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Systematic Review.To elucidate treatment modalities and outcomes of patients with traumatic cervical spondyloptosis (TCS).Traumatic cervical spondyloptosis (TCS) is rare and typically leads to devastating neurological injury. Management strategies vary from case to case.A systematic review of the literature identified cases of adult TCS, and data was analyzed to characterize the patient population and to assess factors that influenced clinical outcome. In addition, an illustrative case is presented in which closed reduction of a severe C7-T1 spondyloptosis injury was guided with the use of cone beam computerized tomography (O-Arm) to overcome difficulties with visualizing the cervicothoracic junction region.In addition to our case, we identified 52 cases of adult TCS from 34 articles. Patient age ranged from 18 to 73 (average 45.6) with male a predominance (n = 37, 71.2%). Neurological function on presentation was most commonly ASIA E (34.6%), followed by ASIA D (21.2%) and ASIA A (19.2%). The most frequently affected levels were C7-T1 (44.2%) followed by C6-7 (33.0%). Closed reduction was attempted in 42 (80.8%) patients. A total of 49 (94.2%) patients underwent surgical treatment, with 31 (63.3%) undergoing single-approach procedures. The presence of neurological injury, cervical level of injury, and age were not significant predictors of successful closed reduction. Similarly, successful closed reduction, age, cervical level of injury, and neurological injury were not predictors of a single-approach treatment.TCS is rare and most frequently appears at or near the cervicothoracic junction and in males. The presentation is typically that of severe neurological injury, but partial neurological recovery occurs in many patients. No predictors of successful closed reduction or single approach surgery are identified. We postulate that the use of intraoperative multiplanar imaging technology like the O-Arm may enhance the ability to achieve a successful closed reduction given the predilection for the injury to occur at the cervicothoracic junction. Prospective study of the durability of constructs by single or combined approaches is warranted.

Spinal meningiomas are benign extra-axial tumors that can present with neurological deficits. Treatment partly depends on the degree of disability as there is no agreed-upon patient selection algorithm at present. We aimed to elucidate general patient selection patterns in patients undergoing surgery for spinal meningioma.Data for patients with spinal tumors admitted between 2016 and 2019 were extracted from the U.S. Nationwide Inpatient Sample. We identified patients with a primary diagnosis of spinal meningioma (using International Classification of Disease, 10Of 6395 patients with spinal meningioma, 5845 (91.4%) underwent surgery. Advanced age, nonwhite race, obesity, diabetes mellitus, chronic renal failure, and anticoagulant/antiplatelet use were less prevalent in the surgical group (all P 0.001). The only positive predictor of surgical treatment was elective admission status (odds ratio, 3.166; P 0.001); negative predictors were low income, Medicaid insurance, anxiety, obesity, and plegia. Patients with bowel-bladder dysfunction, plegia, or radiculopathy were less likely to undergo surgical treatment. The surgery group was less likely to experience certain complications (deep vein thrombosis, P 0.001; pulmonary embolism, P = 0.002). Increased total hospital charges were associated with nonwhite race, diabetes, depression, obesity, myelopathy, plegia, and surgery.Patients treated surgically had a decreased incidence of complications, comorbidities, and Medicaid payer status. A pattern of increased utilization of health care resources and spending was also observed in the surgery group. The results indicate a potentially underserved population of patients with spinal meningioma.

Spinal cord stimulation (SCS) is an effective treatment modality for chronic pain conditions for which other treatment modalities have failed to provide relief. Ample prospective studies exist supporting its indications for use and overall efficacy. However, less is known about how SCS is used at the population level. Our objective is to understand the demographics, clinical characteristics, and utilization patterns of open and percutaneous SCS procedures.The Nationwide Inpatient Sample data base of 2016-2019 was queried for cases of percutaneous or open placement (through laminotomy/laminectomy) of SCS (excluding SCS trials) using International Classification of Disease (ICD), 10th revision, procedure coding system. Baseline demographic characteristics, complications, ICD-Clinical Modification, Diagnosis Related Group, length of stay (LOS), and yearly implementation data were collected. Complications and outcomes were evaluated in total and between the open and percutaneous SCS groups.A total of 2455 inpatients had an SCS placed, of whom 1970 (80.2%) received SCS through open placement. Placement of open SCS was associated with Caucasian race (odds ratio [OR] = 1.671, p 0.001), private insurance (OR = 1.332, p = 0.02), and age more than 65 years (OR = 1.25, p = 0.034). The most common diagnosis was failed back surgery syndrome (23.8%). Patients with percutaneous SCS were more likely to have a hospital stay of 1 day (OR = 2.318; 95% CI, 1.586-3.387; p 0.001). Implant complications during the inpatient stay were positively associated with open SCS placement and reported in 9.4% of these cases (OR = 3.247, p 0.001).Patients who underwent open SCS placement were more likely to be older, Caucasian, and privately insured. Open SCS placement showed greater LOS and implant-related complications during their hospital stay. These findings highlight both potential socioeconomic disparities in health care access for chronic pain relief and the importance of increasing age and medical comorbidities as important factors that can influence SCS implants in the inpatient setting.

