Percutaneous lumbar interbody fusion results in less perioperative opioid usage compared to minimally invasive transforaminal lumbar interbody fusion: a single institution, multi-surgeon retrospective study.

Background: Ultra-minimally invasive percutaneous lumbar interbody fusion (percLIF) has been demonstrated to further minimize tissue trauma and has been associated with improved clinical outcomes including decreased blood loss, post-operative pain and length of stay when compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. A single-institution retrospective study was conducted to investigate whether 1-level percLIF is associated with decreased narcotic consumption compared to 1-level MIS-TLIF in the first 24-hour following surgery. Methods: A retrospective study of patients undergoing either single-level percLIF or MIS-TLIF from January 2018 to December 2021. Opioid consumption in the 24-hour following surgery was converted into total morphine milligram equivalents (MME). The primary outcome used univariate and multivariate regression analysis to compare MME consumption between the MIS-TLIF and percLIF groups. Secondary outcome variables included, estimated blood loss, total intraoperative MME, MME at discharge, MME at 30 days post-op, exiting nerve root injury, post-anesthesia care unit (PACU) visual analogue scale (VAS) score at handoff, time to first ambulation, distance ambulated post-operative day one and hospital length of stay. Results: A total of 51 patients (21 percLIF vs. 30 MIS-TLIF) were included in the study. Univariate regression analysis revealed that on average patients who underwent percLIF had a 24-hour postoperative MME -50.8 mg (95% CI: -91.6, -10) lower than those who had MIS-TLIF (P=0.02). On multivariable analysis, after adjusting for sex and age, 24-hour postoperative MME closely failed to meet statistical significance (P=0.06) with an average of -40.8 mg (95% CI: -83.2, 1.6) MME in percLIF patients compared to MIS-TLIF. There was no statistically significant difference in MME between MIS-TLIF and percLIF at the time of discharge and at 30 days post-op. Conclusions: In the setting of the current opioid epidemic in the United States and increased numbers of patients undergoing lumbar interbody fusion, spine surgeons must continue to do their part helping reduce the need for opioid prescriptions for postoperative pain management. New "ultra-MIS" techniques such as percLIF allow surgeons to further decrease tissue trauma, which should lead to reduced need for post-operative narcotic requirements.

CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion.

BACKGROUND: With the expanding eligibility for endovascular therapy (EVT) of patients presenting in the late window (6-24 hours after last known well), we aimed to derive a score to predict favorable outcomes associated with EVT versus best medical management. METHODS AND RESULTS: A multinational observational cohort of patients from the CLEAR (Computed Tomography for Late Endovascular Reperfusion) study with proximal intracranial occlusion (2014-2022) was queried (n=58 sites). Logistic regression analyses were used to derive a 9-point score for predicting good functional outcome (modified Rankin Scale score 0-2 or return to premorbid modified Rankin Scale score) at 90 days, with sensitivity analyses for prespecified subgroups conducted using bootstrapped random forest regressions. Secondary outcomes included 90-day functional independence (modified Rankin Scale score 0-2), poor outcome (modified Rankin Scale score 5-6), and 90-day survival. The score was externally validated with a single-center cohort (2014-2023). Of the 3231 included patients (n=2499 EVT), a 9-point score included age, early computed tomography ischemic changes, and stroke severity, with higher points indicating a higher probability of a good functional outcome. The areas under the curve for the primary outcome among EVT and best medical management subgroups were 0.72 (95% CI, 0.70-0.74) and 0.87 (95% CI, 0.84-0.90), respectively, with similar performance in the external validation cohort (area under the curve, 0.71 [95% CI, 0.66-0.76]). There was a significant interaction between the score and EVT for good functional outcome, functional independence, and poor outcome (all Pinteraction<0.001), with greater benefit favoring patients with lower and midrange scores. CONCLUSIONS: This score is a pragmatic tool that can estimate the probability of a good outcome with EVT in the late window. REGISTRATION: URL: https://www.Clinicaltrials.gov; Unique identifier: NCT04096248.

