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Posterior column osteotomy for spinal realignment in patients with prior lumbar fusion: illustrative case
No full textBackground: Iatrogenic flat back syndrome following prior posterolateral fusion without interbody support is challenging, especially with adjacent segment stenosis. While pedicle subtraction osteotomy (PSO) offers strong correction, it is associated with higher morbidity. Alternative techniques with reduced risk are needed.
Observations: The authors present the case of a 71-year-old woman with a 25-year-old L4-S1 fusion and severe sagittal deformity who underwent a Schwab grade 2 posterior column osteotomy (PCO) through the L4-5 fusion mass, with insertion of interbody cages of varying heights and lordotic angles. Preoperative parameters included C7 sagittal vertical axis (SVA) +10 cm, pelvic incidence (PI) 65°, lumbar lordosis (LL) -13°, PI-LL mismatch 79°, and pelvic tilt (PT) 43°. Postoperative improvements were C7 SVA +5.7 cm, LL 41°, PI-LL mismatch 24°, and PT 35°. The 285-minute surgery had an estimated blood loss of 1100 mL. At 1 month, the patient could walk a one-quarter mile, compared with < 50 feet before surgery.
Lessons: This modified PCO technique provides effective decompression and substantial sagittal correction for iatrogenic flat back syndrome while potentially reducing morbidity compared with PSO. By distributing correction across multiple levels, this approach offers a valuable alternative for patients with moderate to severe sagittal imbalance and concurrent stenosis above prior fusion constructs-avoiding a three-column osteotomy. https://thejns.org/doi/10.3171/CASE25251
Association of the 2017 ACGME US Resident Duty Hour Policy Change With Hospital Quality and Patient Experience
No full textBackground: In 2017, the Accreditation Council for Graduate Medical Education (ACGME) updated select US residency duty hour requirements to improve continuity of care and resident education. It is unknown if this policy change affected hospital quality of care and patient experience.
Objective: To evaluate the association of the 2017 duty hour policy change with hospital quality and patient experience in teaching vs nonteaching hospitals.
Methods: In this observational difference-in-differences (DiD) study, hospital quality (patient outcomes) and patient experience metrics were obtained from Centers for Medicare & Medicaid Services Care Compare data from before (July 1, 2014-June 30, 2016) and after (July 1, 2017-June 30, 2019) the 2017 policy change in teaching and nonteaching hospitals. Primary outcomes include hospital quality (five 30-day readmission indicator rates, five 30-day mortality rates, 8 patient safety indicators), and patient experience (5 measures from Hospital Consumer Assessment of Healthcare Providers and Systems survey).
Results: A total of 2935 hospitals (250 teaching; 2685 nonteaching) were included. When comparing before and after the 2017 policy change, teaching hospitals had greater reductions in hospital-wide readmission (DiD coefficient -0.26; 95% CI, -0.34 to -0.18; P<.001), heart failure readmission (DiD coefficient -0.48; 95% CI, -0.78 to -0.19; P<.002), and stroke mortality rates (DiD coefficient -0.56; 95% CI, -0.94 to -0.19; P<.01) than did nonteaching hospitals. There were no significant differences between teaching and nonteaching hospitals in other outcomes before vs after policy change.
Conclusions: After the 2017 duty hour policy change, there was no evidence of worsening of hospital quality or patient experience in teaching hospitals, compared to nonteaching hospitals
Relationship Between Hospital Team Segregation Index, Heart Failure, and Ischemic Heart Disease
No full textBackground: The extent of structural racism in cardiovascular care is not well studied.
Objectives: The purpose of this study was to determine whether hospital segregation index (SI) (degree of dissimilarity between teams caring for Black vs White patients) is associated with receipt of a cardiologist's care, readmission up to 30 days, and 1-year survival for Black vs White patients admitted with heart failure (HF) or ischemic heart disease (IHD).
Methods: Using Optum's Clinformatics Data Mart, we examined the effect of hospital SI on Black and White patients admitted with primary diagnoses of HF or IHD from 2010 to 2018 using mixed effects models. Hospitals were grouped by SI tertile.
