observation of cosmologically distant objects.
In April 2021, the US government made substantial investments in students' safe return to school by providing resources for school-based coronavirus disease 2019 (COVID-19) mitigation strategies, ...including COVID-19 diagnostic testing. However, testing uptake and access among vulnerable children and children with medical complexities remained unclear.
The Rapid Acceleration of Diagnostics Underserved Populations program was established by the National Institutes of Health to implement and evaluate COVID-19 testing programs in underserved populations. Researchers partnered with schools to implement COVID-19 testing programs. The authors of this study evaluated COVID-19 testing program implementation and enrollment and sought to determine key implementation strategies. A modified Nominal Group Technique was used to survey program leads to identify and rank testing strategies to provide a consensus of high-priority strategies for infectious disease testing in schools for vulnerable children and children with medical complexities.
Among the 11 programs responding to the survey, 4 (36%) included prekindergarten and early care education, 8 (73%) worked with socioeconomically disadvantaged populations, and 4 focused on children with developmental disabilities. A total of 81 916 COVID-19 tests were performed. "Adapting testing strategies to meet the needs, preferences, and changing guidelines," "holding regular meetings with school leadership and staff," and "assessing and responding to community needs" were identified as key implementation strategies by program leads.
School-academic partnerships helped provide COVID-19 testing in vulnerable children and children with medical complexities using approaches that met the needs of these populations. Additional work is needed to develop best practices for in-school infectious disease testing in all children.
PurposeTo explore relationships between patterns of fetal anthropometric growth, as reflective of fetal wellbeing, and global retinal nerve fiber layer (RNFL) thickness measured in young adulthood. ...MethodsParticipants (n = 481) from within a Western Australian pregnancy cohort study underwent five serial ultrasound scans during gestation, with fetal biometry measured at each scan. Optic disc parameters were measured via spectral-domain optical coherence tomography imaging at a 20-year follow-up eye examination. Generalized estimating equations were used to evaluate differences in global RNFL thickness between groups of participants who had undergone similar growth trajectories based on fetal head circumference (FHC), abdominal circumference (FAC), femur length (FFL), and estimated fetal weight (EFW). ResultsParticipants with consistently large FHCs throughout gestation had significantly thicker global RNFLs than those with any other pattern of FHC growth (P = 0.023), even after adjustment for potential confounders (P = 0.037). Based on model fit statistics, FHC growth trajectory was a better predictor of global RNFL thickness than birth weight or head circumference at birth. RNFL thickness did not vary significantly between groups of participants with different growth trajectories based on FAC, FFL, or EFW. ConclusionsFHC growth is associated with RNFL thickness in young adulthood and, moreover, is a better predictor than either birth weight or head circumference at birth. Translational RelevanceThis research demonstrates an association between intrauterine growth and long-term optic nerve health, providing a basis for further exploring the extent of the influence of fetal wellbeing on clinical conditions linked to RNFL thinning.
PDF
