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There are no existing practices or methods to ensure cleanliness, sterility, or prevent cross-contamination when it comes to common operating room (OR) tape. The authors hypothesized that adhesive tapes used by anesthesia providers in ORs and off-site surgical areas might be colonized by microorganisms and that culturing these tape rolls would reveal significant monomicrobial and polymicrobial contamination. Material and Methods: The primary objective of this observational cohort study was to report and compare contamination rate including polymicrobial contamination rate between tape specimens collected from storage site and specimen from the ORs, off-sites, and after use on a patient. The outcome measures were the culture reports of the adhesive tapes. The authors then designed an intervention that integrated anesthesia providers' hand hygiene and maintenance of a barrier between the OR tapes and OR surfaces.The authors reported gross contamination and cross-contamination among the OR off-site tapes. The contamination rates reported for tapes from OR, off-site specimens, and patient specimens were 68.2%,63.2%, and 100%, respectively. The authors again cultured adhesive tapes after the intervention and reported improved outcomes.The current quality improvement (QI) project identified the potential for OR tapes to serve as microbial vectors. The authors advocate environmental decontamination and anesthesia providers' hand hygiene in parallel as a part of routine anesthesia care in their practice and agree that the endotracheal tubes (ETTs) and orogastric or nasogastric tubes should be pre-packaged with single-use tape, which can be used for securing devices.

SUMMARYTo achieve smooth motor performance in a rich and changing sensory environment, motor outputs must be constantly updated in response to sensory feedback. Although proprioception and cutaneous information are known to modulate motor output, it is unclear whether they work together in the spinal cord to shape complex motor actions such as locomotion. Here we identify the medial deep dorsal horn as a “hot zone” of convergent proprioceptive and cutaneous input for locomotion. Due to increased responsiveness to sensory input, inhibitory interneurons in the medial deep dorsal horn area are preferentially recruited in locomotion. To study inhibitory interneurons in this area, we utilize an intersectional genetic strategy to isolate and ablate a population of parvalbumin-expressing glycinergic interneurons in the medial deep dorsal horn (dPVs). Using histological and electrophysiological methods we find that dPVs integrate convergent proprioceptive and cutaneous input while targeting diffuse ventral horn motor networks. dPV ablation paired with behavioral testing and EMG recordings reveals a role for dPVs in the timing and magnitude of muscle recruitment, controlling step-cycle transition, kinematics, and limb coordination in a state and phase-dependent manner. Together, our results suggest that convergent sensory inputs work in concert to coordinate the activity of dPVs, and in-turn regulate motor output in a contextually relevant manner.HighlightsInhibitory interneurons in the medial deep dorsal horn (mDDH), functionally represented by a large glycinergic PV expressing subpopulation (dPVs), receive convergent input from cutaneous receptors and proprioceptors and are preferentially recruited during locomotion.While dPVs diffusely target motor networks, the temporal dynamics of their activity is regulated by incoming inputs, suggesting a role in modulation of motor output timing.Ablation of dPVs alters stance-to-swing transition and step frequency during high-speed locomotion, likely to result from loss of sensory mediated muscle inhibition.Ablation of dPVs alters joint kinematics at the transition from stance-to-swing, likely to result from loss of sensory mediated muscle amplitude attenuation.