Results: Overall, 119,272 patients (29.4% Black, 70.6% White) with HF and 183,165 patients (17.9% Black and 82.1% White) with IHD were analyzed. Across SI tertiles, Black patients with HF had lower odds of receiving a cardiologist's care compared to White patients. Across SI tertiles and cardiology care, there was no difference in the hazard of readmission by race, and odds of 1-year survival were higher for Black patients. Among patients with IHD, there was no difference in odds of receiving cardiology care between races across SI tertiles. Black patients not seen by cardiologists had 20% higher hazard of readmission at high SI hospitals (HR: 1.20; 95% CI: 1.00-1.44). Odds of 1-year survival were higher for Black patients (OR: 1.10; 95% CI: 1.04-1.17) seen by cardiologists in low SI hospitals.
Conclusions: Among Black vs White patients, HF outcomes did not vary by SI tertiles. However, in IHD, SI impacted Black patients' risk of readmission and survival
Pulmonary V̇O2 on-kinetics and walking net V̇O2 associate with fatigue and mood disturbance in postmenopausal women
No full textPostmenopausal women often experience fatigue and mood disturbance both of which interfere with quality-of-life. Since greater physical function aids psychosocial well-being, we hypothesized the acute cardiopulmonary responses during walking may reveal important factors linked to fatigue and mood disturbance. In this cross-sectional study, women of similar body mass index (BMI) aged 55-75 y were dichotomized to mid-life (55-65 y; 83.4 ± 8.4 kg/m2; n = 14) or older (≥65 y; 81.8 ± 10.4 kg/m2; n = 11) groups. A 6-minute walk test was used to estimate peak aerobic capacity (V̇O2peak). A treadmill task coupled with indirect calorimetry measured mean response time (MRT) - representing the duration to reach 63 % of steady-state net oxygen uptake (V̇O2). Average daily fatigue and fatigue interference were measured with the Fatigue Symptom Inventory. General mood disturbance was measured with the Profile of Mood States (POMS) questionnaire. Age-group differences were not detected in fatigue ratings, MRT, or walking net V̇O2. However, older women had lower aerobic capacity (p = 0.002, ES = 1.39) and greater disturbance in the POMS Depression-Dejection subscale (p = 0.042, ES = 0.41). Among all participants, and independent of V̇O2peak, MRT correlated with average daily fatigue (r = 0.500, p = 0.015), fatigue interference (r = 0.421, p = 0.046), and POMS total mood disturbance (rs = 0.437, p = 0.037). Regression modeling revealed MRT and walking net V̇O2 jointly explained 55 % (R = 0.744, p < 0.001) of the variance in average daily fatigue. In conclusion, MRT and walking net V̇O2 may serve as important points of intervention to alleviate fatigue and mood disturbance in postmenopausal women
The Use of a Survey to Cultivate a Collection of Creative Adaptations for Hospitalized Children with Physical Disabilities
No full textIUIThe following study is focused on finding creative ways to accommodate and adapt art therapy for physically disabled patients.