High-Intensity Interval vs. Moderate-Intensity Continuous Training in Parkinson's Disease: A Randomized Trial.

Exercise training is recommended to improve quality of life in those living with Parkinson's Disease (PD); however, the optimal prescription to improve cardiorespiratory fitness and disease-related motor symptoms remains unknown. Twenty-nine participants with PD were randomly allocated to either 10-weeks of high-intensity interval training (HIIT) (n=15; 6 female) or moderate-intensity continuous training (MICT) (n=14; 5 female). The primary outcome was the change in maximal oxygen consumption (VO2peak). Secondary outcomes included changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Part III motor score, Parkinson's Disease Fatigue Scale (PFS-16), resting and exercise cardiovascular measures, gait, balance, and knee extensor strength and fatigability. Exercise training increased VO2peak (main effect of time, P<0.01), with a clinically-meaningful difference in the change following HIIT vs. MICT (∆3.7±3.7 vs. 1.7±3.2 ml∙kg-1∙min-1, P=0.099). The UPDRS motor score improved over time (P<0.001) but without any differences between HIIT vs. MICT (∆-9.7±1.3 vs. -8.4±1.4, P=0.51). Self-reported subjective fatigue (PFS-16) decreased over time (P<0.01) but was similar between HIIT and MICT groups (P=0.6). Gait, balance, blood pressure, and heart rate were unchanged with training (all P>0.09). Knee extensor strength increased over time (P=0.03) but did not differ between HIIT vs. MICT (∆8.2±5.9 vs. 11.7±6.2 Nm, P=0.69). HIIT alone increased muscular endurance of the knee extensors during an isotonic task to failure (P=0.04). In participants with PD, HIIT and MICT both increased VO2peak and led to improvements in motor symptoms and perceived fatigue; HIIT may offer the potential for larger changes in VO2peak and reduced knee extensor fatigability.

Phacofragmentation of Posteriorly Dislocated Lens Fragments: Limbal versus Pars Plana Approach.

PURPOSE: To assess intra-operative complications and feasibility of removing crystalline lens fragments from the vitreous cavity through a limbal incision compared to a pars plana approach. DESIGN: Retrospective cohort study. SUBJECTS: 16 eyes underwent phacofragmentation via a limbal approach (Group A) and 9 eyes through a pars plana approach (Group B) at an academic center over a 10-year period. METHODS: We collected pre-operative, intra-operative, and post-operative data. We compared rates of intraoperative complications, including corneal wound burn, iris or capsular damage, retinal tears, and hemorrhage, and recorded post-operative BCVA and IOP measurements at the one-month post-operative appointment. We also compared rates of post-operative complications, including corneal edema, choroidal detachment, or retinal detachment. MAIN OUTCOME MEASURES: Primary outcomes of the study were the rates of intraoperative complications and the feasibility of crystalline lens removal with the limbal approach. We defined the latter outcome as the ability to complete lens removal without switching to the pars plana route. RESULTS: Mean BCVA for group A was 1.6, and for group B was 2.0 (p = .19). There was no significant difference between the two groups in the incidence of intraoperative complications, including corneal wound burn, iris damage, anterior capsular tear, iatrogenic retinal tear, or suprachoroidal hemorrhage (p > .99). There was no significant difference in the incidence of intra-operative vitreous hemorrhage (p = .36). Additionally, there was no significant difference in post-operative corneal edema (p = .27), choroidal detachment (p = .52), or retinal detachment (p > .99). The mean post-operative BCVA was 1.0 in group A and 1.0 in group B (p = .75). We completed all cases in group A using the limbal approach without switching to the pars plana route. CONCLUSION: Phacofragmentation through a limbal incision provides a feasible option for dropped nuclear fragment removal and is not associated with a higher risk of complications than the pars plana route.

Association of surgeon's sex, and surgeon-patient dyad with financial outcomes among patients undergoing cancer surgery.