SUMMARYImprovements in the speed and cost of expression profiling of neuronal tissues offer an unprecedented opportunity to define ever finer subgroups of neurons for functional studies. In the spinal cord, single cell RNA sequencing studies1,2support decades of work on spinal cord lineage studies3–5, offering a unique opportunity to probe adult function based on developmental lineage. While Cre/Flp recombinase intersectional strategies remain a powerful tool to manipulate spinal neurons6–8, the field lacks genetic tools and strategies to restrict manipulations to the adult mouse spinal cord at the speed at which new tools develop. This study establishes a new workflow for intersectional mouse-viral strategies to dissect adult spinal function based on developmental lineages in a modular fashion. To restrict manipulations to the spinal cord, we generate a brain-sparingHoxb8FlpOmouse line restricting Flp recombinase expression to caudal tissue. Recapitulating endogenousHoxb8gene expression9, Flp-dependent reporter expression is present in the caudal embryo starting day 9.5. This expression restricts Flp activity in the adult to the caudal brainstem and below.Hoxb8FlpOheterozygous and homozygous mice do not develop any of the sensory or locomotor phenotypes evident in Hoxb8 heterozygous or mutant animals10,11, suggesting normal developmental function of the Hoxb8 gene and protein inHoxb8FlpOmice. Compared to the variability of brain recombination in available caudal Cre and Flp lines12,13Hoxb8FlpOactivity is not present in the brain above the caudal brainstem, independent of mouse genetic background. Lastly, we combine theHoxb8FlpOmouse line with dorsal horn developmental lineage Cre mouse lines to express GFP in developmentally determined dorsal horn populations. Using GFP-dependent Cre recombinase viruses14and Cre recombinase-dependent inhibitory chemogenetics, we target developmentally defined lineages in the adult. We show how developmental knock-out versus transient adult silencing of the same RORβlineage neurons affects adult sensorimotor behavior. In summary, this new mouse line and viral approach provides a blueprint to dissect adult somatosensory circuit function using Cre/Flp genetic tools to target spinal cord interneurons based on genetic lineage.In briefWe describe the generation of aHoxb8FlpOmouse line that targets Flp-recombinase expression to the spinal cord, dorsal root ganglia, and caudal viscera. This line can be used in intersectional Cre/Flp strategies to restrict manipulations to the caudal nervous system. Additionally, we describe an intersectional genetics+viral strategy to convert developmental GFP expression into adult Cre expression, allowing for modular incorporation of viral tools into intersectional genetics. This approach allows for manipulation of a developmentally determined lineage in the adult. This strategy is also more accessible than traditional intersectional genetics, and can adapt to the constantly evolving available viral repertoire.Highlights-A newHoxb8FlpOmouse line allows Flp-dependent recombination in the spinal cord, dorsal root ganglia, and caudal viscera.-We observed no ectopic brain expression across mouse genetic backgrounds with theHoxb8FlpOmouse line.-Combining this new mouse line for intersectional genetics and a viral approach, we provide a novel pipeline to target and manipulate developmentally defined adult spinal circuits.

Carnitine insufficiency is reported in type 1 diabetes mellitus. To determine whether this is accompanied by defects in biosynthesis and/or renal uptake, liver and kidney were obtained from male Sprague-Dawley rats with streptozotocin-induced diabetes. Diabetic rats exhibited the metabolic consequences of type 1 diabetes, including hypoinsulinemia, hyperglycemia, and increased urine output. Systemic hypocarnitinemia, expressed as free carnitine levels, was evident in the plasma, liver, and kidney of diabetic rats. Compared to control rats, the low free carnitine in the plasma of diabetic rats was accompanied by decreased expression of γ-butyrobetaine hydroxylase in liver and kidney, suggesting impaired carnitine biosynthesis. Expression of organic cation transporter-2 in kidney was also reduced, indicating impaired renal reabsorption, and confirmed by the presence of elevated levels of free carnitine in the urine of diabetic rats. Insulin treatment of diabetic rats reversed the plasma hypocarnitinemia, increased the free carnitine content in both kidney and liver, and prevented urinary losses of free carnitine. This was associated with increased expression of γ-butyrobetaine hydroxylase and organic cation transporter-2. The results of our study indicate that type 1 diabetes induced with streptozotocin disrupts carnitine biosynthesis and renal uptake mechanisms, leading to carnitine insufficiency. These aberrations in carnitine homeostasis are prevented with daily insulin treatment.

