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Utilization of Neuromonitoring in Surgical Cervical Spondylosis Patients With the Presence or Absence of Myelopathy: Is It Standard?
No full textSTUDY DESIGN: Cross-sectional, observational study.
OBJECTIVE: Investigate the frequency of intraoperative neuromonitoring (IONM) utilization among Medicare patients diagnosed with cervical spondylosis (CS), both with and without myelopathy.
BACKGROUND: IONM is widely used as a tool in spine surgery. However, the overall prevalence of neuromonitoring utilization among CS undergoing surgical intervention is not well characterized.
METHODS: This study observed neuromonitoring usage in CS patients who had cervical spinal procedures from 2012 to 2020, using a 5% random sample of Medicare data. Logistic regression compared patient characteristics between those who received neuromonitoring and those who did not. The model included age, sex, region, Elixhauser Comorbidity Index score, year of surgery, elective status, and procedure type. Odds ratios with a 95% CI were generated for each covariate.
RESULTS: Of the 6224 patients who underwent cervical procedures for CS, 4053 were included in the study, with 2845 having myelopathy and 1208 without. Myelopathy patients had a higher number of hospitalizations (2884) compared with non-myelopathy patients (1229). Among myelopathy patients, the prevalence of neuromonitoring increased from 49.2% in 2012 to 56.5% in 2020. The range of utilization for each type of monitoring was: 96.4%-100% for somatosensory evoked potential, 73.2%-86.1% for electromyography, 70.0%-86.1% for motor evoked potential, and 17.6%-33.6% for other modalities. For non-myelopathy patients, neuromonitoring prevalence increased from 33.1% in 2012 to 43.3% in 2020. The range of utilization for each type of monitoring was: 93.0%-100% for somatosensory evoked potential, 68.9%-89.7% for electromyography, 55.8%-77.4% for motor evoked potential, and 17.8%-36.4% for other modalities.
CONCLUSIONS: This study investigates the utilization of IONM during cervical spinal surgeries in Medicare patients with cervical spondylotic myelopathy or CS between 2012 and 2020. Although IONM is employed in cervical spine procedures, its adoption and standardization appear to vary across the country and different health care settings
Analysis of Endoscope-Assisted Retrosigmoid Approach versus Modified Transjugular Approach for Microvascular Decompression of the Facial Nerve: A Comparative Cadaveric Study.
No full textOBJECTIVE: Two main approaches for microvascular decompression for hemifacial spasm include the retrosigmoid approach (RA) and the modified transjugular-tubercular approach (MTA). This anatomical study compares both and evaluates the value of neuroendoscopy.
METHODS: Dissections were performed on 4 cadaveric human heads, performing RA on one side and MTA on the other. Anatomical landmarks were determined beforehand, and the accessibility to each was evaluated by determining visibility with a microscope and 0°, 30°, and 45° endoscopes. The degree of freedom at each landmark, representing the working area afforded by each approach, was measured using vectors from the boundaries of the craniotomy to the points of interest.
RESULTS: MTA yielded 90.1% greater degree of freedom (P \u3c 0.00001) at the internal acoustic canal and 118.3% greater access (P \u3c 0.001) to the facial nerve root exit zone than RA. For landmarks with sub-100% microscopic visualization, the 0° endoscope improved visualization for 15/16 (94%) landmarks with RA and 9/9 (100%) with MTA. Introducing 30° and 45° angled endoscopes improved visualization in every instance. Although MTA provided a higher visualization for some landmarks with the microscope and 0° endoscope, all discrepancies were eliminated with the 30° endoscope, while the 45° endoscope showed identical visualization.
CONCLUSIONS: Despite the greater degree of freedom with MTA, visualizing and manipulating the facial nerve at the root exit zone was comparable between both approaches, with the use of angled endoscopy further improving visualization and accessibility. As such, the endoscope-assisted RA, with its smaller exposure and soft-tissue disruption, is a viable approach for microvascular decompression for hemifacial spasm
Assessing hepatic arterial injuries in the setting of normothermic machine perfusion in liver transplantation: A noninvasive approach.
No full textBREATHLESS ON DAPTOMYCIN: UNVEILING EOSINOPHILIC PNEUMONITIS AFTER TREATMENT FOR PROSTHETIC JOINT INFECTION
No full textDOUBLE TROUBLE: UNMASKING ADENOVIRUS AND EBV IN AN ELDERLY PATIENT WITH PANCYTOPENIA AND TRANSAMINITIS
No full textSemi-automated tortuosity measurements confirm generalizability of IMPERATIVE trial results to real-world patients with acute ischemic stroke undergoing thrombectomy.
No full textBackgroundCriticism of clinical trials of endovascular therapy of acute ischemic stroke due to large vessel occlusion includes their lack of generalizability. We aimed to evaluate the impact of vessel tortuosity on the outcomes of large-bore and super-bore aspiration catheters in the Imperative Trial and to compare trial\u27s selection of patients to a real-world setting.MethodsUsing baseline craniocervical angiography, we performed semi-automated analysis of various tortuosity characteristics. Comparison of tortuosity characteristics was made to a previously published cohort of 100 consecutive patients treated with thrombectomy (real-world cohort).ResultsOf the 249 Imperative Trial patients with anterior circulation strokes, 187 (89%) had complete tortuosity assessments from the aortic arch to the occlusion site. Tortuosity indexes for the common carotid, extracranial and intracranial internal carotid artery segments were similar for both cohorts (right side 0.18 ± 0.10, 0.17 ± 0.09, 0.45 ± 0.09 vs. 0.20 ± 0.09, 0.17 ± 0.09, 0.45 ± 0.09; left side: 0.12 ± 0.08, 0.19 ± 0.09, 0.44 ± 0.07 vs. 0.15 ± 0.08, 0.18 ± 0.08, 0.47 ± 0.07 in the Imperative Trial and in the real-world cohort, respectively). The proportion of patients with type 3 aortic arches was higher in the Imperative Trial than the real-word cohort (26% vs. 15%
Sodium-Glucose Cotransporter-2 Canagliflozin\u27s Impact on Cardiovascular Disease in the Setting of Metabolic Syndrome: A Proteomic Analysis.
No full textRATIONALE: Ischemic heart disease (IHD) is the leading cause of global mortality and is often complicated by metabolic syndrome (MetS), making its management challenging. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors, such as canagliflozin (CAN), have demonstrated cardioprotective effects, but the precise molecular mechanisms underlying these benefits in the setting of IHD and MetS remain unclear.
OBJECTIVES: This study aimed to investigate the myocardial phenotypic changes induced by CAN treatment using a highly sensitive proteomic approach in a large animal model of IHD and MetS.
FINDINGS: In a swine model of MetS and chronic myocardial ischemia, CAN treatment led to significant metabolic shifts, including the downregulation of glycolysis and gluconeogenesis and the upregulation of oxidative phosphorylation and electron transport chain activity. Proteomic analysis revealed increased expression of vesicular and mitochondrial transport proteins in chronically ischemic myocardium and elevated thioredoxin levels in non-ischemic myocardium, indicating improved mitochondrial function, reduced oxidative stress, and enhanced cytoskeletal remodeling.
CONCLUSIONS: CAN treatment induces extensive myocardial adaptations that contribute to its cardioprotective effects, particularly by optimizing myocardial metabolism, mitigating oxidative stress, and promoting ventricular remodeling. These findings provide valuable insights into the therapeutic potential of CAN in IHD and MetS and highlight the utility of proteomics in advancing heart failure treatment strategies