BACKGROUND AND OBJECTIVES: Surgeon sex has been associated with perioperative clinical outcomes among patients undergoing oncologic surgery. There may be variations in financial outcomes relative to the surgeon-patient dyad. We sought to define the association of surgeon's sex with perioperative financial outcomes following cancer surgery. METHODS: Patients who underwent resection of lung, breast, hepato-pancreato-biliary (HPB), or colorectal cancer between 2014 and 2021 were identified from the Medicare Standard Analytic Files. A generalized linear model with gamma regression was utilized to characterize the association between sex concordance and expenditures. RESULTS: Among 207,935 Medicare beneficiaries (breast: n = 14,753, 7.1%, lung: n = 59,644, 28.7%, HPB: n = 23,400, 11.3%, colorectal: n = 110,118, 53.0%), 87.8% (n = 182,643) and 12.2% (n = 25,292) of patients were treated by male and female surgeons, respectively. On multivariable analysis, female surgeon sex was associated with slightly reduced index expenditures (mean difference -$353, 95%CI -$580, -$126; p = 0.003). However, there were no differences in 90-day post-discharge inpatient (mean difference -$-225, 95%CI -$570, -$121; p = 0.205) and total expenditures (mean difference $133, 95%CI -$279, $545; p = 0.525). CONCLUSIONS: There was minor risk-adjusted variation in perioperative expenditures relative to surgeon sex. To improve perioperative financial outcomes, a diverse surgical workforce with respect to patient and surgeon sex is warranted.

Demystifying normal-anion-gap metabolic acidosis: pathophysiology, aetiology, evaluation and diagnosis.

Normal-anion-gap metabolic acidosis (NAGMA) is a common but often under-recognised and poorly understood condition, especially by less-experienced clinicians. In adults, NAGMA might be an initial clue to a more significant underlying pathology, such as autoimmune diseases, hypergammaglobulinemia or drug toxicities. However, identifying the aetiology can be challenging due to the diverse processes involved in the development of acidosis. A better understanding of the pathophysiology of NAGMA can help treating physicians suspect and evaluate the condition early and reach the correct diagnosis. This article provides an overview of renal acid-base regulation, discusses the pathophysiological processes involved in developing NAGMA and provides a framework for evaluation to reach an accurate diagnosis.

Endovascular Thrombectomy Versus Intravenous Thrombolysis of Posterior Cerebral Artery Occlusion Stroke.

BACKGROUND AND PURPOSE: Posterior cerebral artery occlusion (PCAo) can cause long-term disability, yet randomized controlled trials to guide optimal reperfusion strategy are lacking. We compared the outcomes of PCAo patients treated with endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) to patients treated with IVT alone. METHODS: From the multicenter retrospective Posterior cerebraL ArTery Occlusion (PLATO) registry, we included patients with isolated PCAo treated with reperfusion therapy within 24 hours of onset between January 2015 and August 2022. The primary outcome was the distribution of the modified Rankin Scale (mRS) at 3 months. Other outcomes comprised 3-month excellent (mRS 0-1) and independent outcome (mRS 0-2), early neurological improvement (ENI), mortality, and symptomatic intracranial hemorrhage (sICH). The treatments were compared using inverse probability weighted regression adjustment. RESULTS: Among 724 patients, 400 received EVT+/-IVT and 324 IVT alone (median age 74 years, 57.7% men). The median National Institutes of Health Stroke Scale score on admission was 7, and the occluded segment was P1 (43.9%), P2 (48.3%), P3-P4 (6.1%), bilateral (1.0%), or fetal posterior cerebral artery (0.7%). Compared to IVT alone, EVT+/-IVT was not associated with improved functional outcome (adjusted common odds ratio [OR] 1.07, 95% confidence interval [CI] 0.79-1.43). EVT increased the odds for ENI (adjusted OR [aOR] 1.49, 95% CI 1.05-2.12), sICH (aOR 2.87, 95% CI 1.23-6.72), and mortality (aOR 1.77, 95% CI 1.07-2.95). CONCLUSION: Despite higher odds for early improvement, EVT+/-IVT did not affect functional outcome compared to IVT alone after PCAo. This may be driven by the increased risk of sICH and mortality after EVT.