Difficulty in debris removal and the transport of fresh dielectric into discharge gap hinders the process performance of electrical discharge machining (EDM) process. Therefore, in this work, an economical low frequency vibration platform was developed to improve the performance of EDM through vibration assistance. The developed vibratory platform functions on an eccentric weight principle and generates a low frequency vibration in the range of 0–100 Hz. The performance of EDM was evaluated in terms of the average surface roughness (Ra), material removal rate (MRR), and tool wear rate (TWR) whilst varying the input machining parameters viz. the pulse-on-time (Ton), peak current (Ip), vibration frequency (VF), and tool rotational speed (TRS). The peak current was found to be the most significant parameter and contributed by 78.16%, 65.86%, and 59.52% to the Ra, MRR, and TWR, respectively. The low frequency work piece vibration contributed to an enhanced surface finish owing to an improved flushing at the discharge gap and debris removal. However, VF range below 100 Hz was not found to be suitable for the satisfactory improvement of the MRR and reduction of the TWR in an electrical discharge drilling operation at selected machining conditions.

Metallic Micro lattice is a very new material that combines different material properties and with different geometrical orientations can achieve better stiffness, strength and good energy absorbing capacity. It is the lightest material ever made. In this paper, an overview of manufacturing, geometrical, mechanical properties and applications are presented. Metallic micro lattice can be produced using different processes and it affects their mechanical properties. An overview of different manufacturing processes is presented in this paper. Further, a study on geometrical and structural properties of these structures has been done. Metallic micro lattice are composed of micro struts. These struts are arranged in different geometrical orientations like honeycomb, folded and foam. On the basis of stress behavior, there are Bending Dominated Structures and Stress Dominated Structures found in open-cell and closed-cell respectively. They have a very good energy absorbing capacity. It was found that in comparison to stretch dominated structures, bending dominated structures had a very low stiffness and low failure strength. Study on energy absorption and damping performance showed that micro lattice has greater efficiency in terms of energy absorption and damping in terms of any other metallic materials available. Further, the thermal expansion study showed that the lattice material undergoes zero or negative thermal expansion. Further, different applications of micro lattice has also been presented.

OBJECTIVE Lower back pain (LBP) is a worldwide health problem, and magnetic resonance imaging (MRI) is a common modality used to aid in its diagnosis. Although specific guidelines for assessing the necessity of MRI usage exist, the use of MRI as the initial imaging method for LBP seems to be more common than necessary in general practice. METHODS We conducted a retrospective chart review of 313 patients who had undergone MRI of the lumbosacral spine during 2014-2015. We recorded and compared various factors, including age, sex, body mass index, current smoking status, race, symptoms, MRI findings, and progression to surgery within the next year. All rates were compared according to whether the MRI results showed radiographically significant findings (MRI-positive) or not (MRI-negative) using the chi-square or Fisher exact tests (if the expected cell count was

We present a case report of a 50-year-old female with a past medical history of chronic headaches diagnosed as supraorbital neuralgia. Her headaches had been refractory to conventional analgesic medications and she had received multiple supraorbital nerve blocks which gave her temporary relief of the headaches lasting up to 2 weeks. The patient also received chemical neurolysis of the supraorbital nerve bilaterally with 10% Lidocaine bilaterally, under fluoroscopic guidance in the pain clinic. The patient reported positive outcome following the block with significant pain control for up to 6-7 months postprocedure. The authors conclude that in a patient with a refractory headache due to supraorbital neuralgia, a 10% lidocaine,injection can be an efficacious alternative to radiofrequency ablation as it yields optimum symptom control for up to 6 - 7 months and is a relatively easy procedure to perform. Furthermore, the procedure is not associated with significant side effects and with reversibility of induced sensory functional deficits, offering an advantage over radiofrequency ablation. Key words: Lidocaine, supraorbital neuralgia, neurolysis, nerve blocks, flouroscopy

In the finance world inventory trading is one of the most necessary activities. Stock market prediction is an act of attempting to decide the future price of a stock other monetary instrument traded on a financial exchange. The technical and integral or the time sequence evaluation is used with the aid of most of the stockbrokers while making the inventory predictions. This paper explains the prediction of a stock using Machine Learning. The input parameters include -open, high, low, close rate, trading volume, Price to Earning Ratio, MA, MACD for more accuracy. The Machine Learning algorithm, Random Forest Regression has been implemented in Python programming language which is used to predict the stock market. The algorithm has been used on the historical stock data along with web- scraping technique that has been applied to catch current market data of the stock. The recursive training model take its predicted value as input to predict further long term future stock rates.