Traumatic brain injury (TBI) is a prevalent cause of disability and death in the pediatric population, often requiring prolonged mechanical ventilation. Patients with significant TBI or intracranial hemorrhage require advanced airway management to protect against aspiration, hypoxia, and hypercarbia, eventually necessitating tracheostomy. While tracheostomy is much less common in children compared to adults, its prevalence among pediatric populations has been steadily increasing. Although early tracheostomy has demonstrated improved outcomes in adult patients, optimal tracheostomy timing in the pediatric population with TBI remains to be definitively established.This retrospective cohort analysis aims to evaluate pediatric TBI patients who undergo tracheostomy and to investigate the impact of tracheostomy timing on outcomes.The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), collected between in 2016 and 2019, was queried using International Classification of Disease 10th edition (ICD10) codes for patients with traumatic brain injury who had received a tracheostomy. Baseline demographics, insurance status, and procedural day data were analyzed with univariate and multivariate regression analyses. Propensity score matching was performed to estimate the incidence of medical complications and mortality related to early versus late tracheostomy timing (as defined by median = 9 days).Of the 68,793 patients (mean age = 14, IQR 4-18) who suffered a TBI, 1,956 (2.8%) received a tracheostomy during their hospital stay. TBI patients who were tracheostomized were older (mean age = 16.5 vs 11.4 years), more likely to have injuries classified as severe TBIs and more likely to have accumulated more than one indicator of parenchymal injury as measured by the Composite Stroke Severity Scale (CSSS1) than non-tracheostomized TBI patients. TBI patients with a tracheostomy were more likely to encounter serious complications such as sepsis, acute kidney injury (AKI), meningitis, or acute respiratory distress syndrome (ARDS). They were also more likely to necessitate an external ventricular drain (EVD) or decompressive hemicraniectomy (DHC) than TBI patients without a tracheostomy. Tracheostomy was also negatively associated with routine discharge. Procedural timing was assessed in 1,867 patients; older children (age15 years) were more likely to undergo earlier placements (p 0.001). Propensity score matching (PSM) comparing early versus late placement was completed by controlling for age, gender, and TBI severity. Those who were subjected to late tracheostomy (9 days) were more likely to face complications such as AKI or deep vein thrombosis (DVT) as well as a host of respiratory conditions such as pulmonary embolism, aspiration pneumonitis, pneumonia, or ARDS. While the timing did not significantly impact mortality across the PSM cohorts, late tracheostomy was associated with increased length of stay (LOS) and ventilator dependence.Tracheostomy, while necessary for some patients who have sustained a TBI, is itself associated with several risks that should be assessed in context of each individual patient's overall condition. Additionally, the timing of the intervention may significantly impact the trajectory of the patient's recovery. Early intervention may reduce the incidence of serious complications as well as length of stay and dependence on a ventilator and facilitate a timelier recovery.

Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Environment may play a role in the type, severity, and outcome of pediatric TBI (pTBI). Our objective was to characterize the impact of poor socioeconomic status (PSES) on the incidence, treatment, and outcomes of pTBI patients.The Kids' Inpatient Database (KID) was queried from 2016 to 2019 for with TBI using International Classification of Disease, 10th revision (ICD 10) codes. Data defining demographics, complications, procedures, and outcomes was extracted. PSES was defined as Medicaid insurance and Q1 median income category.26,417 patients had pTBI. 11,040 (41.8 %) of pTBI patients were on Medicaid insurance. 13,119 and 8165 (30.9 %) were in Q1 median income category. Land transport caused the majority of pTBI (41 %). Patients on Medicaid or Q1 median income were more likely to experience assault (OR 2.927, CI 95 % 2.455-3.491, p 0.001 OR 2.033, CI 95 % 1.722-2.4000 p 0.001 respectively). On propensity matched analysis, PSES was associated with increased mortality (OR 1.667, 95 % CI 1.322-2.100, p 0.01), length of stay (LOS) (OR 1.369, 95 % CI 1.201-1.559, p 0.01), and major complicated trauma (OR 1.354 95 % CI 1.090-1.682 p = 0.007). Total hospital charges were higher in pTBI patients on Medicaid ($112,101.52, +/- $203,716.35) versus non-Medicaid ($109,064.37 +/- $212,057.98) (p 0.001).PSES is correlated with increased mortality, complications, and longer LOS. Healthcare coverage and clinical training should take these disparities into account to provide improved care and optimize healthcare resource utilization.Level IV, Retrospective Database.

