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Study Design This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States. Purpose This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications. Overview of Literature Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization. Methods Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. Results A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p

Abstract During metastatic dissemination, circulating tumour cells (CTCs) enter capillary beds, where they experience mechanical constriction forces. The transient and persistent effects of these forces on CTCs behaviour remain poorly understood. Here, we developed a high-throughput microfluidic platform mimicking human capillaries to investigate the impact of mechanical constriction forces on malignant and normal breast cell lines. We observed that capillary constrictions induced nuclear envelope rupture in both cancer and normal cells, leading to transient changes in nuclear and cytoplasmic area. Constriction forces transiently activated cGAS/STING and pathways involved in inflammation (NF-κB, STAT and IRF3), especially in the non-malignant cell line. Furthermore, the non-malignant cell line experienced transcriptional changes, particularly downregulation of epithelial markers, while the metastatic cell lines showed minimal alterations. These findings suggest that mechanical constriction forces within capillaries may promote differential effects in malignant and normal cell lines.

IntroductionUse of mechanical ventilation during general anesthesia is a necessary practice in the anesthetization of small cetaceans as spontaneous ventilation fails to provide adequate gas exchange. Currently available methods of ventilation do not account for the intermittent breathing strategy of representative species within this infraorder of fully aquatic mammals and may have a significant effect on cardiac and respiratory physiology.MethodsTo understand the impact of mechanical ventilation on cardiopulmonary function in one small species of cetacean, the bottlenose dolphin (Tursiops truncatus), we compared controlled mechanical ventilation (CMV) to a novel ventilation method known as apneustic anesthesia ventilation (AAV). AAV simulates the normal inspiratory breath-hold pattern of dolphins. Ten anesthetic procedures (dental procedure, n = 9; bronchoscopy, n = 2) were performed on nine dolphins (age range: 10–42 years; mean = 32 years; median = 37 years; female = 3, 40%; male = 6, 60%). In a cross-over study design, dolphins were instrumented and randomly assigned to AAV or CMV as the initial mode of ventilation, then switched to the alternate mode. Baseline cardiopulmonary data were collected and again after 30 min on each mode of ventilation. Cardiac index, stroke volume index, systemic vascular resistance, alveolar dead space, alveolar-arterial oxygen tension gradient, arterial oxygen content, oxygen delivery index, and dynamic respiratory system compliance index were calculated at each of the four time points.ResultsDuring AAV, dolphins had higher arterial oxygen tension, higher mean airway pressure, reduced alveolar dead space ventilation and lower alveolar-arterial oxygen difference. Cardiovascular performance was not statistically different between the two modes.DiscussionOur study suggests AAV, which more closely resembles the conscious intermittent respiratory pattern phenotype of dolphins, improves ventilation and pulmonary function in the anesthetized dolphin. Future studies should evaluate the cardiopulmonary effects of neutral buoyancy and cardiopulmonary sparing drug protocols to reduce the need for hemodynamic support of current protocols.

Objectives: In vivo magnetic resonance spectroscopy (MRS) was used to investigate neurometabolic homeostasis in children with functional neurological disorder (FND) in three regions of interest: supplementary motor area (SMA), anterior default mode network (aDMN), and posterior default mode network (dDMN). Metabolites assessed included N-acetyl aspartate (NAA), a marker of neuron function; myo-inositol (mI), a glial-cell marker; choline (Cho), a membrane marker; glutamate plus glutamine (Glx), a marker of excitatory neurotransmission; γ-aminobutyric acid (GABA), a marker of inhibitor neurotransmission; and creatine (Cr), an energy marker. The relationship between excitatory (glutamate and glutamine) and inhibitory (GABA) neurotransmitter (E/I) balance was also examined. Methods: MRS data were acquired for 32 children with mixed FND (25 girls, 7 boys, aged 10.00 to 16.08 years) and 41 healthy controls of similar age using both short echo point-resolved spectroscopy (PRESS) and Mescher-Garwood point-resolved spectroscopy (MEGAPRESS) sequences in the three regions of interest. Results: In the SMA, children with FND had lower NAA/Cr, mI/Cr (trend level), and GABA/Cr ratios. In the aDMN, no group differences in metabolite ratios were found. In the pDMN, children with FND had lower NAA/Cr and mI/Cr (trend level) ratios. While no group differences in E/I balance were found (FND vs. controls), E/I balance in the aDMN was lower in children with functional seizures—a subgroup within the FND group. Pearson correlations found that increased arousal (indexed by higher heart rate) was associated with lower mI/Cr in the SMA and pDMN. Conclusions: Our findings of multiple differences in neurometabolites in children with FND suggest dysfunction on multiple levels of the biological system: the neuron (lower NAA), the glial cell (lower mI), and inhibitory neurotransmission (lower GABA), as well as dysfunction in energy regulation in the subgroup with functional seizures.

The purpose of this quantitative descriptive study was to examine personal and professional self-care practices reported by K-12 music teachers while also exploring the relationships between self-care and age, gender, years of experience, and several other contextual variables. The research team designed an instrument, based on a previous measure created by psychologists, to examine self-care behaviors. A sample of 337 music educators completed the instrument. We found very few meaningful relationships between self-care and demographic or contextual variables, although some patterns in common self-care practices were identified. Across both personal and professional domains, teachers reported a high level of activity in maintaining interpersonal relationships. Within the professional domain, participants reported activities most often that pertained to professional development. The least reported behaviors within the personal domain pertained to promotive habits for physical well-being such as taking time off when ill, regularly exercising, or healthful eating.