Gadolinium-based contrast agents (GBCAs) are widely used in imaging today. GBCAs are used in 25% of all MRI examinations and, at times, are used to facilitate the fluoroscopic-guided interventional procedures associated with chronic pain. Gadolinium, Gd3+, is the most paramagnetic element

The functional state of denervated muscle is a critical factor in the ability to restore movement after injury- or disease-related paralysis. Here we used peripheral optogenetic stimulation and transcriptome profiling in the mouse whisker system to investigate the time course of changes in neuromuscular function following complete unilateral facial nerve transection. While most skeletal muscles rapidly lose functionality after lower motor neuron denervation, optogenetic muscle stimulation of the paralyzed whisker pad revealed sustained increases in the sensitivity, velocity, and amplitude of whisker movements, and reduced fatigability, starting 48 h after denervation. RNA-seq analysis showed distinct regulation of multiple gene families in denervated whisker pad muscles compared to the atrophy-prone soleus, including prominent changes in ion channels and contractile fibers. Together, our results define the unique functional and transcriptomic landscape of denervated facial muscles, and have general implications for restoring movement after neuromuscular injury or disease.New & NoteworthyOptogenetic activation of muscle can be used to non-invasively induce movements and probe muscle function. We used this technique in mice to investigate changes in whisker movements following facial nerve transection. We found unexpectedly enhanced functional properties of whisker pad muscle following denervation, accompanied by unique transcriptomic changes. Our findings highlight the utility of the mouse whisker pad for investigating the restoration of movement after paralysis.

Objective The sacroiliac joint can be a primary source of pain or part of multifactorial syndromes. As there is no single historical, physical examination-based, or radiological feature that definitively establishes a diagnosis of sacroiliac joint pain, diagnostic blocks are regarded as the gold standard. The primary aim of this randomized trial was to compare the posteroanterior approach with the classic oblique approach for sacroiliac joint injection based on an assessment of procedure times and patient-reported pain outcomes in subjects scheduled for fluoroscopically-guided sacroiliac joint injections. Methods Thirty patients were randomized into 2 groups of 15 patients each. The endpoints measured included the total length of procedure time, fluoroscopic time, needling time (length of time the needle was maneuvered), and pre- and postprocedure visual analogue scale pain scores. Results The posteroanterior approach was significantly shorter in terms of procedure time (p=0.03) and needling time (p=0.01) than the oblique approach. Adjusting for body mass index, the mean procedure and needling times were significantly shorter in the posteroanterior group than in the oblique group. Conclusion This study of the posteroanterior approach for fluoroscopic-guided sacroiliac joint injection observed shorter times for fluoroscopy, needling, and the overall procedure than were recorded for the widely prevalent oblique approach. This may translate to lower radiation exposure, lower procedural costs, and enhanced ergonomics of fluoroscopicallyguided sacroiliac joint injections.

An 80-year-old woman presented with chronic lumbosacral pain since her laminectomy and instrumentation 10 years ago. Examination was consistent with left sacroiliitis, and the patient underwent an elective left sacroiliac joint injection. Two days following her procedure she fell and landed on her left hip and on the next day, she presented to the emergency room with acutely worsening left gluteal pain. On evaluation in the emergency department, she was found to be suffering from a fever, headache, nausea, vomiting, and dysuria. A computed tomography (CT) scan was performed and this showed extensive foci of gas throughout the posterior aspect of the left iliopsoas muscle, sacrum, and ileum surrounding the left sacroiliac joint. The patient underwent emergent surgical debridement. The microbiology report of blood culture revealed clostridium perfringens, while her pathology showed necrosis and acute inflammation of fibroadipose tissue, skeletal muscle, and fat. The patient’s hospital course resulted in multi-organ failure and the family elected for comfort care measures only. Unfortunately, she passed away 36 hours later. Septic arthritis is a potential catastrophic complication following intra-articular steroid therapy. The cause of the septic joint can be multifactorial but is likely caused by one of the following processes: direct inoculation of bacteria by the injection, hematogenous seeding of the percutaneous injection tract, or due to activation of a quiescent infection by the injected steroid. Clostridial spores are very resistant to standard aseptic skin preparations, including chlorhexidine and betadine solutions. The only effective methods to eliminate the spores is to heat them at a temperature greater than 100 degrees Celsius for 10 minutes or with use of a 10% potassium hydroxide (KOH) solution. We hypothesize that clostridium spores were present on the patient’s skin from previous stool soiling, and that these were introduced directly into the soft tissue by needle trauma. Rare complications such as this one are scarcely reported in the literature and thus it becomes difficult to adequately identify risk factors or to formulate strategies to improve practice management. Key words: Lower back pain, sacroiliitis, sacroiliac joint injection, clostridium perfringens, gas gangrene