There are known classifications that describe thoracolumbar (TL) burst type injury but it is unclear which have the most influence on management. Our objective is to investigate the association of classification publications with the quantity and type of the most influential articles on TL burst fractures.Web of Science was searched, and exclusion and inclusion criteria were used to extract the top 100 cited articles on TL burst fractures. The effects on type, number, and other variables were separated into four eras as defined by four major classification publications.30 out of the top 100 articles represent level 1 or 2 evidence. The most influential journal wasIn 1994, two articles marked the beginning of an era of highly influential TL burst fracture literature. The 2005 TLICS score was associated with a preceding increase in LOE and productivity. Following 2005, the literature saw a decrease in productivity and an increase in systematic review/meta-analysis (SR-MAs). These trends represent an increase in scholarly discussion that led to a systematic synthesis of the existing literature after publication of the 2005 TLICS article.

Aberrant signaling of mechanistic target of rapamycin (mTOR aka mammalian target of rapamycin) is shown to be linked to tumorigenesis of numerous malignancies including glioblastoma (GB). mTOR is a serine threonine kinase that functions by forming two multiprotein complexes. These complexes are named mTORC1 and mTORC2 and activate downstream substrates that execute cellular and metabolic functions. This signaling cascade of PI3K/AKT/mTOR is often upregulated due to frequent loss of the tumor suppressor PTEN, a phosphatase that functions antagonistically to PI3K. mTOR regulates cell growth, motility, and metabolism by forming two multiprotein complexes, mTORC1 and mTORC2, which are composed of special binding partners. These complexes are sensitive to distinct stimuli. mTORC1 is sensitive to nutrients and mTORC2 is regulated via PI3K and growth factor signaling. Since rapamycin and its analogue are less effective in treatment of GB, we used novel ATP-competitive dual inhibitors of mTORC1 and mTORC2, namely, Torin1, Torin2, and XL388. Torin2 caused a concentration dependent pharmacodynamic effects on inhibition of phosphorylation of the mTORC1 substrates S6K

Objective The Medicaid patient population and health care costs for spine surgeries among these patients have increased since 2010. Hospital length of stay (LOS) contributes appreciably to hospital costs for patients undergoing primary lumbar spine surgery (PLSS). The aim of this study was to identify independent risk factors for increased LOS in patients undergoing PLSS. Patients and methods In a single-center retrospective study, we reviewed demographic and clinical data from electronic medical records for 181 consecutive adult patients who underwent PLSS involving 1–3 levels from July 2014 to July 2017. We performed regression analyses to identify independent risk factors for increased LOS and to quantify their effects as percent changes in LOS. Results Among 181 patients who underwent PLSS, the mean LOS was 3.57 days. Based on the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologist (ASA) classification, patients with Medicaid insurance were healthier than non-Medicaid patients (mean CCI: 0.34 versus 0.65; p = 0.041, ASA: 1.71 versus 1.91; p = 0.046) yet Medicaid patients had a longer LOS compared with non-Medicaid patients (mean LOS: 4.03 versus 3.30 days; p = 0.047). There was no significant difference in discharge disposition between Medicaid and non-Medicaid patients (Home = 82.35 % versus 79.65 %; p = 0.855). Medicaid patients also had significantly less spinal levels involved in their surgery (1.44 versus 1.67; p = 0.027). Multivariable regression modeling identified independent risk factors positively associated with increased LOS as age (+1.0 % per year; p = 0.007), Medicaid insurance status (+28.7 %; p = 0.007), and CCI (10.1 % per increment in CCI; p = 0.030). Fusion surgery also was an independent risk factor for increased LOS when compared with laminectomy (−54.1 %; p Conclusions Increasing age, Medicaid insurance status, higher CCI, and fusion surgery were independently associated with increased LOS after PLSS. This information is useful for preoperative patient counseling, shared decision-making, and risk stratification and may help to further ongoing discussion regarding contributors to rising health care costs. Findings of increased LOS among Medicaid patients will help direct efforts to identify factors that contribute to this health care expense.