Endovascular Therapy in the Extended Time Window for Large Vessel Occlusion in Patients With Pre-Stroke Disability.

BACKGROUND AND PURPOSE: We compared the outcomes of endovascular therapy (EVT) in an extended time window in patients with large-vessel occlusion (LVO) between patients with and without pre-stroke disability. METHODS: In this prespecified analysis of the multinational CT for Late Endovascular Reperfusion study (66 participating sites, 10 countries between 2014 and 2022), we analyzed data from patients with acute ischemic stroke with a pre-stroke modified Rankin Scale (mRS) score of 0-4 and LVO who underwent EVT 6-24 hours from the time last seen well. The primary outcome was the composite of functional independence (FI; mRS score 0-2) or return to the pre-stroke mRS score (return of Rankin, RoR) at 90 days. Outcomes were compared between patients with pre-stroke disability (pre-stroke mRS score 2-4) and those without (mRS score 0-1). RESULTS: A total of 2,231 patients (median age, 72 years; median National Institutes of Health Stroke Scale score, 16) were included in the present analysis. Of these, 564 (25%) had pre-stroke disability. The primary outcome (FI or RoR) was observed in 30.7% of patients with pre-stroke disability (FI, 16.5%; RoR, 30.7%) compared to 44.1% of patients without (FI, 44.1%; RoR, 13.0%) (P<0.001). In multivariable logistic regression analysis with inverse probability of treatment weighting, pre-stroke disability was not associated with significantly lower odds of achieving FI or RoR (adjusted odds ratio 0.73, 95% confidence interval 0.43-1.25). Symptomatic intracranial hemorrhage occurred in 6.3% of both groups (P=0.995). CONCLUSION: A considerable proportion of patients with late-presenting LVO and pre-stroke disability regained pre-stroke mRS scores after EVT. EVT may be appropriate for patients with pre-stroke disability presenting in the extended time window.

Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia.

BACKGROUND: The optimal anesthetic strategy for endovascular therapy (EVT) in acute ischemic stroke is still under debate. The aim of this study was to compare the clinical outcomes of patients with isolated posterior cerebral artery (PCA) occlusion stroke undergoing EVT by anesthesia modality with conscious sedation (non-GA) versus general anesthesia (GA). METHODS: Patients from the Posterior CerebraL Artery Occlusion (PLATO) study were analyzed with regard to anesthetic strategy. GA was compared with non-GA using multivariable logistic regression and inverse probability of weighting treatment (IPTW) methods. The primary endpoint was the 90-day distribution of the modified Rankin Scale (mRS) score. Secondary outcomes included functional independence or return to Rankin at day 90, and successful reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b to 3. Safety endpoints were symptomatic intracranial hemorrhage and mortality. RESULTS: Among 376 patients with isolated PCA occlusion stroke treated with EVT, 183 (49%) had GA. The treatment groups were comparable, although the GA group contained more patients with severe stroke and lower posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS). On IPTW analysis, there was no difference between groups with regard to ordinal mRS shift analysis (common OR 0.89, 95% CI 0.53 to 1.51, P=0.67) or functional independence (OR 0.84, 95% CI 0.50 to 1.39, P=0.49). There were greater odds for successful reperfusion with GA (OR 1.70, 95% CI 1.17 to 2.47, P=0.01). Safety outcomes were comparable between groups. CONCLUSION: In patients with isolated PCA occlusion undergoing EVT, patients treated with GA had higher reperfusion rates compared with non-GA. Both GA and non-GA strategies were safe and functional outcomes were similar.

Effective Surgical Site Infection Prevention Strategies for Diabetic Patients Undergoing Surgery: A Systematic Review.

Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population. From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English. The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.

The impact of genre-based instruction on Saudi university students' English writing performance and motivation: a mixed-method study.