Percutaneous radiofrequency ablation (RFA) of the sphenopalatine ganglion (SPG) has been shown to be an effective modality of treatment for patients with intractable chronic cluster headaches (CHs). While the use of fluoroscopy for RFA of the SPG is common, to our knowledge there are no documented cases of procedures using cone beam computed tomography (CBCT) for image guidance. We present a case report of a patient suffering from chronic intractable CH with complete long-lasting relief after RFA of the SPG using CBCT. The case reaffirms the potential efficacy of RFA of the SPG in a case of chronic cluster headache as well as the use of CBCT as a superior alternative to bi-plane fluoroscopy for image guidance in the management of chronic CH.Cone beam computed tomography, sphenopalatine ganglion block, cluster headache, interventional pain, autonomic cephalalgia, radiofrequency ablation.

Neuropathic pain (NP) is initiated or caused by a primary lesion or dysfunction in the nervous system. The NP in cancer patients is typically due to a combination of inflammatory, neuropathic, ischemic, infiltrative, and compression mechanisms that involve one or more anatomic sites. These patients will often have various types of co-existing pain syndromes and co-morbidities. Thus, any treatment plan needs to be individualized. After a thorough clinical assessment and evaluation, a combination therapy including anticonvulsants, antidepressants, N-methyl-D-aspartate antagonists, opiates, topical agents, and interventional procedures should be considered in these patients.

An 80-year-old woman presented with chronic lumbosacral pain since her laminectomy and instrumentation 10 years ago. Examination was consistent with left sacroiliitis, and the patient underwent an elective left sacroiliac joint injection. Two days following her procedure she fell and landed on her left hip and on the next day, she presented to the emergency room with acutely worsening left gluteal pain. On evaluation in the emergency department, she was found to be suffering from a fever, headache, nausea, vomiting, and dysuria. A computed tomography (CT) scan was performed and this showed extensive foci of gas throughout the posterior aspect of the left iliopsoas muscle, sacrum, and ileum surrounding the left sacroiliac joint. The patient underwent emergent surgical debridement. The microbiology report of blood culture revealed clostridium perfringens, while her pathology showed necrosis and acute inflammation of fibroadipose tissue, skeletal muscle, and fat. The patient's hospital course resulted in multi-organ failure and the family elected for comfort care measures only. Unfortunately, she passed away 36 hours later. Septic arthritis is a potential catastrophic complication following intra-articular steroid therapy. The cause of the septic joint can be multifactorial but is likely caused by one of the following processes: direct inoculation of bacteria by the injection, hematogenous seeding of the percutaneous injection tract, or due to activation of a quiescent infection by the injected steroid. Clostridial spores are very resistant to standard aseptic skin preparations, including chlorhexidine and betadine solutions. The only effective methods to eliminate the spores is to heat them at a temperature greater than 100 degrees Celsius for 10 minutes or with use of a 10% potassium hydroxide (KOH) solution. We hypothesize that clostridium spores were present on the patient's skin from previous stool soiling, and that these were introduced directly into the soft tissue by needle trauma. Rare complications such as this one are scarcely reported in the literature and thus it becomes difficult to adequately identify risk factors or to formulate strategies to improve practice management.