A detailed tectono-stratigraphic analysis of the Malvinas Basin was achieved by the interpretation of around 65,000 km of 2D seismic reflection profiles. Five main seismo-stratigraphic units and their sub-units, informally named units U1 to U5 a/b, bound by major unconformities were identified and correlated with the Mesozoic to Cenozoic main tectonic phases of the basin. Unit U1 (Pre-168 Ma) represents the seismic basement. Unit U2 (168–150.5 Ma, syn rift phase) thickens and deepens southwards. Units U1 and U2 are affected by several syn-rift normal faults that exhibit a main NE–SW strike direction in the south of the basin and a NW–SE strike direction in the centre of the basin. This suggests that the Malvinas Basin may have developed initially as a rift basin with two different extensional directions: (1) a NW–SE directed extension probably linked with the opening of the Weddell Sea (Early Mid-Jurassic), and (2) a NE–SW directed extension most likely linked with the Jurassic back-arc extension of Gondwana and probably later with the onset of the opening of the South Atlantic during Late Jurassic to Early Cretaceous time. Unit U3 (150.5–68 Ma, sag phase) is mainly an aggradational wedge-shaped unit. Unit U4 (68–42.5 Ma, transtensional foredeep phase) overlies unconformable unit U3. It deepens in the south because of an N–S/NW–SE directed extensional regime. Accumulation rates decrease during units U2, U3, and U4 from 4.84, to 1.23 to 0.8 km3/Ma × 103. Units U5a and U5b (42.5–5.5 and 5.5–0 Ma, transpressional foredeep phase) finally represent a change from aggradation to progradation sedimentary pattern and to a left-lateral transpressional regime in the south. The sediment supply was considerably higher than before and a thick sedimentary wedge has been deposited until today. Accumulations rates increased in units U5a and U5b from 2.28 to 8.91 km3/Ma × 103.

Solar thermal driven cooling systems for residential applications are a promising alternative to electric compression chillers, although its market introduction still represents a challenge, mainly due to the higher investment costs. The most common system configuration is an absorption chiller driven by a solar thermal system, backed up by a secondary heating source, normally a gas boiler. Heat storage in the primary (solar) circuit is mandatory to stabilize and extend the operation of the chiller, whereas a cold storage tank is not so common. This paper deals with the selection of the most suitable configuration for residential cooling systems with solar energy. In Spain, where cooling needs are usually higher than heating needs, the interest of a reversible heat pump as auxiliary system and a secondary cooling storage are analyzed. A complete TRNSYS model has been developed to compare a configuration with just hot storage (of typical capacity 40 L/m 2 of solar collector surface) and a configuration with both, hot and cool storages. The most suitable configuration is very sensible to the solar collector area. As the collector area increases, the advantages of a cool storage vanish. Increasing the collector area tends to increase the temperature of the hot storage, leading to higher thermal losses in both the collector and the tank. When the storage volume is concentrated in one tank, these effects are mitigated. The effect of other variables on the optimal configuration are also analyzed: collector efficiency curve, COP of the absorption chiller, storage size, and temperature set-points of the chillers.

Resumen Objetivo Entre las alternativas a la cirugia conservadora del cancer de mama, la ablacion por radiofrecuencia (ARF) es la que ha alcanzado mayor difusion. Nuestro objetivo es determinar la factibilidad, seguridad y eficacia de esta tecnica en nuestro medio. Material y metodos Se realiza ARF de carcinomas de mama con anestesia local y en la sala de ecografia, tratamiento quirurgico y comprobacion histologica posterior, evaluando los efectos de la ARF sobre el tumor y los tejidos circundantes. Se incluyeron 35 pacientes con edad media de 61,2±8,25 anos, todas con carcinoma infiltrante confirmado percutaneamente, El grado de necrosis de coagulacion y la afectacion de margenes se evaluaron con tincion de hematoxilina-eosina, y la viabilidad celular o efectividad de la ARF mediante NADH-diaforasa. Resultados El 85,7% de pacientes no sintio molestias. El 11,4% refirio dolor ligero que pudo ser controlado. El dolor intenso obligo a detener el procedimiento en 1 paciente. No se produjeron otras complicaciones. Se encontraron cambios de necrosis coagulativa en todos los casos, catalogada como completa en 32/35 (91,4%). La NADH-diaforasa resulto negativa en 27/32 casos en que se realizo. Una fue ligeramente positiva y 4 no valorables. Conclusion La ARF es una tecnica factible, bien tolerada, segura y eficaz en casi el 90% de los tumores infiltrantes de mama. La confirmacion de su eficacia debera hacerse mediante seguimiento prolongado de pacientes no intervenidas, con ensayos clinicos en fase III cuidadosamente disenados y monitorizados.