Despite the important role motivation plays in students' writing learning and development, not much attention has been given to experimenting particular instructional techniques for developing students' writing motivation. One of the least researched teaching techniques in writing motivation studies is genre-based instruction. In this study, we examined the impact of genre-based instruction on 21 Saudi university students' English argumentative and classification essay writing performance and their writing motivation dimensions (writing apprehension, anxiety, self-efficacy and self-concept). Drawing upon the quasi-experimental research design and non-random sampling technique, we used genre-based instruction with a representative intact class of English-as-a-foreign-language (EFL) writing students at a Saudi university. To examine the potential impact of the treatment, we collected pre- and post-instruction data, along with data gathered through an open-ended questionnaire. The results showed that genre-based instruction has contributed significantly to improving the students' writing performance and also their writing motivation dimensions. These positive gains varied from one writing quality aspect and motivational variable to another. The students' answers to the open-ended questionnaire also showed the positive writing learning and motivation improvements they experienced. It is generally concluded that developing students' language and rhetorical awareness and text composition performance seems to be a prerequisite for improving their writing motivation levels. The paper ends with discussing the implications of the results.

Surface-normal illuminated pseudo-planar Ge-on-Si avalanche photodiodes with high gain and low noise.

Germanium-on-Silicon (Ge-on-Si) avalanche photodiodes (APDs) are of considerable interest as low intensity light detectors for emerging applications. The Ge absorption layer detects light at wavelengths up to ≈ 1600 nm with the Si acting as an avalanche medium, providing high gain with low excess avalanche noise. Such APDs are typically used in waveguide configurations as growing a sufficiently thick Ge absorbing layer is challenging. Here, we report on a new vertically illuminated pseudo-planar Ge-on-Si APD design utilizing a 2 µm thick Ge absorber and a 1.4 µm thick Si multiplication region. At a wavelength of 1550 nm, 50 µm diameter devices show a responsivity of 0.41 A/W at unity gain, a maximum avalanche gain of 101 and an excess noise factor of 3.1 at a gain of 20. This excess noise factor represents a record low noise for all configurations of Ge-on-Si APDs. These APDs can be inexpensively manufactured and have potential integration in silicon photonic platforms allowing use in a variety of applications requiring high-sensitivity detectors at wavelengths around 1550 nm.

Textbook oncologic outcomes among patients undergoing laparoscopic, robotic and open surgery for intrahepatic and perihilar cholangiocarcinoma.

BACKGROUND: Textbook oncologic outcome (TOO) serves as a composite, oncologic metric for surgical quality of care. We sought to evaluate variations in TOO among patients undergoing laparoscopic, robotic, and open surgery for intrahepatic (iCCA) and perihilar (pCCA) cholangiocarcinoma. METHODS: Patients who underwent liver resection for iCCA and pCCA between 2010 and 2018 were identified from the National Cancer Database. Entropy balancing was performed for covariate balancing and multivariable regression was used to evaluate the association between surgical approach and TOO. RESULTS: Among 5434 patients who underwent hepatic resection between 2010 and 2018, 3888 (71.6%) had iCCA, and 1546 (28.4%) had pCCA. TOO was achieved in 11.7% (n = 454), and 18.8% (n = 291) of patients with iCCA and pCCA, respectively. There was a difference in achievement of TOO relative to operative approach among patients with iCCA (robotic: 6.2% vs. laparoscopic: 8.1% vs. open: 12.5%; p = 0.002). After entropy balancing, patients with iCCA undergoing laparoscopic surgery had 32% reduced odds of achieving TOO (Ref: open surgery; laparoscopic, OR 0.68, 95%CI 0.49-0.93; p = 0.016; robotic, OR 0.69, 95%CI 0.34-1.39; p = 0.298). CONCLUSIONS: Usage of composite oncologic measures such as TOO may allow for a holistic assessment of different approaches to hepatic resection among patients with CCA.

Sunlight exposure might account for the relatively low COVID-19 morbidity and mortality in tropical countries.

