Search

Background: Frailty status has been associated with higher rates of complications after spine surgery. However, frailty patients constitute a heterogeneous group based on the combinations of comorbidities. The objective of this study is to compare the combinations of variables that compose the modified 5-factor frailty index score (mFI-5) based on the number of comorbidities in terms of complications, reoperation, readmission, and mortality after spine surgery., Methods: The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database from 2009-2019 was used to identify patients who underwent elective spine surgery. The mFI-5 item score was calculated and patients were classified according to number and combination of comorbidities. Multivariable analysis was used to assess the independent impact of each combination of comorbidities in the mFI-5 score on the risk of complications., Results: A total of 167, 630 patients were included with a mean age of 59.9 ± 13.6 years. The risk of complications was the lowest in patients with diabetes + hypertension (OR = 1.2) and highest in those with the combination of congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disease (COPD), and dependent status (OR = 6.6); there was a high variation in complication rate based on specific combinations., Conclusions: There is high variability in terms of relative risk of complications based on the number and combination of different comorbidities, especially with CHF and dependent status. Therefore, frailty status encompasses a heterogeneous group and sub-stratification of frailty status is necessary to identify patients with significantly higher risk of complications., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Frailty status and hypoalbuminemia have been associated with higher rates of complications after spine surgery. However, the combination of both conditions has not been fully analyzed. The objective of this study was to assess the effect of frailty and hypoalbuminemia on the risk of complications after spine surgery., Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2009 to 2019 was used. Frailty status was calculated using the modified 5-item frailty index (mFI-5). Patients were classified into nonfrail (mFI = 0), pre-frail (mFI = 1), and frail (mFI ≥2) groups and also based on albumin levels into normal (≥3.5 g/dL) and hypoalbuminemia groups (<3.5 g/dL). The latter group was also subclassified into mild and severe hypoalbuminemia groups. Multivariable analysis was used. A Spearman ρ correlation between albuminemia and mFI-5 was also performed., Results: A total of 69,519 patients (36,705 men [52.8%] and 32,814 women [47.2%]) with a mean age of 61.0 ± 13.2 years were included. Patients were classified as nonfrail (n = 24,897), pre-frail (n = 28,897), and frail groups (n = 15,725). Hypoalbuminemia was significantly higher in the frail group (11.4%) compared with the nonfrail group (4.3%). An inverse correlation was observed between albumin levels and frailty status (ρ = -0.139; P < 0.0001). Frail patients with severe hypoalbuminemia had significantly higher risk of complications (odds ratio [OR], 5.0), reoperation (OR, 3.3), readmission (OR, 3.1), and mortality (OR, 31.8) compared with patients without hypoalbuminemia., Conclusions: The combination of frailty and hypoalbuminemia significantly increases the risk of complications after spine surgery. The prevalence of hypoalbuminemia in the frailty group was significantly higher than in nonfrail patients (11.4% vs. 4.3%). Both conditions should be evaluated preoperatively., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF) or anterior lumbar interbody fusion/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures., Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between 2 time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the 2 procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as P < 0.05., Results: For both approaches, there was an increase in age and American Society of Anesthesiologists class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; P < 0.001), and more patients were rated American Society of Anesthesiologists class 3 (DID: -2.4%; P = 0.033) in the ALIF/LLIF cohort than in the PLIF/TLIF cohort. Length of stay declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF than for patients who underwent PLIF/TLIF (DID: 0.2%; P = 0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; P = 0.080; ALIF/LLIF DID: -0.2%; P = 0.696)., Conclusions: Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and length of stay, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF-specific care than in PLIF/TLIF., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients., Methods: Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention., Results: 84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO 2 has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge., Conclusion: The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported., Practice Implications: This work shows one effective education strategy taken in place that can be replicated in different settings., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES)., Background: In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear., Methods: Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization., Results: In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI., Conclusions: In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis., (Copyright © 2018. Published by Elsevier Inc.)