The effect of inorganic inhibitors on the corrosion behavior of 1018 carbon steel in the mixture LiBr (55%) + ethylene glycol + H2O at room temperature has been evaluated. Used inhibitors included LiNO3 (Lithium Nitrate), Li2MoO4 (Lithium Molybdate) and Li2CrO4 (Lithium Chromate) at concentrations of 5, 20 and 50 ppm. Electrochemical techniques included potentiodynamic polarization curves, electrochemical noise resistance (EN) and electrochemical impedance spectroscopy (EIS) measurements. Additionally, adsorption isotherms were calculated. The results obtained showed that both, the corrosion rate and the passive current density decreased with inhibitors, and, in general terms, inhibitors efficiency increased with inhibitor concentration, except in the case of Li2CrO4, where the highest efficiency was obtained with 20 ppm of inhibitor. Pitting potential with 5 ppm of inhibitor, regardless its chemical composition, was more active than in absence of inhibitor, increased at 20 ppm, especially with Li2CrO4, and remained unaltered with 50 ppm. EN measurements showed that at 5 ppm of inhibitor, the number of film rupture/repassivation events was higher than that obtained at 20 or 50 ppm. Adsorption isotherms suggested a different adsorption mechanism for each inhibitor, whereas EIS results suggested that the corrosion process when nitrates were added was under charge transfer control, but in the case of molybdates or chromates was under diffusion control.

Three new antitumour drugs containing two 5-fluorouracil moieties at both ends of the structure and a two amide bond linker were synthesized. Appropriated bis-acetal were reacted with two equivalents of 5-FU to afford the desired compounds. These drugs were evaluated for their ability to induce myogenic maturation in vitro on human rhabdomyosarcoma cells in an experimental model. Compounds 5 and 6 induced morphological and phenotypical differentiation in rhabdomyosarcoma cells at 4.5 and 3.5 microM, respectively. These new cell differentiating agents could be used as an alternative to selective destruction of undifferentiated cells. A potential role of the differentiation therapy as an alternative approach to the treatment of rhabdomyosarcomas is suggested.

The theoretical conformational analysis of thiepane 9 and 1,4-oxathiepane 10 has been carried out by molecular mechanics (Allinger's MM2 force field), studying both chair/twist chair (C/TC) and boat/twist boat (B/TB) families as well as the transitions between the families. Both compounds show a conformational preference for the twist chair conformations. The B/TB family has a smaller number of stationary points than the corresponding one in cycloheptane, the existing boat forms are of minimum energy and twist boat forms have proved to be energetic maxima. Non-bonding interactions between the hydrogen atoms of the rings seem to control the stability of the different conformations in both compounds.

A double label design was used to study the in vivo incorporation of [U- 14 C] and [2- 3 H]glycerol into total and individual phospholipids of various brain subcellular fractions isolated from 20-day old normal and undernourished rats. In control animals, synthesis of glycerophospholipids of microsomes, mitochondria and nerve endings seems to occur through the glycerol-3-phosphate (G-3-P) pathway while a large part of the synthesis of myelin glycerophospholipids appears to proceed through the dihydroxyacetone phosphate (DHAP) pathway. In starved animals, on the other hand the incorporation of phospholipid precursors through the DHAP pathway was found to be lower than in controls while synthesis of phospholipids in the other subcellular fractions was unaffected. The possible relationship between the synthesis of glycerophospholipids and especially plasmalogens of the myelin membrane and microperoxisomes of oligodendroglial cells, where the enzymes of the DHAP pathway are located, is discussed.

The demand for larger diameter, low dislocation density InP substrates has traditionally been filled by highly doped LEC-grown material. We describe the use of the vertical gradient freeze (VGF) technique to produce uniformly high quality wafers from 〈111〉 seeded, 750 g, 50 mm diameter single crystals. Typical dislocation levels are in the low 10 2 cm -2 range, independent of doping level. The dislocations are shown to be uniformly distributed across a wafer and from seed to tail. This adaptation of the VGF technique features seeded growth in pyrolytic boron nitride crucibles under low axial and radial thermal gradients as well as independent stoichiometry control. The reduction of thermally generated strain eliminates the need for impurity hardening of InP to achieve low defect levels. Comparisons with typical LEC results will be made in terms of growth striae, defect distribution and incidence of slip, as well as stoichiometry control. The design of the crystal growth equipment, the growth sequence and aspects of the process control will be discussed. Impurity incorporation will be discussed in terms of spark source mass spectrometry and low temperature compensation ratio estimates. Comparisons of room temperature mobilities are made with other high purity InP material.