The present study aimed at exploring whether sunlight exposure might account for the relative difference in COVID-19-related morbidity and mortality between tropical and non-tropical countries. A retrospective observational study was designed and data from the World Health Organization weekly COVID-19 epidemiological update was compiled. We examined the total number of confirmed COVID-19 cases per 100 000 population, as well as the total number of COVID-19-related mortalities per 100 000 population. Solar variables data were obtained from the Global Solar Atlas website (https://globalsolaratlas.info/). These data were analyzed to determine the association of sunlight exposure to COVID-19-related morbidity and mortality in tropical and non-tropical countries. Results revealed a statistically significant decrease in the number of confirmed COVID-19 cases per 100 000 population (P<0.001), as well as the number of COVID-19-related mortalities per 100 000 population (P<0.001) between tropical and non-tropical countries. Analyses of sunlight exposure data found that specific photovoltaic power output, global horizontal irradiation, diffuse horizontal irradiation and global tilted irradiation at optimum angle were significantly inversely correlated to COVID-19-related morbidity and mortality. This suggests that stronger sunlight exposure potentially leads to lower COVID-19-related morbidity and mortality. Findings from this study suggest that the relatively low COVID-19-related morbidity and mortality in tropical countries were possibly due to better sunlight exposure that translates into adequate vitamin D status.

Correlation between carriers of Methicillin-resistant Staphylococcus aureus and the incidence of MRSA surgical site infections in orthopedic surgery patients.

OBJECTIVE: Surgical site infection (SSI) is a devastating complication in orthopedic surgery. Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious organism in SSI, especially in orthopedic patients. We aimed to understand the association between MRSA carriers and the rate of SSI caused by MRSA in orthopedic patients. PATIENTS AND METHODS: We prospectively performed a cohort investigation on patients admitted to the Department of Orthopedic between April and August 2023. Samples were taken preoperatively from the nose and post-operatively in surgical wounds. All samples were grown in MeReSa Agar and defined as positive with MRSA characteristics. Data analysis was performed using SPSS Statistics. A significant difference between groups was assessed using either the Chi-square test or Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: We obtained 526 nasal swabs of patients, and 140 (26.6%) samples were positive for MRSA. Our study revealed significant associations between MRSA carriers and the following factors: history of recent hospitalization (OR: 1.81; 95% CI: 1.172-2.795; p=0.007), smoking history (OR: 1.55; 95% CI: 1.011-2.383; p=0.044), and antibiotic exposures (OR: 2.19; 95% CI: 1.305-3.703; p=0.003). Our findings showed a significant association between SSI and the following factors: history of antibiotic exposures (OR: 2.89; 95% CI: 1.264-6.566; p=0.003), blood loss volume >500 ml (OR: 2.522; 95% CI: 1.245-5.108; p=0.008) and contaminated surgical wounds (OR: 5.97; 95% CI: 2.907-12.266; p=0.001). Patients with MRSA carriers tended to have an increased risk of having an MRSA SSI with an odds ratio of 3.44 (95% CI: 1.13-10.48; p=0.047). CONCLUSIONS: Our study highlights the increased risk of MRSA carriage in patients with a history of smoking, recent hospital admission, or antibiotic exposure. Our reports also identify potential risk factors for SSI, such as previous antibiotic exposure, blood loss, and contaminated wounds. Furthermore, our research establishes an association between MRSA colonization and MRSA SSI, which emphasizes the criticality of decolonization strategies. A further prospective multicenter study is needed to elaborate on our study findings.