Hygroscopic properties of water-soluble matter (WSM) extracted from fine-mode aerosols (PM2.5) in the marine atmospheric boundary layer of the Bay of Bengal (BoB) have been investigated during a cruise from 27th December 2008 to 30th January 2009. Hygroscopic growth factors were measured on particles generated from the WSM using an H-TDMA system with an initial dry size of 100 nm in the range of 5-95% relative humidity (RH). The measured hygroscopic growth of WSM at 90% RH, g(90%)WSM, were ranged from 1.11 to 1.74 (mean: 1.43 ± 0.19) over the northern BoB and 1.12 to 1.38 (mean: 1.25 ± 0.09) over the southern BoB. A key finding is that distinct hygroscopic growth factors are associated with the air masses from the Indo-Gangetic plains (IGP), which are clearly distinguishable from those associated with air masses from Southeast Asia (SEA). We found higher (lower) g(90%)WSM over the northern (southern) BoB, which were associated with an IGP (SEA) air masses, probably due the formation of high hygroscopic salts such as (NH4)2SO4. On the other hand, biomass burning influenced SEA air masses confer the low hygroscopic salts such as K2SO4, MgSO4, and organic salts over the southern BoB. Interestingly, mass fractions of water-soluble organic matter (WSOM) showed negative and positive correlations with g(90%)WSM over the northern and southern BoB, respectively, suggesting that the mixing state of organic and inorganic fractions could play a major role on the g(90%)WSM over the BoB. Further, WSOM/SO4(2-) mass ratios suggest that SO4(2-) dominates the g(90%)WSM over the northern BoB whereas WSOM fractions were important over the southern BoB. The present study also suggests that aging process could significantly alter the hygroscopic growth of aerosol particles over the BoB, especially over the southern BoB., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Temporal variability (November'09-March'10) in the mass concentrations of PM2.5, mineral dust, organic carbon and elemental carbon (OC and EC), water-soluble organic carbon (WSOC) and inorganic species (WSIS) has been studied in the atmospheric outflow to the Bay of Bengal from a sampling site [Kharagpur: 22.02°N, 87.11°E] in the Indo-Gangetic Plain (IGP). Based on diagnostic ratios of carbonaceous species [OC/EC ≈ 7.0 ± 2.2, WSOC/OC ≈ 0.52 ± 0.16, and K(+)/EC≈0.48±0.17], we document dominant impact from biomass burning emissions (wood-fuel and post-harvest agricultural-waste burning) in the IGP-outflow. Relatively high concentration of sulphate (SO4(2-) ≈ 6.9-25.3 μg m(-3); SO4(2-)/ΣWSIS=45-77%) and characteristic ratios of nss-SO4(2-)/EC (3.9 ± 2.1) and nss-SO4(2-)/OC (0.61 ± 0.46) provide information on absorption/scattering properties of aerosols. Based on quantitative assessment of individual components of PM2.5, we document aerosol organic carbon-to-organic mass (OC to OM) conversion factor centring at 1.5 ± 0.2 (range: 1.3-2.7) in the atmospheric outflow from IGP. The aerosol composition over the Bay of Bengal shows striking similarity with the diagnostic ratios documented for the IGP-outflow. Relatively high conversion factor for assessing the mass of organic aerosols over the Bay of Bengal (1.1-3.7) provides evidence for their oxidation during long-range atmospheric transport., (Copyright © 2014 Elsevier B.V. All rights reserved.)

This study presents the first data set on atmospheric input of N, P and Fe to the Northern Indian Ocean. Based on the chemical analysis of ambient aerosols, collected from the marine atmospheric boundary layer (MABL) during the continental outflow (January-April), we document that dry-deposition fluxes (μmolm(-2) d(-1)) of N (2-167), P (0.5-4.8) and Fe (0.02-1.2) to the Bay of Bengal are significantly higher compared to those over the Arabian Sea [N: 0.2-18.6; P: 0.3-0.9; Fe: 0.001-0.015]. Using atmospherically derived P and Fe, C-fixation (1.1 Pg yr(-1)) in the Bay of Bengal is dominated by anthropogenic sources. In contrast, C-fixation (0.03 Pg yr(-1)) in the Arabian Sea is limited by P and Fe. This is attributed to the poor fractional solubility of atmospheric mineral dust transported to the Arabian Sea. However, N-fixation by diazotrophs in the two oceanic regions is somewhat similar (0.5 Tg yr(-1)). Our estimate of N-deposition (0.2 Tg yr(-1)) to the Northern Indian Ocean is significantly lower compared to model results (~800-1200 mg-Nm(-2)yr(-1)≈5.7-8.6 Tg yr(-1) by Duce et al. (2008); ~4.1 Tg yr(-1) by Okin et al. (2011); ~0.8 Tg yr(-1) by Kanakidou et al. (2012)). An overestimate of N-deposition by models could arise due to inappropriate parameterization of temporal variability associated with the continental outflow spread over only four months., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Platelets gradually lose their disc shape during storage. The authors studied simultaneous changes in platelet cytosolic Ca2+ (Cai) and the polymerization state of actin as related to the shape. Platelet concentrates were stored under blood bank conditions for up to 10 days. Aliquots were removed and analyzed as follows: platelet Cai and increments in Cai induced by adenosine diphosphate (ADP) were determined by fluorescence of fura-2-loaded cells; loss of disc shape was determined by differences in light scattering intensity induced by stirring; and the ratio of globular and total actin (G/T) of platelets in plasma was determined by a modification of the DNase inhibition assay. Globular actin was found to be 86 +/- 3% of total actin in freshly drawn platelets suspended in plasma. The following changes occurred during storage: G/T in platelet concentrates increased from 63 +/- 5 (day 0) to 74 +/- 2% in the first 24 hours then fell to 33 +/- 6% by day 10. The percent discoid platelets also increased from day 0 to day 1 then fell in the ensuing days. There was an initial drop in Cai from day 0 to day 1, after which Cai increased on days 3 and 6. Globular actin polymerization during storage closely correlated with the change in percent discs (r = 0.95). During 6 days of storage Cai was highly correlated with shape change (r = 0.97) and to a lesser extent (r = 0.87) with the ratio of globular actin. The authors conclude that actin polymerization, shape, and Ca2+ change in a related fashion during storage.