Phenotypic diversity of theca cells in growing follicles of the human ovary is described, with a differentiation trajectory proposed that initiates after follicle activation and results in multiple theca-cell subpopulations in antral follicles.

In Colombia, timely access to palliative care (PC) is hampered by difficulties in identifying and referring to necessary services. The SPARC (Sheffield Profile for Assessment and Referral for Care) instrument provides a holistic needs assessment to improve referrals for different forms of care. SPARC was recently validated in Colombian Spanish (SPARC-Sp) but has not yet been implemented in clinical practice. We undertook workshops that aimed to co-design an implementation strategy to inform a future trial testing SPARC-Sp in the Colombian healthcare system. Workshop attendees included patients, informal caregivers, healthcare professionals, volunteers, administrative staff and decision makers. Discussions within the workshops refined implementation and dissemination strategies for SPARC-Sp in practical scenarios. Results include the need for education, clarification and demystification of PC and the lack of time and skills of professionals to identify patients’ needs. Attendees recognized SPARC-Sp as a valuable tool for highlighting patients’ concerns, whose adaptations are needed in Colombia to address the low literacy of the population and specificities of the healthcare system. We proposed local adaptations to SPARC-Sp and produced five educational videos aimed at health professionals, patients and caregivers to strengthen understanding of holistic needs in PC while building a strategy for SPARC-Sp implementation in the Colombian context.

Multiple techniques have been used for estimating age in bottlenose dolphins (Tursiops truncatus). The longest established technique is via counts of growth later groups (GLGs) in the longitudinal section of an extracted mandibular tooth. Previous studies to validate GLGs have primarily used younger dolphins (less than 16yrs old) due to the limited number of known age older animals. This study assessed the accuracy of age estimates for bottlenose dolphins using both GLG analysis and a newer technique, pectoral flipper radiography (PFR) for dolphins ranging from 0 to 58yrs, with a majority of samples (70%) over 16yrs. GLGs were assessed by two expert independent readers on tooth sections from 52 different dolphins (85% over 16yrs, maximum age 58yrs), and assessments of PFRs were performed by two experienced veterinarians on 37 dolphins (54% over 16yrs, maximum age 54yrs). Results demonstrated both techniques became less accurate in older dolphins, particularly those > 30yrs, with errors as large as 37yrs for GLG estimates. The root mean squared error (RMSE) for age estimation using GLGs for dolphins ≤15 years of age was 1.46yrs compared to 1.58yrs using PFRs demonstrating the accuracy of both techniques in this age bracket. For dolphins >30yrs, RMSE increased to 17yrs in GLG aging and 8.25yrs in PFR. Challenges in obtaining accurate age estimates in GLGs were primarily due to sectioning and staining difficulties in visualizing the newest GLG layers, in the very old animals. Complications in reading the layers included obtaining a good section, the presence of accessory layers, GLG compression, and tooth curvature or wear removing the neonatal line influencing aging biases. In pectoral flipper aging, the primary challenge was obtaining a true dorsoventral radiograph in a live dolphin during a health assessment, as well as the subjective assessment of scoring and reliance on degenerative changes accurately estimate age in geriatric dolphins. While access to the radiography equipment can be a limiting factor, the improved accuracy for age estimation in adult dolphins, the less invasive nature, and reduced processing time to results make pectoral radiography a preferred alternative technique for estimating age in live dolphins.

A good explanation of lithium-ion batteries (LIBs) needs to convincingly account for the spontaneous, energy-releasing movement of lithium ions and electrons out of the negative and into the positive electrode, the defining characteristic of working LIBs. We analyze a discharging battery with a two-phase LiFePO4/FePO4 positive electrode (cathode) from a thermodynamic perspective and show that, compared to loosely-bound lithium in the negative electrode (anode), lithium in the ionic positive electrode is more strongly bonded, moves there in an energetically downhill irreversible process, and ends up trapped in the positive electrode. Only a sufficiently high charging voltage can drive it back to the other electrode. Since the stronger bonding in the positive electrode lowers the energy by ∼320 kJ mol−1, a lot of energy is released. This explanation is quantitatively supported by an analysis of cohesive-energy differences of the electrode materials. Since electrons are only intermediates in the discharge reaction and the chemical potential of the electron cannot be measured, electrons do not need to be assigned a distinct energetic role. The incorporation of Li+ and an electron into the cathode is accompanied by the reduction of another ion or atom, usually a transition metal such as Fe or Co. The metal's ionization energy in the corresponding oxidation step correlates with the cell voltage, based on a decomposition of cohesive energy into electronic and ionic components. We relate the differences in cohesive energies to the chemical potential of lithium atoms, which is quantified, for instance for a two-phase electrode. The analysis is extended to a single-phase LixCoO2 cathode, whose average voltage can be calculated from the cohesive-energy difference between LiCoO2 and CoO2. [ABSTRACT FROM AUTHOR]