Contrast Staining in Noninfarcted Tissue after Endovascular Treatment of Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Contrast staining is a common finding after endovascular treatment of acute ischemic stroke. It typically occurs in infarcted tissue and is considered an indicator of irreversible brain damage. Contrast staining in noninfarcted tissue has not been systematically investigated. We sought to assess the incidence, risk factors, and clinical significance of contrast staining in noninfarcted tissue after endovascular treatment. MATERIALS AND METHODS: We conducted a retrospective review of consecutive patients who underwent endovascular treatment for anterior circulation large-vessel occlusion acute ischemic stroke. Contrast staining, defined as new hyperdensity on CT after endovascular treatment, was categorized as either contrast staining in infarcted tissue if the stained region demonstrated restricted diffusion on follow-up MR imaging or contrast staining in noninfarcted tissue if the stained region demonstrated no restricted diffusion. Baseline differences between patients with and without contrast staining in noninfarcted tissue were compared. Logistic regression was used to identify independent associations for contrast staining in noninfarcted tissue after endovascular treatment. RESULTS: Among 194 patients who underwent endovascular treatment for large-vessel occlusion acute ischemic stroke and met the inclusion criteria, contrast staining in infarcted tissue was noted in 52/194 (26.8%) patients; contrast staining in noninfarcted tissue, in 26 (13.4%) patients. Both contrast staining in infarcted tissue and contrast staining in noninfarcted tissue were noted in 5.6% (11/194). Patients with contrast staining in noninfarcted tissue were found to have a higher likelihood of having an ASPECTS of 8-10, to be associated with contrast staining in infarcted tissue, and to achieve successful reperfusion compared with those without contrast staining in noninfarcted tissue. In contrast staining in noninfarcted tissue regions, the average attenuation was 40 HU, significantly lower than the contrast staining in infarcted tissue regions (53 HU). None of the patients with contrast staining in noninfarcted tissue had clinical worsening during their hospital stay. The median discharge mRS was significantly lower in patients with contrast staining in noninfarcted tissue than in those without (3 versus 4; P = .018). No independent predictors of contrast staining in noninfarcted tissue were found. CONCLUSIONS: Contrast staining can be seen outside the infarcted tissue after endovascular treatment of acute ischemic stroke, likely attributable to the reversible disruption of the BBB in ischemic but not infarcted tissue. While generally benign, understanding its characteristics is important because it may mimic pathologic conditions such as infarcted tissue and cerebral edema.

The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology.

BACKGROUND: The rise of minimally invasive lumbar fusions and advanced imaging technologies has facilitated the introduction of novel surgical techniques with the trans-facet approach being one of the newest additions. We aimed to quantify any pathology-driven anatomic changes to the trans-facet corridor, which could thereby alter the ideal laterality of approach to the disc space. METHODS: In this retrospective cohort study, we measured the areas and maximum permissible cannula diameters of the trans-facet corridor using commercially available software (BrainLab, Munich, Germany). Exiting and traversing nerve roots, thecal sacs, and lumbar vertebrae were manually segmented on T2-SPACE magnetic resonance imaging. Spondylolisthesis, disc protrusions, and disc space heights were recorded. RESULTS: A total of 118 trans-facet corridors were segmented bilaterally in 16 patients (65.6 ± 12.1 years, 43.8% female, body mass index 29.2 ± 5.1 kg/m2). The mean areas at L1-L2, L2-L3, L3-L4, and L4-L5 were 89.4 ± 24.9 mm2, 124 ± 39.4 mm2, 123 ± 26.6 mm2, and 159 ± 42.7 mm2, respectively. The mean permissible cannula diameter at the same levels were 7.85 ± 1.43 mm, 8.98 ± 1.72 mm, 8.93 ± 1.26 mm, and 10.2 ± 1.94 mm, respectively. Both parameters increased caudally. Higher degrees for spondylolisthesis were associated with larger areas and maximum cannula diameters on regression analysis (P < 0.001). CONCLUSIONS: Our results illustrate that pathology, like spondylolisthesis, can increase the area of the trans-facet corridor. By understanding this effect, surgeons can better decide on the optimal approach to the disc while taking into consideration a patient's unique anatomy.

Ocular RNA nanomedicine: engineered delivery nanoplatforms in treating eye diseases.

Ocular disorders remain a major global health challenge with unmet medical needs. RNA nanomedicine has shown significant therapeutic benefits and safety profiles in patients with complex eye disorders, already benefiting numerous patients with gene-related eye disorders. The effective delivery of RNA to the unique structure of the eye is challenging owing to RNA instability, off-target effects, and ocular physiological barriers. Specifically tailored RNA medication, coupled with sophisticated engineered delivery platforms, is crucial to guide and advance developments in treatments for oculopathy. Herein we review recent advances in RNA-based nanomedicine, innovative delivery strategies, and current clinical progress and present challenges in ocular disease therapy.