Using a mixed-method, survey approach, with quantitative demographic data and qualitative insights into art therapy
experiences, 23 art therapists were asked about how they helped disabled patients/clients participate in art therapy, what
traditional/non-traditional materials they used, and how they implemented these adaptations. Participants were credentialed/
licensed art therapists in the United States who worked with physically disabled patients/clients. Participants reported using
many different creative adaptations, including adapting the space, materials, and directives. There were also many different
ideas about how to implement these adaptations, which showcases the need for individualized care for every patient with
disabilities. No disability or patient is the same. Therefore, each needs specific mental health treatment services. Future
research focused on accommodating intellectual, developmental, visual, and hearing disabilities would help to fill the gap in
the current literature for adaptive art therapy
Theoretical Investigation of Optoelectronic Oscillators Near Higher Order Bifurcations for Radio-Frequency Sensing
No full textIUIThe optoelectronic oscillator (OEO) is a time delayed system that exhibits a period doubling route to chaos. The period doubling nature of the OEO introduces bifurcation points where the system transitions from simple periodic behavior to chaotic dynamics. Near these bifurcation points, the OEO can amplify and mix weak injected radio-frequency signals. We introduce a simple model that effectively captures the dynamics of OEOs. Analytic expressions are derived and shown to agree with numerical simulations
Stringent Abortion Laws and the Physician Struggle
No full textRestrictive abortion laws undermine evidence-based maternal care, forcing health care professionals to act against scientific standards and creating ethical dilemmas that compromise maternal health
USP11 Promotes Endothelial Apoptosis-Resistance in Pulmonary Arterial Hypertension by Deubiquitinating HINT3
No full textPulmonary arterial hypertension (PAH) is a progressive, lethal, and incurable disease of the pulmonary vasculature. A previous genome-wide association study (GWAS) with Affymetrix microarray analysis data exhibited elevated histidine triad nucleotide-binding protein 3 (HINT3) in the lung samples of PAH compared to control subjects (failed donors, FD) and the positive correlations of HINT3 with deubiquitinase USP11 and B-cell lymphoma 2 (BCL2). In this study, we aim to investigate the roles and interplay of USP11 and HINT3 in the apoptosis resistance of PAH. The levels of USP11 and HINT3 were increased in the lungs of idiopathic PAH (IPAH) patients and Hypoxia/Sugen-treated mice. USP11 and HINT3 interacted physically, as shown by co-immunoprecipitation (co-IP) assay in human pulmonary arterial endothelial cells (HPAECs). HINT3 was degraded by polyubiquitination, which was reversed by USP11. Furthermore, HINT3 interacted with the anti-apoptotic mediator, BCL2. Overexpression of USP11 increased BCL2 content, congruent to elevated lung tissue levels seen in IPAH patients and Hypoxia/Sugen-treated mice. Conversely, the knockdown of HINT3 function led to a depletion of BCL2. Thus, we conclude that USP11 stabilizes HINT3 activation, which contributes to endothelial apoptosis-resistance of pulmonary arterial endothelial cells in PAH. This can potentially be a novel therapeutic target for ubiquitination modulators for PAH
The absence of Peroxiredoxin-1 in human pancreatic ductal adenocarcinoma (PDAC) markedly reduces cell survival and tumor growth when coupled with the inhibition of Ref-1 redox signaling
No full textPancreatic ductal adenocarcinoma (PDAC) remains highly resistant to therapy, surviving despite hypoxia, oxidative stress, and nutrient deprivation. Redox effector factor-1 (Ref-1) regulates several oncogenic transcription factors (TFs) and is controlled by peroxiredoxins (PRDX). We investigated how Ref-1 inhibition by APX2014, combined with PRDX expression, affects pancreatic cancer cells from multiple patient lines. Silencing or CRISPR/Cas9 knockout of PRDX1-but not PRDX2-6-sensitized PDAC cell lines to APX2014 both in vitro and in vivo without affecting Ref-1's DNA repair function of apurinic/apyrimidinic endonuclease. The combination of PRDX1 loss and APX2014 treatment increased apoptosis and decreased TF activity (NF-κB, HIF-1α) and their downstream targets, TNFAIP2, Survivin, and CA9. A 3D co-culture with PRDX1-null tumor spheroids and cancer-associated fibroblasts (CAFs) showed that (i) Ref-1 inhibition impaired PRDX1-null tumor growth, and (ii) PRDX1 loss reduced CAF viability, highlighting redox crosstalk within the tumor microenvironment (TME). In a PDAC xenograft model, PRDX1-knockout tumors treated with APX2014 had smaller volumes, lighter weights, lower Ref-1, and decreased Ki-67, with improved animal survival. Patient microarrays indicated increased Ref-1 and PRDX1 levels versus normal tissue, emphasizing their clinical relevance. Overall, these data identify PRDX1 as a key factor for PDAC's susceptibility to Ref-1 blockade, suggesting dual targeting could disrupt TME redox signaling, limit tumor progression, and improve APX therapy. These findings support dual targeting of Ref-1 and PRDX1 as a promising therapeutic approach in PDAC and other redox-driven cancers